Senate File 26
SENATE FILE
BY RAGAN
(COMPANION TO LSB 1058HH
BY GREIMANN)
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to the healthy and well kids in Iowa program.
2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
3 TLSB 1058XS 80
4 pf/sh/8
PAG LIN
1 1 Section 1. Section 514I.4, subsection 4, Code 2003, is
1 2 amended to read as follows:
1 3 4. The department shall do or shall provide for all of the
1 4 following:
1 5 a. Develop a program application form not to exceed two
1 6 pages in length, which is consistent with the rules of the
1 7 board, which is easy to understand, complete, and concise, and
1 8 which, to the greatest extent possible, coordinates with the
1 9 medical assistance program.
1 10 b. Establish the family cost sharing amount, based on a
1 11 sliding fee scale, if established by amounts with the approval
1 12 of the board.
1 13 c. Perform annual, random reviews of enrollee applications
1 14 to ensure compliance with program eligibility and enrollment
1 15 policies. Quality assurance reports shall be made to the
1 16 board and the department based upon the data maintained by the
1 17 administrative contractor.
1 18 c. d. Perform other duties as determined by the department
1 19 with the approval of the board.
1 20 Sec. 2. Section 514I.5, subsection 7, paragraphs d and e,
1 21 Code 2003, are amended to read as follows:
1 22 d. Develop, with the assistance of the department, an
1 23 outreach plan, and provide for periodic assessment of the
1 24 effectiveness of the outreach plan. The plan shall provide
1 25 outreach to families of children likely to be eligible for
1 26 assistance under the program, to inform them of the
1 27 availability of and to assist the families in enrolling
1 28 children in the program. The outreach efforts may include,
1 29 but are not limited to, a comprehensive statewide media
1 30 campaign, solicitation of cooperation from programs, agencies,
1 31 and other persons who are likely to have contact with eligible
1 32 children, including but not limited to those associated with
1 33 the educational system, and the development of community plans
1 34 for outreach and marketing.
1 35 e. In consultation with the clinical advisory committee,
2 1 select a single, nationally recognized functional health
2 2 assessment form for an initial assessment of all eligible
2 3 assess the initial health status of children participating in
2 4 the program, establish a baseline for comparison purposes, and
2 5 develop appropriate indicators to measure the subsequent
2 6 health status of eligible children participating in the
2 7 program.
2 8 Sec. 3. Section 514I.5, subsection 7, paragraph i, Code
2 9 2003, is amended by striking the paragraph.
2 10 Sec. 4. Section 514I.5, subsection 7, paragraph l,
2 11 unnumbered paragraph 1, Code 2003, is amended to read as
2 12 follows:
2 13 Establish an advisory committee to make recommendations to
2 14 the board and to the general assembly on or before by January
2 15 1, 1999, annually concerning the provision of health insurance
2 16 coverage to children with special health care needs under the
2 17 program. The committee shall include individuals with
2 18 experience in, knowledge of, or expertise in this area. The
2 19 recommendations shall address, but are not limited to, all of
2 20 the following:
2 21 Sec. 5. Section 514I.5, subsection 8, paragraph e, Code
2 22 2003, is amended by adding the following new subparagraphs:
2 23 NEW SUBPARAGRAPH. (15) Care coordination. For the
2 24 purposes of this subparagraph, "care coordination" means
2 25 coordinating the provision of services to children and
2 26 families to assure that the children receive health care
2 27 services by promoting the coordination of social supports and
2 28 medical services across organizations and providers. Care
2 29 coordination may include but is not limited to educating
2 30 families about the services provided under the family's health
2 31 insurance coverage plan; assisting families in selecting
2 32 providers; assisting families with scheduling of health care
2 33 appointments, transportation to attend health care
2 34 appointments, and translation during health care appointments;
2 35 and assisting families in accessing community support
3 1 services.
3 2 NEW SUBPARAGRAPH. (16) Dental services, including the
3 3 coverage of partial dentures and dentures, with an annual
3 4 coverage maximum of one thousand five hundred dollars.
3 5 NEW SUBPARAGRAPH. (17) Mental health and substance abuse
3 6 benefits, including coverage of Axis I and Axis II diagnoses
3 7 as specified in the diagnostic and statistical manual of
3 8 mental disorders; coverage of the full continuum of
3 9 evaluation, treatment, and services; provision of adequate
3 10 provider panels; use of admission, discharge, continued stay,
3 11 and placement criteria specific to children and adolescents;
3 12 and the use of Iowa juvenile placement criteria for substance
3 13 abuse services.
3 14 NEW SUBPARAGRAPH. (18) Medically necessary nutrition
3 15 services provided by a licensed dietician based upon a
3 16 physician referral.
3 17 NEW SUBPARAGRAPH. (19) Physical and occupational therapy
3 18 services provided by a licensed physical therapist or a
3 19 licensed occupational therapist, after referral by a
3 20 physician.
3 21 NEW SUBPARAGRAPH. (20) Case management for children with
3 22 special health care needs. For the purposes of this
3 23 subparagraph, "case management" means services intended to
3 24 coordinate various clinical services to ensure the best
3 25 clinical outcomes, and "children with special health care
3 26 needs" means children who have or are at increased risk for a
3 27 chronic physical, developmental, behavioral, or emotional
3 28 condition and who also require health and related services of
3 29 a type or amount beyond that required by children, generally.
