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