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House File 393 - EnrolledAn Actrelating to programs and activities under the purview of
the department of public health, including effective date
provisions and providing for a repeal.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
Program Flexibility and Efficiencies
Section 1. Section 125.59, subsection 1, paragraph b, Code
2017, is amended to read as follows:
b. If the transferred amount for this subsection exceeds
grant requests funded to the ten thousand dollar maximum, the
Iowa department of public health may use the remainder for
activities and public information resources that align with
best practices for substance-related disorder prevention or to
increase grants pursuant to subsection 2.
Sec. 2. Section 135.11, subsection 31, Code 2017, is amended
by striking the subsection.
Sec. 3. Section 135.150, subsection 2, Code 2017, is amended
to read as follows:
2. The department shall report semiannually annually to the
general assembly’s standing committees on government oversight
regarding the operation of the gambling treatment program.
The report shall include but is not limited to information on
the moneys expended and grants awarded for operation of the
gambling treatment program.
DIVISION II
Medical home and Patient-centered health advisory council
Sec. 4. Section 135.15, Code 2017, is amended by adding the
following new subsection:
NEW SUBSECTION. 6. For the purposes of this section,
“dental home” means a network of individualized care based on
risk assessment, which includes oral health education, dental
screenings, preventive services, diagnostic services, treatment
services, and emergency services.
Sec. 5. Section 135.159, Code 2017, is amended by striking
the section and inserting in lieu thereof the following:
135.159 Patient-centered health advisory council.
1. The department shall establish a patient-centered health
advisory council which shall include but is not limited to
all of the following members, selected by their respective
-1-organizations, and any other members the department determines
necessary:
a. The director of human services, or the director’s
designee.
b. The commissioner of insurance, or the commissioner’s
designee.
c. A representative of the federation of Iowa insurers.
d. A representative of the Iowa dental association.
e. A representative of the Iowa nurses association.
f. A physician and an osteopathic physician licensed
pursuant to chapter 148 who are family physicians and members
of the Iowa academy of family physicians.
g. A health care consumer.
h. A representative of the Iowa collaborative safety net
provider network established pursuant to section 135.153.
i. A representative of the Iowa developmental disabilities
council.
j. A representative of the Iowa chapter of the American
academy of pediatrics.
k. A representative of the child and family policy center.
l. A representative of the Iowa pharmacy association.
m. A representative of the Iowa chiropractic society.
n. A representative of the university of Iowa college of
public health.
o. A certified palliative care physician.
2. The patient-centered health advisory council may utilize
the assistance of other relevant public health and health care
expertise when necessary to carry out the council’s purposes
and responsibilities.
3. A public member of the patient-centered health advisory
council shall receive reimbursement for actual expenses
incurred while serving in the member’s official capacity
only if the member is not eligible for reimbursement by the
organization the member represents.
4. The purposes of the patient-centered health advisory
-2-council shall include all of the following:
a. To serve as a resource on emerging health care
transformation initiatives in Iowa.
b. To convene stakeholders in Iowa to streamline efforts
that support state-level and community-level integration and
focus on reducing fragmentation of the health care system.
c. To encourage partnerships and synergy between community
health care partners in the state who are working on new
system-level models to provide better health care at lower
costs by focusing on shifting from volume-based to value-based
health care.
d. To lead discussions on the transformation of the
health care system to a patient-centered infrastructure that
integrates and coordinates services and supports to address
social determinants of health and to meet population health
goals.
e. To provide a venue for education and information
gathering for stakeholders and interested parties to learn
about emerging health care initiatives across the state.
f. To develop recommendations for submission to the
department related to health care transformation issues.
Sec. 6. Section 249N.2, subsections 15 and 19, Code 2017,
are amended to read as follows:
15. “Medical home” means medical home as defined in
section 135.157. a team approach to providing health care that
originates in a primary care setting; fosters a partnership
among the patient, the personal provider, and other health care
professionals, and where appropriate, the patient’s family;
utilizes the partnership to access and integrate all medical
and nonmedical health-related services across all elements of
the health care system and the patient’s community as needed by
the patient and the patient’s family to achieve maximum health
potential; maintains a centralized, comprehensive record of all
health-related services to promote continuity of care; and has
all of the following characteristics:
-3- a. A personal provider.
b. A provider-directed team-based medical practice.
c. Whole person orientation.
d. Coordination and integration of care.
e. Quality and safety.
f. Enhanced access to health care.
g. A payment system that appropriately recognizes the added
value provided to patients who have a patient-centered medical
home.
19. “Primary medical provider” means the personal provider
as defined in section 135.157 trained to provide first contact
and continuous and comprehensive care to a member, chosen by
a member or to whom a member is assigned under the Iowa health
and wellness plan.
Sec. 7. Section 249N.2, Code 2017, is amended by adding the
following new subsections:
NEW SUBSECTION. 17A. “Personal provider” means the
patient’s first point of contact in the health care system
with a primary care provider who identifies the patient’s
health-related needs and, working with a team of health
care professionals and providers of medical and nonmedical
health-related services, provides for and coordinates
appropriate care to address the health-related needs
identified.
NEW SUBSECTION. 18A. “Primary care provider” includes but
is not limited to any of the following licensed or certified
health care professionals who provide primary care:
a. A physician who is a family or general practitioner, a
pediatrician, an internist, an obstetrician, or a gynecologist.
b. An advanced registered nurse practitioner.
c. A physician assistant.
d. A chiropractor.
Sec. 8. Section 249N.6, subsection 2, paragraph c, Code
2017, is amended to read as follows:
c. The department shall develop a mechanism for primary
-4-medical providers, medical homes, and participating accountable
care organizations to jointly facilitate member care
coordination. The Iowa health and wellness plan shall provide
for reimbursement of care coordination services provided
under the plan consistent with the reimbursement methodology
developed pursuant to section 135.159.
Sec. 9. Section 249N.6, subsection 3, paragraph a, Code
2017, is amended to read as follows:
a. The department shall provide procedures for accountable
care organizations that emerge through local markets to
participate in the Iowa health and wellness plan provider
network. Such accountable care organizations shall incorporate
the medical home as defined and specified in chapter 135,
division XXII, as a foundation and shall emphasize whole-person
orientation and coordination and integration of both clinical
services and nonclinical community and social supports that
address social determinants of health. A participating
accountable care organization shall enter into a contract with
the department to ensure the coordination and management of the
health of attributed members, to produce quality health care
outcomes, and to control overall cost.
Sec. 10. PALLIATIVE CARE REVIEW — PATIENT-CENTERED HEALTH
ADVISORY COUNCIL. The patient-centered health advisory council
shall review the current level of public awareness regarding
and the availability of palliative care services in the state
and shall submit a report to the governor and the general
assembly by December 31, 2017, including the council’s findings
and providing recommendations to increase public awareness
and reduce barriers to access to palliative care services
throughout the state.
Sec. 11. REPEAL. Sections 135.157 and 135.158, Code 2017,
are repealed.
DIVISION III
workforce programming
Sec. 12. Section 84A.11, subsection 4, Code 2017, is amended
-5-to read as follows:
4. The nursing workforce data clearinghouse shall be
established and maintained in a manner consistent with the
health care delivery infrastructure and health care workforce
resources strategic plan developed pursuant to section 135.164
135.163.
Sec. 13. Section 135.107, subsection 3, Code 2017, is
amended to read as follows:
3. The center for rural health and primary care shall
establish a primary care provider recruitment and retention
endeavor, to be known as PRIMECARRE. The endeavor shall
include a health care workforce and community support grant
program, and a primary care provider loan repayment program,
and a primary care provider community scholarship program. The
endeavor shall be developed and implemented in a manner to
promote and accommodate local creativity in efforts to recruit
and retain health care professionals to provide services in
the locality. The focus of the endeavor shall be to promote
and assist local efforts in developing health care provider
recruitment and retention programs. The center for rural
health and primary care may enter into an agreement with the
college student aid commission for the administration of the
center’s grant and loan repayment programs.
a. Community Health care workforce and community support
grant program.
(1) The center for rural health and primary care shall adopt
rules establishing an flexible application process processes
based upon the department’s strategic plan to be used by the
center to establish a grant assistance program as provided
in this paragraph “a”, and establishing the criteria to be
used in evaluating the applications. Selection criteria
shall include a method for prioritizing grant applications
based on illustrated efforts to meet the health care provider
needs of the locality and surrounding area. Such assistance
may be in the form of a forgivable loan, grant, or other
-6-nonfinancial assistance as deemed appropriate by the center.
An application submitted shall may contain a commitment of at
least a dollar-for-dollar match of matching funds for the grant
assistance. Application may be made for assistance by a single
community or group of communities or in response to programs
recommended in the strategic plan to address health workforce
shortages.
(2) Grants awarded under the program shall be subject to the
following limitations:
(a) Ten thousand dollars for a single community or region
with a population of ten thousand or less. An award shall not
be made under this program to a community with a population of
more than ten thousand.
(b) An amount not to exceed one dollar per capita for a
region in which the population exceeds ten thousand. For
purposes of determining the amount of a grant for a region,
the population of the region shall not include the population
of any community with a population of more than ten thousand
located in the region awarded to rural, underserved areas or
special populations as identified by the department’s strategic
plan or evidence-based documentation.
b. Primary care provider loan repayment program.
(1) A primary care provider loan repayment program is
established to increase the number of health professionals
practicing primary care in federally designated health
professional shortage areas of the state. Under the program,
loan repayment may be made to a recipient for educational
expenses incurred while completing an accredited health
education program directly related to obtaining credentials
necessary to practice the recipient’s health profession.
(2) The center for rural health and primary care shall adopt
rules relating to the establishment and administration of the
primary care provider loan repayment program. Rules adopted
pursuant to this paragraph shall provide, at a minimum, for all
of the following:
-7- (a) Determination of eligibility requirements and
qualifications of an applicant to receive loan repayment under
the program, including but not limited to years of obligated
service, clinical practice requirements, and residency
requirements. One year of obligated service shall be provided
by the applicant in exchange for each year of loan repayment,
unless federal requirements otherwise require. Loan repayment
under the program shall not be approved for a health provider
whose license or certification is restricted by a medical
regulatory authority of any jurisdiction of the United States,
other nations, or territories.
(b) Identification of federally designated health
professional shortage areas of the state and prioritization of
such areas according to need.
(c) Determination of the amount and duration of the loan
repayment an applicant may receive, giving consideration to the
availability of funds under the program, and the applicant’s
outstanding educational loans and professional credentials.
(d) Determination of the conditions of loan repayment
applicable to an applicant.
(e) Enforcement of the state’s rights under a loan repayment
program contract, including the commencement of any court
action.
(f) Cancellation of a loan repayment program contract for
reasonable cause unless federal requirements otherwise require.
(g) Participation in federal programs supporting repayment
of loans of health care providers and acceptance of gifts,
grants, and other aid or amounts from any person, association,
foundation, trust, corporation, governmental agency, or other
entity for the purposes of the program.
(h) Upon availability of state funds, determination of
eligibility criteria and qualifications for participating
communities and applicants not located in federally designated
shortage areas.
(i) Other rules as necessary.
-8- (3) The center for rural health and primary care may enter
into an agreement under chapter 28E with the college student
aid commission for the administration of this program.
c. Primary care provider community scholarship program.
(1) A primary care provider community scholarship program
is established to recruit and to provide scholarships to train
primary health care practitioners in federally designated
health professional shortage areas of the state. Under
the program, scholarships may be awarded to a recipient for
educational expenses incurred while completing an accredited
health education program directly related to obtaining the
credentials necessary to practice the recipient’s health
profession.
(2) The department shall adopt rules relating to the
establishment and administration of the primary care provider
community scholarship program. Rules adopted pursuant to
this paragraph shall provide, at a minimum, for all of the
following:
(a) Determination of eligibility requirements and
qualifications of an applicant to receive scholarships under
the program, including but not limited to years of obligated
service, clinical practice requirements, and residency
requirements. One year of obligated service shall be provided
by the applicant in exchange for each year of scholarship
receipt, unless federal requirements otherwise require.
(b) Identification of federally designated health
professional shortage areas of the state and prioritization of
such areas according to need.
(c) Determination of the amount of the scholarship an
applicant may receive.
(d) Determination of the conditions of scholarship to be
awarded to an applicant.
(e) Enforcement of the state’s rights under a scholarship
contract, including the commencement of any court action.
(f) Cancellation of a scholarship contract for reasonable
-9-cause.
(g) Participation in federal programs supporting
scholarships for health care providers and acceptance of gifts,
grants, and other aid or amounts from any person, association,
foundation, trust, corporation, governmental agency, or other
entity for the purposes of the program.
(h) Upon availability of state funds, determination of
eligibility criteria and qualifications for participating
communities and applicants not located in federally designated
shortage areas.
(i) Other rules as necessary.
(3) The center for rural health and primary care may enter
into an agreement under chapter 28E with the college student
aid commission for the administration of this program.
Sec. 14. Section 135.107, subsection 4, paragraphs a, b, and
c, Code 2017, are amended to read as follows:
a. Eligibility under any of the programs established under
the primary care provider recruitment and retention endeavor
shall be based upon a community health services assessment
completed under subsection 2, paragraph “a”. A community
or region, as applicable, shall submit a letter of intent
to conduct a community health services assessment and to
apply for assistance under this subsection. The letter shall
be in a form and contain information as determined by the
center. A letter of intent shall be submitted to the center by
January 1 preceding the fiscal year for which an application
for assistance is to be made. Participation in a community
health services assessment process shall be documented by the
community or region.
b. Assistance under this subsection shall not be granted
until such time as the community or region making application
has completed the a community health services assessment and
adopted a long-term community health services assessment and
developmental plan. In addition to any other requirements, a
developmental an applicant’s plan shall include, to the extent
-10-possible, a clear commitment to informing high school students
of the health care opportunities which may be available to such
students.
c. The center for rural health and primary care shall
seek additional assistance and resources from other state
departments and agencies, federal agencies and grant programs,
private organizations, and any other person, as appropriate.
The center is authorized and directed to accept on behalf of
the state any grant or contribution, federal or otherwise,
made to assist in meeting the cost of carrying out the purpose
of this subsection. All federal grants to and the federal
receipts of the center are appropriated for the purpose set
forth in such federal grants or receipts. Funds appropriated
by the general assembly to the center for implementation of
this subsection shall first be used for securing any available
federal funds requiring a state match, with remaining funds
being used for the health care workforce and community support
grant program.
Sec. 15. Section 135.107, subsection 5, paragraph a, Code
2017, is amended to read as follows:
a. There is established an advisory committee to the
center for rural health and primary care consisting of one
representative, approved by the respective agency, of each
of the following agencies: the department of agriculture
and land stewardship, the Iowa department of public health,
the department of inspections and appeals, the a national or
regional institute for rural health policy, the rural health
resource center, the institute of agricultural medicine
and occupational health, and the Iowa state association of
counties. The governor shall appoint two representatives
of consumer groups active in rural health issues and a
representative of each of two farm organizations active within
the state, a representative of an agricultural business in
the state, a representative of a critical needs hospital,
a practicing rural family physician, a practicing rural
-11-physician assistant, a practicing rural advanced registered
nurse practitioner, and a rural health practitioner who is
not a physician, physician assistant, or advanced registered
nurse practitioner, as members of the advisory committee. The
advisory committee shall also include as members two state
representatives, one appointed by the speaker of the house of
representatives and one by the minority leader of the house,
and two state senators, one appointed by the majority leader of
the senate and one by the minority leader of the senate.
Sec. 16. Section 135.163, Code 2017, is amended to read as
follows:
135.163 Health and long-term care access.
The department shall coordinate public and private efforts
to develop and maintain an appropriate health care delivery
infrastructure and a stable, well-qualified, diverse, and
sustainable health care workforce in this state. The health
care delivery infrastructure and the health care workforce
shall address the broad spectrum of health care needs of Iowans
throughout their lifespan including long-term care needs. The
department shall, at a minimum, do all of the following:
1. Develop a strategic plan for health care delivery
infrastructure and health care workforce resources in this
state.
2. Provide for the continuous collection of data to provide
a basis for health care strategic planning and health care
policymaking.
3. Make recommendations regarding the health care delivery
infrastructure and the health care workforce that assist
in monitoring current needs, predicting future trends, and
informing policymaking.
Sec. 17. Section 135.175, subsection 1, paragraph b, Code
2017, is amended to read as follows:
b. A health care workforce shortage fund is created in
the state treasury as a separate fund under the control of
the department, in cooperation with the entities identified
-12-in this section as having control over the accounts within
the fund. The fund and the accounts within the fund shall
be controlled and managed in a manner consistent with the
principles specified and the strategic plan developed pursuant
to sections section 135.163 and 135.164.
Sec. 18. Section 135.175, subsections 6 and 7, Code 2017,
are amended to read as follows:
6. a. Moneys in the fund and the accounts in the fund shall
only be appropriated in a manner consistent with the principles
specified and the strategic plan developed pursuant to sections
section 135.163 and 135.164 to support the medical residency
training state matching grants program, the fulfilling Iowa’s
need for dentists matching grant program, and to provide
funding for state health care workforce shortage programs as
provided in this section.
b. State programs that may receive funding from the fund
and the accounts in the fund, if specifically designated for
the purpose of drawing down federal funding, are the primary
care recruitment and retention endeavor (PRIMECARRE), the Iowa
affiliate of the national rural recruitment and retention
network, the oral and health delivery systems bureau of the
department, the primary care office and shortage designation
program, and the state office of rural health, and the Iowa
health workforce center, administered through the oral and
health delivery systems bureau of health care access of the
department of public health; the area health education centers
programs at Des Moines university — osteopathic medical center
and the university of Iowa; the Iowa collaborative safety net
provider network established pursuant to section 135.153; any
entity identified by the federal government entity through
which federal funding for a specified health care workforce
shortage initiative is received; and a program developed in
accordance with the strategic plan developed by the department
of public health in accordance with sections section 135.163
and 135.164.
-13- c. State appropriations to the fund shall be allocated in
equal amounts to each of the accounts within the fund, unless
otherwise specified in the appropriation or allocation. Any
federal funding received for the purposes of addressing state
health care workforce shortages shall be deposited in the
health care workforce shortage national initiatives account,
unless otherwise specified by the source of the funds, and
shall be used as required by the source of the funds. If use
of the federal funding is not designated, the funds shall be
used in accordance with the strategic plan developed by the
department of public health in accordance with sections section
135.163 and 135.164, or to address workforce shortages as
otherwise designated by the department of public health. Other
sources of funding shall be deposited in the fund or account
and used as specified by the source of the funding.
7. No more than five percent of the moneys in any of the
accounts within the fund, not to exceed one hundred thousand
dollars in each account, shall be used for administrative
purposes, unless otherwise provided by the appropriation,
allocation, or source of the funds.
Sec. 19. REPEAL. Sections 135.164 and 135.180, Code 2017,
are repealed.
DIVISION IV
unfunded OR outdated program PROVISIONS
Sec. 20. Section 135.11, subsection 25, Code 2017, is
amended by striking the subsection.
Sec. 21. Section 135.141, subsection 2, paragraph c, Code
2017, is amended by striking the paragraph.
