House File 302 - Introduced



                                       HOUSE FILE       
                                       BY  FORD


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

                                      A BILL FOR

  1 An Act prohibiting certain financial incentives for health care
  2    providers by group managed care health plans.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  4 TLSB 2514HH 81
  5 av/cf/24

PAG LIN



  1  1    Section 1.  NEW SECTION.  514C.13A  GROUP MANAGED CARE
  1  2 HEALTH PLANS == PROHIBITION OF CERTAIN FINANCIAL INCENTIVES
  1  3 FOR HEALTH CARE PROVIDERS.
  1  4    1.  A managed care health plan, as defined in section
  1  5 514C.13, shall not contain any provision in a contract with
  1  6 any health care provider, as defined in section 514C.13, that,
  1  7 as its predominant purpose, creates direct financial
  1  8 incentives for the health care provider to withhold medically
  1  9 necessary, covered health care services.
  1 10    2.  This section shall not be construed to prohibit a
  1 11 contract between a health care provider and a managed care
  1 12 health plan that contains financial incentives for efficient
  1 13 management of the utilization and cost of covered health care
  1 14 services.
  1 15                           EXPLANATION
  1 16    This bill creates new Code section 514C.13A to prohibit
  1 17 provisions in a contract between a managed care health plan
  1 18 and a health care provider that have a predominant purpose of
  1 19 creating direct financial incentives for the health care
  1 20 provider to withhold medically necessary, covered health care
  1 21 services.
  1 22    The new Code section specifically states that the
  1 23 prohibition against such clauses does not extend to financial
  1 24 incentives for efficient management of the utilization and
  1 25 cost of covered health care services.
  1 26 LSB 2514HH 81
  1 27 av:nh/cf/24