3 30 Sec. 6. Section 514I.5, subsection 8, paragraph h, Code
3 31 2003, is amended to read as follows:
3 32 h. The amount of any cost sharing under the program which
3 33 shall may be assessed on a sliding fee scale based on family
3 34 income, which provides for a minimum amount of cost sharing,
3 35 and which complies with federal law.
4 1 Sec. 7. Section 514I.5, subsection 8, paragraph m, Code
4 2 2003, is amended by striking the paragraph.
4 3 Sec. 8. Section 514I.6, subsection 3, Code 2003, is
4 4 amended by striking the subsection.
4 5 Sec. 9. Section 514I.7, subsection 2, paragraph c, Code
4 6 2003, is amended to read as follows:
4 7 c. Forward names of children who appear to be eligible for
4 8 medical assistance or other public health insurance coverage
4 9 to local to the department of human services offices or other
4 10 appropriate person or agency for follow up follow=up and
4 11 retain the identifying data on children who are referred.
4 12 Sec. 10. Section 514I.7, subsection 2, paragraph h, Code
4 13 2003, is amended by striking the paragraph.
4 14 Sec. 11. Section 514I.8, subsection 2, paragraph e, Code
4 15 2003, is amended to read as follows:
4 16 e. Is not currently covered under or was not covered
4 17 within the prior six months under a group health plan as
4 18 defined in 42 U.S.C. } 300gg=91(a)(1) or other health benefit
4 19 plan, unless the coverage was involuntarily lost or unless
4 20 dropping the coverage is allowed by rule of the board.
4 21 Sec. 12. Section 514I.10, Code 2003, is amended to read as
4 22 follows:
4 23 514I.10 COST SHARING.
4 24 1. Cost sharing for eligible children whose family income
4 25 is at or below one hundred fifty percent of the federal
4 26 poverty level shall not exceed the standards permitted under
4 27 42 U.S.C. } 1396(o)(a)(3) or } 1396(o)(b)(1).
4 28 2. Cost sharing for eligible children whose family income
4 29 is between equals or exceeds one hundred fifty percent and two
4 30 hundred percent of the federal poverty level shall may include
4 31 a premium or copayment amount which is at least a minimum
4 32 amount but which does not exceed five percent of the annual
4 33 family income. The amount of the any premium or the copayment
4 34 amount shall be based on family income and size.
4 35 EXPLANATION
5 1 This bill amends portions of the Code relating to the
5 2 healthy and well kids in Iowa (hawk=i) program and the medical
5 3 assistance program.
5 4 The bill deletes the requirement that the department of
5 5 human services (DHS) establish family cost sharing based on a
5 6 sliding fee scale. The new language reflects current practice
5 7 which is establishment of a cost sharing amount approved by
5 8 the hawk=i board. The bill also directs DHS to perform
5 9 annual, random reviews of enrollee applications to ensure
5 10 program compliance. Quality assurance reports are to be made
5 11 to the board and to DHS based upon the data maintained by the
5 12 administrative contractor of the program.
5 13 The bill eliminates the requirement that the outreach
5 14 efforts developed by the board include a comprehensive
5 15 statewide media campaign. The bill directs the board, in
5 16 consultation with the clinical advisory committee, to assess
5 17 the initial health status of children participating in the
5 18 program, establish a baseline, and develop appropriate
5 19 indicators to assess the subsequent health status of children
5 20 participating in the program, rather than directing the board
5 21 to select a single, nationally recognized assessment form for
5 22 children participating in the program. The bill eliminates
5 23 the requirement that the board perform periodic random reviews
5 24 of enrollee applications to assure program compliance, as this
5 25 function is given to the department under the bill. The bill
5 26 also directs the advisory committee on children with special
5 27 health care needs to make recommendations, annually, by
5 28 January 1, rather than only one time by January 1, 1999.
5 29 The bill adds benefits to the hawk=i benefit package,
5 30 including care coordination, dental services, mental health
5 31 and substance abuse benefits, medically necessary nutrition
5 32 services, physical and occupational therapy services, and case
5 33 management for children with special health care needs.
5 34 The bill eliminates the directive to the hawk=i board to
5 35 adopt rules to address approval of a program application in
6 1 cases in which prior employer=sponsored coverage ended less
6 2 than six months prior to determination of eligibility for the
6 3 program. The bill also eliminates a requirement that
6 4 participating insurers submit a marketing plan to the hawk=i
6 5 board consistent with the board's outreach plan, for approval
6 6 by the board.
6 7 The bill amends the directive to the administrative
6 8 contractor to forward names of children who appear to be
6 9 eligible for health insurance coverage, other than medical
6 10 assistance, to local offices of DHS or other appropriate
6 11 persons, and limits the directive to forwarding the names of
6 12 children who appear to be eligible for medical assistance only
6 13 to the state offices of DHS. The bill also eliminates the
6 14 directive to the administrative contractor to make program
6 15 applications available through the mail and through local
6 16 sites, as determined by DHS, including to schools, local
6 17 health departments, local department of human services
6 18 offices, and other locations.
6 19 The bill also provides that a child may participate in the
6 20 hawk=i program if, among other criteria, the child is not
6 21 currently covered or was not covered in the past six months
6 22 under a group health plan unless allowed by rule of the board.
6 23 The bill also allows for cost sharing based upon the family
6 24 income percentage which is either below 150 percent of the
6 25 federal poverty level or which equals or exceeds 150 percent
6 26 of the federal poverty level.
6 27 LSB 1058XS 80
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