HSB 45 (LSB 1252DP (18) 85)

SENATE/HOUSE FILE _____

BY  (PROPOSED DEPARTMENT OF PUBLIC HEALTH BILL)

A BILL FOR

An Act relating to programs and services under the purview of the department of public health.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I

ORGANIZED DELIVERY SYSTEMS
    Section 1.  Section 135H.3, subsection 2, Code 2013, is amended to read as follows:
   2.  If a child is diagnosed with a biologically based mental illness as defined in section 514C.22 and meets the medical assistance program criteria for admission to a psychiatric medical institution for children, the child shall be deemed to meet the acuity criteria for medically necessary inpatient benefits under a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits issued by a carrier, as defined in section 513B.2, or by an organized delivery system authorized under 1993 Iowa Acts, ch. 158, that is subject to section 514C.22. Such medically necessary benefits shall not be excluded or denied as care that is substantially custodial in nature under section 514C.22, subsection 8, paragraph “b”.
    Sec. 2.  Section 505.32, subsection 2, paragraph i, Code 2013, is amended by striking the paragraph.
    Sec. 3.  Section 507B.4, subsection 1, Code 2013, is amended to read as follows:
   1.  For purposes of subsection 3, paragraph “p”, “insurer” means an entity providing a plan of health insurance, health care benefits, or health care services, or an entity subject to the jurisdiction of the commissioner performing utilization review, including an insurance company offering sickness and accident plans, a health maintenance organization, an organized delivery system authorized under 1993 Iowa Acts, ch. 158, and licensed by the department of public health, a nonprofit health service corporation, a plan established pursuant to chapter 509A for public employees, or any other entity providing a plan of health insurance, health care benefits, or health care services. However, “insurer” does not include an entity that sells disability income or long-term care insurance.
    Sec. 4.  Section 507B.4A, subsection 2, paragraph a, Code 2013, is amended to read as follows:
   a.  An insurer providing accident and sickness insurance under chapter 509, 514, or 514A; a health maintenance organization; an organized delivery system authorized under 1993 Iowa Acts, ch. 158, and licensed by the department of public health; or another entity providing health insurance or health benefits subject to state insurance regulation shall either accept and pay or deny a clean claim.
    Sec. 5.  Section 509.3A, subsection 11, Code 2013, is amended by striking the subsection.
    Sec. 6.  Section 509.19, subsection 2, paragraph d, Code 2013, is amended by striking the paragraph.
    Sec. 7.  Section 513B.2, subsection 8, paragraph k, Code 2013, is amended by striking the paragraph.
    Sec. 8.  Section 513B.7, subsection 3, Code 2013, is amended to read as follows:
   3.  A small employer carrier or organized delivery system shall make the information and documentation described in subsection 1 available to the commissioner or the director of public health upon request. The information is not a public record or otherwise subject to disclosure under chapter 22, and is considered proprietary and trade secret information and is not subject to disclosure by the commissioner or the director of public health to persons outside of the division or department except as agreed to by the small employer carrier or organized delivery system or as ordered by a court of competent jurisdiction.
    Sec. 9.  Section 513B.10, subsection 1, paragraph b, subparagraph (2), unnumbered paragraph 1, Code 2013, is amended to read as follows:
   Deny such coverage to such employers within the service area of such plan if the carrier or organized delivery system has demonstrated to the applicable state authority
 
commissioner both of the following:
    Sec. 10.  Section 513B.10, subsection 3, paragraph c, Code 2013, is amended to read as follows:
   c.  A carrier or organized delivery system shall waive any waiting period applicable to a preexisting condition exclusion or limitation period with respect to particular services under health insurance coverage for the period of time an individual was covered by creditable coverage, provided that the creditable coverage was continuous to a date not more than sixty-three days prior to the effective date of the new coverage. Any period that an individual is in a waiting period for any coverage under group health insurance coverage, or is in an affiliation period, shall not be taken into account in determining the period of continuous coverage. A health maintenance organization that does not use preexisting condition limitations in any of its health insurance coverage may impose an affiliation period. For purposes of this section, “affiliation period” means a period of time not to exceed sixty days for new entrants and not to exceed ninety days for late enrollees during which no premium shall be collected and coverage issued is not effective, so long as the affiliation period is applied uniformly, without regard to any health status-related factors. This paragraph does not preclude application of a waiting period applicable to all new enrollees under the health insurance coverage, provided that any carrier or organized delivery system-imposed
 
