Senate File 2213 S-5045 Amend Senate File 2213 as follows: 1 1. By striking everything after the enacting clause 2 and inserting: 3 < Section 1. LEGISLATIVE FINDINGS —— GOALS AND 4 INTENT. 5 1. The general assembly finds all of the following: 6 a. In the majority of states, Medicaid managed care 7 has been introduced on an incremental basis, beginning 8 with the enrollment of low-income children and parents 9 and proceeding in stages to include nonelderly persons 10 with disabilities and older individuals. Iowa, unlike 11 the majority of states, is implementing Medicaid 12 managed care hastily and simultaneously across a broad 13 and diverse population that includes individuals with 14 complex health care and long-term services and supports 15 needs, making these individuals especially vulnerable 16 to receiving inappropriate, inadequate, or substandard 17 services and supports. 18 b. The success or failure of Medicaid managed 19 care in Iowa depends on proper strategic planning and 20 strong oversight, and the incorporation of the core 21 values, principles, and goals of the strategic plan 22 into Medicaid managed care contractual obligations. 23 While Medicaid managed care techniques may create 24 pathways and offer opportunities toward quality 25 improvement and predictability in costs, if cost 26 savings and administrative efficiencies are the 27 primary goals, Medicaid managed care may instead erect 28 new barriers and limit the care and support options 29 available, especially to high-need, vulnerable Medicaid 30 recipients. A well-designed strategic plan and 31 effective oversight ensure that cost savings, improved 32 health outcomes, and efficiencies are not achieved 33 at the expense of diminished program integrity, a 34 reduction in the quality or availability of services, 35 -1- SF2213.2830 (2) 86 pf/nh 1/ 48 #1.

or adverse consequences to the health and well-being of 1 Medicaid recipients. 2 c. Strategic planning should include all of the 3 following: 4 (1) Guidance in establishing and maintaining a 5 robust and appropriate workforce and a provider network 6 capable of addressing all of the diverse, distinct, and 7 wide-ranging treatment and support needs of Medicaid 8 recipients. 9 (2) Developing a sound methodology for establishing 10 and adjusting capitation rates to account for all 11 essential costs involved in treating and supporting the 12 entire spectrum of needs across recipient populations. 13 (3) Addressing the sufficiency of information and 14 data resources to enable review of factors such as 15 utilization, service trends, system performance, and 16 outcomes. 17 (4) Building effective working relationships and 18 developing strategies to support community-level 19 integration that provides cross-system coordination 20 and synchronization among the various service sectors, 21 providers, agencies, and organizations to further 22 holistic well-being and population health goals. 23 d. While the contracts entered into between the 24 state and managed care organizations function as a 25 mechanism for enforcing requirements established by the 26 federal and state governments and allow states to shift 27 the financial risk associated with caring for Medicaid 28 recipients to these contractors, the state ultimately 29 retains responsibility for the Medicaid program and 30 the oversight of the performance of the program’s 31 contractors. Administration of the Medicaid program 32 benefits by managed care organizations should not be 33 viewed by state policymakers and state agencies as a 34 means of divesting themselves of their constitutional 35 -2- SF2213.2830 (2) 86 pf/nh 2/ 48

and statutory responsibilities to ensure that 1 recipients of publicly funded services and supports, as 2 well as taxpayers in general, are effectively served. 3 e. Overseeing the performance of Medicaid managed 4 care contractors requires a different set of skills 5 than those required for administering a fee-for-service 6 program. In the absence of the in-house capacity of 7 the department of human services to perform tasks 8 specific to Medicaid managed care oversight, the state 9 essentially cedes its responsibilities to private 10 contractors and relinquishes its accountability to the 11 public. In order to meet these responsibilities, state 12 policymakers must ensure that the state, including the 13 department of human services as the state Medicaid 14 agency, has the authority and resources, including 15 the adequate number of qualified personnel and the 16 necessary tools, to carry out these responsibilities, 17 provide effective administration, and ensure 18 accountability and compliance. 19 f. State policymakers must also ensure that 20 Medicaid managed care contracts contain, at a minimum, 21 clear, unambiguous performance standards, operating 22 guidelines, data collection, maintenance, retention, 23 and reporting requirements, and outcomes expectations 24 so that contractors and subcontractors are held 25 accountable to clear contract specifications. 26 g. As with all system and program redesign efforts 27 undertaken in the state to date, the assumption 28 of the administration of Medicaid program benefits 29 by managed care organizations must involve ongoing 30 stakeholder input and earn the trust and support of 31 these stakeholders. Medicaid recipients, providers, 32 advocates, and other stakeholders have intimate 33 knowledge of the people and processes involved in 34 ensuring the health and safety of Medicaid recipients, 35 -3- SF2213.2830 (2) 86 pf/nh 3/ 48

