Text: S03393 Text: S03395 Text: S03300 - S03399 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 462, as amended, passed, and
1 2 reprinted by the Senate, as follows:
1 3 #1. Page 1, by inserting after line 34 the
1 4 following:
1 5 "a. The department shall research the feasibility
1 6 of establishing a program of developing community-
1 7 based residential facilities or "second chance homes"
1 8 for young mothers and children. The research shall
1 9 consider potential benefits of second chance homes
1 10 including the potential effects of deterring child
1 11 abuse by use of the homes. The research is subject to
1 12 all of the following provisions:
1 13 b. The department shall consider developing the
1 14 home in a manner to provide supervision by mature
1 15 adult couples. The program should coordinate
1 16 comprehensive services for pregnant or parenting
1 17 teens, including but not limited to educational
1 18 services, vocational services, personal and family
1 19 counseling, parent education classes, and assistance
1 20 in developing independent living and homemaking
1 21 skills.
1 22 c. The department shall consider various options
1 23 for designing second chance homes so that the homes
1 24 will not necessarily be government-operated
1 25 institutions. The options considered shall include
1 26 operation by churches and community groups with state
1 27 guidance through administrative rules. If the program
1 28 is implemented, administrative rules will delineate
1 29 how the homes will be structured and specify the
1 30 combination of support, services, and participant
1 31 obligations to help teenage mothers to become good
1 32 mothers, finish school, and gain adequate skills to
1 33 support their children.
1 34 d. The department shall consider a design which
1 35 provides incentive grants to communities that pledge
1 36 private funding and in-kind services equal to at least
1 37 one-half of the cost of operating a second chance
1 38 home. In addition, operating expenses could be
1 39 supported in part by participants' welfare payments,
1 40 food stamps, housing assistance, and other forms of
1 41 public assistance for which participants are eligible,
1 42 as well as a commitment from communities.
1 43 e. The department shall submit a report to the
1 44 general assembly on or before January 8, 1996,
1 45 concerning the research conducted pursuant to this
1 46 subsection."
1 47 #2. Page 7, line 12, by inserting after the figure
1 48 "1995." the following: "The department of human
1 49 services shall submit a report on a quarterly basis to
1 50 the general assembly during the months in which the
2 1 general assembly is in session and to the fiscal
2 2 committee of the legislative council during the months
2 3 in which the general assembly is not in session,
2 4 describing the progress and activities of the
2 5 integrated substance abuse managed care program."
2 6 #3. Page 7, by striking lines 13 through 29 and
2 7 inserting the following:
2 8 "10. a. Beginning September 1, 1995, the
2 9 department may require prior authorization for any
2 10 brand name prescription drug which has an "A" rated
2 11 generic bioequivalent as determined by the federal
2 12 food and drug administration and which is recommended
2 13 for prior authorization by the drug utilization review
2 14 commission. The department shall establish an
2 15 educational program through the drug utilization
2 16 review commission to review and encourage the use of
2 17 these "A" rated generic equivalents within the medical
2 18 assistance program. The department shall adopt
2 19 administrative rules to implement the prior
2 20 authorization provisions of this paragraph. The
2 21 department shall not expand the requirement of prior
2 22 authorization for drugs other than the "A" rated
2 23 generic bioequivalents authorized under this
2 24 paragraph, without prior approval of the general
2 25 assembly for such expansion. Beginning January 1,
2 26 1996, prior authorization shall not be required for
2 27 clozapine. The department shall consider expert
2 28 medical opinion in revising administrative rules
2 29 applicable to clozapine.
2 30 aa. The department shall amend the contract with
2 31 the department's fiscal agent regarding prior
2 32 authorization of prescription drugs to provide for
2 33 review by the fiscal agent of inquiries for prior
2 34 authorization during pharmacy business hours,
2 35 evenings, Saturdays and during pharmacy peak business
2 36 hours on Sundays, and shall consider providing for
2 37 review by the fiscal agent of inquiries on a seven-
2 38 day-per-week, 24-hour-per-day basis.
