Text: HF02208 Text: HF02210 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 249A.3, Code Supplement 2001, is 1 2 amended by adding the following new subsection: 1 3 NEW SUBSECTION. 4A. Presumptive eligibility under the 1 4 medical assistance program shall be established for a child 1 5 who is under nineteen years of age. A determination of 1 6 presumptive eligibility shall be made only once in a twelve- 1 7 month period. 1 8 Sec. 2. Section 514I.4, subsection 4, Code 2001, is 1 9 amended to read as follows: 1 10 4. The department shall do or shall provide for all of the 1 11 following: 1 12 a. Develop a program application form not to exceed two 1 13 pages in length, which is consistent with the rules of the 1 14 board, which is easy to understand, complete, and concise, and 1 15 which, to the greatest extent possible, coordinates with the 1 16 medical assistance program. 1 17 b. Establish the family cost sharingamount, based on a1 18sliding fee scale, if established byamounts with the approval 1 19 of the board. 1 20 c. Perform annual, random reviews of enrollee applications 1 21 to ensure compliance with program eligibility and enrollment 1 22 policies. Quality assurance reports shall be made to the 1 23 board and the department based upon the data maintained by the 1 24 administrative contractor. 1 25c.d. Perform other duties as determined by the department 1 26 with the approval of the board. 1 27 Sec. 3. Section 514I.5, subsection 7, paragraphs d and e, 1 28 Code 2001, are amended to read as follows: 1 29 d. Develop, with the assistance of the department, an 1 30 outreach plan, and provide for periodic assessment of the 1 31 effectiveness of the outreach plan. The plan shall provide 1 32 outreach to families of children likely to be eligible for 1 33 assistance under the program, to inform them of the 1 34 availability of and to assist the families in enrolling 1 35 children in the program. The outreach efforts may include, 2 1 but are not limited to,a comprehensive statewide media2 2campaign,solicitation of cooperation from programs, agencies, 2 3 and other persons who are likely to have contact with eligible 2 4 children, including but not limited to those associated with 2 5 the educational system, and the development of community plans 2 6 for outreach and marketing. 2 7 e. In consultation with the clinical advisory committee, 2 8select a single, nationally recognized functional health2 9assessment form for an initial assessment of all eligible2 10 assess the initial health status of children participating in 2 11 the program, establish a baseline for comparison purposes, and 2 12 develop appropriate indicators to measure the subsequent 2 13 health status ofeligiblechildren participating in the 2 14 program. 2 15 Sec. 4. Section 514I.5, subsection 7, paragraph i, Code 2 16 2001, is amended by striking the paragraph. 2 17 Sec. 5. Section 514I.5, subsection 7, paragraph l, 2 18 unnumbered paragraph 1, Code 2001, is amended to read as 2 19 follows: 2 20 Establish an advisory committee to make recommendations to 2 21 the board and to the general assemblyon or beforeby January 2 22 1,1999,annually concerning the provision of health insurance 2 23 coverage to children with special health care needsunder the2 24program. The committee shall include individuals with 2 25 experience in, knowledge of, or expertise in this area. The 2 26 recommendations shall address, but are not limited to, all of 2 27 the following: 2 28 Sec. 6. Section 514I.5, subsection 8, paragraph e, Code 2 29 2001, is amended by adding the following new subparagraphs: 2 30 NEW SUBPARAGRAPH. (15) Care coordination. For the 2 31 purposes of this subparagraph, "care coordination" means 2 32 coordinating the provision of services to children and 2 33 families to assure that the children receive health care 2 34 services by promoting the coordination of social supports and 2 35 medical services across organizations and providers. Care 3 1 coordination may include but is not limited to educating 3 2 families about the services provided under the family's health 3 3 insurance coverage plan; assisting families in selecting 3 4 providers; assisting families with scheduling of health care 3 5 appointments, transportation to attend health care 3 6 appointments, and translation during health care appointments; 3 7 and assisting families in accessing community support 3 8 services. 