House File 841 - Introduced
HOUSE FILE
BY GIPP and MURPHY
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to health care reform, including provisions
2 relating to the medical assistance program, providing
3 appropriations, providing effective dates, and providing for
4 retroactive applicability.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 TLSB 3523HH 81
7 pf/gg/14
PAG LIN
1 1 DIVISION I
1 2 IOWACARE
1 3 Section 1. NEW SECTION. 249J.1 TITLE.
1 4 This chapter shall be known and may be cited as the
1 5 "Iowacare Act".
1 6 Sec. 2. NEW SECTION. 249J.2 FEDERAL FINANCIAL
1 7 PARTICIPATION == CONTINGENT IMPLEMENTATION.
1 8 This chapter shall be implemented only to the extent that
1 9 federal matching funds are available for nonfederal
1 10 expenditures under this chapter. The department shall not
1 11 expend funds under this chapter, including but not limited to
1 12 expenditures for reimbursement of providers and program
1 13 administration, if appropriated nonfederal funds are not
1 14 matched by federal financial participation.
1 15 Sec. 3. NEW SECTION. 249J.3 DEFINITIONS.
1 16 As used in this chapter, unless the context otherwise
1 17 requires:
1 18 1. "Department" means the department of human services.
1 19 2. "Director" means the director of human services.
1 20 3. "Expansion population" means the individuals who are
1 21 eligible for benefits under the medical assistance program
1 22 solely as provided in this chapter.
1 23 4. "Full benefit dually eligible Medicare Part D
1 24 beneficiary" means a person who is eligible for coverage for
1 25 Medicare Part D drugs and is simultaneously eligible for full
1 26 medical assistance benefits pursuant to chapter 249A, under
1 27 any category of eligibility.
1 28 5. "Full benefit recipient" means an adult who is eligible
1 29 for full medical assistance benefits pursuant to chapter 249A
1 30 under any category of eligibility.
1 31 6. "Medical assistance" or "Medicaid" means medical
1 32 assistance as defined in section 249A.2.
1 33 7. "Medicare Part D" means the Medicare Part D program
1 34 established pursuant to the Medicare Prescription Drug,
1 35 Improvement, and Modernization Act of 2003, Pub L. No. 108=
2 1 173.
2 2 8. "Nursing facility" means a nursing facility as defined
2 3 in section 135C.1.
2 4 9. "Public hospital" means a public hospital as defined in
2 5 section 249I.3.
2 6 Sec. 4. NEW SECTION. 240J.4 LEGISLATIVE FINDINGS ==
2 7 PURPOSE.
2 8 1. The general assembly finds that:
2 9 a. The health care system in Iowa and throughout the
2 10 nation is at a crossroads. While health care spending is
2 11 increasing at an unsustainable rate, corresponding increases
2 12 in quality, access, and healthy outcomes are not being
2 13 achieved.
2 14 b. Like other government=based support systems before it,
2 15 the Medicaid program is also at a crossroads and requires
2 16 bold, innovative ideas to realize transformation.
2 17 c. Previously, the federal government has looked to the
2 18 states to demonstrate in the microcosm the benefits of system
2 19 change on a greater scale. As in the past, the state of Iowa
2 20 is prepared to act as a laboratory for successful reform.
2 21 2. It is the purpose of this chapter to propose a variety
2 22 of initiatives to increase the efficiency, quality, and
2 23 effectiveness of the health care system; to increase access to
2 24 appropriate health care; to provide incentives to consumers to
2 25 engage in responsible health care utilization and personal
2 26 health care management; to reward providers based on quality
2 27 of care and improved service delivery; and to encourage the
2 28 utilization of information technology, to the greatest extent
2 29 possible, to reduce fragmentation and increase coordination of
2 30 care and quality outcomes.
2 31 DIVISION II
2 32 MEDICAID EXPANSION
2 33 Sec. 5. NEW SECTION. 249J.5 EXPANSION POPULATION
2 34 ELIGIBILITY.
2 35 1. Except as otherwise provided in this chapter, an
3 1 individual nineteen through sixty=four years of age shall be
3 2 eligible solely for the expansion population benefits
3 3 described in this chapter when provided through the expansion
3 4 population provider network as described in this chapter, if
3 5 the individual meets all of the following conditions:
3 6 a. The individual is not eligible for coverage under the
3 7 medical assistance program in effect on April 1, 2005, or was
3 8 eligible for coverage under the medical assistance program in
3 9 effect on April 1, 2005, but chose not to enroll in that
3 10 program.
3 11 b. The individual has a family income at or below two
3 12 hundred percent of the federal poverty level as defined by the
3 13 most recently revised poverty income guidelines published by
3 14 the United States department of health and human services.
3 15 c. The individual fulfills all other conditions of
3 16 participation for the expansion population described in this
3 17 chapter, including requirements relating to personal financial
3 18 responsibility.
3 19 2. Individuals otherwise eligible solely for family
3 20 planning benefits authorized under the medical assistance
3 21 family planning services waiver, effective January 1, 2005, as
3 22 described in 2004 Iowa Acts, chapter 1175, section 116,
3 23 subsection 8, may also be eligible for expansion population
3 24 benefits provided through the expansion population provider
3 25 network.
3 26 3. Enrollment for the expansion population may be limited,
3 27 closed, or reduced and the scope and duration of expansion
3 28 services provided may be limited, reduced, or terminated if
3 29 the department determines that federal medical assistance
3 30 program matching funds or appropriated state funds will not be
3 31 available to pay for existing or additional enrollment.
3 32 4. Eligibility for the expansion population shall not
3 33 include individuals who have access to group health insurance
3 34 or who were terminated from health insurance coverage in the
3 35 six=month period prior to application for coverage through the
4 1 expansion population, unless such coverage was involuntarily
4 2 terminated or the reason for not accessing group health
4 3 insurance or for terminating coverage is allowed by rule of
4 4 the department.
4 5 5. Each expansion population member shall provide to the
4 6 department all insurance information required by the health
4 7 insurance premium payment program.
4 8 Sec. 6. NEW SECTION. 249J.6 EXPANSION POPULATION
4 9 BENEFITS.
4 10 1. Beginning July 1, 2005, the expansion population shall
4 11 be eligible for all of the following expansion services:
4 12 a. Inpatient hospital procedures described in the
4 13 diagnostic related group codes designated by the department.
4 14 b. Outpatient hospital services described in the
4 15 diagnostic related group codes designated by the department.
4 16 c. Physician and licensed nurse practitioner services
4 17 described in the current procedural terminology codes
4 18 specified by the department.
4 19 d. Dental services described in the dental codes specified
4 20 by the department.
4 21 e. Limited pharmacy benefits provided by an expansion
4 22 population provider network hospital pharmacy and solely
4 23 related to an appropriately billed expansion population
4 24 service.
4 25 f. Transportation to and from an expansion population
4 26 provider network provider only when provided by the provider
4 27 or a volunteer.
4 28 2. Beginning no later than March 1, 2006, all expansion
4 29 population members shall receive a single complete medical
4 30 examination and personal health improvement plan within ninety
4 31 days of enrollment in the program. These services may be
4 32 provided by an expansion population provider network
4 33 physician, a licensed practical nurse, a registered nurse, a
4 34 physician assistant, or any other physician or licensed nurse
4 35 practitioner available to any full benefit recipient.
5 1 3. Beginning no later than July 1, 2006, expansion
5 2 population members shall be provided all of the following:
5 3 a. Access to a pharmacy assistance clearinghouse program
5 4 to match expansion population members with free prescription
5 5 drug programs provided by the pharmaceutical industry.
5 6 b. Access to a medical information hotline, accessible
5 7 twenty=four hours per day, seven days per week, to assist
5 8 expansion population members in making appropriate choices
5 9 about the use of emergency room and other health care
5 10 services.
5 11 4. Expansion population members shall remain eligible for
5 12 all services not covered under the expansion population for
5 13 which the expansion population member is otherwise entitled
5 14 under state or federal law.
5 15 5. Members of the expansion population shall not be
5 16 considered full benefit dually eligible Medicare Part D
5 17 beneficiaries for the purposes of calculating the state's
5 18 payment under Medicare Part D, until such time as the
5 19 expansion population is eligible for all of the same benefits
5 20 as full benefit recipients under the medical assistance
5 21 program.
5 22 Sec. 7. NEW SECTION. 249J.7 EXPANSION POPULATION
5 23 PROVIDER NETWORK.
5 24 1. Expansion population members shall only be eligible to
5 25 receive expansion population services through a provider
5 26 included in the expansion population provider network. Except
5 27 as otherwise provided in this chapter, the expansion
5 28 population provider network shall be limited to a publicly
5 29 owned acute care teaching hospital located in a county with a
5 30 population over three hundred fifty thousand, the university
5 31 of Iowa hospitals and clinics, and the state hospitals for
5 32 persons with mental illness designated pursuant to section
5 33 226.1.
