Senate File 296 H-1373 Amend Senate File 296, as amended, passed, and 1 reprinted by the Senate, as follows: 2 1. By striking everything after the enacting clause 3 and inserting: 4 < DIVISION I 5 HEALTHY IOWA PLAN 6 Section 1. NEW SECTION . 249N.1 Title. 7 This chapter shall be known and may be cited as the 8 “Healthy Iowa Plan” . 9 Sec. 2. NEW SECTION . 249N.2 Definitions. 10 As used in this chapter, unless the context 11 otherwise requires: 12 1. “Accountable care organization” means a 13 risk-bearing, integrated health care organization 14 characterized by a payment and care delivery model that 15 ties provider reimbursement to quality metrics and 16 reductions in the total cost of care for an attributed 17 population of patients. 18 2. “Affordable Care Act” or “federal Act” means the 19 federal Patient Protection and Affordable Care Act, 20 Pub. L. No. 111-148 as amended by the federal Health 21 Care and Education Reconciliation Act of 2010, Pub. L. 22 No. 111-152. 23 3. “Clean claim” means a claim submitted by a 24 healthy Iowa plan provider that may be adjudicated as 25 paid or denied. 26 4. “Covered benefits” means reimbursable health 27 care services as specified in section 249N.6. 28 5. “Department” means the department of human 29 services. 30 6. “Director” means the director of human services. 31 7. “Essential health benefits” means essential 32 health benefits as defined in section 1302 of the 33 Affordable Care Act, that include at least the general 34 categories and the items and services covered within 35 the categories of ambulatory patient services; 36 emergency services; hospitalization; maternity and 37 newborn care; mental health and substance use disorder 38 services, including behavioral health treatment; 39 prescription drugs; rehabilitative and habilitative 40 services and devices; laboratory services; preventive 41 and wellness services and chronic disease management; 42 and pediatric services, including oral and vision care. 43 8. “Federal approval” means approval by the centers 44 for Medicare and Medicaid services of the United States 45 department of health and human services. 46 9. “Federal poverty level” means the most recently 47 revised poverty income guidelines published by the 48 United States department of health and human services. 49 10. “Full benefits recipient” means an adult who is 50 -1- SF296.1964 (2) 85 pf/rj 1/ 21 #1.
eligible for full medical assistance benefits pursuant 1 to chapter 249A under any category of eligibility. 2 11. “Healthy Iowa plan” or “plan” means the healthy 3 Iowa plan established under this chapter. 4 12. “Healthy Iowa plan provider” means any provider 5 enrolled in the medical assistance program or any 6 participating accountable care organization. 7 13. “Healthy Iowa plan provider network” means the 8 health care delivery network approved by the department 9 for healthy Iowa plan members. 10 14. “Medical assistance program” or “Medicaid” means 11 the program paying all or part of the costs of care and 12 services provided to an individual pursuant to chapter 13 249A and Tit. XIX of the federal Social Security Act. 14 15. “Medicare” means the federal Medicare program 15 established pursuant to Tit. XVIII of the federal 16 Social Security Act. 17 16. “Member” means an individual who meets the 18 eligibility requirements of section 249N.5 and is 19 enrolled in the healthy Iowa plan. 20 17. “My health rewards account” means an account 21 established by the department pursuant to section 22 249N.9 on behalf of a member to contain contributions 23 from the member, financial incentives earned by the 24 member, and other payments made by the plan, to be used 25 by the member for payment of required contributions, 26 cost-sharing, and health improvements. 27 18. “Participating accountable care organization” 28 means an accountable care organization approved by the 29 department to participate in the healthy Iowa plan 30 provider network. 31 19. “Preventive care services” means care that is 32 provided to an individual to promote health, prevent 33 disease, or diagnose disease. 34 20. “Primary medical provider” means the primary 35 care provider chosen by a member or to whom a member 36 is assigned to provide and manage the member’s primary 37 care and to provide referrals, as necessary and 38 required by the healthy Iowa plan, to other healthy 39 Iowa plan providers. 40 21. “Value-based reimbursement” means a payment 41 methodology that links provider reimbursement to 42 improved performance by health care providers by 43 holding health care providers accountable for both the 44 cost and quality of care provided. 45 Sec. 3. NEW SECTION . 249N.3 Purpose —— 46 establishment of healthy Iowa plan. 47 1. The purpose of this chapter is to establish and 48 administer a healthy Iowa plan to promote increased 49 access to health care, quality health care outcomes, 50 -2- SF296.1964 (2) 85 pf/rj 2/ 21
and the use of personal responsibility mechanisms that 1 encourage individuals with incomes at or below one 2 hundred percent of the federal poverty level to be 3 cost-conscious consumers of health care and to exhibit 4 healthy behaviors. 5 2. The healthy Iowa plan is established within the 6 medical assistance program and shall be administered by 7 the department. Except as otherwise specified in this 8 chapter, the rules applicable to the medical assistance 9 program pursuant to chapter 249A shall be applicable 10 to the healthy Iowa plan. 11 3. The department may contract with a third-party 12 administrator to provide eligibility determination 13 support, and to administer enrollment, member 14 outreach, my health rewards account services, and other 15 components of the healthy Iowa plan. 16 Sec. 4. NEW SECTION . 249N.4 Federal financial 17 participation —— limitations of program. 18 1. This chapter shall be implemented only to the 19 extent that federal matching funds are available for 20 nonfederal expenditures under this chapter. Except as 21 otherwise provided in section 249N.11, the department 22 shall not expend funds under this chapter, including 23 but not limited to expenditures for reimbursement of 24 providers and program administration, if appropriated 25 nonfederal funds are not matched by federal financial 26 participation. 27 2. Enrollment in the healthy Iowa plan may be 28 limited, closed, or reduced and the scope and duration 29 of services provided under the healthy Iowa plan may 30 be limited, reduced, or terminated if the department 31 determines that federal financial participation or 32 appropriated nonfederal funds will not be available to 33 pay for existing or additional enrollment costs. 34 3. The provisions of this chapter shall not be 35 construed, are not intended as, and shall not imply a 36 grant of entitlement to services for individuals who 37 are eligible for covered benefits under this chapter 38 or for utilization of services that do not exist or 39 are not otherwise available under this chapter. Any 40 state obligation to provide covered benefits pursuant 41 to this chapter is limited to the extent of the funds 42 appropriated or distributed for the purposes of this 43 chapter. 44 4. The provisions of this chapter shall not be 45 construed and are not intended to affect the provision 46 of services to medical assistance program recipients 47 existing on January 1, 2014. 48 Sec. 5. NEW SECTION . 249N.5 Healthy Iowa plan —— 49 eligibility. 50 -3- SF296.1964 (2) 85 pf/rj 3/ 21
