Text: H09119 Text: H09121 Text: H09100 - H09199 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 2517 as amended, passed, and
1 2 reprinted by the House, as follows:
1 3 #1. Page 1, by inserting before line 1 the
1 4 following:
1 5 "Section 1. NEW SECTION. 432.13 PREMIUM TAX
1 6 EXEMPTION – HAWK-I PROGRAM.
1 7 Premiums collected by participating insurers under
1 8 chapter 514I, are exempt from premium tax."
1 9 #2. Page 1, by striking lines 15 through 22 and
1 10 inserting the following: "the general assembly is not
1 11 in session, the department, with the approval of the
1 12 HAWK-I board, shall proceed to implement and
1 13 administer those provisions, subject to review by the
1 14 next regular session of the general assembly.
1 15 ___. It is the intent of the general assembly,
1 16 recognizing the importance of outreach to the
1 17 successful utilization of the program by eligible
1 18 children, that within the limitations of funding
1 19 allowed for outreach and administration expenses, the
1 20 maximum amount possible be used for outreach.
1 21 ___. It is the intent of the general assembly that
1 22 the HAWK-I program be an integral part of the
1 23 continuum of health insurance coverage and that the
1 24 program be developed and implemented in such a manner
1 25 as to facilitate movement of families between health
1 26 insurance providers and to facilitate the transition
1 27 of families to private sector health insurance
1 28 coverage."
1 29 #3. Page 1, line 27, by striking the words "HAWK-I
1 30 board" and inserting the following: "department".
1 31 #4. Page 1, by inserting after line 28 the
1 32 following:
1 33 "___. "Benchmark benefit package" means any of the
1 34 following:
1 35 a. The standard blue cross/blue shield preferred
1 36 provider option service benefit plan, described in and
1 37 offered under 5 U.S.C. } 8903(1).
1 38 b. A health benefits coverage plan that is offered
1 39 and generally available to state employees in this
1 40 state.
1 41 c. The plan of a health maintenance organization
1 42 as defined in 42 U.S.C. } 300e, with the largest
1 43 insured commercial, nonmedical assistance enrollment
1 44 of covered lives in the state."
1 45 #5. Page 1, by striking lines 32 through 34 and
1 46 inserting the following:
1 47 "___. "Department" means the department of human
1 48 services.
1 49 ___. "Director" means the director of human
1 50 services."
2 1 #6. Page 2, line 4, by striking the word "governs"
2 2 and inserting the following: "adopts rules and
2 3 establishes policy for, and directs the department
2 4 regarding,".
2 5 #7. Page 2, line 10, by inserting after the word
2 6 "licensed" the following: "by the division of
2 7 insurance of the department of commerce".
2 8 #8. Page 2, line 13, by striking the words "HAWK-I
2 9 board to offer" and inserting the following:
2 10 "department to provide".
2 11 #9. Page 2, line 21, by striking the word "care".
2 12 #10. Page 2, by striking lines 25 through 27, and
2 13 inserting the following:
2 14 "2. Health insurance coverage under the program".
2 15 #11. Page 2, by inserting after line 35 the
2 16 following:
2 17 "___. Nothing in this chapter shall be construed
2 18 or is intended as, or shall imply, a grant of
2 19 entitlement for services to persons who are eligible
2 20 for participation in the program based upon
2 21 eligibility consistent with the requirements of this
2 22 chapter. Any state obligation to provide services
2 23 pursuant to this chapter is limited to the extent of
2 24 the funds appropriated or provided for this chapter.
2 25 ___. Participating insurers under this chapter are
2 26 not subject to the requirements of chapters 513B and
2 27 513C."
2 28 #12. Page 3, by striking lines 1 through 12 and
2 29 inserting the following:
2 30 "Sec. ___. NEW SECTION. 514I.3A DIRECTOR AND
2 31 DEPARTMENT – DUTIES – POWERS.
2 32 1. The director, with the approval of the HAWK-I
2 33 board, shall implement this chapter. The director
2 34 shall do all of the following:
2 35 a. At least every six months, evaluate the scope
2 36 of the program currently being provided under this
2 37 chapter, project the probable cost of continuing the
2 38 program, and compare the probable cost with the
2 39 remaining balance of the state appropriation made for
2 40 payment of assistance under this chapter during the
2 41 current appropriation period. The director shall
2 42 report the findings of the evaluation to the board and
2 43 shall annually report findings to the governor and the
2 44 general assembly by January 1.
2 45 b. Establish premiums to be paid to participating
2 46 insurers for provision of health insurance coverage.
