Text: HF02516 Text: HF02518 Text: HF02500 - HF02599 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 HOUSE FILE 2517
1 2
1 3 AN ACT
1 4 ESTABLISHING A HEALTHY AND WELL KIDS IN IOWA (HAWK-I) PROGRAM
1 5 TO PROVIDE HEALTH INSURANCE TO ELIGIBLE CHILDREN, PROVIDING
1 6 FOR A REPEAL, AND PROVIDING AN EFFECTIVE DATE.
1 7
1 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 9
1 10 Section 1. NEW SECTION. 432.13 PREMIUM TAX EXEMPTION –
1 11 HAWK-I PROGRAM.
1 12 Premiums collected by participating insurers under chapter
1 13 514I, are exempt from premium tax.
1 14 Sec. 2. NEW SECTION. 514I.1 INTENT OF THE GENERAL
1 15 ASSEMBLY.
1 16 1. It is the intent of the general assembly to provide
1 17 health care coverage to eligible children that improves access
1 18 to preventive, diagnostic, and treatment health services which
1 19 result in improved health status using in part resources made
1 20 available from the passage of Title XXI of the federal Social
1 21 Security Act.
1 22 2. It is the intent of the general assembly that the
1 23 program be implemented and administered in compliance with
1 24 Title XXI of the federal Social Security Act. If, as a
1 25 condition of receiving federal funds for the program, federal
1 26 law requires implementation and administration of the program
1 27 in a manner not provided in this chapter, during a period when
1 28 the general assembly is not in session, the department, with
1 29 the approval of the HAWK-I board, shall proceed to implement
1 30 and administer those provisions, subject to review by the next
1 31 regular session of the general assembly.
1 32 3. It is the intent of the general assembly, recognizing
1 33 the importance of outreach to the successful utilization of
1 34 the program by eligible children, that within the limitations
1 35 of funding allowed for outreach and administration expenses,
2 1 the maximum amount possible be used for outreach.
2 2 4. It is the intent of the general assembly that the HAWK-
2 3 I program be an integral part of the continuum of health
2 4 insurance coverage and that the program be developed and
2 5 implemented in such a manner as to facilitate movement of
2 6 families between health insurance providers and to facilitate
2 7 the transition of families to private sector health insurance
2 8 coverage.
2 9 Sec. 3. NEW SECTION. 514I.2 DEFINITIONS.
2 10 As used in this chapter, unless the context otherwise
2 11 requires:
2 12 1. "Administrative contractor" means the person with whom
2 13 the department enters a contract to administer the HAWK-I
2 14 program under this chapter.
2 15 2. "Benchmark benefit package" means any of the following:
2 16 a. The standard blue cross/blue shield preferred provider
2 17 option service benefit plan, described in and offered under 5
2 18 U.S.C. } 8903(1).
2 19 b. A health benefits coverage plan that is offered and
2 20 generally available to state employees in this state.
2 21 c. The plan of a health maintenance organization as
2 22 defined in 42 U.S.C. } 300e, with the largest insured
2 23 commercial, nonmedical assistance enrollment of covered lives
2 24 in the state.
2 25 3. "Cost sharing" means the payment of a premium or
2 26 copayment as provided for by Title XXI of the federal Social
2 27 Security Act and section 514I.9.
2 28 4. "Department" means the department of human services.
2 29 5. "Director" means the director of human services.
2 30 6. "Eligible child" means an individual who meets the
2 31 criteria for participation in the program under section
2 32 514I.7.
2 33 7. "HAWK-I board" or "board" means the entity which adopts
2 34 rules and establishes policy for, and directs the department
2 35 regarding, the HAWK-I program.
3 1 8. "HAWK-I program" or "program" means the healthy and
3 2 well kids in Iowa program created in this chapter to provide
3 3 health insurance coverage to eligible children.
3 4 9. "Health insurance coverage" means health insurance
3 5 coverage as defined in 42 U.S.C. } 300gg(91).
3 6 10. "Participating insurer" means any entity licensed by
3 7 the division of insurance of the department of commerce to
3 8 provide health insurance in Iowa or an organized delivery
3 9 system licensed by the director of public health that has
3 10 contracted with the department to provide health insurance
3 11 coverage to eligible children under this chapter.
3 12 11. "Qualified child health plan" or "plan" means health
3 13 insurance coverage provided by a participating insurer under
3 14 this chapter.
