Bill Text: IA HF2356 | 2017-2018 | 87th General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: A bill for an act relating to agreements between individuals and health care professionals for the provision of certain primary care health services for a service charge that covers an agreed upon period of time. (Formerly HF 2275.) Effective 7-1-18.

Spectrum: Committee Bill

Status: (Passed) 2018-03-28 - Signed by Governor. H.J. 700. [HF2356 Detail]

Download: Iowa-2017-HF2356-Introduced.html

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House File 2356 - Introduced




                                 HOUSE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO HF 2275)

                                      A BILL FOR

  1 An Act relating to agreements between individuals and health
  2    care professionals for the provision of certain primary care
  3    health services for a service charge that covers an agreed
  4    upon period of time.
  5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 5639HV (1) 87
    ko/rj

PAG LIN



  1  1    Section 1.  NEW SECTION.  135N.1  Direct primary care
  1  2 agreements.
  1  3    1.  Definitions.  For the purpose of this section:
  1  4    a.  "Direct patient" means an individual, or an individual
  1  5 and the individual's immediate family, that is party to a
  1  6 direct primary care agreement.
  1  7    b.  "Direct patient's representative" means a parent,
  1  8 guardian, or an individual holding a durable power of attorney
  1  9 for health care for a direct patient.
  1 10    c.  "Direct primary care agreement" means an agreement
  1 11 between a direct provider and a direct patient, or the direct
  1 12 patient's representative, in which the direct provider agrees
  1 13 to provide primary care health services for a specified period
  1 14 of time to the direct patient for a direct service charge.
  1 15    d.  "Direct provider" means a health care professional
  1 16 licensed, accredited, registered, or certified to perform
  1 17 specified primary care health services consistent with the law
  1 18 of this state. "Direct provider" includes an individual health
  1 19 care professional or other legal health care entity alone or
  1 20 with other health care professionals professionally associated
  1 21 with the individual health care professional or other legal
  1 22 health care entity.
  1 23    e.  "Direct service charge" means a charge for primary care
  1 24 health services provided by a direct provider to a direct
  1 25 patient covered by a direct primary care agreement. "Direct
  1 26 service charge" may include a periodic retainer, a membership
  1 27 fee, a subscription fee, or a charge in any other form paid by
  1 28 a direct patient to a direct provider under a direct primary
  1 29 care agreement.
  1 30    f.  "Durable power of attorney for health care" means the same
  1 31 as defined in section 144B.1.
  1 32    g.  "Primary care health services" means general health care
  1 33 services of the type provided at the time a patient seeks
  1 34 preventive care or first seeks health care services for a
  1 35 specific health concern. Primary care health services include
  2  1 all of the following:
  2  2    (1)  Care which promotes and maintains mental and physical
  2  3 health and wellness.
  2  4    (2)  Care which prevents disease.
  2  5    (3)  Screening, diagnosing, and treatment of acute or
  2  6 chronic conditions caused by disease, injury, or illness.
  2  7    (4)  Patient counseling and education.
  2  8    (5)  Provision of a broad spectrum of preventive and curative
  2  9 health care over a period of time.
  2 10    (6)  Coordination of care.
  2 11    2.  Requirements for a valid direct primary care agreement.
  2 12    a.  In order to be a valid agreement, a direct primary care
  2 13 agreement must meet all of the following requirements:
  2 14    (1)  Be in writing.
  2 15    (2)  Be signed by the direct provider, or an agent of the
  2 16 direct provider, and the direct patient or the direct patient's
  2 17 representative.
  2 18    (3)  Describe the scope of the primary care health services
  2 19 covered by the direct primary care agreement.
  2 20    (4)  State each of the direct provider's locations where
  2 21 a direct patient may obtain primary care health services and
  2 22 specify any out=of=office primary care health services that are
  2 23 covered under the direct primary care agreement.
  2 24    (5)  Specify the direct service charge and the frequency
  2 25 at which the direct service charge must be paid by the direct
  2 26 patient. A direct patient shall not be required to pay more
  2 27 than twelve months of a direct service charge in advance.
  2 28    (6)  Specify any additional costs for primary care health
  2 29 services not covered by the direct service charge for which the
  2 30 direct patient will be responsible.
  2 31    (7)  Specify the duration of the direct primary care
  2 32 agreement, whether renewal is automatic, and if required the
  2 33 procedure for renewal of the direct primary care agreement.
  2 34    (8)  Specify the terms and conditions under which the
  2 35 direct primary care agreement may be terminated by the
  3  1 direct provider. A termination of the direct primary care
  3  2 agreement by the direct provider shall include a minimum of
  3  3 a thirty=calendar=day advance, written notice to the direct
  3  4 patient or to the direct patient's representative.
  3  5    (9)  Specify that the direct primary care agreement may
