SF 196 (LSB 1609XS (16) 85)

SENATE FILE 196

BY  PETERSEN, HATCH, DEARDEN, BEALL, DOTZLER, DVORSKY, HART, BOLKCOM, RAGAN, BRASE, MATHIS, QUIRMBACH, SODDERS, BLACK, and JOCHUM

A BILL FOR

An Act relating to prenatal and postpartum care. 
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  135.131A  Prenatal ultrasound.
   1.  The department shall adopt guidelines that require attending health care providers to offer each pregnant woman as part of the woman’s prenatal care the option of undergoing a minimum of two ultrasounds when medically indicated to maximize the possibility of assessing the risk factors for and preventing premature birth, stillbirth, or other delivery complications. The guidelines adopted shall be consistent with or may adopt by reference the practice guidelines for the performance of obstetric ultrasound examinations as approved and published by the American institute of ultrasound in medicine in conjunction with the American college of radiology and the American college of obstetricians and gynecologists.
   2.  The attending health care provider shall provide the following information to the pregnant woman regarding the ultrasounds:
   a.  That the ultrasounds are voluntary at the discretion of the pregnant woman.
   b.  Upon request of the pregnant woman, the complete results of the ultrasound, including any risks associated with the findings to determine the most effective way to manage the pregnancy, labor, and delivery.
   c.  That health care coverage is provided in accordance with section 514C.30 and through the medical assistance program.
   3.  The attending health care provider shall document the pregnant woman’s declining of an ultrasound in the pregnant woman’s medical record.
   4.  This section shall not be interpreted to limit the number of ultrasounds provided to a woman during pregnancy or to hold a health care provider liable for not providing an ultrasound as specified in this section if the pregnant woman does not seek prenatal care.
   5.  For the purposes of this section “attending health care provider” means a licensed physician, nurse practitioner, certified nurse midwife, physician assistant, or other health care provider who has the primary responsibility for the treatment and care of a pregnant woman.
    Sec. 2.  NEW SECTION.  135.131B  Fetal movement education.
   An attending health care provider, as defined in section 135.131A, shall provide to a pregnant woman prior to the third trimester of the pregnancy, educational materials regarding, and an explanation of the procedure to monitor, fetal movement to reduce the risk of fetal death. The center for congenital and inherited disorders shall make the fetal movement educational materials available to attending health care providers upon request.
    Sec. 3.  NEW SECTION.  136A.5A  Newborn pulse oximetry screening tests.
   1.  Each newborn born in this state shall receive a pulse oximetry screening test in conjunction with the metabolic screening required pursuant to section 136A.5 in accordance with rules adopted by the department.
   2.  An attending health care provider, as defined in section 135.131A, shall ensure that every newborn under the provider’s care receives the pulse oximetry screening test in accordance with rules adopted by the department.
   3.  This section does not apply if a parent objects to the screening. If a parent objects to the screening of a newborn, the attending health care provider shall document the refusal in the newborn’s medical record and shall obtain a written refusal from the parent and report the refusal to the department as provided by rule of the department.
   4.  The results of each newborn’s pulse oximetry screening test shall be reported in a manner consistent with the reporting of the results of metabolic screenings pursuant to section 136A.5, and in accordance with rules adopted by the center for congenital and inherited disorders in collaboration with the department.
    Sec. 4.  NEW SECTION.  514C.30  Prenatal care —— ultrasounds.
   1.
  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide minimum ultrasound benefits coverage for insured pregnant women. The provisions of this section apply to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2013.
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A plan established pursuant to chapter 509A for public employees.
   (5)  A plan established by any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   2.  As used in this section, “minimum ultrasound benefits coverage” means coverage for benefits which are equal to or greater than a minimum of two ultrasounds as part of a woman’s prenatal care offered at times when medically indicated to maximize the possibility of assessing the risk factors for and preventing premature birth, stillbirth, or other delivery complications as specified under the guidelines adopted by the department of public health pursuant to section 135.131A.

   3.  Notice of availability of the coverage shall be provided to the insured in a summary of benefits and coverage issued to the insured at the time of delivery, continuation, or renewal of the coverage, policy, or plan. The coverage shall provide that the ultrasounds shall be offered to but are voluntary on the part of the pregnant woman.
   4.  This section shall not be interpreted to limit the number of ultrasounds provided to a woman during pregnancy or to hold a health care provider liable for not providing an ultrasound covered under this section if the insured does not seek prenatal care.
   5.  The commissioner of insurance shall adopt rules under chapter 17A necessary to implement this section.
    Sec. 5.  NEW SECTION.  514C.31  Newborn pulse oximetry screening.
   1.
  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage to an insured for newborn pulse oximetry screening as required to be administered pursuant to section 136A.5A. The provisions of this section apply to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2013.
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A plan established pursuant to chapter 509A for public employees.
   (5)  A plan established by any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.

