Senate
File
2213
S-5052
Amend
Senate
File
2213
as
follows:
1
1.
By
striking
everything
after
the
enacting
clause
2
and
inserting:
3
<
HEALTH
POLICY
OVERSIGHT
COMMITTEE
4
Section
1.
Section
2.45,
subsection
6,
Code
2016,
5
is
amended
to
read
as
follows:
6
6.
The
legislative
health
policy
oversight
7
committee,
which
shall
be
composed
of
ten
members
of
8
the
general
assembly,
consisting
of
five
members
from
9
each
house,
to
be
appointed
by
the
legislative
council.
10
The
legislative
health
policy
oversight
committee
11
shall
receive
updates
and
review
data,
public
input
and
12
concerns,
and
make
recommendations
for
improvements
to
13
and
changes
in
law
or
rule
regarding
Medicaid
managed
14
care
meet
at
least
four
times
annually
to
evaluate
15
state
health
policy
and
provide
continuing
oversight
16
for
publicly
funded
programs,
including
but
not
limited
17
to
all
facets
of
the
Medicaid
and
hawk-i
programs
18
to,
at
a
minimum,
ensure
effective
and
efficient
19
administration
of
these
programs,
address
stakeholder
20
concerns,
monitor
program
costs
and
expenditures,
and
21
make
recommendations
relative
to
the
programs
.
22
Sec.
2.
HEALTH
POLICY
OVERSIGHT
COMMITTEE
23
——
SUBJECT
MATTER
REVIEW
FOR
2016
LEGISLATIVE
24
INTERIM.
During
the
2016
legislative
interim,
the
25
health
policy
oversight
committee
created
in
section
26
2.45
shall,
as
part
of
the
committee’s
evaluation
27
of
state
health
policy
and
review
of
all
facets
of
28
the
Medicaid
and
hawk-i
programs,
review
and
make
29
recommendations
regarding,
at
a
minimum,
all
of
the
30
following:
31
1.
The
resources
and
duties
of
the
office
of
32
long-term
care
ombudsman
relating
to
the
provision
of
33
assistance
to
and
advocacy
for
Medicaid
recipients
34
to
determine
the
designation
of
duties
and
level
of
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23
#1.
resources
necessary
to
appropriately
address
the
needs
1
of
such
individuals.
The
committee
shall
consider
the
2
health
consumer
ombudsman
alliance
report
submitted
to
3
the
general
assembly
in
December
2015,
as
well
as
input
4
from
the
office
of
long-term
care
ombudsman
and
other
5
entities
in
making
recommendations.
6
2.
The
health
benefits
and
health
benefit
7
utilization
management
criteria
for
the
Medicaid
8
and
hawk-i
programs
to
determine
the
sufficiency
9
and
appropriateness
of
the
benefits
offered
and
the
10
utilization
of
these
benefits.
11
3.
Prior
authorization
requirements
relative
12
to
benefits
provided
under
the
Medicaid
and
hawk-i
13
programs,
including
but
not
limited
to
pharmacy
14
benefits.
15
4.
Consistency
and
uniformity
in
processes,
16
procedures,
forms,
and
other
activities
across
all
17
Medicaid
and
hawk-i
program
participating
insurers
and
18
managed
care
organizations,
including
but
not
limited
19
to
cost
and
quality
reporting,
credentialing,
billing,
20
prior
authorization,
and
critical
incident
reporting.
21
5.
Provider
network
adequacy
including
the
use
of
22
out-of-network
and
out-of-state
providers.
23
6.
The
role
and
interplay
of
other
advisory
and
24
oversight
entities,
including
but
not
limited
to
the
25
medical
assistance
advisory
council
and
the
hawk-i
26
board.
27
REVIEW
OF
PROGRAM
INTEGRITY
DUTIES
28
Sec.
3.
REVIEW
OF
PROGRAM
INTEGRITY
DUTIES
——
29
WORKGROUP
——
REPORT.
30
1.
