House Amendment 1636


PAG LIN




     1  1    Amend House File 841, as amended, passed, and
     1  2 reprinted by the House, as follows:
     1  3 #1.  Page 3, line 8, by inserting after the word
     1  4 <on> the following:  <or after>.
     1  5 #2.  Page 5, line 31, by inserting after the word
     1  6 <the> the following:  <health risk assessment, the>.
     1  7 #3.  Page 6, line 20, by inserting after the word
     1  8 <clinic> the following:  <or rural health clinic>.
     1  9 #4.  Page 6, lines 21 and 22, by striking the words
     1 10 <or rural health clinics>.
     1 11 #5.  Page 7, line 33, by striking the word <ten>
     1 12 and inserting the following:  <twenty>.
     1 13 #6.  Page 8, by striking lines 17 through 20, and
     1 14 inserting the following:
     1 15    <1.  Beginning July 1, 2005, each expansion
     1 16 population member whose family income equals or
     1 17 exceeds one hundred percent of the federal poverty
     1 18 level as defined by the most recently revised poverty
     1 19 income guidelines published by the United States
     1 20 department of health and human services shall pay a
     1 21 monthly premium not to exceed one=twelfth of five
     1 22 percent of the member's annual family income, and each
     1 23 expansion population member whose family income is
     1 24 less than one hundred percent of the federal poverty
     1 25 level as defined by the most recently revised poverty
     1 26 income guidelines published by the United States
     1 27 department of health and human services shall pay a
     1 28 monthly premium not to exceed one=twelfth of two
     1 29 percent of the member's annual family income.  All
     1 30 premiums shall be paid on the last day of the month of
     1 31 coverage.  The department>.
     1 32 #7.  Page 9, line 6, by inserting after the word
     1 33 <member.> the following:  <The department shall also
     1 34 waive the required out=of=pocket expenditures for an
     1 35 individual expansion population member based upon a
     1 36 hardship that would accrue from imposing such required
     1 37 expenditures.>
     1 38 #8.  Page 9, by inserting after line 26, the
     1 39 following:
     1 40    <4.  The department shall track the impact of the
     1 41 out=of=pocket expenditures on patient enrollment and
     1 42 shall report the findings on at least a quarterly
     1 43 basis to the medical assistance projections and
     1 44 assessment council established pursuant to section
     1 45 249J.19.  The findings shall include estimates of the
     1 46 number of expansion population members complying with
     1 47 payment of required out=of=pocket expenditures, the
     1 48 number of expansion population members not complying
     1 49 with payment of required out=of=pocket expenditures
     1 50 and the reasons for noncompliance, any impact as a
     2  1 result of the out=of=pocket requirements on the
     2  2 provision of services to the populations previously
     2  3 served, the administrative time and cost associated
     2  4 with administering the out=of=pocket requirements, and
     2  5 the benefit to the state resulting from the out=of=
     2  6 pocket expenditures.  To the extent possible, the
     2  7 department shall track the income level of the member,
     2  8 the health condition of the member, and the family
     2  9 status of the member relative to the out=of=pocket
     2 10 information.>
     2 11 #9.  By striking page 13, line 32, through page 14,
     2 12 line 6, and inserting the following:  <pursuant to
     2 13 section 249A.3, and also meet the criteria specified
     2 14 in section 234.7, subsection 2, if enacted in the 2005
     2 15 legislative session.>
     2 16 #10.  By striking page 14, line 8, through page 15,
     2 17 line 7, and inserting the following:
     2 18    <1.  The department of human services shall submit
     2 19 an amendment to the home and community=based services
     2 20 waiver for the elderly to the centers for Medicare and
     2 21 Medicaid services of the United States department of
     2 22 health and human services to provide for inclusion of
     2 23 case management as a medical assistance covered
     2 24 service.  The department of human services shall
     2 25 develop the amendment in collaboration with the
     2 26 department of elder affairs.
     2 27    2.  If the request for an amendment to the waiver
     2 28 is approved, the department of elder affairs shall use
     2 29 existing funding for case management as nonfederal
     2 30 matching funds.  The department of elder affairs, in
     2 31 collaboration with the department of human services,
     2 32 shall determine the amount of existing funding that
     2 33 would be eligible for use as nonfederal matching funds
     2 34 so that sufficient funding is retained to also provide
     2 35 case management services for frail elders who are not
     2 36 eligible for the medical assistance program.
     2 37    3.  The department of human services, in
     2 38 collaboration with the department of elder affairs,
     2 39 shall establish a reimbursement rate for case
     2 40 management for the frail elderly such that the amount