3 9 NEW SUBPARAGRAPH. (16) Dental services, including the 3 10 coverage of partial dentures and dentures, with an annual 3 11 coverage maximum of one thousand five hundred dollars. 3 12 NEW SUBPARAGRAPH. (17) Mental health and substance abuse 3 13 benefits, including coverage of Axis I and Axis II diagnoses 3 14 as specified in the diagnostic and statistical manual of 3 15 mental disorders; coverage of the full continuum of 3 16 evaluation, treatment, and services; provision of adequate 3 17 provider panels; use of admission, discharge, continued stay, 3 18 and placement criteria specific to children and adolescents; 3 19 and the use of Iowa juvenile placement criteria for substance 3 20 abuse services. 3 21 NEW SUBPARAGRAPH. (18) Medically necessary nutrition 3 22 services provided by a licensed dietician based upon a 3 23 physician referral. 3 24 NEW SUBPARAGRAPH. (19) Physical and occupational therapy 3 25 services provided by a licensed physical therapist or a 3 26 licensed occupational therapist, after referral by a 3 27 physician. 3 28 NEW SUBPARAGRAPH. (20) Pharmacist patient care services. 3 29 Sec. 7. Section 514I.5, subsection 8, paragraph h, Code 3 30 2001, is amended to read as follows: 3 31 h. The amount of any cost sharing under the program which 3 32shallmay be assessedon a sliding fee scalebased on family 3 33 income, which provides for a minimum amount of cost sharing,3 34 and which complies with federal law. 3 35 Sec. 8. Section 514I.5, subsection 8, paragraph m, Code 4 1 2001, is amended by striking the paragraph. 4 2 Sec. 9. Section 514I.6, subsection 3, Code 2001, is 4 3 amended by striking the subsection. 4 4 Sec. 10. Section 514I.7, subsection 2, paragraph c, Code 4 5 2001, is amended to read as follows: 4 6 c. Forward names of children who appear to be eligible for 4 7 medical assistanceor other public health insurance coverage4 8to localto the department of human servicesoffices or other4 9appropriate person or agencyforfollow upfollow-up and 4 10 retaintheidentifying data on children who are referred. 4 11 Sec. 11. Section 514I.7, subsection 2, paragraph h, Code 4 12 2001, is amended by striking the paragraph. 4 13 Sec. 12. Section 514I.8, subsection 2, paragraph c, Code 4 14 2001, is amended to read as follows: 4 15 c. Is a member of a family whose income does not exceed 4 16 two hundred percent of the federal poverty level, as defined 4 17 in 42 U.S.C. } 9902(2), including any revision required by 4 18 such section. Determination of an applicant's income shall be 4 19 made on the basis of the applicant's self-declaration of 4 20 income. 4 21 Sec. 13. Section 514I.8, subsection 2, paragraph e, Code 4 22 2001, is amended to read as follows: 4 23 e. Is not currently covered under or was not covered 4 24 within the prior six months under a group health plan as 4 25 defined in 42 U.S.C. } 300gg-91(a)(1)or other health benefit4 26plan, unless the coverage was involuntarily lost orunless 4 27dropping the coverage isallowed by rule of the board. 4 28 Sec. 14. Section 514I.8, subsection 3, Code 2001, is 4 29 amended to read as follows: 4 30 3. In accordance with the rules adopted by the board, a 4 31 childmayshall be determined to be presumptively eligible for 4 32 the program pending a final eligibility determination. 4 33 Following final determination of eligibility by the 4 34 administrative contractor, a child shall be eligible for a 4 35 twelve-month period. At the end of the twelve-month period, 5 1 the administrative contractor shall conduct a review of the 5 2 circumstances of the eligible child's family to establish 5 3 eligibility and cost sharing for the subsequent twelve-month 5 4 period. 5 5 Sec. 15. Section 514I.10, Code 2001, is amended to read as 5 6 follows: 5 7 514I.10 COST SHARING. 5 8 1. Cost sharing for eligible children whose family income 5 9 isat orbelow one hundred fifty percent of the federal 5 10 poverty level shall not exceed the standards permitted under 5 11 42 U.S.C. } 1396(o)(a)(3) or } 1396(o)(b)(1). 