and are able to offer valuable insight into the 1 barriers likely to be encountered as well as propose 2 solutions for overcoming these obstacles. Local 3 communities and providers of services and supports 4 have firsthand experience working with the Medicaid 5 recipients they serve and are able to identify factors 6 that must be considered to make a system successful. 7 Agencies and organizations that have specific expertise 8 and experience with the services and supports needs of 9 Medicaid recipients and their families are uniquely 10 placed to provide needed assistance in developing 11 the measures for and in evaluating the quality of the 12 program. 13 2. It is the intent of the general assembly that 14 the Medicaid program be implemented and administered, 15 including through Medicaid managed care policies 16 and contract provisions, in a manner that safeguards 17 the interests of Medicaid recipients, encourages the 18 participation of Medicaid providers, and protects 19 the interests of all taxpayers, while attaining the 20 goals of Medicaid modernization to improve quality and 21 access, promote accountability for outcomes, and create 22 a more predictable and sustainable Medicaid budget. 23 HEALTH POLICY OVERSIGHT COMMITTEE 24 Sec. 2. Section 2.45, subsection 6, Code 2016, is 25 amended to read as follows: 26 6. The legislative health policy oversight 27 committee, which shall be composed of ten members of 28 the general assembly, consisting of five members from 29 each house, to be appointed by the legislative council. 30 The legislative health policy oversight committee 31 shall receive updates and review data, public input and 32 concerns, and make recommendations for improvements to 33 and changes in law or rule regarding Medicaid managed 34 care meet at least four times annually to evaluate 35 -4- SF2213.2830 (2) 86 pf/nh 4/ 48

state health policy and provide continuing oversight 1 for publicly funded programs, including but not limited 2 to all facets of the Medicaid and hawk-i programs 3 to, at a minimum, ensure effective and efficient 4 administration of these programs, address stakeholder 5 concerns, monitor program costs and expenditures, and 6 make recommendations relative to the programs . 7 Sec. 3. HEALTH POLICY OVERSIGHT COMMITTEE 8 —— SUBJECT MATTER REVIEW FOR 2016 LEGISLATIVE 9 INTERIM. During the 2016 legislative interim, the 10 health policy oversight committee created in section 11 2.45 shall, as part of the committee’s evaluation 12 of state health policy and review of all facets of 13 the Medicaid and hawk-i programs, review and make 14 recommendations regarding, at a minimum, all of the 15 following: 16 1. The resources and duties of the office of 17 long-term care ombudsman relating to the provision of 18 assistance to and advocacy for Medicaid recipients 19 to determine the designation of duties and level of 20 resources necessary to appropriately address the needs 21 of such individuals. The committee shall consider the 22 health consumer ombudsman alliance report submitted to 23 the general assembly in December 2015, as well as input 24 from the office of long-term care ombudsman and other 25 entities in making recommendations. 26 2. The health benefits and health benefit 27 utilization management criteria for the Medicaid 28 and hawk-i programs to determine the sufficiency 29 and appropriateness of the benefits offered and the 30 utilization of these benefits. 31 3. Prior authorization requirements relative 32 to benefits provided under the Medicaid and hawk-i 33 programs, including but not limited to pharmacy 34 benefits. 35 -5- SF2213.2830 (2) 86 pf/nh 5/ 48

