Senate File 2284 - Introduced SENATE FILE 2284 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 2092) A BILL FOR An Act relating to the provision of health home services 1 under Medicaid managed care, and including effective date 2 provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5792SV (3) 87 pf/rh

S.F. 2284 Section 1. PROVISION OF HEALTH HOME SERVICES UNDER MEDICAID 1 MANAGED CARE. The department of human services shall amend 2 Medicaid managed care contracts and adopt rules pursuant to 3 chapter 17A to require all of the following: 4 1. That health home services be provided in accordance 5 with the state plan amendments approved pursuant to section 6 2703 of the federal Patient Protection and Affordable Care 7 Act for health home services for Medicaid members with 8 chronic conditions or serious and persistent mental health 9 conditions, including the requirement that comprehensive care 10 coordination services be provided by care coordinators who are 11 part of the health home’s team of health care professionals or 12 designated providers to meet provider standards and provider 13 infrastructure requirements, and to deliver health home 14 services to qualified members. Comprehensive care coordination 15 for Medicaid members receiving health home services shall not 16 be provided in a manner other than through the use of health 17 home provider types as specified in the applicable state plan 18 amendment, and shall not be provided by the managed care 19 organization through internal resources or other contracted 20 providers. 21 2. That if a Medicaid member is receiving health home 22 services, and based on the member’s array of services 23 would potentially have more than one case manager or care 24 coordinator, the member shall be provided the opportunity to 25 select the member’s own case manager or care coordinator. 26 Additionally, such Medicaid member shall be allowed to change 27 the health home provider from whom the member receives health 28 home services. 29 Sec. 2. HEALTH HOME EVALUATION —— ADMINISTRATIVE RULES 30 REQUIRED. The department of human services shall continue to 31 administer the health homes state plan option for Medicaid 32 members as specified in state plan amendments IA-16-012 and 33 IA-16-013, and as administered on or before June 30, 2017. 34 The department shall evaluate the health home program for 35 -1- LSB 5792SV (3) 87 pf/rh 1/ 3

S.F. 2284 quality assurance purposes, and shall report the results 1 of the evaluation to the governor and the general assembly 2 by October 1, 2018. The department shall make any future 3 changes to the health home program only through the rulemaking 4 process pursuant to chapter 17A, and such changes shall not be 5 implemented until such rules are effective. 6 Sec. 3. EFFECTIVE DATE. This Act, being deemed of immediate 7 importance, takes effect upon enactment. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill requires the department of human services (DHS) to 12 amend Medicaid managed care contracts and adopt administrative 13 rules to require the following: 14 1. That health home services be provided in accordance 15 with the state plan amendments, including the requirement 16 that comprehensive care coordination services be provided 17 by care coordinators who are part of the health home’s team 18 of health care professionals or designated providers to 19 meet provider standards and deliver health home services to 20 qualified members. Comprehensive care coordination shall not 21 be provided in a manner other than through the use of the 22 health home provider types as specified in the applicable state 23 plan amendment, and shall not be provided by the managed care 24 organization through internal resources or other contracted 25 providers. 26 2. That if a Medicaid member is receiving health home 27 services, and based on the member’s array of services 28 would potentially have more than one case manager or care 29 coordinator, the member shall be given the opportunity to 30 select the member’s own case manager or care coordinator. 31 Additionally, such Medicaid member shall be allowed to change 32 the health home provider from whom the member receives health 33 home services. 34 The bill also requires DHS to continue to administer the 35 -2- LSB 5792SV (3) 87 pf/rh 2/ 3

S.F. 2284 health home state plan option as administered on or before June 1 30, 2017. DHS is required to evaluate the health home program 2 and submit a report of the results of the evaluation to the 3 governor and the general assembly by October 1, 2018. DHS is 4 required to make any future changes to the health home program 5 only through the rulemaking process and such changes shall not 6 be implemented until such rules are effective. 7 The bill takes effect upon enactment. 8 -3- LSB 5792SV (3) 87 pf/rh 3/ 3