SF 2092 (LSB 5392XS (19) 83)

SENATE FILE 2092

BY  HATCH, DEARDEN, KIBBIE, BEALL, RAGAN, BOLKCOM, GRONSTAL, FRAISE, BLACK, JOCHUM, STEWART, SCHMITZ, DANIELSON, DOTZLER, HECKROTH, WARNSTADT, HORN, SENG, QUIRMBACH, McCOY, WILHELM, HOGG, DVORSKY, KREIMAN, SCHOENJAHN, and SODDERS

A BILL FOR

An Act relating to health reform in Iowa by creating an IowaCare plus program and an Iowa choice exchange.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
IOWACARE PLUS PROGRAM
    Section 1.  NEW SECTION.  217A.1  Title.

   This chapter shall be known and may be cited as the “IowaCare Plus Act”.
    Sec. 2.  NEW SECTION.  217A.2  Definitions.

   As used in this chapter, unless the context otherwise requires:

   1.  “Department” means the department of human services.
   2.  “Director” means the director of human services.
   3.  “Eligible individual” means an individual who meets the eligibility requirements in section 217A.4.
   4.  “Full benefit recipient rate” means the rate paid to a provider for an adult who is eligible for full medical assistance benefits pursuant to chapter 249A under any category of eligibility.
   5.  “Fund” means the IowaCare plus trust fund created in section 217A.8.
   6.  “Iowa Medicaid enterprise” means the Iowa Medicaid enterprise as defined in section 249J.3.
   7.  “IowaCare plus member” or “member” means an IowaCare plus member with active eligibility status.
   8.  “Premium assistance payment” means a premium payment made on behalf of a member in the program, under a schedule established by the department.
   9.  “Program” means the IowaCare plus program created in this chapter.
    Sec. 3.  NEW SECTION.  217A.3  Purposes —— principles —— administration.
   1.  An IowaCare plus program shall be created to do all of the following:
   a.  To improve the health of adults in the state.
   b.  To improve the quality of health care and access to health care in the state.
   c.  To provide health care coverage to adults in the state who would otherwise be uninsured.
   d.  To increase the range of health care coverage options available to Iowans.
   e.  To slow the growth of per capita health care spending.
   f.  To serve as a model for reforming the health care delivery system.
   2.  The IowaCare plus program shall be established and administered in accordance with the following guiding health care coverage reform principles:
   a.  Health care coverage should be accessible.
   b.  Health care coverage should be continuous.
   c.  Health care coverage should be affordable to individuals and families.
   d.  The provision of health care coverage should be sustainable for Iowa.
   e.  Health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.
   3.  a.  The program shall be administered by the Iowa Medicaid enterprise.
   b.  The program shall be administered consistent with the Iowa medical assistance program. State and federal laws, rules and regulations applicable to the Iowa medical assistance program pursuant to chapter 249A and 42 C.F.R. pts. 430 through 456 shall apply to the IowaCare plus program, with the exception of benefits and eligibility provisions inconsistent with sections 217A.4 and 217A.5.
   c.  The provisions of this chapter shall not be construed, are not intended as, and shall not imply a grant of entitlement for services to individuals who are eligible for assistance under this chapter or for utilization of services that do not exist or are not otherwise available on July 1, 2010. Any state obligation to provide services pursuant to this chapter is limited to the extent of the funds appropriated or distributed for the purposes of this chapter.
   d.  All agencies and offices of the state, or of any political subdivision of the state, shall fully cooperate with the Iowa Medicaid enterprise and the department in carrying out the purposes of this section.
    Sec. 4.  NEW SECTION.  217A.4  IowaCare plus —— eligibility.
   1.  Except as otherwise provided in this chapter, an individual nineteen through sixty-four years of age shall be eligible for the membership benefits described in section 217A.5 when provided through the regional provider network as described in section 217A.6, if the individual meets all of the following conditions:
   a.  The individual is not eligible for health care coverage under any other public program or through group or individual health insurance, or health care coverage offered through group or individual health insurance is not affordable.
   b.  The individual has a family income above two hundred percent but not in excess of four hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services.
   c.  The individual’s or family member’s employer has not provided health insurance coverage in the last six months for which the individual is eligible and for which the employer covers at least twenty percent of the annual premium cost of a family health insurance plan or at least thirty-three percent of an individual health insurance plan.
   d.  The individual has not accepted a financial incentive from the individual’s employer to decline the employer’s subsidized health insurance plan.
   e.  The individual fulfills all other conditions of participation described in this chapter, including requirements relating to personal financial responsibility.
   2.  Following initial enrollment, an IowaCare plus member shall reenroll annually by the last day of the month preceding the month in which the member initially enrolled. The department may provide a process for automatic reenrollment of members.
   3.  The department shall develop a plan for outreach and education that is designed to ensure that Iowans are informed about the program and are encouraged to enroll in the program. The outreach and education plan shall include a focus on targeting populations that are underserved by the health care delivery system.