The
director
of
human
services
shall
convene
31
a
workgroup
comprised
of
members
including
the
32
commissioner
of
insurance,
the
auditor
of
state,
the
33
Medicaid
director
and
bureau
chiefs
of
the
managed
care
34
organization
oversight
and
supports
bureau,
the
Iowa
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23
Medicaid
enterprise
support
bureau,
and
the
medical
1
and
long-term
services
and
supports
bureau,
and
a
2
representative
of
the
program
integrity
unit,
or
their
3
designees;
and
representatives
of
other
appropriate
4
state
agencies
or
other
entities
including
but
not
5
limited
to
the
office
of
the
attorney
general,
the
6
office
of
long-term
care
ombudsman,
and
the
Medicaid
7
fraud
control
unit
of
the
investigations
division
8
of
the
department
of
inspections
and
appeals.
The
9
workgroup
shall
do
all
of
the
following:
10
a.
Review
the
duties
of
each
entity
with
11
responsibilities
relative
to
Medicaid
program
integrity
12
and
managed
care
organizations;
review
state
and
13
federal
laws,
regulations,
requirements,
guidance,
and
14
policies
relating
to
Medicaid
program
integrity
and
15
managed
care
organizations;
and
review
the
laws
of
16
other
states
relating
to
Medicaid
program
integrity
17
and
managed
care
organizations.
The
workgroup
shall
18
determine
areas
of
duplication,
fragmentation,
19
and
gaps;
shall
identify
possible
integration,
20
collaboration
and
coordination
of
duties;
and
shall
21
determine
whether
existing
general
state
Medicaid
22
program
and
fee-for-service
policies,
laws,
and
23
rules
are
sufficient,
or
if
changes
or
more
specific
24
policies,
laws,
and
rules
are
required
to
provide
25
for
comprehensive
and
effective
administration
and
26
oversight
of
the
Medicaid
program
including
under
the
27
fee-for-service
and
managed
care
methodologies.
28
b.
Review
historical
uses
of
the
Medicaid
29
fraud
fund
created
in
section
249A.50
and
make
30
recommendations
for
future
uses
of
the
moneys
in
the
31
fund
and
any
changes
in
law
necessary
to
adequately
32
address
program
integrity.
33
c.
Review
medical
loss
ratio
provisions
relative
34
to
Medicaid
managed
care
contracts
and
make
35
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23
recommendations
regarding,
at
a
minimum,
requirements
1
for
the
necessary
collection,
maintenance,
retention,
2
reporting,
and
sharing
of
data
and
information
by
3
Medicaid
managed
care
organizations
for
effective
4
determination
of
compliance,
and
to
identify
the
5
costs
and
activities
that
should
be
included
in
the
6
calculation
of
administrative
costs,
medical
costs
or
7
benefit
expenses,
health
quality
improvement
costs,
8
and
other
costs
and
activities
incidental
to
the
9
determination
of
a
medical
loss
ratio.
10
d.
Review
the
capacity
of
state
agencies,
including
11
the
need
for
specialized
training
and
expertise,
to
12
address
Medicaid
and
managed
care
organization
program
13
integrity
and
provide
recommendations
for
the
provision
14
of
necessary
resources
and
infrastructure,
including
15
annual
budget
projections.
16
e.
Review
the
incentives
and
penalties
applicable
17
to
violations
of
program
integrity
requirements
to
18
determine
their
adequacy
in
combating
waste,
fraud,
19
abuse,
and
other
violations
that
divert
limited
20
resources
that
would
otherwise
be
expended
to
safeguard
21
the
health
and
welfare
of
Medicaid
recipients,
and
make
22
recommendations
for
necessary
adjustments
to
improve
23
compliance.
24
f.
Make
recommendations
regarding
the
quarterly
and
25
annual
auditing
of
financial
reports
required
to
be
26
performed
for
each
Medicaid
managed
care
organization
27
to
ensure
that
the
activities
audited
provide
28
sufficient
information
to
the
division
of
insurance
29
of
the
department
of
commerce
and
the
department
30
of
human
services
to
ensure
program
integrity.
The
31
recommendations
shall
also
address
the
need
for
32
additional
audits
or
other
reviews
of
managed
care
33
organizations.
34
g.
Review
and
make
recommendations
to
prohibit
35
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cost-shifting
between
state
and
local
and
public
and
1
private
funding
sources
for
services
and
supports
2
provided
to
Medicaid
recipients
whether
directly
or
3
indirectly
through
the
Medicaid
program.
