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 TLSB 1684YH (5) 89 ko/rn
H.F. 687 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 35 -1- LSB 1684YH (5) 89 ko/rn 1/ 5
H.F. 687 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. 35 -2- LSB 1684YH (5) 89 ko/rn 2/ 5
H.F. 687 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 35 -3- LSB 1684YH (5) 89 ko/rn 3/ 5
H.F. 687 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 35 -4- LSB 1684YH (5) 89 ko/rn 4/ 5
H.F. 687 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. 15 -5- LSB 1684YH (5) 89 ko/rn 5/ 5