Sec. 22. Section 135.141, subsection 2, paragraph e, Code
2017, is amended to read as follows:
e. For the purpose of paragraphs “c” and paragraph “d”,
an employee or agent of the department may enter into and
examine any premises containing potentially dangerous agents
with the consent of the owner or person in charge of the
premises or, if the owner or person in charge of the premises
-14-refuses admittance, with an administrative search warrant
obtained under section 808.14. Based on findings of the risk
assessment and examination of the premises, the director may
order reasonable safeguards or take any other action reasonably
necessary to protect the public health pursuant to rules
adopted to administer this subsection.
Sec. 23. Section 901B.1, subsection 4, paragraph a, Code
2017, is amended to read as follows:
a. The district department of correctional services shall
place an individual committed to it under section 907.3 to the
sanction and level of supervision which is appropriate to the
individual based upon a current risk assessment evaluation.
Placements may be to levels two and three of the corrections
continuum. The district department may, with the approval of
the Iowa department of public health and the department of
corrections, place an individual in a level three substance
abuse treatment facility established pursuant to section
135.130, to assist the individual in complying with a condition
of probation. The district department may, with the approval
of the department of corrections, place an individual in a
level four violator facility established pursuant to section
904.207 only as a penalty for a violation of a condition
imposed under this section.
Sec. 24. REPEAL. Sections 135.26, 135.29, 135.130, and
135.152, Code 2017, are repealed.
DIVISION V
miscellaneous provisions
Sec. 25. Section 135A.2, subsection 6, Code 2017, is amended
to read as follows:
6. “Local board of health” means a county or district board
of health the same as defined in section 137.102.
Sec. 26. REPEAL. Section 135.132, Code 2017, is repealed.
DIVISION VI
iowa health information network
Sec. 27. Section 136.3, subsection 13, Code 2017, is amended
-15-by striking the subsection.
Sec. 28. EFFECTIVE DATE. This division of this Act
takes effect upon the assumption of the administration and
governance, including but not limited to the assumption of the
assets and liabilities, of the Iowa health information network
by the designated entity as defined in 2015 Iowa Acts, ch.73,
section 2. The department of public health shall notify the
Code editor of the date of such assumption by the designated
entity.
DIVISION VII
ORGANIZED DELIVERY SYSTEMS
Sec. 29. Section 135H.3, subsection 2, Code 2017, is amended
to read as follows:
2. If a child is diagnosed with a biologically based mental
illness as defined in section 514C.22 and meets the medical
assistance program criteria for admission to a psychiatric
medical institution for children, the child shall be deemed
to meet the acuity criteria for medically necessary inpatient
benefits under a group policy, contract, or plan providing
for third-party payment or prepayment of health, medical, and
surgical coverage benefits issued by a carrier, as defined in
section 513B.2, or by an organized delivery system authorized
under 1993 Iowa Acts, ch.158, that is subject to section
514C.22. Such medically necessary benefits shall not be
excluded or denied as care that is substantially custodial in
nature under section 514C.22, subsection 8, paragraph “b”.
Sec. 30. Section 505.32, subsection 2, paragraph h, Code
2017, is amended by striking the paragraph.
Sec. 31. Section 505.32, subsection 4, paragraph b,
subparagraphs (1) and (2), Code 2017, are amended to read as
follows:
(1) The commissioner may establish methodologies to provide
uniform and consistent side-by-side comparisons of the health
care coverage options that are offered by carriers, organized
delivery systems, and public programs in this state including
-16-but not limited to benefits covered and not covered, the amount
of coverage for each service, including copays and deductibles,
administrative costs, and any prior authorization requirements
for coverage.
(2) The commissioner may require each carrier, organized
delivery system, and public program in this state to describe
each health care coverage option offered by that carrier,
organized delivery system, or public program in a manner
so that the various options can be compared as provided in
subparagraph (1).
Sec. 32. Section 507B.4, subsection 1, Code 2017, is amended
to read as follows:
1. For purposes of subsection 3, paragraph “p”, “insurer”
means an entity providing a plan of health insurance, health
care benefits, or health care services, or an entity subject
to the jurisdiction of the commissioner performing utilization
review, including an insurance company offering sickness and
accident plans, a health maintenance organization, an organized
delivery system authorized under 1993 Iowa Acts, ch.158, and
licensed by the department of public health, a nonprofit health
service corporation, a plan established pursuant to chapter
509A for public employees, or any other entity providing a
plan of health insurance, health care benefits, or health care
services. However, “insurer” does not include an entity that
sells disability income or long-term care insurance.
Sec. 33. Section 507B.4A, subsection 2, paragraph a, Code
2017, is amended to read as follows:
a. An insurer providing accident and sickness insurance
under chapter 509, 514, or 514A; a health maintenance
organization; an organized delivery system authorized under
1993 Iowa Acts, ch.158, and licensed by the department of
public health; or another entity providing health insurance or
health benefits subject to state insurance regulation shall
either accept and pay or deny a clean claim.
Sec. 34. Section 509.3A, subsection 11, Code 2017, is
-17-amended by striking the subsection.
Sec. 35. Section 509.19, subsection 2, paragraph d, Code
2017, is amended by striking the paragraph.
Sec. 36. Section 509A.6, Code 2017, is amended to read as
follows:
509A.6 Contract with insurance carrier, or health maintenance
organization, or organized delivery system.
The governing body may contract with a nonprofit corporation
operating under the provisions of this chapter or chapter
514 or with any insurance company having a certificate of
authority to transact an insurance business in this state with
respect of a group insurance plan, which may include life,
accident, health, hospitalization and disability insurance
during period of active service of such employees, with the
right of any employee to continue such life insurance in force
after termination of active service at such employee’s sole
expense; may contract with a nonprofit corporation operating
under and governed by the provisions of this chapter or chapter
514 with respect of any hospital or medical service plan; and
may contract with a health maintenance organization or an
organized delivery system authorized to operate in this state
with respect to health maintenance organization or organized
delivery system activities.
Sec. 37. Section 513B.2, subsection 8, paragraph k, Code
2017, is amended by striking the paragraph.
Sec. 38. Section 513B.5, Code 2017, is amended to read as
follows:
513B.5 Provisions on renewability of coverage.
1. Health insurance coverage subject to this chapter is
renewable with respect to all eligible employees or their
dependents, at the option of the small employer, except for one
or more of the following reasons:
a. The health insurance coverage sponsor fails to pay, or to
make timely payment of, premiums or contributions pursuant to
the terms of the health insurance coverage.
-18- b. The health insurance coverage sponsor performs an
act or practice constituting fraud or makes an intentional
misrepresentation of a material fact under the terms of the
coverage.
c. Noncompliance with the carrier’s or organized delivery
system’s minimum participation requirements.
d. Noncompliance with the carrier’s or organized delivery
system’s employer contribution requirements.
e. A decision by the carrier or organized delivery system
to discontinue offering a particular type of health insurance
coverage in the state’s small employer market. Health
insurance coverage may be discontinued by the carrier or
organized delivery system in that market only if the carrier or
organized delivery system does all of the following:
(1) Provides advance notice of its decision to discontinue
such plan to the commissioner or director of public health.
Notice to the commissioner or director, at a minimum, shall be
no less than three days prior to the notice provided for in
subparagraph (2) to affected small employers, participants, and
beneficiaries.
(2) Provides notice of its decision not to renew such
plan to all affected small employers, participants, and
beneficiaries no less than ninety days prior to the nonrenewal
of the plan.
(3) Offers to each plan sponsor of the discontinued
coverage, the option to purchase any other coverage currently
offered by the carrier or organized delivery system to other
employers in this state.
(4) Acts uniformly, in opting to discontinue the coverage
and in offering the option under subparagraph (3), without
regard to the claims experience of the sponsors under the
discontinued coverage or to a health status-related factor
relating to any participants or beneficiaries covered or new
participants or beneficiaries who may become eligible for the
coverage.
-19- f. A decision by the carrier or organized delivery system to
discontinue offering and to cease to renew all of its health
insurance coverage delivered or issued for delivery to small
employers in this state. A carrier or organized delivery
system making such decision shall do all of the following:
(1) Provide advance notice of its decision to discontinue
such coverage to the commissioner or director of public health.
Notice to the commissioner or director, at a minimum, shall be
no less than three days prior to the notice provided for in
subparagraph (2) to affected small employers, participants, and
beneficiaries.
(2) Provide notice of its decision not to renew such
coverage to all affected small employers, participants, and
beneficiaries no less than one hundred eighty days prior to the
nonrenewal of the coverage.
(3) Discontinue all health insurance coverage issued or
delivered for issuance to small employers in this state and
cease renewal of such coverage.
g. The membership of an employer in an association, which
is the basis for the coverage which is provided through such
association, ceases, but only if the termination of coverage
under this paragraph occurs uniformly without regard to
any health status-related factor relating to any covered
individual.
h. The commissioner or director of public health finds that
the continuation of the coverage is not in the best interests
of the policyholders or certificate holders, or would impair
the carrier’s or organized delivery system’s ability to meet
its contractual obligations.
i. At the time of coverage renewal, a carrier or organized
delivery system may modify the health insurance coverage for
a product offered under group health insurance coverage in
the small group market, for coverage that is available in
such market other than only through one or more bona fide
associations, if such modification is consistent with the laws
-20-of this state, and is effective on a uniform basis among group
health insurance coverage with that product.
2. A carrier or organized delivery system that elects not to
renew health insurance coverage under subsection 1, paragraph
“f”, shall not write any new business in the small employer
market in this state for a period of five years after the date
of notice to the commissioner or director of public health.
3. This section, with respect to a carrier or organized
delivery system doing business in one established geographic
service area of the state, applies only to such carrier’s or
organized delivery system’s operations in that service area.
Sec. 39. Section 513B.6, unnumbered paragraph 1, Code 2017,
is amended to read as follows:
A small employer carrier or organized delivery system shall
make reasonable disclosure in solicitation and sales materials
provided to small employers of all of the following:
Sec. 40. Section 513B.6, subsection 2, Code 2017, is amended
to read as follows:
2. The provisions concerning the small employer carrier’s
or organized delivery system’s right to change premium rates
and factors, including case characteristics, which affect
changes in premium rates.
Sec. 41. Section 513B.7, Code 2017, is amended to read as
follows:
513B.7 Maintenance of records.
1. A small employer carrier or organized delivery system
shall maintain at its principal place of business a complete
and detailed description of its rating practices and renewal
underwriting practices, including information and documentation
which demonstrate that its rating methods and practices are
based upon commonly accepted actuarial assumptions and are in
accordance with sound actuarial principles.
2. A small employer carrier or organized delivery system
shall file each March 1 with the commissioner or the director
of public health an actuarial certification that the small
-21-employer carrier or organized delivery system is in compliance
with this section and that the rating methods of the small
employer carrier or organized delivery system are actuarially
sound. A copy of the certification shall be retained by the
small employer carrier or organized delivery system at its
principal place of business.
3. A small employer carrier or organized delivery system
shall make the information and documentation described in
subsection 1 available to the commissioner or the director of
public health upon request. The information is not a public
record or otherwise subject to disclosure under chapter 22,
and is considered proprietary and trade secret information
and is not subject to disclosure by the commissioner or the
director of public health to persons outside of the division or
department except as agreed to by the small employer carrier or
organized delivery system or as ordered by a court of competent
jurisdiction.
Sec. 42. Section 513B.9A, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
A carrier or organized delivery system offering group health
insurance coverage shall not establish rules for eligibility,
including continued eligibility, of an individual to enroll
under the terms of the coverage based on any of the following
health status-related factors in relation to the individual or
a dependent of the individual:
Sec. 43. Section 513B.9A, subsection 4, paragraph a, Code
2017, is amended to read as follows:
a. A carrier or organized delivery system offering health
insurance coverage shall not require an individual, as a
condition of enrollment or continued enrollment under the
coverage, to pay a premium or contribution which is greater
than a premium or contribution for a similarly situated
individual enrolled in the coverage on the basis of a health
status-related factor in relation to the individual or to a
dependent of an individual enrolled under the coverage.
-22- Sec. 44. Section 513B.9A, subsection 4, paragraph b,
subparagraph (2), Code 2017, is amended to read as follows:
(2) Prevent a carrier or organized delivery system
offering group health insurance coverage from establishing
premium discounts or rebates or modifying otherwise applicable
copayments or deductibles in return for adherence to programs
of health promotion and disease prevention.
Sec. 45. Section 513B.10, Code 2017, is amended to read as
follows:
513B.10 Availability of coverage.
1. a. A carrier or an organized delivery system that offers
health insurance coverage in the small group market shall
accept every small employer that applies for health insurance
coverage and shall accept for enrollment under such coverage
every eligible individual who applies for enrollment during the
period in which the individual first becomes eligible to enroll
under the terms of the health insurance coverage and shall not
place any restriction which is inconsistent with eligibility
rules established under this chapter.
b. A carrier or organized delivery system that offers health
insurance coverage in the small group market through a network
plan may do either of the following:
(1) Limit employers that may apply for such coverage to
those with eligible individuals who live, work, or reside in
the service area for such network plan.
(2) Deny such coverage to such employers within the service
area of such plan if the carrier or organized delivery system
has demonstrated to the applicable state authority both of the
following:
(a) The carrier or organized delivery system will not have
the capacity to deliver services adequately to enrollees of any
additional groups because of its obligations to existing group
contract holders and enrollees.
(b) The carrier or organized delivery system is applying
this subparagraph uniformly to all employers without regard to
-23-the claims experience of those employers and their employees
and their dependents, or any health status-related factor
relating to such employees or dependents.
c. A carrier or organized delivery system, upon denying
health insurance coverage in any service area pursuant to
paragraph “b”, subparagraph (2), shall not offer coverage in the
small group market within such service area for a period of one
hundred eighty days after the date such coverage is denied.
d. A carrier or organized delivery system may deny health
insurance coverage in the small group market if the issuer has
demonstrated to the commissioner or director of public health
both of the following:
(1) The carrier or organized delivery system does not have
the financial reserves necessary to underwrite additional
coverage.
(2) The carrier or organized delivery system is applying the
provisions of this paragraph uniformly to all employers in the
small group market in this state consistent with state law and
without regard to the claims experience of those employers and
the employees and dependents of such employers, or any health
status-related factor relating to such employees and their
dependents.
e. A carrier or organized delivery system, upon denying
health insurance coverage pursuant to paragraph “d”, shall not
offer coverage in connection with health insurance coverages
in the small group market in this state for a period of one
hundred eighty days after the date such coverage is denied or
until the carrier or organized delivery system has demonstrated
to the commissioner or director of public health that the
carrier or organized delivery system has sufficient financial
reserves to underwrite additional coverage, whichever is later.
The commissioner or director may provide for the application of
this paragraph on a service area-specific basis.
f. Paragraph “a” shall not be construed to preclude
a carrier or organized delivery system from establishing
-24-employer contribution rules or group participation rules for
the offering of health insurance coverage in the small group
market.
2. A carrier or organized delivery system, subject to
subsection 1, shall issue health insurance coverage to an
eligible small employer that applies for the coverage and
agrees to make the required premium payments and satisfy the
other reasonable provisions of the health insurance coverage
not inconsistent with this chapter. A carrier or organized
delivery system is not required to issue health insurance
coverage to a self-employed individual who is covered by, or is
eligible for coverage under, health insurance coverage offered
by an employer.
3. Health insurance coverage for small employers shall
satisfy all of the following:
a. A carrier or organized delivery system offering group
health insurance coverage, with respect to a participant or
beneficiary, may impose a preexisting condition exclusion only
as follows:
(1) The exclusion relates to a condition, whether physical
or mental, regardless of the cause of the condition, for
which medical advice, diagnosis, care, or treatment was
recommended or received within the six-month period ending on
the enrollment date. However, genetic information shall not be
treated as a condition under this subparagraph in the absence
of a diagnosis of the condition related to such information.
(2) The exclusion extends for a period of not more than
twelve months, or eighteen months in the case of a late
enrollee, after the enrollment date.
(3) The period of any such preexisting condition exclusion
is reduced by the aggregate of the periods of creditable
coverage applicable to the participant or beneficiary as of the
enrollment date.
b. A carrier or organized delivery system offering group
health insurance coverage shall not impose any preexisting
-25-condition exclusion as follows:
(1) In the case of a child who is adopted or placed for
adoption before attaining eighteen years of age and who, as of
the last day of the thirty-day period beginning on the date
of the adoption or placement for adoption, is covered under
creditable coverage. This subparagraph shall not apply to
coverage before the date of such adoption or placement for
adoption.
(2) In the case of an individual who, as of the last day
of the thirty-day period beginning with the date of birth, is
covered under creditable coverage.
(3) Relating to pregnancy as a preexisting condition.
c. A carrier or organized delivery system shall waive
any waiting period applicable to a preexisting condition
exclusion or limitation period with respect to particular
services under health insurance coverage for the period
of time an individual was covered by creditable coverage,
provided that the creditable coverage was continuous to a
date not more than sixty-three days prior to the effective
date of the new coverage. Any period that an individual
is in a waiting period for any coverage under group health
insurance coverage, or is in an affiliation period, shall not
be taken into account in determining the period of continuous
coverage. A health maintenance organization that does not
use preexisting condition limitations in any of its health
insurance coverage may impose an affiliation period. For
purposes of this section, “affiliation period” means a period
of time not to exceed sixty days for new entrants and not to
exceed ninety days for late enrollees during which no premium
shall be collected and coverage issued is not effective, so
long as the affiliation period is applied uniformly, without
regard to any health status-related factors. This paragraph
does not preclude application of a waiting period applicable
to all new enrollees under the health insurance coverage,
provided that any carrier or organized delivery system-imposed
-26- carrier-imposed waiting period is no longer than sixty days and
is used in lieu of a preexisting condition exclusion.
d. Health insurance coverage may exclude coverage for late
enrollees for preexisting conditions for a period not to exceed
eighteen months.
e. (1) Requirements used by a carrier or organized delivery
system in determining whether to provide coverage to a small
employer shall be applied uniformly among all small employers
applying for coverage or receiving coverage from the carrier
or organized delivery system.
(2) In applying minimum participation requirements with
respect to a small employer, a carrier or organized delivery
system shall not consider employees or dependents who have
other creditable coverage in determining whether the applicable
percentage of participation is met.
(3) A carrier or organized delivery system shall not
increase any requirement for minimum employee participation
or modify any requirement for minimum employer contribution
applicable to a small employer at any time after the small
employer has been accepted for coverage.
f. (1) If a carrier or organized delivery system offers
coverage to a small employer, the carrier or organized delivery
system shall offer coverage to all eligible employees of the
small employer and the employees’ dependents. A carrier or
organized delivery system shall not offer coverage to only
certain individuals or dependents in a small employer group or
to only part of the group.
(2) Except as provided under paragraphs “a” and “d”, a
carrier or organized delivery system shall not modify health
insurance coverage with respect to a small employer or any
eligible employee or dependent through riders, endorsements, or
other means, to restrict or exclude coverage or benefits for
certain diseases, medical conditions, or services otherwise
covered by the health insurance coverage.
g. A carrier or organized delivery system offering coverage
-27-through a network plan shall not be required to offer coverage
or accept applications pursuant to subsection 1 with respect to
a small employer where any of the following apply applies:
(1) The small employer does not have eligible individuals
who live, work, or reside in the service area for the network
plan.
(2) The small employer does have eligible individuals who
live, work, or reside in the service area for the network plan,
but the carrier or organized delivery system, if required, has
demonstrated to the commissioner or the director of public
health that it will not have the capacity to deliver services
adequately to enrollees of any additional groups because of its
obligations to existing group contract holders and enrollees
and that it is applying the requirements of this lettered
paragraph uniformly to all employers without regard to the
claims experience of those employers and their employees and
the employees’ dependents, or any health status-related factor
relating to such employees and dependents.