4
2.
The
department
of
human
services
shall
submit
5
a
report
of
the
workgroup
to
the
governor,
the
health
6
policy
oversight
committee
created
in
section
2.45,
7
and
the
general
assembly
initially,
on
or
before
8
November
15,
2016,
and
on
or
before
November
15,
9
on
an
annual
basis
thereafter,
to
provide
findings
10
and
recommendations
for
a
coordinated
approach
11
to
comprehensive
and
effective
administration
and
12
oversight
of
the
Medicaid
program
including
under
the
13
fee-for-service
and
managed
care
methodologies.
14
MEDICAID
OMBUDSMAN
15
Sec.
4.
Section
231.44,
Code
2016,
is
amended
to
16
read
as
follows:
17
231.44
Utilization
of
resources
——
assistance
and
18
advocacy
related
to
long-term
services
and
supports
19
under
the
Medicaid
program.
20
1.
The
office
of
long-term
care
ombudsman
may
21
shall
utilize
its
available
resources
to
provide
22
assistance
and
advocacy
services
to
eligible
recipients
23
of
long-term
services
and
supports
,
or
individuals
24
seeking
long-term
services
and
supports,
and
the
25
families
or
legal
representatives
of
such
eligible
26
recipients,
of
long-term
services
and
supports
provided
27
through
individuals
under
the
Medicaid
program.
Such
28
assistance
and
advocacy
shall
include
but
is
not
29
limited
to
all
of
the
following:
30
a.
Assisting
recipients
such
individuals
in
31
understanding
the
services,
coverage,
and
access
32
provisions
and
their
rights
under
Medicaid
managed
33
care.
34
b.
Developing
procedures
for
the
tracking
and
35
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reporting
of
the
outcomes
of
individual
requests
for
1
assistance,
the
obtaining
of
necessary
services
and
2
supports,
and
other
aspects
of
the
services
provided
to
3
eligible
recipients
such
individuals
.
4
c.
Providing
advice
and
assistance
relating
to
the
5
preparation
and
filing
of
complaints,
grievances,
and
6
appeals
of
complaints
or
grievances,
including
through
7
processes
available
under
managed
care
plans
and
the
8
state
appeals
process,
relating
to
long-term
services
9
and
supports
under
the
Medicaid
program.
10
d.
Accessing
the
results
of
a
review
of
a
level
11
of
care
assessment
or
reassessment
by
a
managed
care
12
organization
in
which
the
managed
care
organization
13
recommends
denial
or
limited
authorization
of
a
14
service,
including
the
type
or
level
of
service,
the
15
reduction,
suspension,
or
termination
of
a
previously
16
authorized
service,
or
a
change
in
level
of
care,
upon
17
the
request
of
an
affected
individual.
18
e.
Receiving
notices
of
disenrollment
or
notices
19
that
would
result
in
a
change
in
level
of
care
for
20
affected
individuals,
including
involuntary
and
21
voluntary
discharges
or
transfers,
from
the
department
22
of
human
services
or
a
managed
care
organization.
23
2.
A
representative
of
the
office
of
long-term
care
24
ombudsman
providing
assistance
and
advocacy
services
25
authorized
under
this
section
for
an
individual,
26
shall
be
provided
access
to
the
individual,
and
shall
27
be
provided
access
to
the
individual’s
medical
and
28
social
records
as
authorized
by
the
individual
or
the
29
individual’s
legal
representative,
as
necessary
to
30
carry
out
the
duties
specified
in
this
section
.
31
3.
A
representative
of
the
office
of
long-term
care
32
ombudsman
providing
assistance
and
advocacy
services
33
authorized
under
this
section
for
an
individual,
shall
34
be
provided
access
to
administrative
records
related
to
35
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the
provision
of
the
long-term
services
and
supports
to
1
the
individual,
as
necessary
to
carry
out
the
duties
2
specified
in
this
section
.
3
4.
The
office
of
long-term
care
ombudsman
and
4
representatives
of
the
office,
when
providing
5
assistance
and
advocacy
services
under
this
section,
6
shall
be
considered
a
health
oversight
agency
as
7
defined
in
45
C.F.R.