carrier-imposed waiting period is no longer than sixty days and is used in lieu of a preexisting condition exclusion.
    Sec. 11.  Section 513C.3, subsection 5, Code 2013, is amended to read as follows:
   5.  “Carrier” means any entity that provides individual health benefit plans in this state. For purposes of this chapter, carrier includes an insurance company, a group hospital or medical service corporation, a fraternal benefit society, a health maintenance organization, and any other entity providing an individual plan of health insurance or health benefits subject to state insurance regulation. “Carrier” does not include an organized delivery system.
    Sec. 12.  Section 513C.3, subsection 7, Code 2013, is amended by striking the subsection.
    Sec. 13.  Section 513C.3, subsection 9, Code 2013, is amended to read as follows:
   9.  “Established service area” means a geographic area, as approved by the commissioner and based upon the carrier’s certificate of authority to transact business in this state, within which the carrier is authorized to provide coverage or a geographic area, as approved by the director and based upon the organized delivery system’s license to transact business in this state, within which the organized delivery system is authorized to provide coverage.
    Sec. 14.  Section 513C.3, subsection 12, Code 2013, is amended by striking the subsection.
    Sec. 15.  Section 513C.3, subsection 15, paragraph a, subparagraph (3), Code 2013, is amended by striking the subparagraph.
    Sec. 16.  Section 513C.7, subsection 1, paragraph b, Code 2013, is amended by striking the paragraph.
    Sec. 17.  Section 513C.10, subsection 10, paragraph b, Code 2013, is amended by striking the paragraph.
    Sec. 18.  Section 514A.3B, subsection 3, paragraph k, Code 2013, is amended by striking the paragraph.
    Sec. 19.  Section 514B.25A, subsection 1, Code 2013, is amended to read as follows:
   1.  Upon a health maintenance organization or organized delivery system authorized to do business in this state and licensed by the director of public health being declared insolvent by the district court, the commissioner may levy an assessment on each health maintenance organization or organized delivery system doing business in this state and licensed by the director of public health, as applicable, to pay claims for uncovered expenditures for enrollees. The commissioner shall not assess an amount in any one calendar year which is more than two percent of the aggregate premium written by each health maintenance organization or organized delivery system.
    Sec. 20.  Section 514C.10, subsection 2, paragraph e, Code 2013, is amended by striking the paragraph.
    Sec. 21.  Section 514C.11, Code 2013, is amended to read as follows:
   514C.11  Services provided by licensed physician assistants and licensed advanced registered nurse practitioners.
   Notwithstanding section 514C.6, a policy or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment of necessary medical or surgical care and treatment provided by a physician assistant licensed pursuant to chapter 148C, or provided by an advanced registered nurse practitioner licensed pursuant to chapter 152 and performed within the scope of the license of the licensed physician assistant or the licensed advanced registered nurse practitioner if the policy or contract would pay for the care and treatment if the care and treatment were provided by a person engaged in the practice of medicine and surgery or osteopathic medicine and surgery under chapter 148. The policy or contract shall provide that policyholders and subscribers under the policy or contract may reject the coverage for services which may be provided by a licensed physician assistant or licensed advanced registered nurse practitioner if the coverage is rejected for all providers of similar services. A policy or contract subject to this section shall not impose a practice or supervision restriction which is inconsistent with or more restrictive than the restriction already imposed by law. This section applies to services provided under a policy or contract delivered, issued for delivery, continued, or renewed in this state on or after July 1, 1996, and to an existing policy or contract, on the policy’s or contract’s anniversary or renewal date, or upon the expiration of the applicable collective bargaining contract, if any, whichever is later. This section does not apply to policyholders or subscribers eligible for coverage under Tit. XVIII of the federal Social Security Act or any similar coverage under a state or federal government plan. For the purposes of this section, third-party payment or prepayment includes an individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 514, or 514A, an individual or group health maintenance organization contract issued and regulated under chapter 514B, an organized delivery system contract regulated under rules adopted by the director of public health, or a preferred provider organization contract regulated pursuant to chapter 514F. Nothing in this section shall be interpreted to require an individual or group health maintenance organization, an organized delivery system, or a preferred provider organization or arrangement to provide payment or prepayment for services provided by a licensed physician assistant or licensed advanced registered nurse practitioner unless the physician assistant’s supervising physician, the physician-physician assistant team, the advanced registered nurse practitioner, or the advanced registered nurse practitioner’s collaborating physician has entered into a contract or other agreement to provide services with the individual or group health maintenance organization, the organized delivery system, or the preferred provider organization or arrangement.
    Sec. 22.  Section 514C.13, subsection 1, paragraph h, Code 2013, is amended by striking the paragraph.
    Sec. 23.  Section 514C.14, subsections 1 and 3, Code 2013, are amended to read as follows:
   1.  Except as provided under subsection 2 or 3, a carrier, as defined in section 513B.2, an organized delivery system authorized under 1993 Iowa Acts, ch. 158, or a plan established pursuant to chapter 509A for public employees, which terminates its contract with a participating health care provider, shall continue to provide coverage under the contract to a covered person in the second or third trimester of pregnancy for continued care from such health care provider. Such persons may continue to receive such treatment or care through postpartum care related to the child birth and delivery. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.
   3.  A carrier, organized delivery system, or
 