4. Consistency and uniformity in processes, 1 procedures, forms, and other activities across all 2 Medicaid and hawk-i program participating insurers and 3 managed care organizations, including but not limited 4 to cost and quality reporting, credentialing, billing, 5 prior authorization, and critical incident reporting. 6 5. Provider network adequacy including the use of 7 out-of-network and out-of-state providers. 8 6. The role and interplay of other advisory and 9 oversight entities, including but not limited to the 10 medical assistance advisory council and the hawk-i 11 board. 12 REVIEW OF PROGRAM INTEGRITY DUTIES 13 Sec. 4. REVIEW OF PROGRAM INTEGRITY DUTIES —— 14 WORKGROUP —— REPORT. 15 1. The director of human services shall convene 16 a workgroup comprised of members including the 17 commissioner of insurance, the auditor of state, the 18 Medicaid director and bureau chiefs of the managed care 19 organization oversight and supports bureau, the Iowa 20 Medicaid enterprise support bureau, and the medical 21 and long-term services and supports bureau, and a 22 representative of the program integrity unit, or their 23 designees; and representatives of other appropriate 24 state agencies or other entities including but not 25 limited to the office of the attorney general, the 26 office of long-term care ombudsman, and the Medicaid 27 fraud control unit of the investigations division 28 of the department of inspections and appeals. The 29 workgroup shall do all of the following: 30 a. Review the duties of each entity with 31 responsibilities relative to Medicaid program integrity 32 and managed care organizations; review state and 33 federal laws, regulations, requirements, guidance, and 34 policies relating to Medicaid program integrity and 35 -6- SF2213.2830 (2) 86 pf/nh 6/ 48

managed care organizations; and review the laws of 1 other states relating to Medicaid program integrity 2 and managed care organizations. The workgroup shall 3 determine areas of duplication, fragmentation, 4 and gaps; shall identify possible integration, 5 collaboration and coordination of duties; and shall 6 determine whether existing general state Medicaid 7 program and fee-for-service policies, laws, and 8 rules are sufficient, or if changes or more specific 9 policies, laws, and rules are required to provide 10 for comprehensive and effective administration and 11 oversight of the Medicaid program including under the 12 fee-for-service and managed care methodologies. 13 b. Review historical uses of the Medicaid 14 fraud fund created in section 249A.50 and make 15 recommendations for future uses of the moneys in the 16 fund and any changes in law necessary to adequately 17 address program integrity. 18 c. Review medical loss ratio provisions relative 19 to Medicaid managed care contracts and make 20 recommendations regarding, at a minimum, requirements 21 for the necessary collection, maintenance, retention, 22 reporting, and sharing of data and information by 23 Medicaid managed care organizations for effective 24 determination of compliance, and to identify the 25 costs and activities that should be included in the 26 calculation of administrative costs, medical costs or 27 benefit expenses, health quality improvement costs, 28 and other costs and activities incidental to the 29 determination of a medical loss ratio. 30 d. Review the capacity of state agencies, including 31 the need for specialized training and expertise, to 32 address Medicaid and managed care organization program 33 integrity and provide recommendations for the provision 34 of necessary resources and infrastructure, including 35 -7- SF2213.2830 (2) 86 pf/nh 7/ 48

annual budget projections. 1 e. Review the incentives and penalties applicable 2 to violations of program integrity requirements to 3 determine their adequacy in combating waste, fraud, 4 abuse, and other violations that divert limited 5 resources that would otherwise be expended to safeguard 6 the health and welfare of Medicaid recipients, and make 7 recommendations for necessary adjustments to improve 8 compliance. 9 f. Make recommendations regarding the quarterly and 10 annual auditing of financial reports required to be 11 performed for each Medicaid managed care organization 12 to ensure that the activities audited provide 13 sufficient information to the division of insurance 14 of the department of commerce and the department 15 of human services to ensure program integrity. The 16 recommendations shall also address the need for 17 additional audits or other reviews of managed care 18 organizations. 19 g. Review and make recommendations to prohibit 20 cost-shifting between state and local and public and 21 private funding sources for services and supports 22 provided to Medicaid recipients whether directly or 23 indirectly through the Medicaid program. 24 2. The department of human services shall submit 25 a report of the workgroup to the governor, the health 26 policy oversight committee created in section 2.45, 27 and the general assembly initially, on or before 28 November 15, 2016, and on or before November 15, 29 on an annual basis thereafter, to provide findings 30 and recommendations for a coordinated approach 31 to comprehensive and effective administration and 32 oversight of the Medicaid program including under the 33 fee-for-service and managed care methodologies. 34 MEDICAID REINVESTMENT FUND 35 -8- SF2213.2830 (2) 86 pf/nh 8/ 48

