House File 2207 - Introduced
HOUSE FILE
BY UPMEYER
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to transfer procedures for and compensation of
2 health care providers outside of the IowaCare provider network
3 and requiring the development and implementation of a plan to
4 transport eligible IowaCare members.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 TLSB 5524YH 82
7 pf/nh/14
PAG LIN
1 1 Section 1. NEW SECTION. 249J.24A NONPARTICIPATING
1 2 PROVIDER EXPANSION POPULATION PROVIDER NETWORK == TRANSFER
1 3 PROCEDURE == COMPENSATION FUND.
1 4 1. The department shall establish a procedure to transfer
1 5 an expansion population member who seeks medical care or
1 6 treatment from a nonparticipating provider in the expansion
1 7 population provider network to a participating provider in the
1 8 expansion population provider network, if medically possible.
1 9 If transfer is not medically possible or if the participating
1 10 provider refuses to accept the transfer of the expansion
1 11 population member, the nonparticipating provider shall be
1 12 compensated through the nonparticipating provider expansion
1 13 population provider network compensation fund in accordance
1 14 with subsection 2.
1 15 2. a. A nonparticipating provider expansion population
1 16 provider network compensation fund is created in the state
1 17 treasury under the authority of the department. Moneys
1 18 designated for deposit in the fund that are received from
1 19 sources including but not limited to appropriations from the
1 20 general fund of the state, grants, and contributions shall be
1 21 deposited in the fund.
1 22 b. Moneys in the fund shall be separate from the general
1 23 fund of the state and shall not be considered part of the
1 24 general fund of the state. The moneys deposited in the fund
1 25 are not subject to section 8.33 and shall not be transferred,
1 26 used, obligated, appropriated, or otherwise encumbered, except
1 27 to provide for the purposes specified in this section.
1 28 Notwithstanding section 12C.7, subsection 2, interest or
1 29 earnings on moneys deposited in the fund shall be credited to
1 30 the fund.
1 31 c. Moneys deposited in the fund shall be used only to
1 32 compensate health care providers who are not participants in
1 33 the expansion population provider network pursuant to section
1 34 249J.7, who provide services to expansion population members,
1 35 if no other third party is liable for reimbursement for the
2 1 services provided.
2 2 d. In order to be compensated through the fund, a health
2 3 care provider shall submit a claim to the department for
2 4 compensation and reimbursement of expenses incurred in
2 5 providing services to an expansion population member. The
2 6 department shall adopt rules relating to the format of and the
2 7 information to be included in the claims submitted. A claim
2 8 shall be submitted to the department within forty=five days of
2 9 provision of the service.
2 10 Sec. 2. PLAN FOR TRANSPORT OF ELIGIBLE IOWACARE MEMBERS.
2 11 The university of Iowa hospitals and clinics, in cooperation
2 12 with the department of human services, shall develop and
2 13 implement no later than October 1, 2008, a plan to provide
2 14 transportation to and from the university of Iowa hospitals
2 15 and clinics for IowaCare members who live beyond the counties
2 16 adjacent to Johnson county. The plan may require the use of
2 17 existing vehicles or utilize volunteer transportation.
2 18 EXPLANATION
2 19 This bill directs the department of human services to
2 20 establish a procedure to transfer an IowaCare member who seeks
2 21 medical care or treatment from a provider who is not
2 22 participating in the IowaCare provider network to an IowaCare
2 23 provider, if medically possible. If transfer is not medically
2 24 possible or if the participating provider refuses to accept
2 25 the transfer of the expansion population member, the
2 26 nonparticipating provider shall be compensated through the
2 27 fund established for such compensation under the bill.
2 28 The bill creates a fund to be used to compensate health
2 29 care providers who are not included in the IowaCare provider
2 30 network and who provide services to expansion population
2 31 members that are not reimbursable by any other third party.
2 32 Moneys to be deposited in the fund are moneys received from
2 33 sources including but not limited to appropriations from the
2 34 general fund of the state, grants, and contributions.
2 35 The bill requires that in order to be compensated through
3 1 the fund, a health care provider must submit claims to the
3 2 department of human services. The bill directs the department
3 3 to adopt rules relating to the format of and the information
3 4 to be included in the claims submitted. A claim shall be
3 5 submitted to the department within 45 days of provision of the
3 6 service.
3 7 The bill also requires the university of Iowa hospitals and
3 8 clinics, in cooperation with the department of human services,
3 9 to develop and implement a plan, no later than October 1,
3 10 2008, to provide transportation to and from the university of
3 11 Iowa hospitals and clinics for IowaCare members who live
3 12 beyond the counties adjacent to Johnson county. The bill
3 13 directs that the plan may require the use of existing vehicles
3 14 or utilize volunteer transportation.
3 15 LSB 5524YH 82
3 16 pf/nh/14