House
File
625
-
Introduced
HOUSE
FILE
625
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HF
289)
A
BILL
FOR
An
Act
relating
to
direct
health
care
agreements,
and
including
1
effective
date
and
applicability
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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625
Section
1.
Section
135N.1,
Code
2021,
is
amended
by
striking
1
the
section
and
inserting
in
lieu
thereof
the
following:
2
135N.1
Direct
health
care
agreements.
3
1.
Definitions.
For
the
purpose
of
this
section:
4
a.
“Direct
health
care
agreement”
means
an
agreement
between
5
a
provider
and
a
patient,
or
the
patient’s
representative,
in
6
which
the
provider
agrees
to
provide
health
care
services
for
a
7
specified
period
of
time
to
the
patient
for
a
service
charge.
8
b.
“Durable
power
of
attorney
for
health
care”
means
the
same
9
as
defined
in
section
144B.1.
10
c.
“Health
care
services”
means
services
for
the
diagnosis,
11
prevention,
treatment,
cure,
or
relief
of
a
health
condition,
12
illness,
injury,
or
disease.
“Health
care
services”
includes
13
dental
care
services.
14
d.
“Patient”
means
an
individual,
or
an
individual
and
the
15
individual’s
immediate
family,
that
is
a
party
to
a
direct
16
health
care
agreement.
17
e.
“Patient’s
representative”
means
a
parent,
guardian,
or
18
an
individual
holding
a
durable
power
of
attorney
for
health
19
care
for
a
patient.
20
f.
“Provider”
means
a
health
care
professional
licensed,
21
accredited,
registered,
or
certified
to
perform
health
care
22
services
consistent
with
the
laws
of
this
state.
“Provider”
23
includes
an
individual
health
care
professional
or
other
24
legal
health
care
entity
alone
or
with
other
health
care
25
professionals
professionally
associated
with
the
individual
26
health
care
professional
or
other
legal
health
care
entity.
27
g.
“Service
charge”
means
a
charge
for
health
care
services
28
provided
by
a
provider
to
a
patient
covered
by
a
direct
health
29
care
agreement.
“Service
charge”
may
include
a
periodic
30
retainer,
a
membership
fee,
a
subscription
fee,
or
a
charge
in
31
any
other
form
paid
by
a
patient
to
a
provider
under
a
direct
32
health
care
agreement.
33
2.
Requirements
for
a
valid
direct
health
care
agreement.
34
a.
In
order
to
be
a
valid
agreement,
a
direct
health
care
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agreement
must
meet
all
of
the
following
requirements:
1
(1)
Be
in
writing.
2
(2)
Be
signed
by
the
provider,
or
an
agent
of
the
provider,
3
and
the
patient
or
the
patient’s
representative.
4
(3)
Describe
the
scope
of
the
health
care
services
covered
5
by
the
direct
health
care
agreement.
6
(4)
State
each
of
the
provider’s
locations
where
a
patient
7
may
obtain
health
care
services
and
specify
any
out-of-office
8
health
care
services
that
are
covered
under
the
direct
health
9
care
agreement.
10
(5)
Specify
the
service
charge
and
the
frequency
at
which
11
the
service
charge
must
be
paid
by
the
patient.
A
patient
12
shall
not
be
required
to
pay
more
than
twelve
months
of
a
13
service
charge
in
advance.
14
(6)
Specify
any
additional
costs
for
health
care
services
15
not
covered
by
the
service
charge
for
which
the
patient
will
16
be
responsible.
17
(7)
Specify
the
duration
of
the
direct
health
care
18
agreement,
whether
renewal
is
automatic,
and
if
required,
the
19
procedure
for
renewal.
20
(8)
Specify
the
terms
and
conditions
under
which
the
direct
21
health
care
agreement
may
be
terminated
by
the
provider.
22
A
termination
of
the
direct
health
care
agreement
by
the
23
provider
shall
include
a
minimum
of
a
thirty-calendar-day
24
advance,
written
notice
to
the
patient
or
to
the
patient’s
25
representative.
26
(9)
Specify
that
the
direct
health
care
agreement
may
be
27
terminated
at
any
time
by
the
patient
upon
written
notice
to
28
the
provider.
29
(10)
State
that
if
the
direct
health
care
agreement
is
30
terminated
by
either
the
patient
or
the
provider
all
of
the
31
following
apply:
32
(a)
Within
thirty
calendar
days
of
the
date
of
the
notice
of
33
termination
from
either
party,
the
provider
shall
refund
all
34
unearned
service
charges
to
the
patient.
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(b)
Within
thirty
calendar
days
of
the
date
of
the
notice
1
of
termination
from
either
party,
the
patient
shall
pay
all
2
outstanding
earned
service
charges
to
the
provider.
3
(11)
Include
a
notice
in
bold,
twelve-point
type
that
states
4
substantially
as
follows:
5
NOTICE.
This
direct
health
care
agreement
is
not
health
6
insurance
and
is
not
a
plan
that
provides
health
coverage
for
7
purposes
of
any
federal
mandates.
This
direct
health
care
8
agreement
only
covers
the
health
care
services
described
in
9
this
agreement.
It
is
recommended
that
you
obtain
health
10
insurance
to
cover
health
care
services
not
covered
under
this
11
direct
health
care
agreement.
You
are
personally
responsible
12
for
the
payment
of
any
additional
health
care
expenses
you
may
13
incur.
14
b.
The
provider
shall
provide
the
patient,
or
the
patient’s
15
representative,
with
a
fully
executed
copy
of
the
direct
health
16
care
agreement
at
the
time
the
direct
health
care
agreement
is
17
executed.
18
3.
Application
for
a
direct
health
care
agreement.