Sec. 5. NEW SECTION . 249A.4C Medicaid reinvestment 1 fund. 2 1. A Medicaid reinvestment fund is created in the 3 state treasury under the authority of the department. 4 The department of human services shall collect an 5 initial contribution of five million dollars from each 6 of the managed care organizations contracting with the 7 state during the fiscal year beginning July 1, 2015, 8 for an aggregate amount of fifteen million dollars, 9 and shall deposit such amount in the fund to be used 10 for Medicaid ombudsman activities through the office 11 of long-term care ombudsman. Additionally, moneys 12 from savings realized from the movement of Medicaid 13 recipients from institutional settings to home and 14 community-based services, the portion of the capitation 15 rate withheld from and not returned to Medicaid managed 16 care organizations at the end of each fiscal year, any 17 recouped excess of capitation rates paid to Medicaid 18 managed care organizations, any overpayments recovered 19 under Medicaid managed care contracts, and any other 20 savings realized from Medicaid managed care or from 21 Medicaid program cost-containment efforts, with the 22 exception of the total amount attributable to the 23 projected savings from Medicaid managed care based on 24 the initial capitation rates established for the fiscal 25 year beginning July 1, 2015, shall be credited to the 26 Medicaid reinvestment fund. 27 2. Notwithstanding section 8.33, moneys credited 28 to the fund from any other account or fund shall 29 not revert to the other account or fund. Moneys 30 in the fund shall only be used as provided in 31 appropriations from the fund for the Medicaid program 32 and for health system transformation and integration, 33 including but not limited to providing the necessary 34 infrastructure and resources to protect the interests 35 -9- SF2213.2830 (2) 86 pf/nh 9/ 48

of Medicaid recipients, maintaining adequate provider 1 participation, and ensuring program integrity. Such 2 uses may include but are not limited to: 3 a. Ensuring appropriate reimbursement of Medicaid 4 providers to maintain the type and number of 5 appropriately trained providers necessary to address 6 the needs of Medicaid recipients. 7 b. Providing home and community-based services 8 as necessary to rebalance the long-term services and 9 supports infrastructure and to reduce Medicaid home and 10 community-based services waiver waiting lists. 11 c. Ensuring that a fully functioning independent 12 Medicaid ombudsman program through the office of 13 long-term care ombudsman is available to provide 14 advocacy services and assistance to eligible and 15 potentially eligible Medicaid recipients. 16 d. Ensuring adequate and appropriate capacity of 17 the department of human services as the single state 18 agency designated to administer and supervise the 19 administration of the Medicaid program, to ensure 20 compliance with state and federal law and program 21 integrity requirements. 22 e. Addressing workforce issues to ensure a 23 competent, diverse, and sustainable health care 24 workforce and to improve access to health care in 25 underserved areas and among underserved populations, 26 recognizing long-term services and supports as an 27 essential component of the health care system. 28 f. Supporting innovation, longer-term community 29 investments, and the activities of local public health 30 agencies, aging and disability resource centers and 31 service agencies, mental health and disability services 32 regions, social services, and child welfare entities 33 and other providers of and advocates for services and 34 supports to encourage health system transformation 35 -10- SF2213.2830 (2) 86 pf/nh 10/ 48

