House File 687 - Introduced
HOUSE FILE 687
BY PRICHARD, McCONKEY,
COHOON, KURTH, JAMES, B.
MEYER, KONFRST, SUNDE,
HALL, HUNTER, JUDGE,
ANDERSON, GJERDE, BOHANNAN,
WILBURN, WESSEL-KROESCHELL,
WILLIAMS, OLSON, MASCHER,
JACOBY, CAHILL, EHLERT,
WINCKLER, STAED, OLDSON,
BROWN-POWERS, THEDE,
DONAHUE, FORBES, BENNETT,
WOLFE, and STECKMAN
A BILL FOR
1 An Act related to health insurance coverage for the assessment
2 or diagnosis of a health condition, illness, or disease
3 related to COVID-19, and for the administration of COVID-19
4 vaccines, and including effective date and retroactive
5 applicability provisions.
6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 Section 1. NEW SECTION. 514C.36 COVID-19 —— coverage.
2 1. As used in this section, unless the context otherwise
3 requires:
4 a. “Commissioner” means the commissioner of insurance.
5 b. “Cost-sharing” means any coverage limit, copayment,
6 coinsurance, deductible, or other out-of-pocket expense
7 obligation imposed on a covered person by a policy, contract,
8 or plan providing for third-party payment or prepayment of
9 health or medical expenses.
10 c. “Covered person” means a policyholder, subscriber, or
11 other individual participating in a policy, contract, or plan
12 providing for third-party payment or prepayment of health or
13 medical expenses.
14 d. “COVID-19” means a severe acute respiratory syndrome
15 coronavirus 2 or the disease caused by severe acute respiratory
16 syndrome coronavirus 2.
17 e. “Facility” means the same as defined in section 514J.102.
18 f. “Health care professional” means the same as defined in
19 section 514J.102.
20 g. “Health care provider” means a health care professional
21 or a facility.
22 h. “Health care services” means services for the assessment
23 or diagnosis of a health condition, illness, or disease related
24 to COVID-19.
25 i. “Vaccines” means any vaccine for COVID-19 licensed by
26 the United States food and drug administration, or for which
27 the United States food and drug administration has issued an
28 emergency use authorization, and that is administered pursuant
29 to guidance issued by federal, state, or county public health
30 officials.
31 2. Notwithstanding the uniformity of treatment requirements
32 of section 514C.6, a policy, contract, or plan that provides
33 for third-party payment or prepayment of health or medical
34 expenses shall comply with the following requirements:
35 a. Waive all cost-sharing requirements for health care
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1 services recommended by a covered person’s health care
2 provider.
3 b. Waive all costs, including administration fees and
4 cost-sharing requirements, for the administration of vaccines.
5 c. Waive prior authorization requirements for all health
6 care services recommended by a covered person’s health care
7 provider, and for the administration of vaccines.
8 d. Waive all requirements mandating a covered person receive
9 health care services or vaccines from an in-network health care
10 provider if the policy, contract, or plan is unable to provide
11 timely and reasonable in-network access to health care services
12 recommended by a covered person’s health care provider, or to
13 vaccines.
14 3. Notwithstanding the uniformity of treatment requirements
15 of section 514C.6, a policy, contract, or plan that provides
16 for third-party payment or prepayment of health or medical
17 expenses shall not retroactively deny reimbursement to a health
18 care provider that provided health care services or that
19 administered a vaccine to a covered person, based on any of the
20 following:
21 a. The health care provider’s network status.
22 b. The covered person receiving a diagnosis other than a
23 diagnosis related to COVID-19.
24 4. All requirements pursuant to subsections 2 and 3 shall
25 be communicated in writing in a policy, contract, or plan that
26 provides for third-party payment or prepayment of health or
27 medical expenses to all covered persons and to all health care
28 providers that are contracted with the policy, contract, or
29 plan.
30 5. This section applies to the following classes of
31 third-party payment provider policies, contracts, or plans:
32 a. Individual or group accident and sickness insurance
33 providing coverage on an expense-incurred basis.
34 b. An individual or group hospital or medical service
35 contract issued pursuant to chapter 509, 514, or 514A.
