House File 2460 H-8228 Amend House File 2460 as follows: 1 1. Page 85, after line 4 by inserting: 2 < REPORTING OF EXISTING DATA REQUIREMENTS, MINUTES, AND 3 RECOMMENDATIONS > 4 2. Page 92, after line 18 by inserting: 5 < DIVISION ___ 6 MEDICAID MANAGED CARE —— ADDITIONAL OVERSIGHT 7 REQUIREMENTS 8 Sec. ___. LEGISLATIVE FINDINGS —— GOALS AND INTENT. 9 1. The general assembly finds all of the following: 10 a. In the majority of states, Medicaid managed care 11 has been introduced on an incremental basis, beginning 12 with the enrollment of low-income children and parents 13 and proceeding in stages to include nonelderly persons 14 with disabilities and older individuals. Iowa, unlike 15 the majority of states, is implementing Medicaid 16 managed care simultaneously across a broad and diverse 17 population that includes individuals with complex 18 health care and long-term services and supports needs, 19 making these individuals especially vulnerable to 20 receiving inappropriate, inadequate, or substandard 21 services and supports. 22 b. The success or failure of Medicaid managed 23 care in Iowa depends on proper strategic planning and 24 strong oversight, and the incorporation of the core 25 values, principles, and goals of the strategic plan 26 into Medicaid managed care contractual obligations. 27 While Medicaid managed care techniques may create 28 pathways and offer opportunities toward quality 29 improvement and predictability in costs, if cost 30 savings and administrative efficiencies are the 31 primary goals, Medicaid managed care may instead erect 32 new barriers and limit the care and support options 33 available, especially to high-need, vulnerable Medicaid 34 recipients. A well-designed strategic plan and 35 -1- HF2460.3509 (3) 86 pf/rn 1/ 48 #1. #2.

effective oversight ensure that cost savings, improved 1 health outcomes, and efficiencies are not achieved 2 at the expense of diminished program integrity, a 3 reduction in the quality or availability of services, 4 or adverse consequences to the health and well-being of 5 Medicaid recipients. 6 c. Strategic planning should include all of the 7 following: 8 (1) Guidance in establishing and maintaining a 9 robust and appropriate workforce and a provider network 10 capable of addressing all of the diverse, distinct, and 11 wide-ranging treatment and support needs of Medicaid 12 recipients. 13 (2) Developing a sound methodology for establishing 14 and adjusting capitation rates to account for all 15 essential costs involved in treating and supporting the 16 entire spectrum of needs across recipient populations. 17 (3) Addressing the sufficiency of information and 18 data resources to enable review of factors such as 19 utilization, service trends, system performance, and 20 outcomes. 21 (4) Building effective working relationships and 22 developing strategies to support community-level 23 integration that provides cross-system coordination 24 and synchronization among the various service sectors, 25 providers, agencies, and organizations to further 26 holistic well-being and population health goals. 27 d. While the contracts entered into between the 28 state and managed care organizations function as a 29 mechanism for enforcing requirements established by the 30 federal and state governments and allow states to shift 31 the financial risk associated with caring for Medicaid 32 recipients to these contractors, the state ultimately 33 retains responsibility for the Medicaid program and 34 the oversight of the performance of the program’s 35 -2- HF2460.3509 (3) 86 pf/rn 2/ 48