3 15 Sec. 4. NEW SECTION. 514I.3 HAWK-I PROGRAM –
3 16 ESTABLISHED.
3 17 1. The HAWK-I program, a statewide program designed to
3 18 improve the health of children and to provide health insurance
3 19 coverage to eligible children on a regional basis which
3 20 complies with Title XXI of the federal Social Security Act, is
3 21 established and shall be implemented January 1, 1999.
3 22 2. Health insurance coverage under the program shall be
3 23 provided by participating insurers and through qualified child
3 24 health plans.
3 25 3. The department of human services is designated to
3 26 receive the state and federal funds appropriated or provided
3 27 for the program, and to submit and maintain the state plan for
3 28 the program, which is approved by the health care financing
3 29 administration of the United States department of health and
3 30 human services.
3 31 4. Nothing in this chapter shall be construed or is
3 32 intended as, or shall imply, a grant of entitlement for
3 33 services to persons who are eligible for participation in the
3 34 program based upon eligibility consistent with the
3 35 requirements of this chapter. Any state obligation to provide
4 1 services pursuant to this chapter is limited to the extent of
4 2 the funds appropriated or provided for this chapter.
4 3 5. Participating insurers under this chapter are not
4 4 subject to the requirements of chapters 513B and 513C.
4 5 Sec. 5. NEW SECTION. 514I.3A DIRECTOR AND DEPARTMENT –
4 6 DUTIES – POWERS.
4 7 1. The director, with the approval of the HAWK-I board,
4 8 shall implement this chapter. The director shall do all of
4 9 the following:
4 10 a. At least every six months, evaluate the scope of the
4 11 program currently being provided under this chapter, project
4 12 the probable cost of continuing the program, and compare the
4 13 probable cost with the remaining balance of the state
4 14 appropriation made for payment of assistance under this
4 15 chapter during the current appropriation period. The director
4 16 shall report the findings of the evaluation to the board and
4 17 shall annually report findings to the governor and the general
4 18 assembly by January 1.
4 19 b. Establish premiums to be paid to participating insurers
4 20 for provision of health insurance coverage.
4 21 c. Contract with participating insurers to provide health
4 22 insurance coverage under this chapter.
4 23 d. Recommend to the board proposed rules necessary to
4 24 implement the program.
4 25 e. Recommend to the board individuals to serve as members
4 26 of the clinical advisory committee.
4 27 2. The director, with the concurrence of the board, shall
4 28 enter into a contract with an administrative contractor. Such
4 29 contract shall be entered into in accordance with the criteria
4 30 established by the board.
4 31 3. The department may enter into contracts with other
4 32 persons whereby the other person provides some or all of the
4 33 functions, pursuant to rules adopted by the board, which are
4 34 required of the director or the department under this section.
4 35 All contracts entered into pursuant to this section shall be
5 1 made available to the public.
5 2 4. The department shall do or shall provide for all of the
5 3 following:
5 4 a. Develop a program application form not to exceed two
5 5 pages in length, which is consistent with the rules of the
5 6 board, which is easy to understand, complete, and concise, and
5 7 which, to the greatest extent possible, coordinates with the
5 8 medical assistance program.
5 9 b. Establish the family cost sharing amount, based on a
5 10 sliding fee scale, if established by the board.
5 11 c. Perform other duties as determined by the department
5 12 with the approval of the board.
5 13 Sec. 6. NEW SECTION. 514I.4 HAWK-I BOARD.
5 14 1. A HAWK-I board for the HAWK-I program is established.
5 15 The board shall meet not less than ten times annually, for the
5 16 purposes of establishing policy for, directing the department
5 17 on, and adopting rules for the program. The board shall
5 18 consist of seven members, including, all of the following:
5 19 a. The commissioner of insurance, or the commissioner's
5 20 designee.
5 21 b. The director of the department of education, or the
5 22 director's designee.
5 23 c. The director of public health, or the director's
5 24 designee.
5 25 d. Four public members appointed by the governor and
5 26 subject to confirmation by the senate. The public members
5 27 shall be members of the general public who have experience,
5 28 knowledge, or expertise in the subject matter embraced within
5 29 this chapter.
