Senate Study Bill 1019 



                                        SENATE FILE       
                                        BY  (PROPOSED COMMITTEE ON
                                             COMMERCE BILL BY
                                             CHAIRPERSON WARNSTADT)


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

                                      A BILL FOR

  1 An Act requiring health care benefit coverage for certain
  2    prosthetic devices and providing an applicability date.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  4 TLSB 1285XC 83
  5 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, as defined by the
  1 11 commissioner of insurance by rule, that is consistent with at
  1 12 a minimum, the coverage and payment for medically necessary
  1 13 prosthetic devices provided under the most recent federal laws
  1 14 for health insurance for the aged and disabled pursuant to 42
  1 15 U.S.C. } 1395k, 13951, and 1395m, and 42 C.F.R. } 410.100,
  1 16 414.202, 414.210, and 414.228, as applicable.  For the
  1 17 purposes of this section, "prosthetic device" means an
  1 18 artificial limb device to replace, in whole or in part, an arm
  1 19 or leg.
  1 20    2.  a.  This section applies to the following classes of
  1 21 third=party payment provider policies, contracts, or plans
  1 22 delivered, issued for delivery, continued, or renewed in this
  1 23 state on or after July 1, 2009:
  1 24    (1)  Individual or group accident and sickness insurance
  1 25 providing coverage on an expense=incurred basis.
  1 26    (2)  An individual or group hospital or medical service
  1 27 contract issued pursuant to chapter 509, 514, or 514A.
  1 28    (3)  An individual or group health maintenance organization
  1 29 contract regulated under chapter 514B.
  1 30    (4)  A plan established pursuant to chapter 509A for public
  1 31 employees.
  1 32    (5)  An organized delivery system licensed by the director
  1 33 of public health.
  1 34    b.  This section shall not apply to accident only,
  1 35 specified disease, short=term hospital or medical, hospital
  2  1 confinement indemnity, credit, dental, vision, Medicare
  2  2 supplement, long=term care, basic hospital and medical=
  2  3 surgical expense coverage as defined by the commissioner,
  2  4 disability income insurance coverage, coverage issued as a
  2  5 supplement to liability insurance, workers' compensation or
  2  6 similar insurance, or automobile medical payment insurance.
  2  7                           EXPLANATION
  2  8    This bill provides that despite the uniformity of treatment
  2  9 requirements of Code section 514C.6, an individual or group
  2 10 policy, contract, or plan providing for third=party payments
  2 11 of health or medical expenses is required to provide coverage
  2 12 benefits for medically necessary prosthetic devices, as
  2 13 defined by the commissioner of insurance by rule, that is
  2 14 consistent with at a minimum, coverage and payment for
  2 15 medically necessary prosthetic devices that is provided for
  2 16 under the most recent federal laws for health insurance for
  2 17 the aged and disabled.  The bill applies to such policies,
  2 18 contracts, or plans delivered, issued for delivery, continued,
  2 19 or renewed in this state on or after July 1, 2009.
  2 20 LSB 1285XC 83
  2 21 av/rj/14