Text: HF00381 Text: HF00383 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 514I.4, subsection 4, Code 2001, is 1 2 amended to read as follows: 1 3 4. The department shall do or shall provide for all of the 1 4 following: 1 5 a. Develop a program application form not to exceed two 1 6 pages in length, which is consistent with the rules of the 1 7 board, which is easy to understand, complete, and concise, and 1 8 which, to the greatest extent possible, coordinates with the 1 9 medical assistance program. 1 10 b. Establish the family cost sharingamount, based on a1 11sliding fee scale, if established byamounts with the approval 1 12 of the board. 1 13 c. Perform periodic, random reviews of enrollee 1 14 applications to ensure compliance with program eligibility and 1 15 enrollment policies. Quality assurance reports shall be made 1 16 to the board and the department based upon the data maintained 1 17 by the administrative contractor. 1 18c.d. Perform other duties as determined by the department 1 19 with the approval of the board. 1 20 Sec. 2. Section 514I.5, subsection 7, paragraphs d and e, 1 21 Code 2001, are amended to read as follows: 1 22 d. Develop, with the assistance of the department, an 1 23 outreach plan, and provide for periodic assessment of the 1 24 effectiveness of the outreach plan. The plan shall provide 1 25 outreach to families of children likely to be eligible for 1 26 assistance under the program, to inform them of the 1 27 availability of and to assist the families in enrolling 1 28 children in the program. The outreach efforts may include, 1 29 but are not limited to,a comprehensive statewide media1 30campaign,solicitation of cooperation from programs, agencies, 1 31 and other persons who are likely to have contact with eligible 1 32 children, including but not limited to those associated with 1 33 the educational system, and the development of community plans 1 34 for outreach and marketing. 1 35 e. In consultation with the clinical advisory committee, 2 1select a single, nationally recognizeddevelop a functional 2 2 health assessment form for an initial assessment ofall2 3eligiblechildren participating in the program, establish a 2 4 baseline for comparison purposes, and develop appropriate 2 5 indicators to measure the health status ofeligiblechildren 2 6 participating in the program. 2 7 Sec. 3. Section 514I.5, subsection 7, paragraph i, Code 2 8 2001, is amended by striking the paragraph. 2 9 Sec. 4. Section 514I.5, subsection 7, paragraph l, 2 10 unnumbered paragraph 1, Code 2001, is amended to read as 2 11 follows: 2 12 Establish an advisory committee to make recommendations to 2 13 the board and to the general assemblyon or beforeby January 2 14 1,1999,annually concerning the provision of health insurance 2 15 coverage to children with special health care needs under the 2 16 program. The committee shall include individuals with 2 17 experience in, knowledge of, or expertise in this area. The 2 18 recommendations shall address, but are not limited to, all of 2 19 the following: 2 20 Sec. 5. Section 514I.5, subsection 8, paragraphs h and m, 2 21 Code 2001, are amended to read as follows: 2 22 h. The amount of any cost sharing under the program which 2 23 shall be assessedon a sliding fee scalebased on family 2 24 income, which provides for a minimum amount of cost sharing, 2 25 and which complies with federal law. 2 26 m. The reasons allowed for approval of an application in 2 27 cases in which prior employer-sponsored coverage ended less 2 28 than six months prior to the determination of eligibility for 2 29 the HAWK-I program. The reasons established by rule shall 2 30 include, but are not limited to, all of the following: 2 31 (1) Loss of employmentdue to factors other than voluntary2 32termination. 2 33(2) Death of a parent.2 34(3) Change in employment to a new employer that does not2 35provide an option for dependent coverage.3 1(4)(2) Change of address so that no employer-sponsored 3 2 coverage is available. 3 3(5)(3) Discontinuation of health benefits to all 3 4 employees of the applicant's employer. 3 5(6)(4) Expiration of the coverage periods established by 3 6 the federal Consolidated Omnibus Budget Reconciliation Act of 3 7 1986, Pub. L. No. 99-272, as amended. 3 8(7)(5) Self-employment. 3 9(8) Termination of health benefits due to a long-term3 10disability.3 11(9)(6) Termination of dependent coverage due to an 3 12 extreme economic hardship on the part ofeitherthe employee 3 13or the employer, as determined by rule. 3 14(10) Substantial reduction in either lifetime medical3 15benefits or benefit category available to an employee and3 16dependents under an employer's health care plan.3 17 If the board determines that the allowance of the six-month 3 18 period from the time of dropping coverage to be eligible for 3 19 participation in the HAWK-I program is insufficient to 3 20 effectively deter applicants or employers of applicants from 3 21 discontinuing employer-sponsored dependent care coverage for 3 22 the purpose of participation in the HAWK-I program, the board 3 23 may adopt rules to extend the time period to a period not to 3 24 exceed twelve months. 3 25 Sec. 6. Section 514I.6, subsection 3, Code 2001, is 3 26 amended by striking the subsection. 