    Sec. 5.  NEW SECTION.  217A.5  IowaCare plus —— benefits.
   1.  IowaCare plus members shall be eligible for all of the following benefits:
   a.  Inpatient hospital procedures described in the diagnostic-related group codes or other applicable inpatient hospital reimbursement methods designated by the department.
   b.  Outpatient hospital services described in the ambulatory patient groupings or non-inpatient services designated by the department.
   c.  Physician and advanced registered nurse practitioner services described in the current procedural terminology codes specified by the department.
   d.  Dental services described in the dental codes specified by the department.
   e.  Limited pharmacy benefits as specified by the department.
   f.  Primary care coordination.
   2.  a.  Each member shall receive a comprehensive medical examination annually. The department may implement a web-based health risk assessment for members that may include facilitation, if deemed to be cost-effective to the program.
   b.  Refusal of a member to participate in a comprehensive medical examination or any health risk assessment implemented by the department shall not be a basis for ineligibility for or disenrollment from the program.
    Sec. 6.  NEW SECTION.  217A.6  Regional provider network.
   1.  The department shall establish a regional provider network and shall enter into contracts or 28E agreements with providers specified for participation in the network. The regional provider network shall include all of the following:
   a.  Providers designated by the department who are part of the Iowa collaborative safety net provider network established pursuant to section 135.153.
   b.  The publicly owned acute care teaching hospital located in a county with a population over three hundred fifty thousand and the university of Iowa hospitals and clinics, that are part of the expansion population provider network as specified in section 249J.7.
   c.  Hospitals designated by the department.
   d.  Other health care providers designated by the department as necessary to provide regional access to the benefits specified under section 217A.5.
   2.  The department may designate specific providers within a region for the provision of primary, specialty, and tertiary care.
   3.  All members shall receive benefits described in section 217A.5 through a medical home. The department shall adopt rules pursuant to chapter 17A, in collaboration with the medical home advisory council created pursuant to section 135.159, specifying requirements for medical homes including certification, with which participating providers shall comply, as appropriate.
   4.  The department may develop a payment rate methodology to support the medical home requirement.
    Sec. 7.  NEW SECTION.  217A.7  Financial participation.
   1.  The department shall adopt rules pursuant to chapter 17A to establish all cost-sharing requirements of the program, including any premiums, deductibles, and copayment amounts. Cost sharing shall be based on a sliding scale and any cost-sharing requirements shall meet the percentage standards for affordability established pursuant to 2009 Iowa Acts, chapter 118, section 1, subsection 4, paragraph “c”.
   2.  Each IowaCare plus member whose family income exceeds two hundred percent but does not exceed three hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services may be eligible for a premium assistance payment as specified by rule of the department.
   3.  Each IowaCare plus member whose family income exceeds three hundred percent but does not exceed four hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services shall pay the entire amount of cost sharing required by the program and is not eligible for a premium assistance payment provided through the program.
   4.  If an eligible individual has access to health care coverage through the individual’s employer, but such health care coverage is not affordable, the program may pay the employee share of the premium up to the amount that the program would subsidize the member through the program, if cost-effective to the program.
   5.  Premiums collected pursuant to this section shall be deposited in the IowaCare plus trust fund created in section 217A.8.
    Sec. 8.  NEW SECTION.  217A.8  IowaCare plus trust fund.
   1.  An IowaCare plus trust fund is created in the state treasury under the authority of the department. Moneys appropriated from the general fund of the state to the fund, moneys collected as premiums pursuant to section 217A.7, and moneys from any other source credited to the fund shall be deposited in the fund. Moneys deposited in or credited to the fund shall be used only as provided in appropriations from the fund for the purpose of the IowaCare plus program.
   2.  The fund shall be separate from the general fund of the state and shall not be considered part of the general fund of the state. The moneys in the fund shall not be considered revenue of the state, but rather shall be moneys of the fund. The moneys in the fund are not subject to section 8.33 and shall not be transferred, used, obligated, appropriated, or otherwise encumbered, except to provide for the purposes of this chapter. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the fund shall be credited to the fund.
   3.  The department shall adopt rules pursuant to chapter 17A to administer the fund.
    Sec. 9.  NEW SECTION.  217A.9  Contingent implementation.

   Implementation of this chapter is contingent upon the availability of funding as determined by the director and as stipulated in rules.
    Sec. 10.  NEW SECTION.  135.162A  Diabetes registry.

