Text: S03143 Text: S03145 Text: S03100 - S03199 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Amend Senate File 408 as follows: 1 2 #1. By striking everything after the enacting 1 3 clause and inserting the following: 1 4 "Section 1. NEW SECTION. 135.131 INTERAGENCY 1 5 PHARMACEUTICALS BULK PURCHASING COUNCIL. 1 6 1. For the purposes of this section, "interagency 1 7 pharmaceuticals bulk purchasing council" or "council" 1 8 means the interagency pharmaceuticals bulk purchasing 1 9 council created in this section. 1 10 2. An interagency pharmaceuticals bulk purchasing 1 11 council is created within the Iowa department of 1 12 public health. The department shall provide staff 1 13 support to the council and the department of 1 14 pharmaceutical care of the university of Iowa 1 15 hospitals and clinics shall act in an advisory 1 16 capacity to the council. The council shall be 1 17 composed of all of the following members: 1 18 a. The director of public health, or the 1 19 director's designee. 1 20 b. The director of human services, or the 1 21 director's designee. 1 22 c. The director of the department of personnel, or 1 23 the director's designee. 1 24 d. A representative of the state board of regents. 1 25 e. The director of the department of corrections, 1 26 or the director's designee. 1 27 f. The director, or the director's designee, of 1 28 any other agency that purchases pharmaceuticals 1 29 designated to be included as a member by the director 1 30 of public health. 1 31 3. The council shall select a chairperson annually 1 32 from its membership. A majority of the members of the 1 33 council shall constitute a quorum. 1 34 4. The council shall do all of the following: 1 35 a. Develop procedures that member agencies must 1 36 follow in purchasing pharmaceuticals. However, a 1 37 member agency may elect not to follow the council's 1 38 procedures if the agency is able to purchase the 1 39 pharmaceuticals for a lower price than the price 1 40 available through the council. An agency that does 1 41 not follow the council's procedures shall report all 1 42 of the following to the council: 1 43 (1) The purchase price for the pharmaceuticals. 1 44 (2) The name of the wholesaler, retailer, or 1 45 manufacturer selling the pharmaceuticals. 1 46 b. Designate a member agency as the central 1 47 purchasing agency for purchasing of pharmaceuticals. 1 48 c. Use existing distribution networks, including 1 49 wholesale and retail distributors, to distribute the 1 50 pharmaceuticals. 2 1 d. Investigate options that maximize purchasing 2 2 power, including expanding purchasing under the 2 3 medical assistance program, qualifying for 2 4 participation in purchasing programs under 42 U.S.C. } 2 5 256b, as amended, and utilizing rebate programs, 2 6 hospital disproportionate share purchasing, multistate 2 7 purchasing alliances, and health department and 2 8 federally qualified health center purchasing. 2 9 e. In collaboration with the department of 2 10 pharmaceutical care of the university of Iowa 2 11 hospitals and clinics, make recommendations to member 2 12 agencies regarding drug utilization review, prior 2 13 authorization, the use of restrictive formularies, the 2 14 use of mail order programs, and copayment structures. 2 15 This paragraph shall not apply to the medical 2 16 assistance program but only to the operations of the 2 17 member agencies. 2 18 5. The central purchasing agency may enter into 2 19 agreements with a local governmental entity to 2 20 purchase pharmaceuticals for the local governmental 2 21 entity. 2 22 6. The council shall develop procedures under 2 23 which the council may disclose information relating to 2 24 the prices manufacturers or wholesalers charge for 2 25 pharmaceuticals by category of pharmaceutical. The 2 26 procedure shall prohibit the council from disclosing 2 27 information that identifies a specific manufacturer or 2 28 wholesaler or the prices charged by a specific 2 29 manufacturer or wholesaler for a specific 2 30 pharmaceutical. 2 31 Sec. 2. NEW SECTION. 135C.31A ASSESSMENT OF 2 32 RESIDENTS – PROGRAM ELIGIBILITY. 