S.F. 117 DIVISION I 1 HEALTH CARE INFRASTRUCTURE —— 2 DIVISION OF HEALTH POLICY 3 Section 1. Section 135.61, subsection 17, Code 2011, is 4 amended by striking the subsection. 5 Sec. 2. Section 135.61, subsection 21, Code 2011, is amended 6 to read as follows: 7 21. “Outpatient surgical facility” means a medical facility 8 which as its primary function provides, through an organized 9 medical staff and on an outpatient basis to patients who are 10 generally ambulatory, that provides surgical procedures not 11 ordinarily performed in a private physician’s office, but 12 not requiring twenty-four hour hospitalization, and which is 13 neither a part of a hospital nor the private office of a health 14 care provider who there engages in the lawful practice of 15 surgery in at least one dedicated, fully equipped operating 16 room to patients who are admitted to and discharged from the 17 facility within the same day, that meets staffing and equipment 18 requirements necessary to ensure patient safety and quality 19 care . “Outpatient surgical facility” includes a facility 20 certified or seeking certification as an ambulatory surgical 21 center , under the federal Medicare program or under the medical 22 assistance program established pursuant to chapter 249A . 23 Sec. 3. Section 135.63, subsection 1, Code 2011, is amended 24 to read as follows: 25 1. A new institutional health service or changed 26 institutional health service shall not be offered or developed 27 in this state without prior application to the department 28 for and receipt of a certificate of need, pursuant to this 29 division . The application shall be made upon forms furnished 30 or prescribed by the department and shall contain such 31 information as the department may require under this division . 32 The application shall be accompanied by a fee equivalent 33 to three-tenths of one percent of the anticipated cost of 34 the project with a minimum fee of six hundred dollars and a 35 -1- LSB 2122SS (3) 84 pf/rj 1/ 18

S.F. 117 maximum fee of twenty-one thousand dollars. The fee shall 1 be remitted retained by the department to the treasurer of 2 state, who shall place it in the general fund of the state 3 for administration and fulfillment of the duties of the 4 division . Revenues retained by the division under this 5 section shall be considered repayment receipts as defined in 6 section 8.2. Notwithstanding section 8.33, moneys retained 7 by the department pursuant to this section are not subject to 8 reversion to the general fund of the state. If an application 9 is voluntarily withdrawn within thirty calendar days after 10 submission, seventy-five percent of the application fee shall 11 be refunded; if the application is voluntarily withdrawn more 12 than thirty but within sixty days after submission, fifty 13 percent of the application fee shall be refunded; if the 14 application is withdrawn voluntarily more than sixty days 15 after submission, twenty-five percent of the application fee 16 shall be refunded. Notwithstanding the required payment of an 17 application fee under this subsection , an applicant for a new 18 institutional health service or a changed institutional health 19 service offered or developed by an intermediate care facility 20 for persons with mental retardation or an intermediate care 21 facility for persons with mental illness as defined pursuant to 22 section 135C.1 is exempt from payment of the application fee. 23 Sec. 4. Section 135.63, subsection 2, paragraph l, Code 24 2011, is amended by striking the paragraph. 25 Sec. 5. Section 135.63, subsection 2, paragraphs n and o, 26 Code 2011, are amended to read as follows: 27 n. Hospice services provided by a hospital , notwithstanding 28 any provision in this division to the contrary. 29 o. The change in ownership , licensure, or organizational 30 structure , or designation of the type of institutional health 31 facility if the health services offered by the successor 32 institutional health facility are unchanged. This exclusion is 33 applicable only if the institutional health facility consents 34 to the change in ownership , licensure, or organizational 35 -2- LSB 2122SS (3) 84 pf/rj 2/ 18

