House
File
2352
-
Introduced
HOUSE
FILE
2352
BY
HUNTER
and
ANDERSON
A
BILL
FOR
An
Act
establishing
the
healthy
Iowa
program
and
including
1
effective
date
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
135E.1
Findings
and
intent
of
the
1
general
assembly.
2
1.
The
general
assembly
finds
that
all
residents
of
the
3
state
have
the
right
to
health
care.
4
2.
It
is
the
intent
of
the
general
assembly:
5
a.
To
provide
comprehensive
universal
single-payer
health
6
care
coverage
and
a
health
care
cost
control
system
for
the
7
benefit
of
all
residents
of
Iowa.
8
b.
To
establish
the
healthy
Iowa
program
to
provide
9
comprehensive,
universal
health
coverage
for
every
Iowa
10
resident
funded
by
broad-based
sources
of
revenue.
11
c.
That
the
state
obtain
waivers
and
other
approvals
12
relating
to
the
Medicaid
program,
the
healthy
and
well
kids
13
in
Iowa
program,
Medicare,
the
federal
Patient
Protection
and
14
Affordable
Care
Act,
and
any
other
federally
regulated
programs
15
related
to
the
provision
of
health
care
so
that
any
federal
16
funds
and
other
subsidies
that
would
otherwise
be
available
to
17
the
state,
Iowa
residents,
and
Iowa
health
care
providers,
is
18
instead
paid
by
the
federal
government
to
the
state
of
Iowa
and
19
deposited
in
the
healthy
Iowa
trust
fund.
20
d.
That
the
state
incorporates
health
care
coverage
of
21
Iowa
residents
who
are
employed
in
other
jurisdictions
into
22
the
waivers
and
other
approvals
involving
federally
regulated
23
programs
related
to
the
provision
of
health
care.
24
e.
That
any
funds
obtained
under
waivers
and
other
approvals
25
involving
federally
regulated
programs
related
to
the
provision
26
of
health
care
be
used
for
health
coverage
that
provides
health
27
benefits
equal
to
or
exceeding
the
health
benefits
provided
28
under
those
programs,
as
well
as
other
program
modifications,
29
including
elimination
of
cost
sharing
and
insurance
premiums.
30
f.
That
the
healthy
Iowa
program
replaces
the
Medicaid
31
program,
the
healthy
and
well
kids
in
Iowa
program,
Medicare,
32
coverage
provided
through
the
federal
Patient
Protection
and
33
Affordable
Care
Act,
and
any
other
federally
regulated
programs
34
relating
to
the
provision
of
health
care,
and
that
those
35
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programs
are
merged
into
the
healthy
Iowa
program,
which
will
1
operate
as
a
true
single-payer
program.
2
g.
That,
even
if
all
necessary
waivers
and
approvals
are
not
3
obtained,
the
state
maximize
the
approvals
received
and
pool
4
multiple
sources
of
funding
to
the
greatest
extent
possible,
5
to
make
the
provision
of
health
care
coverage
and
health
care
6
under
the
healthy
Iowa
program
as
seamless
as
possible.
7
h.
To
extend
the
current
benefits
and
current
health
care
8
coverage
provided
under
the
healthy
and
well
kids
in
Iowa
9
program
to
all
Iowa
residents.
10
i.
That
the
healthy
Iowa
program
addresses
the
high
cost
11
of
prescription
drugs
to
ensure
that
prescription
drugs
are
12
affordable
for
patients.
13
j.
That
neither
health
information
technology
nor
clinical
14
practice
guidelines
limit
the
effective
exercise
of
the
15
professional
judgment
of
health
care
providers.
16
k.
That
health
care
providers
be
authorized
to
override
17
health
information
technology
or
clinical
practice
guidelines
18
if
it
is
consistent
with
the
treating
health
care
provider’s
19
determination
of
medical
necessity
and
if,
in
the
professional
20
judgment
of
the
health
care
provider,
it
is
in
the
best
21
interest
of
the
patient
and
consistent
with
the
patient’s
22
wishes.
23
l.
To
develop
a
revenue
plan
for
the
healthy
Iowa
program,
24
in
consultation
with
appropriate
stakeholders,
taking
into
25
consideration
anticipated
federal
revenue
available
for
the
26
program.
27
m.
To
require
that
all
federal
revenue
received
for
the
28
healthy
Iowa
program
be
deposited
in
an
account
within
the
29
healthy
Iowa
trust
fund
to
be
known
as
the
healthy
Iowa
trust
30
fund
account.
31
Sec.
2.
NEW
SECTION
.
135E.2
Definitions.
32
As
used
in
this
chapter,
unless
the
context
otherwise
33
requires:
34
1.
“Affiliation”
means
any
of
the
following:
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a.
A
financial
interest.
1
b.
A
position
of
governance,
including
membership
on
a
board
2
of
directors,
regardless
of
compensation.
3
c.
A
relationship
through
which
compensation
is
received.
4
d.
A
relationship
for
the
provision
of
services
as
a
5
regulated
lobbyist.
6
2.
“Affordable
Care
Act”
means
the
federal
Patient
7
Protection
and
Affordable
Care
Act
(Pub.
L.
No.
111-148),
as
8
amended
by
the
federal
Health
Care
and
Education
Reconciliation
9
Act
of
2010
(Pub.
L.
No.
111-152),
and
any
amendments
to,
or
10
regulations
or
guidance
issued
under,
those
Acts.
11
3.
“Allied
health
practitioner”
means
a
group
of
health
12
professionals
who
apply
their
expertise
to
prevent
disease
13
transmission;
diagnose,
treat,
and
rehabilitate
people
of
all
14
ages
and
in
all
specialties;
and,
with
a
range
of
technical
and
15
support
staff,
deliver
direct
patient
care,
rehabilitation,
16
treatment,
diagnosis,
and
health
improvement
interventions
to
17
restore
and
maintain
optimal
physical,
sensory,
psychological,
18
cognitive,
and
social
functions.
“Allied
health
practitioner”
19
includes
but
is
not
limited
to
audiologists,
physical
20
therapists,
occupational
therapists,
social
workers,
and
21
radiographers.
22
4.
“Board”
means
the
healthy
Iowa
board
which
adopts
rules
23
and
establishes
policy
for
and
directs
the
agency
regarding
the
24
healthy
Iowa
program.
25
5.
“Care
coordination”
means
services
provided
by
a
care
26
coordinator
under
the
healthy
Iowa
program.
27
6.
“Care
coordinator”
means
an
individual
or
entity
approved
28
by
the
healthy
Iowa
board
to
provide
care
coordination.
29
7.
“Carrier”
means
carrier
as
defined
in
section
513B.2.
30
8.
“Director”
means
the
director
of
the
healthy
Iowa
31
program.
32
9.
“Essential
community
provider”
means
a
person
or
entity
33
acting
as
a
safety
net
clinic,
safety
net
health
care
provider,
34
or
rural
hospital.
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10.
“Federally
matched
public
health
program”
means
the
1
Medicaid
program
or
the
healthy
and
well
kids
in
Iowa
program
2
established
in
section
514I.3.
3
11.
“Fund”
means
the
healthy
Iowa
trust
fund.
4
12.
“Health
care
provider”
means
any
of
the
following:
5
a.
A
person
who
is
licensed,
certified,
registered,
or
6
authorized
to
practice
a
health
care
profession
in
the
state
7
pursuant
to
chapter
147A,
148,
148A,
148B,
148C,
148E,
148F,
8
148G,
149,
151,
152,
152A,
152B,
153,
154,
154A,
154B,
154C,
9
154D,
154F,
155,
or
155A,
who
practices
the
profession
in
which
10
they
are
licensed,
certified,
registered,
or
authorized,
and
11
who
provides
a
health
care
service
in
this
state.
12
b.
A
health
care
entity
licensed
under
title
IV
that
employs
13
or
utilizes
the
health
care
services
of
a
person
described
14
in
paragraph
“a”
,
including
but
not
limited
to
a
hospital
15
licensed
pursuant
to
chapter
135B,
a
health
care
facility
16
licensed
pursuant
to
chapter
135C,
a
subacute
mental
health
17
care
facility
licensed
pursuant
to
chapter
135G,
a
psychiatric
18
medical
institution
for
children
licensed
pursuant
to
chapter
19
135H,
a
hospice
program
licensed
pursuant
to
chapter
135J,
an
20
entity
providing
emergency
medical
services
pursuant
to
chapter
21
147A,
and
a
pharmacy
licensed
pursuant
to
chapter
155A.
22
13.
“Health
care
service”
means
any
health
care
service,
23
including
care
coordination
that
is
included
as
a
benefit
under
24
the
healthy
Iowa
program.
25
14.
“Health
maintenance
organization”
means
a
health
26
maintenance
organization
as
defined
in
section
514B.1.
27
15.
“Healthy
Iowa
agency”
means
the
healthy
Iowa
agency
28
created
in
this
chapter
as
an
independent
agency
to
provide
29
comprehensive,
universal
single-payer
health
care
coverage
30
and
a
health
care
cost
control
system
for
the
benefit
of
all
31
residents
of
Iowa,
and
to
implement
the
healthy
Iowa
program.
32
16.
“Healthy
Iowa
program”
means
the
healthy
Iowa
program
33
created
in
this
chapter
to
provide
comprehensive,
universal
34
single-payer
health
care
coverage.
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17.
“Implementation
period”
means
the
period
during
which
1
the
healthy
Iowa
program
is
subject
to
special
eligibility
and
2
financing
provisions
until
the
healthy
Iowa
program
is
fully
3
implemented.
4
18.
“Long-term
care”
means
long-term
care,
treatment,
5
maintenance,
or
services
as
defined
by
the
healthy
Iowa
board.
6
19.
“Medicaid”
means
the
Medicaid
program
established
under
7
chapter
249A.
8
20.
“Medicare”
means
the
program
established
pursuant
to
9
Tit.
XVIII
of
the
federal
Social
Security
Act,
42
U.S.C.
§1395
10
et
seq.
11
21.
“Member”
means
an
individual
who
is
enrolled
in
the
12
healthy
Iowa
program.
13
22.
“Out-of-state
health
care
service”
means
a
health
14
care
service
provided
in
person
under
any
of
the
following
15
circumstances:
16
a.
It
is
medically
necessary
that
the
health
care
service
be
17
provided
while
the
member
is
physically
outside
of
this
state
18
for
a
period
of
time
not
exceed
ninety
days.
19
b.
It
is
clinically
appropriate
and
necessary
that
the
20
health
care
service
is
provided
outside
this
state
because
the
21
health
care
service
can
only
be
provided
by
a
particular
health
22
care
provider
physically
located
outside
of
this
state.
23
23.
“Participating
health
care
provider”
means
an
individual
24
or
entity
that
is
a
health
care
provider
qualified
pursuant
to
25
section
135E.15
that
provides
health
care
services
to
members
26
under
the
healthy
Iowa
program.
27
24.
“Prescription
drugs”
means
a
controlled
substance
28
requiring
a
prescription
as
defined
in
section
124.101,
29
subsection
5.
30
25.
“Resident”
means
an
individual,
without
regard
to
that
31
individual’s
immigration
status,
whose
primary
place
of
abode
32
is
in
this
state
and
who
meets
the
Iowa
residence
requirements
33
adopted
by
the
healthy
Iowa
board.
34
Sec.
3.
NEW
SECTION
.
135E.3
Healthy
Iowa
agency
and
program
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——
created.
1
1.
A
healthy
Iowa
agency
is
created
as
an
independent
2
agency
which
shall
be
responsible
for
the
planning,
3
development,
implementation,
and
regulation
of
the
provision
of
4
comprehensive,
universal
single-payer
health
care
coverage
in
5
this
state
under
the
healthy
Iowa
program
and
of
a
health
care
6
cost
control
system
for
the
benefit
of
all
residents.
7
2.
The
purposes
of
the
healthy
Iowa
agency
include
all
of
8
the
following:
9
a.
To
create
the
healthy
Iowa
program.
10
b.
To
provide
comprehensive,
universal
single-payer
health
11
care
services
for
all
residents.
12
c.
To
provide
a
health
care
cost
control
system
for
the
13
benefit
of
all
residents.
14
d.
To
provide
choice
of
and
access
to
health
care
15
coordinators
and
health
care
providers
for
all
residents.
16
e.
To
provide
broad-based
public
financing
of
health
care
17
services
for
all
residents.
18
f.
To
establish
mechanisms
for
participating
health
care
19
providers
to
collectively
negotiate
with
the
healthy
Iowa
20
program
regarding
any
matter
relating
to
the
administration
21
of
the
healthy
Iowa
program,
including
but
not
limited
to
22
rates
of
payment
for
health
care
services,
rates
of
payment
23
for
prescription
drugs
and
nonprescription
drugs,
and
payment
24
methodologies.
25
g.
To
ensure
transparency
and
accountability
of
the
healthy
26
Iowa
program
to
the
public.
27
h.
To
provide
for
the
collection
of
data
to
promote
28
transparency,
assess
adherence
to
patient
care
standards
29
established
under
this
chapter,
compare
patient
outcomes,
and
30
review
utilization
of
health
care
services
reimbursed
through
31
the
healthy
Iowa
program.
32
3.
This
chapter
and
any
rule
or
policy
adopted
under
this
33
chapter
shall
not
be
construed,
is
not
intended
as,
and
shall
34
not
imply,
a
change
or
impact
in
any
way
on
the
authority
of
any
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of
the
following:
1
a.
The
authority
of
a
licensing
board
or
other
agencies
of
2
this
state
otherwise
has
relative
to
the
provision
of
health
3
care
services
or
health
care
providers
under
law.
4
b.
The
authority
the
healthy
Iowa
program,
the
healthy
Iowa
5
board,
a
licensing
board,
the
department
of
public
health,
or
6
the
department
of
inspections
and
appeals
has
to
establish
or
7
revise
licensure
standards
for
health
care
providers.
8
c.
The
authority
the
healthy
Iowa
program
has
to
carry
out
9
any
function
not
authorized
by
waivers.
10
d.
The
authority
an
employer
has
to
create
an
employment
11
benefit
or
to
require,
prohibit,
or
limit
the
provision
of
any
12
employment
benefit.
13
4.
This
chapter
shall
not
be
construed
to
allow
the
healthy
14
Iowa
program,
other
agencies
of
this
state,
local
agencies,
15
or
public
employees,
acting
under
color
of
law,
to
provide
or
16
disclose
to
anyone,
including
but
not
limited
to
the
federal
17
government,
any
personally
identifiable
information
obtained
18
by
the
healthy
Iowa
program,
including
but
not
limited
to
a
19
person’s
religious
beliefs,
practices,
or
affiliation,
national
20
origin,
ethnicity,
or
immigration
status,
for
law
enforcement
21
or
immigration
purposes.
