House File 2539 - Enrolled

PAG LIN

1	1	HOUSE FILE 2539
1	2
1	3	AN ACT
1	4 RELATING TO HEALTH CARE REFORM INCLUDING HEALTH CARE COVERAGE
1	5	INTENDED FOR CHILDREN AND ADULTS, HEALTH INFORMATION TECH-
1	6	NOLOGY, LONG-TERM LIVING PLANNING AND PATIENT AUTONOMY IN
1	7	HEALTH CARE, PREEXISTING CONDITIONS AND DEPENDENT CHILDREN
1	8	COVERAGE, MEDICAL HOMES, PREVENTION AND CHRONIC CARE MANAGE-
1	9	MENT, DISEASE PREVENTION AND WELLNESS INITIATIVES, HEALTH
1 10	CARE TRANSPARENCY, HEALTH CARE ACCESS, THE DIRECT CARE WORK-
1 11	FORCE, MAKING APPROPRIATIONS, AND INCLUDING EFFECTIVE DATE
1 12	AND APPLICABILITY PROVISIONS.
1 13
1 14 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 15
1 16	DIVISION I
1 17	HEALTH CARE COVERAGE INTENT
1 18	Section 1.	DECLARATION OF INTENT.
1 19	1.	It is the intent of the general assembly to progress
1 20 toward achievement of the goal that all Iowans have health
1 21 care coverage with the following priorities:
1 22	a.	The goal that all children in the state have health
1 23 care coverage which meets certain standards of quality and
1 24 affordability with the following priorities:
1 25	(1)	Covering all children who are declared eligible for
1 26 the medical assistance program or the hawk=i program pursuant
1 27 to chapter 514I no later than January 1, 2011.
1 28	(2)	Building upon the current hawk=i program by creating a
1 29 hawk=i expansion program to provide coverage to children who
1 30 meet the hawk=i program's eligibility criteria but whose
1 31 income is at or below three hundred percent of the federal
1 32 poverty level, beginning July 1, 2009.
1 33	(3)	If federal reauthorization of the state children's
1 34 health insurance program provides sufficient federal
35 allocations to the state and authorization to cover such
1 children as an option under the state children's health
2	2 insurance program, requiring the department of human services
2	3 to expand coverage under the state children's health insurance
2	4 program to cover children with family incomes at or below
2	5 three hundred percent of the federal poverty level, with
2	6 appropriate cost sharing established for families with incomes
2	7 above two hundred percent of the federal poverty level.
2	8	b.	The goal that the Iowa comprehensive health insurance
2	9 association, in consultation with the Iowa choice health care
2 10 coverage advisory council established in section 514E.6,
2 11 develop a comprehensive plan to first cover all children
2 12 without health care coverage that utilizes and modifies
2 13 existing public programs including the medical assistance
2 14 program, the hawk=i program, and the hawk=i expansion program,
2 15 and then to provide access to private unsubsidized,
2 16 affordable, qualified health care coverage for children,
2 17 adults, and families, who are not otherwise eligible for
2 18 health care coverage through public programs, that is
2 19 available for purchase by January 1, 2010.
2 20	c.	The goal of decreasing health care costs and health
2 21 care coverage costs by instituting health insurance reforms
2 22 that assure the availability of private health insurance
2 23 coverage for Iowans by addressing issues involving guaranteed
2 24 availability and issuance to applicants, preexisting condition
2 25 exclusions, portability, and allowable or required pooling and
2 26 rating classifications.
2 27	DIVISION II
2 28	HAWK=I AND MEDICAID EXPANSION
2 29	Sec. 2.	Section 249A.3, subsection 1, paragraph l, Code
2 30 Supplement 2007, is amended to read as follows:
2 31	l.	Is an infant whose income is not more than two hundred
2 32 percent of the federal poverty level, as defined by the most
2 33 recently revised income guidelines published by the United
34 States department of health and human services.	Additionally,
  2 35 effective July 1, 2009, medical assistance shall be provided
  3  1 to an infant whose family income is at or below three hundred
  3  2 percent of the federal poverty level, as defined by the most
  3  3 recently revised poverty income guidelines published by the

  3  4 United States department of health and human services, if
  3  5 otherwise eligible.
6	Sec. 3.	Section 249A.3, Code Supplement 2007, is amended
3	7 by adding the following new subsection:
3	8	NEW SUBSECTION.	14.	Once initial eligibility for the
3	9 family medical assistance program=related medical assistance
3 10 is determined for a child described under subsection 1,
3 11 paragraphs "b", "f", "g", "j", "k", "l", or "n" or under
3 12 subsection 2, paragraphs "e", "f", or "h", the department
3 13 shall provide continuous eligibility for a period of up to
3 14 twelve months, until the child's next annual review of
3 15 eligibility under the medical assistance program, if the child
3 16 would otherwise be determined ineligible due to excess
3 17 countable income but otherwise remains eligible.
3 18	Sec. 4.	NEW SECTION.	422.12K	INCOME TAX FORM ==
3 19 INDICATION OF DEPENDENT CHILD HEALTH CARE COVERAGE.
3 20	1.	The director shall draft the income tax form to allow
3 21 beginning with the tax returns for tax year 2008, a person who
3 22 files an individual or joint income tax return with the
3 23 department under section 422.13 to indicate the presence or
3 24 absence of health care coverage for each dependent child for
3 25 whom an exemption is claimed.
3 26	2.	Beginning with the income tax return for tax year 2008,
3 27 a person who files an individual or joint income tax return
3 28 with the department under section 422.13, may report on the
3 29 income tax return, in the form required, the presence or
3 30 absence of health care coverage for each dependent child for
3 31 whom an exemption is claimed.
3 32	a.	If the taxpayer indicates on the income tax return that
3 33 a dependent child does not have health care coverage, and the
3 34 income of the taxpayer's tax return does not exceed the
35 highest level of income eligibility standard for the medical
1 assistance program pursuant to chapter 249A or the hawk=i
4	2 program pursuant to chapter 514I, the department shall send a
4	3 notice to the taxpayer indicating that the dependent child may
4	4 be eligible for the medical assistance program or the hawk=i
4	5 program and providing information about how to enroll in the
4	6 programs.
4	7	b.	Notwithstanding any other provision of law to the
4	8 contrary, a taxpayer shall not be subject to a penalty for not
4	9 providing the information required under this section.
4 10	c.	The department shall consult with the department of
4 11 human services in developing the tax return form and the
4 12 information to be provided to tax filers under this section.
4 13	3.	The department, in cooperation with the department of
4 14 human services, shall adopt rules pursuant to chapter 17A to
4 15 administer this section, including rules defining "health care
4 16 coverage" for the purpose of indicating its presence or
4 17 absence on the tax form.
4 18	4.	The department, in cooperation with the department of
4 19 human services, shall report, annually, to the governor and
4 20 the general assembly all of the following:
4 21	a.	The number of Iowa families, by income level, claiming
4 22 the state income tax exemption for dependent children.
4 23	b.	The number of Iowa families, by income level, claiming
4 24 the state income tax exemption for dependent children who also
4 25 indicate the presence or absence of health care coverage for
4 26 the dependent children.
4 27	c.	The effect of the reporting requirements and provision
4 28 of information requirements under this section on the number
4 29 and percentage of children in the state who are uninsured.
4 30	Sec. 5.	Section 514I.1, subsection 4, Code 2007, is
4 31 amended to read as follows:
4 32	4.	It is the intent of the general assembly that the
4 33 hawk=i program be an integral part of the continuum of health
4 34 insurance coverage and that the program be developed and
35 implemented in such a manner as to facilitate movement of
1 families between health insurance providers and to facilitate
5	2 the transition of families to private sector health insurance
5	3 coverage.	It is the intent of the general assembly in
  5  4 developing such continuum of health insurance coverage and in
  5  5 facilitating such transition, that beginning July 1, 2009, the
  5  6 department implement the hawk=i expansion program.
5	7	Sec. 6.	Section 514I.1, Code 2007, is amended by adding
5	8 the following new subsection:
5	9	NEW SUBSECTION.	5.	It is the intent of the general
5 10 assembly that if federal reauthorization of the state
5 11 children's health insurance program provides sufficient
5 12 federal allocations to the state and authorization to cover
5 13 such children as an option under the state children's health
5 14 insurance program, the department shall expand coverage under

5 15 the state children's health insurance program to cover
5 16 children with family incomes at or below three hundred percent
5 17 of the federal poverty level.
5 18	Sec. 7.	Section 514I.2, Code 2007, is amended by adding
5 19 the following new subsection:
5 20	NEW SUBSECTION.	7A.	"Hawk=i expansion program" or "hawk=i
5 21 expansion" means the healthy and well kids in Iowa expansion
5 22 program created in section 514I.12 to provide health insurance
5 23 to children who meet the hawk=i program eligibility criteria
5 24 pursuant to section 514I.8, with the exception of the family
5 25 income criteria, and whose family income is at or below three
5 26 hundred percent of the federal poverty level, as defined by
5 27 the most recently revised poverty income guidelines published
5 28 by the United States department of health and human services.
5 29	Sec. 8.	Section 514I.5, subsection 7, paragraph d, Code
5 30 Supplement 2007, is amended to read as follows:
5 31	d.	Develop, with the assistance of the department, an
5 32 outreach plan, and provide for periodic assessment of the
5 33 effectiveness of the outreach plan.	The plan shall provide
5 34 outreach to families of children likely to be eligible for
35 assistance under the program, to inform them of the
1 availability of and to assist the families in enrolling
6	2 children in the program.	The outreach efforts may include,
6	3 but are not limited to, solicitation of cooperation from
6	4 programs, agencies, and other persons who are likely to have
6	5 contact with eligible children, including but not limited to
6	6 those associated with the educational system, and the
6	7 development of community plans for outreach and marketing.
6	8 Other state agencies shall assist the department in data
  6  9 collection related to outreach efforts to potentially eligible
  6 10 children and their families.
6 11	Sec. 9.	Section 514I.5, subsection 7, Code Supplement
6 12 2007, is amended by adding the following new paragraph:
6 13	NEW PARAGRAPH.	l.	Develop options and recommendations to
6 14 allow children eligible for the hawk=i or hawk=i expansion
6 15 program to participate in qualified employer=sponsored health
6 16 plans through a premium assistance program.	The options and
6 17 recommendations shall ensure reasonable alignment between the
6 18 benefits and costs of the hawk=i and hawk=i expansion programs
6 19 and the employer=sponsored health plans consistent with
6 20 federal law.	The options and recommendations shall be
6 21 completed by January 1, 2009, and submitted to the governor
6 22 and the general assembly for consideration as part of the
6 23 hawk=i and hawk=i expansion programs.
6 24	Sec. 10.	Section 514I.7, subsection 2, paragraph a, Code
6 25 2007, is amended to read as follows:
6 26	a.	Determine individual eligibility for program enrollment
6 27 based upon review of completed applications and supporting
6 28 documentation.	The administrative contractor shall not enroll
6 29 a child who has group health coverage or any child who has
  6 30 dropped coverage in the previous six months, unless the
  6 31 coverage was involuntarily lost or unless the reason for
  6 32 dropping coverage is allowed by rule of the board.
6 33	Sec. 11.	Section 514I.8, subsection 1, Code 2007, is
6 34 amended to read as follows:
35	1.	Effective July 1, 1998, and notwithstanding any medical
1 assistance program eligibility criteria to the contrary,
7	2 medical assistance shall be provided to, or on behalf of, an
7	3 eligible child under the age of nineteen whose family income
7	4 does not exceed one hundred thirty=three percent of the
7	5 federal poverty level, as defined by the most recently revised
7	6 poverty income guidelines published by the United States
7	7 department of health and human services.	Additionally,
7	8 effective July 1, 2000, and notwithstanding any medical
7	9 assistance program eligibility criteria to the contrary,
7 10 medical assistance shall be provided to, or on behalf of, an
7 11 eligible infant whose family income does not exceed two
7 12 hundred percent of the federal poverty level, as defined by
7 13 the most recently revised poverty income guidelines published
7 14 by the United States department of health and human services.
7 15 Effective July 1, 2009, and notwithstanding any medical
  7 16 assistance program eligibility criteria to the contrary,
  7 17 medical assistance shall be provided to, or on behalf of, an
  7 18 eligible infant whose family income is at or below three
  7 19 hundred percent of the federal poverty level, as defined by
  7 20 the most recently revised poverty income guidelines published
  7 21 by the United States department of health and human services.
7 22	Sec. 12.	Section 514I.10, subsection 2, Code 2007, is
7 23 amended to read as follows:
7 24	2.	Cost sharing for eligible children whose family income
7 25 equals or exceeds one hundred fifty percent but does not

  7 26 exceed two hundred percent of the federal poverty level may
7 27 include a premium or copayment amount which does not exceed
7 28 five percent of the annual family income.	The amount of any
7 29 premium or the copayment amount shall be based on family
7 30 income and size.
7 31	Sec. 13.	Section 514I.11, subsections 1 and 3, Code 2007,
7 32 are amended to read as follows:
7 33	1.	A hawk=i trust fund is created in the state treasury
7 34 under the authority of the department of human services, in
35 which all appropriations and other revenues of the program and
  8  1 the hawk=i expansion program such as grants, contributions,
2 and participant payments shall be deposited and used for the
8	3 purposes of the program and the hawk=i expansion program.	The
8	4 moneys in the fund shall not be considered revenue of the
8	5 state, but rather shall be funds of the program.
8	6	3.	Moneys in the fund are appropriated to the department
8	7 and shall be used to offset any program and hawk=i expansion
  8  8 program costs.
8	9	Sec. 14.	NEW SECTION.	514I.12	HAWK=I EXPANSION PROGRAM.
8 10	1.	All children less than nineteen years of age who meet
8 11 the hawk=i program eligibility criteria pursuant to section
8 12 514I.8, with the exception of the family income criteria, and
8 13 whose family income is at or below three hundred percent of
8 14 the federal poverty level, shall be eligible for the hawk=i
8 15 expansion program.
8 16	2.	To the greatest extent possible, the provisions of
8 17 section 514I.4, relating to the director and department duties
8 18 and powers, section 514I.5 relating to the hawk=i board,
8 19 section 514I.6 relating to participating insurers, and section
8 20 514I.7 relating to the administrative contractor shall apply
8 21 to the hawk=i expansion program.	The department shall adopt
8 22 any rules necessary, pursuant to chapter 17A, and shall amend
8 23 any existing contracts to facilitate the application of such
8 24 sections to the hawk=i expansion program.
8 25	3.	The hawk=i board shall establish by rule pursuant to
8 26 chapter 17A, the cost=sharing amounts, criteria for
8 27 modification of the cost=sharing amounts, and graduated
8 28 premiums for children under the hawk=i expansion program.
8 29	Sec. 15.	MAXIMIZATION OF ENROLLMENT AND RETENTION ==
8 30 MEDICAL ASSISTANCE AND HAWK=I PROGRAMS.
8 31	1.	The department of human services, in collaboration with
8 32 the department of education, the department of public health,
8 33 the division of insurance of the department of commerce, the
8 34 hawk=i board, consumers who are not recipients of or advocacy
35 groups representing recipients of the medical assistance or
1 hawk-i program, the covering kids and families coalition, and
9	2 the covering kids now task force, shall develop a plan to
9	3 maximize enrollment and retention of eligible children in the
9	4 hawk=i and medical assistance programs.	In developing the
9	5 plan, the collaborative shall review, at a minimum, all of the
9	6 following strategies:
9	7	a.	Streamlined enrollment in the hawk=i and medical
9	8 assistance programs.	The collaborative shall identify
9 information and documentation that may be shared across
9 10 departments and programs to simplify the determination of
9 11 eligibility or eligibility factors, and any interagency
9 12 agreements necessary to share information consistent with
9 13 state and federal confidentiality and other applicable
9 14 requirements.
9 15	b.	Conditional eligibility for the hawk=i and medical
9 16 assistance programs.
9 17	c.	Expedited renewal for the hawk=i and medical assistance
9 18 programs.
9 19	2.	Following completion of the review the department of
9 20 human services shall compile the plan which shall address all
9 21 of the following relative to implementation of the strategies
9 22 specified in subsection 1:
9 23	a.	Federal limitations and quantifying of the risk of
9 24 federal disallowance.
9 25	b.	Any necessary amendment of state law or rule.
9 26	c.	Budgetary implications and cost=benefit analyses.
9 27	d.	Any medical assistance state plan amendments, waivers,
9 28 or other federal approval necessary.
9 29	e.	An implementation time frame.
9 30	3.	The department of human services shall submit the plan
9 31 to the governor and the general assembly no later than 9 32 December 1, 2008.
9 33	Sec. 16.	MEDICAL ASSISTANCE, HAWK=I, AND HAWK=I EXPANSION
9 34 PROGRAMS == COVERING CHILDREN == APPROPRIATION.	There is
9 35 appropriated from the general fund of the state to the
1 department of human services for the designated fiscal years,

