H.F. 50 Section 1. NEW SECTION . 514C.36 Medically necessary food, 1 vitamins, and individual amino acids. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Cost-sharing” means any coverage limit, copayment, 5 coinsurance, deductible, or other out-of-pocket expense 6 obligation imposed on a covered person by a policy, contract, 7 or plan providing for third-party payment or prepayment of 8 health or medical expenses. 9 b. “Covered condition” means all of the following: 10 (1) Inherited metabolic disorders including all of the 11 following: 12 (a) A disorder classified as a metabolic disorder on 13 the most recent United States secretary of health and human 14 services recommended uniform screening panel core and secondary 15 conditions list, as recommended by the United States health 16 resources and services administration advisory committee on 17 heritable disorders in newborns and children. 18 (b) N-acetyl glutamate synthase deficiency. 19 (c) Ornithine transcarbamylase deficiency. 20 (d) Carbamoyl phosphate synthestase deficiency. 21 (e) Inherited disorders of mitochondrial functioning. 22 (2) Medical and surgical conditions of malabsorption, 23 including all of the following: 24 (a) Impaired absorption of nutrients caused by disorders 25 affecting the absorptive surface, functional length, and 26 motility of the gastrointestinal tract, including short bowel 27 syndrome and chronic intestinal pseudo-obstruction. 28 (b) Malabsorption due to liver or pancreatic disease. 29 (3) Immunoglobulin E and non-immunoglobulin E-mediated 30 allergies to food proteins including all of the following: 31 (a) Food protein-induced enterocolitis syndrome. 32 (b) Eosinophilic disorders, including eosinophilic 33 esophagitis, eosinophilic gastroenteritis, eosinophilic 34 colitis, and post-transplant eosinophilic disorders. 35 -1- LSB 1140YH (3) 89 ko/rn 1/ 6

H.F. 50 (4) Inflammatory or immune mediated conditions of the 1 alimentary tract, including all of the following: 2 (a) Inflammatory bowel disease, including Crohn’s disease, 3 ulcerative colitis, and indeterminate colitis. 4 (b) Gastroesophageal reflux disease that is nonresponsive 5 to standard medical therapies. 6 c. “Covered person” means a policyholder, subscriber, or 7 other person participating in a policy, contract, or plan that 8 provides for third-party payment or prepayment of health or 9 medical expenses. 10 d. “Durable medical equipment” means the same as defined in 11 42 U.S.C. §1395x(n). 12 e. “Health care professional” means the same as defined in 13 section 514J.102. 14 f. “Health carrier” means the same as defined in section 15 514J.102. 16 g. “Low protein modified food product” means a type of food 17 that is modified to be low in protein and formulated for oral 18 consumption for individuals with inborn errors of protein 19 metabolism. “Low protein modified food product” shall not 20 include foods that are naturally low in protein. 21 h. “Medically necessary food” means food, including a low 22 protein modified food product, an amino acid preparation 23 product, a modified fat preparation product, a prescription 24 nutritional formula, or an over-the-counter nutritional formula 25 that meets all of the following requirements: 26 (1) Is furnished pursuant to a prescription, order, or 27 recommendation of a covered person’s health care professional 28 for the dietary management of a covered condition. 29 (2) Is a specially formulated and processed product for the 30 partial or exclusive feeding of an individual by means of oral 31 intake or enteral feeding by tube. 32 (3) Is intended for the dietary management of an individual 33 who because of therapeutic or chronic medical needs has limited 34 or impaired capacity to ingest, digest, absorb, or metabolize 35 -2- LSB 1140YH (3) 89 ko/rn 2/ 6