§164.501
for
the
purposes
of
8
health
oversight
activities
as
described
in
45
C.F.R.
9
§164.512(d)
including
access
to
the
health
records
10
and
other
appropriate
information
of
an
individual,
11
including
from
the
department
of
human
services
or
12
the
applicable
Medicaid
managed
care
organization,
13
as
necessary
to
fulfill
the
duties
specified
under
14
this
section.
The
department
of
human
services,
15
in
collaboration
with
the
office
of
long-term
care
16
ombudsman,
shall
adopt
rules
to
ensure
compliance
17
by
affected
entities
with
this
subsection
and
to
18
ensure
recognition
of
the
office
of
long-term
care
19
ombudsman
as
a
duly
authorized
and
identified
agent
or
20
representative
of
the
state.
21
5.
The
department
of
human
services
and
Medicaid
22
managed
care
organizations
shall
inform
eligible
23
and
potentially
eligible
Medicaid
recipients
of
the
24
advocacy
services
and
assistance
available
through
the
25
office
of
long-term
care
ombudsman
and
shall
provide
26
contact
and
other
information
regarding
the
advocacy
27
services
and
assistance
to
eligible
and
potentially
28
eligible
Medicaid
recipients
as
directed
by
the
office
29
of
long-term
care
ombudsman.
30
6.
When
providing
assistance
and
advocacy
services
31
under
this
section,
the
office
of
long-term
care
32
ombudsman
shall
act
as
an
independent
agency,
and
the
33
office
of
long-term
care
ombudsman
and
representatives
34
of
the
office
shall
be
free
of
any
undue
influence
that
35
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restrains
the
ability
of
the
office
or
the
office’s
1
representatives
from
providing
such
services
and
2
assistance.
3
7.
The
office
of
long-term
care
ombudsman
shall,
in
4
addition
to
other
duties
prescribed
and
at
a
minimum,
5
do
all
of
the
following
in
the
furtherance
of
the
6
provision
of
advocacy
services
and
assistance
under
7
this
section:
8
a.
Represent
the
interests
of
eligible
and
9
potentially
eligible
Medicaid
recipients
before
10
governmental
agencies.
11
b.
Analyze,
comment
on,
and
monitor
the
development
12
and
implementation
of
federal,
state,
and
local
laws,
13
regulations,
and
other
governmental
policies
and
14
actions,
and
recommend
any
changes
in
such
laws,
15
regulations,
policies,
and
actions
as
determined
16
appropriate
by
the
office
of
long-term
care
ombudsman.
17
c.
To
maintain
transparency
and
accountability
for
18
activities
performed
under
this
section,
including
19
for
the
purposes
of
claiming
federal
financial
20
participation
for
activities
that
are
performed
to
21
assist
with
administration
of
the
Medicaid
program:
22
(1)
Have
complete
and
direct
responsibility
for
the
23
administration,
operation,
funding,
fiscal
management,
24
and
budget
related
to
such
activities,
and
directly
25
employ,
oversee,
and
supervise
all
paid
and
volunteer
26
staff
associated
with
these
activities.
27
(2)
Establish
separation-of-duties
requirements,
28
provide
limited
access
to
work
space
and
work
29
product
for
only
necessary
staff,
and
limit
access
to
30
documents
and
information
as
necessary
to
maintain
the
31
confidentiality
of
the
protected
health
information
of
32
individuals
served
under
this
section.
33
(3)
Collect
and
submit,
annually,
to
the
governor,
34
the
health
policy
oversight
committee
created
in
35
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23
section
2.45,
and
the
general
assembly,
all
of
the
1
following
with
regard
to
those
seeking
advocacy
2
services
or
assistance
under
this
section:
3
(a)
The
number
of
contacts
by
contact
type
and
4
geographic
location.
5
(b)
The
type
of
assistance
requested
including
the
6
name
of
the
managed
care
organization
involved,
if
7
applicable.
8
(c)
The
time
frame
between
the
time
of
the
initial
9
contact
and
when
an
initial
response
was
provided.
10
(d)
The
amount
of
time
from
the
initial
contact
to
11
resolution
of
the
problem
or
concern.
12
(e)
The
actions
taken
in
response
to
the
request
13
for
advocacy
or
assistance.
