Senate File 480 - Introduced SENATE FILE 480 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 117) A BILL FOR An Act relating to health care and policy, and health care 1 infrastructure and integration of public and private 2 programs, and related matters, and including effective date 3 provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 2122SV (6) 84 pf/rj

S.F. 480 DIVISION I 1 HEALTH CARE INFRASTRUCTURE —— 2 CERTIFICATE OF NEED 3 Section 1. Section 135.61, subsection 17, Code 2011, is 4 amended by striking the subsection. 5 Sec. 2. Section 135.61, subsection 21, Code 2011, is amended 6 to read as follows: 7 21. “Outpatient surgical facility” means a medical facility 8 which as its primary function provides, through an organized 9 medical staff and on an outpatient basis to patients who are 10 generally ambulatory, that provides surgical procedures not 11 ordinarily performed in a private physician’s office, but 12 not requiring twenty-four hour hospitalization, and which is 13 neither a part of a hospital nor the private office of a health 14 care provider who there engages in the lawful practice of 15 surgery in at least one dedicated, fully equipped operating 16 room, which has the capacity to permit administration of 17 general anesthesia, to patients who are admitted to and 18 discharged from the facility within the same day, that meets 19 staffing and equipment requirements necessary to ensure patient 20 safety and quality care . “Outpatient surgical facility” 21 includes a facility certified or seeking certification as an 22 ambulatory surgical center , under the federal Medicare program 23 or under the medical assistance program established pursuant to 24 chapter 249A . 25 Sec. 3. Section 135.63, subsection 1, Code 2011, is amended 26 to read as follows: 27 1. A new institutional health service or changed 28 institutional health service shall not be offered or developed 29 in this state without prior application to the department 30 for and receipt of a certificate of need, pursuant to this 31 division . The application shall be made upon forms furnished 32 or prescribed by the department and shall contain such 33 information as the department may require under this division . 34 The application shall be accompanied by a fee equivalent to 35 -1- LSB 2122SV (6) 84 pf/rj 1/ 20

S.F. 480 three-tenths of one percent of the anticipated cost of the 1 project with a minimum fee of six hundred dollars and a maximum 2 fee of twenty-one thousand dollars. The fee shall be remitted 3 retained by the department to the treasurer of state, who shall 4 place it in the general fund of the state for administration 5 and fulfillment of the duties set out in this division VI of 6 this chapter. Revenues retained by the department under this 7 section shall be considered repayment receipts as defined in 8 section 8.2. Notwithstanding section 8.33, moneys retained 9 by the department pursuant to this section are not subject to 10 reversion to the general fund of the state. If an application 11 is voluntarily withdrawn within thirty calendar days after 12 submission, seventy-five percent of the application fee shall 13 be refunded; if the application is voluntarily withdrawn more 14 than thirty but within sixty days after submission, fifty 15 percent of the application fee shall be refunded; if the 16 application is withdrawn voluntarily more than sixty days 17 after submission, twenty-five percent of the application fee 18 shall be refunded. Notwithstanding the required payment of an 19 application fee under this subsection , an applicant for a new 20 institutional health service or a changed institutional health 21 service offered or developed by an intermediate care facility 22 for persons with mental retardation or an intermediate care 23 facility for persons with mental illness as defined pursuant to 24 section 135C.1 is exempt from payment of the application fee. 25 Sec. 4. Section 135.63, subsection 2, paragraph l, Code 26 2011, is amended by striking the paragraph and inserting in 27 lieu thereof the following: 28 l. The repair, remodeling, or renovation of any 29 institutional health facility necessary to meet federal or 30 state compliance if the repair, remodeling, or renovation does 31 not add new health services or additional bed capacity for 32 existing health services, notwithstanding any provision of this 33 division to the contrary. 34 Sec. 5. Section 135.63, subsection 2, paragraphs n and o, 35 -2- LSB 2122SV (6) 84 pf/rj 2/ 20