contractors. Administration of the Medicaid program 1 benefits by managed care organizations should not be 2 viewed by state policymakers and state agencies as a 3 means of divesting themselves of their constitutional 4 and statutory responsibilities to ensure that 5 recipients of publicly funded services and supports, as 6 well as taxpayers in general, are effectively served. 7 e. Overseeing the performance of Medicaid managed 8 care contractors requires a different set of skills 9 than those required for administering a fee-for-service 10 program. In the absence of the in-house capacity of 11 the department of human services to perform tasks 12 specific to Medicaid managed care oversight, the state 13 essentially cedes its responsibilities to private 14 contractors and relinquishes its accountability to the 15 public. In order to meet these responsibilities, state 16 policymakers must ensure that the state, including the 17 department of human services as the state Medicaid 18 agency, has the authority and resources, including 19 the adequate number of qualified personnel and the 20 necessary tools, to carry out these responsibilities, 21 provide effective administration, and ensure 22 accountability and compliance. 23 f. State policymakers must also ensure that 24 Medicaid managed care contracts contain, at a minimum, 25 clear, unambiguous performance standards, operating 26 guidelines, data collection, maintenance, retention, 27 and reporting requirements, and outcomes expectations 28 so that contractors and subcontractors are held 29 accountable to clear contract specifications. 30 g. As with all system and program redesign efforts 31 undertaken in the state to date, the assumption 32 of the administration of Medicaid program benefits 33 by managed care organizations must involve ongoing 34 stakeholder input and earn the trust and support of 35 -3- HF2460.3509 (3) 86 pf/rn 3/ 48

these stakeholders. Medicaid recipients, providers, 1 advocates, and other stakeholders have intimate 2 knowledge of the people and processes involved in 3 ensuring the health and safety of Medicaid recipients, 4 and are able to offer valuable insight into the 5 barriers likely to be encountered as well as propose 6 solutions for overcoming these obstacles. Local 7 communities and providers of services and supports 8 have firsthand experience working with the Medicaid 9 recipients they serve and are able to identify factors 10 that must be considered to make a system successful. 11 Agencies and organizations that have specific expertise 12 and experience with the services and supports needs of 13 Medicaid recipients and their families are uniquely 14 placed to provide needed assistance in developing 15 the measures for and in evaluating the quality of the 16 program. 17 2. It is the intent of the general assembly that 18 the Medicaid program be implemented and administered, 19 including through Medicaid managed care policies 20 and contract provisions, in a manner that safeguards 21 the interests of Medicaid recipients, encourages the 22 participation of Medicaid providers, and protects 23 the interests of all taxpayers, while attaining the 24 goals of Medicaid modernization to improve quality and 25 access, promote accountability for outcomes, and create 26 a more predictable and sustainable Medicaid budget. 27 HEALTH POLICY OVERSIGHT COMMITTEE 28 Sec. ___. Section 2.45, subsection 6, Code 2016, is 29 amended to read as follows: 30 6. The legislative health policy oversight 31 committee, which shall be composed of ten members of 32 the general assembly, consisting of five members from 33 each house, to be appointed by the legislative council. 34 The legislative health policy oversight committee 35 -4- HF2460.3509 (3) 86 pf/rn 4/ 48

shall receive updates and review data, public input and 1 concerns, and make recommendations for improvements to 2 and changes in law or rule regarding Medicaid managed 3 care meet at least four times annually to evaluate 4 state health policy and provide continuing oversight 5 for publicly funded programs, including but not limited 6 to all facets of the Medicaid and hawk-i programs 7 to, at a minimum, ensure effective and efficient 8 administration of these programs, address stakeholder 9 concerns, monitor program costs and expenditures, and 10 make recommendations relative to the programs . 11 Sec. ___. HEALTH POLICY OVERSIGHT COMMITTEE 12 —— SUBJECT MATTER REVIEW FOR 2016 LEGISLATIVE 13 INTERIM. During the 2016 legislative interim, the 14 health policy oversight committee created in section 15 2.45 shall, as part of the committee’s evaluation 16 of state health policy and review of all facets of 17 the Medicaid and hawk-i programs, review and make 18 recommendations regarding, at a minimum, all of the 19 following: 20 1. The resources and duties of the office of 21 long-term care ombudsman relating to the provision of 22 assistance to and advocacy for Medicaid recipients 23 to determine the designation of duties and level of 24 resources necessary to appropriately address the needs 25 of such individuals. The committee shall consider the 26 health consumer ombudsman alliance report submitted to 27 the general assembly in December 2015, as well as input 28 from the office of long-term care ombudsman and other 29 entities in making recommendations. 30 2. The health benefits and health benefit 31 utilization management criteria for the Medicaid 32 and hawk-i programs to determine the sufficiency 33 and appropriateness of the benefits offered and the 34 utilization of these benefits. 35 -5- HF2460.3509 (3) 86 pf/rn 5/ 48

