Bill Text: IA SF2276 | 2021-2022 | 89th General Assembly | Introduced


Bill Title: A bill for an act relating to direct health care agreements, and including effective date and applicability provisions.(Formerly SSB 3071.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2022-03-22 - Withdrawn. S.J. 583. [SF2276 Detail]

Download: Iowa-2021-SF2276-Introduced.html
Senate File 2276 - Introduced SENATE FILE 2276 BY COMMITTEE ON COMMERCE (SUCCESSOR TO SSB 3071) A BILL FOR An Act relating to direct health care agreements, and including 1 effective date and applicability provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5827SV (1) 89 ko/rn
S.F. 2276 Section 1. Section 135N.1, Code 2022, is amended by striking 1 the section and inserting in lieu thereof the following: 2 135N.1 Direct health care agreements. 3 1. Definitions. For the purpose of this section: 4 a. “Direct health care agreement” means an agreement between 5 a provider and a patient, or the patient’s representative, in 6 which the provider agrees to provide health care services for a 7 specified period of time to the patient for a service charge. 8 b. “Durable power of attorney for health care” means the same 9 as defined in section 144B.1. 10 c. “Health care services” means services for the diagnosis, 11 prevention, treatment, cure, or relief of a health condition, 12 illness, injury, or disease. “Health care services” includes 13 dental care services. 14 d. “Patient” means an individual, or an individual and the 15 individual’s immediate family, that is a party to a direct 16 health care agreement. 17 e. “Patient’s representative” means a parent, guardian, or 18 an individual holding a durable power of attorney for health 19 care for a patient. 20 f. “Provider” means a health care professional licensed, 21 accredited, registered, or certified to perform health care 22 services consistent with the laws of this state. “Provider” 23 includes an individual health care professional or other 24 legal health care entity alone or with other health care 25 professionals professionally associated with the individual 26 health care professional or other legal health care entity. 27 g. “Service charge” means a charge for health care services 28 provided by a provider to a patient covered by a direct health 29 care agreement. “Service charge” may include a periodic 30 retainer, a membership fee, a subscription fee, or a charge in 31 any other form paid by a patient to a provider under a direct 32 health care agreement. 33 2. Requirements for a valid direct health care agreement. 34 a. In order to be a valid agreement, a direct health care 35 -1- LSB 5827SV (1) 89 ko/rn 1/ 6
S.F. 2276 agreement must meet all of the following requirements: 1 (1) Be in writing. 2 (2) Be signed by the provider, or an agent of the provider, 3 and the patient or the patient’s representative. 4 (3) Describe the scope of the health care services covered 5 by the direct health care agreement. 6 (4) State each of the provider’s locations where a patient 7 may obtain health care services and specify any out-of-office 8 health care services that are covered under the direct health 9 care agreement. 10 (5) Specify the service charge and the frequency at which 11 the service charge must be paid by the patient. A patient 12 shall not be required to pay more than twelve months of a 13 service charge in advance. 14 (6) Specify any additional costs for health care services 15 not covered by the service charge for which the patient will 16 be responsible. 17 (7) Specify the duration of the direct health care 18 agreement, whether renewal is automatic, and if required, the 19 procedure for renewal. 20 (8) Specify the terms and conditions under which the direct 21 health care agreement may be terminated by the provider. 22 A termination of the direct health care agreement by the 23 provider shall include a minimum of a thirty-calendar-day 24 advance, written notice to the patient or to the patient’s 25 representative. 26 (9) Specify that the direct health care agreement may be 27 terminated at any time by the patient upon written notice to 28 the provider. 29 (10) State that if the direct health care agreement is 30 terminated by either the patient or the provider all of the 31 following apply: 32 (a) Within thirty calendar days of the date of the notice of 33 termination from either party, the provider shall refund all 34 unearned service charges to the patient. 35 -2- LSB 5827SV (1) 89 ko/rn 2/ 6
S.F. 2276 (b) Within thirty calendar days of the date of the notice 1 of termination from either party, the patient shall pay all 2 outstanding earned service charges to the provider. 3 (11) Include a notice in bold, twelve-point type that states 4 substantially as follows: 5 NOTICE. This direct health care agreement is not health 6 insurance and is not a plan that provides health coverage for 7 purposes of any federal mandates. This direct health care 8 agreement only covers the health care services described in 9 this agreement. It is recommended that you obtain health 10 insurance to cover health care services not covered under this 11 direct health care agreement. You are personally responsible 12 for the payment of any additional health care expenses you may 13 incur. 