5 30 e. Two members of the senate and two members of the house
5 31 of representatives, serving as ex officio members. The
5 32 legislative members of the board shall be appointed by the
5 33 majority leader of the senate, after consultation with the
5 34 president of the senate, and by the minority leader of the
5 35 senate, and by the speaker of the house, after consultation
6 1 with the majority leader, and by the minority leader of the
6 2 house of representatives. Legislative members shall receive
6 3 compensation pursuant to section 2.12.
6 4 2. A public member shall not have a conflict of interest
6 5 with the administrative contractor.
6 6 3. Members appointed by the governor and legislative
6 7 members of the board shall serve two-year terms. The filling
6 8 of positions reserved for the public representatives,
6 9 vacancies, membership terms, payment of compensation and
6 10 expenses, and removal of the members are governed by chapter
6 11 69. Members of the board are entitled to receive
6 12 reimbursement of actual expenses incurred in the discharge of
6 13 their duties. Public members of the board are also eligible
6 14 to receive compensation as provided in section 7E.6. The
6 15 members shall select a chairperson on an annual basis from
6 16 among the membership of the board.
6 17 4. The board shall approve any contract entered into
6 18 pursuant to this chapter. All contracts entered into pursuant
6 19 to this chapter shall be made available to the public.
6 20 5. The department of human services shall act as support
6 21 staff to the board.
6 22 6. The board may receive and accept grants, loans, or
6 23 advances of funds from any person and may receive and accept
6 24 from any source contributions of money, property, labor, or
6 25 any other thing of value, to be held, used, and applied for
6 26 the purposes of the program.
6 27 7. The HAWK-I board shall do all of the following:
6 28 a. Develop the criteria to be included in a request for
6 29 proposals for the selection of any administrative contractor
6 30 for the program.
6 31 b. Define, in consultation with the department, the
6 32 regions of the state for which plans are offered in a manner
6 33 as to ensure access to services for all children participating
6 34 in the program.
6 35 c. Approve the benefit package design, review the benefit
7 1 package design on a periodic basis, and make necessary changes
7 2 in the benefit design to reflect the results of the periodic
7 3 reviews.
7 4 d. Develop, with the assistance of the department, an
7 5 outreach plan for implementation by the administrative
7 6 contractor, and provide for periodic assessment of the
7 7 effectiveness of the outreach plan. The plan shall provide
7 8 outreach to families of children likely to be eligible for
7 9 assistance under the program or for other health insurance
7 10 coverage or care programs, to inform them of the availability
7 11 of and to assist the families in enrolling children in the
7 12 program. The outreach efforts shall include, but are not
7 13 limited to, a comprehensive, statewide media campaign,
7 14 solicitation of cooperation from programs, agencies, and other
7 15 persons who are likely to have contact with eligible children,
7 16 including but not limited to those associated with the
7 17 educational system, and the development of community plans for
7 18 outreach and marketing.
7 19 e. In consultation with the clinical advisory committee,
7 20 select a single, nationally recognized functional health
7 21 assessment form for an initial assessment of all eligible
7 22 children participating in the program, establish a baseline
7 23 for comparison purposes, and develop appropriate indicators to
7 24 measure the health status of eligible children participating
7 25 in the program.
7 26 f. Review, in consultation with the department, and take
7 27 necessary steps to improve interaction between the program and
7 28 other public and private programs which provide services to
7 29 the population of eligible children. The board, in
7 30 consultation with the department, shall also develop and
7 31 implement a plan to improve the medical assistance program in
7 32 coordination with the Hawk-I program, including but not
7 33 limited to a provision to coordinate eligibility between the
7 34 medical assistance program and the HAWK-I program, and to
7 35 provide for common processes and procedures under both
8 1 programs to reduce duplication and bureaucracy.
8 2 g. By January 1, annually, prepare, with the assistance of
8 3 the department, and submit a report to the governor, the
8 4 general assembly, and the council on human services,
8 5 concerning the board's activities, findings, and
8 6 recommendations.
8 7 h. Solicit input from the public regarding the program and
8 8 related issues and services.
8 9 i. Perform periodic random reviews of enrollee
8 10 applications to assure compliance with program eligibility and
8 11 enrollment policies. Quality assurance reports shall be made
8 12 based upon the data maintained by the administrative
8 13 contractor.
8 14 j. Establish and consult with a clinical advisory
8 15 committee to make recommendations to the board regarding the
8 16 clinical aspects of the HAWK-I program.