  3  6 be terminated at any time by the direct patient upon written
  3  7 notice to the direct provider.
  3  8    (10)  State that if the direct primary care agreement is
  3  9 terminated by either the direct patient or the direct provider
  3 10 all of the following apply:
  3 11    (a)  Within thirty calendar days of the date of the notice of
  3 12 termination from either party, the direct provider shall refund
  3 13 all unearned direct service charges to the direct patient.
  3 14    (b)  Within thirty calendar days of the date of the notice
  3 15 of termination from either party, the direct patient shall pay
  3 16 all outstanding earned direct service charges to the direct
  3 17 provider.
  3 18    (11)  Include a notice in bold, twelve=point font that states
  3 19 substantially as follows:
  3 20    NOTICE.  This direct primary care agreement is not health
  3 21 insurance and is not a plan that provides health coverage
  3 22 for purposes of any federal mandates. This direct primary
  3 23 care agreement only covers the primary care health services
  3 24 described in this agreement. It is recommended that you obtain
  3 25 health insurance to cover health care services not covered
  3 26 under this direct primary care agreement. You are personally
  3 27 responsible for the payment of any additional health care
  3 28 expenses you may incur.
  3 29    b.  The direct provider shall provide the direct patient, or
  3 30 the direct patient's representative, with a fully executed copy
  3 31 of the direct primary care agreement at the time the direct
  3 32 primary care agreement is executed.
  3 33    3.  Application for a direct primary care agreement.  If
  3 34 a direct provider requires a prospective direct patient to
  3 35 complete an application for a direct primary care agreement,
  4  1 the direct provider shall provide a written disclaimer on each
  4  2 application that informs the prospective direct patient of the
  4  3 direct patient's financial rights and responsibilities and
  4  4 that states that the direct provider will not bill a health
  4  5 insurance carrier for primary care health services covered
  4  6 under the direct primary care agreement. The disclaimer shall
  4  7 also include the identical notice required by subsection 2,
  4  8 paragraph "a", subparagraph (11).
  4  9    4.  Notice required for changes to the terms or conditions of
  4 10 a direct primary care agreement.
  4 11    a.  A direct provider shall provide at least a
  4 12 sixty=calendar=day advance, written notice to a direct patient
  4 13 of any of the following changes to a direct primary care
  4 14 agreement:
  4 15    (1)  Any change in the scope of the primary care health
  4 16 services covered under the agreement.
  4 17    (2)  Any change in the direct provider's locations where the
  4 18 direct patient may access primary care health services.
  4 19    (3)  Any change in the out=of=office services that are
  4 20 covered under the direct primary care service agreement.
  4 21    (4)  Any change in the direct service charge.
  4 22    (5)  Any change in the additional costs for primary care
  4 23 health services not covered by the direct service charge.
  4 24    (6)  Any change in the renewal terms.
  4 25    (7)  Any change in the terms to terminate the agreement.
  4 26    b.  A direct provider shall provide the notice by mailing
  4 27 a letter to the address of the direct patient that the direct
  4 28 provider has on file. The postmark date on the letter shall be
  4 29 the first day of the required sixty=calendar=day notice period.
  4 30    5.  Discrimination based on an individual's health status.  A
  4 31 direct provider shall not refuse to accept a new direct patient
  4 32 or discontinue care of an existing direct patient based solely
  4 33 on the new direct patient's or the existing direct patient's
  4 34 health status.
  4 35    6.  A direct primary care agreement is not insurance.
  5  1    a.  A direct primary care agreement is not insurance and
  5  2 shall not be subject to the authority of the commissioner of
  5  3 insurance. Neither a direct care provider, nor an agent of
  5  4 a direct care provider, shall be required to be licensed by
  5  5 the commissioner to transact the business of insurance in this
  5  6 state or to obtain a certificate issued by the commissioner to
  5  7 market or offer a direct primary care agreement.
  5  8    b.  A direct provider shall not bill an insurer for a service
  5  9 provided under a direct primary care agreement. A direct
  5 10 patient may submit a request for reimbursement to an insurer if
  5 11 permitted under the direct patient's policy of insurance. This
  5 12 paragraph does not prohibit a direct provider from billing a
  5 13 direct patient's insurance for a service provided to the direct
  5 14 patient by the direct provider that is not provided under the
  5 15 direct primary care agreement.
  5 16    7.  Third=party payment of a direct service charge.  A direct
  5 17 provider may accept payment of a direct service charge for
  5 18 a direct patient either directly or indirectly from a third
  5 19 party. A direct provider may accept all or part of a direct
  5 20 service charge paid by an employer on behalf of an employee who
  5 21 is a direct patient of the direct provider. A direct provider
  5 22 shall not enter directly into an agreement with an employer
  5 23 relating to a direct primary care agreement between the direct
  5 24 provider and employees of the employer, other than an agreement
  5 25 to establish the timing and method of the payment of a direct
