House File 25 



                                     HOUSE FILE       
                                     BY  HUNTER


    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 1629HH 83
  6 av/rj/14

PAG LIN



  1  1    Section 1.  Section 514J.3A, Code 2009, is amended to read
  1  2 as follows:
  1  3    514J.3A  EXTERNAL REVIEW == 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 a telephone number or
  1  8 internet site information for an insured to obtain more
  1  9 information regarding initiation of the external review
  1 10 process for coverage decisions under this chapter.
  1 11    2.  The telephone number or internet site information for
  1 12 an insured to obtain more information regarding initiation of
  1 13 the external review process in this chapter shall also be
  1 14 posted in a prominent place in the office of a private
  1 15 practitioner or group of practitioners who are health care
  1 16 providers as defined in section 135.61, or an institutional
  1 17 health care facility as 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 review process for health care
  1 30 coverage decisions under Code chapter 514J.  The bill adds a
  1 31 requirement that a telephone number or internet site
  1 32 information allowing for an insured to obtain more information
  1 33 about the external review process be printed on the insured's
  1 34 insurance card, and be posted in a prominent place in health
  1 35 care facilities and health care provider offices.
  2  1 LSB 1629HH 83
  2  2 av/rj/14