S.F. 480 Code 2011, are amended to read as follows: 1 n. Hospice services provided by a hospital , notwithstanding 2 any provision in this division to the contrary. 3 o. The change in ownership , licensure, or organizational 4 structure , or designation of the type of institutional health 5 facility if the health services offered by the successor 6 institutional health facility are unchanged. This exclusion is 7 applicable only if the institutional health facility consents 8 to the change in ownership , licensure, or organizational 9 structure , or designation of the type of institutional health 10 facility and ceases offering the health services simultaneously 11 with the initiation of the offering of health services by the 12 successor institutional health facility. 13 DIVISION II 14 OFFICE OF HEALTH POLICY 15 Sec. 6. Section 135.163, Code 2011, is amended to read as 16 follows: 17 135.163 Health and long-term care access Office of health 18 policy . 19 1. The An office of health policy is created in the 20 department shall coordinate to integrate public and private 21 efforts to develop in formulating and implementing a state 22 health policy agenda. The department shall coordinate the 23 efforts of appropriate divisions within the department to 24 support the work of the office. The state health policy agenda 25 shall accomplish all of the following: 26 a. Develop and maintain an appropriate health care delivery 27 infrastructure and a stable, well-qualified, diverse, and 28 sustainable health care workforce in this state. The health 29 care delivery infrastructure and the health care workforce 30 shall address the broad spectrum of health care needs of Iowans 31 throughout their lifespan including long-term care needs. 32 b. Establish a methodology and process to achieve cultural 33 transformation that emphasizes health and wellness by removing 34 barriers across the spectrum of personal, professional, and 35 -3- LSB 2122SV (6) 84 pf/rj 3/ 20

S.F. 480 community constructs to empower individual behavioral and 1 systemic change. 2 c. Provide for the collection, analysis, and use of cost 3 and quality data to inform decisions by individual consumers, 4 businesses, and policymakers in determining the most effective 5 and efficient use of resources in arriving at economically 6 sustainable health care outcomes. 7 2. The office shall be staffed by a coordinator who is 8 a health economist. The coordinator may utilize existing 9 councils and workgroups as necessary and shall establish 10 a technical advisory council to assist in the development 11 of policy priorities and the strategic plan described in 12 subsection 3. The technical advisory council shall include 13 but is not limited to representatives of the university of 14 Iowa college of public health and the university of Iowa 15 public policy center, health planners, health care consumers, 16 health care purchasers, state and local agencies that regulate 17 entities involved in health care, health care providers, and 18 health care facilities. 19 3. The department office of health policy shall, at a 20 minimum, do all of the following: 21 1. a. Develop a strategic plan for health care delivery 22 infrastructure and health care workforce resources in this 23 state in accordance with section 135.164 . The office shall 24 act as an ongoing resource to the health facilities council in 25 evaluating and updating the certificate of need program. 26 2. b. Provide for the continuous collection of data to 27 provide a basis for health care strategic planning and health 28 care policymaking decision making by individual consumers, 29 businesses, and policymakers . 30 3. Make recommendations regarding the health care delivery 31 infrastructure and the health care workforce that assist 32 in monitoring current needs, predicting future trends, and 33 informing policymaking. 34 c. Develop and implement a blueprint to make Iowa one of the 35 -4- LSB 2122SV (6) 84 pf/rj 4/ 20

S.F. 480 healthiest states by the year 2014. 1 Sec. 7. Section 135.164, Code 2011, is amended to read as 2 follows: 3 135.164 Strategic plan. 4 1. Development of a strategic plan. The office 5 shall develop a strategic plan for health care delivery 6 infrastructure and health care workforce resources . The 7 strategic plan shall describe the existing health care system, 8 describe and provide a rationale for the desired health 9 care system, provide an action plan for implementation of 10 changes necessary to achieve the desired health care system , 11 and provide methods to evaluate the system. The plan shall 12 incorporate expenditure control methods and integrate criteria 13 for evidence-based health care. The department office shall 14 do all of the following in developing the strategic plan for 15 health care delivery infrastructure and health care workforce 16 resources : 17 a. Conduct strategic health planning activities related to 18 preparation of the strategic plan. 19 b. Develop a computerized system for accessing, analyzing, 20 and disseminating data relevant to strategic health planning. 21 The department office may enter into data sharing agreements 22 and contractual arrangements necessary to obtain or disseminate 23 relevant data. 24 c. Conduct research and analysis or arrange for research 25 and analysis projects to be conducted by public or private 26 organizations to further the development of the strategic plan. 27 d. Establish a technical advisory committee to assist in 28 the development of the strategic plan. The members of the 29 committee may include but are not limited to health economists, 30 representatives of the university of Iowa college of public 31 health, health planners, representatives of health care 32 purchasers, representatives of state and local agencies that 33 regulate entities involved in health care, representatives 34 of health care providers and health care facilities, and 35 -5- LSB 2122SV (6) 84 pf/rj 5/ 20

