House
File
393
-
Introduced
HOUSE
FILE
393
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HSB
25)
A
BILL
FOR
An
Act
relating
to
programs
and
activities
under
the
purview
1
of
the
department
of
public
health,
and
including
effective
2
date
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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DIVISION
I
1
PROGRAM
FLEXIBILITY
AND
EFFICIENCIES
2
Section
1.
Section
125.59,
subsection
1,
paragraph
b,
Code
3
2017,
is
amended
to
read
as
follows:
4
b.
If
the
transferred
amount
for
this
subsection
exceeds
5
grant
requests
funded
to
the
ten
thousand
dollar
maximum,
the
6
Iowa
department
of
public
health
may
use
the
remainder
for
7
activities
and
public
information
resources
that
align
with
8
best
practices
for
substance-related
disorder
prevention
or
to
9
increase
grants
pursuant
to
subsection
2
.
10
Sec.
2.
Section
135.11,
subsection
31,
Code
2017,
is
amended
11
by
striking
the
subsection.
12
Sec.
3.
Section
135.150,
subsection
2,
Code
2017,
is
amended
13
to
read
as
follows:
14
2.
The
department
shall
report
semiannually
annually
to
the
15
general
assembly’s
standing
committees
on
government
oversight
16
regarding
the
operation
of
the
gambling
treatment
program.
17
The
report
shall
include
but
is
not
limited
to
information
on
18
the
moneys
expended
and
grants
awarded
for
operation
of
the
19
gambling
treatment
program.
20
DIVISION
II
21
MEDICAL
HOME
AND
PATIENT-CENTERED
HEALTH
ADVISORY
COUNCIL
22
Sec.
4.
Section
135.15,
Code
2017,
is
amended
by
adding
the
23
following
new
subsection:
24
NEW
SUBSECTION
.
6.
For
the
purposes
of
this
section,
25
“dental
home”
means
a
network
of
individualized
care
based
on
26
risk
assessment,
which
includes
oral
health
education,
dental
27
screenings,
preventive
services,
diagnostic
services,
treatment
28
services,
and
emergency
services.
29
Sec.
5.
Section
135.159,
Code
2017,
is
amended
by
striking
30
the
section
and
inserting
in
lieu
thereof
the
following:
31
135.159
Patient-centered
health
advisory
council.
32
1.
The
department
shall
establish
a
patient-centered
health
33
advisory
council
which
shall
include
but
is
not
limited
to
34
all
of
the
following
members,
selected
by
their
respective
35
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organizations,
and
any
other
members
the
department
determines
1
necessary:
2
a.
The
director
of
human
services,
or
the
director’s
3
designee.
4
b.
The
commissioner
of
insurance,
or
the
commissioner’s
5
designee.
6
c.
A
representative
of
the
federation
of
Iowa
insurers.
7
d.
A
representative
of
the
Iowa
dental
association.
8
e.
A
representative
of
the
Iowa
nurses
association.
9
f.
A
physician
and
an
osteopathic
physician
licensed
10
pursuant
to
chapter
148
who
are
family
physicians
and
members
11
of
the
Iowa
academy
of
family
physicians.
12
g.
A
health
care
consumer.
13
h.
A
representative
of
the
Iowa
collaborative
safety
net
14
provider
network
established
pursuant
to
section
135.153.
15
i.
A
representative
of
the
Iowa
developmental
disabilities
16
council.
17
j.
A
representative
of
the
Iowa
chapter
of
the
American
18
academy
of
pediatrics.
19
k.
A
representative
of
the
child
and
family
policy
center.
20
l.
A
representative
of
the
Iowa
pharmacy
association.
21
m.
A
representative
of
the
Iowa
chiropractic
society.
22
n.
A
representative
of
the
university
of
Iowa
college
of
23
public
health.
24
o.
A
certified
palliative
care
physician.
25
2.
The
patient-centered
health
advisory
council
may
utilize
26
the
assistance
of
other
relevant
public
health
and
health
care
27
expertise
when
necessary
to
carry
out
the
council’s
purposes
28
and
responsibilities.
29
3.
A
public
member
of
the
patient-centered
health
advisory
30
council
shall
receive
reimbursement
for
actual
expenses
31
incurred
while
serving
in
the
member’s
official
capacity
32
only
if
the
member
is
not
eligible
for
reimbursement
by
the
33
organization
the
member
represents.
34
4.
The
purposes
of
the
patient-centered
health
advisory
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council
shall
include
all
of
the
following:
1
a.
To
serve
as
a
resource
on
emerging
health
care
2
transformation
initiatives
in
Iowa.
3
b.
To
convene
stakeholders
in
Iowa
to
streamline
efforts
4
that
support
state-level
and
community-level
integration
and
5
focus
on
reducing
fragmentation
of
the
health
care
system.
6
c.
