House File 215 - Introduced
HOUSE FILE
BY FREVERT
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to reimbursement of nonparticipating providers
2 for expansion population benefits provided to IowaCare program
3 members, and creating a nonparticipating provider compensation
4 fund.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 TLSB 2029HH 83
7 pf/rj/24
PAG LIN
1 1 Section 1. NEW SECTION. 249J.24A NONPARTICIPATING
1 2 PROVIDER == PROCEDURE FOR PROVISION OF EXPANSION POPULATION
1 3 BENEFITS == COMPENSATION FUND.
1 4 1. The department shall establish a procedure to reimburse
1 5 a nonparticipating provider for expansion population benefits
1 6 as specified pursuant to section 249J.6 provided to an
1 7 expansion population member by the nonparticipating provider
1 8 if the nonparticipating provider does the following, based on
1 9 the situation presented:
1 10 a. Contacts the appropriate participating provider prior
1 11 to providing expansion population benefits and verifies
1 12 consensus regarding one of the following courses of action:
1 13 (1) If the nonparticipating provider and the participating
1 14 provider agree that the medical status of the expansion
1 15 population member indicates it is medically possible to
1 16 postpone provision of services which include expansion
1 17 population benefits, the nonparticipating provider shall
1 18 direct the expansion population member to the appropriate
1 19 participating provider for services.
1 20 (2) If the nonparticipating provider and the participating
1 21 provider agree that the medical status of the expansion
1 22 population member indicates it is not medically possible to
1 23 postpone provision of services which include expansion
1 24 population benefits, the nonparticipating provider shall
1 25 provide the medically necessary services.
1 26 b. Notwithstanding paragraph "a", if the medical status of
1 27 the expansion population member indicates a medical emergency
1 28 and the nonparticipating provider is not able to contact the
1 29 appropriate participating provider prior to providing the
1 30 medically necessary services, the nonparticipating provider
1 31 documents the medical emergency and informs the appropriate
1 32 participating provider immediately after the expansion
1 33 population member has been stabilized of any expansion
1 34 population benefits provided.
1 35 2. If a nonparticipating provider complies with the
2 1 requirements of subsection 1 and provides expansion population
2 2 benefits to an expansion population member and also complies
2 3 with the requirements of subsection 3, paragraph "d", relating
2 4 to submitting of claims and other required documentation, the
2 5 nonparticipating provider may be reimbursed for any expansion
2 6 population benefits provided to the expansion population
2 7 member.
2 8 3. a. A nonparticipating provider compensation fund is
2 9 created in the state treasury under the authority of the
2 10 department. Moneys designated for deposit in the fund that
2 11 are received from sources including but not limited to
2 12 appropriations from the general fund of the state, grants, and
2 13 contributions shall be deposited in the fund.
2 14 b. Moneys in the fund shall be separate from the general
2 15 fund of the state and shall not be considered part of the
2 16 general fund of the state. The moneys deposited in the fund
2 17 are not subject to section 8.33 and shall not be transferred,
2 18 used, obligated, appropriated, or otherwise encumbered, except
2 19 to provide for the purposes specified in this section.
2 20 Notwithstanding section 12C.7, subsection 2, interest or
2 21 earnings on moneys deposited in the fund shall be credited to
2 22 the fund.
2 23 c. Moneys deposited in the fund shall be used only to
2 24 reimburse providers who are not participants in the expansion
2 25 population provider network pursuant to section 249J.7, who
2 26 provide expansion population benefits to expansion population
2 27 members, if no other third party is liable for reimbursement
2 28 for the benefits provided.
2 29 d. In order to be reimbursed for any expansion population
2 30 benefits provided, a nonparticipating provider shall comply
2 31 with the requirements of subsection 1 and shall submit a claim
2 32 to the department for reimbursement for the expansion
2 33 population benefits provided. The department shall adopt
2 34 rules relating to the format of and information to be included
2 35 in the claims submitted and for documenting compliance by the
3 1 nonparticipating provider with subsection 1. A claim and any
3 2 other documentation required by rule shall be submitted to the
3 3 department within forty=five days of provision of the
3 4 expansion population benefits.
3 5 EXPLANATION
3 6 This bill requires the department of human services to
3 7 establish a procedure to reimburse nonparticipating providers
3 8 under the IowaCare program for expansion population benefits
3 9 provided to an IowaCare member by the nonparticipating
3 10 provider. The bill provides a required process for a
3 11 nonparticipating provider to follow in determining, based upon
3 12 a consensus with the appropriate participating provider,
3 13 whether provision of services which include expansion
3 14 population benefits may be postponed or must be provided by
3 15 the nonparticipating provider. If the providers reach
3 16 consensus that services must be provided or if the situation
3 17 presented is a medical emergency and the nonparticipating
3 18 provider determines that services must be provided, the
3 19 nonparticipating provider may submit a claim and other
3 20 required documentation to the department for reimbursement for
3 21 expansion population benefits provided. The bill also
3 22 establishes a nonparticipating provider compensation fund to
3 23 be used to reimburse nonparticipating providers for the
3 24 provision of expansion population benefits to IowaCare
3 25 members.
3 26 LSB 2029HH 83
3 27 pf/rj/24