HOUSE FILE 82

BY  DE BOEF, LOFGREN, CHAMBERS, HUSEMAN, IVERSON, FORRISTALL, RAYHONS, DRAKE, GARRETT, WORTHAN, PAUSTIAN, FRY, SANDS, DOLECHECK, BALTIMORE, SWEENEY, HAGER, SHAW, PEARSON, ALONS, MASSIE, and HELLAND

A BILL FOR

An Act concerning rules relating to copayments and other information regarding services provided to medical assistance recipients.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

   Section 1.  ADMINISTRATIVE RULES——COPAYMENTS FOR CERTAIN SERVICES PROVIDED UNDER THE MEDICAL ASSISTANCE PROGRAM.  The department of human services shall adopt or amend rules under the medical assistance program to provide for all of the following:
   1.  A copayment charge shall not be applicable for a recipient of care as an inpatient at a hospital, nursing facility, state mental health institute, or other medical institution if the person is required, as a condition of receiving services in the hospital, facility, or institution, to spend for costs of necessary medical care all but a minimal amount of income for personal needs.
   2.  A copayment charge of five dollars shall be applicable for all covered services rendered in a hospital emergency room if the medical condition does not result in an inpatient admission to the hospital at the time of the emergency room visit or at a subsequent time.
   3.  The eligibility card of any recipient of medical assistance twenty-one years of age or older shall include a statement regarding the copayment charge for office visits and emergency room visits.
   4.  Any Medipass program card shall include a statement informing the recipient that the recipient must see the doctor whose name is printed on the card or receive a referral from such doctor in order to receive coverage for nonemergent medical services.
EXPLANATION
   This bill directs the department of human services to adopt or amend rules for the medical assistance program to provide for all of the following:
   1. That a copayment charge shall not be applicable for a recipient of care as an inpatient at a hospital, nursing facility, state mental health institute, or other medical institution if the person is required, as a condition of receiving services in the hospital, facility, or institution, to spend for costs of necessary medical care all but a minimal amount of income for personal needs. Current rules provide that a copayment does not apply to such care in such facilities, but does not specify that the copayment is only not applicable to care provided to an individual as an inpatient.
   2. A copayment charge of $5 for all covered services rendered in a hospital emergency room if the medical condition does not result in an inpatient admission to the hospital at the time of the emergency room visit or at a subsequent time. Current rules provide that copayment charges are not applicable for emergency services.
   3. The eligibility card of any recipient of medical assistance 21 years of age or older is to include a statement of the copayment charge for office visits and emergency room visits.
   4. A Medipass program card is to include a statement informing the recipient that the recipient must see the doctor whose name is printed on the card or receive a referral from such doctor in order to receive coverage for nonemergent medical services.