8 17 k. Prescribe the elements to be included in a health
8 18 improvement program plan required to be developed by a
8 19 participating insurer. The elements shall include but are not
8 20 limited to health maintenance and prevention and health risk
8 21 assessment.
8 22 l. Establish an advisory committee to make recommendations
8 23 to the board and to the general assembly on or before January
8 24 1, 1999, concerning the provision of health insurance coverage
8 25 to children with special health care needs under the program.
8 26 The committee shall include individuals with experience in,
8 27 knowledge of, or expertise in this area. The recommendations
8 28 shall address, but are not limited to, all of the following:
8 29 (1) The definition of the target population of children
8 30 with special health care needs for the purposes of determining
8 31 eligibility under the program.
8 32 (2) Eligibility options for and assessment of children
8 33 with special health care needs for eligibility.
8 34 (3) Benefit options for children with special health care
8 35 needs.
9 1 (4) Options for enrollment of children with special health
9 2 care needs in and disenrollment of children with special
9 3 health care needs from qualified child health plans utilizing
9 4 a capitated fee form of payment.
9 5 (5) The appropriateness and quality of care for children
9 6 with special health care needs.
9 7 (6) The coordination of health services provided for
9 8 children with special health care needs under the program with
9 9 services provided by other publicly funded programs.
9 10 8. The HAWK-I board, in consultation with the department
9 11 of human services, shall adopt rules which address, but are
9 12 not limited to addressing, all of the following:
9 13 a. Implementation and administration of the program.
9 14 b. The program application form. The form shall include a
9 15 request for information regarding other health insurance
9 16 coverage for each child.
9 17 c. Criteria for the selection of an administrative
9 18 contractor for the program.
9 19 d. Qualifying standards for selecting participating
9 20 insurers for the program.
9 21 e. The benefits to be included in a qualified child health
9 22 plan which are those included in a benchmark or benchmark
9 23 equivalent plan and which comply with Title XXI of the federal
9 24 Social Security Act. Benefits covered shall include but are
9 25 not limited to all of the following:
9 26 (1) Inpatient hospital services including medical,
9 27 surgical, intensive care unit, mental health, and substance
9 28 abuse services.
9 29 (2) Nursing care services including skilled nursing
9 30 facility services.
9 31 (3) Outpatient hospital services including emergency room,
9 32 surgery, lab, and x-ray services and other services.
9 33 (4) Physician services, including surgical and medical,
9 34 and including office visits, newborn care, well-baby and well-
9 35 child care, immunizations, urgent care, specialist care,
10 1 allergy testing and treatment, mental health visits, and
10 2 substance abuse visits.
10 3 (5) Ambulance services.
10 4 (6) Physical therapy.
10 5 (7) Speech therapy.
10 6 (8) Durable medical equipment.
10 7 (9) Home health care.
10 8 (10) Hospice services.
10 9 (11) Prescription drugs.
10 10 (12) Dental services including preventive services.
10 11 (13) Medically necessary hearing services.
10 12 (14) Vision services including corrective lenses.
10 13 f. Standards for program eligibility. The standards shall
10 14 not discriminate on the basis of diagnosis. Within a defined
10 15 group of covered eligible children, the standards shall not
10 16 cover children of higher income families without covering
10 17 children of families with lower incomes. The standards shall
10 18 not deny eligibility based on a child having a preexisting
10 19 medical condition.
10 20 g. Presumptive eligibility criteria for the program.
10 21 h. The amount of any cost sharing under the program which
10 22 shall be assessed on a sliding fee scale based on family
10 23 income, which provides for a minimum amount of cost sharing,
10 24 and which complies with federal law.
10 25 i. The reasons for disenrollment including, but not
10 26 limited to, nonpayment of premiums, eligibility for medical
10 27 assistance or other insurance coverage, admission to a public
10 28 institution, relocation from the area, and change in income.
10 29 j. Conflict of interest provisions applicable to the
10 30 administrative contractor and participating insurers, and
10 31 between public members of the board and the administrative
10 32 contractor and participating insurers.
10 33 k. Penalties for breach of contract or other violations of
10 34 requirements or provisions under the program.
10 35 l. A mechanism for participating insurers to report any
11 1 rebates received, to the department.
11 2 m. The reasons allowed for approval of an application in
11 3 cases in which prior employer-sponsored coverage ended less
11 4 than six months prior to the determination of eligibility for
11 5 the HAWK-I program. The reasons established by rule shall
11 6 include, but are not limited to, all of the following:
11 7 (1) Loss of employment due to factors other than voluntary
11 8 termination.