5 34 2. Expansion population services provided to expansion
5 35 population members by providers included in the expansion
6 1 population provider network shall be payable at the full
6 2 benefit recipient rates.
6 3 3. Unless otherwise prohibited by law, a provider under
6 4 the expansion population provider network may deny care to an
6 5 individual who refuses to apply for coverage under the
6 6 expansion population.
6 7 Sec. 8. NEW SECTION. 249J.8 EXPANSION POPULATION MEMBERS
6 8 == FINANCIAL PARTICIPATION.
6 9 1. Beginning July 1, 2005, each expansion population
6 10 member shall pay a monthly premium not to exceed one=twelfth
6 11 of five percent of the member's annual family income. An
6 12 expansion population member shall pay the monthly premium for
6 13 a minimum four=month period, regardless of the length of
6 14 enrollment of the member. An expansion population member
6 15 shall not be required to pay any premium if the department
6 16 determines that the total cost of activities related to
6 17 collection of the premium exceeds ninety=five percent of the
6 18 premium collected. Timely payment of premiums, including any
6 19 arrearages accrued from prior enrollment, is a condition of
6 20 receiving any expansion population services. An expansion
6 21 population member shall also pay the same copayments required
6 22 of other adult recipients of the medical assistance program.
6 23 2. The department may reduce the required out=of=pocket
6 24 expenditures for an individual expansion population member
6 25 based upon the member's increased wellness activities such as
6 26 smoking cessation or compliance with the personal health
6 27 improvement plan completed by the member.
6 28 3. The department shall submit to the governor and the
6 29 general assembly by March 15, 2006, a design for each of the
6 30 following:
6 31 a. An insurance cost subsidy program for expansion
6 32 population members who have access to employer health
6 33 insurance plans, provided that the design shall require that
6 34 no less than fifty percent of the cost of such insurance shall
6 35 be paid by the employer.
7 1 b. A health care account program option for individuals
7 2 eligible for enrollment in the expansion population. The
7 3 health care account program option shall be available only to
7 4 adults who have been enrolled in the expansion population for
7 5 at least twelve consecutive calendar months. Under the health
7 6 care account program option, the individual would agree to
7 7 exchange one year's receipt of benefits under the expansion
7 8 population to which the individual would otherwise be entitled
7 9 for a credit of up to a specified amount toward any medical
7 10 assistance program covered service. The balance in the health
7 11 care account at the end of the year, if any, would be
7 12 available for withdrawal by the individual.
7 13 Sec. 9. NEW SECTION. 249J.9 FUTURE EXPANSION POPULATION,
7 14 BENEFIT, AND PROVIDER NETWORK GROWTH.
7 15 1. POPULATION. The department shall contract with the
7 16 division of insurance of the department of commerce or another
7 17 appropriate entity to track, on an annual basis, the number of
7 18 uninsured and underinsured Iowans, the cost of private market
7 19 insurance coverage, and other barriers to access to private
7 20 insurance for Iowans. Based on these findings and available
7 21 funds, the department shall make recommendations, annually, to
7 22 the governor and the general assembly regarding further
7 23 expansion of the expansion population.
7 24 2. BENEFITS.
7 25 a. The department shall not provide additional services to
7 26 expansion population members without express authorization
7 27 provided by the general assembly.
7 28 b. The department, upon the recommendation of the
7 29 clinicians advisory panel established pursuant to section
7 30 249J.17, may change the scope of any of the available
7 31 expansion population services, but this subsection shall not
7 32 be construed to authorize the department to make expenditures
7 33 in excess of the amount appropriated for benefits for the
7 34 expansion population.
7 35 3. EXPANSION POPULATION PROVIDER NETWORK.
8 1 a. The department shall not expand the expansion
8 2 population provider network until the department complies
8 3 fully with the financial obligations to the provider network
8 4 described in section 249J.7.
8 5 b. The department may limit access to the expansion
8 6 population provider network by the expansion population to the
8 7 extent the department deems necessary to meet the financial
8 8 obligations to each member of the expansion population
8 9 provider network. This subsection shall not be construed to
8 10 authorize the department to make any expenditure in excess of
8 11 the amount appropriated for benefits for the expansion
8 12 population.
8 13 Sec. 10. NEW SECTION. 249J.10 MAXIMIZATION OF FUNDING
8 14 FOR INDIGENT PATIENTS.
8 15 1. Unencumbered certified local matching funds may be used
8 16 to cover the state share of the cost of services for the
8 17 expansion population.
8 18 2. The department of human services shall include in its
8 19 annual budget submission, recommendations relating to a
8 20 disproportionate share hospital and indirect medical education
8 21 allocation plan that maximizes the availability of federal
8 22 funds for payments to hospitals for the care and treatment of
8 23 indigent patients.
8 24 3. If state and federal law and regulations so provide and
8 25 if federal disproportionate share hospital funds and indirect
8 26 medical education funds are available under Title XIX of the
8 27 federal Social Security Act, federal disproportionate share
8 28 hospital funds and indirect medical education funds shall be
8 29 distributed as specified by the department.
8 30 DIVISION III
8 31 REBALANCING LONG=TERM CARE
8 32 Sec. 11. NEW SECTION. 249J.11 NURSING FACILITY LEVEL OF
8 33 CARE DETERMINATION FOR FACILITY=BASED AND COMMUNITY=BASED
8 34 SERVICES.
8 35 The department shall amend the medical assistance state
9 1 plan to provide for all of the following:
9 2 1. That nursing facility level of care services under the
9 3 medical assistance program shall be available to an individual
9 4 admitted to a nursing facility on or after July 1, 2005, if
9 5 the individual meets all of the following criteria:
9 6 a. The individual requires the physical assistance of one
9 7 or more persons on a daily basis for three or more activities
9 8 of daily living which may include but are not limited to
9 9 locomotion, dressing, eating, hygiene, or toileting.
9 10 b. The individual requires the establishment of a safe,
9 11 secure environment due to chronic confusion or mental illness.
9 12 c. The individual has established a dependency requiring
9 13 residency in a medical institution for more than one year.
9 14 2. That an individual admitted to a nursing facility prior
9 15 to July 1, 2005, and an individual applying for home and
9 16 community=based services waiver services at the nursing
9 17 facility level of care on or after July 1, 2005, shall meet
9 18 all of the following criteria:
9 19 a. The individual requires hands=on assistance, not
9 20 including cueing or setting up, on a daily basis for one to
9 21 three activities of daily living which may include but are not
9 22 limited to personal grooming such as dressing or hygiene.
9 23 b. The individual requires the establishment of a safe,
9 24 secure environment due to chronic confusion or mental illness.
9 25 3. That, beginning July 1, 2005, if appropriate home and
9 26 community=based services waiver services at the nursing
9 27 facility level of care are not available to an individual in
9 28 the individual's community at the time of the determination,
9 29 and nursing facility level of care is medically necessary, the
9 30 criteria for admission of the individual to a nursing facility
9 31 for nursing facility level of care services shall be the
9 32 criteria in effect on June 30, 2005.
9 33 Sec. 12. NEW SECTION. 249J.12 SERVICES FOR PERSONS WITH
9 34 MENTAL RETARDATION OR DEVELOPMENTAL DISABILITIES.
9 35 1. The department shall develop and implement a case=mix
10 1 adjusted reimbursement system for both institution=based and
10 2 community=based services for persons with mental retardation
10 3 or developmental disabilities by January 1, 2007.
10 4 2. The department, in consultation with interested
10 5 parties, shall develop a plan for submission to the governor
10 6 and the general assembly no later than July 1, 2007, to
10 7 enhance alternatives for community=based care for individuals
10 8 who would otherwise require care in an intermediate care
10 9 facility for persons with mental retardation.
10 10 Sec. 13. NEW SECTION. 249J.13 CHILDREN'S MENTAL HEALTH.
10 11 1. The department shall provide medical assistance waiver
10 12 services to not more than three hundred children, without
10 13 regard to family income, who meet both of the following
10 14 criteria:
10 15 a. The child requires behavioral health care services and
10 16 qualifies for the care level provided by a psychiatric medical
10 17 institution for children.
10 18 b. The child requires treatment to cure or alleviate a
10 19 serious mental illness or disorder, or emotional damage as
10 20 evidenced by severe anxiety, depression, withdrawal, or
10 21 untoward aggressive behavior toward the child's self or others
10 22 and the child's parent, guardian, or custodian is unable to
10 23 provide such treatment.
10 24 2. If necessary, the department shall renegotiate the
10 25 medical assistance contract provisions for behavioral health
10 26 services for the contractor to address the needs of the
10 27 children described in subsection 1.
10 28 DIVISION IV
10 29 HEALTH PROMOTION PARTNERSHIPS
10 30 Sec. 14. NEW SECTION. 249J.14 HEALTH PROMOTION
10 31 PARTNERSHIPS.
10 32 1. SERVICES FOR ADULTS AT STATE MENTAL HEALTH INSTITUTES.
