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 35 -1- SF2213.2878 (1) 86 pf/nh 1/ 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 35 -2- SF2213.2878 (1) 86 pf/nh 2/ 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 -3- SF2213.2878 (1) 86 pf/nh 3/ 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 -4- SF2213.2878 (1) 86 pf/nh 4/ 23
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 -5- SF2213.2878 (1) 86 pf/nh 5/ 23
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 -6- SF2213.2878 (1) 86 pf/nh 6/ 23
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 -7- SF2213.2878 (1) 86 pf/nh 7/ 23
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 -8- SF2213.2878 (1) 86 pf/nh 8/ 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 -9- SF2213.2878 (1) 86 pf/nh 9/ 23
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 -10- SF2213.2878 (1) 86 pf/nh 10/ 23
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 -11- SF2213.2878 (1) 86 pf/nh 11/ 23
(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 -12- SF2213.2878 (1) 86 pf/nh 12/ 23
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 -13- SF2213.2878 (1) 86 pf/nh 13/ 23
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 -14- SF2213.2878 (1) 86 pf/nh 14/ 23
(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 -15- SF2213.2878 (1) 86 pf/nh 15/ 23
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- SF2213.2878 (1) 86 pf/nh 16/ 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 -17- SF2213.2878 (1) 86 pf/nh 17/ 23
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 -18- SF2213.2878 (1) 86 pf/nh 18/ 23
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 -19- SF2213.2878 (1) 86 pf/nh 19/ 23
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- SF2213.2878 (1) 86 pf/nh 20/ 23
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 -21- SF2213.2878 (1) 86 pf/nh 21/ 23
(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 -22- SF2213.2878 (1) 86 pf/nh 22/ 23
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 -23- SF2213.2878 (1) 86 pf/nh 23/ 23