10	2 the following amounts, or so much thereof as is necessary, for
10	3 the purpose designated:
10	4	To cover children as provided in this Act under the medical
10	5 assistance, hawk=i, and hawk=i expansion programs and outreach
10	6 under the current structure of the programs:
10	7 FY 2008=2009 ..................................... $	4,800,000
10	8 FY 2009=2010 ..................................... $ 14,800,000
10	9 FY 2010=2011 ..................................... $ 24,800,000
10 10	DIVISION III
10 11	IOWA CHOICE HEALTH CARE COVERAGE
10 12	AND ADVISORY COUNCIL
10 13	Sec. 17.	Section 514E.1, Code 2007, is amended by adding
10 14 the following new subsections:
10 15	NEW SUBSECTION.	14A.	"Iowa choice health care coverage
10 16 advisory council" or "advisory council" means the advisory
10 17 council created in section 514E.6.
10 18	NEW SUBSECTION.	21.	"Qualified health care coverage"
10 19 means creditable coverage which meets minimum standards of
10 20 quality and affordability as determined by the association by
10 21 rule.
10 22	Sec. 18.	Section 514E.2, subsection 3, unnumbered
10 23 paragraph 1, Code 2007, is amended to read as follows:
10 24	The association shall submit to the commissioner a plan of
10 25 operation for the association and any amendments necessary or
10 26 suitable to assure the fair, reasonable, and equitable
27 administration of the association.	The plan of operation
 10 28 shall include provisions for the development of a
 10 29 comprehensive health care coverage plan as provided in section
 10 30 514E.5.  In developing the comprehensive plan the association
 10 31 shall give deference to the recommendations made by the
 10 32 advisory council as provided in section 514E.6, subsection 1.
 10 33 The association shall approve or disapprove but shall not
 10 34 modify recommendations made by the advisory council.
 10 35 Recommendations that are approved shall be included in the
 11  1 plan of operation submitted to the commissioner.
 11  2 Recommendations that are disapproved shall be submitted to the
 11  3 commissioner with reasons for the disapproval.	The plan of
4 operation becomes effective upon approval in writing by the
11	5 commissioner prior to the date on which the coverage under
11	6 this chapter must be made available.	After notice and
11	7 hearing, the commissioner shall approve the plan of operation
11	8 if the plan is determined to be suitable to assure the fair,
11	9 reasonable, and equitable administration of the association,
11 10 and provides for the sharing of association losses, if any, on
11 11 an equitable and proportionate basis among the member
11 12 carriers.	If the association fails to submit a suitable plan
11 13 of operation within one hundred eighty days after the
11 14 appointment of the board of directors, or if at any later time
11 15 the association fails to submit suitable amendments to the
11 16 plan, the commissioner shall adopt, pursuant to chapter 17A,
11 17 rules necessary to implement this section.	The rules shall
11 18 continue in force until modified by the commissioner or
11 19 superseded by a plan submitted by the association and approved
11 20 by the commissioner.	In addition to other requirements, the
11 21 plan of operation shall provide for all of the following:
11 22	Sec. 19.	NEW SECTION.	514E.5	IOWA CHOICE HEALTH CARE
11 23 COVERAGE.
11 24	1.	The association, in consultation with the Iowa choice
11 25 health care coverage advisory council, shall develop a
11 26 comprehensive health care coverage plan to provide health care
11 27 coverage to all children without such coverage, that utilizes
11 28 and modifies existing public programs including the medical
11 29 assistance program, hawk=i program, and hawk=i expansion
11 30 program, and to provide access to private unsubsidized,
11 31 affordable, qualified health care coverage to children who are
11 32 not otherwise eligible for health care coverage through public
11 33 programs.
11 34	2.	The comprehensive plan developed by the association and
35 the advisory council, shall also consider and recommend
1 options to provide access to private unsubsidized, affordable,
12	2 qualified health care coverage to all Iowa children less than
12	3 nineteen years of age with a family income that is more than
12	4 three hundred percent of the federal poverty level and to
12	5 adults and families who are not otherwise eligible for health
12	6 care coverage through public programs.
12	7	3.	As part of the comprehensive plan developed, the
12	8 association, in consultation with the advisory council, shall
12	9 define what constitutes qualified health care coverage for
12 10 children less than nineteen years of age.	For the purposes of
12 11 this definition and for designing health care coverage options
12 12 for children, the association, in consultation with the

12 13 advisory council, shall recommend the benefits to be included
12 14 in such coverage and shall explore the value of including
12 15 coverage for the treatment of mental and behavioral disorders.
12 16 The association and the advisory council shall perform a cost
12 17 analysis as part of their consideration of benefit options.
12 18 The association and the advisory council shall also consider
12 19 whether to include coverage of the following benefits:
12 20	a.	Inpatient hospital services including medical,
12 21 surgical, intensive care unit, mental health, and substance
12 22 abuse services.
12 23	b.	Nursing care services including skilled nursing
12 24 facility services.
12 25	c.	Outpatient hospital services including emergency room,
12 26 surgery, lab, and x=ray services and other services.
12 27	d.	Physician services, including surgical and medical,
12 28 office visits, newborn care, well=baby and well=child care,
12 29 immunizations, urgent care, specialist care, allergy testing
12 30 and treatment, mental health visits, and substance abuse
12 31 visits.
12 32	e.	Ambulance services.
12 33	f.	Physical therapy.
12 34	g.	Speech therapy.
35	h.	Durable medical equipment.
1	i.	Home health care.
13	2	j.	Hospice services.
13	3	k.	Prescription drugs.
13	4	l.	Dental services including preventive services.
13	5	m.	Medically necessary hearing services.
13	6	n.	Vision services including corrective lenses.
13	7	o.	No underwriting requirements and no preexisting
13	8 condition exclusions.
13	9	p.	Chiropractic services.
13 10	4.	As part of the comprehensive plan developed, the
13 11 association, in consultation with the advisory council, shall
13 12 consider and recommend affordable health care coverage options
13 13 for purchase for children less than nineteen years of age with
13 14 a family income that is more than three hundred percent of the
13 15 federal poverty level, with the goal of including health care
13 16 coverage options for which the contribution requirement for
13 17 all cost=sharing expenses is no more than two percent of
13 18 family income per each child covered, up to a maximum of six
13 19 and one=half percent of family income per family.	The
13 20 association, in consultation with the advisory council, shall
13 21 also consider and recommend whether such health care coverage
13 22 options should require a copayment for services received in an
13 23 amount determined by the association.
13 24	5.	As part of the comprehensive plan, the association, in
13 25 consultation with the advisory council, shall define what
13 26 constitutes qualified health care coverage for adults and
13 27 families who are not eligible for a public program.	The
13 28 association, in consultation with the advisory council, shall
13 29 develop and recommend affordable health care coverage options
13 30 for purchase by such adults and families that provide a
13 31 selection of health benefit plans and standardized benefits
13 32 with the goal of including health care coverage options for
13 33 which the contribution requirement for all cost=sharing
13 34 expenses is no more than six and one=half percent of family
35 income.
1	6.	As part of the comprehensive plan the association and
14	2 the advisory council may collaborate with health insurance
14	3 carriers to do the following, including but not limited to:
14	4	a.	Design solutions to issues relating to guaranteed
14	5 issuance of insurance, preexisting condition exclusions,
14	6 portability, and allowable pooling and rating classifications.
14	7	b.	Formulate principles that ensure fair and appropriate
14	8 practices relating to issues involving individual health care
14	9 policies such as recision and preexisting condition clauses,
14 10 and that provide for a binding third=party review process to
14 11 resolve disputes related to such issues.
14 12	c.	Design affordable, portable health care coverage
14 13 options for low=income children, adults, and families.
14 14	d.	Design a proposed premium schedule for health care
14 15 coverage options that are recommended which includes the
14 16 development of rating factors that are consistent with market
14 17 conditions.
14 18	e.	Design protocols to limit the transfer from
14 19 employer=sponsored or other private health care coverage to
14 20 state=developed health care coverage plans.
14 21	7.	The association shall submit the comprehensive plan
14 22 required by this section to the governor and the general
14 23 assembly by December 15, 2008.	The appropriations to cover

14 24 children under the medical assistance, hawk=i, and hawk=i
14 25 expansion programs as provided in this Act and to provide
14 26 related outreach for fiscal year 2009=2010 and fiscal year
14 27 2010=2011 are contingent upon enactment of a comprehensive
14 28 plan during the 2009 regular session of the Eighty=third
14 29 General Assembly that provides health care coverage for all
14 30 children in the state.	Enactment of a comprehensive plan
14 31 shall include a determination of what the prospects are of
14 32 federal action which may impact the comprehensive plan and the
14 33 fiscal impact of the comprehensive plan on the state budget.
14 34	Sec. 20.	NEW SECTION.	514E.6	IOWA CHOICE HEALTH CARE
35 COVERAGE ADVISORY COUNCIL.
1	1.	The Iowa choice health care coverage advisory council
15	2 is created for the purpose of assisting the association with
15	3 developing a comprehensive health care coverage plan as
15	4 provided in section 514E.5.	The advisory council shall make
15	5 recommendations concerning the design and implementation of
15	6 the comprehensive plan including but not limited to a
15	7 definition of what constitutes qualified health care coverage,
15	8 suggestions for the design of health care coverage options,
15	9 and implementation of a health care coverage reporting
15 10 requirement.
15 11	2.	The advisory council consists of the following persons
15 12 who are voting members unless otherwise provided:
15 13	a.	The two most recent former governors, or if one or both
15 14 of them are unable or unwilling to serve, a person or persons
15 15 appointed by the governor.
15 16	b.	Seven members appointed by the director of public
15 17 health:
15 18	(1)	A representative of the federation of Iowa insurers.
15 19	(2)	A health economist who resides in Iowa.
15 20	(3)	Two consumers, one of whom shall be a representative
15 21 of a children's advocacy organization and one of whom shall be
15 22 a member of a minority.
15 23	(4)	A representative of organized labor.
15 24	(5)	A representative of an organization of employers.
15 25	(6)	A representative of the Iowa association of health
15 26 underwriters.
15 27	c.	The following members shall be ex officio, nonvoting
15 28 members of the council:
15 29	(1)	The commissioner of insurance, or a designee.
15 30	(2)	The director of human services, or a designee.
15 31	(3)	The director of public health, or a designee.
15 32	(4)	Four members of the general assembly, one appointed by
15 33 the speaker of the house of representatives, one appointed by
15 34 the minority leader of the house of representatives, one
35 appointed by the majority leader of the senate, and one
1 appointed by the minority leader of the senate.
16	2	3.	The members of the council appointed by the director of
16	3 public health shall be appointed for terms of six years
16	4 beginning and ending as provided in section 69.19.	Such a
16	5 member of the board is eligible for reappointment.	The
16	6 director shall fill a vacancy for the remainder of the
16	7 unexpired term.
16	8	4.	The members of the council shall annually elect one
16	9 voting member as chairperson and one as vice chairperson.
16 10 Meetings of the council shall be held at the call of the
16 11 chairperson or at the request of a majority of the council's
16 12 members.
16 13	5.	The members of the council shall not receive
16 14 compensation for the performance of their duties as members
16 15 but each member shall be paid necessary expenses while engaged
16 16 in the performance of duties of the council.	Any legislative
16 17 member shall be paid the per diem and expenses specified in
16 18 section 2.10.
16 19	6.	The members of the council are subject to and are
16 20 officials within the meaning of chapter 68B.
16 21	DIVISION IV
16 22	HEALTH INSURANCE OVERSIGHT
16 23	Sec. 21.	Section 505.8, Code Supplement 2007, is amended
16 24 by adding the following new subsection:
16 25	NEW SUBSECTION.	5A.	The commissioner shall have
16 26 regulatory authority over health benefit plans and adopt rules
16 27 under chapter 17A as necessary, to promote the uniformity,
16 28 cost efficiency, transparency, and fairness of such plans for
16 29 physicians licensed under chapters 148, 150, and 150A, and
16 30 hospitals licensed under chapter 135B, for the purpose of
16 31 maximizing administrative efficiencies and minimizing
16 32 administrative costs of health care providers and health
16 33 insurers.
16 34	Sec. 22.	HEALTH INSURANCE OVERSIGHT == APPROPRIATION.

