House File 2462 - Introduced HOUSE FILE 2462 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HSB 632) A BILL FOR An Act relating to programs and activities under the purview of 1 the department of human services. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5317HV (4) 87 pf/rh

H.F. 2462 DIVISION I 1 HEALTHY AND WELL KIDS IN IOWA —— DIRECTOR DUTIES 2 Section 1. Section 514I.4, subsection 5, Code 2018, is 3 amended by adding the following new paragraphs: 4 NEW PARAGRAPH . d. Collect and track monthly family premiums 5 to assure that payments are current. 6 NEW PARAGRAPH . e. Verify the number of program enrollees 7 with each participating insurer for determination of the amount 8 of premiums to be paid to each participating insurer. 9 Sec. 2. Section 514I.7, subsection 2, paragraphs g and i, 10 Code 2018, are amended by striking the paragraphs. 11 DIVISION II 12 SHARING OF INCARCERATION DATA 13 Sec. 3. Section 249A.38, Code 2018, is amended to read as 14 follows: 15 249A.38 Inmates of public institutions —— suspension or 16 termination of medical assistance. 17 1. The following conditions shall apply to Following the 18 first thirty days of commitment, the department shall suspend 19 the eligibility of an individual who is an inmate of a public 20 institution as defined in 42 C.F.R. §435.1010 , who is enrolled 21 in the medical assistance program at the time of commitment to 22 the public institution, and who remains eligible for medical 23 assistance as an individual except for the individual’s 24 institutional status : 25 a. The department shall suspend the individual’s 26 eligibility for up to the initial twelve months of the period 27 of commitment. The department shall delay the suspension 28 of eligibility for a period of up to the first thirty days 29 of commitment if such delay is approved by the centers for 30 Medicare and Medicaid services of the United States department 31 of health and human services. If such delay is not approved, 32 the department shall suspend eligibility during the entirety 33 of the initial twelve months of the period of commitment. 34 Claims submitted on behalf of the individual under the medical 35 -1- LSB 5317HV (4) 87 pf/rh 1/ 7

H.F. 2462 assistance program for covered services provided during the 1 delay period shall only be reimbursed if federal financial 2 participation is applicable to such claims. 3 b. The department shall terminate an individual’s 4 eligibility following a twelve-month period of suspension 5 of the individual’s eligibility under paragraph “a” , during 6 the period of the individual’s commitment to the public 7 institution . 8 2. a. A public institution shall provide the department and 9 the social security administration with a monthly report of the 10 individuals who are committed to the public institution and of 11 the individuals who are discharged from the public institution. 12 The monthly report to the department shall include the date 13 of commitment or the date of discharge, as applicable, of 14 each individual committed to or discharged from the public 15 institution during the reporting period. The monthly report 16 shall be made through the reporting system created by the 17 department for public, nonmedical institutions to report inmate 18 populations. Any medical assistance expenditures, including 19 but not limited to monthly managed care capitation payments, 20 provided on behalf of an individual who is an inmate of a 21 public institution but is not reported to the department 22 in accordance with this subsection, shall be the financial 23 responsibility of the respective public institution. 24 b. The department shall provide a public institution with 25 the forms necessary to be used by the individual in expediting 26 restoration of the individual’s medical assistance benefits 27 upon discharge from the public institution. 28 3. This section applies to individuals as specified in 29 subsection 1 on or after January 1, 2012. 30 4. 3. The department may adopt rules pursuant to chapter 31 17A to implement this section. 32 DIVISION III 33 MEDICAID PROGRAM ADMINISTRATION 34 Sec. 4. MEDICAID PROGRAM. It is the intent of the general 35 -2- LSB 5317HV (4) 87 pf/rh 2/ 7

H.F. 2462 assembly to promote the effective and efficient administration 1 of the Medicaid program through data-driven policymaking and 2 prudent oversight. 3 DIVISION IV 4 MEDICAID PROGRAM PHARMACY COPAYMENT 5 Sec. 5. 2005 Iowa Acts, chapter 167, section 42, is amended 6 to read as follows: 7 SEC. 42. COPAYMENTS FOR PRESCRIPTION DRUGS UNDER THE 8 MEDICAL ASSISTANCE PROGRAM. The department of human services 9 shall require recipients of medical assistance to pay the 10 following copayments a copayment of $1 on each prescription 11 filled for a covered prescription drug, including each refill 12 of such prescription , as follows: 13 1. A copayment of $1 on each prescription filled for each 14 covered nonpreferred generic prescription drug. 15 2. A copayment of $1 for each covered preferred brand–name 16 or generic prescription drug. 17 3. A copayment of $1 for each covered nonpreferred 18 brand–name prescription drug for which the cost to the state is 19 up to and including $25. 20 4. A copayment of $2 for each covered nonpreferred 21 brand–name prescription drug for which the cost to the state is 22 more than $25 and up to and including $50. 23 5. A copayment of $3 for each covered nonpreferred 24 brand–name prescription drug for which the cost to the state 25 is more than $50 . 26 DIVISION V 27 MEDICAL ASSISTANCE ADVISORY COUNCIL 28 Sec. 6. Section 249A.4B, subsection 2, paragraph a, 29 subparagraphs (27) and (28), Code 2018, are amended by striking 30 the subparagraphs. 31 Sec. 7. MEDICAL ASSISTANCE ADVISORY COUNCIL —— REVIEW OF 32 MEDICAID MANAGED CARE REPORT DATA. The executive committee 33 of the medical assistance advisory council shall review 34 the data collected and analyzed for inclusion in periodic 35 -3- LSB 5317HV (4) 87 pf/rh 3/ 7