(3) A carrier or organized delivery system, upon denying
health insurance coverage in a service area pursuant to
subparagraph (2), shall not offer coverage in the small
employer market within such service area for a period of one
hundred eighty days after the coverage is denied.
4. A carrier or organized delivery system shall not be
required to offer coverage to small employers pursuant to
subsection 1 for any period of time where the commissioner or
director of public health determines that the acceptance of the
offers by small employers in accordance with subsection 1 would
place the carrier or organized delivery system in a financially
impaired condition.
5. A carrier or organized delivery system shall not be
required to provide coverage to small employers pursuant to
subsection 1 if the carrier or organized delivery system elects
not to offer new coverage to small employers in this state.
However, a carrier or organized delivery system that elects not
-28-to offer new coverage to small employers under this subsection
shall be allowed to maintain its existing policies in the
state, subject to the requirements of section 513B.5.
6. A carrier or organized delivery system that elects not to
offer new coverage to small employers pursuant to subsection 5
shall provide notice to the commissioner or director of public
health and is prohibited from writing new business in the small
employer market in this state for a period of five years from
the date of notice to the commissioner or director.
Sec. 46. Section 513C.3, subsection 5, Code 2017, is amended
to read as follows:
5. “Carrier” means any entity that provides individual
health benefit plans in this state. For purposes of this
chapter, carrier includes an insurance company, a group
hospital or medical service corporation, a fraternal benefit
society, a health maintenance organization, and any other
entity providing an individual plan of health insurance
or health benefits subject to state insurance regulation.
“Carrier” does not include an organized delivery system.
Sec. 47. Section 513C.3, subsection 7, Code 2017, is amended
by striking the subsection.
Sec. 48. Section 513C.3, subsection 9, Code 2017, is amended
to read as follows:
9. “Established service area” means a geographic area,
as approved by the commissioner and based upon the carrier’s
certificate of authority to transact business in this state,
within which the carrier is authorized to provide coverage or
a geographic area, as approved by the director and based upon
the organized delivery system’s license to transact business
in this state, within which the organized delivery system is
authorized to provide coverage.
Sec. 49. Section 513C.3, subsection 12, Code 2017, is
amended by striking the subsection.
Sec. 50. Section 513C.3, subsection 15, paragraph a,
subparagraph (3), Code 2017, is amended by striking the
-29-subparagraph.
Sec. 51. Section 513C.3, subsection 18, Code 2017, is
amended to read as follows:
18. “Restricted network provision” means a provision of an
individual health benefit plan that conditions the payment
of benefits, in whole or in part, on the use of health care
providers that have entered into a contractual arrangement with
the carrier or the organized delivery system to provide health
care services to covered individuals.
Sec. 52. Section 513C.5, subsection 1, unnumbered paragraph
1, Code 2017, is amended to read as follows:
Premium rates for any block of individual health benefit
plan business issued on or after January 1, 1996, or the date
rules are adopted by the commissioner of insurance and the
director of public health and become effective, whichever
date is later, by a carrier subject to this chapter shall be
limited to the composite effect of allocating costs among the
following:
Sec. 53. Section 513C.6, Code 2017, is amended to read as
follows:
513C.6 Provisions on renewability of coverage.
1. An individual health benefit plan subject to this
chapter is renewable with respect to an eligible individual or
dependents, at the option of the individual, except for one or
more of the following reasons:
a. The individual fails to pay, or to make timely payment
of, premiums or contributions pursuant to the terms of the
individual health benefit plan.
b. The individual performs an act or practice constituting
fraud or makes an intentional misrepresentation of a material
fact under the terms of the individual health benefit plan.
c. A decision by the individual carrier or organized
delivery system to discontinue offering a particular type
of individual health benefit plan in the state’s individual
insurance market. An individual health benefit plan may be
-30-discontinued by the carrier or organized delivery system in
that market with the approval of the commissioner or the
director and only if the carrier or organized delivery system
does all of the following:
(1) Provides advance notice of its decision to discontinue
such plan to the commissioner or director. Notice to the
commissioner or director, at a minimum, shall be no less than
three days prior to the notice provided for in subparagraph (2)
to affected individuals.
(2) Provides notice of its decision not to renew such plan
to all affected individuals no less than ninety days prior
to the nonrenewal date of any discontinued individual health
benefit plans.
(3) Offers to each individual of the discontinued plan the
option to purchase any other health plan currently offered by
the carrier or organized delivery system to individuals in this
state.
(4) Acts uniformly in opting to discontinue the plan and
in offering the option under subparagraph (3), without regard
to the claims experience of any affected eligible individual
or beneficiary under the discontinued plan or to a health
status-related factor relating to any covered individuals or
beneficiaries who may become eligible for the coverage.
d. A decision by the carrier or organized delivery system
to discontinue offering and to cease to renew all of its
individual health benefit plans delivered or issued for
delivery to individuals in this state. A carrier or organized
delivery system making such decision shall do all of the
following:
(1) Provide advance notice of its decision to discontinue
such plan to the commissioner or director. Notice to the
commissioner or director, at a minimum, shall be no less than
three days prior to the notice provided for in subparagraph (2)
to affected individuals.
(2) Provide notice of its decision not to renew such plan
-31-to all individuals and to the commissioner or director in each
state in which an individual under the discontinued plan is
known to reside, no less than one hundred eighty days prior to
the nonrenewal of the plan.
e. The commissioner or director finds that the continuation
of the coverage is not in the best interests of the
individuals, or would impair the carrier’s or organized
delivery system’s ability to meet its contractual obligations.
2. At the time of coverage renewal, a carrier or organized
delivery system may modify the health insurance coverage for
a policy form offered to individuals in the individual market
so long as such modification is consistent with state law and
effective on a uniform basis among all individuals with that
policy form.
3. An individual carrier or organized delivery system that
elects not to renew an individual health benefit plan under
subsection 1, paragraph “d”, shall not write any new business in
the individual market in this state for a period of five years
after the date of notice to the commissioner or director.
4. This section, with respect to a carrier or organized
delivery system doing business in one established geographic
service area of the state, applies only to such carrier’s or
organized delivery system’s operations in that service area.
5. A carrier or organized delivery system offering coverage
through a network plan is not required to renew or continue in
force coverage or to accept applications from an individual who
no longer resides or lives in, or is no longer employed in,
the service area of such carrier or organized delivery system,
or no longer resides or lives in, or is no longer employed
in, a service area for which the carrier is authorized to do
business, but only if coverage is not offered or terminated
uniformly without regard to health status-related factors of a
covered individual.
6. A carrier or organized delivery system offering coverage
through a bona fide association is not required to renew or
-32-continue in force coverage or to accept applications from an
individual through an association if the membership of the
individual in the association on which the basis of coverage
is provided ceases, but only if the coverage is not offered or
terminated under this paragraph uniformly without regard to
health status-related factors of a covered individual.
7. An individual who has coverage as a dependent under a
basic or standard health benefit plan may, when that individual
is no longer a dependent under such coverage, elect to continue
coverage under the basic or standard health benefit plan if
the individual so elects immediately upon termination of the
coverage under which the individual was covered as a dependent.
Sec. 54. Section 513C.7, subsection 1, Code 2017, is amended
to read as follows:
1. a. (1) A carrier shall file with the commissioner, in
a form and manner prescribed by the commissioner, the basic
or standard health benefit plan. A basic or standard health
benefit plan filed pursuant to this paragraph may be used by
a carrier beginning thirty days after it is filed unless the
commissioner disapproves of its use.
(2) b. The commissioner may at any time, after providing
notice and an opportunity for a hearing to the carrier,
disapprove the continued use by a carrier of a basic or
standard health benefit plan on the grounds that the plan does
not meet the requirements of this chapter.
b. (1) An organized delivery system shall file with the
director, in a form and manner prescribed by the director,
the basic or standard health benefit plan to be used by the
organized delivery system. A basic or standard health benefit
plan filed pursuant to this paragraph may be used by the
organized delivery system beginning thirty days after it is
filed unless the director disapproves of its use.
(2) The director may at any time, after providing notice and
an opportunity for a hearing to the organized delivery system,
disapprove the continued use by an organized delivery system of
-33-a basic or standard health benefit plan on the grounds that the
plan does not meet the requirements of this chapter.
Sec. 55. Section 513C.7, subsection 3, Code 2017, is amended
to read as follows:
3. A carrier or an organized delivery system shall not
modify a basic or standard health benefit plan with respect
to an individual or dependent through riders, endorsements,
or other means to restrict or exclude coverage for certain
diseases or medical conditions otherwise covered by the health
benefit plan.
Sec. 56. Section 513C.9, subsections 1, 2, 3, 6, and 8, Code
2017, are amended to read as follows:
1. A carrier, an organized delivery system, or an agent
shall not do either of the following:
a. Encourage or direct individuals to refrain from
filing an application for coverage with the carrier or the
organized delivery system because of the health status, claims
experience, industry, occupation, or geographic location of the
individuals.
b. Encourage or direct individuals to seek coverage from
another carrier or another organized delivery system because of
the health status, claims experience, industry, occupation, or
geographic location of the individuals.
2. Subsection 1, paragraph “a”, shall not apply with respect
to information provided by a carrier or an organized delivery
system or an agent to an individual regarding the established
geographic service area of the carrier or the organized
delivery system, or the restricted network provision of the
carrier or the organized delivery system.
3. A carrier or an organized delivery system shall not,
directly or indirectly, enter into any contract, agreement, or
arrangement with an agent that provides for, or results in, the
compensation paid to an agent for a sale of a basic or standard
health benefit plan to vary because of the health status or
permitted rating characteristics of the individual or the
-34-individual’s dependents.
6. Denial by a carrier or an organized delivery system of an
application for coverage from an individual shall be in writing
and shall state the reason or reasons for the denial.
8. If a carrier or an organized delivery system enters into
a contract, agreement, or other arrangement with a third-party
administrator to provide administrative, marketing, or other
services related to the offering of individual health benefit
plans in this state, the third-party administrator is subject
to this section as if it were a carrier or an organized
delivery system.
Sec. 57. Section 513C.10, subsection 1, paragraph a, Code
2017, is amended to read as follows:
a. All persons that provide health benefit plans in this
state including insurers providing accident and sickness
insurance under chapter 509, 514, or 514A, whether on an
individual or group basis; fraternal benefit societies
providing hospital, medical, or nursing benefits under chapter
512B; and health maintenance organizations, organized delivery
systems, other entities providing health insurance or health
benefits subject to state insurance regulation, and all other
insurers as designated by the board of directors of the Iowa
comprehensive health insurance association with the approval of
the commissioner shall be members of the association.
Sec. 58. Section 513C.10, subsection 2, paragraph a, Code
2017, is amended to read as follows:
a. Rates for basic and standard coverages as provided in
this chapter shall be determined by each carrier or organized
delivery system as the product of a basic and standard factor
and the lowest rate available for issuance by that carrier or
organized delivery system adjusted for rating characteristics
and benefits. Basic and standard factors shall be established
annually by the Iowa comprehensive health insurance association
board with the approval of the commissioner. Multiple basic
and standard factors for a distinct grouping of basic and
-35-standard policies may be established. A basic and standard
factor is limited to a minimum value defined as the ratio
of the average of the lowest rate available for issuance and
the maximum rate allowable by law divided by the lowest rate
available for issuance. A basic and standard factor is limited
to a maximum value defined as the ratio of the maximum rate
allowable by law divided by the lowest rate available for
issuance. The maximum rate allowable by law and the lowest
rate available for issuance is determined based on the rate
restrictions under this chapter. For policies written after
January 1, 2002, rates for the basic and standard coverages
as provided in this chapter shall be calculated using the
basic and standard factors and shall be no lower than the
maximum rate allowable by law. However, to maintain assessable
loss assessments at or below one percent of total health
insurance premiums or payments as determined in accordance
with subsection 6, the Iowa comprehensive health insurance
association board with the approval of the commissioner may
increase the value for any basic and standard factor greater
than the maximum value.
Sec. 59. Section 513C.10, subsections 3, 4, 7, 8, 9, and 10,
Code 2017, are amended to read as follows:
3. Following the close of each calendar year, the
association, in conjunction with the commissioner, shall
require each carrier or organized delivery system to report
the amount of earned premiums and the associated paid losses
for all basic and standard plans issued by the carrier or
organized delivery system. The reporting of these amounts must
be certified by an officer of the carrier or organized delivery
system.
4. The board shall develop procedures and assessment
mechanisms and make assessments and distributions as required
to equalize the individual carrier and organized delivery
system gains or losses so that each carrier or organized
delivery system receives the same ratio of paid claims to
-36-ninety percent of earned premiums as the aggregate of all
basic and standard plans insured by all carriers and organized
delivery systems in the state.
7. The board shall develop procedures for distributing
the assessable loss assessments to each carrier and organized
delivery system in proportion to the carrier’s and organized
delivery system’s respective share of premium for basic and
standard plans to the statewide total premium for all basic and
standard plans.
8. The board shall ensure that procedures for collecting
and distributing assessments are as efficient as possible
for carriers and organized delivery systems. The board may
establish procedures which combine, or offset, the assessment
from, and the distribution due to, a carrier or organized
delivery system.
9. A carrier or an organized delivery system may
petition the association board to seek remedy from writing a
significantly disproportionate share of basic and standard
policies in relation to total premiums written in this state
for health benefit plans. Upon a finding that a carrier or
organized delivery system has written a disproportionate share,
the board may agree to compensate the carrier or organized
delivery system either by paying to the carrier or organized
delivery system an additional fee not to exceed two percent
of earned premiums from basic and standard policies for that
carrier or organized delivery system or by petitioning the
commissioner or director, as appropriate, for remedy.
10. a. The commissioner, upon a finding that the acceptance
of the offer of basic and standard coverage by individuals
pursuant to this chapter would place the carrier in a
financially impaired condition, shall not require the carrier
to offer coverage or accept applications for any period of time
the financial impairment is deemed to exist.
b. The director, upon a finding that the acceptance of the
offer of basic and standard coverage by individuals pursuant
-37-to this chapter would place the organized delivery system in a
financially impaired condition, shall not require the organized
delivery system to offer coverage or accept applications for
any period of time the financial impairment is deemed to exist.
Sec. 60. Section 514A.3B, subsection 3, paragraph k, Code
2017, is amended by striking the paragraph.
Sec. 61. Section 514B.25A, Code 2017, is amended to read as
follows:
514B.25A Insolvency protection — assessment.
1. Upon a health maintenance organization or organized
delivery system authorized to do business in this state and
licensed by the director of public health being declared
insolvent by the district court, the commissioner may levy an
assessment on each health maintenance organization or organized
delivery system doing business in this state and licensed by
the director of public health, as applicable, to pay claims
for uncovered expenditures for enrollees. The commissioner
shall not assess an amount in any one calendar year which is
more than two percent of the aggregate premium written by each
health maintenance organization or organized delivery system.
2. The commissioner may use funds obtained through an
assessment under subsection 1 to pay claims for uncovered
expenditures for enrollees of an insolvent health maintenance
organization or organized delivery system and administrative
costs. The commissioner, by rule, may prescribe the time,
manner, and form for filing claims under this section. The
commissioner may require claims to be allowed by an ancillary
receiver or the domestic receiver or liquidator.
3. a. A receiver or liquidator of an insolvent health
maintenance organization or organized delivery system shall
allow a claim in the proceeding in an amount equal to uncovered
expenditures and administrative costs paid under this section.
b. A person receiving benefits under this section for
uncovered expenditures is deemed to have assigned the rights
under the covered health care plan certificates to the
-38-commissioner to the extent of the benefits received. The
commissioner may require an assignment of such rights by a
payee, enrollee, or beneficiary, to the commissioner as a
condition precedent to the receipt of such benefits. The
commissioner is subrogated to these rights against the assets
of the insolvent health maintenance organization or organized
delivery system that are held by a receiver or liquidator of
a foreign jurisdiction.
c. The assigned subrogation rights of the commissioner and
allowed claims under this subsection have the same priority
against the assets of the insolvent health maintenance
organization or organized delivery system as those claims of
persons entitled to receive benefits under this section or for
similar expenses in the receivership or liquidation.
4. If funds assessed under subsection 1 are unused
following the completion of the liquidation of an insolvent
health maintenance organization or organized delivery system,
the commissioner shall distribute the remaining amounts, if
such amounts are not de minimis, to the health maintenance
organizations or organized delivery systems that were assessed.
5. The aggregate coverage of uncovered expenditures under
this section shall not exceed three hundred thousand dollars
with respect to one individual. Continuation of coverage
shall cease after the lesser of one year after the health
maintenance organization or organized delivery system is
terminated by insolvency or the remaining term of the contract.
The commissioner may provide continuation of coverage on a
reasonable basis, including, but not limited to, continuation
of the health maintenance organization or organized delivery
system contract or substitution of indemnity coverage in a form
as determined by the commissioner.
6. The commissioner may waive an assessment of a health
maintenance organization or organized delivery system if such
organization or system is impaired financially or would be
impaired financially as a result of such assessment. A health
-39-maintenance organization or organized delivery system that
fails to pay an assessment within thirty days after notice of
the assessment is subject to a civil forfeiture of not more
than one thousand dollars for each day the failure continues,
and suspension or revocation of its certificate of authority.
An action taken by the commissioner to enforce an assessment
under this section may be appealed by the health maintenance
organization or organized delivery system pursuant to chapter
17A.
Sec. 62. Section 514C.10, subsection 2, paragraph e, Code
2017, is amended by striking the paragraph.
Sec. 63. Section 514C.11, Code 2017, is amended to read as
follows:
514C.11 Services provided by licensed physician assistants
and licensed advanced registered nurse practitioners.
1. Notwithstanding section 514C.6, a policy or contract
providing for third-party payment or prepayment of health or
medical expenses shall include a provision for the payment of
necessary medical or surgical care and treatment provided by
a physician assistant licensed pursuant to chapter 148C, or
provided by an advanced registered nurse practitioner licensed
pursuant to chapter 152 and performed within the scope of the
license of the licensed physician assistant or the licensed
advanced registered nurse practitioner if the policy or
contract would pay for the care and treatment if the care and
treatment were provided by a person engaged in the practice
of medicine and surgery or osteopathic medicine and surgery
under chapter 148. The policy or contract shall provide that
policyholders and subscribers under the policy or contract may
reject the coverage for services which may be provided by a
licensed physician assistant or licensed advanced registered
nurse practitioner if the coverage is rejected for all
providers of similar services. A policy or contract subject
to this section shall not impose a practice or supervision
restriction which is inconsistent with or more restrictive than
-40-the restriction already imposed by law.
2. This section applies to services provided under a policy
or contract delivered, issued for delivery, continued, or
renewed in this state on or after July 1, 1996, and to an
existing policy or contract, on the policy’s or contract’s
anniversary or renewal date, or upon the expiration of the
applicable collective bargaining contract, if any, whichever
is later. This section does not apply to policyholders or
subscribers eligible for coverage under Tit.XVIII of the
federal Social Security Act or any similar coverage under a
state or federal government plan.
3. For the purposes of this section, third-party payment or
prepayment includes an individual or group policy of accident
or health insurance or individual or group hospital or health
care service contract issued pursuant to chapter 509, 514, or
514A, an individual or group health maintenance organization
contract issued and regulated under chapter 514B, an organized
delivery system contract regulated under rules adopted by the
director of public health, or a preferred provider organization
contract regulated pursuant to chapter 514F.