   1.  The department shall establish a uniform, statewide registry for the collection of data regarding diabetes. The purposes of the registry are to collect and serve as a repository for data about the prevalence and incidence of diabetes occurring in the population; to assist medical providers in tracking and improving the care of patients with diabetes; to provide a clearinghouse of information for individuals, their families, and providers about diabetes; to make the data available for scientific and medical research; and to assist in making decisions about the allocation of public resources.
   2.  The department shall adopt rules pursuant to chapter 17A to administer the registry including the reporting format, the data to be collected, the use of data collected, and confidentiality of and access to the data.
   3.  In addition to the collection of data, the department shall provide training and on-site support for providers to participate in the registry, to change patterns of patient care through use of evidence-based practices by the provider, and to enable involvement by patients in patient education, self-management, and follow-up plans.
   4.  Implementation of this section is contingent upon the availability of funding as determined by the director of public health and stipulated in rules.
    Sec. 11.  Section 249J.7, Code 2009, is amended to read as follows:
   249J.7  Expansion population provider network.
   1.  a.  Expansion population members shall only be eligible to receive expansion population services through a provider included in the expansion population provider network. Except as otherwise provided in this chapter, the expansion population provider network shall be limited to a publicly owned acute care teaching hospital located in a county with a population over three hundred fifty thousand, the university of Iowa hospitals and clinics, and the state hospitals for persons with mental illness designated pursuant to section 226.1 with the exception of the programs at such state hospitals for persons with mental illness that provide substance abuse treatment, serve gero-psychiatric patients, or treat sexually violent predators and a regional provider network utilizing providers that are part of the Iowa collaborative safety net provider network established pursuant to section 135.153, designated by the department to provide primary care to members. 
   b.  The regional provider network shall include at least one primary care provider for each county designated to serve expansion population members residing in that county. Payment shall only be made to the county’s designated primary care provider for eligible primary care services provided to a member. The department shall adopt rules pursuant to chapter 17A, in collaboration with the medical home advisory council created pursuant to section 135.159, specifying requirements for medical homes including certification, with which regional provider network participating providers shall comply, as appropriate. The department may also designate other private providers and hospitals to participate in the regional provider network, to provide primary and specialty care, subject to the availability of funds.
   c.  Tertiary care shall be provided to eligible expansion population members residing in any county in the state at the university of Iowa hospitals and clinics.
   d.  Once the statutorily specified amount of funding is distributed to the publicly owned acute care teaching hospital located in a county with a population over three hundred fifty thousand, eligible expansion population members may receive primary care services through other primary care providers located in that county as designated by the department.
   2.  Expansion population services provided to expansion population members by providers included in the expansion population provider network shall be payable at the full benefit recipient rates.
   3.  Providers included in the expansion population provider network shall submit clean claims within twenty days of the date of provision of an expansion population service to an expansion population member.
   4.  Unless otherwise prohibited by law, a provider under the expansion population provider network may deny care to an individual who refuses to apply for coverage under the expansion population.
   5.  Notwithstanding the provision of section 347.16, subsection 2, requiring the provision of free care and treatment to the persons described in that subsection, the publicly owned acute care teaching hospital described in subsection 1 may require any sick or injured person seeking care or treatment at that hospital to be subject to financial participation, including but not limited to copayments or premiums, and may deny nonemergent care or treatment to any person who refuses to be subject to such financial participation.
   6.  The department shall utilize certified public expenditures at the university of Iowa hospitals and clinics to maximize the availability of state funding to provide necessary access to both local primary and specialty physician care to expansion population members. The department shall determine, in collaboration with the university of Iowa hospitals and clinics and the Iowa collaborative safety net provider network established pursuant to section 135.153, the maximum amount of expenditures that can be claimed using certified public expenditures by the university of Iowa hospitals and clinics. Based upon the amount determined, any state appropriation of these funds shall be made in equal sums to the university of Iowa college of medicine for reimbursement of physician services provided to expansion population members and to the providers designated to participate in the regional provider network to offset costs incurred in providing eligible services to expansion population members.
    Sec. 12.  Section 263.18, subsection 4, Code 2009, is amended to read as follows:
   4.  The physicians and surgeons on the staff of the university of Iowa hospitals and clinics who care for patients provided for in this section may charge for the medical services provided under such rules, regulations, and plans approved by the state board of regents. However, a physician or surgeon who provides treatment or care for an expansion population member pursuant to chapter 249J shall not charge or only receive any compensation for the treatment or care except the salary or compensation fixed by the state board of regents to be paid from the hospital fund provided in accordance with section 249J.7.
    Sec. 13.  IOWACARE —— EXTENSION OF WAIVER.  The department of human services shall amend the extension proposal for the IowaCare section 1115 demonstration waiver and shall submit applicable state plan amendments under the medical assistance program to provide expansion population services through the expansion population network pursuant to section 249J.7, as amended by this Act, within the budget neutrality cap and subject to availability of state matching funds.

