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 -1-