House File 2002 - Introduced HOUSE FILE 2002 BY FORBES , STAED , HUNTER , BENNETT , PRICHARD , KACENA , KEARNS , BROWN-POWERS , ABDUL-SAMAD , WINCKLER , KURTH , GASKILL , STECKMAN , RUNNING-MARQUARDT , T. TAYLOR , ISENHART , MASCHER , ANDERSON , and HEDDENS A BILL FOR An Act relating to health care coverage including the 1 establishment of a healthy Iowans for a public option and 2 the administration of the Medicaid program, and including 3 effective date provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5017YH (5) 87 pf/rj

H.F. 2002 DIVISION I 1 LEGISLATIVE INTENT 2 Section 1. LEGISLATIVE INTENT. The Medicaid program has 3 been utilized and expanded in a bipartisan manner since its 4 inception to provide a health care safety net to seniors in 5 nursing facilities, to people with disabilities living in 6 the community, to pregnant women and children, and to poor 7 and working class families. The federal Patient Protection 8 and Affordable Care Act provided many opportunities for 9 improvement in health care and health care coverage, including 10 an opportunity for further expansion of the Medicaid program 11 to additional populations. It is the intent of the general 12 assembly to establish a public health care coverage safety net 13 by utilizing a Medicaid program buy-in option to counteract the 14 effects of inadequate private competition and make affordable 15 health care coverage accessible to those Iowans without 16 individual health care coverage. 17 DIVISION II 18 HEALTHY IOWANS FOR A PUBLIC OPTION —— ESTABLISHMENT 19 Sec. 2. HEALTHY IOWANS FOR A PUBLIC OPTION. 20 1. The department of human services shall apply to the 21 secretary of the United States department of health and human 22 services for any necessary waiver pursuant to 42 U.S.C. §1315 23 or 42 U.S.C. §18052, to do all of the following: 24 a. Allow the department of human services to establish and 25 administer the healthy Iowans for a public option to provide 26 coverage to individuals who are eligible for and enroll in the 27 healthy Iowans for a public option established in this section. 28 The department may make coverage through the healthy Iowans 29 for a public option available for purchase through the Iowa 30 state-federal partnership marketplace created pursuant to the 31 federal Patient Protection and Affordable Care Act as defined 32 in section 249N.2. 33 b. Allow an individual who is determined eligible for 34 advanced premium tax credits and cost-sharing reductions 35 -1- LSB 5017YH (5) 87 pf/rj 1/ 5

H.F. 2002 pursuant to 45 C.F.R. §155.305 to use such credits and 1 reductions to purchase coverage through the healthy Iowans for 2 a public option. 3 2. If the secretary of the United States department 4 of health and human services grants the necessary waivers 5 requested under this section, the department of human services 6 shall do all of the following: 7 a. Establish the healthy Iowans for a public option 8 to provide coverage for individuals who are not otherwise 9 eligible for the Medicaid program and who do not have access to 10 affordable employer-sponsored health care coverage. Coverage 11 under the healthy Iowans for a public option shall provide the 12 same benefits as those specified for Iowa health and wellness 13 plan members under section 249N.5. 14 b. Administer the healthy Iowans for a public option through 15 the Iowa Medicaid enterprise. The duties of the Iowa Medicaid 16 enterprise may include determining member eligibility for the 17 program using policies and procedures adopted by rule of the 18 department pursuant to chapter 17A; maintaining eligibility 19 files with pertinent eligibility determination and ongoing 20 enrollment information; providing periodic reports to the 21 department for administrative oversight and monitoring of 22 compliance with federal requirements; and maintaining data for 23 the purpose of quality assurance reports as required by rule 24 of the department. 25 3. If the secretary of the United States department 26 of health and human services grants the necessary waivers 27 requested under this section, the department of human services 28 may make the healthy Iowans for a public option available on 29 the Iowa state-federal partnership marketplace created pursuant 30 to the federal Patient Protection and Affordable Care Act as 31 defined in section 249N.2. 32 4. The department of human services shall adopt rules 33 pursuant to chapter 17A as necessary to administer this 34 section. 35 -2- LSB 5017YH (5) 87 pf/rj 2/ 5

