HF 2002 (LSB 5017YH (5) 87)

HOUSE FILE 2002

BY  FORBES, STAED, HUNTER, BENNETT, PRICHARD, KACENA, KEARNS, BROWN-POWERS, ABDUL-SAMAD, WINCKLER, KURTH, GASKILL, STECKMAN, RUNNING-MARQUARDT, T. TAYLOR, ISENHART, MASCHER, ANDERSON, and HEDDENS

A BILL FOR

An Act relating to health care coverage including the establishment of a healthy Iowans for a public option and the administration of the Medicaid program, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
LEGISLATIVE INTENT

    Section 1.  LEGISLATIVE INTENT.  The Medicaid program has been utilized and expanded in a bipartisan manner since its inception to provide a health care safety net to seniors in nursing facilities, to people with disabilities living in the community, to pregnant women and children, and to poor and working class families. The federal Patient Protection and Affordable Care Act provided many opportunities for improvement in health care and health care coverage, including an opportunity for further expansion of the Medicaid program to additional populations. It is the intent of the general assembly to establish a public health care coverage safety net by utilizing a Medicaid program buy-in option to counteract the effects of inadequate private competition and make affordable health care coverage accessible to those Iowans without individual health care coverage.
DIVISION II
HEALTHY IOWANS FOR A PUBLIC OPTION —— ESTABLISHMENT

    Sec. 2.  HEALTHY IOWANS FOR A PUBLIC OPTION.
   1.  The department of human services shall apply to the secretary of the United States department of health and human services for any necessary waiver pursuant to 42 U.S.C. §1315 or 42 U.S.C. §18052, to do all of the following:
   a.  Allow the department of human services to establish and administer the healthy Iowans for a public option to provide coverage to individuals who are eligible for and enroll in the healthy Iowans for a public option established in this section. The department may make coverage through the healthy Iowans for a public option available for purchase through the Iowa state-federal partnership marketplace created pursuant to the federal Patient Protection and Affordable Care Act as defined in section 249N.2. 
   b.  Allow an individual who is determined eligible for advanced premium tax credits and cost-sharing reductions pursuant to 45 C.F.R. §155.305 to use such credits and reductions to purchase coverage through the healthy Iowans for a public option.
   2.  If the secretary of the United States department of health and human services grants the necessary waivers requested under this section, the department of human services shall do all of the following: 
   a.  Establish the healthy Iowans for a public option to provide coverage for individuals who are not otherwise eligible for the Medicaid program and who do not have access to affordable employer-sponsored health care coverage. Coverage under the healthy Iowans for a public option shall provide the same benefits as those specified for Iowa health and wellness plan members under section 249N.5. 
   b.  Administer the healthy Iowans for a public option through the Iowa Medicaid enterprise. The duties of the Iowa Medicaid enterprise may include determining member eligibility for the program using policies and procedures adopted by rule of the department pursuant to chapter 17A; maintaining eligibility files with pertinent eligibility determination and ongoing enrollment information; providing periodic reports to the department for administrative oversight and monitoring of compliance with federal requirements; and maintaining data for the purpose of quality assurance reports as required by rule of the department.
   3.  If the secretary of the United States department of health and human services grants the necessary waivers requested under this section, the department of human services may make the healthy Iowans for a public option available on the Iowa state-federal partnership marketplace created pursuant to the federal Patient Protection and Affordable Care Act as defined in section 249N.2.
   4.  The department of human services shall adopt rules pursuant to chapter 17A as necessary to administer this section.
DIVISION III
TERMINATION OF MEDICAID MANAGED CARE CONTRACTS

    Sec. 3.  TERMINATION OF MEDICAID MANAGED CARE CONTRACTS —— TRANSITION TO ADMINISTRATION BY IOWA MEDICAID ENTERPRISE —— EFFECTIVE DATE.  The department of human services shall, upon the effective date of this division of this Act, terminate the contracts executed with managed care organizations to administer the Iowa high quality health care initiative as established by the department, in accordance with the termination provisions of the contracts. The termination shall include a transition period to ensure that health care delivery and coverage for affected Medicaid members is not disrupted. The department of human services shall seek any Medicaid state plan and waiver amendments necessary to complete the transition and, upon completion of the transition, shall instead administer the Medicaid program under alternative value-based payment methodologies to promote quality and efficiency, investment in patient-centered, integrated, primary and preventive care, improved health care outcomes, innovation and integration in the organization and delivery of health care, and health care cost containment and minimization of administrative costs.
    Sec. 4.  EFFECTIVE UPON ENACTMENT.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the provision of health insurance coverage in the state.
   Division I of the bill provides legislative intent to establish a public health care coverage safety net by utilizing a Medicaid program buy-in option to counteract the effects of inadequate private competition and make affordable health care coverage accessible to those Iowans without individual health care coverage. 
   Division II of the bill provides for the establishment of healthy Iowans for a public option. The bill directs the department of human services (DHS) to apply to the secretary of the United States department of health and human services for any necessary federal waivers relative to the Medicaid program and the federal Patient Protection and Affordable Care Act (ACA) to allow DHS to establish and administer the healthy Iowans for a public option to provide coverage to individuals who are eligible for and enroll in the healthy Iowans for a public option established in the bill, and to allow an individual who is determined eligible for advanced premium tax credits and cost-sharing reductions under the ACA to use such credits and reductions to purchase coverage through the healthy Iowans for a public option.
   The bill provides that if the necessary waivers are granted by the secretary of the United States department of health and human services, DHS shall establish and administer the healthy Iowans for a public option through the Iowa Medicaid enterprise. The department may make coverage through the healthy Iowans for a public option available for purchase through the Iowa state-federal partnership marketplace created pursuant to the ACA. Coverage under the healthy Iowans for a public option includes the same benefits as those specified for Iowa health and wellness plan members under Code chapter 249N.
   The bill directs DHS to adopt rules pursuant to Code chapter 17A as necessary to administer the bill.
   Division III of the bill requires DHS, upon the effective date of Division III of the bill, to terminate the contracts executed with managed care organizations to administer the Iowa high quality health care initiative as established by DHS, in accordance with the termination provisions of the contracts. The termination shall include a transition period to ensure that health care delivery and coverage for affected Medicaid members is not disrupted. DHS is directed to seek any Medicaid state plan and waiver amendments necessary to complete the transition and, upon completion of the transition, to instead administer the Medicaid program under alternative payment methodologies to promote quality and efficiency, patient-centered, integrated, primary and preventive care, and innovation and integration in the organization and delivery of health care. 
   Division III of the bill takes effect upon enactment.