35 There is appropriated from the general fund of the state to
1 the insurance division of the department of commerce for the
17	2 fiscal year beginning July 1, 2008, and ending June 30, 2009,
17	3 the following amount, or so much thereof as is necessary, for
17	4 the purpose designated:
17	5	For identification and regulation of procedures and
17	6 practices related to health care as provided in section 505.8,
17	7 subsection 5A:
17	8 .................................................. $	80,000
17	9	DIVISION V
17 10	IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
17 11	DIVISION XXI
17 12	IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
17 13	Sec. 23.	NEW SECTION.	135.154	DEFINITIONS.
17 14	As used in this division, unless the context otherwise
17 15 requires:
17 16	1.	"Board" means the state board of health created
17 17 pursuant to section 136.1.
17 18	2.	"Department" means the department of public health.
17 19	3.	"Health care professional" means a person who is
17 20 licensed, certified, or otherwise authorized or permitted by
17 21 the law of this state to administer health care in the
17 22 ordinary course of business or in the practice of a
17 23 profession.
17 24	4.	"Health information technology" means the application
17 25 of information processing, involving both computer hardware
17 26 and software, that deals with the storage, retrieval, sharing,
17 27 and use of health care information, data, and knowledge for
17 28 communication, decision making, quality, safety, and
17 29 efficiency of clinical practice, and may include but is not
17 30 limited to:
17 31	a.	An electronic health record that electronically
17 32 compiles and maintains health information that may be derived
17 33 from multiple sources about the health status of an individual
17 34 and may include a core subset of each care delivery
35 organization's electronic medical record such as a continuity
1 of care record or a continuity of care document, computerized
18	2 physician order entry, electronic prescribing, or clinical
18	3 decision support.
18	4	b.	A personal health record through which an individual
18	5 and any other person authorized by the individual can maintain
18	6 and manage the individual's health information.
18	7	c.	An electronic medical record that is used by health
18	8 care professionals to electronically document, monitor, and
18	9 manage health care delivery within a care delivery
18 10 organization, is the legal record of the patient's encounter
18 11 with the care delivery organization, and is owned by the care
18 12 delivery organization.
18 13	d.	A computerized provider order entry function that
18 14 permits the electronic ordering of diagnostic and treatment
18 15 services, including prescription drugs.
18 16	e.	A decision support function to assist physicians and
18 17 other health care providers in making clinical decisions by
18 18 providing electronic alerts and reminders to improve
18 19 compliance with best practices, promote regular screenings and
18 20 other preventive practices, and facilitate diagnoses and
18 21 treatments.
18 22	f.	Tools to allow for the collection, analysis, and
18 23 reporting of information or data on adverse events, the
18 24 quality and efficiency of care, patient satisfaction, and
18 25 other health care=related performance measures.
18 26	5.	"Interoperability" means the ability of two or more
18 27 systems or components to exchange information or data in an
18 28 accurate, effective, secure, and consistent manner and to use
18 29 the information or data that has been exchanged and includes
18 30 but is not limited to:
18 31	a.	The capacity to connect to a network for the purpose of
18 32 exchanging information or data with other users.
18 33	b.	The ability of a connected, authenticated user to
18 34 demonstrate appropriate permissions to participate in the
35 instant transaction over the network.
1	c.	The capacity of a connected, authenticated user to
19	2 access, transmit, receive, and exchange usable information
19	3 with other users.
19	4	6.	"Recognized interoperability standard" means
19	5 interoperability standards recognized by the office of the
19	6 national coordinator for health information technology of the
19	7 United States department of health and human services.
19	8	Sec. 24.	NEW SECTION.	135.155	IOWA ELECTRONIC HEALTH ==
19	9 PRINCIPLES == GOALS.
19 10	1.	Health information technology is rapidly evolving so

19 11 that it can contribute to the goals of improving access to and
19 12 quality of health care, enhancing efficiency, and reducing
19 13 costs.
19 14	2.	To be effective, the health information technology
19 15 system shall comply with all of the following principles:
19 16	a.	Be patient=centered and market=driven.
19 17	b.	Be based on approved standards developed with input
19 18 from all stakeholders.
19 19	c.	Protect the privacy of consumers and the security and
19 20 confidentiality of all health information.
19 21	d.	Promote interoperability.
19 22	e.	Ensure the accuracy, completeness, and uniformity of
19 23 data.
19 24	3.	Widespread adoption of health information technology is
19 25 critical to a successful health information technology system
19 26 and is best achieved when all of the following occur:
19 27	a.	The market provides a variety of certified products
19 28 from which to choose in order to best fit the needs of the
19 29 user.
19 30	b.	The system provides incentives for health care
19 31 professionals to utilize the health information technology and
19 32 provides rewards for any improvement in quality and efficiency
19 33 resulting from such utilization.
19 34	c.	The system provides protocols to address critical
35 problems.
1	d.	The system is financed by all who benefit from the
20	2 improved quality, efficiency, savings, and other benefits that
20	3 result from use of health information technology.
20	4	Sec. 25.	NEW SECTION.	135.156	ELECTRONIC HEALTH
20	5 INFORMATION == DEPARTMENT DUTIES == ADVISORY COUNCIL ==
20	6 EXECUTIVE COMMITTEE.
20	7	1.	a.	The department shall direct a public and private
20	8 collaborative effort to promote the adoption and use of health
20	9 information technology in this state in order to improve
20 10 health care quality, increase patient safety, reduce health
20 11 care costs, enhance public health, and empower individuals and
20 12 health care professionals with comprehensive, real=time
20 13 medical information to provide continuity of care and make the
20 14 best health care decisions.	The department shall provide
20 15 coordination for the development and implementation of an
20 16 interoperable electronic health records system, telehealth
20 17 expansion efforts, the health information technology
20 18 infrastructure, and other health information technology
20 19 initiatives in this state.	The department shall be guided by
20 20 the principles and goals specified in section 135.155.
20 21	b.	All health information technology efforts shall
20 22 endeavor to represent the interests and meet the needs of
20 23 consumers and the health care sector, protect the privacy of
20 24 individuals and the confidentiality of individuals'
20 25 information, promote physician best practices, and make
20 26 information easily accessible to the appropriate parties.	The
20 27 system developed shall be consumer=driven, flexible, and
20 28 expandable.
20 29	2.	a.	An electronic health information advisory council
20 30 is established which shall consist of the representatives of
20 31 entities involved in the electronic health records system task
20 32 force established pursuant to section 217.41A, Code 2007, a
20 33 pharmacist, a licensed practicing physician, a consumer who is
20 34 a member of the state board of health, a representative of the
35 state's Medicare quality improvement organization, the
1 executive director of the Iowa communications network, a
21	2 representative of the private telecommunications industry, a
21	3 representative of the Iowa collaborative safety net provider
21	4 network created in section 135.153, a nurse informaticist from
21	5 the university of Iowa, and any other members the department
21	6 or executive committee of the advisory council determines
21	7 necessary and appoints to assist the department or executive
21	8 committee at various stages of development of the electronic
21	9 health information system.	Executive branch agencies shall
21 10 also be included as necessary to assist in the duties of the
21 11 department and the executive committee.	Public members of the
21 12 advisory council shall receive reimbursement for actual
21 13 expenses incurred while serving in their official capacity
21 14 only if they are not eligible for reimbursement by the
21 15 organization that they represent.	Any legislative members
21 16 shall be paid the per diem and expenses specified in section 21 17 2.10.
21 18	b.	An executive committee of the electronic health
21 19 information advisory council is established.	Members of the
21 20 executive committee of the advisory council shall receive
21 21 reimbursement for actual expenses incurred while serving in

21 22 their official capacity only if they are not eligible for
21 23 reimbursement by the organization that they represent.	The
21 24 executive committee shall consist of the following members:
21 25	(1)	Three members, each of whom is the chief information
21 26 officer of one of the three largest private health care
21 27 systems in the state.
21 28	(2)	One member who is the chief information officer of the
21 29 university of Iowa hospitals and clinics, or the chief
21 30 information officer's designee, selected by the director of
21 31 the university of Iowa hospitals and clinics.
21 32	(3)	One member who is a representative of a rural hospital
21 33 who is a member of the Iowa hospital association, selected by
21 34 the Iowa hospital association.
35	(4)	One member who is a consumer member of the state board
1 of health, selected by the state board of health.
22	2	(5)	One member who is a licensed practicing physician,
22	3 selected by the Iowa medical society.
22	4	(6)	One member who is licensed to practice nursing,
22	5 selected by the Iowa nurses association.
22	6	(7)	One representative of an insurance carrier selected by
22	7 the federation of Iowa insurers.
22	8	3.	The executive committee, with the technical assistance
22	9 of the advisory council and the support of the department
22 10 shall do all of the following:
22 11	a.	Develop a statewide health information technology plan
22 12 by July 1, 2009.	In developing the plan, the executive
22 13 committee shall seek the input of providers, payers, and
22 14 consumers.	Standards and policies developed for the plan
22 15 shall promote and be consistent with national standards
22 16 developed by the office of the national coordinator for health
22 17 information technology of the United States department of
22 18 health and human services and shall address or provide for all
22 19 of the following:
22 20	(1)	The effective, efficient, statewide use of electronic
22 21 health information in patient care, health care policymaking,
22 22 clinical research, health care financing, and continuous
22 23 quality improvement.	The executive committee shall recommend
22 24 requirements for interoperable electronic health records in
22 25 this state including a recognized interoperability standard.
22 26	(2)	Education of the public and health care sector about
22 27 the value of health information technology in improving
22 28 patient care, and methods to promote increased support and
22 29 collaboration of state and local public health agencies,
22 30 health care professionals, and consumers in health information
22 31 technology initiatives.
22 32	(3)	Standards for the exchange of health care information.
22 33	(4)	Policies relating to the protection of privacy of
22 34 patients and the security and confidentiality of patient
35 information.
1	(5)	Policies relating to information ownership.
23	2	(6)	Policies relating to governance of the various facets
23	3 of the health information technology system.
23	4	(7)	A single patient identifier or alternative mechanism
23	5 to share secure patient information.	If no alternative
23	6 mechanism is acceptable to the executive committee, all health
23	7 care professionals shall utilize the mechanism selected by the
23	8 executive committee by July 1, 2010.
23	9	(8)	A standard continuity of care record and other issues
23 10 related to the content of electronic transmissions.	All
23 11 health care professionals shall utilize the standard
23 12 continuity of care record by July 1, 2010.
23 13	(9)	Requirements for electronic prescribing.
23 14	(10)	Economic incentives and support to facilitate
23 15 participation in an interoperable system by health care
23 16 professionals.
23 17	b.	Identify existing and potential health information
23 18 technology efforts in this state, regionally, and nationally,
23 19 and integrate existing efforts to avoid incompatibility
23 20 between efforts and avoid duplication.
23 21	c.	Coordinate public and private efforts to provide the
23 22 network backbone infrastructure for the health information
23 23 technology system.	In coordinating these efforts, the
23 24 executive committee shall do all of the following:
23 25	(1)	Develop policies to effectuate the logical
23 26 cost=effective usage of and access to the state=owned network,
23 27 and support of telecommunication carrier products, where
23 28 applicable.
23 29	(2)	Consult with the Iowa communications network, private
23 30 fiberoptic networks, and any other communications entity to
23 31 seek collaboration, avoid duplication, and leverage
23 32 opportunities in developing a network backbone.

23 33	(3)	Establish protocols to ensure compliance with any
23 34 applicable federal standards.
35	(4)	Determine costs for accessing the network at a level
1 that provides sufficient funding for the network.
24	2	d.	Promote the use of telemedicine.
24	3	(1)	Examine existing barriers to the use of telemedicine
24	4 and make recommendations for eliminating these barriers.
24	5	(2)	Examine the most efficient and effective systems of
24	6 technology for use and make recommendations based on the
24	7 findings.
24	8	e.	Address the workforce needs generated by increased use
24	9 of health information technology.
24 10	f.	Recommend rules to be adopted in accordance with
24 11 chapter 17A to implement all aspects of the statewide health
24 12 information technology plan and the network.
24 13	g.	Coordinate, monitor, and evaluate the adoption, use,
24 14 interoperability, and efficiencies of the various facets of
24 15 health information technology in this state.
24 16	h.	Seek and apply for any federal or private funding to
24 17 assist in the implementation and support of the health
24 18 information technology system and make recommendations for
24 19 funding mechanisms for the ongoing development and maintenance
24 20 costs of the health information technology system.
24 21	i.	Identify state laws and rules that present barriers to
24 22 the development of the health information technology system
24 23 and recommend any changes to the governor and the general
24 24 assembly.
24 25	4.	Recommendations and other activities resulting from the
24 26 work of the department or the executive committee shall be
24 27 presented to the board for action or implementation.
24 28	Sec. 26.	Section 8D.13, Code 2007, is amended by adding
24 29 the following new subsection:
24 30	NEW SUBSECTION.	20.	Access shall be offered to the Iowa
24 31 hospital association only for the purposes of collection,
24 32 maintenance, and dissemination of health and financial data
24 33 for hospitals and for hospital education services.	The Iowa
24 34 hospital association shall be responsible for all costs
35 associated with becoming part of the network, as determined by
1 the commission.
25	2	Sec. 27.	Section 136.3, Code 2007, is amended by adding
25	3 the following new subsection:
25	4	NEW SUBSECTION.	11.	Perform those duties authorized
25	5 pursuant to section 135.156.
25	6	Sec. 28.	Section 217.41A, Code 2007, is repealed.
25	7	Sec. 29.	IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM ==
25	8 APPROPRIATION.	There is appropriated from the general fund of
25	9 the state to the department of public health for the fiscal
25 10 year beginning July 1, 2008, and ending June 30, 2009, the
25 11 following amount, or so much thereof as is necessary, for the
25 12 purpose designated:
25 13	For administration of the Iowa health information
25 14 technology system, and for not more than the following
25 15 full=time equivalent positions:
25 16 .................................................. $	190,600
25 17 ............................................... FTEs	2.00
25 18	DIVISION VI
25 19	LONG=TERM LIVING PLANNING AND
25 20	PATIENT AUTONOMY IN HEALTH CARE
25 21	Sec. 30.	NEW SECTION.	231.62	END=OF=LIFE CARE
25 22 INFORMATION.
25 23	1.	The department shall consult with the Iowa medical
25 24 society, the Iowa end=of=life coalition, the Iowa hospice
25 25 organization, the university of Iowa palliative care program,
25 26 and other health care professionals whose scope of practice
25 27 includes end=of=life care to develop educational and
25 28 patient=centered information on end=of=life care for
25 29 terminally ill patients and health care professionals.
25 30	2.	For the purposes of this section, "end=of=life care"
25 31 means care provided to meet the physical, psychological,
25 32 social, spiritual, and practical needs of terminally ill
25 33 patients and their caregivers.
25 34	Sec. 31.	END=OF=LIFE CARE INFORMATION == APPROPRIATION.
35 There is appropriated from the general fund of the state to
1 the department of elder affairs for the fiscal year beginning
26	2 July 1, 2008, and ending June 30, 2009, the following amount,
26	3 or so much thereof as is necessary, for the purpose
26	4 designated:
26	5	For activities associated with the end=of=life care
26	6 information requirements of this division:
26	7 .................................................. $	10,000
26	8	Sec. 32.	LONG=TERM LIVING PLANNING TOOLS == PUBLIC

