Senate File 2356 - Introduced SENATE FILE 2356 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 2092) A BILL FOR An Act relating to health reform in Iowa by creating an 1 IowaCare plus program and an Iowa insurance information 2 exchange. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5392SV (5) 83 pf:av/rj

S.F. 2356 DIVISION I 1 IOWACARE PLUS PROGRAM 2 Section 1. NEW SECTION . 217A.1 Title. 3 This chapter shall be known and may be cited as the “IowaCare 4 Plus Act” . 5 Sec. 2. NEW SECTION . 217A.2 Definitions. 6 As used in this chapter, unless the context otherwise 7 requires: 8 1. “Department” means the department of human services. 9 2. “Director” means the director of human services. 10 3. “Eligible individual” means an individual who meets the 11 eligibility requirements in section 217A.4. 12 4. “Federal poverty level” means the federal poverty 13 level as defined by the most recently revised poverty income 14 guidelines published by the United States department of health 15 and human services. 16 5. “Full benefit recipient rate” means the rate paid to 17 a provider for an adult who is eligible for full medical 18 assistance benefits pursuant to chapter 249A under any category 19 of eligibility. 20 6. “Fund” means the IowaCare plus trust fund created in 21 section 217A.8. 22 7. “Iowa Medicaid enterprise” means the Iowa Medicaid 23 enterprise as defined in section 249J.3. 24 8. “IowaCare plus member” or “member” means an IowaCare plus 25 member with active eligibility status. 26 9. “Premium assistance payment” means a premium payment 27 made on behalf of a member in the program, under a schedule 28 established by the department. 29 10. “Program” means the IowaCare plus program created in 30 this chapter. 31 Sec. 3. NEW SECTION . 217A.3 Purposes —— principles —— 32 administration. 33 1. An IowaCare plus program shall be created to do all of 34 the following: 35 -1- LSB 5392SV (5) 83 pf:av/rj 1/ 26

S.F. 2356 a. To improve the health of adults in the state. 1 b. To improve the quality of health care and access to 2 health care in the state. 3 c. To provide health care coverage to adults in the state 4 who would otherwise be uninsured. 5 d. To increase the range of health care coverage options 6 available to Iowans. 7 e. To slow the growth of per capita health care spending. 8 f. To serve as a model for reforming the health care 9 delivery system. 10 2. The IowaCare plus program shall be established and 11 administered in accordance with the following guiding health 12 care coverage reform principles: 13 a. Health care coverage should be accessible. 14 b. Health care coverage should be continuous. 15 c. Health care coverage should be affordable to individuals 16 and families. 17 d. The provision of health care coverage should be 18 sustainable for Iowa. 19 e. Health care coverage should enhance health and well-being 20 by promoting access to high-quality care that is effective, 21 efficient, safe, timely, patient-centered, and equitable. 22 3. a. The program shall be administered by the Iowa 23 Medicaid enterprise. 24 b. The program shall be administered consistent with the 25 Iowa medical assistance program. State and federal laws, rules 26 and regulations applicable to the Iowa medical assistance 27 program pursuant to chapter 249A and 42 C.F.R. pts. 430 28 through 456 shall apply to the IowaCare plus program, with the 29 exception of benefits and eligibility provisions inconsistent 30 with sections 217A.4 and 217A.5. 31 c. The provisions of this chapter shall not be construed, 32 are not intended as, and shall not imply a grant of entitlement 33 for services to individuals who are eligible for assistance 34 under this chapter or for utilization of services that do 35 -2- LSB 5392SV (5) 83 pf:av/rj 2/ 26