S.F. 117 structure , or designation of the type of institutional health 1 facility and ceases offering the health services simultaneously 2 with the initiation of the offering of health services by the 3 successor institutional health facility. 4 Sec. 6. Section 135.163, Code 2011, is amended to read as 5 follows: 6 135.163 Health and long-term care access Division of health 7 policy . 8 1. The A division of health policy is created in the 9 department shall coordinate to integrate public and private 10 efforts to develop in formulating and implementing a state 11 health policy agenda to accomplish all of the following: 12 a. Develop and maintain an appropriate health care delivery 13 infrastructure and a stable, well-qualified, diverse, and 14 sustainable health care workforce in this state. The health 15 care delivery infrastructure and the health care workforce 16 shall address the broad spectrum of health care needs of Iowans 17 throughout their lifespan including long-term care needs. 18 b. Establish a methodology and process to achieve cultural 19 transformation that emphasizes health and wellness by removing 20 barriers across the spectrum of personal, professional, and 21 community constructs to empower individual behavioral and 22 systemic change. 23 c. Provide for the collection, analysis, and use of cost 24 and quality data to inform decisions by individual consumers, 25 businesses, and policymakers in determining the most effective 26 and efficient use of resources in arriving at economically 27 sustainable health care outcomes. 28 2. The division administrator shall be a health economist. 29 The administrator may utilize existing councils and workgroups 30 as necessary and shall establish a technical advisory 31 council to assist in the development of policy priorities 32 and the strategic plan described in subsection 3. The 33 technical advisory council shall include but is not limited to 34 representatives of the university of Iowa college of public 35 -3- LSB 2122SS (3) 84 pf/rj 3/ 18

S.F. 117 health and the university of Iowa public policy center, health 1 planners, health care consumers, health care purchasers, state 2 and local agencies that regulate entities involved in health 3 care, health care providers, and health care facilities. 4 3. The department health policy division shall, at a 5 minimum, do all of the following: 6 1. a. Develop a strategic plan for health care delivery 7 infrastructure and health care workforce resources in this 8 state in accordance with section 135.164 . The division shall 9 act as an ongoing resource to the health facilities council in 10 evaluating and updating the certificate of need program. 11 2. b. Provide for the continuous collection of data to 12 provide a basis for health care strategic planning and health 13 care policymaking decision making by individual consumers, 14 businesses, and policymakers . 15 3. Make recommendations regarding the health care delivery 16 infrastructure and the health care workforce that assist 17 in monitoring current needs, predicting future trends, and 18 informing policymaking. 19 c. Develop and implement a blueprint to make Iowa one of the 20 healthiest states by the year 2014. 21 Sec. 7. Section 135.164, Code 2011, is amended to read as 22 follows: 23 135.164 Strategic plan. 24 1. Development of a strategic plan. The division 25 shall develop a strategic plan for health care delivery 26 infrastructure and health care workforce resources . The 27 strategic plan shall describe the existing health care system, 28 describe and provide a rationale for the desired health 29 care system, provide an action plan for implementation of 30 changes necessary to achieve the desired health care system , 31 and provide methods to evaluate the system. The plan shall 32 incorporate expenditure control methods and integrate criteria 33 for evidence-based health care. The department division shall 34 do all of the following in developing the strategic plan for 35 -4- LSB 2122SS (3) 84 pf/rj 4/ 18

S.F. 117 health care delivery infrastructure and health care workforce 1 resources : 2 a. Conduct strategic health planning activities related to 3 preparation of the strategic plan. 4 b. Develop a computerized system for accessing, analyzing, 5 and disseminating data relevant to strategic health planning. 6 The department division may enter into data sharing agreements 7 and contractual arrangements necessary to obtain or disseminate 8 relevant data. 9 c. Conduct research and analysis or arrange for research 10 and analysis projects to be conducted by public or private 11 organizations to further the development of the strategic plan. 12 d. Establish a technical advisory committee to assist in 13 the development of the strategic plan. The members of the 14 committee may include but are not limited to health economists, 15 representatives of the university of Iowa college of public 16 health, health planners, representatives of health care 17 purchasers, representatives of state and local agencies that 18 regulate entities involved in health care, representatives 19 of health care providers and health care facilities, and 20 consumers. 21 2. Guiding principles. The strategic plan shall include 22 statewide health planning policies and goals related to the 23 availability of health care facilities and services, the 24 availability of appropriate health care workforce resources, 25 health and wellness promotion, the quality of care, and the 26 cost of care. The policies and goals shall be based on the 27 following principles: 28 a. That a strategic health planning process, responsive to 29 changing health and social needs and conditions, is essential 30 to the health, safety, and welfare of Iowans. The process 31 shall be reviewed and updated as necessary to ensure that the 32 strategic plan addresses all of the following: 33 (1) Promoting and maintaining the health of all Iowans. 34 (2) Providing accessible health care services through the 35 -5- LSB 2122SS (3) 84 pf/rj 5/ 18

