Senate Amendment 5152 PAG LIN 1 1 Amend Senate File 2356 as follows: 1 2 #1. By striking page 11, line 15, through page 21, 1 3 line 26, and inserting: 1 4 <Sec. ___. NEW SECTION. 505.32 Iowa insurance 1 5 information exchange. 1 6 1. Purposes. The purposes of this section include 1 7 but are not limited to providing an information 1 8 clearinghouse where all Iowans can obtain information 1 9 about health care coverage that is available in the 1 10 state including comparisons of benefits, premiums, and 1 11 out=of=pocket costs and where the uninsured can receive 1 12 assistance regarding health care coverage. 1 13 2. Definitions. As used in this section, unless 1 14 the context otherwise requires: 1 15 a. "Board" means the advisory board of the Iowa 1 16 insurance information exchange. 1 17 b. "Carrier" means an insurer providing accident 1 18 and sickness insurance under chapter 509, 514, or 1 19 514A and includes a health maintenance organization 1 20 established under chapter 514B if payments received 1 21 by the health maintenance organization are considered 1 22 premiums pursuant to section 514B.31 and are taxed 1 23 under chapter 432. "Carrier" also includes a 1 24 corporation which becomes a mutual insurer pursuant 1 25 to section 514.23 and any other person as defined in 1 26 section 4.1, who is or may become liable for the tax 1 27 imposed by chapter 432. 1 28 c. "Commissioner" means the commissioner of 1 29 insurance. 1 30 d. "Creditable coverage" means the same as defined 1 31 in section 513B.2. 1 32 e. "Exchange" means the Iowa insurance information 1 33 exchange. 1 34 f. "Group health plan" means the same as defined in 1 35 section 513B.2. 1 36 g. "Health care services" means services, the 1 37 coverage of which is authorized under chapter 509, 514, 1 38 514A, or 514B and includes services for the purposes 1 39 of preventing, alleviating, curing, or healing human 1 40 illness, injury, or physical disability. 1 41 h. "Health insurance" means accident and sickness 1 42 insurance authorized by chapter 509, 514, or 514A. 1 43 i. (1) "Health insurance coverage" means health 1 44 insurance coverage offered to individuals. 1 45 (2) "Health insurance coverage" does not include any 1 46 of the following: 1 47 (a) Coverage for accident=only or disability income 1 48 insurance. 1 49 (b) Coverage issued as a supplement to liability 1 50 insurance. 2 1 (c) Liability insurance, including general 2 2 liability insurance and automobile liability insurance. 2 3 (d) Workers' compensation or similar insurance. 2 4 (e) Automobile medical=payment insurance. 2 5 (f) Credit=only insurance. 2 6 (g) Coverage for on=site medical clinic care. 2 7 (h) Other similar insurance coverage, specified in 2 8 federal regulations, under which benefits for medical 2 9 care are secondary or incidental to other insurance 2 10 coverage or benefits. 2 11 (3) "Health insurance coverage" does not include 2 12 benefits provided under a separate policy as follows: 2 13 (a) Limited=scope dental or vision benefits. 2 14 (b) Benefits for long=term care, nursing home care, 2 15 home health care, or community=based care. 2 16 (c) Any other similar limited benefits as provided 2 17 by rule of the commissioner. 2 18 (4) "Health insurance coverage" does not include 2 19 benefits offered as independent noncoordinated benefits 2 20 as follows: 2 21 (a) Coverage only for a specified disease or 2 22 illness. 2 23 (b) A hospital indemnity or other fixed indemnity 2 24 insurance. 2 25 (5) "Health insurance coverage" does not include 2 26 Medicare supplemental health insurance as defined under 2 27 section 1882(g)(1) of the federal Social Security Act, 2 28 coverage supplemental to the coverage provided under 2 29 10 U.S.C. ch. 55 and similar supplemental coverage 2 30 provided to coverage under group health insurance 2 31 coverage. 2 32 j. "Medical assistance program" means the 2 33 federal=state assistance program established under Tit. 2 34 XIX of the federal Social Security Act and chapter 2 35 249A. 2 36 k. "Medicare" means the federal government health 2 37 insurance program established under Tit. XVIII of the 2 38 federal Social Security Act. 2 39 l. "Organized delivery system" means an organized 2 40 delivery system as licensed by the director of public 2 41 health. 2 42 3. Iowa insurance information exchange established == 2 43 advisory board. 2 44 a. An Iowa insurance information exchange is 2 45 established in the insurance division of the department 2 46 of commerce under the purview of the commissioner of 2 47 insurance. 2 48 b. The exchange shall exercise its powers in 2 49 consultation with the advisory board established under 2 50 this subsection. 3 1 c. The advisory board of the exchange shall consist 3 2 of the following members: 3 3 (1) The following persons who are voting members 3 4 of the board appointed by the governor and subject to 3 5 confirmation by the senate: 3 6 (a) A health care academic with a background in 3 7 economics, law, or public health. 