House File 2460 H-8247 Amend House File 2460 as follows: 1 1. Page 41, line 14, by striking < 17,045,964 > and 2 inserting < 19,119,864 > 3 2. Page 43, after line 3 by inserting: 4 < ___. Of the funds appropriated in this section, 5 $2,073,900 shall be used for the purposes of additional 6 Medicaid managed care oversight requirements as 7 otherwise specified in this Act, $360,000 of which 8 shall be transferred to the appropriation in this Act 9 for the office of long-term care ombudsman to be used 10 for the purposes specified in section 231.44. 11 3. Page 85, after line 4 by inserting: 12 < REPORTING OF EXISTING DATA REQUIREMENTS, MINUTES, AND 13 RECOMMENDATIONS > 14 4. Page 92, after line 18 by inserting: 15 < DIVISION ___ 16 MEDICAID MANAGED CARE —— ADDITIONAL OVERSIGHT 17 REQUIREMENTS 18 Sec. ___. LEGISLATIVE FINDINGS —— GOALS AND INTENT. 19 1. The general assembly finds all of the following: 20 a. In the majority of states, Medicaid managed care 21 has been introduced on an incremental basis, beginning 22 with the enrollment of low-income children and parents 23 and proceeding in stages to include nonelderly persons 24 with disabilities and older individuals. Iowa, unlike 25 the majority of states, is implementing Medicaid 26 managed care simultaneously across a broad and diverse 27 population that includes individuals with complex 28 health care and long-term services and supports needs, 29 making these individuals especially vulnerable to 30 receiving inappropriate, inadequate, or substandard 31 services and supports. 32 b. The success or failure of Medicaid managed 33 care in Iowa depends on proper strategic planning and 34 strong oversight, and the incorporation of the core 35 -1- HF2460.3521 (3) 86 pf/rn 1/ 43 #1. #2.

values, principles, and goals of the strategic plan 1 into Medicaid managed care contractual obligations. 2 While Medicaid managed care techniques may create 3 pathways and offer opportunities toward quality 4 improvement and predictability in costs, if cost 5 savings and administrative efficiencies are the 6 primary goals, Medicaid managed care may instead erect 7 new barriers and limit the care and support options 8 available, especially to high-need, vulnerable Medicaid 9 recipients. A well-designed strategic plan and 10 effective oversight ensure that cost savings, improved 11 health outcomes, and efficiencies are not achieved 12 at the expense of diminished program integrity, a 13 reduction in the quality or availability of services, 14 or adverse consequences to the health and well-being of 15 Medicaid recipients. 16 c. Strategic planning should include all of the 17 following: 18 (1) Guidance in establishing and maintaining a 19 robust and appropriate workforce and a provider network 20 capable of addressing all of the diverse, distinct, and 21 wide-ranging treatment and support needs of Medicaid 22 recipients. 23 (2) Developing a sound methodology for establishing 24 and adjusting capitation rates to account for all 25 essential costs involved in treating and supporting the 26 entire spectrum of needs across recipient populations. 27 (3) Addressing the sufficiency of information and 28 data resources to enable review of factors such as 29 utilization, service trends, system performance, and 30 outcomes. 31 (4) Building effective working relationships and 32 developing strategies to support community-level 33 integration that provides cross-system coordination 34 and synchronization among the various service sectors, 35 -2- HF2460.3521 (3) 86 pf/rn 2/ 43

providers, agencies, and organizations to further 1 holistic well-being and population health goals. 2 d. While the contracts entered into between the 3 state and managed care organizations function as a 4 mechanism for enforcing requirements established by the 5 federal and state governments and allow states to shift 6 the financial risk associated with caring for Medicaid 7 recipients to these contractors, the state ultimately 8 retains responsibility for the Medicaid program and 9 the oversight of the performance of the program’s 10 contractors. Administration of the Medicaid program 11 benefits by managed care organizations should not be 12 viewed by state policymakers and state agencies as a 13 means of divesting themselves of their constitutional 14 and statutory responsibilities to ensure that 15 recipients of publicly funded services and supports, as 16 well as taxpayers in general, are effectively served. 17 e. Overseeing the performance of Medicaid managed 18 care contractors requires a different set of skills 19 than those required for administering a fee-for-service 20 program. In the absence of the in-house capacity of 21 the department of human services to perform tasks 22 specific to Medicaid managed care oversight, the state 23 essentially cedes its responsibilities to private 24 contractors and relinquishes its accountability to the 25 public. In order to meet these responsibilities, state 26 policymakers must ensure that the state, including the 27 department of human services as the state Medicaid 28 agency, has the authority and resources, including 29 the adequate number of qualified personnel and the 30 necessary tools, to carry out these responsibilities, 31 provide effective administration, and ensure 32 accountability and compliance. 33 f. State policymakers must also ensure that 34 Medicaid managed care contracts contain, at a minimum, 35 -3- HF2460.3521 (3) 86 pf/rn 3/ 43