26	9 EDUCATION CAMPAIGN.	The legal services development and
26 10 substitute decision maker programs of the department of elder
26 11 affairs, in collaboration with other appropriate agencies and
26 12 interested parties, shall research existing long=term living
26 13 planning tools that are designed to increase quality of life
26 14 and contain health care costs and recommend a public education
26 15 campaign strategy on long=term living to the general assembly
26 16 by January 1, 2009.
26 17	Sec. 33.	LONG=TERM CARE OPTIONS PUBLIC EDUCATION CAMPAIGN.
26 18 The department of elder affairs, in collaboration with the
26 19 insurance division of the department of commerce, shall
26 20 implement a long=term care options public education campaign.
26 21 The campaign may utilize such tools as the "Own Your Future
26 22 Planning Kit" administered by the centers for Medicare and
26 23 Medicaid services, the administration on aging, and the office
26 24 of the assistant secretary for planning and evaluation of the
26 25 United States department of health and human services, and
26 26 other tools developed through the aging and disability
26 27 resource center program of the administration on aging and the
26 28 centers for Medicare and Medicaid services designed to promote
26 29 health and independence as Iowans age, assist older Iowans in
26 30 making informed choices about the availability of long=term
26 31 care options, including alternatives to facility=based care,
26 32 and to streamline access to long=term care.
26 33	Sec. 34.	LONG=TERM CARE OPTIONS PUBLIC EDUCATION CAMPAIGN
26 34 == APPROPRIATION.	There is appropriated from the general fund
35 of the state to the department of elder affairs for the fiscal
1 year beginning July 1, 2008, and ending June 30, 2009, the
27	2 following amount, or so much thereof as is necessary, for the
27	3 purpose designated:
27	4	For activities associated with the long=term care options
27	5 public education campaign requirements of this division:
27	6 .................................................. $	75,000
27	7	Sec. 35.	HOME AND COMMUNITY=BASED SERVICES PUBLIC
27	8 EDUCATION CAMPAIGN.	The department of elder affairs shall
27	9 work with other public and private agencies to identify
27 10 resources that may be used to continue the work of the aging
27 11 and disability resource center established by the department
27 12 through the aging and disability resource center grant program
27 13 efforts of the administration on aging and the centers for
27 14 Medicare and Medicaid services of the United States department
27 15 of health and human services, beyond the federal grant period
27 16 ending September 30, 2008.
27 17	Sec. 36.	PATIENT AUTONOMY IN HEALTH CARE DECISIONS PILOT
27 18 PROJECT.
27 19	1.	The department of public health shall establish a
27 20 two=year community coalition for patient treatment wishes
27 21 across the health care continuum pilot project, beginning July
27 22 1, 2008, and ending June 30, 2010, in a county with a
27 23 population of between fifty thousand and one hundred thousand.
27 24 The pilot project shall utilize the process based upon the
27 25 national physicians orders for life sustaining treatment
27 26 program initiative, including use of a standardized physician
27 27 order for scope of treatment form.	The process shall require
27 28 validation of the physician order for scope of treatment form
27 29 by the signature of an individual other than the patient or
27 30 the patient's legal representative who is not an employee of
27 31 the patient's physician.	The pilot project may include
27 32 applicability to chronically ill, frail, and elderly or
27 33 terminally ill individuals in hospitals licensed pursuant to
27 34 chapter 135B, nursing facilities or residential care
35 facilities licensed pursuant to chapter 135C, or hospice
1 programs as defined in section 135J.1.
28	2	2.	The department of public health shall convene an
28	3 advisory council, consisting of representatives of entities
28	4 with interest in the pilot project, including but not limited
28	5 to the Iowa hospital association, the Iowa medical society,
28	6 organizations representing health care facilities,
28	7 representatives of health care providers, and the Iowa trial
28	8 lawyers association, to develop recommendations for expanding
28	9 the pilot project statewide.	The advisory council shall
28 10 report its findings and recommendations, including
28 11 recommendations for legislation, to the governor and the
28 12 general assembly by January 1, 2010.
28 13	3.	The pilot project shall not alter the rights of
28 14 individuals who do not execute a physician order for scope of
28 15 treatment.
28 16	a.	If an individual is a qualified patient as defined in
28 17 section 144A.2, the individual's declaration executed under
28 18 chapter 144A shall control health care decision making for the
28 19 individual in accordance with chapter 144A.	A physician order

28 20 for scope of treatment shall not supersede a declaration
28 21 executed pursuant to chapter 144A.	If an individual has not
28 22 executed a declaration pursuant to chapter 144A, health care
28 23 decision making relating to life=sustaining procedures for the
28 24 individual shall be governed by section 144A.7.
28 25	b.	If an individual has executed a durable power of
28 26 attorney for health care pursuant to chapter 144B, the
28 27 individual's durable power of attorney for health care shall
28 28 control health care decision making for the individual in
28 29 accordance with chapter 144B.	A physician order for scope of
28 30 treatment shall not supersede a durable power of attorney for
28 31 health care executed pursuant to chapter 144B.
28 32	c.	In the absence of actual notice of the revocation of a
28 33 physician order for scope of treatment, a physician, health
28 34 care provider, or any other person who complies with a
35 physician order for scope of treatment shall not be subject to
1 liability, civil or criminal, for actions taken under this
29	2 section which are in accordance with reasonable medical
29	3 standards.	Any physician, health care provider, or other
29	4 person against whom criminal or civil liability is asserted
29	5 because of conduct in compliance with this section may
29	6 interpose the restriction on liability in this paragraph as an
29	7 absolute defense.
29	8	DIVISION VII
29	9	HEALTH CARE COVERAGE
29 10	Sec. 37.	NEW SECTION.	505.31	REIMBURSEMENT ACCOUNTS.
29 11	The commissioner of insurance shall assist employers with
29 12 twenty=five or fewer employees with implementing and
29 13 administering plans under section 125 of the Internal Revenue
29 14 Code, including medical expense reimbursement accounts and
29 15 dependent care accounts.	The commissioner shall provide
29 16 information about the assistance available to small employers
29 17 on the insurance division's internet site.
29 18	Sec. 38.	Section 509.3, Code 2007, is amended by adding
29 19 the following new subsection:
29 20	NEW SUBSECTION.	8.	A provision that the insurer will
29 21 permit continuation of existing coverage for an unmarried
29 22 child of an insured or enrollee who so elects, at least
29 23 through the policy anniversary date on or after the date the
29 24 child marries, ceases to be a resident of this state, or
29 25 attains the age of twenty=five years old, whichever occurs
29 26 first, or so long as the unmarried child maintains full=time
29 27 status as a student in an accredited institution of
29 28 postsecondary education.
29 29	Sec. 39.	NEW SECTION.	509A.13B	CONTINUATION OF DEPENDENT
29 30 COVERAGE.
29 31	If a governing body, a county board of supervisors, or a
29 32 city council has procured accident or health care coverage for
29 33 its employees under this chapter such coverage shall permit
29 34 continuation of existing coverage for an unmarried child of an
35 insured or enrollee who so elects, at least through the policy
1 anniversary date on or after the date the child marries,
30	2 ceases to be a resident of this state, or attains the age of
30	3 twenty=five years old, whichever occurs first, or so long as
30	4 the unmarried child maintains full=time status as a student in
30	5 an accredited institution of postsecondary education.
30	6	Sec. 40.	Section 513C.7, subsection 2, paragraph a, Code
30	7 2007, is amended to read as follows:
30	8	a.	The individual basic or standard health benefit plan
30	9 shall not deny, exclude, or limit benefits for a covered
30 10 individual for losses incurred more than twelve months
30 11 following the effective date of the individual's coverage due
30 12 to a preexisting condition.	A preexisting condition shall not
30 13 be defined more restrictively than any of the following:
30 14	(1)	a.	A condition that would cause an ordinarily prudent
30 15 person to seek medical advice, diagnosis, care, or treatment
30 16 during the twelve months immediately preceding the effective
30 17 date of coverage.
30 18	(2)	b.	A condition for which medical advice, diagnosis,
30 19 care, or treatment was recommended or received during the
30 20 twelve months immediately preceding the effective date of
30 21 coverage.
30 22	(3)	c.	A pregnancy existing on the effective date of
30 23 coverage.
30 24	Sec. 41.	Section 513C.7, subsection 2, paragraph b, Code
30 25 2007, is amended by striking the paragraph.
30 26	Sec. 42.	NEW SECTION.	514A.3B	ADDITIONAL REQUIREMENTS.
30 27	1.	An insurer which accepts an individual for coverage
30 28 under an individual policy or contract of accident and health
30 29 insurance shall waive any time period applicable to a
30 30 preexisting condition exclusion or limitation period

30 31 requirement of the policy or contract with respect to
30 32 particular services in an individual health benefit plan for
30 33 the period of time the individual was previously covered by
30 34 qualifying previous coverage as defined in section 513C.3 that
35 provided benefits with respect to such services, provided that
1 the qualifying previous coverage was continuous to a date not
31	2 more than sixty=three days prior to the effective date of the
31	3 new policy or contract.	Any days of coverage provided to an
31	4 individual pursuant to chapter 249A or 514I, or Medicare
31	5 coverage provided pursuant to Title XVIII of the federal
31	6 Social Security Act, do not constitute qualifying previous
31	7 coverage.	Such days of chapter 249A or 514I or Medicare
31	8 coverage shall be counted as part of the maximum
31	9 sixty=three=day grace period and shall not constitute a basis
31 10 for the waiver of any preexisting condition exclusion or
31 11 limitation period.
31 12	2.	An insurer issuing an individual policy or contract of
31 13 accident and health insurance which provides coverage for
31 14 children of the insured shall permit continuation of existing
31 15 coverage for an unmarried child of an insured or enrollee who
31 16 so elects, at least through the policy anniversary date on or
31 17 after the date the child marries, ceases to be a resident of
31 18 this state, or attains the age of twenty=five years old,
31 19 whichever occurs first, or so long as the unmarried child
31 20 maintains full=time status as a student in an accredited
31 21 institution of postsecondary education.
31 22	Sec. 43.	APPLICABILITY.	This division of this Act applies
31 23 to policies or contracts of accident and health insurance
31 24 delivered or issued for delivery or continued or renewed in
31 25 this state on or after July 1, 2008.
31 26	DIVISION VIII
31 27	MEDICAL HOME
31 28	DIVISION XXII
31 29	MEDICAL HOME
31 30	Sec. 44.	NEW SECTION.	135.157	DEFINITIONS.
31 31	As used in this chapter, unless the context otherwise
31 32 requires:
31 33	1.	"Board" means the state board of health created
31 34 pursuant to section 136.1.
35	2.	"Department" means the department of public health.
1	3.	"Health care professional" means a person who is
32	2 licensed, certified, or otherwise authorized or permitted by
32	3 the law of this state to administer health care in the
32	4 ordinary course of business or in the practice of a
32	5 profession.
32	6	4.	"Medical home" means a team approach to providing
32	7 health care that originates in a primary care setting; fosters
32	8 a partnership among the patient, the personal provider, and
32	9 other health care professionals, and where appropriate, the
32 10 patient's family; utilizes the partnership to access all
32 11 medical and nonmedical health=related services needed by the
32 12 patient and the patient's family to achieve maximum health
32 13 potential; maintains a centralized, comprehensive record of
32 14 all health=related services to promote continuity of care; and
32 15 has all of the characteristics specified in section 135.158.
32 16	5.	"National committee for quality assurance" means the
32 17 nationally recognized, independent nonprofit organization that
32 18 measures the quality and performance of health care and health
32 19 care plans in the United States; provides accreditation,
32 20 certification, and recognition programs for health care plans
32 21 and programs; and is recognized in Iowa as an accrediting
32 22 organization for commercial and Medicaid=managed care
32 23 organizations.
32 24	6.	"Personal provider" means the patient's first point of
32 25 contact in the health care system with a primary care provider
32 26 who identifies the patient's health needs, and, working with a
32 27 team of health care professionals, provides for and
32 28 coordinates appropriate care to address the health needs
32 29 identified.
32 30	7.	"Primary care" means health care which emphasizes
32 31 providing for a patient's general health needs and utilizes
32 32 collaboration with other health care professionals and
32 33 consultation or referral as appropriate to meet the needs
32 34 identified.
35	8.	"Primary care provider" means any of the following who
1 provide primary care and meet certification standards:
33	2	a.	A physician who is a family or general practitioner, a
33	3 pediatrician, an internist, an obstetrician, or a
33	4 gynecologist.
33	5	b.	An advanced registered nurse practitioner.
33	6	c.	A physician assistant.

33	7	d.	A chiropractor licensed pursuant to chapter 151.
33	8	Sec. 45.	NEW SECTION.	135.158	MEDICAL HOME PURPOSES ==
33	9 CHARACTERISTICS.
33 10	1.	The purposes of a medical home are the following:
33 11	a.	To reduce disparities in health care access, delivery,
33 12 and health care outcomes.
33 13	b.	To improve quality of health care and lower health care
33 14 costs, thereby creating savings to allow more Iowans to have
33 15 health care coverage and to provide for the sustainability of
33 16 the health care system.
33 17	c.	To provide a tangible method to document if each Iowan
33 18 has access to health care.
33 19	2.	A medical home has all of the following
33 20 characteristics:
33 21	a.	A personal provider.	Each patient has an ongoing
33 22 relationship with a personal provider trained to provide first
33 23 contact and continuous and comprehensive care.
33 24	b.	A provider=directed medical practice.	The personal
33 25 provider leads a team of individuals at the practice level who
33 26 collectively take responsibility for the ongoing health care
33 27 of patients.
33 28	c.	Whole person orientation.	The personal provider is
33 29 responsible for providing for all of a patient's health care
33 30 needs or taking responsibility for appropriately arranging
33 31 health care by other qualified health care professionals.
33 32 This responsibility includes health care at all stages of life
33 33 including provision of acute care, chronic care, preventive
33 34 services, and end=of=life care.
35	d.	Coordination and integration of care.	Care is
1 coordinated and integrated across all elements of the complex
34	2 health care system and the patient's community.	Care is
34	3 facilitated by registries, information technology, health
34	4 information exchanges, and other means to assure that patients
34	5 receive the indicated care when and where they need and want
34	6 the care in a culturally and linguistically appropriate
34	7 manner.
34	8	e.	Quality and safety.	The following are quality and
34	9 safety components of the medical home:
34 10	(1)	Provider=directed medical practices advocate for their
34 11 patients to support the attainment of optimal,
34 12 patient=centered outcomes that are defined by a care planning
34 13 process driven by a compassionate, robust partnership between
34 14 providers, the patient, and the patient's family.
34 15	(2)	Evidence=based medicine and clinical decision=support
34 16 tools guide decision making.
34 17	(3)	Providers in the medical practice accept
34 18 accountability for continuous quality improvement through
34 19 voluntary engagement in performance measurement and
34 20 improvement.
34 21	(4)	Patients actively participate in decision making and
34 22 feedback is sought to ensure that the patients' expectations
34 23 are being met.
34 24	(5)	Information technology is utilized appropriately to
34 25 support optimal patient care, performance measurement, patient
34 26 education, and enhanced communication.
34 27	(6)	Practices participate in a voluntary recognition
34 28 process conducted by an appropriate nongovernmental entity to
34 29 demonstrate that the practice has the capabilities to provide
34 30 patient=centered services consistent with the medical home
34 31 model.
34 32	(7)	Patients and families participate in quality
34 33 improvement activities at the practice level.
34 34	f.	Enhanced access to health care.	Enhanced access to
35 health care is available through systems such as open
1 scheduling, expanded hours, and new options for communication
35	2 between the patient, the patient's personal provider, and
35	3 practice staff.
35	4	g.	Payment.	The payment system appropriately recognizes
35	5 the added value provided to patients who have a
35	6 patient=centered medical home.	The payment structure
35	7 framework of the medical home provides all of the following:
35	8	(1)	Reflects the value of provider and nonprovider staff
35	9 and patient=centered care management work that is in addition
35 10 to the face=to=face visit.
35 11	(2)	Pays for services associated with coordination of
35 12 health care both within a given practice and between
35 13 consultants, ancillary providers, and community resources.
35 14	(3)	Supports adoption and use of health information
35 15 technology for quality improvement.
35 16	(4)	Supports provision of enhanced communication access
35 17 such as secure electronic mail and telephone consultation.