2 47 c. Contract with participating insurers to provide
2 48 health insurance coverage under this chapter.
2 49 d. Recommend to the board proposed rules necessary
2 50 to implement the program.
3 1 e. Recommend to the board individuals to serve as
3 2 members of the clinical advisory committee.
3 3 2. The director, with the concurrence of the
3 4 board, shall enter into a contract with an
3 5 administrative contractor. Such contract shall be
3 6 entered into in accordance with the criteria
3 7 established by the board.
3 8 3. The department may enter into contracts with
3 9 other persons whereby the other person provides some
3 10 or all of the functions, pursuant to rules adopted by
3 11 the board, which are required of the director or the
3 12 department under this section. All contracts entered
3 13 into pursuant to this section shall be made available
3 14 to the public.
3 15 4. The department shall do or shall provide for
3 16 all of the following:
3 17 a. Develop a program application form not to
3 18 exceed two pages in length, which is consistent with
3 19 the rules of the board, which is easy to understand,
3 20 complete, and concise, and which, to the greatest
3 21 extent possible, coordinates with the medical
3 22 assistance program.
3 23 b. Establish the family cost sharing amount, based
3 24 on a sliding fee scale, if established by the board.
3 25 c. Perform other duties as determined by the
3 26 department with the approval of the board."
3 27 #13. Page 3, lines 14 and 15, by striking the
3 28 words "established which" and inserting the following:
3 29 "established. The board shall meet not less than ten
3 30 times annually, for the purposes of establishing
3 31 policy for, directing the department on, and adopting
3 32 rules for the program. The board".
3 33 #14. Page 3, line 19, by striking the words "human
3 34 services" and inserting the following: "education".
3 35 #15. Page 3, by striking lines 27 through 30 and
3 36 inserting the following: "this chapter."
3 37 #16. Page 4, by inserting after line 22 the
3 38 following:
3 39 "5A. The board may receive and accept grants,
3 40 loans, or advances of funds from any person and may
3 41 receive and accept from any source contributions of
3 42 money, property, labor, or any other thing of value,
3 43 to be held, used, and applied for the purposes of the
3 44 program."
3 45 #17. Page 4, by striking lines 24 through 27 and
3 46 inserting the following:
3 47 "___. Develop the criteria to be included in a
3 48 request for proposals for the selection of any
3 49 administrative contractor for the program."
3 50 #18. Page 4, line 28, by inserting after the word
4 1 "Define" the following: ", in consultation with the
4 2 department,".
4 3 #19. Page 4, line 29, by inserting after the word
4 4 "offered" the following: "in a manner as to ensure
4 5 access to services for all children participating in
4 6 the program".
4 7 #20. Page 4, by striking line 30 and inserting the
4 8 following:
4 9 "c. Approve the benefit package design, review the
4 10 benefit package".
4 11 #21. Page 4, by striking lines 33 through 35.
4 12 #22. Page 5, by striking lines 1 through 3 and
4 13 inserting the following:
4 14 "d. Develop, with the assistance of the
4 15 department, an outreach plan for implementation by the
4 16 administrative contractor, and provide for periodic
4 17 assessment of the effectiveness of the outreach plan.
4 18 The plan shall provide outreach to".
4 19 #23. Page 5, line 5, by inserting after the word
4 20 "coverage" the following: "or care programs".
4 21 #24. Page 5, by striking lines 14 through 16 and
4 22 inserting the following:
4 23 "___. In consultation with the clinical advisory
4 24 committee, select a single, nationally recognized
4 25 functional health assessment form for an initial
4 26 assessment of all".
4 27 #25. Page 5, line 21, by inserting after the word
4 28 "Review" the following: ", in consultation with the
4 29 department,".
4 30 #26. Page 5, line 24, by inserting after the word
4 31 "board" the following: ", in consultation with the
4 32 department,".
4 33 #27. Page 5, by striking lines 28 through 30 and
4 34 inserting the following: "and the HAWK-I program, and
4 35 to provide for common processes and".
4 36 #28. By striking page 5, line 33, through page 6,
4 37 line 1, and inserting the following:
4 38 "g. By January 1, annually, prepare, with the
4 39 assistance of the department, and submit a report to
4 40 the governor, the general assembly, and the council on
4 41 human services, concerning the board's activities,
4 42 findings, and recommendations."
4 43 #29. Page 6, line 2, by striking the word
4 44 "Receive" and inserting the following: "Solicit".
4 45 #30. Page 6, by striking lines 9 through 11.
4 46 #31. Page 6, line 12, by inserting after the word
4 47 "Establish" the following: "and consult with".