and integration through a broad range of prevention 1 strategies and population-based approaches to meet the 2 holistic needs of the population as a whole. 3 3. The department shall establish a mechanism to 4 measure and certify the amount of savings resulting 5 from Medicaid managed care and Medicaid program 6 cost-containment activities and shall ensure that such 7 realized savings are credited to the fund and used as 8 provided in appropriations from the fund. 9 MEDICAID OMBUDSMAN 10 Sec. 6. Section 231.44, Code 2016, is amended to 11 read as follows: 12 231.44 Utilization of resources —— assistance and 13 advocacy related to long-term services and supports 14 under the Medicaid program. 15 1. The office of long-term care ombudsman may 16 shall utilize its available resources to provide 17 assistance and advocacy services to eligible recipients 18 of long-term services and supports , or individuals 19 seeking long-term services and supports, and the 20 families or legal representatives of such eligible 21 recipients, of long-term services and supports provided 22 through individuals under the Medicaid program. Such 23 assistance and advocacy shall include but is not 24 limited to all of the following: 25 a. Assisting recipients such individuals in 26 understanding the services, coverage, and access 27 provisions and their rights under Medicaid managed 28 care. 29 b. Developing procedures for the tracking and 30 reporting of the outcomes of individual requests for 31 assistance, the obtaining of necessary services and 32 supports, and other aspects of the services provided to 33 eligible recipients such individuals . 34 c. Providing advice and assistance relating to the 35 -11- SF2213.2830 (2) 86 pf/nh 11/ 48

preparation and filing of complaints, grievances, and 1 appeals of complaints or grievances, including through 2 processes available under managed care plans and the 3 state appeals process, relating to long-term services 4 and supports under the Medicaid program. 5 d. Accessing the results of a review of a level 6 of care assessment or reassessment by a managed care 7 organization in which the managed care organization 8 recommends denial or limited authorization of a 9 service, including the type or level of service, the 10 reduction, suspension, or termination of a previously 11 authorized service, or a change in level of care, upon 12 the request of an affected individual. 13 e. Receiving notices of disenrollment or notices 14 that would result in a change in level of care for 15 affected individuals, including involuntary and 16 voluntary discharges or transfers, from the department 17 of human services or a managed care organization. 18 2. A representative of the office of long-term care 19 ombudsman providing assistance and advocacy services 20 authorized under this section for an individual, 21 shall be provided access to the individual, and shall 22 be provided access to the individual’s medical and 23 social records as authorized by the individual or the 24 individual’s legal representative, as necessary to 25 carry out the duties specified in this section . 26 3. A representative of the office of long-term care 27 ombudsman providing assistance and advocacy services 28 authorized under this section for an individual, shall 29 be provided access to administrative records related to 30 the provision of the long-term services and supports to 31 the individual, as necessary to carry out the duties 32 specified in this section . 33 4. The office of long-term care ombudsman and 34 representatives of the office, when providing 35 -12- SF2213.2830 (2) 86 pf/nh 12/ 48

assistance and advocacy services under this section, 1 shall be considered a health oversight agency as 2 defined in 45 C.F.R. §164.501 for the purposes of 3 health oversight activities as described in 45 C.F.R. 4 §164.512(d) including access to the health records 5 and other appropriate information of an individual, 6 including from the department of human services or 7 the applicable Medicaid managed care organization, 8 as necessary to fulfill the duties specified under 9 this section. The department of human services, 10 in collaboration with the office of long-term care 11 ombudsman, shall adopt rules to ensure compliance 12 by affected entities with this subsection and to 13 ensure recognition of the office of long-term care 14 ombudsman as a duly authorized and identified agent or 15 representative of the state. 16 5. The department of human services and Medicaid 17 managed care organizations shall inform eligible 18 and potentially eligible Medicaid recipients of the 19 advocacy services and assistance available through the 20 office of long-term care ombudsman and shall provide 21 contact and other information regarding the advocacy 22 services and assistance to eligible and potentially 23 eligible Medicaid recipients as directed by the office 24 of long-term care ombudsman. 25 6. When providing assistance and advocacy services 26 under this section, the office of long-term care 27 ombudsman shall act as an independent agency, and the 28 office of long-term care ombudsman and representatives 29 of the office shall be free of any undue influence that 30 restrains the ability of the office or the office’s 31 representatives from providing such services and 32 assistance. 33 7. The office of long-term care ombudsman shall, in 34 addition to other duties prescribed and at a minimum, 35 -13- SF2213.2830 (2) 86 pf/nh 13/ 48