22
5.
This
chapter
shall
not
be
construed
to
allow
law
23
enforcement
agencies
to
use
healthy
Iowa
program
moneys,
24
facilities,
property,
equipment,
or
personnel
to
investigate,
25
enforce,
or
assist
in
the
investigation
or
enforcement
of
any
26
criminal,
civil,
or
administrative
violation
or
warrant
for
a
27
violation
of
any
requirement
that
individuals
register
with
the
28
federal
government
or
any
federal
agency
based
on
religion,
29
national
origin,
ethnicity,
or
immigration
status.
30
Sec.
4.
NEW
SECTION
.
135E.4
Healthy
Iowa
board
——
created.
31
1.
A
healthy
Iowa
board
is
created
consisting
of
the
32
following
voting
members:
33
a.
Four
public
members
appointed
by
the
governor,
subject
34
to
confirmation
by
the
senate.
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b.
Two
public
members
appointed
by
the
senate
majority
1
leader
subject
to
section
2.32A.
2
c.
Two
public
members
appointed
by
the
speaker
of
the
house
3
of
representatives
subject
to
section
2.32A.
4
2.
The
director
of
human
services
or
the
director’s
designee
5
shall
serve
as
an
ex
officio
member
of
the
board.
6
3.
The
voting
members
shall
serve
four-year
staggered
7
terms.
A
vacancy
shall
be
filled
for
the
unexpired
portion
of
8
the
term
and
in
the
same
manner
as
the
original
appointment.
9
Any
member
may
be
reappointed
for
an
additional
term.
10
4.
Members
of
the
board
shall
not
receive
compensation
as
a
11
member
of
the
board
but
are
entitled
to
receive
reimbursement
12
of
actual
expenses
incurred
in
the
discharge
of
their
duties.
13
Public
members
of
the
board
are
also
eligible
to
receive
14
compensation
as
provided
in
section
7E.6.
15
5.
In
making
appointments
under
this
section,
an
appointing
16
authority
shall
do
all
of
the
following:
17
a.
Assure
that
the
appointee
has
demonstrated
and
18
acknowledged
expertise
in
health
care.
19
b.
Consider
the
expertise
of
the
other
members
of
the
20
board
and
attempt
to
make
appointments
so
that
the
board’s
21
composition
reflects
a
diversity
of
expertise
in
various
22
aspects
of
health
care
services.
23
c.
Consider
the
cultural,
ethnic,
and
geographical
diversity
24
of
this
state
so
that
the
board’s
composition
reflects
the
25
communities
of
this
state.
26
d.
Assure
that
the
board’s
composition
is
comprised
of
all
27
of
the
following:
28
(1)
At
least
one
representative
of
a
labor
organization
29
representing
registered
nurses.
30
(2)
At
least
one
representative
of
the
general
public.
31
(3)
At
least
one
representative
of
a
labor
organization
not
32
representing
registered
nurses.
33
(4)
At
least
one
representative
of
the
health
care
provider
34
community.
35
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6.
The
board
shall
determine
the
time,
location,
and
1
frequency
of
the
board’s
meetings.
Five
members
of
the
board
2
constitute
a
quorum
and
the
affirmative
vote
of
a
majority
of
3
the
voting
members
is
necessary
for
any
substantive
action
to
4
be
taken
by
the
board.
5
7.
The
members
of
the
board
shall
elect
a
chairperson
on
an
6
annual
basis
from
among
the
membership
of
the
board.
7
8.
A
member
of
the
board
may
be
removed
for
incompetence,
8
misconduct,
or
failure
to
perform
the
duties
of
the
position.
9
9.
The
board
shall
approve
all
contracts
entered
into
10
pursuant
to
this
chapter.
All
contracts
entered
into
pursuant
11
to
this
chapter
shall
be
made
available
to
the
public.
12
10.
The
board
may
receive
and
accept
grants,
loans,
or
13
advances
of
moneys
from
any
person
and
may
receive
and
accept
14
from
any
source
contributions
of
moneys,
property,
labor,
or
15
any
other
thing
of
value,
to
be
held,
used,
and
applied
for
the
16
purposes
of
the
healthy
Iowa
program.
17
11.
A
member
of
the
board
shall
do
all
of
the
following:
18
a.
Meet
the
requirements
of
this
chapter
and
all
applicable
19
state
and
federal
laws
and
regulations.
20
b.
Serve
the
public
interest
of
the
individuals,
employers,
21
and
taxpayers
seeking
health
care
coverage
through
the
healthy
22
Iowa
healthy
Iowa
program.
23
c.
Ensure
the
sound
operation
and
fiscal
solvency
of
the
24
healthy
Iowa
program.
25
12.
A
member
of
the
board,
within
the
two-year
period
26
immediately
preceding
the
member’s
appointment,
while
serving
27
on
the
board,
and
for
two
years
immediately
after
the
end
28
of
the
member’s
term,
and
staff
of
the
board,
shall
not
be
29
employed
or
have
been
employed
in
any
capacity
by,
a
consultant
30
to
a
member
of
the
board
of,
have
an
affiliation
with,
receive
31
compensation
from,
or
otherwise
be
a
representative
of
any
of
32
the
following:
33
a.
A
health
care
provider,
unless
the
member
or
staff
34
practices
a
health
care
profession
as
an
employee
of
another
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health
care
provider.
1
b.
A
pharmaceutical
company.
2
c.
A
medical
equipment
company.
3
d.
An
insurance
company.
4
e.
A
carrier,
an
insurance
producer,
a
third-party
5
administrator,
a
managed
care
organization,
or
any
other
person
6
contracting
directly
with
the
healthy
Iowa
program.
7
f.
A
member,
a
board
member,
or
an
employee
of
a
trade
8
association
of
health
care
facilities,
health
clinics,
health
9
care
providers,
carriers,
insurance
producers,
third-party
10
administrators,
managed
care
organizations,
or
any
association
11
of
entities
in
a
position
to
contract
directly
with
the
12
healthy
Iowa
program,
unless
the
member
or
employee
receives
no
13
compensation
for
rendering
services
as
a
health
care
provider
14
and
does
not
have
an
ownership
interest
in
a
health
care
15
practice.
16
13.
A
member
of
the
board
shall
perform
the
member’s
duties
17
in
good
faith,
in
the
manner
the
member
reasonably
believes
18
to
be
in
the
best
interest
of
the
healthy
Iowa
program,
and
19
without
intentional
or
reckless
disregard
of
the
care
an
20
ordinarily
prudent
person
in
a
like
position
would
use
under
21
similar
circumstances.
A
member
of
the
board
who
performs
the
22
member’s
duties
in
accordance
with
the
standards
specified
in
23
this
subsection
shall
not
be
liable
personally
for
actions
24
taken
as
a
member
when
performed
in
good
faith,
without
intent
25
to
defraud,
and
in
connection
with
the
administration
of
this
26
chapter
or
actions
or
conduct
related
to
this
chapter.
27
14.
A
member
of
the
board
shall
be
subject
to
chapter
68B.
28
In
addition
to
the
disclosures
required
pursuant
to
chapter
29
68B,
a
member
of
the
board
shall
disclose
to
the
board
and
30
to
the
public
any
relationship
that
the
member
has
with
a
31
health
care
provider,
pharmaceutical
company,
medical
equipment
32
company,
insurance
company,
carrier,
insurance
producer,
33
third-party
administrator,
managed
care
organization,
or
other
34
entity
in
an
industry
involved
in
matters
likely
to
come
before
35
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the
board.
1
15.
On
all
matters
that
come
before
the
board,
a
member
2
shall
do
all
of
the
following:
3
a.
Adhere
strictly
to
the
conflict
of
interest
provisions
4
of
section
68B.2A.
5
b.
Provide
full
disclosure
to
the
board
and
the
public
on
6
any
matter
that
gives
rise
to
a
potential
conflict
of
interest
7
and
the
manner
in
which
the
member
will
comply
with
public
8
disclosure
required
by
chapter
68B
and
rules
adopted
pursuant
9
to
chapter
68B
to
avoid
any
conflict
of
interest
or
appearance
10
of
a
conflict
of
interest.
11
16.
A
member
of
the
board
shall
not
have
an
interest,
direct
12
or
indirect,
in
a
contract
for
the
purchase
of
goods,
including
13
materials
and
profits,
or
for
the
performance
of
services
for
14
the
healthy
Iowa
program.
A
contract
entered
into
in
violation
15
of
this
section
is
voidable.
16
Sec.
5.
NEW
SECTION
.
135E.5
Director
——
appointment.
17
1.
a.
The
board
shall
appoint
a
director
of
the
healthy
18
Iowa
program.
19
b.
The
director
shall
serve
at
the
pleasure
of
the
board.
20
c.
The
board
shall
determine
the
appropriate
compensation
21
for
the
director.
22
2.
Under
the
direction
of
and
with
the
approval
of
the
23
board,
the
director
shall
administer
this
chapter.
The
24
director
shall
do
all
of
the
following:
25
a.
Act
as
the
chief
administrative
officer
of
the
healthy
26
Iowa
program,
including
the
healthy
Iowa
trust
fund.
27
b.
Direct,
organize,
administer,
and
manage
the
internal
28
operations
of
the
healthy
Iowa
program
and
the
board,
and
29
establish
guidelines
and
procedures
to
promote
the
orderly
and
30
efficient
administration
of
the
healthy
Iowa
agency.
31
c.
Perform
all
duties
necessary
to
comply
with
and
carry
out
32
the
provisions
of
this
chapter,
other
state
law,
and
federal
33
law.
34
d.
Recommend
to
the
board
proposed
rules
necessary
to
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administer
the
healthy
Iowa
program.
1
e.
Prepare
a
budget
for
the
healthy
Iowa
program
and
prepare
2
reports
as
required
by
law.
3
f.
Present
the
healthy
Iowa
agency’s
proposed
budget
to
the
4
board
prior
to
December
31
of
each
year.
5
g.
Appoint
the
administrators
within
the
healthy
Iowa
6
program.
7
h.
Provide
for
the
receipt
and
disbursement
of
federal
8
moneys
allocated
to
the
state
and
its
political
subdivisions
9
for
health
care
services
and
coverage
purposes.
10
i.
Include
in
the
healthy
Iowa
program’s
annual
budget
all
11
estimated
federal
funds
to
be
received
or
allocated
to
the
12
healthy
Iowa
program.
13
j.
Employ,
or
designate
another
to
employ,
personnel
14
as
necessary
to
carry
out
the
duties
and
responsibilities
15
prescribed
under
this
chapter
consistent
with
the
merit
system
16
provisions
of
chapter
8A,
subchapter
IV.
17
k.
As
necessary,
retain
as
independent
contractors
18
attorneys,
financial
consultants,
and
any
other
professionals
19
or
consultants
necessary
to
carry
out
the
planning,
20
development,
and
operations
of
the
healthy
Iowa
program
and
the
21
provisions
of
this
chapter.
22
3.
The
director
or
the
director’s
designee
shall
23
give
preference
in
hiring
under
this
section
to
all
24
individuals
displaced
or
unemployed
as
a
direct
result
of
the
25
implementation
of
the
healthy
Iowa
program.
26
Sec.
6.
NEW
SECTION
.
135E.6
Board
and
director
——
duties
27
——
powers.
28
1.
Subject
to
any
limitations
under
this
chapter
or
other
29
applicable
law,
the
enumeration
of
specific
powers
in
this
30
chapter
is
not
intended
to
restrict
the
board’s
power
to
take
31
any
lawful
action
that
the
board
determines
is
necessary
32
or
convenient
to
carry
out
the
functions
authorized
by
the
33
Affordable
Care
Act
and
consistent
with
the
purposes
of
the
34
healthy
Iowa
program.
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2.
The
board
shall
do
all
of
the
following:
1
a.
Adopt
rules
pursuant
to
chapter
17A
to
implement
and
2
administer
this
chapter.
3
b.
Consult
with
and
solicit
input
from
the
healthy
Iowa
4
advisory
committee
and
any
other
person
as
the
board
determines
5
appropriate.
6
c.
Promote
the
public
understanding
and
awareness
of
7
available
benefits
and
options
through
the
healthy
Iowa
8
program.
9
d.
Avoid
jeopardizing
federal
financial
participation
in
the
10
programs
that
are
incorporated
into
the
healthy
Iowa
program.
11
e.
Ensure
that
there
is
adequate
funding
to
meet
the
health
12
care
service
needs
of
residents
and
to
compensate
health
care
13
providers
that
participate
in
the
healthy
Iowa
program.
14
f.
Evaluate
requests
for
capital
expenses
required
to
meet
15
the
health
care
service
needs
of
residents.
16
g.
Approve
the
benefits
provided
by
the
healthy
Iowa
17
program.
18
h.
Evaluate
the
performance
of
the
healthy
Iowa
program.
19
i.
Evaluate
and
make
recommendations
to
the
general
assembly
20
on
any
legislation
related
to
the
healthy
Iowa
program.
21
j.
Guarantee
that
mechanisms
for
public
feedback
are
22
accessible
and
nondiscriminatory.
23
k.
Develop
a
plan
to
coordinate
the
activities
of
the
24
healthy
Iowa
program
with
the
activities
of
the
department
of
25
public
health’s
bureau
of
health
planning
and
the
department
26
of
human
services’
mental
health
planning
and
advisory
council
27
to
ensure
appropriate
planning
for
the
effective
delivery
and
28
equitable
distribution
of
health
care
services
throughout
the
29
state.
30
l.
Provide
grants
from
moneys
in
the
healthy
Iowa
trust
31
fund
or
moneys
otherwise
appropriated
for
this
purpose
to
the
32
health
planning
programs
established
by
the
bureau
of
health
33
planning
of
the
department
of
public
health
or
the
mental
34
health
planning
and
advisory
council
of
the
department
of
human
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services
to
support
the
operation
of
those
health
planning
1
programs.
2
m.
Allocate
moneys
from
the
healthy
Iowa
trust
fund
3
or
moneys
otherwise
appropriated
for
this
purpose
to
the
4
department
of
human
services
or
the
department
of
education
5
workforce
training
and
economic
development
fund
to
be
used
for
6
all
of
the
following
purposes:
7
(1)
A
program
for
retraining
and
assisting
job
transition
8
for
individuals
employed
or
previously
employed
in
the
fields
9
of
health
insurance,
health
care
service
plans,
and
other
10
third-party
payments
for
health
care
services.
