House Study Bill 757
HOUSE FILE
BY (PROPOSED COMMITTEE ON
HUMAN RESOURCES BILL BY
CHAIRPERSON SMITH)
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 health care
2 coverage intended for children, health information technology,
3 end=of=life care promotion, preexisting conditions and
4 dependent children coverage, and medical homes, providing an
5 appropriation, and including an applicability provision.
6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
7 TLSB 6541YC 82
8 av:pf/rj/14
PAG LIN
1 1 DIVISION I
1 2 HEALTH CARE COVERAGE INTENT
1 3 Section 1. DECLARATION OF INTENT.
1 4 1. It is the intent of the general assembly, as funding
1 5 becomes available, to progress toward achievement of the goal
1 6 that all Iowans have health care coverage which meets certain
1 7 standards of quality and affordability with the initial
1 8 priority being that all children have such health care
1 9 coverage by December 31, 2010.
1 10 2. It is also the intent of the general assembly that if
1 11 sufficient funding is available, and if federal
1 12 reauthorization of the state children's health insurance
1 13 program provides sufficient federal allocations to the state
1 14 and authorization to cover such children as an option under
1 15 the state children's health insurance program, the department
1 16 of human services may expand coverage under the state
1 17 children's health insurance program to cover children with
1 18 family incomes up to three hundred percent of the federal
1 19 poverty level.
1 20 DIVISION II
1 21 IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
1 22 Sec. 2. NEW SECTION. 8.70 DEFINITIONS.
1 23 As used in this division, unless the context otherwise
1 24 requires:
1 25 1. "Health care professional" means a person who is
1 26 licensed, certified, or otherwise authorized or permitted by
1 27 the law of this state to administer health care in the
1 28 ordinary course of business of in the practice of a
1 29 profession.
1 30 2. "Health information technology" means the application
1 31 of information processing, involving both computer hardware
1 32 and software, that deals with the storage, retrieval, sharing,
1 33 and use of health care information, data, and knowledge for
1 34 communication, decision making, quality, safety, and
1 35 efficiency of clinical practice, and may include but is not
2 1 limited to:
2 2 a. An electronic health record that electronically
2 3 compiles and maintains health information that may be derived
2 4 from multiple sources about the health status of an individual
2 5 and may include a core subset of each care delivery
2 6 organization's electronic medical record such as a continuity
2 7 of care record or a continuity of care document, computerized
2 8 physician order entry, electronic prescribing, or clinical
2 9 decision support.
2 10 b. A personal health record through which an individual
2 11 and any other person authorized by the individual can maintain
2 12 and manage the individual's health information.
2 13 c. An electronic medical record that is used by health
2 14 care professionals to electronically document, monitor, and
2 15 manage health care delivery within a care delivery
2 16 organization, is the legal record of the patient's encounter
2 17 with the care delivery organization, and is owned by the care
2 18 delivery organization.
2 19 d. A computerized provider order entry function that
2 20 permits the electronic ordering of diagnostic and treatment
2 21 services, including prescription drugs.
2 22 e. A decision support function to assist physicians and
2 23 other health care providers in making clinical decisions by
2 24 providing electronic alerts and reminders to improve
2 25 compliance with best practices, promote regular screenings and
2 26 other preventive practices, and facilitate diagnoses and
2 27 treatments.
2 28 f. Tools to allow for the collection, analysis, and
2 29 reporting of information or data on adverse events, the
2 30 quality and efficiency of care, patient satisfaction, and
2 31 other health care=related performance measures.
2 32 3. "Interoperability" means the ability of two or more
2 33 systems or components to exchange information or data in an
2 34 accurate, effective, secure, and consistent manner and to use
2 35 the information or data that has been exchanged and includes
3 1 but is not limited to:
3 2 a. The capacity to connect to a network for the purpose of
3 3 exchanging information or data with other users.
3 4 b. The ability of a connected, authenticated user to
3 5 demonstrate appropriate permissions to participate in the
3 6 instant transaction over the network.
3 7 c. The capacity of a connected, authenticated user to
3 8 access, transmit, receive, and exchange usable information
3 9 with other users.
3 10 4. "Recognized interoperability standard" means
3 11 interoperability standards recognized by the office of the
3 12 national coordinator for health information technology of the
3 13 United States department of health and human services.
3 14 Sec. 3. NEW SECTION. 8.71 IOWA ELECTRONIC HEALTH ==
3 15 PRINCIPLES == GOALS.
3 16 1. Health information technology is rapidly evolving so
3 17 that it can contribute to the goals of improving access to and
3 18 quality of health care, enhancing efficiency, and reducing
3 19 costs.
3 20 2. To be effective, the health information technology
3 21 system shall comply with all of the following principles:
3 22 a. Be patient=centered and market=driven.
3 23 b. Be based on approved standards developed with input
3 24 from all stakeholders.
3 25 c. Protect the privacy of consumers and the security and
3 26 confidentiality of all health information.
3 27 d. Promote interoperability.
3 28 e. Ensure the accuracy, completeness, and uniformity of
3 29 data.
3 30 3. Widespread adoption of health information technology is
3 31 critical to a successful health information technology system
3 32 and is best achieved when all of the following occur:
3 33 a. The market provides a variety of certified products
3 34 from which to choose in order to best fit the needs of the
3 35 user.
4 1 b. The system provides incentives for health care
4 2 professionals to utilize the health information technology and
4 3 provides rewards for any improvement in quality and efficiency
4 4 resulting from such utilization.
