House Study Bill 141 HOUSE FILE BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON PETERSEN) Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring health care benefit coverage for certain 2 medically necessary prosthetic devices and providing an 3 applicability date. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1927YC 83 6 av/rj/14 PAG LIN 1 1 Section 1. NEW SECTION. 514C.24 COVERAGE FOR PROSTHETIC 1 2 DEVICES. 1 3 1. Notwithstanding the uniformity of treatment 1 4 requirements of section 514C.6, a policy, contract, or plan 1 5 providing for third=party payment or prepayment of health or 1 6 medical expenses shall provide coverage benefits for medically 1 7 necessary prosthetic devices when prescribed by a physician 1 8 licensed under chapter 148. Such coverage benefits for 1 9 medically necessary prosthetic devices shall provide coverage 1 10 for medically necessary prosthetic devices, that at a minimum, 1 11 equals the coverage and payment for medically necessary 1 12 prosthetic devices provided under the most recent federal laws 1 13 for health insurance for the aged and disabled pursuant to 42 1 14 U.S.C. } 1395k, 13951, and 1395m, and 42 C.F.R. } 410.100, 1 15 414.202, 414.210, and 414.228, as applicable. For the 1 16 purposes of this section, "prosthetic device" means an 1 17 artificial limb device to replace, in whole or in part, an arm 1 18 or leg. 1 19 2. a. This section applies to the following classes of 1 20 third=party payment provider policies, contracts, or plans 1 21 delivered, issued for delivery, continued, or renewed in this 1 22 state on or after July 1, 2009: 1 23 (1) Individual or group accident and sickness insurance 1 24 providing coverage on an expense=incurred basis. 1 25 (2) An individual or group hospital or medical service 1 26 contract issued pursuant to chapter 509, 514, or 514A. 1 27 (3) An individual or group health maintenance organization 1 28 contract regulated under chapter 514B. 1 29 (4) A plan established pursuant to chapter 509A for public 1 30 employees. 1 31 (5) An organized delivery system licensed by the director 1 32 of public health. 1 33 b. This section shall not apply to accident only, 1 34 specified disease, short=term hospital or medical, hospital 1 35 confinement indemnity, credit, dental, vision, Medicare 2 1 supplement, long=term care, basic hospital and medical= 2 2 surgical expense coverage as defined by the commissioner, 2 3 disability income insurance coverage, coverage issued as a 2 4 supplement to liability insurance, workers' compensation or 2 5 similar insurance, or automobile medical payment insurance. 2 6 EXPLANATION 2 7 This bill provides that despite the uniformity of treatment 2 8 requirements of Code section 514C.6, an individual or group 2 9 policy, contract, or plan providing for third=party payments 2 10 of health or medical expenses is required to provide coverage 2 11 benefits for medically necessary prosthetic devices, that at a 2 12 minimum, equals the coverage and payment for medically 2 13 necessary prosthetic devices that is provided for under the 2 14 most recent federal laws for health insurance for the aged and 2 15 disabled. The bill applies to such policies, contracts, or 2 16 plans delivered, issued for delivery, continued, or renewed in 2 17 this state on or after July 1, 2009. 2 18 LSB 1927YC 83 2 19 av/rj/14.1