House File 638 - Introduced



                                       HOUSE FILE       
                                       BY  JOCHUM


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

                                      A BILL FOR

  1 An Act relating to patient access to providers under certain
  2    managed care health plans or indemnity plans.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  4 TLSB 1038YH 81
  5 av/gg/14

PAG LIN



  1  1    Section 1.  NEW SECTION.  514C.22  PROVIDER ACCESS UNDER
  1  2 MANAGED CARE HEALTH PLAN OR INDEMNITY PLAN WITH LIMITED
  1  3 PROVIDER NETWORK.
  1  4    1.  A managed care health plan or indemnity plan with a
  1  5 limited provider network shall provide patients direct access
  1  6 to providers licensed under chapter 147, 148, 148A, 148C, 149,
  1  7 150, 150A, 151, 152, 153, 154, 154B, or 155A.  Access to such
  1  8 provider shall not be made conditional upon a referral by a
  1  9 provider licensed under another chapter.  Referral to a
  1 10 specialist may be conditioned upon referral by a primary care
  1 11 provider licensed under the same chapter.  Access to a class
  1 12 of providers licensed under one chapter shall not be subject
  1 13 to a copayment, deductible, or premium rate different than
  1 14 provided for access to a class of providers licensed under
  1 15 another chapter.  Access to a specialist may be subject to a
  1 16 different copayment or deductible than access to a primary
  1 17 care provider.  Access to a nonparticipating provider may be
  1 18 restricted, or may be subject to different copayments,
  1 19 deductibles, or premium rates.
  1 20    2.  For purposes of this section, "managed care health plan
  1 21 or indemnity plan with a limited provider network" means a
  1 22 health maintenance organization, accountable health plan,
  1 23 preferred provider organization, exclusive provider
  1 24 organization, point of service plan, or similar health plan.
  1 25    3.  This section does not apply if an employer offers
  1 26 employees a choice of health plans, either directly or
  1 27 indirectly through a health insurance purchasing cooperative,
  1 28 provided that the offered choices include at least one
  1 29 indemnity plan which includes an unrestricted choice of
  1 30 providers, or at least one managed care health plan or
  1 31 indemnity plan with a limited provider network which provides
  1 32 access as otherwise required by this section.
  1 33                           EXPLANATION
  1 34    New Code section 514C.22 provides that a managed care
  1 35 health plan or indemnity plan with a limited provider network
  2  1 must provide patients direct access to certain licensed
  2  2 physicians, physical and occupational therapists, physician
  2  3 assistants, podiatrists, osteopathic physicians,
  2  4 chiropractors, nurses, dietitians, dentists, optometrists,
  2  5 psychologists, and pharmacists.  The Code section does not
  2  6 apply if an employer offers employees a choice of health
  2  7 plans, either directly or indirectly through a health
  2  8 insurance purchasing cooperative, provided that the offered
  2  9 choices include at least one indemnity plan which includes an
  2 10 unrestricted choice of provider, or at least one managed care
  2 11 health plan or indemnity plan with a limited provider network
  2 12 which provides access as otherwise required by this section.
  2 13 LSB 1038YH 81
  2 14 av/gg/14