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
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