4 5 c. The system provides protocols to address critical
4 6 problems.
4 7 d. The system is financed by all who benefit from the
4 8 improved quality, efficiency, savings, and other benefits that
4 9 result from use of health information technology.
4 10 Sec. 4. NEW SECTION. 8.72 IOWA ELECTRONIC HEALTH
4 11 INFORMATION COMMISSION.
4 12 1. a. An electronic health information commission is
4 13 created as a public and private collaborative effort to
4 14 promote the adoption and use of health information technology
4 15 in this state in order to improve health care quality,
4 16 increase patient safety, reduce health care costs, enhance
4 17 public health, and empower individuals and health care
4 18 professionals with comprehensive, real=time medical
4 19 information to provide continuity of care and make the best
4 20 health care decisions. The commission shall provide oversight
4 21 for the development, implementation, and coordination of an
4 22 interoperable electronic health records system, telehealth
4 23 expansion efforts, the health information technology
4 24 infrastructure, and other health information technology
4 25 initiatives in this state. The commission shall be guided by
4 26 the principles and goals specified in section 8.71.
4 27 b. All health information technology efforts shall
4 28 endeavor to represent the interests and meet the needs of
4 29 consumers and the health care sector, protect the privacy of
4 30 individuals and the confidentiality of individuals'
4 31 information, promote physician best practices, and make
4 32 information easily accessible to the appropriate parties. The
4 33 system developed shall be consumer=driven, flexible, and
4 34 expandable.
4 35 2. The commission shall consist of five voting members who
5 1 are individuals with broad experience and vision in health
5 2 care and health technology, and four members of the general
5 3 assembly who shall serve as ex officio, nonvoting members.
5 4 The voting members shall be appointed by the governor, subject
5 5 to confirmation by the senate. The legislative members of the
5 6 commission shall be appointed by the majority leader of the
5 7 senate, the minority leader of the senate, the speaker of the
5 8 house of representatives, and the minority leader of the house
5 9 of representatives.
5 10 3. a. The voting members shall serve terms of three years
5 11 beginning and ending as provided in section 69.19. Voting
5 12 member appointments shall comply with sections 69.16 and
5 13 69.16A. Voting members shall receive reimbursement for actual
5 14 expenses incurred while serving in their official capacity and
5 15 voting members may also be eligible to receive compensation as
5 16 provided in section 7E.6. Legislative members shall be paid
5 17 the per diem and expenses specified in section 2.10.
5 18 Vacancies shall be filled by the original appointing authority
5 19 and in the manner of the original appointments. A person
5 20 appointed to fill a vacancy for a member shall serve only for
5 21 the unexpired portion of the term. A voting member is
5 22 eligible for reappointment for two successive terms.
5 23 b. The voting members shall select a chairperson,
5 24 annually, from among the membership. The commission shall
5 25 meet at least quarterly and at the call of the chairperson. A
5 26 majority of the voting members of the commission constitutes a
5 27 quorum. Any action taken by the commission must be adopted by
5 28 the affirmative vote of a majority of its voting membership.
5 29 c. The commission is located for administrative purposes
5 30 within the department of management. The department shall
5 31 provide office space, staff assistance, administrative
5 32 support, and necessary supplies and equipment for the
5 33 commission.
5 34 4. The commission shall do all of the following:
5 35 a. Establish a technical advisory group which shall
6 1 consist of the representatives of entities involved in the
6 2 electronic health records system task force established
6 3 pursuant to section 217.41A, Code 2007, and any other members
6 4 the commission determines necessary to assist in the
6 5 commission's duties at various stages of development of the
6 6 electronic health information system. Executive branch
6 7 agencies shall also be included as necessary to assist in the
6 8 duties of the commission. Public members of the technical
6 9 advisory group shall receive reimbursement for actual expenses
6 10 incurred while serving in their official capacity only if they
6 11 are not eligible for reimbursement by the organization that
6 12 they represent. Any legislative members shall be paid the per
6 13 diem and expenses specified in section 2.10.
6 14 b. Adopt a statewide health information technology plan by
6 15 January 1, 2009. In developing the plan, the commission shall
6 16 seek the input of providers, payers, and consumers. Standards
6 17 and policies developed for the plan shall promote and be
6 18 consistent with national standards developed by the office of
6 19 the national coordinator for health information technology of
6 20 the United States department of health and human services and
6 21 shall address or provide for all of the following:
6 22 (1) The effective, efficient, statewide use of electronic
6 23 health information in patient care, health care policymaking,
6 24 clinical research, health care financing, and continuous
6 25 quality improvement. The commission shall adopt requirements
6 26 for interoperable electronic health records in this state
6 27 including a recognized interoperability standard.
6 28 (2) Education of the public and health care sector about
6 29 the value of health information technology in improving
6 30 patient care, and methods to promote increased support and
6 31 collaboration of state and local public health agencies,
6 32 health care professionals, and consumers in health information
6 33 technology initiatives.
6 34 (3) Standards for the exchange of health care information
6 35 and interoperable electronic health records.
7 1 (4) Policies relating to the protection of privacy of
7 2 patients and the security and confidentiality of patient
7 3 information.
7 4 (5) Policies relating to information ownership.
7 5 (6) Policies relating to governance of the various facets
7 6 of the health information technology system.