4. Nothing in this section shall be interpreted to require
an individual or group health maintenance organization, an
organized delivery system, or a preferred provider organization
or arrangement to provide payment or prepayment for services
provided by a licensed physician assistant or licensed advanced
registered nurse practitioner unless the physician assistant’s
supervising physician, the physician-physician assistant team,
the advanced registered nurse practitioner, or the advanced
registered nurse practitioner’s collaborating physician has
entered into a contract or other agreement to provide services
with the individual or group health maintenance organization,
the organized delivery system, or the preferred provider
organization or arrangement.
Sec. 64. Section 514C.13, subsection 1, paragraph h, Code
2017, is amended by striking the paragraph.
-41- Sec. 65. Section 514C.13, subsection 2, Code 2017, is
amended to read as follows:
2. A carrier or organized delivery system which offers to
a small employer a limited provider network plan to provide
health care services or benefits to the small employer’s
employees shall also offer to the small employer a point of
service option to the limited provider network plan.
Sec. 66. Section 514C.13, subsection 3, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
A carrier or organized delivery system which offers to a
large employer a limited provider network plan to provide
health care services or benefits to the large employer’s
employees shall also offer to the large employer one or more
of the following:
Sec. 67. Section 514C.14, subsections 1 and 3, Code 2017,
are amended to read as follows:
1. Except as provided under subsection 2 or 3, a carrier,
as defined in section 513B.2, an organized delivery system
authorized under 1993 Iowa Acts, ch.158, or a plan established
pursuant to chapter 509A for public employees, which terminates
its contract with a participating health care provider,
shall continue to provide coverage under the contract to a
covered person in the second or third trimester of pregnancy
for continued care from such health care provider. Such
persons may continue to receive such treatment or care through
postpartum care related to the child birth and delivery.
Payment for covered benefits and benefit levels shall be
according to the terms and conditions of the contract.
3. A carrier, organized delivery system, or a plan
established under chapter 509A, which terminates the contract
of a participating health care provider for cause shall not
be liable to pay for health care services provided by the
health care provider to a covered person following the date of
termination.
Sec. 68. Section 514C.15, Code 2017, is amended to read as
-42-follows:
514C.15 Treatment options.
A carrier, as defined in section 513B.2,; an organized
delivery system authorized under 1993 Iowa Acts, ch.158,
and licensed by the director of public health; or a plan
established pursuant to chapter 509A for public employees,
shall not prohibit a participating provider from, or penalize a
participating provider for, doing either of the following:
1. Discussing treatment options with a covered individual,
notwithstanding the carrier’s, organized delivery system’s, or
plan’s position on such treatment option.
2. Advocating on behalf of a covered individual within
a review or grievance process established by the carrier,
organized delivery system, or chapter 509A plan, or established
by a person contracting with the carrier, organized delivery
system, or chapter 509A plan.
Sec. 69. Section 514C.16, subsection 1, Code 2017, is
amended to read as follows:
1. A carrier, as defined in section 513B.2,; an organized
delivery system authorized under 1993 Iowa Acts, ch.158,
and licensed by the director of public health; or a plan
established pursuant to chapter 509A for public employees,
which provides coverage for emergency services, is responsible
for charges for emergency services provided to a covered
individual, including services furnished outside any
contractual provider network or preferred provider network.
Coverage for emergency services is subject to the terms and
conditions of the health benefit plan or contract.
Sec. 70. Section 514C.17, subsections 1 and 3, Code 2017,
are amended to read as follows:
1. Except as provided under subsection 2 or 3, if a carrier,
as defined in section 513B.2, an organized delivery system
authorized under 1993 Iowa Acts, ch.158, or a plan established
pursuant to chapter 509A for public employees, terminates its
contract with a participating health care provider, a covered
-43-individual who is undergoing a specified course of treatment
for a terminal illness or a related condition, with the
recommendation of the covered individual’s treating physician
licensed under chapter 148 may continue to receive coverage for
treatment received from the covered individual’s physician for
the terminal illness or a related condition, for a period of
up to ninety days. Payment for covered benefits and benefit
levels shall be according to the terms and conditions of the
contract.
3. Notwithstanding subsections 1 and 2, a carrier,
organized delivery system, or a plan established under chapter
509A which terminates the contract of a participating health
care provider for cause shall not be required to cover health
care services provided by the health care provider to a covered
person following the date of termination.
Sec. 71. Section 514C.18, subsection 2, paragraph a,
subparagraph (6), Code 2017, is amended by striking the
subparagraph.
Sec. 72. Section 514C.19, subsection 7, paragraph a,
subparagraph (6), Code 2017, is amended by striking the
subparagraph.
Sec. 73. Section 514C.20, subsection 3, paragraph f, Code
2017, is amended by striking the paragraph.
Sec. 74. Section 514C.21, subsection 2, paragraph d, Code
2017, is amended by striking the paragraph.
Sec. 75. Section 514C.22, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
Notwithstanding the uniformity of treatment requirements of
section 514C.6, a group policy, contract, or plan providing
for third-party payment or prepayment of health, medical, and
surgical coverage benefits issued by a carrier, as defined in
section 513B.2, or by an organized delivery system authorized
under 1993 Iowa Acts, ch.158, shall provide coverage benefits
for treatment of a biologically based mental illness if either
of the following is satisfied:
-44- Sec. 76. Section 514C.22, subsection 6, Code 2017, is
amended to read as follows:
6. A carrier, organized delivery system, or plan
established pursuant to chapter 509A may manage the benefits
provided through common methods including, but not limited to,
providing payment of benefits or providing care and treatment
under a capitated payment system, prospective reimbursement
rate system, utilization control system, incentive system for
the use of least restrictive and least costly levels of care,
a preferred provider contract limiting choice of specific
providers, or any other system, method, or organization
designed to assure services are medically necessary and
clinically appropriate.
Sec. 77. Section 514C.25, subsection 2, paragraph a,
subparagraph (5), Code 2017, is amended by striking the
subparagraph.
Sec. 78. Section 514C.26, subsection 5, paragraph a,
subparagraph (6), Code 2017, is amended by striking the
subparagraph.
Sec. 79. Section 514C.27, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
Notwithstanding the uniformity of treatment requirements
of section 514C.6, a group policy or contract providing for
third-party payment or prepayment of health or medical expenses
issued by a carrier, as defined in section 513B.2, or by an
organized delivery system authorized under 1993 Iowa Acts, ch.
158, shall provide coverage benefits to an insured who is a
veteran for treatment of mental illness and substance abuse if
either of the following is satisfied:
Sec. 80. Section 514C.27, subsection 6, Code 2017, is
amended to read as follows:
6. A carrier, organized delivery system, or plan
established pursuant to chapter 509A may manage the benefits
provided through common methods including but not limited to
providing payment of benefits or providing care and treatment
-45-under a capitated payment system, prospective reimbursement
rate system, utilization control system, incentive system for
the use of least restrictive and least costly levels of care,
a preferred provider contract limiting choice of specific
providers, or any other system, method, or organization
designed to assure services are medically necessary and
clinically appropriate.
Sec. 81. Section 514C.29, subsection 2, paragraph e, Code
2017, is amended by striking the paragraph.
Sec. 82. Section 514C.30, subsection 2, paragraph e, Code
2017, is amended by striking the paragraph.
Sec. 83. Section 514E.1, subsection 6, paragraph k, Code
2017, is amended by striking the paragraph.
Sec. 84. Section 514E.1, subsection 17, Code 2017, is
amended by striking the subsection.
Sec. 85. Section 514E.2, subsection 1, paragraph a, Code
2017, is amended to read as follows:
a. All carriers and all organized delivery systems licensed
by the director of public health providing health insurance or
health care services in Iowa, whether on an individual or group
basis, and all other insurers designated by the association’s
board of directors and approved by the commissioner shall be
members of the association.
Sec. 86. Section 514E.2, subsection 2, paragraph a,
subparagraph (3), Code 2017, is amended to read as follows:
(3) Two members selected by the members of the association,
one of whom shall be a representative from a corporation
operating pursuant to chapter 514 on July 1, 1989, or
any successor in interest, and one of whom shall be a
representative of an organized delivery system or an insurer
providing coverage pursuant to chapter 509 or 514A.
Sec. 87. Section 514E.7, subsection 1, paragraph a,
subparagraphs (1) and (2), Code 2017, are amended to read as
follows:
(1) A notice of rejection or refusal to issue substantially
-46-similar insurance for health reasons by one carrier or
organized delivery system.
(2) A refusal by a carrier or organized delivery system to
issue insurance except at a rate exceeding the plan rate.
Sec. 88. Section 514E.7, subsection 1, paragraph b, Code
2017, is amended to read as follows:
b. A rejection or refusal by a carrier or organized delivery
system offering only stoploss, excess of loss, or reinsurance
coverage with respect to an applicant under paragraph “a”,
subparagraphs (1) and (2), is not sufficient evidence for
purposes of this subsection.
Sec. 89. Section 514E.9, Code 2017, is amended to read as
follows:
514E.9 Rules.
Pursuant to chapter 17A, the commissioner and the director
of public health shall adopt rules to provide for disclosure
by carriers and organized delivery systems of the availability
of insurance coverage from the association, and to otherwise
implement this chapter.
Sec. 90. Section 514E.11, Code 2017, is amended to read as
follows:
514E.11 Notice of association policy.
Every carrier, including a health maintenance organization
subject to chapter 514B and an organized delivery system,
authorized to provide health care insurance or coverage for
health care services in Iowa, shall provide a notice of the
availability of coverage by the association to any person
who receives a rejection of coverage for health insurance
or health care services, or a rate for health insurance or
coverage for health care services that will exceed the rate of
an association policy, and that person is eligible to apply
for health insurance provided by the association. Application
for the health insurance shall be on forms prescribed by the
association’s board of directors and made available to the
carriers and organized delivery systems and other entities
-47-providing health care insurance or coverage for health care
services regulated by the commissioner.
Sec. 91. Section 514F.5, Code 2017, is amended to read as
follows:
514F.5 Experimental treatment review.
1. A carrier, as defined in section 513B.2, an organized
delivery system authorized under 1993 Iowa Acts, ch.158, or a
plan established pursuant to chapter 509A for public employees,
that limits coverage for experimental medical treatment, drugs,
or devices, shall develop and implement a procedure to evaluate
experimental medical treatments and shall submit a description
of the procedure to the division of insurance. The procedure
shall be in writing and must describe the process used to
determine whether the carrier, organized delivery system,
or chapter 509A plan will provide coverage for new medical
technologies and new uses of existing technologies. The
procedure, at a minimum, shall require a review of information
from appropriate government regulatory agencies and published
scientific literature concerning new medical technologies, new
uses of existing technologies, and the use of external experts
in making decisions. A carrier, organized delivery system,
or chapter 509A plan shall include appropriately licensed
or qualified professionals in the evaluation process. The
procedure shall provide a process for a person covered under
a plan or contract to request a review of a denial of coverage
because the proposed treatment is experimental. A review of
a particular treatment need not be reviewed more than once a
year.
2. A carrier, organized delivery system, or chapter 509A
plan that limits coverage for experimental treatment, drugs, or
devices shall clearly disclose such limitations in a contract,
policy, or certificate of coverage.
Sec. 92. Section 514I.2, subsection 10, Code 2017, is
amended to read as follows:
10. “Participating insurer” means any entity licensed by the
-48-division of insurance of the department of commerce to provide
health insurance in Iowa or an organized delivery system
licensed by the director of public health that has contracted
with the department to provide health insurance coverage to
eligible children under this chapter.
Sec. 93. Section 514J.102, subsection 24, Code 2017, is
amended to read as follows:
24. “Health carrier” means an entity subject to the
insurance laws and regulations of this state, or subject
to the jurisdiction of the commissioner, including an
insurance company offering sickness and accident plans, a
health maintenance organization, a nonprofit health service
corporation, a plan established pursuant to chapter 509A
for public employees, or any other entity providing a plan
of health insurance, health care benefits, or health care
services. “Health carrier” includes, for purposes of this
chapter, an organized delivery system.
Sec. 94. Section 514J.102, subsection 29, Code 2017, is
amended by striking the subsection.
Sec. 95. Section 514K.1, subsection 1, unnumbered paragraph
1, Code 2017, is amended to read as follows:
A health maintenance organization, an organized delivery
system, or an insurer using a preferred provider arrangement
shall provide to each of its enrollees at the time of
enrollment, and shall make available to each prospective
enrollee upon request, written information as required by rules
adopted by the commissioner and the director of public health.
The information required by rule shall include, but not be
limited to, all of the following:
Sec. 96. Section 514K.1, subsection 2, Code 2017, is amended
to read as follows:
2. The commissioner and the director shall annually publish
a consumer guide providing a comparison by plan on performance
measures, network composition, and other key information to
enable consumers to better understand plan differences.
-49- Sec. 97. Section 514L.1, subsection 3, Code 2017, is amended
to read as follows:
3. “Provider of third-party payment or prepayment of
prescription drug expenses” or “provider” means a provider of an
individual or group policy of accident or health insurance or
an individual or group hospital or health care service contract
issued pursuant to chapter 509, 514, or 514A, a provider of a
plan established pursuant to chapter 509A for public employees,
a provider of an individual or group health maintenance
organization contract issued and regulated under chapter 514B,
a provider of an organized delivery system contract regulated
under rules adopted by the director of public health, a
provider of a preferred provider contract issued pursuant to
chapter 514F, a provider of a self-insured multiple employer
welfare arrangement, and any other entity providing health
insurance or health benefits which provide for payment or
prepayment of prescription drug expenses coverage subject to
state insurance regulation.
Sec. 98. Section 514L.2, subsection 1, paragraph a,
unnumbered paragraph 1, Code 2017, is amended to read as
follows:
A provider of third-party payment or prepayment of
prescription drug expenses, including the provider’s agents or
contractors and pharmacy benefits managers, that issues a card
or other technology for claims processing and an administrator
of the payor, excluding administrators of self-funded employer
sponsored health benefit plans qualified under the federal
Employee Retirement Income Security Act of 1974, shall issue
to its insureds a card or other technology containing uniform
prescription drug information. The commissioner of insurance
shall adopt rules for the uniform prescription drug information
card or technology applicable to those entities subject to
regulation by the commissioner of insurance. The director of
public health shall adopt rules for the uniform prescription
drug information card or technology applicable to organized
-50-delivery systems. The rules shall require at least both of the
following regarding the card or technology:
Sec. 99. Section 521F.2, subsection 7, Code 2017, is amended
to read as follows:
7. “Health organization” means a health maintenance
organization, limited service organization, dental or vision
plan, hospital, medical and dental indemnity or service
corporation or other managed care organization licensed under
chapter 514, or 514B, or 1993 Iowa Acts, ch.158, or any other
entity engaged in the business of insurance, risk transfer,
or risk retention, that is subject to the jurisdiction of the
commissioner of insurance or the director of public health.
“Health organization” does not include an insurance company
licensed to transact the business of insurance under chapter
508, 515, or 520, and which is otherwise subject to chapter
521E.
Sec. 100. 1993 Iowa Acts, chapter 158, section 4, is amended
to read as follows:
SEC. 4. EMERGENCY RULES. Pursuant to sections 1, and 2, and
3 of this Act, the commissioner of insurance or the director of
public health shall adopt administrative rules under section
17A.4, subsection 2, and section 17A.5, subsection 2, paragraph
“b”, to implement the provisions of this Act and the rules
shall become effective immediately upon filing, unless a later
effective date is specified in the rules. Any rules adopted in
accordance with the provisions of this section shall also be
published as notice of intended action as provided in section
17A.4.
Sec. 101. REPEAL. Section 135.120, Code 2017, is repealed.
Sec. 102. REPEAL. 1993 Iowa Acts, chapter 158, section 3,
is repealed.
Sec. 103. CODE EDITOR’S DIRECTIVE. The Code editor shall
correct and eliminate any references to the term “organized
delivery system” or other forms of the term anywhere else in
the Iowa Code or Iowa Code Supplement, in any bills awaiting
-51-codification, in this Act, and in any bills enacted by the
Eighty-seventh General Assembly, 2017 Regular Session, or any
extraordinary session.
DIVISION VIII
HEALTH DATA
Sec. 104. Section 135.166, Code 2017, is amended to read as
follows:
135.166 Health care data — collection and use — collection
from hospitals.
1. a. The department of public health shall enter into
a memorandum of understanding to utilize the Iowa hospital
association to act as the department’s intermediary in
collecting, maintaining, and disseminating hospital inpatient,
outpatient, and ambulatory information data, as initially
authorized in 1996 Iowa Acts, ch.1212, §5, subsection 1,
paragraph “a”, subparagraph (4), and 641 IAC 177.3.
2. b. The memorandum of understanding shall include but
is not limited to provisions that address the duties of the
department and the Iowa hospital association regarding the
collection, reporting, disclosure, storage, and confidentiality
of the data.
2. Unless otherwise authorized or required by state or
federal law, data collected under this section shall not
include the social security number of the individual subject
of the data.
DIVISION IX
BIRTH CERTIFICATES
Sec. 105. Section 144.13A, subsections 1 and 2, Code 2017,
are amended to read as follows:
1. The state registrar shall charge the parent a fee of
twenty dollars for the registration of a certificate of birth
as follows:.
a. Beginning July 1, 2003, and ending June 30, 2005, a fee
of fifteen dollars.
b. Beginning July 1, 2005, a fee of twenty dollars.
-52- 2. The state registrar shall charge the parent a separate
fee established under section 144.46 for a certified copy of
the certificate. The certified copy shall include all of the
information included in the original certificate of birth and
shall be letter-sized. The certified copy shall be mailed to
the parent by the state registrar. The mailing of a certified
copy of the certificate to a biological parent shall not be
precluded by the execution of a release of custody under
chapter 600A, and, upon request, a biological parent shall be
provided with a certified copy of the certificate unless the
parental rights of the biological parent are terminated.
Sec. 106. Section 144.13A, Code 2017, is amended by adding
the following new subsection:
NEW SUBSECTION. 2A. a. If, during the period between
May 1993 and October 2009, a parent was issued a smaller than
letter-sized certified copy of the certificate of birth under
this section, which did not include all of the information
included in the original certificate of birth, upon request
of a parent, the state registrar shall issue to the parent a
single letter-sized certified copy replacement that includes
all of the information provided in the original certificate of
birth. A parent shall not be required to exchange the smaller
certified copy for the larger certified copy replacement, but
may retain the smaller certified copy.
b. Notwithstanding the amount of the fee charged under
subsection 2, the state registrar shall not charge a fee
for the issuance of a single letter-sized certified copy of
the certificate of birth requested by a parent under this
subsection.
c. This subsection shall not apply if a new certificate of
birth was substituted for the original certificate of birth
pursuant to section 144.24.
d. The department shall post the application form and
instructions for requesting a letter-sized certified copy
replacement as specified in this subsection on the department’s
-53-internet site. This paragraph is repealed June 30, 2022.