S.F. 480 consumers. 1 2. Guiding principles. The strategic plan shall include 2 statewide health planning policies and goals related to the 3 availability of health care facilities and services, the 4 availability of appropriate health care workforce resources, 5 health and wellness promotion, the quality of care, and the 6 cost of care. The policies and goals shall be based on the 7 following principles: 8 a. That a strategic health planning process, responsive to 9 changing health and social needs and conditions, is essential 10 to the health, safety, and welfare of Iowans. The process 11 shall be reviewed and updated as necessary to ensure that the 12 strategic plan addresses all of the following: 13 (1) Promoting and maintaining the health of all Iowans. 14 (2) Providing accessible health care services through the 15 maintenance of an adequate appropriate and sustainable supply 16 of health facilities and an adequate a competent workforce 17 reserve . 18 (3) Controlling excessive increases in costs. 19 (4) Applying specific quality criteria and population 20 health indicators. 21 (5) Recognizing prevention and wellness as priorities in 22 health care programs to improve quality and reduce costs and 23 promoting prevention and wellness across all sectors to improve 24 individual well-being and health outcomes, while reducing human 25 and financial costs . 26 (6) Addressing periodic priority issues including disaster 27 planning, public health threats, and public safety dilemmas. 28 (7) Coordinating health care delivery and resource 29 development efforts among state agencies including those tasked 30 with facility, services, and professional provider licensure; 31 state and federal reimbursement; health service utilization 32 data systems; and others. 33 (8) Recognizing long-term care as an integral component of 34 the health care delivery infrastructure and as an essential 35 -6- LSB 2122SV (6) 84 pf/rj 6/ 20

S.F. 480 service provided by the health care workforce. 1 b. That both consumers and providers throughout the state 2 must be involved in the health planning process, outcomes of 3 which shall be clearly articulated and available for public 4 review and use. 5 c. That the supply of a health care service has a 6 substantial impact on utilization of the service, independent 7 of the effectiveness, medical necessity, or appropriateness of 8 the particular health care service for a particular individual. 9 d. That given that health care resources are not unlimited, 10 the impact of any new health care service or facility on 11 overall health expenditures in this state must be considered. 12 e. That excess capacity of health care services and 13 facilities places an increased economic burden on the public. 14 f. That the likelihood that a requested new health care 15 facility, service, or equipment will improve health care 16 quality and outcomes must be considered. 17 g. That development and ongoing maintenance of current and 18 accurate health care information and statistics related to cost 19 and quality of health care and projections of the need for 20 health care facilities and services are necessary to developing 21 an effective health care planning strategy. 22 h. That the certificate of need program as a component 23 of the health care planning regulatory process must balance 24 considerations of access to quality care at a reasonable 25 cost for all Iowans, optimal use of existing health care 26 resources, fostering of expenditure control, and elimination of 27 unnecessary duplication of health care facilities and services, 28 while supporting improved health care outcomes. 29 i. That strategic health care planning must be concerned 30 with the stability of the health care system, encompassing 31 health care financing, quality, and the availability of 32 information and services for all residents. 33 3. Components of the strategic plan. The health care 34 delivery infrastructure and health care workforce resources 35 -7- LSB 2122SV (6) 84 pf/rj 7/ 20