11
(2)
A
program
for
retraining
and
assisting
job
transition
12
for
those
individuals
employed
or
previously
employed
in
13
fields
providing
services
to
health
care
providers
to
address
14
the
needs
of
third-party
payers
for
health
care
services,
15
whose
jobs
may
be
or
have
been
ended
as
a
result
of
the
16
implementation
of
the
healthy
Iowa
program.
17
n.
Organize,
administer,
and
market
the
healthy
Iowa
program
18
and
program
services
as
a
single-payer
program
under
the
name
19
“Healthy
Iowa”
or
any
other
name
as
the
board
determines.
20
o.
Sue,
be
sued,
plead,
and
be
impleaded.
21
p.
Apply
for,
accept,
and
expend
federal,
state,
or
private
22
moneys
or
contracts
for
the
implementation
of
the
healthy
Iowa
23
program
or
other
state
or
federal
health
care
programs
for
24
residents.
25
q.
Maintain
an
office
at
a
place
designated
by
the
board.
26
r.
Create
subcommittees
from
among
its
members.
27
s.
Establish
divisions
and
subdivisions
within
the
healthy
28
Iowa
program.
29
t.
Make
agreements
with
a
grantor
or
payor
of
moneys,
30
property,
or
services,
including
agreements
to
perform
any
31
study,
plan,
demonstration,
or
project.
32
u.
Enter
into
any
agreements,
contracts,
or
memoranda
33
of
understanding
and
execute
the
instruments
necessary
or
34
convenient
to
manage
its
own
affairs
and
carry
out
the
purposes
35
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of
this
chapter,
including
but
not
limited
to
contracts
with
1
health
care
providers
and
care
coordinators.
2
v.
Share
information
with
relevant
state
entities,
3
consistent
with
the
confidentiality
provisions
in
this
chapter,
4
necessary
for
the
administration
of
the
healthy
Iowa
program.
5
w.
Subject
to
the
limitations
of
this
chapter,
exercise
any
6
other
power
that
is
reasonably
necessary
or
convenient
to
carry
7
out
the
purposes
of
this
chapter.
8
x.
Adopt
rules
pursuant
to
chapter
17A
regarding
residency
9
requirements
under
the
healthy
Iowa
program.
In
adopting
10
such
rules,
the
board
shall
be
guided
by
the
principles
and
11
requirements
set
forth
in
the
Medicaid
program
without
regard
12
to
immigration
status.
13
y.
Contract
with
not-for-profit
organizations
to
provide
any
14
of
the
following:
15
(1)
Assistance
to
consumers
in
the
selection
of
a
care
16
coordinator,
enrollment,
obtaining
of
health
care
services,
17
disenrollment,
and
other
matters
relating
to
the
healthy
Iowa
18
program.
19
(2)
Assistance
to
health
care
providers
providing,
seeking,
20
or
considering
whether
to
provide
health
care
services
under
21
the
healthy
Iowa
program.
22
z.
Delegate
to
the
director
any
of
its
duties
under
this
23
section
subject
to
all
of
the
following:
24
(1)
The
board
shall
ensure
that
any
entity
under
a
contract
25
or
other
agreement
with
the
healthy
Iowa
program
complies
with
26
the
provisions
of
this
chapter
when
performing
services
on
27
behalf
of
the
healthy
Iowa
program.
28
(2)
The
operations
of
the
healthy
Iowa
program
are
subject
29
to
the
provisions
of
this
chapter
whether
the
operations
are
30
performed
directly
by
the
healthy
Iowa
program
or
through
an
31
entity
under
a
contract
or
other
agreement
with
the
healthy
32
Iowa
program.
33
Sec.
7.
NEW
SECTION
.
135E.7
Healthy
Iowa
program
——
34
implementation
——
coordination
with
other
health
care
coverage.
35
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1.
The
board
shall
determine
the
date
of
implementation
of
1
the
healthy
Iowa
program
when
individuals
may
begin
enrolling
2
in
the
healthy
Iowa
program
and
the
date
the
implementation
3
period
ends.
4
2.
An
insurer,
carrier,
or
health
maintenance
organization
5
shall
not
offer
benefits
or
cover
any
services
for
which
6
coverage
is
offered
to
individuals
under
the
healthy
Iowa
7
program.
8
3.
An
insurer,
carrier,
or
health
maintenance
organization
9
that
is
issued
a
certificate
of
authority
by
the
commissioner
10
of
insurance
may
offer
only
the
following:
11
a.
Benefits
that
do
not
duplicate
the
health
care
services
12
covered
by
the
healthy
Iowa
program.
13
b.
Benefits
available
to
individuals
and
their
families
who
14
are
employed
or
self-employed
in
this
state
but
who
are
not
15
residents.
16
c.
Benefits
available
during
the
implementation
period
17
to
individuals
who
enroll
or
may
enroll
in
the
healthy
Iowa
18
program.
19
4.
This
chapter
shall
not
prohibit
a
resident
who
is
20
employed
outside
this
state
from
choosing
to
receive
health
21
insurance
benefits
through
the
resident’s
employer
and
from
22
opting
out
of
participation
in
the
healthy
Iowa
program.
23
5.
After
the
end
of
the
implementation
period,
board
members
24
shall
enroll
as
members
of
the
healthy
Iowa
program.
25
6.
a.
No
later
than
July
1,
2020,
the
board
shall
develop
26
a
proposal,
consistent
with
the
principles
of
this
chapter,
27
for
provision
by
the
healthy
Iowa
program
of
long-term
care
28
coverage,
including
the
development
of
a
proposal,
consistent
29
with
the
principles
of
this
chapter,
for
its
funding.
30
b.
In
developing
the
proposal
required
in
paragraph
“a”
,
31
the
board
shall
consult
with
a
special
advisory
committee,
32
appointed
by
the
chairperson
of
the
board,
that
includes
33
representatives
of
consumers
and
potential
consumers
of
34
long-term
care,
providers
of
long-term
care,
members
of
35
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organized
labor,
and
other
interested
parties.
1
7.
The
board
shall
develop
proposals
for
all
of
the
2
following:
3
a.
Accommodating
employer
retiree
health
benefits
for
people
4
who
have
been
members
of
the
healthy
Iowa
program
but
live
as
5
retirees
outside
this
state.
6
b.
Accommodating
employer
retiree
health
benefits
for
people
7
who
earned
or
accrued
those
benefits
while
residing
in
this
8
state
prior
to
the
implementation
of
the
healthy
Iowa
program
9
and
who
live
as
retirees
outside
this
state.
10
c.
For
healthy
Iowa
program
coverage
of
health
care
services
11
covered
under
the
state
workers’
compensation
law,
including
12
whether
and
how
to
continue
funding
for
those
health
care
13
services
under
the
workers’
compensation
law
and
whether
and
14
how
to
incorporate
an
element
of
experience
rating.
15
Sec.
8.
NEW
SECTION
.
135E.8
Data
collection.
16
1.
The
board
shall
require
and
enforce
the
collection
17
and
availability
of
all
of
the
following
data
to
promote
18
transparency,
assess
adherence
to
patient
care
standards,
19
compare
patient
outcomes,
and
review
utilization
of
health
care
20
services
paid
for
by
the
healthy
Iowa
program:
21
a.
Inpatient
discharge
data,
including
acuity
and
risk
of
22
mortality.
23
b.
Emergency
department,
ambulatory
surgery,
and
other
24
outpatient
department
data,
including
charge
data,
length
of
25
stay,
and
patients’
unit
of
observation.
26
c.
Hospital
annual
financial
data,
including
all
of
the
27
following:
28
(1)
Community
benefits
by
hospital
in
dollar
value.
29
(2)
Number
of
employees
and
classification
by
hospital
30
unit.
31
(3)
Number
of
hours
worked
by
hospital
unit.
32
(4)
Employee
wage
information
by
job
title
and
hospital
33
unit.
34
(5)
Number
of
registered
nurses
per
staffed
bed
by
hospital
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unit.
1
(6)
Type
and
value
of
health
information
technology.
2
(7)
Annual
spending
on
health
information
technology,
3
including
purchases,
upgrades,
and
maintenance.
4
d.
Physician
services
and
office
visits,
including
charge
5
data.
6
e.
Prescription
drug
cost
and
charge
data
for
prescription
7
drugs
prescribed
and
dispensed
through
hospitals
or
a
8
physician’s
office.
9
2.
Data
collected
under
subsection
1
shall
be
reported
10
to
the
healthy
Iowa
program
and
to
the
public
health
data
11
management
program
of
the
department
of
public
health.
12
3.
The
board
shall
make
all
disclosed
data
collected
under
13
subsection
1
publicly
available
and
searchable
through
an
14
internet
site
and
through
the
department
of
public
health’s
15
public
health
data
management
program.
16
4.
The
board
shall,
directly
and
through
grants
to
17
not-for-profit
entities,
conduct
programs
using
data
collected
18
through
the
healthy
Iowa
program
to
promote
and
protect
public,
19
environmental,
and
occupational
health,
including
cooperation
20
with
other
data
collection
and
research
programs
of
the
21
department
of
public
health
consistent
with
this
chapter
and
22
otherwise
applicable
law.
23
5.
Prior
to
the
end
of
the
healthy
Iowa
program
24
implementation
period,
the
board
shall
provide
for
the
25
collection
and
availability
of
all
of
the
following
data
on
the
26
number
of
patients
served
by
hospitals
and
the
dollar
value
of
27
the
care
provided,
at
cost,
for
all
of
the
following
categories
28
of
data
items:
29
a.
Patients
receiving
charity
care.
30
b.
Contractual
adjustments
of
county
and
indigent
programs,
31
including
traditional
and
managed
care.
32
c.
Bad
debt.
33
6.
The
healthy
Iowa
program,
any
state
or
local
agency,
34
or
any
public
employee
acting
under
color
of
law
shall
not
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provide
or
disclose
to
anyone,
including
but
not
limited
to
the
1
federal
government,
any
personally
identifiable
information
2
obtained
under
this
section,
including
but
not
limited
to
a
3
person’s
religious
beliefs,
practices,
or
affiliation,
national
4
origin,
ethnicity,
or
immigration
status
for
law
enforcement
5
or
immigration
purposes.
6
Sec.
9.
NEW
SECTION
.
135E.9
Healthy
Iowa
advisory
committee
7
——
established.
8
1.
A
healthy
Iowa
advisory
committee
for
the
healthy
Iowa
9
program
is
established.
10
2.
The
healthy
Iowa
advisory
committee
shall
consist
of
all
11
of
the
following
voting
members:
12
a.
(1)
Four
physicians
who
are
board
certified
in
the
13
individual’s
specialty,
at
least
one
of
whom
shall
be
a
14
psychiatrist.
15
(2)
The
physician
members
shall
include
all
of
the
16
following:
17
(a)
One
physician
appointed
by
the
senate
majority
leader.
18
(b)
One
physician
appointed
by
the
governor.
19
(c)
Two
physicians
appointed
by
the
speaker
of
the
house
of
20
representatives
who
are
primary
care
providers.
21
b.
Two
registered
nurses
appointed
by
the
senate
majority
22
leader.
23
c.
One
licensed
allied
health
practitioner
appointed
by
the
24
speaker
of
the
house
of
representatives.
25
d.
One
mental
health
care
provider
appointed
by
the
senate
26
majority
leader.
27
e.
One
dentist
appointed
by
the
governor.
28
f.
One
representative
of
private
hospitals
appointed
by
the
29
governor.
30
g.
One
representative
of
public
hospitals
appointed
by
the
31
governor.
32
h.
(1)
Four
consumers
of
health
care
services.
33
(2)
The
consumer
members
shall
include
all
of
the
following,
34
one
of
whom
shall
be
a
person
with
a
disability:
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(a)
Two
consumers
appointed
by
the
governor.
1
(b)
One
consumer
appointed
by
the
senate
majority
leader
who
2
is
a
healthy
Iowa
program
member
and
who
is
sixty-five
years
of
3
age
or
older.
4
(c)
One
consumer
appointed
by
the
speaker
of
the
house
of
5
representatives.
6
i.
One
representative
of
organized
labor
appointed
by
the
7
speaker
of
the
house
of
representatives.
8
j.
One
representative
of
community
providers
appointed
by
9
the
senate
majority
leader.
10
k.
One
member
of
organized
labor
appointed
by
the
senate
11
majority
leader.
12
l.
One
representative
of
a
business
that
employs
less
than
13
twenty-five
people,
appointed
by
the
governor.
14
m.
One
representative
of
a
business
that
employs
more
than
15
two
hundred
fifty
people,
appointed
by
the
speaker
of
the
house
16
of
representatives.
17
n.
One
pharmacist
appointed
by
the
speaker
of
the
house
of
18
representatives.
19
3.
Appointed
members,
except
for
consumer
members,
shall
20
have
worked
in
the
field
they
represent
for
a
period
of
at
21
least
two
years
prior
to
being
appointed.
22
4.
Members
shall
serve
four-year
staggered
terms.
A
vacancy
23
shall
be
filled
for
the
unexpired
portion
of
the
term
and
in
24
the
same
manner
as
the
original
appointment.
Any
member
may
25
be
reappointed
for
an
additional
term,
but
shall
not
serve
for
26
more
than
two
consecutive
full
terms.
27
5.
Members
shall
not
receive
compensation
as
a
member
28
but
are
entitled
to
receive
reimbursement
of
actual
expenses
29
incurred
in
the
discharge
of
their
duties.
Public
members
are
30
also
eligible
to
receive
compensation
as
provided
in
section
31
7E.6.
32
6.
In
making
appointments
of
members
under
this
section,
the
33
appointing
authority
shall
make
good-faith
efforts
to
ensure
34
that
their
appointments,
as
a
whole,
reflect,
to
the
greatest
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extent
feasible,
the
social
and
geographic
diversity
of
this
1
state.
2
7.
The
healthy
Iowa
advisory
committee
shall
advise
the
3
board
on
all
matters
of
policy
related
to
the
healthy
Iowa
4
program.
5
8.
a.
The
healthy
Iowa
advisory
committee
shall
meet
at
6
least
six
times
per
year
in
a
place
convenient
to
the
public
7
in
accordance
with
chapter
21
and
records
of
the
healthy
8
Iowa
advisory
committee
shall
be
subject
to
the
open
records
9
requirements
of
chapter
22.
10
b.