7 7 (7) A single patient identifier or alternative mechanism
7 8 to share secure patient information. If no alternative
7 9 mechanism is acceptable to the commission, all health care
7 10 professionals shall utilize the mechanism selected by the
7 11 commission by January 1, 2010.
7 12 (8) A standard continuity of care record and other issues
7 13 related to the content of electronic transmissions. All
7 14 health care professionals shall utilize the standard
7 15 continuity of care record by January 1, 2010.
7 16 (9) Requirements for electronic prescribing.
7 17 (10) Economic incentives and support to facilitate
7 18 participation in an interoperable system by health care
7 19 professionals.
7 20 c. Identify existing and potential health information
7 21 technology efforts in this state, regionally, and nationally,
7 22 and integrate existing efforts to avoid incompatibility
7 23 between efforts and avoid duplication.
7 24 d. Coordinate public and private efforts to provide the
7 25 network backbone infrastructure for the health information
7 26 technology system. In coordinating these efforts, the
7 27 commission shall do all of the following:
7 28 (1) Adopt policies to effectuate the logical cost
7 29 effective usage of and access to the state=owned network, and
7 30 support of telecommunication carrier products, where
7 31 applicable.
7 32 (2) Consult with the Iowa communications network, private
7 33 fiberoptic networks, and any other communications entity to
7 34 seek collaboration, avoid duplication, and leverage
7 35 opportunities in developing a backbone network.
8 1 (3) Establish protocols to ensure compliance with any
8 2 applicable federal standards.
8 3 (4) Determine costs for accessing the network at a level
8 4 that provides sufficient funding for the network.
8 5 e. Promote the use of telemedicine.
8 6 (1) Examine existing barriers to the use of telemedicine
8 7 and make recommendations for eliminating these barriers.
8 8 (2) Examine the most efficient and effective systems of
8 9 technology for use and make recommendations based on the
8 10 findings.
8 11 f. Address the workforce needs generated by increased use
8 12 of health information technology.
8 13 g. Adopt rules in accordance with chapter 17A to implement
8 14 all aspects of the statewide plan and the network.
8 15 h. Coordinate, monitor, and evaluate the adoption, use,
8 16 interoperability, and efficiencies of the various facets of
8 17 health information technology in this state.
8 18 i. Seek and apply for any federal or private funding to
8 19 assist in the implementation and support of the health
8 20 information technology system and make recommendations for
8 21 funding mechanisms for the ongoing development and maintenance
8 22 costs of the health information technology system.
8 23 j. Identify state laws and rules that present barriers to
8 24 the development of the health information technology system
8 25 and recommend any changes to the governor and the general
8 26 assembly.
8 27 Sec. 5. Section 217.41A, Code 2007, is repealed.
8 28 DIVISION III
8 29 END=OF=LIFE CARE PROMOTION
8 30 Sec. 6. NEW SECTION. 231.62 END=OF=LIFE CARE PROMOTION.
8 31 1. The department shall consult with the Iowa medical
8 32 society, the Iowa end=of=life coalition, the Iowa hospice
8 33 organization, the university of Iowa palliative care program,
8 34 and other health care professionals whose scope of practice
8 35 includes end=of=life care to develop educational and
9 1 patient=centered information on end=of=life care for
9 2 terminally ill patients and health care professionals.
9 3 2. For the purposes of this section, "end=of=life care"
9 4 means care provided to meet the physical, psychological,
9 5 social, spiritual, and practical needs of terminally ill
9 6 patients and their caregivers.
9 7 DIVISION IV
9 8 HEALTH CARE COVERAGE
9 9 Sec. 7. Section 509.3, Code 2007, is amended by adding the
9 10 following new subsection:
9 11 NEW SUBSECTION. 8. A provision that the insurer will
9 12 permit continuation of existing coverage for an unmarried
9 13 dependent child of an insured or enrollee who so elects, at
9 14 least through the age of twenty=five years old or so long as
9 15 the dependent child maintains full=time status as a student in
9 16 an accredited institution of postsecondary education,
9 17 whichever occurs last, at a premium established in accordance
9 18 with the insurer's rating practices.
9 19 Sec. 8. Section 513B.2, subsection 6, paragraph b, Code
9 20 Supplement 2007, is amended to read as follows:
9 21 b. A small employer carrier may shall establish additional
9 22 groupings under each of the subparagraphs in paragraph "a" on
9 23 the basis of underwriting criteria which are expected to
9 24 produce substantial variation in the health care costs. A
9 25 small employer carrier shall offer health insurance coverage
9 26 to a bona fide association as defined in section 509.1,
9 27 subsection 8, paragraph "b", that utilizes the rating bands
9 28 devised pursuant to the additional groupings established.
9 29 Sec. 9. Section 513C.7, subsection 2, paragraph a, Code
9 30 2007, is amended to read as follows:
9 31 a. The individual basic or standard health benefit plan
9 32 shall not deny, exclude, or limit benefits for a covered
9 33 individual for losses incurred more than twelve months
9 34 following the effective date of the individual's coverage due
9 35 to a preexisting condition. A preexisting condition shall not
10 1 be defined more restrictively than any of the following:
10 2 (1) a. A condition that would cause an ordinarily prudent
10 3 person to seek medical advice, diagnosis, care, or treatment
10 4 during the twelve months immediately preceding the effective
10 5 date of coverage.
10 6 (2) b. A condition for which medical advice, diagnosis,
10 7 care, or treatment was recommended or received during the
10 8 twelve months immediately preceding the effective date of
10 9 coverage.