3. Prior authorization requirements relative 1 to benefits provided under the Medicaid and hawk-i 2 programs, including but not limited to pharmacy 3 benefits. 4 4. Consistency and uniformity in processes, 5 procedures, forms, and other activities across all 6 Medicaid and hawk-i program participating insurers and 7 managed care organizations, including but not limited 8 to cost and quality reporting, credentialing, billing, 9 prior authorization, and critical incident reporting. 10 5. Provider network adequacy including the use of 11 out-of-network and out-of-state providers. 12 6. The role and interplay of other advisory and 13 oversight entities, including but not limited to the 14 medical assistance advisory council and the hawk-i 15 board. 16 REVIEW OF PROGRAM INTEGRITY DUTIES 17 Sec. ___. REVIEW OF PROGRAM INTEGRITY DUTIES —— 18 WORKGROUP —— REPORT. 19 1. The director of human services shall convene 20 a workgroup comprised of members including the 21 commissioner of insurance, the auditor of state, the 22 Medicaid director and bureau chiefs of the managed care 23 organization oversight and supports bureau, the Iowa 24 Medicaid enterprise support bureau, and the medical 25 and long-term services and supports bureau, and a 26 representative of the program integrity unit, or their 27 designees; and representatives of other appropriate 28 state agencies or other entities including but not 29 limited to the office of the attorney general, the 30 office of long-term care ombudsman, and the Medicaid 31 fraud control unit of the investigations division 32 of the department of inspections and appeals. The 33 workgroup shall do all of the following: 34 a. Review the duties of each entity with 35 -6- HF2460.3509 (3) 86 pf/rn 6/ 48

responsibilities relative to Medicaid program integrity 1 and managed care organizations; review state and 2 federal laws, regulations, requirements, guidance, and 3 policies relating to Medicaid program integrity and 4 managed care organizations; and review the laws of 5 other states relating to Medicaid program integrity 6 and managed care organizations. The workgroup shall 7 determine areas of duplication, fragmentation, 8 and gaps; shall identify possible integration, 9 collaboration and coordination of duties; and shall 10 determine whether existing general state Medicaid 11 program and fee-for-service policies, laws, and 12 rules are sufficient, or if changes or more specific 13 policies, laws, and rules are required to provide 14 for comprehensive and effective administration and 15 oversight of the Medicaid program including under the 16 fee-for-service and managed care methodologies. 17 b. Review historical uses of the Medicaid 18 fraud fund created in section 249A.50 and make 19 recommendations for future uses of the moneys in the 20 fund and any changes in law necessary to adequately 21 address program integrity. 22 c. Review medical loss ratio provisions relative 23 to Medicaid managed care contracts and make 24 recommendations regarding, at a minimum, requirements 25 for the necessary collection, maintenance, retention, 26 reporting, and sharing of data and information by 27 Medicaid managed care organizations for effective 28 determination of compliance, and to identify the 29 costs and activities that should be included in the 30 calculation of administrative costs, medical costs or 31 benefit expenses, health quality improvement costs, 32 and other costs and activities incidental to the 33 determination of a medical loss ratio. 34 d. Review the capacity of state agencies, including 35 -7- HF2460.3509 (3) 86 pf/rn 7/ 48

the need for specialized training and expertise, to 1 address Medicaid and managed care organization program 2 integrity and provide recommendations for the provision 3 of necessary resources and infrastructure, including 4 annual budget projections. 5 e. Review the incentives and penalties applicable 6 to violations of program integrity requirements to 7 determine their adequacy in combating waste, fraud, 8 abuse, and other violations that divert limited 9 resources that would otherwise be expended to safeguard 10 the health and welfare of Medicaid recipients, and make 11 recommendations for necessary adjustments to improve 12 compliance. 13 f. Make recommendations regarding the quarterly and 14 annual auditing of financial reports required to be 15 performed for each Medicaid managed care organization 16 to ensure that the activities audited provide 17 sufficient information to the division of insurance 18 of the department of commerce and the department 19 of human services to ensure program integrity. The 20 recommendations shall also address the need for 21 additional audits or other reviews of managed care 22 organizations. 23 g. Review and make recommendations to prohibit 24 cost-shifting between state and local and public and 25 private funding sources for services and supports 26 provided to Medicaid recipients whether directly or 27 indirectly through the Medicaid program. 28 2. The department of human services shall submit 29 a report of the workgroup to the governor, the health 30 policy oversight committee created in section 2.45, 31 and the general assembly initially, on or before 32 November 15, 2016, and on or before November 15, 33 on an annual basis thereafter, to provide findings 34 and recommendations for a coordinated approach 35 -8- HF2460.3509 (3) 86 pf/rn 8/ 48

