Bill Text: IA SF453 | 2019-2020 | 88th General Assembly | Introduced

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Bill Title: A bill for an act relating to third-party payment of coverage benefits for medical food, and including applicability provisions.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2019-03-05 - Subcommittee: Costello, Greene, and Quirmbach. S.J. 469. [SF453 Detail]

Download: Iowa-2019-SF453-Introduced.html

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Senate File 453 - Introduced
SENATE FILE 453
BY CELSI
A BILL FOR
An Act relating to third-party payment of coverage benefits for
medical food, and including applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 514C.35 Medical food —— coverage.
1. As used in this section, unless the context otherwise
requires:
a. “Enteral nutrition” means to provide food to an
individual through a tube placed in the individual’s nose,
stomach, or small intestine.
b. “Gastromony feeding tube” means a tube that goes through
an individual’s skin into the individual’s stomach for purposes
of enteral nutrition.
c. “Health care professional” means the same as defined in
section 514J.102.
d. “Jejunostomy feeding tube” means a tube that goes into an
individual’s small intestine for purposes of enteral nutrition.
e. “Medical food” means a food which is formulated to
be consumed or administered as enteral nutrition under the
supervision of a health care professional, or at the direction
of a health care professional, and which is intended for the
specific dietary management of a disease or condition for which
distinctive nutritional requirements, based on recognized
scientific principles, are established by medical evaluation.
f. “Nasoenteral feeding tube” or “nasogastric feeding tube”
means a tube that goes into an individual’s nose for purposes
of enteral nutrition.
2. Notwithstanding the uniformity of treatment requirements
of section 514C.6, a policy, contract, or plan providing
for third-party payment or prepayment of health or medical
expenses shall provide coverage benefits for medical food that
is administered or consumed via a gastronomy feeding tube, a
jejunostomy feeding tube, a nasoenteral feeding tube, or a
nasogastric feeding tube.
3. This section applies to the following classes of
third-party payment provider policies, contracts, or plans
delivered, issued for delivery, continued, or renewed in this
state on or after January 1, 2020:
a. Individual or group accident and sickness insurance
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providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service
contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization
contract regulated under chapter 514B.
d. A plan established pursuant to chapter 509A for public
employees.
4. This section shall not apply to accident-only,
specified disease, short-term hospital or medical, hospital
confinement indemnity, credit, dental, vision, Medicare
supplement, long-term care, basic hospital and medical-surgical
expense coverage as defined by the commissioner, disability
income insurance coverage, coverage issued as a supplement
to liability insurance, workers’ compensation or similar
insurance, or automobile medical payment insurance.
5. The commissioner of insurance shall adopt rules pursuant
to chapter 17A as necessary to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to third-party payment of coverage
benefits for medical food.
The bill defines “medical food” as a food which is
formulated to be consumed or administered as enteral nutrition
under the supervision of a health care professional, or at
the direction of a health care professional, and which is
intended for the specific dietary management of a disease or
condition for which distinctive nutritional requirements, based
on recognized scientific principles, are established by medical
evaluation. “Enteral nutrition” is defined in the bill as
providing food to an individual through a tube placed in the
individual’s nose, stomach, or small intestine.
The bill requires a health insurer to provide coverage
benefits for medical food that is consumed or administered
via a gastronomy feeding tube, a jejunostomy feeding tube,
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S.F. 453
a nasoenteral feeding tube, or a nasogastric feeding tube.
“Gastronomy feeding tube”, “jejunostomy feeding tube”,
“nasoenteral feeding tube”, and “nasogastric feeding tube” are
defined in the bill.
The bill requires the commissioner of insurance to adopt
rules to administer the Code section.
The bill is applicable to third-party payment provider
policies, contracts, or plans delivered, issued for delivery,
continued, or renewed in this state on or after January 1,
2020, including individual or group accident and sickness
insurance providing coverage on an expense-incurred basis, an
individual or group hospital or medical service contract issued
pursuant to Code chapter 509, 514, or 514A, an individual or
group health maintenance organization contract regulated under
Code chapter 514B, and a plan established pursuant to Code
chapter 509A for public employees.
The bill does not apply to accident-only, specified disease,
short-term hospital or medical, hospital confinement indemnity,
credit, dental, vision, Medicare supplement, long-term care,
basic hospital and medical-surgical expense coverage as defined
by the commissioner, disability income insurance coverage,
coverage issued as a supplement to liability insurance,
workers’ compensation or similar insurance, or automobile
medical payment insurance.
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