1. Except as otherwise provided in this chapter, 1 an individual nineteen through sixty-four years of age 2 shall be eligible for covered benefits specified in 3 this chapter when provided through the healthy Iowa 4 plan provider network as described in this chapter, if 5 the individual meets all of the following conditions: 6 a. The individual meets the citizenship or alienage 7 requirements of the medical assistance program, is a 8 resident of Iowa, and provides a social security number 9 upon application for the plan. 10 b. The individual has household income at or below 11 one hundred percent of the federal poverty level. 12 Household income shall be determined using the modified 13 adjusted gross income methodology pursuant to section 14 2002 of the Affordable Care Act. 15 c. The individual fulfills all other conditions 16 of participation in the healthy Iowa plan, including 17 member financial participation pursuant to section 18 249N.8. 19 2. The following individuals are not eligible for 20 the healthy Iowa plan: 21 a. An individual eligible as a full benefits 22 recipient under the medical assistance program. 23 b. An individual who is entitled to or enrolled 24 for Medicare benefits under part A, or is enrolled for 25 Medicare benefits under part B, of Tit. XVIII of the 26 federal Social Security Act. 27 c. An individual who is pregnant and otherwise 28 eligible for the medical assistance program pursuant to 29 section 249A.3. 30 d. An individual who has access to affordable 31 employer-sponsored health care coverage, as defined by 32 rule of the department to align with rules adopted by 33 the federal internal revenue service under the federal 34 Affordable Care Act. 35 3. a. Each applicant for the healthy Iowa 36 plan shall provide to the department all insurance 37 information required by the health insurance premium 38 payment program in accordance with rules adopted by the 39 department. 40 b. The department may elect to pay the 41 cost of premiums for applicants with access 42 to employer-sponsored health care coverage if 43 the department determines such payment to be 44 cost-effective. 45 c. Eligibility for the healthy Iowa plan is a 46 qualifying event under the federal Health Insurance 47 Portability and Accountability Act of 1996, Pub. L. No. 48 104-191. 49 d. If premium payment is provided under this 50 -4- SF296.1964 (2) 85 pf/rj 4/ 21
subsection for employer-sponsored health care coverage, 1 the healthy Iowa plan shall supplement such coverage 2 as necessary to provide the covered benefits specified 3 under section 249N.6. 4 4. The department shall implement the healthy Iowa 5 plan in a manner that ensures that the healthy Iowa 6 plan is the payor of last resort. 7 5. A member is eligible for coverage effective 8 the first day of the month following the month of 9 application for enrollment. 10 6. Following initial enrollment, a member is 11 eligible for covered benefits for twelve months, 12 subject to program termination and other limitations 13 otherwise specified in this chapter. The department 14 shall review the member’s eligibility on at least an 15 annual basis. 16 Sec. 6. NEW SECTION . 249N.6 Healthy Iowa plan —— 17 covered benefits. 18 Members shall receive coverage for benefits pursuant 19 to 42 U.S.C. § 1396u-7(b)(1)(B), adjusted as necessary 20 to provide the essential health benefits required 21 pursuant to section 1302 of the federal Act, and 22 including habilitation services consistent with the 23 state medical assistance program section 1915I waiver. 24 Sec. 7. NEW SECTION . 249N.7 Healthy Iowa plan 25 provider network. 26 1. The department shall develop a regionalized 27 healthy Iowa plan provider network statewide. 28 2. The healthy Iowa plan provider network shall 29 include all providers enrolled in the medical 30 assistance program and participating accountable care 31 organizations. Reimbursement under this chapter shall 32 only be made to such healthy Iowa plan providers for 33 covered benefits. 34 3. a. Upon enrollment, a member shall choose a 35 primary medical provider within the healthy Iowa plan 36 provider network. 37 b. If the member does not choose a primary medical 38 provider, the department shall assign the member to 39 a primary medical provider in accordance with the 40 mandatory enrollment provisions specified in rules 41 adopted by the department pursuant to chapter 249A 42 and in accordance with quality data available to the 43 department. 44 c. The department shall develop a mechanism for 45 primary medical providers and participating accountable 46 care organizations within a region to jointly 47 facilitate member care coordination. 48 4. a. The healthy Iowa plan provider network shall 49 include at least one participating accountable care 50 -5- SF296.1964 (2) 85 pf/rj 5/ 21