to comprehensive and effective administration and 1 oversight of the Medicaid program including under the 2 fee-for-service and managed care methodologies. 3 MEDICAID REINVESTMENT FUND 4 Sec. ___. NEW SECTION . 249A.4C Medicaid 5 reinvestment fund. 6 1. A Medicaid reinvestment fund is created in the 7 state treasury under the authority of the department. 8 The department of human services shall collect an 9 initial contribution of five million dollars from each 10 of the managed care organizations contracting with the 11 state during the fiscal year beginning July 1, 2015, 12 for an aggregate amount of fifteen million dollars, 13 and shall deposit such amount in the fund to be used 14 for Medicaid ombudsman activities through the office 15 of long-term care ombudsman. Additionally, moneys 16 from savings realized from the movement of Medicaid 17 recipients from institutional settings to home and 18 community-based services, the portion of the capitation 19 rate withheld from and not returned to Medicaid managed 20 care organizations at the end of each fiscal year, any 21 recouped excess of capitation rates paid to Medicaid 22 managed care organizations, any overpayments recovered 23 under Medicaid managed care contracts, and any other 24 savings realized from Medicaid managed care or from 25 Medicaid program cost-containment efforts, with the 26 exception of the total amount attributable to the 27 projected savings from Medicaid managed care based on 28 the initial capitation rates established for the fiscal 29 year beginning July 1, 2015, shall be credited to the 30 Medicaid reinvestment fund. 31 2. Notwithstanding section 8.33, moneys credited 32 to the fund from any other account or fund shall 33 not revert to the other account or fund. Moneys 34 in the fund shall only be used as provided in 35 -9- HF2460.3509 (3) 86 pf/rn 9/ 48

appropriations from the fund for the Medicaid program 1 and for health system transformation and integration, 2 including but not limited to providing the necessary 3 infrastructure and resources to protect the interests 4 of Medicaid recipients, maintaining adequate provider 5 participation, and ensuring program integrity. Such 6 uses may include but are not limited to: 7 a. Ensuring appropriate reimbursement of Medicaid 8 providers to maintain the type and number of 9 appropriately trained providers necessary to address 10 the needs of Medicaid recipients. 11 b. Providing home and community-based services 12 as necessary to rebalance the long-term services and 13 supports infrastructure and to reduce Medicaid home and 14 community-based services waiver waiting lists. 15 c. Ensuring that a fully functioning independent 16 Medicaid ombudsman program through the office of 17 long-term care ombudsman is available to provide 18 advocacy services and assistance to eligible and 19 potentially eligible Medicaid recipients. 20 d. Ensuring adequate and appropriate capacity of 21 the department of human services as the single state 22 agency designated to administer and supervise the 23 administration of the Medicaid program, to ensure 24 compliance with state and federal law and program 25 integrity requirements. 26 e. Addressing workforce issues to ensure a 27 competent, diverse, and sustainable health care 28 workforce and to improve access to health care in 29 underserved areas and among underserved populations, 30 recognizing long-term services and supports as an 31 essential component of the health care system. 32 f. Supporting innovation, longer-term community 33 investments, and the activities of local public health 34 agencies, aging and disability resource centers and 35 -10- HF2460.3509 (3) 86 pf/rn 10/ 48