H.F. 2002 DIVISION III 1 TERMINATION OF MEDICAID MANAGED CARE CONTRACTS 2 Sec. 3. TERMINATION OF MEDICAID MANAGED CARE CONTRACTS —— 3 TRANSITION TO ADMINISTRATION BY IOWA MEDICAID ENTERPRISE —— 4 EFFECTIVE DATE. The department of human services shall, upon 5 the effective date of this division of this Act, terminate 6 the contracts executed with managed care organizations to 7 administer the Iowa high quality health care initiative 8 as established by the department, in accordance with the 9 termination provisions of the contracts. The termination 10 shall include a transition period to ensure that health care 11 delivery and coverage for affected Medicaid members is not 12 disrupted. The department of human services shall seek any 13 Medicaid state plan and waiver amendments necessary to complete 14 the transition and, upon completion of the transition, shall 15 instead administer the Medicaid program under alternative 16 value-based payment methodologies to promote quality and 17 efficiency, investment in patient-centered, integrated, primary 18 and preventive care, improved health care outcomes, innovation 19 and integration in the organization and delivery of health 20 care, and health care cost containment and minimization of 21 administrative costs. 22 Sec. 4. EFFECTIVE UPON ENACTMENT. This division of this 23 Act, being deemed of immediate importance, takes effect upon 24 enactment. 25 EXPLANATION 26 The inclusion of this explanation does not constitute agreement with 27 the explanation’s substance by the members of the general assembly. 28 This bill relates to the provision of health insurance 29 coverage in the state. 30 Division I of the bill provides legislative intent to 31 establish a public health care coverage safety net by utilizing 32 a Medicaid program buy-in option to counteract the effects of 33 inadequate private competition and make affordable health care 34 coverage accessible to those Iowans without individual health 35 -3- LSB 5017YH (5) 87 pf/rj 3/ 5

H.F. 2002 care coverage. 1 Division II of the bill provides for the establishment of 2 healthy Iowans for a public option. The bill directs the 3 department of human services (DHS) to apply to the secretary 4 of the United States department of health and human services 5 for any necessary federal waivers relative to the Medicaid 6 program and the federal Patient Protection and Affordable Care 7 Act (ACA) to allow DHS to establish and administer the healthy 8 Iowans for a public option to provide coverage to individuals 9 who are eligible for and enroll in the healthy Iowans for 10 a public option established in the bill, and to allow an 11 individual who is determined eligible for advanced premium tax 12 credits and cost-sharing reductions under the ACA to use such 13 credits and reductions to purchase coverage through the healthy 14 Iowans for a public option. 15 The bill provides that if the necessary waivers are granted 16 by the secretary of the United States department of health 17 and human services, DHS shall establish and administer the 18 healthy Iowans for a public option through the Iowa Medicaid 19 enterprise. The department may make coverage through the 20 healthy Iowans for a public option available for purchase 21 through the Iowa state-federal partnership marketplace created 22 pursuant to the ACA. Coverage under the healthy Iowans for a 23 public option includes the same benefits as those specified for 24 Iowa health and wellness plan members under Code chapter 249N. 25 The bill directs DHS to adopt rules pursuant to Code chapter 26 17A as necessary to administer the bill. 27 Division III of the bill requires DHS, upon the effective 28 date of Division III of the bill, to terminate the contracts 29 executed with managed care organizations to administer the 30 Iowa high quality health care initiative as established by 31 DHS, in accordance with the termination provisions of the 32 contracts. The termination shall include a transition period 33 to ensure that health care delivery and coverage for affected 34 Medicaid members is not disrupted. DHS is directed to seek 35 -4- LSB 5017YH (5) 87 pf/rj 4/ 5

H.F. 2002 any Medicaid state plan and waiver amendments necessary to 1 complete the transition and, upon completion of the transition, 2 to instead administer the Medicaid program under alternative 3 payment methodologies to promote quality and efficiency, 4 patient-centered, integrated, primary and preventive care, and 5 innovation and integration in the organization and delivery of 6 health care. 7 Division III of the bill takes effect upon enactment. 8 -5- LSB 5017YH (5) 87 pf/rj 5/ 5