S.F. _____ H.F. _____ Section 1. Section 8A.504, subsection 1, paragraph c, 1 subparagraph (1), Code 2011, is amended to read as follows: 2 (1) Any debt, which is assigned to the department of human 3 services, or which is owed to the department of human services 4 for unpaid premiums under section 249A.3, subsection 2, 5 paragraph “a” , subparagraph (1), or section 249J.8, subsection 6 1, or which the child support recovery unit is otherwise 7 attempting to collect, or which the foster care recovery unit 8 of the department of human services is attempting to collect 9 on behalf of a child receiving foster care provided by the 10 department of human services. 11 Sec. 2. Section 217.34, Code 2011, is amended to read as 12 follows: 13 217.34 Debt setoff. 14 The investigations division of the department of inspections 15 and appeals and the department of human services shall provide 16 assistance to set off against a person’s or provider’s income 17 tax refund or rebate any debt which has accrued through written 18 contract, nonpayment of premiums pursuant to section 249A.3, 19 subsection 2, paragraph “a” , subparagraph (1), or section 20 249J.8, subsection 1, subrogation, departmental recoupment 21 procedures, or court judgment and which is in the form of a 22 liquidated sum due and owing the department of human services. 23 The department of inspections and appeals, with approval of the 24 department of human services, shall adopt rules under chapter 25 17A necessary to assist the department of administrative 26 services in the implementation of the setoff under section 27 8A.504 in regard to money owed to the state for public 28 assistance overpayments or nonpayment of premiums as specified 29 in this section . The department of human services shall adopt 30 rules under chapter 17A necessary to assist the department of 31 administrative services in the implementation of the setoff 32 under section 8A.504 , in regard to collections by the child 33 support recovery unit and the foster care recovery unit. 34 Sec. 3. Section 249A.3, subsection 2, paragraph a, 35 -1- LSB 1238DP (11) 84 pf/nh 1/ 5

S.F. _____ H.F. _____ subparagraph (1), Code 2011, is amended to read as follows: 1 (1) (a) As allowed under 42 U.S.C. 2 § 1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, 3 who are less than sixty-five years of age, who are members of 4 families whose income is less than two hundred fifty percent of 5 the most recently revised official poverty guidelines published 6 by the United States department of health and human services 7 for the family, who have earned income and who are eligible for 8 medical assistance or additional medical assistance under this 9 section if earnings are disregarded. As allowed by 42 U.S.C. 10 § 1396a(r)(2), unearned income shall also be disregarded in 11 determining whether an individual is eligible for assistance 12 under this subparagraph. For the purposes of determining the 13 amount of an individual’s resources under this subparagraph 14 and as allowed by 42 U.S.C. § 1396a(r)(2), a maximum of ten 15 thousand dollars of available resources shall be disregarded, 16 and any additional resources held in a retirement account, in a 17 medical savings account, or in any other account approved under 18 rules adopted by the department shall also be disregarded. 19 (b) Individuals eligible for assistance under this 20 subparagraph, whose individual income exceeds one hundred 21 fifty percent of the official poverty guidelines published 22 by the United States department of health and human services 23 for an individual, shall pay a premium. The amount of the 24 premium shall be based on a sliding fee schedule adopted by 25 rule of the department and shall be based on a percentage of 26 the individual’s income. The maximum premium payable by an 27 individual whose income exceeds one hundred fifty percent of 28 the official poverty guidelines shall be commensurate with 29 the cost of state employees’ group health insurance in this 30 state. The payment to and acceptance by an automated case 31 management system or the department of the premium required 32 under this subparagraph shall not automatically confer initial 33 or continuing program eligibility on an individual. A premium 34 paid to and accepted by the department’s premium payment 35 -2- LSB 1238DP (11) 84 pf/nh 2/ 5

