|HOUSE PROPOSAL OF AMENDMENT||2007-2008|
AN ACT RELATING TO HEALTH INSURANCE PLAN REIMBURSEMENT FOR COVERED SERVICES PROVIDED BY NATUROPATHIC PHYSICIANS
The House proposes to the Senate to amend the bill by striking all after the enacting clause and inserting in lieu thereof the following:
Sec. 1. 8 V.S.A. § 4088d is added to read:
§ 4088d. COVERAGE FOR COVERED SERVICES PROVIDED BY
(a) A health insurance plan shall provide coverage for medically necessary health care services covered by the plan when provided by a naturopathic physician licensed in this state for treatment within the scope of practice described in chapter 81 of Title 26. Health care services provided by naturopathic physicians may be subject to reasonable deductibles, co‑payment and co‑insurance amounts, fee or benefit limits, practice parameters, cost‑effectiveness and clinical efficacy standards, and utilization review consistent with any applicable regulations published by the department of banking, insurance, securities, and health care administration. Any amounts, limits, standards, and review shall not function to direct treatment in a manner unfairly discriminative against naturopathic care, and collectively shall be no more restrictive than those applicable under the same policy to care or services provided by other health care providers, but may allow for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers. A health insurance plan may require that the naturopathic physician’s services be provided by a licensed naturopathic physician under contract with the insurer or shall be covered in a manner consistent with out‑of‑network provider reimbursement practices for primary care providers. Nothing contained herein shall be construed as impeding or preventing either the provision or the coverage of health care services by licensed naturopathic physicians, within the lawful scope of naturopathic practice, in hospital facilities on a staff or employee basis.
(b) As used in this section, “health insurance plan” means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this state by a health insurer, as defined by 18 V.S.A. § 9402. The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage.
Sec. 2. EFFECTIVE DATE
This act shall be effective on October 1, 2007.
The Vermont General Assembly
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