clear, unambiguous performance standards, operating 1 guidelines, data collection, maintenance, retention, 2 and reporting requirements, and outcomes expectations 3 so that contractors and subcontractors are held 4 accountable to clear contract specifications. 5 g. As with all system and program redesign efforts 6 undertaken in the state to date, the assumption 7 of the administration of Medicaid program benefits 8 by managed care organizations must involve ongoing 9 stakeholder input and earn the trust and support of 10 these stakeholders. Medicaid recipients, providers, 11 advocates, and other stakeholders have intimate 12 knowledge of the people and processes involved in 13 ensuring the health and safety of Medicaid recipients, 14 and are able to offer valuable insight into the 15 barriers likely to be encountered as well as propose 16 solutions for overcoming these obstacles. Local 17 communities and providers of services and supports 18 have firsthand experience working with the Medicaid 19 recipients they serve and are able to identify factors 20 that must be considered to make a system successful. 21 Agencies and organizations that have specific expertise 22 and experience with the services and supports needs of 23 Medicaid recipients and their families are uniquely 24 placed to provide needed assistance in developing 25 the measures for and in evaluating the quality of the 26 program. 27 2. It is the intent of the general assembly that 28 the Medicaid program be implemented and administered, 29 including through Medicaid managed care policies 30 and contract provisions, in a manner that safeguards 31 the interests of Medicaid recipients, encourages the 32 participation of Medicaid providers, and protects 33 the interests of all taxpayers, while attaining the 34 goals of Medicaid modernization to improve quality and 35 -4- HF2460.3521 (3) 86 pf/rn 4/ 43

access, promote accountability for outcomes, and create 1 a more predictable and sustainable Medicaid budget. 2 HEALTH POLICY OVERSIGHT COMMITTEE 3 Sec. ___. Section 2.45, subsection 6, Code 2016, is 4 amended to read as follows: 5 6. The legislative health policy oversight 6 committee, which shall be composed of ten members of 7 the general assembly, consisting of five members from 8 each house, to be appointed by the legislative council. 9 The legislative health policy oversight committee 10 shall receive updates and review data, public input and 11 concerns, and make recommendations for improvements to 12 and changes in law or rule regarding Medicaid managed 13 care meet at least four times annually to evaluate 14 state health policy and provide continuing oversight 15 for publicly funded programs, including but not limited 16 to all facets of the Medicaid and hawk-i programs 17 to, at a minimum, ensure effective and efficient 18 administration of these programs, address stakeholder 19 concerns, monitor program costs and expenditures, and 20 make recommendations relative to the programs . 21 Sec. ___. HEALTH POLICY OVERSIGHT COMMITTEE 22 —— SUBJECT MATTER REVIEW FOR 2016 LEGISLATIVE 23 INTERIM. During the 2016 legislative interim, the 24 health policy oversight committee created in section 25 2.45 shall, as part of the committee’s evaluation 26 of state health policy and review of all facets of 27 the Medicaid and hawk-i programs, review and make 28 recommendations regarding, at a minimum, all of the 29 following: 30 1. The resources and duties of the office of 31 long-term care ombudsman relating to the provision of 32 assistance to and advocacy for Medicaid recipients 33 to determine the designation of duties and level of 34 resources necessary to appropriately address the needs 35 -5- HF2460.3521 (3) 86 pf/rn 5/ 43