S.F. 2356 not exist or are not otherwise available on July 1, 2010. 1 Any state obligation to provide services pursuant to this 2 chapter is limited to the extent of the funds appropriated or 3 distributed for the purposes of this chapter. 4 d. All agencies and offices of the state, or of any 5 political subdivision of the state, shall fully cooperate with 6 the Iowa Medicaid enterprise and the department in carrying out 7 the purposes of this section. 8 Sec. 4. NEW SECTION . 217A.4 IowaCare plus —— eligibility. 9 1. Except as otherwise provided in this chapter, an 10 individual nineteen through sixty-four years of age shall be 11 eligible for the membership benefits described in section 12 217A.5 when provided through the regional provider network as 13 described in section 217A.6, if the individual meets all of the 14 following conditions: 15 a. The individual is not eligible for health care coverage 16 under any other public program or through group or individual 17 health insurance, or health care coverage offered through group 18 or individual health insurance is not affordable. 19 b. The individual has a family income above two hundred 20 percent but not in excess of three hundred percent of the 21 federal poverty level. 22 c. The individual’s or family member’s employer has not 23 provided health insurance coverage in the last six months for 24 which the individual is eligible and for which the employer 25 covers at least twenty percent of the annual premium cost of a 26 family health insurance plan or at least thirty-three percent 27 of an individual health insurance plan. 28 d. The individual has not accepted a financial incentive 29 from the individual’s employer to decline the employer’s 30 subsidized health insurance plan. 31 e. The individual fulfills all other conditions of 32 participation described in this chapter, including requirements 33 relating to personal financial responsibility. 34 2. Following initial enrollment, an IowaCare plus member 35 -3- LSB 5392SV (5) 83 pf:av/rj 3/ 26

S.F. 2356 shall reenroll annually by the last day of the month preceding 1 the month in which the member initially enrolled. The 2 department may provide a process for automatic reenrollment of 3 members. 4 3. The department shall develop a plan for outreach and 5 education that is designed to ensure that Iowans are informed 6 about the program and are encouraged to enroll in the program. 7 The outreach and education plan shall include a focus on 8 targeting populations that are underserved by the health care 9 delivery system. 10 Sec. 5. NEW SECTION . 217A.5 IowaCare plus —— benefits. 11 1. IowaCare plus members shall be eligible for all of the 12 following benefits: 13 a. Inpatient hospital procedures described in the 14 diagnostic-related group codes or other applicable inpatient 15 hospital reimbursement methods designated by the department. 16 b. Outpatient hospital services described in the ambulatory 17 patient groupings or non-inpatient services designated by the 18 department. 19 c. Physician and advanced registered nurse practitioner 20 services described in the current procedural terminology codes 21 specified by the department. 22 d. Dental services described in the dental codes specified 23 by the department. 24 e. Limited pharmacy benefits as specified by the department. 25 f. Primary care coordination. 26 g. Podiatry services. 27 2. a. Each member shall receive a comprehensive medical 28 examination annually. The department may implement a 29 web-based health risk assessment for members that may include 30 facilitation, if deemed to be cost-effective to the program. 31 b. Refusal of a member to participate in a comprehensive 32 medical examination or any health risk assessment implemented 33 by the department shall not be a basis for ineligibility for or 34 disenrollment from the program. 35 -4- LSB 5392SV (5) 83 pf:av/rj 4/ 26

S.F. 2356 Sec. 6. NEW SECTION . 217A.6 Regional provider network. 1 1. The department shall establish a regional provider 2 network and shall enter into contracts or 28E agreements with 3 providers specified for participation in the network. The 4 regional provider network shall include all of the following: 5 a. Providers designated by the department who are part of 6 the Iowa collaborative safety net provider network established 7 pursuant to section 135.153. 8 b. The publicly owned acute care teaching hospital located 9 in a county with a population over three hundred fifty thousand 10 and the university of Iowa hospitals and clinics, that are part 11 of the expansion population provider network as specified in 12 section 249J.7. 13 c. Hospitals designated by the department. 14 d. Other health care providers designated by the department 15 as necessary to provide regional access to the benefits 16 specified under section 217A.5. 17 2. The department may designate specific providers within a 18 region for the provision of primary, specialty, and tertiary 19 care. 20 3. The department shall provide for reimbursement of 21 nonparticipating providers for covered services under the 22 IowaCare plus program in accordance with section 249J.24A. 23 4. All members shall receive benefits described in section 24 217A.5 through a medical home. The department shall adopt 25 rules pursuant to chapter 17A, in collaboration with the 26 medical home advisory council created pursuant to section 27 135.159, specifying requirements for medical homes including 28 certification, with which participating providers shall comply, 29 as appropriate. 30 5. The department may develop a payment rate methodology to 31 support the medical home requirement. 32 Sec. 7. NEW SECTION . 217A.7 Financial participation. 33 1. The department shall adopt rules pursuant to chapter 34 17A to establish all cost-sharing requirements of the 35 -5- LSB 5392SV (5) 83 pf:av/rj 5/ 26