To
encourage
partnerships
and
synergy
between
community
7
health
care
partners
in
the
state
who
are
working
on
new
8
system-level
models
to
provide
better
health
care
at
lower
9
costs
by
focusing
on
shifting
from
volume-based
to
value-based
10
health
care.
11
d.
To
lead
discussions
on
the
transformation
of
the
12
health
care
system
to
a
patient-centered
infrastructure
that
13
integrates
and
coordinates
services
and
supports
to
address
14
social
determinants
of
health
and
to
meet
population
health
15
goals.
16
e.
To
provide
a
venue
for
education
and
information
17
gathering
for
stakeholders
and
interested
parties
to
learn
18
about
emerging
health
care
initiatives
across
the
state.
19
f.
To
develop
recommendations
for
submission
to
the
20
department
related
to
health
care
transformation
issues.
21
Sec.
6.
Section
249N.2,
subsections
15
and
19,
Code
2017,
22
are
amended
to
read
as
follows:
23
15.
“Medical
home”
means
medical
home
as
defined
in
24
section
135.157
.
a
team
approach
to
providing
health
care
that
25
originates
in
a
primary
care
setting;
fosters
a
partnership
26
among
the
patient,
the
personal
provider,
and
other
health
care
27
professionals,
and
where
appropriate,
the
patient’s
family;
28
utilizes
the
partnership
to
access
and
integrate
all
medical
29
and
nonmedical
health-related
services
across
all
elements
of
30
the
health
care
system
and
the
patient’s
community
as
needed
by
31
the
patient
and
the
patient’s
family
to
achieve
maximum
health
32
potential;
maintains
a
centralized,
comprehensive
record
of
all
33
health-related
services
to
promote
continuity
of
care;
and
has
34
all
of
the
following
characteristics:
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a.
A
personal
provider.
1
b.
A
provider-directed
team-based
medical
practice.
2
c.
Whole
person
orientation.
3
d.
Coordination
and
integration
of
care.
4
e.
Quality
and
safety.
5
f.
Enhanced
access
to
health
care.
6
g.
A
payment
system
that
appropriately
recognizes
the
added
7
value
provided
to
patients
who
have
a
patient-centered
medical
8
home.
9
19.
“Primary
medical
provider”
means
the
personal
provider
10
as
defined
in
section
135.157
trained
to
provide
first
contact
11
and
continuous
and
comprehensive
care
to
a
member,
chosen
by
12
a
member
or
to
whom
a
member
is
assigned
under
the
Iowa
health
13
and
wellness
plan.
14
Sec.
7.
Section
249N.2,
Code
2017,
is
amended
by
adding
the
15
following
new
subsections:
16
NEW
SUBSECTION
.
17A.
“Personal
provider”
means
the
17
patient’s
first
point
of
contact
in
the
health
care
system
18
with
a
primary
care
provider
who
identifies
the
patient’s
19
health-related
needs
and,
working
with
a
team
of
health
20
care
professionals
and
providers
of
medical
and
nonmedical
21
health-related
services,
provides
for
and
coordinates
22
appropriate
care
to
address
the
health-related
needs
23
identified.
24
NEW
SUBSECTION
.
18A.
“Primary
care
provider”
includes
but
25
is
not
limited
to
any
of
the
following
licensed
or
certified
26
health
care
professionals
who
provide
primary
care:
27
a.
A
physician
who
is
a
family
or
general
practitioner,
a
28
pediatrician,
an
internist,
an
obstetrician,
or
a
gynecologist.
29
b.
An
advanced
registered
nurse
practitioner.
30
c.
A
physician
assistant.
31
d.
A
chiropractor.
32
Sec.
8.
Section
249N.6,
subsection
2,
paragraph
c,
Code
33
2017,
is
amended
to
read
as
follows:
34
c.
The
department
shall
develop
a
mechanism
for
primary
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medical
providers,
medical
homes,
and
participating
accountable
1
care
organizations
to
jointly
facilitate
member
care
2
coordination.
The
Iowa
health
and
wellness
plan
shall
provide
3
for
reimbursement
of
care
coordination
services
provided
4
under
the
plan
consistent
with
the
reimbursement
methodology
5
developed
pursuant
to
section
135.159
.
6
Sec.
9.
Section
249N.6,
subsection
3,
paragraph
a,
Code
7
2017,
is
amended
to
read
as
follows:
8
a.
The
department
shall
provide
procedures
for
accountable
9
care
organizations
that
emerge
through
local
markets
to
10
participate
in
the
Iowa
health
and
wellness
plan
provider
11
network.
Such
accountable
care
organizations
shall
incorporate
12
the
medical
home
as
defined
and
specified
in
chapter
135,
13
division
XXII
,
as
a
foundation
and
shall
emphasize
whole-person
14
orientation
and
coordination
and
integration
of
both
clinical
15
services
and
nonclinical
community
and
social
supports
that
16
address
social
determinants
of
health.
