Bill Text: IA SF2107 | 2011-2012 | 84th General Assembly | Introduced
Bill Title: A bill for an act requiring acceptance of universal health care practitioner credentialing application forms by certain credentialing entities.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-02-01 - Introduced, referred to Commerce. S.J. 163. [SF2107 Detail]
Download: Iowa-2011-SF2107-Introduced.html
Senate
File
2107
-
Introduced
SENATE
FILE
2107
BY
DOTZLER
(COMPANION
TO
LSB
5784HH
BY
LOFGREN)
A
BILL
FOR
An
Act
requiring
acceptance
of
universal
health
care
1
practitioner
credentialing
application
forms
by
certain
2
credentialing
entities.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
TLSB
5784XS
(4)
84
av/nh
S.F.
2107
Section
1.
Section
514F.6,
Code
2011,
is
amended
by
adding
1
the
following
new
subsection:
2
NEW
SUBSECTION
.
01.
a.
A
health
insurer,
hospital,
or
3
other
entity
that
credentials
physicians,
advanced
registered
4
nurse
practitioners,
physician
assistants,
or
other
health
5
care
practitioners,
shall
accept
the
Iowa
statewide
universal
6
practitioner
credentialing
application
forms
developed
and
7
maintained
by
the
Iowa
credentialing
coalition
when
submitted
8
by
a
physician,
advanced
registered
nurse
practitioner,
9
physician
assistant,
or
any
other
health
care
practitioner
10
applicant
required
to
be
credentialed
by
the
credentialing
11
entity.
12
b.
A
health
insurer,
hospital,
or
other
credentialing
13
entity
is
not
required
to
use
the
Iowa
statewide
universal
14
practitioner
credentialing
application
forms
exclusively,
and
15
in
accepting
the
universal
application
forms
as
required
by
16
this
subsection,
is
not
precluded
from
requesting
additional
17
information
from
the
applicant
necessary
to
complete
the
18
credentialing
process
consistent
with
information
required
by
19
the
credentialing
entity’s
own
forms.
20
Sec.
2.
Section
514F.6,
subsection
1,
Code
2011,
is
amended
21
to
read
as
follows:
22
1.
The
commissioner
shall
adopt
rules
to
provide
for
23
the
retrospective
payment
of
clean
claims
for
covered
24
services
provided
by
a
physician,
advanced
registered
nurse
25
practitioner,
or
physician
assistant
,
or
other
health
care
26
practitioner,
during
the
credentialing
period,
once
the
27
physician,
advanced
registered
nurse
practitioner,
or
physician
28
assistant
,
or
other
health
care
practitioner
is
credentialed.
29
Sec.
3.
Section
514F.6,
subsection
2,
Code
2011,
is
amended
30
by
striking
the
subsection
and
inserting
in
lieu
thereof
the
31
following:
32
2.
As
used
in
this
section,
unless
the
context
otherwise
33
requires:
34
a.
“Advanced
registered
nurse
practitioner”
means
a
licensed
35
-1-
LSB
5784XS
(4)
84
av/nh
1/
3
S.F.
2107
nurse
who
is
also
registered
to
practice
in
an
advanced
role.
1
b.
“Clean
claim”
means
the
same
as
defined
in
section
2
507B.4A,
subsection
2,
paragraph
“b”
.
3
c.
“Credentialing”
means
a
process
through
which
a
4
credentialing
entity
makes
a
determination
based
on
criteria
5
established
by
the
credentialing
entity
concerning
whether
a
6
physician,
advanced
registered
nurse
practitioner,
physician
7
assistant,
or
other
health
care
practitioner
is
eligible
to
8
provide
health
care
services
to
a
patient
and
to
receive
9
reimbursement
for
the
health
care
services
provided
under
10
an
agreement
entered
into
between
the
physician,
advanced
11
registered
nurse
practitioner,
physician
assistant,
or
other
12
health
care
practitioner,
and
the
credentialing
entity.
13
d.
“Credentialing
period”
means
the
time
period
between
14
the
credentialing
entity’s
receipt
of
a
physician’s,
advanced
15
registered
nurse
practitioner’s,
physician
assistant’s,
or
16
other
health
care
practitioner’s
application
for
credentialing
17
and
approval
of
that
application
by
the
credentialing
entity.
18
e.
“Health
insurer”
means
a
carrier,
as
defined
in
section
19
513B.2.
20
f.
“Hospital”
means
the
same
as
defined
in
section
135B.1.
21
g.
“Physician”
means
a
licensed
doctor
of
medicine
and
22
surgery
or
a
licensed
doctor
of
osteopathic
medicine
and
23
surgery.
24
h.
“Physician
assistant”
means
a
person
who
is
licensed
to
25
practice
as
a
physician
assistant
under
the
supervision
of
one
26
or
more
physicians.
27
EXPLANATION
28
This
bill
amends
Code
section
514F.6
to
require
a
health
29
insurer,
hospital,
or
other
entity
that
credentials
physicians,
30
advanced
registered
nurse
practitioners,
physician
assistants,
31
or
other
health
care
practitioners
to
accept
the
Iowa
32
statewide
universal
practitioner
credentialing
application
33
forms
developed
and
maintained
by
the
Iowa
credentialing
34
coalition.
A
credentialing
entity
is
not
required
to
use
the
35
-2-
LSB
5784XS
(4)
84
av/nh
2/
3
S.F.
2107
universal
credentialing
forms
exclusively
and
can
request
1
additional
information
from
applicants
necessary
to
complete
2
the
credentialing
process
consistent
with
information
required
3
by
the
credentialing
entity’s
own
forms.
4
The
bill
also
changes
the
definition
of
“credentialing”
5
to
include
a
process
utilized
by
any
entity,
not
just
health
6
insurers,
that
credentials
physicians,
advanced
registered
7
nurse
practitioners,
physician
assistants,
or
other
health
8
care
practitioners.
Corresponding
changes
are
made
in
other
9
definitions.
“Credentialing”
is
now
defined
as
a
process
10
through
which
a
credentialing
entity
makes
a
determination
11
based
on
criteria
established
by
the
credentialing
entity
12
concerning
whether
a
physician,
advanced
registered
nurse
13
practitioner,
physician
assistant,
or
other
health
care
14
practitioner
is
eligible
to
provide
health
care
services
to
15
a
patient
and
to
receive
reimbursement
for
the
health
care
16
services
provided
under
an
agreement
entered
into
between
17
the
physician,
advanced
registered
nurse
practitioner,
18
physician
assistant,
or
other
health
care
practitioner,
and
the
19
credentialing
entity.
20
The
bill
also
adds
definitions
of
“health
insurer”
and
21
“hospital”
and
reorganizes
all
the
definitions
in
the
Code
22
section
so
that
they
are
in
alphabetical
order.
23
-3-
LSB
5784XS
(4)
84
av/nh
3/
3