S.F. 480 strategic plan developed by the department office shall include 1 all of the following: 2 a. Assessment and objectives. A health care system 3 assessment and objectives component that does all of the 4 following: 5 (1) Describes state and regional population demographics, 6 health status indicators, and trends in health status and 7 health care needs. 8 (2) Identifies key policy objectives for the state health 9 care system related to access to care, health care outcomes, 10 quality, and cost-effectiveness. 11 b. Certificate of need determinations. A health care 12 facilities and services plan that assesses the demand for 13 health care facilities and services to inform state health care 14 planning efforts and direct certificate of need determinations 15 for those facilities and services subject to certificate of 16 need. The plan shall include all of the following: 17 (1) An inventory of each geographic region’s existing 18 health care facilities and services. 19 (2) Projections of the need for each category of health care 20 facility and service, including those subject to certificate 21 of need. 22 (3) Policies to guide the addition of new or expanded health 23 care facilities and services to promote the use of quality, 24 evidence-based, cost-effective health care delivery options, 25 including any recommendations for criteria, standards, and 26 methods relevant to the certificate of need review process. 27 (4) An assessment of the availability of health 28 care providers, public health resources, transportation 29 infrastructure, and other considerations necessary to support 30 the needed health care facilities and services in each region . 31 (5) An analysis of and recommended revisions to division VI 32 of this chapter to direct certificate of need determinations in 33 a manner that reflects the statewide health planning policies 34 and goals specified in subsection 2. The analysis shall 35 -8- LSB 2122SV (6) 84 pf/rj 8/ 20

S.F. 480 specifically address inclusions in and exclusions from the 1 certificate of need process and whether the exclusions comport 2 with the policies and goals specified in subsection 2. 3 c. Data resources. A health care data resources plan that 4 identifies data elements necessary to properly conduct planning 5 activities and to review certificate of need applications, 6 including data related to inpatient and outpatient utilization 7 and outcomes information, and financial and utilization 8 information related to charity care, quality, and cost. The 9 plan shall provide all of the following: 10 (1) An inventory of existing data resources, both public 11 and private, that store and disclose information relevant 12 to the health care planning process, including information 13 necessary to conduct certificate of need activities. The plan 14 shall identify any deficiencies in the inventory of existing 15 data resources and the data necessary to conduct comprehensive 16 health care planning activities. The plan may recommend that 17 the department office be authorized to access existing data 18 sources and conduct appropriate analyses of such data or 19 that other agencies expand their data collection activities 20 as statutory authority permits. The plan may identify any 21 computing information technology infrastructure deficiencies 22 that impede the proper storage, transmission, and analysis of 23 health care planning data. 24 (2) Recommendations for increasing the availability of data 25 related to health care planning to provide greater community 26 involvement in the health care planning process and consistency 27 in data used for certificate of need applications and 28 determinations. The plan shall also integrate the requirements 29 for annual reports by hospitals and health care facilities 30 pursuant to section 135.75 , the provisions relating to analyses 31 and studies by the department pursuant to section 135.76 , 32 the data compilation provisions of section 135.78 , and the 33 provisions for contracts for assistance with analyses, studies, 34 and data pursuant to section 135.83 . 35 -9- LSB 2122SV (6) 84 pf/rj 9/ 20

S.F. 480 d. e. Evaluation of trends. An assessment of emerging 1 trends in health care delivery and technology as they relate to 2 access to health care facilities and services, quality of care, 3 and costs of care. The assessment shall recommend any changes 4 to the scope of health care facilities and services covered by 5 the certificate of need program that may be warranted by these 6 emerging trends. In addition, the assessment may recommend 7 any changes to criteria used by the department to review 8 certificate of need applications, as necessary. 9 e. f. Rural health care resources plan. A rural health care 10 resources plan to assess the availability of health resources 11 in rural areas of the state, assess the unmet needs of these 12 communities, and evaluate how federal and state reimbursement 13 policies can be modified, if necessary, to more efficiently and 14 effectively meet the health care needs of rural communities. 15 The plan shall consider the unique health care needs of rural 16 communities, the adequacy of the rural health care workforce, 17 and transportation needs for accessing appropriate care. 18 f. g. Workforce resources plan. A health care workforce 19 resources plan to assure a competent, diverse, and sustainable 20 health care workforce in Iowa and to improve access to health 21 care in underserved areas and among underserved populations. 22 The plan shall include the establishment of an advisory council 23 to inform and advise the department and policymakers regarding 24 issues relevant to the health care workforce in Iowa. The 25 health care workforce resources plan shall recognize long-term 26 care as an essential service provided by the health care 27 workforce. 28 h. Blueprint for a healthy Iowa. A blueprint for a 29 healthy Iowa to provide a methodology and process for cultural 30 transformation that emphasizes health and wellness by removing 31 barriers across the spectrum of personal, professional, and 32 community constructs to empower individual behavioral and 33 systemic change. The blueprint shall provide for coordination 34 of existing public and private health and wellness initiatives 35 -10- LSB 2122SV (6) 84 pf/rj 10/ 20

