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