-54-______________________________
LINDA UPMEYERSpeaker of the House______________________________
JACK WHITVERPresident of the Senate I hereby certify that this bill originated in the House and is known as House File 393, Eighty-seventh General Assembly.______________________________
CARMINE BOALChief Clerk of the HouseApproved _______________, 2017______________________________
TERRY E. BRANSTADGovernorpf/nh/md
the department of public health, including effective date
provisions and providing for a repeal.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
Program Flexibility and Efficiencies
Section 1. Section 125.59, subsection 1, paragraph b, Code
2017, is amended to read as follows:
b. If the transferred amount for this subsection exceeds
grant requests funded to the ten thousand dollar maximum, the
Iowa department of public health may use the remainder for
activities and public information resources that align with
best practices for substance-related disorder prevention or to
increase grants pursuant to subsection 2.
Sec. 2. Section 135.11, subsection 31, Code 2017, is amended
by striking the subsection.
Sec. 3. Section 135.150, subsection 2, Code 2017, is amended
to read as follows:
2. The department shall report semiannually annually to the
general assembly’s standing committees on government oversight
regarding the operation of the gambling treatment program.
The report shall include but is not limited to information on
the moneys expended and grants awarded for operation of the
gambling treatment program.
DIVISION II
Medical home and Patient-centered health advisory council
Sec. 4. Section 135.15, Code 2017, is amended by adding the
following new subsection:
NEW SUBSECTION. 6. For the purposes of this section,
“dental home” means a network of individualized care based on
risk assessment, which includes oral health education, dental
screenings, preventive services, diagnostic services, treatment
services, and emergency services.
Sec. 5. Section 135.159, Code 2017, is amended by striking
the section and inserting in lieu thereof the following:
135.159 Patient-centered health advisory council.
1. The department shall establish a patient-centered health
advisory council which shall include but is not limited to
all of the following members, selected by their respective
-1-organizations, and any other members the department determines
necessary:
a. The director of human services, or the director’s
designee.
b. The commissioner of insurance, or the commissioner’s
designee.
c. A representative of the federation of Iowa insurers.
d. A representative of the Iowa dental association.
e. A representative of the Iowa nurses association.
f. A physician and an osteopathic physician licensed
pursuant to chapter 148 who are family physicians and members
of the Iowa academy of family physicians.
g. A health care consumer.
h. A representative of the Iowa collaborative safety net
provider network established pursuant to section 135.153.
i. A representative of the Iowa developmental disabilities
council.
j. A representative of the Iowa chapter of the American
academy of pediatrics.
k. A representative of the child and family policy center.
l. A representative of the Iowa pharmacy association.
m. A representative of the Iowa chiropractic society.
n. A representative of the university of Iowa college of
public health.
o. A certified palliative care physician.
2. The patient-centered health advisory council may utilize
the assistance of other relevant public health and health care
expertise when necessary to carry out the council’s purposes
and responsibilities.
3. A public member of the patient-centered health advisory
council shall receive reimbursement for actual expenses
incurred while serving in the member’s official capacity
only if the member is not eligible for reimbursement by the
organization the member represents.
4. The purposes of the patient-centered health advisory
-2-council shall include all of the following:
a. To serve as a resource on emerging health care
transformation initiatives in Iowa.
b. To convene stakeholders in Iowa to streamline efforts
that support state-level and community-level integration and
focus on reducing fragmentation of the health care system.
c. To encourage partnerships and synergy between community
health care partners in the state who are working on new
system-level models to provide better health care at lower
costs by focusing on shifting from volume-based to value-based
health care.
d. To lead discussions on the transformation of the
health care system to a patient-centered infrastructure that
integrates and coordinates services and supports to address
social determinants of health and to meet population health
goals.
e. To provide a venue for education and information
gathering for stakeholders and interested parties to learn
about emerging health care initiatives across the state.
f. To develop recommendations for submission to the
department related to health care transformation issues.
Sec. 6. Section 249N.2, subsections 15 and 19, Code 2017,
are amended to read as follows:
15. “Medical home” means medical home as defined in
section 135.157. a team approach to providing health care that
originates in a primary care setting; fosters a partnership
among the patient, the personal provider, and other health care
professionals, and where appropriate, the patient’s family;
utilizes the partnership to access and integrate all medical
and nonmedical health-related services across all elements of
the health care system and the patient’s community as needed by
the patient and the patient’s family to achieve maximum health
potential; maintains a centralized, comprehensive record of all
health-related services to promote continuity of care; and has
all of the following characteristics:
-3- a. A personal provider.
b. A provider-directed team-based medical practice.
c. Whole person orientation.
d. Coordination and integration of care.
e. Quality and safety.
f. Enhanced access to health care.
g. A payment system that appropriately recognizes the added
value provided to patients who have a patient-centered medical
home.
19. “Primary medical provider” means the personal provider
as defined in section 135.157 trained to provide first contact
and continuous and comprehensive care to a member, chosen by
a member or to whom a member is assigned under the Iowa health
and wellness plan.
Sec. 7. Section 249N.2, Code 2017, is amended by adding the
following new subsections:
NEW SUBSECTION. 17A. “Personal provider” means the
patient’s first point of contact in the health care system
with a primary care provider who identifies the patient’s
health-related needs and, working with a team of health
care professionals and providers of medical and nonmedical
health-related services, provides for and coordinates
appropriate care to address the health-related needs
identified.
NEW SUBSECTION. 18A. “Primary care provider” includes but
is not limited to any of the following licensed or certified
health care professionals who provide primary care:
a. A physician who is a family or general practitioner, a
pediatrician, an internist, an obstetrician, or a gynecologist.
b. An advanced registered nurse practitioner.
c. A physician assistant.
d. A chiropractor.
Sec. 8. Section 249N.6, subsection 2, paragraph c, Code
2017, is amended to read as follows:
c. The department shall develop a mechanism for primary
-4-medical providers, medical homes, and participating accountable
care organizations to jointly facilitate member care
coordination. The Iowa health and wellness plan shall provide
for reimbursement of care coordination services provided
under the plan consistent with the reimbursement methodology
developed pursuant to section 135.159.
Sec. 9. Section 249N.6, subsection 3, paragraph a, Code
2017, is amended to read as follows:
a. The department shall provide procedures for accountable
care organizations that emerge through local markets to
participate in the Iowa health and wellness plan provider
network. Such accountable care organizations shall incorporate
the medical home as defined and specified in chapter 135,
division XXII, as a foundation and shall emphasize whole-person
orientation and coordination and integration of both clinical
services and nonclinical community and social supports that
address social determinants of health. A participating
accountable care organization shall enter into a contract with
the department to ensure the coordination and management of the
health of attributed members, to produce quality health care
outcomes, and to control overall cost.
Sec. 10. PALLIATIVE CARE REVIEW — PATIENT-CENTERED HEALTH
ADVISORY COUNCIL. The patient-centered health advisory council
shall review the current level of public awareness regarding
and the availability of palliative care services in the state
and shall submit a report to the governor and the general
assembly by December 31, 2017, including the council’s findings
and providing recommendations to increase public awareness
and reduce barriers to access to palliative care services
throughout the state.
Sec. 11. REPEAL. Sections 135.157 and 135.158, Code 2017,
are repealed.
DIVISION III
workforce programming
Sec. 12. Section 84A.11, subsection 4, Code 2017, is amended
-5-to read as follows:
4. The nursing workforce data clearinghouse shall be
established and maintained in a manner consistent with the
health care delivery infrastructure and health care workforce
resources strategic plan developed pursuant to section 135.164
135.163.
Sec. 13. Section 135.107, subsection 3, Code 2017, is
amended to read as follows:
3. The center for rural health and primary care shall
establish a primary care provider recruitment and retention
endeavor, to be known as PRIMECARRE. The endeavor shall
include a health care workforce and community support grant
program, and a primary care provider loan repayment program,
and a primary care provider community scholarship program. The
endeavor shall be developed and implemented in a manner to
promote and accommodate local creativity in efforts to recruit
and retain health care professionals to provide services in
the locality. The focus of the endeavor shall be to promote
and assist local efforts in developing health care provider
recruitment and retention programs. The center for rural
health and primary care may enter into an agreement with the
college student aid commission for the administration of the
center’s grant and loan repayment programs.
a. Community Health care workforce and community support
grant program.
(1) The center for rural health and primary care shall adopt
rules establishing an flexible application process processes
based upon the department’s strategic plan to be used by the
center to establish a grant assistance program as provided
in this paragraph “a”, and establishing the criteria to be
used in evaluating the applications. Selection criteria
shall include a method for prioritizing grant applications
based on illustrated efforts to meet the health care provider
needs of the locality and surrounding area. Such assistance
may be in the form of a forgivable loan, grant, or other
-6-nonfinancial assistance as deemed appropriate by the center.
An application submitted shall may contain a commitment of at
least a dollar-for-dollar match of matching funds for the grant
assistance. Application may be made for assistance by a single
community or group of communities or in response to programs
recommended in the strategic plan to address health workforce
shortages.
(2) Grants awarded under the program shall be subject to the
following limitations:
(a) Ten thousand dollars for a single community or region
with a population of ten thousand or less. An award shall not
be made under this program to a community with a population of
more than ten thousand.
(b) An amount not to exceed one dollar per capita for a
region in which the population exceeds ten thousand. For
purposes of determining the amount of a grant for a region,
the population of the region shall not include the population
of any community with a population of more than ten thousand
located in the region awarded to rural, underserved areas or
special populations as identified by the department’s strategic
plan or evidence-based documentation.
b. Primary care provider loan repayment program.
(1) A primary care provider loan repayment program is
established to increase the number of health professionals
practicing primary care in federally designated health
professional shortage areas of the state. Under the program,
loan repayment may be made to a recipient for educational
expenses incurred while completing an accredited health
education program directly related to obtaining credentials
necessary to practice the recipient’s health profession.
(2) The center for rural health and primary care shall adopt
rules relating to the establishment and administration of the
primary care provider loan repayment program. Rules adopted
pursuant to this paragraph shall provide, at a minimum, for all
of the following:
-7- (a) Determination of eligibility requirements and
qualifications of an applicant to receive loan repayment under
the program, including but not limited to years of obligated
service, clinical practice requirements, and residency
requirements. One year of obligated service shall be provided
by the applicant in exchange for each year of loan repayment,
unless federal requirements otherwise require. Loan repayment
under the program shall not be approved for a health provider
whose license or certification is restricted by a medical
regulatory authority of any jurisdiction of the United States,
other nations, or territories.
(b) Identification of federally designated health
professional shortage areas of the state and prioritization of
such areas according to need.
(c) Determination of the amount and duration of the loan
repayment an applicant may receive, giving consideration to the
availability of funds under the program, and the applicant’s
outstanding educational loans and professional credentials.
(d) Determination of the conditions of loan repayment
applicable to an applicant.
(e) Enforcement of the state’s rights under a loan repayment
program contract, including the commencement of any court
action.
(f) Cancellation of a loan repayment program contract for
reasonable cause unless federal requirements otherwise require.
(g) Participation in federal programs supporting repayment
of loans of health care providers and acceptance of gifts,
grants, and other aid or amounts from any person, association,
foundation, trust, corporation, governmental agency, or other
entity for the purposes of the program.
(h) Upon availability of state funds, determination of
eligibility criteria and qualifications for participating
communities and applicants not located in federally designated
shortage areas.
(i) Other rules as necessary.
-8- (3) The center for rural health and primary care may enter
into an agreement under chapter 28E with the college student
aid commission for the administration of this program.
c. Primary care provider community scholarship program.
(1) A primary care provider community scholarship program
is established to recruit and to provide scholarships to train
primary health care practitioners in federally designated
health professional shortage areas of the state. Under
the program, scholarships may be awarded to a recipient for
educational expenses incurred while completing an accredited
health education program directly related to obtaining the
credentials necessary to practice the recipient’s health
profession.
(2) The department shall adopt rules relating to the
establishment and administration of the primary care provider
community scholarship program. Rules adopted pursuant to
this paragraph shall provide, at a minimum, for all of the
following:
(a) Determination of eligibility requirements and
qualifications of an applicant to receive scholarships under
the program, including but not limited to years of obligated
service, clinical practice requirements, and residency
requirements. One year of obligated service shall be provided
by the applicant in exchange for each year of scholarship
receipt, unless federal requirements otherwise require.
(b) Identification of federally designated health
professional shortage areas of the state and prioritization of
such areas according to need.
(c) Determination of the amount of the scholarship an
applicant may receive.
(d) Determination of the conditions of scholarship to be
awarded to an applicant.
(e) Enforcement of the state’s rights under a scholarship
contract, including the commencement of any court action.
(f) Cancellation of a scholarship contract for reasonable
-9-cause.
(g) Participation in federal programs supporting
scholarships for health care providers and acceptance of gifts,
grants, and other aid or amounts from any person, association,
foundation, trust, corporation, governmental agency, or other
entity for the purposes of the program.
(h) Upon availability of state funds, determination of
eligibility criteria and qualifications for participating
communities and applicants not located in federally designated
shortage areas.
(i) Other rules as necessary.
(3) The center for rural health and primary care may enter
into an agreement under chapter 28E with the college student
aid commission for the administration of this program.
Sec. 14. Section 135.107, subsection 4, paragraphs a, b, and
c, Code 2017, are amended to read as follows:
a. Eligibility under any of the programs established under
the primary care provider recruitment and retention endeavor
shall be based upon a community health services assessment
completed under subsection 2, paragraph “a”. A community
or region, as applicable, shall submit a letter of intent
to conduct a community health services assessment and to
apply for assistance under this subsection. The letter shall
be in a form and contain information as determined by the
center. A letter of intent shall be submitted to the center by
January 1 preceding the fiscal year for which an application
for assistance is to be made. Participation in a community
health services assessment process shall be documented by the
community or region.
b. Assistance under this subsection shall not be granted
until such time as the community or region making application
has completed the a community health services assessment and
adopted a long-term community health services assessment and
developmental plan. In addition to any other requirements, a
developmental an applicant’s plan shall include, to the extent
-10-possible, a clear commitment to informing high school students
of the health care opportunities which may be available to such
students.
c. The center for rural health and primary care shall
seek additional assistance and resources from other state
departments and agencies, federal agencies and grant programs,
private organizations, and any other person, as appropriate.
The center is authorized and directed to accept on behalf of
the state any grant or contribution, federal or otherwise,
made to assist in meeting the cost of carrying out the purpose
of this subsection. All federal grants to and the federal
receipts of the center are appropriated for the purpose set
forth in such federal grants or receipts. Funds appropriated
by the general assembly to the center for implementation of
this subsection shall first be used for securing any available
federal funds requiring a state match, with remaining funds
being used for the health care workforce and community support
grant program.
Sec. 15. Section 135.107, subsection 5, paragraph a, Code
2017, is amended to read as follows:
a. There is established an advisory committee to the
center for rural health and primary care consisting of one
representative, approved by the respective agency, of each
of the following agencies: the department of agriculture
and land stewardship, the Iowa department of public health,
the department of inspections and appeals, the a national or
regional institute for rural health policy, the rural health
resource center, the institute of agricultural medicine
and occupational health, and the Iowa state association of
counties. The governor shall appoint two representatives
of consumer groups active in rural health issues and a
representative of each of two farm organizations active within
the state, a representative of an agricultural business in
the state, a representative of a critical needs hospital,
a practicing rural family physician, a practicing rural
-11-physician assistant, a practicing rural advanced registered
nurse practitioner, and a rural health practitioner who is
not a physician, physician assistant, or advanced registered
nurse practitioner, as members of the advisory committee. The
advisory committee shall also include as members two state
representatives, one appointed by the speaker of the house of
representatives and one by the minority leader of the house,
and two state senators, one appointed by the majority leader of
the senate and one by the minority leader of the senate.
Sec. 16. Section 135.163, Code 2017, is amended to read as
follows:
135.163 Health and long-term care access.
The department shall coordinate public and private efforts
to develop and maintain an appropriate health care delivery
infrastructure and a stable, well-qualified, diverse, and
sustainable health care workforce in this state. The health
care delivery infrastructure and the health care workforce
shall address the broad spectrum of health care needs of Iowans
throughout their lifespan including long-term care needs. The
department shall, at a minimum, do all of the following:
1. Develop a strategic plan for health care delivery
infrastructure and health care workforce resources in this
state.
2. Provide for the continuous collection of data to provide
a basis for health care strategic planning and health care
policymaking.
3. Make recommendations regarding the health care delivery
infrastructure and the health care workforce that assist
in monitoring current needs, predicting future trends, and
informing policymaking.
Sec. 17. Section 135.175, subsection 1, paragraph b, Code
2017, is amended to read as follows:
b. A health care workforce shortage fund is created in
the state treasury as a separate fund under the control of
the department, in cooperation with the entities identified
-12-in this section as having control over the accounts within
the fund. The fund and the accounts within the fund shall
be controlled and managed in a manner consistent with the
principles specified and the strategic plan developed pursuant
to sections section 135.163 and 135.164.
Sec. 18. Section 135.175, subsections 6 and 7, Code 2017,
are amended to read as follows:
6. a. Moneys in the fund and the accounts in the fund shall
only be appropriated in a manner consistent with the principles
specified and the strategic plan developed pursuant to sections
section 135.163 and 135.164 to support the medical residency
training state matching grants program, the fulfilling Iowa’s
need for dentists matching grant program, and to provide
funding for state health care workforce shortage programs as
provided in this section.
b. State programs that may receive funding from the fund
and the accounts in the fund, if specifically designated for
the purpose of drawing down federal funding, are the primary
care recruitment and retention endeavor (PRIMECARRE), the Iowa
affiliate of the national rural recruitment and retention
network, the oral and health delivery systems bureau of the
department, the primary care office and shortage designation
program, and the state office of rural health, and the Iowa
health workforce center, administered through the oral and
health delivery systems bureau of health care access of the
department of public health; the area health education centers
programs at Des Moines university — osteopathic medical center
and the university of Iowa; the Iowa collaborative safety net
provider network established pursuant to section 135.153; any
entity identified by the federal government entity through
which federal funding for a specified health care workforce
shortage initiative is received; and a program developed in
accordance with the strategic plan developed by the department
of public health in accordance with sections section 135.163
and 135.164.
-13- c. State appropriations to the fund shall be allocated in
equal amounts to each of the accounts within the fund, unless
otherwise specified in the appropriation or allocation. Any
federal funding received for the purposes of addressing state
health care workforce shortages shall be deposited in the
health care workforce shortage national initiatives account,
unless otherwise specified by the source of the funds, and
shall be used as required by the source of the funds. If use
of the federal funding is not designated, the funds shall be
used in accordance with the strategic plan developed by the
department of public health in accordance with sections section
135.163 and 135.164, or to address workforce shortages as
otherwise designated by the department of public health. Other
sources of funding shall be deposited in the fund or account
and used as specified by the source of the funding.
7. No more than five percent of the moneys in any of the
accounts within the fund, not to exceed one hundred thousand
dollars in each account, shall be used for administrative
purposes, unless otherwise provided by the appropriation,
allocation, or source of the funds.
Sec. 19. REPEAL. Sections 135.164 and 135.180, Code 2017,
are repealed.
DIVISION IV
unfunded OR outdated program PROVISIONS
Sec. 20. Section 135.11, subsection 25, Code 2017, is
amended by striking the subsection.
Sec. 21. Section 135.141, subsection 2, paragraph c, Code
2017, is amended by striking the paragraph.
Sec. 22. Section 135.141, subsection 2, paragraph e, Code
2017, is amended to read as follows:
e. For the purpose of paragraphs “c” and paragraph “d”,
an employee or agent of the department may enter into and
examine any premises containing potentially dangerous agents
with the consent of the owner or person in charge of the
premises or, if the owner or person in charge of the premises
-14-refuses admittance, with an administrative search warrant
obtained under section 808.14. Based on findings of the risk
assessment and examination of the premises, the director may
order reasonable safeguards or take any other action reasonably
necessary to protect the public health pursuant to rules
adopted to administer this subsection.