organization per region with which the department shall 1 contract to ensure the coordination and management 2 of the health of the members within the region, to 3 produce improved health care quality, and to control 4 overall cost. The department shall contract with the 5 acute care teaching hospital located in a county with 6 a population over three hundred fifty thousand to act 7 as a participating accountable care organization within 8 the region specified by the department. 9 b. The department shall establish the 10 qualifications, contracting processes, and 11 contract terms for a participating accountable care 12 organization. The department shall also establish 13 a methodology for attribution of a specified member 14 population to the participating accountable care 15 organization. 16 c. A participating accountable care organization 17 contract shall establish accountability based on 18 quality performance and total cost of care metrics for 19 the attributed population. The metrics shall include 20 but are not limited to risk sharing, including both 21 shared savings and shared costs, between the state and 22 the participating accountable care organization. 23 d. The department shall ensure that payments made 24 to participating accountable care organizations do not 25 exceed available funds in the healthy Iowa account 26 created in section 249N.11. 27 e. The participating accountable care organization 28 shall provide access by members to primary medical 29 providers within thirty miles or thirty minutes of a 30 member’s residence, unless such access is technically 31 infeasible. 32 5. To the extent possible, members shall have 33 a choice of providers within the healthy Iowa plan 34 provider network, subject to the results of attribution 35 under this section and subject to all of the following: 36 a. Member choice may be limited by the 37 participating accountable care organization, with prior 38 approval of the department, if the member’s health 39 condition would benefit from limiting the member’s 40 choice of a healthy Iowa plan provider to ensure 41 coordination of services, or due to overutilization of 42 covered benefits. The participating accountable care 43 organization shall provide thirty days’ notice to the 44 member prior to limitation of such choice. 45 b. The department may require that access to 46 services not provided through the participating 47 accountable care organization be subject to prior 48 authorization by the participating accountable care 49 organization, if such prior authorization is projected 50 -6- SF296.1964 (2) 85 pf/rj 6/ 21
to improve health care delivery in the region. 1 6. a. A healthy Iowa plan provider shall submit 2 clean claims within twenty days of the date of 3 provision of a covered benefit to a member. 4 b. A healthy Iowa plan provider shall be reimbursed 5 for covered benefits under the healthy Iowa plan 6 utilizing the same reimbursement methodology as 7 that applicable to individuals eligible for medical 8 assistance under section 249A.3, subsection 1. 9 c. Notwithstanding paragraph “b” , a participating 10 accountable care organization under contract with the 11 department shall be reimbursed utilizing a value-based 12 reimbursement methodology. 13 7. a. Healthy Iowa plan providers shall exchange 14 member health information as provided by rule to 15 facilitate coordination and management of care, 16 improved health outcomes, and reduction in costs. 17 b. The department shall provide the health care 18 claims data of attributed members to a member’s 19 participating accountable care organization on a 20 timeframe established by rule of the department. 21 Sec. 8. NEW SECTION . 249N.8 Member financial 22 participation. 23 1. Membership in the healthy Iowa plan shall 24 require payment of a monthly contribution and 25 cost-sharing amounts, annually, that align with the 26 cost-sharing limitations requirements for American 27 health benefit exchanges under the Affordable Care 28 Act. Copayments under the healthy Iowa plan shall 29 be applicable only to nonemergency use of a hospital 30 emergency department. Contribution and cost-sharing 31 amounts, including an annual deductible, shall be 32 established by rule of the department. 33 2. a. Even though a member is eligible for 34 coverage effective the first day of the month following 35 the month of application for enrollment, claims for 36 covered benefits shall not be paid until the initial 37 monthly contribution payment is made by the member. 38 If the initial monthly contribution payment is made 39 within sixty days of the eligibility date, claims for 40 covered benefits are payable from the effective date 41 of eligibility. 42 b. Timely payment of monthly contributions, 43 within sixty days of the date the payment is due, is 44 a condition of membership. A member who does not 45 make such timely payment is subject to disenrollment 46 from the plan, following notice from the department. 47 Following such disenrollment, an individual is not 48 eligible for reapplication for membership in the plan 49 for twelve months from the date of disenrollment. 50 -7- SF296.1964 (2) 85 pf/rj 7/ 21
c. A member may request a hardship exemption if 1 a hardship would accrue from imposing payment of the 2 monthly contribution. Information regarding the 3 contribution obligation and the hardship exemption, 4 including the process by which a prospective member may 5 apply for the hardship exemption, shall be provided to 6 a prospective member at the time of application for 7 enrollment. 8 3. Any required member contributions or 9 cost-sharing that are unpaid are a debt owed the state. 10 Sec. 9. NEW SECTION . 249N.9 My health rewards 11 accounts. 12 1. The department shall establish a my health 13 rewards account for each healthy Iowa plan member. 14 2. The plan shall deposit all of the following in a 15 member’s health rewards account: 16 a. All member contributions collected under section 17 249N.8. 18 b. Financial incentive payments paid by the plan, 19 annually, for the member’s completion of a health risk 20 assessment, completion of an annual physical, receipt 21 of preventive services specified by the plan, or the 22 entering into by a member of a health responsibility 23 and self-sufficiency agreement, as specified by rule of 24 the department. 25 c. A payment paid by the plan upon initial 26 enrollment and annually thereafter, of an amount that 27 is the difference between the sum of the required 28 contributions made by the member plus the financial 29 incentive amounts paid by the plan, and the total 30 annual deductible for the member as established by 31 rule. 32 3. The moneys in a member’s account shall only be 33 distributed from the account and used to improve the 34 health of the member as specified by rule based on best 35 practices. Such uses may include but are not limited 36 to payment for smoking cessation services or nutrition 37 counseling, or payment of required contributions or 38 cost-sharing amounts, exclusive of copayments for 39 nonemergency use of a hospital emergency department. 40 A member’s deductible amount under the plan shall be 41 debited against the member’s account annually. 42 4. If a member demonstrates an established pattern 43 of failure to pay required contribution or cost-sharing 44 amounts, or a pattern of inappropriate use of emergency 45 department or covered benefits, the member may be 46 subject to forfeiture of the funds in the account, 47 following notice from the department. 48 5. Any funds remaining in a member’s my health 49 rewards account annually at the end of a twelve-month 50 -8- SF296.1964 (2) 85 pf/rj 8/ 21