35 18	(5)	Recognizes the value of provider work associated with
35 19 remote monitoring of clinical data using technology.
35 20	(6)	Allows for separate fee=for=service payments for
35 21 face=to=face visits.	Payments for health care management
35 22 services that are in addition to the face=to=face visit do not
35 23 result in a reduction in the payments for face=to=face visits.
35 24	(7)	Recognizes case mix differences in the patient
35 25 population being treated within the practice.
35 26	(8)	Allows providers to share in savings from reduced
35 27 hospitalizations associated with provider=guided health care
35 28 management in the office setting.
35 29	(9)	Allows for additional payments for achieving
35 30 measurable and continuous quality improvements.
35 31	Sec. 46.	NEW SECTION.	135.159	MEDICAL HOME SYSTEM ==
35 32 ADVISORY COUNCIL == DEVELOPMENT AND IMPLEMENTATION.
35 33	1.	The department shall administer the medical home
35 34 system.	The department shall adopt rules pursuant to chapter
35 17A necessary to administer the medical home system.
1	2.	a.	The department shall establish an advisory council
36	2 which shall include but is not limited to all of the following
36	3 members, selected by their respective organizations, and any
36	4 other members the department determines necessary to assist in
36	5 the department's duties at various stages of development of
36	6 the medical home system:
36	7	(1)	The director of human services, or the director's
36	8 designee.
36	9	(2)	The commissioner of insurance, or the commissioner's
36 10 designee.
36 11	(3)	A representative of the federation of Iowa insurers.
36 12	(4)	A representative of the Iowa dental association.
36 13	(5)	A representative of the Iowa nurses association.
36 14	(6)	A physician licensed pursuant to chapter 148 and a
36 15 physician licensed pursuant to chapter 150 who are family
36 16 physicians and members of the Iowa academy of family
36 17 physicians.
36 18	(7)	A health care consumer.
36 19	(8)	A representative of the Iowa collaborative safety net
36 20 provider network established pursuant to section 135.153.
36 21	(9)	A representative of the governor's developmental
36 22 disabilities council.
36 23	(10)	A representative of the Iowa chapter of the American
36 24 academy of pediatrics.
36 25	(11)	A representative of the child and family policy
36 26 center.
36 27	(12)	A representative of the Iowa pharmacy association.
36 28	(13)	A representative of the Iowa chiropractic society.
36 29	(14)	A representative of the university of Iowa college of
36 30 public health.
36 31	b.	Public members of the advisory council shall receive
36 32 reimbursement for actual expenses incurred while serving in
36 33 their official capacity only if they are not eligible for
36 34 reimbursement by the organization that they represent.
35	3.	The department shall develop a plan for implementation
1 of a statewide medical home system.	The department, in
37	2 collaboration with parents, schools, communities, health
37	3 plans, and providers, shall endeavor to increase healthy
37	4 outcomes for children and adults by linking the children and
37	5 adults with a medical home, identifying health improvement
37	6 goals for children and adults, and linking reimbursement
37	7 strategies to increasing healthy outcomes for children and
37	8 adults.	The plan shall provide that the medical home system
37	9 shall do all of the following:
37 10	a.	Coordinate and provide access to evidence=based health
37 11 care services, emphasizing convenient, comprehensive primary
37 12 care and including preventive, screening, and well=child
37 13 health services.
37 14	b.	Provide access to appropriate specialty care and
37 15 inpatient services.
37 16	c.	Provide quality=driven and cost=effective health care.
37 17	d.	Provide access to pharmacist=delivered medication
37 18 reconciliation and medication therapy management services,
37 19 where appropriate.
37 20	e.	Promote strong and effective medical management
37 21 including but not limited to planning treatment strategies,
37 22 monitoring health outcomes and resource use, sharing
37 23 information, and organizing care to avoid duplication of
37 24 service.	The plan shall provide that in sharing information,
37 25 the priority shall be the protection of the privacy of
37 26 individuals and the security and confidentiality of the
37 27 individual's information.	Any sharing of information required
37 28 by the medical home system shall comply and be consistent with

37 29 all existing state and federal laws and regulations relating
37 30 to the confidentiality of health care information and shall be
37 31 subject to written consent of the patient.
37 32	f.	Emphasize patient and provider accountability.
37 33	g.	Prioritize local access to the continuum of health care
37 34 services in the most appropriate setting.
35	h.	Establish a baseline for medical home goals and
1 establish performance measures that indicate a child or adult
38	2 has an established and effective medical home.	For children,
38	3 these goals and performance measures may include but are not
38	4 limited to childhood immunizations rates, well=child care
38	5 utilization rates, care management for children with chronic
38	6 illnesses, emergency room utilization, and oral health service
38	7 utilization.
38	8	i.	For children, coordinate with and integrate guidelines,
38	9 data, and information from existing newborn and child health
38 10 programs and entities, including but not limited to the
38 11 healthy opportunities to experience, success=healthy families
38 12 Iowa program, the community empowerment program, the center
38 13 for congenital and inherited disorders screening and health
38 14 care programs, standards of care for pediatric health
38 15 guidelines, the office of multicultural health established in
38 16 section 135.12, the oral health bureau established in section
38 17 135.15, and other similar programs and services.
38 18	4.	The department shall develop an organizational
38 19 structure for the medical home system in this state.	The
38 20 organizational structure plan shall integrate existing
38 21 resources, provide a strategy to coordinate health care
38 22 services, provide for monitoring and data collection on
38 23 medical homes, provide for training and education to health
38 24 care professionals and families, and provide for transition of
38 25 children to the adult medical care system.	The organizational
38 26 structure may be based on collaborative teams of stakeholders
38 27 throughout the state such as local public health agencies, the
38 28 collaborative safety net provider network established in
38 29 section 135.153, or a combination of statewide organizations.
38 30 Care coordination may be provided through regional offices or
38 31 through individual provider practices.	The organizational
38 32 structure may also include the use of telemedicine resources,
38 33 and may provide for partnering with pediatric and family
38 34 practice residency programs to improve access to preventive
35 care for children.	The organizational structure shall also
1 address the need to organize and provide health care to
39	2 increase accessibility for patients including using venues
39	3 more accessible to patients and having hours of operation that
39	4 are conducive to the population served.
39	5	5.	The department shall adopt standards and a process to
39	6 certify medical homes based on the national committee for
39	7 quality assurance standards.	The certification process and
39	8 standards shall provide mechanisms to monitor performance and
39	9 to evaluate, promote, and improve the quality of health of and
39 10 health care delivered to patients through a medical home.	The
39 11 mechanism shall require participating providers to monitor
39 12 clinical progress and performance in meeting applicable
39 13 standards and to provide information in a form and manner
39 14 specified by the department.	The evaluation mechanism shall
39 15 be developed with input from consumers, providers, and payers.
39 16 At a minimum the evaluation shall determine any increased
39 17 quality in health care provided and any decrease in cost
39 18 resulting from the medical home system compared with other
39 19 health care delivery systems.	The standards and process shall
39 20 also include a mechanism for other ancillary service providers
39 21 to become affiliated with a certified medical home.
39 22	6.	The department shall adopt education and training
39 23 standards for health care professionals participating in the
39 24 medical home system.
39 25	7.	The department shall provide for system simplification
39 26 through the use of universal referral forms, internet=based
39 27 tools for providers, and a central medical home internet site
39 28 for providers.
39 29	8.	The department shall recommend a reimbursement
39 30 methodology and incentives for participation in the medical
39 31 home system to ensure that providers enter and remain
39 32 participating in the system.	In developing the
39 33 recommendations for incentives, the department shall consider,
39 34 at a minimum, providing incentives to promote wellness,
35 prevention, chronic care management, immunizations, health
1 care management, and the use of electronic health records.	In
40	2 developing the recommendations for the reimbursement system,
40	3 the department shall analyze, at a minimum, the feasibility of
40	4 all of the following:

40	5	a.	Reimbursement under the medical assistance program to
40	6 promote wellness and prevention, provide care coordination,
40	7 and provide chronic care management.
40	8	b.	Increasing reimbursement to Medicare levels for certain
40	9 wellness and prevention services, chronic care management, and
40 10 immunizations.
40 11	c.	Providing reimbursement for primary care services by
40 12 addressing the disparities between reimbursement for specialty
40 13 services and primary care services.
40 14	d.	Increased funding for efforts to transform medical
40 15 practices into certified medical homes, including emphasizing
40 16 the implementation of the use of electronic health records.
40 17	e.	Targeted reimbursement to providers linked to health
40 18 care quality improvement measures established by the
40 19 department.
40 20	f.	Reimbursement for specified ancillary support services
40 21 such as transportation for medical appointments and other such
40 22 services.
40 23	g.	Providing reimbursement for medication reconciliation
40 24 and medication therapy management service, where appropriate.
40 25	9.	The department shall coordinate the requirements and
40 26 activities of the medical home system with the requirements
40 27 and activities of the dental home for children as described in
40 28 section 249J.14, subsection 7, and shall recommend financial
40 29 incentives for dentists and nondental providers to promote
40 30 oral health care coordination through preventive dental
40 31 intervention, early identification of oral disease risk,
40 32 health care coordination and data tracking, treatment, chronic
40 33 care management, education and training, parental guidance,
40 34 and oral health promotions for children.
35	10.	The department shall integrate the recommendations and
1 policies developed by the prevention and chronic care
41	2 management advisory council into the medical home system.
41	3	11.	Implementation phases.
41	4	a.	Initial implementation shall require participation in
41	5 the medical home system of children who are recipients of full
41	6 benefits under the medical assistance program.	The department
41	7 shall work with the department of human services and shall
41	8 recommend to the general assembly a reimbursement methodology
41	9 to compensate providers participating under the medical
41 10 assistance program for participation in the medical home
41 11 system.
41 12	b.	The department shall work with the department of human
41 13 services to expand the medical home system to adults who are
41 14 recipients of full benefits under the medical assistance
41 15 program and the expansion population under the IowaCare
41 16 program.	The department shall work with the centers for
41 17 Medicare and Medicaid services of the United States department
41 18 of health and human services to allow Medicare recipients to
41 19 utilize the medical home system.
41 20	c.	The department shall work with the department of
41 21 administrative services to allow state employees to utilize
41 22 the medical home system.
41 23	d.	The department shall work with insurers and
41 24 self=insured companies, if requested, to make the medical home
41 25 system available to individuals with private health care
41 26 coverage.
41 27	12.	The department shall provide oversight for all
41 28 certified medical homes.	The department shall review the
41 29 progress of the medical home system and recommend improvements
41 30 to the system, as necessary.
41 31	13.	The department shall annually evaluate the medical
41 32 home system and make recommendations to the governor and the
41 33 general assembly regarding improvements to and continuation of
41 34 the system.
35	14.	Recommendations and other activities resulting from
1 the duties authorized for the department under this section
42	2 shall require approval by the board prior to any subsequent
42	3 action or implementation.
42	4	Sec. 47.	Section 136.3, Code 2007, is amended by adding
42	5 the following new subsection:
42	6	NEW SUBSECTION.	12.	Perform those duties authorized
42	7 pursuant to section 135.159.
42	8	Sec. 48.	Section 249J.14, subsection 7, Code 2007, is
42	9 amended to read as follows:
42 10	7.	DENTAL HOME FOR CHILDREN.	By July 1, 2008 December 31,
 42 11 2010, every recipient of medical assistance who is a child
42 12 twelve years of age or younger shall have a designated dental
42 13 home and shall be provided with the dental screenings, and
42 14 preventive care identified in the oral health standards
42 15 services, diagnostic services, treatment services, and

 42 16 emergency services as defined under the early and periodic
42 17 screening, diagnostic, and treatment program.
42 18	Sec. 49.	MEDICAL HOME SYSTEM == APPROPRIATION.	There is
42 19 appropriated from the general fund of the state to the
42 20 department of public health for the fiscal year beginning July
42 21 1, 2008, and ending June 30, 2009, the following amount, or so
42 22 much thereof as is necessary, for the purpose designated:
42 23	For activities associated with the medical home system
42 24 requirements of this division and for not more than the
42 25 following full=time equivalent positions:
42 26 .................................................. $	165,600
42 27 ............................................... FTEs	4.00
42 28	DIVISION IX
42 29	PREVENTION AND CHRONIC CARE MANAGEMENT
42 30	DIVISION XXIII
42 31	PREVENTION AND CHRONIC CARE MANAGEMENT
42 32	Sec. 50.	NEW SECTION.	135.160	DEFINITIONS.
42 33	For the purpose of this division, unless the context
42 34 otherwise requires:
35	1.	"Board" means the state board of health created
1 pursuant to section 136.1.
43	2	2.	"Chronic care" means health care services provided by a
43	3 health care professional for an established clinical condition
43	4 that is expected to last a year or more and that requires
43	5 ongoing clinical management attempting to restore the
43	6 individual to highest function, minimize the negative effects
43	7 of the chronic condition, and prevent complications related to
43	8 the chronic condition.
43	9	3.	"Chronic care information system" means approved
43 10 information technology to enhance the development and
43 11 communication of information to be used in providing chronic
43 12 care, including clinical, social, and economic outcomes of
43 13 chronic care.
43 14	4.	"Chronic care management" means a system of coordinated
43 15 health care interventions and communications for individuals
43 16 with chronic conditions, including significant patient
43 17 self=care efforts, systemic supports for the health care
43 18 professional and patient relationship, and a chronic care plan
43 19 emphasizing prevention of complications utilizing
43 20 evidence=based practice guidelines, patient empowerment
43 21 strategies, and evaluation of clinical, humanistic, and
43 22 economic outcomes on an ongoing basis with the goal of
43 23 improving overall health.
43 24	5.	"Chronic care plan" means a plan of care between an
43 25 individual and the individual's principal health care
43 26 professional that emphasizes prevention of complications
43 27 through patient empowerment including but not limited to
43 28 providing incentives to engage the patient in the patient's
43 29 own care and in clinical, social, or other interventions
43 30 designed to minimize the negative effects of the chronic
43 31 condition.
43 32	6.	"Chronic care resources" means health care
43 33 professionals, advocacy groups, health departments, schools of
43 34 public health and medicine, health plans, and others with
35 expertise in public health, health care delivery, health care
1 financing, and health care research.
44	2	7.	"Chronic condition" means an established clinical
44	3 condition that is expected to last a year or more and that
44	4 requires ongoing clinical management.
44	5	8.	"Department" means the department of public health.
44	6	9.	"Director" means the director of public health.
44	7	10.	"Eligible individual" means a resident of this state
44	8 who has been diagnosed with a chronic condition or is at an
44	9 elevated risk for a chronic condition and who is a recipient
44 10 of medical assistance, is a member of the expansion population
44 11 pursuant to chapter 249J, or is an inmate of a correctional
44 12 institution in this state.
44 13	11.	"Health care professional" means health care
44 14 professional as defined in section 135.157.
44 15	12.	"Health risk assessment" means screening by a health
44 16 care professional for the purpose of assessing an individual's
44 17 health, including tests or physical examinations and a survey
44 18 or other tool used to gather information about an individual's
44 19 health, medical history, and health risk factors during a
44 20 health screening.
44 21	Sec. 51.	NEW SECTION.	135.161	PREVENTION AND CHRONIC
44 22 CARE MANAGEMENT INITIATIVE == ADVISORY COUNCIL.
44 23	1.	The director, in collaboration with the prevention and
44 24 chronic care management advisory council, shall develop a
44 25 state initiative for prevention and chronic care management.
44 26 The state initiative consists of the state's plan for

