HF 577 (LSB 2617HH (3) 88)

HOUSE FILE 577

BY  BROWN-POWERS and WILLIAMS

A BILL FOR

An Act relating to substance use disorder services and reimbursement, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
INTEGRATED PROVIDER NETWORK PROVIDERS —— REIMBURSEMENT

    Section 1.  INTEGRATED PROVIDER NETWORK PROVIDERS —— MEDICAID PROVIDERS —— REIMBURSEMENT.  The department of human services shall establish an integrated provider network provider as a participating provider type under the Medicaid program comparable to the integrated provider network providers under contract with the department of public health. The department shall designate and utilize the Medicaid community mental health center enhanced fee schedule as the minimum reimbursement for services provided by Medicaid integrated provider network providers. 
    Sec. 2.  EMERGENCY RULES.  The department may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to administer the provisions of this division. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
    Sec. 3.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION II
BEHAVIORAL HEALTH SERVICES —— REIMBURSEMENT

    Sec. 4.  SUBSTANCE USE DISORDER —— INTENSIVE OUTPATIENT AND RESIDENTIAL TREATMENT —— REIMBURSEMENT.
   1.  For the fiscal year beginning July 1, 2019, the department of human services shall establish reimbursement rates for substance use disorder intensive outpatient and residential treatment services provided under a Medicaid 1915(b)(3) waiver in alignment with the reimbursement rates provided for the same services under the substance abuse prevention and treatment block grant awarded by the United States department of health and human services substance abuse and mental health services administration and administered by the department of public health. 
   2.  The department of public health in collaboration with the department of human services shall review and make recommendations for Medicaid 1915(b)(3) waiver reimbursement rates for substance use disorder intensive outpatient and residential treatment services using a projected cost report agreed upon by the departments and the integrated provider network providers. The departments shall establish time frames for release of the agreed-upon projected cost report form to providers and the deadline for submission of the completed projected cost reports by providers to the departments, in order to allow sufficient time for review and the making of recommended adjustments to the Medicaid 1915(b)(3) waiver reimbursement rates for Medicaid integrated provider network providers effective January 1, 2020. 
   3.  The department of public health in collaboration with the department of human services and behavioral health providers shall review reimbursement rates for behavioral health services and Medicaid 1915(b)(3) waiver services using the projected cost report agreed upon by the departments and the integrated provider network providers. The departments shall establish time frames for release of the agreed-upon projected cost report form to behavioral health providers and the deadline for submission of the completed projected cost reports by behavioral health providers to the departments, in order to allow sufficient time for the departments to review and make recommended adjustments to the Medicaid 1915(b)(3) waiver reimbursement rates and the behavioral health services fee schedule effective July 1, 2020. 
   4.  The department of public health in collaboration with the department of human services shall establish an ongoing plan for regular review of reimbursement for substance use disorder treatment and to provide information to the governor and the general assembly in a timely manner to allow for provision of appropriate funding for any change in reimbursement.
    Sec. 5.  EMERGENCY RULES.  The department may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to administer the provisions of this division. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
    Sec. 6.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION III
MEDICATION-ASSISTED TREATMENT

    Sec. 7.  MEDICATION-ASSISTED TREATMENT —— PRIOR AUTHORIZATION PROHIBITED.  The department of human services shall adopt rules pursuant to chapter 17A that prohibit prior authorization for medication-assisted treatment under both Medicaid fee-for-service or managed care administration. The department of human services shall also include this prohibition in any contract entered into with a Medicaid managed care organization. For the purposes of this section, “medication-assisted treatment” means the medically monitored use of certain substance use disorder medications in combination with other treatment services.
    Sec. 8.  EMERGENCY RULES.  The department may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to administer the provisions of this division. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
    Sec. 9.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION IV
SUBSTANCE USE DISORDER ADVISORY PANEL

