House File 2190

                                       HOUSE FILE       
                                       BY  CONNORS


    Passed House,  Date               Passed Senate, Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         
                 Approved                            

                                      A BILL FOR

  1 An Act prohibiting discrimination by specified insurers, plans,
  2    and health maintenance organizations in entering into
  3    contracts for participation with health care providers.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  5 TLSB 5397HH 80
  6 rn/gg/14

PAG LIN

  1  1    Section 1.  Section 514F.2, Code 2003, is amended to read
  1  2 as follows:
  1  3    514F.2  UTILIZATION AND COST CONTROL.
  1  4    1.  Nothing contained in the chapters of Title XIII,
  1  5 subtitle 1, of the Code shall be construed to prohibit or
  1  6 discourage insurers, nonprofit service corporations, health
  1  7 maintenance organizations, or self=insurers for health care
  1  8 benefits to employees from providing payments of benefits or
  1  9 providing care and treatment under capitated payment systems,
  1 10 prospective reimbursement rate systems, utilization control
  1 11 systems, incentive systems for the use of least restrictive
  1 12 and least costly levels of care, preferred provider contracts
  1 13 limiting choice of specific provider, or other systems,
  1 14 methods or organizations designed to contain costs without
  1 15 sacrificing care or treatment outcome, provided these systems
  1 16 do not limit or make optional payment or reimbursement for
  1 17 health care services on a basis solely related to the license
  1 18 under or the practices authorized by chapter 151 or on a basis
  1 19 that is dependent upon a method of classification,
  1 20 categorization, or description based upon differences in
  1 21 terminology used by different licensees under the chapters of
  1 22 Title IV, subtitle 3, of the Code in describing human ailments
  1 23 or their diagnosis or treatment.
  1 24    2.  Notwithstanding subsection 1, an insurer, nonprofit
  1 25 service corporation, health maintenance organization, or self=
  1 26 insurer for health care benefits to employees shall not
  1 27 discriminate against any provider who is located within the
  1 28 geographic coverage area of the plan and who is willing to
  1 29 meet the terms and conditions for participation established by
  1 30 the insurer, nonprofit service corporation, health maintenance
  1 31 organization, or self=insurer for health care benefits.
  1 32                           EXPLANATION
  1 33    This bill provides that an insurer, nonprofit service
  1 34 corporation, health maintenance organization, or self=insurer
  1 35 for health care benefits to employees shall not be permitted
  2  1 to discriminate against any provider who is located within the
  2  2 geographic coverage area of the plan and who is willing to
  2  3 meet the terms and conditions for participation established by
  2  4 the specified insurer or organization.  This provision would
  2  5 constitute a limitation on the provisions of Code section
  2  6 514F.2 regarding cost control measures undertaken by insurers
  2  7 or organizations that involved limiting the number of
  2  8 qualified health care providers with whom the insurer or
  2  9 organization contracted for participation in the plan.
  2 10 LSB 5397HH 80
  2 11 rn/gg/14