14
(f)
The
outcomes
of
requests
to
address
problems
or
15
concerns.
16
4.
8.
For
the
purposes
of
this
section
:
17
a.
“Institutional
setting”
includes
a
long-term
care
18
facility,
an
elder
group
home,
or
an
assisted
living
19
program.
20
b.
“Long-term
services
and
supports”
means
the
broad
21
range
of
health,
health-related,
and
personal
care
22
assistance
services
and
supports,
provided
in
both
23
institutional
settings
and
home
and
community-based
24
settings,
necessary
for
older
individuals
and
persons
25
with
disabilities
who
experience
limitations
in
their
26
capacity
for
self-care
due
to
a
physical,
cognitive,
or
27
mental
disability
or
condition.
28
Sec.
5.
NEW
SECTION
.
231.44A
Willful
interference
29
with
duties
related
to
long-term
services
and
supports
30
——
penalty.
31
Willful
interference
with
a
representative
of
the
32
office
of
long-term
care
ombudsman
in
the
performance
33
of
official
duties
in
accordance
with
section
231.44
34
is
a
violation
of
section
231.44,
subject
to
a
penalty
35
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prescribed
by
rule.
The
office
of
long-term
care
1
ombudsman
shall
adopt
rules
specifying
the
amount
of
a
2
penalty
imposed,
consistent
with
the
penalties
imposed
3
under
section
231.42,
subsection
8,
and
specifying
4
procedures
for
notice
and
appeal
of
penalties
imposed.
5
Any
moneys
collected
pursuant
to
this
section
shall
be
6
deposited
in
the
general
fund
of
the
state.
7
MEDICAL
ASSISTANCE
ADVISORY
COUNCIL
8
Sec.
6.
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
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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
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(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
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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
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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
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(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
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business
entity
representatives
of
the
council.
The
1
mission
of
the
stakeholder
safeguards
subcommittee
2
is
to
provide
for
ongoing
stakeholder
engagement
and
3
feedback
on
issues
affecting
Medicaid
recipients,
4
providers,
and
other
stakeholders,
including
but
not
5
limited
to
benefits
such
as
transportation,
benefit
6
utilization
management,
the
inclusion
of
out-of-state
7
and
out-of-network
providers
and
the
use
of
single-case
8
agreements,
and
reimbursement
of
providers
and
9
services.
10
(2)
The
long-term
services
and
supports
11
subcommittee
which
shall
be
chaired
by
the
state
12
long-term
care
ombudsman,
or
the
ombudsman’s
designee.
13
The
mission
of
the
long-term
services
and
supports
14
subcommittee
is
to
be
a
resource
and
to
provide
advice
15
on
policy
development
and
program
administration
16
relating
to
Medicaid
long-term
services
and
supports
17
including
but
not
limited
to
developing
outcomes
and
18
performance
measures
for
Medicaid
managed
care
for
the
19
long-term
services
and
supports
population;
addressing
20
issues
related
to
home
and
community-based
services
21
waivers
and
waiting
lists;
and
reviewing
the
system
of
22
long-term
services
and
supports
to
ensure
provision
of
23
home
and
community-based
services
and
the
rebalancing
24
of
the
health
care
infrastructure
in
accordance
with
25
state
and
federal
law
including
but
not
limited
to
the
26
principles
established
in
Olmstead
v.
L.C.,
527
U.S.
27
581
(1999)
and
the
federal
Americans
with
Disabilities
28
Act
and
in
a
manner
that
reflects
a
sustainable,
29
person-centered
approach
to
improve
health
and
life
30
outcomes,
supports
maximum
independence,
addresses
31
medical
and
social
needs
in
a
coordinated,
integrated
32
manner,
and
provides
for
sufficient
resources
including
33
a
stable,
well-qualified
workforce.
The
subcommittee
34
shall
also
address
and
make
recommendations
regarding
35
-16-
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23
the
need
for
an
ombudsman
function
for
eligible
and
1
potentially
eligible
Medicaid
recipients
beyond
the
2
long-term
services
and
supports
population.
3
(3)
The
transparency,
data,
and
program
evaluation
4
subcommittee
which
shall
be
chaired
by
the
director
of
5
the
university
of
Iowa
public
policy
center,
or
the
6
director’s
designee.
