SENATE FILE 2107

BY  DOTZLER

(COMPANION TO LSB 5784HH BY LOFGREN)

A BILL FOR

An Act requiring acceptance of universal health care practitioner credentialing application forms by certain credentialing entities.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 514F.6, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  01.
  a.  A health insurer, hospital, or other entity that credentials physicians, advanced registered nurse practitioners, physician assistants, or other health care practitioners, shall accept the Iowa statewide universal practitioner credentialing application forms developed and maintained by the Iowa credentialing coalition when submitted by a physician, advanced registered nurse practitioner, physician assistant, or any other health care practitioner applicant required to be credentialed by the credentialing entity.
   b.  A health insurer, hospital, or other credentialing entity is not required to use the Iowa statewide universal practitioner credentialing application forms exclusively, and in accepting the universal application forms as required by this subsection, is not precluded from requesting additional information from the applicant necessary to complete the credentialing process consistent with information required by the credentialing entity’s own forms.
    Sec. 2.  Section 514F.6, subsection 1, Code 2011, is amended to read as follows:
   1.  The commissioner shall adopt rules to provide for the retrospective payment of clean claims for covered services provided by a physician, advanced registered nurse practitioner, or physician assistant, or other health care practitioner, during the credentialing period, once the physician, advanced registered nurse practitioner, or physician assistant, or other health care practitioner is credentialed.
    Sec. 3.  Section 514F.6, subsection 2, Code 2011, is amended by striking the subsection and inserting in lieu thereof the following:
   2.  As used in this section, unless the context otherwise requires:
   a.  “Advanced registered nurse practitioner” means a licensed nurse who is also registered to practice in an advanced role.
   b.  “Clean claim” means the same as defined in section 507B.4A, subsection 2, paragraph “b”.
   c.  “Credentialing” means a process through which a credentialing entity makes a determination based on criteria established by the credentialing entity concerning whether a physician, advanced registered nurse practitioner, physician assistant, or other health care practitioner is eligible to provide health care services to a patient and to receive reimbursement for the health care services provided under an agreement entered into between the physician, advanced registered nurse practitioner, physician assistant, or other health care practitioner, and the credentialing entity.
   d.  “Credentialing period” means the time period between the credentialing entity’s receipt of a physician’s, advanced registered nurse practitioner’s, physician assistant’s, or other health care practitioner’s application for credentialing and approval of that application by the credentialing entity.
   e.  “Health insurer” means a carrier, as defined in section 513B.2.
   f.  “Hospital” means the same as defined in section 135B.1.
   g.  “Physician” means a licensed doctor of medicine and surgery or a licensed doctor of osteopathic medicine and surgery.
   h.  “Physician assistant” means a person who is licensed to practice as a physician assistant under the supervision of one or more physicians.
EXPLANATION
   This bill amends Code section 514F.6 to require a health insurer, hospital, or other entity that credentials physicians, advanced registered nurse practitioners, physician assistants, or other health care practitioners to accept the Iowa statewide universal practitioner credentialing application forms developed and maintained by the Iowa credentialing coalition. A credentialing entity is not required to use the universal credentialing forms exclusively and can request additional information from applicants necessary to complete the credentialing process consistent with information required by the credentialing entity’s own forms.
   The bill also changes the definition of “credentialing” to include a process utilized by any entity, not just health insurers, that credentials physicians, advanced registered nurse practitioners, physician assistants, or other health care practitioners. Corresponding changes are made in other definitions. “Credentialing” is now defined as a process through which a credentialing entity makes a determination based on criteria established by the credentialing entity concerning whether a physician, advanced registered nurse practitioner, physician assistant, or other health care practitioner is eligible to provide health care services to a patient and to receive reimbursement for the health care services provided under an agreement entered into between the physician, advanced registered nurse practitioner, physician assistant, or other health care practitioner, and the credentialing entity.
   The bill also adds definitions of “health insurer” and “hospital” and reorganizes all the definitions in the Code section so that they are in alphabetical order.