S.F. 117 maintenance of an adequate appropriate and sustainable supply 1 of health facilities and an adequate a competent workforce 2 reserve . 3 (3) Controlling excessive increases in costs. 4 (4) Applying specific quality criteria and population 5 health indicators. 6 (5) Recognizing prevention and wellness as priorities in 7 health care programs to improve quality and reduce costs and 8 promoting prevention and wellness across all sectors to improve 9 individual well-being and health outcomes, while reducing human 10 and financial costs . 11 (6) Addressing periodic priority issues including disaster 12 planning, public health threats, and public safety dilemmas. 13 (7) Coordinating health care delivery and resource 14 development efforts among state agencies including those tasked 15 with facility, services, and professional provider licensure; 16 state and federal reimbursement; health service utilization 17 data systems; and others. 18 (8) Recognizing long-term care as an integral component of 19 the health care delivery infrastructure and as an essential 20 service provided by the health care workforce. 21 b. That both consumers and providers throughout the state 22 must be involved in the health planning process, outcomes of 23 which shall be clearly articulated and available for public 24 review and use. 25 c. That the supply of a health care service has a 26 substantial impact on utilization of the service, independent 27 of the effectiveness, medical necessity, or appropriateness of 28 the particular health care service for a particular individual. 29 d. That given that health care resources are not unlimited, 30 the impact of any new health care service or facility on 31 overall health expenditures in this state must be considered. 32 e. That excess capacity of health care services and 33 facilities places an increased economic burden on the public. 34 f. That the likelihood that a requested new health care 35 -6- LSB 2122SS (3) 84 pf/rj 6/ 18

S.F. 117 facility, service, or equipment will improve health care 1 quality and outcomes must be considered. 2 g. That development and ongoing maintenance of current and 3 accurate health care information and statistics related to cost 4 and quality of health care and projections of the need for 5 health care facilities and services are necessary to developing 6 an effective health care planning strategy. 7 h. That the certificate of need program as a component 8 of the health care planning regulatory process must balance 9 considerations of access to quality care at a reasonable 10 cost for all Iowans, optimal use of existing health care 11 resources, fostering of expenditure control, and elimination of 12 unnecessary duplication of health care facilities and services, 13 while supporting improved health care outcomes. 14 i. That strategic health care planning must be concerned 15 with the stability of the health care system, encompassing 16 health care financing, quality, and the availability of 17 information and services for all residents. 18 3. Components of the strategic plan. The health care 19 delivery infrastructure and health care workforce resources 20 strategic plan developed by the department division shall 21 include all of the following: 22 a. Assessment and objectives. A health care system 23 assessment and objectives component that does all of the 24 following: 25 (1) Describes state and regional population demographics, 26 health status indicators, and trends in health status and 27 health care needs. 28 (2) Identifies key policy objectives for the state health 29 care system related to access to care, health care outcomes, 30 quality, and cost-effectiveness. 31 b. Certificate of need determinations. A health care 32 facilities and services plan that assesses the demand for 33 health care facilities and services to inform state health care 34 planning efforts and direct certificate of need determinations 35 -7- LSB 2122SS (3) 84 pf/rj 7/ 18

S.F. 117 for those facilities and services subject to certificate of 1 need. The plan shall include all of the following: 2 (1) An inventory of each geographic region’s existing 3 health care facilities and services. 4 (2) Projections of the need for each category of health care 5 facility and service, including those subject to certificate 6 of need. 7 (3) Policies to guide the addition of new or expanded health 8 care facilities and services to promote the use of quality, 9 evidence-based, cost-effective health care delivery options, 10 including any recommendations for criteria, standards, and 11 methods relevant to the certificate of need review process. 12 (4) An assessment of the availability of health 13 care providers, public health resources, transportation 14 infrastructure, and other considerations necessary to support 15 the needed health care facilities and services in each region . 16 (5) An analysis of and recommended revisions to division VI 17 of this chapter to direct certificate of need determinations in 18 a manner that reflects the statewide health planning policies 19 and goals specified in subsection 2. The analysis shall 20 specifically address inclusions in and exclusions from the 21 certificate of need process and whether the exclusions comport 22 with the policies and goals specified in subsection 2. 23 c. Data resources. A health care data resources plan that 24 identifies data elements necessary to properly conduct planning 25 activities and to review certificate of need applications, 26 including data related to inpatient and outpatient utilization 27 and outcomes information, and financial and utilization 28 information related to charity care, quality, and cost. The 29 plan shall provide all of the following: 30 (1) An inventory of existing data resources, both public 31 and private, that store and disclose information relevant 32 to the health care planning process, including information 33 necessary to conduct certificate of need activities. The plan 34 shall identify any deficiencies in the inventory of existing 35 -8- LSB 2122SS (3) 84 pf/rj 8/ 18