of such individuals. The committee shall consider the 1 health consumer ombudsman alliance report submitted to 2 the general assembly in December 2015, as well as input 3 from the office of long-term care ombudsman and other 4 entities in making recommendations. 5 2. The health benefits and health benefit 6 utilization management criteria for the Medicaid 7 and hawk-i programs to determine the sufficiency 8 and appropriateness of the benefits offered and the 9 utilization of these benefits. 10 3. Prior authorization requirements relative 11 to benefits provided under the Medicaid and hawk-i 12 programs, including but not limited to pharmacy 13 benefits. 14 4. Consistency and uniformity in processes, 15 procedures, forms, and other activities across all 16 Medicaid and hawk-i program participating insurers and 17 managed care organizations, including but not limited 18 to cost and quality reporting, credentialing, billing, 19 prior authorization, and critical incident reporting. 20 5. Provider network adequacy including the use of 21 out-of-network and out-of-state providers. 22 6. The role and interplay of other advisory and 23 oversight entities, including but not limited to the 24 medical assistance advisory council and the hawk-i 25 board. 26 REVIEW OF PROGRAM INTEGRITY DUTIES 27 Sec. ___. REVIEW OF PROGRAM INTEGRITY DUTIES —— 28 WORKGROUP —— REPORT. 29 1. The director of human services shall convene 30 a workgroup comprised of members including the 31 commissioner of insurance, the auditor of state, the 32 Medicaid director and bureau chiefs of the managed care 33 organization oversight and supports bureau, the Iowa 34 Medicaid enterprise support bureau, and the medical 35 -6- HF2460.3521 (3) 86 pf/rn 6/ 43

and long-term services and supports bureau, and a 1 representative of the program integrity unit, or their 2 designees; and representatives of other appropriate 3 state agencies or other entities including but not 4 limited to the office of the attorney general, the 5 office of long-term care ombudsman, and the Medicaid 6 fraud control unit of the investigations division 7 of the department of inspections and appeals. The 8 workgroup shall do all of the following: 9 a. Review the duties of each entity with 10 responsibilities relative to Medicaid program integrity 11 and managed care organizations; review state and 12 federal laws, regulations, requirements, guidance, and 13 policies relating to Medicaid program integrity and 14 managed care organizations; and review the laws of 15 other states relating to Medicaid program integrity 16 and managed care organizations. The workgroup shall 17 determine areas of duplication, fragmentation, 18 and gaps; shall identify possible integration, 19 collaboration and coordination of duties; and shall 20 determine whether existing general state Medicaid 21 program and fee-for-service policies, laws, and 22 rules are sufficient, or if changes or more specific 23 policies, laws, and rules are required to provide 24 for comprehensive and effective administration and 25 oversight of the Medicaid program including under the 26 fee-for-service and managed care methodologies. 27 b. Review historical uses of the Medicaid 28 fraud fund created in section 249A.50 and make 29 recommendations for future uses of the moneys in the 30 fund and any changes in law necessary to adequately 31 address program integrity. 32 c. Review medical loss ratio provisions relative 33 to Medicaid managed care contracts and make 34 recommendations regarding, at a minimum, requirements 35 -7- HF2460.3521 (3) 86 pf/rn 7/ 43

for the necessary collection, maintenance, retention, 1 reporting, and sharing of data and information by 2 Medicaid managed care organizations for effective 3 determination of compliance, and to identify the 4 costs and activities that should be included in the 5 calculation of administrative costs, medical costs or 6 benefit expenses, health quality improvement costs, 7 and other costs and activities incidental to the 8 determination of a medical loss ratio. 9 d. Review the capacity of state agencies, including 10 the need for specialized training and expertise, to 11 address Medicaid and managed care organization program 12 integrity and provide recommendations for the provision 13 of necessary resources and infrastructure, including 14 annual budget projections. 15 e. Review the incentives and penalties applicable 16 to violations of program integrity requirements to 17 determine their adequacy in combating waste, fraud, 18 abuse, and other violations that divert limited 19 resources that would otherwise be expended to safeguard 20 the health and welfare of Medicaid recipients, and make 21 recommendations for necessary adjustments to improve 22 compliance. 23 f. Make recommendations regarding the quarterly and 24 annual auditing of financial reports required to be 25 performed for each Medicaid managed care organization 26 to ensure that the activities audited provide 27 sufficient information to the division of insurance 28 of the department of commerce and the department 29 of human services to ensure program integrity. The 30 recommendations shall also address the need for 31 additional audits or other reviews of managed care 32 organizations. 33 g. Review and make recommendations to prohibit 34 cost-shifting between state and local and public and 35 -8- HF2460.3521 (3) 86 pf/rn 8/ 43

