House Amendment 8559
PAG LIN
1 1 Amend Senate File 2356, as amended, passed, and
1 2 reprinted by the Senate, as follows:
1 3 #1. Page 1, by striking lines 2 through 17 and
1 4 inserting:
1 5 IOWACARE PROGRAM AND OTHER HEALTH CARE OPTIONS>
1 6 #2. Page 2, line 6, after <network.> by inserting
1 7 <In developing the phase=in plan the department shall
1 8 consult with the medical assistance projections and
1 9 assessment council created in section 249J.20. Any
1 10 plan developed shall be approved by the council prior
1 11 to implementation. The phase=in of the regional
1 12 provider network shall be implemented in a manner that
1 13 ensures that program expenditures do not exceed budget
1 14 neutrality limits and funded program capacity, and that
1 15 ensures compliance with the eligibility maintenance of
1 16 effort requirements of the federal American Recovery
1 17 and Reinvestment Act of 2009.>
1 18 #3. Page 2, by striking lines 30 through 32 and
1 19 inserting <such hospital has reached service capacity,
1 20 the hospital and the>
1 21 #4. Page 4, by striking lines 7 through 16.
1 22 #5. By striking page 5, line 25, through page 13,
1 23 line 5, and inserting:
1 24 <DIVISION ii
1 25 IOWA INSURANCE INFORMATION EXCHANGE
1 26 Sec. ___. NEW SECTION. 505.32 Iowa insurance
1 27 information exchange.
1 28 1. Purpose. The purpose of this section is to
1 29 establish an information clearinghouse where all Iowans
1 30 can obtain information about health care coverage that
1 31 is available in this state including availability of
1 32 care delivered by safety=net providers and comparisons
1 33 of benefits, premiums, and out=of=pocket costs.
1 34 2. Definitions. As used in this section, unless
1 35 the context otherwise requires:
1 36 a. "Carrier" means an insurer providing accident
1 37 and sickness insurance under chapter 509, 514, or
1 38 514A and includes a health maintenance organization
1 39 established under chapter 514B if payments received
1 40 by the health maintenance organization are considered
1 41 premiums pursuant to section 514B.31 and are taxed
1 42 under chapter 432. "Carrier" also includes a
1 43 corporation which becomes a mutual insurer pursuant
1 44 to section 514.23 and any other person as defined in
1 45 section 4.1, subsection 20, who is or may become liable
1 46 for the tax imposed by chapter 432.
1 47 b. "Commissioner" means the commissioner of
1 48 insurance.
1 49 c. "Creditable coverage" means the same as defined
1 50 in section 513B.2.
2 1 d. "Exchange" means the Iowa insurance information
2 2 exchange.
2 3 e. "Health insurance" means accident and sickness
2 4 insurance authorized by chapter 509, 514, or 514A.
2 5 f. (1) "Health insurance coverage" means health
2 6 insurance coverage offered to individuals.
2 7 (2) "Health insurance coverage" does not include any
2 8 of the following:
2 9 (a) Coverage for accident=only, or disability
2 10 income insurance.
2 11 (b) Coverage issued as a supplement to liability
2 12 insurance.
2 13 (c) Liability insurance, including general
2 14 liability insurance and automobile liability insurance.
2 15 (d) Workers' compensation or similar insurance.
2 16 (e) Automobile medical=payment insurance.
2 17 (f) Credit=only insurance.
2 18 (g) Coverage for on=site medical clinic care.
2 19 (h) Other similar insurance coverage, specified in
2 20 federal regulations, under which benefits for medical
2 21 care are secondary or incidental to other insurance
2 22 coverage or benefits.
2 23 (3) "Health insurance coverage" does not include
2 24 benefits provided under a separate policy as follows:
2 25 (a) Limited=scope dental or vision benefits.
2 26 (b) Benefits for long=term care, nursing home care,
2 27 home health care, or community=based care.
2 28 (c) Any other similar limited benefits as provided
2 29 by rule of the commissioner.
2 30 (4) "Health insurance coverage" does not include
2 31 benefits offered as independent noncoordinated benefits
2 32 as follows:
2 33 (a) Coverage only for a specified disease or
2 34 illness.
2 35 (b) A hospital indemnity or other fixed indemnity
2 36 insurance.
2 37 (5) "Health insurance coverage" does not include
2 38 Medicare supplemental health insurance as defined under
2 39 section 1882(g)(1) of the federal Social Security Act,
2 40 coverage supplemental to the coverage provided under
2 41 10 U.S.C. ch. 55 and similar supplemental coverage
2 42 provided to coverage under group health insurance
2 43 coverage.
2 44 g. "Legislative health care coverage commission" or
2 45 "commission" means the legislative health care coverage
2 46 commission created in 2009 Iowa Acts, ch. 118, section
2 47 1.