H.F. 50 ordinary foodstuffs or certain nutrients, or who has other 1 special medically determined nutrient requirements, the dietary 2 management of which cannot be achieved solely by modification 3 of a normal diet. 4 (4) Is intended to be used under medical supervision, 5 including in a home setting. 6 (5) Is intended only for an individual receiving active 7 and ongoing medical supervision where the individual requires 8 medical care and instruction on the use of the food on a 9 recurring basis. 10 (6) Is not a food that is taken as part of an overall diet 11 designed to reduce the risk of a disease, the risk of a medical 12 condition, or as a weight loss product, even if the food is 13 recommended by a health care professional. 14 (7) Is not a food marketed as gluten-free for the management 15 of celiac disease or non-celiac gluten sensitivity. 16 (8) Is not a food marketed for the management of diabetes. 17 i. “Medically necessary vitamins and individual amino acids” 18 means vitamins and amino acids that are used for the management 19 of a covered condition pursuant to a prescription, order, or 20 recommendation of a covered person’s health care professional. 21 2. a. Notwithstanding the uniformity of treatment 22 requirements of section 514C.6, a policy, contract, or plan 23 providing for third-party payment or prepayment of health 24 or medical expenses shall provide coverage for all of the 25 following: 26 (1) Medically necessary food and the medical equipment and 27 supplies, not to include durable medical equipment, necessary 28 to administer the food. 29 (2) Medically necessary vitamins and individual amino 30 acids. 31 b. Coverage shall be a minimum of eighty percent of the 32 cost to a covered person for medically necessary food and the 33 medical equipment and supplies necessary to administer the 34 food, and medically necessary vitamins and individual amino 35 -3- LSB 1140YH (3) 89 ko/rn 3/ 6

H.F. 50 acids. 1 c. Coverage shall not be subject to cost-sharing that is 2 greater than the cost-sharing that the policy, contract, or 3 plan requires for other health or medical expenses covered 4 under the policy, contract, or plan. 5 d. Prior authorization shall not be required for coverage. 6 3. a. This section shall apply to the following classes 7 of third-party payment provider contracts, policies, or plans 8 delivered, issued for delivery, continued, or renewed in this 9 state: 10 (1) Individual or group accident and sickness insurance 11 providing coverage on an expense-incurred basis. 12 (2) An individual or group hospital or medical service 13 contract issued pursuant to chapter 509, 514, or 514A. 14 (3) An individual or group health maintenance organization 15 contract regulated under chapter 514B. 16 (4) A plan established for public employees pursuant to 17 chapter 509A. 18 b. This section shall not apply to accident-only, 19 specified disease, short-term hospital or medical, hospital 20 confinement indemnity, credit, dental, vision, Medicare 21 supplement, long-term care, basic hospital and medical-surgical 22 expense coverage as defined by the commissioner, disability 23 income insurance coverage, coverage issued as a supplement 24 to liability insurance, workers’ compensation or similar 25 insurance, or automobile medical payment insurance. 26 4. The commissioner of insurance shall adopt rules pursuant 27 to chapter 17A as necessary to administer this section. 28 Sec. 2. APPLICABILITY. This Act applies to third-party 29 payment provider contracts, policies, or plans delivered, 30 issued for delivery, continued, or renewed in this state on or 31 after January 1, 2022. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -4- LSB 1140YH (3) 89 ko/rn 4/ 6

H.F. 50 This bill relates to third-party payment of insurance 1 benefits for medically necessary food, and vitamins and 2 individual amino acids, for certain covered conditions. 3 The bill defines “covered condition” as inherited metabolic 4 disorders; medical and surgical conditions of malabsorption; 5 immunoglobulin E and non-immunoglobulin E-mediated allergies to 6 food proteins; and inflammatory or immune mediated conditions 7 of the alimentary tract. The definition also includes, as 8 detailed in the bill, specific conditions under each of the 9 different categories of conditions. The bill also defines 10 “medically necessary food” and “medically necessary vitamins 11 and individual amino acids”. 12 The bill requires a health carrier that offers individual, 13 group, or small group contracts, policies, or plans in this 14 state that provide for third-party payment or prepayment of 15 health or medical expenses to offer coverage for medically 16 necessary food and the medical equipment and supplies, not to 17 include durable medical equipment, necessary to administer 18 the food; and for medically necessary vitamins and individual 19 amino acids. The bill requires that the coverage be a minimum 20 of 80 percent of the cost to a covered person for medically 21 necessary food and the medical equipment and supplies necessary 22 to administer the food, and medically necessary vitamins and 23 individual amino acids. The bill prohibits the coverage 24 from being subject to cost-sharing that is greater than the 25 cost-sharing that the policy, contract, or plan requires for 26 other health or medical expenses covered under the policy, 27 contract, or plan. Prior authorization cannot be a requirement 28 for coverage. 29 The commissioner of insurance must adopt rules to administer 30 the requirements of the bill. 31 The bill applies to third-party payment provider contracts, 32 policies, or plans delivered, issued for delivery, continued, 33 or renewed in this state on or after January 1, 2022, by the 34 third-party payment providers enumerated in the bill. The bill 35 -5- LSB 1140YH (3) 89 ko/rn 5/ 6