SF 2143 (LSB 6053XS (2) 83)

SENATE FILE 2143

BY  DANIELSON

A BILL FOR

An Act relating to an explanation of benefits for the medical assistance program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  EXPLANATION OF BENEFITS —— MEDICAL ASSISTANCE PROGRAM.  The department of human services shall develop and utilize an explanation of benefits to be provided to recipients of the medical assistance program. The purposes of providing the explanation of benefits are to inform recipients of the medical assistance program services for which the department is billed on their behalf, to assist the department in tracking any services incorrectly recorded or not received, and to provide the department with a mechanism of identifying providers, provider groups, and geographic areas for evaluation of care and treatment patterns. The explanation of benefits shall at a minimum provide a recipient with information including the name of the provider, type of service, date of service, and amount paid by the medical assistance program. The explanation of benefits shall also provide a means for the recipient to contact the department regarding any errors in the explanation of benefits.
EXPLANATION
   This bill directs the department of human services (DHS) to develop and utilize explanations of benefits (EOB) to be provided to recipients of the medical assistance program. The bill provides that the purposes of the EOBs are to inform recipients of the Medicaid programs services for which DHS is billed on their behalf, to assist DHS in tracking any services incorrectly recorded or not received, and to provide DHS with a mechanism to identify providers, provider groups, and geographic areas for evaluation of care and treatment patterns. The EOBs are to include, at a minimum, the name of the provider, type of service, date of service, and amount paid by the Medicaid program. The EOB is also to provide a means for the recipient to contact DHS regarding any errors in the EOB.