Senate
File
313
H-1686
Amend
Senate
File
313,
as
passed
by
the
Senate,
as
1
follows:
2
1.
Page
5,
after
line
10
by
inserting:
3
<
Sec.
___.
Section
249J.24A,
subsection
1,
Code
4
2011,
is
amended
to
read
as
follows:
5
1.
A
nonparticipating
provider
may
be
reimbursed
6
for
covered
expansion
population
services
provided
to
7
an
expansion
population
member
by
a
nonparticipating
8
provider
if
the
nonparticipating
provider
contacts
the
9
appropriate
participating
provider
prior
to
providing
10
covered
services
to
verify
consensus
regarding
one
of
11
the
following
courses
of
action
if
any
of
the
following
12
conditions
is
met
:
13
a.
If
the
nonparticipating
provider
and
the
14
participating
provider
agree
that
the
medical
status
15
of
the
expansion
population
member
indicates
it
16
is
medically
possible
to
postpone
provision
of
17
services,
the
nonparticipating
provider
shall
direct
18
the
expansion
population
member
to
the
appropriate
19
participating
provider
for
services.
20
b.
a.
If
the
nonparticipating
provider
and
the
21
participating
provider
agree
determines
that
the
22
medical
status
of
the
expansion
population
member
23
indicates
it
is
not
medically
possible
advisable
to
24
postpone
provision
of
services,
the
nonparticipating
25
provider
shall
provide
medically
necessary
services.
26
c.
b.
If
the
nonparticipating
provider
and
the
27
participating
provider
agree
that
transfer
of
the
28
expansion
population
member
is
not
possible
due
to
lack
29
of
available
inpatient
capacity,
the
nonparticipating
30
provider
shall
provide
medically
necessary
services.
31
d.
c.
If
the
medical
status
of
the
expansion
32
population
member
indicates
a
medical
emergency
and
the
33
nonparticipating
provider
is
not
able
to
contact
the
34
appropriate
participating
provider
prior
to
providing
35
medically
necessary
services,
the
nonparticipating
36
provider
shall
document
the
medical
emergency
37
and
inform
the
appropriate
participating
provider
38
immediately
after
the
member
has
been
stabilized
of
any
39
covered
services
provided.
40
Sec.
___.
Section
249J.24A,
subsection
2,
paragraph
41
a,
Code
2011,
is
amended
to
read
as
follows:
42
a.
If
the
nonparticipating
provider
meets
43
the
requirements
specified
in
subsection
1
,
the
44
nonparticipating
provider
shall
be
reimbursed
for
45
covered
expansion
population
services
,
limited
to
46
emergency
and
other
inpatient
hospital
services
47
provided
to
the
expansion
population
member
up
to
the
48
point
of
transfer
to
another
provider,
discharge,
49
or
transfer
to
another
level
of
care,
through
the
50
-1-
SF313.2809
(3)
84
pf/nh
1/
2
#1.
nonparticipating
provider
reimbursement
fund
in
1
accordance
with
rules
adopted
by
the
department
of
2
human
services.
However,
any
funds
received
from
3
participating
providers,
appropriated
to
participating
4
providers,
or
deposited
in
the
IowaCare
account
5
pursuant
to
section
249J.24
,
shall
not
be
transferred
6
or
appropriated
to
the
nonparticipating
provider
7
reimbursement
fund
or
otherwise
used
to
reimburse
8
nonparticipating
providers.
>
9
2.
By
renumbering
as
necessary.
10
______________________________
HEATON
of
Henry
-2-
SF313.2809
(3)
84
pf/nh
2/
2
#2.