11 9 (2) Death of a parent.
11 10 (3) Change in employment to a new employer that does not
11 11 provide an option for dependent coverage.
11 12 (4) Change of address so that no employer-sponsored
11 13 coverage is available.
11 14 (5) Discontinuation of health benefits to all employees of
11 15 the applicant's employer.
11 16 (6) Expiration of the coverage periods established by the
11 17 federal Consolidated Omnibus Budget Reconciliation Act of
11 18 1986, Pub. L. No. 99-272, as amended.
11 19 (7) Self-employment.
11 20 (8) Termination of health benefits due to a long-term
11 21 disability.
11 22 (9) Termination of dependent coverage due to an extreme
11 23 economic hardship on the part of either the employee or the
11 24 employer, as determined by rule.
11 25 (10) Substantial reduction in either lifetime medical
11 26 benefits or benefit category available to an employee and
11 27 dependents under an employer's health care plan.
11 28 If the board determines that the allowance of the six-month
11 29 period from the time of dropping coverage to be eligible for
11 30 participation in the HAWK-I program is insufficient to
11 31 effectively deter applicants or employers of applicants from
11 32 discontinuing employer-sponsored dependent care coverage for
11 33 the purpose of participation in the HAWK-I program, the board
11 34 may adopt rules to extend the time period to a period not to
11 35 exceed twelve months.
12 1 n. The data to be maintained by the administrative
12 2 contractor including data to be collected for the purposes of
12 3 quality assurance reports.
12 4 Sec. 7. NEW SECTION. 514I.5 PARTICIPATING INSURERS.
12 5 Participating insurers shall meet the qualifying standards
12 6 established by rule under this chapter and shall perform all
12 7 of the following functions:
12 8 1. Provide plan cards and membership booklets to
12 9 qualifying families.
12 10 2. Provide or reimburse accessible, quality medical
12 11 services.
12 12 3. Submit a marketing plan to the HAWK-I board which is
12 13 consistent with the board's outreach plan, for approval by the
12 14 board.
12 15 4. Require that any plan provided by the participating
12 16 insurer establishes and maintains a conflict management system
12 17 that includes methods for both preventing and resolving
12 18 disputes involving the health care needs of eligible children,
12 19 and a process for resolution of such disputes.
12 20 5. Provide the administrative contractor with all of the
12 21 following information pertaining to the participating
12 22 insurer's plan:
12 23 a. A list of providers of medical services under the plan.
12 24 b. Information regarding plan rules relating to referrals
12 25 to specialists.
12 26 c. Information regarding the plan's conflict management
12 27 system.
12 28 d. Other information as directed by the board.
12 29 6. Submit a plan for a health improvement program to the
12 30 department, for approval by the board.
12 31 7. Develop a plan for provider network development
12 32 including criteria for access to pediatric subspecialty
12 33 services.
12 34 Sec. 8. NEW SECTION. 514I.6 ADMINISTRATIVE CONTRACTOR.
12 35 1. An administrative contractor shall be selected by the
13 1 HAWK-I board through a request for proposals process.
13 2 2. The administrative contractor shall do all of the
13 3 following:
13 4 a. Perform outreach activities, based upon the outreach
13 5 plan approved by the HAWK-I board, primarily through
13 6 coordination with locally based outreach efforts, including
13 7 but not limited to those associated with the educational
13 8 system.
13 9 b. Determine individual eligibility for program enrollment
13 10 based upon review of completed applications and supporting
13 11 documentation. The administrative contractor shall not enroll
13 12 a child who has group health coverage or any child who has
13 13 dropped coverage in the previous six months, unless the
13 14 coverage was involuntarily lost or unless the reason for
13 15 dropping coverage is allowed by rule of the board.
13 16 c. Enroll qualifying children in the program with
13 17 maintenance of a supporting eligibility file or database.
13 18 d. Forward names of children who appear to be eligible for
13 19 medical assistance or other public health insurance coverage
13 20 to local department of human services offices or other
13 21 appropriate person or agency for follow up and retain the
13 22 identifying data on children who are referred.
13 23 e. Monitor and assess the medical care provided through or
13 24 by participating insurers as well as complaints and
13 25 grievances.
13 26 f. Verify and forward to the department participating
13 27 insurers' payment requests.