10 33 Beginning July 1, 2005, inpatient and outpatient hospital
10 34 services at the state hospitals for persons with mental
10 35 illness designated pursuant to section 226.1 shall be covered
11 1 services under the medical assistance program.
11 2 2. DIETARY COUNSELING. By July 1, 2006, the department
11 3 shall design and begin implementation of a strategy to provide
11 4 dietary counseling and support to child and adult recipients
11 5 of medical assistance to assist these recipients in avoiding
11 6 excessive weight gain or loss and to assist in development of
11 7 personal weight loss programs for recipients determined by the
11 8 recipient's health care provider to be clinically overweight.
11 9 3. ELECTRONIC MEDICAL RECORDS. By October 1, 2006, the
11 10 department shall develop a practical strategy for expanding
11 11 utilization of electronic medical recordkeeping by medical
11 12 assistance program providers. The plan shall focus,
11 13 initially, on medical assistance program recipients whose
11 14 quality of care would be significantly enhanced by the
11 15 availability of electronic medical recordkeeping.
11 16 4. PROVIDER INCENTIVE PAYMENT PROGRAMS. By January 1,
11 17 2007, the department shall design and implement a medical
11 18 assistance provider incentive payment program based upon
11 19 evaluation of public and private sector models.
11 20 5. HEALTH ASSESSMENT FOR MEDICAL ASSISTANCE RECIPIENTS
11 21 WITH MENTAL RETARDATION OR DEVELOPMENTAL DISABILITIES. The
11 22 department shall work with the university of Iowa college of
11 23 medicine and college of dentistry to determine whether the
11 24 physical and dental health of recipients of medical assistance
11 25 who are persons with mental retardation or developmental
11 26 disabilities are being regularly and fully addressed and to
11 27 identify barriers to such care. The department shall report
11 28 the department's findings to the governor and the general
11 29 assembly by January 1, 2007.
11 30 6. SMOKING CESSATION. The department shall implement a
11 31 program to reduce smoking among recipients of medical
11 32 assistance who are children to less than one percent and among
11 33 those who are adults to less than ten percent, by July 1,
11 34 2007.
11 35 7. DENTAL HOME FOR CHILDREN. By July 1, 2008, every
12 1 recipient of medical assistance who is a child twelve years of
12 2 age or younger shall have a designated dental home and shall
12 3 be provided with the dental screenings and preventive care
12 4 identified in the oral health standards under the early and
12 5 periodic screening, diagnostic, and treatment program.
12 6 DIVISION V
12 7 IOWA MEDICAID ENTERPRISE
12 8 Sec. 15. NEW SECTION. 249J.15 COST AND QUALITY
12 9 PERFORMANCE EVALUATION.
12 10 Beginning July 1, 2005, the department shall contract with
12 11 an independent consulting firm to do all of the following:
12 12 1. Annually evaluate and compare the cost and quality of
12 13 care provided by the medical assistance program with the cost
12 14 and quality of care available through private insurance and
12 15 managed care organizations doing business in the state.
12 16 2. Annually evaluate the improvements by the medical
12 17 assistance program in the cost and quality of services
12 18 provided to Iowans over the cost and quality of care provided
12 19 in the prior year.
12 20 Sec. 16. NEW SECTION. 249J.16 OPERATIONS == PERFORMANCE
12 21 EVALUATION.
12 22 Beginning July 1, 2005, the department shall submit a
12 23 report of the results of an evaluation of the performance of
12 24 each component of the Iowa Medicaid enterprise using the
12 25 performance standards contained in the contracts with the Iowa
12 26 Medicaid enterprise partners.
12 27 Sec. 17. NEW SECTION. 249J.17 CLINICIANS ADVISORY PANEL
12 28 == CLINICAL MANAGEMENT.
12 29 1. Beginning July 1, 2005, the medical director of the
12 30 Iowa Medicaid enterprise, with the approval of the medical
12 31 assistance director, shall assemble and chair a clinicians
12 32 advisory panel to recommend to the department clinically
12 33 appropriate health care utilization management and coverage
12 34 decisions for the medical assistance program which are not
12 35 otherwise addressed by the Iowa medical assistance drug
13 1 utilization review commission created pursuant to section
13 2 249A.24 or the medical assistance pharmaceutical and
13 3 therapeutics committee established pursuant to section
13 4 249A.20A. The meetings shall be open to the public except to
13 5 the extent necessary to prevent the disclosure of personal
13 6 health information.
13 7 2. The medical director of the Iowa Medicaid enterprise
13 8 shall prepare an annual report summarizing the recommendations
13 9 made by the panel and adopted by the department regarding
13 10 clinically appropriate health care utilization management and
13 11 coverage under the medical assistance program.
13 12 Sec. 18. NEW SECTION. 249J.18 HEALTH CARE SERVICES
13 13 PRICING ADVISORY COUNCIL.
13 14 The department shall establish a health care services
13 15 pricing advisory council to receive information on third=party
13 16 payor rates in the state and, as appropriate, the usual and
13 17 customary charges of health care providers. The advisory
13 18 council shall regularly review and make recommendations to the
13 19 department regarding pricing changes, based upon a business
13 20 model and the federal pricing standard. The council shall
13 21 establish procedures for the appropriate protection of
13 22 confidential business information. The members of the
13 23 advisory council shall be selected by the director of human
13 24 services and at least one member of the council shall be a
13 25 health care economist. A member of the council shall not
13 26 serve other than in the member's individual capacity, and
13 27 shall not be employed by, or receive any form of payment from,
13 28 any provider or insurer or other third=party payor.
13 29 DIVISION VI
13 30 GOVERNANCE
13 31 Sec. 19. NEW SECTION. 249J.19 MEDICAL ASSISTANCE
13 32 PROJECTIONS AND ASSESSMENT COUNCIL.
13 33 1. A medical assistance projections and assessment council
13 34 is created consisting of the following members:
13 35 a. The co=chairpersons and ranking members of the
14 1 legislative joint appropriations subcommittee on health and
14 2 human services, or a member of the appropriations subcommittee
14 3 designated by the co=chairperson or ranking member.
14 4 b. The chairpersons and ranking members of the human
14 5 resources committees of the senate and the house of
14 6 representatives, or a member of the committee designated by
14 7 the chairperson or ranking member.
14 8 c. The chairpersons and ranking members of the
14 9 appropriations committees of the senate and the house of
14 10 representatives, or a member of the committee designated by
14 11 the chairperson or ranking member.
14 12 2. The council shall meet as often as deemed necessary,
14 13 but shall meet at least quarterly. The council may use
14 14 sources of information deemed appropriate, and the department
14 15 and other agencies of state government shall provide
14 16 information to the council as requested. The legislative
14 17 services agency shall provide staff support to the council.
14 18 3. The council shall select a chairperson, annually, from
14 19 its membership. A majority of the members of the council
14 20 shall constitute a quorum.
14 21 4. The council shall do all of the following:
14 22 a. Make quarterly cost projections for the medical
14 23 assistance program.
14 24 b. Review quarterly reports on all initiatives under this
14 25 chapter, including those provisions in the design,
14 26 development, and implementation phases, and make additional
14 27 recommendations for medical assistance program reform on an
14 28 annual basis.
14 29 c. Review quarterly reports on the success of the Iowa
14 30 Medicaid enterprise based upon the contractual performance
14 31 measures for each Iowa Medicaid enterprise partner.
14 32 d. Assure that the expansion population is managed at all
14 33 times within funding limitations. In assuring such
14 34 compliance, the council shall assume that supplemental funding
14 35 will not be available for coverage of services provided to the
15 1 expansion population.
15 2 5. The department of human services, the department of
15 3 management, and the legislative services agency shall utilize
15 4 a joint process to arrive at an annual consensus projection
15 5 for medical assistance program expenditures for submission to
15 6 the council. By December 15 of each fiscal year, the council
15 7 shall agree to a projection of expenditures for the fiscal
15 8 year beginning the following July 1, based upon the consensus
15 9 projection submitted.
15 10 DIVISION VII
15 11 ENHANCING THE FEDERAL=STATE FINANCIAL PARTNERSHIP
15 12 Sec. 20. NEW SECTION. 249J.20 PAYMENTS TO HEALTH CARE
15 13 PROVIDERS BASED ON ACTUAL COSTS.
15 14 Payments under the medical assistance program to public
15 15 hospitals and nursing facilities shall not exceed the actual
15 16 medical assistance costs reported on the Medicare hospital and
15 17 hospital health care complex cost report submitted to the
15 18 centers for Medicare and Medicaid services of the United
15 19 States department of health and human services. The hospitals
15 20 and nursing facilities shall retain one hundred percent of the
15 21 medical assistance payments earned under state reimbursement
15 22 rules. State reimbursement rules may provide for
15 23 reimbursement at less than actual cost.
15 24 Sec. 21. NEW SECTION. 249J.21 INDEPENDENT ANNUAL AUDIT.
