Senate File 225 - Introduced



                                       SENATE FILE       
                                       BY  TINSMAN


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

                                      A BILL FOR

  1 An Act relating to reimbursement under the medical assistance
  2    program for services provided in a provider=based practice
  3    that includes nonphysician practitioners.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  5 TLSB 2923SS 81
  6 pf/sh/8

PAG LIN



  1  1    Section 1.  NEW SECTION.  249A.35  REIMBURSEMENT OF
  1  2 SERVICES IN PROVIDER=BASED PRACTICE.
  1  3    1.  If a provider=based practice includes a nonphysician
  1  4 practitioner, any physician covered service provided to a
  1  5 medical assistance recipient that is within the nonphysician
  1  6 practitioner's legal scope of practice to provide, whether
  1  7 actually provided by a physician or a nonphysician
  1  8 practitioner, shall be billed at the lesser of the provider's
  1  9 billed charge or the percentage of the physician fee schedule
  1 10 rate applicable to the nonphysician practitioner that would be
  1 11 paid if the nonphysician practitioner billed directly for the
  1 12 service.
  1 13    2.  For the purposes of this section, a provider=based
  1 14 practice is considered to include a nonphysician practitioner
  1 15 if the nonphysician is under the fiscal, administrative, or
  1 16 professional control, through employment or through a
  1 17 contractual or other arrangement, of an individual physician
  1 18 practice, a physician group practice, a hospital, a clinic, or
  1 19 a nursing facility or any other entity deemed a provider=based
  1 20 practice by rule of the department.
  1 21    3.  The department of human services shall adopt rules
  1 22 pursuant to chapter 17A to administer this section.
  1 23                           EXPLANATION
  1 24    This bill relates to reimbursement of services provided
  1 25 under the medical assistance program.  The bill provides that
  1 26 if a provider=based practice includes a nonphysician
  1 27 practitioner, any physician covered service provided to a
  1 28 medical assistance recipient that is within the nonphysician
  1 29 practitioner's legal scope of practice to provide, whether the
  1 30 service is actually provided by a physician or a nonphysician
  1 31 practitioner, is to be billed at the lesser of the provider's
  1 32 billed charge or the percentage of the physician fee schedule
  1 33 rate applicable to the nonphysician practitioner that would be
  1 34 paid if the nonphysician practitioner billed directly for the
  1 35 service.
  2  1    The bill also directs the department of human services to
  2  2 adopt rules pursuant to Code chapter 17A to administer the
  2  3 bill.
  2  4 LSB 2923SS 81
  2  5 pf:nh/sh/8