2 48 h. "Medicare" means the federal government health
2 49 insurance program established under Tit. XVIII of the
2 50 federal Social Security Act.
3 1 i. "Organized delivery system" means an organized
3 2 delivery system as licensed by the director of public
3 3 health.
3 4 3. Iowa insurance information exchange
3 5 established. An Iowa insurance information exchange is
3 6 established in the insurance division of the department
3 7 of commerce under the authority of the commissioner of
3 8 insurance.
3 9 a. The commissioner, in collaboration with the
3 10 legislative health care coverage commission, shall
3 11 develop a plan of operation for the exchange within
3 12 one hundred eighty days from the effective date of
3 13 this section. The plan shall create an information
3 14 clearinghouse that provides resources where Iowans can
3 15 obtain information about health care coverage that is
3 16 available in the state.
3 17 b. The commissioner shall keep records of all
3 18 financial transactions related to the establishment
3 19 and operation of the exchange and shall deliver an
3 20 annual fiscal report of the costs of administering the
3 21 exchange to the general assembly by December 15 of each
3 22 year.
3 23 4. Powers and duties of exchange.
3 24 a. The commissioner shall report on the status of
3 25 the exchange at all regular meetings of the legislative
3 26 health care coverage commission, including progress in
3 27 developing and implementing the exchange operationally,
3 28 resources available through the exchange, information
3 29 about utilization of the resources offered by
3 30 the exchange, including demographic information
3 31 that illustrates how and by whom the exchange is
3 32 being utilized, and the costs of implementing and
3 33 operating the exchange. The commissioner may make
3 34 recommendations to the commission for including but not
3 35 limited to the following:
3 36 (1) Promotion of greater transparency in providing
3 37 quality data on health care providers and health care
3 38 coverage plans and in providing data on the cost of
3 39 medical care that is easily accessible to the public.
3 40 (2) Statutory options that improve seamlessness in
3 41 the health care system in this state.
3 42 (3) Funding opportunities to increase health care
3 43 coverage in the state, particularly for individuals who
3 44 have been denied access to health insurance coverage.
3 45 b. The commissioner shall implement and maintain
3 46 information on the insurance division internet site
3 47 that is easily accessible and available to consumers
3 48 and purchasers of health insurance coverage regarding
3 49 each carrier licensed to do business in this state.
3 50 The information provided shall be understandable to
4 1 consumers and purchasers of health insurance coverage
4 2 and shall include but is not limited to information
4 3 regarding plan design, premium rate filings and
4 4 approvals, health care cost information, and any
4 5 other information specific to this state that the
4 6 commissioner determines may be beneficial to consumers
4 7 and purchasers of health insurance coverage. The
4 8 commissioner may contract with outside vendors and
4 9 entities to assist in providing this information on the
4 10 internet site.
4 11 c. The exchange shall provide information about
4 12 all public and private health care coverage that is
4 13 available in this state including the cost to the
4 14 public, and comparisons of benefits, premiums, and
4 15 out=of=pocket costs.
4 16 (1) The commissioner may establish methodologies
4 17 to provide uniform and consistent side=by=side
4 18 comparisons of the health care coverage options that
4 19 are offered by carriers, organized delivery systems,
4 20 and public programs in this state including but not
4 21 limited to benefits covered and not covered, the
4 22 amount of coverage for each service, including copays
4 23 and deductibles, administrative costs, and any prior
4 24 authorization requirements for coverage.
4 25 (2) The commissioner may require each carrier,
4 26 organized delivery system, and public program in this
4 27 state to describe each health care coverage option
4 28 offered by that carrier, organized delivery system, or
4 29 public program in a manner so that the various options
4 30 can be compared as provided in subparagraph (1).
4 31 d. The commissioner shall provide ongoing
4 32 information to taxpayers about the costs of public
4 33 health care programs to the state, including the
4 34 administrative costs of the programs and the percentage
4 35 and source of state and federal funding for the
4 36 programs, utilizing information provided by the
4 37 department of human services and the department of
4 38 public health.
4 39 e. The exchange may provide information to assist
4 40 Iowans with making an informed choice when selecting
4 41 health care coverage.
4 42 f. The commissioner may utilize independent
4 43 consultants, as deemed necessary, to assist in carrying
4 44 out the powers and duties of the exchange.
4 45 g. The commissioner may periodically advertise
4 46 the general availability of health care coverage
4 47 information available from the exchange.
4 48 5. Rules. The commissioner shall adopt rules
4 49 pursuant to chapter 17A to implement the provisions of
4 50 this section.>
5 1 #6. By renumbering as necessary.
SMITH of Marshall
UPMEYER of Hancock
HUNTER of Polk
SF2356.2672 (2) 83
av/rj
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