service agencies, mental health and disability services 1 regions, social services, and child welfare entities 2 and other providers of and advocates for services and 3 supports to encourage health system transformation 4 and integration through a broad range of prevention 5 strategies and population-based approaches to meet the 6 holistic needs of the population as a whole. 7 3. The department shall establish a mechanism to 8 measure and certify the amount of savings resulting 9 from Medicaid managed care and Medicaid program 10 cost-containment activities and shall ensure that such 11 realized savings are credited to the fund and used as 12 provided in appropriations from the fund. 13 MEDICAID OMBUDSMAN 14 Sec. ___. Section 231.44, Code 2016, is amended to 15 read as follows: 16 231.44 Utilization of resources —— assistance and 17 advocacy related to long-term services and supports 18 under the Medicaid program. 19 1. The office of long-term care ombudsman may 20 shall utilize its available resources to provide 21 assistance and advocacy services to eligible recipients 22 of long-term services and supports , or individuals 23 seeking long-term services and supports, and the 24 families or legal representatives of such eligible 25 recipients, of long-term services and supports provided 26 through individuals under the Medicaid program. Such 27 assistance and advocacy shall include but is not 28 limited to all of the following: 29 a. Assisting recipients such individuals in 30 understanding the services, coverage, and access 31 provisions and their rights under Medicaid managed 32 care. 33 b. Developing procedures for the tracking and 34 reporting of the outcomes of individual requests for 35 -11- HF2460.3509 (3) 86 pf/rn 11/ 48

assistance, the obtaining of necessary services and 1 supports, and other aspects of the services provided to 2 eligible recipients such individuals . 3 c. Providing advice and assistance relating to the 4 preparation and filing of complaints, grievances, and 5 appeals of complaints or grievances, including through 6 processes available under managed care plans and the 7 state appeals process, relating to long-term services 8 and supports under the Medicaid program. 9 d. Accessing the results of a review of a level 10 of care assessment or reassessment by a managed care 11 organization in which the managed care organization 12 recommends denial or limited authorization of a 13 service, including the type or level of service, the 14 reduction, suspension, or termination of a previously 15 authorized service, or a change in level of care, upon 16 the request of an affected individual. 17 e. Receiving notices of disenrollment or notices 18 that would result in a change in level of care for 19 affected individuals, including involuntary and 20 voluntary discharges or transfers, from the department 21 of human services or a managed care organization. 22 2. A representative of the office of long-term care 23 ombudsman providing assistance and advocacy services 24 authorized under this section for an individual, 25 shall be provided access to the individual, and shall 26 be provided access to the individual’s medical and 27 social records as authorized by the individual or the 28 individual’s legal representative, as necessary to 29 carry out the duties specified in this section . 30 3. A representative of the office of long-term care 31 ombudsman providing assistance and advocacy services 32 authorized under this section for an individual, shall 33 be provided access to administrative records related to 34 the provision of the long-term services and supports to 35 -12- HF2460.3509 (3) 86 pf/rn 12/ 48

the individual, as necessary to carry out the duties 1 specified in this section . 2 4. The office of long-term care ombudsman and 3 representatives of the office, when providing 4 assistance and advocacy services under this section, 5 shall be considered a health oversight agency as 6 defined in 45 C.F.R. §164.501 for the purposes of 7 health oversight activities as described in 45 C.F.R. 8 §164.512(d) including access to the health records 9 and other appropriate information of an individual, 10 including from the department of human services or 11 the applicable Medicaid managed care organization, 12 as necessary to fulfill the duties specified under 13 this section. The department of human services, 14 in collaboration with the office of long-term care 15 ombudsman, shall adopt rules to ensure compliance 16 by affected entities with this subsection and to 17 ensure recognition of the office of long-term care 18 ombudsman as a duly authorized and identified agent or 19 representative of the state. 20 5. The department of human services and Medicaid 21 managed care organizations shall inform eligible 22 and potentially eligible Medicaid recipients of the 23 advocacy services and assistance available through the 24 office of long-term care ombudsman and shall provide 25 contact and other information regarding the advocacy 26 services and assistance to eligible and potentially 27 eligible Medicaid recipients as directed by the office 28 of long-term care ombudsman. 29 6. When providing assistance and advocacy services 30 under this section, the office of long-term care 31 ombudsman shall act as an independent agency, and the 32 office of long-term care ombudsman and representatives 33 of the office shall be free of any undue influence that 34 restrains the ability of the office or the office’s 35 -13- HF2460.3509 (3) 86 pf/rn 13/ 48