10 10 (3) c. A pregnancy existing on the effective date of
10 11 coverage.
10 12 Sec. 10. Section 513C.7, subsection 2, paragraph b, Code
10 13 2007, is amended by striking the paragraph.
10 14 Sec. 11. NEW SECTION. 514A.3B ADDITIONAL REQUIREMENTS.
10 15 1. An insurer which accepts an individual for coverage
10 16 under an individual policy or contract of accident and health
10 17 insurance shall waive any time period applicable to a
10 18 preexisting condition exclusion or limitation period
10 19 requirement of the policy or contract with respect to
10 20 particular services in an individual health benefit plan for
10 21 the period of time the individual was previously covered by
10 22 qualifying previous coverage as defined in section 513C.3 that
10 23 provided benefits with respect to such services, provided that
10 24 the qualifying previous coverage was continuous to a date not
10 25 more than sixty=three days prior to the effective date of the
10 26 new policy or contract. For purposes of this section, periods
10 27 of coverage under medical assistance provided pursuant to
10 28 chapter 249A or 514I, or Medicare coverage provided pursuant
10 29 to Title XVIII of the federal Social Security Act shall not be
10 30 counted with respect to the sixty=three=day requirement.
10 31 2. An insurer issuing an individual policy or contract of
10 32 accident and health insurance which provides coverage for
10 33 dependent children of the insured shall permit continuation of
10 34 coverage for an unmarried dependent child of an insured or
10 35 enrollee who so elects, at least through the age of
11 1 twenty=five years old or so long as the dependent child
11 2 maintains full=time status as a student in an accredited
11 3 institution of postsecondary education, whichever occurs last,
11 4 at a premium established in accordance with the insurer's
11 5 rating practices.
11 6 Sec. 12. APPLICABILITY. This division of this Act applies
11 7 to policies or contracts of accident and health insurance
11 8 delivered or issued for delivery or continued or renewed in
11 9 this state on or after July 1, 2008.
11 10 DIVISION V
11 11 MEDICAL HOME
11 12 Sec. 13. NEW SECTION. 135.154 DEFINITIONS.
11 13 As used in this chapter, unless the context otherwise
11 14 requires:
11 15 1. "Department" means the department of public health.
11 16 2. "Health care professional" means a person who is
11 17 licensed, certified, or otherwise authorized or permitted by
11 18 the law of this state to administer health care in the
11 19 ordinary course of business or in the practice of a
11 20 profession.
11 21 3. "Medical home" means a team approach to providing
11 22 health care that originates in a primary care setting; fosters
11 23 a partnership among the patient, the primary care physician
11 24 and other health care professionals, and where appropriate,
11 25 the patient's family; utilizes the partnership to access all
11 26 medical and nonmedical health=related services needed by the
11 27 patient and the patient's family to achieve maximum health
11 28 potential; maintains a centralized, comprehensive record of
11 29 all health=related services to promote continuity of care; and
11 30 has all of the characteristics specified in section 135.155.
11 31 4. "Medical home commission" or "commission" means the
11 32 medical home commission created in section 135.156.
11 33 5. "National committee for quality assurance" means the
11 34 nationally recognized, independent nonprofit organization that
11 35 measures the quality and performance of health care and health
12 1 care plans in the United States; provides accreditation,
12 2 certification, and recognition programs for health care plans
12 3 and programs; and is recognized in Iowa as an accrediting
12 4 organization for commercial and Medicaid=managed care
12 5 organizations.
12 6 6. "Nonphysician primary care professionals" means
12 7 providers of health care other than physicians who render some
12 8 primary care services including advanced registered nurse
12 9 practitioners, physician assistants, pharmacists, and other
12 10 health care professionals.
12 11 7. "Personal provider" means the patient's first point of
12 12 contact in the health care system with a primary care provider
12 13 who identifies the patient's health needs, and, working with a
12 14 team of health care professionals, provides for and
12 15 coordinates appropriate care to address the health needs
12 16 identified.
12 17 8. "Primary care" means health care which emphasizes
12 18 providing for a patient's general health needs and utilizes
12 19 collaboration with other health care professionals and
12 20 consultation or referral as appropriate to meet the needs
12 21 identified.
12 22 9. "Primary care physician" means a generalist physician
12 23 who is specifically trained to provide primary care at the
12 24 point of first contact, and takes continuing responsibility
12 25 for providing the patient's care.
12 26 Sec. 14. NEW SECTION. 135.155 MEDICAL HOME PURPOSES ==
12 27 CHARACTERISTICS.
12 28 1. The purposes of a medical home are the following:
12 29 a. To reduce disparities in health care access, delivery,
12 30 and health care outcomes.
12 31 b. To improve quality of health care and lower health care
12 32 costs, thereby creating savings to allow more Iowans to have
12 33 health care coverage and to provide for the sustainability of
12 34 the health care system.
12 35 c. To provide a tangible method to document if each Iowan
13 1 has access to health care.
13 2 2. A medical home has all of the following
13 3 characteristics:
13 4 a. A personal provider. Each patient has an ongoing
13 5 relationship with a personal provider trained to provide first
13 6 contact and continuous and comprehensive care.
13 7 b. A provider=directed medical practice. The personal
13 8 provider leads a team of individuals at the practice level who
13 9 collectively take responsibility for the ongoing health care
13 10 of patients.