2 33 Beginning July 1, 2003, a health care facility 2 34 receiving reimbursement through the medical assistance 2 35 program under chapter 249A shall assist the Iowa 2 36 commission of veterans affairs in determining, prior 2 37 to the initial admission of a resident, the 2 38 prospective resident's eligibility for benefits 2 39 through the federal department of veterans affairs. 2 40 The health care facility shall also assist the Iowa 2 41 commission of veterans affairs in determining such 2 42 eligibility for residents residing in the facility on 2 43 July 1, 2003. The department of inspections and 2 44 appeals, in cooperation with the department of human 2 45 services, shall adopt rules to administer this 2 46 section, including a provision that ensures that if a 2 47 resident is eligible for benefits through the federal 2 48 department of veterans affairs or other third-party 2 49 payor, the payor of last resort for reimbursement to 2 50 the health care facility is the medical assistance 3 1 program. This section shall not apply to the 3 2 admission of an individual to a state mental health 3 3 institute for acute psychiatric care. 3 4 Sec. 3. NEW SECTION. 249A.20A PREFERRED DRUG 3 5 LIST PROGRAM. 3 6 1. The department shall establish and implement a 3 7 preferred drug list program under the medical 3 8 assistance program. The department shall submit a 3 9 medical assistance state plan amendment to the centers 3 10 for Medicare and Medicaid services of the United 3 11 States department of health and human services, no 3 12 later than May 1, 2003, to implement the program. 3 13 2. a. A medical assistance pharmaceutical and 3 14 therapeutics committee shall be established within the 3 15 department by July 1, 2003, for the purpose of 3 16 developing and providing ongoing review of the 3 17 preferred drug list. 3 18 b. (1) The members of the committee shall be 3 19 appointed by the governor and shall include health 3 20 care professionals who possess recognized knowledge 3 21 and expertise in one or more of the following: 3 22 (a) The clinically appropriate prescribing of 3 23 covered outpatient drugs. 3 24 (b) The clinically appropriate dispensing and 3 25 monitoring of covered outpatient drugs. 3 26 (c) Drug use review, evaluation, and intervention. 3 27 (d) Medical quality assurance. 3 28 (2) The membership of the committee shall be 3 29 comprised of at least one third but not more than 3 30 fifty-one percent licensed and actively practicing 3 31 physicians and at least one third licensed and 3 32 actively practicing pharmacists. 3 33 c. The members shall be appointed to terms of two 3 34 years. Members may be appointed to more than one 3 35 term. The department shall provide staff support to 3 36 the committee. Committee members shall select a 3 37 chairperson and vice chairperson annually from the 3 38 committee membership. 3 39 3. The pharmaceutical and therapeutics committee 3 40 shall recommend a preferred drug list to the 3 41 department. The committee shall develop the preferred 3 42 drug list by considering each drug's clinically 3 43 meaningful therapeutic advantages in terms of safety, 3 44 effectiveness, and clinical outcome. The committee 3 45 shall use evidence-based research methods in selecting 3 46 the drugs to be included on the preferred drug list. 3 47 The committee shall periodically review all drug 3 48 classes included on the preferred drug list and may 3 49 amend the list to ensure that the list provides for 3 50 medically appropriate drug therapies for medical 4 1 assistance recipients and achieves cost savings to the 4 2 medical assistance program. The department may 4 3 procure a sole source contract with an outside entity 4 4 or contractor to provide professional administrative 4 5 support to the pharmaceutical and therapeutics 4 6 committee in researching and recommending drugs to be 4 7 placed on the preferred drug list. 4 8 4. With the exception of drugs prescribed for the 4 9 treatment of human immunodeficiency virus or acquired 4 10 immune deficiency syndrome, transplantation, or cancer 4 11 and drugs prescribed for mental illness with the 4 12 exception of drugs and drug compounds that do not have 4 13 a significant variation in a therapeutic profile or 4 14 side affect profile within a therapeutic class, 4 15 prescribing and dispensing of prescription drugs not 4 16 included on the preferred drug list shall be subject 4 17 to prior authorization. 