   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   2.  Notice of availability of the coverage shall be provided to the insured in a summary of benefits issued to the insured at the time of delivery, continuation, or renewal of the contract, policy, or plan.
   3.  The commissioner of insurance shall adopt rules under chapter 17A necessary to implement this section.
    Sec. 6.  MEDICAL ASSISTANCE PROGRAM —— PRENATAL AND NEWBORN COVERED BENEFITS.  The department of human services shall include as covered benefits under the medical assistance program the prenatal ultrasounds as specified pursuant to section 135.131A and the newborn pulse oximetry screening tests as specified pursuant to section 136A.5A. The department shall amend the medical assistance state plan as necessary to implement this provision.
    Sec. 7.  CODE EDITOR DIRECTIVE.  The Code editor shall create a new division in chapter 135, following division XV, titled “Prenatal and postpartum information and education” to include sections 135.131A and 135.131B, as enacted in this Act.
EXPLANATION
   This bill relates to health care provided during and after a pregnancy.
   The bill requires an attending health care provider to offer each pregnant woman the option of undergoing a minimum of two ultrasounds as medically indicated to maximize the possibility of assessing the risk factors for and preventing premature birth, stillbirth, or other delivery complications under guidelines adopted by the department of public health (DPH). The guidelines adopted are to be consistent with the practice guidelines approved and published by the American institute of ultrasound in medicine in conjunction with the American college of radiology and the American college of obstetricians and gynecologists.
   The bill specifies the information to be provided to the pregnant woman regarding the ultrasound upon request of the pregnant woman, and requires the attending health care provider to document the pregnant woman’s declining of an ultrasound in the pregnant woman’s medical record. The bill provides that the provision is not to be interpreted to limit the number of ultrasounds provided to a woman during pregnancy or to hold a provider liable for not providing an ultrasound as specified under the provision if the pregnant woman does not seek prenatal care.
   The bill directs an attending health care provider to provide to a pregnant woman prior to the third trimester of the pregnancy, educational materials regarding, and an explanation of the procedure to monitor, fetal movement to reduce the risk of fetal death. The bill specifies that the center for congenital and inherited disorders shall make the educational materials available to attending health care providers upon request.
   The bill adds to Code chapter 136A (center for congenital and inherited disorders) a requirement that each newborn born in this state receive a pulse oximetry screening test in conjunction with the metabolic screening required under the Code chapter. An attending health care provider is required to ensure that every newborn under the provider’s care receives the pulse oximetry screening test. However, the requirement does not apply if a parent objects to the screening. If a parent objects to the screening, the attending health care provider is required to document the refusal in the newborn’s medical record and to obtain a written refusal from the parent and report the refusal to the department of public health. The results of the screening are to be reported in a manner consistent with the reporting of the results of metabolic screenings and in accordance with rules adopted by the center for congenital and inherited disorders in collaboration with DPH.
   The bill requires that a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses provide minimum ultrasound benefits coverage on or after July 1, 2013. The bill specifies the classes of third-party payment provider contracts or policies subject and not subject to the requirement; defines “minimum ultrasound benefits coverage”; and requires that notice of availability and the voluntary nature of the coverage be provided to the insured. The bill provides that the provision is not to be interpreted to limit the number of ultrasounds provided to a woman during pregnancy or to hold a provider liable for not providing an ultrasound covered under the bill if the insured does not seek prenatal care. The bill directs the commissioner of insurance to adopt rules under Code chapter 17A necessary to implement the provision.
   The bill requires that a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses provide coverage for the newborn pulse oximetry screening as specified in Code section 136A.5A as enacted in the bill. The bill specifies the classes of third-party payment provider contracts, policies, or plans subject and not subject to the requirement, and requires that notice of availability of the coverage be provided to the insured. The bill directs the commissioner of insurance to adopt rules under Code chapter 17A necessary to implement the provision.
   The bill also directs the department of human services (DHS) to include as covered benefits under the medical assistance program the prenatal ultrasounds as specified pursuant to Code section 135.131A and the newborn pulse oximetry screening tests as specified pursuant to Code section 136A.5A. The bill directs DHS to amend the Medicaid state plan as necessary to implement the provision.
   The bill includes a Code editor directive to create a new division in Code chapter 135 (department of public health) to include the Code sections relating to prenatal ultrasounds and fetal movement education.