Text: H08475 Text: H08477 Text: H08400 - H08499 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 2298, as amended, passed, and
1 2 reprinted by the Senate, as follows:
1 3 #1. Page 134, by inserting after line 12, the
1 4 following:
1 5 "Sec. . NEW SECTION. 249A.35 MEDICAL
1 6 ASSISTANCE CRISIS INTERVENTION TEAM.
1 7 1. A medical assistance crisis intervention team
1 8 is created. The team shall consist of the following
1 9 members:
1 10 a. The president of the university of Iowa.
1 11 b. A representative of the Iowa hospital
1 12 association.
1 13 c. A representative of the Iowa medical society.
1 14 d. A representative of the Iowa health care
1 15 association.
1 16 e. A representative of the federation of Iowa
1 17 insurers.
1 18 f. A representative of the Iowa association of
1 19 community providers.
1 20 g. Two members selected by the president of the
1 21 university of Iowa.
1 22 2. The president of the university of Iowa shall
1 23 act as the chairperson of the team. Members of the
1 24 team are entitled to receive reimbursement of actual
1 25 expenses incurred in the discharge of their duties.
1 26 3. The department of human services shall provide
1 27 staff to the team as determined by the division
1 28 administrator of the division of medical services.
1 29 4. The team shall do all of the following:
1 30 a. Provide a projection of medical assistance
1 31 program and administrative costs through June 30,
1 32 2008, based on services provided as of June 30, 2004.
1 33 b. Hold at least four monthly public meetings,
1 34 beginning in July 2004, in at least four
1 35 geographically balanced venues around the state. The
1 36 team shall submit a report of its findings from these
1 37 meetings to the general assembly on or before December
1 38 1, 2004.
1 39 5. The team may provide any additional
1 40 recommendations to the general assembly at any time
1 41 regarding the medical assistance program including but
1 42 not limited to recommendations regarding services,
1 43 eligibility, rates, care management, and program
1 44 administration.
1 45 6. The department of human services shall assist
1 46 the team as follows:
1 47 a. On or before July 1, 2004, the department shall
1 48 submit to the team and make available to the public an
1 49 initial analysis which includes all of the following
1 50 data:
2 1 (1) The number of medical assistance program
2 2 enrolled eligibles by cohort grouped on the basis of
2 3 factors such as age, income, disability, and optional
2 4 eligibility, for the period beginning July 1, 1999,
2 5 and ending June 30, 2004.
2 6 (2) A projection of the number of medical
2 7 assistance program enrolled eligibles in each of the
2 8 cohorts identified in subparagraph (1), for the period
2 9 beginning July 1, 2005, and ending June 30, 2008. The
2 10 projection shall be accompanied by a statement of the
2 11 underlying assumptions.
2 12 (3) The actual cost of all services and of each
2 13 service for each cohort described in subparagraph (1),
2 14 for the period beginning July 1, 1999, and ending June
2 15 30, 2004. The analysis of the data shall identify the
2 16 total cost for each cohort, the cost per member per
2 17 month for each cohort, and the twenty most utilized
2 18 medical procedures or services and the ten most
2 19 prevalent diagnoses associated within each cohort.
2 20 The analysis of the data shall identify, to the
2 21 greatest extent possible, the reason for changes in
2 22 total costs and the costs per member, per month during
2 23 the period, including but not limited to rate
2 24 adjustments, service utilization, and eligibility
2 25 growth.
2 26 (4) To the extent practical, a comparison of the
2 27 rates paid by commercial insurers to their Iowa
2 28 provider network and the rates paid by Medicare, with
2 29 the rates paid by the medical assistance program for
2 30 the same services, for the fiscal year beginning July
2 31 1, 2003, and ending June 30, 2004.