4 18 5. The department may negotiate supplemental 4 19 rebates from manufacturers that are in addition to 4 20 those required by Title XIX of the federal Social 4 21 Security Act. The committee shall consider a product 4 22 for inclusion on the preferred drug list if the 4 23 manufacturer provides a supplemental rebate. The 4 24 department may procure a sole source contract with an 4 25 outside entity or contractor to conduct negotiations 4 26 for supplemental rebates. 4 27 6. The department shall publish and disseminate 4 28 the preferred drug list to all medical assistance 4 29 providers in this state. 4 30 7. Until such time as the pharmaceutical and 4 31 therapeutics committee is operational, the department 4 32 shall adopt and utilize a preferred drug list 4 33 developed by a midwestern state that has received 4 34 approval for its medical assistance state plan 4 35 amendment from the centers for Medicare and Medicaid 4 36 services of the United States department of health and 4 37 human services. 4 38 8. The department may procure a sole source 4 39 contract with an outside entity or contactor to 4 40 participate in a pharmaceutical pooling program with 4 41 midwestern or other states to provide for an enlarged 4 42 pool of individuals for the purchase of pharmaceutical 4 43 products and services for medical assistance 4 44 recipients. 4 45 9. The department may adopt administrative rules 4 46 under section 17A.4, subsection 2, and section 17A.5, 4 47 subsection 2, paragraph "b", to implement this 4 48 section. 4 49 10. Any savings realized under this section may be 4 50 used to the extent necessary to pay the costs 5 1 associated with implementation of this section prior 5 2 to reversion to the medical assistance program. The 5 3 department shall report the amount of any savings 5 4 realized and the amount of any costs paid to the 5 5 legislative fiscal committee on a quarterly basis. 5 6 Sec. 4. NEW SECTION. 249A.20B NURSING FACILITY 5 7 QUALITY ASSURANCE ASSESSMENT. 5 8 1. The department may assess nursing facilities a 5 9 quality assurance assessment not to exceed six percent 5 10 of the total annual revenue of the facility. 5 11 2. The department of human services shall submit a 5 12 medical assistance state plan amendment to the centers 5 13 for Medicare and Medicaid services of the United 5 14 States department of health and human services to 5 15 effectuate the nursing facility quality assurance 5 16 assessment. 5 17 3. The department of human services shall submit 5 18 an application to the secretary of the United States 5 19 department of health and human services to request a 5 20 waiver of the uniform tax requirement pursuant to 42 5 21 U.S.C. } 1396b(w)(3)(E) and 42 C.F.R. } 433.68(e)(2). 5 22 4. The quality assurance assessment shall be paid 5 23 to the department in equal monthly amounts on or 5 24 before the fifteenth day of each month. The 5 25 department may deduct the monthly assessment amount 5 26 from medical assistance payments to a nursing 5 27 facility. The amount deducted from payments shall not 5 28 exceed the total amount of the fee due. 5 29 5. Revenue generated from the quality assurance 5 30 assessment shall be deposited in the senior living 5 31 trust fund created in section 249H.4. The revenues 5 32 shall only be used for services for which federal 5 33 financial participation under the medical assistance 5 34 program is available to match state funds. 5 35 6. If federal financial participation to match the 5 36 assessments made under subsection 1 becomes 5 37 unavailable under federal law, the department shall 5 38 terminate the imposition of the assessment beginning 5 39 on the date that the federal statutory, regulatory, or 5 40 interpretive change takes effect. 5 41 7. The department may procure a sole source 5 42 contract to implement the provisions of this section. 5 43 8. For the purposes of this section, "nursing 5 44 facility" means nursing facility as defined in section 5 45 135C.1, excluding residential care facilities and 5 46 nursing facilities that are operated by the state. 