Sec. 23. Section 901B.1, subsection 4, paragraph a, Code
2017, is amended to read as follows:
a. The district department of correctional services shall
place an individual committed to it under section 907.3 to the
sanction and level of supervision which is appropriate to the
individual based upon a current risk assessment evaluation.
Placements may be to levels two and three of the corrections
continuum. The district department may, with the approval of
the Iowa department of public health and the department of
corrections, place an individual in a level three substance
abuse treatment facility established pursuant to section
135.130, to assist the individual in complying with a condition
of probation. The district department may, with the approval
of the department of corrections, place an individual in a
level four violator facility established pursuant to section
904.207 only as a penalty for a violation of a condition
imposed under this section.
Sec. 24. REPEAL. Sections 135.26, 135.29, 135.130, and
135.152, Code 2017, are repealed.
DIVISION V
miscellaneous provisions
Sec. 25. Section 135A.2, subsection 6, Code 2017, is amended
to read as follows:
6. “Local board of health” means a county or district board
of health the same as defined in section 137.102.
Sec. 26. REPEAL. Section 135.132, Code 2017, is repealed.
DIVISION VI
iowa health information network
Sec. 27. Section 136.3, subsection 13, Code 2017, is amended
-15-by striking the subsection.
Sec. 28. EFFECTIVE DATE. This division of this Act
takes effect upon the assumption of the administration and
governance, including but not limited to the assumption of the
assets and liabilities, of the Iowa health information network
by the designated entity as defined in 2015 Iowa Acts, ch.73,
section 2. The department of public health shall notify the
Code editor of the date of such assumption by the designated
entity.
DIVISION VII
ORGANIZED DELIVERY SYSTEMS
Sec. 29. Section 135H.3, subsection 2, Code 2017, is amended
to read as follows:
2. If a child is diagnosed with a biologically based mental
illness as defined in section 514C.22 and meets the medical
assistance program criteria for admission to a psychiatric
medical institution for children, the child shall be deemed
to meet the acuity criteria for medically necessary inpatient
benefits under a group policy, contract, or plan providing
for third-party payment or prepayment of health, medical, and
surgical coverage benefits issued by a carrier, as defined in
section 513B.2, or by an organized delivery system authorized
under 1993 Iowa Acts, ch.158, that is subject to section
514C.22. Such medically necessary benefits shall not be
excluded or denied as care that is substantially custodial in
nature under section 514C.22, subsection 8, paragraph “b”.
Sec. 30. Section 505.32, subsection 2, paragraph h, Code
2017, is amended by striking the paragraph.
Sec. 31. Section 505.32, subsection 4, paragraph b,
subparagraphs (1) and (2), Code 2017, are amended to read as
follows:
(1) The commissioner may establish methodologies to provide
uniform and consistent side-by-side comparisons of the health
care coverage options that are offered by carriers, organized
delivery systems, and public programs in this state including
-16-but not limited to benefits covered and not covered, the amount
of coverage for each service, including copays and deductibles,
administrative costs, and any prior authorization requirements
for coverage.
(2) The commissioner may require each carrier, organized
delivery system, and public program in this state to describe
each health care coverage option offered by that carrier,
organized delivery system, or public program in a manner
so that the various options can be compared as provided in
subparagraph (1).
Sec. 32. Section 507B.4, subsection 1, Code 2017, is amended
to read as follows:
1. For purposes of subsection 3, paragraph “p”, “insurer”
means an entity providing a plan of health insurance, health
care benefits, or health care services, or an entity subject
to the jurisdiction of the commissioner performing utilization
review, including an insurance company offering sickness and
accident plans, a health maintenance organization, an organized
delivery system authorized under 1993 Iowa Acts, ch.158, and
licensed by the department of public health, a nonprofit health
service corporation, a plan established pursuant to chapter
509A for public employees, or any other entity providing a
plan of health insurance, health care benefits, or health care
services. However, “insurer” does not include an entity that
sells disability income or long-term care insurance.
Sec. 33. Section 507B.4A, subsection 2, paragraph a, Code
2017, is amended to read as follows:
a. An insurer providing accident and sickness insurance
under chapter 509, 514, or 514A; a health maintenance
organization; an organized delivery system authorized under
1993 Iowa Acts, ch.158, and licensed by the department of
public health; or another entity providing health insurance or
health benefits subject to state insurance regulation shall
either accept and pay or deny a clean claim.
Sec. 34. Section 509.3A, subsection 11, Code 2017, is
-17-amended by striking the subsection.
Sec. 35. Section 509.19, subsection 2, paragraph d, Code
2017, is amended by striking the paragraph.
Sec. 36. Section 509A.6, Code 2017, is amended to read as
follows:
509A.6 Contract with insurance carrier, or health maintenance
organization, or organized delivery system.
The governing body may contract with a nonprofit corporation
operating under the provisions of this chapter or chapter
514 or with any insurance company having a certificate of
authority to transact an insurance business in this state with
respect of a group insurance plan, which may include life,
accident, health, hospitalization and disability insurance
during period of active service of such employees, with the
right of any employee to continue such life insurance in force
after termination of active service at such employee’s sole
expense; may contract with a nonprofit corporation operating
under and governed by the provisions of this chapter or chapter
514 with respect of any hospital or medical service plan; and
may contract with a health maintenance organization or an
organized delivery system authorized to operate in this state
with respect to health maintenance organization or organized
delivery system activities.
Sec. 37. Section 513B.2, subsection 8, paragraph k, Code
2017, is amended by striking the paragraph.
Sec. 38. Section 513B.5, Code 2017, is amended to read as
follows:
513B.5 Provisions on renewability of coverage.
1. Health insurance coverage subject to this chapter is
renewable with respect to all eligible employees or their
dependents, at the option of the small employer, except for one
or more of the following reasons:
a. The health insurance coverage sponsor fails to pay, or to
make timely payment of, premiums or contributions pursuant to
the terms of the health insurance coverage.
-18- b. The health insurance coverage sponsor performs an
act or practice constituting fraud or makes an intentional
misrepresentation of a material fact under the terms of the
coverage.
c. Noncompliance with the carrier’s or organized delivery
system’s minimum participation requirements.
d. Noncompliance with the carrier’s or organized delivery
system’s employer contribution requirements.
e. A decision by the carrier or organized delivery system
to discontinue offering a particular type of health insurance
coverage in the state’s small employer market. Health
insurance coverage may be discontinued by the carrier or
organized delivery system in that market only if the carrier or
organized delivery system does all of the following:
(1) Provides advance notice of its decision to discontinue
such plan to the commissioner or director of public health.
Notice to the commissioner or director, at a minimum, shall be
no less than three days prior to the notice provided for in
subparagraph (2) to affected small employers, participants, and
beneficiaries.
(2) Provides notice of its decision not to renew such
plan to all affected small employers, participants, and
beneficiaries no less than ninety days prior to the nonrenewal
of the plan.
(3) Offers to each plan sponsor of the discontinued
coverage, the option to purchase any other coverage currently
offered by the carrier or organized delivery system to other
employers in this state.
(4) Acts uniformly, in opting to discontinue the coverage
and in offering the option under subparagraph (3), without
regard to the claims experience of the sponsors under the
discontinued coverage or to a health status-related factor
relating to any participants or beneficiaries covered or new
participants or beneficiaries who may become eligible for the
coverage.
-19- f. A decision by the carrier or organized delivery system to
discontinue offering and to cease to renew all of its health
insurance coverage delivered or issued for delivery to small
employers in this state. A carrier or organized delivery
system making such decision shall do all of the following:
(1) Provide advance notice of its decision to discontinue
such coverage to the commissioner or director of public health.
Notice to the commissioner or director, at a minimum, shall be
no less than three days prior to the notice provided for in
subparagraph (2) to affected small employers, participants, and
beneficiaries.
(2) Provide notice of its decision not to renew such
coverage to all affected small employers, participants, and
beneficiaries no less than one hundred eighty days prior to the
nonrenewal of the coverage.
(3) Discontinue all health insurance coverage issued or
delivered for issuance to small employers in this state and
cease renewal of such coverage.
g. The membership of an employer in an association, which
is the basis for the coverage which is provided through such
association, ceases, but only if the termination of coverage
under this paragraph occurs uniformly without regard to
any health status-related factor relating to any covered
individual.
h. The commissioner or director of public health finds that
the continuation of the coverage is not in the best interests
of the policyholders or certificate holders, or would impair
the carrier’s or organized delivery system’s ability to meet
its contractual obligations.
i. At the time of coverage renewal, a carrier or organized
delivery system may modify the health insurance coverage for
a product offered under group health insurance coverage in
the small group market, for coverage that is available in
such market other than only through one or more bona fide
associations, if such modification is consistent with the laws
-20-of this state, and is effective on a uniform basis among group
health insurance coverage with that product.
2. A carrier or organized delivery system that elects not to
renew health insurance coverage under subsection 1, paragraph
“f”, shall not write any new business in the small employer
market in this state for a period of five years after the date
of notice to the commissioner or director of public health.
3. This section, with respect to a carrier or organized
delivery system doing business in one established geographic
service area of the state, applies only to such carrier’s or
organized delivery system’s operations in that service area.
Sec. 39. Section 513B.6, unnumbered paragraph 1, Code 2017,
is amended to read as follows:
A small employer carrier or organized delivery system shall
make reasonable disclosure in solicitation and sales materials
provided to small employers of all of the following:
Sec. 40. Section 513B.6, subsection 2, Code 2017, is amended
to read as follows:
2. The provisions concerning the small employer carrier’s
or organized delivery system’s right to change premium rates
and factors, including case characteristics, which affect
changes in premium rates.
Sec. 41. Section 513B.7, Code 2017, is amended to read as
follows:
513B.7 Maintenance of records.
1. A small employer carrier or organized delivery system
shall maintain at its principal place of business a complete
and detailed description of its rating practices and renewal
underwriting practices, including information and documentation
which demonstrate that its rating methods and practices are
based upon commonly accepted actuarial assumptions and are in
accordance with sound actuarial principles.
2. A small employer carrier or organized delivery system
shall file each March 1 with the commissioner or the director
of public health an actuarial certification that the small
-21-employer carrier or organized delivery system is in compliance
with this section and that the rating methods of the small
employer carrier or organized delivery system are actuarially
sound. A copy of the certification shall be retained by the
small employer carrier or organized delivery system at its
principal place of business.
3. A small employer carrier or organized delivery system
shall make the information and documentation described in
subsection 1 available to the commissioner or the director of
public health upon request. The information is not a public
record or otherwise subject to disclosure under chapter 22,
and is considered proprietary and trade secret information
and is not subject to disclosure by the commissioner or the
director of public health to persons outside of the division or
department except as agreed to by the small employer carrier or
organized delivery system or as ordered by a court of competent
jurisdiction.
Sec. 42. Section 513B.9A, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
A carrier or organized delivery system offering group health
insurance coverage shall not establish rules for eligibility,
including continued eligibility, of an individual to enroll
under the terms of the coverage based on any of the following
health status-related factors in relation to the individual or
a dependent of the individual:
Sec. 43. Section 513B.9A, subsection 4, paragraph a, Code
2017, is amended to read as follows:
a. A carrier or organized delivery system offering health
insurance coverage shall not require an individual, as a
condition of enrollment or continued enrollment under the
coverage, to pay a premium or contribution which is greater
than a premium or contribution for a similarly situated
individual enrolled in the coverage on the basis of a health
status-related factor in relation to the individual or to a
dependent of an individual enrolled under the coverage.
-22- Sec. 44. Section 513B.9A, subsection 4, paragraph b,
subparagraph (2), Code 2017, is amended to read as follows:
(2) Prevent a carrier or organized delivery system
offering group health insurance coverage from establishing
premium discounts or rebates or modifying otherwise applicable
copayments or deductibles in return for adherence to programs
of health promotion and disease prevention.
Sec. 45. Section 513B.10, Code 2017, is amended to read as
follows:
513B.10 Availability of coverage.
1. a. A carrier or an organized delivery system that offers
health insurance coverage in the small group market shall
accept every small employer that applies for health insurance
coverage and shall accept for enrollment under such coverage
every eligible individual who applies for enrollment during the
period in which the individual first becomes eligible to enroll
under the terms of the health insurance coverage and shall not
place any restriction which is inconsistent with eligibility
rules established under this chapter.
b. A carrier or organized delivery system that offers health
insurance coverage in the small group market through a network
plan may do either of the following:
(1) Limit employers that may apply for such coverage to
those with eligible individuals who live, work, or reside in
the service area for such network plan.
(2) Deny such coverage to such employers within the service
area of such plan if the carrier or organized delivery system
has demonstrated to the applicable state authority both of the
following:
(a) The carrier or organized delivery system will not have
the capacity to deliver services adequately to enrollees of any
additional groups because of its obligations to existing group
contract holders and enrollees.
(b) The carrier or organized delivery system is applying
this subparagraph uniformly to all employers without regard to
-23-the claims experience of those employers and their employees
and their dependents, or any health status-related factor
relating to such employees or dependents.
c. A carrier or organized delivery system, upon denying
health insurance coverage in any service area pursuant to
paragraph “b”, subparagraph (2), shall not offer coverage in the
small group market within such service area for a period of one
hundred eighty days after the date such coverage is denied.
d. A carrier or organized delivery system may deny health
insurance coverage in the small group market if the issuer has
demonstrated to the commissioner or director of public health
both of the following:
(1) The carrier or organized delivery system does not have
the financial reserves necessary to underwrite additional
coverage.
(2) The carrier or organized delivery system is applying the
provisions of this paragraph uniformly to all employers in the
small group market in this state consistent with state law and
without regard to the claims experience of those employers and
the employees and dependents of such employers, or any health
status-related factor relating to such employees and their
dependents.
e. A carrier or organized delivery system, upon denying
health insurance coverage pursuant to paragraph “d”, shall not
offer coverage in connection with health insurance coverages
in the small group market in this state for a period of one
hundred eighty days after the date such coverage is denied or
until the carrier or organized delivery system has demonstrated
to the commissioner or director of public health that the
carrier or organized delivery system has sufficient financial
reserves to underwrite additional coverage, whichever is later.
The commissioner or director may provide for the application of
this paragraph on a service area-specific basis.
f. Paragraph “a” shall not be construed to preclude
a carrier or organized delivery system from establishing
-24-employer contribution rules or group participation rules for
the offering of health insurance coverage in the small group
market.
2. A carrier or organized delivery system, subject to
subsection 1, shall issue health insurance coverage to an
eligible small employer that applies for the coverage and
agrees to make the required premium payments and satisfy the
other reasonable provisions of the health insurance coverage
not inconsistent with this chapter. A carrier or organized
delivery system is not required to issue health insurance
coverage to a self-employed individual who is covered by, or is
eligible for coverage under, health insurance coverage offered
by an employer.
3. Health insurance coverage for small employers shall
satisfy all of the following:
a. A carrier or organized delivery system offering group
health insurance coverage, with respect to a participant or
beneficiary, may impose a preexisting condition exclusion only
as follows:
(1) The exclusion relates to a condition, whether physical
or mental, regardless of the cause of the condition, for
which medical advice, diagnosis, care, or treatment was
recommended or received within the six-month period ending on
the enrollment date. However, genetic information shall not be
treated as a condition under this subparagraph in the absence
of a diagnosis of the condition related to such information.
(2) The exclusion extends for a period of not more than
twelve months, or eighteen months in the case of a late
enrollee, after the enrollment date.
(3) The period of any such preexisting condition exclusion
is reduced by the aggregate of the periods of creditable
coverage applicable to the participant or beneficiary as of the
enrollment date.
b. A carrier or organized delivery system offering group
health insurance coverage shall not impose any preexisting
-25-condition exclusion as follows:
(1) In the case of a child who is adopted or placed for
adoption before attaining eighteen years of age and who, as of
the last day of the thirty-day period beginning on the date
of the adoption or placement for adoption, is covered under
creditable coverage. This subparagraph shall not apply to
coverage before the date of such adoption or placement for
adoption.
(2) In the case of an individual who, as of the last day
of the thirty-day period beginning with the date of birth, is
covered under creditable coverage.
(3) Relating to pregnancy as a preexisting condition.
c. A carrier or organized delivery system shall waive
any waiting period applicable to a preexisting condition
exclusion or limitation period with respect to particular
services under health insurance coverage for the period
of time an individual was covered by creditable coverage,
provided that the creditable coverage was continuous to a
date not more than sixty-three days prior to the effective
date of the new coverage. Any period that an individual
is in a waiting period for any coverage under group health
insurance coverage, or is in an affiliation period, shall not
be taken into account in determining the period of continuous
coverage. A health maintenance organization that does not
use preexisting condition limitations in any of its health
insurance coverage may impose an affiliation period. For
purposes of this section, “affiliation period” means a period
of time not to exceed sixty days for new entrants and not to
exceed ninety days for late enrollees during which no premium
shall be collected and coverage issued is not effective, so
long as the affiliation period is applied uniformly, without
regard to any health status-related factors. This paragraph
does not preclude application of a waiting period applicable
to all new enrollees under the health insurance coverage,
provided that any carrier or organized delivery system-imposed
-26- carrier-imposed waiting period is no longer than sixty days and
is used in lieu of a preexisting condition exclusion.
d. Health insurance coverage may exclude coverage for late
enrollees for preexisting conditions for a period not to exceed
eighteen months.
e. (1) Requirements used by a carrier or organized delivery
system in determining whether to provide coverage to a small
employer shall be applied uniformly among all small employers
applying for coverage or receiving coverage from the carrier
or organized delivery system.
(2) In applying minimum participation requirements with
respect to a small employer, a carrier or organized delivery
system shall not consider employees or dependents who have
other creditable coverage in determining whether the applicable
percentage of participation is met.
(3) A carrier or organized delivery system shall not
increase any requirement for minimum employee participation
or modify any requirement for minimum employer contribution
applicable to a small employer at any time after the small
employer has been accepted for coverage.
f. (1) If a carrier or organized delivery system offers
coverage to a small employer, the carrier or organized delivery
system shall offer coverage to all eligible employees of the
small employer and the employees’ dependents. A carrier or
organized delivery system shall not offer coverage to only
certain individuals or dependents in a small employer group or
to only part of the group.
(2) Except as provided under paragraphs “a” and “d”, a
carrier or organized delivery system shall not modify health
insurance coverage with respect to a small employer or any
eligible employee or dependent through riders, endorsements, or
other means, to restrict or exclude coverage or benefits for
certain diseases, medical conditions, or services otherwise
covered by the health insurance coverage.
g. A carrier or organized delivery system offering coverage
-27-through a network plan shall not be required to offer coverage
or accept applications pursuant to subsection 1 with respect to
a small employer where any of the following apply applies:
(1) The small employer does not have eligible individuals
who live, work, or reside in the service area for the network
plan.
(2) The small employer does have eligible individuals who
live, work, or reside in the service area for the network plan,
but the carrier or organized delivery system, if required, has
demonstrated to the commissioner or the director of public
health that it will not have the capacity to deliver services
adequately to enrollees of any additional groups because of its
obligations to existing group contract holders and enrollees
and that it is applying the requirements of this lettered
paragraph uniformly to all employers without regard to the
claims experience of those employers and their employees and
the employees’ dependents, or any health status-related factor
relating to such employees and dependents.