  5 26 service charge paid by the employer on behalf of the employee.
  5 27    8.  Sale or transfer of a direct primary care agreement.  A
  5 28 direct primary care agreement shall not be sold or transferred
  5 29 by a direct care provider without the prior written consent
  5 30 of the direct patient who is a party to the direct primary
  5 31 care agreement. A direct patient shall not sell or transfer a
  5 32 direct primary care agreement to which the direct patient is a
  5 33 party.
  5 34                           EXPLANATION
  5 35 The inclusion of this explanation does not constitute agreement with
  6  1 the explanation's substance by the members of the general assembly.
  6  2    This bill relates to agreements between individuals and
  6  3 health care professionals for the provision of certain primary
  6  4 care health services for a service charge that covers an agreed
  6  5 upon period of time.
  6  6    The bill defines a direct primary care agreement as an
  6  7 agreement between a direct provider and a direct patient,
  6  8 or the direct patient's representative, in which the direct
  6  9 provider agrees to provide primary care health services to
  6 10 the direct patient for a direct service charge for the period
  6 11 of time designated in the agreement. A direct patient is an
  6 12 individual, or an individual and the individual's immediate
  6 13 family. A direct provider is defined in the bill. A direct
  6 14 service charge is a charge for primary care health services, as
  6 15 defined in the bill, provided by a direct provider to a direct
  6 16 patient and may include a periodic retainer, a membership fee,
  6 17 a subscription fee, or other charge paid by a direct patient to
  6 18 a direct provider.
  6 19    The bill requires that a direct primary care agreement must
  6 20 be in writing, must be signed by the direct provider and the
  6 21 direct patient, must describe the scope of the primary care
  6 22 health services included under the agreement, must state each
  6 23 direct provider location where primary care health services may
  6 24 be obtained by a direct patient, must specify any out=of=office
  6 25 services that are included under the agreement, must specify
  6 26 the direct service charge and how often it must be paid, must
  6 27 specify any additional costs that may be assessed to the direct
  6 28 patient for primary care health services not covered by the
  6 29 direct service charge, and it must specify the duration of the
  6 30 direct primary care agreement and how the agreement is renewed.
  6 31    The bill requires that the terms and conditions for
  6 32 termination of the direct primary care agreement by the direct
  6 33 provider or the direct patient be included in the agreement.
  6 34    The bill requires that a notice be included on the direct
  6 35 primary care agreement and application that advises that the
  7  1 agreement is not health insurance and is not a plan that
  7  2 provides health coverage for purposes of any federal mandates.
  7  3 The notice advises that the agreement only covers the primary
  7  4 care health services described in the agreement and recommends
  7  5 that the direct patient obtain health insurance to cover other
  7  6 health care services as the patient is responsible for all
  7  7 additional expenses incurred.
  7  8    A direct provider shall give a copy of the executed direct
  7  9 primary care agreement to the direct patient.
  7 10    The bill requires a direct provider to give at least
  7 11 a 60=calendar=day advance, written notice to an existing
  7 12 direct patient of changes, as outlined in the bill, to a
  7 13 direct primary care service agreement. A direct provider is
  7 14 prohibited from refusing to accept a new direct patient or
  7 15 discontinuing care for an existing direct patient based solely
  7 16 on the patient's health status.
  7 17    The bill provides that a direct primary care agreement
  7 18 is not insurance and is not subject to the authority of the
  7 19 commissioner of insurance. A direct care provider is not
  7 20 required to be licensed by the commissioner to transact the
  7 21 business of insurance in this state, or to obtain a certificate
  7 22 issued by the commissioner to market or offer a direct primary
  7 23 care agreement.
  7 24    The bill prohibits a direct provider from billing an insurer
  7 25 for services provided under a direct primary care agreement.
  7 26 A direct patient may submit a request for reimbursement to
  7 27 an insurer if permitted under the direct patient's policy of
  7 28 insurance. A direct provider may bill a direct patient's
  7 29 insurance for services provided by the direct provider that are
  7 30 not provided under a direct primary care agreement.
  7 31    A direct provider may accept payment of a direct service
  7 32 charge for a direct patient either directly or indirectly from
  7 33 a third party. A direct provider may accept all or part of
  7 34 a direct service charge paid by an employer on behalf of an
  7 35 employee but may not enter directly into an agreement with an
  8  1 employer relating to a direct primary care agreement between
  8  2 the direct provider and employees of that employer.
  8  3    The bill allows a direct provider to sell or transfer a
  8  4 primary care agreement with the prior written consent of the
  8  5 direct patient. A direct patient shall not sell or transfer a
  8  6 direct primary care agreement.
       LSB 5639HV (1) 87
       ko/rj