private funding sources for services and supports 1 provided to Medicaid recipients whether directly or 2 indirectly through the Medicaid program. 3 2. The department of human services shall submit 4 a report of the workgroup to the governor, the health 5 policy oversight committee created in section 2.45, 6 and the general assembly initially, on or before 7 November 15, 2016, and on or before November 15, 8 on an annual basis thereafter, to provide findings 9 and recommendations for a coordinated approach 10 to comprehensive and effective administration and 11 oversight of the Medicaid program including under the 12 fee-for-service and managed care methodologies. 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 -9- HF2460.3521 (3) 86 pf/rn 9/ 43

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 -10- HF2460.3521 (3) 86 pf/rn 10/ 43

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 -11- HF2460.3521 (3) 86 pf/rn 11/ 43

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 -12- HF2460.3521 (3) 86 pf/rn 12/ 43

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 -13- HF2460.3521 (3) 86 pf/rn 13/ 43

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 MEDICAL ASSISTANCE ADVISORY COUNCIL 5 Sec. ___. Section 249A.4B, Code 2016, is amended to 6 read as follows: 7 249A.4B Medical assistance advisory council. 8 1. A medical assistance advisory council is 9 created to comply with 42 C.F.R. §431.12 based on 10 section 1902(a)(4) of the federal Social Security Act 11 and to advise the director about health and medical 12 care services under the medical assistance Medicaid 13 program , participate in Medicaid policy development 14 and program administration, and provide guidance on 15 key issues related to the Medicaid program, whether 16 administered under a fee-for-service, managed care, or 17 other methodology, including but not limited to access 18 to care, quality of care, and service delivery . 19 a. The council shall have the opportunity for 20 participation in policy development and program 21 administration, including furthering the participation 22 of recipients of the program, and without limiting this 23 general authority shall specifically do all of the 24 following: 25 (1) Formulate, review, evaluate, and recommend 26 policies, rules, agency initiatives, and legislation 27 pertaining to the Medicaid program. The council shall 28 have the opportunity to comment on proposed rules 29 prior to commencement of the rulemaking process and on 30 waivers and state plan amendment applications. 31 (2) Prior to the annual budget development process, 32 engage in setting priorities, including consideration 33 of the scope and utilization management criteria 34 for benefits, beneficiary eligibility, provider and 35 -14- HF2460.3521 (3) 86 pf/rn 14/ 43

services reimbursement rates, and other budgetary 1 issues. 2 (3) Provide oversight for and review of the 3 administration of the Medicaid program. 4 (4) Ensure that the membership of the council 5 effectively represents all relevant and concerned 6 viewpoints, particularly those of consumers, providers, 7 and the general public; create public understanding; 8 and ensure that the services provided under the 9 Medicaid program meet the needs of the people served. 10 b. The council shall meet no more than at least 11 quarterly , and prior to the next subsequent meeting 12 of the executive committee . The director of public 13 health The public member acting as a co-chairperson 14 of the executive committee and the professional or 15 business entity member acting as a co-chairperson of 16 the executive committee, shall serve as chairperson 17 co-chairpersons of the council. 18 2. The council shall include all of the following 19 voting members: 20 a. The president, or the president’s 21 representative, of each of the following professional 22 or business entities, or a member of each of the 23 following professional or business entities, selected 24 by the entity: 25 (1) The Iowa medical society. 26 (2) The Iowa osteopathic medical association. 27 (3) The Iowa academy of family physicians. 28 (4) The Iowa chapter of the American academy of 29 pediatrics. 30 (5) The Iowa physical therapy association. 31 (6) The Iowa dental association. 32 (7) The Iowa nurses association. 33 (8) The Iowa pharmacy association. 34 (9) The Iowa podiatric medical society. 35 -15- HF2460.3521 (3) 86 pf/rn 15/ 43