If
19
a
provider
requires
a
prospective
patient
to
complete
an
20
application
for
a
direct
health
care
agreement,
the
provider
21
shall
provide
a
written
disclaimer
on
each
application
that
22
informs
the
prospective
patient
of
the
patient’s
financial
23
rights
and
responsibilities
and
that
states
that
the
provider
24
will
not
bill
a
health
insurance
carrier
for
health
care
25
services
covered
under
the
direct
health
care
agreement.
The
26
disclaimer
shall
also
include
the
identical
notice
required
by
27
subsection
2,
paragraph
“a”
,
subparagraph
(11).
28
4.
Notice
required
for
changes
to
the
terms
or
conditions
of
29
a
direct
health
care
agreement.
30
a.
A
provider
shall
provide
at
least
a
sixty-calendar-day
31
advance,
written
notice
to
a
patient
of
any
of
the
following
32
changes
to
a
direct
health
care
agreement:
33
(1)
Any
change
in
the
scope
of
the
health
care
services
34
covered
under
the
agreement.
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(2)
Any
change
in
the
provider’s
locations
where
the
patient
1
may
access
health
care
services.
2
(3)
Any
change
in
the
out-of-office
services
that
are
3
covered
under
the
direct
health
care
service
agreement.
4
(4)
Any
change
in
the
service
charge.
5
(5)
Any
change
in
the
additional
costs
for
health
care
6
services
not
covered
by
the
service
charge.
7
(6)
Any
change
in
the
renewal
terms.
8
(7)
Any
change
in
the
terms
to
terminate
the
agreement.
9
b.
A
provider
shall
provide
the
notice
by
mailing
a
letter
10
to
the
last
known
address
of
the
patient
that
the
provider
has
11
on
file.
The
postmark
date
on
the
letter
shall
be
the
first
day
12
of
the
required
sixty-calendar-day
notice
period.
13
5.
Discrimination
based
on
an
individual’s
health
status.
A
14
provider
shall
not
refuse
to
accept
a
new
patient
or
15
discontinue
care
of
an
existing
patient
based
solely
on
the
new
16
patient’s
or
the
existing
patient’s
health
status.
17
6.
A
direct
health
care
agreement
is
not
insurance.
18
a.
A
direct
health
care
agreement
shall
be
deemed
to
not
19
be
insurance
and
shall
not
be
subject
to
the
authority
of
the
20
commissioner
of
insurance.
Neither
a
provider
or
an
agent
of
a
21
provider
shall
be
required
to
be
licensed
by
the
commissioner
22
to
transact
the
business
of
insurance
in
this
state,
or
to
23
obtain
a
certificate
issued
by
the
commissioner
to
market
or
24
offer
a
direct
health
care
agreement.
25
b.
A
provider
shall
not
bill
an
insurer
for
a
health
care
26
service
provided
under
a
direct
health
care
agreement.
A
27
patient
may
submit
a
request
for
reimbursement
to
an
insurer
28
if
permitted
under
the
patient’s
policy
of
insurance.
This
29
paragraph
does
not
prohibit
a
provider
from
billing
a
patient’s
30
insurance
for
a
health
care
service
provided
to
the
patient
by
31
the
provider
that
is
not
covered
under
the
direct
health
care
32
agreement.
33
7.
Third-party
payment
of
a
service
charge.
A
provider
34
may
accept
payment
of
a
service
charge
for
a
patient
either
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directly
or
indirectly
from
a
third
party.
A
provider
may
1
accept
all
or
part
of
a
service
charge
paid
by
an
employer
2
on
behalf
of
an
employee
who
is
a
patient
of
the
provider.
3
A
provider
shall
not
enter
directly
into
an
agreement
with
4
an
employer
relating
to
a
health
care
agreement
between
the
5
provider
and
employees
of
the
employer,
other
than
an
agreement
6
to
establish
the
timing
and
method
of
the
payment
of
a
service
7
charge
paid
by
the
employer
on
behalf
of
the
employee.
8
8.
Sale
or
transfer
of
a
direct
health
care
agreement.
A
9
direct
health
care
agreement
shall
not
be
sold
or
transferred
10
by
a
provider
without
the
prior
written
consent
of
the
patient
11
who
is
a
party
to
the
direct
health
care
agreement.
A
patient
12
shall
not
sell
or
transfer
a
direct
health
care
agreement
to
13
which
the
patient
is
a
party.
14
Sec.
2.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
15
importance,
takes
effect
upon
enactment.
16
Sec.
3.
APPLICABILITY.
This
Act
applies
to
direct
health
17
care
agreements
that
are
fully
executed
on
or
after
the
date
18
of
enactment.
19
EXPLANATION
20
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
21
the
explanation’s
substance
by
the
members
of
the
general
assembly.
22
This
bill
relates
to
direct
health
care
agreements.
23
Current
law
allows
certain
primary
care
health
professionals
24
to
enter
into
a
direct
primary
care
agreement
with
a
patient
25
to
provide
certain
primary
care
health
services
for
a
set
26
service
charge
that
covers
a
specific
period
of
time.
The
bill
27
broadens
the
types
of
health
care
professionals
that
may
enter
28
into
a
direct
health
care
agreement
to
include
health
care
29
professionals
that
perform
health
care
services.
“Health
care
30
services”
is
defined
in
the
bill
as
services
for
the
diagnosis,
31
prevention,
treatment,
cure,
or
relief
of
a
health
condition,
32
illness,
injury,
or
disease,
and
includes
dental
care
services.
33
The
bill
takes
effect
upon
enactment
and
applies
to
direct
34
health
care
agreements
that
are
fully
executed
on
or
after
the
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date
of
enactment.
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