(3) A carrier or organized delivery system, upon denying
health insurance coverage in a service area pursuant to
subparagraph (2), shall not offer coverage in the small
employer market within such service area for a period of one
hundred eighty days after the coverage is denied.
4. A carrier or organized delivery system shall not be
required to offer coverage to small employers pursuant to
subsection 1 for any period of time where the commissioner or
director of public health determines that the acceptance of the
offers by small employers in accordance with subsection 1 would
place the carrier or organized delivery system in a financially
impaired condition.
5. A carrier or organized delivery system shall not be
required to provide coverage to small employers pursuant to
subsection 1 if the carrier or organized delivery system elects
not to offer new coverage to small employers in this state.
However, a carrier or organized delivery system that elects not
-28-to offer new coverage to small employers under this subsection
shall be allowed to maintain its existing policies in the
state, subject to the requirements of section 513B.5.
6. A carrier or organized delivery system that elects not to
offer new coverage to small employers pursuant to subsection 5
shall provide notice to the commissioner or director of public
health and is prohibited from writing new business in the small
employer market in this state for a period of five years from
the date of notice to the commissioner or director.
Sec. 46. Section 513C.3, subsection 5, Code 2017, is amended
to read as follows:
5. “Carrier” means any entity that provides individual
health benefit plans in this state. For purposes of this
chapter, carrier includes an insurance company, a group
hospital or medical service corporation, a fraternal benefit
society, a health maintenance organization, and any other
entity providing an individual plan of health insurance
or health benefits subject to state insurance regulation.
“Carrier” does not include an organized delivery system.
Sec. 47. Section 513C.3, subsection 7, Code 2017, is amended
by striking the subsection.
Sec. 48. Section 513C.3, subsection 9, Code 2017, is amended
to read as follows:
9. “Established service area” means a geographic area,
as approved by the commissioner and based upon the carrier’s
certificate of authority to transact business in this state,
within which the carrier is authorized to provide coverage or
a geographic area, as approved by the director and based upon
the organized delivery system’s license to transact business
in this state, within which the organized delivery system is
authorized to provide coverage.
Sec. 49. Section 513C.3, subsection 12, Code 2017, is
amended by striking the subsection.
Sec. 50. Section 513C.3, subsection 15, paragraph a,
subparagraph (3), Code 2017, is amended by striking the
-29-subparagraph.
Sec. 51. Section 513C.3, subsection 18, Code 2017, is
amended to read as follows:
18. “Restricted network provision” means a provision of an
individual health benefit plan that conditions the payment
of benefits, in whole or in part, on the use of health care
providers that have entered into a contractual arrangement with
the carrier or the organized delivery system to provide health
care services to covered individuals.
Sec. 52. Section 513C.5, subsection 1, unnumbered paragraph
1, Code 2017, is amended to read as follows:
Premium rates for any block of individual health benefit
plan business issued on or after January 1, 1996, or the date
rules are adopted by the commissioner of insurance and the
director of public health and become effective, whichever
date is later, by a carrier subject to this chapter shall be
limited to the composite effect of allocating costs among the
following:
Sec. 53. Section 513C.6, Code 2017, is amended to read as
follows:
513C.6 Provisions on renewability of coverage.
1. An individual health benefit plan subject to this
chapter is renewable with respect to an eligible individual or
dependents, at the option of the individual, except for one or
more of the following reasons:
a. The individual fails to pay, or to make timely payment
of, premiums or contributions pursuant to the terms of the
individual health benefit plan.
b. The individual performs an act or practice constituting
fraud or makes an intentional misrepresentation of a material
fact under the terms of the individual health benefit plan.
c. A decision by the individual carrier or organized
delivery system to discontinue offering a particular type
of individual health benefit plan in the state’s individual
insurance market. An individual health benefit plan may be
-30-discontinued by the carrier or organized delivery system in
that market with the approval of the commissioner or the
director and only if the carrier or organized delivery system
does all of the following:
(1) Provides advance notice of its decision to discontinue
such plan to the commissioner or director. Notice to the
commissioner or director, at a minimum, shall be no less than
three days prior to the notice provided for in subparagraph (2)
to affected individuals.
(2) Provides notice of its decision not to renew such plan
to all affected individuals no less than ninety days prior
to the nonrenewal date of any discontinued individual health
benefit plans.
(3) Offers to each individual of the discontinued plan the
option to purchase any other health plan currently offered by
the carrier or organized delivery system to individuals in this
state.
(4) Acts uniformly in opting to discontinue the plan and
in offering the option under subparagraph (3), without regard
to the claims experience of any affected eligible individual
or beneficiary under the discontinued plan or to a health
status-related factor relating to any covered individuals or
beneficiaries who may become eligible for the coverage.
d. A decision by the carrier or organized delivery system
to discontinue offering and to cease to renew all of its
individual health benefit plans delivered or issued for
delivery to individuals in this state. A carrier or organized
delivery system making such decision shall do all of the
following:
(1) Provide advance notice of its decision to discontinue
such plan to the commissioner or director. Notice to the
commissioner or director, at a minimum, shall be no less than
three days prior to the notice provided for in subparagraph (2)
to affected individuals.
(2) Provide notice of its decision not to renew such plan
-31-to all individuals and to the commissioner or director in each
state in which an individual under the discontinued plan is
known to reside, no less than one hundred eighty days prior to
the nonrenewal of the plan.
e. The commissioner or director finds that the continuation
of the coverage is not in the best interests of the
individuals, or would impair the carrier’s or organized
delivery system’s ability to meet its contractual obligations.
2. At the time of coverage renewal, a carrier or organized
delivery system may modify the health insurance coverage for
a policy form offered to individuals in the individual market
so long as such modification is consistent with state law and
effective on a uniform basis among all individuals with that
policy form.
3. An individual carrier or organized delivery system that
elects not to renew an individual health benefit plan under
subsection 1, paragraph “d”, shall not write any new business in
the individual market in this state for a period of five years
after the date of notice to the commissioner or director.
4. This section, with respect to a carrier or organized
delivery system doing business in one established geographic
service area of the state, applies only to such carrier’s or
organized delivery system’s operations in that service area.
5. A carrier or organized delivery system offering coverage
through a network plan is not required to renew or continue in
force coverage or to accept applications from an individual who
no longer resides or lives in, or is no longer employed in,
the service area of such carrier or organized delivery system,
or no longer resides or lives in, or is no longer employed
in, a service area for which the carrier is authorized to do
business, but only if coverage is not offered or terminated
uniformly without regard to health status-related factors of a
covered individual.
6. A carrier or organized delivery system offering coverage
through a bona fide association is not required to renew or
-32-continue in force coverage or to accept applications from an
individual through an association if the membership of the
individual in the association on which the basis of coverage
is provided ceases, but only if the coverage is not offered or
terminated under this paragraph uniformly without regard to
health status-related factors of a covered individual.
7. An individual who has coverage as a dependent under a
basic or standard health benefit plan may, when that individual
is no longer a dependent under such coverage, elect to continue
coverage under the basic or standard health benefit plan if
the individual so elects immediately upon termination of the
coverage under which the individual was covered as a dependent.
Sec. 54. Section 513C.7, subsection 1, Code 2017, is amended
to read as follows:
1. a. (1) A carrier shall file with the commissioner, in
a form and manner prescribed by the commissioner, the basic
or standard health benefit plan. A basic or standard health
benefit plan filed pursuant to this paragraph may be used by
a carrier beginning thirty days after it is filed unless the
commissioner disapproves of its use.
(2) b. The commissioner may at any time, after providing
notice and an opportunity for a hearing to the carrier,
disapprove the continued use by a carrier of a basic or
standard health benefit plan on the grounds that the plan does
not meet the requirements of this chapter.
b. (1) An organized delivery system shall file with the
director, in a form and manner prescribed by the director,
the basic or standard health benefit plan to be used by the
organized delivery system. A basic or standard health benefit
plan filed pursuant to this paragraph may be used by the
organized delivery system beginning thirty days after it is
filed unless the director disapproves of its use.
(2) The director may at any time, after providing notice and
an opportunity for a hearing to the organized delivery system,
disapprove the continued use by an organized delivery system of
-33-a basic or standard health benefit plan on the grounds that the
plan does not meet the requirements of this chapter.
Sec. 55. Section 513C.7, subsection 3, Code 2017, is amended
to read as follows:
3. A carrier or an organized delivery system shall not
modify a basic or standard health benefit plan with respect
to an individual or dependent through riders, endorsements,
or other means to restrict or exclude coverage for certain
diseases or medical conditions otherwise covered by the health
benefit plan.
Sec. 56. Section 513C.9, subsections 1, 2, 3, 6, and 8, Code
2017, are amended to read as follows:
1. A carrier, an organized delivery system, or an agent
shall not do either of the following:
a. Encourage or direct individuals to refrain from
filing an application for coverage with the carrier or the
organized delivery system because of the health status, claims
experience, industry, occupation, or geographic location of the
individuals.
b. Encourage or direct individuals to seek coverage from
another carrier or another organized delivery system because of
the health status, claims experience, industry, occupation, or
geographic location of the individuals.
2. Subsection 1, paragraph “a”, shall not apply with respect
to information provided by a carrier or an organized delivery
system or an agent to an individual regarding the established
geographic service area of the carrier or the organized
delivery system, or the restricted network provision of the
carrier or the organized delivery system.
3. A carrier or an organized delivery system shall not,
directly or indirectly, enter into any contract, agreement, or
arrangement with an agent that provides for, or results in, the
compensation paid to an agent for a sale of a basic or standard
health benefit plan to vary because of the health status or
permitted rating characteristics of the individual or the
-34-individual’s dependents.
6. Denial by a carrier or an organized delivery system of an
application for coverage from an individual shall be in writing
and shall state the reason or reasons for the denial.
8. If a carrier or an organized delivery system enters into
a contract, agreement, or other arrangement with a third-party
administrator to provide administrative, marketing, or other
services related to the offering of individual health benefit
plans in this state, the third-party administrator is subject
to this section as if it were a carrier or an organized
delivery system.
Sec. 57. Section 513C.10, subsection 1, paragraph a, Code
2017, is amended to read as follows:
a. All persons that provide health benefit plans in this
state including insurers providing accident and sickness
insurance under chapter 509, 514, or 514A, whether on an
individual or group basis; fraternal benefit societies
providing hospital, medical, or nursing benefits under chapter
512B; and health maintenance organizations, organized delivery
systems, other entities providing health insurance or health
benefits subject to state insurance regulation, and all other
insurers as designated by the board of directors of the Iowa
comprehensive health insurance association with the approval of
the commissioner shall be members of the association.
Sec. 58. Section 513C.10, subsection 2, paragraph a, Code
2017, is amended to read as follows:
a. Rates for basic and standard coverages as provided in
this chapter shall be determined by each carrier or organized
delivery system as the product of a basic and standard factor
and the lowest rate available for issuance by that carrier or
organized delivery system adjusted for rating characteristics
and benefits. Basic and standard factors shall be established
annually by the Iowa comprehensive health insurance association
board with the approval of the commissioner. Multiple basic
and standard factors for a distinct grouping of basic and
-35-standard policies may be established. A basic and standard
factor is limited to a minimum value defined as the ratio
of the average of the lowest rate available for issuance and
the maximum rate allowable by law divided by the lowest rate
available for issuance. A basic and standard factor is limited
to a maximum value defined as the ratio of the maximum rate
allowable by law divided by the lowest rate available for
issuance. The maximum rate allowable by law and the lowest
rate available for issuance is determined based on the rate
restrictions under this chapter. For policies written after
January 1, 2002, rates for the basic and standard coverages
as provided in this chapter shall be calculated using the
basic and standard factors and shall be no lower than the
maximum rate allowable by law. However, to maintain assessable
loss assessments at or below one percent of total health
insurance premiums or payments as determined in accordance
with subsection 6, the Iowa comprehensive health insurance
association board with the approval of the commissioner may
increase the value for any basic and standard factor greater
than the maximum value.
Sec. 59. Section 513C.10, subsections 3, 4, 7, 8, 9, and 10,
Code 2017, are amended to read as follows:
3. Following the close of each calendar year, the
association, in conjunction with the commissioner, shall
require each carrier or organized delivery system to report
the amount of earned premiums and the associated paid losses
for all basic and standard plans issued by the carrier or
organized delivery system. The reporting of these amounts must
be certified by an officer of the carrier or organized delivery
system.
4. The board shall develop procedures and assessment
mechanisms and make assessments and distributions as required
to equalize the individual carrier and organized delivery
system gains or losses so that each carrier or organized
delivery system receives the same ratio of paid claims to
-36-ninety percent of earned premiums as the aggregate of all
basic and standard plans insured by all carriers and organized
delivery systems in the state.
7. The board shall develop procedures for distributing
the assessable loss assessments to each carrier and organized
delivery system in proportion to the carrier’s and organized
delivery system’s respective share of premium for basic and
standard plans to the statewide total premium for all basic and
standard plans.
8. The board shall ensure that procedures for collecting
and distributing assessments are as efficient as possible
for carriers and organized delivery systems. The board may
establish procedures which combine, or offset, the assessment
from, and the distribution due to, a carrier or organized
delivery system.
9. A carrier or an organized delivery system may
petition the association board to seek remedy from writing a
significantly disproportionate share of basic and standard
policies in relation to total premiums written in this state
for health benefit plans. Upon a finding that a carrier or
organized delivery system has written a disproportionate share,
the board may agree to compensate the carrier or organized
delivery system either by paying to the carrier or organized
delivery system an additional fee not to exceed two percent
of earned premiums from basic and standard policies for that
carrier or organized delivery system or by petitioning the
commissioner or director, as appropriate, for remedy.
10. a. The commissioner, upon a finding that the acceptance
of the offer of basic and standard coverage by individuals
pursuant to this chapter would place the carrier in a
financially impaired condition, shall not require the carrier
to offer coverage or accept applications for any period of time
the financial impairment is deemed to exist.
b. The director, upon a finding that the acceptance of the
offer of basic and standard coverage by individuals pursuant
-37-to this chapter would place the organized delivery system in a
financially impaired condition, shall not require the organized
delivery system to offer coverage or accept applications for
any period of time the financial impairment is deemed to exist.
Sec. 60. Section 514A.3B, subsection 3, paragraph k, Code
2017, is amended by striking the paragraph.
Sec. 61. Section 514B.25A, Code 2017, is amended to read as
follows:
514B.25A Insolvency protection — assessment.
1. Upon a health maintenance organization or organized
delivery system authorized to do business in this state and
licensed by the director of public health being declared
insolvent by the district court, the commissioner may levy an
assessment on each health maintenance organization or organized
delivery system doing business in this state and licensed by
the director of public health, as applicable, to pay claims
for uncovered expenditures for enrollees. The commissioner
shall not assess an amount in any one calendar year which is
more than two percent of the aggregate premium written by each
health maintenance organization or organized delivery system.
2. The commissioner may use funds obtained through an
assessment under subsection 1 to pay claims for uncovered
expenditures for enrollees of an insolvent health maintenance
organization or organized delivery system and administrative
costs. The commissioner, by rule, may prescribe the time,
manner, and form for filing claims under this section. The
commissioner may require claims to be allowed by an ancillary
receiver or the domestic receiver or liquidator.
3. a. A receiver or liquidator of an insolvent health
maintenance organization or organized delivery system shall
allow a claim in the proceeding in an amount equal to uncovered
expenditures and administrative costs paid under this section.
b. A person receiving benefits under this section for
uncovered expenditures is deemed to have assigned the rights
under the covered health care plan certificates to the
-38-commissioner to the extent of the benefits received. The
commissioner may require an assignment of such rights by a
payee, enrollee, or beneficiary, to the commissioner as a
condition precedent to the receipt of such benefits. The
commissioner is subrogated to these rights against the assets
of the insolvent health maintenance organization or organized
delivery system that are held by a receiver or liquidator of
a foreign jurisdiction.
c. The assigned subrogation rights of the commissioner and
allowed claims under this subsection have the same priority
against the assets of the insolvent health maintenance
organization or organized delivery system as those claims of
persons entitled to receive benefits under this section or for
similar expenses in the receivership or liquidation.
4. If funds assessed under subsection 1 are unused
following the completion of the liquidation of an insolvent
health maintenance organization or organized delivery system,
the commissioner shall distribute the remaining amounts, if
such amounts are not de minimis, to the health maintenance
organizations or organized delivery systems that were assessed.
5. The aggregate coverage of uncovered expenditures under
this section shall not exceed three hundred thousand dollars
with respect to one individual. Continuation of coverage
shall cease after the lesser of one year after the health
maintenance organization or organized delivery system is
terminated by insolvency or the remaining term of the contract.
The commissioner may provide continuation of coverage on a
reasonable basis, including, but not limited to, continuation
of the health maintenance organization or organized delivery
system contract or substitution of indemnity coverage in a form
as determined by the commissioner.
6. The commissioner may waive an assessment of a health
maintenance organization or organized delivery system if such
organization or system is impaired financially or would be
impaired financially as a result of such assessment. A health
-39-maintenance organization or organized delivery system that
fails to pay an assessment within thirty days after notice of
the assessment is subject to a civil forfeiture of not more
than one thousand dollars for each day the failure continues,
and suspension or revocation of its certificate of authority.
An action taken by the commissioner to enforce an assessment
under this section may be appealed by the health maintenance
organization or organized delivery system pursuant to chapter
17A.
Sec. 62. Section 514C.10, subsection 2, paragraph e, Code
2017, is amended by striking the paragraph.
Sec. 63. Section 514C.11, Code 2017, is amended to read as
follows:
514C.11 Services provided by licensed physician assistants
and licensed advanced registered nurse practitioners.
1. Notwithstanding section 514C.6, a policy or contract
providing for third-party payment or prepayment of health or
medical expenses shall include a provision for the payment of
necessary medical or surgical care and treatment provided by
a physician assistant licensed pursuant to chapter 148C, or
provided by an advanced registered nurse practitioner licensed
pursuant to chapter 152 and performed within the scope of the
license of the licensed physician assistant or the licensed
advanced registered nurse practitioner if the policy or
contract would pay for the care and treatment if the care and
treatment were provided by a person engaged in the practice
of medicine and surgery or osteopathic medicine and surgery
under chapter 148. The policy or contract shall provide that
policyholders and subscribers under the policy or contract may
reject the coverage for services which may be provided by a
licensed physician assistant or licensed advanced registered
nurse practitioner if the coverage is rejected for all
providers of similar services. A policy or contract subject
to this section shall not impose a practice or supervision
restriction which is inconsistent with or more restrictive than
-40-the restriction already imposed by law.
2. This section applies to services provided under a policy
or contract delivered, issued for delivery, continued, or
renewed in this state on or after July 1, 1996, and to an
existing policy or contract, on the policy’s or contract’s
anniversary or renewal date, or upon the expiration of the
applicable collective bargaining contract, if any, whichever
is later. This section does not apply to policyholders or
subscribers eligible for coverage under Tit.XVIII of the
federal Social Security Act or any similar coverage under a
state or federal government plan.
3. For the purposes of this section, third-party payment or
prepayment includes an individual or group policy of accident
or health insurance or individual or group hospital or health
care service contract issued pursuant to chapter 509, 514, or
514A, an individual or group health maintenance organization
contract issued and regulated under chapter 514B, an organized
delivery system contract regulated under rules adopted by the
director of public health, or a preferred provider organization
contract regulated pursuant to chapter 514F.