44 27 developing a chronic care organizational structure for
44 28 prevention and chronic care management, including coordinating
44 29 the efforts of health care professionals and chronic care
44 30 resources to promote the health of residents and the
44 31 prevention and management of chronic conditions, developing
44 32 and implementing arrangements for delivering prevention
44 33 services and chronic care management, developing significant
44 34 patient self=care efforts, providing systemic support for the
35 health care professional=patient relationship and options for
1 channeling chronic care resources and support to health care
45	2 professionals, providing for community development and
45	3 outreach and education efforts, and coordinating information
45	4 technology initiatives with the chronic care information
45	5 system.
45	6	2.	The director may accept grants and donations and shall
45	7 apply for any federal, state, or private grants available to
45	8 fund the initiative.	Any grants or donations received shall
45	9 be placed in a separate fund in the state treasury and used
45 10 exclusively for the initiative or as federal law directs.
45 11	3.	a.	The director shall establish and convene an
45 12 advisory council to provide technical assistance to the
45 13 director in developing a state initiative that integrates
45 14 evidence=based prevention and chronic care management
45 15 strategies into the public and private health care systems,
45 16 including the medical home system.	Public members of the
45 17 advisory council shall receive their actual and necessary
45 18 expenses incurred in the performance of their duties and may
45 19 be eligible to receive compensation as provided in section 45 20 7E.6.
45 21	b.	The advisory council shall elicit input from a variety
45 22 of health care professionals, health care professional
45 23 organizations, community and nonprofit groups, insurers,
45 24 consumers, businesses, school districts, and state and local
45 25 governments in developing the advisory council's
45 26 recommendations.
45 27	c.	The advisory council shall submit initial
45 28 recommendations to the director for the state initiative for
45 29 prevention and chronic care management no later than July 1,
45 30 2009.	The recommendations shall address all of the following:
45 31	(1)	The recommended organizational structure for
45 32 integrating prevention and chronic care management into the
45 33 private and public health care systems.	The organizational
45 34 structure recommended shall align with the organizational
35 structure established for the medical home system developed
1 pursuant to division XXII.	The advisory council shall also
46	2 review existing prevention and chronic care management
46	3 strategies used in the health insurance market and in private
46	4 and public programs and recommend ways to expand the use of
46	5 such strategies throughout the health insurance market and in
46	6 the private and public health care systems.
46	7	(2)	A process for identifying leading health care
46	8 professionals and existing prevention and chronic care
46	9 management programs in the state, and coordinating care among
46 10 these health care professionals and programs.
46 11	(3)	A prioritization of the chronic conditions for which
46 12 prevention and chronic care management services should be
46 13 provided, taking into consideration the prevalence of specific
46 14 chronic conditions and the factors that may lead to the
46 15 development of chronic conditions; the fiscal impact to state
46 16 health care programs of providing care for the chronic
46 17 conditions of eligible individuals; the availability of
46 18 workable, evidence=based approaches to chronic care for the
46 19 chronic condition; and public input into the selection
46 20 process.	The advisory council shall initially develop
46 21 consensus guidelines to address the two chronic conditions
46 22 identified as having the highest priority and shall also
46 23 specify a timeline for inclusion of additional specific
46 24 chronic conditions in the initiative.
46 25	(4)	A method to involve health care professionals in
46 26 identifying eligible patients for prevention and chronic care
46 27 management services, which includes but is not limited to the
46 28 use of a health risk assessment.
46 29	(5)	The methods for increasing communication between
46 30 health care professionals and patients, including patient
46 31 education, patient self=management, and patient follow=up
46 32 plans.
46 33	(6)	The educational, wellness, and clinical management
46 34 protocols and tools to be used by health care professionals,
35 including management guideline materials for health care
1 delivery.
47	2	(7)	The use and development of process and outcome

47	3 measures and benchmarks, aligned to the greatest extent
47	4 possible with existing measures and benchmarks such as the
47	5 best in class estimates utilized in the national healthcare
47	6 quality report of the agency for health care research and
47	7 quality of the United States department of health and human
47	8 services, to provide performance feedback for health care
47	9 professionals and information on the quality of health care,
47 10 including patient satisfaction and health status outcomes.
47 11	(8)	Payment methodologies to align reimbursements and
47 12 create financial incentives and rewards for health care
47 13 professionals to utilize prevention services, establish
47 14 management systems for chronic conditions, improve health
47 15 outcomes, and improve the quality of health care, including
47 16 case management fees, payment for technical support and data
47 17 entry associated with patient registries, and the cost of
47 18 staff coordination within a medical practice.
47 19	(9)	Methods to involve public and private groups, health
47 20 care professionals, insurers, third=party administrators,
47 21 associations, community and consumer groups, and other
47 22 entities to facilitate and sustain the initiative.
47 23	(10)	Alignment of any chronic care information system or
47 24 other information technology needs with other health care
47 25 information technology initiatives.
47 26	(11)	Involvement of appropriate health resources and
47 27 public health and outcomes researchers to develop and
47 28 implement a sound basis for collecting data and evaluating the
47 29 clinical, social, and economic impact of the initiative,
47 30 including a determination of the impact on expenditures and
47 31 prevalence and control of chronic conditions.
47 32	(12)	Elements of a marketing campaign that provides for
47 33 public outreach and consumer education in promoting prevention
47 34 and chronic care management strategies among health care
35 professionals, health insurers, and the public.
1	(13)	A method to periodically determine the percentage of
48	2 health care professionals who are participating, the success
48	3 of the empowerment=of=patients approach, and any results of
48	4 health outcomes of the patients participating.
48	5	(14)	A means of collaborating with the health professional
48	6 licensing boards pursuant to chapter 147 to review prevention
48	7 and chronic care management education provided to licensees,
48	8 as appropriate, and recommendations regarding education
48	9 resources and curricula for integration into existing and new
48 10 education and training programs.
48 11	4.	Following submission of initial recommendations to the
48 12 director for the state initiative for prevention and chronic
48 13 care management by the advisory council, the director shall
48 14 submit the state initiative to the board for approval.
48 15 Subject to approval of the state initiative by the board, the
48 16 department shall initially implement the state initiative
48 17 among the population of eligible individuals.	Following
48 18 initial implementation, the director shall work with the
48 19 department of human services, insurers, health care
48 20 professional organizations, and consumers in implementing the
48 21 initiative beyond the population of eligible individuals as an
48 22 integral part of the health care delivery system in the state.
48 23 The advisory council shall continue to review and make
48 24 recommendations to the director regarding improvements to the
48 25 initiative.	Any recommendations are subject to approval by
48 26 the board.
48 27	Sec. 52.	NEW SECTION.	135.162	CLINICIANS ADVISORY PANEL.
48 28	1.	The director shall convene a clinicians advisory panel
48 29 to advise and recommend to the department clinically
48 30 appropriate, evidence=based best practices regarding the
48 31 implementation of the medical home as defined in section
48 32 135.157 and the prevention and chronic care management
48 33 initiative pursuant to section 135.161.	The director shall
48 34 act as chairperson of the advisory panel.
35	2.	The clinicians advisory panel shall consist of nine
1 members representing licensed medical health care providers
49	2 selected by their respective professional organizations.
49	3 Terms of members shall begin and end as provided in section
49	4 69.19.	Any vacancy shall be filled in the same manner as
49	5 regular appointments are made for the unexpired portion of the
49	6 regular term.	Members shall serve terms of three years.	A
49	7 member is eligible for reappointment for three successive
49	8 terms.
49	9	3.	The clinicians advisory panel shall meet on a quarterly
49 10 basis to receive updates from the director regarding strategic
49 11 planning and implementation progress on the medical home and
49 12 the prevention and chronic care management initiative and
49 13 shall provide clinical consultation to the department

49 14 regarding the medical home and the initiative.
49 15	Sec. 53.	Section 136.3, Code 2007, is amended by adding
49 16 the following new subsection:
49 17	NEW SUBSECTION.	13.	Perform those duties authorized
49 18 pursuant to section 135.161.
49 19	Sec. 54.	PREVENTION AND CHRONIC CARE MANAGEMENT ==
49 20 APPROPRIATION.	There is appropriated from the general fund of
49 21 the state to the department of public health for the fiscal
49 22 year beginning July 1, 2008, and ending June 30, 2009, the
49 23 following amount, or so much thereof as is necessary, for the
49 24 purpose designated:
49 25	For activities associated with the prevention and chronic
49 26 care management requirements of this division:
49 27 .................................................. $	190,500
49 28	DIVISION X
49 29	FAMILY OPPORTUNITY ACT
49 30	Sec. 55.	2007 Iowa Acts, chapter 218, section 126,
49 31 subsection 1, is amended to read as follows:
49 32	1.	The provision in this division of this Act relating to
49 33 eligibility for certain persons with disabilities under the
34 medical assistance program shall only be implemented if the
 49 35 department of human services determines that funding is
 50  1 available in appropriations made in this Act, in combination
 50  2 with federal allocations to the state, for the state
 50  3 children's health insurance program, in excess of the amount
 50  4 needed to cover the current and projected enrollment under the
 50  5 state children's health insurance program beginning January 1,

 50  6 2009.

If such a determination is made, the department of

 50  7 human services shall transfer funding from the appropriations
 50  8 made in this Act for the state children's health insurance
 50  9 program, not otherwise required for that program, to the
 50 10 appropriations made in this Act for medical assistance, as
 50 11 necessary, to implement such provision of this division of
 50 12 this Act.
13	DIVISION XI
50 14	MEDICAL ASSISTANCE QUALITY IMPROVEMENT
50 15	Sec. 56.	NEW SECTION.	249A.36	MEDICAL ASSISTANCE QUALITY
50 16 IMPROVEMENT COUNCIL.
50 17	1.	A medical assistance quality improvement council is
50 18 established.	The council shall evaluate the clinical outcomes
50 19 and satisfaction of consumers and providers with the medical
50 20 assistance program.	The council shall coordinate efforts with
50 21 the cost and quality performance evaluation completed pursuant
50 22 to section 249J.16.
50 23	2.	a.	The council shall consist of seven voting members
50 24 appointed by the majority leader of the senate, the minority
50 25 leader of the senate, the speaker of the house, and the
50 26 minority leader of the house of representatives.	At least one
50 27 member of the council shall be a consumer and at least one
50 28 member shall be a medical assistance program provider.	An
50 29 individual who is employed by a private or nonprofit
50 30 organization that receives one million dollars or more in
50 31 compensation or reimbursement from the department, annually,
50 32 is not eligible for appointment to the council.	The members
50 33 shall serve terms of two years beginning and ending as
50 34 provided in section 69.19, and appointments shall comply with
35 sections 69.16 and 69.16A.	Members shall receive
1 reimbursement for actual expenses incurred while serving in
51	2 their official capacity and may also be eligible to receive
51	3 compensation as provided in section 7E.6.	Vacancies shall be
51	4 filled by the original appointing authority and in the manner
51	5 of the original appointment.	A person appointed to fill a
51	6 vacancy shall serve only for the unexpired portion of the
51	7 term.
51	8	b.	The members shall select a chairperson, annually, from
51	9 among the membership.	The council shall meet at least
51 10 quarterly and at the call of the chairperson.	A majority of
51 11 the members of the council constitutes a quorum.	Any action
51 12 taken by the council must be adopted by the affirmative vote
51 13 of a majority of its voting membership.
51 14	c.	The department shall provide administrative support and
51 15 necessary supplies and equipment for the council.
51 16	3.	The council shall consult with and advise the Iowa
51 17 Medicaid enterprise in establishing a quality assessment and
51 18 improvement process.
51 19	a.	The process shall be consistent with the health plan
51 20 employer data and information set developed by the national
51 21 committee for quality assurance and with the consumer
51 22 assessment of health care providers and systems developed by
51 23 the agency for health care research and quality of the United
51 24 States department of health and human services.	The council

51 25 shall also coordinate efforts with the Iowa healthcare
51 26 collaborative and the state's Medicare quality improvement
51 27 organization to create consistent quality measures.
51 28	b.	The process may utilize as a basis the medical
51 29 assistance and state children's health insurance quality
51 30 improvement efforts of the centers for Medicare and Medicaid
51 31 services of the United States department of health and human
51 32 services.
51 33	c.	The process shall include assessment and evaluation of
51 34 both managed care and fee=for=service programs, and shall be
35 applicable to services provided to adults and children.
1	d.	The initial process shall be developed and implemented
52	2 by December 31, 2008, with the initial report of results to be
52	3 made available to the public by June 30, 2009.	Following the
52	4 initial report, the council shall submit a report of results
52	5 to the governor and the general assembly, annually, in
52	6 January.
52	7	DIVISION XII
52	8	HEALTH AND LONG=TERM CARE ACCESS
52	9	DIVISION XXIV
52 10	Sec. 57.	NEW SECTION.	135.163	HEALTH AND LONG=TERM CARE
52 11 ACCESS.
52 12	The department shall coordinate public and private efforts
52 13 to develop and maintain an appropriate health care delivery
52 14 infrastructure and a stable, well=qualified, diverse, and
52 15 sustainable health care workforce in this state.	The health
52 16 care delivery infrastructure and the health care workforce
52 17 shall address the broad spectrum of health care needs of
52 18 Iowans throughout their lifespan including long=term care
52 19 needs.	The department shall, at a minimum, do all of the
52 20 following:
52 21	1.	Develop a strategic plan for health care delivery
52 22 infrastructure and health care workforce resources in this
52 23 state.
52 24	2.	Provide for the continuous collection of data to
52 25 provide a basis for health care strategic planning and health
52 26 care policymaking.
52 27	3.	Make recommendations regarding the health care delivery
52 28 infrastructure and the health care workforce that assist in
52 29 monitoring current needs, predicting future trends, and
52 30 informing policymaking.
52 31	Sec. 58.	NEW SECTION.	135.164	STRATEGIC PLAN.
52 32	1.	The strategic plan for health care delivery
52 33 infrastructure and health care workforce resources shall
52 34 describe the existing health care system, describe and provide
35 a rationale for the desired health care system, provide an
1 action plan for implementation, and provide methods to
53	2 evaluate the system.	The plan shall incorporate expenditure
53	3 control methods and integrate criteria for evidence=based
53	4 health care.	The department shall do all of the following in
53	5 developing the strategic plan for health care delivery
53	6 infrastructure and health care workforce resources:
53	7	a.	Conduct strategic health planning activities related to
53	8 preparation of the strategic plan.
53	9	b.	Develop a computerized system for accessing, analyzing,
53 10 and disseminating data relevant to strategic health planning.
53 11 The department may enter into data sharing agreements and
53 12 contractual arrangements necessary to obtain or disseminate
53 13 relevant data.
53 14	c.	Conduct research and analysis or arrange for research
53 15 and analysis projects to be conducted by public or private
53 16 organizations to further the development of the strategic
53 17 plan.
53 18	d.	Establish a technical advisory committee to assist in
53 19 the development of the strategic plan.	The members of the
53 20 committee may include but are not limited to health
53 21 economists, representatives of the university of Iowa college
53 22 of public health, health planners, representatives of health
53 23 care purchasers, representatives of state and local agencies
53 24 that regulate entities involved in health care,
53 25 representatives of health care providers and health care
53 26 facilities, and consumers.
53 27	2.	The strategic plan shall include statewide health
53 28 planning policies and goals related to the availability of
53 29 health care facilities and services, the quality of care, and
53 30 the cost of care.	The policies and goals shall be based on
53 31 the following principles:
53 32	a.	That a strategic health planning process, responsive to
53 33 changing health and social needs and conditions, is essential
53 34 to the health, safety, and welfare of Iowans.	The process
35 shall be reviewed and updated as necessary to ensure that the