    Sec. 10.  SUBSTANCE USE DISORDER ADVISORY PANEL.  The department of public health in collaboration with the department of human services shall establish a substance use disorder advisory panel to review access to substance use disorder services and to resolve barriers to access. The members of the advisory panel shall include but are not limited to representatives of hospital-affiliated substance use disorder treatment programs, the integrated provider network, and others with interest or expertise in substance use disorder treatment services and reimbursement.
DIVISION V
MEDICAID WAIVER OPPORTUNITIES

    Sec. 11.  MEDICAID WAIVER OPPORTUNITIES.  The department of human services in collaboration with the department of public health shall review opportunities including application for the federal Medicaid 1115 demonstration waiver or amendments to the existing federal Medicaid 1915(b) waiver to enhance access to and reimbursement for substance use disorder treatment services. The departments shall report findings and recommendations to the governor and the general assembly by October 1, 2019. 
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 substance use disorder services and reimbursement. 
   Division I of the bill requires the department of human services (DHS) to establish an integrated provider network provider as a participating provider type under the Medicaid program comparable to the integrated provider network providers under contract with the department of public health (DPH). The bill requires DHS to designate and utilize the Medicaid community mental health center enhanced fee schedule as the minimum reimbursement for services provided by Medicaid integrated provider network providers. The division provides for emergency rulemaking and takes effect upon enactment.
   Division II of the bill relates to reimbursement of behavioral health services. The bill requires that for the fiscal year beginning July 1, 2019, DHS shall establish reimbursement rates for substance use disorder intensive outpatient and residential treatment services provided under a Medicaid 1915(b)(3) waiver in alignment with the reimbursement rates provided for the same services under the substance abuse prevention and treatment block grant administered by DPH.  Additionally, Division II requires DPH in collaboration with DHS to review and make recommendations for Medicaid 1915(b)(3) waiver reimbursement rates for substance use disorder intensive outpatient and residential treatment services using a projected cost report agreed upon by the departments and the integrated provider network providers. The departments are required to establish time frames for release of the agreed-upon projected cost report form to providers and the deadline for submission of the completed projected cost reports by providers to the departments, to allow sufficient time for review and adjustments to reimbursement rates for Medicaid integrated provider network service providers effective January 1, 2020. Division II also requires DPH in collaboration with DHS and behavioral health providers to review reimbursement rates for behavioral health services and Medicaid 1915(b)(3) waiver services using the projected cost report agreed upon. Again, the departments shall establish time frames and deadlines for the cost reports to allow sufficient time for the departments to review and make recommended adjustments to the reimbursement rates and the behavioral health services fee schedule effective July 1, 2020. Finally, the division directs DPH in collaboration with DHS to establish an ongoing plan for regular review of reimbursement for substance use disorder treatment services and to provide information to the governor and the general assembly in a timely manner to allow for provision of appropriate funding for the next fiscal year. The division provides for emergency rulemaking and takes effect upon enactment. 
   Division III of the bill requires DHS to adopt administrative rules to prohibit prior authorization for the provision of medication-assisted treatment under either Medicaid fee-for-service or managed care administration. The division also requires DHS to include this prohibition in any contract entered into with a Medicaid managed care organization. Under the division, “medication-assisted treatment” means the medically monitored use of certain substance use disorder medications in combination with other treatment services. The division provides for emergency rulemaking and takes effect upon enactment. 
   Division IV of the bill requires DPH in collaboration with DHS to establish an advisory panel to review access to substance use disorder services and to resolve barriers to access. The members of the advisory panel include but are not limited to representatives of hospital-affiliated substance use disorder treatment programs, the integrated provider network, and others with interest or expertise in substance use disorder treatment services and reimbursement.
   Division V of the bill directs DHS in collaboration with DPH to review opportunities including application for a federal Medicaid 1115 demonstration waiver or amendments to the existing federal Medicaid 1915(b) waiver to enhance access to and reimbursement for substance use disorder treatment services. The departments shall report findings and recommendations to the governor and the general assembly by October 1, 2019.