a plan established under chapter 509A, which terminates the contract of a participating health care provider for cause shall not be liable to pay for health care services provided by the health care provider to a covered person following the date of termination.
    Sec. 24.  Section 514C.15, unnumbered paragraph 1, Code 2013, is amended to read as follows:
   A carrier, as defined in section 513B.2; an organized delivery system authorized under 1993 Iowa Acts, ch. 158, and licensed by the director of public health;, or a plan established pursuant to chapter 509A for public employees, shall not prohibit a participating provider from, or penalize a participating provider for, doing either of the following:
    Sec. 25.  Section 514C.16, subsection 1, Code 2013, is amended to read as follows:
   1.  A carrier, as defined in section 513B.2; an organized delivery system authorized under 1993 Iowa Acts, ch. 158, and licensed by the director of public health;, or a plan established pursuant to chapter 509A for public employees, which provides coverage for emergency services, is responsible for charges for emergency services provided to a covered individual, including services furnished outside any contractual provider network or preferred provider network. Coverage for emergency services is subject to the terms and conditions of the health benefit plan or contract.
    Sec. 26.  Section 514C.17, subsections 1 and 3, Code 2013, are amended to read as follows:
   1.  Except as provided under subsection 2 or 3, if a carrier, as defined in section 513B.2, an organized delivery system authorized under 1993 Iowa Acts, ch. 158, or a plan established pursuant to chapter 509A for public employees, terminates its contract with a participating health care provider, a covered individual who is undergoing a specified course of treatment for a terminal illness or a related condition, with the recommendation of the covered individual’s treating physician licensed under chapter 148 may continue to receive coverage for treatment received from the covered individual’s physician for the terminal illness or a related condition, for a period of up to ninety days. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.
   3.  Notwithstanding subsections 1 and 2, a carrier, organized delivery system, or
 