5 47 9. The department may adopt administrative rules 5 48 under section 17A.4, subsection 2, and section 17A.5, 5 49 subsection 2, paragraph "b", to implement this 5 50 section. 6 1 Sec. 5. NEW SECTION. 249A.29A HOME AND 6 2 COMMUNITY-BASED SERVICES WAIVER – ELIGIBILITY 6 3 DETERMINATIONS. 6 4 1. A level of care eligibility determination of an 6 5 individual seeking approval by the department to 6 6 receive services under a waiver shall be completed 6 7 only by a person not participating as a provider of 6 8 services under a waiver. For the purposes of this 6 9 section, "provider" and "waiver" mean provider and 6 10 waiver as defined in section 249A.29. 6 11 2. Funds appropriated to the department of elder 6 12 affairs for the purpose of conducting level of care 6 13 eligibility determinations shall be transferred and 6 14 made available to the department of human services. 6 15 3. The department of human services may procure a 6 16 sole source contract with an outside entity or 6 17 contractor to conduct level-of-care eligibility 6 18 determinations. 6 19 4. The department may adopt administrative rules 6 20 under section 17A.4, subsection 2, and section 17A.5, 6 21 subsection 2, paragraph "b", to implement this 6 22 section. 6 23 Sec. 6. Section 249B.3, subsection 1, unnumbered 6 24 paragraph 1, Code 2003, is amended to read as follows: 6 25 The departmentmayshall issue a notice 6 26 establishing and demanding payment of an accrued or 6 27 accruing spousal support debt due and owing to the 6 28 department. The notice shall be served upon the 6 29 community spouse in accordance with the rules of civil 6 30 procedure. The notice shall include all of the 6 31 following: 6 32 Sec. 7. MEDICAL ASSISTANCE PROGRAM – 6 33 PHARMACEUTICALS – RECIPIENT REQUIREMENTS. 6 34 1. The department of human services shall 6 35 reimburse pharmacy dispensing fees using a single rate 6 36 of $4.26 per prescription or the pharmacy's usual and 6 37 customary fee, whichever is lower. 6 38 2. The department of human services shall require 6 39 recipients of medical assistance to pay the following 6 40 copayment on each prescription filled for a covered 6 41 prescription drug, including on each refill of such 6 42 prescription, as follows: 6 43 a. A copayment of $1 for each covered generic 6 44 prescription drug. 6 45 b. A copayment of 50 cents for each covered brand- 6 46 name prescription drug for which the cost to the state 6 47 is $10 or less. 6 48 c. A copayment of $1 for each covered brand-name 6 49 prescription drug for which the cost to the state is 6 50 more than $10 and up to and including $25. 7 1 d. A copayment of $2 for each covered brand-name 7 2 prescription drug for which the cost to the state is 7 3 more than $25 and up to and including $50. 7 4 e. A copayment of $3 for each covered brand-name 7 5 prescription drug for which the cost to the state is 7 6 over $50. 7 7 3. The department of human services shall 7 8 establish an ingredient reimbursement basis equal to 7 9 the average wholesale price minus 12 percent for 7 10 pharmacy reimbursement for prescription drugs under 7 11 the medical assistance program. 7 12 4. a. The department of human services shall 7 13 continue the sole source contract relative to the 7 14 state maximum allowable cost (SMAC) program as 7 15 authorized in 2001 Iowa Acts, chapter 191, section 31, 7 16 subsection 1, paragraph "b", subparagraph (5). The 7 17 department shall expand the state maximum allowable 7 18 cost program for prescription drugs to the greatest 7 19 extent possible as determined under the contract. 7 20 b. Pharmacies and providers that are enrolled in 7 21 the medical assistance program shall make available 7 22 drug acquisition cost information, product 7 23 availability information, and other information deemed 7 24 necessary by the department for the determination of 7 25 reimbursement rates and the efficient operation of the 7 26 pharmacy benefit. Pharmacies and providers shall 7 27 produce and submit the requested information in the 7 28 manner and format requested by the department or its 7 29 designee at no cost to the department or designee. 7 30 Pharmacies and providers shall submit information to 7 31 the department or its designee within thirty days 7 32 following receipt of a request for information unless 7 33 the department or its designee grants an extension 7 34 upon written request of the pharmacy or provider. 