Senate Amendment 5334
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. Page 5, after line 24 by inserting:
1 23 <Sec. ___. IOWACARE POPULATION == OPTIMIZATION
1 24 OF SERVICE DELIVERY AND OUTCOMES. The publicly owned
1 25 acute care teaching hospital located in a county
1 26 with a population over three hundred fifty thousand,
1 27 the federally qualified health center located in
1 28 such county, and the university of Iowa hospitals
1 29 and clinics shall actively collaborate to optimize
1 30 effective and efficient delivery of services that
1 31 result in the best possible outcomes for IowaCare
1 32 members.>
1 33 #6. By striking page 5, line 25, through page 13,
1 34 line 5, and inserting:
1 35 <DIVISION ii
1 36 IOWA INSURANCE INFORMATION EXCHANGE
1 37 Sec. ___. NEW SECTION. 505.32 Iowa insurance
1 38 information exchange.
1 39 1. Purpose. The purpose of this section is to
1 40 establish an information clearinghouse where all Iowans
1 41 can obtain information about health care coverage that
1 42 is available in this state including availability of
1 43 care delivered by safety=net providers and comparisons
1 44 of benefits, premiums, and out=of=pocket costs.
1 45 2. Definitions. As used in this section, unless
1 46 the context otherwise requires:
1 47 a. "Carrier" means an insurer providing accident
1 48 and sickness insurance under chapter 509, 514, or
1 49 514A and includes a health maintenance organization
1 50 established under chapter 514B if payments received
2 1 by the health maintenance organization are considered
2 2 premiums pursuant to section 514B.31 and are taxed
2 3 under chapter 432. "Carrier" also includes a
2 4 corporation which becomes a mutual insurer pursuant
2 5 to section 514.23 and any other person as defined in
2 6 section 4.1, subsection 20, who is or may become liable
2 7 for the tax imposed by chapter 432.
2 8 b. "Commissioner" means the commissioner of
2 9 insurance.
2 10 c. "Creditable coverage" means the same as defined
2 11 in section 513B.2.
2 12 d. "Exchange" means the Iowa insurance information
2 13 exchange.
2 14 e. "Health insurance" means accident and sickness
2 15 insurance authorized by chapter 509, 514, or 514A.
2 16 f. (1) "Health insurance coverage" means health
2 17 insurance coverage offered to individuals.
2 18 (2) "Health insurance coverage" does not include any
2 19 of the following:
2 20 (a) Coverage for accident=only, or disability
2 21 income insurance.
2 22 (b) Coverage issued as a supplement to liability
2 23 insurance.
2 24 (c) Liability insurance, including general
2 25 liability insurance and automobile liability insurance.
2 26 (d) Workers' compensation or similar insurance.
2 27 (e) Automobile medical=payment insurance.
2 28 (f) Credit=only insurance.
2 29 (g) Coverage for on=site medical clinic care.
2 30 (h) Other similar insurance coverage, specified in
2 31 federal regulations, under which benefits for medical
2 32 care are secondary or incidental to other insurance
2 33 coverage or benefits.
2 34 (3) "Health insurance coverage" does not include
2 35 benefits provided under a separate policy as follows:
2 36 (a) Limited=scope dental or vision benefits.
2 37 (b) Benefits for long=term care, nursing home care,
2 38 home health care, or community=based care.
2 39 (c) Any other similar limited benefits as provided
2 40 by rule of the commissioner.
2 41 (4) "Health insurance coverage" does not include
2 42 benefits offered as independent noncoordinated benefits
2 43 as follows:
2 44 (a) Coverage only for a specified disease or
2 45 illness.
2 46 (b) A hospital indemnity or other fixed indemnity
2 47 insurance.
2 48 (5) "Health insurance coverage" does not include
2 49 Medicare supplemental health insurance as defined under
2 50 section 1882(g)(1) of the federal Social Security Act,
3 1 coverage supplemental to the coverage provided under
3 2 10 U.S.C. ch. 55 and similar supplemental coverage
3 3 provided to coverage under group health insurance
3 4 coverage.
3 5 g. "Legislative health care coverage commission" or
3 6 "commission" means the legislative health care coverage
3 7 commission created in 2009 Iowa Acts, ch. 118, section
3 8 1.
3 9 h. "Medicare" means the federal government health
3 10 insurance program established under Tit. XVIII of the
3 11 federal Social Security Act.
3 12 i. "Organized delivery system" means an organized
3 13 delivery system as licensed by the director of public
3 14 health.