S.F. 480 and shall include recommendations for replication of health and 1 wellness initiatives for which evidence-based success has been 2 demonstrated. 3 i. Long-term living plan. A long-term living plan that 4 reflects the intent specified in section 231F.1 in a manner 5 that most effectively and efficiently meets the needs of 6 Iowa’s population. The plan may include recommendations 7 for modification of requirements for certificate of need 8 determinations, health care workforce requirements, and funding 9 to promote the specified intent. 10 4. The department shall submit the initial statewide health 11 care delivery infrastructure and resources strategic plan to 12 the governor and the general assembly by January 1, 2010, and 13 shall submit an updated strategic plan to the governor and the 14 general assembly every two years thereafter. 15 4. The office shall develop a timeline for completion and 16 submission of the various components of the strategic plan to 17 the governor and the general assembly and shall submit the 18 proposed timeline to the governor and the general assembly by 19 October 1, 2011. The component relating to certificate of 20 need determinations shall be completed and submitted to the 21 governor and the general assembly by October 1, 2011. The 22 office may contract with public or private entities to provide 23 impartial, evidence-based research and analysis in developing 24 this component of the strategic plan. 25 Sec. 8. EFFECTIVE UPON ENACTMENT. This division of this 26 Act, being deemed of immediate importance, takes effect upon 27 enactment. 28 DIVISION III 29 MEDICATION THERAPY MANAGEMENT 30 Sec. 9. NEW SECTION . 135P.1 Medication therapy management. 31 1. As used in this chapter, unless the context otherwise 32 requires: 33 a. “Eligible employee” means an employee of the state 34 including an employee of the state board of regents or 35 -11- LSB 2122SV (6) 84 pf/rj 11/ 20

S.F. 480 institutions under the state board of regents for whom group 1 health plans are established pursuant to chapter 509A providing 2 for third-party payment or prepayment for health or medical 3 expenses, and employees of a governmental subdivision for whom 4 the governmental subdivision provides for third-party payment 5 or prepayment for health or medical expenses. 6 b. “Medication therapy management” means a systematic 7 process performed by a licensed pharmacist, designed to 8 optimize therapeutic outcomes through improved medication use 9 and reduced risk of adverse drug events, including all of the 10 following services: 11 (1) A medication therapy review and in-person consultation 12 relating to all medications, vitamins, and herbal supplements 13 currently being taken by an eligible individual. 14 (2) A medication action plan, subject to the limitations 15 specified in this section, communicated to the individual and 16 the individual’s primary care physician or other appropriate 17 prescriber to address safety issues, inconsistencies, 18 duplicative therapy, omissions, and medication costs. The 19 medication action plan may include recommendations to the 20 prescriber for changes in drug therapy. 21 (3) Documentation and follow-up to ensure consistent levels 22 of pharmacy services and positive outcomes. 23 2. a. The department of administrative services shall, and 24 the state board of regents and governmental subdivisions at 25 the election of the state board of regents or the governmental 26 subdivision respectively may, utilize a request for proposals 27 process to contract for the provision of medication therapy 28 management services for eligible employees who meet any of the 29 following criteria: 30 (1) An individual who takes four or more prescription drugs 31 to treat or prevent two or more chronic medical conditions. 32 (2) An individual with a prescription drug therapy problem 33 who is identified by the prescribing physician or other 34 appropriate prescriber, and referred to a pharmacist for 35 -12- LSB 2122SV (6) 84 pf/rj 12/ 20