A
participating
17
accountable
care
organization
shall
enter
into
a
contract
with
18
the
department
to
ensure
the
coordination
and
management
of
the
19
health
of
attributed
members,
to
produce
quality
health
care
20
outcomes,
and
to
control
overall
cost.
21
Sec.
10.
PALLIATIVE
CARE
REVIEW
——
PATIENT-CENTERED
HEALTH
22
ADVISORY
COUNCIL.
The
patient-centered
health
advisory
council
23
shall
review
the
current
level
of
public
awareness
regarding
24
and
the
availability
of
palliative
care
services
in
the
state
25
and
shall
submit
a
report
to
the
governor
and
the
general
26
assembly
by
December
31,
2017,
including
the
council’s
findings
27
and
providing
recommendations
to
increase
public
awareness
28
and
reduce
barriers
to
access
to
palliative
care
services
29
throughout
the
state.
30
Sec.
11.
REPEAL.
Sections
135.157
and
135.158,
Code
2017,
31
are
repealed.
32
DIVISION
III
33
WORKFORCE
PROGRAMMING
34
Sec.
12.
Section
84A.11,
subsection
4,
Code
2017,
is
amended
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to
read
as
follows:
1
4.
The
nursing
workforce
data
clearinghouse
shall
be
2
established
and
maintained
in
a
manner
consistent
with
the
3
health
care
delivery
infrastructure
and
health
care
workforce
4
resources
strategic
plan
developed
pursuant
to
section
135.164
5
135.163
.
6
Sec.
13.
Section
135.107,
subsection
3,
Code
2017,
is
7
amended
to
read
as
follows:
8
3.
The
center
for
rural
health
and
primary
care
shall
9
establish
a
primary
care
provider
recruitment
and
retention
10
endeavor,
to
be
known
as
PRIMECARRE.
The
endeavor
shall
11
include
a
health
care
workforce
and
community
support
grant
12
program
,
and
a
primary
care
provider
loan
repayment
program
,
13
and
a
primary
care
provider
community
scholarship
program
.
The
14
endeavor
shall
be
developed
and
implemented
in
a
manner
to
15
promote
and
accommodate
local
creativity
in
efforts
to
recruit
16
and
retain
health
care
professionals
to
provide
services
in
17
the
locality.
The
focus
of
the
endeavor
shall
be
to
promote
18
and
assist
local
efforts
in
developing
health
care
provider
19
recruitment
and
retention
programs.
The
center
for
rural
20
health
and
primary
care
may
enter
into
an
agreement
with
the
21
college
student
aid
commission
for
the
administration
of
the
22
center’s
grant
and
loan
repayment
programs.
23
a.
Community
Health
care
workforce
and
community
support
24
grant
program.
25
(1)
The
center
for
rural
health
and
primary
care
shall
adopt
26
rules
establishing
an
flexible
application
process
processes
27
based
upon
the
department’s
strategic
plan
to
be
used
by
the
28
center
to
establish
a
grant
assistance
program
as
provided
29
in
this
paragraph
“a”
,
and
establishing
the
criteria
to
be
30
used
in
evaluating
the
applications.
Selection
criteria
31
shall
include
a
method
for
prioritizing
grant
applications
32
based
on
illustrated
efforts
to
meet
the
health
care
provider
33
needs
of
the
locality
and
surrounding
area.
Such
assistance
34
may
be
in
the
form
of
a
forgivable
loan,
grant,
or
other
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nonfinancial
assistance
as
deemed
appropriate
by
the
center.
1
An
application
submitted
shall
may
contain
a
commitment
of
at
2
least
a
dollar-for-dollar
match
of
matching
funds
for
the
grant
3
assistance.
Application
may
be
made
for
assistance
by
a
single
4
community
or
group
of
communities
or
in
response
to
programs
5
recommended
in
the
strategic
plan
to
address
health
workforce
6
shortages
.
7
(2)
Grants
awarded
under
the
program
shall
be
subject
to
the
8
following
limitations:
9
(a)
Ten
thousand
dollars
for
a
single
community
or
region
10
with
a
population
of
ten
thousand
or
less.
An
award
shall
not
11
be
made
under
this
program
to
a
community
with
a
population
of
12
more
than
ten
thousand.
13
(b)
An
amount
not
to
exceed
one
dollar
per
capita
for
a
14
region
in
which
the
population
exceeds
ten
thousand.
For
15
purposes
of
determining
the
amount
of
a
grant
for
a
region,
16
the
population
of
the
region
shall
not
include
the
population
17
of
any
community
with
a
population
of
more
than
ten
thousand
18
located
in
the
region
awarded
to
rural,
underserved
areas
or
19
special
populations
as
identified
by
the
department’s
strategic
20
plan
or
evidence-based
documentation
.
21
b.
Primary
care
provider
loan
repayment
program.
22
(1)
A
primary
care
provider
loan
repayment
program
is
23
established
to
increase
the
number
of
health
professionals
24
practicing
primary
care
in
federally
designated
health
25
professional
shortage
areas
of
the
state.
