1998 Legislation
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SENATE BILL NO. 1459 – Hospital-based rehab treatment


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Daily Data Tracking History

S1459.......................................by COMMERCE AND HUMAN RESOURCES
HOSPITAL-BASED REHABILITATION - Amends existing law to include
hospital-based rehabilitation treatment in the definition of basic health
care services under the law regarding managed care.

02/13    Senate intro - 1st rdg - to printing
02/16    Rpt prt - to Com/HuRes
02/20    Rpt out - rec d/p - to 2nd rdg
02/23    2nd rdg - to 3rd rdg
02/26    3rd rdg - PASSED - 35-0-0
      AYES -- Andreason, Boatright, Branch, Bunderson, Burtenshaw, Cameron,
      Crow, Danielson, Darrington, Diede, Dunklin, Frasure, Geddes, Hansen,
      Hawkins, Ingram, Ipsen, Keough, King, Lee, McLaughlin, Noh, Parry,
      Richardson, Riggs, Risch, Sandy, Schroeder, Sorensen, Stennett,
      Sweeney, Thorne, Twiggs, Wheeler, Whitworth
      NAYS -- None
      Absent and excused -- None
    Floor Sponsor - King
    Title apvd - to House
02/27    House intro - 1st rdg - to Bus
03/12    Rpt out - rec d/p - to 2nd rdg
03/13    2nd rdg - to 3rd rdg
03/16    3rd rdg - PASSED - 70-0-0
      AYES -- Alltus, Barraclough, Barrett, Bell, Bieter, Bivens,
      Black(15), Black(23), Boe, Bruneel, Callister, Campbell, Chase,
      Clark, Crane, Crow, Cuddy, Deal, Denney, Ellsworth, Field(13),
      Field(20), Gagner, Geddes, Gould, Hadley, Hansen, Henbest, Hornbeck,
      Jaquet, Jones(9) Jones(22), Jones(20), Judd, Kellogg, Kempton,
      Kendell, Kjellander, Kunz, Lake, Linford, Loertscher, Mader, Marley,
      McKague, Meyer, Miller, Mortensen, Newcomb, Pischner, Pomeroy,
      Reynolds, Richman, Ridinger, Robison, Sali, Schaefer, Stevenson,
      Stoicheff, Stone, Stubbs, Taylor, Tilman, Tippets, Trail, Watson,
      Wheeler, Wood, Zimmermann, Mr. Speaker.
      NAYS -- None
      Absent and excused -- None
    Floor Sponsor - Deal
    Title apvd - to Senate
03/16    To enrol
03/18    Rpt enrol - Pres signed
    Sp signed
03/19    To Governor
03/20    Governor signed
         Session Law Chapter 142
         Effective: 07/01/98

Bill Text


 ||||              LEGISLATURE OF THE STATE OF IDAHO             ||||
Fifty-fourth Legislature                 Second Regular Session - 1998