S.F. 480 medication therapy management services. 1 (3) An individual who meets other criteria established by 2 the third-party payment provider contract, policy, or plan. 3 b. For any contract for medication therapy management 4 services for eligible employees of the state under the purview 5 of the department of administrative services all of the 6 following shall apply: 7 (1) The department shall utilize an advisory committee 8 comprised of an equal number of physicians and pharmacists to 9 provide advice and oversight regarding the contract and the 10 evaluation processes. The department shall appoint the members 11 of the advisory committee from designees of the Iowa pharmacy 12 association, the Iowa medical society, and the Iowa osteopathic 13 medical association. 14 (2) The contract shall require the contractor to provide 15 annual reports to the general assembly detailing the costs, 16 savings, estimated cost avoidance and return on investment, and 17 patient outcomes related to the medication therapy management 18 services provided. The contractor shall guarantee demonstrated 19 annual savings, including any savings associated with cost 20 avoidance at least equal to the contract’s costs with any 21 shortfall amount refunded to the state. The department and the 22 contractor shall agree on the terms, conditions, and applicable 23 measurement standards associated with the demonstration of 24 savings. The department shall verify that the demonstrated 25 savings reported by the contractor were attained in accordance 26 with the agreed upon measurement standards. The contractor 27 shall be prohibited from using the contractor’s employees to 28 provide the medication therapy management services and shall 29 instead be required to contract with licensed pharmacies, 30 pharmacists, or physicians. 31 c. The fees for pharmacist-delivered medication therapy 32 management services shall be separate from the reimbursement 33 for prescription drug product or dispensing services; shall 34 be determined by each third-party payment provider contract, 35 -13- LSB 2122SV (6) 84 pf/rj 13/ 20

S.F. 480 policy, or plan; and must be reasonable based on the resources 1 and time required to provide the service. 2 d. A fee shall be established for physician reimbursement 3 for services delivered for medication therapy management as 4 determined by each third-party payment provider contract, 5 policy, or plan, and must be reasonable based on the resources 6 and time required to provide the service. 7 e. If any part of the medication therapy management 8 plan developed by a pharmacist incorporates services which 9 are outside the pharmacist’s independent scope of practice 10 including the initiation of therapy, modification of dosages, 11 therapeutic interchange, or changes in drug therapy, the 12 express authorization of the individual’s physician or other 13 appropriate prescriber is required. 14 Sec. 10. APPLICATION. The department of administrative 15 services shall continue to contract for the provision of 16 medication therapy management services under the initial 17 contract entered into pursuant to 2010 Iowa Acts, chapter 1193, 18 section 166. Upon completion of the initial contract term, 19 the department shall utilize a request for proposals process 20 to subsequently contract for medication therapy management 21 services pursuant to section 135P.1 as enacted in this Act. 22 Sec. 11. EFFECTIVE UPON ENACTMENT. This division of this 23 Act, being deemed of immediate importance, takes effect upon 24 enactment. 25 DIVISION IV 26 DIRECTIVES FOR INTEGRATION OF PUBLIC AND PRIVATE PROGRAMS 27 Sec. 12. PLAN FOR SEAMLESS PUBLIC AND PRIVATE PROGRAM 28 INTEGRATION IN IOWA HEALTH BENEFIT EXCHANGE. The department 29 of human services, division of insurance of the department of 30 commerce, department of public health, department of revenue, 31 department of workforce development, and other appropriate 32 agencies, shall develop a plan to meet the requirements of the 33 federal Patient Protection and Affordable Care Act, Pub. L. 34 No. 111-148, relating to a health benefit exchange. The plan 35 -14- LSB 2122SV (6) 84 pf/rj 14/ 20