S.F. _____ H.F. _____ process that is subsequently determined to be untimely or to 1 have been paid on behalf of an individual ineligible for the 2 program shall be refunded to the remitter in accordance with 3 rules adopted by the department. Any unpaid premium shall be a 4 debt owed the department. 5 Sec. 4. Section 249J.7, subsection 1, paragraph a, Code 6 2011, is amended to read as follows: 7 a. Expansion population members shall only be eligible 8 to receive expansion population services through a provider 9 included in the expansion population provider network. Except 10 as otherwise provided in this chapter , the expansion population 11 provider network shall be limited to a the following: 12 (1) A publicly owned acute care teaching hospital located in 13 a county with a population over three hundred fifty thousand , 14 the . 15 (2) The university of Iowa hospitals and clinics , and a . 16 (3) A regional provider network utilizing the federally 17 qualified health centers or federally qualified health center 18 look-alikes in the state, to provide primary care to members 19 as designated by the department in the phase-in plan utilizing 20 criteria specified in paragraph “b” . 21 Sec. 5. Section 249J.8, subsection 1, Code 2011, is amended 22 to read as follows: 23 1. a. Each The total monthly premium and other cost-sharing 24 for an expansion population member whose family income exceeds 25 one hundred fifty percent of the federal poverty level as 26 defined by the most recently revised poverty income guidelines 27 published by the United States department of health and human 28 services shall pay a monthly premium not to exceed one-twelfth 29 of five percent of the member’s annual family income regardless 30 of the number of expansion population members in the household. 31 The department shall adopt rules to establish a premium 32 schedule in accordance with this subsection that is calculated 33 based on a member’s family income for each ten percent 34 increment of the federal poverty level . 35 -3- LSB 1238DP (11) 84 pf/nh 3/ 5

S.F. _____ H.F. _____ b. Each An expansion population member whose family income 1 is equal to or less than one hundred fifty percent of the 2 federal poverty level as defined by the most recently revised 3 poverty income guidelines published by the United States 4 department of health and human services shall not be subject to 5 payment of a monthly premium. 6 c. All premiums shall be paid on by the last day of the 7 month of coverage. 8 d. The department shall deduct the amount of any monthly 9 premiums paid by an expansion population member for benefits 10 under the healthy and well kids in Iowa program when computing 11 the amount of monthly premiums owed under this subsection . 12 e. An expansion population member shall respond to the 13 monthly premium notices either through timely payment or a 14 request for a hardship exemption during the entire period of 15 the member’s enrollment. 16 f. Regardless of the length of enrollment, the member 17 is subject to payment of the premium for a minimum of four 18 consecutive months. However, an expansion population member 19 who complies with the requirement of payment of the premium 20 for a minimum of four consecutive months during a consecutive 21 twelve-month period of enrollment shall be deemed to have 22 complied with this requirement for the subsequent consecutive 23 twelve-month period of enrollment and shall only be subject to 24 payment of the monthly premium on a month-by-month basis. 25 g. Timely payment of premiums , including any arrearages 26 accrued from prior enrollment, is a condition of receiving any 27 expansion population services. An expansion population member 28 who does not provide timely payment within sixty days of the 29 date the premium is due is subject to disenrollment. 30 h. Any unpaid premiums are a debt owed to the department. 31 i. The payment to and acceptance by an automated case 32 management system or the department of the premium required 33 under this subsection shall not automatically confer initial or 34 continuing program eligibility on an individual. 35 -4- LSB 1238DP (11) 84 pf/nh 4/ 5

S.F. _____ H.F. _____ j. A premium paid to and accepted by the department’s 1 premium payment process that is subsequently determined to 2 be untimely or to have been paid on behalf of an individual 3 ineligible for the program shall be refunded to the remitter in 4 accordance with rules adopted by the department. 5 k. Premiums collected under this subsection shall be 6 deposited in the premiums subaccount of the account for health 7 care transformation created pursuant to section 249J.23 . 8 l. An expansion population member shall also pay the same 9 copayments required of other adult recipients of medical 10 assistance. 11 EXPLANATION 12 This bill relates to medical assistance program-related 13 provisions. The bill provides that unpaid premiums under the 14 Medicaid for employed people with disabilities (MEPD) program 15 and the IowaCare program are considered “qualifying debts” 16 subject to debt setoff procedures. 17 The bill amends provisions describing the provider network 18 for the IowaCare program to reflect inclusion of a regional 19 provider network. 20 The bill amends provisions relating to financial 21 participation of IowaCare members to comply with federal 22 requirements for renewal of the IowaCare waiver. Under the 23 bill, IowaCare members with household incomes at or below 24 150 percent of the federal poverty level (FPL) would not be 25 assessed a monthly premium. Those with incomes greater than 26 150 percent of the FPL, regardless of the number of IowaCare 27 members in the household, would be assessed a monthly premium 28 not to exceed one-twelfth of 5 percent of the household’s 29 monthly income in accordance with federal requirements. The 30 bill also provides that a member is subject to disenrollment if 31 premiums are not paid within 60 days of the date the premiums 32 are due. 33 -5- LSB 1238DP (11) 84 pf/nh 5/ 5