Senate Amendment 5354


PAG LIN

     1  1    Amend House File 2531, as amended, passed, and
     1  2 reprinted by the House, as follows:
     1  3 #1.  Page 46, after line 5 by inserting:
     1  4                          <DIVISION ___
     1  5             HEALTHCARE PROGRAMS AND APPROPRIATIONS
     1  6    Section 1.  Section 249J.7, Code 2009, is amended to
     1  7 read as follows:
     1  8    249J.7  Expansion population provider network.
     1  9    1.  a.  Expansion population members shall only
     1 10 be eligible to receive expansion population services
     1 11 through a provider included in the expansion population
     1 12 provider network. Except as otherwise provided
     1 13 in this chapter, the expansion population provider
     1 14 network shall be limited to a publicly owned acute care
     1 15 teaching hospital located in a county with a population
     1 16 over three hundred fifty thousand, the university of
     1 17 Iowa hospitals and clinics, and the state hospitals
     1 18 for persons with mental illness designated pursuant
     1 19 to section 226.1 with the exception of the programs
     1 20 at such state hospitals for persons with mental
     1 21 illness that provide substance abuse treatment, serve
     1 22 gero=psychiatric patients, or treat sexually violent
     1 23 predators and a regional provider network utilizing
     1 24 the federally qualified health centers or federally
     1 25 qualified health center look=alikes in the state, to
     1 26 provide primary care to members.
     1 27    b.  (1)  The department shall develop a plan to
     1 28 phase=in the regional provider network by determining
     1 29 the most highly underserved areas on a statewide
     1 30 and regional basis, and targeting these areas for
     1 31 prioritization in implementing the regional provider
     1 32 network.  In developing the phase=in plan the
     1 33 department shall consult with the medical assistance
     1 34 projections and assessment council created in section
     1 35 249J.20.  Any plan developed shall be approved by
     1 36 the council prior to implementation.  The phase=in of
     1 37 the regional provider network shall be implemented
     1 38 in a manner that ensures that program expenditures
     1 39 do not exceed budget neutrality limits and funded
     1 40 program capacity, and that ensures compliance with the
     1 41 eligibility maintenance of effort requirements of the
     1 42 federal American Recovery and Reinvestment Act of 2009.
     1 43    (2)  Payment shall only be made to designated
     1 44 participating primary care providers for eligible
     1 45 primary care services provided to a member.
     1 46    (3)  The department shall adopt rules pursuant to
     1 47 chapter 17A, in collaboration with the medical home
     1 48 advisory council established pursuant to section
     1 49 135.159, specifying requirements for medical homes
     1 50 including certification, with which regional provider
     2  1 network participating providers shall comply, as
     2  2 appropriate.
     2  3    (4)  The department may also designate other private
     2  4 providers and hospitals to participate in the regional
     2  5 provider network, to provide primary and specialty
     2  6 care, subject to the availability of funds.
     2  7    (5)  Notwithstanding any provision to the contrary,
     2  8 the department shall develop a methodology to reimburse
     2  9 regional provider network participating providers
     2 10 designated under this subsection.
     2 11    c.  Tertiary care shall only be provided to eligible
     2 12 expansion population members residing in any county
     2 13 in the state at the university of Iowa hospitals and
     2 14 clinics.
     2 15    d.  Until such time as the publicly owned acute
     2 16 care teaching hospital located in a county with a
     2 17 population over three hundred fifty thousand notifies
     2 18 the department that such hospital has reached service
     2 19 capacity, the hospital and the university of Iowa
     2 20 hospitals and clinics shall remain the only expansion
     2 21 population providers for the residents of such county.
     2 22    2.  Expansion population services provided to
     2 23 expansion population members by providers included in
     2 24 the expansion population provider network the publicly
     2 25 owned acute care teaching hospital located in a county
     2 26 with a population over three hundred fifty thousand and
     2 27 the university of Iowa hospitals and clinics shall be
     2 28 payable at the full benefit recipient rates.
     2 29    3.  Providers included in the expansion population
     2 30 provider network shall submit clean claims within
     2 31 twenty days of the date of provision of an expansion
     2 32 population service to an expansion population member.
     2 33    4.  Unless otherwise prohibited by law, a provider
     2 34 under the expansion population provider network may
     2 35 deny care to an individual who refuses to apply for
     2 36 coverage under the expansion population.
     2 37    5.  Notwithstanding the provision of section
     2 38 347.16, subsection 2, requiring the provision of free
     2 39 care and treatment to the persons described in that
     2 40 subsection, the publicly owned acute care teaching
     2 41 hospital described in subsection 1 may require any sick
     2 42 or injured person seeking care or treatment at that
     2 43 hospital to be subject to financial participation,
     2 44 including but not limited to copayments or premiums,
     2 45 and may deny nonemergent care or treatment to any
     2 46 person who refuses to be subject to such financial
     2 47 participation.