7 35 c. The state maximum allowable cost shall be 7 36 established at the average wholesale acquisition cost 7 37 for a prescription drug and all equivalent products, 7 38 adjusted by a multiplier of 1.4. The department shall 7 39 update the state maximum allowable cost every two 7 40 months, or more often if necessary, to ensure adequate 7 41 product availability. 7 42 d. The department shall review its current method 7 43 for determining which prescription drugs are to be 7 44 included in the SMAC program and shall adjust the 7 45 method to maximize the cost savings realized through 7 46 the SMAC program. 7 47 e. The department shall report any savings 7 48 realized through the SMAC program to the legislative 7 49 fiscal committee on a monthly basis. 7 50 5. The department of human services shall require 8 1 recipients of medical assistance to pay a copayment of 8 2 $3 for each physician office visit. 8 3 6. The department of human services shall maximize 8 4 expansion of prior authorization of prescription drugs 8 5 under the medical assistance program beyond the 25 8 6 current categories of medications. 8 7 7. The department of human services shall 8 8 establish a fixed-fee reimbursement schedule for home 8 9 health agencies under the medical assistance program. 8 10 8. The department may adopt emergency rules to 8 11 implement this section. 8 12 Sec. 8. HOME AND COMMUNITY-BASED SERVICES WAIVERS 8 13 CONSOLIDATION – BUDGET NEUTRALITY. It is the intent 8 14 of the general assembly that the consolidation of home 8 15 and community-based services waivers by the department 8 16 of human services be designed in a manner that does 8 17 not result in additional cost, with the exception of 8 18 any services added to the waivers through legislative 8 19 enactment. The department of human services shall 8 20 submit an initial report regarding the cost neutrality 8 21 and status of the waiver consolidation to the 8 22 legislative fiscal committee no later than January 31, 8 23 2004, and a subsequent report no later than July 31, 8 24 2004. 8 25 Sec. 9. NURSING FACILITY REIMBURSEMENT. 8 26 Notwithstanding 2001 Iowa Acts, chapter 192, section 8 27 4, subsection 2, paragraph "c", and subsection 3, 8 28 paragraph "a", subparagraph (2), if projected state 8 29 fund expenditures for reimbursement of nursing 8 30 facilities for the fiscal year beginning July 1, 2003, 8 31 in accordance with the reimbursement rate specified in 8 32 2001 Iowa Acts, chapter 192, section 4, subsection 2, 8 33 paragraph "c", exceeds $147,252,856, the department 8 34 shall adjust the inflation factor of the reimbursement 8 35 rate calculation to provide reimbursement within the 8 36 amount projected. 8 37 Sec. 10. UTILIZATION MANAGEMENT AND TARGETED 8 38 AUDITS. 8 39 1. The department of human services shall conduct 8 40 ongoing review of recipients and providers of medical 8 41 assistance services to determine the appropriateness 8 42 of the scope, duration, and utilization of services. 8 43 If inappropriate usage is identified, the department 8 44 shall implement procedures necessary to restrict 8 45 utilization. 8 46 2. The department of human services shall conduct 8 47 a review of selected medical assistance services 8 48 categories and providers for state fiscal years 8 49 beginning July 1, 2001, July 1, 2002, and July 1, 8 50 2003. The review shall include intense data analysis 9 1 to test compliance with rules, regulations, and 9 2 policies and selected on-site audits. 9 3 3. The review required under subsection 2 shall 9 4 attempt to identify any incorrectly paid billings or 9 5 claims for the state medical assistance program. If 9 6 inappropriate payments are identified, provider 9 7 billings shall be adjusted accordingly. If there is 9 8 substantiated evidence to suggest fraudulent activity, 9 9 the department shall submit the audit data regarding 9 10 the medical assistance provider or recipient to the 9 11 department of inspections and appeals for further 9 12 action. 9 13 4. The department of human services may procure a 9 14 sole source contract to implement the provisions of 9 15 this section. 