The
mission
of
the
transparency,
7
data,
and
program
evaluation
subcommittee
is
to
8
ensure
Medicaid
program
transparency;
ensure
the
9
collection,
maintenance,
retention,
reporting,
and
10
analysis
of
sufficient
and
meaningful
data
to
provide
11
transparency
and
inform
policy
development
and
program
12
effectiveness;
support
development
and
administration
13
of
a
consumer-friendly
dashboard;
and
promote
the
14
ongoing
evaluation
of
Medicaid
stakeholder
satisfaction
15
with
the
Medicaid
program.
16
(4)
The
program
integrity
subcommittee
which
shall
17
be
chaired
by
the
Medicaid
director,
or
the
director’s
18
designee.
The
mission
of
the
program
integrity
19
subcommittee
is
to
ensure
that
a
comprehensive
system
20
including
specific
policies,
laws,
and
rules
and
21
adequate
resources
and
measures
are
in
place
to
22
effectively
administer
the
program
and
to
maintain
23
compliance
with
federal
and
state
program
integrity
24
requirements.
25
(5)
A
health
workforce
subcommittee,
co-chaired
26
by
the
bureau
chief
of
the
bureau
of
oral
and
health
27
delivery
systems
of
the
department
of
public
health,
28
or
the
bureau
chief’s
designee,
and
the
director
of
29
the
national
alliance
on
mental
illness
of
Iowa,
or
30
the
director’s
designee.
The
mission
of
the
health
31
workforce
subcommittee
is
to
assess
the
sufficiency
32
and
proficiency
of
the
current
and
projected
health
33
workforce;
identify
barriers
to
and
gaps
in
health
34
workforce
development
initiatives
and
health
35
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workforce
data
to
provide
foundational,
evidence-based
1
information
to
inform
policymaking
and
resource
2
allocation;
evaluate
the
most
efficient
application
3
and
utilization
of
roles,
functions,
responsibilities,
4
activities,
and
decision-making
capacity
of
health
5
care
professionals
and
other
allied
and
support
6
personnel;
and
make
recommendations
for
improvement
7
in,
and
alternative
modes
of,
health
care
delivery
in
8
order
to
provide
a
competent,
diverse,
and
sustainable
9
health
workforce
in
the
state.
The
subcommittee
shall
10
work
in
collaboration
with
the
office
of
statewide
11
clinical
education
programs
of
the
university
of
Iowa
12
Carver
college
of
medicine,
Des
Moines
university,
13
Iowa
workforce
development,
and
other
entities
with
14
interest
or
expertise
in
the
health
workforce
in
15
carrying
out
the
subcommittee’s
duties
and
developing
16
recommendations.
17
b.
The
co-chairpersons
of
the
council
shall
18
appoint
members
to
each
subcommittee
from
the
general
19
membership
of
the
council.
Consideration
in
appointing
20
subcommittee
members
shall
include
the
individual’s
21
knowledge
about,
and
interest
or
expertise
in,
matters
22
that
come
before
the
subcommittee.
23
c.
Subcommittees
shall
meet
at
the
call
of
the
24
co-chairpersons
or
chairperson
of
the
subcommittee,
25
or
at
the
request
of
a
majority
of
the
members
of
the
26
subcommittee.
27
4.
6.
For
each
council
meeting,
executive
28
committee
meeting,
or
subcommittee
meeting,
a
quorum
29
shall
consist
of
fifty
percent
of
the
membership
30
qualified
to
vote.
Where
a
quorum
is
present,
a
31
position
is
carried
by
a
majority
of
the
members
32
qualified
to
vote.
33
7.
For
each
council
meeting,
other
than
those
34
held
during
the
time
the
general
assembly
is
in
35
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session,
each
legislative
member
of
the
council
shall
1
be
reimbursed
for
actual
travel
and
other
necessary
2
expenses
and
shall
receive
a
per
diem
as
specified
in
3
section
7E.6
for
each
day
in
attendance,
as
shall
the
4
members
of
the
council
,
or
the
executive
committee
,
5
or
a
subcommittee,
for
each
day
in
attendance
at
a
6
council,
executive
committee,
or
subcommittee
meeting,
7
who
are
recipients
or
the
family
members
of
recipients
8
of
medical
assistance,
regardless
of
whether
the
9
general
assembly
is
in
session.