do all of the following in the furtherance of the 1 provision of advocacy services and assistance under 2 this section: 3 a. Represent the interests of eligible and 4 potentially eligible Medicaid recipients before 5 governmental agencies. 6 b. Analyze, comment on, and monitor the development 7 and implementation of federal, state, and local laws, 8 regulations, and other governmental policies and 9 actions, and recommend any changes in such laws, 10 regulations, policies, and actions as determined 11 appropriate by the office of long-term care ombudsman. 12 c. To maintain transparency and accountability for 13 activities performed under this section, including 14 for the purposes of claiming federal financial 15 participation for activities that are performed to 16 assist with administration of the Medicaid program: 17 (1) Have complete and direct responsibility for the 18 administration, operation, funding, fiscal management, 19 and budget related to such activities, and directly 20 employ, oversee, and supervise all paid and volunteer 21 staff associated with these activities. 22 (2) Establish separation-of-duties requirements, 23 provide limited access to work space and work 24 product for only necessary staff, and limit access to 25 documents and information as necessary to maintain the 26 confidentiality of the protected health information of 27 individuals served under this section. 28 (3) Collect and submit, annually, to the governor, 29 the health policy oversight committee created in 30 section 2.45, and the general assembly, all of the 31 following with regard to those seeking advocacy 32 services or assistance under this section: 33 (a) The number of contacts by contact type and 34 geographic location. 35 -14- SF2213.2830 (2) 86 pf/nh 14/ 48

(b) The type of assistance requested including the 1 name of the managed care organization involved, if 2 applicable. 3 (c) The time frame between the time of the initial 4 contact and when an initial response was provided. 5 (d) The amount of time from the initial contact to 6 resolution of the problem or concern. 7 (e) The actions taken in response to the request 8 for advocacy or assistance. 9 (f) The outcomes of requests to address problems or 10 concerns. 11 4. 8. For the purposes of this section : 12 a. “Institutional setting” includes a long-term care 13 facility, an elder group home, or an assisted living 14 program. 15 b. “Long-term services and supports” means the broad 16 range of health, health-related, and personal care 17 assistance services and supports, provided in both 18 institutional settings and home and community-based 19 settings, necessary for older individuals and persons 20 with disabilities who experience limitations in their 21 capacity for self-care due to a physical, cognitive, or 22 mental disability or condition. 23 Sec. 7. NEW SECTION . 231.44A Willful interference 24 with duties related to long-term services and supports 25 —— penalty. 26 Willful interference with a representative of the 27 office of long-term care ombudsman in the performance 28 of official duties in accordance with section 231.44 29 is a violation of section 231.44, subject to a penalty 30 prescribed by rule. The office of long-term care 31 ombudsman shall adopt rules specifying the amount of a 32 penalty imposed, consistent with the penalties imposed 33 under section 231.42, subsection 8, and specifying 34 procedures for notice and appeal of penalties imposed. 35 -15- SF2213.2830 (2) 86 pf/nh 15/ 48

Any moneys collected pursuant to this section shall be 1 deposited in the Medicaid reinvestment fund created in 2 section 249A.4C. 3 MEDICAL ASSISTANCE ADVISORY COUNCIL 4 Sec. 8. Section 249A.4B, Code 2016, is amended to 5 read as follows: 6 249A.4B Medical assistance advisory council. 7 1. A medical assistance advisory council is 8 created to comply with 42 C.F.R. §431.12 based on 9 section 1902(a)(4) of the federal Social Security Act 10 and to advise the director about health and medical 11 care services under the medical assistance Medicaid 12 program , participate in Medicaid policy development 13 and program administration, and provide guidance on 14 key issues related to the Medicaid program, whether 15 administered under a fee-for-service, managed care, or 16 other methodology, including but not limited to access 17 to care, quality of care, and service delivery . 18 a. The council shall have the opportunity for 19 participation in policy development and program 20 administration, including furthering the participation 21 of recipients of the program, and without limiting this 22 general authority shall specifically do all of the 23 following: 24 (1) Formulate, review, evaluate, and recommend 25 policies, rules, agency initiatives, and legislation 26 pertaining to the Medicaid program. The council shall 27 have the opportunity to comment on proposed rules 28 prior to commencement of the rulemaking process and on 29 waivers and state plan amendment applications. 30 (2) Prior to the annual budget development process, 31 engage in setting priorities, including consideration 32 of the scope and utilization management criteria 33 for benefits, beneficiary eligibility, provider and 34 services reimbursement rates, and other budgetary 35 -16- SF2213.2830 (2) 86 pf/nh 16/ 48