Under
the
program,
26
loan
repayment
may
be
made
to
a
recipient
for
educational
27
expenses
incurred
while
completing
an
accredited
health
28
education
program
directly
related
to
obtaining
credentials
29
necessary
to
practice
the
recipient’s
health
profession.
30
(2)
The
center
for
rural
health
and
primary
care
shall
adopt
31
rules
relating
to
the
establishment
and
administration
of
the
32
primary
care
provider
loan
repayment
program.
Rules
adopted
33
pursuant
to
this
paragraph
shall
provide,
at
a
minimum,
for
all
34
of
the
following:
35
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(a)
Determination
of
eligibility
requirements
and
1
qualifications
of
an
applicant
to
receive
loan
repayment
under
2
the
program,
including
but
not
limited
to
years
of
obligated
3
service,
clinical
practice
requirements,
and
residency
4
requirements.
One
year
of
obligated
service
shall
be
provided
5
by
the
applicant
in
exchange
for
each
year
of
loan
repayment,
6
unless
federal
requirements
otherwise
require.
Loan
repayment
7
under
the
program
shall
not
be
approved
for
a
health
provider
8
whose
license
or
certification
is
restricted
by
a
medical
9
regulatory
authority
of
any
jurisdiction
of
the
United
States,
10
other
nations,
or
territories.
11
(b)
Identification
of
federally
designated
health
12
professional
shortage
areas
of
the
state
and
prioritization
of
13
such
areas
according
to
need.
14
(c)
Determination
of
the
amount
and
duration
of
the
loan
15
repayment
an
applicant
may
receive,
giving
consideration
to
the
16
availability
of
funds
under
the
program,
and
the
applicant’s
17
outstanding
educational
loans
and
professional
credentials.
18
(d)
Determination
of
the
conditions
of
loan
repayment
19
applicable
to
an
applicant.
20
(e)
Enforcement
of
the
state’s
rights
under
a
loan
repayment
21
program
contract,
including
the
commencement
of
any
court
22
action.
23
(f)
Cancellation
of
a
loan
repayment
program
contract
for
24
reasonable
cause
unless
federal
requirements
otherwise
require
.
25
(g)
Participation
in
federal
programs
supporting
repayment
26
of
loans
of
health
care
providers
and
acceptance
of
gifts,
27
grants,
and
other
aid
or
amounts
from
any
person,
association,
28
foundation,
trust,
corporation,
governmental
agency,
or
other
29
entity
for
the
purposes
of
the
program.
30
(h)
Upon
availability
of
state
funds,
determination
of
31
eligibility
criteria
and
qualifications
for
participating
32
communities
and
applicants
not
located
in
federally
designated
33
shortage
areas.
34
(i)
Other
rules
as
necessary.
35
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(3)
The
center
for
rural
health
and
primary
care
may
enter
1
into
an
agreement
under
chapter
28E
with
the
college
student
2
aid
commission
for
the
administration
of
this
program.
3
c.
Primary
care
provider
community
scholarship
program.
4
(1)
A
primary
care
provider
community
scholarship
program
5
is
established
to
recruit
and
to
provide
scholarships
to
train
6
primary
health
care
practitioners
in
federally
designated
7
health
professional
shortage
areas
of
the
state.
Under
8
the
program,
scholarships
may
be
awarded
to
a
recipient
for
9
educational
expenses
incurred
while
completing
an
accredited
10
health
education
program
directly
related
to
obtaining
the
11
credentials
necessary
to
practice
the
recipient’s
health
12
profession.
13
(2)
The
department
shall
adopt
rules
relating
to
the
14
establishment
and
administration
of
the
primary
care
provider
15
community
scholarship
program.
Rules
adopted
pursuant
to
16
this
paragraph
shall
provide,
at
a
minimum,
for
all
of
the
17
following:
18
(a)
Determination
of
eligibility
requirements
and
19
qualifications
of
an
applicant
to
receive
scholarships
under
20
the
program,
including
but
not
limited
to
years
of
obligated
21
service,
clinical
practice
requirements,
and
residency
22
requirements.
One
year
of
obligated
service
shall
be
provided
23
by
the
applicant
in
exchange
for
each
year
of
scholarship
24
receipt,
unless
federal
requirements
otherwise
require.
25
(b)
Identification
of
federally
designated
health
26
professional
shortage
areas
of
the
state
and
prioritization
of
27
such
areas
according
to
need.
28
(c)
Determination
of
the
amount
of
the
scholarship
an
29
applicant
may
receive.
30
(d)
Determination
of
the
conditions
of
scholarship
to
be
31
awarded
to
an
applicant.
32
(e)
Enforcement
of
the
state’s
rights
under
a
scholarship
33
contract,
including
the
commencement
of
any
court
action.
34
(f)
Cancellation
of
a
scholarship
contract
for
reasonable
35
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cause.