9 16 5. Any savings realized under this section may be 9 17 used to the extent necessary to pay the costs 9 18 associated with implementation of this section prior 9 19 to reversion to the medical assistance program. The 9 20 department shall report the amount of any savings 9 21 realized and the amount of any costs paid to the 9 22 chairpersons of the joint appropriations subcommittee 9 23 on health and human services. 9 24 Sec. 11. MEDICAL ASSISTANCE – CERTAIN PUBLICLY 9 25 OWNED HOSPITALS – PHYSICIAN SUPPLEMENTAL PAYMENTS. 9 26 1. For the fiscal year beginning July 1, 2003, and 9 27 for each fiscal year thereafter, the department of 9 28 human services shall institute a supplemental payment 9 29 adjustment applicable to physician services provided 9 30 to medical assistance recipients at publicly owned 9 31 acute care teaching hospitals. The adjustment shall 9 32 generate supplemental payments to physicians which are 9 33 equal to the difference between the physician's charge 9 34 and the physician's fee schedule under the medical 9 35 assistance program. To the extent of the supplemental 9 36 payments, a qualifying hospital shall, after receipt 9 37 of the payments, transfer to the department of human 9 38 services an amount equal to the actual supplemental 9 39 payments that were made in that month. The department 9 40 of human services shall deposit these payments in the 9 41 department's medical assistance account. The 9 42 department of human services shall amend the medical 9 43 assistance state plan as necessary to implement this 9 44 section. The department may adopt emergency rules to 9 45 implement this section. 9 46 2. The department may use any savings realized 9 47 under this section to the extent necessary to pay the 9 48 costs associated with implementation of this section 9 49 prior to reversion to the medical assistance program. 9 50 The department shall report the amount of any savings 10 1 realized and the amount of any costs paid to the 10 2 chairpersons of the joint appropriations subcommittee 10 3 on health and human services. 10 4 3. The department of human services shall, in any 10 5 compilation of data or other report distributed to the 10 6 public concerning payments to providers under the 10 7 medical assistance program, set forth reimbursements 10 8 to physicians of the university of Iowa college of 10 9 medicine through supplemental adjustments as a 10 10 separate item and shall not include such payments in 10 11 the amounts otherwise reported as the reimbursement to 10 12 a physician for services to medical assistance 10 13 recipients. 10 14 Sec. 12. CHRONIC CARE MANAGEMENT. 10 15 1. The department of human services shall 10 16 aggressively pursue chronic disease management in 10 17 order to improve care and reduce costs under the 10 18 medical assistance program. 10 19 2. The department of human services, in 10 20 cooperation with the department's fiscal agent and in 10 21 consultation with a chronic care management resource 10 22 group, shall profile medical assistance recipients 10 23 within a select number of disease diagnosis 10 24 categories. The assessment shall focus on those 10 25 diagnosis areas that present the greatest opportunity 10 26 for impact to improved care and cost reduction. 10 27 3. The department of human services, in 10 28 consultation with a chronic care management resource 10 29 group, shall conduct a chronic disease management 10 30 pilot project for a select number of individuals who 10 31 are participants in the medical assistance program. 10 32 The project shall focus on a select number of chronic 10 33 diseases which may include congestive heart failure, 10 34 diabetes, and asthma. The initial pilot project shall 10 35 be implemented by October 1, 2003. 10 36 4. The department of human services shall issue a 10 37 request for proposals or otherwise solicit bids from 10 38 potential vendors to manage individuals with select 10 39 chronic diseases following the conclusion of the 10 40 profiling of medical assistance recipients. The 10 41 management of chronic diseases for individuals under 10 42 this subsection may be coordinated with the pilot 10 43 project established in subsection 3. 