S.F. 117 data resources and the data necessary to conduct comprehensive 1 health care planning activities. The plan may recommend that 2 the department division be authorized to access existing data 3 sources and conduct appropriate analyses of such data or 4 that other agencies expand their data collection activities 5 as statutory authority permits. The plan may identify any 6 computing information technology infrastructure deficiencies 7 that impede the proper storage, transmission, and analysis of 8 health care planning data. 9 (2) Recommendations for increasing the availability of data 10 related to health care planning to provide greater community 11 involvement in the health care planning process and consistency 12 in data used for certificate of need applications and 13 determinations. The plan shall also integrate the requirements 14 for annual reports by hospitals and health care facilities 15 pursuant to section 135.75 , the provisions relating to analyses 16 and studies by the department pursuant to section 135.76 , 17 the data compilation provisions of section 135.78 , and the 18 provisions for contracts for assistance with analyses, studies, 19 and data pursuant to section 135.83 . 20 d. All-payer claims database plan. A plan to establish 21 an all-payer claims database to provide for the collection 22 and analysis of claims data from multiple payers of health 23 care. The plan shall establish the goals of the database 24 which may include but are not limited to determining health 25 care utilization patterns and rates; identifying gaps in 26 prevention and health promotion services; evaluating access to 27 care; assisting with benefit design and planning; analyzing 28 statewide and local health care expenditures by provider, 29 employer, and geography; informing the development of payment 30 systems for providers; and establishing clinical guidelines 31 related to quality, safety, and continuity of care. The plan 32 shall identify a standard means of data collection, statutory 33 changes necessary to the collection and use of the data, and 34 the types of claims for which collection of data is required 35 -9- LSB 2122SS (3) 84 pf/rj 9/ 18

S.F. 117 which may include but are not limited to eligibility data; 1 provider information; medical data; private and public medical, 2 pharmacy, and dental claims data; and other appropriate data. 3 The plan shall also include an implementation and maintenance 4 schedule including a proposed budget and funding plan and 5 vision for the future. 6 d. e. Evaluation of trends. An assessment of emerging 7 trends in health care delivery and technology as they relate to 8 access to health care facilities and services, quality of care, 9 and costs of care. The assessment shall recommend any changes 10 to the scope of health care facilities and services covered by 11 the certificate of need program that may be warranted by these 12 emerging trends. In addition, the assessment may recommend 13 any changes to criteria used by the department to review 14 certificate of need applications, as necessary. 15 e. f. Rural health care resources plan. A rural health care 16 resources plan to assess the availability of health resources 17 in rural areas of the state, assess the unmet needs of these 18 communities, and evaluate how federal and state reimbursement 19 policies can be modified, if necessary, to more efficiently and 20 effectively meet the health care needs of rural communities. 21 The plan shall consider the unique health care needs of rural 22 communities, the adequacy of the rural health care workforce, 23 and transportation needs for accessing appropriate care. 24 f. g. Workforce resources plan. A health care workforce 25 resources plan to assure a competent, diverse, and sustainable 26 health care workforce in Iowa and to improve access to health 27 care in underserved areas and among underserved populations. 28 The plan shall include the establishment of an advisory council 29 to inform and advise the department and policymakers regarding 30 issues relevant to the health care workforce in Iowa. The 31 health care workforce resources plan shall recognize long-term 32 care as an essential service provided by the health care 33 workforce. 34 h. Provider payment system plan. The provider payment 35 -10- LSB 2122SS (3) 84 pf/rj 10/ 18

