House File 580 - Introduced HOUSE FILE BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HF 354) 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 eligible services provided to IowaCare program members. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1187HV 83 5 pf/nh/24 PAG LIN 1 1 Section 1. NONPARTICIPATING PROVIDER == IOWACARE == 1 2 REIMBURSEMENT FOR ELIGIBLE SERVICES PROVIDED TO A MEMBER. 1 3 Beginning July 1, 2010, the department of human services shall 1 4 include in any medical assistance program waiver relating to 1 5 the continuation of the IowaCare program pursuant to chapter 1 6 249J, provisions for reimbursement of eligible services 1 7 provided to an expansion population member by a 1 8 nonparticipating provider if the nonparticipating provider 1 9 does all of the following: 1 10 1. Contacts the appropriate participating provider prior 1 11 to providing eligible services to verify consensus regarding 1 12 one of the following courses of action: 1 13 a. 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, the nonparticipating provider 1 17 shall direct the expansion population member to the 1 18 appropriate participating provider for services. 1 19 b. If the nonparticipating provider and the participating 1 20 provider agree that the medical status of the expansion 1 21 population member indicates it is not medically possible to 1 22 postpone provision of services, the nonparticipating provider 1 23 shall provide medically necessary services. 1 24 2. Notwithstanding subsection 1, if the medical status of 1 25 the expansion population member indicates a medical emergency 1 26 and the nonparticipating provider is not able to contact the 1 27 appropriate participating provider prior to providing 1 28 medically necessary services, the nonparticipating provider 1 29 shall document the medical emergency and inform the 1 30 appropriate participating provider immediately after the 1 31 member has been stabilized of any eligible services provided. 1 32 EXPLANATION 1 33 This bill requires that in any Medicaid program waiver 1 34 relating to the continuation of the IowaCare program submitted 1 35 on or after July 1, 2010, the department of human services 2 1 must include provisions for reimbursement of eligible services 2 2 provided to an expansion population member by a 2 3 nonparticipating provider if the nonparticipating provider 2 4 complies with certain requirements. The requirements include 2 5 contacting the appropriate participating provider prior to 2 6 providing eligible services to verify consensus regarding 2 7 which provider should provide services to the member, based 2 8 upon the medical status of the member. If the member's 2 9 medical status indicates that provision of services may be 2 10 postponed, the nonparticipating provider shall direct the 2 11 member to the appropriate participating provider for services. 2 12 If the member's medical status indicates that it is not 2 13 medically possible to postpone provision of services to the 2 14 member, the nonparticipating provider shall provide medically 2 15 necessary services. If the medical status of the member 2 16 indicates a medical emergency and the nonparticipating 2 17 provider is not able to contact the appropriate participating 2 18 provider prior to providing medically necessary services, the 2 19 nonparticipating provider shall document the medical emergency 2 20 and inform the appropriate participating provider immediately 2 21 after the member has been stabilized of any eligible services 2 22 provided. 2 23 LSB 1187HV 83 2 24 pf/nh/24