15 25 The department shall contract with a certified public
15 26 accountant to provide an analysis, on an annual basis, to the
15 27 governor and the general assembly regarding compliance of the
15 28 Iowa medical assistance program with each of the following:
15 29 1. That the state has not instituted any new provider
15 30 taxes as defined by the centers for Medicare and Medicaid
15 31 services of the United States department of health and human
15 32 services.
15 33 2. That public hospitals and nursing facilities are not
15 34 paid more than the actual costs of care for medical assistance
15 35 program and disproportionate share hospital program recipients
16 1 based upon Medicare program principles of accounting and cost
16 2 reporting.
16 3 3. That the state is not recycling federal funds provided
16 4 under Title XIX of the Social Security Act as defined by the
16 5 centers for Medicare and Medicaid services of the United
16 6 States department of health and human services.
16 7 DIVISION VIII
16 8 LIMITATIONS
16 9 Sec. 22. NEW SECTION. 249J.22 LIMITATIONS.
16 10 1. The provisions of this chapter shall not be construed,
16 11 are not intended as, and shall not imply a grant of
16 12 entitlement for services to individuals who are eligible for
16 13 assistance under this chapter or for utilization of services
16 14 that do not exist or are not otherwise available on the
16 15 effective date of this Act. Any state obligation to provide
16 16 services pursuant to this chapter is limited to the extent of
16 17 the funds appropriated or distributed for the purposes of this
16 18 chapter.
16 19 2. The provisions of this chapter shall not be construed
16 20 and are not intended to affect the provision of services to
16 21 recipients of medical assistance services existing on the
16 22 effective date of this Act.
16 23 DIVISION IX
16 24 HOSPITAL TRUST FUND
16 25 Sec. 23. Section 249I.3, subsections 4 and 5, Code 2005,
16 26 are amended to read as follows:
16 27 4. "Hospital trust fund" means the fund and the accounts
16 28 of the fund created in this chapter to secure funds based on
16 29 hospital inpatient and outpatient prospective payment
16 30 methodologies under the medical assistance program and to
16 31 provide for the deposit of moneys from various sources for the
16 32 support of certain public hospitals.
16 33 5. "Public hospital" means a hospital licensed pursuant to
16 34 chapter 135B and governed pursuant to chapter 145A, 226, 347,
16 35 347A, or 392.
17 1 Sec. 24. Section 249I.4, Code 2005, is amended to read as
17 2 follows:
17 3 249I.4 HOSPITAL TRUST FUND == CREATED == APPROPRIATIONS.
17 4 1. A hospital trust fund is created in the state treasury
17 5 under the authority of the department of human services.
17 6 Moneys received through agreements for the trust fund and
17 7 moneys received from sources, including grants, contributions,
17 8 and participant payments, shall be deposited in the trust
17 9 fund.
17 10 2. Moneys deposited in the trust fund and the accounts of
17 11 the trust fund shall be used only as provided in
17 12 appropriations or distributions from the trust fund to the
17 13 department and the accounts of the trust fund for the purposes
17 14 specified in the appropriation or distribution.
17 15 3. The trust fund and the accounts of the trust fund shall
17 16 be separate from the general fund of the state and shall not
17 17 be considered part of the general fund of the state. The
17 18 moneys in the trust fund and the accounts of the trust fund
17 19 shall not be considered revenue of the state, but rather shall
17 20 be funds of the trust fund and the accounts of the trust fund.
17 21 The moneys in the trust fund and the accounts of the trust
17 22 fund are not subject to section 8.33 and shall not be
17 23 transferred, used, obligated, appropriated, or otherwise
17 24 encumbered, except to provide for the purposes of this
17 25 chapter. Notwithstanding section 12C.7, subsection 2,
17 26 interest or earnings on moneys deposited in the trust fund and
17 27 the accounts of the trust fund shall be credited to the trust
17 28 fund and the accounts of the trust fund.
17 29 4. The department shall adopt rules pursuant to chapter
17 30 17A to administer the trust fund and the accounts of the trust
17 31 fund and to establish procedures for participation by public
17 32 hospitals.
17 33 5. The treasurer of state shall provide a quarterly report
17 34 of trust fund activities and balances to the director.
17 35 6. The hospital trust fund shall consist of the following
18 1 accounts:
18 2 a. THE PUBLIC HOSPITAL ACCOUNT. Moneys received through
18 3 agreements for the trust fund based on hospital inpatient and
18 4 outpatient prospective payment methodologies, and moneys
18 5 received from other sources for deposit in the account,
18 6 including grants, contributions, and participant payments,
18 7 shall be deposited in the public hospital account.
18 8 b. THE INDIGENT PATIENT CARE PROGRAM ACCOUNT. Moneys
18 9 appropriated from the general fund of the state to the
18 10 account, moneys received as federal financial participation
18 11 funds pursuant to chapter 249J and credited to the account,
18 12 moneys received for disproportionate share hospitals and
18 13 credited to the account, moneys received for indirect medical
18 14 education and credited to the account, proceeds transferred
18 15 from the county treasurer as specified in subsection 8, and
18 16 moneys from any other source credited to the account shall be
18 17 deposited in the account. Moneys in the account shall be
18 18 appropriated to the university of Iowa hospitals and clinics
18 19 for the purposes provided in the federal law making the funds
18 20 available or as specified in the state appropriation, and
18 21 shall be distributed as determined by the department.
18 22 c. THE ACUTE CARE TEACHING HOSPITAL ACCOUNT. Moneys
18 23 appropriated from the general fund of the state to the
18 24 account, moneys received as federal financial participation
18 25 funds pursuant to chapter 249J and credited to the account,
18 26 moneys received for disproportionate share hospitals and
18 27 credited to the account, moneys received for indirect medical
18 28 education and credited to the account, proceeds transferred
18 29 from the county treasurer as specified in subsection 8, and
18 30 moneys received from any other source and credited to the
18 31 account shall be deposited in the account. Moneys in the
18 32 account shall be appropriated to a publicly owned acute care
18 33 teaching hospital located in a county with a population over
18 34 three hundred fifty thousand, for the purposes provided in the
18 35 federal law making the funds available or as specified in the
19 1 state appropriation, and shall be distributed as determined by
19 2 the department.
19 3 d. THE STATE HOSPITALS FOR PERSONS WITH MENTAL ILLNESS
19 4 ACCOUNT. Moneys appropriated from the general fund of the
19 5 state to the account, moneys received as federal financial
19 6 participation funds pursuant to chapter 249J and credited to
19 7 the account, moneys received for disproportionate share
19 8 hospitals and credited to the account, proceeds transferred
19 9 from the county treasurer as specified in subsection 8, and
19 10 moneys received from any other source and credited to the
19 11 account shall be deposited in the account. Moneys in the
19 12 account shall be appropriated to the state hospitals for
19 13 persons with mental illness designated pursuant to section
19 14 226.1 for the purposes provided in the federal law making the
19 15 funds available or as specified in the state appropriation,
19 16 and shall be distributed as determined by the department.
19 17 7. The department shall determine the distribution of
19 18 moneys from each account in the fund based upon the source of
19 19 receipt of the moneys. Notwithstanding section 262.28,
19 20 payments to be made to participating hospitals under
19 21 subsection 6, paragraphs "b" through "d", may be made on a
19 22 prospective basis in varying monthly installments. After the
19 23 close of the state fiscal year, the payments shall be adjusted
19 24 to reflect actual expenditures, and the adjusted payments
19 25 shall be made prior to September 1. If payments to a
19 26 participating hospital under subsection 6, paragraphs "b"
19 27 through "d", are made in excess of actual expenditures, the
19 28 participating hospital shall remit the excess amount to the
19 29 department. If payments to a participating hospital under
19 30 subsection 6, paragraphs "b" through "d", are insufficient to
19 31 reflect actual expenditures, the department shall pay the
19 32 difference to the participating hospital.
19 33 8. Notwithstanding any provision to the contrary, from
19 34 each semiannual collection of taxes levied under section 347.7
19 35 collected after July 1, 2005, the county treasurer of the
20 1 county with a population over three hundred fifty thousand in
20 2 which a publicly owned acute care teaching hospital is located
20 3 shall transfer the proceeds collected pursuant to section
20 4 347.7, which would otherwise be distributed to the county
20 5 hospital, to the treasurer of state for deposit by the
20 6 treasurer of state in the indigent patient care program
20 7 account, the acute care teaching hospital account, and the
20 8 state hospitals for persons with mental illness account under
20 9 this section, in amounts determined by the department. The
20 10 board of trustees of the acute care teaching hospital
20 11 identified in this subsection and the department shall execute
20 12 an agreement under chapter 28E to specify the requirements
20 13 relative to transfer of the proceeds and the distribution of
20 14 moneys to the hospital from the acute care teaching hospital
20 15 account.
20 16 9. The state board of regents on behalf of the university
20 17 of Iowa hospitals and clinics and the department shall execute
20 18 an agreement under chapter 28E to specify the requirements
20 19 relating to distribution of moneys to the hospital from the
20 20 indigent patient care program account.