S.F. 2356 program, including any premiums, deductibles, and copayment 1 amounts. Cost-sharing shall be based on a sliding scale. Any 2 cost-sharing requirements for IowaCare plus members whose 3 family income exceeds two hundred percent but does not exceed 4 three hundred percent of the federal poverty level shall meet 5 the percentage standards for affordability established pursuant 6 to 2009 Iowa Acts, chapter 118, section 1, subsection 4, 7 paragraph “c” . 8 2. Each IowaCare plus member whose family income exceeds 9 two hundred percent but does not exceed three hundred percent 10 of the federal poverty level may be eligible for a premium 11 assistance payment as specified by rule of the department. 12 3. If an eligible individual has access to health care 13 coverage through the individual’s employer, but such health 14 care coverage is not affordable, the program may pay the 15 employee share of the premium up to the amount that the 16 program would subsidize the member through the program, if 17 cost-effective to the program. 18 4. Premiums collected pursuant to this section shall be 19 deposited in the IowaCare plus trust fund created in section 20 217A.8. 21 Sec. 8. NEW SECTION . 217A.8 IowaCare plus trust fund. 22 1. An IowaCare plus trust fund is created in the state 23 treasury under the authority of the department. Moneys 24 appropriated from the general fund of the state to the fund, 25 moneys collected as premiums pursuant to section 217A.7, and 26 moneys from any other source credited to the fund shall be 27 deposited in the fund. Moneys deposited in or credited to the 28 fund shall be used only as provided in appropriations from the 29 fund for the purpose of the IowaCare plus program. 30 2. The fund shall be separate from the general fund of the 31 state and shall not be considered part of the general fund of 32 the state. The moneys in the fund shall not be considered 33 revenue of the state, but rather shall be moneys of the fund. 34 The moneys in the fund are not subject to section 8.33 and 35 -6- LSB 5392SV (5) 83 pf:av/rj 6/ 26

S.F. 2356 shall not be transferred, used, obligated, appropriated, or 1 otherwise encumbered, except to provide for the purposes of 2 this chapter. Notwithstanding section 12C.7, subsection 2, 3 interest or earnings on moneys deposited in the fund shall be 4 credited to the fund. 5 3. The department shall adopt rules pursuant to chapter 17A 6 to administer the fund. 7 Sec. 9. NEW SECTION . 217A.9 Contingent implementation. 8 Implementation of this chapter is contingent upon the 9 availability of funding as determined by the director and as 10 stipulated in rules. 11 Sec. 10. Section 249J.6, subsection 1, Code 2009, is amended 12 by adding the following new paragraph: 13 NEW PARAGRAPH . g. Podiatry services. 14 Sec. 11. Section 249J.7, Code 2009, is amended to read as 15 follows: 16 249J.7 Expansion population provider network. 17 1. a. Expansion population members shall only be eligible 18 to receive expansion population services through a provider 19 included in the expansion population provider network. Except 20 as otherwise provided in this chapter, the expansion population 21 provider network shall be limited to a publicly owned acute 22 care teaching hospital located in a county with a population 23 over three hundred fifty thousand, the university of Iowa 24 hospitals and clinics, and the state hospitals for persons 25 with mental illness designated pursuant to section 226.1 with 26 the exception of the programs at such state hospitals for 27 persons with mental illness that provide substance abuse 28 treatment, serve gero-psychiatric patients, or treat sexually 29 violent predators and a regional provider network utilizing the 30 federally qualified health centers, to provide primary care to 31 members. 32 b. (1) The department shall develop a plan to phase-in 33 the regional provider network by determining the most highly 34 underserved areas on a statewide and regional basis, and 35 -7- LSB 5392SV (5) 83 pf:av/rj 7/ 26