2 39 aaa. (1) The department of human services shall
2 40 conduct a study of the prior authorization program
2 41 based upon the program data collected during fiscal
2 42 year 1994-1995, including a review of a sampling of
2 43 specific drugs for which prior authorization is
2 44 required. The study shall be completed by October 1,
2 45 1995, and a report of the findings of the study shall
2 46 be submitted to the chairpersons and ranking members
2 47 of the senate and house appropriations committees, to
2 48 the chairpersons and ranking members of the joint
2 49 human services appropriations committee, and to the
2 50 legislative fiscal bureau. The study shall address
3 1 and include information and recommendations regarding
3 2 all of the following:
3 3 (a) A comparison of the costs associated with the
3 4 prescribing of generic drugs rather than brand name
3 5 drugs, taking into consideration any rebates or other
3 6 cost reductions associated with the use of brand name
3 7 drugs.
3 8 (b) A review of the time associated with the prior
3 9 authorization process including telephone
3 10 communications between providers and the department's
3 11 prior authorization fiscal agent and with delays for
3 12 either party. The review shall include an analysis of
3 13 the average time associated with each inquiry by
3 14 classification of drug.
3 15 (c) A review of the number of denials of
3 16 authorization by classification of drug by the fiscal
3 17 agent and the rationale for the denials.
3 18 (d) A review of the actual and projected cost
3 19 savings and workability of the prior authorization
3 20 program.
3 21 (e) A review of the services provided by the
3 22 fiscal agent including a comparison of the services of
3 23 the fiscal agent with private pay insurers in
3 24 providing a similar service, and an evaluation of the
3 25 current availability of the fiscal agent and any
3 26 improvements to the program which might result from
3 27 increased availability.
3 28 (f) A review of the volume of inquiries for prior
3 29 authorization during a weekly period including an
3 30 analysis of the days and times of peak volume as
3 31 compared with the availability of the fiscal agent for
3 32 responding to inquiries.
3 33 (g) An analysis of the time which elapses between
3 34 the submission of a bill to the department for
3 35 reimbursement and actual reimbursement.
3 36 (2) Following receipt of the report from the
3 37 department, the legislative fiscal bureau shall review
3 38 the study. The review shall include all of the
3 39 following:
3 40 (a) An evaluation of the cost and savings
3 41 methodology utilized by the department, including an
3 42 analysis of whether all governmental costs and savings
3 43 were included or adequately addressed in the savings
3 44 methodology used during fiscal year 1994-1995. If the
3 45 legislative fiscal bureau determines that the cost and
3 46 savings methodology utilized by the department or the
3 47 fiscal agent did not include or adequately address all
3 48 governmental costs, the legislative fiscal bureau
3 49 shall provide recommendations to the general assembly
3 50 to improve the cost and savings methodology for future
4 1 application.
4 2 (b) An individualized assessment of the prior
4 3 authorization program based on a random sample of not
4 4 more than 50 individual prior authorization actions,
4 5 of which one-half shall be approval actions and one-
4 6 half shall be denial actions. The random sample shall
4 7 be provided by the department to the legislative
4 8 fiscal bureau based upon a random sampling methodology
4 9 submitted by the legislative fiscal bureau. All data
4 10 deemed necessary by the legislative fiscal bureau to
4 11 conduct the assessment shall be provided by the
4 12 department including but not limited to the date and
4 13 time of the prior authorization contact between the
4 14 fiscal agent and the provider; the name, address, and
4 15 telephone number of the provider; and the
4 16 classification of the drug for which prior
4 17 authorization was sought. If the action was an
4 18 approval action, the department shall provide a
4 19 statement of the actual cost associated with the
4 20 substituted drug and the cost associated with the
4 21 alternative drug. If the action was a denial action,
4 22 the department shall provide the rationale for the
4 23 denial.
4 24 b. The department of human services shall, when it
4 25 is economically beneficial, implement maximum
4 26 allowable costs for multiple source drugs in
4 27 accordance with federal guidelines.
4 28 c. The department shall develop a plan to
4 29 administratively pursue reimbursement for pharmacy
4 30 services for which a recipient of medical assistance
4 31 also has third-party coverage. The department shall
4 32 develop the plan in cooperation with the insurance
4 33 division of the department of commerce and with
4 34 representatives of the Iowa pharmacists association.
4 35 The department shall submit the plan to the general
4 36 assembly on or before January 1, 1996, and shall
4 37 implement the plan on or before May 1, 1996. The
4 38 department shall also include a preliminary estimate
4 39 of the costs of administratively pursuing
4 40 reimbursement for pharmacy services in the budget
4 41 submitted to the council of human services for fiscal
4 42 year 1996-1997."