enrollment period are subject to the following: 1 a. If the member renews enrollment, the funds 2 shall remain in the account to be used to defray the 3 costs of the member’s contributions and cost-sharing 4 requirements in the subsequent enrollment period. 5 However, if the member did not complete the preventive 6 care services specified by the plan during the prior 7 enrollment period, any portion of the remaining amount 8 paid by the plan shall not be used to defray the 9 costs of the member’s contributions or cost-sharing 10 requirements in the subsequent enrollment period. 11 b. If an individual is no longer eligible for 12 the plan, does not reenroll in the plan, or is 13 terminated from the plan for nonpayment of required 14 contributions or cost-sharing amounts, the plan shall 15 refund a prorated amount of the member’s contributions 16 as determined by rule of the department, less any 17 outstanding contributions or cost-sharing owed by the 18 member, to the individual within sixty days of such 19 occurrence. Any portion of the remaining amount in the 20 account paid by the plan shall revert to the healthy 21 Iowa account. 22 Sec. 10. NEW SECTION . 249N.10 Funding —— county 23 and county hospital contributions —— certified public 24 expenditures. 25 1. Notwithstanding any provision to the contrary 26 relating to the taxes levied by a county pursuant to 27 section 331.424A for which the collection is performed 28 after January 1, 2014, the county treasurer of each 29 county shall distribute thirty-seven and eighty-four 30 hundredths percent of the maximum amount authorized to 31 be levied and collected pursuant to section 331.424A, 32 to the treasurer of state for deposit in the healthy 33 Iowa account created in section 249N.11. One-half 34 of the total amount specified under this subsection 35 shall be distributed by each county treasurer to the 36 treasurer of state by October 15, and one-half of the 37 total amount shall be distributed to the treasurer of 38 state by April 15, annually. 39 2. Notwithstanding any provision to the contrary, 40 for the collection of taxes levied under section 347.7, 41 for which the collection is performed after January 42 1, 2014, the county treasurer of a county with a 43 population over three hundred fifty thousand in which a 44 publicly owned acute care teaching hospital is located 45 shall distribute the proceeds collected pursuant to 46 section 347.7, in a total amount of forty-two million 47 dollars annually, which would otherwise be distributed 48 to the county hospital, to the treasurer of state for 49 deposit in the healthy Iowa account created in section 50 -9- SF296.1964 (2) 85 pf/rj 9/ 21
249N.11 as follows: 1 a. The first nineteen million dollars in 2 collections pursuant to section 347.7, between July 3 1 and December 31 annually, shall be distributed to 4 the treasurer of state for deposit in the healthy Iowa 5 account and collections during this time period in 6 excess of nineteen million dollars shall be distributed 7 to the acute care teaching hospital identified in this 8 subsection. In addition, of the collections during 9 this time period in excess of nineteen million dollars 10 received by the acute care teaching hospital, two 11 million dollars shall be distributed by the acute care 12 teaching hospital to the treasurer of state for deposit 13 in the healthy Iowa account in the month of January 14 following the July 1 through December 31 period. 15 b. The first nineteen million dollars in 16 collections pursuant to section 347.7, between January 17 1 and June 30 annually, shall be distributed to the 18 treasurer of state for deposit in the healthy Iowa 19 account and collections during this time period in 20 excess of nineteen million dollars shall be distributed 21 to the acute care teaching hospital identified in 22 this subsection. In addition, of the collections 23 during this time period in excess of nineteen million 24 dollars received by the acute care teaching hospital, 25 two million dollars shall be distributed by the acute 26 care teaching hospital to the treasurer of state for 27 deposit in the healthy Iowa account in the month of 28 July following the January 1 through June 30 period. 29 3. In addition to the funding specified in this 30 section, the university of Iowa hospitals and clinics 31 shall certify public expenditures in an amount equal to 32 provide the nonfederal share of total expenditures not 33 to exceed thirty million dollars annually. 34 Sec. 11. NEW SECTION . 249N.11 Healthy Iowa 35 account. 36 1. A healthy Iowa account is created in the state 37 treasury under the authority of the department. Moneys 38 appropriated from the general fund of the state to the 39 account, proceeds distributed from county treasurers as 40 specified in section 249N.10, and moneys from any other 41 source credited to the account shall be deposited in 42 the account. Moneys deposited in or credited to the 43 account are appropriated to the department of human 44 services to be used for the purposes of the healthy 45 Iowa plan including administration of the plan and to 46 provide nonfederal matching funds for the healthy Iowa 47 plan, as specified in this chapter. An amount shall 48 be appropriated from the account to the county with a 49 population over three hundred fifty thousand in which a 50 -10- SF296.1964 (2) 85 pf/rj 10/ 21