20 21 DIVISION X
20 22 CORRESPONDING PROVISIONS
20 23 Sec. 25. Section 218.78, subsection 1, Code 2005, is
20 24 amended to read as follows:
20 25 1. All institutional receipts of the department of human
20 26 services, including funds received from client participation
20 27 at the state resource centers under section 222.78 and at the
20 28 state mental health institutes under section 230.20, shall be
20 29 deposited in the general fund except for reimbursements for
20 30 services provided to another institution or state agency, for
20 31 receipts deposited in the revolving farm fund under section
20 32 904.706, for deposits into the medical assistance fund under
20 33 section 249A.11, any medical assistance payments received
20 34 through the expansion program pursuant to chapter 249J, and
20 35 rentals charged to employees or others for room, apartment, or
21 1 house and meals, which shall be available to the institutions.
21 2 Sec. 26. Section 249A.4, subsection 8, unnumbered
21 3 paragraph 1, Code 2005, is amended to read as follows:
21 4 Shall advise and consult at least semiannually with a
21 5 council composed of the presidents of the following
21 6 organizations, or a president's representative who is a member
21 7 of the organization represented by the president: the Iowa
21 8 medical society, the Iowa osteopathic medical association, the
21 9 Iowa academy of family physicians, the Iowa chapter of the
21 10 American academy of pediatrics, the Iowa physical therapy
21 11 association, the Iowa dental association, the Iowa nurses
21 12 association, the Iowa pharmacy association, the Iowa podiatric
21 13 medical society, the Iowa optometric association, the Iowa
21 14 association of community providers, the Iowa psychological
21 15 association, the Iowa psychiatric society, the Iowa chapter of
21 16 the national association of social workers, the Iowa hospital
21 17 association, the Iowa association of rural health clinics, the
21 18 opticians' association of Iowa, inc., the Iowa association of
21 19 hearing health professionals, the Iowa speech and hearing
21 20 association, the Iowa health care association, the Iowa
21 21 association for home care, the Iowa council of health care
21 22 centers, the Iowa physician assistant society, the Iowa
21 23 association of nurse practitioners, the Iowa occupational
21 24 therapy association, the Iowa association of homes and
21 25 services for the aging, the ARC of Iowa which was formerly
21 26 known as the association for retarded citizens of Iowa, the
21 27 alliance for the mentally ill of Iowa, Iowa state association
21 28 of counties, and the governor's developmental disabilities
21 29 council, together with one person designated by the Iowa
21 30 chiropractic society; one state representative from each of
21 31 the two major political parties appointed by the speaker of
21 32 the house, one state senator from each of the two major
21 33 political parties appointed by the president of the senate,
21 34 after consultation with the majority leader and the minority
21 35 leader of the senate, each for a term of two years; four
22 1 public representatives equal in number to the number of
22 2 representatives of professional groups and associations
22 3 specifically represented on the council under this subsection,
22 4 appointed by the governor for staggered terms of two years
22 5 each, none of whom shall be members of, or practitioners of,
22 6 or have a pecuniary interest in any of the professions or
22 7 businesses represented by any of the several professional
22 8 groups and associations specifically represented on the
22 9 council under this subsection, and at least one all of whom
22 10 shall be a recipient current or former recipients of medical
22 11 assistance; the director of public health, or a representative
22 12 designated by the director; the dean of Des Moines university
22 13 == osteopathic medical center, or a representative designated
22 14 by the dean; and the dean of the university of Iowa college of
22 15 medicine, or a representative designated by the dean.
22 16 Sec. 27. Section 249I.5, Code 2005, is amended to read as
22 17 follows:
22 18 249I.5 STATE PLAN AMENDMENT.
22 19 The director shall amend the state medical assistance plan
22 20 as necessary to implement this chapter. The director shall
22 21 amend the state medical assistance plan to provide that
22 22 agreements entered into under this chapter to secure funds
22 23 based on hospital inpatient and outpatient prospective payment
22 24 methodologies under the medical assistance program are
22 25 terminated effective June 30, 2005.
22 26 Sec. 28. 2004 Iowa Acts, chapter 1175, section 86,
22 27 subsection 2, paragraph b, unnumbered paragraph 2, and
22 28 subparagraphs (1) and (2), are amended to read as follows:
22 29 Of the amount appropriated in this lettered paragraph,
22 30 $25,950,166 shall be considered encumbered and shall not be
22 31 expended for any purpose until January 1 July 1, 2005.
22 32 (1) However, if the department of human services adjusts
22 33 hospital payments to provide an increased base rate to offset
22 34 the high cost incurred for providing services to medical
22 35 assistance patients on or prior to January 1 July 1, 2005, a
23 1 portion of the amount specified in this unnumbered paragraph
23 2 equal to the increased Medicaid payment shall revert to the
23 3 general fund of the state. Notwithstanding section 8.54,
23 4 subsection 7, the amount required to revert under this
23 5 subparagraph shall not be considered to be appropriated for
23 6 purposes of the state general fund expenditure limitation for
23 7 the fiscal year beginning July 1, 2004.
23 8 (2) If the adjustment described in subparagraph (1) to
23 9 increase the base rate is not made on or prior to January 1
23 10 July 1, 2005, the amount specified in this unnumbered
23 11 paragraph shall no longer be considered encumbered, may be
23 12 expended, and shall be available for the purposes originally
23 13 specified.
23 14 Sec. 29. 2003 Iowa Acts, chapter 112, section 11,
23 15 subsection 1, is amended to read as follows:
23 16 1. For the fiscal year years beginning July 1, 2003, and
23 17 ending June 30, 2004, and beginning July 1, 2004, and for each
23 18 fiscal year thereafter ending June 30, 2005, the department of
23 19 human services shall institute a supplemental payment
23 20 adjustment applicable to physician services provided to
23 21 medical assistance recipients at publicly owned acute care
23 22 teaching hospitals. The adjustment shall generate
23 23 supplemental payments to physicians which are equal to the
23 24 difference between the physician's charge and the physician's
23 25 fee schedule under the medical assistance program. To the
23 26 extent of the supplemental payments, a qualifying hospital
23 27 shall, after receipt of the payments, transfer to the
23 28 department of human services an amount equal to the actual
23 29 supplemental payments that were made in that month. The
23 30 department of human services shall deposit these payments in
23 31 the department's medical assistance account. The department
23 32 of human services shall amend the medical assistance state
23 33 plan as necessary to implement this section. The department
23 34 may adopt emergency rules to implement this section. The
23 35 department of human services shall amend the medical
24 1 assistance state plan to eliminate this provision effective
24 2 June 30, 2005.
24 3 Sec. 30. CORRESPONDING DIRECTIVES TO DEPARTMENT. The
24 4 department shall do all of the following:
24 5 1. Withdraw the request for a waiver submitted to the
24 6 centers for Medicare and Medicaid services of the United
24 7 States department of health and human services regarding the
24 8 nursing facility quality assurance assessment as directed
24 9 pursuant to 2003 Iowa Acts, chapter 112, section 4, as amended
24 10 by 2003 Iowa Acts, chapter 179, section 162, and 2004 Iowa
24 11 Acts, chapter 1085, sections 8, 10, and 11.
24 12 2. Amend the medical assistance state plan to eliminate
24 13 the mechanism to secure funds based on hospital inpatient and
24 14 outpatient prospective payment methodologies under the medical
24 15 assistance program, effective June 30, 2005.
24 16 3. Amend the medical assistance state plan amendment to
24 17 establish mechanisms to receive supplemental disproportionate
24 18 share hospital and indirect medical education funds as
24 19 originally submitted, to be approved for the state fiscal year
24 20 beginning July 1, 2004, and ending June 30, 2005, only, and be
24 21 eliminated effective June 30, 2005.
24 22 4. Amend the medical assistance state plan amendment to
24 23 establish a physician payment adjustment from the university
24 24 of Iowa hospitals and clinics, as originally submitted as
24 25 described in 2003 Iowa Acts, chapter 112, section 11,
24 26 subsection 1, to be approved for the state fiscal years
24 27 beginning July 1, 2003, and ending June 30, 2004, and
24 28 beginning July 1, 2004, and ending June 30, 2005, and be
24 29 eliminated effective June 30, 2005.
24 30 Sec. 31. Sections 249A.20B and 249A.34, Code 2005, are
24 31 repealed.
24 32 Sec. 32. 2003 Iowa Acts, chapter 112, section 4, 2003 Iowa
24 33 Acts, chapter 179, section 162, and 2004 Iowa Acts, chapter
24 34 1085, sections 8, 10, and 11, are repealed.
24 35 DIVISION XI
25 1 PHARMACY COPAYMENTS
25 2 Sec. 33. COPAYMENTS FOR PRESCRIPTION DRUGS UNDER THE
25 3 MEDICAL ASSISTANCE PROGRAM. The department of human services
25 4 shall require recipients of medical assistance to pay the
25 5 following copayments on each prescription filled for a covered
25 6 prescription drug, including each refill of such prescription,
25 7 as follows:
25 8 1. A copayment of $1 for each covered generic prescription
25 9 drug not included on the prescription drug list.