10
5.
8.
The
department
shall
provide
staff
support
11
and
independent
technical
assistance
to
the
council
,
12
and
the
executive
committee
,
and
the
subcommittees
.
13
6.
9.
The
director
shall
consider
comply
with
14
the
requirements
of
this
section
regarding
the
15
duties
of
the
council,
and
the
deliberations
and
16
recommendations
offered
by
of
the
council
,
and
the
17
executive
committee
,
and
the
subcommittees
shall
be
18
reflected
in
the
director’s
preparation
of
medical
19
assistance
budget
recommendations
to
the
council
20
on
human
services
pursuant
to
section
217.3
,
and
in
21
implementation
of
medical
assistance
program
policies
,
22
and
in
administration
of
the
Medicaid
program
.
23
10.
The
council,
executive
committee,
and
24
subcommittees
shall
jointly
submit
quarterly
reports
25
to
the
health
policy
oversight
committee
created
in
26
section
2.45
and
shall
jointly
submit
a
report
to
the
27
governor
and
the
general
assembly
initially
by
January
28
1,
2017,
and
annually,
therefore,
summarizing
the
29
outcomes
and
findings
of
their
respective
deliberations
30
and
any
recommendations
including
but
not
limited
to
31
those
for
changes
in
law
or
policy.
32
11.
The
council,
executive
committee,
and
33
subcommittees
may
enlist
the
services
of
persons
who
34
are
qualified
by
education,
expertise,
or
experience
35
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to
advise,
consult
with,
or
otherwise
assist
the
1
council,
executive
committee,
or
subcommittees
in
the
2
performance
of
their
duties.
The
council,
executive
3
committee,
or
subcommittees
may
specifically
enlist
4
the
assistance
of
entities
such
as
the
university
of
5
Iowa
public
policy
center
to
provide
ongoing
evaluation
6
of
the
Medicaid
program
and
to
make
evidence-based
7
recommendations
to
improve
the
program.
The
council,
8
executive
committee,
and
subcommittees
shall
enlist
9
input
from
the
patient-centered
health
advisory
council
10
created
in
section
135.159,
the
mental
health
and
11
disabilities
services
commission
created
in
section
12
225C.5,
the
commission
on
aging
created
in
section
13
231.11,
the
bureau
of
substance
abuse
of
the
department
14
of
public
health,
the
Iowa
developmental
disabilities
15
council,
and
other
appropriate
state
and
local
entities
16
to
provide
advice
to
the
council,
executive
committee,
17
and
subcommittees.
18
12.
The
department,
in
accordance
with
42
C.F.R.
19
§431.12,
shall
seek
federal
financial
participation
for
20
the
activities
of
the
council,
the
executive
committee,
21
and
the
subcommittees.
22
PATIENT-CENTERED
HEALTH
RESOURCES
AND
INFRASTRUCTURE
23
Sec.
7.
Section
135.159,
subsection
2,
Code
2016,
24
is
amended
to
read
as
follows:
25
2.
a.
The
department
shall
establish
a
26
patient-centered
health
advisory
council
which
shall
27
include
but
is
not
limited
to
all
of
the
following
28
members,
selected
by
their
respective
organizations,
29
and
any
other
members
the
department
determines
30
necessary
to
assist
in
the
department’s
duties
at
31
various
stages
of
development
of
the
medical
home
32
system
and
in
the
transformation
to
a
patient-centered
33
infrastructure
that
integrates
and
coordinates
services
34
and
supports
to
address
social
determinants
of
health
35
-20-
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and
meet
population
health
goals
:
1
(1)
The
director
of
human
services,
or
the
2
director’s
designee.
3
(2)
The
commissioner
of
insurance,
or
the
4
commissioner’s
designee.
5
(3)
A
representative
of
the
federation
of
Iowa
6
insurers.
7
(4)
A
representative
of
the
Iowa
dental
8
association.
9
(5)
A
representative
of
the
Iowa
nurses
10
association.