DIVISION II
IOWA CHOICE EXCHANGE
    Sec. 14.  NEW SECTION.  514M.1  Short title.

   This chapter shall be known and may be cited as the “Iowa Choice Exchange Act”.
    Sec. 15.  NEW SECTION.  514M.2  Purposes.

   The purposes of this chapter include but are not limited to the following:

   1.  To provide a portal where uninsured Iowans can receive assistance in obtaining health care coverage.
   2.  To provide an information clearinghouse where all Iowans can obtain information about health care coverage that is available in the state including comparisons of benefits, premiums, and out-of-pocket costs.
    Sec. 16.  NEW SECTION.  514M.3  Definitions.  

   As used in this chapter, unless the context otherwise requires:

   1.  “Board” means the board of directors of the Iowa choice exchange.
   2.  “Carrier” means an insurer providing accident and sickness insurance under chapter 509, 514, or 514A and includes a health maintenance organization established under chapter 514B if payments received by the health maintenance organization are considered premiums pursuant to section 514B.31 and are taxed under chapter 432. “Carrier” also includes a corporation which becomes a mutual insurer pursuant to section 514.23 and any other person as defined in section 4.1, who is or may become liable for the tax imposed by chapter 432.
   3.  “Commissioner” means the commissioner of insurance.
   4.  “Creditable coverage” means health benefits or coverage provided to an individual under any of the following:
   a.  A group health plan.
   b.  Health insurance coverage.
   c.  Part A or part B Medicare pursuant to Tit. XVIII of the federal Social Security Act.
   d.  Medicaid pursuant to Tit. XIX of the federal Social Security Act, other than coverage consisting solely of benefits under section 1928 of that Act.
   e.  10 U.S.C. ch. 55.
   f.  A health or medical care program provided through the Indian health service or a tribal organization.
   g.  A state health benefits risk pool.
   h.  A health plan offered under 5 U.S.C. ch. 89.
   i.  A public health plan as defined under federal regulations.
   j.  A health benefit plan under section 5(e) of the federal Peace Corps Act, 22 U.S.C. § 2504(e).
   k.  An organized delivery system licensed by the director of public health.
   l.  The hawk-i program authorized by chapter 514I.
   5.  “Director” means the director of revenue.
   6.  “Exchange” means the Iowa choice exchange.
   7.  “Executive director” means the executive director of the Iowa choice exchange.
   8.a.  “Group health plan” means an employee welfare benefit plan as defined in section 3(1) of the federal Employee Retirement Income Security Act of 1974, to the extent that the plan provides medical care including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement, or otherwise.
   b.  For purposes of this subsection, “medical care” means medical care for which amounts are paid for any of the following:
   (1)  The diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting a structure or function of the body.
   (2)  Transportation primarily for and essential to medical care referred to in subparagraph (1).
   (3)  Insurance covering medical care referred to in subparagraph (1) or (2).
   c.  For purposes of this subsection, the following apply:
   (1)  A plan, fund, or program established or maintained by a partnership which, but for this subsection, would not be an employee welfare benefit plan, shall be treated as an employee welfare benefit plan which is a group health plan to the extent that the plan, fund, or program provides medical care, including items and services paid for as medical care for present or former partners in the partnership or to the dependents of such partners, as defined under the terms of the plan, fund, or program, either directly or through insurance, reimbursement, or otherwise.
   (2)  With respect to a group health plan, the term “employer” includes a partnership with respect to a partner.
   (3)  With respect to a group health plan, the term “participant” includes the following:
   (a)  With respect to a group health plan maintained by a partnership, an individual who is a partner in the partnership.
   (b)  With respect to a group health plan maintained by a self-employed individual under which one or more of the self-employed individual’s employees are participants, the self-employed individual, if that individual is, or may become, eligible to receive benefits under the plan or the individual’s dependents may be eligible to receive benefits under the plan.
   9.  “Health care services” means services, the coverage of which is authorized under chapter 509, 514, 514A, or 514B and includes services for the purposes of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
   10.  “Health insurance” means accident and sickness insurance authorized by chapter 509, 514, or 514A.
   11.a.  “Health insurance coverage” means health insurance coverage offered to individuals, including group conversion coverage.
   b.  “Health insurance coverage” does not include any of the following:
   (1)  Coverage for accident-only or disability income insurance.
   (2)  Coverage issued as a supplement to liability insurance.
   (3)  Liability insurance, including general liability insurance and automobile liability insurance.
   (4)  Workers’ compensation or similar insurance.
   (5)  Automobile medical-payment insurance.
   (6)  Credit-only insurance.
   (7)  Coverage for on-site medical clinic care.
   (8)  Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance coverage or benefits.
   c.  “Health insurance coverage” does not include benefits provided under a separate policy as follows:
   (1)  Limited-scope dental or vision benefits.
   (2)  Benefits for long-term care, nursing home care, home health care, or community-based care.
   (3)  Any other similar limited benefits as provided by rule of the commissioner.
   d.  “Health insurance coverage” does not include benefits offered as independent noncoordinated benefits as follows:
   (1)  Coverage only for a specified disease or illness.
   (2)  A hospital indemnity or other fixed indemnity insurance.
   e.  “Health insurance coverage” does not include Medicare supplemental health insurance as defined under section 1882(g)(1) of the federal Social Security Act, coverage supplemental to the coverage provided under 10 U.S.C. ch. 55 and similar supplemental coverage provided to coverage under group health insurance coverage.
   12.  “Medical assistance program” means the federal-state assistance program established under Tit. XIX of the federal Social Security Act and chapter 249A.
   13.  “Medicare” means the federal government health insurance program established under Tit. XVIII of the federal Social Security Act.
   14.  “Organized delivery system” means an organized delivery system as licensed by the director of public health.
    Sec. 17.  NEW SECTION.  514M.4  Iowa choice exchange created —— board of directors.  