1
(g)
Participation
in
federal
programs
supporting
2
scholarships
for
health
care
providers
and
acceptance
of
gifts,
3
grants,
and
other
aid
or
amounts
from
any
person,
association,
4
foundation,
trust,
corporation,
governmental
agency,
or
other
5
entity
for
the
purposes
of
the
program.
6
(h)
Upon
availability
of
state
funds,
determination
of
7
eligibility
criteria
and
qualifications
for
participating
8
communities
and
applicants
not
located
in
federally
designated
9
shortage
areas.
10
(i)
Other
rules
as
necessary.
11
(3)
The
center
for
rural
health
and
primary
care
may
enter
12
into
an
agreement
under
chapter
28E
with
the
college
student
13
aid
commission
for
the
administration
of
this
program.
14
Sec.
14.
Section
135.107,
subsection
4,
paragraphs
a,
b,
and
15
c,
Code
2017,
are
amended
to
read
as
follows:
16
a.
Eligibility
under
any
of
the
programs
established
under
17
the
primary
care
provider
recruitment
and
retention
endeavor
18
shall
be
based
upon
a
community
health
services
assessment
19
completed
under
subsection
2
,
paragraph
“a”
.
A
community
20
or
region,
as
applicable,
shall
submit
a
letter
of
intent
21
to
conduct
a
community
health
services
assessment
and
to
22
apply
for
assistance
under
this
subsection
.
The
letter
shall
23
be
in
a
form
and
contain
information
as
determined
by
the
24
center.
A
letter
of
intent
shall
be
submitted
to
the
center
by
25
January
1
preceding
the
fiscal
year
for
which
an
application
26
for
assistance
is
to
be
made.
Participation
in
a
community
27
health
services
assessment
process
shall
be
documented
by
the
28
community
or
region.
29
b.
Assistance
under
this
subsection
shall
not
be
granted
30
until
such
time
as
the
community
or
region
making
application
31
has
completed
the
a
community
health
services
assessment
and
32
adopted
a
long-term
community
health
services
assessment
and
33
developmental
plan.
In
addition
to
any
other
requirements,
a
34
developmental
an
applicant’s
plan
shall
include
,
to
the
extent
35
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possible,
a
clear
commitment
to
informing
high
school
students
1
of
the
health
care
opportunities
which
may
be
available
to
such
2
students.
3
c.
The
center
for
rural
health
and
primary
care
shall
4
seek
additional
assistance
and
resources
from
other
state
5
departments
and
agencies,
federal
agencies
and
grant
programs,
6
private
organizations,
and
any
other
person,
as
appropriate.
7
The
center
is
authorized
and
directed
to
accept
on
behalf
of
8
the
state
any
grant
or
contribution,
federal
or
otherwise,
9
made
to
assist
in
meeting
the
cost
of
carrying
out
the
purpose
10
of
this
subsection
.
All
federal
grants
to
and
the
federal
11
receipts
of
the
center
are
appropriated
for
the
purpose
set
12
forth
in
such
federal
grants
or
receipts.
Funds
appropriated
13
by
the
general
assembly
to
the
center
for
implementation
of
14
this
subsection
shall
first
be
used
for
securing
any
available
15
federal
funds
requiring
a
state
match,
with
remaining
funds
16
being
used
for
the
health
care
workforce
and
community
support
17
grant
program.
18
Sec.
15.
Section
135.107,
subsection
5,
paragraph
a,
Code
19
2017,
is
amended
to
read
as
follows:
20
a.
There
is
established
an
advisory
committee
to
the
21
center
for
rural
health
and
primary
care
consisting
of
one
22
representative,
approved
by
the
respective
agency,
of
each
23
of
the
following
agencies:
the
department
of
agriculture
24
and
land
stewardship,
the
Iowa
department
of
public
health,
25
the
department
of
inspections
and
appeals,
the
a
national
or
26
regional
institute
for
rural
health
policy,
the
rural
health
27
resource
center,
the
institute
of
agricultural
medicine
28
and
occupational
health,
and
the
Iowa
state
association
of
29
counties.
The
governor
shall
appoint
two
representatives
30
of
consumer
groups
active
in
rural
health
issues
and
a
31
representative
of
each
of
two
farm
organizations
active
within
32
the
state,
a
representative
of
an
agricultural
business
in
33
the
state,
a
representative
of
a
critical
needs
hospital,
34
a
practicing
rural
family
physician,
a
practicing
rural
35
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physician
assistant,
a
practicing
rural
advanced
registered
1
nurse
practitioner,
and
a
rural
health
practitioner
who
is
2
not
a
physician,
physician
assistant,
or
advanced
registered
3
nurse
practitioner,
as
members
of
the
advisory
committee.
The
4
advisory
committee
shall
also
include
as
members
two
state
5
representatives,
one
appointed
by
the
speaker
of
the
house
of
6
representatives
and
one
by
the
minority
leader
of
the
house,
7
and
two
state
senators,
one
appointed
by
the
majority
leader
of
8
the
senate
and
one
by
the
minority
leader
of
the
senate.