H.F. 2462 reports to the general assembly, including but not limited 1 to the information and data specified in 2016 Iowa Acts, 2 chapter 1139, section 93, to determine which data points and 3 information should be included and analyzed to more accurately 4 identify trends and issues with, and promote the effective and 5 efficient administration of, Medicaid managed care for all 6 stakeholders. At a minimum, the areas of focus shall include 7 consumer protection, provider network access and safeguards, 8 outcome achievement, and program integrity. The executive 9 committee shall report its findings and recommendations to the 10 medical assistance advisory council for review and comment by 11 October 1, 2018, and shall submit a final report of findings 12 and recommendations to the governor and the general assembly by 13 December 31, 2018. 14 DIVISION VI 15 TARGETED CASE MANAGEMENT AND INPATIENT PSYCHIATRIC SERVICES 16 REIMBURSEMENT 17 Sec. 8. Section 249A.31, Code 2018, is amended to read as 18 follows: 19 249A.31 Cost-based reimbursement. 20 1. Providers of individual case management services for 21 persons with an intellectual disability, a developmental 22 disability, or chronic mental illness shall receive cost-based 23 reimbursement for one hundred percent of the reasonable 24 costs for the provision of the services in accordance with 25 standards adopted by the mental health and disability services 26 commission pursuant to section 225C.6 . Effective July 1, 2018, 27 targeted case management services shall be reimbursed based 28 on a statewide fee schedule amount developed by rule of the 29 department pursuant to chapter 17A. 30 2. Effective July 1, 2010 2014 , the department shall apply 31 a cost-based reimbursement methodology for reimbursement of 32 psychiatric medical institution for children providers of 33 inpatient psychiatric services for individuals under twenty-one 34 years of age shall be reimbursed as follows: 35 -4- LSB 5317HV (4) 87 pf/rh 4/ 7

H.F. 2462 a. For non-state-owned providers, services shall be 1 reimbursed according to a fee schedule without reconciliation . 2 b. For state-owned providers, services shall be reimbursed 3 at one hundred percent of the actual and allowable cost of 4 providing the service. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill relates to programs and activities under the 9 purview of the department of human services (DHS). The bill is 10 organized into divisions. 11 Division I of the bill relates to the healthy and well 12 kids in Iowa (hawk-i) program by transferring two duties of 13 the administrative contractor, the capitation process and 14 member premium collection, to DHS through the Iowa Medicaid 15 enterprise. 16 Division II of the bill relates to suspension of Medicaid 17 relating to inmates of public institutions. The bill requires 18 DHS to suspend eligibility of an individual following the first 19 30 days of the individual’s commitment to the institution. The 20 bill also requires public institutions to provide a monthly 21 report of the individuals who are committed to the public 22 institution and of the individuals who are discharged from 23 the public institution to DHS and to the social security 24 administration. The report to DHS is required to include 25 the date of commitment or discharge, as applicable, of 26 each individual committed to or discharged from the public 27 institution during the reporting period, and the report is to 28 be made through the reporting system created by DHS for public, 29 nonmedical institutions to report inmate populations. Any 30 medical assistance expenditures, including but not limited to 31 monthly managed care capitation payments, provided on behalf of 32 an individual who is an inmate of a public institution but is 33 not reported as required, shall be the financial responsibility 34 of the respective public institution. 35 -5- LSB 5317HV (4) 87 pf/rh 5/ 7

H.F. 2462 Division III of the bill relates to Medicaid provision 1 administration and provides that it is the intent of the 2 general assembly to promote the effective and efficient 3 administration of the Medicaid program through data-driven 4 policymaking and provider oversight. 5 Division IV of the bill eliminates the various copayments 6 for a covered prescription drug under the Medicaid program 7 based upon the prescription drug’s status, and instead provides 8 that a recipient of Medicaid is required to pay a copayment of 9 $1 on each prescription filled for a covered prescription drug, 10 including each refill of such prescription. 11 Division V of the bill relates to the medical assistance 12 advisory council (MAAC). The bill directs the executive 13 committee of MAAC to review data collected and analyzed in 14 periodic reports to the general assembly to determine which 15 data points should be included and analyzed to more accurately 16 identify trends and issues with, and promote the effective and 17 efficient administration of, Medicaid managed care for all 18 stakeholders. The executive committee is required to report 19 its findings and recommendations to the MAAC for review and 20 comment by October 1, 2018, and to submit a final report to the 21 governor and the general assembly by December 31, 2018. 22 Division VI of the bill amends the reimbursement provision 23 for targeted case management services under the Medicaid 24 program which is currently established as cost-based 25 reimbursement for 100 percent of the reasonable costs for 26 provision of the services. Under the bill, effective July 27 1, 2018, targeted case management services will instead be 28 reimbursed based on a statewide fee schedule amount developed 29 by rule of the department in accordance with Code chapter 17A. 30 This division of the bill also amends the reimbursement 31 provision for psychiatric medical institutions for children to 32 provide that inpatient psychiatric services for individuals 33 under 21 years of age that are provided by non-state-owned 34 providers shall be reimbursed according to a fee schedule 35 -6- LSB 5317HV (4) 87 pf/rh 6/ 7

H.F. 2462 without reconciliation and for state-owned providers shall be 1 reimbursed at 100 percent of the actual and allowable cost of 2 providing the service. 3 -7- LSB 5317HV (4) 87 pf/rh 7/ 7