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