Eleven
members
of
the
healthy
Iowa
advisory
committee
11
constitute
a
quorum
and
the
affirmative
vote
of
at
least
twelve
12
voting
members
is
necessary
for
any
substantive
action
to
be
13
taken.
14
9.
The
healthy
Iowa
advisory
committee
shall
elect
a
15
chairperson
from
among
its
membership
who
shall
serve
two
years
16
and
who
may
be
reelected
as
chairperson
for
an
additional
two
17
years.
18
10.
Members
shall
not
use
for
personal
benefit
any
19
information
that
is
filed
with,
or
obtained
by,
the
healthy
20
Iowa
advisory
committee
and
that
is
not
generally
available
to
21
the
public.
22
11.
A
member
shall
perform
the
member’s
duties
in
good
23
faith,
in
the
manner
the
member
reasonably
believes
to
be
in
24
the
best
interest
of
the
healthy
Iowa
program,
and
without
25
intentional
or
reckless
disregard
of
the
care
an
ordinarily
26
prudent
person
in
a
like
position
would
use
under
similar
27
circumstances.
A
member
who
performs
the
member’s
duties
in
28
accordance
with
this
subsection
shall
not
be
liable
personally
29
for
actions
taken
as
a
member
when
done
in
good
faith,
without
30
intent
to
defraud,
and
in
connection
with
the
administration
of
31
this
chapter
or
actions
or
conduct
related
to
this
chapter.
32
12.
A
member
shall
be
subject
to
the
provisions
of
chapter
33
68B.
In
addition
to
the
disclosures
required
pursuant
to
34
chapter
68B,
a
member
shall
disclose
to
the
healthy
Iowa
35
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advisory
committee
and
to
the
public
any
relationship
1
that
the
member
has
with
a
health
care
provider,
health
2
clinic,
pharmaceutical
company,
medical
equipment
company,
3
insurance
company,
carrier,
insurance
producer,
third-party
4
administrator,
managed
care
organization,
or
other
entity
in
an
5
industry
involved
in
matters
likely
to
come
before
the
healthy
6
Iowa
advisory
committee.
7
13.
On
all
matters
that
come
before
the
healthy
Iowa
8
advisory
committee,
members
shall
do
all
of
the
following:
9
a.
Adhere
strictly
to
the
conflict
of
interest
provisions
10
of
section
68B.2A.
11
b.
Provide
full
disclosure
to
the
healthy
Iowa
advisory
12
committee
and
the
public
on
any
matter
that
gives
rise
to
a
13
potential
conflict
of
interest
and
the
manner
in
which
the
14
member
will
comply
with
public
disclosure
required
by
chapter
15
68B
and
rules
adopted
pursuant
to
chapter
68B
to
avoid
any
16
conflict
of
interest
or
appearance
of
a
conflict
of
interest.
17
14.
A
member
shall
not
have
an
interest,
direct
or
indirect,
18
in
a
contract
for
the
purchase
of
goods,
including
materials
19
and
profits,
and
the
performance
of
services
for
the
healthy
20
Iowa
program
or
the
healthy
Iowa
advisory
committee.
A
21
contract
entered
into
in
violation
of
this
section
is
void.
22
15.
A
member
may
be
removed
for
incompetence,
misconduct,
or
23
failure
to
perform
the
duties
of
the
position.
24
Sec.
10.
NEW
SECTION
.
135E.10
Eligibility
and
enrollment
25
——
generally.
26
1.
Each
resident
is
eligible
and
entitled
to
enroll
as
a
27
member
in
and
receive
benefits
for
health
care
services
covered
28
by
the
healthy
Iowa
program.
29
2.
A
member
shall
not
pay
any
fee,
payment,
or
other
charge
30
for
enrolling
in
or
being
a
member.
31
3.
A
participating
health
care
provider
or
participating
32
care
coordinator
shall
not
do
any
of
the
following:
33
a.
Require
members
to
pay
any
premium,
copayment,
34
coinsurance,
deductible,
or
any
other
form
of
cost
sharing
for
35
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any
covered
health
care
services.
1
b.
Use
preexisting
medical
conditions
to
determine
the
2
eligibility
of
a
member
to
receive
benefits
for
health
care
3
services
covered
by
the
program.
4
c.
Refuse
to
provide
health
care
services
to
a
member
5
on
the
basis
of
age,
citizenship,
claims
experience,
color,
6
creed,
familial
status,
gender
identity,
genetic
information,
7
geography,
health
status,
immigration
status,
marital
status,
8
medical
condition,
medical
history,
mental
disability,
military
9
or
veteran
status,
national
origin,
physical
disability,
10
primary
language,
race,
receipt
of
health
care,
religion,
sex,
11
sexual
orientation,
or
source
of
income.
12
d.
A
college,
university,
or
other
institution
of
higher
13
education
in
this
state
may
purchase
coverage
under
the
healthy
14
Iowa
program
for
a
student,
or
a
student’s
dependent,
who
is
15
not
a
resident.
16
Sec.
11.
NEW
SECTION
.
135E.11
Eligibility
and
enrollment
——
17
cross
border
employees.
18
1.
If
a
resident
is
employed
outside
this
state
by
an
19
employer
that
is
subject
to
the
laws
of
this
state,
the
20
employer
and
resident
shall
pay
any
payroll
premium
adopted
21
under
this
chapter
as
if
the
employment
were
in
this
state.
22
2.
If
a
resident
is
employed
outside
this
state
by
an
23
employer
that
is
not
subject
to
the
laws
of
this
state,
24
either
the
employer
and
resident
may
comply
with
any
payroll
25
premium
adopted
under
this
chapter
as
if
the
employee
were
26
employed
in
this
state,
or
the
resident
shall
pay
the
payroll
27
premium
adopted
under
this
chapter
as
if
the
resident
were
28
self-employed
in
this
state.
29
3.
Any
payroll
premium
adopted
under
this
chapter
applies
30
to
all
of
the
following:
31
a.
A
resident
of
another
state
employed
in
this
state.
32
b.
A
resident
of
another
state
self-employed
in
this
state.
33
4.
a.
A
resident
who
is
employed
outside
this
state
34
may
choose
to
receive
health
insurance
benefits
through
the
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resident’s
employer
and
opt
out
of
participation
in
the
healthy
1
Iowa
program.
2
b.
The
board
shall
develop
and
implement
rules
establishing
3
procedures
for
state
residents
employed
outside
this
state
to
4
opt
out
of
participation
in
the
healthy
Iowa
program.
5
5.
If
any
provision
of
this
section
or
application
of
the
6
provision
to
any
person
or
circumstance
is
held
to
violate
the
7
federal
Employee
Retirement
Income
Security
Act
of
1974
in
any
8
court
of
competent
jurisdiction,
the
provision
or
application
9
found
invalid
shall
be
null
and
void
and
the
invalidity
shall
10
not
affect
other
provisions
or
any
other
application
of
this
11
chapter
that
can
be
given
effect
without
the
invalid
provision
12
or
application.
13
Sec.
12.
NEW
SECTION
.
135E.12
Health
benefit
credit.
14
1.
a.
If
an
individual
who
is
a
resident
of
another
state
15
is
employed
in
this
state,
the
individual
and
the
individual’s
16
employer
may
be
eligible
for
a
credit
against
any
payroll
17
premium
payment
requirement
adopted
under
this
chapter
that
the
18
individual
or
the
individual’s
employer
would
otherwise
pay
19
relative
to
that
individual.
20
b.
The
credit
available
under
this
subsection
shall
be
for
21
the
amount
spent
on
health
benefits
for
the
individual
that
22
would
otherwise
be
covered
by
the
healthy
Iowa
program
if
that
23
individual
were
a
member
of
the
healthy
Iowa
program.
24
c.
The
credit
available
under
this
subsection
shall
be
25
distributed
between
the
individual
and
employer
in
the
same
26
proportion
as
the
actual
spending
by
each
for
the
health
27
benefits.
28
d.
An
employer
and
employee
may
apply
their
respective
29
portion
of
the
credit
available
under
this
subsection
to
their
30
respective
portion
of
any
payroll
premium
payment
requirement
31
adopted
under
this
chapter.
32
2.
a.
If
an
individual
who
is
a
resident
of
another
state
33
is
self-employed
in
this
state,
the
individual
is
eligible
34
for
a
credit
against
any
payroll
premium
payment
requirement
35
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adopted
under
this
chapter
that
the
individual
would
otherwise
1
pay.
2
b.
Credit
taken
under
this
subsection
shall
be
in
the
3
amount
that
the
individual
spends
on
health
benefits
that
4
would
otherwise
be
covered
by
the
healthy
Iowa
program
if
the
5
individual
were
a
member
of
the
healthy
Iowa
program.
6
3.
a.
The
credit
available
for
non-employment-based
7
spending
by
an
individual
under
subsection
2
is
limited
to
8
spending
for
health
benefits.
9
b.
An
individual
shall
not
be
eligible
for
credit
under
10
subsection
2
for
out-of-pocket
health
care
services
spending.
11
4.
Credit
under
this
section
is
available
regardless
of
12
the
cost
or
comprehensiveness
of
the
health
benefits,
and
13
regardless
of
the
form
of
the
health
benefits.
14
5.
a.
An
employer
or
individual
is
eligible
for
credit
15
under
this
section
only
against
payroll
premiums
payment
16
requirement
adopted
under
this
chapter.
17
b.
An
employer
or
individual
shall
not
apply
any
health
18
benefits
spending
in
excess
of
the
payroll
premium
payment
19
requirement
to
other
tax
liability.
20
6.
If
any
provision
of
this
section
or
application
of
the
21
provision
to
any
person
or
circumstance
is
held
to
violate
the
22
federal
Employee
Retirement
Income
Security
Act
in
any
court
23
of
competent
jurisdiction,
the
provision
or
the
application
24
found
invalid
shall
be
null
and
void
and
the
invalidity
shall
25
not
affect
other
provisions
or
any
other
application
of
this
26
chapter
that
can
be
given
effect
without
the
invalid
provision
27
or
application.
28
Sec.
13.
NEW
SECTION
.
135E.13
Covered
benefits.
29
1.
a.
All
members
are
eligible
to
receive
covered
health
30
care
services
benefits
under
the
program.
31
b.
Covered
health
care
services
benefits
under
the
program
32
include
all
medical
care
that
is
medically
necessary
as
33
determined
by
the
member’s
treating
physician
in
accordance
34
with
the
program
standards
established
in
section
135E.19
and
35
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by
the
board.
1
c.
A
member’s
treating
physician
shall
be
a
person
2
licensed
to
engage
in
the
practice
of
medicine
and
surgery
or
3
osteopathic
medicine
and
surgery
pursuant
to
chapter
148.
4
2.
Covered
health
care
services
benefits
for
members
5
include
but
are
not
limited
to
all
of
the
following:
6
a.
Licensed
inpatient
and
licensed
outpatient
medical
and
7
health
care
facility
services.
8
b.
Inpatient
and
outpatient
health
care
services.
9
c.
Diagnostic
imaging,
laboratory
services,
and
other
10
diagnostic
and
evaluative
services.
11
d.
Medical
equipment,
appliances,
and
assistive
technology,
12
including
prosthetics,
eyeglasses,
and
hearing
aids
and
13
the
repair,
technical
support,
and
customization
needed
for
14
individual
use.
15
e.
Inpatient
and
outpatient
rehabilitative
care.
16
f.
Emergency
care
services.
17
g.
Emergency
transportation.
18
h.
Necessary
transportation
for
health
care
services
for
19
persons
with
disabilities
or
who
may
qualify
as
low-income.
20
i.
Child
and
adult
immunizations
and
preventive
care.
21
j.
Health
and
wellness
education.
22
k.
Hospice
care.
23
l.
Care
in
a
skilled
nursing
facility.
24
m.
Home
health
care,
including
home
health
care
provided
in
25
an
assisted
living
facility.
26
n.
Mental
health
services.
27
o.
Substance
abuse
treatment.
28
p.
Dental
care.
29
q.
Vision
care.
30
r.
Prescription
drugs.
31
s.
Pediatric
care.
32
t.
Prenatal
and
postnatal
care.
33
u.
Podiatric
care.
34
v.
Chiropractic
care.
35
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w.
Acupuncture.
1
x.
Therapies
that
are
shown
by
the
United
States
national
2
institutes
of
health,
national
center
for
complementary
and
3
integrative
health
to
be
safe
and
effective.
4
y.
Blood
and
blood
products.
5
z.
Dialysis.
6
aa.
Adult
day
care.
7
ab.
Rehabilitative
and
habilitative
services.
8
ac.
Ancillary
health
care
or
social
services
previously
9
covered
by
integrated
health
homes
as
determined
under
Iowa
10
Medicaid
enterprise
administrative
rules
and
as
designated
11
under
42
U.S.C.
§1396w-4.
12
ad.
Case
management
and
care
coordination.
13
ae.
Language
interpretation
and
translation
for
health
care
14
services,
including
sign
language
and
braille
or
other
services
15
needed
for
individuals
with
communication
barriers.
16
af.
Health
care
and
long-term
supportive
services
covered
17
under
Medicaid
or
the
healthy
and
well
kids
in
Iowa
program
on
18
June
30,
2017.
19
ag.
All
of
the
following
health
care
services
required
20
to
be
covered
under
any
of
the
following
provisions,
without
21
regard
to
whether
the
member
would
otherwise
be
eligible
for
or
22
covered
by
the
program
or
source
referred
to:
23
(1)
The
healthy
and
well
kids
in
Iowa
program
pursuant
to
24
chapter
514I.
25
(2)
The
Medicaid
program.
26
(3)
The
federal
Medicare
program
pursuant
to
Tit.
XVIII
of
27
the
federal
Social
Security
Act,
42
U.S.C.
§1395
et
seq.
28
(4)
A
health
maintenance
organization
as
defined
in
section
29
514B.1.
30
(5)
A
managed
health
care
program
as
defined
by
rule
of
31
the
department
of
human
services,
including
health
maintenance
32
organizations,
prepaid
health
plans,
the
Medicaid
patient
33
access
to
service
system,
Iowa
plan
for
behavioral
health,
34
programs
of
all-inclusive
care
for
the
elderly,
Iowa
health
35
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link,
and
the
Iowa
health
and
wellness
plan.
1
ah.
Any
additional
health
care
services
authorized
by
the
2
board.
3
ai.
All
essential
health
benefits
mandated
by
the
Affordable
4
Care
Act
as
of
January
1,
2017.
5
Sec.
14.
NEW
SECTION
.
135E.14
Covered
benefits
——
6
additions.
7
1.