S.F. 117 system plan to provide recommendations to reform the health 1 care provider payment system as an effective way to promote 2 coordination of care, lower costs, and improve quality. The 3 plan shall analyze and make recommendations regarding but not 4 limited to accountable care organizations, a global payment 5 system, or an episode of care payment system. 6 i. Blueprint for a healthy Iowa. A blueprint for a 7 healthy Iowa to provide a methodology and process for cultural 8 transformation that emphasizes health and wellness by removing 9 barriers across the spectrum of personal, professional, and 10 community constructs to empower individual behavioral and 11 systemic change. The blueprint shall provide for coordination 12 of existing public and private health and wellness initiatives 13 and shall include recommendations for replication of health and 14 wellness initiatives for which evidence-based success has been 15 demonstrated. 16 j. Long-term living plan. A long-term living plan that 17 reflects the intent specified in section 231F.1 in a manner 18 that most effectively and efficiently meets the needs of 19 Iowa’s population. The plan may include recommendations 20 for modification of requirements for certificate of need 21 determinations, health care workforce requirements, and funding 22 to promote the specified intent. 23 4. The department shall submit the initial statewide health 24 care delivery infrastructure and resources strategic plan to 25 the governor and the general assembly by January 1, 2010, and 26 shall submit an updated strategic plan to the governor and the 27 general assembly every two years thereafter. 28 4. The division shall develop a timeline for completion 29 and submission of the various components of the strategic plan 30 to the governor and the general assembly and shall submit the 31 proposed timeline to the governor and the general assembly 32 by October 1, 2011. The components relating to certificate 33 of need determinations, the all-payer claims database, and 34 the provider payment system shall be completed and submitted 35 -11- LSB 2122SS (3) 84 pf/rj 11/ 18

S.F. 117 to the governor and the general assembly by October 1, 2011. 1 The division may contract with public or private entities to 2 provide impartial, evidence-based research and analysis in 3 developing these components of the strategic plan. 4 Sec. 8. EFFECTIVE UPON ENACTMENT. This division of this 5 Act, being deemed of immediate importance, takes effect upon 6 enactment. 7 DIVISION II 8 MEDICATION THERAPY MANAGEMENT 9 Sec. 9. NEW SECTION . 8A.440 Medication therapy management. 10 1. As used in this section, unless the context otherwise 11 requires: 12 a. “Eligible employee” means an employee of the state 13 including an employee of the state board of regents or 14 institutions under the state board of regents for whom group 15 health plans are established pursuant to chapter 509A providing 16 for third-party payment or prepayment for health or medical 17 expenses, and employees of a governmental subdivision for whom 18 the governmental subdivision provides for third-party payment 19 or prepayment for health or medical expenses. 20 b. “Medication therapy management” means a systematic 21 process performed by a licensed pharmacist, designed to 22 optimize therapeutic outcomes through improved medication use 23 and reduced risk of adverse drug events, including all of the 24 following services: 25 (1) A medication therapy review and in-person consultation 26 relating to all medications, vitamins, and herbal supplements 27 currently being taken by an eligible individual. 28 (2) A medication action plan, subject to the limitations 29 specified in this section, communicated to the individual and 30 the individual’s primary care physician or other appropriate 31 prescriber to address safety issues, inconsistencies, 32 duplicative therapy, omissions, and medication costs. The 33 medication action plan may include recommendations to the 34 prescriber for changes in drug therapy. 35 -12- LSB 2122SS (3) 84 pf/rj 12/ 18

S.F. 117 (3) Documentation and follow-up to ensure consistent levels 1 of pharmacy services and positive outcomes. 2 2. a. The department shall continue to contract for 3 the provision of medication therapy management services for 4 eligible employees as initially required pursuant to 2010 Iowa 5 Acts, chapter 1193, section 166, and shall amend the contract 6 to include, beginning July 1, 2011, eligible employees who 7 are employees of the state board of regents and institutions 8 under the state board of regents and employees of governmental 9 subdivisions, at the election of the governmental subdivision, 10 who meet any of the following criteria: 11 (1) An individual who takes four or more prescription drugs 12 to treat or prevent two or more chronic medical conditions. 13 (2) An individual with a prescription drug therapy problem 14 who is identified by the prescribing physician or other 15 appropriate prescriber, and referred to a pharmacist for 16 medication therapy management services. 17 (3) An individual who meets other criteria established by 18 the third-party payment provider contract, policy, or plan. 19 b. The department shall utilize an advisory committee 20 comprised of an equal number of physicians and pharmacists 21 to provide advice and oversight regarding the contract and 22 evaluation processes. The department shall appoint the members 23 of the advisory committee from designees of the Iowa pharmacy 24 association, the Iowa medical society, and the Iowa osteopathic 25 medical association. 26 c. The contract shall require the company to provide annual 27 reports to the general assembly detailing the costs, savings, 28 estimated cost avoidance and return on investment, and patient 29 outcomes related to the medication therapy management services 30 provided. The company shall guarantee demonstrated annual 31 savings, including any savings associated with cost avoidance 32 at least equal to the program’s costs with any shortfall amount 33 refunded to the state. The department and the company shall 34 agree on the terms, conditions, and applicable measurement 35 -13- LSB 2122SS (3) 84 pf/rj 13/ 18