25 10 2. A copayment of $1 for each covered brand=name or
25 11 generic prescription drug included on the prescription drug
25 12 list.
25 13 3. A copayment of $1 for each covered brand=name
25 14 prescription drug not included on the prescription drug list
25 15 for which the cost to the state is up to and including $25.
25 16 4. A copayment of $2 for each covered brand=name
25 17 prescription drug not included on the prescription drug list
25 18 for which the cost to the state is more than $25 and up to and
25 19 including $50.
25 20 5. A copayment of $3 for each covered brand=name
25 21 prescription drug not included on the preferred drug list for
25 22 which the cost to the state is more than $50.
25 23 DIVISION XII
25 24 STATE PAPERS PROGRAM
25 25 Sec. 34. Section 135B.31, Code 2005, is amended to read as
25 26 follows:
25 27 135B.31 EXCEPTIONS.
25 28 Nothing in this This division is not intended or should and
25 29 shall not affect in any way that the obligation of public
25 30 hospitals under chapter 347 or municipal hospitals, as well as
25 31 the state hospital at Iowa City, to provide medical or
25 32 obstetrical and newborn care for indigent persons under
25 33 chapter 255 or 255A, wherein medical care or treatment is
25 34 provided by hospitals of that category to patients of certain
25 35 entitlement, nor to the operation by the state of mental or
26 1 other hospitals authorized by law. Nothing herein This
26 2 division shall not in any way affect or limit the practice of
26 3 dentistry or the practice of oral surgery by a dentist.
26 4 Sec. 35. Section 144.13A, subsection 3, Code 2005, is
26 5 amended to read as follows:
26 6 3. If the person responsible for the filing of the
26 7 certificate of birth under section 144.13 is not the parent,
26 8 the person is entitled to collect the fee from the parent.
26 9 The fee shall be remitted to the state registrar. If the
26 10 expenses of the birth are reimbursed under the medical
26 11 assistance program established by chapter 249A, or paid for
26 12 under the statewide indigent patient care program established
26 13 by chapter 255, or paid for under the obstetrical and newborn
26 14 indigent patient care program established by chapter 255A, or
26 15 if the parent is indigent and unable to pay the expenses of
26 16 the birth and no other means of payment is available to the
26 17 parent, the registration fee and certified copy fee are
26 18 waived. If the person responsible for the filing of the
26 19 certificate is not the parent, the person is discharged from
26 20 the duty to collect and remit the fee under this section if
26 21 the person has made a good faith effort to collect the fee
26 22 from the parent.
26 23 Sec. 36. Section 249A.4, subsection 12, Code 2005, is
26 24 amended by striking the subsection.
26 25 Sec. 37. Section 271.6, Code 2005, is amended to read as
26 26 follows:
26 27 271.6 INTEGRATED TREATMENT OF UNIVERSITY HOSPITAL
26 28 PATIENTS.
26 29 The authorities of the Oakdale campus may authorize
26 30 patients for admission to the hospital on the Oakdale campus
26 31 who are referred from the university hospitals and who shall
26 32 retain the same status, classification, and authorization for
26 33 care which they had at the university hospitals. Patients
26 34 referred from the university hospitals to the Oakdale campus
26 35 shall be deemed to be patients of the university hospitals.
27 1 Chapters 255 and 255A and The operating policies of the
27 2 university hospitals shall apply to the patients and to the
27 3 payment for their care the same as the provisions apply to
27 4 patients who are treated on the premises of the university
27 5 hospitals.
27 6 Sec. 38. Section 331.381, subsection 9, Code 2005, is
27 7 amended by striking the subsection.
27 8 Sec. 39. Section 331.502, subsection 17, Code 2005, is
27 9 amended by striking the subsection.
27 10 Sec. 40. Section 331.552, subsection 13, Code 2005, is
27 11 amended to read as follows:
27 12 13. Make transfer payments to the state for school
27 13 expenses for blind and deaf children, and support of persons
27 14 with mental illness, and hospital care for the indigent as
27 15 provided in sections 230.21, 255.26, 269.2, and 270.7.
27 16 Sec. 41. Section 331.653, subsection 26, Code 2005, is
27 17 amended by striking the subsection.
27 18 Sec. 42. Section 331.756, subsection 53, Code 2005, is
27 19 amended by striking the subsection.
27 20 Sec. 43. Section 602.8102, subsection 48, Code 2005, is
27 21 amended by striking the subsection.
27 22 Sec. 44. Chapters 255 and 255A, Code 2005, are repealed.
27 23 DIVISION XIII
27 24 STATE MEDICAL INSTITUTION
27 25 Sec. 45. NEW SECTION. 218A.1 STATE MEDICAL INSTITUTION.
27 26 1. All of the following shall be collectively designated
27 27 as a single state medical institution:
27 28 a. The mental health institute, Mount Pleasant, Iowa.
27 29 b. The mental health institute, Independence, Iowa.
27 30 c. The mental health institute, Clarinda, Iowa.
27 31 d. The mental health institute, Cherokee, Iowa.
27 32 e. The Glenwood state resource center.
27 33 f. The Woodward state resource center.
27 34 2. Necessary portions of the institutes and resource
27 35 centers shall remain licensed as separate hospitals and as
28 1 separate intermediate care facilities for persons with mental
28 2 retardation, and the locations and operations of the
28 3 institutes and resource centers shall not be subject to
28 4 consolidation to comply with this chapter.
28 5 3. The state medical institution shall qualify for
28 6 payments described in subsection 4 for the fiscal period
28 7 beginning July 1, 2005, and ending June 30, 2010, if the state
28 8 medical institution and the various parts of the institution
28 9 comply with the requirements for payment specified in
28 10 subsection 4, and all of the following conditions are met:
28 11 a. The total number of beds in the state medical
28 12 institution licensed as hospital beds is less than fifty
28 13 percent of the total number of all state medical institution
28 14 beds. In determining compliance with this requirement,
28 15 however, any reduction in the total number of beds that occurs
28 16 as the result of reduction in census due to an increase in
28 17 utilization of home and community=based services shall not be
28 18 considered.
28 19 b. An individual is appointed by the director of human
28 20 services to serve as the director of the state medical
28 21 institution and an individual is appointed by the director of
28 22 human services to serve as medical director of the state
28 23 medical institution. The individual appointed to serve as the
28 24 director of the state medical institution may also be an
28 25 employee of the department of human services or of a component
28 26 part of the state medical institution. The individual
28 27 appointed to serve as medical director of the state medical
28 28 institution may also serve as the medical director of one of
28 29 the component parts of the state medical institution.
28 30 c. The director of the state medical institution, in
28 31 consultation with the directors of all licensed intermediate
28 32 care facilities for persons with mental retardation in the
28 33 state, develops and presents a plan to the centers for
28 34 Medicare and Medicaid services of the United States department
28 35 of health and human services no later than July 1, 2007, to
29 1 reduce the number of individuals in intermediate care
29 2 facilities for persons with mental retardation in the state
29 3 and concurrently to increase the number of individuals with
29 4 mental retardation and developmental disabilities in the state
29 5 who have access to home and community=based services.
29 6 4. The department of human services shall submit a waiver
29 7 to the centers for Medicare and Medicaid services of the
29 8 United States department of health and human services to
29 9 provide for all of the following:
29 10 a. Coverage under the medical assistance program, with
29 11 appropriate federal matching funding, for inpatient and
29 12 outpatient hospital services provided to eligible individuals
29 13 by any part of the state medical institution that maintains a
29 14 state license as a hospital.
29 15 b. Disproportionate share hospital payments for services
29 16 provided by any part of the state medical institution that
29 17 maintains a state license as a hospital.
29 18 c. Imposition of an assessment on intermediate care
29 19 facilities for persons with mental retardation on any part of
29 20 the state medical institution that provides an intermediate
29 21 care facility for persons with mental retardation.
29 22 DIVISION XIV
29 23 APPROPRIATIONS AND EFFECTIVE DATES
29 24 Sec. 46. APPROPRIATIONS FROM HOSPITAL TRUST FUND ACCOUNTS.