13 11 c. Whole person orientation. The personal provider is
13 12 responsible for providing for all of a patient's health care
13 13 needs or taking responsibility for appropriately arranging
13 14 health care by other qualified health care professionals.
13 15 This responsibility includes health care at all stages of life
13 16 including provision of acute care, chronic care, preventive
13 17 services, and end=of=life care.
13 18 d. Coordination and integration of care. Care is
13 19 coordinated and integrated across all elements of the complex
13 20 health care system and the patient's community. Care is
13 21 facilitated by registries, information technology, health
13 22 information exchanges, and other means to assure that patients
13 23 get the indicated care when and where they need and want the
13 24 care in a culturally and linguistically appropriate manner.
13 25 e. Quality and safety. The following are quality and
13 26 safety components of the medical home:
13 27 (1) Provider=directed medical practices advocate for their
13 28 patients to support the attainment of optimal,
13 29 patient=centered outcomes that are defined by a care planning
13 30 process driven by a compassionate, robust partnership between
13 31 providers, the patient, and the patient's family.
13 32 (2) Evidence=based medicine and clinical decision=support
13 33 tools guide decision making.
13 34 (3) Providers in the medical practice accept
13 35 accountability for continuous quality improvement through
14 1 voluntary engagement in performance measurement and
14 2 improvement.
14 3 (4) Patients actively participate in decision making and
14 4 feedback is sought to ensure that the patients' expectations
14 5 are being met.
14 6 (5) Information technology is utilized appropriately to
14 7 support optimal patient care, performance measurement, patient
14 8 education, and enhanced communication.
14 9 (6) Practices participate in a voluntary recognition
14 10 process conducted by an appropriate nongovernmental entity to
14 11 demonstrate that the practice has the capabilities to provide
14 12 patient=centered services consistent with the medical home
14 13 model.
14 14 (7) Patients and families participate in quality
14 15 improvement activities at the practice level.
14 16 f. Enhanced access to health care. Enhanced access to
14 17 health care is available through systems such as open
14 18 scheduling, expanded hours, and new options for communication
14 19 between the patient, the patient's personal provider, and
14 20 practice staff.
14 21 g. Payment. The payment system appropriately recognizes
14 22 the added value provided to patients who have a
14 23 patient=centered medical home. The payment structure
14 24 framework of the medical home provides all of the following:
14 25 (1) Reflects the value of provider and nonprovider staff
14 26 and patient=centered care management work that is in addition
14 27 to the face=to=face visit.
14 28 (2) Pays for services associated with coordination of
14 29 health care both within a given practice and between
14 30 consultants, ancillary providers, and community resources.
14 31 (3) Supports adoption and use of health information
14 32 technology for quality improvement.
14 33 (4) Supports provision of enhanced communication access
14 34 such as secure electronic mail and telephone consultation.
14 35 (5) Recognizes the value of physician work associated with
15 1 remote monitoring of clinical data using technology.
15 2 (6) Allows for separate fee=for=service payments for
15 3 face=to=face visits. Payments for health care management
15 4 services that are in addition to the face=to=face visit do not
15 5 result in a reduction in the payments for face=to=face visits.
15 6 (7) Recognizes case mix differences in the patient
15 7 population being treated within the practice.
15 8 (8) Allows providers to share in savings from reduced
15 9 hospitalizations associated with provider=guided health care
15 10 management in the office setting.
15 11 (9) Allows for additional payments for achieving
15 12 measurable and continuous quality improvements.
15 13 Sec. 15. NEW SECTION. 135.156 MEDICAL HOME COMMISSION.
15 14 1. A medical home commission is created consisting of the
15 15 following members:
15 16 a. The director of public health, or the director's
15 17 designee, who shall act as chairperson of the commission.
15 18 b. The director of human services, or the director's
15 19 designee.
15 20 c. The commissioner of insurance, or the commissioner's
15 21 designee.
15 22 d. A representative of health insurers.
15 23 e. A representative of the Iowa dental association.
15 24 f. A representative of the Iowa nurses association.
15 25 g. A family physician who is a member of the Iowa academy
15 26 of family physicians.
15 27 h. A health care consumer.
15 28 i. A representative of the Iowa collaborative safety net
15 29 provider network established pursuant to section 135.153.
15 30 j. A representative of the Iowa pharmacy association.
15 31 2. a. Members of the commission from the organizations
15 32 specified in subsection 1 shall be selected by the respective
15 33 organization. Terms of public members of the commission shall
15 34 begin and end as provided by section 69.19. Any vacancy shall
15 35 be filled in the same manner as regular appointments are made
16 1 for the unexpired portion of the regular term. Public members
16 2 shall serve terms of three years. A member is eligible for
16 3 reappointment for two successive terms.
16 4 b. Public members of the commission shall receive their
16 5 actual and necessary expenses incurred in the performance of
16 6 their duties and may be eligible to receive compensation as
16 7 provided in section 7E.6.
16 8 c. The commission shall meet at least quarterly and in
16 9 accordance with rules adopted by the commission.
16 10 d. A majority of the members of the commission constitutes
16 11 a quorum. Any action taken by the commission must be adopted
16 12 by the affirmative vote of a majority of its voting
16 13 membership.
16 14 e. The commission is located for administrative purposes
16 15 within the division of health promotion and chronic disease
16 16 management within the department. The commission shall
16 17 coordinate efforts with other divisions, bureaus, and offices
16 18 within the department including but not limited to the office
16 19 of multicultural health established in section 135.12 and oral
16 20 health bureau established in section 135.15, in order to avoid
16 21 duplication of efforts. The department shall provide office
16 22 space, staff assistance, administrative support, and necessary
16 23 supplies and equipment to the commission.