     2 48    6.  The department shall utilize up to seven million
     2 49 three hundred thousand dollars in certified public
     2 50 expenditures at the university of Iowa hospitals
     3  1 and clinics to maximize the availability of state
     3  2 funding to provide necessary access to both primary
     3  3 and specialty physician care to expansion population
     3  4 members.  The resulting savings to the state shall
     3  5 be utilized to reimburse physician services provided
     3  6 to expansion population members at the university of
     3  7 Iowa hospitals and clinics and to reimburse providers
     3  8 designated to participate in the regional provider
     3  9 network for services provided to expansion population
     3 10 members.
     3 11    7.  The  department shall adopt rules to establish
     3 12 clinical transfer and referral protocols to be used by
     3 13 providers included in the expansion population provider
     3 14 network.
     3 15    Sec. ___.  2010 Iowa Acts, Senate File 2156, section
     3 16 5, if enacted, is repealed.
     3 17    Sec. ___.  2010 Iowa Acts, Senate File 2356, section
     3 18 2, amending section 249J.7, if enacted, is repealed.
     3 19    Sec. ___.  2010 Iowa Acts, House File 2526, section
     3 20 11, subsection 13, if enacted, is amended to read as
     3 21 follows:
     3 22    13.  The university of Iowa hospitals and clinics
     3 23 shall either certify public expenditures or transfer to
     3 24 the medical assistance appropriation an amount equal
     3 25 to provide the nonfederal share for increased medical
     3 26 assistance payments for inpatient hospital services of
     3 27 $7,500,000 up to $9,900,000.  The university of Iowa
     3 28 hospitals and clinics shall receive and retain 100
     3 29 percent of the total increase in medical assistance
     3 30 payments.
     3 31    Sec. ___.  2010 Iowa Acts, House File 2526, section
     3 32 41, subsection 3, unnumbered paragraph 2, if enacted,
     3 33 is amended to read as follows:
     3 34    For salaries, support, maintenance, equipment, and
     3 35 miscellaneous purposes for the provision of medical and
     3 36 surgical treatment of indigent patients, for provision
     3 37 of services to members of the expansion population
     3 38 pursuant to chapter 249J, and for medical education:
     3 39 .................................................. $12,000,000 14,000,000
     3 40    Sec. ___.  2010 Iowa Acts, House File 2526, section
     3 41 41, subsection 6, if enacted, is amended to read as
     3 42 follows:
     3 43    6.  Contingent upon enactment of 2010 Iowa Acts,
     3 44 Senate File 2356, there is appropriated from the
     3 45 IowaCare account created in section 249J.24 to the
     3 46 department of human services for the fiscal year
     3 47 beginning July 1, 2010, and ending June 30, 2011, the
     3 48 following amount, or so much thereof as is necessary to
     3 49 be used for the purposes designated:
     3 50    For payment to nonparticipating providers for
     4  1 covered services provided in accordance with section
     4  2 249J.24A:
     4  3 .................................................. $  2,000,000
     4  4    Sec. ___.  HOSPITAL HEALTH CARE ACCESS TRUST FUND  ==
     4  5  APPROPRIATIONS.  There is appropriated from the
     4  6 hospital health care access trust fund created in
     4  7 section 249M.4, if enacted by 2010 Iowa Acts, Senate
     4  8 File 2388, to the department of human services for the
     4  9 fiscal year beginning July 1, 2010, and ending June 30,
     4 10 2011, the following amounts, or so much thereof as is
     4 11 necessary, for the purposes designated:
     4 12    1.  For the medical assistance program:
     4 13 .................................................. $ 39,406,000
     4 14    Of the funds appropriated in this subsection,
     4 15 $20,542,883 shall be used for reimbursement of
     4 16 hospitals under the medical  assistance program in
     4 17 accordance with section 249M.4, if enacted by 2010 Iowa
     4 18 Acts, Senate File 2388.
     4 19    2.  For deposit in the nonparticipating provider
     4 20 reimbursement fund created in section 249J.24A for the
     4 21 purposes of the fund:
     4 22 .................................................. $    594,000
     4 23    Sec. ___.  NONPARTICIPATING PROVIDER REIMBURSEMENT
     4 24 FUND == APPROPRIATION.  Contingent upon enactment of
     4 25 2010 Iowa Acts, Senate File 2388, there is appropriated
     4 26 from the nonparticipating provider reimbursement
     4 27 fund created in section 249J.24A to the department of
     4 28 human services for the fiscal year beginning July 1,
     4 29 2010, and ending June 30, 2011, the following amount,
     4 30 or so much thereof as is necessary, for the purposes
     4 31 designated:
     4 32    To reimburse nonparticipating providers in
     4 33 accordance with section 249J.24A:
     4 34 .................................................. $  2,000,000
     4 35    Sec. ___.  MEDICAL ASSISTANCE PROGRAM ==
     4 36 APPROPRIATION REDUCTION.  The appropriation from the
     4 37 general fund of the state to the department of human
     4 38 services for the medical assistance program for the
     4 39 fiscal year beginning July 1, 2010, and ending June 30,
     4 40 2011, as specified in 2010 Iowa Acts, House File 2526,
     4 41 section 11, if enacted, is reduced by $18,863,117.>
     4 42 #2.  By renumbering as necessary.


                                        
          JOE BOLKCOM


                                        
          JACK HATCH


                                        
          AMANDA RAGAN
          HF2531.2843 (6) 83
          pf/rj

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