5 12 2. Cost sharing for eligible children whose family income 5 13is betweenequals or exceeds one hundred fifty percentand two5 14hundred percentof the federal poverty levelshallmay include 5 15 a premium or copayment amountwhich is at least a minimum5 16amount butwhich does not exceed five percent of the annual 5 17 family income. The amount oftheany premium or the copayment 5 18 amount shall be based on family income and size. 5 19 EXPLANATION 5 20 This bill amends portions of the Code relating to the 5 21 healthy and well kids in Iowa (hawk-i) program and the medical 5 22 assistance program. 5 23 The bill provides for presumptive eligibility under the 5 24 medical assistance program and the healthy and well kids in 5 25 Iowa program. 5 26 The bill deletes the requirement that the department of 5 27 human services (DHS) establish family cost sharing based on a 5 28 sliding fee scale. The new language reflects current practice 5 29 which is establishment of a cost sharing amount approved by 5 30 the hawk-i board. The bill also directs DHS to perform 5 31 annual, random reviews of enrollee applications to ensure 5 32 program compliance. Quality assurance reports are to be made 5 33 to the board and to DHS based upon the data maintained by the 5 34 administrative contractor of the program. 5 35 The bill eliminates the requirement that the outreach 6 1 efforts developed by the board include a comprehensive 6 2 statewide media campaign. The bill directs the board, in 6 3 consultation with the clinical advisory committee, to assess 6 4 the initial health status of children participating in the 6 5 program, establish a baseline, and develop appropriate 6 6 indicators to assess the subsequent health status of children 6 7 participating in the program, rather than directing the board 6 8 to select a single, nationally recognized assessment form for 6 9 children participating in the program. The bill eliminates 6 10 the requirement that the board perform periodic random reviews 6 11 of enrollee applications to assure program compliance, as this 6 12 function is given to the department under the bill. The bill 6 13 also directs the advisory committee on children with special 6 14 health care needs to make recommendations, annually, by 6 15 January 1, rather than only one time by January 1, 1999. 6 16 The bill adds benefits to the hawk-i benefit package, 6 17 including care coordination, dental services, mental health 6 18 and substance abuse benefits, medically necessary nutrition 6 19 services, physical and occupational therapy services, and 6 20 pharmacist patient care services. 6 21 The bill eliminates the directive to the hawk-i board to 6 22 adopt rules to address approval of a program application in 6 23 cases in which prior employer-sponsored coverage ended less 6 24 than six months prior to determination of eligibility for the 6 25 program. The bill also eliminates a requirement that 6 26 participating insurers submit a marketing plan to the hawk-i 6 27 board consistent with the board's outreach plan, for approval 6 28 by the board. 6 29 The bill amends the directive to the administrative 6 30 contractor to forward names of children who appear to be 6 31 eligible for health insurance coverage, other than medical 6 32 assistance, to local offices of DHS or other appropriate 6 33 persons, and limits the directive to forwarding the names of 6 34 children who appear to be eligible for medical assistance only 6 35 to the state offices of DHS. The bill also eliminates the 7 1 directive to the administrative contractor to make program 7 2 applications available through the mail and through local 7 3 sites, as determined by DHS, including to schools, local 7 4 health departments, local department of human services 7 5 offices, and other locations. 7 6 The bill provides for determination of an applicant's 7 7 income based upon an applicant's self-declaration of income. 7 8 The bill also provides that a child may participate in the 7 9 hawk-i program if, among other criteria, the child is not 7 10 currently covered or was not covered in the past six months 7 11 under a group health plan unless allowed by rule of the board. 7 12 The bill also allows for cost sharing based upon the family 7 13 income percentage which is either below 150 percent of the 7 14 federal poverty level or which equals or exceeds 150 percent 7 15 of the federal poverty level. 7 16 LSB 5618HH 79 7 17 pf/sh/8.1
Text: HF02208 Text: HF02210 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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