                                      IN THE SENATE

                                   SENATE BILL NO. 1459


 1                                        AN ACT

 5    Be It Enacted by the Legislature of the State of Idaho:

 6        SECTION  1.  That  Section 41-3903, Idaho Code, be, and the same is hereby
 7    amended to read as follows:

 8        41-3903.  DEFINITIONS. (1) "Basic health care services" means the  follow-
 9    ing services: preventive care, emergency care, inpatient and outpatient hospi-
10    tal and  physician care,  hospital-based rehabilitation treatment, 
11    diagnostic  laboratory  and  diagnostic and therapeutic radiological services.
12    It does not include mental health services or services  for  alcohol  or  drug
13    abuse, dental or vision services or long-term rehabilitation treatment.
14        (2)  "Coinsurance"  means  a  percentage amount a member is responsible to
15    pay out-of-pocket for health care services after satisfaction of  any applica-
16    ble deductibles or copayments, or both.
17        (3)  "Copayment" means an amount a member must pay to a provider  in  pay-
18    ment for a specific health care service which is not fully prepaid.
19        (4)  "Deductible"  means  the  amount of expense a member must first incur
20    before the managed care organization begins payment for covered services.
21        (5)  "Director" means the director of the department of insurance  of  the
22    state of Idaho.
23        (6)  "Emergency facility" means any hospital or other facility where emer-
24    gency  services  are  provided  to  a  member including, but not limited to, a
25    physician's office.
26        (7)  "Emergency services" means those health care services that  are  pro-
27    vided  in  a hospital or other emergency facility after the sudden onset of  a
28    medical condition that manifests itself by  symptoms  of  sufficient  severity
29    including, but not limited to, severe pain, that the absence of immediate med-
30    ical  attention could reasonably be expected by a prudent person who possesses
31    an average knowledge of health and medicine, to result in:
32        (a)  Placing the patient's health in serious jeopardy;
33        (b)  Serious impairment to bodily functions; or
34        (c)  Serious dysfunction of any bodily organ or part.
35        (8)  "Employer" means any person, firm, corporation, partnership or  asso-
36    ciation.
37        (9)  "Enrollee"  means a person who either individually or through a group
38    has entered into a contract for services under a managed care plan.
39        (10) "General managed care plan" means a managed care plan which  provides
40    directly  or arranges to provide, at a minimum, basic health care services.  A
41    general managed care plan shall include basic health care services.
42        (11) "Health care contract" means a contract entered  into  by  a  managed
43    care organization and an enrollee.


 1        (12) "Health  care  services"  means those services offered or provided by
 2    health care facilities and health care providers relating to  the  prevention,
 3    cure or treatment of illness, injury or disease.
 4        (13) "Limited  managed care plan" means a managed care plan which provides
 5    dental care services, vision care services, mental health services,  substance
 6    abuse  services,    pharmaceutical  services,  podiatric care services or such
 7    other services as the director may establish by rule to be limited health care
 8    services. Limited health care services shall not  include  hospital,  medical,
 9    surgical  or emergency services except as those services are provided incident
10    to limited health care services.
11        (14) "Managed care organization" means a public or private person or orga-
12    nization which offers a managed  care  plan.   Unless  otherwise  specifically
13    stated,  the provisions of this chapter shall apply to any person or organiza-
14    tion offering a managed care plan, whether or not a certificate  of  authority
15    to offer the plan is required under this chapter.
16        (15) "Managed care plan" means a contract of coverage given to an individ-
17    ual,  family  or  group  of  covered individuals pursuant to which a member is
18    entitled to receive a defined set of health care benefits through an organized
19    system of health care providers in  exchange  for  defined  consideration  and
20    which requires the member to use, or creates financial incentives for the mem-
21    ber  to  use,  health care providers owned, managed, employed by or under con-
22    tract with the managed care organization.
23        (16) "Member" means a policyholder, enrollee or other individual  partici-
24    pating in a managed care plan.
25        (17) "Person"  means  any  natural or artificial person including, but not
26    limited to, individuals, partnerships,  associations,  corporations  or  other
27    legally recognized entities.
28        (18) "Provider" means any physician, hospital, or other person licensed or
29    otherwise authorized to furnish health care services.
30        (19) "Utilization management program" means a system of reviewing the med-
31    ical  necessity,  appropriateness, or quality of health care services and sup-
32    plies provided under a managed care plan using specified  guidelines.  Such  a
33    system  may  include,  but  is not limited to, preadmission certification, the
34    application of practice guidelines, continued stay review, discharge planning,
35    preauthorization of ambulatory procedures and retrospective review.

Statement of Purpose / Fiscal Impact


                                  RS 08027
    The purpose of this legislation is to clarify the definition of "basic health care services" in the 
    managed care reform act passed by the legislature last year. By adding the four words 
    "hospital based rehabilitation treatment" to the definition, it is clear that the intent of the 
    language was not to exclude acute rehabilitation services as services considered basic 
    health care services. Hospital based rehabilitation is a basic health care service as 
    contemplated in the statute. It is an adjunct to almost all acute inpatient and outpatient care. 
    The second sentence of the definition appropriately excludes longterm rehabilitation 
    treatment. This additional language is intended to contrast and be a clarification to this 
                                FISCAL NOTE
    There will be no fiscal impact on the state general fund nor on any local taxing entity.
     Name: Steven A. Millard
    Organization: Idaho Hospital 
    Telephone: (208) 338-5100, 
    ext. 203
    S 1459