The
board,
on
a
regular
basis,
shall
evaluate
whether
8
covered
benefits
under
the
healthy
Iowa
program
should
be
9
improved
or
adjusted
to
promote
the
health
of
beneficiaries,
10
account
for
changes
in
medical
practice
or
new
information
from
11
medical
research,
or
respond
to
other
relevant
developments
in
12
health
science.
In
carrying
out
this
duty,
the
board
shall
13
consult
with
the
persons
described
in
subsection
2
on
all
of
14
the
following:
15
a.
Identifying
specific
complementary
and
integrative
16
medicine
practices
that,
on
the
basis
of
research
findings
or
17
promising
clinical
interventions,
are
appropriate
to
include
as
18
benefits
under
the
healthy
Iowa
program
package.
19
b.
Identifying
barriers
to
the
effective
provision
and
20
integration
of
such
practices
into
the
delivery
of
health
care,
21
and
identifying
mechanisms
for
overcoming
such
barriers.
22
2.
The
board
shall
consult
with
all
of
the
following
when
23
carrying
out
the
requirements
of
subsection
1:
24
a.
Institutions
of
higher
education,
private
research
25
institutes,
and
individual
researchers
with
extensive
26
experience
in
complementary
and
alternative
medicine
and
the
27
integration
of
such
practices
into
the
delivery
of
health
care.
28
b.
Nationally
recognized
providers
of
complementary
and
29
integrative
medicine.
30
c.
Such
other
officials,
entities,
and
individuals
with
31
expertise
in
complementary
and
integrative
medicine
as
the
32
board
determines
appropriate.
33
3.
a.
Health
care
providers
and
members
may
petition
the
34
board
to
improve
or
adjust
covered
benefits
under
the
healthy
35
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Iowa
program.
1
b.
The
board
shall
develop
and
adopt
rules
pursuant
to
2
chapter
17A
establishing
procedures
for
members
to
petition
the
3
board
to
improve
or
adjust
covered
benefits
under
the
healthy
4
Iowa
program.
5
Sec.
15.
NEW
SECTION
.
135E.15
Delivery
of
care
——
6
participating
health
care
providers.
7
1.
Any
health
care
provider
is
qualified
to
participate
in
8
the
healthy
Iowa
program
if
the
health
care
provider
meets
all
9
of
the
following
criteria:
10
a.
The
health
care
provider
is
licensed
to
practice
in
this
11
state
and
is
otherwise
in
good
standing.
12
b.
The
health
care
provider’s
services
are
performed
while
13
physically
present
in
this
state.
14
c.
The
health
care
provider
agrees
to
accept
program
rates
15
as
payment
in
full
for
all
covered
health
care
services.
16
2.
The
board
shall
establish
and
maintain
procedures
and
17
standards
for
recognizing
health
care
providers
located
outside
18
this
state
for
purposes
of
providing
coverage
under
the
program
19
for
members
who
require
out-of-state
health
care
services
while
20
the
member
is
physically
outside
this
state
for
a
period
of
21
time
not
to
exceed
ninety
days.
22
3.
Any
health
care
provider
qualified
to
participate
under
23
this
section
may
provide
covered
health
care
services
under
the
24
healthy
Iowa
program
as
long
as
the
health
care
provider
is
25
legally
authorized
to
perform
the
health
care
service
for
the
26
individual
and
under
the
circumstances
involved.
27
4.
A
member
may
choose
to
receive
health
care
services
28
under
the
healthy
Iowa
program
from
any
participating
provider,
29
consistent
with
all
of
the
following:
30
a.
Provisions
of
this
section.
31
b.
The
willingness
or
availability
of
the
health
care
32
provider.
33
c.
Provisions
of
this
chapter
prohibiting
discrimination
34
against
members.
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d.
The
appropriate
clinically
relevant
circumstances
and
1
standards.
2
5.
The
board
may
establish
and
maintain
procedures
for
3
member
enrollment
and
disenrollment
with
participating
health
4
care
providers
that
are
health
maintenance
organizations,
group
5
medical
practices,
or
essential
community
providers
that
offer
6
comprehensive
services.
7
6.
a.
Participating
health
care
providers
shall
not
use
8
health
information
technology
or
clinical
practice
guidelines
9
that
limit
the
effective
exercise
of
the
professional
judgment
10
of
a
physician
or
registered
nurse.
11
b.
A
physician
or
registered
nurse
may
override
health
12
information
technology
and
clinical
practice
guidelines
if
all
13
of
the
following
criteria
are
met:
14
(1)
It
is
consistent
with
the
treating
physician’s
or
15
registered
nurse’s
determination
of
medical
necessity.
16
(2)
In
the
professional
judgment
of
the
treating
physician
17
or
registered
nurse,
it
is
in
the
best
interest
of
the
patient
18
and
consistent
with
the
patient’s
wishes.
19
7.
The
board
shall
establish
and
maintain
procedures
and
20
standards
for
recognizing
health
care
providers
located
outside
21
this
state
for
purposes
of
providing
coverage
under
the
healthy
22
Iowa
program
for
health
care
services
provided
outside
this
23
state
under
the
healthy
Iowa
program.
24
Sec.
16.
NEW
SECTION
.
135E.16
Delivery
of
care
——
care
25
coordination.
26
1.
Care
coordinators
shall
provide
care
coordination,
27
including
administrative
tracking
and
medical
recordkeeping
28
services,
to
members.
29
2.
a.
Care
coordinators
may
employ
or
utilize
the
services
30
of
other
individuals
or
entities
to
assist
in
providing
care
31
coordination
for
a
member,
consistent
with
rules
adopted
by
the
32
board
and
consistent
with
the
statutory
requirements
for
care
33
coordinator
licensure.
34
b.
Care
coordinators
shall
give
preference,
when
employing
35
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or
utilizing
the
services
of
other
individuals,
to
those
1
individuals
who
have
transitioned
out
of
employment
due
to
2
displacement
resulting
from
implementation
of
the
healthy
Iowa
3
program.
4
3.
Care
coordinators
shall
comply
with
all
federal
and
5
state
privacy
laws,
including
but
not
limited
to
the
federal
6
Health
Insurance
Portability
and
Accountability
Act
of
7
1996,
Pub.
L.
No.
104-191,
42
U.S.C.
§1320d
et
seq.
and
its
8
implementing
regulations,
and
the
disclosure
of
mental
health
9
and
psychological
information
requirements
of
chapter
228.
10
4.
A
referral
from
a
care
coordinator
is
not
required
for
a
11
member
to
receive
health
care
services
from
any
participating
12
health
care
provider.
13
5.
A
care
coordinator
may
be
an
individual
or
entity
14
approved
by
the
board
that
is
any
of
the
following:
15
a.
A
health
care
provider
that
is
any
of
the
following:
16
(1)
The
member’s
primary
care
provider.
17
(2)
The
member’s
provider
of
primary
gynecological
care.
18
(3)
At
the
option
of
a
member
who
has
a
chronic
condition
19
that
requires
specialty
care,
a
specialist
health
care
provider
20
who
regularly
and
continually
provides
treatment
to
the
member
21
for
that
condition.
22
b.
An
entity
licensed
as
any
of
the
following:
23
(1)
A
hospital
licensed
pursuant
to
chapter
135B.
24
(2)
A
limited
service
organization
established
under
the
25
requirements
of
section
514B.33.
26
(3)
An
outpatient
surgical
facility,
as
defined
in
section
27
135.61,
certified
as
an
ambulatory
surgical
center
under
the
28
federal
Medicare
program
or
under
the
Medicaid
program.
29
(4)
An
organized
outpatient
health
facility
as
defined
in
30
section
135.61.
31
(5)
A
licensed
subacute
care
facility
for
persons
with
32
serious
and
persistent
mental
illness
as
defined
in
section
33
135G.1.
34
(6)
A
licensed
psychiatric
medical
institution
for
children
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as
defined
in
section
135H.1.
1
(7)
A
entity
certified
by
the
department
of
human
services
2
to
provide
home
and
community-based
services,
including
3
habilitation
services,
the
program
of
all-inclusive
care
for
4
the
elderly,
home
health
services,
private
duty
nursing
and
5
personal
care
programs,
or
targeted
case
management.
6
(8)
A
medical
care
ambulance
service
or
nontransport
7
service
that
has
received
authorization
from
the
department
8
pursuant
to
section
147A.5.
9
(9)
A
health
maintenance
organization
as
defined
in
section
10
514B.1.
11
(10)
A
licensed
nursing
facility
as
defined
in
section
12
135C.1.
13
(11)
A
licensed
nursing
home
as
defined
in
section
155.1.
14
(12)
A
licensed
residential
care
facility
as
defined
in
15
section
135C.1.
16
(13)
A
licensed
intermediate
care
facility
for
persons
with
17
an
intellectual
disability
as
defined
in
section
135C.1.
18
(14)
A
licensed
intermediate
care
facility
for
persons
with
19
mental
illness
as
defined
in
section
135C.1.
20
(15)
A
licensed
health
care
facility
that
provides
adult
day
21
services
as
defined
in
section
135C.1.
22
(16)
A
licensed
health
care
facility
that
provides
23
rehabilitative
services
as
defined
in
section
135C.1.
24
(17)
A
facility
that
provides
hospice
care
under
a
licensed
25
hospice
program
as
defined
in
section
135J.1.
26
(18)
A
licensed
boarding
home
as
defined
in
section
135O.1.
27
(19)
A
certified
assisted
living
program
as
defined
in
28
section
231C.2.
29
(20)
A
designated
community
mental
health
center
as
defined
30
in
section
230A.102.
31
(21)
A
certified
elder
group
home
as
defined
in
section
32
231B.1.
33
c.
(1)
A
Taft-Hartley
health
and
welfare
fund,
with
respect
34
to
its
members
and
their
family
members.
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(2)
This
provision
does
not
preclude
a
Taft-Hartley
health
1
and
welfare
fund
from
becoming
a
care
coordinator
under
2
paragraph
“d”
.
3
d.
Any
not-for-profit
or
governmental
entity
approved
by
the
4
healthy
Iowa
board.
5
6.
a.
(1)
A
healthy
Iowa
program
member
shall
enroll
with
6
a
healthy
Iowa
care
coordinator
prior
to
receiving
health
care
7
services.
8
(2)
A
member
shall
enroll
with
a
care
coordinator
within
9
sixty
days
of
enrollment
in
the
healthy
Iowa
program.
10
(3)
The
healthy
Iowa
program
shall
only
reimburse
a
health
11
care
provider
for
services
if
the
member
is
enrolled
with
a
12
care
coordinator
at
the
time
the
health
care
services
are
13
provided.
14
b.
If
a
member
receives
health
care
services
before
choosing
15
a
care
coordinator,
the
healthy
Iowa
program
shall
assist
the
16
member,
when
appropriate,
in
choosing
a
care
coordinator.
17
c.
A
member
shall
remain
enrolled
with
a
care
coordinator
18
until
the
member
becomes
enrolled
with
a
different
care
19
coordinator
or
ceases
to
be
a
member.
20
d.
A
member
may
change
the
member’s
care
coordinator
based
21
on
rules
applicable
to
selecting
a
primary
medical
provider
22
or
a
medical
home
under
the
Iowa
health
and
wellness
program
23
pursuant
to
chapter
249N.
24
7.
This
section
shall
not
be
interpreted
to
authorize
25
any
individual
to
engage
in
any
act
in
violation
of
the
26
individual’s
professional
licensure
under
title
IV.
27
8.
An
individual
or
entity
shall
not
act
as
a
care
28
coordinator
unless
the
health
care
services
included
in
care
29
coordination
are
within
the
individual’s
professional
scope
of
30
practice
or
within
the
entity’s
legal
authority.
31
9.
a.
The
board
shall
adopt
rules
pursuant
to
chapter
32
17A
regarding
and
including
but
not
limited
to
all
of
the
33
following:
34
(1)
Procedures
and
standards
for
an
individual
or
entity
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to
be
approved
as
a
care
coordinator
under
the
healthy
Iowa
1
program.
2
(2)
Procedures
and
standards
relating
to
the
limitation,
3
suspension,
or
revocation
of
an
individual’s
approval
as
a
care
4
coordinator
based
on
a
determination
that
the
individual
or
5
entity
is
incompetent
to
be
a
care
coordinator.
6
(3)
Procedures
and
standards
relating
to
the
limitation,
7
suspension,
or
revocation
of
the
approval
of
an
individual’s
8
or
entity’s
approval
as
a
care
coordinator
based
on
an
9
exhibited
course
of
conduct
that
is
inconsistent
with
healthy
10
Iowa
program
standards
and
regulations
or
that
exhibits
an
11
unwillingness
to
meet
those
standards
and
regulations.
12
(4)
Procedures
and
standards
relating
to
the
limitation,
13
suspension,
or
revocation
of
approval
of
an
individual
or
14
entity
as
a
care
coordinator
based
on
a
determination
that
the
15
individual
or
entity
is
a
potential
threat
to
the
public
health
16
or
safety.
17
b.
The
rules
adopted
by
the
board
under
this
subsection
18
shall
be
consistent
with
professional
practice,
licensure
19
standards,
and
regulations
established
pursuant
to
title
IV,
20
title
VI,
and
title
XIII,
as
applicable.
21
c.
In
developing
and
implementing
rules
or
standards
for
22
the
approval
of
care
coordinators
for
individuals
receiving
23
chronic
mental
health
care
services,
the
board
shall
consult
24
with
the
division
of
mental
health
and
disability
services
of
25
the
department
of
human
services.
26
10.
To
maintain
approval
under
the
program,
a
care
27
coordinator
shall
do
all
of
the
following:
28
a.
Renew
the
person’s
status
as
a
care
coordinator
every
29
three
years
pursuant
to
rules
adopted
by
the
board.
30
b.
Provide
the
healthy
Iowa
program
any
data
required
by
the
31
department
of
human
services
or
the
department
of
public
health
32
and
as
required
by
the
board
that
would
enable
the
board
to
33
evaluate
the
impact
of
care
coordinators
on
quality,
outcomes,
34
and
cost
of
health
care.
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11.
This
chapter
shall
not
be
construed
to
alter
the
1
professional
practice
of
health
care
providers
or
their
2
licensure
standards
established
pursuant
to
title
IV.
3
12.
a.
Care
coordinators
shall
not
use
health
information
4
technology
or
clinical
practice
guidelines
that
limit
the
5
effective
exercise
of
the
professional
judgment
of
physicians
6
and
registered
nurses.
7
b.