16 24 3. The commission may adopt rules pursuant to chapter 17A
16 25 to administer the programs of the commission.
16 26 Sec. 16. NEW SECTION. 135.157 MEDICAL HOME SYSTEM ==
16 27 DEVELOPMENT AND IMPLEMENTATION.
16 28 1. The commission shall develop a plan for implementation
16 29 of a statewide medical home system. The initial phase shall
16 30 focus on providing a medical home for children, beginning with
16 31 those children who are recipients of medical assistance or the
16 32 hawk=i program, and expanding to children covered through the
16 33 exchange created pursuant to section 514M.4. The second phase
16 34 shall focus on providing a medical home to the expansion
16 35 population under the IowaCare program and to adult recipients
17 1 of medical assistance. The third phase shall focus on
17 2 providing a medical home to adults covered through the
17 3 exchange created pursuant to section 514M.4. The commission,
17 4 in collaboration with parents, schools, communities, health
17 5 plans, and providers, shall endeavor to increase healthy
17 6 outcomes for children and adults by linking the children and
17 7 adults with a medical home, identifying health improvement
17 8 goals for children and adults, and linking reimbursement
17 9 strategies to increasing healthy outcomes for children and
17 10 adults. The plan shall provide that the medical home system
17 11 shall do all of the following:
17 12 a. Coordinate and provide access to evidence=based health
17 13 care services, emphasizing convenient, comprehensive primary
17 14 care and including preventive, screening, and well=child
17 15 health services.
17 16 b. Provide access to appropriate specialty care and
17 17 inpatient services.
17 18 c. Provide quality=driven and cost=effective health care.
17 19 d. Provide access to pharmacist=delivered medication
17 20 reconciliation and medication therapy management services,
17 21 where appropriate.
17 22 e. Promote strong and effective medical management
17 23 including but not limited to planning treatment strategies,
17 24 monitoring health outcomes and resource use, sharing
17 25 information, and organizing care to avoid duplication of
17 26 service.
17 27 f. Emphasize patient and provider accountability.
17 28 g. Prioritize local access to the continuum of health care
17 29 services in the most appropriate setting.
17 30 h. Establish a baseline for medical home goals and
17 31 establish performance measures that indicate a child or adult
17 32 has an established and effective medical home. For children,
17 33 these goals and performance measures may include but are not
17 34 limited to childhood immunizations rates, well=child care
17 35 utilization rates, care management for children with chronic
18 1 illnesses, emergency room utilization, and preventive oral
18 2 health service utilization.
18 3 i. For children, coordinate with and integrate guidelines,
18 4 data, and information from existing newborn and child health
18 5 programs and entities, including but not limited to the
18 6 healthy opportunities to experience, success=healthy families
18 7 Iowa program, the community empowerment program, the center
18 8 for congenital and inherited disorders screening and health
18 9 care programs, standards of care for pediatric health
18 10 guidelines, the office of multicultural health established in
18 11 section 135.12, the oral health bureau established in section
18 12 135.15, and other similar programs and services.
18 13 2. The commission shall develop an organizational
18 14 structure for the medical home system in this state. The
18 15 organizational structure plan shall integrate existing
18 16 resources, provide a strategy to coordinate health care
18 17 services, provide for monitoring and data collection on
18 18 medical homes, provide for training and education to health
18 19 care professionals and families, and provide for transition of
18 20 children to the adult medical care system. The organizational
18 21 structure may be based on collaborative teams of stakeholders
18 22 throughout the state such as local public health agencies, the
18 23 collaborative safety net provider network established in
18 24 section 135.153, or a combination of statewide organizations.
18 25 Care coordination may be provided through regional offices or
18 26 through individual provider practices. The organizational
18 27 structure may also include the use of telemedicine resources,
18 28 and may provide for partnering with pediatric and family
18 29 practice residency programs to improve access to preventive
18 30 care for children. The organizational structure shall also
18 31 address the need to organize and provide health care to
18 32 increase accessibility for patients including using venues
18 33 more accessible to patients and having hours of operation that
18 34 are conducive to the population served.
18 35 3. The commission shall adopt standards and a process to
19 1 certify medical homes based on the national committee for
19 2 quality assurance standards. The certification process and
19 3 standards shall provide mechanisms to monitor performance and
19 4 to evaluate, promote, and improve the quality of health of and
19 5 health care delivered to patients through a medical home. The
19 6 mechanism shall require participating providers to monitor
19 7 clinical progress and performance in meeting applicable
19 8 standards and to provide information in a form and manner
19 9 specified by the commission. The evaluation mechanism shall
19 10 be developed with input from consumers, providers, and payers.
19 11 At a minimum the evaluation shall determine any increased
19 12 quality in health care provided and any decrease in cost
19 13 resulting from the medical home system compared with other
19 14 health care delivery systems. The standards and process shall
19 15 also include a mechanism for other ancillary service providers
19 16 to become affiliated with a certified medical home.
19 17 4. The commission shall adopt education and training
19 18 standards for health care professionals participating in the
19 19 medical home system.
19 20 5. The commission shall provide for system simplification
19 21 through the use of universal referral forms, internet=based
19 22 tools for providers, and a central medical home internet site
19 23 for providers.