4. Nothing in this section shall be interpreted to require
an individual or group health maintenance organization, an
organized delivery system, or a preferred provider organization
or arrangement to provide payment or prepayment for services
provided by a licensed physician assistant or licensed advanced
registered nurse practitioner unless the physician assistant’s
supervising physician, the physician-physician assistant team,
the advanced registered nurse practitioner, or the advanced
registered nurse practitioner’s collaborating physician has
entered into a contract or other agreement to provide services
with the individual or group health maintenance organization,
the organized delivery system, or the preferred provider
organization or arrangement.
Sec. 64. Section 514C.13, subsection 1, paragraph h, Code
2017, is amended by striking the paragraph.
-41- Sec. 65. Section 514C.13, subsection 2, Code 2017, is
amended to read as follows:
2. A carrier or organized delivery system which offers to
a small employer a limited provider network plan to provide
health care services or benefits to the small employer’s
employees shall also offer to the small employer a point of
service option to the limited provider network plan.
Sec. 66. Section 514C.13, subsection 3, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
A carrier or organized delivery system which offers to a
large employer a limited provider network plan to provide
health care services or benefits to the large employer’s
employees shall also offer to the large employer one or more
of the following:
Sec. 67. Section 514C.14, subsections 1 and 3, Code 2017,
are amended to read as follows:
1. Except as provided under subsection 2 or 3, a carrier,
as defined in section 513B.2, an organized delivery system
authorized under 1993 Iowa Acts, ch.158, or a plan established
pursuant to chapter 509A for public employees, which terminates
its contract with a participating health care provider,
shall continue to provide coverage under the contract to a
covered person in the second or third trimester of pregnancy
for continued care from such health care provider. Such
persons may continue to receive such treatment or care through
postpartum care related to the child birth and delivery.
Payment for covered benefits and benefit levels shall be
according to the terms and conditions of the contract.
3. A carrier, organized delivery system, or a plan
established under chapter 509A, which terminates the contract
of a participating health care provider for cause shall not
be liable to pay for health care services provided by the
health care provider to a covered person following the date of
termination.
Sec. 68. Section 514C.15, Code 2017, is amended to read as
-42-follows:
514C.15 Treatment options.
A carrier, as defined in section 513B.2,; an organized
delivery system authorized under 1993 Iowa Acts, ch.158,
and licensed by the director of public health; or a plan
established pursuant to chapter 509A for public employees,
shall not prohibit a participating provider from, or penalize a
participating provider for, doing either of the following:
1. Discussing treatment options with a covered individual,
notwithstanding the carrier’s, organized delivery system’s, or
plan’s position on such treatment option.
2. Advocating on behalf of a covered individual within
a review or grievance process established by the carrier,
organized delivery system, or chapter 509A plan, or established
by a person contracting with the carrier, organized delivery
system, or chapter 509A plan.
Sec. 69. Section 514C.16, subsection 1, Code 2017, is
amended to read as follows:
1. A carrier, as defined in section 513B.2,; an organized
delivery system authorized under 1993 Iowa Acts, ch.158,
and licensed by the director of public health; or a plan
established pursuant to chapter 509A for public employees,
which provides coverage for emergency services, is responsible
for charges for emergency services provided to a covered
individual, including services furnished outside any
contractual provider network or preferred provider network.
Coverage for emergency services is subject to the terms and
conditions of the health benefit plan or contract.
Sec. 70. Section 514C.17, subsections 1 and 3, Code 2017,
are amended to read as follows:
1. Except as provided under subsection 2 or 3, if a carrier,
as defined in section 513B.2, an organized delivery system
authorized under 1993 Iowa Acts, ch.158, or a plan established
pursuant to chapter 509A for public employees, terminates its
contract with a participating health care provider, a covered
-43-individual who is undergoing a specified course of treatment
for a terminal illness or a related condition, with the
recommendation of the covered individual’s treating physician
licensed under chapter 148 may continue to receive coverage for
treatment received from the covered individual’s physician for
the terminal illness or a related condition, for a period of
up to ninety days. Payment for covered benefits and benefit
levels shall be according to the terms and conditions of the
contract.
3. Notwithstanding subsections 1 and 2, a carrier,
organized delivery system, or a plan established under chapter
509A which terminates the contract of a participating health
care provider for cause shall not be required to cover health
care services provided by the health care provider to a covered
person following the date of termination.
Sec. 71. Section 514C.18, subsection 2, paragraph a,
subparagraph (6), Code 2017, is amended by striking the
subparagraph.
Sec. 72. Section 514C.19, subsection 7, paragraph a,
subparagraph (6), Code 2017, is amended by striking the
subparagraph.
Sec. 73. Section 514C.20, subsection 3, paragraph f, Code
2017, is amended by striking the paragraph.
Sec. 74. Section 514C.21, subsection 2, paragraph d, Code
2017, is amended by striking the paragraph.
Sec. 75. Section 514C.22, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
Notwithstanding the uniformity of treatment requirements of
section 514C.6, a group policy, contract, or plan providing
for third-party payment or prepayment of health, medical, and
surgical coverage benefits issued by a carrier, as defined in
section 513B.2, or by an organized delivery system authorized
under 1993 Iowa Acts, ch.158, shall provide coverage benefits
for treatment of a biologically based mental illness if either
of the following is satisfied:
-44- Sec. 76. Section 514C.22, subsection 6, Code 2017, is
amended to read as follows:
6. A carrier, organized delivery system, or plan
established pursuant to chapter 509A may manage the benefits
provided through common methods including, but not limited to,
providing payment of benefits or providing care and treatment
under a capitated payment system, prospective reimbursement
rate system, utilization control system, incentive system for
the use of least restrictive and least costly levels of care,
a preferred provider contract limiting choice of specific
providers, or any other system, method, or organization
designed to assure services are medically necessary and
clinically appropriate.
Sec. 77. Section 514C.25, subsection 2, paragraph a,
subparagraph (5), Code 2017, is amended by striking the
subparagraph.
Sec. 78. Section 514C.26, subsection 5, paragraph a,
subparagraph (6), Code 2017, is amended by striking the
subparagraph.
Sec. 79. Section 514C.27, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
Notwithstanding the uniformity of treatment requirements
of section 514C.6, a group policy or contract providing for
third-party payment or prepayment of health or medical expenses
issued by a carrier, as defined in section 513B.2, or by an
organized delivery system authorized under 1993 Iowa Acts, ch.
158, shall provide coverage benefits to an insured who is a
veteran for treatment of mental illness and substance abuse if
either of the following is satisfied:
Sec. 80. Section 514C.27, subsection 6, Code 2017, is
amended to read as follows:
6. A carrier, organized delivery system, or plan
established pursuant to chapter 509A may manage the benefits
provided through common methods including but not limited to
providing payment of benefits or providing care and treatment
-45-under a capitated payment system, prospective reimbursement
rate system, utilization control system, incentive system for
the use of least restrictive and least costly levels of care,
a preferred provider contract limiting choice of specific
providers, or any other system, method, or organization
designed to assure services are medically necessary and
clinically appropriate.
Sec. 81. Section 514C.29, subsection 2, paragraph e, Code
2017, is amended by striking the paragraph.
Sec. 82. Section 514C.30, subsection 2, paragraph e, Code
2017, is amended by striking the paragraph.
Sec. 83. Section 514E.1, subsection 6, paragraph k, Code
2017, is amended by striking the paragraph.
Sec. 84. Section 514E.1, subsection 17, Code 2017, is
amended by striking the subsection.
Sec. 85. Section 514E.2, subsection 1, paragraph a, Code
2017, is amended to read as follows:
a. All carriers and all organized delivery systems licensed
by the director of public health providing health insurance or
health care services in Iowa, whether on an individual or group
basis, and all other insurers designated by the association’s
board of directors and approved by the commissioner shall be
members of the association.
Sec. 86. Section 514E.2, subsection 2, paragraph a,
subparagraph (3), Code 2017, is amended to read as follows:
(3) Two members selected by the members of the association,
one of whom shall be a representative from a corporation
operating pursuant to chapter 514 on July 1, 1989, or
any successor in interest, and one of whom shall be a
representative of an organized delivery system or an insurer
providing coverage pursuant to chapter 509 or 514A.
Sec. 87. Section 514E.7, subsection 1, paragraph a,
subparagraphs (1) and (2), Code 2017, are amended to read as
follows:
(1) A notice of rejection or refusal to issue substantially
-46-similar insurance for health reasons by one carrier or
organized delivery system.
(2) A refusal by a carrier or organized delivery system to
issue insurance except at a rate exceeding the plan rate.
Sec. 88. Section 514E.7, subsection 1, paragraph b, Code
2017, is amended to read as follows:
b. A rejection or refusal by a carrier or organized delivery
system offering only stoploss, excess of loss, or reinsurance
coverage with respect to an applicant under paragraph “a”,
subparagraphs (1) and (2), is not sufficient evidence for
purposes of this subsection.
Sec. 89. Section 514E.9, Code 2017, is amended to read as
follows:
514E.9 Rules.
Pursuant to chapter 17A, the commissioner and the director
of public health shall adopt rules to provide for disclosure
by carriers and organized delivery systems of the availability
of insurance coverage from the association, and to otherwise
implement this chapter.
Sec. 90. Section 514E.11, Code 2017, is amended to read as
follows:
514E.11 Notice of association policy.
Every carrier, including a health maintenance organization
subject to chapter 514B and an organized delivery system,
authorized to provide health care insurance or coverage for
health care services in Iowa, shall provide a notice of the
availability of coverage by the association to any person
who receives a rejection of coverage for health insurance
or health care services, or a rate for health insurance or
coverage for health care services that will exceed the rate of
an association policy, and that person is eligible to apply
for health insurance provided by the association. Application
for the health insurance shall be on forms prescribed by the
association’s board of directors and made available to the
carriers and organized delivery systems and other entities
-47-providing health care insurance or coverage for health care
services regulated by the commissioner.
Sec. 91. Section 514F.5, Code 2017, is amended to read as
follows:
514F.5 Experimental treatment review.
1. A carrier, as defined in section 513B.2, an organized
delivery system authorized under 1993 Iowa Acts, ch.158, or a
plan established pursuant to chapter 509A for public employees,
that limits coverage for experimental medical treatment, drugs,
or devices, shall develop and implement a procedure to evaluate
experimental medical treatments and shall submit a description
of the procedure to the division of insurance. The procedure
shall be in writing and must describe the process used to
determine whether the carrier, organized delivery system,
or chapter 509A plan will provide coverage for new medical
technologies and new uses of existing technologies. The
procedure, at a minimum, shall require a review of information
from appropriate government regulatory agencies and published
scientific literature concerning new medical technologies, new
uses of existing technologies, and the use of external experts
in making decisions. A carrier, organized delivery system,
or chapter 509A plan shall include appropriately licensed
or qualified professionals in the evaluation process. The
procedure shall provide a process for a person covered under
a plan or contract to request a review of a denial of coverage
because the proposed treatment is experimental. A review of
a particular treatment need not be reviewed more than once a
year.
2. A carrier, organized delivery system, or chapter 509A
plan that limits coverage for experimental treatment, drugs, or
devices shall clearly disclose such limitations in a contract,
policy, or certificate of coverage.
Sec. 92. Section 514I.2, subsection 10, Code 2017, is
amended to read as follows:
10. “Participating insurer” means any entity licensed by the
-48-division of insurance of the department of commerce to provide
health insurance in Iowa or an organized delivery system
licensed by the director of public health that has contracted
with the department to provide health insurance coverage to
eligible children under this chapter.
Sec. 93. Section 514J.102, subsection 24, Code 2017, is
amended to read as follows:
24. “Health carrier” means an entity subject to the
insurance laws and regulations of this state, or subject
to the jurisdiction of the commissioner, including an
insurance company offering sickness and accident plans, a
health maintenance organization, a nonprofit health service
corporation, a plan established pursuant to chapter 509A
for public employees, or any other entity providing a plan
of health insurance, health care benefits, or health care
services. “Health carrier” includes, for purposes of this
chapter, an organized delivery system.
Sec. 94. Section 514J.102, subsection 29, Code 2017, is
amended by striking the subsection.
Sec. 95. Section 514K.1, subsection 1, unnumbered paragraph
1, Code 2017, is amended to read as follows:
A health maintenance organization, an organized delivery
system, or an insurer using a preferred provider arrangement
shall provide to each of its enrollees at the time of
enrollment, and shall make available to each prospective
enrollee upon request, written information as required by rules
adopted by the commissioner and the director of public health.
The information required by rule shall include, but not be
limited to, all of the following:
Sec. 96. Section 514K.1, subsection 2, Code 2017, is amended
to read as follows:
2. The commissioner and the director shall annually publish
a consumer guide providing a comparison by plan on performance
measures, network composition, and other key information to
enable consumers to better understand plan differences.
-49- Sec. 97. Section 514L.1, subsection 3, Code 2017, is amended
to read as follows:
3. “Provider of third-party payment or prepayment of
prescription drug expenses” or “provider” means a provider of an
individual or group policy of accident or health insurance or
an individual or group hospital or health care service contract
issued pursuant to chapter 509, 514, or 514A, a provider of a
plan established pursuant to chapter 509A for public employees,
a provider of an individual or group health maintenance
organization contract issued and regulated under chapter 514B,
a provider of an organized delivery system contract regulated
under rules adopted by the director of public health, a
provider of a preferred provider contract issued pursuant to
chapter 514F, a provider of a self-insured multiple employer
welfare arrangement, and any other entity providing health
insurance or health benefits which provide for payment or
prepayment of prescription drug expenses coverage subject to
state insurance regulation.
Sec. 98. Section 514L.2, subsection 1, paragraph a,
unnumbered paragraph 1, Code 2017, is amended to read as
follows:
A provider of third-party payment or prepayment of
prescription drug expenses, including the provider’s agents or
contractors and pharmacy benefits managers, that issues a card
or other technology for claims processing and an administrator
of the payor, excluding administrators of self-funded employer
sponsored health benefit plans qualified under the federal
Employee Retirement Income Security Act of 1974, shall issue
to its insureds a card or other technology containing uniform
prescription drug information. The commissioner of insurance
shall adopt rules for the uniform prescription drug information
card or technology applicable to those entities subject to
regulation by the commissioner of insurance. The director of
public health shall adopt rules for the uniform prescription
drug information card or technology applicable to organized
-50-delivery systems. The rules shall require at least both of the
following regarding the card or technology:
Sec. 99. Section 521F.2, subsection 7, Code 2017, is amended
to read as follows:
7. “Health organization” means a health maintenance
organization, limited service organization, dental or vision
plan, hospital, medical and dental indemnity or service
corporation or other managed care organization licensed under
chapter 514, or 514B, or 1993 Iowa Acts, ch.158, or any other
entity engaged in the business of insurance, risk transfer,
or risk retention, that is subject to the jurisdiction of the
commissioner of insurance or the director of public health.
“Health organization” does not include an insurance company
licensed to transact the business of insurance under chapter
508, 515, or 520, and which is otherwise subject to chapter
521E.
Sec. 100. 1993 Iowa Acts, chapter 158, section 4, is amended
to read as follows:
SEC. 4. EMERGENCY RULES. Pursuant to sections 1, and 2, and
3 of this Act, the commissioner of insurance or the director of
public health shall adopt administrative rules under section
17A.4, subsection 2, and section 17A.5, subsection 2, paragraph
“b”, to implement the provisions of this Act and the rules
shall become effective immediately upon filing, unless a later
effective date is specified in the rules. Any rules adopted in
accordance with the provisions of this section shall also be
published as notice of intended action as provided in section
17A.4.
Sec. 101. REPEAL. Section 135.120, Code 2017, is repealed.
Sec. 102. REPEAL. 1993 Iowa Acts, chapter 158, section 3,
is repealed.
Sec. 103. CODE EDITOR’S DIRECTIVE. The Code editor shall
correct and eliminate any references to the term “organized
delivery system” or other forms of the term anywhere else in
the Iowa Code or Iowa Code Supplement, in any bills awaiting
-51-codification, in this Act, and in any bills enacted by the
Eighty-seventh General Assembly, 2017 Regular Session, or any
extraordinary session.
DIVISION VIII
HEALTH DATA
Sec. 104. Section 135.166, Code 2017, is amended to read as
follows:
135.166 Health care data — collection and use — collection
from hospitals.
1. a. The department of public health shall enter into
a memorandum of understanding to utilize the Iowa hospital
association to act as the department’s intermediary in
collecting, maintaining, and disseminating hospital inpatient,
outpatient, and ambulatory information data, as initially
authorized in 1996 Iowa Acts, ch.1212, §5, subsection 1,
paragraph “a”, subparagraph (4), and 641 IAC 177.3.
2. b. The memorandum of understanding shall include but
is not limited to provisions that address the duties of the
department and the Iowa hospital association regarding the
collection, reporting, disclosure, storage, and confidentiality
of the data.
2. Unless otherwise authorized or required by state or
federal law, data collected under this section shall not
include the social security number of the individual subject
of the data.
DIVISION IX
BIRTH CERTIFICATES
Sec. 105. Section 144.13A, subsections 1 and 2, Code 2017,
are amended to read as follows:
1. The state registrar shall charge the parent a fee of
twenty dollars for the registration of a certificate of birth
as follows:.
a. Beginning July 1, 2003, and ending June 30, 2005, a fee
of fifteen dollars.
b. Beginning July 1, 2005, a fee of twenty dollars.
-52- 2. The state registrar shall charge the parent a separate
fee established under section 144.46 for a certified copy of
the certificate. The certified copy shall include all of the
information included in the original certificate of birth and
shall be letter-sized. The certified copy shall be mailed to
the parent by the state registrar. The mailing of a certified
copy of the certificate to a biological parent shall not be
precluded by the execution of a release of custody under
chapter 600A, and, upon request, a biological parent shall be
provided with a certified copy of the certificate unless the
parental rights of the biological parent are terminated.
Sec. 106. Section 144.13A, Code 2017, is amended by adding
the following new subsection:
NEW SUBSECTION. 2A. a. If, during the period between
May 1993 and October 2009, a parent was issued a smaller than
letter-sized certified copy of the certificate of birth under
this section, which did not include all of the information
included in the original certificate of birth, upon request
of a parent, the state registrar shall issue to the parent a
single letter-sized certified copy replacement that includes
all of the information provided in the original certificate of
birth. A parent shall not be required to exchange the smaller
certified copy for the larger certified copy replacement, but
may retain the smaller certified copy.
b. Notwithstanding the amount of the fee charged under
subsection 2, the state registrar shall not charge a fee
for the issuance of a single letter-sized certified copy of
the certificate of birth requested by a parent under this
subsection.
c. This subsection shall not apply if a new certificate of
birth was substituted for the original certificate of birth
pursuant to section 144.24.
d. The department shall post the application form and
instructions for requesting a letter-sized certified copy
replacement as specified in this subsection on the department’s
-53-internet site. This paragraph is repealed June 30, 2022.
-54-______________________________
LINDA UPMEYERSpeaker of the House______________________________
JACK WHITVERPresident of the Senate I hereby certify that this bill originated in the House and is known as House File 393, Eighty-seventh General Assembly.______________________________
CARMINE BOALChief Clerk of the HouseApproved _______________, 2017______________________________
TERRY E. BRANSTADGovernorpf/nh/md