3 8 (b) An executive of a carrier. 3 9 (c) A health benefits manager of a company. 3 10 (d) A health care analyst representing a public or 3 11 private employee bargaining unit. 3 12 (e) A health care analyst representing an organized 3 13 consumer group. 3 14 (f) A health care provider. 3 15 (g) An insurance agent. 3 16 (2) The following persons who are ex officio, 3 17 nonvoting members of the board: 3 18 (a) The commissioner of insurance, or a designee. 3 19 (b) The Iowa Medicaid director, or a designee. 3 20 (c) Four members of the general assembly, 3 21 one appointed by the speaker of the house of 3 22 representatives, one appointed by the minority leader 3 23 of the house of representatives, one appointed by the 3 24 majority leader of the senate, and one appointed by the 3 25 minority leader of the senate. 3 26 d. Each member of the board appointed by the 3 27 governor shall be a resident of this state and the 3 28 composition of voting members of the board shall be in 3 29 compliance with sections 69.16, 69.16A, and 69.16C. 3 30 e. The voting members of the board shall be 3 31 appointed for terms of six years beginning and ending 3 32 as provided in section 69.19. A member of the board is 3 33 eligible for reappointment. The governor shall fill 3 34 a vacancy for the remainder of the unexpired term. A 3 35 member of the board may be removed by the governor for 3 36 misfeasance, malfeasance, or willful neglect of duty or 3 37 other cause after notice and a public hearing unless 3 38 the notice and hearing are waived by the member in 3 39 writing. 3 40 f. The voting members of the board shall annually 3 41 elect one of the members as chairperson and one as vice 3 42 chairperson. 3 43 g. A majority of the voting members of the board 3 44 constitutes a quorum. The affirmative vote of a 3 45 majority of the voting members is necessary for any 3 46 action taken by the board. The majority shall not 3 47 include a member who has a conflict of interest and 3 48 a statement by a member of a conflict of interest is 3 49 conclusive for this purpose. A vacancy in the voting 3 50 membership of the board does not impair the right of a 4 1 quorum to exercise the rights and perform the duties 4 2 of the board. An action taken by the board under this 4 3 section may be authorized by resolution at a regular 4 4 or special meeting and each resolution may take effect 4 5 immediately and need not be published or posted. 4 6 Meetings of the board shall be held at the call of the 4 7 chairperson or at the request of a majority of the 4 8 voting members. 4 9 h. Members of the board may be reimbursed from the 4 10 moneys of the exchange for expenses incurred by them as 4 11 members, but shall not be otherwise compensated by the 4 12 exchange for their services. 4 13 i. The members of the board are subject to and are 4 14 officials within the meaning of chapter 68B. 4 15 j. The board shall consult with and provide 4 16 recommendations to assist the commissioner in carrying 4 17 out the powers and duties of the exchange set forth in 4 18 subsection 5. 4 19 k. The commissioner shall provide administrative 4 20 and technical support to the board in carrying out its 4 21 duties under this section. 4 22 4. Plan of operation. 4 23 a. The commissioner, in consultation with the 4 24 board, shall establish a plan of operation for the 4 25 exchange that assures the fair, reasonable, and 4 26 equitable administration of the exchange, within ninety 4 27 days after the appointment of the board. In addition 4 28 to other requirements, the plan of operation shall 4 29 provide for all of the following: 4 30 (1) The handling and accounting of assets and 4 31 moneys of the exchange. 4 32 (2) The amount and method of reimbursing expenses 4 33 of the members of the board. 4 34 (3) Regular times and places for meetings of the 4 35 board. 4 36 (4) Records to be kept of all financial 4 37 transactions, and an annual fiscal report of the costs 4 38 of administering the exchange to be delivered to the 4 39 general assembly by December 15 of each year. 4 40 (5) The periodic advertising of the general 4 41 availability of health coverage information and 4 42 assistance from the exchange. 4 43 (6) Additional provisions necessary or proper for 4 44 the execution of the powers and duties of the exchange. 4 45 b. The exchange has the general powers and 4 46 authority enumerated by this subsection and pursuant 4 47 to subsection 5 and executed in accordance with the 4 48 plan of operation established by the commissioner under 4 49 paragraph "a". 4 50 c. The exchange shall develop and implement the 5 1 plan of operation and corresponding timeline detailing 5 2 action steps toward implementing this section, by 5 3 rules adopted pursuant to chapter 17A as provided in 5 4 subsection 6. 5 5 5. Powers and duties of exchange. 