S.F. 2356 targeting these areas for prioritization in implementing the 1 regional provider network. 2 (2) Payment shall only be made to designated participating 3 primary care providers for eligible primary care services 4 provided to a member. 5 (3) The department shall adopt rules pursuant to chapter 6 17A, in collaboration with the medical home advisory council 7 created pursuant to section 135.159, specifying requirements 8 for medical homes including certification, with which regional 9 provider network participating providers shall comply, as 10 appropriate. 11 (4) The department may also designate other private 12 providers and hospitals to participate in the regional provider 13 network, to provide primary and specialty care, subject to the 14 availability of funds. 15 c. Tertiary care shall be provided to eligible expansion 16 population members residing in any county in the state at the 17 university of Iowa hospitals and clinics. 18 d. Until such time as the publicly owned acute care 19 teaching hospital located in a county with a population over 20 three hundred fifty thousand notifies the department that such 21 hospital has reached service capacity or has exceeded the 22 statutorily authorized amount of funding as determined and 23 appropriated on an annual basis, the hospital shall remain the 24 only expansion population provider for the residents of such 25 county. 26 2. Expansion population services provided to expansion 27 population members by providers included in the expansion 28 population provider network shall be payable at the full 29 benefit recipient rates. 30 3. Providers included in the expansion population provider 31 network shall submit clean claims within twenty days of the 32 date of provision of an expansion population service to an 33 expansion population member. 34 4. Unless otherwise prohibited by law, a provider under 35 -8- LSB 5392SV (5) 83 pf:av/rj 8/ 26

S.F. 2356 the expansion population provider network may deny care to 1 an individual who refuses to apply for coverage under the 2 expansion population. 3 5. Notwithstanding the provision of section 347.16, 4 subsection 2, requiring the provision of free care and 5 treatment to the persons described in that subsection, the 6 publicly owned acute care teaching hospital described in 7 subsection 1 may require any sick or injured person seeking 8 care or treatment at that hospital to be subject to financial 9 participation, including but not limited to copayments 10 or premiums, and may deny nonemergent care or treatment 11 to any person who refuses to be subject to such financial 12 participation. 13 6. The department shall utilize certified public 14 expenditures at the university of Iowa hospitals and clinics to 15 maximize the availability of state funding to provide necessary 16 access to both local primary and specialty physician care to 17 expansion population members. The department shall determine, 18 in collaboration with the university of Iowa hospitals and 19 clinics and the Iowa collaborative safety net provider network 20 established pursuant to section 135.153, the maximum amount 21 of expenditures that can be claimed using certified public 22 expenditures by the university of Iowa hospitals and clinics 23 within the existing budget neutrality cap . Any federal funds 24 received as matching funds, based on the amount of certified 25 public expenditures determined, shall be allocated one-half to 26 the university of Iowa college of medicine for reimbursement of 27 physician services provided to expansion population members, 28 three-eighths to the providers designated to participate in 29 the regional provider network to offset the costs incurred in 30 providing eligible services to expansion population members, 31 and one-eighth for deposit in the nonparticipating provider 32 reimbursement fund created in section 249J.24A to be used in 33 accordance with the purposes and requirements of the fund to 34 offset the costs incurred in providing eligible services to 35 -9- LSB 5392SV (5) 83 pf:av/rj 9/ 26

S.F. 2356 expansion population members. 1 7. The department shall adopt rules to establish clinical 2 transfer protocols to be used by providers included in the 3 expansion population provider network. 4 Sec. 12. Section 263.18, subsection 4, Code 2009, is amended 5 to read as follows: 6 4. The physicians and surgeons on the staff of the 7 university of Iowa hospitals and clinics who care for patients 8 provided for in this section may charge for the medical 9 services provided under such rules, regulations, and plans 10 approved by the state board of regents. However, a physician 11 or surgeon who provides treatment or care for an expansion 12 population member pursuant to chapter 249J shall not charge 13 or only receive any compensation for the treatment or care 14 except the salary or compensation fixed by the state board 15 of regents to be paid from the hospital fund provided in 16 accordance with section 249J.7 . 17 Sec. 13. REVIEW OF MEDICAL TRANSPORTATION COSTS FOR 18 IOWACARE. The department of human services shall review the 19 costs of transportation to and from a provider included in 20 the expansion population provider network under the IowaCare 21 program. The department shall report the results of the review 22 to the general assembly by December 15, 2010. 23 Sec. 14. DIABETES —— PLAN FOR COORDINATION OF CARE. The 24 department of public health shall work with all appropriate 25 entities to develop a plan for coordination of care for 26 individuals with diabetes who receive care through community 27 health centers, rural health clinics, free clinics, and other 28 members of the Iowa collaborative safety net provider network 29 established pursuant to section 135.153, as determined by the 30 department. The plan may include provisions to establish a 31 diabetic registry, to provide access to medically necessary 32 drugs through entities such as the Iowa prescription drug 33 corporation, and to collect data as necessary to assist the 34 affected medical providers in tracking and improving the care 35 -10- LSB 5392SV (5) 83 pf:av/rj 10/ 26

