SF 345 (LSB 1356SV (1) 88)

SENATE FILE 345

BY  COMMITTEE ON JUDICIARY

(SUCCESSOR TO SSB 1074)

A BILL FOR

An Act relating to the payment of required medical aid provided to prisoners of county jails.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 356.15, Code 2019, is amended to read as follows:
   356.15  Expenses.
   1.  All charges and expenses for the safekeeping and maintenance of prisoners in the custody of the county sheriff shall be allowed by the board of supervisors, except those with the exception of the following prisoners: 
   a.  Those committed or detained by the authority of the courts of the United States, in which cases the United States must pay such expenses to the county, or those. 
   b.  Those committed for violation of a city ordinance, in which case the city shall pay expenses to the county, or those. 
   c.  Those committed or detained from another state, in which case the governmental entity from the other state sending the prisoners shall pay expenses to the county.
   2.  Notwithstanding the charges and expenses allowed pursuant to subsection 1, the costs of required medical aid furnished to prisoners in the custody of the county sheriff pursuant to section 356.5 shall be paid as specified in sections 356.15A and 804.28. 
    Sec. 2.  NEW SECTION.  356.15A  Responsibility for payment of required medical aid —— priority for providers seeking reimbursement.
   1.  For purposes of this section:
   a.  “Governmental agency” means the state or a state department, division, commission, institution, or authority, an agency, city, county, and any other political subdivision or special district in this state established pursuant to law, and, except where otherwise indicated, also means the United States or a department, division, or agency of the United States, and an agency, commission, or authority established pursuant to an interstate compact or agreement.
   b.  “Health insurer” means an entity providing a plan of health insurance, health care benefits, or health care services, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, or any other entity providing a plan of health insurance, health care benefits, or health care services. 
   c.  “Prisoner” means any individual confined in a jail.
   2.  A prisoner has the primary responsibility for payment of the costs of required medical aid provided pursuant to section 356.5. A provider of such medical aid to a prisoner shall seek reimbursement from the following sources in the following priority order:
   a.  (1)  From a health insurer, if the prisoner is entitled to payment or reimbursement for the costs of such medical aid under the terms and provisions of a policy, plan, contract, or other agreement with a health insurer. This paragraph shall not be interpreted to expand or enlarge the liability of any such health insurer and such health insurer shall not be responsible for paying or reimbursing any costs of medical aid for which the health insurer is not otherwise responsible under the terms of the applicable policy, plan, contract, or other agreement.
   (2)  A prisoner who is entitled to payment or reimbursement for the costs of medical aid provided under the terms of a policy, plan, contract, or other agreement with a health insurer shall cooperate fully with the provider of such medical aid to secure payment from such health insurer.
   b.  From any other available source, including, when appropriate, the United States department of veterans affairs, the United states social security administration, the department of human services, or other similar source.
   c.  (1)  Upon a demonstration that reimbursement from the sources specified in paragraphs “a” and “b” is not available, in whole or in part, for the medical aid provided, from the appropriate governmental agency if the governmental agency is otherwise required by law to pay for the costs of the medical aid. Reimbursement under this paragraph “c” shall be at the Medicare rate, the Medicaid rate, or at the rate negotiated between the governmental agency and the provider, whichever rate is lowest.
   (2)  Payment under this paragraph “c” shall be made within ninety days following the demonstration that alternative reimbursement is not available. 
   (3)  (a)  For the purposes of this paragraph “c”, a demonstration that reimbursement is not available shall be deemed sufficient if a provider of medical aid signs an affidavit stating all of the following:
   (i)  In the case of a health insurer, a written denial of payment has been issued by the health insurer.
   (ii)  In all other cases, efforts have been made to identify sources and to collect from those sources, and more than one hundred eighty days have passed since the medical aid was rendered or the normal collection efforts have been exhausted but full payment has not been received.
   (b)  The affidavit shall be forwarded to the appropriate governmental agency.
   (4)  A provider of medical aid shall not be required to file suit in a court of law or retain the services of a collection agency to satisfy the required demonstration that reimbursement is not available pursuant to this paragraph “c”.
   3.  Except as provided in chapters 669 and 670, a governmental agency shall not be responsible for payment of the costs of any medical aid provided to a prisoner if such medical aid is provided after the individual is released from the custody of the governmental agency or when the individual is released on parole.
   4.  Any governmental agency presenting a prisoner for medical aid shall notify the provider of such medical aid of all information available to the governmental agency concerning potential sources of payment.
   5.  This section does not preclude a city or a county from seeking reimbursement from a prisoner for the costs of medical aid incurred by the city or county for the prisoner’s medical aid including as provided pursuant to section 356.7.
   6.  Payment for medical aid provided to a prisoner at a state-funded hospital shall be provided through state funds received by the hospital.
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 payment of required medical aid provided to prisoners of county jails.
   The bill provides that while it is the duty of the keeper of a jail to furnish necessary medical aid to a prisoner, the prisoner has the primary responsibility for payment of the costs of the medical aid provided. The bill requires a provider of the medical aid to seek reimbursement from sources in the following priority order: (1) from a health insurer, if the prisoner is entitled to payment or reimbursement for the costs of the medical aid under the terms and provisions of a policy, plan, contract, or other agreement with a health insurer, (2) from any other available source, including, when appropriate, the United States department of veterans affairs, the United States social security administration, the department of human services, or other similar source, and (3) upon demonstration, by affidavit as provided in the bill, that reimbursement is not available, in whole or in part, through either the first or second priority source, from the appropriate governmental agency, if the governmental agency is otherwise required by law to pay for the costs of the medical aid. If a governmental agency is required to pay for the medical aid, payment must be made within 90 days, at the Medicare rate, the Medicaid rate, or the rate negotiated between the governmental agency and the provider, whichever rate is lowest. A provider of medical aid is not required to file suit in a court of law or retain the services of a collection agency to satisfy the required demonstration that reimbursement is not available. Unless otherwise provided by law, a governmental agency is not responsible for payment of the costs of any medical aid provided to a prisoner if the medical aid is provided after the individual is released from the custody of the governmental agency or when the individual is released on parole. A governmental agency presenting a prisoner for medical aid shall notify the provider of the medical aid of all information available to the governmental agency concerning potential sources of payment. The bill does not preclude a city or a county from seeking reimbursement from a prisoner for the costs of medical aid incurred by the city or county for the prisoner’s medical aid, and medical aid provided to prisoners at a state-funded hospital shall be provided through state funds received by the hospital.