Text: SF00025 Text: SF00027 Text: SF00000 - SF00099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 514I.4, subsection 4, Code 2003, 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 annual, random reviews of enrollee applications 1 14 to ensure compliance with program eligibility and enrollment 1 15 policies. Quality assurance reports shall be made to the 1 16 board and the department based upon the data maintained by the 1 17 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 2003, 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 recognized functional health2 2assessment form for an initial assessment of all eligible2 3 assess the initial health status of children participating in 2 4 the program, establish a baseline for comparison purposes, and 2 5 develop appropriate indicators to measure the subsequent 2 6 health status ofeligiblechildren participating in the 2 7 program. 2 8 Sec. 3. Section 514I.5, subsection 7, paragraph i, Code 2 9 2003, is amended by striking the paragraph. 2 10 Sec. 4. Section 514I.5, subsection 7, paragraph l, 2 11 unnumbered paragraph 1, Code 2003, is amended to read as 2 12 follows: 2 13 Establish an advisory committee to make recommendations to 2 14 the board and to the general assemblyon or beforeby January 2 15 1,1999,annually concerning the provision of health insurance 2 16 coverage to children with special health care needsunder the2 17program. The committee shall include individuals with 2 18 experience in, knowledge of, or expertise in this area. The 2 19 recommendations shall address, but are not limited to, all of 2 20 the following: 2 21 Sec. 5. Section 514I.5, subsection 8, paragraph e, Code 2 22 2003, is amended by adding the following new subparagraphs: 2 23 NEW SUBPARAGRAPH. (15) Care coordination. For the 2 24 purposes of this subparagraph, "care coordination" means 2 25 coordinating the provision of services to children and 2 26 families to assure that the children receive health care 2 27 services by promoting the coordination of social supports and 2 28 medical services across organizations and providers. Care 2 29 coordination may include but is not limited to educating 2 30 families about the services provided under the family's health 2 31 insurance coverage plan; assisting families in selecting 2 32 providers; assisting families with scheduling of health care 2 33 appointments, transportation to attend health care 2 34 appointments, and translation during health care appointments; 2 35 and assisting families in accessing community support 3 1 services. 3 2 NEW SUBPARAGRAPH. (16) Dental services, including the 3 3 coverage of partial dentures and dentures, with an annual 3 4 coverage maximum of one thousand five hundred dollars. 3 5 NEW SUBPARAGRAPH. (17) Mental health and substance abuse 3 6 benefits, including coverage of Axis I and Axis II diagnoses 3 7 as specified in the diagnostic and statistical manual of 3 8 mental disorders; coverage of the full continuum of 3 9 evaluation, treatment, and services; provision of adequate 3 10 provider panels; use of admission, discharge, continued stay, 3 11 and placement criteria specific to children and adolescents; 3 12 and the use of Iowa juvenile placement criteria for substance 3 13 abuse services. 3 14 NEW SUBPARAGRAPH. (18) Medically necessary nutrition 3 15 services provided by a licensed dietician based upon a 3 16 physician referral. 3 17 NEW SUBPARAGRAPH. (19) Physical and occupational therapy 3 18 services provided by a licensed physical therapist or a 3 19 licensed occupational therapist, after referral by a 3 20 physician. 3 21 NEW SUBPARAGRAPH. (20) Case management for children with 3 22 special health care needs. For the purposes of this 3 23 subparagraph, "case management" means services intended to 3 24 coordinate various clinical services to ensure the best 3 25 clinical outcomes, and "children with special health care 3 26 needs" means children who have or are at increased risk for a 3 27 chronic physical, developmental, behavioral, or emotional 3 28 condition and who also require health and related services of 3 29 a type or amount beyond that required by children, generally. 3 30 Sec. 6. Section 514I.5, subsection 8, paragraph h, Code 3 31 2003, is amended to read as follows: 3 32 h. The amount of any cost sharing under the program which 3 33shallmay be assessedon a sliding fee scalebased on family 3 34 income, which provides for a minimum amount of cost sharing,3 35 and which complies with federal law. 4 1 Sec. 7. Section 514I.5, subsection 8, paragraph m, Code 4 2 2003, is amended by striking the paragraph. 4 3 Sec. 8. Section 514I.6, subsection 3, Code 2003, is 4 4 amended by striking the subsection. 4 5 Sec. 9. Section 514I.7, subsection 2, paragraph c, Code 4 6 2003, is amended to read as follows: 4 7 c. Forward names of children who appear to be eligible for 4 8 medical assistanceor other public health insurance coverage4 9to localto the department of human servicesoffices or other4 10appropriate person or agencyforfollow upfollow-up and 4 11 retaintheidentifying data on children who are referred. 