S.F. 2356 of their patients with diabetes, while also informing future 1 public policy decision makers regarding improved care for 2 individuals with diabetes, notwithstanding an individual’s 3 health care coverage status or choice of health care provider. 4 Sec. 15. IOWACARE —— EXTENSION OF WAIVER. The department 5 of human services shall amend the extension proposal for the 6 IowaCare section 1115 demonstration waiver and shall submit 7 applicable state plan amendments under the medical assistance 8 program to provide expansion population services through the 9 expansion population network pursuant to section 249J.7, as 10 amended by this Act, within the budget neutrality cap and 11 subject to availability of state matching funds. 12 DIVISION II 13 IOWA INSURANCE INFORMATION EXCHANGE 14 Sec. 16. NEW SECTION . 514M.1 Short title. 15 This chapter shall be known and may be cited as the “Iowa 16 Insurance Information Exchange Act” . 17 Sec. 17. NEW SECTION . 514M.2 Purposes. 18 The purposes of this chapter include but are not limited to 19 the following: 20 1. To provide an information clearinghouse where all 21 Iowans can obtain information about health care coverage that 22 is available in the state including comparisons of benefits, 23 premiums, and out-of-pocket costs and where the uninsured can 24 receive assistance regarding health care coverage. 25 2. To expand transparency concerning the quality of care and 26 pricing of health care services. 27 Sec. 18. NEW SECTION . 514M.3 Definitions. 28 As used in this chapter, unless the context otherwise 29 requires: 30 1. “Board” means the board of directors of the Iowa 31 insurance information exchange. 32 2. “Carrier” means an insurer providing accident and 33 sickness insurance under chapter 509, 514, or 514A and 34 includes a health maintenance organization established under 35 -11- LSB 5392SV (5) 83 pf:av/rj 11/ 26

S.F. 2356 chapter 514B if payments received by the health maintenance 1 organization are considered premiums pursuant to section 2 514B.31 and are taxed under chapter 432. “Carrier” also 3 includes a corporation which becomes a mutual insurer pursuant 4 to section 514.23 and any other person as defined in section 5 4.1, who is or may become liable for the tax imposed by chapter 6 432. 7 3. “Commissioner” means the commissioner of insurance. 8 4. “Creditable coverage” means the same as defined in 9 section 513B.2. 10 5. “Director” means the director of revenue. 11 6. “Exchange” means the Iowa insurance information exchange. 12 7. “Executive director” means the executive director of the 13 Iowa insurance information exchange. 14 8. “Group health plan” means the same as defined in section 15 513B.2. 16 9. “Health care services” means services, the coverage of 17 which is authorized under chapter 509, 514, 514A, or 514B and 18 includes services for the purposes of preventing, alleviating, 19 curing, or healing human illness, injury, or physical 20 disability. 21 10. “Health insurance” means accident and sickness insurance 22 authorized by chapter 509, 514, or 514A. 23 11. a. “Health insurance coverage” means health insurance 24 coverage offered to individuals. 25 b. “Health insurance coverage” does not include any of the 26 following: 27 (1) Coverage for accident-only or disability income 28 insurance. 29 (2) Coverage issued as a supplement to liability insurance. 30 (3) Liability insurance, including general liability 31 insurance and automobile liability insurance. 32 (4) Workers’ compensation or similar insurance. 33 (5) Automobile medical-payment insurance. 34 (6) Credit-only insurance. 35 -12- LSB 5392SV (5) 83 pf:av/rj 12/ 26