   1.  An Iowa choice exchange is created as a nonprofit corporation under the purview of the insurance division of the department of commerce.
   a.  All carriers and all organized delivery systems licensed by the director of public health providing health insurance or health care services in Iowa, whether on an individual or group basis, and all other insurers designated by the exchange’s board of directors and approved by the commissioner shall be members of the exchange.
   b.  The exchange shall operate under a plan of operation established and approved under section 514M.5 and shall exercise its powers through a board of directors established under this section.
   2.  The board of directors of the exchange shall consist of the following members:
   a.  The following persons who are voting members of the board appointed by the governor and subject to confirmation by the senate:
   (1)  A health care academic with a background in economics, law, or public health.
   (2)  An executive of a carrier.
   (3)  A health benefits manager of a company.
   (4)  A health care analyst representing a public or private employee bargaining unit.
   (5)  A health care analyst representing an organized consumer group.
   (6)  A health care provider.
   (7)  An insurance agent.
   b.  The following persons who are ex officio, nonvoting members of the board:
   (1)  The commissioner of insurance, or a designee.
   (2)  The Iowa Medicaid director, or a designee.
   (3)  Four members of the general assembly, one appointed by the speaker of the house of representatives, one appointed by the minority leader of the house of representatives, one appointed by the majority leader of the senate, and one appointed by the minority leader of the senate.
   c.  Each member of the board appointed by the governor shall be a resident of this state and the composition of voting members of the board shall be in compliance with sections 69.16, 69.16A, and 69.16C.
   d.  The voting members of the board shall be appointed for terms of six years beginning and ending as provided in section 69.19. A member of the board is eligible for reappointment. The governor shall fill a vacancy for the remainder of the unexpired term. A member of the board may be removed by the governor for misfeasance, malfeasance, or willful neglect of duty or other cause after notice and a public hearing unless the notice and hearing are waived by the member in writing.
   e.  The voting members of the board shall annually elect one of the members as chairperson and one as vice chairperson.
   f.  A majority of the voting members of the board constitutes a quorum. The affirmative vote of a majority of the voting members is necessary for any action taken by the board. The majority shall not include a member who has a conflict of interest and a statement by a member of a conflict of interest is conclusive for this purpose. A vacancy in the voting membership of the board does not impair the right of a quorum to exercise the rights and perform the duties of the board. An action taken by the board under this chapter may be authorized by resolution at a regular or special meeting and each resolution may take effect immediately and need not be published or posted. Meetings of the board shall be held at the call of the chairperson or at the request of a majority of the voting members.
   g.  Members of the board may be reimbursed from the moneys of the exchange for expenses incurred by them as members, but shall not be otherwise compensated by the exchange for their services.
   h.  The voting members of the board shall give bond as required for public officers in chapter 64.
   i.  The members of the board are subject to and are officials within the meaning of chapter 68B.
   j.  All employees of the exchange are exempt from chapter 8A, subchapter IV, and chapter 97B.
   3.  The voting members of the board shall appoint an executive director to supervise the administrative affairs and general management and operations of the exchange. The executive director shall not be a member of the board, shall serve at the pleasure of the board, and shall receive compensation as fixed by the board. The executive director shall keep a record of the proceedings of the board and shall be custodian of all books, documents, and papers filed with the board, the minute book or journal of the board, and the official seal of the board. The executive director may cause copies to be made of minutes and other records and documents of the board and may give certificates under the official seal of the board that the copies are true copies, and persons dealing with the board may rely upon the certificates.
   4.  The exchange shall be considered a governmental body for the purposes of chapter 21 and a government body for the purposes of chapter 22.
   5.  The board may hire independent consultants, as they deem necessary, to assist them in carrying out the provisions of this chapter.
    Sec. 18.  NEW SECTION.  514M.5  Plan of operation ——assessments.  
   1.  The board shall submit to the commissioner a plan of operation for the exchange and any amendments necessary or suitable to assure the fair, reasonable, and equitable administration of the exchange within ninety days after the appointment of the board. After notice and hearing, the commissioner shall approve the plan of operation if the plan is determined to be suitable to assure the fair, reasonable, and equitable administration of the exchange, and includes a methodology that may be used to share exchange costs on an equitable and proportionate basis among the member carriers. In addition to other requirements, the plan of operation shall provide for all of the following:
   a.  The handling and accounting of assets and moneys of the exchange.
   b.  The amount and method of reimbursing expenses of the members of the board.
   c.  Regular times and places for meetings of the board.
   d.  Records to be kept of all financial transactions, and the annual fiscal reporting to the commissioner.
   e.  The periodic advertising of the general availability of health coverage information and assistance from the exchange.
   f.  Additional provisions necessary or proper for the execution of the powers and duties of the exchange.
   2.  The exchange has the general powers and authority enumerated by this section and pursuant to section 514M.6 and executed in accordance with the plan of operation approved by the commissioner under subsection 1.