representatives from providing such services and 1 assistance. 2 7. The office of long-term care ombudsman shall, in 3 addition to other duties prescribed and at a minimum, 4 do all of the following in the furtherance of the 5 provision of advocacy services and assistance under 6 this section: 7 a. Represent the interests of eligible and 8 potentially eligible Medicaid recipients before 9 governmental agencies. 10 b. Analyze, comment on, and monitor the development 11 and implementation of federal, state, and local laws, 12 regulations, and other governmental policies and 13 actions, and recommend any changes in such laws, 14 regulations, policies, and actions as determined 15 appropriate by the office of long-term care ombudsman. 16 c. To maintain transparency and accountability for 17 activities performed under this section, including 18 for the purposes of claiming federal financial 19 participation for activities that are performed to 20 assist with administration of the Medicaid program: 21 (1) Have complete and direct responsibility for the 22 administration, operation, funding, fiscal management, 23 and budget related to such activities, and directly 24 employ, oversee, and supervise all paid and volunteer 25 staff associated with these activities. 26 (2) Establish separation-of-duties requirements, 27 provide limited access to work space and work 28 product for only necessary staff, and limit access to 29 documents and information as necessary to maintain the 30 confidentiality of the protected health information of 31 individuals served under this section. 32 (3) Collect and submit, annually, to the governor, 33 the health policy oversight committee created in 34 section 2.45, and the general assembly, all of the 35 -14- HF2460.3509 (3) 86 pf/rn 14/ 48

following with regard to those seeking advocacy 1 services or assistance under this section: 2 (a) The number of contacts by contact type and 3 geographic location. 4 (b) The type of assistance requested including the 5 name of the managed care organization involved, if 6 applicable. 7 (c) The time frame between the time of the initial 8 contact and when an initial response was provided. 9 (d) The amount of time from the initial contact to 10 resolution of the problem or concern. 11 (e) The actions taken in response to the request 12 for advocacy or assistance. 13 (f) The outcomes of requests to address problems or 14 concerns. 15 4. 8. For the purposes of this section : 16 a. “Institutional setting” includes a long-term care 17 facility, an elder group home, or an assisted living 18 program. 19 b. “Long-term services and supports” means the broad 20 range of health, health-related, and personal care 21 assistance services and supports, provided in both 22 institutional settings and home and community-based 23 settings, necessary for older individuals and persons 24 with disabilities who experience limitations in their 25 capacity for self-care due to a physical, cognitive, or 26 mental disability or condition. 27 Sec. ___. NEW SECTION . 231.44A Willful 28 interference with duties related to long-term services 29 and supports —— penalty. 30 Willful interference with a representative of the 31 office of long-term care ombudsman in the performance 32 of official duties in accordance with section 231.44 33 is a violation of section 231.44, subject to a penalty 34 prescribed by rule. The office of long-term care 35 -15- HF2460.3509 (3) 86 pf/rn 15/ 48

ombudsman shall adopt rules specifying the amount of a 1 penalty imposed, consistent with the penalties imposed 2 under section 231.42, subsection 8, and specifying 3 procedures for notice and appeal of penalties imposed. 4 Any moneys collected pursuant to this section shall be 5 deposited in the Medicaid reinvestment fund created in 6 section 249A.4C. 7 MEDICAL ASSISTANCE ADVISORY COUNCIL 8 Sec. ___. Section 249A.4B, Code 2016, is amended to 9 read as follows: 10 249A.4B Medical assistance advisory council. 11 1. A medical assistance advisory council is 12 created to comply with 42 C.F.R. §431.12 based on 13 section 1902(a)(4) of the federal Social Security Act 14 and to advise the director about health and medical 15 care services under the medical assistance Medicaid 16 program , participate in Medicaid policy development 17 and program administration, and provide guidance on 18 key issues related to the Medicaid program, whether 19 administered under a fee-for-service, managed care, or 20 other methodology, including but not limited to access 21 to care, quality of care, and service delivery . 22 a. The council shall have the opportunity for 23 participation in policy development and program 24 administration, including furthering the participation 25 of recipients of the program, and without limiting this 26 general authority shall specifically do all of the 27 following: 28 (1) Formulate, review, evaluate, and recommend 29 policies, rules, agency initiatives, and legislation 30 pertaining to the Medicaid program. The council shall 31 have the opportunity to comment on proposed rules 32 prior to commencement of the rulemaking process and on 33 waivers and state plan amendment applications. 34 (2) Prior to the annual budget development process, 35 -16- HF2460.3509 (3) 86 pf/rn 16/ 48