4 48 #32. Page 6, by striking lines 18 and 19 and
4 49 inserting the following: "limited to health
4 50 maintenance and prevention and health risk
5 1 assessment."
5 2 #33. Page 6, by inserting before line 20 the
5 3 following:
5 4 "m. Establish an advisory committee to make
5 5 recommendations to the board and to the general
5 6 assembly on or before January 1, 1999, concerning the
5 7 provision of health insurance coverage to children
5 8 with special health care needs under the program. The
5 9 committee shall include individuals with experience
5 10 in, knowledge of, or expertise in this area. The
5 11 recommendations shall address, but are not limited to,
5 12 all of the following:
5 13 (1) The definition of the target population of
5 14 children with special health care needs for the
5 15 purposes of determining eligibility under the program.
5 16 (2) Eligibility options for and assessment of
5 17 children with special health care needs for
5 18 eligibility.
5 19 (3) Benefit options for children with special
5 20 health care needs.
5 21 (4) Options for enrollment of children with
5 22 special health care needs in and disenrollment of
5 23 children with special health care needs from qualified
5 24 child health plans utilizing a capitated fee form of
5 25 payment.
5 26 (5) The appropriateness and quality of care for
5 27 children with special health care needs.
5 28 (6) The coordination of health services provided
5 29 for children with special health care needs under the
5 30 program with services provided by other publicly
5 31 funded programs."
5 32 #34. Page 6, line 20, by striking the word
5 33 "cooperation" and inserting the following:
5 34 "consultation".
5 35 #35. Page 6, by striking lines 30 and 31 and
5 36 inserting the following: "insurers for the program."
5 37 #36. Page 6, by striking lines 33 and 34 and
5 38 inserting the following: "plan which are those
5 39 included in a benchmark or benchmark equivalent plan
5 40 and which comply".
5 41 #37. Page 6, line 35, by striking the words "and
5 42 which".
5 43 #38. Page 7, by striking lines 1 and 2, and
5 44 inserting the following: ". Benefits covered shall
5 45 include but are not limited to all of the following:"
5 46 #39. Page 7, line 22, by striking the word
5 47 "preventative" and inserting the following:
5 48 "preventive".
5 49 #40. Page 7, by striking lines 32 and 33 and
5 50 inserting the following:
6 1 "g. Presumptive eligibility criteria for the
6 2 program."
6 3 #41. By striking page 7, line 35, through page 8,
6 4 line 2, and inserting the following: "shall be
6 5 assessed on a sliding fee scale based on family
6 6 income, which provides for a minimum amount of cost
6 7 sharing, and which complies with federal law."
6 8 #42. Page 8, line 14, by striking the word "board"
6 9 and inserting the following: "department".
6 10 #43. Page 9, by striking lines 21 and 22.
6 11 #44. Page 9, by inserting after line 29, the
6 12 following:
6 13 "4A. Require that any plan provided by the
6 14 participating insurer establishes and maintains a
6 15 conflict management system that includes methods for
6 16 both preventing and resolving disputes involving the
6 17 health care needs of eligible children, and a process
6 18 for resolution of such disputes."
6 19 #45. Page 10, by striking lines 1 and 2 and
6 20 inserting the following:
6 21 "c. Information regarding the plan's conflict
6 22 management system."
6 23 #46. Page 10, by striking lines 4 and 5 and
6 24 inserting the following:
6 25 "___. Submit a plan for a health improvement
6 26 program to the department, for approval by the board."
6 27 #47. Page 10, line 15, by striking the word
6 28 "developed" and inserting the following: "approved".
6 29 #48. Page 10, by striking lines 33 through 35.
6 30 #49. Page 11, line 4, by striking the words "of
6 31 human services".
6 32 #50. Page 11, by striking lines 6 through 8.
6 33 #51. Page 11, by striking lines 9 through 13 and
6 34 inserting the following:
6 35 "___. Develop and issue appropriate approval,
6 36 denial, and cancellation notifications to inform
6 37 applicants and enrollees of the status of the
6 38 applicant's or enrollee's eligibility to participate
6 39 in the program. Additionally, the administrative
6 40 contractor shall process applications, including
6 41 verifications and mailing of approvals and denials,
6 42 within ten working days of receipt of the application,
6 43 unless the application cannot be processed within this
6 44 period for a reason that is beyond the control of the
6 45 administrative contractor."
6 46 #52. Page 11, lines 15 and 16, by striking the
6 47 words "of human services".
6 48 #53. Page 11, line 20, by striking the words
6 49 "HAWK-I board" and inserting the following:
6 50 "department".