S.F. 480 shall address issues relating to eligibility determinations 1 for Medicaid, hawk-i, and tax credit subsidies; information 2 technology and process reengineering; necessary policy, 3 statutory, and regulatory changes; financing; and tools 4 and strategies necessary for implementation. The plan 5 shall provide for integration and seamless operation of the 6 eligibility system, which shall be housed within the department 7 of human services, with the Iowa health benefit exchange, if 8 created. The departments shall submit a joint plan to the 9 joint appropriations subcommittee on health and human services 10 by October 15, 2011. 11 Sec. 13. BENCHMARK PLAN DEVELOPMENT —— ANALYSIS OF 12 INCLUSION OF BEHAVIORAL HEALTH BENEFITS. The department of 13 human services shall analyze how the inclusion of behavioral 14 health benefits in a benchmark plan developed under the 15 federal Patient Protection and Affordable Care Act, Pub. L. No. 16 111-148, would impact the delivery and financing of behavioral 17 health services in the state. The department shall report its 18 findings to the joint appropriations subcommittee on health and 19 human services no later than sixty days following the receipt 20 of federal directives or regulations regarding requirements for 21 benchmark plans. 22 Sec. 14. FEDERAL FUNDING OPPORTUNITIES. The department 23 of human services, department of public health, division of 24 insurance of the department of commerce, and other affected 25 state agencies shall pursue all federal funding opportunities 26 under the federal Patient Protection and Affordable Care Act, 27 Pub. L. No. 111-148, including but not limited to funding 28 relating to implementation funding for the health benefit 29 exchange and eligibility system planning and implementation. 30 The departments shall coordinate efforts to the maximum extent 31 possible and shall report their activities on a monthly basis 32 to the joint appropriations subcommittee on health and human 33 services. 34 Sec. 15. ALL-PAYER CLAIMS DATABASE PLAN. The department of 35 -15- LSB 2122SV (6) 84 pf/rj 15/ 20

S.F. 480 human services shall develop a plan to establish an all-payer 1 claims database to provide for the collection and analysis of 2 claims data from multiple payers of health care. The plan 3 shall establish the goals of the database which may include 4 but are not limited to determining health care utilization 5 patterns and rates; identifying gaps in prevention and health 6 promotion services; evaluating access to care; assisting with 7 benefit design and planning; analyzing statewide and local 8 health care expenditures by provider, employer, and geography; 9 informing the development of payment systems for providers; and 10 establishing clinical guidelines related to quality, safety, 11 and continuity of care. The plan shall identify a standard 12 means of data collection, statutory changes necessary to the 13 collection and use of the data, and the types of claims for 14 which collection of data is required which may include but are 15 not limited to eligibility data; provider information; medical 16 data; private and public medical, pharmacy, and dental claims 17 data; and other appropriate data. The plan shall also include 18 an implementation and maintenance schedule including a proposed 19 budget and funding plan and vision for the future. 20 Sec. 16. PROVIDER PAYMENT SYSTEM PLAN —— PILOT PROJECT. 21 1. The department of human services shall develop a provider 22 payment system plan to provide recommendations to reform the 23 health care provider payment system as an effective way to 24 promote coordination of care, lower costs, and improve quality. 25 The plan shall provide analysis and recommendations regarding 26 but not limited to accountable care organizations, a global 27 payment system, or an episode of care payment system. 28 2. a. If an entity applies for certification from the 29 secretary of the United States department of health and 30 human services prior to January 1, 2012, and is subsequently 31 certified to administer an accountable care organization 32 pilot project, pursuant to the federal Patient Protection and 33 Accountability Act, Pub. L. No. 111-148, the department of 34 human services shall work with the entity to provide access to 35 -16- LSB 2122SV (6) 84 pf/rj 16/ 20

S.F. 480 the complete deidentified claims data of the medical assistance 1 recipients receiving health care services through the pilot 2 project for the purposes of identifying areas of utilization, 3 need, and potential cost savings to the medical assistance 4 program. The department shall also employ new payment models, 5 information technology, and data analytics provisions necessary 6 to the administration of the pilot project. 7 b. The department of human services shall work with 8 an entity to administer an accountable care organization 9 pilot project, only if the entity meets all of the following 10 requirements: 11 (1) At a minimum, includes the participation of a 12 prospective payment system hospital, ten primary care 13 physicians, a home health care practice, a palliative care 14 services, a hospice service, and a community mental health 15 center, all of which agree to be paid under a partial or global 16 payment for identified services. 17 (2) Requires all participating providers to utilize 18 electronic health records. 19 (3) Includes delivery of mental health services to 20 recipients of medical assistance through collaboration with the 21 regional community mental health center, a federally qualified 22 health center, and at least one nursing facility. 23 c. The entity certified to implement the pilot project shall 24 report to the joint appropriations subcommittee for health and 25 human services during the 2012 legislative session detailing 26 the progress and expected outcomes of the pilot project. 27 Sec. 17. EFFECTIVE UPON ENACTMENT. This division of this 28 Act, being deemed of immediate importance, takes effect upon 29 enactment. 30 EXPLANATION 31 This bill relates to health care and health policy. 32 Division I of the bill relates to certificate of need 33 determinations. The bill amends certificate of need 34 exclusions relating to institutional health facilities, 35 -17- LSB 2122SV (6) 84 pf/rj 17/ 20