29 25 1. There is appropriated from the indigent patient care
29 26 program account created in section 249I.4 to the university of
29 27 Iowa hospitals and clinics for the fiscal year beginning July
29 28 1, 2005, and ending June 30, 2006, the following amount, or so
29 29 much thereof as is necessary, to be used for the purposes
29 30 designated:
29 31 For salaries, support, maintenance, equipment, and
29 32 miscellaneous purposes, for the provision of medical and
29 33 surgical treatment of indigent patients, for provision of
29 34 services to recipients under the medical assistance program
29 35 expansion population pursuant to chapter 249J, as enacted in
30 1 this Act, and for medical education:
30 2 .................................................. $ 27,284,584
30 3 2. There is appropriated from the acute care teaching
30 4 hospital account created in section 249I.4 to a publicly owned
30 5 acute care teaching hospital located in a county with a
30 6 population over three hundred fifty thousand for the fiscal
30 7 year beginning July 1, 2005, and ending June 30, 2006, the
30 8 following amount, or so much thereof as is necessary, to be
30 9 used for the purposes designated:
30 10 For the provision of medical and surgical treatment of
30 11 indigent patients and for provision of services to recipients
30 12 under the medical assistance program expansion population
30 13 pursuant to chapter 249J, as enacted in this Act:
30 14 .................................................. $ 34,000,000
30 15 3. There is appropriated from the state hospitals for
30 16 persons with mental illness account created in section 249I.4
30 17 to the state hospitals for persons with mental illness
30 18 designated pursuant to section 226.1 for the fiscal year
30 19 beginning July 1, 2005, and ending June 30, 2006, the
30 20 following amounts, or so much thereof as is necessary, to be
30 21 used for the purposes designated:
30 22 a. For services at the state mental health institute at
30 23 Cherokee, including services to recipients under the medical
30 24 assistance program expansion population pursuant to chapter
30 25 249J, as enacted in this Act:
30 26 .................................................. $ 8,700,968
30 27 b. For services at the state mental health institute at
30 28 Clarinda to recipients under the medical assistance program
30 29 expansion population pursuant to chapter 249J, as enacted in
30 30 this Act:
30 31 .................................................. $ 4,951,913
30 32 c. For services at the state mental health institute at
30 33 Independence to recipients under the medical assistance
30 34 program expansion population pursuant to chapter 249J, as
30 35 enacted in this Act:
31 1 .................................................. $ 11,513,490
31 2 d. For services at the state mental health institute at
31 3 Mount Pleasant to recipients under the medical assistance
31 4 program expansion population designation pursuant to chapter
31 5 249J, as enacted in this Act:
31 6 .................................................. $ 4,100,254
31 7 Sec. 47. EFFECTIVE DATES == CONTINGENT REDUCTION ==
31 8 RETROACTIVE APPLICABILITY.
31 9 1. This Act, being deemed of immediate importance, takes
31 10 effect upon enactment.
31 11 2. Any provision of this Act requiring federal approval of
31 12 a Medicaid state plan amendment or a waiver shall be
31 13 implemented only if such approval is received.
31 14 3. If the Eighty=first General Assembly enacts legislation
31 15 appropriating moneys from the general fund of the state to the
31 16 university of Iowa hospitals and clinics for salaries,
31 17 support, maintenance, equipment, and miscellaneous purposes
31 18 and for medical and surgical treatment of indigent patients as
31 19 provided in chapter 255, for medical education, and for full=
31 20 time equivalent positions, the appropriation is reduced by
31 21 $27,284,584.
31 22 4. The provisions of this Act amending 2003 Iowa Acts,
31 23 chapter 112, section 11, and repealing section 249A.20B, are
31 24 retroactively applicable to May 2, 2003.
31 25 5. The section of this Act amending 2004 Iowa Acts,
31 26 chapter 1175, section 86, is retroactively applicable to May
31 27 17, 2004.
31 28 EXPLANATION
31 29 This bill relates to health care reform and includes
31 30 provisions relating to the medical assistance (Medicaid)
31 31 program and indigent patients.
31 32 The bill creates a new Code chapter, chapter 249J, entitled
31 33 the Iowacare Act. The bill provides that the new Code chapter
31 34 is to be implemented only to the extent that federal matching
31 35 funds are available for nonfederal expenditures and that the
32 1 department of human services (DHS) is prohibited from
32 2 expending funds under the Code chapter if appropriated
32 3 nonfederal funds are not matched by federal financial
32 4 participation.
32 5 The bill provides definitions, legislative findings, and
32 6 the purpose of the chapter.
32 7 The bill establishes the eligibility requirements,
32 8 benefits, and provider network for an expansion population
32 9 designation under the medical assistance program. An
32 10 individual is eligible for coverage under the expansion
32 11 population if the individual is 19 through 64 years of age;
32 12 has a family income at or below 200 percent of the federal
32 13 poverty level; and fulfills all other conditions of
32 14 participation for the expansion population described in the
32 15 chapter. Additionally, individuals otherwise eligible solely
32 16 for family planning benefits authorized under the medical
32 17 assistance family planning services waiver may be eligible for
32 18 expansion population benefits. The bill provides that
32 19 enrollment for the expansion population may be limited,
32 20 closed, or reduced and the scope and duration of expansion
32 21 population services provided may be limited, reduced, or
32 22 terminated if the department determines that federal medical
32 23 assistance program matching funds or appropriated state funds
32 24 will not be available to pay for existing or additional
32 25 enrollment.
32 26 The bill provides that benefits to the expansion population
32 27 include certain inpatient hospital procedures, outpatient
32 28 hospital services, physician and licensed nurse practitioner
32 29 services, dental services, limited pharmacy benefits, and
32 30 transportation to and from an expansion population provider
32 31 network provider. Beginning no later than March 1, 2006, all
32 32 expansion population members are required to receive a single
32 33 complete medical examination and personal health improvement
32 34 plan within 90 days of enrollment in the program. Beginning
32 35 no later than July 1, 2006, expansion population members are
33 1 also to be provided with access to a pharmacy assistance
33 2 clearinghouse program and access to a medical information
33 3 hotline, accessible 24 hours per day, seven days per week.
33 4 Expansion population members remain eligible for all services
33 5 not covered under the expansion population for which the
33 6 expansion population member is otherwise entitled under state
33 7 or federal law.
33 8 The bill provides that expansion population members are
33 9 only eligible to receive expansion population services through
33 10 an expansion population provider network which is limited to a
33 11 publicly owned acute care teaching hospital located in a
33 12 county with a population over 350,000, the university of Iowa
33 13 hospitals and clinics, and the state hospitals for persons
33 14 with mental illness designated pursuant to Code section 226.1.
33 15 Services provided by providers of the network are payable at
33 16 the full benefit recipient rates and a provider under the
33 17 network may deny care to an individual who refuses to apply
33 18 for coverage under the expansion population.
33 19 The bill requires that each expansion population member pay
33 20 a monthly premium unless the premium is waived. An expansion
33 21 population member is also required to pay the same copayments
33 22 required of other adult recipients of the medical assistance
33 23 program. The bill authorizes DHS to reduce the required out=
33 24 of=pocket expenditures for an individual expansion population
33 25 member based upon the member's increased wellness activities
33 26 or compliance with the personal health improvement plan
33 27 completed by the member.
33 28 The bill requires DHS to submit to the governor and the
33 29 general assembly by March 15, 2006, a design for an insurance
33 30 cost subsidy program for expansion population members who have
33 31 access to employer health insurance plans, and a health care
33 32 account program option for individuals eligible for enrollment
33 33 in the expansion population.
33 34 The bill provides for future expansions in population,
33 35 benefits, and the provider network for the expansion
34 1 population based upon empirical findings and subject to
34 2 meeting financial obligations to the provider network and
34 3 within existing appropriations.
34 4 The bill provides that unencumbered certified local
34 5 matching funds may be used to cover the state share of the
34 6 cost of services for the expansion population. The bill
34 7 directs DHS to include in its annual budget submission,
34 8 recommendations relating to a disproportionate share hospital
34 9 and indirect medical education allocation plan that maximizes
34 10 the availability of federal funds for payments to hospitals
34 11 for the care and treatment of indigent patients. The bill
34 12 also provides that if federal law and regulations allow, and
34 13 if federal disproportionate share hospital funds and indirect
34 14 medical education funds are available, the funds are to be
34 15 distributed as specified by the department.
34 16 The bill directs DHS to amend the medical assistance state
34 17 plan to provide for an increase in the level of care required
34 18 for new nursing facility admissions beginning July 1, 2005,
34 19 while continuing the same level of care requirement for home
34 20 and community=based services waiver services in effect prior
34 21 to July 1, 2005. The bill also provides that if, beginning
34 22 July 1, 2005, appropriate home and community=based services at
34 23 the nursing facility level of care are not available to an
34 24 individual in the individual's community at the time of the
34 25 determination, and nursing facility level of care is medically
34 26 necessary, the criteria for admission of the individual to a
34 27 nursing facility for nursing facility level of care services
34 28 shall be the criteria in effect on June 30, 2005. The bill
34 29 also directs DHS, in consultation with interested parties, to
34 30 develop a plan for submission to the governor and the general
34 31 assembly by July 1, 2007, to enhance access to community=based
34 32 care alternatives for individuals who would otherwise require
34 33 care in an intermediate care facility for persons with mental
34 34 retardation. The bill also directs DHS to implement a case=
34 35 mix adjusted reimbursement system for both institution=based
35 1 and community=based services for persons with mental
35 2 retardation or developmental disabilities by January 1, 2007,
35 3 and to develop a plan for submission to the governor and the
35 4 general assembly by July 1, 2007, to enhance alternatives for
35 5 community=based care for individuals who would otherwise
35 6 require care in an intermediate care facility for persons with
35 7 mental retardation. The bill also directs DHS to provide
35 8 medical assistance waiver services to not more than 300
35 9 children, without regard to family income, who meet both of
35 10 the following criteria: require behavioral health care
35 11 services and qualify for the care level provided by a
35 12 psychiatric medical institution for children, and require
35 13 treatment to cure or alleviate a serious mental illness or
35 14 disorder, or emotional damage as evidenced by severe anxiety,
35 15 depression, withdrawal, or untoward aggressive behavior toward
35 16 the child's self or others and the child's parent, guardian,
35 17 or custodian is unable to provide such treatment.