S.F. 2356 (7) Coverage for on-site medical clinic care. 1 (8) Other similar insurance coverage, specified in 2 federal regulations, under which benefits for medical care 3 are secondary or incidental to other insurance coverage or 4 benefits. 5 c. “Health insurance coverage” does not include benefits 6 provided under a separate policy as follows: 7 (1) Limited-scope dental or vision benefits. 8 (2) Benefits for long-term care, nursing home care, home 9 health care, or community-based care. 10 (3) Any other similar limited benefits as provided by rule 11 of the commissioner. 12 d. “Health insurance coverage” does not include benefits 13 offered as independent noncoordinated benefits as follows: 14 (1) Coverage only for a specified disease or illness. 15 (2) A hospital indemnity or other fixed indemnity 16 insurance. 17 e. “Health insurance coverage” does not include Medicare 18 supplemental health insurance as defined under section 19 1882(g)(1) of the federal Social Security Act, coverage 20 supplemental to the coverage provided under 10 U.S.C. ch. 55 21 and similar supplemental coverage provided to coverage under 22 group health insurance coverage. 23 12. “Medical assistance program” means the federal-state 24 assistance program established under Tit. XIX of the federal 25 Social Security Act and chapter 249A. 26 13. “Medicare” means the federal government health insurance 27 program established under Tit. XVIII of the federal Social 28 Security Act. 29 14. “Organized delivery system” means an organized delivery 30 system as licensed by the director of public health. 31 Sec. 19. NEW SECTION . 514M.4 Iowa insurance information 32 exchange created —— board of directors. 33 1. An Iowa insurance information exchange is created as 34 a nonprofit corporation under the purview of the insurance 35 -13- LSB 5392SV (5) 83 pf:av/rj 13/ 26

S.F. 2356 division of the department of commerce. 1 a. All carriers and all organized delivery systems licensed 2 by the director of public health providing health insurance or 3 health care services in Iowa, whether on an individual or group 4 basis, and all other insurers designated by the exchange’s 5 board of directors and approved by the commissioner shall be 6 members of the exchange. 7 b. The exchange shall operate under a plan of operation 8 established and approved under section 514M.5 and shall 9 exercise its powers through a board of directors established 10 under this section. 11 2. The board of directors of the exchange shall consist of 12 the following members: 13 a. The following persons who are voting members of the board 14 appointed by the governor and subject to confirmation by the 15 senate: 16 (1) A health care academic with a background in economics, 17 law, or public health. 18 (2) An executive of a carrier. 19 (3) A health benefits manager of a company. 20 (4) A health care analyst representing a public or private 21 employee bargaining unit. 22 (5) A health care analyst representing an organized 23 consumer group. 24 (6) A health care provider. 25 (7) An insurance agent. 26 b. The following persons who are ex officio, nonvoting 27 members of the board: 28 (1) The commissioner of insurance, or a designee. 29 (2) The Iowa Medicaid director, or a designee. 30 (3) Four members of the general assembly, one appointed 31 by the speaker of the house of representatives, one appointed 32 by the minority leader of the house of representatives, 33 one appointed by the majority leader of the senate, and one 34 appointed by the minority leader of the senate. 35 -14- LSB 5392SV (5) 83 pf:av/rj 14/ 26

S.F. 2356 c. Each member of the board appointed by the governor shall 1 be a resident of this state and the composition of voting 2 members of the board shall be in compliance with sections 3 69.16, 69.16A, and 69.16C. 4 d. The voting members of the board shall be appointed for 5 terms of six years beginning and ending as provided in section 6 69.19. A member of the board is eligible for reappointment. 7 The governor shall fill a vacancy for the remainder of the 8 unexpired term. A member of the board may be removed by the 9 governor for misfeasance, malfeasance, or willful neglect of 10 duty or other cause after notice and a public hearing unless 11 the notice and hearing are waived by the member in writing. 12 e. The voting members of the board shall annually elect one 13 of the members as chairperson and one as vice chairperson. 14 f. A majority of the voting members of the board constitutes 15 a quorum. The affirmative vote of a majority of the voting 16 members is necessary for any action taken by the board. 17 The majority shall not include a member who has a conflict 18 of interest and a statement by a member of a conflict of 19 interest is conclusive for this purpose. A vacancy in the 20 voting membership of the board does not impair the right of a 21 quorum to exercise the rights and perform the duties of the 22 board. An action taken by the board under this chapter may be 23 authorized by resolution at a regular or special meeting and 24 each resolution may take effect immediately and need not be 25 published or posted. Meetings of the board shall be held at 26 the call of the chairperson or at the request of a majority of 27 the voting members. 28 g. Members of the board may be reimbursed from the moneys 29 of the exchange for expenses incurred by them as members, but 30 shall not be otherwise compensated by the exchange for their 31 services. 32 h. The voting members of the board shall give bond as 33 required for public officers in chapter 64. 34 i. The members of the board are subject to and are officials 35 -15- LSB 5392SV (5) 83 pf:av/rj 15/ 26

