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