engage in setting priorities, including consideration 1 of the scope and utilization management criteria 2 for benefits, beneficiary eligibility, provider and 3 services reimbursement rates, and other budgetary 4 issues. 5 (3) Provide oversight for and review of the 6 administration of the Medicaid program. 7 (4) Ensure that the membership of the council 8 effectively represents all relevant and concerned 9 viewpoints, particularly those of consumers, providers, 10 and the general public; create public understanding; 11 and ensure that the services provided under the 12 Medicaid program meet the needs of the people served. 13 b. The council shall meet no more than at least 14 quarterly , and prior to the next subsequent meeting 15 of the executive committee . The director of public 16 health The public member acting as a co-chairperson 17 of the executive committee and the professional or 18 business entity member acting as a co-chairperson of 19 the executive committee, shall serve as chairperson 20 co-chairpersons of the council. 21 2. The council shall include all of the following 22 voting members: 23 a. The president, or the president’s 24 representative, of each of the following professional 25 or business entities, or a member of each of the 26 following professional or business entities, selected 27 by the entity: 28 (1) The Iowa medical society. 29 (2) The Iowa osteopathic medical association. 30 (3) The Iowa academy of family physicians. 31 (4) The Iowa chapter of the American academy of 32 pediatrics. 33 (5) The Iowa physical therapy association. 34 (6) The Iowa dental association. 35 -17- HF2460.3509 (3) 86 pf/rn 17/ 48

(7) The Iowa nurses association. 1 (8) The Iowa pharmacy association. 2 (9) The Iowa podiatric medical society. 3 (10) The Iowa optometric association. 4 (11) The Iowa association of community providers. 5 (12) The Iowa psychological association. 6 (13) The Iowa psychiatric society. 7 (14) The Iowa chapter of the national association 8 of social workers. 9 (15) The coalition for family and children’s 10 services in Iowa. 11 (16) The Iowa hospital association. 12 (17) The Iowa association of rural health clinics. 13 (18) The Iowa primary care association. 14 (19) Free clinics of Iowa. 15 (20) The opticians’ association of Iowa, inc. 16 (21) The Iowa association of hearing health 17 professionals. 18 (22) The Iowa speech and hearing association. 19 (23) The Iowa health care association. 20 (24) The Iowa association of area agencies on 21 aging. 22 (25) AARP. 23 (26) The Iowa caregivers association. 24 (27) The Iowa coalition of home and community-based 25 services for seniors. 26 (28) The Iowa adult day services association. 27 (29) Leading age Iowa. 28 (30) The Iowa association for home care. 29 (31) The Iowa council of health care centers. 30 (32) The Iowa physician assistant society. 31 (33) The Iowa association of nurse practitioners. 32 (34) The Iowa nurse practitioner society. 33 (35) The Iowa occupational therapy association. 34 (36) The ARC of Iowa, formerly known as the 35 -18- HF2460.3509 (3) 86 pf/rn 18/ 48

