Senate File 2207
SENATE FILE
BY COMMITTEE ON HUMAN RESOURCES
(SUCCESSOR TO SSB 3007)
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to provisions of an accident or health policy
2 regarding equal compensation of certain providers of
3 equivalent services and accessibility to certain providers.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
5 TLSB 5932SV 80
6 pf/sh/8
PAG LIN
1 1 Section 1. Section 509.3, Code 2003, is amended by adding
1 2 the following new subsections:
1 3 NEW SUBSECTION. 8. a. A provision that any services
1 4 provided by a participating health care provider licensed
1 5 pursuant to chapter 149, 151, or 154, which services are
1 6 provided within the scope of practice of the health care
1 7 provider as that scope of practice is defined pursuant to
1 8 chapter 149, 151, or 154, shall be compensated at the same
1 9 level as equivalent services provided by a participating
1 10 provider licensed in the practice of medicine and surgery
1 11 pursuant to chapter 148 or 150A.
1 12 b. Services shall be deemed equivalent if the services are
1 13 described using the same current procedural terminology codes
1 14 as published by the American medical association, or any
1 15 successor coding system.
1 16 c. For the purposes of the current procedural terminology
1 17 code, or any successor code, which is restricted to use only
1 18 by specific health care providers with the exception of
1 19 providers licensed under chapter 148 or 150A, the same level
1 20 of compensation means the compensation level that has the same
1 21 ratio to the then=current payment levels in the federal
1 22 Medicare resource=based relative value system for those
1 23 restrictive codes as the compensation level for evaluation and
1 24 management services codes, any equivalent code utilitized
1 25 under the Medicare resource=based relative value system, or
1 26 any successor coding system has to the current payment levels
1 27 in the federal Medicare resource=based relative value system
1 28 for evaluation and management services codes.
1 29 d. This subsection shall not be interpreted to prohibit a
1 30 policy from reimbursing health care providers licensed
1 31 pursuant to chapter 149, 151, or 154, using a flat fee per
1 32 visit or per case if the fee bears a reasonable relationship
1 33 to the number and types of services provided and if the per
1 34 visit or per case fees are determined in a manner that is
1 35 consistent with the compensation parameters established in
2 1 paragraph "c".
2 2 NEW SUBSECTION. 9. A provision that a covered person
2 3 shall have direct access to any participating provider
2 4 licensed pursuant to section 149, 151, or 154, selected by the
2 5 covered person, without prior referral.
2 6 NEW SUBSECTION. 10. A provision that the person issuing
2 7 the policy shall ensure an adequate number of participating
2 8 providers to provide reasonable accessibility, timeliness of
2 9 care, convenience, and continuity of care to the covered
2 10 person.
2 11 Sec. 2. Section 509.3, unnumbered paragraph 2, Code 2003,
2 12 is amended to read as follows:
2 13 In addition to the provisions required in subsections 1
2 14 through 7 10, the commissioner shall require provisions
2 15 through the adoption of rules implementing the federal Health
2 16 Insurance Portability and Accountability Act, Pub. L. No. 104=
2 17 191.
2 18 EXPLANATION
2 19 This bill provides that a policy of group accident or
2 20 health insurance or a combination of these that covers such
2 21 services is to include a provision that if the services are
2 22 provided by a health care provider licensed to be engaged in
2 23 the practice of podiatry, chiropractic, or optometry, and the
2 24 services provided are within the scope of practice of the
2 25 health care provider, the services are to be compensated at
2 26 the same level as equivalent services provided by a provider
2 27 licensed to practice medicine and surgery or osteopathic
2 28 medicine and surgery. The bill provides for deeming of
2 29 services as equivalent based on codes published by the
2 30 American medical association, and for determination of the
2 31 same level of compensation based on the federal Medicare
2 32 resource=based relative value system or an equivalent
2 33 successor coding system. The bill does not prohibit the use
2 34 of a flat fee reimbursement system if the compensation is
2 35 consistent with the compensation parameters established in the
3 1 bill.
3 2 Under the bill, a covered person is to have direct access
3 3 to a participating provider licensed to be engaged in the
3 4 practice of podiatry, chiropractic, or optometry rather than
3 5 being subject to prior referral. Additionally, the person
3 6 issuing the policy is to ensure adequate accessibility to
3 7 participating providers.
3 8 LSB 5932SV 80
3 9 pf/sh/8