House File 311 - Reprinted



                                        HOUSE FILE       
                                        BY  COMMITTEE ON COMMERCE

                                        (SUCCESSOR TO HSB 141)


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

                                      A BILL FOR

  1 An Act requiring health care benefit coverage for certain
  2    medically necessary prosthetic devices and providing an
  3    applicability date.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  5 TLSB 1927HV 83
  6 av/rj/14

PAG LIN



  1  1    Section 1.  NEW SECTION.  514C.24  COVERAGE FOR PROSTHETIC
  1  2 DEVICES.
  1  3    1.  Notwithstanding the uniformity of treatment
  1  4 requirements of section 514C.6, a policy, contract, or plan
  1  5 providing for third=party payment or prepayment of health or
  1  6 medical expenses shall provide coverage benefits for medically
  1  7 necessary prosthetic devices when prescribed by a physician
  1  8 licensed under chapter 148.  Coverage required under this
  1  9 section shall be limited to the most appropriate medically
  1 10 necessary model of a prosthetics device that adequately meets
  1 11 the medical needs of the patient as determined by the
  1 12 patient's treating physician.  Such coverage benefits for
  1 13 medically necessary prosthetic devices shall provide coverage
  1 14 for medically necessary prosthetic devices, that at a minimum,
  1 15 equals the coverage and payment for medically necessary
  1 16 prosthetic devices provided under the most recent federal laws
  1 17 for health insurance for the aged and disabled pursuant to 42
  1 18 U.S.C. } 1395k, 13951, and 1395m, and 42 C.F.R. } 410.100,
  1 19 414.202, 414.210, and 414.228, as applicable.  For the
  1 20 purposes of this section, "prosthetic device" means an
  1 21 artificial limb device to replace, in whole or in part, an arm
  1 22 or leg.
  1 23    2.  a.  This section applies to the following classes of
  1 24 third=party payment provider policies, contracts, or plans
  1 25 delivered, issued for delivery, continued, or renewed in this
  1 26 state on or after July 1, 2009:
  1 27    (1)  Individual or group accident and sickness insurance
  1 28 providing coverage on an expense=incurred basis.
  1 29    (2)  An individual or group hospital or medical service
  1 30 contract issued pursuant to chapter 509, 514, or 514A.
  1 31    (3)  An individual or group health maintenance organization
  1 32 contract regulated under chapter 514B.
  1 33    (4)  A plan established pursuant to chapter 509A for public
  1 34 employees.
  1 35    (5)  An organized delivery system licensed by the director
  2  1 of public health.
  2  2    b.  This section shall not apply to accident only,
  2  3 specified disease, short=term hospital or medical, hospital
  2  4 confinement indemnity, credit, dental, vision, Medicare
  2  5 supplement, long=term care, basic hospital and medical=
  2  6 surgical expense coverage as defined by the commissioner,
  2  7 disability income insurance coverage, coverage issued as a
  2  8 supplement to liability insurance, workers' compensation or
  2  9 similar insurance, or automobile medical payment insurance.
  2 10 HF 311
  2 11 av/cm/25