2 32 (5) An estimate of the program costs for the
2 33 medical assistance program for the period beginning
2 34 July 1, 2005, and ending June 30, 2008, based on all
2 35 of the following assumptions:
2 36 (a) The enrollment projections described in
2 37 subparagraph (2) and assuming reasonable change in
2 38 service utilization patterns, but no change in
2 39 provider rates in effect on June 30, 2004. The
2 40 projection shall include total and total program costs
2 41 per member, per month for each cohort and total cost
2 42 and the program cost per member per month for each
2 43 cohort for the period beginning July 1, 2005, and
2 44 ending June 30, 2008. The assumptions used in
2 45 developing the projections shall be clearly stated.
2 46 (b) The enrollment projections described in
2 47 subparagraph (2) and assuming reasonable change in
2 48 service utilization patterns, and additionally
2 49 assuming that all medical assistance program fee for
2 50 service rates are equal to ninety-eight percent of the
3 1 usual and customary charges for such service in the
3 2 fiscal year beginning July 1, 2003, and ending June
3 3 30, 2004, and grow at an annual rate of two percent
3 4 annually through June 30, 2008, and assuming that
3 5 commensurate changes are made in rates paid to medical
3 6 assistance program managed care organizations.
3 7 (6) If the projections for later years exceed the
3 8 spending standard established in subparagraph (5),
3 9 subparagraph subdivision (b), a base rate and the
3 10 annual inflation adjustments that would result in
3 11 spending being limited to the spending standard
3 12 established in that paragraph.
3 13 (7) A description of the cost, member, provider,
3 14 and service quality impact of all of the following:
3 15 (a) Application of medical assistance program
3 16 allowable limits on optional services.
3 17 (b) Service utilization control strategies
3 18 including managed care and prior authorization in the
3 19 pharmacy, medical and behavioral, and long-term care
3 20 areas that have been utilized in other states or
3 21 jurisdictions that could potentially be utilized in
3 22 Iowa. The department shall identify the
3 23 administrative costs associated with each strategy.
3 24 (c) Accessible disease management and enhanced
3 25 primary care case management strategies with
3 26 particular attention to the timing of costs and
3 27 benefits.
3 28 (d) Accessible health promotion strategies and
3 29 disease prevention activities with particular
3 30 attention to the timing of costs and benefits.
3 31 (e) Enhanced surveillance and utilization review,
3 32 revenue collection, estate recovery, and cost
3 33 avoidance activities in future years.
3 34 (f) The federal Prescription Drug and Medicare
3 35 Improvement Act of 2003.
3 36 (g) The program options and cost savings
3 37 potentially associated with reducing the populations
3 38 of intermediate care facilities for the mentally
3 39 retarded and nursing facilities due to the
3 40 availability of home and community-based services,
3 41 including consumer-directed home care.
3 42 b. The department shall present the analysis
3 43 described in paragraph "a" at the initial meeting of
3 44 the team in July 2004. The department shall adjust,
3 45 expand, or otherwise modify its analysis based on the
3 46 requests of the team at its subsequent monthly
3 47 meetings and shall assist the team in compiling the
3 48 team's final report to the general assembly.
3 49 Sec. . REPORT – MEDICAID PROGRAM FINANCING.
3 50 On or before August 1, 2004, the department of human
4 1 services shall submit a report to the chairpersons and
4 2 ranking members of the joint appropriations
4 3 subcommittee on health and human services, the
4 4 legislative services agency, the legislative caucus
4 5 staffs, and the medical assistance crisis intervention
4 6 team created in section 249A.35, providing
4 7 recommendations to reduce costs or provide revenue
4 8 enhancements to reduce the projected program and
4 9 administrative costs of the medical assistance program
4 10 by $130,000,000 for the fiscal year beginning July 1,
4 11 2005, and ending June 30, 2006."
4 12 #2. Page 138, by inserting after line 11, the
4 13 following:
4 14 " . The section of this division of this Act
4 15 creating section 249A.35, relating to the medical
4 16 assistance crisis intervention team, takes effect upon
4 17 enactment."
4 18 #3. By renumbering as necessary.
4 19
4 20
4 21
4 22 CARROLL of Poweshiek
4 23 SF 2298.748 80
4 24 pf/gg
Text: H08475 Text: H08477 Text: H08400 - H08499 Text: H Index Bills and Amendments: General Index Bill History: General Index
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