issues. 1 (3) Provide oversight for and review of the 2 administration of the Medicaid program. 3 (4) Ensure that the membership of the council 4 effectively represents all relevant and concerned 5 viewpoints, particularly those of consumers, providers, 6 and the general public; create public understanding; 7 and ensure that the services provided under the 8 Medicaid program meet the needs of the people served. 9 b. The council shall meet no more than at least 10 quarterly , and prior to the next subsequent meeting 11 of the executive committee . The director of public 12 health The public member acting as a co-chairperson 13 of the executive committee and the professional or 14 business entity member acting as a co-chairperson of 15 the executive committee, shall serve as chairperson 16 co-chairpersons of the council. 17 2. The council shall include all of the following 18 voting members: 19 a. The president, or the president’s 20 representative, of each of the following professional 21 or business entities, or a member of each of the 22 following professional or business entities, selected 23 by the entity: 24 (1) The Iowa medical society. 25 (2) The Iowa osteopathic medical association. 26 (3) The Iowa academy of family physicians. 27 (4) The Iowa chapter of the American academy of 28 pediatrics. 29 (5) The Iowa physical therapy association. 30 (6) The Iowa dental association. 31 (7) The Iowa nurses association. 32 (8) The Iowa pharmacy association. 33 (9) The Iowa podiatric medical society. 34 (10) The Iowa optometric association. 35 -17- SF2213.2830 (2) 86 pf/nh 17/ 48

(11) The Iowa association of community providers. 1 (12) The Iowa psychological association. 2 (13) The Iowa psychiatric society. 3 (14) The Iowa chapter of the national association 4 of social workers. 5 (15) The coalition for family and children’s 6 services in Iowa. 7 (16) The Iowa hospital association. 8 (17) The Iowa association of rural health clinics. 9 (18) The Iowa primary care association. 10 (19) Free clinics of Iowa. 11 (20) The opticians’ association of Iowa, inc. 12 (21) The Iowa association of hearing health 13 professionals. 14 (22) The Iowa speech and hearing association. 15 (23) The Iowa health care association. 16 (24) The Iowa association of area agencies on 17 aging. 18 (25) AARP. 19 (26) The Iowa caregivers association. 20 (27) The Iowa coalition of home and community-based 21 services for seniors. 22 (28) The Iowa adult day services association. 23 (29) Leading age Iowa. 24 (30) The Iowa association for home care. 25 (31) The Iowa council of health care centers. 26 (32) The Iowa physician assistant society. 27 (33) The Iowa association of nurse practitioners. 28 (34) The Iowa nurse practitioner society. 29 (35) The Iowa occupational therapy association. 30 (36) The ARC of Iowa, formerly known as the 31 association for retarded citizens of Iowa. 32 (37) The national alliance for the mentally ill on 33 mental illness of Iowa. 34 (38) The Iowa state association of counties. 35 -18- SF2213.2830 (2) 86 pf/nh 18/ 48