7 1 #54. Page 11, line 25, by striking the word
7 2 "divisions" and inserting the following:
7 3 "department".
7 4 #55. Page 11, line 26, by striking the words
7 5 "HAWK-I board" and inserting the following:
7 6 "department".
7 7 #56. By striking page 11, line 33, through page
7 8 12, line 5, and inserting the following:
7 9 "___. Collect and track monthly family premiums to
7 10 assure that payments are current."
7 11 #57. Page 12, line 7, by inserting after the word
7 12 "contractor" the following: "in that participating
7 13 insurer's plan".
7 14 #58. Page 12, by striking line 14 and inserting
7 15 the following:
7 16 "1. Effective July 1, 1998, and notwithstanding
7 17 any medical assistance program eligibility criteria to
7 18 the contrary, medical assistance shall be provided to,
7 19 or on behalf of, an eligible child under the age of
7 20 nineteen whose family income does not exceed one
7 21 hundred thirty-three percent of the federal poverty
7 22 level, as defined by the most recently revised poverty
7 23 income guidelines published by the United States
7 24 department of health and human services.
7 25 2. A child may participate in the HAWK-I program
7 26 if the child".
7 27 #59. Page 12, by striking lines 22 through 24 and
7 28 inserting the following:
7 29 "___. Is not eligible for medical assistance
7 30 pursuant to chapter 249A."
7 31 #60. Page 13, line 2, by inserting after the word
7 32 "eligible" the following: "for the program pending a
7 33 final eligibility determination".
7 34 #61. Page 13, by striking lines 6 and 7 and
7 35 inserting the following: "the administrative
7 36 contractor shall conduct a review of the circumstances
7 37 of the eligible child's family to establish
7 38 eligibility and cost sharing for the subsequent
7 39 twelve-month period."
7 40 #62. Page 13, by inserting after line 14 the
7 41 following:
7 42 "___. The board shall study and shall make
7 43 recommendations to the governor and to the general
7 44 assembly regarding the level of family income which is
7 45 appropriate for application of the program, and the
7 46 feasibility of allowing families with incomes above
7 47 the level of eligibility for the program to purchase
7 48 insurance for children through the program.
7 49 ___. The board and the council on human services
7 50 shall cooperate and seek appropriate coordination in
8 1 administration of the program and the medical
8 2 assistance program and shall develop a plan for a
8 3 unified medical assistance and HAWK-I program system
8 4 which includes the use of a single health insurance
8 5 card by enrollees of either program."
8 6 #63. Page 13, by striking lines 22 through 26 and
8 7 inserting the following: "the results of the initial
8 8 benefits package used."
8 9 #64. Page 14, lines 8 and 9, by striking the words
8 10 "a minimum of two percent" and inserting the
8 11 following: "at least a minimum amount".
8 12 #65. Page 14, by inserting after line 13, the
8 13 following:
8 14 "Sec. ___. APPOINTMENT OF MEMBERS OF THE HAWK-I
8 15 BOARD. The members of the HAWK-I board shall be
8 16 appointed within thirty days of enactment of this Act
8 17 and may begin performing board duties prior to the
8 18 beginning of the official commencement of the terms of
8 19 the appointed board members as provided under this
8 20 Act.
8 21 Sec. ___. OUTREACH. Notwithstanding any provision
8 22 to the contrary, including section 8.33, any moneys
8 23 remaining in the Iowa healthy kids trust fund pursuant
8 24 to chapter 514H and any moneys remaining from grants,
8 25 contributions, or other sources which were designated
8 26 for the purposes of the healthy kids program shall be
8 27 transferred to the department of human services and
8 28 used to implement outreach activities for the HAWK-I
8 29 program immediately upon enactment of this Act.
8 30 Sec. ___. EMERGENCY RULES. The department of
8 31 human services may adopt emergency rules to implement
8 32 changes in the medical assistance program by July 1,
8 33 1998, and the department of human services and the
8 34 board may each adopt emergency rules only to the
8 35 extent necessary to implement the HAWK-I program by
8 36 January 1, 1999. Any rules adopted in accordance with
8 37 this section shall also be published as notice of
8 38 intended action as provided in section 17A.4.
8 39 Sec. ___. Chapter 514H is repealed."
8 40 #66. Title page, line 2, by inserting after the
8 41 word "children" the following: ", providing for a
8 42 repeal,".
8 43 #67. By renumbering as necessary.
8 44 HF 2517S
8 45 pf/cc/26
Text: H09119 Text: H09121 Text: H09100 - H09199 Text: H Index Bills and Amendments: General Index Bill History: General Index
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