4 43 #4. Page 8, by inserting after line 21 the
4 44 following:
4 45 "Sec. 200. The department of human services shall
4 46 seek federal approval on or before August 1, 1995, for
4 47 the implementation of a pilot program to allow medical
4 48 assistance program reimbursement for payment of
4 49 services provided by persons who provide a home and
4 50 services to a total of seventy-five persons who
5 1 currently reside in nursing homes. The department, in
5 2 cooperation with the department of elder affairs,
5 3 shall develop a program which will result in a cost
5 4 savings to the state or in cost neutrality, and shall
5 5 develop parameters for the program which shall include
5 6 but are not limited to all of the following:
5 7 a. A maximum income eligibility level, established
5 8 by the department, which applies to persons providing
5 9 a home and services and seeking reimbursement through
5 10 the medical assistance program.
5 11 b. An evaluative component which enables the
5 12 department to measure the financial and quality of
5 13 life aspects of the pilot program in comparison with
5 14 placement of a person in a nursing home.
5 15 c. A maximum reimbursement rate of $15,000,
5 16 annually, for housing and services provided by the
5 17 home provider under the pilot program.
5 18 d. Any other criteria necessary to implement the
5 19 pilot program including but not limited to
5 20 implementation in a manner which targets current
5 21 nursing home residents in both rural and urban areas
5 22 of the state."
5 23 #5. Page 8, by inserting after line 21 the
5 24 following:
5 25 " . The department of human services shall
5 26 consult with the department of inspections and
5 27 appeals, the Iowa state association of counties, and
5 28 the Iowa association of rehabilitation and residential
5 29 facilities in adopting administrative rules
5 30 identifying optimum staffing ratios for intermediate
5 31 care facilities for the mentally retarded (ICFMR).
5 32 The administrative rules shall be implemented on or
5 33 before January 1, 1996."
5 34 #6. Page 9, line 2, by inserting after the word
5 35 "plan." the following: "The department shall submit a
5 36 report on a quarterly basis to the general assembly
5 37 during the months in which the general assembly is in
5 38 session and to the fiscal committee of the legislative
5 39 council during the months in which the general
5 40 assembly is not in session, describing the progress
5 41 and activities of the prepaid mental health services
5 42 plan."
5 43 #7. Page 10, by striking line 12 and inserting the
5 44 following:
5 45 "................................................. $ 7,740,000"
5 46 #8. Page 11, line 10, by inserting after the
5 47 figure "12." the following: "The department may adopt
5 48 emergency rules to implement the provisions of this
5 49 lettered paragraph."
5 50 #9. Page 12, line 5, by striking the figure
6 1 "640,270" and inserting the following: "636,641".
6 2 #10. Page 12, line 11, by striking the figure
6 3 "1,679,769" and inserting the following: "1,676,139".
6 4 #11. Page 14, by striking line 1 and inserting the
6 5 following:
6 6 "................................................. $ 6,390,000"
6 7 #12. Page 16, by striking line 13 and inserting
6 8 the following:
6 9 "................................................. $ 13,480,000"
6 10 #13. Page 16, by striking line 18 and inserting
6 11 the following:
6 12 "................................................. $ 4,980,000"
6 13 #14. Page 16, by striking line 23 and inserting
6 14 the following:
6 15 "................................................. $ 8,500,000"
6 16 #15. Page 17, by striking line 7 and inserting the
6 17 following:
6 18 "................................................. $ 83,380,000"
6 19 #16. Page 18, line 1, by striking the word
6 20 "administrative" and inserting the following:
6 21 "emergency".
6 22 #17. Page 21, lines 12 and 13, by striking the
6 23 words "a portion may be used" and inserting the
6 24 following: "$1,000,000 is allocated".
6 25 #18. Page 21, line 16, by inserting after the word
6 26 "placement." the following: "On or before January 4,
6 27 1996, the department shall review the use of the
6 28 funding allocated in this subsection and project
6 29 whether an amount of the funding will be unused by the
6 30 close of the fiscal year. If an amount is projected,
6 31 the department shall transfer the projected amount to
6 32 the appropriation in this Act for family support
6 33 subsidy for use to provide assistance to additional
6 34 families who would otherwise remain on the waiting
6 35 list for that program. The department shall work with
6 36 the Iowa governor's planning council for developmental
6 37 disabilities, the arc of Iowa, the Iowa respite
6 38 coalition, and the Iowa family support initiative to
6 39 review use of the program funded in this section and
6 40 develop recommendations for consideration in the 1996
6 41 legislative session. The recommendations shall
6 42 address how much of the funding should be directed to
6 43 families trying to keep their children with
6 44 disabilities in the family home, potential
6 45 administrative rule revisions to improve the program,
6 46 and actions for the department to take to inform
6 47 families about the program."