(39) The Iowa developmental disabilities council. 1 (40) The Iowa chiropractic society. 2 (41) The Iowa academy of nutrition and dietetics. 3 (42) The Iowa behavioral health association. 4 (43) The midwest association for medical equipment 5 services or an affiliated Iowa organization. 6 (44) The Iowa public health association. 7 (45) The epilepsy foundation. 8 b. Public representatives which may include members 9 of consumer groups, including recipients of medical 10 assistance or their families, consumer organizations, 11 and others, which shall be appointed by the governor 12 in equal in number to the number of representatives of 13 the professional and business entities specifically 14 represented under paragraph “a” , appointed by the 15 governor for staggered terms of two years each, none 16 of whom shall be members of, or practitioners of, or 17 have a pecuniary interest in any of the professional 18 or business entities specifically represented under 19 paragraph “a” , and a majority of whom shall be current 20 or former recipients of medical assistance or members 21 of the families of current or former recipients. 22 3. The council shall include all of the following 23 nonvoting members: 24 c. a. The director of public health, or the 25 director’s designee. 26 d. b. The director of the department on aging, or 27 the director’s designee. 28 c. The state long-term care ombudsman, or the 29 ombudsman’s designee. 30 d. The ombudsman appointed pursuant to section 31 2C.3, or the ombudsman’s designee. 32 e. The dean of Des Moines university —— osteopathic 33 medical center, or the dean’s designee. 34 f. The dean of the university of Iowa college of 35 -19- SF2213.2830 (2) 86 pf/nh 19/ 48

medicine, or the dean’s designee. 1 g. The following members of the general assembly, 2 each for a term of two years as provided in section 3 69.16B : 4 (1) Two members of the house of representatives, 5 one appointed by the speaker of the house of 6 representatives and one appointed by the minority 7 leader of the house of representatives from their 8 respective parties. 9 (2) Two members of the senate, one appointed by the 10 president of the senate after consultation with the 11 majority leader of the senate and one appointed by the 12 minority leader of the senate. 13 3. 4. a. An executive committee of the council is 14 created and shall consist of the following members of 15 the council: 16 (1) As voting members: 17 (a) Five of the professional or business entity 18 members designated pursuant to subsection 2 , paragraph 19 “a” , and selected by the members specified under that 20 paragraph. 21 (2) (b) Five of the public members appointed 22 pursuant to subsection 2 , paragraph “b” , and selected 23 by the members specified under that paragraph. Of the 24 five public members, at least one member shall be a 25 recipient of medical assistance. 26 (3) (2) As nonvoting members: 27 (a) The director of public health, or the 28 director’s designee. 29 (b) The director of the department on aging, or the 30 director’s designee. 31 (c) The state long-term care ombudsman, or the 32 ombudsman’s designee. 33 (d) The ombudsman appointed pursuant to section 34 2C.3, or the ombudsman’s designee. 35 -20- SF2213.2830 (2) 86 pf/nh 20/ 48

b. The executive committee shall meet on a monthly 1 basis. The director of public health A public member 2 of the executive committee selected by the public 3 members appointed pursuant to subsection 2, paragraph 4 “b” , and a professional or business entity member of 5 the executive committee selected by the professional 6 or business entity members appointed pursuant to 7 subsection 2, paragraph “a” , shall serve as chairperson 8 co-chairpersons of the executive committee. 9 c. Based upon the deliberations of the council , 10 and the executive committee, and the subcommittees, 11 the executive committee , the council, and the 12 subcommittees, respectively, shall make recommendations 13 to the director , to the health policy oversight 14 committee created in section 2.45, to the general 15 assembly’s joint appropriations subcommittee on health 16 and human services, and to the general assembly’s 17 standing committees on human resources regarding the 18 budget, policy, and administration of the medical 19 assistance program. 20 5. a. The council shall create the following 21 subcommittees, and may create additional subcommittees 22 as necessary to address Medicaid program policies, 23 administration, budget, and other factors and issues: 24 (1) A stakeholder safeguards subcommittee, for 25 which the co-chairpersons shall be a public member 26 of the council appointed pursuant to subsection 2, 27 paragraph “b” , and selected by the public members of 28 the council, and a representative of a professional 29 or business entity appointed pursuant to subsection 30 2, paragraph “a” , and selected by the professional or 31 business entity representatives of the council. The 32 mission of the stakeholder safeguards subcommittee 33 is to provide for ongoing stakeholder engagement and 34 feedback on issues affecting Medicaid recipients, 35 -21- SF2213.2830 (2) 86 pf/nh 21/ 48