HOUSE FILE 2243

BY  BERRY, KRESSIG, and KAJTAZOVIC

A BILL FOR

An Act relating to directives to the department of human services regarding changes in the IowaCare and Medicaid programs.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  IOWACARE AND MEDICAID PROGRAM —— DIRECTIVES TO DEPARTMENT OF HUMAN SERVICES.  The department of human services shall submit any waiver or state plan amendments under the medical assistance program to the centers for Medicare and Medicaid services of the United States department of health and human services as necessary to implement the following directives:
   1.  Amend the specifications for utilization of funds appropriated from the IowaCare account created in section 249J.24 to the department of human services for a laboratory test and radiology pool to allow federally qualified health centers, designated by the department as part of the IowaCare regional provider network that do not have the capability to provide such services on site, to utilize laboratory and radiology providers selected by the individual federally qualified health center and approved by the department in addition to any laboratory and radiology providers designated for that federally qualified health center by the department. Notwithstanding any provision to the contrary, the department shall amend specifications for utilization of the funds to restrict expenditures to payment for routine screening and basic diagnostic testing and to allow adjustment of reimbursement for covered services to provide reimbursement in an amount that is no greater than the Medicaid reimbursement rate.
   2.  Allow federally qualified health centers that are not participating regional provider network providers to refer patients directly to the university of Iowa hospitals and clinics or to the publicly owned acute care teaching hospital located in a county with a population over 350,000 that is a participating provider for specialty services.
   3.  Reimburse federally qualified health centers for all medical, oral, and behavioral health care services provided to a Medicaid program recipient on the same day at the federally qualified health center.
EXPLANATION
   This bill directs the department of human services (DHS) to submit any waiver or state plan amendments under the medical assistance program to the centers for Medicare and Medicaid services of the United States department of health and human services as necessary to implement three directives:
   1. Amend the specifications for utilization of funds appropriated to DHS for a laboratory test and radiology pool to allow federally qualified health centers (FQHCs) that are regional providers under the IowaCare program to utilize laboratory and radiology providers selected by the individual FQHC in addition to those laboratory and radiology providers designated by the department. The bill also provides for restriction of expenditures of funds under the pool for routine screening and basic diagnostic testing and provides for adjustment of reimbursement for covered services to provide reimbursement that is not greater than the Medicaid reimbursement rate.
   2. Allow FQHCs that are not participating regional providers under the IowaCare program to refer patients directly to the university of Iowa hospitals and clinics or to Broadlawns medical center in Des Moines for specialty services.
   3. Reimburse FQHCs for all medical, oral, and behavioral health care services provided to a Medicaid program recipient on the same day at the FQHC.