a plan established under chapter 509A which terminates the contract of a participating health care provider for cause shall not be required to cover health care services provided by the health care provider to a covered person following the date of termination.
    Sec. 27.  Section 514C.18, subsection 2, paragraph a, subparagraph (6), Code 2013, is amended by striking the subparagraph.
    Sec. 28.  Section 514C.19, subsection 7, paragraph a, subparagraph (6), Code 2013, is amended by striking the subparagraph.
    Sec. 29.  Section 514C.20, subsection 3, paragraph f, Code 2013, is amended by striking the paragraph.
    Sec. 30.  Section 514C.21, subsection 2, paragraph d, Code 2013, is amended by striking the paragraph.
    Sec. 31.  Section 514C.22, subsection 1, unnumbered paragraph 1, Code 2013, is amended to read as follows:
   Notwithstanding the uniformity of treatment requirements of section 514C.6, a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits issued by a carrier, as defined in section 513B.2, or by an organized delivery system authorized under 1993 Iowa Acts, ch. 158, shall provide coverage benefits for treatment of a biologically based mental illness if either of the following is satisfied:
    Sec. 32.  Section 514C.25, subsection 2, paragraph a, subparagraph (5), Code 2013, is amended by striking the subparagraph.
    Sec. 33.  Section 514C.26, subsection 5, paragraph a, subparagraph (6), Code 2013, is amended by striking the subparagraph.
    Sec. 34.  Section 514C.27, subsection 1, unnumbered paragraph 1, Code 2013, is amended to read as follows:
   Notwithstanding the uniformity of treatment requirements of section 514C.6, a group policy or contract providing for third-party payment or prepayment of health or medical expenses issued by a carrier, as defined in section 513B.2, or by an organized delivery system authorized under 1993 Iowa Acts, chapter 158, shall provide coverage benefits to an insured who is a veteran for treatment of mental illness and substance abuse if either of the following is satisfied:
    Sec. 35.  Section 514C.29, subsection 2, paragraph e, Code 2013, is amended by striking the paragraph.
    Sec. 36.  Section 514E.1, subsection 6, paragraph k, Code 2013, is amended by striking the paragraph.
    Sec. 37.  Section 514E.1, subsection 17, Code 2013, is amended by striking the subsection.
    Sec. 38.  Section 514E.2, subsection 1, paragraph a, Code 2013, is amended to read as follows:
   a.  All carriers and all organized delivery systems licensed by the director of public health providing health insurance or health care services in Iowa, whether on an individual or group basis, and all other insurers designated by the association’s board of directors and approved by the commissioner shall be members of the association.
    Sec. 39.  Section 514F.5, Code 2013, is amended to read as follows:
   514F.5  Experimental treatment review.
   1.  A carrier, as defined in section 513B.2, an organized delivery system authorized under 1993 Iowa Acts, ch. 158, or a plan established pursuant to chapter 509A for public employees, that limits coverage for experimental medical treatment, drugs, or devices, shall develop and implement a procedure to evaluate experimental medical treatments and shall submit a description of the procedure to the division of insurance. The procedure shall be in writing and must describe the process used to determine whether the carrier, organized delivery system, or chapter 509A plan will provide coverage for new medical technologies and new uses of existing technologies. The procedure, at a minimum, shall require a review of information from appropriate government regulatory agencies and published scientific literature concerning new medical technologies, new uses of existing technologies, and the use of external experts in making decisions. A carrier, organized delivery system, or chapter 509A plan shall include appropriately licensed or qualified professionals in the evaluation process. The procedure shall provide a process for a person covered under a plan or contract to request a review of a denial of coverage because the proposed treatment is experimental. A review of a particular treatment need not be reviewed more than once a year.
   2.  A carrier, organized delivery system, or chapter 509A plan that limits coverage for experimental treatment, drugs, or devices shall clearly disclose such limitations in a contract, policy, or certificate of coverage.
    Sec. 40.  Section 514I.2, subsection 10, Code 2013, is amended to read as follows:
   10.  “Participating insurer” means any entity licensed by the division of insurance of the department of commerce to provide health insurance in Iowa or an organized delivery system licensed by the director of public health that has contracted with the department to provide health insurance coverage to eligible children under this chapter.
    Sec. 41.  Section 514J.102, subsection 23, Code 2013, is amended to read as follows:
   23.  “Health carrier” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to chapter 509A for public employees, or any other entity providing a plan of health insurance, health care benefits, or health care services. “Health carrier” includes, for purposes of this chapter, an organized delivery system.
    Sec. 42.  Section 514J.102, subsection 28, Code 2013, is amended by striking the subsection.
    Sec. 43.  Section 514L.1, subsection 3, Code 2013, is amended to read as follows:
   3.  “Provider of third-party payment or prepayment of prescription drug expenses” or “provider” means a provider of an individual or group policy of accident or health insurance or an individual or group hospital or health care service contract issued pursuant to chapter 509, 514, or 514A, a provider of a plan established pursuant to chapter 509A for public employees, a provider of an individual or group health maintenance organization contract issued and regulated under chapter 514B, a provider of an organized delivery system contract regulated under rules adopted by the director of public health, a provider of a preferred provider contract issued pursuant to chapter 514F, a provider of a self-insured multiple employer welfare arrangement, and any other entity providing health insurance or health benefits which provide for payment or prepayment of prescription drug expenses coverage subject to state insurance regulation.
    Sec. 44.  Section 514L.2, subsection 1, paragraph a, unnumbered paragraph 1, Code 2013, is amended to read as follows:
   A provider of third-party payment or prepayment of prescription drug expenses, including the provider’s agents or contractors and pharmacy benefits managers, that issues a card or other technology for claims processing and an administrator of the payor, excluding administrators of self-funded employer sponsored health benefit plans qualified under the federal Employee Retirement Income Security Act of 1974, shall issue to its insureds a card or other technology containing uniform prescription drug information. The commissioner of insurance shall adopt rules for the uniform prescription drug information card or technology applicable to those entities subject to regulation by the commissioner of insurance. The director of public health shall adopt rules for the uniform prescription drug information card or technology applicable to organized delivery systems. The rules shall require at least both of the following regarding the card or technology:
    Sec. 45.  Section 521F.2, subsection 7, Code 2013, is amended to read as follows:
   7.  “Health organization” means a health maintenance organization, limited service organization, dental or vision plan, hospital, medical and dental indemnity or service corporation or other managed care organization licensed under chapter 514,
 