9
Sec.
16.
Section
135.163,
Code
2017,
is
amended
to
read
as
10
follows:
11
135.163
Health
and
long-term
care
access.
12
The
department
shall
coordinate
public
and
private
efforts
13
to
develop
and
maintain
an
appropriate
health
care
delivery
14
infrastructure
and
a
stable,
well-qualified,
diverse,
and
15
sustainable
health
care
workforce
in
this
state.
The
health
16
care
delivery
infrastructure
and
the
health
care
workforce
17
shall
address
the
broad
spectrum
of
health
care
needs
of
Iowans
18
throughout
their
lifespan
including
long-term
care
needs
.
The
19
department
shall,
at
a
minimum,
do
all
of
the
following:
20
1.
Develop
a
strategic
plan
for
health
care
delivery
21
infrastructure
and
health
care
workforce
resources
in
this
22
state.
23
2.
Provide
for
the
continuous
collection
of
data
to
provide
24
a
basis
for
health
care
strategic
planning
and
health
care
25
policymaking.
26
3.
Make
recommendations
regarding
the
health
care
delivery
27
infrastructure
and
the
health
care
workforce
that
assist
28
in
monitoring
current
needs,
predicting
future
trends,
and
29
informing
policymaking.
30
Sec.
17.
Section
135.175,
subsection
1,
paragraph
b,
Code
31
2017,
is
amended
to
read
as
follows:
32
b.
A
health
care
workforce
shortage
fund
is
created
in
33
the
state
treasury
as
a
separate
fund
under
the
control
of
34
the
department,
in
cooperation
with
the
entities
identified
35
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in
this
section
as
having
control
over
the
accounts
within
1
the
fund.
The
fund
and
the
accounts
within
the
fund
shall
2
be
controlled
and
managed
in
a
manner
consistent
with
the
3
principles
specified
and
the
strategic
plan
developed
pursuant
4
to
sections
section
135.163
and
135.164
.
5
Sec.
18.
Section
135.175,
subsections
6
and
7,
Code
2017,
6
are
amended
to
read
as
follows:
7
6.
a.
Moneys
in
the
fund
and
the
accounts
in
the
fund
shall
8
only
be
appropriated
in
a
manner
consistent
with
the
principles
9
specified
and
the
strategic
plan
developed
pursuant
to
sections
10
section
135.163
and
135.164
to
support
the
medical
residency
11
training
state
matching
grants
program,
the
fulfilling
Iowa’s
12
need
for
dentists
matching
grant
program,
and
to
provide
13
funding
for
state
health
care
workforce
shortage
programs
as
14
provided
in
this
section
.
15
b.
State
programs
that
may
receive
funding
from
the
fund
16
and
the
accounts
in
the
fund,
if
specifically
designated
for
17
the
purpose
of
drawing
down
federal
funding,
are
the
primary
18
care
recruitment
and
retention
endeavor
(PRIMECARRE),
the
Iowa
19
affiliate
of
the
national
rural
recruitment
and
retention
20
network,
the
oral
and
health
delivery
systems
bureau
of
the
21
department,
the
primary
care
office
and
shortage
designation
22
program,
and
the
state
office
of
rural
health,
and
the
Iowa
23
health
workforce
center,
administered
through
the
oral
and
24
health
delivery
systems
bureau
of
health
care
access
of
the
25
department
of
public
health;
the
area
health
education
centers
26
programs
at
Des
Moines
university
——
osteopathic
medical
center
27
and
the
university
of
Iowa;
the
Iowa
collaborative
safety
net
28
provider
network
established
pursuant
to
section
135.153
;
any
29
entity
identified
by
the
federal
government
entity
through
30
which
federal
funding
for
a
specified
health
care
workforce
31
shortage
initiative
is
received;
and
a
program
developed
in
32
accordance
with
the
strategic
plan
developed
by
the
department
33
of
public
health
in
accordance
with
sections
section
135.163
34
and
135.164
.
35
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c.
State
appropriations
to
the
fund
shall
be
allocated
in
1
equal
amounts
to
each
of
the
accounts
within
the
fund,
unless
2
otherwise
specified
in
the
appropriation
or
allocation.
Any
3
federal
funding
received
for
the
purposes
of
addressing
state
4
health
care
workforce
shortages
shall
be
deposited
in
the
5
health
care
workforce
shortage
national
initiatives
account,
6
unless
otherwise
specified
by
the
source
of
the
funds,
and
7
shall
be
used
as
required
by
the
source
of
the
funds.
If
use
8
of
the
federal
funding
is
not
designated,
the
funds
shall
be
9
used
in
accordance
with
the
strategic
plan
developed
by
the
10
department
of
public
health
in
accordance
with
sections
section
11
135.163
and
135.164
,
or
to
address
workforce
shortages
as
12
otherwise
designated
by
the
department
of
public
health.
