SF 2055 (LSB 5379XS (4) 87)

SENATE FILE 2055

BY  PETERSEN, RAGAN, MATHIS, BOWMAN, HORN, DOTZLER, JOCHUM, TAYLOR, DVORSKY, BISIGNANO, LYKAM, BOULTON, QUIRMBACH, BOLKCOM, DANIELSON, McCOY, HART, ALLEN, D. JOHNSON, and KINNEY

A BILL FOR

An Act relating to the provision of integrated health homes for individuals with serious and persistent mental illness under Medicaid managed care, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  MEDICAID MANAGED CARE —— INTEGRATED HEALTH HOMES FOR PERSONS WITH SERIOUS AND PERSISTENT MENTAL ILLNESS (SPMI INTEGRATED HEALTH HOMES).  The department of human services shall adopt rules pursuant to chapter 17A and shall amend existing Medicaid managed care contracts to ensure that SPMI integrated health homes with a Medicaid managed care organization acting as the lead entity, are administered in a manner that reflects the criteria established for SPMI integrated health homes and that meets the specifications of the Medicaid state plan amendment (SPA), IA-16-013, including but not limited to:
   1.  The target population served by an SPMI integrated health home shall include Medicaid members with serious mental illness (SMI) or serious emotional disturbance (SED) as defined in the SPA.
   2.  Medicaid member participation in an SPMI integrated health home shall be voluntary and the state shall provide assurances that members will be provided a free choice of health home providers.
   3.  An SPMI integrated health home shall be accredited as a community mental health center; a mental health service provider; a residential, licensed group care setting; or a psychiatric medical institution for children (PMIC); or shall meet national accreditation standards that apply to mental health rehabilitative services. An SPMI integrated health home shall also demonstrate the provision of community-based mental health services to the target population.
   4.  An SPMI integrated health home shall consist of a team-based model that provides a single point of whole-person, patient-centered, comprehensive, accessible, coordinated care across the spectrum of medical, behavioral, and social service needs, conditions, and aspects of a member’s life, and shall provide for transitions of care the member may experience. An SPMI integrated health home team of professionals shall include, at a minimum, a nurse care manager, a care coordinator, and either a peer support specialist or a family support specialist, depending upon the population served. The SPMI integrated health home care coordinator, as an integral component of the team, shall be embedded within the construct of such team, and shall not be provided through external, supplementary sources, to ensure that a member maintains the member’s best possible health by accessing and utilizing services and supports at home and in community settings where the member lives, works, and socializes.
    Sec. 2.  EFFECTIVE DATE.  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 directs the department of human services (DHS) to adopt rules pursuant to Code chapter 17A and amend existing Medicaid managed care contracts to ensure that integrated health homes for individuals with serious and persistent mental illness (SPMI integrated health homes) which have a Medicaid managed care organization acting as the lead entity, are provided in a manner that reflects the criteria established for SPMI integrated health homes by DHS and that meet the specifications of the Medicaid state plan amendment. The bill specifies that these criteria and specifications include: the target population served includes Medicaid members with serious mental illness (SMI) or serious emotional disturbance (SED); Medicaid member participation is voluntary and the state provides assurances that members will be provided a free choice of health home providers; an SPMI integrated health home is accredited as a certain type of provider or meets certain national accreditation standards, and demonstrates the provision of community-based mental health services to the target population; the SPMI integrated health home is a team-based model consisting of, at a minimum, a nurse care manager, a care coordinator, and either a peer support specialist or a family support specialist, depending upon the population served; and the SPMI integrated health home care coordinator, as an integral component of the team, shall be embedded within the construct of such team, and shall not be provided through external, supplementary sources, to ensure that a member maintains the member’s best possible health by accessing and utilizing services and supports at home and in community settings where the member lives, works, and socializes.
   The bill takes effect upon enactment.