(10) The Iowa optometric association. 1 (11) The Iowa association of community providers. 2 (12) The Iowa psychological association. 3 (13) The Iowa psychiatric society. 4 (14) The Iowa chapter of the national association 5 of social workers. 6 (15) The coalition for family and children’s 7 services in Iowa. 8 (16) The Iowa hospital association. 9 (17) The Iowa association of rural health clinics. 10 (18) The Iowa primary care association. 11 (19) Free clinics of Iowa. 12 (20) The opticians’ association of Iowa, inc. 13 (21) The Iowa association of hearing health 14 professionals. 15 (22) The Iowa speech and hearing association. 16 (23) The Iowa health care association. 17 (24) The Iowa association of area agencies on 18 aging. 19 (25) AARP. 20 (26) The Iowa caregivers association. 21 (27) The Iowa coalition of home and community-based 22 services for seniors. 23 (28) The Iowa adult day services association. 24 (29) Leading age Iowa. 25 (30) The Iowa association for home care. 26 (31) The Iowa council of health care centers. 27 (32) The Iowa physician assistant society. 28 (33) The Iowa association of nurse practitioners. 29 (34) The Iowa nurse practitioner society. 30 (35) The Iowa occupational therapy association. 31 (36) The ARC of Iowa, formerly known as the 32 association for retarded citizens of Iowa. 33 (37) The national alliance for the mentally ill on 34 mental illness of Iowa. 35 -16- HF2460.3521 (3) 86 pf/rn 16/ 43

(38) The Iowa state association of counties. 1 (39) The Iowa developmental disabilities council. 2 (40) The Iowa chiropractic society. 3 (41) The Iowa academy of nutrition and dietetics. 4 (42) The Iowa behavioral health association. 5 (43) The midwest association for medical equipment 6 services or an affiliated Iowa organization. 7 (44) The Iowa public health association. 8 (45) The epilepsy foundation. 9 b. Public representatives which may include members 10 of consumer groups, including recipients of medical 11 assistance or their families, consumer organizations, 12 and others, which shall be appointed by the governor 13 in equal in number to the number of representatives of 14 the professional and business entities specifically 15 represented under paragraph “a” , appointed by the 16 governor for staggered terms of two years each, none 17 of whom shall be members of, or practitioners of, or 18 have a pecuniary interest in any of the professional 19 or business entities specifically represented under 20 paragraph “a” , and a majority of whom shall be current 21 or former recipients of medical assistance or members 22 of the families of current or former recipients. 23 3. The council shall include all of the following 24 nonvoting members: 25 c. a. The director of public health, or the 26 director’s designee. 27 d. b. The director of the department on aging, or 28 the director’s designee. 29 c. The state long-term care ombudsman, or the 30 ombudsman’s designee. 31 d. The ombudsman appointed pursuant to section 32 2C.3, or the ombudsman’s designee. 33 e. The dean of Des Moines university —— osteopathic 34 medical center, or the dean’s designee. 35 -17- HF2460.3521 (3) 86 pf/rn 17/ 43

f. The dean of the university of Iowa college of 1 medicine, or the dean’s designee. 2 g. The following members of the general assembly, 3 each for a term of two years as provided in section 4 69.16B : 5 (1) Two members of the house of representatives, 6 one appointed by the speaker of the house of 7 representatives and one appointed by the minority 8 leader of the house of representatives from their 9 respective parties. 10 (2) Two members of the senate, one appointed by the 11 president of the senate after consultation with the 12 majority leader of the senate and one appointed by the 13 minority leader of the senate. 14 3. 4. a. An executive committee of the council is 15 created and shall consist of the following members of 16 the council: 17 (1) As voting members: 18 (a) Five of the professional or business entity 19 members designated pursuant to subsection 2 , paragraph 20 “a” , and selected by the members specified under that 21 paragraph. 22 (2) (b) Five of the public members appointed 23 pursuant to subsection 2 , paragraph “b” , and selected 24 by the members specified under that paragraph. Of the 25 five public members, at least one member shall be a 26 recipient of medical assistance. 27 (3) (2) As nonvoting members: 28 (a) The director of public health, or the 29 director’s designee. 30 (b) The director of the department on aging, or the 31 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 -18- HF2460.3521 (3) 86 pf/rn 18/ 43