or 514B, or 1993 Iowa Acts, ch. 158, or any other entity engaged in the business of insurance, risk transfer, or risk retention, that is subject to the jurisdiction of the commissioner of insurance or the director of public health. “Health organization” does not include an insurance company licensed to transact the business of insurance under chapter 508, 515, or 520, and which is otherwise subject to chapter 521E.
    Sec. 46.  1993 Iowa Acts, chapter 158, section 4, is amended to read as follows:
   SEC. 4.
  EMERGENCY RULES.  Pursuant to sections 1,
 
and 2, and 3 of this Act, the commissioner of insurance or the director of public health shall adopt administrative rules under section 17A.4, subsection 2, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this Act and the rules shall become effective immediately upon filing, unless a later effective date is specified in the rules. Any rules adopted in accordance with the provisions of this section shall also be published as notice of intended action as provided in section 17A.4.
    Sec. 47.  REPEAL.  Section 135.120, Code 2013, is repealed.
    Sec. 48.  REPEAL.  1993 Iowa Acts, chapter 158, section 3, is repealed.
    Sec. 49.  CODE EDITOR DIRECTIVE —— ORGANIZED DELIVERY SYSTEMS.
   1.  Sections 505.32, 509A.6, 513B.5, 513B.6, 513B.7, 513B.9A, 513B.10, 513C.3, 513C.6, 513C.7, 513C.9, 513C.10, 514B.25A, 514C.13, 514C.15, 514C.22, 514C.27, 514E.2, 514E.7, 514E.9, 514E.11, 514K.1, Code 2013, are amended as follows:
   a.  By striking from the sections “organized delivery system”.
   b.  By striking from the sections “organized delivery systems”.
   c.  By striking from the sections “organized delivery system’s”.
   d.  By striking from the sections “system”.
   2.  Sections 513B.5, 513B.7, 513B.10, 513C.5, 513C.6, 513C.10, 514E.9, and 514K.1, Code 2013, are amended as follows:
   a.  By striking from the sections “director of public health”.
   b.  By striking from the sections “director”.

DIVISION II

TRAUMA SYSTEM QUALITY IMPROVEMENT
    Sec. 50.  Section 147A.25, subsection 1, paragraph h, Code 2013, is amended to read as follows:
   h.  Iowa foundation of medical care director
 
A representative of the state’s Medicare quality improvement organization.

