Senate File 453 - Introduced SENATE FILE 453 BY CELSI A BILL FOR An Act relating to third-party payment of coverage benefits for 1 medical food, and including applicability provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2653XS (3) 88 ko/rn
S.F. 453 Section 1. NEW SECTION . 514C.35 Medical food —— coverage. 1 1. As used in this section, unless the context otherwise 2 requires: 3 a. “Enteral nutrition” means to provide food to an 4 individual through a tube placed in the individual’s nose, 5 stomach, or small intestine. 6 b. “Gastromony feeding tube” means a tube that goes through 7 an individual’s skin into the individual’s stomach for purposes 8 of enteral nutrition. 9 c. “Health care professional” means the same as defined in 10 section 514J.102. 11 d. “Jejunostomy feeding tube” means a tube that goes into an 12 individual’s small intestine for purposes of enteral nutrition. 13 e. “Medical food” means a food which is formulated to 14 be consumed or administered as enteral nutrition under the 15 supervision of a health care professional, or at the direction 16 of a health care professional, and which is intended for the 17 specific dietary management of a disease or condition for which 18 distinctive nutritional requirements, based on recognized 19 scientific principles, are established by medical evaluation. 20 f. “Nasoenteral feeding tube” or “nasogastric feeding tube” 21 means a tube that goes into an individual’s nose for purposes 22 of enteral nutrition. 23 2. Notwithstanding the uniformity of treatment requirements 24 of section 514C.6, a policy, contract, or plan providing 25 for third-party payment or prepayment of health or medical 26 expenses shall provide coverage benefits for medical food that 27 is administered or consumed via a gastronomy feeding tube, a 28 jejunostomy feeding tube, a nasoenteral feeding tube, or a 29 nasogastric feeding tube. 30 3. This section applies to the following classes of 31 third-party payment provider policies, contracts, or plans 32 delivered, issued for delivery, continued, or renewed in this 33 state on or after January 1, 2020: 34 a. Individual or group accident and sickness insurance 35 -1- LSB 2653XS (3) 88 ko/rn 1/ 3
S.F. 453 providing coverage on an expense-incurred basis. 1 b. An individual or group hospital or medical service 2 contract issued pursuant to chapter 509, 514, or 514A. 3 c. An individual or group health maintenance organization 4 contract regulated under chapter 514B. 5 d. A plan established pursuant to chapter 509A for public 6 employees. 7 4. This section shall not apply to accident-only, 8 specified disease, short-term hospital or medical, hospital 9 confinement indemnity, credit, dental, vision, Medicare 10 supplement, long-term care, basic hospital and medical-surgical 11 expense coverage as defined by the commissioner, disability 12 income insurance coverage, coverage issued as a supplement 13 to liability insurance, workers’ compensation or similar 14 insurance, or automobile medical payment insurance. 15 5. The commissioner of insurance shall adopt rules pursuant 16 to chapter 17A as necessary to administer this section. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill relates to third-party payment of coverage 21 benefits for medical food. 22 The bill defines “medical food” as a food which is 23 formulated to be consumed or administered as enteral nutrition 24 under the supervision of a health care professional, or at 25 the direction of a health care professional, and which is 26 intended for the specific dietary management of a disease or 27 condition for which distinctive nutritional requirements, based 28 on recognized scientific principles, are established by medical 29 evaluation. “Enteral nutrition” is defined in the bill as 30 providing food to an individual through a tube placed in the 31 individual’s nose, stomach, or small intestine. 32 The bill requires a health insurer to provide coverage 33 benefits for medical food that is consumed or administered 34 via a gastronomy feeding tube, a jejunostomy feeding tube, 35 -2- LSB 2653XS (3) 88 ko/rn 2/ 3
S.F. 453 a nasoenteral feeding tube, or a nasogastric feeding tube. 1 “Gastronomy feeding tube”, “jejunostomy feeding tube”, 2 “nasoenteral feeding tube”, and “nasogastric feeding tube” are 3 defined in the bill. 4 The bill requires the commissioner of insurance to adopt 5 rules to administer the Code section. 6 The bill is applicable to third-party payment provider 7 policies, contracts, or plans delivered, issued for delivery, 8 continued, or renewed in this state on or after January 1, 9 2020, including individual or group accident and sickness 10 insurance providing coverage on an expense-incurred basis, an 11 individual or group hospital or medical service contract issued 12 pursuant to Code chapter 509, 514, or 514A, an individual or 13 group health maintenance organization contract regulated under 14 Code chapter 514B, and a plan established pursuant to Code 15 chapter 509A for public employees. 16 The bill does not apply to accident-only, specified disease, 17 short-term hospital or medical, hospital confinement indemnity, 18 credit, dental, vision, Medicare supplement, long-term care, 19 basic hospital and medical-surgical expense coverage as defined 20 by the commissioner, disability income insurance coverage, 21 coverage issued as a supplement to liability insurance, 22 workers’ compensation or similar insurance, or automobile 23 medical payment insurance. 24 -3- LSB 2653XS (3) 88 ko/rn 3/ 3