publicly owned acute care teaching hospital is located, 1 annually, to offset any difference between the amount 2 of proceeds required to be distributed by the county 3 treasurer to the account and the actual amount received 4 by the hospital in reimbursements through the healthy 5 Iowa plan in the preceding fiscal year. 6 2. The account shall be separate from the general 7 fund of the state and shall not be considered part 8 of the general fund of the state. The moneys in 9 the account shall not be considered revenue of the 10 state, but rather shall be funds of the account. 11 The moneys in the account are not subject to 12 section 8.33 and shall not be transferred, used, 13 obligated, appropriated, or otherwise encumbered, 14 except to provide for the purposes of this chapter. 15 Notwithstanding section 12C.7, subsection 2, interest 16 or earnings on moneys deposited in the account shall 17 be credited to the account. 18 3. The department shall adopt rules pursuant to 19 chapter 17A to administer the account. 20 Sec. 12. NEW SECTION . 249N.12 Adoption of rules —— 21 sole-source administration. 22 1. The department shall adopt rules pursuant to 23 chapter 17A as necessary to administer this chapter. 24 The department may adopt emergency rules under section 25 17A.4, subsection 3, and section 17A.5, subsection 2, 26 paragraph “b” , as necessary for the administration 27 of this chapter and the rules shall become effective 28 immediately upon filing or on a later effective date 29 specified in the rules, unless the effective date is 30 delayed by the administrative rules review committee. 31 Any rules adopted in accordance with this section 32 shall not take effect before the rules are reviewed 33 by the administrative rules review committee. The 34 delay authority provided to the administrative rules 35 review committee under section 17A.4, subsection 7, and 36 section 17A.8, subsection 9, shall be applicable to a 37 delay imposed under this section, notwithstanding a 38 provision in those sections making them inapplicable 39 to section 17A.5, subsection 2, paragraph “b” . Any 40 rules adopted in accordance with the provisions of this 41 section shall also be published as notice of intended 42 action as provided in section 17A.4. 43 2. Notwithstanding section 8.47 or any other 44 provision of law to the contrary, the department may 45 utilize a sole-source approach to administer this 46 chapter. 47 Sec. 13. Section 249J.26, subsection 2, Code 2013, 48 is amended to read as follows: 49 2. This chapter is repealed October December 31, 50 -11- SF296.1964 (2) 85 pf/rj 11/ 21
2013. 1 Sec. 14. HEALTHY IOWA ACCOUNT —— APPROPRIATION FROM 2 GENERAL FUND —— FY 2013-2014. There is appropriated 3 from the general fund of the state to the department of 4 human services for the fiscal year beginning July 1, 5 2013, and ending June 30, 2014, the following amount 6 or so much thereof as is necessary for the purposes 7 designated: 8 For deposit in the healthy Iowa account created in 9 section 249N.11, as enacted in this division of this 10 Act, to be used for the purposes of the account: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,000,000 12 Sec. 15. MEDICAL ASSISTANCE APPROPRIATION 13 —— TRANSFER TO THE HEALTHY IOWA ACCOUNT —— FY 14 2013-2014. Of the funds appropriated to the department 15 of human services from the general fund of the state 16 for the fiscal year beginning July 1, 2013, and ending 17 June 30, 2014, for the medical assistance program, 18 $35,500,000 is transferred to the healthy Iowa account 19 created in section 249N.11, as enacted in this division 20 of this Act, for the purposes of the account. 21 Sec. 16. DIRECTIVE TO DEPARTMENT OF HUMAN 22 SERVICES. Upon enactment of this division of this 23 Act, the department of human services shall request 24 federal approval of a medical assistance section 1115 25 demonstration waiver to implement this division of this 26 Act effective January 1, 2014. 27 Sec. 17. EFFECTIVE UPON ENACTMENT AND CONTINGENT 28 IMPLEMENTATION. 29 1. This division of this Act, being deemed of 30 immediate importance, takes effect upon enactment. 31 However, the department of human services shall 32 implement this division of this Act effective January 33 1, 2014, contingent and only upon receipt of federal 34 approval of the waiver request submitted under this 35 division of this Act. 36 2. Notwithstanding subsection 1, if any portion 37 of the waiver is denied or if federal approval or 38 financial participation relative to any portion of the 39 waiver is denied, the department shall only implement 40 this division of this Act in accordance with both of 41 the following: 42 a. To the extent that federal approval is received 43 and federal financial participation is available. 44 b. To the extent federal approval is not required 45 and federal participation is not applicable. 46 3. The distributions of taxes levied pursuant 47 to section 331.424A and distributed by each county 48 treasurer to the treasurer of state pursuant to 49 section 249N.10 and the distribution of taxes levied 50 -12- SF296.1964 (2) 85 pf/rj 12/ 21
pursuant to section 347.7 and distributed by the county 1 treasurer of a county with a population over three 2 hundred fifty thousand in which a publicly owned acute 3 care teaching hospital is located to the treasurer 4 of state pursuant to section 249N.10, shall not be 5 distributed until the department of human services 6 has received federal approval of the waiver request 7 submitted under this division of this Act. 8 DIVISION II 9 MEDICAL MALPRACTICE ACTIONS 10 Sec. 18. Section 147.139, Code 2013, is amended to 11 read as follows: 12 147.139 Expert witness testimony —— standards. 13 1. If the standard of care given by a physician 14 and surgeon or an osteopathic physician and surgeon 15 licensed pursuant to chapter 148 , or a dentist licensed 16 pursuant to chapter 153 , is at issue, the court shall 17 only allow a person to qualify as an expert witness and 18 to testify on the issue of the appropriate standard of 19 care if the person’s medical or dental qualifications 20 relate directly to the medical problem or problems at 21 issue and the type of treatment administered in the 22 case. , breach of the standard of care, or proximate 23 cause of any damages or injury as a result of said 24 breach if all of the following qualifications of the 25 person are established: 26 a. The person is licensed to practice medicine, 27 osteopathic medicine, or dentistry and in the five 28 years preceding the allegedly negligent act, was 29 engaged in the active practice of medicine, osteopathic 30 medicine, or dentistry, or was a qualified instructor 31 at an accredited university of medicine and surgery, 32 osteopathic medicine and surgery, or dentistry. 33 b. The person practices or provides university 34 instruction in the same or substantially similar 35 specialty as the defendant. 36 c. If the defendant is board-certified in a 37 specialty, the person is also certified in that 38 specialty by a board recognized by the American board 39 of medical specialties or the American osteopathic 40 association and is licensed and in good standing in 41 each state of licensure, and has not had the person’s 42 license revoked or suspended in the past five years. 43 2. A person who is not licensed in this state who 44 testifies pursuant to this section as an expert against 45 a defendant, whether in contract or tort arising out 46 of the provision of or failure to provide care, shall 47 be deemed to hold a temporary license to practice in 48 this state for the purpose of providing such testimony 49 and shall be subject to the authority of the applicable 50 -13- SF296.1964 (2) 85 pf/rj 13/ 21