Physicians
and
registered
nurses
may
override
health
8
information
technology
and
clinical
practice
guidelines
if
all
9
of
the
following
criteria
are
met:
10
(1)
It
is
consistent
with
the
treating
physician’s
11
determination
of
medical
necessity.
12
(2)
In
the
professional
judgment
of
the
treating
physician
13
or
registered
nurse,
it
is
in
the
best
interest
of
the
patient
14
and
consistent
with
the
patient’s
wishes.
15
Sec.
17.
NEW
SECTION
.
135E.17
Rates
and
payment
16
methodologies.
17
1.
a.
The
board
shall
adopt
rules
pursuant
to
chapter
17A
18
regarding
contracting
and
establishing
payment
methodologies
19
for
covered
health
care
services
and
care
coordination
provided
20
to
members
under
the
healthy
Iowa
program
by
participating
21
providers
and
care
coordinators.
22
b.
The
board
may
adopt
a
variety
of
payment
methodologies,
23
including
those
established
on
a
demonstration
basis.
24
c.
All
payment
rates
under
the
healthy
Iowa
program
shall
be
25
reasonable
and
reasonably
related
to
the
cost
of
efficiently
26
providing
the
health
care
service
and
ensuring
an
adequate
and
27
accessible
supply
of
health
care
services.
28
2.
a.
Health
care
services
provided
to
members
under
the
29
healthy
Iowa
program,
with
the
exception
of
care
coordination,
30
shall
be
paid
for
on
a
fee-for-service
basis
unless
and
until
31
the
board
establishes
another
payment
methodology.
32
b.
A
rebuttable
presumption
exists
that
the
Medicare
rate
of
33
reimbursement
constitutes
a
reasonable
fee-for-service
payment
34
rate.
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3.
Notwithstanding
subsection
2,
health
maintenance
1
organizations,
essential
community
providers,
and
group
2
medical
practices
that
provide
comprehensive,
coordinated
3
services
shall
be
reimbursed
on
the
basis
of
a
capitated
system
4
operating
budget
or
a
noncapitated
system
operating
budget.
5
4.
a.
Payment
for
health
care
services
established
under
6
this
chapter
shall
be
considered
payment
in
full.
7
b.
A
participating
health
care
provider
shall
not
charge
any
8
rate
in
excess
of
the
payment
established
under
this
chapter
9
for
any
health
care
service
provided
to
a
member
and
shall
not
10
solicit
or
accept
payment
from
any
member
or
third
party
for
11
any
health
care
service,
except
as
provided
under
federal
law.
12
c.
This
section
does
not
preclude
the
healthy
Iowa
program
13
from
acting
as
a
primary
or
secondary
payer
in
conjunction
with
14
another
third-party
payer
when
permitted
by
federal
law.
15
5.
a.
The
board
may
adopt
rules
pursuant
to
chapter
16
17A
to
provide
payment
methodologies
for
the
payment
of
17
capital-related
expenses
for
specifically
identified
capital
18
expenditures
incurred
by
not-for-profit
or
governmental
19
entities
that
are
health
care
entities
licensed
under
title
IV,
20
including
but
not
limited
to
hospitals,
health
care
facilities,
21
subacute
mental
health
care
facilities,
psychiatric
medical
22
institutions
for
children,
entities
providing
licensed
hospice
23
programs,
and
entities
providing
emergency
medical
care.
24
b.
Any
capital-related
expense
generated
by
a
capital
25
expenditure
that
requires
prior
approval
by
the
board
shall
not
26
be
paid
unless
such
prior
approval
has
been
received.
27
c.
Approval
of
a
capital
expenditure
shall
be
based
on
28
achievement
of
the
program
standards
described
in
section
29
135E.19.
30
6.
Payment
methodologies
and
rates
shall
include
a
distinct
31
component
of
reimbursement
for
direct
and
indirect
graduate
32
medical
education.
33
7.
a.
The
board
shall
adopt
rules
pursuant
to
chapter
34
17A
regarding
payment
methodologies
and
procedures
to
pay
for
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health
care
services
provided
to
a
member
while
the
member
is
1
located
outside
this
state
for
a
period
of
time
not
to
exceed
2
ninety
days
except
as
provided
in
paragraph
“b”
.
3
b.
(1)
The
board
may
adopt
rules
pursuant
to
chapter
17A
4
regarding
payment
methodologies
and
procedures
to
pay
for
5
health
care
services
provided
to
a
member
while
the
member
is
6
outside
this
state
for
a
period
of
time
not
to
exceed
ninety
7
days
if
it
is
medically
necessary
as
determined
by
the
member’s
8
treating
physician
in
accordance
with
the
program
standards
9
established
in
section
135E.19
and
by
the
board.
10
(2)
A
member’s
treating
physician
is
a
person
licensed
to
11
engage
in
the
practice
of
medicine
and
surgery
or
osteopathic
12
medicine
and
surgery
pursuant
to
chapter
148.
13
Sec.
18.
NEW
SECTION
.
135E.18
Rate
negotiations.
14
1.
The
healthy
Iowa
program
shall
engage
in
good-faith
15
negotiations
with
health
care
provider
representatives
under
16
chapter
135F
to
develop
all
of
the
following:
17
a.
Rates
of
payment
for
health
care
services.
18
b.
Rates
of
payment
for
prescription
and
nonprescription
19
drugs.
20
c.
Payment
methodologies.
21
2.
Rate
negotiations
shall
be
conducted
annually
through
a
22
single
entity
on
behalf
of
the
entire
program
for
prescription
23
and
nonprescription
drugs.
24
3.
a.
The
board
shall
establish
a
prescription
drug
25
formulary
system,
which
shall
discourage
the
use
of
26
ineffective,
dangerous,
or
excessively
costly
medications
when
27
better
alternatives
are
available.
28
b.
The
formulary
established
under
this
subsection
shall
29
promote
the
use
of
generic
medications
to
the
greatest
extent
30
possible.
31
c.
Clinicians
and
patients
may
petition
the
board
to
add
32
new
pharmaceuticals
or
to
remove
ineffective
or
dangerous
33
medications
from
the
formulary.
34
d.
The
board
shall
adopt
rules
pursuant
to
chapter
17A
35
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regarding
the
use
of
off-formulary
medications
which
allow
for
1
patient
access
but
do
not
compromise
the
formulary.
2
Sec.
19.
NEW
SECTION
.
135E.19
Program
standards.
3
1.
The
healthy
Iowa
program
shall
establish
a
single
4
standard
of
safe,
therapeutic
health
care
services
for
all
5
residents.
6
2.
The
board
shall
adopt
rules
pursuant
to
chapter
17A
to
7
establish
requirements
and
standards
for
the
program
and
for
8
care
coordinators
and
health
care
providers,
consistent
with
9
this
chapter
and
consistent
with
the
applicable
professional
10
practice
and
licensure
standards
for
health
care
providers,
11
health
care
facilities,
and
health
care
professionals
12
established
in
title
IV,
title
VI,
and
title
XIII,
as
13
applicable.
The
rules
adopted
under
this
subsection
shall
14
address
all
of
the
following:
15
a.
Requirements
and
standards
for
the
scope,
quality,
and
16
accessibility
of
health
care
services.
17
b.
Requirements
and
standards
for
interactions
between
18
health
care
providers
and
members.
19
c.
Requirements
and
standards
for
interactions
between
care
20
coordinators
and
health
care
providers,
including
credentialing
21
and
participation
in
health
care
organization
networks,
and
22
terms,
methods,
and
rates
of
payment.
23
3.
The
board
shall
adopt
rules
pursuant
to
chapter
17A
to
24
establish
requirements
and
standards
to
promote
all
of
the
25
following:
26
a.
Simplification,
transparency,
uniformity,
and
fairness
in
27
health
care
provider
credentialing
and
participation
in
health
28
care
organization
networks,
referrals,
payment
procedures
and
29
rates,
claims
processing,
and
approval
of
health
care
services,
30
as
applicable.
31
b.
In-person
primary
and
preventive
care,
care
coordination,
32
efficient
and
effective
health
care
services,
quality
33
assurance,
and
promotion
of
public,
environmental,
and
34
occupational
health.
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c.
Elimination
of
health
care
disparities,
including
1
geographic
disparities,
racial
disparities,
income-based
2
disparities,
gender-based
disparities,
sex-based
disparities,
3
and
other
disparities.
4
d.
Nondiscrimination
with
respect
to
members
and
health
5
care
providers
on
the
basis
of
age,
citizenship,
claims
6
experience,
color,
creed,
familial
status,
gender
identity,
7
genetic
information,
geography,
health
status,
immigration
8
status,
marital
status,
medical
condition,
medical
history,
9
mental
disability,
military
or
veteran
status,
national
origin,
10
physical
disability,
primary
language,
race,
receipt
of
health
11
care,
religion,
sex,
sexual
orientation,
or
source
of
income.
12
e.
Provision
of
health
care
services
under
the
healthy
13
Iowa
program
that
is
appropriate
to
the
patient’s
clinically
14
relevant
circumstances.
15
f.
Accessibility
of
care
coordination
and
health
care
16
services,
including
accessibility
for
people
with
disabilities
17
and
people
with
limited
ability
to
speak
or
understand
English.
18
g.
Providing
care
coordination
and
health
care
services
in
19
a
culturally
competent
manner.
20
4.
The
board
shall
adopt
rules
pursuant
to
chapter
17A
to
21
establish
requirements
and
standards,
to
the
extent
authorized
22
by
federal
law,
for
replacing
and
merging
with
the
healthy
23
Iowa
program
any
health
care
services
and
ancillary
services
24
currently
provided
by
other
programs,
including
but
not
limited
25
to
Medicare,
the
Affordable
Care
Act,
and
federally
matched
26
public
health
programs.
27
5.
a.
Any
participating
health
care
provider
or
care
28
coordinator
that
is
organized
as
a
for-profit
entity
shall
meet
29
the
same
requirements
and
standards
as
entities
organized
as
30
not-for-profit
entities.
31
b.
Payments
under
the
program
to
for-profit
entities
shall
32
not
be
calculated
to
accommodate
the
generation
of
profit,
33
excess
revenue,
revenue
for
dividends,
or
other
return
on
34
investment
or
the
payment
of
taxes
that
would
not
be
paid
by
a
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not-for-profit
entity.
1
6.
a.
A
participating
health
care
provider
shall
do
all
of
2
the
following:
3
(1)
Furnish
information
as
required
by
the
department
of
4
public
health,
including
the
public
health
data
management
5
program.
6
(2)
Permit
examination
of
information
by
the
healthy
Iowa
7
program
as
may
be
reasonably
required
for
purposes
of
reviewing
8
accessibility
and
utilization
of
health
care
services,
quality
9
assurance,
cost
containment,
the
making
of
payments,
and
10
statistical
or
other
studies
of
the
operation
of
the
healthy
11
Iowa
program
or
for
protection
and
promotion
of
public,
12
environmental,
and
occupational
health.
13
b.
The
board
shall
use
data
collected
under
this
subsection
14
to
ensure
that
clinical
practices
meet
the
utilization,
15
quality,
and
access
standards
of
the
healthy
Iowa
program.
16
7.
In
developing
requirements
and
standards
and
making
17
other
policy
determinations
under
this
chapter,
the
board
18
shall
consult
with
representatives
of
members,
health
care
19
providers,
care
coordinators,
health
care
organizations,
labor
20
organizations
representing
health
care
provider
employees,
and
21
other
interested
parties.
22
Sec.
20.
NEW
SECTION
.
135E.20
Advocacy
for
necessary
health
23
care.
24
1.
As
part
of
a
health
care
provider’s
duty
to
exercise
25
a
professional
standard
of
care
when
evaluating
a
patient’s
26
medical
condition,
a
participating
health
care
provider
under
27
the
healthy
Iowa
program
shall
do
all
of
the
following:
28
a.
Advocate
for
medically
necessary
health
care
services
for
29
the
provider’s
patients.
30
b.
Act
in
the
exclusive
interest
of
patients.
31
2.
Consistent
with
subsection
1
and
with
professional
32
standards
of
care
under
title
IV,
a
patient’s
treating
33
physician
or
health
care
provider
is
responsible
for
the
34
determination
of
the
health
care
services
medically
necessary
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for
the
patient.
1
3.
Consistent
with
subsection
1
and
with
professional
2
standards
of
care
under
title
IV,
title
VI,
and
title
XIII,
3
care
coordinators
and
health
care
providers
shall
use
4
reasonable
care
and
diligence
in
safeguarding
their
patients
5
and
shall
not
impair
any
health
care
provider’s
duty
to
6
advocate
for
medically
appropriate
health
care
services
for
7
patients.
8
4.
Consistent
with
subsection
1
and
with
professional
9
standards
of
care
under
title
IV,
title
VI,
and
title
XIII,
any
10
pecuniary
interest
or
relationship
of
a
physician
or
health
11
care
provider,
including
any
interest
or
relationship
disclosed
12
or
reported
under
this
section,
that
impairs
the
physician’s
or
13
health
care
provider’s
ability
to
provide
medically
necessary
14
health
care
services
to
a
patient
violates
the
physician’s
or
15
health
care
provider’s
duty
to
advocate
for
medically
necessary
16
health
care
services
for
patients.
17
5.
A
health
care
provider
violates
the
duty
to
provide
18
medically
necessary
care
services
under
this
section
if
the
19
health
care
provider
accepts
any
bonus,
incentive
payment,
or
20
compensation
based
on
any
of
the
following:
21
a.
A
patient’s
utilization
of
health
care
services.
22
b.
The
financial
results
of
any
other
health
care
provider
23
or
care
coordinator
with
which
the
health
care
provider
or
24
care
coordinator
has
a
pecuniary
interest
or
contractual
25
relationship,
including
employment
or
other
compensation-based
26
relationship.
27
c.
The
financial
results
of
any
health
maintenance
28
organization,
essential
community
providers,
or
group
medical
29
practices
that
receives
capitated
payments
from
the
healthy
30
Iowa
program.
31
6.
To
evaluate
and
review
compliance
by
participating
32
health
care
providers
and
care
coordinators
under
the
healthy
33
Iowa
program,
participating
health
care
providers
and
care
34
coordinators
shall
report,
at
least
annually,
to
the
department
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of
public
health’s
public
health
data
management
program
all
1
of
the
following:
2
a.
Any
beneficial
interest
in
or
compensation
arrangement
3
with
an
entity
to
which
the
participating
health
care
provider
4
referred
a
patient.
5
b.
Any
membership,
proprietary
interest,
or
co-ownership
in
6
any
form
in
or
with
a
clinical
or
bioanalytical
laboratory.