S.F. 117 standards associated with the demonstration of savings. The 1 department shall verify that the demonstrated savings reported 2 by the company were attained in accordance with the agreed upon 3 measurement standards. The company shall be prohibited from 4 using the company’s employees to provide the medication therapy 5 management services and shall instead be required to contract 6 with licensed pharmacies, pharmacists, or physicians. 7 d. The fees for pharmacist-delivered medication therapy 8 management services shall be separate from the reimbursement 9 for prescription drug product or dispensing services; shall 10 be determined by each third-party payment provider contract, 11 policy, or plan; and must be reasonable based on the resources 12 and time required to provide the service. 13 e. A fee shall be established for physician reimbursement 14 for services delivered for medication therapy management as 15 determined by each third-party payment provider contract, 16 policy, or plan, and must be reasonable based on the resources 17 and time required to provide the service. 18 f. If any part of the medication therapy management 19 plan developed by a pharmacist incorporates services which 20 are outside the pharmacist’s independent scope of practice 21 including the initiation of therapy, modification of dosages, 22 therapeutic interchange, or changes in drug therapy, the 23 express authorization of the individual’s physician or other 24 appropriate prescriber is required. 25 Sec. 10. REPEAL. 2010 Iowa Acts, chapter 1193, section 166, 26 is repealed. 27 Sec. 11. EFFECTIVE UPON ENACTMENT. This division of this 28 Act, being deemed of immediate importance, takes effect upon 29 enactment. 30 DIVISION III 31 DIRECTIVES FOR INTEGRATION OF PUBLIC AND PRIVATE PROGRAMS 32 Sec. 12. PLAN FOR SEAMLESS PUBLIC AND PRIVATE PROGRAM 33 INTEGRATION IN IOWA HEALTH BENEFIT EXCHANGE. The department 34 of human services, division of insurance of the department of 35 -14- LSB 2122SS (3) 84 pf/rj 14/ 18

S.F. 117 commerce, department of public health, department of revenue, 1 department of workforce development, and other appropriate 2 agencies, shall develop a plan to meet the requirements of the 3 federal Patient Protection and Affordable Care Act, Pub. L. 4 No. 111-148, relating to a health benefit exchange. The plan 5 shall address issues relating to eligibility determinations 6 for Medicaid, hawk-i, and tax credit subsidies; information 7 technology and process reengineering; necessary policy, 8 statutory, and regulatory changes; financing; and tools 9 and strategies necessary for implementation. The plan 10 shall provide for integration and seamless operation of the 11 eligibility system, which shall be housed within the department 12 of human services, with the Iowa health benefit exchange, if 13 created. The departments shall submit a joint plan to the 14 joint appropriations subcommittee on health and human services 15 by October 15, 2011. 16 Sec. 13. BENCHMARK PLAN DEVELOPMENT —— ANALYSIS OF 17 INCLUSION OF BEHAVIORAL HEALTH BENEFITS. The department of 18 human services shall analyze how the inclusion of behavioral 19 health benefits in a benchmark plan developed under the 20 federal Patient Protection and Affordable Care Act, Pub. L. No. 21 111-148, would impact the delivery and financing of behavioral 22 health services in the state. The department shall report its 23 findings to the joint appropriations subcommittee on health and 24 human services no later than October 15, 2011. 25 Sec. 14. FEDERAL FUNDING OPPORTUNITIES. The department 26 of human services, department of public health, division of 27 insurance of the department of commerce, and other affected 28 state agencies shall pursue all federal funding opportunities 29 under the federal Patient Protection and Affordable Care Act, 30 Pub. L. No. 111-148, including but not limited to funding 31 relating to implementation funding for the health benefit 32 exchange and eligibility system planning and implementation. 33 The departments shall coordinate efforts to the maximum extent 34 possible and shall report their activities on a monthly basis 35 -15- LSB 2122SS (3) 84 pf/rj 15/ 18

