House File 2356 - Enrolled
HOUSE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO HF 2275)
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A BILL FOR
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House File 2356
AN ACT
RELATING TO AGREEMENTS BETWEEN INDIVIDUALS AND HEALTH
CARE PROFESSIONALS FOR THE PROVISION OF CERTAIN PRIMARY CARE
HEALTH SERVICES FOR A SERVICE CHARGE THAT COVERS AN AGREED
UPON PERIOD OF TIME.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. NEW SECTION. 135N.1 Direct primary care
agreements.
1. Definitions. For the purpose of this section:
a. "Direct patient" means an individual, or an individual
and the individual's immediate family, that is party to a
direct primary care agreement.
b. "Direct patient's representative" means a parent,
guardian, or an individual holding a durable power of attorney
for health care for a direct patient.
c. "Direct primary care agreement" means an agreement
between a direct provider and a direct patient, or the direct
patient's representative, in which the direct provider agrees
to provide primary care health services for a specified period
of time to the direct patient for a direct service charge.
d. "Direct provider" means a health care professional
licensed, accredited, registered, or certified to perform
specified primary care health services consistent with the law
of this state. "Direct provider" includes an individual health
care professional or other legal health care entity alone or
with other health care professionals professionally associated
with the individual health care professional or other legal
health care entity.
e. "Direct service charge" means a charge for primary care
health services provided by a direct provider to a direct
patient covered by a direct primary care agreement. "Direct
service charge" may include a periodic retainer, a membership
fee, a subscription fee, or a charge in any other form paid by
a direct patient to a direct provider under a direct primary
care agreement.
f. "Durable power of attorney for health care" means the same
as defined in section 144B.1.
g. "Primary care health services" means general health care
services of the type provided at the time a patient seeks
preventive care or first seeks health care services for a
specific health concern. "Primary care health services" include
all of the following:
(1) Care which promotes and maintains mental and physical
health and wellness.
(2) Care which prevents disease.
(3) Screening, diagnosing, and treatment of acute or
chronic conditions caused by disease, injury, or illness.
(4) Patient counseling and education.
(5) Provision of a broad spectrum of preventive and curative
health care over a period of time.
(6) Coordination of care.
2. Requirements for a valid direct primary care agreement.
a. In order to be a valid agreement, a direct primary care
agreement must meet all of the following requirements:
(1) Be in writing.
(2) Be signed by the direct provider, or an agent of the
direct provider, and the direct patient or the direct patient's
representative.
(3) Describe the scope of the primary care health services
covered by the direct primary care agreement.
(4) State each of the direct provider's locations where
a direct patient may obtain primary care health services and
specify any out=of=office primary care health services that are
covered under the direct primary care agreement.
(5) Specify the direct service charge and the frequency
at which the direct service charge must be paid by the direct
patient. A direct patient shall not be required to pay more
than twelve months of a direct service charge in advance.
(6) Specify any additional costs for primary care health
services not covered by the direct service charge for which the
direct patient will be responsible.
(7) Specify the duration of the direct primary care
agreement, whether renewal is automatic, and if required the
procedure for renewal of the direct primary care agreement.
(8) Specify the terms and conditions under which the
direct primary care agreement may be terminated by the
direct provider. A termination of the direct primary care
agreement by the direct provider shall include a minimum of
a thirty=calendar=day advance, written notice to the direct
patient or to the direct patient's representative.
(9) Specify that the direct primary care agreement may
be terminated at any time by the direct patient upon written
notice to the direct provider.
(10) State that if the direct primary care agreement is
terminated by either the direct patient or the direct provider
all of the following apply:
(a) Within thirty calendar days of the date of the notice of
termination from either party, the direct provider shall refund
all unearned direct service charges to the direct patient.
(b) Within thirty calendar days of the date of the notice
of termination from either party, the direct patient shall pay
all outstanding earned direct service charges to the direct
provider.
(11) Include a notice in bold, twelve=point font that states
substantially as follows:
NOTICE. This direct primary care agreement is not health
insurance and is not a plan that provides health coverage
for purposes of any federal mandates. This direct primary
care agreement only covers the primary care health services
described in this agreement. It is recommended that you obtain
health insurance to cover health care services not covered
under this direct primary care agreement. You are personally
responsible for the payment of any additional health care
expenses you may incur.
b. The direct provider shall provide the direct patient, or
the direct patient's representative, with a fully executed copy
of the direct primary care agreement at the time the direct
primary care agreement is executed.
3. Application for a direct primary care agreement. If
a direct provider requires a prospective direct patient to
complete an application for a direct primary care agreement,
the direct provider shall provide a written disclaimer on each
application that informs the prospective direct patient of the
direct patient's financial rights and responsibilities and
that states that the direct provider will not bill a health
insurance carrier for primary care health services covered
under the direct primary care agreement. The disclaimer shall
also include the identical notice required by subsection 2,
paragraph "a", subparagraph (11).
4. Notice required for changes to the terms or conditions of
a direct primary care agreement.
a. A direct provider shall provide at least a
sixty=calendar=day advance, written notice to a direct patient
of any of the following changes to a direct primary care
agreement:
(1) Any change in the scope of the primary care health
services covered under the agreement.
(2) Any change in the direct provider's locations where the
direct patient may access primary care health services.
(3) Any change in the out=of=office services that are
covered under the direct primary care service agreement.
(4) Any change in the direct service charge.
(5) Any change in the additional costs for primary care
health services not covered by the direct service charge.
(6) Any change in the renewal terms.
(7) Any change in the terms to terminate the agreement.
b. A direct provider shall provide the notice by mailing
a letter to the address of the direct patient that the direct
provider has on file. The postmark date on the letter shall be
the first day of the required sixty=calendar=day notice period.
5. Discrimination based on an individual's health status. A
direct provider shall not refuse to accept a new direct patient
or discontinue care of an existing direct patient based solely
on the new direct patient's or the existing direct patient's
health status.
6. A direct primary care agreement is not insurance.
a. A direct primary care agreement is not insurance and
shall not be subject to the authority of the commissioner of
insurance. Neither a direct care provider, nor an agent of
a direct care provider, shall be required to be licensed by
the commissioner to transact the business of insurance in this
state or to obtain a certificate issued by the commissioner to
market or offer a direct primary care agreement.
b. A direct provider shall not bill an insurer for a service
provided under a direct primary care agreement. A direct
patient may submit a request for reimbursement to an insurer if
permitted under the direct patient's policy of insurance. This
paragraph does not prohibit a direct provider from billing a
direct patient's insurance for a service provided to the direct
patient by the direct provider that is not provided under the
direct primary care agreement.
7. Third=party payment of a direct service charge. A direct
provider may accept payment of a direct service charge for
a direct patient either directly or indirectly from a third
party. A direct provider may accept all or part of a direct
service charge paid by an employer on behalf of an employee who
is a direct patient of the direct provider. A direct provider
shall not enter directly into an agreement with an employer
relating to a direct primary care agreement between the direct
provider and employees of the employer, other than an agreement
to establish the timing and method of the payment of a direct
service charge paid by the employer on behalf of the employee.
8. Sale or transfer of a direct primary care agreement. A
direct primary care agreement shall not be sold or transferred
by a direct care provider without the prior written consent
of the direct patient who is a party to the direct primary
care agreement. A direct patient shall not sell or transfer a
direct primary care agreement to which the direct patient is a
party.
LINDA UPMEYER
CHARLES SCHNEIDE
CARMINE BOAL
KIM REYNOLDS
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