5 6 a. The exchange shall develop a system that 5 7 provides a portal where uninsured Iowans can receive 5 8 assistance in how to obtain public or private health 5 9 care coverage. The department of human services shall 5 10 determine the eligibility of uninsured Iowans for 5 11 public programs and provide assistance with enrollment 5 12 in the appropriate public programs. The exchange shall 5 13 provide assistance with how to obtain private health 5 14 insurance coverage that meets certain standards of 5 15 quality and affordability to uninsured Iowans who are 5 16 not eligible for or do not wish to enroll in public 5 17 programs. The exchange, in consultation with the 5 18 board, shall develop a methodology to create a seamless 5 19 system that allows individuals to move between public 5 20 and private health care coverage, including increasing 5 21 opportunities for obtaining creditable coverage. 5 22 b. The exchange shall establish three categories 5 23 of benefits including basic or catastrophic benefits, 5 24 an intermediate level of benefits, and comprehensive 5 25 benefits coverage, that meet affordability limits 5 26 established pursuant to 2009 Iowa Acts ch. 118, section 5 27 1, subsection 4, paragraph "c". 5 28 c. (1) The exchange shall establish an information 5 29 clearinghouse to provide information to all Iowans 5 30 about all public and private health care coverage that 5 31 is available in the state including comparisons of 5 32 benefits, premiums, and out=of=pocket costs. 5 33 (2) The exchange may establish standards to provide 5 34 uniform and consistent information about the health 5 35 care coverage options offered by each carrier and 5 36 public program that includes but is not limited to 5 37 what benefits are covered and not covered, the amount 5 38 of coverage for each service, including copays and 5 39 deductibles, and any prior authorization requirements 5 40 for coverage. 5 41 (3) The exchange may require each carrier, 5 42 organized delivery system, and public program to 5 43 categorize and describe the category of benefits to 5 44 which each health care coverage option offered by a 5 45 carrier, organized delivery system, or public program 5 46 belongs as set forth in paragraph "b". 5 47 (4) The exchange shall provide ongoing information 5 48 to taxpayers about the costs of public health care 5 49 programs to the state, including the percentage and 5 50 source of state and federal funding for the programs. 6 1 (5) The exchange may provide counseling to assist 6 2 Iowans with making an informed choice when selecting 6 3 health care coverage. 6 4 d. The exchange shall encourage or develop the use 6 5 of common definitions for quality of care and pricing 6 6 of health care services and develop and implement 6 7 methodologies that provide quality and cost data on 6 8 health care services and health care coverage offered 6 9 in the state that is meaningful to consumers, patients, 6 10 and purchasers. 6 11 e. The commissioner may hire independent 6 12 consultants, as deemed necessary, to assist in carrying 6 13 out the powers and duties of the exchange. 6 14 f. The exchange shall collaborate with, including 6 15 but not limited to the board, the department of human 6 16 services, the department of public health, health care 6 17 providers, members of an organized consumer=purchaser 6 18 group, members of the Iowa collaborative safety net 6 19 provider network, and carriers to carry out the duties 6 20 of the exchange including dissemination of information 6 21 about the services offered by the exchange to the 6 22 public. 6 23 6. Rules. The commissioner shall adopt rules 6 24 pursuant to chapter 17A to implement the provisions of 6 25 this section. 6 26 7. Iowa insurance information exchange fund created. 6 27 a. An Iowa insurance information exchange fund is 6 28 created in the state treasury as a separate fund under 6 29 the control of the exchange. All moneys appropriated 6 30 or transferred to the fund shall be credited to the 6 31 fund. All moneys deposited or paid into the fund shall 6 32 only be appropriated to the exchange to be used for the 6 33 purposes set forth in this section. 6 34 b. Notwithstanding section 8.33, any balance in 6 35 the fund on June 30 of each fiscal year shall not 6 36 revert to the general fund of the state, but shall be 6 37 available for purposes of this section in subsequent 6 38 fiscal years. Notwithstanding section 12C.7, interest 6 39 earnings on moneys in the fund shall be credited to the 6 40 fund. 6 41 Sec. ___. INITIAL MEMBERS OF ADVISORY BOARD OF 6 42 THE IOWA INSURANCE INFORMATION EXCHANGE. The initial 6 43 voting members of the advisory board of the Iowa 6 44 insurance information exchange shall be appointed 6 45 within thirty days after the effective date of this 6 46 division of this Act.> 6 47 #2. By renumbering as necessary. JACK HATCH RICH OLIVE SF2356.1580 (3) 83 av/nh -1-