licensing board in this state including but not limited 1 to section 147.55. 2 Sec. 19. NEW SECTION . 147.140 Malpractice review 3 panels. 4 1. For the purpose of this section, “health care 5 provider” means a physician and surgeon, osteopathic 6 physician and surgeon, dentist, podiatric physician, 7 optometrist, pharmacist, chiropractor, physician 8 assistant, advanced registered nurse practitioner, or 9 nurse licensed pursuant to this chapter, a facility 10 certified as an ambulatory surgical center under the 11 federal Medicare program, a hospital licensed pursuant 12 to chapter 135B, or a health care facility licensed 13 pursuant to chapter 135C. 14 2. a. Immediately after the filing of any action 15 for personal injury or wrongful death against any 16 health care provider based upon the alleged negligence 17 of the licensee in the practice of that profession 18 or occupation, or upon the alleged negligence of a 19 facility certified as an ambulatory surgical center 20 under the federal Medicare program, hospital, or 21 health care facility in patient care and the answer 22 thereto by all named defendants, the chief judge of 23 the judicial district within which the action is filed 24 shall select a person pursuant to subsection 4 to serve 25 as chairperson of a malpractice review panel to review 26 the validity of the action. 27 b. Upon the selection of the chairperson, all legal 28 proceedings in the malpractice action shall be stayed 29 until thirty days after the malpractice review panel 30 issues its findings under subsection 13. 31 3. a. The chairperson selected pursuant to 32 subsection 2 shall serve as a nonvoting member of the 33 malpractice review panel. 34 b. The chairperson shall select the members of the 35 malpractice review panel pursuant to subsection 6. 36 4. a. All of the following persons shall be 37 eligible to serve on a review panel: 38 (1) Retired judges, and senior judges and retired 39 senior judges as defined in section 602.9202. 40 (2) Health care providers and attorneys recommended 41 by their respective professions to serve on malpractice 42 review panels pursuant to this section. As a condition 43 of licensure as a health care provider or as an 44 attorney in this state, a health care provider or 45 attorney selected to serve on a malpractice review 46 panel shall be required to serve if so selected. 47 (3) Residents of this state who are neither 48 attorneys nor health care providers. 49 b. For purposes of selecting members of a 50 -14- SF296.1964 (2) 85 pf/rj 14/ 21
malpractice review panel, the clerk of the supreme 1 court shall maintain a list of persons identified in 2 paragraph “a” , subparagraphs (1) and (2). Persons 3 identified in paragraph “a” , subparagraph (3), shall be 4 selected from a current jury pool. 5 5. a. The chairperson of the malpractice review 6 panel shall be compensated. If the chairperson is 7 receiving compensation for the chairperson’s service 8 on the review panel pursuant to section 602.1612, the 9 chairperson shall not receive additional compensation 10 for serving on the review panel. 11 b. A resident of this state who is neither an 12 attorney nor a health care provider who is selected as 13 a member of a review panel shall receive fifty dollars 14 per day for participating in hearings and deliberations 15 relating to service on the review panel. 16 c. All members of a review panel shall be 17 reimbursed for travel expenses. 18 6. a. Within ten days of receipt of the 19 notification of selection as chairperson of the 20 malpractice review panel, the chairperson shall select 21 the following persons to serve as members of the 22 malpractice review panel for the particular malpractice 23 action as follows: 24 (1) An attorney licensed to practice law in this 25 state. 26 (2) A health care provider licensed in this state. 27 (3) A resident of this state who is neither an 28 attorney nor a health care provider. 29 b. A person who is not referred to in paragraph “a” 30 may be selected to serve on the review panel if agreed 31 to by all parties to the malpractice action. 32 7. a. Within thirty days of convening the 33 malpractice review panel, a party to the proceedings 34 shall produce to all other parties all medical and 35 health care provider records within the possession 36 or control of the party pertaining to the plaintiff 37 regardless of whether the party believes such records 38 are relevant to the proceedings. 39 b. The chairperson may permit reasonable discovery, 40 and if so allowed, shall determine a timetable for any 41 additional discovery prior to the hearing before the 42 malpractice review panel. Depositions of persons other 43 than the parties and experts designated by the parties 44 shall not be taken except for good cause shown by the 45 party requesting the deposition. 46 c. The chairperson shall have the power to issue 47 subpoenas for both discovery and compulsion of 48 testimony in the same manner and method as the district 49 court. 50 -15- SF296.1964 (2) 85 pf/rj 15/ 21
d. The chairperson shall also determine a date by 1 which the plaintiff must submit a certificate-of-merit 2 affidavit as provided in subsection 8 for each 3 defendant the plaintiff intends to call as a witness to 4 testify with respect to the issues of the applicable 5 standard of care, breach of the applicable standard of 6 care, or causation. 7 8. a. A plaintiff shall submit a separate 8 certificate-of-merit affidavit for each defendant named 9 in the malpractice action. The affidavit submitted 10 for each defendant must be signed by an expert. The 11 affidavit must certify under the oath of the expert all 12 of the following: 13 (1) The expert’s statement of familiarity with the 14 applicable standard of care. 15 (2) The expert’s statement that the standard of 16 care was breached by the health care provider named as 17 the defendant. 18 (3) The expert’s statement of the actions that the 19 health care provider failed to take or should have 20 taken to comply with the standard of care. 21 (4) The expert’s statement of the manner by which 22 the breach of the standard of care was the cause of the 23 injury alleged in the petition. 24 b. A single expert need not certify all of the 25 elements in paragraph “a” in regard to one particular 26 defendant, however, each of the elements must be 27 certified by an expert in regard to each defendant. 