     2 41 of state funding necessary to pay for such case
     2 42 management does not exceed the amount appropriated to
     2 43 the department of elder affairs for case management
     2 44 for the frail elderly in the fiscal year beginning
     2 45 July 1, 2005.  Any state savings realized from
     2 46 including case management under the home and
     2 47 community=based services waiver for the elderly shall
     2 48 be used for services for the frail elderly and for
     2 49 substitute decision=making services to eligible
     2 50 individuals pursuant to chapter 231E, if enacted by
     3  1 the Eighty=first General Assembly.
     3  2    4.  The department of human services, in
     3  3 collaboration with the department of elder affairs,
     3  4 shall determine whether case management for the frail
     3  5 elderly should continue to be provided through a sole
     3  6 source contract or if a request for proposals process
     3  7 should be initiated to provide the services.  The
     3  8 departments shall submit their recommendations to the
     3  9 general assembly by January 1, 2006.>
     3 10 #11.  Page 16, line 17, by inserting after the word
     3 11 <department> the following:  <, in collaboration with
     3 12 Iowa department of public health programs relating to
     3 13 tobacco use prevention and cessation,>.
     3 14 #12.  Page 16, line 35, by striking the word <date>
     3 15 and inserting the following:  <data>.
     3 16 #13.  Page 19, line 12, by striking the word
     3 17 <Costs> and inserting the following:  <The department
     3 18 shall inform the members of the task force that
     3 19 costs>.
     3 20 #14.  Page 19, line 13, by striking the word
     3 21 <shall> and inserting the following:  <may>.
     3 22 #15.  Page 26, line 7, by inserting after the
     3 23 figure <262.28> the following:  <or any provision of
     3 24 this chapter to the contrary>.
     3 25 #16.  Page 26, line 10, by inserting after the word
     3 26 <installments> the following:  <based upon the amount
     3 27 appropriated or allocated, as applicable to a specific
     3 28 public hospital, in a specific fiscal year>.
     3 29 #17.  Page 26, line 32, by inserting after the word
     3 30 <account.> the following:  <The agreement shall
     3 31 include provisions relating to exceptions to the
     3 32 deadline for submission of clean claims as required
     3 33 pursuant to section 249J.7 and provisions relating to
     3 34 data reporting requirements regarding the expansion
     3 35 population.>
     3 36 #18.  Page 27, line 3, by inserting after the
     3 37 figure <4.> the following:  <Notwithstanding the
     3 38 specified amount of proceeds to be transferred under
     3 39 this subsection, if the amount allocated that does not
     3 40 require federal matching funds under an appropriation
     3 41 in a subsequent fiscal year to such hospital for
     3 42 medical and surgical treatment of indigent patients,
     3 43 for provision of services to expansion population
     3 44 members, and for medical education, is reduced from
     3 45 the amount allocated that does not require federal
     3 46 matching funds under the appropriation for the fiscal
     3 47 year beginning July 1, 2005, the amount of proceeds
     3 48 required to be transferred under this subsection in
     3 49 that subsequent fiscal year shall be reduced in the
     3 50 same amount as the amount allocated that does not
     4  1 require federal matching funds under that
     4  2 appropriation.>
     4  3 #19.  Page 27, line 9, by inserting after the word
     4  4 <account.> the following:  <The agreement shall
     4  5 include provisions relating to exceptions to the
     4  6 deadline for submission of clean claims as required
     4  7 pursuant to section 249J.7 and provisions relating to
     4  8 data reporting requirements regarding the expansion
     4  9 population.>
     4 10 #20.  Page 46, by striking line 33, and inserting
     4 11 the following:  <services to members of the>.
     4 12 #21.  Page 47, by striking lines 10 and 11 and
     4 13 inserting the following:  <indigent patients, for
     4 14 provision of services to members of the expansion
     4 15 population>.
     4 16 #22.  Page 47, line 16, by striking the figure
     4 17 <36,000,000> and inserting the following:
     4 18 <37,000,000>.
     4 19 #23.  Page 47, line 20, by striking the figure
     4 20 <36,000,000> and inserting the following:
     4 21 <37,000,000>.
     4 22 #24.  Page 47, by striking line 31, and inserting
     4 23 the following:  <members of the expansion>.
     4 24 #25.  Page 48, by striking line 2, and inserting
     4 25 the following:  <members of the expansion>.
     4 26 #26.  Page 48, by striking line 8, and inserting
     4 27 the following:  <members of the expansion>.
     4 28 #27.  Page 48, by striking line 14, and inserting
     4 29 the following:  <services to members of the>.
     4 30 #28.  By renumbering, relettering, or redesignating
     4 31 and correcting internal references as necessary.
     4 32 HF 841.S
     4 33 pf/cc/26

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