4 12 Sec. 10. Section 514I.7, subsection 2, paragraph h, Code 4 13 2003, is amended by striking the paragraph. 4 14 Sec. 11. Section 514I.8, subsection 2, paragraph e, Code 4 15 2003, is amended to read as follows: 4 16 e. Is not currently covered under or was not covered 4 17 within the prior six months under a group health plan as 4 18 defined in 42 U.S.C. } 300gg-91(a)(1)or other health benefit4 19plan, unless the coverage was involuntarily lost orunless 4 20dropping the coverage isallowed by rule of the board. 4 21 Sec. 12. Section 514I.10, Code 2003, is amended to read as 4 22 follows: 4 23 514I.10 COST SHARING. 4 24 1. Cost sharing for eligible children whose family income 4 25 isat orbelow one hundred fifty percent of the federal 4 26 poverty level shall not exceed the standards permitted under 4 27 42 U.S.C. } 1396(o)(a)(3) or } 1396(o)(b)(1). 4 28 2. Cost sharing for eligible children whose family income 4 29is betweenequals or exceeds one hundred fifty percentand two4 30hundred percentof the federal poverty levelshallmay include 4 31 a premium or copayment amountwhich is at least a minimum4 32amount butwhich does not exceed five percent of the annual 4 33 family income. The amount oftheany premium or the copayment 4 34 amount shall be based on family income and size. 4 35 EXPLANATION 5 1 This bill amends portions of the Code relating to the 5 2 healthy and well kids in Iowa (hawk-i) program and the medical 5 3 assistance program. 5 4 The bill deletes the requirement that the department of 5 5 human services (DHS) establish family cost sharing based on a 5 6 sliding fee scale. The new language reflects current practice 5 7 which is establishment of a cost sharing amount approved by 5 8 the hawk-i board. The bill also directs DHS to perform 5 9 annual, random reviews of enrollee applications to ensure 5 10 program compliance. Quality assurance reports are to be made 5 11 to the board and to DHS based upon the data maintained by the 5 12 administrative contractor of the program. 5 13 The bill eliminates the requirement that the outreach 5 14 efforts developed by the board include a comprehensive 5 15 statewide media campaign. The bill directs the board, in 5 16 consultation with the clinical advisory committee, to assess 5 17 the initial health status of children participating in the 5 18 program, establish a baseline, and develop appropriate 5 19 indicators to assess the subsequent health status of children 5 20 participating in the program, rather than directing the board 5 21 to select a single, nationally recognized assessment form for 5 22 children participating in the program. The bill eliminates 5 23 the requirement that the board perform periodic random reviews 5 24 of enrollee applications to assure program compliance, as this 5 25 function is given to the department under the bill. The bill 5 26 also directs the advisory committee on children with special 5 27 health care needs to make recommendations, annually, by 5 28 January 1, rather than only one time by January 1, 1999. 5 29 The bill adds benefits to the hawk-i benefit package, 5 30 including care coordination, dental services, mental health 5 31 and substance abuse benefits, medically necessary nutrition 5 32 services, physical and occupational therapy services, and case 5 33 management for children with special health care needs. 5 34 The bill eliminates the directive to the hawk-i board to 5 35 adopt rules to address approval of a program application in 6 1 cases in which prior employer-sponsored coverage ended less 6 2 than six months prior to determination of eligibility for the 6 3 program. The bill also eliminates a requirement that 6 4 participating insurers submit a marketing plan to the hawk-i 6 5 board consistent with the board's outreach plan, for approval 6 6 by the board. 6 7 The bill amends the directive to the administrative 6 8 contractor to forward names of children who appear to be 6 9 eligible for health insurance coverage, other than medical 6 10 assistance, to local offices of DHS or other appropriate 6 11 persons, and limits the directive to forwarding the names of 6 12 children who appear to be eligible for medical assistance only 6 13 to the state offices of DHS. The bill also eliminates the 6 14 directive to the administrative contractor to make program 6 15 applications available through the mail and through local 6 16 sites, as determined by DHS, including to schools, local 6 17 health departments, local department of human services 6 18 offices, and other locations. 6 19 The bill also provides that a child may participate in the 6 20 hawk-i program if, among other criteria, the child is not 6 21 currently covered or was not covered in the past six months 6 22 under a group health plan unless allowed by rule of the board. 6 23 The bill also allows for cost sharing based upon the family 6 24 income percentage which is either below 150 percent of the 6 25 federal poverty level or which equals or exceeds 150 percent 6 26 of the federal poverty level. 6 27 LSB 1058XS 80 6 28 pf/sh/8
Text: SF00025 Text: SF00027 Text: SF00000 - SF00099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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