   3.  Following the close of each calendar year, the exchange shall determine the net payments received, the expenses of administration, and the incurred costs of the exchange for the year. The exchange shall certify the amount of any net costs for the preceding calendar year to the commissioner and director of revenue. The net costs may be assessed by the exchange to all members of the exchange in proportion to their respective shares of total health insurance premiums or payments for subscriber contracts received in Iowa during the second preceding calendar year, coinciding with or ending during the calendar year or on any other equitable basis as provided in the plan of operation. In sharing costs, the exchange may abate or defer in any part the assessment of a member, if, in the opinion of the board, payment of the assessment would endanger the ability of the member to fulfill its contractual obligations. The exchange may also provide for an initial or interim assessment against members of the exchange if necessary to assure the financial capability of the exchange to meet the incurred or estimated operating costs of the exchange until the next calendar year is completed. Net gains of the exchange, if any, shall be held by the exchange at interest to offset future costs.
   a.  For purposes of this subsection, “total health insurance premiums” and “payments for subscriber contracts” include, without limitation, premiums or other amounts paid to or received by a member for individual and group health plan coverage provided under any chapter of the Code or Iowa Acts, and “paid losses” includes, without limitation, claims paid by a member operating on a self-funded basis for individual and group health plan coverage provided under any chapter of the Code or Iowa Acts.
   b.  For purposes of calculating and conducting the assessment under this subsection, the exchange shall have the express authority to require members to report on an annual basis each member’s total health insurance premiums and payments for subscriber contracts and paid losses.
   4.  The exchange shall conduct annual audits to assure the general accuracy of the financial data submitted to the exchange, and the exchange shall have an annual audit of its operations, made by an independent certified public accountant.
   5.  The exchange is subject to examination by the commissioner. Not later than April 30 of each year, the board shall submit to the commissioner a financial report for the preceding calendar year in a form approved by the commissioner.
   6.  The exchange is subject to oversight by the legislative fiscal committee of the legislative council. Not later than April 30 of each year, the board shall submit to the governor, the speaker of the house of representatives, the majority leader of the senate, and the legislative fiscal committee a financial report for the preceding year in a form approved by the legislative fiscal committee.
   7.  The exchange is exempt from payment of all fees and all taxes levied by this state or any of its political subdivisions.
   8.  The exchange shall develop and implement a plan of operation and corresponding timeline detailing action steps toward implementing this chapter, by rules adopted pursuant to chapter 17A as provided in section 514M.7.
    Sec. 19.  NEW SECTION.  514M.6  Powers and duties of exchange.
   1.  The exchange shall develop a system that provides a portal where uninsured Iowans can receive assistance in obtaining public or private health care coverage. In doing so the exchange shall contract with the department of human services to determine the eligibility of uninsured Iowans for public programs and to provide assistance with enrollment in the appropriate public programs. The exchange shall provide assistance with obtaining private health insurance coverage that meets certain standards of quality and affordability to uninsured Iowans who are not eligible for or do not wish to enroll in public programs. The exchange shall develop a seamless system that allows individuals to move between public and private health care coverage, including increasing opportunities for obtaining creditable coverage.
   2.  The exchange shall establish quality standards for private health insurance coverage that has three levels of benefits including basic or catastrophic benefits, an intermediate level of benefits, and comprehensive benefits coverage, and that meets affordability limits established pursuant to 2009 Iowa Acts ch. 118, section 1, subsection 4, paragraph “c”.
   3.  a.  The exchange shall establish an information clearinghouse to provide information to all Iowans about all public and private health care coverage that is available in the state including comparisons of benefits, premiums, and out-of-pocket costs.
   b.  The exchange may establish standards for carriers, organized delivery systems, and public programs to provide uniform and consistent information about the health care coverage options offered by each carrier and public program that includes but is not limited to what benefits are covered and not covered, the amount of coverage for each service, including copays and deductibles, and any prior authorization requirements for coverage.
   c.  The exchange may require each carrier, organized delivery system, and public program to categorize and describe which of the three levels of benefits each health care coverage option offered by a carrier, organized delivery system, or public program provides as set forth in subsection 2.
   d.  The exchange shall provide ongoing information to taxpayers about the costs of public health care programs to the state, including the percentage and source of state and federal funding for the programs.
   e.  The exchange may provide counseling to assist Iowans with making an informed choice when selecting health care coverage.
   4.  The exchange shall maintain an ongoing effort to monitor federal law and federal health reform efforts and to report that information to the governor and to the general assembly so that the state is in a position to do any of the following:
   a.  Participate in any early opt-in opportunities available prior to the full execution date of any enacted federal health care reform legislation.
   b.  Participate in any opportunities available under any enacted federal legislation that creates incentives or otherwise allows states to engage in reform of their insurance markets.
   c.  Aggressively seek opportunities to obtain and leverage federal funding for health care coverage of Iowans and to improve Iowa’s health care system.
   5.  The exchange may develop standards related to the marketing of health insurance coverage by carriers and organized delivery systems, including but not limited to the following:
   a.  Limits on the marketing approaches that may be used.
   b.  Prior approval of marketing materials used.
   6.  The exchange shall encourage or develop the use of common definitions for quality of care and pricing of health care services and develop and implement methodologies that provide quality and cost data on health care services and health care coverage offered in the state.
   7.  The exchange shall collaborate with, including but not limited to, the department of human services, the department of public health, the commissioner, the department of human services, health care providers, members of the Iowa collaborative safety net provider network, and carriers to carry out the duties of the exchange including dissemination of information about the services offered by the exchange to the public.
    Sec. 20.  NEW SECTION.  514M.7  Rules.  