6 48 #19. Page 23, by inserting after line 9 the
6 49 following:
6 50 " . The department, in cooperation with
7 1 interested social service providers, shall study the
7 2 feasibility of expanding existing confidentiality
7 3 provisions to allow social service providers to form
7 4 local teams to discuss provision of the most
7 5 appropriate services in individual cases."
7 6 #20. Page 23, by inserting after line 9 the
7 7 following:
7 8 "100. Notwithstanding section 234.39, if a child
7 9 was removed from the child's home and placed in foster
7 10 care during the fiscal year beginning July 1, 1994,
7 11 based upon an allegation of child abuse that was
7 12 subsequently determined to be unfounded, a support
7 13 obligation shall not be established for the child's
7 14 parent or guardian for the cost of the foster care."
7 15 #21. Page 23, by inserting after line 9 the
7 16 following:
7 17 " . The department shall continue to make
7 18 adoption presubsidy and adoption subsidy payments to
7 19 adoptive parents at the beginning of the month for the
7 20 current month."
7 21 #22. Page 23, by striking lines 15 and 16 and
7 22 inserting the following:
7 23 "For community-based programs directed to child
7 24 abuse prevention and adolescent pregnancy prevention,
7 25 including salaries, support".
7 26 #23. Page 23, by striking line 19 and inserting
7 27 the following:
7 28 "................................................. $ 2,620,000"
7 29 #24. Page 23, line 21, by striking the figure
7 30 "756,048" and inserting the following: "754,000".
7 31 #25. Page 23, line 31, by striking the figure
7 32 "300,000" and inserting the following: "298,000".
7 33 #26. Page 24, line 32, by striking the figure
7 34 "732,789" and inserting the following: "731,014".
7 35 #27. By striking page 24, line 35, through page
7 36 25, line 3, and inserting the following:
7 37 " . Moneys appropriated in this section which
7 38 are otherwise unallocated shall be distributed among
7 39 the allocations specified in this section. The
7 40 distribution shall be made based upon the specific
7 41 allocation's proportion of the total amount allocated
7 42 in this section. Moneys distributed in accordance
7 43 with this subsection shall be used for the purposes
7 44 designated in the specific subsection."
7 45 #28. Page 27, by striking line 30 and inserting
7 46 the following:
7 47 "................................................. $ 43,190,000"
7 48 #29. Page 27, by striking line 35 and inserting
7 49 the following:
7 50 "................................................. $ 14,840,000"
8 1 #30. Page 28, by striking line 3 and inserting the
8 2 following:
8 3 "................................................. $ 6,000,000"
8 4 #31. Page 28, by striking line 6 and inserting the
8 5 following:
8 6 "................................................. $ 17,590,000"
8 7 #32. Page 28, by striking line 9 and inserting the
8 8 following:
8 9 "................................................. $ 4,760,000"
8 10 #33. Page 28, by striking line 29 and inserting
8 11 the following:
8 12 "................................................. $ 66,260,000"
8 13 #34. Page 28, by striking line 34 and inserting
8 14 the following:
8 15 "................................................. $ 35,830,000"
8 16 #35. Page 29, by striking line 2 and inserting the
8 17 following:
8 18 "................................................. $ 30,430,000"
8 19 #36. Page 29, by striking lines 8 through 11.
8 20 #37. Page 30, by striking line 3 and inserting the
8 21 following:
8 22 "................................................. $ 1,110,000"
8 23 #38. Page 30, by striking line 33 and inserting
8 24 the following:
8 25 "................................................. $ 5,470,000"
8 26 #39. Page 31, by striking line 8 and inserting the
8 27 following:
8 28 "................................................. $ 16,230,000"
8 29 #40. Page 31, line 9, by striking the figure
8 30 "15,888,182" and inserting the following:
8 31 "15,951,138".
8 32 #41. Page 31, by striking lines 11 and 12 and
8 33 inserting the following: "mental health and
8 34 developmental disabilities services. The moneys shall
8 35 be".
8 36 #42. Page 31, by striking lines 22 and 23 and
8 37 inserting the following: "persons with a disability,
8 38 as defined in section 255C.2. However, no more".
