Senate Amendment 5164
PAG LIN
1 1 Amend Senate File 2356 as follows:
1 2 #1. Page 3, by striking lines 16 through 19 and
1 3 inserting:
1 4 <a. (1) The individual is not eligible for health
1 5 care coverage under any other public program, with the
1 6 exception of coverage through the Iowa comprehensive
1 7 health insurance association pursuant to chapter 514E.
1 8 (2) The individual is not eligible for health care
1 9 coverage through group or individual health insurance.
1 10 (3) Health care coverage offered to the individual
1 11 through group or individual health insurance is not
1 12 affordable as specified in section 217A.7.>
1 13 #2. Page 3, by striking lines 25 through 28 and
1 14 inserting <which the individual is eligible or the
1 15 individual has not had individual health insurance
1 16 coverage in the last six months.>
1 17 #3. Page 4, by striking line 27.
1 18 #4. Page 5, line 8, after <135.153> by inserting
1 19 <that meet the requirements for medical homes developed
1 20 pursuant to this section>
1 21 #5. Page 5, line 21, after <shall> by inserting
1 22 <develop a methodology to>
1 23 #6. Page 5, line 31, after <5.> by inserting
1 24 <IowaCare plus member services provided to members by
1 25 providers included in the regional provider network
1 26 shall be payable at the full benefit recipient rates.>
1 27 #7. Page 5, line 34, by striking <1.>
1 28 #8. Page 6, line 8, after <"c".> by inserting
1 29 <Premiums collected pursuant to this section shall be
1 30 deposited in the IowaCare plus trust fund created in
1 31 section 217A.8.>
1 32 #9. Page 6, after line 8 by inserting:
1 33 <2. Each IowaCare plus member may be eligible
1 34 for premium assistance as specified by rule of the
1 35 department.>
1 36 #10. Page 6, by striking lines 9 through 21 and
1 37 inserting:
1 38 <Sec. ___. NEW SECTION. 217A.7A Coverage
1 39 options == eligible individuals.
1 40 1. If an eligible individual is eligible for
1 41 premium assistance under section 217A.7, the department
1 42 shall require, that prior to provision of coverage
1 43 through the IowaCare plus program, the eligible
1 44 individual provides proof that the eligible individual
1 45 is unable to obtain individual or group coverage
1 46 that is affordable as specified in section 217A.7 as
1 47 follows:
1 48 a. In the individual market, even if the program
1 49 pays the individual share of the annual premium up
1 50 to the amount that the program would subsidize the
2 1 eligible individual through the program.
2 2 b. If the individual has access to health care
2 3 coverage through the individual's employer, for which
2 4 coverage the employer pays at least fifty percent of
2 5 the annual premium cost, even if the program pays the
2 6 employee share of the annual premium up to the amount
2 7 the program would subsidize the individual through the
2 8 program.
2 9 2. If an eligible individual provides proof that
2 10 the eligible individual is unable to obtain individual
2 11 or group coverage as specified in subsection 1, the
2 12 eligible individual may obtain coverage under the
2 13 program.
2 14 3. The department shall adopt rules to implement
2 15 this section, including the documentation necessary for
2 16 an eligible individual to provide proof of inability
2 17 to obtain coverage.>
2 18 #11. Page 7, line 10, after <of> by inserting
2 19 <federal>
2 20 #12. Page 7, by striking lines 12 through 14.
2 21 #13. Page 7, line 31, after <centers> and inserting
2 22 <or federally qualified health center look=alikes in
2 23 the state>
2 24 #14. Page 8, after line 15 by inserting:
2 25 <(5) Notwithstanding any provision to the contrary,
2 26 the department shall develop a methodology to reimburse
2 27 regional provider network participating providers
2 28 designated under this subsection.>
2 29 #15. Page 8, by striking lines 24 through 26 and
2 30 inserting <appropriated on an annual basis, the
2 31 hospital and the university of Iowa hospitals and
2 32 clinics shall remain the only expansion population
2 33 providers for the residents of such county.>
2 34 #16. Page 8, by striking lines 27 through 30 and
2 35 inserting:
2 36 <2. Expansion population services provided to
2 37 expansion population members by providers included in
2 38 the expansion population provider network the publicly
2 39 owned acute care teaching hospital located in a county
2 40 with a population over three hundred fifty thousand and
2 41 the university of Iowa hospitals and clinics shall be
2 42 payable at the full benefit recipient rates.>
2 43 #17. By striking page 9, line 14, through page 10,
2 44 line 1, and inserting:
2 45 <6. The department shall utilize certified public
2 46 expenditures at the university of Iowa hospitals and
2 47 clinics to maximize the availability of state funding
2 48 to provide necessary access to both local primary
2 49 and specialty physician care to expansion population
2 50 members. The resulting savings to the state shall be
3 1 utilized to reimburse physician services provided to
3 2 expansion population members at the university of Iowa
3 3 college of medicine, to reimburse providers designated
3 4 to participate in the regional provider network for
3 5 services provided to expansion population members,
3 6 and for deposit in the nonparticipating provider
3 7 reimbursement fund created in section 249J.24A to be
3 8 used in accordance with the purposes and requirements
3 9 of the fund.>
3 10 #18. Page 10, after line 4 by inserting:
3 11 <Sec. ___. Section 249J.24A, Code Supplement 2009,
3 12 is amended by adding the following new subsection:
3 13 NEW SUBSECTION. 5. Notwithstanding any provision
3 14 to the contrary, moneys in the fund may also be used
3 15 in accordance with the methodology developed by the
3 16 department for reimbursement of nonparticipating
3 17 providers in the IowaCare plus program's regional
3 18 provider network established pursuant to section
3 19 217A.6. However, prioritization in allocation
3 20 of moneys within the fund shall be to provide
3 21 reimbursement to nonparticipating providers as defined
3 22 in this section.>
3 23 #19. By renumbering as necessary.
JACK HATCH
RICH OLIVE
SF2356.1645 (3) 83
pf/rj
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