Senate File 508 - Reprinted



                                       SENATE FILE       
                                       BY  COMMITTEE ON COMMERCE

                                       (SUCCESSOR TO SSB 1076)


    Passed Senate, Date               Passed House,  Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         
                 Approved                            

                                      A BILL FOR

  1 An Act requiring health care benefit coverage for certain
  2    prosthetic devices and providing an applicability date.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  4 TLSB 1942SV 82
  5 av/gg/14

PAG LIN



  1  1    Section 1.  NEW SECTION.  514C.23  COVERAGE FOR PROSTHETIC
  1  2 DEVICES.
  1  3    1.  Notwithstanding the uniformity of treatment
  1  4 requirements of section 514C.6, a policy or contract providing
  1  5 for third=party payment or prepayment of health or medical
  1  6 expenses shall provide coverage benefits for medically
  1  7 necessary prosthetic devices when prescribed by a physician
  1  8 licensed under chapter 148, 150, or 150A.  Such coverage
  1  9 benefits for medically necessary prosthetic devices shall
  1 10 provide coverage for medically necessary prosthetic devices
  1 11 that, at a minimum, equals the coverage and payment for
  1 12 medically necessary prosthetic devices provided under federal
  1 13 laws for health insurance for the aged and disabled pursuant
  1 14 to 42 U.S.C. } 1395k, 13951, and 1395m, and 42 C.F.R. }
  1 15 414.202, 414.210, 414.228, and 410.100, as applicable.  For
  1 16 the purposes of this section, "prosthetic device" means an
  1 17 artificial limb device to replace, in whole or in part, an arm
  1 18 or leg.
  1 19    2.  a.  This section applies to the following classes of
  1 20 third=party payment provider contracts or policies delivered,
  1 21 issued for delivery, continued, or renewed in this state on or
  1 22 after July 1, 2007:
  1 23    (1)  Individual or group accident and sickness insurance
  1 24 providing coverage on an expense=incurred basis.
  1 25    (2)  An individual or group hospital or medical service
  1 26 contract issued pursuant to chapter 509, 514, or 514A.
  1 27    (3)  An individual or group health maintenance organization
  1 28 contract regulated under chapter 514B.
  1 29    (4)  A plan established pursuant to chapter 509A for public
  1 30 employees.
  1 31    (5)  An organized delivery system licensed by the director
  1 32 of public health.
  1 33    b.  This section shall not apply to accident only,
  1 34 specified disease, short=term hospital or medical, hospital
  1 35 confinement indemnity, credit, dental, vision, Medicare
  2  1 supplement, long=term care, basic hospital and medical=
  2  2 surgical expense coverage as defined by the commissioner,
  2  3 disability income insurance coverage, coverage issued as a
  2  4 supplement to liability insurance, workers' compensation or
  2  5 similar insurance, or automobile medical payment insurance.
  2  6 SF 508
  2  7 av:rj/cc/26