House File 2142 - Introduced HOUSE FILE 2142 BY STECKMAN , HEDDENS , WINCKLER , McCONKEY , KURTH , BENNETT , JACOBY , GASKILL , WOLFE , LENSING , GAINES , HUNTER , KACENA , BRECKENRIDGE , NIELSEN , STAED , MASCHER , KEARNS , OURTH , T. TAYLOR , FORBES , PRICHARD , OLDSON , KRESSIG , ISENHART , COHOON , BEARINGER , and M. SMITH A BILL FOR An Act relating to the provision of integrated health homes 1 for individuals with serious and persistent mental illness 2 under Medicaid managed care, and including effective date 3 provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5379YH (2) 87 pf/rh

H.F. 2142 Section 1. MEDICAID MANAGED CARE —— INTEGRATED HEALTH 1 HOMES FOR PERSONS WITH SERIOUS AND PERSISTENT MENTAL ILLNESS 2 (SPMI INTEGRATED HEALTH HOMES). The department of human 3 services shall adopt rules pursuant to chapter 17A and shall 4 amend existing Medicaid managed care contracts to ensure that 5 SPMI integrated health homes with a Medicaid managed care 6 organization acting as the lead entity, are administered in 7 a manner that reflects the criteria established for SPMI 8 integrated health homes and that meets the specifications of 9 the Medicaid state plan amendment (SPA), IA-16-013, including 10 but not limited to: 11 1. The target population served by an SPMI integrated health 12 home shall include Medicaid members with serious mental illness 13 (SMI) or serious emotional disturbance (SED) as defined in the 14 SPA. 15 2. Medicaid member participation in an SPMI integrated 16 health home shall be voluntary and the state shall provide 17 assurances that members will be provided a free choice of 18 health home providers. 19 3. An SPMI integrated health home shall be accredited 20 as a community mental health center; a mental health service 21 provider; a residential, licensed group care setting; or a 22 psychiatric medical institution for children (PMIC); or shall 23 meet national accreditation standards that apply to mental 24 health rehabilitative services. An SPMI integrated health home 25 shall also demonstrate the provision of community-based mental 26 health services to the target population. 27 4. An SPMI integrated health home shall consist of a 28 team-based model that provides a single point of whole-person, 29 patient-centered, comprehensive, accessible, coordinated care 30 across the spectrum of medical, behavioral, and social service 31 needs, conditions, and aspects of a member’s life, and shall 32 provide for transitions of care the member may experience. 33 An SPMI integrated health home team of professionals 34 shall include, at a minimum, a nurse care manager, a care 35 -1- LSB 5379YH (2) 87 pf/rh 1/ 3

H.F. 2142 coordinator, and either a peer support specialist or a family 1 support specialist, depending upon the population served. The 2 SPMI integrated health home care coordinator, as an integral 3 component of the team, shall be embedded within the construct 4 of such team, and shall not be provided through external, 5 supplementary sources, to ensure that a member maintains the 6 member’s best possible health by accessing and utilizing 7 services and supports at home and in community settings where 8 the member lives, works, and socializes. 9 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 10 importance, takes effect upon enactment. 11 EXPLANATION 12 The inclusion of this explanation does not constitute agreement with 13 the explanation’s substance by the members of the general assembly. 14 This bill directs the department of human services (DHS) to 15 adopt rules pursuant to Code chapter 17A and amend existing 16 Medicaid managed care contracts to ensure that integrated 17 health homes for individuals with serious and persistent mental 18 illness (SPMI integrated health homes) which have a Medicaid 19 managed care organization acting as the lead entity, are 20 provided in a manner that reflects the criteria established 21 for SPMI integrated health homes by DHS and that meet the 22 specifications of the Medicaid state plan amendment. The bill 23 specifies that these criteria and specifications include: 24 the target population served includes Medicaid members with 25 serious mental illness (SMI) or serious emotional disturbance 26 (SED); Medicaid member participation is voluntary and the 27 state provides assurances that members will be provided a free 28 choice of health home providers; an SPMI integrated health 29 home is accredited as a certain type of provider or meets 30 certain national accreditation standards, and demonstrates 31 the provision of community-based mental health services 32 to the target population; the SPMI integrated health home 33 is a team-based model consisting of, at a minimum, a nurse 34 care manager, a care coordinator, and either a peer support 35 -2- LSB 5379YH (2) 87 pf/rh 2/ 3

H.F. 2142 specialist or a family support specialist, depending upon the 1 population served; and the SPMI integrated health home care 2 coordinator, as an integral component of the team, shall be 3 embedded within the construct of such team, and shall not be 4 provided through external, supplementary sources, to ensure 5 that a member maintains the member’s best possible health by 6 accessing and utilizing services and supports at home and 7 in community settings where the member lives, works, and 8 socializes. 9 The bill takes effect upon enactment. 10 -3- LSB 5379YH (2) 87 pf/rh 3/ 3