Iowa Admin. Code r. 191-40.4
An HMO shall have a basic written organizational document setting forth its scheme of organization and establishing a governing body appropriate to its form of organization. The governing body shall be responsible for matters of policy and operation.
The HMO shall develop bylaws or guidelines which describe the scope of the health care services the HMO renders to enrollees either directly by its medical staff or dental staff, if dental care is provided, or through arrangements with others outside of the organization. Initial bylaws, guidelines, and revisions thereto shall be submitted to the commissioner of insurance for review and approval.
The bylaws, guidelines, or similar document shall provide for "reasonable representation" on the governing body by enrollees. "Reasonable representation" as used in Iowa Code section 5146.7 shall require not less than 30 percent of the governing board members be enrollees who are not providers or are not associated with a provider Enrollees shall have the opportunity to nominate said enrollee representatives.
The HMO may provide upon its initial formation that all representatives on the governing board shall be selected by the organizers of the HMO. Such members shall serve until the first annual meeting or election. If there are no enrollee representatives on the initial governing board, they shall be elected at the first annual meeting or election.
The nomination procedures for enrollee representatives should provide for the following to assure an adequate opportunity for participation by enrollees:
The HMO shall be deemed to have complied with these requirements if it provides notice in its regular newsletter to enrollees of the opportunity to and the procedures for nomination of enrollee representatives.
Nomination procedures may be waived by the commissioner for a period of up to three years from the HMO's commencement of delivery of services to enrollees.
For purposes of this rule, an HMO operated directly by a corporation or corporations subject to Iowa Code chapter 514 and rule 191-34.7(514) shall be deemed to be in compliance with this rule if it is or they are in compliance with Iowa Code section 5144. and rule 191-34.7(514).
This rule is intended to implement Iowa Code section 514B.7.
Iowa Admin. Code r. 191-40.4