Senate File 38 - Introduced
SENATE FILE
BY RAGAN, WARNSTADT, BEALL,
WILHELM, OLIVE, SCHOENJAHN,
HECKROTH, STEWART, and
DOTZLER
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to transfer procedures for and compensation of
2 health care providers not participating in IowaCare.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 1776XS 83
5 pf/nh/14
PAG LIN
1 1 Section 1. NEW SECTION. 249J.24A NONPARTICIPATING
1 2 PROVIDER EXPANSION POPULATION PROVIDER NETWORK == TRANSFER
1 3 PROCEDURE == COMPENSATION FUND.
1 4 1. The department shall establish a procedure to transfer
1 5 an expansion population member who seeks medical care or
1 6 treatment for a covered service from a nonparticipating
1 7 provider in the expansion population provider network to a
1 8 participating provider in the expansion population provider
1 9 network, if medically possible. If transfer is not medically
1 10 possible or if the participating provider refuses to accept
1 11 the transfer of the expansion population member, the
1 12 nonparticipating provider shall be compensated for the covered
1 13 service provided through the nonparticipating provider
1 14 expansion population provider network compensation fund in
1 15 accordance with subsection 2.
1 16 2. a. A nonparticipating provider expansion population
1 17 provider network compensation fund is created in the state
1 18 treasury under the authority of the department. Moneys
1 19 designated for deposit in the fund that are received from
1 20 sources including but not limited to appropriations from the
1 21 general fund of the state, grants, and contributions shall be
1 22 deposited in the fund.
1 23 b. Moneys in the fund shall be separate from the general
1 24 fund of the state and shall not be considered part of the
1 25 general fund of the state. The moneys deposited in the fund
1 26 are not subject to section 8.33 and shall not be transferred,
1 27 used, obligated, appropriated, or otherwise encumbered, except
1 28 to provide for the purposes specified in this section.
1 29 Notwithstanding section 12C.7, subsection 2, interest or
1 30 earnings on moneys deposited in the fund shall be credited to
1 31 the fund.
1 32 c. Moneys deposited in the fund shall be used only to
1 33 compensate nonparticipating providers in the expansion
1 34 population provider network pursuant to section 249J.7, who
1 35 provide covered services to expansion population members, if
2 1 no other third party is liable for reimbursement for the
2 2 services provided.
2 3 d. In order to be compensated through the fund, a health
2 4 care provider shall submit a claim to the department for
2 5 compensation and reimbursement of expenses incurred in
2 6 providing covered services to an expansion population member.
2 7 The department shall adopt rules relating to the format of and
2 8 the information to be included in the claims submitted. A
2 9 claim shall be submitted to the department within forty=five
2 10 days of provision of the covered service.
2 11 e. The department shall attempt to maximize receipt of
2 12 federal matching funds under the medical assistance program
2 13 for covered services provided under this section.
2 14 3. For the purposes of this section, "nonparticipating
2 15 provider" means a hospital licensed pursuant to chapter 135B
2 16 that is not a member of the expansion population provider
2 17 network as specified in section 249J.7.
2 18 EXPLANATION
2 19 This bill directs the department of human services to
2 20 establish a procedure to transfer an IowaCare member who seeks
2 21 medical care or treatment for a covered service from a
2 22 provider who is not participating in the IowaCare provider
2 23 network to an IowaCare provider, if medically possible. If
2 24 transfer is not medically possible or if the participating
2 25 provider refuses to accept the transfer of the expansion
2 26 population member, the nonparticipating provider shall be
2 27 compensated through the fund established for such compensation
2 28 under the bill.
2 29 The bill creates a fund to be used to compensate health
2 30 care providers who are not included in the IowaCare provider
2 31 network and who provide covered services to expansion
2 32 population members that are not reimbursable by any other
2 33 third party. Moneys to be deposited in the fund are moneys
2 34 received from sources including but not limited to
2 35 appropriations from the general fund of the state, grants, and
3 1 contributions.
3 2 The bill requires that in order to be compensated through
3 3 the fund, a health care provider must submit claims to the
3 4 department of human services. The bill directs the department
3 5 to adopt rules relating to the format of and the information
3 6 to be included in the claims submitted. A claim shall be
3 7 submitted to the department within 45 days of provision of the
3 8 service. The bill directs the department to attempt to
3 9 maximize receipt of federal matching funds under the medical
3 10 assistance program for covered services provided under the
3 11 bill. The bill also defines "nonparticipating provider" for
3 12 the purposes of the bill.
3 13 LSB 1776XS 83
3 14 pf/nh/14