House File 49
HOUSE FILE
BY GREIMANN and B. HANSEN
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to the healthy and well kids in Iowa program.
2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
3 TLSB 1058HH 80
4 pf/sh/8
PAG LIN
1 1 Section 1. Section 514I.4, subsection 4, Code 2003, is
1 2 amended to read as follows:
1 3 4. The department shall do or shall provide for all of the
1 4 following:
1 5 a. Develop a program application form not to exceed two
1 6 pages in length, which is consistent with the rules of the
1 7 board, which is easy to understand, complete, and concise, and
1 8 which, to the greatest extent possible, coordinates with the
1 9 medical assistance program.
1 10 b. Establish the family cost sharing amount, based on a
1 11 sliding fee scale, if established by amounts with the approval
1 12 of the board.
1 13 c. Perform annual, random reviews of enrollee applications
1 14 to ensure compliance with program eligibility and enrollment
1 15 policies. Quality assurance reports shall be made to the
1 16 board and the department based upon the data maintained by the
1 17 administrative contractor.
1 18 c. d. Perform other duties as determined by the department
1 19 with the approval of the board.
1 20 Sec. 2. Section 514I.5, subsection 7, paragraphs d and e,
1 21 Code 2003, are amended to read as follows:
1 22 d. Develop, with the assistance of the department, an
1 23 outreach plan, and provide for periodic assessment of the
1 24 effectiveness of the outreach plan. The plan shall provide
1 25 outreach to families of children likely to be eligible for
1 26 assistance under the program, to inform them of the
1 27 availability of and to assist the families in enrolling
1 28 children in the program. The outreach efforts may include,
1 29 but are not limited to, a comprehensive statewide media
1 30 campaign, solicitation of cooperation from programs, agencies,
1 31 and other persons who are likely to have contact with eligible
1 32 children, including but not limited to those associated with
1 33 the educational system, and the development of community plans
1 34 for outreach and marketing.
1 35 e. In consultation with the clinical advisory committee,
2 1 select a single, nationally recognized functional health
2 2 assessment form for an initial assessment of all eligible
2 3 assess the initial health status of children participating in
2 4 the program, establish a baseline for comparison purposes, and
2 5 develop appropriate indicators to measure the subsequent
2 6 health status of eligible children participating in the
2 7 program.
2 8 Sec. 3. Section 514I.5, subsection 7, paragraph i, Code
2 9 2003, is amended by striking the paragraph.
2 10 Sec. 4. Section 514I.5, subsection 7, paragraph l,
2 11 unnumbered paragraph 1, Code 2003, is amended to read as
2 12 follows:
2 13 Establish an advisory committee to make recommendations to
2 14 the board and to the general assembly on or before by January
2 15 1, 1999, annually concerning the provision of health insurance
2 16 coverage to children with special health care needs under the
2 17 program. The committee shall include individuals with
2 18 experience in, knowledge of, or expertise in this area. The
2 19 recommendations shall address, but are not limited to, all of
2 20 the following:
2 21 Sec. 5. Section 514I.5, subsection 8, paragraph h, Code
2 22 2003, is amended to read as follows:
2 23 h. The amount of any cost sharing under the program which
2 24 shall may be assessed on a sliding fee scale based on family
2 25 income, which provides for a minimum amount of cost sharing,
2 26 and which complies with federal law.
2 27 Sec. 6. Section 514I.5, subsection 8, paragraph m, Code
2 28 2003, is amended by striking the paragraph.
2 29 Sec. 7. Section 514I.6, subsection 3, Code 2003, is
2 30 amended by striking the subsection.
2 31 Sec. 8. Section 514I.7, subsection 2, paragraph c, Code
2 32 2003, is amended to read as follows:
2 33 c. Forward names of children who appear to be eligible for
2 34 medical assistance or other public health insurance coverage
2 35 to local to the department of human services offices or other
3 1 appropriate person or agency for follow up follow=up and
3 2 retain the identifying data on children who are referred.
3 3 Sec. 9. Section 514I.7, subsection 2, paragraph h, Code
3 4 2003, is amended by striking the paragraph.