13 28 g. Develop and issue appropriate approval, denial, and
13 29 cancellation notifications to inform applicants and enrollees
13 30 of the status of the applicant's or enrollee's eligibility to
13 31 participate in the program. Additionally, the administrative
13 32 contractor shall process applications, including verifications
13 33 and mailing of approvals and denials, within ten working days
13 34 of receipt of the application, unless the application cannot
13 35 be processed within this period for a reason that is beyond
14 1 the control of the administrative contractor.
14 2 h. Create and maintain eligibility files that are
14 3 compatible with the data system of the department including,
14 4 but not limited to, data regarding beneficiaries, enrollment
14 5 dates, disenrollments, and annual financial redeterminations.
14 6 i. Make program applications available through the mail
14 7 and through local sites, as determined by the department,
14 8 including, but not limited to, schools, local health
14 9 departments, local department of human services offices, and
14 10 other locations.
14 11 j. Provide electronic access to the administrative
14 12 contractor's database to the department.
14 13 k. Provide periodic reports to the department for
14 14 administrative oversight and monitoring of federal
14 15 requirements.
14 16 l. Perform annual financial reviews of eligibility for
14 17 each beneficiary.
14 18 m. Receive completed applications and verifications at a
14 19 central location.
14 20 n. Collect and track monthly family premiums to assure
14 21 that payments are current.
14 22 o. Notify each participating insurer of new program
14 23 enrollees who are enrolled by the administrative contractor in
14 24 that participating insurer's plan.
14 25 p. Verify the number of program enrollees with each
14 26 participating insurer for determination of the amount of
14 27 premiums to be paid to each participating insurer.
14 28 q. Maintain data for the purpose of quality assurance
14 29 reports as required by rule of the board.
14 30 Sec. 9. NEW SECTION. 514I.7 ELIGIBLE CHILD.
14 31 1. Effective July 1, 1998, and notwithstanding any medical
14 32 assistance program eligibility criteria to the contrary,
14 33 medical assistance shall be provided to, or on behalf of, an
14 34 eligible child under the age of nineteen whose family income
14 35 does not exceed one hundred thirty-three percent of the
15 1 federal poverty level, as defined by the most recently revised
15 2 poverty income guidelines published by the United States
15 3 department of health and human services.
15 4 2. A child may participate in the HAWK-I program if the
15 5 child meets all of the following criteria:
15 6 a. Is less than nineteen years of age.
15 7 b. Is a resident of this state.
15 8 c. Is a member of a family whose adjusted gross income
15 9 does not exceed one hundred eighty-five percent of the federal
15 10 poverty level, as defined in 42 U.S.C. } 9902(2), including
15 11 any revision required by such section.
15 12 d. Is not eligible for medical assistance pursuant to
15 13 chapter 249A.
15 14 e. Is not currently covered under or was not covered
15 15 within the prior six months under a group health plan as
15 16 defined in 42 U.S.C. } 300Ggg-91(a)(1) or other health benefit
15 17 plan, unless the coverage was involuntarily lost or unless
15 18 dropping the coverage is allowed by rule of the board.
15 19 f. Is not a member of a family that is eligible for health
15 20 benefits coverage under a state health benefits plan on the
15 21 basis of a family member's employment with a public agency in
15 22 this state.
15 23 g. Is not an inmate of a public institution or a patient
15 24 in an institution for mental diseases.
15 25 3. In accordance with the rules adopted by the board, a
15 26 child may be determined to be presumptively eligible for the
15 27 program pending a final eligibility determination. Following
15 28 final determination of eligibility by the administrative
15 29 contractor, a child shall be eligible for a twelve-month
15 30 period. At the end of the twelve-month period, the
15 31 administrative contractor shall conduct a review of the
15 32 circumstances of the eligible child's family to establish
15 33 eligibility and cost sharing for the subsequent twelve-month
15 34 period.
15 35 4. Once an eligible child is enrolled in a plan, the
16 1 eligible child shall remain enrolled in the plan unless a
16 2 determination is made, according to criteria established by
16 3 the board, that the eligible child should be allowed to enroll
16 4 in another qualified child health plan or should be
16 5 disenrolled. An enrollee may change plan enrollment once a
16 6 year on the enrollee's anniversary date.