   The commissioner and the board shall adopt rules pursuant to chapter 17A to implement the provisions of this chapter.
    Sec. 21.  NEW SECTION.  514M.8  Iowa choice exchange fund created.
   1.  An Iowa choice exchange fund is created in the state treasury as a separate fund under the control of the exchange. All moneys appropriated or transferred to the fund shall be credited to the fund. All moneys deposited or paid into the fund shall only be appropriated to the exchange to be used for the purposes set forth in this chapter.
   2.  Notwithstanding section 8.33, any balance in the fund on June 30 of each fiscal year shall not revert to the general fund of the state, but shall be available for purposes of this chapter in subsequent fiscal years. Notwithstanding section 12C.7, interest earnings on moneys in the fund shall be credited to the fund.
    Sec. 22.  NEW SECTION.  514M.9  Collective action —— immunity.

   The participation by carriers or members in the exchange or any joint or collective action required by this chapter shall not be the basis of any legal civil action, or criminal liability against the exchange or members of it either jointly or separately.
    Sec. 23.  NEW SECTION.  514M.10  Contingent implementation.

   Implementation of this chapter is contingent upon the availability of funding as determined by the commissioner and stipulated in rules adopted by the commissioner.
    Sec. 24.  INITIAL MEMBERS OF BOARD OF DIRECTORS OF THE IOWA CHOICE EXCHANGE.  The initial voting members of the board of directors of the Iowa choice exchange shall be appointed within thirty days after the implementation date of this division of this Act.
EXPLANATION
   DIVISION I —— IOWACARE PLUS PROGRAM.  New Code chapter 217A creates the IowaCare plus program based on specified purposes and principles. The program is to be administered by the Iowa Medicaid enterprise. The division specifies eligibility criteria for the program including that an individual must be between 19 through 64 years of age and have a family income above 200 percent but not in excess of 400 percent of the federal poverty level. The division specifies the benefits under the program including inpatient hospital services, outpatient hospital services, physician and advanced registered nurse practitioner services, dental services, limited pharmacy benefits, and primary care coordination. The division directs the department of human services (DHS) to establish a regional provider network to provide services under the program utilizing the university of Iowa hospitals and clinics and Broadlawns medical center as current expansion population provider network, the Iowa collaborative safety net provider network, private providers, and hospitals as specified by the department. The division directs DHS to establish cost sharing for the program by rule based on a sliding fee schedule and also provides for premium assistance for those individuals with incomes over 200 and not exceeding 300 percent of the federal poverty level. Members of the program with incomes in excess of 300 percent but not in excess of 400 percent of the federal poverty level must pay all cost sharing required under the program. The division creates an IowaCare plus trust fund under the authority of DHS to be used for the IowaCare plus program. Implementation of the program is contingent upon the availability of funding. 
   The division also directs DHS to amend the extension proposal for the IowaCare program and submit applicable state plan amendments to allow for expansion population members under the IowaCare program to utilize additional providers included in the regional provider network, private providers, and hospitals as specified by DHS; to access tertiary care at the university of Iowa hospitals and clinics for any eligible member residing in any county in the state; and to provide access to other providers for primary and specialty care, subject to availability of funding.
   Division I also establishes a diabetes registry for the collection of data regarding diabetes. The purposes of the registry are to collect and serve as a repository for data about the prevalence and incidence of diabetes occurring in the population; to assist medical providers in tracking and improving the care of patients with diabetes; to provide a clearinghouse of information for individuals, their families, and providers about diabetes; to make the data available for research; and to assist in making decisions about the allocation of public resources. Implementation of the registry is also contingent upon availability of funding.
