Text: S05609 Text: S05611 Text: S05600 - S05699 Text: S 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 8 45 8 46 8 47 NANCY BOETTGER 8 48 ELAINE SZYMONIAK 8 49 JOHN REDWINE 8 50 JERRY BEHN 9 1 WILMER RENSINK 9 2 MAGGIE TINSMAN 9 3 ROBERT E. DVORSKY 9 4 JOHNIE HAMMOND 9 5 DICK L. DEARDEN 9 6 PATRICIA HARPER 9 7 LYLE E. ZIEMAN 9 8 NEAL SCHUERER 9 9 MERLIN E. BARTZ 9 10 HF 2517.513 77 9 11 pf/jw/28
Text: S05609 Text: S05611 Text: S05600 - S05699 Text: S Index Bills and Amendments: General Index Bill History: General Index
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