S.F. 480 including outpatient surgical facilities, hospitals, and 1 nursing facilities. The bill also provides for retention of 2 certificate of need fees by the department for administration 3 of the program. 4 Division II of the bill relates to the office of health 5 policy. Current law directs DPH to coordinate public and 6 private efforts to develop and maintain an appropriate health 7 care infrastructure and workforce, to develop a strategic plan 8 to address various components of the health care infrastructure 9 and workforce, and to utilize a technical advisory committee 10 to assist in the development of the strategic plan. Under 11 the bill, the office of health policy is created in DPH to 12 fulfill the duties of the department in integrating public and 13 private efforts in formulating and implementing a state health 14 policy agenda that addresses the health care infrastructure 15 and workforce, cultural transformation to emphasize health and 16 wellness across all sectors, and the collection, analysis, 17 and use of cost and quality data. The bill provides that the 18 coordinator of the office is to be a health economist and 19 directs the office to establish a technical advisory council 20 to assist the office in development of policy priorities and 21 the strategic plan. 22 The bill specifies the duties of the office relating to 23 development of a strategic plan, collection of data, and 24 development of a blueprint to make Iowa one of the healthiest 25 states by the year 2014. 26 The bill specifies the components of the strategic plan 27 including the addressing of a health care system assessment and 28 objectives; certificate of need determinations; data resources; 29 evaluation of trends; rural health care resources; workforce 30 resources; a blueprint for a healthy Iowa; and long-term 31 living. 32 The bill directs the office of health policy to develop a 33 timeline for completion and submission of the components of 34 the strategic plan to the governor and the general assembly. 35 -18- LSB 2122SV (6) 84 pf/rj 18/ 20

S.F. 480 The bill directs the office to complete and submit the 1 components relating to certificate of need determinations to 2 the governor and the general assembly by October 1, 2011. The 3 bill authorizes the office to contract with public or private 4 entities to provide impartial, evidence-based research and 5 analysis in developing this component of the strategic plan. 6 Division II takes effect upon enactment. 7 Division III of the bill relates to medication therapy 8 management. The bill codifies the pilot program for medication 9 therapy management implemented on July 1, 2010, for eligible 10 state employees and authorizes employees of the state board 11 of regents or institutions under the state board of regents 12 and employees of governmental subdivisions at the election 13 of the governmental subdivision to participate in medication 14 therapy management through a request for proposals process if 15 so determined by the authorizing entity. Division III takes 16 effect upon enactment. 17 Division IV of the bill provides directives to state 18 departments relative to provisions in the federal Patient 19 Protection and Affordability Act. 20 Division IV directs the department of human services, 21 division of insurance, department of public health, 22 department of revenue, department of workforce development, 23 and other appropriate agencies, to develop a plan to meet 24 the requirements of the federal Act relating to a health 25 benefit exchange. The plan is to address issues relating to 26 eligibility determinations for Medicaid, hawk-i, and tax credit 27 subsidies; information technology and process reengineering; 28 necessary policy, statutory, and regulatory changes; financing; 29 and tools and strategies necessary for implementation. The 30 plan is to provide for integration and seamless operation 31 of the eligibility system, which shall be housed within the 32 department of human services, with the Iowa health benefit 33 exchange, if created. The plan is to be submitted by October 34 15, 2011. 35 -19- LSB 2122SV (6) 84 pf/rj 19/ 20