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