28 c. If a plaintiff fails to submit a 29 certificate-of-merit affidavit within the time 30 period determined by the chairperson, the chairperson 31 shall file a motion with the district court to dismiss 32 the plaintiff’s malpractice action with regard to the 33 defendant for which the certificate-of-merit affidavit 34 was not submitted. The district court shall then 35 dismiss with prejudice the plaintiff’s malpractice 36 action against the defendant. 37 9. a. Within six months from the date all members 38 of the malpractice review panel were appointed, unless 39 the time period has been extended by the chairperson 40 for good cause shown by a requesting party, the 41 chairperson of the review panel shall hold a hearing of 42 the full review panel to review the plaintiff’s claims 43 and the defendant’s defenses. In no event shall any 44 extension cause the hearing to occur more than one year 45 after all review panel members were appointed. 46 b. Except as otherwise provided in this subsection, 47 one combined hearing or hearings shall be held for 48 all claims under this section arising out of the 49 same malpractice action. If the malpractice action 50 -16- SF296.1964 (2) 85 pf/rj 16/ 21
includes more than one defendant, the parties may, 1 upon agreement of all parties, require that separate 2 hearings be held for each defendant or group of 3 defendants. The chairperson may, for good cause shown, 4 order separate hearings. 5 10. At the hearing before the malpractice review 6 panel, all parties who are natural persons shall be 7 personally present and all entity parties shall have 8 a representative present with responsibility for the 9 subject matter that is the subject of the malpractice 10 action. If a plaintiff fails to appear at the hearing, 11 the chairperson shall file a motion with the district 12 court to dismiss the plaintiff’s action with prejudice, 13 and the court shall grant the motion. If the defendant 14 fails to appear at the hearing, the defendant shall 15 be precluded from presenting any evidence or making 16 any presentation before the malpractice review panel 17 or at any subsequent trial. The absence of a party 18 or an entity’s representative may be excused by the 19 chairperson for good cause shown. 20 11. At the hearing before the malpractice review 21 panel, the plaintiff shall present the plaintiff’s 22 case to the review panel and each defendant shall 23 present the defendant’s case in response to the 24 plaintiff’s presentation. Wide latitude shall be 25 afforded the parties in the conduct of the hearing 26 including but not limited to the right of examination 27 and cross-examination of witnesses by attorneys for 28 the parties. Depositions allowed to be taken under 29 subsection 7 shall be admissible regardless of whether 30 the person deposed is available at the hearing. The 31 Iowa rules of civil procedure shall not apply at 32 the hearing, and evidence may be admitted if such 33 evidence is evidence upon which reasonable persons are 34 accustomed to rely. The chairperson shall make all 35 procedural rulings and such rulings shall be binding 36 and final. The hearing shall be recorded either 37 electronically or by a court reporter. The cost of 38 recording the hearing shall be equally divided among 39 the parties. The record of the proceedings and all 40 documents presented as exhibits shall be confidential 41 except in the following circumstances: 42 a. Any testimony or writings made under oath may 43 be used in subsequent proceedings for purposes of 44 impeachment. 45 b. The party who made a statement or presented 46 evidence agrees to the submission, use, or disclosure 47 of the statement or evidence. 48 c. The parties unanimously agree upon disclosure of 49 any part of the record or proceedings. 50 -17- SF296.1964 (2) 85 pf/rj 17/ 21
12. Upon the conclusion of the hearing, the 1 malpractice review panel may request from any party 2 additional evidence, records, or other information to 3 be submitted in writing or at a continuation of the 4 hearing. A continued hearing shall be held as soon as 5 possible. A continued hearing shall be attended by 6 the same review panel members and parties who attended 7 the initial hearing, unless otherwise agreed to by all 8 parties. 9 13. The malpractice review panel shall issue its 10 findings in writing within thirty days of submission of 11 all presentations and evidence. 12 a. The review panel’s findings shall contain 13 answers to all of the following questions: 14 (1) Whether the acts or omissions complained of 15 constitute a deviation from the applicable standard 16 of care by the health care provider charged with such 17 care. 18 (2) If the acts or omissions complained of are 19 found to have constituted a deviation from the 20 applicable standard of care, whether the acts or 21 omissions complained of proximately caused the injury 22 complained of. 23 (3) If negligence on the part of a health care 24 provider is found, whether any negligence on the part 25 of the plaintiff was equal to or greater than the 26 negligence of the health care provider. 27 b. The review panel shall make any affirmative 28 finding by a preponderance of the evidence. 29 c. With regard to each question, the review 30 panel’s findings with regard to each question shall be 31 determined by a majority of the panel members. The 32 determination of the answer to any question by any 33 individual review panel member shall be confidential 34 and shall not be disclosed to any party or other member 35 of the public. The findings shall reflect the number 36 of review panel members making a determination of an 37 answer in the affirmative and in making a determination 38 of an answer in the negative. The findings, including 39 the cumulative determinations in the affirmative and 40 the negative for each answer, shall be signed by all 41 review panel members, with each review panel member 42 attesting that the written findings accurately reflect 43 the determinations made. 44 d. The chairperson of the review panel shall serve 45 the findings upon the parties within seven days of 46 the date of the findings. The review panel’s written 47 findings shall be preserved until thirty days after 48 final judgment or the action is finally resolved after 49 which time such findings shall be destroyed. All 50 -18- SF296.1964 (2) 85 pf/rj 18/ 21