1 strategic plan addresses all of the following:
54	2	(1)	Promoting and maintaining the health of all Iowans.
54	3	(2)	Providing accessible health care services through the
54	4 maintenance of an adequate supply of health facilities and an
54	5 adequate workforce.
54	6	(3)	Controlling excessive increases in costs.
54	7	(4)	Applying specific quality criteria and population
54	8 health indicators.
54	9	(5)	Recognizing prevention and wellness as priorities in
54 10 health care programs to improve quality and reduce costs.
54 11	(6)	Addressing periodic priority issues including disaster
54 12 planning, public health threats, and public safety dilemmas.
54 13	(7)	Coordinating health care delivery and resource
54 14 development efforts among state agencies including those
54 15 tasked with facility, services, and professional provider
54 16 licensure; state and federal reimbursement; health service
54 17 utilization data systems; and others.
54 18	(8)	Recognizing long=term care as an integral component of
54 19 the health care delivery infrastructure and as an essential
54 20 service provided by the health care workforce.
54 21	b.	That both consumers and providers throughout the state
54 22 must be involved in the health planning process, outcomes of
54 23 which shall be clearly articulated and available for public
54 24 review and use.
54 25	c.	That the supply of a health care service has a
54 26 substantial impact on utilization of the service, independent
54 27 of the effectiveness, medical necessity, or appropriateness of
54 28 the particular health care service for a particular
54 29 individual.
54 30	d.	That given that health care resources are not
54 31 unlimited, the impact of any new health care service or
54 32 facility on overall health expenditures in this state must be
54 33 considered.
54 34	e.	That excess capacity of health care services and
35 facilities places an increased economic burden on the public.
1	f.	That the likelihood that a requested new health care
55	2 facility, service, or equipment will improve health care
55	3 quality and outcomes must be considered.
55	4	g.	That development and ongoing maintenance of current and
55	5 accurate health care information and statistics related to
55	6 cost and quality of health care and projections of the need
55	7 for health care facilities and services are necessary to
55	8 developing an effective health care planning strategy.
55	9	h.	That the certificate of need program as a component of
55 10 the health care planning regulatory process must balance
55 11 considerations of access to quality care at a reasonable cost
55 12 for all Iowans, optimal use of existing health care resources,
55 13 fostering of expenditure control, and elimination of
55 14 unnecessary duplication of health care facilities and
55 15 services, while supporting improved health care outcomes.
55 16	i.	That strategic health care planning must be concerned
55 17 with the stability of the health care system, encompassing
55 18 health care financing, quality, and the availability of
55 19 information and services for all residents.
55 20	3.	The health care delivery infrastructure and health care
55 21 workforce resources strategic plan developed by the department
55 22 shall include all of the following:
55 23	a.	A health care system assessment and objectives
55 24 component that does all of the following:
55 25	(1)	Describes state and regional population demographics,
55 26 health status indicators, and trends in health status and
55 27 health care needs.
55 28	(2)	Identifies key policy objectives for the state health
55 29 care system related to access to care, health care outcomes,
55 30 quality, and cost=effectiveness.
55 31	b.	A health care facilities and services plan that
55 32 assesses the demand for health care facilities and services to
55 33 inform state health care planning efforts and direct
55 34 certificate of need determinations, for those facilities and
35 services subject to certificate of need.	The plan shall
1 include all of the following:
56	2	(1)	An inventory of each geographic region's existing
56	3 health care facilities and services.
56	4	(2)	Projections of the need for each category of health
56	5 care facility and service, including those subject to
56	6 certificate of need.
56	7	(3)	Policies to guide the addition of new or expanded
56	8 health care facilities and services to promote the use of
56	9 quality, evidence=based, cost=effective health care delivery
56 10 options, including any recommendations for criteria,
56 11 standards, and methods relevant to the certificate of need

56 12 review process.
56 13	(4)	An assessment of the availability of health care
56 14 providers, public health resources, transportation
56 15 infrastructure, and other considerations necessary to support
56 16 the needed health care facilities and services in each region.
56 17	c.	A health care data resources plan that identifies data
56 18 elements necessary to properly conduct planning activities and
56 19 to review certificate of need applications, including data
56 20 related to inpatient and outpatient utilization and outcomes
56 21 information, and financial and utilization information related
56 22 to charity care, quality, and cost.	The plan shall provide
56 23 all of the following:
56 24	(1)	An inventory of existing data resources, both public
56 25 and private, that store and disclose information relevant to
56 26 the health care planning process, including information
56 27 necessary to conduct certificate of need activities.	The plan
56 28 shall identify any deficiencies in the inventory of existing
56 29 data resources and the data necessary to conduct comprehensive
56 30 health care planning activities.	The plan may recommend that
56 31 the department be authorized to access existing data sources
56 32 and conduct appropriate analyses of such data or that other
56 33 agencies expand their data collection activities as statutory
56 34 authority permits.	The plan may identify any computing
35 infrastructure deficiencies that impede the proper storage,
1 transmission, and analysis of health care planning data.
57	2	(2)	Recommendations for increasing the availability of
57	3 data related to health care planning to provide greater
57	4 community involvement in the health care planning process and
57	5 consistency in data used for certificate of need applications
57	6 and determinations.	The plan shall also integrate the
57	7 requirements for annual reports by hospitals and health care
57	8 facilities pursuant to section 135.75, the provisions relating
57	9 to analyses and studies by the department pursuant to section
57 10 135.76, the data compilation provisions of section 135.78, and
57 11 the provisions for contracts for assistance with analyses,
57 12 studies, and data pursuant to section 135.83.
57 13	d.	An assessment of emerging trends in health care
57 14 delivery and technology as they relate to access to health
57 15 care facilities and services, quality of care, and costs of
57 16 care.	The assessment shall recommend any changes to the scope
57 17 of health care facilities and services covered by the
57 18 certificate of need program that may be warranted by these
57 19 emerging trends.	In addition, the assessment may recommend
57 20 any changes to criteria used by the department to review
57 21 certificate of need applications, as necessary.
57 22	e.	A rural health care resources plan to assess the
57 23 availability of health resources in rural areas of the state,
57 24 assess the unmet needs of these communities, and evaluate how
57 25 federal and state reimbursement policies can be modified, if
57 26 necessary, to more efficiently and effectively meet the health
57 27 care needs of rural communities.	The plan shall consider the
57 28 unique health care needs of rural communities, the adequacy of
57 29 the rural health care workforce, and transportation needs for
57 30 accessing appropriate care.
57 31	f.	A health care workforce resources plan to assure a
57 32 competent, diverse, and sustainable health care workforce in
57 33 Iowa and to improve access to health care in underserved areas
57 34 and among underserved populations.	The plan shall include the
35 establishment of an advisory council to inform and advise the
1 department and policymakers regarding issues relevant to the
58	2 health care workforce in Iowa.	The health care workforce
58	3 resources plan shall recognize long=term care as an essential
58	4 service provided by the health care workforce.
58	5	4.	The department shall submit the initial statewide
58	6 health care delivery infrastructure and resources strategic
58	7 plan to the governor and the general assembly by January 1,
58	8 2010, and shall submit an updated strategic plan to the
58	9 governor and the general assembly every two years thereafter.
58 10	Sec. 59.	HEALTH CARE ACCESS == APPROPRIATION.	There is
58 11 appropriated from the general fund of the state to the
58 12 department of public health for the fiscal year beginning July
58 13 1, 2008, and ending June 30, 2009, the following amount, or so
58 14 much thereof as is necessary, for the purpose designated:
58 15	For activities associated with the health care access
58 16 requirements of this division, and for not more than the
58 17 following full=time equivalent positions:
58 18 .................................................. $	172,200
58 19 ............................................... FTEs	3.00
58 20	DIVISION XIII
58 21	PREVENTION AND WELLNESS
58 22	INITIATIVES

58 23	Sec. 60.	Section 135.27, Code 2007, is amended by striking
58 24 the section and inserting in lieu thereof the following:
58 25	135.27	IOWA HEALTHY COMMUNITIES INITIATIVE == GRANT
58 26 PROGRAM.
58 27	1.	PROGRAM GOALS.	The department shall establish a grant
58 28 program to energize local communities to transform the
58 29 existing culture into a culture that promotes healthy
58 30 lifestyles and leads collectively, community by community, to
58 31 a healthier state.	The grant program shall expand an existing
58 32 healthy communities initiative to assist local boards of
58 33 health, in collaboration with existing community resources, to
58 34 build community capacity in addressing the prevention of
35 chronic disease that results from risk factors including
1 overweight and obesity conditions.
59	2	2.	DISTRIBUTION OF GRANTS.	The department shall
59	3 distribute the grants on a competitive basis and shall support
59	4 the grantee communities in planning and developing wellness
59	5 strategies and establishing methodologies to sustain the
59	6 strategies.	Grant criteria shall be consistent with the
59	7 existing statewide initiative between the department and the
59	8 department's partners that promotes increased opportunities
59	9 for physical activity and healthy eating for Iowans of all
59 10 ages, or its successor, and the statewide comprehensive plan
59 11 developed by the existing statewide initiative to increase
59 12 physical activity, improve nutrition, and promote healthy
59 13 behaviors.	Grantees shall demonstrate an ability to maximize
59 14 local, state, and federal resources effectively and
59 15 efficiently.
59 16	3.	DEPARTMENTAL SUPPORT.	The department shall provide
59 17 support to grantees including capacity=building strategies,
59 18 technical assistance, consultation, and ongoing evaluation.
59 19	4.	ELIGIBILITY.	Local boards of health representing a
59 20 coalition of health care providers and community and private
59 21 organizations are eligible to submit applications.
59 22	Sec. 61.	NEW SECTION.	135.27A	GOVERNOR'S COUNCIL ON
59 23 PHYSICAL FITNESS AND NUTRITION.
59 24	1.	A governor's council on physical fitness and nutrition
59 25 is established consisting of twelve members appointed by the
59 26 governor who have expertise in physical activity, physical
59 27 fitness, nutrition, and promoting healthy behaviors.	At least
59 28 one member shall be a representative of elementary and
59 29 secondary physical education professionals, at least one
59 30 member shall be a health care professional, at least one
59 31 member shall be a registered dietician, at least one member
59 32 shall be recommended by the department of elder affairs, and
59 33 at least one member shall be an active nutrition or fitness
59 34 professional.	In addition, at least one member shall be a
35 member of a racial or ethnic minority.	The governor shall
1 select a chairperson for the council.	Members shall serve
60	2 terms of three years beginning and ending as provided in
60	3 section 69.19.	Appointments are subject to sections 69.16 and
60	4 69.16A.	Members are entitled to receive reimbursement for
60	5 actual expenses incurred while engaged in the performance of
60	6 official duties.	A member of the council may also be eligible
60	7 to receive compensation as provided in section 7E.6.
60	8	2.	The council shall assist in developing a strategy for
60	9 implementation of the statewide comprehensive plan developed
60 10 by the existing statewide initiative to increase physical
60 11 activity, improve physical fitness, improve nutrition, and
60 12 promote healthy behaviors.	The strategy shall include
60 13 specific components relating to specific populations and
60 14 settings including early childhood, educational, local
60 15 community, worksite wellness, health care, and older Iowans.
60 16 The initial draft of the implementation plan shall be
60 17 submitted to the governor and the general assembly by December 60 18 1, 2008.
60 19	3.	The council shall assist the department in establishing
60 20 and promoting a best practices internet site.	The internet
60 21 site shall provide examples of wellness best practices for
60 22 individuals, communities, workplaces, and schools and shall
60 23 include successful examples of both evidence=based and
60 24 nonscientific programs as a resource.
60 25	4.	The council shall provide oversight for the governor's
60 26 physical fitness challenge.	The governor's physical fitness
60 27 challenge shall be administered by the department and shall
60 28 provide for the establishment of partnerships with communities
60 29 or school districts to offer the physical fitness challenge
60 30 curriculum to elementary and secondary school students.	The
60 31 council shall develop the curriculum, including benchmarks and
60 32 rewards, for advancing the school wellness policy through the
60 33 challenge.

60 34	Sec. 62.	IOWA HEALTHY COMMUNITIES INITIATIVE ==
35 APPROPRIATION.	There is appropriated from the general fund of
1 the state to the department of public health for the fiscal
61	2 year beginning July 1, 2008, and ending June 30, 2009, the
61	3 following amount, or so much thereof as is necessary, for the
61	4 purpose designated:
61	5	For Iowa healthy communities initiative grants distributed
61	6 beginning January 1, 2009, and for not more than the following
61	7 full=time equivalent positions:
61	8 .................................................. $	900,000
61	9 ............................................... FTEs	3.00
61 10	Sec. 63.	GOVERNOR'S COUNCIL ON PHYSICAL FITNESS AND
61 11 NUTRITION == APPROPRIATION.	There is appropriated from the
61 12 general fund of the state to the department of public health
61 13 for the fiscal period beginning July 1, 2008, and ending June
61 14 30, 2009, the following amount, or so much thereof as is
61 15 necessary, for the purpose designated:
61 16	For the governor's council on physical fitness:
61 17 .................................................. $	112,100
61 18	Sec. 64.	SMALL BUSINESS QUALIFIED WELLNESS PROGRAM TAX
61 19 CREDIT == PLAN.	The department of public health, in
61 20 consultation with the insurance division of the department of
61 21 commerce and the department of revenue, shall develop a plan
61 22 to provide a tax credit to small businesses that provide
61 23 qualified wellness programs to improve the health of their
61 24 employees.	The plan shall include specification of what
61 25 constitutes a small business for the purposes of the qualified
61 26 wellness program, the minimum standards for use by a small
61 27 business in establishing a qualified wellness program, the
61 28 criteria and a process for certification of a small business
61 29 qualified wellness program, and the process for claiming a
61 30 small business qualified wellness program tax credit.	The
61 31 department of public health shall submit the plan including
61 32 any recommendations for changes in law to implement a small
61 33 business qualified wellness program tax credit to the governor
61 34 and the general assembly by December 15, 2008.
35	DIVISION XIV
1	HEALTH CARE TRANSPARENCY
62	2	DIVISION XXV
62	3	HEALTH CARE TRANSPARENCY
62	4	Sec. 65.	NEW SECTION.	135.165	HEALTH CARE TRANSPARENCY
62	5 == REPORTING REQUIREMENTS == HOSPITALS AND NURSING FACILITIES.
62	6	Each hospital and nursing facility in this state that is
62	7 recognized by the Internal Revenue Code as a nonprofit
62	8 organization or entity shall submit to the department of
62	9 public health and the legislative services agency, annually, a
62 10 copy of the hospital's internal revenue service form 990,
62 11 including but not limited to schedule J or any successor
62 12 schedule that provides compensation information for certain
62 13 officers, directors, trustees, and key employees, information
62 14 about the highest compensated employees, and information
62 15 regarding revenues, expenses, excess or surplus revenues, and
62 16 reserves within ninety days following the due date for filing
62 17 the hospital's or nursing facility's return for the taxable
62 18 year.
62 19	Sec. 66.	Section 136.3, Code 2007, is amended by adding
62 20 the following new subsection:
62 21	NEW SUBSECTION.	14.	To the greatest extent possible
62 22 integrate the efforts of the governing entities of the Iowa
62 23 health information technology system pursuant to division XXI,
62 24 the medical home pursuant to division XXII, the prevention and
62 25 chronic care management initiative pursuant to division XXIII,
62 26 and health and long=term care access pursuant to division
62 27 XXIV.
62 28	Sec. 67.	HEALTH CARE QUALITY AND COST TRANSPARENCY ==
62 29 WORKGROUP.
62 30	1.	A health care quality and cost transparency workgroup
62 31 is created to develop recommendations for legislation and
62 32 policies regarding health care quality and cost including
62 33 measures to be utilized in providing transparency to consumers
62 34 of health care and health care coverage.	Membership of the
35 workgroup shall be determined by the legislative council in
1 consultation with the chairpersons and ranking members of the
63	2 joint appropriations subcommittee on health and human services
63	3 and the chairpersons and ranking members of the committees on
63	4 human resources of the senate and house of representatives.
63	5 Membership of the workgroup shall include but is not limited
63	6 to representatives of the Iowa healthcare collaborative, the
63	7 department of public health, the department of human services,
63	8 the insurance division of the department of commerce, the Iowa
63	9 hospital association, the Iowa medical society, the Iowa