3 15 3. Iowa insurance information exchange
3 16 established. An Iowa insurance information exchange is
3 17 established in the insurance division of the department
3 18 of commerce under the authority of the commissioner of
3 19 insurance.
3 20 a. The commissioner, in collaboration with the
3 21 legislative health care coverage commission, shall
3 22 develop a plan of operation for the exchange within
3 23 one hundred eighty days from the effective date of
3 24 this section. The plan shall create an information
3 25 clearinghouse that provides resources where Iowans can
3 26 obtain information about health care coverage that is
3 27 available in the state.
3 28 b. The commissioner shall keep records of all
3 29 financial transactions related to the establishment
3 30 and operation of the exchange and shall deliver an
3 31 annual fiscal report of the costs of administering the
3 32 exchange to the general assembly by December 15 of each
3 33 year.
3 34 4. Powers and duties of exchange.
3 35 a. The commissioner shall report on the status of
3 36 the exchange at all regular meetings of the legislative
3 37 health care coverage commission, including progress in
3 38 developing and implementing the exchange operationally,
3 39 resources available through the exchange, information
3 40 about utilization of the resources offered by
3 41 the exchange, including demographic information
3 42 that illustrates how and by whom the exchange is
3 43 being utilized, and the costs of implementing and
3 44 operating the exchange. The commissioner may make
3 45 recommendations to the commission for including but not
3 46 limited to the following:
3 47 (1) Promotion of greater transparency in providing
3 48 quality data on health care providers and health care
3 49 coverage plans and in providing data on the cost of
3 50 medical care that is easily accessible to the public.
4 1 (2) Statutory options that improve seamlessness in
4 2 the health care system in this state.
4 3 (3) Funding opportunities to increase health care
4 4 coverage in the state, particularly for individuals who
4 5 have been denied access to health insurance coverage.
4 6 b. The commissioner shall implement and maintain
4 7 information on the insurance division internet site
4 8 that is easily accessible and available to consumers
4 9 and purchasers of health insurance coverage regarding
4 10 each carrier licensed to do business in this state.
4 11 The information provided shall be understandable to
4 12 consumers and purchasers of health insurance coverage
4 13 and shall include but is not limited to information
4 14 regarding plan design, premium rate filings and
4 15 approvals, health care cost information, and any
4 16 other information specific to this state that the
4 17 commissioner determines may be beneficial to consumers
4 18 and purchasers of health insurance coverage. The
4 19 commissioner may contract with outside vendors and
4 20 entities to assist in providing this information on the
4 21 internet site.
4 22 c. The exchange shall provide information about
4 23 all public and private health care coverage that is
4 24 available in this state including the cost to the
4 25 public, and comparisons of benefits, premiums, and
4 26 out=of=pocket costs.
4 27 (1) The commissioner may establish methodologies
4 28 to provide uniform and consistent side=by=side
4 29 comparisons of the health care coverage options that
4 30 are offered by carriers, organized delivery systems,
4 31 and public programs in this state including but not
4 32 limited to benefits covered and not covered, the
4 33 amount of coverage for each service, including copays
4 34 and deductibles, administrative costs, and any prior
4 35 authorization requirements for coverage.
4 36 (2) The commissioner may require each carrier,
4 37 organized delivery system, and public program in this
4 38 state to describe each health care coverage option
4 39 offered by that carrier, organized delivery system, or
4 40 public program in a manner so that the various options
4 41 can be compared as provided in subparagraph (1).
4 42 d. The commissioner shall provide ongoing
4 43 information to taxpayers about the costs of public
4 44 health care programs to the state, including the
4 45 administrative costs of the programs and the percentage
4 46 and source of state and federal funding for the
4 47 programs, utilizing information provided by the
4 48 department of human services and the department of
4 49 public health.
4 50 e. The exchange may provide information to assist
5 1 Iowans with making an informed choice when selecting
5 2 health care coverage.
5 3 f. The commissioner may utilize independent
5 4 consultants, as deemed necessary, to assist in carrying
5 5 out the powers and duties of the exchange.
5 6 g. The commissioner may periodically advertise
5 7 the general availability of health care coverage
5 8 information available from the exchange.
5 9 5. Rules. The commissioner shall adopt rules
5 10 pursuant to chapter 17A to implement the provisions of
5 11 this section.>
5 12 #7. Title page, by striking lines 1 through 4 and
5 13 inserting <An Act relating to the health care including
5 14 IowaCare program provisions and the creation of an Iowa
5 15 insurance information exchange to promote transparency,
5 16 quality, seamlessness, and informed choices relative
5 17 to health care coverage.>
5 18 #8. By renumbering as necessary.
SF2356.2864.H (1) 83
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