14 b. The provider shall provide the patient, or the patient’s 15 representative, with a fully executed copy of the direct health 16 care agreement at the time the direct health care agreement is 17 executed. 18 3. Application for a direct health care agreement. If 19 a provider requires a prospective patient to complete an 20 application for a direct health care agreement, the provider 21 shall provide a written disclaimer on each application that 22 informs the prospective patient of the patient’s financial 23 rights and responsibilities and that states that the provider 24 will not bill a health insurance carrier for health care 25 services covered under the direct health care agreement. The 26 disclaimer shall also include the identical notice required by 27 subsection 2, paragraph “a” , subparagraph (11). 28 4. Notice required for changes to the terms or conditions of 29 a direct health care agreement. 30 a. A provider shall provide at least a sixty-calendar-day 31 advance, written notice to a patient of any of the following 32 changes to a direct health care agreement: 33 (1) Any change in the scope of the health care services 34 covered under the agreement. 35 -3- LSB 5827SV (1) 89 ko/rn 3/ 6
S.F. 2276 (2) Any change in the provider’s locations where the patient 1 may access health care services. 2 (3) Any change in the out-of-office services that are 3 covered under the direct health care service agreement. 4 (4) Any change in the service charge. 5 (5) Any change in the additional costs for health care 6 services not covered by the service charge. 7 (6) Any change in the renewal terms. 8 (7) Any change in the terms to terminate the agreement. 9 b. A provider shall provide the notice by mailing a letter 10 to the last known address of the patient that the provider has 11 on file. The postmark date on the letter shall be the first day 12 of the required sixty-calendar-day notice period. 13 5. Discrimination based on an individual’s health status. A 14 provider shall not refuse to accept a new patient or 15 discontinue care of an existing patient based solely on the new 16 patient’s or the existing patient’s health status. 17 6. A direct health care agreement is not insurance. 18 a. A direct health care agreement shall be deemed to not 19 be insurance and shall not be subject to the authority of the 20 commissioner of insurance. Neither a provider or an agent of a 21 provider shall be required to be licensed by the commissioner 22 to transact the business of insurance in this state, or to 23 obtain a certificate issued by the commissioner to market or 24 offer a direct health care agreement. 25 b. A provider shall not bill an insurer for a health care 26 service provided under a direct health care agreement. A 27 patient may submit a request for reimbursement to an insurer 28 if permitted under the patient’s policy of insurance. This 29 paragraph does not prohibit a provider from billing a patient’s 30 insurance for a health care service provided to the patient by 31 the provider that is not covered under the direct health care 32 agreement. 33 7. Third-party payment of a service charge. A provider 34 may accept payment of a service charge for a patient either 35 -4- LSB 5827SV (1) 89 ko/rn 4/ 6
S.F. 2276 directly or indirectly from a third party. A provider may 1 accept all or part of a service charge paid by an employer 2 on behalf of an employee who is a patient of the provider. 3 A provider shall not enter directly into an agreement with 4 an employer relating to a health care agreement between the 5 provider and employees of the employer, other than an agreement 6 to establish the timing and method of the payment of a service 7 charge paid by the employer on behalf of the employee. 8 8. Sale or transfer of a direct health care agreement. A 9 direct health care agreement shall not be sold or transferred 10 by a provider without the prior written consent of the patient 11 who is a party to the direct health care agreement. A patient 12 shall not sell or transfer a direct health care agreement to 13 which the patient is a party. 14 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 15 importance, takes effect upon enactment. 16 Sec. 3. APPLICABILITY. This Act applies to direct health 17 care agreements that are fully executed on or after the date 18 of enactment. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to direct health care agreements. 23 Current law allows certain primary care health professionals 24 to enter into a direct primary care agreement with a patient 25 to provide certain primary care health services for a set 26 service charge that covers a specific period of time. The bill 27 broadens the types of health care professionals that may enter 28 into a direct health care agreement to include health care 29 professionals that perform health care services. “Health care 30 services” is defined in the bill as services for the diagnosis, 31 prevention, treatment, cure, or relief of a health condition, 32 illness, injury, or disease, and includes dental care services. 33 The bill takes effect upon enactment and applies to direct 34 health care agreements that are fully executed on or after the 35 -5- LSB 5827SV (1) 89 ko/rn 5/ 6
S.F. 2276 date of enactment. 1 -6- LSB 5827SV (1) 89 ko/rn 6/ 6
feedback