House Amendment to Senate File 313 S-3292 Amend Senate File 313, as passed by the Senate, as 1 follows: 2 1. Page 1, before line 1 by inserting: 3 < DIVISION I 4 MEDICAL ASSISTANCE —— GENERAL PROVISIONS > 5 2. Page 5, after line 10 by inserting: 6 < Sec. ___. Section 249J.24A, subsection 1, Code 7 2011, is amended to read as follows: 8 1. A nonparticipating provider may be reimbursed 9 for covered expansion population services provided to 10 an expansion population member by a nonparticipating 11 provider if the nonparticipating provider contacts the 12 appropriate participating provider prior to providing 13 covered services to verify consensus regarding one of 14 the following courses of action if any of the following 15 conditions is met : 16 a. If the nonparticipating provider and the 17 participating provider agree that the medical status 18 of the expansion population member indicates it 19 is medically possible to postpone provision of 20 services, the nonparticipating provider shall direct 21 the expansion population member to the appropriate 22 participating provider for services. 23 b. a. If the nonparticipating provider and the 24 participating provider agree determines that the 25 medical status of the expansion population member 26 indicates it is not medically possible advisable to 27 postpone provision of services, the nonparticipating 28 provider shall provide medically necessary services. 29 c. b. If the nonparticipating provider and the 30 participating provider agree that transfer of the 31 expansion population member is not possible due to lack 32 of available inpatient capacity, the nonparticipating 33 provider shall provide medically necessary services. 34 d. c. If the medical status of the expansion 35 population member indicates a medical emergency and the 36 nonparticipating provider is not able to contact the 37 appropriate participating provider prior to providing 38 medically necessary services, the nonparticipating 39 provider shall document the medical emergency 40 and inform the appropriate participating provider 41 immediately after the member has been stabilized of any 42 covered services provided. 43 Sec. ___. Section 249J.24A, subsection 2, paragraph 44 a, Code 2011, is amended to read as follows: 45 a. If the nonparticipating provider meets 46 the requirements specified in subsection 1 , the 47 nonparticipating provider shall be reimbursed for 48 covered expansion population services , limited to 49 emergency and other inpatient hospital services 50 -1- SF313.2834.H (2) 84 mb 1/ 3 #1. #2.

provided to the expansion population member up to the 1 point of transfer to another provider, discharge, 2 or transfer to another level of care, through the 3 nonparticipating provider reimbursement fund in 4 accordance with rules adopted by the department of 5 human services. However, any funds received from 6 participating providers, appropriated to participating 7 providers, or deposited in the IowaCare account 8 pursuant to section 249J.24 , shall not be transferred 9 or appropriated to the nonparticipating provider 10 reimbursement fund or otherwise used to reimburse 11 nonparticipating providers. > 12 3. Page 5, after line 10 by inserting: 13 < Sec. ___. Section 514I.5, subsection 3, Code 2011, 14 is amended to read as follows: 15 3. Members appointed by the governor shall 16 serve two-year staggered terms as designated by the 17 governor, and legislative members of the board shall 18 serve two-year terms. The filling of positions 19 reserved for the public representatives, vacancies, 20 membership terms, payment of compensation and expenses, 21 and removal of the members are governed by chapter 22 69 . Members of the board are entitled to receive 23 reimbursement of actual expenses incurred in the 24 discharge of their duties. Public members of the 25 board are also eligible to receive compensation as 26 provided in section 7E.6 . A majority of the voting 27 members constitutes a quorum and the affirmative vote 28 of a majority of the voting members is necessary for 29 any substantive action to be taken by the board. The 30 members shall select a chairperson on an annual basis 31 from among the membership of the board. > 32 4. Page 5, after line 10 by inserting: 33 < DIVISION II 34 MEDICAID PRESCRIPTION DRUGS 35 Sec. ___. Section 249A.20A, subsection 4, Code 36 2011, is amended to read as follows: 37 4. With the exception of drugs prescribed for the 38 treatment of human immunodeficiency virus or acquired 39 immune deficiency syndrome, transplantation, or cancer 40 and drugs prescribed for mental illness with the 41 exception of drugs and drug compounds that do not 42 have a significant variation in a therapeutic profile 43 or side effect profile within a therapeutic class, 44 prescribing and dispensing of prescription drugs not 45 included on the preferred drug list shall be subject to 46 prior authorization. 47 Sec. ___. 2010 Iowa Acts, chapter 1031, section 48 348, is amended to read as follows: 49 SEC. 348. MEDICAID NONPREFERRED DRUG LIST 50 -2- SF313.2834.H (2) 84 mb 2/ 3 #3. #4.

PRESCRIBING. 1 1. The department shall adopt rules pursuant 2 to chapter 17A to restrict physicians and other 3 prescribers to prescribing not more than a 72-hour 4 or three-day supply of a prescription drug not 5 included on the medical assistance preferred drug list 6 while seeking approval to continue prescribing the 7 medication. 8 2. Notwithstanding subsection 1, the department 9 shall adopt rules pursuant to chapter 17A to restrict a 10 physician or other prescriber prescribing a chemically 11 unique mental health prescription drug to prescribing 12 not more than a seven-day supply of the prescription 13 drug while requesting approval to continue to prescribe 14 the medication. The rules shall provide that if 15 an approval or disapproval is not received by the 16 physician or other prescriber within 48 hours of the 17 request, the request is deemed approved. 18 Sec. ___. REPEAL. 2010 Iowa Acts, chapter 1031, 19 section 349, is repealed. 20 Sec. ___. RESCINDING AND ADOPTION OF RULES. The 21 department of human services shall rescind the rules 22 adopted pursuant to 2010 Iowa Acts, chapter 1031, 23 section 347, chapter 1031, section 349, subsection 24 2, and chapter 1031, section 349, and shall instead 25 adopt emergency rules under section 17A.4, subsection 26 3, and section 17A.5, subsection 2, paragraph “b”, 27 to implement section 249A.20A, as amended in this 28 division of this Act, and the rules shall be effective 29 immediately upon filing and retroactively applicable to 30 January 1, 2011, unless a later date is specified in 31 the rules. Any rules adopted in accordance with this 32 section shall also be published as a notice of intended 33 action as provided in section 17A.4. 34 Sec. ___. EFFECTIVE UPON ENACTMENT AND RETROACTIVE 35 APPLICABILITY. This division of this Act, being deemed 36 of immediate importance, takes effect upon enactment 37 and applies retroactively to January 1, 2011. > 38 5. Title page, line 2, after < provisions > by 39 inserting < and providing effective date and retroactive 40 applicability provisions > 41 6. By renumbering as necessary. 42 -3- SF313.2834.H (2) 84 mb 3/ 3 #5.