Other
13
sources
of
funding
shall
be
deposited
in
the
fund
or
account
14
and
used
as
specified
by
the
source
of
the
funding.
15
7.
No
more
than
five
percent
of
the
moneys
in
any
of
the
16
accounts
within
the
fund
,
not
to
exceed
one
hundred
thousand
17
dollars
in
each
account,
shall
be
used
for
administrative
18
purposes,
unless
otherwise
provided
by
the
appropriation,
19
allocation,
or
source
of
the
funds.
20
Sec.
19.
REPEAL.
Sections
135.164
and
135.180,
Code
2017,
21
are
repealed.
22
DIVISION
IV
23
UNFUNDED
OR
OUTDATED
PROGRAM
PROVISIONS
24
Sec.
20.
Section
135.11,
subsection
25,
Code
2017,
is
25
amended
by
striking
the
subsection.
26
Sec.
21.
Section
135.141,
subsection
2,
paragraph
c,
Code
27
2017,
is
amended
by
striking
the
paragraph.
28
Sec.
22.
Section
135.141,
subsection
2,
paragraph
e,
Code
29
2017,
is
amended
to
read
as
follows:
30
e.
For
the
purpose
of
paragraphs
“c”
and
paragraph
“d”
,
31
an
employee
or
agent
of
the
department
may
enter
into
and
32
examine
any
premises
containing
potentially
dangerous
agents
33
with
the
consent
of
the
owner
or
person
in
charge
of
the
34
premises
or,
if
the
owner
or
person
in
charge
of
the
premises
35
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refuses
admittance,
with
an
administrative
search
warrant
1
obtained
under
section
808.14
.
Based
on
findings
of
the
risk
2
assessment
and
examination
of
the
premises,
the
director
may
3
order
reasonable
safeguards
or
take
any
other
action
reasonably
4
necessary
to
protect
the
public
health
pursuant
to
rules
5
adopted
to
administer
this
subsection
.
6
Sec.
23.
Section
901B.1,
subsection
4,
paragraph
a,
Code
7
2017,
is
amended
to
read
as
follows:
8
a.
The
district
department
of
correctional
services
shall
9
place
an
individual
committed
to
it
under
section
907.3
to
the
10
sanction
and
level
of
supervision
which
is
appropriate
to
the
11
individual
based
upon
a
current
risk
assessment
evaluation.
12
Placements
may
be
to
levels
two
and
three
of
the
corrections
13
continuum.
The
district
department
may,
with
the
approval
of
14
the
Iowa
department
of
public
health
and
the
department
of
15
corrections,
place
an
individual
in
a
level
three
substance
16
abuse
treatment
facility
established
pursuant
to
section
17
135.130
,
to
assist
the
individual
in
complying
with
a
condition
18
of
probation.
The
district
department
may,
with
the
approval
19
of
the
department
of
corrections,
place
an
individual
in
a
20
level
four
violator
facility
established
pursuant
to
section
21
904.207
only
as
a
penalty
for
a
violation
of
a
condition
22
imposed
under
this
section
.
23
Sec.
24.
REPEAL.
Sections
135.26,
135.29,
135.130,
and
24
135.152,
Code
2017,
are
repealed.
25
DIVISION
V
26
MISCELLANEOUS
PROVISIONS
27
Sec.
25.
Section
135A.2,
subsection
6,
Code
2017,
is
amended
28
to
read
as
follows:
29
6.
“Local
board
of
health”
means
a
county
or
district
board
30
of
health
the
same
as
defined
in
section
137.102
.
31
Sec.
26.
REPEAL.
Section
135.132,
Code
2017,
is
repealed.
32
DIVISION
VI
33
IOWA
HEALTH
INFORMATION
NETWORK
34
Sec.
27.
Section
136.3,
subsection
13,
Code
2017,
is
amended
35
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by
striking
the
subsection.
1
Sec.
28.
EFFECTIVE
DATE.
This
division
of
this
Act
2
takes
effect
upon
the
assumption
of
the
administration
and
3
governance,
including
but
not
limited
to
the
assumption
of
the
4
assets
and
liabilities,
of
the
Iowa
health
information
network
5
by
the
designated
entity
as
defined
in
2015
Iowa
Acts,
ch.73,
6
section
2.
The
department
of
public
health
shall
notify
the
7
Code
editor
of
the
date
of
such
assumption
by
the
designated
8
entity.
9
DIVISION
VII
10
ORGANIZED
DELIVERY
SYSTEMS
11
Sec.
29.
Section
135H.3,
subsection
2,
Code
2017,
is
amended
12
to
read
as
follows:
13
2.