16 7 5. The board shall study and shall make recommendations to
16 8 the governor and to the general assembly regarding the level
16 9 of family income which is appropriate for application of the
16 10 program, and the feasibility of allowing families with incomes
16 11 above the level of eligibility for the program to purchase
16 12 insurance for children through the program.
16 13 6. The board and the council on human services shall
16 14 cooperate and seek appropriate coordination in administration
16 15 of the program and the medical assistance program and shall
16 16 develop a plan for a unified medical assistance and HAWK-I
16 17 program system which includes the use of a single health
16 18 insurance card by enrollees of either program.
16 19 Sec. 10. NEW SECTION. 514I.8 PROGRAM BENEFITS.
16 20 1. Until June 30, 1999, the benefits provided under the
16 21 program shall be those benefits established by rule of the
16 22 board and in compliance with Title XXI of the federal Social
16 23 Security Act.
16 24 2. On or before June 30, 1999, the HAWK-I board shall
16 25 adopt rules to amend the benefits package based upon review of
16 26 the results of the initial benefits package used.
16 27 3. Subsequent to June 30, 1999, the HAWK-I board shall
16 28 review the benefits package annually and shall determine
16 29 additions to or deletions from the benefits package offered.
16 30 The HAWK-I board shall submit the recommendations to the
16 31 general assembly for any amendment to the benefits package.
16 32 4. Benefits, in addition to those required by rule, may be
16 33 provided to eligible children by a participating insurer if
16 34 the benefits are provided at no additional cost to the state.
16 35 Sec. 11. NEW SECTION. 514I.9 COST SHARING.
17 1 1. Cost sharing for eligible children whose family
17 2 adjusted gross income is at or below one hundred fifty percent
17 3 of the federal poverty level shall not exceed the standards
17 4 permitted under 42 U.S.C. } 1396(o)(a)(3) or } 1396(o)(b)(1).
17 5 2. Cost sharing for eligible children whose family
17 6 adjusted gross income is between one hundred fifty percent and
17 7 one hundred eighty-five percent of the federal poverty level
17 8 shall include a premium or copayment amount which is at least
17 9 a minimum amount but which does not exceed five percent of the
17 10 annual family adjusted gross income. The amount of the
17 11 premium or the copayment amount shall be based on a sliding
17 12 fee scale established by rule which is based on family
17 13 adjusted gross income and the size of the family.
17 14 Sec. 12. APPOINTMENT OF MEMBERS OF THE HAWK-I BOARD. The
17 15 members of the HAWK-I board shall be appointed within thirty
17 16 days of enactment of this Act and may begin performing board
17 17 duties prior to the beginning of the official commencement of
17 18 the terms of the appointed board members as provided under
17 19 this Act.
17 20 Sec. 13. OUTREACH. Notwithstanding any provision to the
17 21 contrary, including section 8.33, any moneys remaining in the
17 22 Iowa healthy kids trust fund pursuant to chapter 514H and any
17 23 moneys remaining from grants, contributions, or other sources
17 24 which were designated for the purposes of the healthy kids
17 25 program shall be transferred to the department of human
17 26 services and used to implement outreach activities for the
17 27 HAWK-I program immediately upon enactment of this Act.
17 28 Sec. 14. EMERGENCY RULES. The department of human
17 29 services may adopt emergency rules to implement changes in the
17 30 medical assistance program by July 1, 1998, and the department
17 31 of human services and the board may each adopt emergency rules
17 32 only to the extent necessary to implement the HAWK-I program
17 33 by January 1, 1999. Any rules adopted in accordance with this
17 34 section shall also be published as notice of intended action
17 35 as provided in section 17A.4.
18 1 Sec. 15. Chapter 514H is repealed.
18 2 Sec. 16. EFFECTIVE DATE. This Act, being deemed of
18 3 immediate importance, takes effect upon enactment.
18 4
18 5
18 6
18 7 RON J. CORBETT
18 8 Speaker of the House
18 9
18 10
18 11
18 12 MARY E. KRAMER
18 13 President of the Senate
18 14
18 15 I hereby certify that this bill originated in the House and
18 16 is known as House File 2517, Seventy-seventh General Assembly.
18 17
18 18
18 19
18 20 ELIZABETH ISAACSON
18 21 Chief Clerk of the House
18 22 Approved , 1998
18 23
18 24
18 25
18 26 TERRY E. BRANSTAD
18 27 Governor
Text: HF02516 Text: HF02518 Text: HF02500 - HF02599 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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