association for retarded citizens of Iowa. 1 (37) The national alliance for the mentally ill on 2 mental illness of Iowa. 3 (38) The Iowa state association of counties. 4 (39) The Iowa developmental disabilities council. 5 (40) The Iowa chiropractic society. 6 (41) The Iowa academy of nutrition and dietetics. 7 (42) The Iowa behavioral health association. 8 (43) The midwest association for medical equipment 9 services or an affiliated Iowa organization. 10 (44) The Iowa public health association. 11 (45) The epilepsy foundation. 12 b. Public representatives which may include members 13 of consumer groups, including recipients of medical 14 assistance or their families, consumer organizations, 15 and others, which shall be appointed by the governor 16 in equal in number to the number of representatives of 17 the professional and business entities specifically 18 represented under paragraph “a” , appointed by the 19 governor for staggered terms of two years each, none 20 of whom shall be members of, or practitioners of, or 21 have a pecuniary interest in any of the professional 22 or business entities specifically represented under 23 paragraph “a” , and a majority of whom shall be current 24 or former recipients of medical assistance or members 25 of the families of current or former recipients. 26 3. The council shall include all of the following 27 nonvoting members: 28 c. a. The director of public health, or the 29 director’s designee. 30 d. b. The director of the department on aging, or 31 the director’s designee. 32 c. The state long-term care ombudsman, or the 33 ombudsman’s designee. 34 d. The ombudsman appointed pursuant to section 35 -19- HF2460.3509 (3) 86 pf/rn 19/ 48

2C.3, or the ombudsman’s designee. 1 e. The dean of Des Moines university —— osteopathic 2 medical center, or the dean’s designee. 3 f. The dean of the university of Iowa college of 4 medicine, or the dean’s designee. 5 g. The following members of the general assembly, 6 each for a term of two years as provided in section 7 69.16B : 8 (1) Two members of the house of representatives, 9 one appointed by the speaker of the house of 10 representatives and one appointed by the minority 11 leader of the house of representatives from their 12 respective parties. 13 (2) Two members of the senate, one appointed by the 14 president of the senate after consultation with the 15 majority leader of the senate and one appointed by the 16 minority leader of the senate. 17 3. 4. a. An executive committee of the council is 18 created and shall consist of the following members of 19 the council: 20 (1) As voting members: 21 (a) Five of the professional or business entity 22 members designated pursuant to subsection 2 , paragraph 23 “a” , and selected by the members specified under that 24 paragraph. 25 (2) (b) Five of the public members appointed 26 pursuant to subsection 2 , paragraph “b” , and selected 27 by the members specified under that paragraph. Of the 28 five public members, at least one member shall be a 29 recipient of medical assistance. 30 (3) (2) As nonvoting members: 31 (a) The director of public health, or the 32 director’s designee. 33 (b) The director of the department on aging, or the 34 director’s designee. 35 -20- HF2460.3509 (3) 86 pf/rn 20/ 48

(c) The state long-term care ombudsman, or the 1 ombudsman’s designee. 2 (d) The ombudsman appointed pursuant to section 3 2C.3, or the ombudsman’s designee. 4 b. The executive committee shall meet on a monthly 5 basis. The director of public health A public member 6 of the executive committee selected by the public 7 members appointed pursuant to subsection 2, paragraph 8 “b” , and a professional or business entity member of 9 the executive committee selected by the professional 10 or business entity members appointed pursuant to 11 subsection 2, paragraph “a” , shall serve as chairperson 12 co-chairpersons of the executive committee. 13 c. Based upon the deliberations of the council , 14 and the executive committee, and the subcommittees, 15 the executive committee , the council, and the 16 subcommittees, respectively, shall make recommendations 17 to the director , to the health policy oversight 18 committee created in section 2.45, to the general 19 assembly’s joint appropriations subcommittee on health 20 and human services, and to the general assembly’s 21 standing committees on human resources regarding the 22 budget, policy, and administration of the medical 23 assistance program. 24 5. a. The council shall create the following 25 subcommittees, and may create additional subcommittees 26 as necessary to address Medicaid program policies, 27 administration, budget, and other factors and issues: 28 (1) A stakeholder safeguards subcommittee, for 29 which the co-chairpersons shall be a public member 30 of the council appointed pursuant to subsection 2, 31 paragraph “b” , and selected by the public members of 32 the council, and a representative of a professional 33 or business entity appointed pursuant to subsection 34 2, paragraph “a” , and selected by the professional or 35 -21- HF2460.3509 (3) 86 pf/rn 21/ 48