S.F. 2356 within the meaning of chapter 68B. 1 j. All employees of the exchange are exempt from chapter 8A, 2 subchapter IV, and chapter 97B. 3 3. The voting members of the board shall appoint an 4 executive director to supervise the administrative affairs 5 and general management and operations of the exchange. The 6 executive director shall not be a member of the board, 7 shall serve at the pleasure of the board, and shall receive 8 compensation as fixed by the board. The executive director 9 shall keep a record of the proceedings of the board and shall 10 be custodian of all books, documents, and papers filed with 11 the board, the minute book or journal of the board, and the 12 official seal of the board. The executive director may cause 13 copies to be made of minutes and other records and documents of 14 the board and may give certificates under the official seal of 15 the board that the copies are true copies, and persons dealing 16 with the board may rely upon the certificates. 17 4. The exchange shall be considered a governmental body 18 for the purposes of chapter 21 and a government body for the 19 purposes of chapter 22. 20 5. The board may hire independent consultants, as they deem 21 necessary, to assist them in carrying out the provisions of 22 this chapter. 23 Sec. 20. NEW SECTION . 514M.5 Plan of operation —— 24 assessments. 25 1. The board shall submit to the commissioner a plan 26 of operation for the exchange and any amendments necessary 27 or suitable to assure the fair, reasonable, and equitable 28 administration of the exchange within ninety days after the 29 appointment of the board. After notice and hearing, the 30 commissioner shall approve the plan of operation if the plan 31 is determined to be suitable to assure the fair, reasonable, 32 and equitable administration of the exchange, and includes a 33 methodology that may be used to share exchange costs on an 34 equitable and proportionate basis among the member carriers. 35 -16- LSB 5392SV (5) 83 pf:av/rj 16/ 26

S.F. 2356 In addition to other requirements, the plan of operation shall 1 provide for all of the following: 2 a. The handling and accounting of assets and moneys of the 3 exchange. 4 b. The amount and method of reimbursing expenses of the 5 members of the board. 6 c. Regular times and places for meetings of the board. 7 d. Records to be kept of all financial transactions, and the 8 annual fiscal reporting to the commissioner. 9 e. The periodic advertising of the general availability of 10 health coverage information and assistance from the exchange. 11 f. Additional provisions necessary or proper for the 12 execution of the powers and duties of the exchange. 13 2. The exchange has the general powers and authority 14 enumerated by this section and pursuant to section 514M.6 and 15 executed in accordance with the plan of operation approved by 16 the commissioner under subsection 1. 17 3. Following the close of each calendar year, the exchange 18 shall determine the net payments received, the expenses of 19 administration, and the incurred costs of the exchange for 20 the year. The exchange shall certify the amount of any net 21 costs for the preceding calendar year to the commissioner 22 and director of revenue. The net costs may be assessed by 23 the exchange to all members of the exchange in proportion to 24 their respective shares of total health insurance premiums 25 or payments for subscriber contracts received in Iowa during 26 the second preceding calendar year, coinciding with or ending 27 during the calendar year or on any other equitable basis as 28 provided in the plan of operation. In sharing costs, the 29 exchange may abate or defer in any part the assessment of 30 a member, if, in the opinion of the board, payment of the 31 assessment would endanger the ability of the member to fulfill 32 its contractual obligations. The exchange may also provide 33 for an initial or interim assessment against members of the 34 exchange if necessary to assure the financial capability of the 35 -17- LSB 5392SV (5) 83 pf:av/rj 17/ 26

S.F. 2356 exchange to meet the incurred or estimated operating costs of 1 the exchange until the next calendar year is completed. Net 2 gains of the exchange, if any, shall be held by the exchange at 3 interest to offset future costs. 4 a. For purposes of this subsection, “total health insurance 5 premiums” and “payments for subscriber contracts” include, 6 without limitation, premiums or other amounts paid to or 7 received by a member for individual and group health plan 8 coverage provided under any chapter of the Code or Iowa Acts, 9 and “paid losses” includes, without limitation, claims paid by 10 a member operating on a self-funded basis for individual and 11 group health plan coverage provided under any chapter of the 12 Code or Iowa Acts. 13 b. For purposes of calculating and conducting the assessment 14 under this subsection, the exchange shall have the express 15 authority to require members to report on an annual basis each 16 member’s total health insurance premiums and payments for 17 subscriber contracts and paid losses. 18 4. The exchange shall collaborate with the commissioner 19 of insurance to assure the general accuracy of the financial 20 data submitted to the exchange, and the exchange shall have 21 an annual audit of its operations, made by an independent 22 certified public accountant. 23 5. The exchange is subject to examination by the 24 commissioner. Not later than April 30 of each year, the board 25 shall submit to the commissioner a financial report for the 26 preceding calendar year in a form approved by the commissioner. 27 6. The exchange is subject to oversight by the legislative 28 fiscal committee of the legislative council. Not later than 29 April 30 of each year, the board shall submit to the governor, 30 the speaker of the house of representatives, the majority 31 leader of the senate, and the legislative fiscal committee a 32 financial report for the preceding year in a form approved by 33 the legislative fiscal committee. 34 7. The exchange is exempt from payment of all fees and 35 -18- LSB 5392SV (5) 83 pf:av/rj 18/ 26