3 27 Sec. 7. Section 514I.7, subsection 2, paragraph c, Code 3 28 2001, is amended to read as follows: 3 29 c. Forward names of children who appear to be eligible for 3 30 medical assistanceor other public health insurance coverage3 31to localto the department of human servicesoffices or other3 32appropriate person or agencyforfollow upfollow-up and 3 33 retaintheidentifying data on children who are referred. 3 34 Sec. 8. Section 514I.7, subsection 2, paragraph h, Code 3 35 2001, is amended by striking the paragraph. 4 1 Sec. 9. Section 514I.8, subsection 2, paragraph e, Code 4 2 2001, is amended to read as follows: 4 3 e. Is not currently covered under or was not covered 4 4 within the prior six months under a group health plan as 4 5 defined in 42 U.S.C. } 300gg-91(a)(1) orother health benefit4 6plan, unless the coverage was involuntarily lost orunless 4 7dropping the coverage isallowed by rule of the board. 4 8 Sec. 10. Section 514I.10, Code 2001, is amended to read as 4 9 follows: 4 10 514I.10 COST SHARING. 4 11 1. Cost sharing for eligible children whose family income 4 12 isat orbelow one hundred fifty percent of the federal 4 13 poverty level shall not exceed the standards permitted under 4 14 42 U.S.C. } 1396(o)(a)(3) or } 1396(o)(b)(1). 4 15 2. Cost sharing for eligible children whose family income 4 16is betweenequals or exceeds one hundred fifty percentand two4 17hundred percentof the federal poverty level shall include a 4 18 premium or copayment amount which is at least a minimum amount 4 19 but which does not exceed five percent of the annual family 4 20 income. The amount of the premium or the copayment amount 4 21 shall be based on family income and size. 4 22 EXPLANATION 4 23 This bill amends portions of the Code relating to the 4 24 healthy and well kids in Iowa (HAWK-I) program. 4 25 The bill deletes the requirement that the department of 4 26 human services (DHS) establish family cost sharing based on a 4 27 sliding fee scale. The new language reflects current practice 4 28 which is establishment of a cost sharing amount approved by 4 29 the HAWK-I board. The bill also directs DHS to perform 4 30 periodic, random reviews of enrollee applications to ensure 4 31 program compliance. Quality assurance reports are to be made 4 32 to the board and to DHS based upon the data maintained by the 4 33 administrative contractor of the program. 4 34 The bill eliminates the requirement that the outreach 4 35 efforts developed by the board include a comprehensive 5 1 statewide media campaign. The bill directs the board to 5 2 develop a functional health assessment form rather than 5 3 selecting a single, nationally recognized assessment form for 5 4 children participating in the program. The bill eliminates 5 5 the requirement that the board perform periodic random reviews 5 6 of enrollee applications to assure program compliance, as this 5 7 function is given to the department under the bill. The bill 5 8 also directs the advisory committee on children with special 5 9 health care needs to make recommendations, annually, by 5 10 January 1, rather than only one time by January 1, 1999. 5 11 The bill eliminates, as reasons allowed for approval of an 5 12 application in cases in which prior employer-sponsored 5 13 coverage ended less than six months prior to determination of 5 14 eligibility for the program, the death of a parent, change in 5 15 employment to a new employer that does not provide an option 5 16 for dependent care coverage, termination of health benefits 5 17 due to a long-term disability, and a substantial reduction in 5 18 either lifetime medical benefits or benefit category available 5 19 to an employee and dependents under an employer's health care 5 20 plan. An existing reason for approval under these 5 21 circumstances, loss of employment due to factors other than 5 22 voluntary termination, is amended to provide that any loss of 5 23 employment is reason for the approval. Another existing 5 24 reason for approval of an application under these 5 25 circumstances is amended so that termination of dependent 5 26 coverage due to an extreme economic hardship on the part of 5 27 only the employee, and not on the part of either the employee 5 28 or employer, is reason to allow approval of an application. 5 29 The bill also eliminates a requirement that participating 5 30 insurers submit a marketing plan to the HAWK-I board 5 31 consistent with the board's outreach plan, for approval by the 5 32 board. 5 33 The bill amends the directive to the administrative 5 34 contractor to forward names of children who appear to be 5 35 eligible for health insurance coverage, other than medical 6 1 assistance, to local offices of DHS or other appropriate 6 2 persons, and limits the directive to forwarding the names of 6 3 children who appear to be eligible for medical assistance only 6 4 to the state offices of DHS. The bill also eliminates the 6 5 directive to the administrative contractor to make program 6 6 applications available through the mail and through local 6 7 sites, as determined by DHS, including to schools, local 6 8 health departments, local department of human services 6 9 offices, and other locations. 6 10 The bill also provides for cost sharing based upon the 6 11 family income percentage which is either below 150 percent of 6 12 the federal poverty level or which equals or exceeds 150 6 13 percent of the federal poverty level. 6 14 LSB 1084HV 79 6 15 pf/gg/8
Text: HF00381 Text: HF00383 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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