8 39 #43. Page 31, by striking line 28 and inserting
8 40 the following: "services provided to persons with a
8 41 disability."
8 42 #44. Page 32, line 11, by striking the word
8 43 "MI/MR/DD/BI" and inserting the following: "a
8 44 disability".
8 45 #45. Page 32, by striking line 13 and inserting
8 46 the following:
8 47 "b. County expenditure reports for services
8 48 provided to persons with a disability for the prior".
8 49 #46. Page 32, by inserting after line 17 the
8 50 following:
9 1 " . Of the funds appropriated in this section,
9 2 not more than $248,862 shall be provided to those
9 3 counties having supplemental per diem contracts in
9 4 effect on June 30, 1994, which were originally
9 5 initiated under 1993 Iowa Acts, chapter 172, section
9 6 16, subsection 2. The amount provided to each county
9 7 shall be equal to the amount the county would be
9 8 eligible to receive under the supplemental per diem
9 9 contracts in effect on June 30, 1994, if the contracts
9 10 were continued in effect for the entire fiscal year
9 11 beginning July 1, 1995."
9 12 #47. Page 35, by striking lines 1 through 4 and
9 13 inserting the following: "served under the pilot
9 14 project or the waiver."
9 15 #48. Page 35, by striking line 35 and inserting
9 16 the following:
9 17 "................................................ $ 38,140,000"
9 18 #49. Page 36, by inserting after line 1 the
9 19 following:
9 20 "The department may exceed the quantity of full-
9 21 time equivalent positions authorized in this section
9 22 by up to 8.5 FTEs as necessary to increase services
9 23 for the permanent placement of children for whom
9 24 parental rights have been terminated and who are under
9 25 the guardianship of the department."
9 26 #50. Page 36, by striking line 33 and inserting
9 27 the following:
9 28 "................................................. $ 919,000"
9 29 #51. Page 39, by inserting after line 34 the
9 30 following:
9 31 "c. The department revises the reimbursement rates
9 32 due to implementation of a redesigned purchase of
9 33 services system."
9 34 #52. By striking page 40, line 34 through page 41,
9 35 line 5 and inserting the following:
9 36 " . The department shall modify reimbursement
9 37 provisions applicable to agencies providing services
9 38 under the department's rehabilitative treatment
9 39 program for children and their families. The
9 40 modification shall address the service utilization
9 41 reimbursement rates under the program to include the
9 42 time a child is away from the agency for good cause."
9 43 #53. Page 41, by inserting after line 12 the
9 44 following:
9 45 "Sec. . STANDARDS FOR CASELOADS AND
9 46 REIMBURSEMENT.
9 47 1. The department of human services shall develop
9 48 a plan for meeting national standards on caseloads for
9 49 the department's social workers.
9 50 2. The department shall also develop a plan for
10 1 improving the adequacy of reimbursement for family
10 2 foster care. The foster care reimbursement rate
10 3 improvement provisions shall provide for basing the
10 4 reimbursement rates on at least 75 percent of the
10 5 United States department of agriculture estimate of
10 6 the costs to raise a child in the calendar year
10 7 immediately preceding the fiscal year. In addition
10 8 the family foster care provisions of the plan shall
10 9 address additional reimbursement for respite care,
10 10 including in-home respite care, and adequate
10 11 allowances for clothing and school expenses. The
10 12 clothing allowance upon a child's initial placement
10 13 shall be at least $250 and at least $50 per month for
10 14 the remainder of the placement. School expenses shall
10 15 be reimbursed for elementary and developmental
10 16 preschool children at not more than $50 per semester
10 17 and for grades seven through twelve at not more than
10 18 $100 per semester. Driver's education expenses shall
10 19 be reimbursed in full.
10 20 3. The department shall submit the planning
10 21 provisions required by this section to the members of
10 22 the joint appropriations subcommittee on human
10 23 services of the senate and house of representatives on
10 24 or before January 8, 1996."
10 25 #54. Page 45, by striking lines 17 through 19 and
10 26 inserting the following: "this Act, relating to any
10 27 prior authorization, and".
10 28 #55. Page 45, line 17, by inserting after the word
10 29 "authorization," the following: "section 200 relating
10 30 to the nursing home waiver pilot program,".
10 31 #56. By renumbering, relettering, or redesignating
10 32 and correcting internal references as necessary.
10 33 SF 462H
10 34 pf/pk/25
Text: S03393 Text: S03395 Text: S03300 - S03399 Text: S Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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