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1 c. An individual or group health maintenance organization
2 contract regulated under chapter 514B.
3 d. A plan established pursuant to chapter 509A for public
4 employees.
5 e. The medical assistance program established pursuant to
6 chapter 249A, including a managed care organization acting
7 pursuant to a contract with the department of human services to
8 provide coverage to medical assistance program members.
9 6. This section shall not apply to accident-only,
10 specified disease, short-term hospital or medical, hospital
11 confinement indemnity, credit, dental, vision, Medicare
12 supplement, long-term care, basic hospital and medical-surgical
13 expense coverage as defined by the commissioner, disability
14 income insurance coverage, coverage issued as a supplement
15 to liability insurance, workers’ compensation or similar
16 insurance, or automobile medical payment insurance.
17 7. The commissioner shall adopt rules pursuant to chapter
18 17A to administer this section. Such rules shall include
19 the requirement that all policies, contracts, or plans that
20 provide for third-party payment or prepayment of health or
21 medical expenses adopt a uniform system of billing that allows
22 health care providers to timely process billing codes related
23 to health care services and vaccines provided pursuant to this
24 section.
25 Sec. 2. EMERGENCY RULES. The commissioner may adopt
26 emergency rules under section 17A.4, subsection 3, and section
27 17A.5, subsection 2, paragraph “b”, to implement this Act and
28 the rules shall be effective immediately upon filing unless
29 a later date is specified in the rules. Any rules adopted
30 in accordance with this section shall also be published as a
31 notice of intended action as provided in section 17A.4.
32 Sec. 3. EFFECTIVE DATE. This Act, being deemed of immediate
33 importance, takes effect upon enactment.
34 Sec. 4. RETROACTIVE APPLICABILITY. This Act applies
35 retroactively to January 1, 2020, for policies, contracts, or
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1 plans that are delivered, issued for delivery, continued, or
2 renewed in this state on or after that date.
3 EXPLANATION
4 The inclusion of this explanation does not constitute agreement with
5 the explanation’s substance by the members of the general assembly.
6 This bill relates to health insurance coverage for the
7 assessment or diagnosis of a health condition, illness, or
8 disease related to COVID-19, and for the administration of
9 COVID-19 vaccines.
10 The bill requires policies, contracts, and plans (plans)
11 that provide for third-party payment or prepayment of health
12 or medical expenses to waive all cost-sharing requirements
13 and prior authorization requirements for health care services
14 recommended by a covered person’s health care provider. The
15 plans must also waive all costs, including administration
16 fees and cost-sharing requirements, for the administration of
17 vaccines. “Vaccines” is defined in the bill as any vaccine
18 for COVID-19 licensed by the United States food and drug
19 administration, or for which the United States food and drug
20 administration has issued an emergency use authorization, and
21 that is administered pursuant to guidance issued by federal,
22 state, or county public health officials. In addition, the
23 plans must waive all requirements mandating that a covered
24 person receive health care services in-network if the plan
25 is unable to provide timely and reasonable in-network access
26 to health care services recommended by the covered person’s
27 health care provider, or to vaccines. “Health care services”
28 is defined in the bill as services for the assessment or
29 diagnosis of a health condition, illness, or disease related to
30 COVID-19. The bill prohibits plans from retroactively denying
31 reimbursement, based on a health care provider’s network
32 status or a covered person receiving a diagnosis other than a
33 diagnosis related to COVID-19, to a health care provider that
34 provided health care services or vaccines to a covered person.
35 The bill requires plans to communicate these requirements in
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1 writing to all covered persons and to all health care providers
2 that are contracted with the plan.
3 The bill specifies the types of specialized health-related
4 insurance that are not subject to the bill. The commissioner
5 of insurance is required to adopt rules to administer the bill
6 and the rules must include the requirement that all plans adopt
7 a uniform system of billing that allows health care providers
8 to timely process billing codes related to health care services
9 provided to covered persons. The commissioner may also adopt
10 emergency rules as outlined in the bill.
11 The bill takes effect upon enactment and applies
12 retroactively to plans that are delivered, issued for delivery,
13 continued, or renewed in this state on or after January 1,
14 2020, by the third-party payment providers enumerated in the
15 bill.
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