7
c.
Any
payments
to
a
clinical
or
bioanalytical
laboratory
8
for
a
test
or
test
series
for
a
patient.
9
d.
Any
profit-sharing
arrangement
with
a
clinical
or
10
bioanalytical
laboratory.
11
e.
Any
contracts
or
subcontracts
entered
into
that
contain
12
incentive
plans,
involve
general
payments
such
as
capitation
13
payments
or
shared
risk
agreements,
and
are
not
tied
to
14
specific
medical
decisions
involving
specific
members
or
groups
15
of
members
with
similar
medical
conditions.
Such
contracts
16
and
subcontracts
include
those
entered
into
with
a
health
17
maintenance
organization
or
group
practice.
18
f.
Any
bonus,
incentive
agreements,
or
compensation
19
arrangements
with
any
other
participating
health
care
provider,
20
care
coordinator,
health
maintenance
organization,
or
group
21
medical
practice
under
the
healthy
Iowa
program.
22
g.
Any
offer,
delivery,
receipt,
or
acceptance
of
rebates,
23
refunds,
commission,
preference,
patronage
dividend,
discount,
24
or
other
consideration
for
a
referral
made
when
treating
a
25
member
of
a
health
maintenance
organization,
to
another
health
26
care
provider
in
the
same
group
practice
as
the
referring
27
health
care
provider,
or
made
for
in-office
ancillary
services
28
or
tests
that
are
furnished
by
the
referring
health
care
29
provider,
a
person
in
the
same
group
practice
as
the
referring
30
health
care
provider,
or
an
individual
employed
or
supervised
31
by
the
referring
health
care
provider.
32
h.
Any
other
referral
or
relationship
that
the
board
finds
33
necessary
to
disclose
to
meet
the
purposes
of
this
section.
34
7.
The
board
may
adopt
rules
pursuant
to
chapter
17A
as
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necessary
to
implement
and
enforce
this
section
and
may
adopt
1
such
rules
to
expand
reporting
requirements
under
this
section.
2
Sec.
21.
NEW
SECTION
.
135E.21
Federal
waivers.
3
1.
The
board
shall
seek
all
federal
waivers
and
other
4
federal
approvals
and
arrangements
and
submit
federal
state
5
plan
amendments
as
necessary
to
operate
the
healthy
Iowa
6
program
consistent
with
this
chapter.
7
2.
a.
The
board
and,
as
appropriate,
the
director
of
human
8
services,
shall
apply
to
the
United
States
secretary
of
health
9
and
human
services
or
other
appropriate
federal
official
for
10
all
waivers
of
requirements,
and
make
other
arrangements
under
11
Medicare,
any
federally
matched
public
health
program,
the
12
Affordable
Care
Act,
and
any
other
federal
programs
pertaining
13
to
the
provision
of
health
care
that
provide
federal
funds
for
14
payment
for
health
care
services
that
are
necessary
to:
15
(1)
Enable
all
members
to
receive
all
benefits
through
the
16
healthy
Iowa
program.
17
(2)
Enable
the
state
to
implement
this
chapter.
18
(3)
Allow
the
state
to
receive
and
deposit
all
federal
19
payments
under
those
programs,
including
funds
that
may
20
be
provided
in
lieu
of
premium
tax
credits,
cost-sharing
21
subsidies,
and
small
business
tax
credits,
in
the
state
22
treasury
to
the
credit
of
the
healthy
Iowa
trust
fund.
23
(4)
Use
moneys
deposited
in
the
healthy
Iowa
trust
fund
24
for
the
healthy
Iowa
program
and
other
provisions
under
this
25
chapter.
26
b.
To
the
greatest
extent
possible,
the
board
shall
27
negotiate
arrangements
with
the
federal
government
to
ensure
28
that
federal
payments
are
paid
to
the
healthy
Iowa
program
in
29
place
of
federal
funding
of,
or
tax
benefits
for,
federally
30
matched
public
health
programs
or
federal
health
programs.
31
c.
(1)
The
board
may
require
members
or
applicants
to
32
provide
information
necessary
for
the
healthy
Iowa
program
to
33
comply
with
any
waiver
or
arrangement
under
this
chapter.
34
(2)
Information
provided
by
members
to
the
board
for
the
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purposes
of
this
paragraph
shall
not
be
used
for
any
other
1
purpose.
2
d.
The
board
may
take
any
additional
actions
necessary
to
3
effectively
implement
the
healthy
Iowa
program
to
the
maximum
4
extent
possible
as
a
single-payer
program
consistent
with
this
5
chapter.
6
3.
a.
The
board
may
take
actions
consistent
with
this
7
chapter
to
enable
the
healthy
Iowa
program
to
administer
8
Medicare
in
this
state.
9
b.
The
healthy
Iowa
program
shall
do
all
of
the
following:
10
(1)
Be
a
provider
of
Medicare
part
B
supplemental
insurance
11
coverage.
12
(2)
Provide
premium
assistance
drug
coverage
under
Medicare
13
part
D
for
eligible
members
of
the
healthy
Iowa
program.
14
4.
The
board
may
waive
or
modify
the
applicability
of
any
15
provisions
of
this
section
relating
to
any
federally
matched
16
public
health
program
or
Medicare,
as
necessary,
to
do
any
of
17
the
following:
18
a.
Implement
any
waiver
arrangement
under
this
section.
19
b.
Maximize
the
federal
benefits
to
the
healthy
Iowa
program
20
under
this
section.
21
5.
a.
The
board
may
apply
for
coverage
for,
and
enroll,
22
any
eligible
member
under
any
federally
matched
public
health
23
program
or
Medicare.
24
b.
Enrollment
in
a
federally
matched
public
health
program
25
or
Medicare
shall
not
cause
any
member
to
lose
any
health
care
26
services
provided
by
the
healthy
Iowa
program
or
diminish
any
27
right
the
member
would
otherwise
have.
28
6.
The
board
shall
take
necessary
action
to
incorporate
29
health
care
coverage
of
residents
who
are
employed
in
another
30
state
into
waivers
and
other
approvals
applied
for
or
obtained
31
under
this
section.
32
7.
a.
The
board
shall
take
necessary
action
to
reduce
or
33
eliminate
a
member’s
coinsurance,
cost-sharing,
or
premium
34
obligations
or
to
increase
the
likelihood
of
an
individual’s
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eligibility
for
any
federal
financial
support
related
to
1
Medicare
or
the
Affordable
Care
Act.
2
b.
The
board
may
act
under
paragraph
“a”
only
upon
a
3
finding
approved
by
the
board
that
the
action
does
all
of
the
4
following:
5
(1)
Helps
to
increase
the
number
of
members
who
are
eligible
6
for
and
enrolled
in
federally
matched
public
health
programs,
7
or
for
any
program
to
reduce
or
eliminate
an
individual’s
8
coinsurance,
cost-sharing,
or
premium
obligations
or
increase
9
an
individual’s
eligibility
for
any
federal
financial
support
10
related
to
Medicare
or
the
Affordable
Care
Act.
11
(2)
Does
not
diminish
any
individual’s
access
to
any
health
12
care
service
or
right
the
individual
would
otherwise
have.
13
(3)
Is
in
the
interest
of
the
healthy
Iowa
program.
14
(4)
Does
not
require
or
has
received
any
necessary
federal
15
waivers
or
approvals
to
ensure
federal
financial
participation.
16
c.
Action
that
the
board
may
take
under
paragraph
“a”
may
17
include
any
of
the
following:
18
(1)
An
increase
to
the
income
eligibility
level
related
to
19
Medicare
or
the
Affordable
Care
Act.
20
(2)
An
increase
to
resource
retention
or
an
elimination
of
21
the
resource
test
for
eligibility
related
to
Medicare
or
the
22
Affordable
Care
Act.
23
(3)
Simplification
of
any
procedural
or
documentation
24
requirement
for
enrollment
related
to
Medicare
or
the
25
Affordable
Care
Act.
26
(4)
An
increase
in
the
benefits
for
any
federally
matched
27
public
health
program
and
for
any
program
in
order
to
reduce
or
28
eliminate
an
individual’s
coinsurance,
cost-sharing,
or
premium
29
obligations
or
increase
an
individual’s
eligibility
for
any
30
federal
financial
support
related
to
Medicare
or
the
Affordable
31
Care
Act.
32
d.
Board
actions
under
this
subsection
shall
not
apply
to
33
eligibility
for
payment
for
long-term
care.
34
8.
To
enable
the
board
to
apply
for
coverage
for,
and
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enroll,
any
eligible
member
under
any
federally
matched
public
1
health
program
or
Medicare,
the
board
may
require
that
all
2
members
or
applicants
provide
the
information
necessary
to
3
enable
the
board
to
determine
whether
the
applicant
is
eligible
4
for
a
federally
matched
public
health
program
or
for
Medicare,
5
or
any
program
or
benefit
under
Medicare.
6
9.
As
a
condition
of
continued
eligibility
for
health
7
care
services
under
the
healthy
Iowa
program,
a
member
who
is
8
eligible
for
benefits
under
Medicare
shall
enroll
in
Medicare,
9
including
parts
A,
B,
and
D.
10
10.
a.
The
healthy
Iowa
program
shall
provide
premium
11
assistance
for
all
members
enrolling
in
a
Medicare
part
D
drug
12
coverage
plan
under
§1860D
of
Tit.
XVIII
of
the
federal
Social
13
Security
Act,
42
U.S.C.
§1395w-101
et
seq.
14
b.
Premium
assistance
required
under
paragraph
“a”
is
15
limited
to
the
low-income
benchmark
premium
amount
established
16
by
the
centers
for
Medicare
and
Medicaid
services
of
the
United
17
States
department
of
health
and
human
services
and
any
other
18
amount
the
federal
agency
establishes
under
its
de
minimis
19
premium
policy,
except
that
those
payments
made
on
behalf
of
20
members
enrolled
in
a
Medicare
advantage
plan
may
exceed
the
21
low-income
benchmark
premium
amount
if
determined
to
be
cost
22
effective
to
the
healthy
Iowa
program.
23
11.
a.
If
the
board
has
reasonable
grounds
to
believe
that
24
a
member
may
be
eligible
for
an
income-related
subsidy
under
25
§1860D-14
of
Tit.
XVIII
of
the
federal
Social
Security
Act,
42
26
U.S.C.
§1395w-114,
the
member
shall
be
required
to
provide
and
27
authorize
the
healthy
Iowa
program
to
obtain
any
information
or
28
documentation
required
to
establish
the
member’s
eligibility
29
for
that
subsidy.
30
b.
The
board
shall
attempt
to
obtain
as
much
of
the
31
information
and
documentation
required
by
paragraph
“a”
as
32
possible.
33
12.
a.
The
healthy
Iowa
program
shall
make
a
reasonable
34
effort
to
notify
members
of
their
obligations
under
this
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section.
1
b.
After
a
reasonable
effort
has
been
made
to
contact
the
2
member,
the
member
shall
be
notified
in
writing
that
the
member
3
has
sixty
days
to
provide
the
required
information.
4
c.
If
the
required
information
is
not
provided
within
the
5
sixty-day
period,
the
member’s
coverage
under
the
healthy
Iowa
6
program
may
be
terminated.
7
d.
Information
provided
by
members
to
the
board
for
the
8
purposes
of
this
section
shall
not
be
used
for
any
other
9
purpose.
10
13.
The
board
shall
assume
responsibility
for
all
benefits
11
and
health
care
services
paid
for
by
the
federal
government
12
with
those
funds.
13
Sec.
22.
NEW
SECTION
.
135E.22
Healthy
Iowa
trust
fund
——
14
special
fund
created.
15
1.
A
special
fund
is
created
in
the
state
treasury,
separate
16
and
apart
from
all
other
public
moneys
or
funds
of
this
state,
17
to
be
known
as
the
healthy
Iowa
trust
fund.
The
fund
shall
18
consist
of
all
of
the
following:
19
a.
All
moneys
appropriated
by
the
state
to
the
fund.
20
b.
All
moneys
received
from
the
federal
government,
as
21
the
result
of
any
waiver
of
requirements
granted
or
other
22
arrangements
agreed
to
by
the
federal
government
for
health
23
care
programs.
24
c.
All
moneys
transferred
to
the
fund
attributable
to
state
25
and
federal
financial
participation
in
Medicaid,
the
healthy
26
and
well
kids
in
Iowa
program,
and
Medicare.
27
d.
All
receipts
and
revenue
after
January
1,
2018,
as
a
28
result
of
the
collection
of
taxes
or
other
moneys,
as
provided
29
by
law,
shall
also
be
deposited
in
the
healthy
Iowa
trust
fund.
30
e.
All
federal
and
state
moneys
received
for
purposes
of
the
31
provision
of
services
authorized
under
Tit.
XX
of
the
federal
32
Social
Security
Act,
42
U.S.C.
§1397
et
seq.,
but
are
provided
33
under
the
healthy
Iowa
program.
34
f.
All
moneys
received
from
other
federal
programs
that
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provide
moneys
for
the
payment
of
health
care
services
that
are
1
provided
under
this
chapter.
2
g.
All
moneys
paid
by
the
state
that
are
equivalent
to
those
3
amounts
that
are
paid
on
behalf
of
residents
under
Medicare,
4
any
federally
matched
public
health
program,
or
the
Affordable
5
Care
Act
for
health
benefits
that
are
equivalent
to
health
6
benefits
covered
under
the
healthy
Iowa
program.
7
2.
All
moneys
in
the
fund
shall
be
deposited,
administered,
8
and
disbursed,
in
the
same
manner
and
under
the
same
conditions
9
and
requirements
as
is
provided
by
law
for
special
funds
in
10
the
state
treasury.
The
moneys
credited
to
the
fund
are
not
11
subject
to
section
8.33
and
shall
not
be
transferred,
used,
12
obligated,
appropriated,
or
otherwise
encumbered
except
as
13
provided
in
this
section.
Moneys
deposited
into
the
fund
are
14
appropriated
and
made
available
to
the
healthy
Iowa
program
to
15
be
used
only
for
the
following
purposes
established
by
this
16
chapter:
17
a.
To
implement
the
purposes
of
the
healthy
Iowa
program.
18
b.
To
be
used
by
the
healthy
Iowa
program
for
the
payment
of
19
claims
or
reimbursement
of
member
benefits.
20
c.
To
be
used
by
the
healthy
Iowa
program
for
the
payment,
21
in
accordance
with
any
agreement
with
the
federal
government,
22
of
amounts
required
to
obtain
federal
waivers
and
such
other
23
purposes
under
the
healthy
Iowa
program
as
may
be
authorized
24
by
law.