S.F. 117 to the joint appropriations subcommittee on health and human 1 services. 2 Sec. 15. EFFECTIVE UPON ENACTMENT. This division of this 3 Act, being deemed of immediate importance, takes effect upon 4 enactment. 5 EXPLANATION 6 This bill relates to health care and health policy. 7 Division I of the bill relates to health care infrastructure 8 and creates a division of health policy within the department 9 of public health (DPH). The bill amends certificate of 10 need exclusions relating to outpatient surgical facilities, 11 hospitals, and nursing facilities. The bill also provides for 12 retention of certificate of need fees by the department for 13 administration of the program. Current law directs DPH to 14 coordinate public and private efforts to develop and maintain 15 an appropriate health care infrastructure and workforce. 16 Current law also directs DPH to develop a strategic plan to 17 address various components of the health care infrastructure 18 and workforce. Current law directs DPH to utilize a technical 19 advisory committee to assist in the development of the 20 strategic plan. 21 Under the bill, the division of health policy is created 22 in DPH to fulfill the duties of the department in integrating 23 public and private efforts in formulating and implementing 24 a state health policy agenda that addresses the health care 25 infrastructure and workforce, cultural transformation to 26 emphasize health and wellness across all sectors, and the 27 collection, analysis, and use of cost and quality data. The 28 bill provides that the administrator of the division is to 29 be a health economist and directs the division to establish 30 a technical advisory council to assist the division in 31 development of policy priorities and the strategic plan. 32 The bill specifies the duties of the division relating 33 to development of a strategic plan, collection of data, and 34 development of a blueprint to make Iowa one of the healthiest 35 -16- LSB 2122SS (3) 84 pf/rj 16/ 18

S.F. 117 states by the year 2014. 1 The bill specifies the components of the strategic plan 2 including the addressing of a health care system assessment and 3 objectives; certificate of need determinations; data resources; 4 an all-payer claims database; evaluation of trends; rural 5 health care resources; workforce resources; a provider payment 6 system; a blueprint for a healthy Iowa; and long-term living. 7 The bill directs the division of health policy to develop 8 a timeline for completion and submission of the components of 9 the strategic plan to the governor and the general assembly. 10 The bill directs the division to complete and submit the 11 components relating to certificate of need determinations, the 12 all-payer claims database, and the provider payment system to 13 the governor and the general assembly by October 1, 2011. The 14 bill authorizes the division to contract with public or private 15 entities to provide impartial, evidence-based research and 16 analysis in developing the components of the strategic plan. 17 Division I takes effect upon enactment. 18 Division II of the bill relates to medication therapy 19 management. The bill directs that the pilot program for 20 medication therapy management implemented on July 1, 2010, for 21 eligible state employees is to be expanded and the contract for 22 the program amended to include employees of the state board of 23 regents or institutions under the state board of regents and 24 employees of governmental subdivisions at the election of the 25 governmental subdivision. The bill repeals the pilot program 26 and codifies the newly expanded program. Division II takes 27 effect upon enactment. 28 Division III of the bill provides directives to state 29 departments relative to provisions in the federal Patient 30 Protection and Affordability Act. 31 Division III directs the department of human services, 32 division of insurance, department of public health, 33 department of revenue, department of workforce development, 34 and other appropriate agencies, to develop a plan to meet 35 -17- LSB 2122SS (3) 84 pf/rj 17/ 18

S.F. 117 the requirements of the federal Act relating to a health 1 benefit exchange. The plan is to address issues relating to 2 eligibility determinations for Medicaid, hawk-i, and tax credit 3 subsidies; information technology and process reengineering; 4 necessary policy, statutory, and regulatory changes; financing; 5 and tools and strategies necessary for implementation. The 6 plan is to provide for integration and seamless operation 7 of the eligibility system, which shall be housed within the 8 department of human services, with the Iowa health benefit 9 exchange, if created. 10 Division III directs the department of human services to 11 analyze how the inclusion of behavioral health benefits in 12 a benchmark plan under the federal Patient Protection and 13 Affordable Care Act would impact the delivery and financing of 14 behavioral health services in the state. The department is to 15 report its findings to the joint appropriations subcommittee on 16 health and human services no later than October 15, 2011. 17 Division III also directs the department of human services, 18 department of public health, division of insurance, and 19 other affected state agencies to pursue all federal funding 20 opportunities under the federal Act including but not 21 limited to funding relating to implementation funding for the 22 health benefit exchange and eligibility system planning and 23 implementation. The bill directs the departments to coordinate 24 efforts to the maximum extent possible and to report their 25 activities on a monthly basis to the joint appropriations 26 subcommittee on health and human services. 27 Division III takes effect upon enactment. 28 -18- LSB 2122SS (3) 84 pf/rj 18/ 18