63 10 health buyers alliance, the AARP Iowa chapter, the university
63 11 of Iowa public policy center, and other interested consumers,
63 12 advocates, purchasers, providers, and legislators.	The
63 13 legislative services agency shall provide staffing assistance
63 14 to the workgroup.
63 15	2.	The workgroup shall do all of the following:
63 16	a.	Review the approaches of other states quality and cost
63 17 in addressing health care transparency information.
63 18	b.	Develop and compile recommendations and strategies to
63 19 lower health care costs and health care coverage costs for
63 20 consumers and businesses.
63 21	c.	Make recommendations, including any necessary
63 22 legislation, regarding reporting of health care quality and
63 23 cost measures.	The measures recommended for adoption shall be
63 24 those measures endorsed by the national quality forum.
63 25 However, if an area of measurement is deemed important by the
63 26 workgroup, but the national quality forum has not endorsed
63 27 such area of measurement, the workgroup may recommend, in
63 28 order of priority, the measures of other national
63 29 accreditation organizations such as the national committee for
63 30 quality assurance, the joint commission, the centers for
63 31 Medicare and Medicaid services of the United States department
63 32 of health and human services, or the agency for healthcare
63 33 research and quality.	Any measure recommended for adoption
63 34 shall be evidence=based and clinically important, reasonably
35 feasible to implement, and easily understood by the health
1 care consumer.
64	2	d.	Make recommendations regarding the collection and
64	3 publishing of health care quality and cost measures.	Measures
64	4 shall be collected from health plans, hospitals, and
64	5 physicians and published on a public internet site available
64	6 to the general public.	The recommendations shall include how
64	7 the internet site will be maintained and utilization of a
64	8 format to ensure that the information provided is understood
64	9 by the health care consumer.
64 10	e.	Submit a written report of all recommendations to the
64 11 general assembly on or before December 15, 2008.
64 12	3.	The legislative council, pursuant to its authority in
64 13 section 2.42, may allocate to the workgroup funding from
64 14 moneys available to it in section 2.12 for the purpose of
64 15 providing expert support to the workgroup.
64 16	Sec. 68.	EFFECTIVE DATE.	The provision in this division
64 17 of this Act creating a health care quality and cost
64 18 transparency workgroup, being deemed of immediate importance,
64 19 takes effect upon enactment.
64 20	DIVISION XV
64 21	DIRECT CARE WORKFORCE
64 22	Sec. 69.	DIRECT CARE WORKER ADVISORY COUNCIL == DUTIES ==
64 23 REPORT.
64 24	1.	As used in this section, unless the context otherwise
64 25 requires:
64 26	a.	"Department" means the department of public health.
64 27	b.	"Direct care" means environmental or chore services,
64 28 health monitoring and maintenance, assistance with
64 29 instrumental activities of daily living, assistance with
64 30 personal care activities of daily living, personal care
64 31 support, or specialty skill services.
64 32	c.	"Direct care worker" means an individual who directly
64 33 provides or assists a consumer in the care of the consumer by
64 34 providing direct care in a variety of settings which may or
35 may not require supervision of the direct care worker,
1 depending on the setting and the skills that the direct care
65	2 workers possess, based on education or certification.
65	3	d.	"Director" means the director of public health.
65	4	2.	A direct care worker advisory council shall be
65	5 appointed by the director and shall include representatives of
65	6 direct care workers, consumers of direct care services,
65	7 educators of direct care workers, other health professionals,
65	8 employers of direct care workers, and appropriate state
65	9 agencies.
65 10	3.	Membership, terms of office, quorum, and expenses shall
65 11 be determined by the director in accordance with the
65 12 applicable provisions of section 135.11.
65 13	4.	The direct care worker advisory council shall advise
65 14 the director regarding regulation and certification of direct
65 15 care workers, based on the work of the direct care workers
65 16 task force established pursuant to 2005 Iowa Acts, chapter 88,
65 17 and shall develop recommendations regarding but not limited to
65 18 all of the following:
65 19	a.	Direct care worker classifications based on functions
65 20 and services provided by direct care workers.

65	
21	
b.	
Functions for each direct care worker classification.	
65	22	c.	An education and training orientation to be provided by	
65 23 employers.
65 24	d.	Education and training requirements for each direct
65 25 care worker classification.
65 26	e.	The standard curriculum required for each direct care
65 27 worker classification.
65 28	f.	Education and training equivalency standards for each
65 29 direct care worker classification.
65 30	g.	Guidelines that allow individuals who are members of
65 31 the direct care workforce prior to the date of required
65 32 certification to be incorporated into the new regulatory
65 33 system.
65 34	h.	Continuing education requirements for each direct care
35 worker classification.
1	i.	Standards for direct care worker educators and
66	2 trainers.
66	3	j.	Certification requirements for each direct care worker
66	4 classification.
66	5	k.	Protections for the title "certified direct care
66	6 worker".
66	7	l.	Standardized requirements for supervision of each
66	8 direct care worker classification, as applicable, and the
66	9 roles and responsibilities of supervisory positions.
66 10	m.	Responsibility for maintenance of credentialing and
66 11 continuing education and training.
66 12	n.	Provision of information to income maintenance workers
66 13 and case managers under the purview of the department of human
66 14 services about the education and training requirements for
66 15 direct care workers to provide the care and services to meet
66 16 consumer needs.
66 17	5.	The direct care worker advisory council shall report
66 18 its recommendations to the director by November 30, 2008,
66 19 including recommendations for any changes in law or rules
66 20 necessary.
66 21	6.	Implementation of certification of direct care workers
66 22 shall begin July 1, 2009.
66 23	Sec. 70.	DIRECT CARE WORKER COMPENSATION ADVISORY
66 24 COMMITTEE == REVIEWS.
66 25	1.	a.	The general assembly recognizes that direct care
66 26 workers play a vital role and make a valuable contribution in
66 27 providing care to Iowans with a variety of needs in both
66 28 institutional and home and community=based settings.
66 29 Recruiting and retaining qualified, highly competent direct
66 30 care workers is a challenge across all employment settings.
66 31 High rates of employee vacancies and staff turnover threaten
66 32 the ability of providers to achieve the core mission of
66 33 providing safe and high quality support to Iowans.
66 34	b.	It is the intent of the general assembly to address the
35 long=term care workforce shortage and turnover rates in order
1 to improve the quality of health care delivered in the
67	2 long=term care continuum by reviewing wages and other
67	3 compensation paid to direct care workers in the state.
67	4	c.	It is the intent of the general assembly that the
67	5 initial review of and recommendations for improving wages and
67	6 other compensation paid to direct care workers focus on
67	7 nonlicensed direct care workers in the nursing facility
67	8 setting.	However, following the initial review of wages and
67	9 other compensation paid to direct care workers in the nursing
67 10 facility setting, the department of human services shall
67 11 convene subsequent advisory committees with appropriate
67 12 representatives of public and private organizations and
67 13 consumers to review the wages and other compensation paid to
67 14 and turnover rates of the entire spectrum of direct care
67 15 workers in the various settings in which they are employed as
67 16 a means of demonstrating the general assembly's commitment to
67 17 ensuring a stable and quality direct care workforce in this
67 18 state.
67 19	2.	The department of human services shall convene an
67 20 initial direct care worker compensation advisory committee to
67 21 develop recommendations for consideration by the general
67 22 assembly during the 2009 legislative session regarding wages
67 23 and other compensation paid to direct care workers in nursing
67 24 facilities.	The committee shall consist of the following
67 25 members, selected by their respective organizations:
67 26	a.	The director of human services, or the director's
67 27 designee.
67 28	b.	The director of public health, or the director's
67 29 designee.
67 30	c.	The director of the department of elder affairs, or the
67 31 director's designee.

67 32	d.	The director of the department of inspections and
67 33 appeals, or the director's designee.
67 34	e.	A representative of the Iowa caregivers association.
35	f.	A representative of the Iowa health care association.
1	g.	A representative of the Iowa association of homes and
68	2 services for the aging.
68	3	h.	A representative of the AARP Iowa chapter.
68	4	3.	The advisory committee shall also include two members
68	5 of the senate and two members of the house of representatives,
68	6 with not more than one member from each chamber being from the
68	7 same political party.	The legislative members shall serve in
68	8 an ex officio, nonvoting capacity.	The two senators shall be
68	9 appointed respectively by the majority leader of the senate
68 10 and the minority leader of the senate, and the two
68 11 representatives shall be appointed respectively by the speaker
68 12 of the house of representatives and the minority leader of the
68 13 house of representatives.
68 14	4.	Public members of the committee shall receive actual
68 15 expenses incurred while serving in their official capacity and
68 16 may also be eligible to receive compensation as provided in
68 17 section 7E.6.	Legislative members of the committee are
68 18 eligible for per diem and reimbursement of actual expenses as
68 19 provided in section 2.10.
68 20	5.	The department of human services shall provide
68 21 administrative support to the committee and the director of
68 22 human services or the director's designee shall serve as
68 23 chairperson of the committee.
68 24	6.	The department shall convene the committee no later
68 25 than July 1, 2008.	Prior to the initial meeting, the
68 26 department of human services shall provide all members of the
68 27 committee with a detailed analysis of trends in wages and
68 28 other compensation paid to direct care workers.
68 29	7.	The committee shall consider options related but not
68 30 limited to all of the following:
68 31	a.	The shortening of the time delay between a nursing
68 32 facility's submittal of cost reports and receipt of the
68 33 reimbursement based upon these cost reports.
68 34	b.	The targeting of appropriations to provide increases in
35 direct care worker compensation.
1	c.	Creation of a nursing facility provider tax.
69	2	8.	Any option considered by the committee shall be
69	3 consistent with federal law and regulations.
69	4	9.	Following its deliberations, the committee shall submit
69	5 a report of its findings and recommendations regarding
69	6 improvement in direct care worker wages and other compensation
69	7 in the nursing facility setting to the governor and the
69	8 general assembly no later than December 12, 2008.
69	9	10.	For the purposes of the initial review, "direct care
69 10 worker" means nonlicensed nursing facility staff who provide
69 11 hands=on care including but not limited to certified nurse
69 12 aides and medication aides.
69 13	Sec. 71.	DIRECT CARE WORKER IN NURSING FACILITIES ==
69 14 TURNOVER REPORT.	The department of human services shall
69 15 modify the nursing facility cost reports utilized for the
69 16 medical assistance program to capture data by the distinct
69 17 categories of nonlicensed direct care workers and other
69 18 employee categories for the purposes of documenting the
69 19 turnover rates of direct care workers and other employees of
69 20 nursing facilities.	The department shall submit a report on
69 21 an annual basis to the governor and the general assembly which
69 22 provides an analysis of direct care worker and other nursing
69 23 facility employee turnover by individual nursing facility, a
69 24 comparison of the turnover rate in each individual nursing
69 25 facility with the state average, and an analysis of any
69 26 improvement or decline in meeting any accountability goals or
69 27 other measures related to turnover rates.	The annual reports
69 28 shall also include any data available regarding turnover rate
69 29 trends, and other information the department deems
69 30 appropriate.	The initial report shall be submitted no later
69 31 than December 1, 2008, and subsequent reports shall be
69 32 submitted no later than December 1, annually, thereafter.
69 33	Sec. 72.	VOLUNTARY EMPLOYER=SPONSORED HEALTH CARE COVERAGE
69 34 DEMONSTRATION PROJECT == DIRECT CARE WORKERS.
35	1.	a.	The department of human services in collaboration
1 with the insurance division of the department of commerce
70	2 shall design a demonstration project to provide a health care
70	3 coverage premium assistance program for nonlicensed direct
70	4 care workers.	Participation in the demonstration project
70	5 shall be offered to employers and nonlicensed direct care
70	6 workers on a voluntary basis.
70	7	b.	The department in collaboration with the division shall

70	8 convene an advisory council consisting of representatives of
70	9 the Iowa caregivers association, the Iowa child and family
70 10 policy center, the Iowa association of homes and services for
70 11 the aging, the Iowa health care association, the federation of
70 12 Iowa insurers, the AARP Iowa chapter, the senior living
70 13 coordinating unit, and other public and private entities with
70 14 interest in the demonstration project to assist in designing
70 15 the project.	The department in collaboration with the
70 16 division shall also review the experiences of other states and
70 17 the medical assistance premium assistance program in designing
70 18 the demonstration project.
70 19	c.	The department and the division, in consultation with
70 20 the advisory council, shall establish criteria to determine
70 21 which nonlicensed direct care workers shall be eligible to
70 22 participate in the demonstration project, the coverage and
70 23 cost parameters of the health care coverage which an employer
70 24 shall provide to be eligible for participation in the project,
70 25 the minimum premium contribution required of an employer to be
70 26 eligible for participation in the project, income eligibility
70 27 parameters for direct care workers participating in the
70 28 project, minimum hours of work required of an employee to be
70 29 eligible for participation in the project, and maximum premium
70 30 cost limits for an employee participating in the project.
70 31	d.	The project design shall allow up to 250 direct care
70 32 workers and their dependents to access health care coverage
70 33 sponsored by the direct care worker's employer.
70 34	e.	To the extent possible, the design of the demonstration
35 project shall incorporate a medical home, wellness and
1 prevention services, and chronic care management.
71	2	2.	The department and the division shall submit the design
71	3 for the demonstration project to the governor and the general
71	4 assembly for review by December 15, 2008.	If the general
71	5 assembly enacts legislation to implement the demonstration
71	6 project and appropriates funding for the demonstration
71	7 project, the department in collaboration with the division
71	8 shall implement the demonstration project for an initial
71	9 two=year period.
71 10	Sec. 73.	EFFECTIVE DATE.	This division of this Act, being
71 11 deemed of immediate importance, takes effect upon enactment. 71 12
71 13
71 14
71 15	PATRICK J. MURPHY
71 16	Speaker of the House
71 17
71 18
71 19
71 20	JOHN P. KIBBIE
71 21	President of the Senate
71 22
71 23	I hereby certify that this bill originated in the House and
71 24 is known as House File 2539, Eighty=second General Assembly. 71 25
71 26
71 27
71 28	MARK BRANDSGARD
71 29	Chief Clerk of the House
71 30 Approved	, 2008
71 31
71 32
71 33  	
71 34 CHESTER J. CULVER
71 35 Governor