35 18 The bill requires DHS to institute a number of health
35 19 promotion partnerships including all of the following:
35 20 1. Beginning July 1, 2005, covering inpatient and
35 21 outpatient hospital services at the state hospitals for
35 22 persons with mental illness designated pursuant to section
35 23 226.1 under the medical assistance program.
35 24 2. By July 1, 2006, designing and beginning implementation
35 25 of a strategy to provide dietary counseling and support to
35 26 child and adult recipients of medical assistance.
35 27 3. By October 1, 2006, developing a practical strategy for
35 28 expanding utilization of electronic medical recordkeeping by
35 29 medical assistance program providers, focusing initially on
35 30 medical assistance program recipients whose quality of care
35 31 would be significantly enhanced by the availability of
35 32 electronic medical recordkeeping.
35 33 4. By January 1, 2007, designing and implementing a
35 34 medical assistance provider incentive program based upon
35 35 evaluation of public and private sector models.
36 1 5. Working with the university of Iowa college of medicine
36 2 and college of dentistry to determine whether the physical and
36 3 dental health of recipients of medical assistance who are
36 4 persons with mental retardation or developmental disabilities
36 5 are being regularly and fully addressed and to identify
36 6 barriers to such care. DHS is required to report the
36 7 department's findings to the governor and the general assembly
36 8 by January 1, 2007.
36 9 6. Implementing a program to reduce smoking among
36 10 recipients of medical assistance who are children to less than
36 11 1 percent and among those who are adults to less than 10
36 12 percent, by July 1, 2007.
36 13 7. By July 1, 2008, requiring every recipient of medical
36 14 assistance who is a child 12 years of age or less to have a
36 15 designated dental home.
36 16 The bill includes requirements for the Iowa Medicaid
36 17 enterprise including an annual evaluation. The bill also
36 18 requires the medical director of the Iowa Medicaid enterprise,
36 19 with the approval of the medical assistance director, to
36 20 assemble and chair a clinicians advisory panel to recommend to
36 21 the department clinically appropriate health care utilization
36 22 management and coverage decisions for the medical assistance
36 23 program which are not otherwise addressed. The medical
36 24 director of the Iowa Medicaid enterprise is to prepare an
36 25 annual report summarizing the recommendations made by the
36 26 panel and adopted by the department regarding clinically
36 27 appropriate health care utilization management and coverage
36 28 under the medical assistance program.
36 29 The bill also directs DHS to establish a health care
36 30 services pricing advisory council to receive information on
36 31 third=party payor rates in the state and, as appropriate, the
36 32 usual and customary charges of providers.
36 33 The bill establishes a medical assistance projections and
36 34 assessment council to make quarterly cost projections for the
36 35 medical assistance program; review quarterly reports on all
37 1 initiatives under the new chapter, including those provisions
37 2 in the design, development, and implementation phases, and
37 3 make additional recommendations for medical assistance program
37 4 reform on an annual basis; review quarterly reports on the
37 5 success of the Iowa Medicaid enterprise based upon the
37 6 contractual performance measures for each Iowa Medicaid
37 7 enterprise partner; and assure that the expansion population
37 8 is managed at all times within funding limitations. The bill
37 9 also provides that DHS, the department of management, and the
37 10 legislative services agency are to utilize a joint process to
37 11 arrive at an annual consensus projection for medical
37 12 assistance program expenditures for submission to the council.
37 13 By December 15 of each fiscal year, the council is to agree to
37 14 a projection of expenditures for the fiscal year beginning the
37 15 following July 1, based upon the consensus projection
37 16 submitted.
37 17 The bill provides that payments under the medical
37 18 assistance program to public hospitals and nursing facilities
37 19 are not to exceed the actual medical assistance costs, that
37 20 the hospitals are to retain 100 percent of the medical
37 21 assistance payments earned under state reimbursement rules,
37 22 and that state reimbursement rules may provide for
37 23 reimbursement at less than actual cost.
37 24 The bill directs DHS to contract with a certified public
37 25 accountant to provide an analysis, on an annual basis, to the
37 26 governor and the general assembly regarding compliance of the
37 27 Iowa medical assistance program with provisions prohibiting
37 28 the institution of new provider taxes, that public hospitals
37 29 and nursing facilities are not paid more than the actual costs
37 30 of care for medical assistance program and disproportionate
37 31 share hospital program recipients based upon Medicare program
37 32 principles of accounting and cost reporting, and that the
37 33 state is not recycling federal funds provided under the
37 34 medical assistance program.
37 35 The bill provides that the provisions of the new chapter
38 1 are not to be construed, are not intended as, and shall not
38 2 imply a grant of entitlement for services to individuals who
38 3 are eligible for assistance under the chapter or for
38 4 utilization of services that do not exist or are not otherwise
38 5 available on the effective date of the bill. Any state
38 6 obligation to provide services pursuant to the chapter is
38 7 limited to the extent of the funds appropriated or distributed
38 8 for the purposes of the chapter. Additionally, the bill
38 9 provides that the provisions of the chapter are not to be
38 10 construed and are not intended to affect the provision of
38 11 services to recipients of medical assistance services existing
38 12 on the effective date of the bill.
38 13 The bill amends the hospital trust fund Code chapter to
38 14 provide for the establishment of accounts in the trust fund
38 15 including the public hospital account, the indigent patient
38 16 care program account, the acute care teaching hospital
38 17 account, and the state hospitals for persons with mental
38 18 illness account. These provisions provide a mechanism for
38 19 deposit of moneys received from various state and federal
38 20 sources and distribution of these moneys to the entities
38 21 described to provide services as specified in the state
38 22 appropriation of the moneys or in the federal law making the
38 23 funds available. The bill also provides a mechanism for
38 24 transfer of the proceeds generated from a county hospital levy
38 25 to the treasurer of state for deposit in the accounts of the
38 26 hospital trust fund. DHS is directed to execute agreements
38 27 under Code chapter 28E with the board of trustees of the acute
38 28 care teaching hospital of the county from which the levy
38 29 proceeds are transferred and with the state board of regents
38 30 on behalf of the university of Iowa hospitals and clinics to
38 31 specify the requirements relative to the transfer and for
38 32 distribution of the proceeds.
38 33 The bill makes corresponding changes to provide for
38 34 representation on the medical assistance advisory council of
38 35 an equal number of current or former recipients of medical
39 1 assistance as there are representatives of the professional
39 2 groups and associations specifically represented on the
39 3 council.
39 4 The bill eliminates a number of existing provisions that
39 5 allowed for intergovernmental transfers under the medical
39 6 assistance program.
39 7 The bill establishes copayments for both generic and brand=
39 8 name prescription drugs included on the prescription drug list
39 9 and not included on the prescription drug list under the
39 10 medical assistance program.
39 11 The bill eliminates the medical and surgical treatment of
39 12 indigent persons chapter (Code chapter 255) and the
39 13 obstetrical and newborn indigent patient care program (Code
39 14 chapter 255A) and makes conforming changes.
39 15 The bill designates the state resource centers and the
39 16 mental health institutes as a single state medical institution
39 17 (SMI) and directs the department of human services to submit a
39 18 waiver to the centers for Medicare and Medicaid services to
39 19 provide for coverage under the medical assistance program,
39 20 with matching funding, for inpatient and outpatient hospital
39 21 services provided to eligible individuals, disproportionate
39 22 share hospital payments for services provided by the portion
39 23 of the SMI that maintains the hospital license, and imposition
39 24 of an assessment on intermediate care facilities for persons
39 25 with mental retardation (ICF/MR) on any part of the SMI that
39 26 provides ICF/MR services.
39 27 The bill makes appropriations from the hospital trust fund
39 28 accounts to the university of Iowa hospitals and clinics, a
39 29 publicly owned acute care teaching hospital located in a
39 30 county with a population over 350,000, and the mental health
39 31 institutes to provide the services specified.
39 32 The bill takes effect upon enactment, but the provisions of
39 33 the bill requiring federal approval are to be implemented only
39 34 if such approval is received. The provisions of the bill
39 35 relating to the nursing facility quality assurance assessment
40 1 are retroactively applicable to the provisions' original
40 2 effective date of May 2, 2003, and the provision relating to
40 3 the enhanced payment to the university of Iowa utilizing the
40 4 appropriation for the indigent patient program is
40 5 retroactively applicable to its original effective date of May
40 6 17, 2004.
40 7 LSB 3523HH 81
40 8 pf:nh/gg/14