19 24 6. The commission shall determine a rate of reimbursement
19 25 and recommend incentives for participation in the medical home
19 26 system to ensure that providers enter and remain participating
19 27 in the system. In adopting the incentives, the commission
19 28 shall consider, at a minimum, providing incentives to promote
19 29 wellness, prevention, chronic care management, immunizations,
19 30 health care management, and the use of electronic health
19 31 records. In developing the reimbursement system and
19 32 incentives, the commission shall analyze, at a minimum, the
19 33 feasibility of all of the following:
19 34 a. Reimbursement under the medical assistance program to
19 35 promote wellness and prevention, provide care coordination,
20 1 and provide chronic care management.
20 2 b. Increasing reimbursement to Medicare levels for certain
20 3 wellness and prevention services, chronic care management, and
20 4 immunizations.
20 5 c. Providing reimbursement for primary care services by
20 6 addressing the disparities between reimbursement for specialty
20 7 services and primary care services.
20 8 d. Increased funding for efforts to transform medical
20 9 practices into certified medical homes, including emphasizing
20 10 the implementation of the use of electronic health records.
20 11 e. Targeted reimbursement to providers linked to health
20 12 care quality improvement measures established by the
20 13 commission.
20 14 f. Reimbursement for specified ancillary support services
20 15 such as transportation for medical appointments and other such
20 16 services.
20 17 g. Providing reimbursement for medication reconciliation
20 18 and medication therapy management service, where appropriate.
20 19 7. The commission shall coordinate the requirements and
20 20 activities of the medical home system with the requirements
20 21 and activities of the dental home for children as described in
20 22 section 249J.14, subsection 7, and shall recommend financial
20 23 incentives for dentists and nondental providers to promote
20 24 oral health care coordination through preventive dental
20 25 intervention, early identification of oral disease risk,
20 26 health care coordination and data tracking, treatment, chronic
20 27 care management, education and training, parental guidance,
20 28 and oral health promotions for children.
20 29 8. The commission shall integrate the recommendations and
20 30 policies developed by the prevention and chronic care
20 31 management advisory council into the medical home system.
20 32 9. Implementation phases.
20 33 a. Initial implementation shall require participation in
20 34 the medical home system of children who are recipients of the
20 35 medical assistance or the hawk=i programs and children who
21 1 have health insurance coverage through the exchange created in
21 2 section 514M.4. The commission shall develop an enhanced
21 3 reimbursement methodology for recipients of medical assistance
21 4 and hawk=i to compensate providers who participate in the
21 5 medical home system. The department of human services shall
21 6 submit any state plan amendments or request any waivers
21 7 necessary from the centers for Medicare and Medicaid services
21 8 of the United States department of health and human services
21 9 for approval of the reimbursement methodology. The commission
21 10 shall work with the exchange to develop an enhanced
21 11 reimbursement methodology for children covered through the
21 12 exchange to compensate providers who participate in the
21 13 medical home system.
21 14 b. The commission shall work with the department of human
21 15 services and with the exchange to expand the medical home
21 16 system to adult recipients of medical assistance, the
21 17 expansion population under the IowaCare program, and adults
21 18 covered through the exchange. The commission shall work with
21 19 the centers for Medicare and Medicaid services of the United
21 20 States department of health and human services to allow
21 21 Medicare recipients to utilize the medical home system.
21 22 c. The commission shall work with the department of
21 23 administrative services to allow state employees to utilize
21 24 the medical home system.
21 25 d. The commission shall work with insurers and
21 26 self=insured companies, if requested, to make the medical home
21 27 system available to individuals with private health care
21 28 coverage.
21 29 10. The commission shall provide oversight for all
21 30 certified medical homes. The commission shall review the
21 31 progress of the medical home system at each meeting and
21 32 recommend improvements to the system, as necessary.
21 33 11. The commission shall annually evaluate the medical
21 34 home system and make recommendations to the governor and the
21 35 general assembly regarding improvements to and continuation of
22 1 the system.
22 2 Sec. 17. Section 249J.14, subsection 7, Code 2007, is
22 3 amended to read as follows:
22 4 7. DENTAL HOME FOR CHILDREN. By July 1, 2008, every Every
22 5 recipient of medical assistance who is a child twelve years of
22 6 age or younger shall have a designated dental home and shall
22 7 be provided with the dental screenings and preventive care
22 8 identified in the oral health standards services as defined
22 9 under the early and periodic screening, diagnostic, and
22 10 treatment program.
22 11 EXPLANATION
22 12 This bill relates to health care reform including health
22 13 information technology, end=of=life care promotion,
22 14 preexisting conditions, dependent care coverage, and medical
22 15 homes.
22 16 Division I of the bill provides the intent of the general
22 17 assembly that all Iowans have health care coverage, as funding
22 18 becomes available, and that the initial priority is that all
22 19 children have health care coverage by December 31, 2010.
22 20 Additionally, the bill provides that it is the intent of the
22 21 general assembly that if the federal reauthorization of the
22 22 state children's health insurance program provides sufficient
22 23 allocations and authorization, the department of human
22 24 services may expand coverage of children to cover children
22 25 with family incomes up to 300 percent of the federal poverty
22 26 level.
22 27 Division II of the bill provides definitions, principles,
22 28 and goals for the Iowa health information technology system.