25
3.
The
treasurer
of
state
is
the
custodian
and
trustee
of
26
the
fund
and
shall
administer
the
fund
in
accordance
with
the
27
purposes
of
the
healthy
Iowa
program.
It
is
the
duty
of
the
28
treasurer
of
state
to
do
all
of
the
following:
29
a.
To
hold
the
trust
funds.
30
b.
To
disburse
the
trust
funds
upon
warrants
drawn
by
the
31
director
of
the
healthy
Iowa
program.
32
4.
The
healthy
Iowa
program
shall
administer
the
healthy
33
Iowa
trust
fund
and
shall
also
administer
all
other
provisions
34
of
this
section.
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5.
All
moneys
in
the
fund,
except
moneys
received
1
pursuant
to
federal
waivers
entered
into
pursuant
to
section
2
135E.21,
which
are
received
from
the
federal
government
3
shall
be
expended
solely
for
the
purposes
and
in
the
amounts
4
found
necessary
by
the
board
for
the
proper
and
efficient
5
administration
of
this
chapter
and
any
federal
waivers
or
6
agreements.
7
6.
Moneys
deposited
in
the
fund
shall
not
be
loaned
to,
or
8
borrowed
by,
any
other
special
fund
or
the
general
fund
of
the
9
state,
or
a
county
general
fund
or
any
other
county
fund.
10
7.
The
board
shall
establish
and
maintain
a
reserve
fund
in
11
the
healthy
Iowa
trust
fund.
12
8.
The
board
or
staff
of
the
board
shall
not
utilize
any
13
moneys
intended
for
the
administrative
and
operational
expenses
14
of
the
board
for
staff
retreats,
promotional
giveaways,
15
excessive
executive
compensation,
or
promotion
of
federal
or
16
state
legislative
or
regulatory
modifications.
17
9.
a.
A
healthy
Iowa
federal
funds
account
is
created
18
within
the
fund.
19
b.
All
federal
moneys
received
shall
be
placed
into
the
20
healthy
Iowa
federal
funds
account.
21
Sec.
23.
NEW
SECTION
.
135E.23
Severability.
22
If
any
provision
of
this
chapter
or
its
application
to
any
23
person
or
circumstance
is
held
invalid,
the
invalidity
does
24
not
affect
other
provisions
or
application
of
this
chapter
25
which
can
be
given
effect
without
the
invalid
provision
or
26
application,
and
to
this
end
the
provisions
of
this
chapter
are
27
severable.
28
Sec.
24.
NEW
SECTION
.
135E.24
Relation
to
other
laws.
29
This
chapter
does
not
preempt
or
prevail
over
and
is
30
not
meant
to
be
construed
to
preempt
or
prevail
over
any
31
ordinances,
resolutions,
or
other
actions
of
a
local
government
32
or
rules
or
actions
of
a
state
agency
that
are
consistent
with
33
this
chapter
or
that
provide
more
protections
and
benefits
to
34
residents
of
this
state
than
this
chapter
or
are
more
stringent
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than
this
chapter.
1
Sec.
25.
NEW
SECTION
.
135F.1
Definitions.
2
As
used
in
this
chapter,
unless
the
context
otherwise
3
requires:
4
1.
a.
“Health
care
provider”
means
a
person
who
meets
all
5
of
the
following
criteria:
6
(1)
Is
licensed,
certified,
registered,
or
authorized
to
7
practice
a
health
care
profession
in
the
state
pursuant
to
8
chapter
147A,
148,
148A,
148B,
148C,
148E,
148F,
148G,
149,
9
151,
152,
152A,
152B,
152C,
153,
154,
154A,
154B,
154C,
154D,
10
154F,
155,
or
155A.
11
(2)
Is
an
approved
health
care
provider
under
the
healthy
12
Iowa
program
created
in
chapter
135E.
13
(3)
Is
an
individual
who
does
any
of
the
following:
14
(a)
Practices
the
profession
in
which
that
person
is
15
licensed,
certified,
registered,
or
authorized
to
practice
16
in
the
state
as
a
health
care
provider
or
as
an
independent
17
contractor.
18
(b)
Is
an
owner,
officer,
shareholder,
or
proprietor
of
a
19
health
care
provider.
20
(c)
Is
an
entity
that
employs
or
utilizes
health
care
21
providers
to
provide
health
care
services
under
the
healthy
22
Iowa
program.
23
b.
“Health
care
provider”
does
not
include
an
individual
who
24
practices
as
an
employee
of
another
health
care
provider.
25
2.
“Health
care
provider
representative”
means
a
third
party
26
that
is
authorized
by
a
health
care
provider
to
negotiate
27
on
behalf
of
the
health
care
provider
with
the
healthy
Iowa
28
program
over
terms
and
conditions
of
participation
affecting
29
those
health
care
providers.
30
Sec.
26.
NEW
SECTION
.
135F.2
Collective
negotiation
31
authorized.
32
1.
Health
care
providers
may
meet
and
communicate
for
the
33
purpose
of
collectively
negotiating
with
the
healthy
Iowa
34
program
on
any
matter
relating
to
the
healthy
Iowa
program
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including
but
not
limited
to
rates
of
payment
for
health
care
1
services,
rates
of
payment
for
prescription
and
nonprescription
2
drugs,
and
payment
methodologies.
3
2.
This
chapter
shall
not
be
construed,
is
not
intended
to
4
be
construed,
and
shall
not
imply
any
of
the
following:
5
a.
To
allow
or
authorize
an
alteration
of
the
terms
of
the
6
internal
and
external
review
procedures
set
forth
in
law.
7
b.
To
allow
a
strike
by
health
care
providers
related
to
the
8
collective
negotiations
under
the
healthy
Iowa
program.
9
c.
To
allow
or
authorize
terms
or
conditions
of
10
participation
that
would
impede
the
ability
of
the
healthy
11
Iowa
program
to
obtain
or
retain
accreditation
by
the
national
12
committee
for
quality
assurance
or
a
similar
body,
or
to
comply
13
with
applicable
state
or
federal
law.
14
Sec.
27.
NEW
SECTION
.
135F.3
Collective
negotiation
——
15
requirements.
16
1.
A
health
care
provider
representative
is
the
only
party
17
authorized
to
negotiate
with
the
healthy
Iowa
program
on
behalf
18
of
the
health
care
providers
as
a
group.
19
2.
A
health
care
provider
shall
be
bound
by
the
terms
20
and
conditions
negotiated
by
the
health
care
provider
21
representative.
22
3.
Health
care
providers
have
the
right
during
collective
23
negotiations
under
this
chapter
to
communicate
with
other
24
health
care
providers
regarding
the
terms
and
conditions
of
25
participation
to
be
negotiated
with
the
healthy
Iowa
program
26
and
to
communicate
with
health
care
provider
representatives.
27
4.
The
healthy
Iowa
program
may
communicate
or
negotiate
28
with
the
health
care
provider
representative,
and
may
offer
29
and
provide
different
terms
and
conditions
of
participation
to
30
individual
competing
health
care
providers.
31
5.
This
section
shall
not
be
construed,
is
not
intended
to
32
be
construed
to,
and
shall
not
imply
any
of
the
following:
33
a.
An
effect
on
or
limitation
to
the
right
of
a
health
care
34
provider
or
group
of
health
care
providers
to
collectively
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petition
a
governmental
entity
for
a
change
in
a
law,
rule,
or
1
regulation.
2
b.
An
effect
on
or
limitation
to
collective
bargaining
3
on
the
part
of
a
health
care
provider
with
the
health
care
4
provider’s
employer
or
any
other
lawful
collective
bargaining.
5
6.
Before
engaging
in
collective
negotiations
with
the
6
healthy
Iowa
program
on
behalf
of
health
care
providers,
a
7
health
care
provider
representative
shall
file
with
the
board,
8
in
the
manner
prescribed
by
the
board,
all
of
the
following
9
information:
10
a.
The
name
of
the
representative.
11
b.
The
representative’s
plan
of
operation.
12
c.
The
representative’s
procedures
to
ensure
compliance
with
13
this
chapter.
14
7.
a.
A
person
who
acts
as
the
representative
of
15
negotiating
parties
under
this
chapter
shall
pay
a
fee
to
the
16
board
to
act
as
a
representative.
17
b.
The
board
shall
set
fees
in
amounts
deemed
reasonable
18
and
necessary
to
cover
the
costs
incurred
by
the
board
in
19
administering
this
chapter.
20
Sec.
28.
NEW
SECTION
.
135F.4
Health
care
providers
——
21
prohibited
collective
action.
22
1.
This
chapter
shall
not
authorize
competing
health
care
23
providers
to
act
in
concert
in
response
to
discussions
or
24
negotiations
of
a
health
care
provider
representative
with
the
25
healthy
Iowa
program,
except
as
authorized
by
other
law.
26
2.
A
health
care
provider
representative
shall
not
27
negotiate
any
agreement
that
excludes,
limits
the
participation
28
or
reimbursement
of,
or
otherwise
limits
the
scope
of
health
29
care
services
to
be
provided
by
any
health
care
provider
or
30
group
of
health
care
providers
with
respect
to
the
performance
31
of
health
care
services
that
are
within
the
health
care
32
provider’s
scope
of
practice,
license,
registration,
or
33
certification.
34
Sec.
29.
NEW
SECTION
.
135F.5
Severability.
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If
any
provision
of
this
chapter
or
its
application
to
any
1
person
or
circumstance
is
held
invalid,
the
invalidity
does
2
not
affect
other
provisions
or
application
of
this
chapter
3
which
can
be
given
effect
without
the
invalid
provision
or
4
application,
and
to
this
end
the
provisions
of
this
chapter
are
5
severable.
6
Sec.
30.
NEW
SECTION
.
135F.6
Relation
to
other
laws.
7
This
chapter
does
not
preempt
or
prevail
over
and
is
8
not
meant
to
be
construed
to
preempt
or
prevail
over
any
9
ordinances,
resolutions,
or
other
actions
of
a
local
government
10
or
rules
or
actions
of
a
state
agency
that
are
consistent
with
11
this
chapter
or
that
provide
more
protections
and
benefits
to
12
Iowa
residents
than
this
chapter
or
are
more
stringent
than
13
this
chapter.
14
Sec.
31.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
15
immediate
importance,
takes
effect
upon
enactment.
16
Sec.
32.
CONTINGENT
IMPLEMENTATION.
Implementation
of
this
17
Act
is
contingent
upon
sufficient
revenue
in
the
healthy
Iowa
18
trust
fund
to
bear
the
costs
of
implementing
the
healthy
Iowa
19
program,
as
determined
by
the
director
of
human
services.
The
20
director
of
human
services
shall
notify
the
secretary
of
the
21
senate,
the
chief
clerk
of
the
house
of
representatives,
and
22
the
Iowa
Code
editor,
in
writing
when
the
healthy
Iowa
trust
23
fund
has
sufficient
revenue
to
bear
the
costs
of
implementing
24
this
Act.
The
department
of
human
services
shall
publish
a
25
copy
of
the
notice
on
its
internet
site.
26
EXPLANATION
27
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
28
the
explanation’s
substance
by
the
members
of
the
general
assembly.
29
This
bill
creates
new
Code
chapter
135E,
establishing
the
30
healthy
Iowa
program,
which
provides
comprehensive,
universal
31
single-payer
health
care
coverage
and
a
health
care
cost
32
control
system
for
all
residents
of
Iowa.
The
bill
provides
33
that
all
residents
of
the
state
are
eligible
to
be
members
of
34
the
healthy
Iowa
program
and
are
eligible
to
receive
health
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care
services
benefits
under
the
program.
The
bill
requires
1
that
the
healthy
Iowa
program
provide
all
members
of
the
2
program
with
certain
health
care
services,
and
incorporate
the
3
health
care
benefits
and
standards
of
other
existing
federal
4
and
state
programs.
The
bill
prohibits
health
care
providers
5
participating
in
the
healthy
Iowa
program
from
refusing
to
6
provide
services
to
a
member
on
the
basis
of
certain
protected
7
categories.
The
bill
establishes
the
healthy
Iowa
board
and
8
public
advisory
committee.
9
The
bill
provides
that
health
care
coverage
under
the
10
healthy
Iowa
program
shall
not
be
subject
to
coinsurance,
11
deductibles,
or
copayments.
The
bill
prohibits
certain
12
insurers,
nonprofit
health
service
plans,
and
health
13
maintenance
organizations
from
offering
benefits
that
duplicate
14
the
services
covered
by
the
program.
The
bill
prohibits
health
15
insurers
from
offering
health
benefits
covering
any
health
care
16
service
for
which
coverage
is
offered
to
individuals
under
17
the
healthy
Iowa
program,
except
as
otherwise
provided,
and
18
prohibits
a
participating
health
care
provider
from
imposing
19
charges
directly
on
healthy
Iowa
members.
20
The
bill
provides
for
approval
of
participating
health
21
care
providers
and
care
coordinators
under
the
program
and
22
provides
for
enrollment
of
residents
in
the
program.
The
bill
23
also
provides
that
healthy
Iowa
program
members
may
choose
a
24
participating
health
care
provider
and
requires
that
members
25
select
a
care
coordinator.
26
The
bill
specifies
healthy
Iowa
program
standards
and
27
payment
for
health
care
services
and
care
coordination,
and
28
requires
that
the
program
provide
reimbursements
to
certain
29
members.
The
bill
establishes
a
health
benefit
credit
for
30
certain
employers
and
residents.
31
The
bill
establishes
the
healthy
Iowa
trust
fund
as
a
special
32
fund
for
the
purpose
of
implementing
the
program
and
its
33
purposes.
The
bill
requires
the
board
and
the
department
of
34
human
services
to
apply
to
the
federal
government
for
waivers
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and
other
approvals
relating
to
federally
regulated
health
care
1
programs.
2
The
bill
also
creates
new
chapter
135F
providing
for
3
collective
negotiations
between
health
care
providers
and
4
the
healthy
Iowa
program.
The
bill
authorizes
health
care
5
providers
to
collectively
negotiate
with
the
program
for
6
rates
of
payment
for
health
care
services,
rates
of
payment
7
for
prescription
and
nonprescription
drugs,
and
payment
8
methodologies
using
a
third-party
representative.
9
Implementation
of
the
bill
is
contingent
upon
sufficient
10
revenue
in
the
healthy
Iowa
trust
fund
to
bear
the
costs
of
11
implementing
the
healthy
Iowa
program
as
determined
by
the
12
director
of
human
services.
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