SF 2083 (LSB 5966XS (1) 87)

SENATE FILE 2083

BY  CHELGREN

A BILL FOR

An Act relating to reimbursement of in-network and out-of-network providers under Medicaid managed care. 
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  MEDICAID MANAGED CARE —— REIMBURSEMENT OF IN-NETWORK AND OUT-OF-NETWORK PROVIDERS.  The department of human services shall adopt rules pursuant to chapter 17A and shall amend all Medicaid managed care contracts to require that beginning July 1, 2018, for each covered service, Medicaid providers that have contracted with a Medicaid managed care organization as an in-network provider be reimbursed at one hundred percent of the fee-for-service reimbursement rate established by the general assembly through the appropriations process for the respective fiscal year, and that Medicaid providers that have not contracted with a Medicaid managed care organization and are considered an out-of-network provider be reimbursed at ninety-five percent of the fee-for-service reimbursement rate established by the general assembly through the appropriations process for the respective fiscal year.
    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 all Medicaid managed care contracts to require that beginning July 1, 2018, for each covered service, Medicaid providers that have contracted with a Medicaid managed care organization as an in-network provider be reimbursed at 100 percent of the fee-for-service reimbursement rate established by the general assembly through the appropriations process for the respective fiscal year, and that Medicaid providers that have not contracted with a Medicaid managed care organization and are considered an out-of-network provider be reimbursed at 95 percent of the fee-for-service reimbursement rate established by the general assembly through the appropriations process for the respective fiscal year.
   The bill takes effect upon enactment.