22 29 The bill creates an electronic health information commission
22 30 as a public and private collaborative effort and directs the
22 31 commission to establish a technical advisory group to assist
22 32 the commission in its duties; to adopt a statewide health
22 33 information technology plan by January 1, 2009; to identify
22 34 existing efforts and integrate these efforts to avoid
22 35 incompatibility and duplication; to coordinate public and
23 1 private efforts to provide the network backbone; to promote
23 2 the use of telemedicine; to address the workforce needs
23 3 generated by increased use of health information technology;
23 4 to adopt necessary rules; to coordinate, monitor, and evaluate
23 5 the adoption, use, interoperability, and efficiencies of the
23 6 various facets of health information technology in the state;
23 7 to seek and apply for federal or private funding to assist in
23 8 implementing the system; and to identify state laws and rules
23 9 that present barriers to the development of the health
23 10 information technology system in the state.
23 11 Division II requires that by January 1, 2010, all health
23 12 care professionals utilize the single patient identifier or
23 13 alternative mechanism and continuity of care record specified
23 14 by the commission.
23 15 Division III directs the department of elder affairs to
23 16 consult with the Iowa medical society, the Iowa end=of=life
23 17 coalition, the Iowa hospice organization, the university of
23 18 Iowa palliative care program, and other health care
23 19 professionals whose scope of practice includes end=of=life
23 20 care to develop educational and patient=centered information
23 21 on end=of=life care for terminally ill patients and health
23 22 care professionals. The division also defines "end=of=life
23 23 care".
23 24 Division IV of the bill amends Code section 509.3 to
23 25 require a group policy of accident or health insurance to
23 26 permit continuation of existing coverage for an unmarried
23 27 dependent child of an insured or enrollee who so elects, until
23 28 the dependent is 25 years old or for as long as the dependent
23 29 is a full=time college student, whichever occurs last, at a
23 30 premium established in accordance with the insurer's rating
23 31 practices.
23 32 Division IV also amends Code section 513B.2(6)(b) to
23 33 require an insurance carrier that provides small group health
23 34 care coverage to establish additional groupings of small
23 35 employers on the basis of underwriting criteria which are
24 1 expected to produce substantial variation in health care
24 2 costs, and to offer health insurance coverage to a bona fide
24 3 association utilizing the rating bands devised pursuant to the
24 4 additional groupings established. Division IV amends Code
24 5 section 513C.7(2)(b) by striking the paragraph, whose content
24 6 is now included in new Code section 514A.3B.
24 7 Division IV creates new Code section 514A.3B which requires
24 8 an insurer which accepts an individual for coverage under an
24 9 individual policy or contract of accident and health insurance
24 10 to waive any time period applicable to a preexisting condition
24 11 exclusion or limitation period of the policy or contract with
24 12 respect to particular services in an individual health benefit
24 13 plan for the period of time the individual was previously
24 14 covered by qualifying previous coverage that was continuous to
24 15 a date not more than 63 days prior to the effective date of
24 16 the new policy or contract.
24 17 New Code section 514A.3B also requires an individual policy
24 18 or contract of accident and sickness insurance to permit
24 19 continuation of existing coverage for an unmarried dependent
24 20 child of an insured or enrollee who so elects, until the
24 21 dependent is 25 years old or for as long as the dependent is a
24 22 full=time college student, whichever occurs last, at a premium
24 23 established in accordance with the insurer's rating practices.
24 24 Division IV applies to policies or contracts of accident
24 25 and health insurance delivered or issued for delivery or
24 26 continued or renewed in this state on or after July 1, 2008.
24 27 Division V of the bill relates to medical homes. The
24 28 division provides definitions, including the definition of a
24 29 medical home which is a team approach to providing health care
24 30 that originates in a primary care setting, and provides for
24 31 continuity in and coordination of care. The division
24 32 specifies the characteristics of a medical home, and creates a
24 33 medical home commission. The commission is directed to
24 34 develop a plan for implementation of a statewide medical home
24 35 system. Implementation is to take place in phases, beginning
25 1 with children who are recipients of medical assistance
25 2 (Medicaid) or the hawk=i program and expanding to children
25 3 covered through the exchange created in the division. The
25 4 second phase would provide a medical home to adults under the
25 5 IowaCare program and adult recipients of Medicaid. The third
25 6 phase would provide for a medical home for adults covered
25 7 through the exchange.
25 8 The division specifies the duties of the medical home
25 9 commission and the organizational structure for the medical
25 10 home system. The division directs the commission to adopt
25 11 standards and a process to certify medical homes based on
25 12 national standards, to adopt education and training standards
25 13 for health care professionals participating in the medical
25 14 home system, to provide for system simplification, to
25 15 determine a rate of reimbursement and recommend incentives for
25 16 participation in the medical home system, and to coordinate
25 17 efforts with the dental home for children, and integrate the
25 18 recommendations of the prevention and chronic care management
25 19 advisory council into the medical home system.
25 20 In addition to the phased=in implementation, the division
25 21 also directs the commission to work with the department of
25 22 administrative services to allow state employees to utilize
25 23 the medical home system, to work with the centers for Medicare
25 24 and Medicaid services of the United States department of
25 25 health and human services to allow Medicare recipients to
25 26 utilize the medical home system and to work with insurers and
25 27 self=insured companies to allow those with private insurance
25 28 to access the medical home system. The commission is directed
25 29 to provide oversight for the medical home system and to
25 30 evaluate and make recommendations regarding improvements to
25 31 and continuation of the medical home system.
25 32 LSB 6541YC 82
25 33 av:pf/rj/14.1