11
(6)
A
physician
and
an
osteopathic
physician
12
licensed
pursuant
to
chapter
148
who
are
family
13
physicians
and
members
of
the
Iowa
academy
of
family
14
physicians.
15
(7)
A
health
care
consumer.
16
(8)
A
representative
of
the
Iowa
collaborative
17
safety
net
provider
network
established
pursuant
to
18
section
135.153
.
19
(9)
A
representative
of
the
Iowa
developmental
20
disabilities
council.
21
(10)
A
representative
of
the
Iowa
chapter
of
the
22
American
academy
of
pediatrics.
23
(11)
A
representative
of
the
child
and
family
24
policy
center.
25
(12)
A
representative
of
the
Iowa
pharmacy
26
association.
27
(13)
A
representative
of
the
Iowa
chiropractic
28
society.
29
(14)
A
representative
of
the
university
of
Iowa
30
college
of
public
health.
31
(15)
A
representative
of
the
Iowa
public
health
32
association.
33
(16)
A
representative
of
the
area
agencies
on
34
aging.
35
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(17)
A
representative
of
the
mental
health
and
1
disability
services
regions.
2
(18)
A
representative
of
early
childhood
Iowa.
3
b.
Public
members
of
the
patient-centered
health
4
advisory
council
shall
receive
reimbursement
for
5
actual
expenses
incurred
while
serving
in
their
6
official
capacity
only
if
they
are
not
eligible
for
7
reimbursement
by
the
organization
that
they
represent.
8
c.
(1)
Beginning
July
1,
2016,
the
9
patient-centered
health
advisory
council
shall
10
do
all
of
the
following:
11
(a)
Review
and
make
recommendations
to
the
12
department
and
to
the
general
assembly
regarding
13
the
building
of
effective
working
relationships
and
14
strategies
to
support
state-level
and
community-level
15
integration,
to
provide
cross-system
coordination
16
and
synchronization,
and
to
more
appropriately
align
17
health
delivery
models
and
service
sectors,
including
18
but
not
limited
to
public
health,
aging
and
disability
19
services
agencies,
mental
health
and
disability
20
services
regions,
social
services,
child
welfare,
and
21
other
providers,
agencies,
organizations,
and
sectors
22
to
address
social
determinants
of
health,
holistic
23
well-being,
and
population
health
goals.
Such
review
24
and
recommendations
shall
include
a
review
of
funding
25
streams
and
recommendations
for
blending
and
braiding
26
funding
to
support
these
efforts.
27
(b)
Assist
in
efforts
to
evaluate
the
health
28
workforce
to
inform
policymaking
and
resource
29
allocation.
30
(2)
The
patient-centered
health
advisory
council
31
shall
submit
a
report
to
the
department,
the
health
32
policy
oversight
committee
created
in
section
2.45,
and
33
the
general
assembly,
initially,
on
or
before
December
34
15,
2016,
and
on
or
before
December
15,
annually,
35
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thereafter,
including
any
findings
or
recommendations
1
resulting
from
the
council’s
deliberations.
2
HAWK-I
PROGRAM
3
Sec.
8.
Section
514I.5,
subsection
8,
paragraph
4
d,
Code
2016,
is
amended
by
adding
the
following
new
5
subparagraph:
6
NEW
SUBPARAGRAPH
.
(17)
Occupational
therapy.
7
Sec.
9.
Section
514I.5,
subsection
8,
Code
2016,
is
8
amended
by
adding
the
following
new
paragraph:
9
NEW
PARAGRAPH
.
m.
The
definition
of
medically
10
necessary
and
the
utilization
management
criteria
under
11
the
hawk-i
program
in
order
to
ensure
that
benefits
12
are
uniformly
and
consistently
provided
across
all
13
participating
insurers
in
the
type
and
manner
that
14
reflects
and
appropriately
meets
the
needs,
including
15
but
not
limited
to
the
habilitative
and
rehabilitative
16
needs,
of
the
child
population
including
those
children
17
with
special
health
care
needs.
18
Sec.
10.
EFFECTIVE
UPON
ENACTMENT.
This
Act,
being
19
deemed
of
immediate
importance,
takes
effect
upon
20
enactment.
>
21
______________________________
DAVID
JOHNSON
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