10 44 5. The department of human services shall amend 10 45 the medical assistance state plan and seek any waivers 10 46 necessary from the centers for Medicare and Medicaid 10 47 services of the United States department of health and 10 48 human services to implement this section. 10 49 6. The department of human services shall submit a 10 50 progress report regarding chronic disease management 11 1 measures undertaken pursuant to this section to the 11 2 governor and the general assembly by November 1, 2003. 11 3 The report shall include recommendations regarding 11 4 incorporating chronic disease management programming 11 5 into the medical assistance system and the potential 11 6 improvements in care and reductions in costs that may 11 7 be obtained through chronic disease management. 11 8 7. The department of human services may adopt 11 9 emergency rules to implement this section. 11 10 8. Any savings realized under this section may be 11 11 used as necessary to pay the costs associated with 11 12 implementation of this section prior to reversion to 11 13 the medical assistance program. The department shall 11 14 report the amount of any savings realized and the 11 15 amount of any costs paid to the chairpersons of the 11 16 joint appropriations subcommittee on health and human 11 17 services. 11 18 Sec. 13. CONTINGENT EFFECTIVE DATE. 11 19 1. Section 249A.20B, as enacted in this Act, shall 11 20 not take effect unless the department of human 11 21 services receives approval of both the medical 11 22 assistance state plan amendment from the centers for 11 23 Medicare and Medicaid services of the United States 11 24 department of health and human services to effectuate 11 25 the nursing facility quality assurance assessment and 11 26 of the application to the secretary of the United 11 27 States department of health and human services for a 11 28 waiver of the uniform tax requirement pursuant to 42 11 29 U.S.C. } 1396b(w)(3)(E) and 42 C.F.R. } 433.68(e)(2). 11 30 If both approvals are received, section 249A.20B shall 11 31 take effect upon the date that both approvals have 11 32 been received by the department and the department 11 33 shall notify the Code editor of the date of receipt of 11 34 the approvals. 11 35 2. If both approvals described in subsection 1 are 11 36 not received by June 30, 2004, the section of this Act 11 37 enacting section 249A.20B shall not take effect. 11 38 Sec. 14. EFFECTIVE DATES. 11 39 1. The section of this Act enacting section 11 40 249A.20A takes effect upon enactment. 11 41 2. The portion of the section of this Act relating 11 42 to the state maximum allowable cost (SMAC) program, 11 43 being deemed of immediate importance, takes effect 11 44 upon enactment. 11 45 3. The section of this Act relating to physician 11 46 supplemental payments at certain publicly owned 11 47 hospitals, being deemed of immediate importance, takes 11 48 effect upon enactment. 11 49 4. The section of this Act relating to chronic 11 50 disease management, being deemed of immediate 12 1 importance, takes effect upon enactment. 12 2 5. The portions of the section of this Act 12 3 enacting section 249A.20B relating to directing the 12 4 department of human services to submit a medical 12 5 assistance state plan amendment to the centers for 12 6 Medicare and Medicaid services of the United States 12 7 department of health and human services to effectuate 12 8 the nursing facility quality assurance assessment and 12 9 directing the department of human services to submit 12 10 an application to the secretary of the United States 12 11 department of health and human services for a waiver 12 12 of the uniform tax requirement pursuant to 42 U.S.C. } 12 13 1396b(w)(3)(E) and 42 C.F.R. } 433.68(e)(2), being 12 14 deemed of immediate importance, take effect upon 12 15 enactment." 12 16 #2. Title page, line 2, by inserting after the 12 17 word "eligibility" the following: "and providing 12 18 effective dates and a contingent effective date". 12 19 12 20 12 21 12 22 KEN VEENSTRA 12 23 SF 408.701 80 12 24 pf/cl
Text: S03143 Text: S03145 Text: S03100 - S03199 Text: S Index Bills and Amendments: General Index Bill History: General Index
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