3 5 Sec. 10. Section 514I.8, subsection 2, paragraph e, Code
3 6 2003, is amended to read as follows:
3 7 e. Is not currently covered under or was not covered
3 8 within the prior six months under a group health plan as
3 9 defined in 42 U.S.C. } 300gg=91(a)(1) or other health benefit
3 10 plan, unless the coverage was involuntarily lost or unless
3 11 dropping the coverage is allowed by rule of the board.
3 12 Sec. 11. Section 514I.10, Code 2003, is amended to read as
3 13 follows:
3 14 514I.10 COST SHARING.
3 15 1. Cost sharing for eligible children whose family income
3 16 is at or below one hundred fifty percent of the federal
3 17 poverty level shall not exceed the standards permitted under
3 18 42 U.S.C. } 1396(o)(a)(3) or } 1396(o)(b)(1).
3 19 2. Cost sharing for eligible children whose family income
3 20 is between equals or exceeds one hundred fifty percent and two
3 21 hundred percent of the federal poverty level shall may include
3 22 a premium or copayment amount which is at least a minimum
3 23 amount but which does not exceed five percent of the annual
3 24 family income. The amount of the any premium or the copayment
3 25 amount shall be based on family income and size.
3 26 EXPLANATION
3 27 This bill amends portions of the Code relating to the
3 28 healthy and well kids in Iowa (hawk=i) program and the medical
3 29 assistance program.
3 30 The bill deletes the requirement that the department of
3 31 human services (DHS) establish family cost sharing based on a
3 32 sliding fee scale. The new language reflects current practice
3 33 which is establishment of a cost sharing amount approved by
3 34 the hawk=i board. The bill also directs DHS to perform
3 35 annual, random reviews of enrollee applications to ensure
4 1 program compliance. Quality assurance reports are to be made
4 2 to the board and to DHS based upon the data maintained by the
4 3 administrative contractor of the program.
4 4 The bill eliminates the requirement that the outreach
4 5 efforts developed by the board include a comprehensive
4 6 statewide media campaign. The bill directs the board, in
4 7 consultation with the clinical advisory committee, to assess
4 8 the initial health status of children participating in the
4 9 program, establish a baseline, and develop appropriate
4 10 indicators to assess the subsequent health status of children
4 11 participating in the program, rather than directing the board
4 12 to select a single, nationally recognized assessment form for
4 13 children participating in the program. The bill eliminates
4 14 the requirement that the board perform periodic random reviews
4 15 of enrollee applications to assure program compliance, as this
4 16 function is given to the department under the bill. The bill
4 17 also directs the advisory committee on children with special
4 18 health care needs to make recommendations, annually, by
4 19 January 1, rather than only one time by January 1, 1999.
4 20 The bill eliminates the directive to the hawk=i board to
4 21 adopt rules to address approval of a program application in
4 22 cases in which prior employer=sponsored coverage ended less
4 23 than six months prior to determination of eligibility for the
4 24 program. The bill also eliminates a requirement that
4 25 participating insurers submit a marketing plan to the hawk=i
4 26 board consistent with the board's outreach plan, for approval
4 27 by the board.
4 28 The bill amends the directive to the administrative
4 29 contractor to forward names of children who appear to be
4 30 eligible for health insurance coverage, other than medical
4 31 assistance, to local offices of DHS or other appropriate
4 32 persons, and limits the directive to forwarding the names of
4 33 children who appear to be eligible for medical assistance only
4 34 to the state offices of DHS. The bill also eliminates the
4 35 directive to the administrative contractor to make program
5 1 applications available through the mail and through local
5 2 sites, as determined by DHS, including to schools, local
5 3 health departments, local department of human services
5 4 offices, and other locations.
5 5 The bill also provides that a child may participate in the
5 6 hawk=i program if, among other criteria, the child is not
5 7 currently covered or was not covered in the past six months
5 8 under a group health plan unless allowed by rule of the board.
5 9 The bill also allows for cost sharing based upon the family
5 10 income percentage which is either below 150 percent of the
5 11 federal poverty level or which equals or exceeds 150 percent
5 12 of the federal poverty level.
5 13 LSB 1058HH 80
5 14 pf/sh/8.2