Senate File 2034 - Introduced
SENATE FILE
BY RAGAN, HOGG, SEYMOUR,
and BEALL
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to transfer procedures for and compensation of
2 health care providers not participating in IowaCare.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 5801SS 82
5 pf/nh/14
PAG LIN
1 1 Section 1. NEW SECTION. 249J.24A NONPARTICIPATING
1 2 PROVIDER EXPANSION POPULATION PROVIDER NETWORK == TRANSFER
1 3 PROCEDURE == COMPENSATION FUND.
1 4 1. The department shall establish a procedure to transfer
1 5 an expansion population member who seeks medical care or
1 6 treatment from a nonparticipating provider in the expansion
1 7 population provider network to a participating provider in the
1 8 expansion population provider network, if medically possible.
1 9 If transfer is not medically possible or if the participating
1 10 provider refuses to accept the transfer of the expansion
1 11 population member, the nonparticipating provider shall be
1 12 compensated through the nonparticipating provider expansion
1 13 population provider network compensation fund in accordance
1 14 with subsection 2.
1 15 2. a. A nonparticipating provider expansion population
1 16 provider network compensation fund is created in the state
1 17 treasury under the authority of the department. Moneys
1 18 designated for deposit in the fund that are received from
1 19 sources including but not limited to appropriations from the
1 20 general fund of the state, grants, and contributions shall be
1 21 deposited in the fund.
1 22 b. Moneys in the fund shall be separate from the general
1 23 fund of the state and shall not be considered part of the
1 24 general fund of the state. The moneys deposited in the fund
1 25 are not subject to section 8.33 and shall not be transferred,
1 26 used, obligated, appropriated, or otherwise encumbered, except
1 27 to provide for the purposes specified in this section.
1 28 Notwithstanding section 12C.7, subsection 2, interest or
1 29 earnings on moneys deposited in the fund shall be credited to
1 30 the fund.
1 31 c. Moneys deposited in the fund shall be used only to
1 32 compensate health care providers who are not participants in
1 33 the expansion population provider network pursuant to section
1 34 249J.7, who provide services to expansion population members,
1 35 if no other third party is liable for reimbursement for the
2 1 services provided.
2 2 d. In order to be compensated through the fund, a health
2 3 care provider shall submit a claim to the department for
2 4 compensation and reimbursement of expenses incurred in
2 5 providing services to an expansion population member. The
2 6 department shall adopt rules relating to the format of and the
2 7 information to be included in the claims submitted. A claim
2 8 shall be submitted to the department within forty=five days of
2 9 provision of the service.
2 10 EXPLANATION
2 11 This bill directs the department of human services to
2 12 establish a procedure to transfer an IowaCare member who seeks
2 13 medical care or treatment from a provider who is not
2 14 participating in the IowaCare provider network to an IowaCare
2 15 provider, if medically possible. If transfer is not medically
2 16 possible or if the participating provider refuses to accept
2 17 the transfer of the expansion population member, the
2 18 nonparticipating provider shall be compensated through the
2 19 fund established for such compensation under the bill.
2 20 The bill creates a fund to be used to compensate health
2 21 care providers who are not included in the IowaCare provider
2 22 network and who provide services to expansion population
2 23 members that are not reimbursable by any other third party.
2 24 Moneys to be deposited in the fund are moneys received from
2 25 sources including but not limited to appropriations from the
2 26 general fund of the state, grants, and contributions.
2 27 The bill requires that in order to be compensated through
2 28 the fund, a health care provider must submit claims to the
2 29 department of human services. The bill directs the department
2 30 to adopt rules relating to the format of and the information
2 31 to be included in the claims submitted. A claim shall be
2 32 submitted to the department within 45 days of provision of the
2 33 service.
2 34 LSB 5801SS 82
2 35 pf/nh/14