Senate File 2107 - Introduced SENATE FILE 2107 BY DOTZLER (COMPANION TO LSB 5784HH BY LOFGREN) A BILL FOR An Act requiring acceptance of universal health care 1 practitioner credentialing application forms by certain 2 credentialing entities. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5784XS (4) 84 av/nh

S.F. 2107 Section 1. Section 514F.6, Code 2011, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 01. a. A health insurer, hospital, or 3 other entity that credentials physicians, advanced registered 4 nurse practitioners, physician assistants, or other health 5 care practitioners, shall accept the Iowa statewide universal 6 practitioner credentialing application forms developed and 7 maintained by the Iowa credentialing coalition when submitted 8 by a physician, advanced registered nurse practitioner, 9 physician assistant, or any other health care practitioner 10 applicant required to be credentialed by the credentialing 11 entity. 12 b. A health insurer, hospital, or other credentialing 13 entity is not required to use the Iowa statewide universal 14 practitioner credentialing application forms exclusively, and 15 in accepting the universal application forms as required by 16 this subsection, is not precluded from requesting additional 17 information from the applicant necessary to complete the 18 credentialing process consistent with information required by 19 the credentialing entity’s own forms. 20 Sec. 2. Section 514F.6, subsection 1, Code 2011, is amended 21 to read as follows: 22 1. The commissioner shall adopt rules to provide for 23 the retrospective payment of clean claims for covered 24 services provided by a physician, advanced registered nurse 25 practitioner, or physician assistant , or other health care 26 practitioner, during the credentialing period, once the 27 physician, advanced registered nurse practitioner, or physician 28 assistant , or other health care practitioner is credentialed. 29 Sec. 3. Section 514F.6, subsection 2, Code 2011, is amended 30 by striking the subsection and inserting in lieu thereof the 31 following: 32 2. As used in this section, unless the context otherwise 33 requires: 34 a. “Advanced registered nurse practitioner” means a licensed 35 -1- LSB 5784XS (4) 84 av/nh 1/ 3

S.F. 2107 nurse who is also registered to practice in an advanced role. 1 b. “Clean claim” means the same as defined in section 2 507B.4A, subsection 2, paragraph “b” . 3 c. “Credentialing” means a process through which a 4 credentialing entity makes a determination based on criteria 5 established by the credentialing entity concerning whether a 6 physician, advanced registered nurse practitioner, physician 7 assistant, or other health care practitioner is eligible to 8 provide health care services to a patient and to receive 9 reimbursement for the health care services provided under 10 an agreement entered into between the physician, advanced 11 registered nurse practitioner, physician assistant, or other 12 health care practitioner, and the credentialing entity. 13 d. “Credentialing period” means the time period between 14 the credentialing entity’s receipt of a physician’s, advanced 15 registered nurse practitioner’s, physician assistant’s, or 16 other health care practitioner’s application for credentialing 17 and approval of that application by the credentialing entity. 18 e. “Health insurer” means a carrier, as defined in section 19 513B.2. 20 f. “Hospital” means the same as defined in section 135B.1. 21 g. “Physician” means a licensed doctor of medicine and 22 surgery or a licensed doctor of osteopathic medicine and 23 surgery. 24 h. “Physician assistant” means a person who is licensed to 25 practice as a physician assistant under the supervision of one 26 or more physicians. 27 EXPLANATION 28 This bill amends Code section 514F.6 to require a health 29 insurer, hospital, or other entity that credentials physicians, 30 advanced registered nurse practitioners, physician assistants, 31 or other health care practitioners to accept the Iowa 32 statewide universal practitioner credentialing application 33 forms developed and maintained by the Iowa credentialing 34 coalition. A credentialing entity is not required to use the 35 -2- LSB 5784XS (4) 84 av/nh 2/ 3

S.F. 2107 universal credentialing forms exclusively and can request 1 additional information from applicants necessary to complete 2 the credentialing process consistent with information required 3 by the credentialing entity’s own forms. 4 The bill also changes the definition of “credentialing” 5 to include a process utilized by any entity, not just health 6 insurers, that credentials physicians, advanced registered 7 nurse practitioners, physician assistants, or other health 8 care practitioners. Corresponding changes are made in other 9 definitions. “Credentialing” is now defined as a process 10 through which a credentialing entity makes a determination 11 based on criteria established by the credentialing entity 12 concerning whether a physician, advanced registered nurse 13 practitioner, physician assistant, or other health care 14 practitioner is eligible to provide health care services to 15 a patient and to receive reimbursement for the health care 16 services provided under an agreement entered into between 17 the physician, advanced registered nurse practitioner, 18 physician assistant, or other health care practitioner, and the 19 credentialing entity. 20 The bill also adds definitions of “health insurer” and 21 “hospital” and reorganizes all the definitions in the Code 22 section so that they are in alphabetical order. 23 -3- LSB 5784XS (4) 84 av/nh 3/ 3