medical and health care provider records shall be 1 returned to the party providing them to the review 2 panel. 3 e. The deliberations and discussion of the review 4 panel shall be privileged and confidential and a review 5 panel member shall not be asked or compelled to testify 6 at a later proceeding concerning the deliberations, 7 discussions, or findings expressed during the review 8 panel’s deliberations, except as such deliberation, 9 discussion, or findings may be required to prove an 10 allegation of intentional fraud. All review panel 11 members and the chairperson shall be immune from 12 liability as a result of participation in or serving 13 as a review panel member, except for instances of 14 intentional fraud by a panel member. 15 14. The effect of the malpractice review panel’s 16 findings shall be as follows: 17 a. If the review panel’s findings are unanimous and 18 unfavorable to the plaintiff in such a manner as would 19 not permit recovery by the plaintiff if the answers 20 were made at trial, all of the following shall apply: 21 (1) The review panel’s findings are admissible 22 in any subsequent court action for professional 23 negligence against the health care provider accused of 24 professional negligence by the claimant based upon the 25 same set of facts which were considered reviewed by the 26 review panel. 27 (2) If the malpractice action proceeds and results 28 in a verdict and judgment for the defendant, the 29 plaintiff shall be required to pay all expert witness 30 fees and court costs incurred by the defendant. 31 (3) If the malpractice action proceeds and results 32 in a verdict and judgment for the plaintiff, any 33 noneconomic damages awarded to the plaintiff shall not 34 exceed two hundred fifty thousand dollars. 35 b. If the review panel’s findings are unanimous and 36 unfavorable to the defendant, in such a manner as would 37 permit the plaintiff to recover if the defendant’s 38 answers were made at trial, all of the following shall 39 apply: 40 (1) The review panel’s findings are admissible 41 in any subsequent court action for professional 42 negligence against the health care provider accused of 43 professional negligence by the claimant based upon the 44 same set of facts which were considered reviewed by the 45 review panel. 46 (2) The defendant shall promptly admit liability or 47 enter into negotiations to pay the plaintiff’s claim 48 for damages. 49 (3) If liability is admitted, the claim may be 50 -19- SF296.1964 (2) 85 pf/rj 19/ 21
resubmitted to the review panel upon agreement of the 1 plaintiff and the defendant for a determination of 2 damages. Any determination of damages by the review 3 panel shall be admissible in any subsequent malpractice 4 action. 5 (4) If liability is not admitted and the parties 6 are not able to resolve the claim through settlement 7 negotiations within thirty days after service of the 8 review panel’s findings, the plaintiff may proceed with 9 the malpractice action. If the plaintiff obtains a 10 verdict or judgment in excess of the plaintiff’s last 11 formal demand in the settlement negotiations following 12 the review panel’s findings, the defendant shall be 13 required to pay all expert witness fees and court costs 14 incurred by the plaintiff. 15 15. a. Upon the selection of all members of the 16 malpractice review panel, each party shall pay to the 17 clerk of the district court a filing fee of two hundred 18 fifty dollars. 19 b. Any party may apply to the chairperson of the 20 malpractice review panel for a waiver of the filing 21 fee. The chairperson shall grant the waiver if the 22 party is indigent. 23 c. Any party who is or was an employee of another 24 party at the time of the claimed injury and was acting 25 in the course and scope of employment with such other 26 party shall not be required to pay a filing fee. 27 Sec. 20. NEW SECTION . 622.31A Evidence-based 28 medical practice guidelines —— affirmative defense. 29 1. For purposes of this section: 30 a. “Evidence-based medical practice guidelines” 31 means voluntary medical practice parameters or 32 protocols established and released through a recognized 33 physician consensus-building organization approved 34 by the United States department of health and human 35 services, through the American medical association’s 36 physician consortium for performance improvement or 37 similar activity, or through a recognized national 38 medical specialty society. 39 b. “Health care provider” means a physician and 40 surgeon, osteopathic physician and surgeon, physician 41 assistant, or advanced registered nurse practitioner. 42 2. In any action for personal injury or wrongful 43 death against any health care provider based upon the 44 alleged negligence of the health care provider in 45 patient care, the health care provider may assert, 46 as an affirmative defense, that the health care 47 provider complied with evidence-based medical practice 48 guidelines in the diagnosis and treatment of a patient. 49 3. A judge may admit evidence-based medical 50 -20- SF296.1964 (2) 85 pf/rj 20/ 21
practice guidelines into evidence if introduced only by 1 a health care provider or by the health care provider’s 2 employer and if the health care provider or the health 3 care provider’s employer establishes foundational 4 evidence in support of the evidence-based medical 5 practice guidelines as well as evidence that the health 6 care provider complied with the guidelines. Evidence 7 of departure from an evidence-based medical practice 8 guideline is admissible only on the issue of whether 9 the health care provider is entitled to assert an 10 affirmative defense. 11 4. This section shall not apply to any of the 12 following: 13 a. A mistaken determination by the health care 14 provider that the evidence-based medical practice 15 guideline applied to a particular patient where 16 such mistake is caused by the health care provider’s 17 negligence or intentional misconduct. 18 b. The health care provider’s failure to properly 19 follow the evidence-based medical practice guideline 20 where such failure is caused by the health care 21 provider’s negligence or intentional misconduct. There 22 shall be no presumption of negligence if a health care 23 provider does not adhere to an evidence-based medical 24 practice guideline. > 25 2. Title page, by striking lines 1 through 5 26 and inserting < An Act relating to health care by 27 establishing the healthy Iowa plan, affecting medical 28 malpractice actions, making appropriations, providing 29 remedies, and including effective date provisions. > 30 ______________________________ COMMITTEE ON APPROPRIATIONS SODERBERG of Plymouth, Chairperson -21- SF296.1964 (2) 85 pf/rj 21/ 21 #2.