2C.3, or the ombudsman’s designee. 1 b. The executive committee shall meet on a monthly 2 basis. The director of public health A public member 3 of the executive committee selected by the public 4 members appointed pursuant to subsection 2, paragraph 5 “b” , and a professional or business entity member of 6 the executive committee selected by the professional 7 or business entity members appointed pursuant to 8 subsection 2, paragraph “a” , shall serve as chairperson 9 co-chairpersons of the executive committee. 10 c. Based upon the deliberations of the council , 11 and the executive committee, and the subcommittees, 12 the executive committee , the council, and the 13 subcommittees, respectively, shall make recommendations 14 to the director , to the health policy oversight 15 committee created in section 2.45, to the general 16 assembly’s joint appropriations subcommittee on health 17 and human services, and to the general assembly’s 18 standing committees on human resources regarding the 19 budget, policy, and administration of the medical 20 assistance program. 21 5. a. The council shall create the following 22 subcommittees, and may create additional subcommittees 23 as necessary to address Medicaid program policies, 24 administration, budget, and other factors and issues: 25 (1) A stakeholder safeguards subcommittee, for 26 which the co-chairpersons shall be a public member 27 of the council appointed pursuant to subsection 2, 28 paragraph “b” , and selected by the public members of 29 the council, and a representative of a professional 30 or business entity appointed pursuant to subsection 31 2, paragraph “a” , and selected by the professional or 32 business entity representatives of the council. The 33 mission of the stakeholder safeguards subcommittee 34 is to provide for ongoing stakeholder engagement and 35 -19- HF2460.3521 (3) 86 pf/rn 19/ 43

feedback on issues affecting Medicaid recipients, 1 providers, and other stakeholders, including but not 2 limited to benefits such as transportation, benefit 3 utilization management, the inclusion of out-of-state 4 and out-of-network providers and the use of single-case 5 agreements, and reimbursement of providers and 6 services. 7 (2) The long-term services and supports 8 subcommittee which shall be chaired by the state 9 long-term care ombudsman, or the ombudsman’s designee. 10 The mission of the long-term services and supports 11 subcommittee is to be a resource and to provide advice 12 on policy development and program administration 13 relating to Medicaid long-term services and supports 14 including but not limited to developing outcomes and 15 performance measures for Medicaid managed care for the 16 long-term services and supports population; addressing 17 issues related to home and community-based services 18 waivers and waiting lists; and reviewing the system of 19 long-term services and supports to ensure provision of 20 home and community-based services and the rebalancing 21 of the health care infrastructure in accordance with 22 state and federal law including but not limited to the 23 principles established in Olmstead v. L.C., 527 U.S. 24 581 (1999) and the federal Americans with Disabilities 25 Act and in a manner that reflects a sustainable, 26 person-centered approach to improve health and life 27 outcomes, supports maximum independence, addresses 28 medical and social needs in a coordinated, integrated 29 manner, and provides for sufficient resources including 30 a stable, well-qualified workforce. The subcommittee 31 shall also address and make recommendations regarding 32 the need for an ombudsman function for eligible and 33 potentially eligible Medicaid recipients beyond the 34 long-term services and supports population. 35 -20- HF2460.3521 (3) 86 pf/rn 20/ 43

(3) The transparency, data, and program evaluation 1 subcommittee which shall be chaired by the director of 2 the university of Iowa public policy center, or the 3 director’s designee. The mission of the transparency, 4 data, and program evaluation subcommittee is to 5 ensure Medicaid program transparency; ensure the 6 collection, maintenance, retention, reporting, and 7 analysis of sufficient and meaningful data to provide 8 transparency and inform policy development and program 9 effectiveness; support development and administration 10 of a consumer-friendly dashboard; and promote the 11 ongoing evaluation of Medicaid stakeholder satisfaction 12 with the Medicaid program. 13 (4) The program integrity subcommittee which shall 14 be chaired by the Medicaid director, or the director’s 15 designee. The mission of the program integrity 16 subcommittee is to ensure that a comprehensive system 17 including specific policies, laws, and rules and 18 adequate resources and measures are in place to 19 effectively administer the program and to maintain 20 compliance with federal and state program integrity 21 requirements. 22 (5) A health workforce subcommittee, co-chaired 23 by the bureau chief of the bureau of oral and health 24 delivery systems of the department of public health, 25 or the bureau chief’s designee, and the director of 26 the national alliance on mental illness of Iowa, or 27 the director’s designee. The mission of the health 28 workforce subcommittee is to assess the sufficiency 29 and proficiency of the current and projected health 30 workforce; identify barriers to and gaps in health 31 workforce development initiatives and health 32 workforce data to provide foundational, evidence-based 33 information to inform policymaking and resource 34 allocation; evaluate the most efficient application 35 -21- HF2460.3521 (3) 86 pf/rn 21/ 43