DIVISION III

REIMBURSEMENT FOR CERTAIN AUTOPSIES
    Sec. 51.  Section 331.802, subsection 2, paragraph c, Code 2013, is amended to read as follows:
   c.  The fee and expenses of the county medical examiner who performs an autopsy or conducts an investigation of a person who dies after being brought into this state for emergency medical treatment by or at the direction of an out-of-state law enforcement officer or public authority shall be paid by the state. A claim for payment shall be filed with the Iowa department of public health. If moneys are not appropriated to the Iowa department of public health for the payment of autopsies under this paragraph, claims for payment shall be forwarded to the state appeal board and, if authorized by the board, shall be paid out of moneys in the general fund of the state not otherwise appropriated.
    Sec. 52.  Section 331.802, subsection 4, Code 2013, is amended to read as follows:
   4.  The county medical examiner shall conduct the investigation in the manner required by the state medical examiner and shall determine whether the public interest requires an autopsy or other special investigation. However, if the death occurred in the manner specified in subsection 3, paragraph “j”, the county medical examiner shall order an autopsy,
 
claims for the expense
 
payment of which shall be reimbursed by the Iowa department of public health
 
filed with the state appeal board and, if authorized by the board, shall be paid out of moneys in the general fund of the state not otherwise appropriated. In determining the need for an autopsy, the county medical examiner may consider the request for an autopsy from a public official or private person, but the state medical examiner or the county attorney of the county where the death occurred may require an autopsy.

DIVISION IV

HIV HOME TEST KITS
    Sec. 53.  REPEAL.  Section 126.25, Code 2013, is repealed.

DIVISION V

TOBACCO CESSATION SERVICES —— MINORS
    Sec. 54.  NEW SECTION.  142A.11  Application for services —— minors.
   A minor shall have the legal capacity to act and give consent to the provision of tobacco cessation services by a hospital, clinic, health care provider, or other tobacco cessation services provider. Consent shall not be subject to later disaffirmance by reason of such minority. The consent of another person, including but not limited to the consent of a spouse, parent, custodian, or guardian, shall not be necessary.
EXPLANATION
   This bill includes provisions that relate to programs and services under the purview of the department of public health (DPH). The bill is organized in divisions.
   Division I relates to organized delivery systems that are regulated by DPH. Organized delivery systems were created pursuant to 1993 Iowa Acts, chapter 158. Rules adopted under the provision define an organized delivery system as “an organization with defined governance that is responsible for delivering or arranging to deliver the full range of health care services covered under a standard benefit plan and is accountable to the public for the cost, quality and access of its services and for the effect of its services on their health.” (641 IAC 201.2) An organization operating as an organized delivery system is required to assume risk and be subject to solvency standards. The bill eliminates all references to organized delivery systems in the Code and repeals the provision in the Acts authorizing the establishment of organized delivery systems. The most recent application for licensure was received by DPH in 1998. Since being authorized in 1993, only two entities applied for licensure as organized delivery systems and both of these entities have since ceased operations.
   Division II relates to the membership of the system evaluation and quality improvement committee for the trauma system in the state. The bill changes the membership by replacing the specific name of the one membership entity with a general reference to the Medicare quality improvement organization in the state.
   Division III relates to county reimbursement for investigations and autopsies that are for persons who die after being brought into the state for emergency medical treatment by or at the direction of an out-of-state law enforcement officer or public authority; or for autopsies relating to the death of a child under the age of two years if death results from an unknown cause or if the circumstances surrounding the death indicate that sudden infant death syndrome may be the cause of death. Current law directs that claims for these investigations and autopsies are to be filed by counties initially with DPH, and, if moneys are not appropriated to DPH for this purpose, the claims are to then be forwarded to the state appeal board. Under the bill, claims would not be initially filed with DPH, but would instead be filed directly with the state appeal board for authorization of payment from the general fund of the state from funds not otherwise appropriated.
   Division IV relates to human immunodeficiency virus (HIV) home test kits. Current law prohibits a person from advertising for sale, offering for sale, or selling an HIV home testing kit for antibody or antigen testing, and provides civil and criminal penalties as well as injunctive relief for violation of the prohibition. The United States food and drug administration approved the use of such kits in July 2012, and the bill repeals the Code provision prohibiting the HIV home test kits in the state.
   Division V of the bill provides that a minor shall have the legal capacity to act and give consent to the provision of tobacco cessation services by a hospital, clinic, health care provider, or other tobacco cessation services provider. Consent is not subject to later disaffirmance by reason of such minority, and the consent of another person is not necessary.