S.F. 2356 all taxes levied by this state or any of its political 1 subdivisions. 2 8. The exchange shall develop and implement a plan of 3 operation and corresponding timeline detailing action steps 4 toward implementing this chapter, by rules adopted pursuant to 5 chapter 17A as provided in section 514M.7. 6 Sec. 21. NEW SECTION . 514M.6 Powers and duties of exchange. 7 1. The exchange shall develop a system that provides 8 a portal where uninsured Iowans can receive assistance in 9 obtaining public or private health care coverage. In doing 10 so the exchange shall contract with the department of human 11 services to determine the eligibility of uninsured Iowans for 12 public programs and to provide assistance with enrollment in 13 the appropriate public programs. The exchange shall provide 14 assistance with obtaining private health insurance coverage 15 that meets certain standards of quality and affordability 16 to uninsured Iowans who are not eligible for or do not wish 17 to enroll in public programs. The exchange shall develop 18 a seamless system that allows individuals to move between 19 public and private health care coverage, including increasing 20 opportunities for obtaining creditable coverage. 21 2. The exchange shall establish three categories of 22 benefits including basic or catastrophic benefits, an 23 intermediate level of benefits, and comprehensive benefits 24 coverage, that meet affordability limits established pursuant 25 to 2009 Iowa Acts ch. 118, section 1, subsection 4, paragraph 26 “c” . 27 3. a. The exchange shall establish an information 28 clearinghouse to provide information to all Iowans about all 29 public and private health care coverage that is available in 30 the state including comparisons of benefits, premiums, and 31 out-of-pocket costs. 32 b. The exchange may establish standards to provide uniform 33 and consistent information about the health care coverage 34 options offered by each carrier and public program that 35 -19- LSB 5392SV (5) 83 pf:av/rj 19/ 26

S.F. 2356 includes but is not limited to what benefits are covered 1 and not covered, the amount of coverage for each service, 2 including copays and deductibles, and any prior authorization 3 requirements for coverage. 4 c. The exchange may require each carrier, organized delivery 5 system, and public program to categorize and describe which of 6 the three levels of benefits each health care coverage option 7 offered by a carrier, organized delivery system, or public 8 program provides as set forth in subsection 2. 9 d. The exchange shall provide ongoing information to 10 taxpayers about the costs of public health care programs to the 11 state, including the percentage and source of state and federal 12 funding for the programs. 13 e. The exchange may provide counseling to assist Iowans with 14 making an informed choice when selecting health care coverage. 15 4. The exchange shall encourage or develop the use of common 16 definitions for quality of care and pricing of health care 17 services and develop and implement methodologies that provide 18 quality and cost data on health care services and health care 19 coverage offered in the state that is meaningful to consumers, 20 patients, and purchasers. 21 5. The exchange shall collaborate with, including but not 22 limited to the department of human services, the department of 23 public health, the commissioner, health care providers, members 24 of an organized consumer-purchaser group, members of the Iowa 25 collaborative safety net provider network, and carriers to 26 carry out the duties of the exchange including dissemination 27 of information about the services offered by the exchange to 28 the public. 29 Sec. 22. NEW SECTION . 514M.7 Rules. 30 The board shall adopt rules pursuant to chapter 17A to 31 implement the provisions of this chapter. 32 Sec. 23. NEW SECTION . 514M.8 Iowa insurance information 33 exchange fund created. 34 1. An Iowa insurance information exchange fund is created in 35 -20- LSB 5392SV (5) 83 pf:av/rj 20/ 26