SSB 3054 (LSB 5686XC (1) 85)

SENATE FILE _____

BY  (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON RAGAN)

A BILL FOR

An Act relating to third-party payment of services provided by physical therapists and occupational therapists.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.30  Services provided by a physical therapist.
   1.  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 not impose a copayment or coinsurance amount on an insured for services provided by a physical therapist licensed pursuant to chapter 148A or by an occupational therapist licensed pursuant to chapter 148B that is greater than the copayment or coinsurance amount imposed on the insured for services provided by a person engaged in the practice of medicine and surgery or osteopathic medicine and surgery under chapter 148 for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
   2.  This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2014:
   a.  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   b.  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   c.  An individual or group health maintenance organization contract regulated under chapter 514B.
   d.  A plan established pursuant to chapter 509A for public employees.
   e.  An organized delivery system licensed by the director of public health.
   3.  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.
EXPLANATION
The inclusion of this explanation does not constitute agreement with

the explanation’s substance by the members of the general assembly.
   This bill provides that a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not impose a copayment or coinsurance amount on an insured for services provided by a physical therapist or occupational therapist that is greater than the copayment or coinsurance amount imposed on the insured for services rendered by a person engaged in the practice of medicine and surgery or osteopathic medicine and surgery for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
   The bill applies to specified individual and group policies, contracts, and plans that are issued for delivery, continued, or renewed in this state on or after July 1, 2014.