House File 2279 HOUSE FILE BY HUNTER, SCHICKEL, JOCHUM, T. TAYLOR, CONNORS, BUKTA, DE BOEF, and MURPHY Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act relating to the provision of certain information for 2 insureds regarding external review of health care coverage 3 decisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5864HH 80 6 av/sh/8 PAG LIN 1 1 Section 1. Section 514J.3A, Code 2003, is amended to read 1 2 as follows: 1 3 514J.3A NOTICE. 1 4 1. An insurance card issued by a carrier or organized 1 5 delivery system for a policy or contract providing for third= 1 6 party payment or prepayment of health or medical expenses 1 7 subject to this section shall contain the telephone number for 1 8 an insured to obtain more information regarding initiation of 1 9 the external review process for coverage decisions under this 1 10 chapter. 1 11 2. The telephone number for an insured to obtain more 1 12 information regarding initiation of the external review 1 13 process in this chapter shall also be posted in a prominent 1 14 place in the office of a private practitioner or group of 1 15 practitioners who are health care providers as defined in 1 16 section 135.61, or an institutional health care facility as 1 17 defined in section 135.61. 1 18 3. When a claim is denied in whole or in part based on 1 19 medical necessity, the carrier or organized delivery system 1 20 shall provide a notice in writing to the enrollee of the 1 21 internal appeal mechanism provided under the carrier or 1 22 organized delivery system's plan or policy. 1 23 4. At the time of a coverage decision, the carrier or 1 24 organized delivery system shall notify the enrollee in writing 1 25 of the right to have the coverage decision reviewed under the 1 26 external review process. 1 27 EXPLANATION 1 28 This bill amends Code section 514J.3A, relating to notice 1 29 provisions for the external process for health care coverage 1 30 decisions under Code chapter 514J. The bill adds a 1 31 requirement that the phone number for an insured to obtain 1 32 more information about the external review process be printed 1 33 on the insured's insurance card, and be posted in a prominent 1 34 place in health care facilities. 1 35 LSB 5864HH 80 2 1 av/sh/8