   DIVISION II —— IOWA CHOICE EXCHANGE. New Code chapter 514M creates the Iowa choice exchange as a nonprofit corporation under the purview of the insurance division of the department of commerce. The stated purposes for creating the exchange are to provide a portal where uninsured Iowans can receive assistance in obtaining health care coverage and provide an information clearinghouse where all Iowans can obtain information about health care coverage.
   New Code section 514M.4 creates the exchange, specifies the membership of the seven voting members of the board of directors, and the ex officio, nonvoting members of the board which include the commissioner of insurance and the Iowa Medicaid director or their designees, and four legislators. The voting members of the board are appointed by the governor, subject to confirmation by the senate for six-year terms, and are required to appoint an executive director to supervise the administrative affairs of the exchange. All licensed carriers and organized delivery systems in the state providing health insurance or health care services are members of the exchange.
   New Code section 514M.5 requires the exchange to submit a plan of operation to the commissioner of insurance for approval. The exchange is also required to determine the net payments received each year and the incurred costs of the exchange for the year. The net costs may be assessed by the exchange against all members in proportion to their respective shares of total health insurance premiums or payments for subscriber contracts received in Iowa. The exchange may provide for an initial or interim assessment against such members to assure the financial capability of the exchange to meet incurred or estimated operating costs until the next calendar year is completed. The exchange is required to conduct annual audits to assure the accuracy of the financial data submitted by members and the accuracy of information regarding the expenses of the exchange. The exchange is subject to oversight by the legislative fiscal committee of the legislative council and must submit an annual financial report by April 30 of each year.
   New Code section 514M.6 specifies the powers and duties of the exchange to carry out its purposes. The exchange is required to contract with the department of human services to make eligibility determinations for public programs.
   The exchange is also required to establish quality and affordability standards for three levels of private health insurance coverage and to provide information about available public and private health care coverage, including comparisons of benefits, premiums, and out-of-pocket costs for each option. The exchange may establish standards for carriers, organized delivery systems, and public programs to provide uniform and consistent information about health care coverage options to facilitate comparisons and may require each carrier, organized delivery system, and public program to categorize which of the three levels of benefits the coverage offered provides. The exchange may offer counseling to assist Iowans with making an informed choice when selecting health care coverage.
   The exchange is also required to conduct ongoing monitoring of federal law and federal health reform efforts and to report that information to the governor and to the general assembly so that the state is in a position to participate in any early opt-in opportunities or insurance market reforms that become available and to aggressively obtain and leverage federal funding for improvements to Iowa’s health care coverage and health care system.
   The exchange may develop marketing standards related to private health care coverage. The exchange is required to encourage or develop the use of common definitions for quality of care and pricing of health care services and develop and implement methodologies that provide quality and cost data on health care services and health care coverage offered in the state.
   The exchange is required to collaborate with other state agencies, health care providers, members of the Iowa collaborative safety net provider network, and carriers and organized delivery systems to carry out its duties. 
   Under Code section 514M.7 the exchange may adopt administrative rules under Code chapter 17A to implement the provisions of the new Code chapter.
   Code section 514M.8 creates the Iowa choice exchange fund in the state treasury as a separate fund under the control of the exchange with all moneys deposited in the fund appropriated to the exchange to be used for the purposes enumerated in new Code chapter 514M.
   New Code section 514M.10 provides that the implementation of the new Code chapter is contingent upon the availability of funding as determined by the commissioner of insurance and stipulated in administrative rules.