If
a
child
is
diagnosed
with
a
biologically
based
mental
14
illness
as
defined
in
section
514C.22
and
meets
the
medical
15
assistance
program
criteria
for
admission
to
a
psychiatric
16
medical
institution
for
children,
the
child
shall
be
deemed
17
to
meet
the
acuity
criteria
for
medically
necessary
inpatient
18
benefits
under
a
group
policy,
contract,
or
plan
providing
19
for
third-party
payment
or
prepayment
of
health,
medical,
and
20
surgical
coverage
benefits
issued
by
a
carrier,
as
defined
in
21
section
513B.2
,
or
by
an
organized
delivery
system
authorized
22
under
1993
Iowa
Acts,
ch.
158,
that
is
subject
to
section
23
514C.22
.
Such
medically
necessary
benefits
shall
not
be
24
excluded
or
denied
as
care
that
is
substantially
custodial
in
25
nature
under
section
514C.22,
subsection
8
,
paragraph
“b”
.
26
Sec.
30.
Section
505.32,
subsection
2,
paragraph
h,
Code
27
2017,
is
amended
by
striking
the
paragraph.
28
Sec.
31.
Section
505.32,
subsection
4,
paragraph
b,
29
subparagraphs
(1)
and
(2),
Code
2017,
are
amended
to
read
as
30
follows:
31
(1)
The
commissioner
may
establish
methodologies
to
provide
32
uniform
and
consistent
side-by-side
comparisons
of
the
health
33
care
coverage
options
that
are
offered
by
carriers
,
organized
34
delivery
systems,
and
public
programs
in
this
state
including
35
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393
but
not
limited
to
benefits
covered
and
not
covered,
the
amount
1
of
coverage
for
each
service,
including
copays
and
deductibles,
2
administrative
costs,
and
any
prior
authorization
requirements
3
for
coverage.
4
(2)
The
commissioner
may
require
each
carrier
,
organized
5
delivery
system,
and
public
program
in
this
state
to
describe
6
each
health
care
coverage
option
offered
by
that
carrier
,
7
organized
delivery
system,
or
public
program
in
a
manner
8
so
that
the
various
options
can
be
compared
as
provided
in
9
subparagraph
(1).
10
Sec.
32.
Section
507B.4,
subsection
1,
Code
2017,
is
amended
11
to
read
as
follows:
12
1.
For
purposes
of
subsection
3
,
paragraph
“p”
,
“insurer”
13
means
an
entity
providing
a
plan
of
health
insurance,
health
14
care
benefits,
or
health
care
services,
or
an
entity
subject
15
to
the
jurisdiction
of
the
commissioner
performing
utilization
16
review,
including
an
insurance
company
offering
sickness
and
17
accident
plans,
a
health
maintenance
organization,
an
organized
18
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158
,
and
19
licensed
by
the
department
of
public
health,
a
nonprofit
health
20
service
corporation,
a
plan
established
pursuant
to
chapter
21
509A
for
public
employees,
or
any
other
entity
providing
a
22
plan
of
health
insurance,
health
care
benefits,
or
health
care
23
services.
However,
“insurer”
does
not
include
an
entity
that
24
sells
disability
income
or
long-term
care
insurance.
25
Sec.
33.
Section
507B.4A,
subsection
2,
paragraph
a,
Code
26
2017,
is
amended
to
read
as
follows:
27
a.
An
insurer
providing
accident
and
sickness
insurance
28
under
chapter
509
,
514
,
or
514A
;
a
health
maintenance
29
organization;
an
organized
delivery
system
authorized
under
30
1993
Iowa
Acts,
ch.
158
,
and
licensed
by
the
department
of
31
public
health;
or
another
entity
providing
health
insurance
or
32
health
benefits
subject
to
state
insurance
regulation
shall
33
either
accept
and
pay
or
deny
a
clean
claim.
34
Sec.
34.
Section
509.3A,
subsection
11,
Code
2017,
is
35
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amended
by
striking
the
subsection.
1
Sec.
35.
Section
509.19,
subsection
2,
paragraph
d,
Code
2
2017,
is
amended
by
striking
the
paragraph.
3
Sec.
36.
Section
509A.6,
Code
2017,
is
amended
to
read
as
4
follows:
5
509A.6
Contract
with
insurance
carrier
,
or
health
maintenance
6
organization
,
or
organized
delivery
system
.
7
The
governing
body
may
contract
with
a
nonprofit
corporation
8
operating
under
the
provisions
of
this
chapter
or
chapter
9
514
or
with
any
insurance
company
having
a
certificate
of
10
authority
to
transact
an
insurance
business
in
this
state
with
11
respect
of
a
group
insurance
plan,
which
may
include
life,
12
accident,
health,
hospitalization
and
disability
insurance
13
during
period
of
active
service
of
such
employees,
with
the
14
right
of
any
employee
to
continue
such
life
insurance
in
force
15
after
termination
of
active
service
at
such
employee’s
sole
16
expense;
may
contract
with
a
nonprofit
corporation
operating
17
under
and
governed
by
the
provisions
of
this
chapter
or
chapter
18
514
with
respect
of
any
hospital
or
medical
service
plan;
and
19
may
contract
with
a
health
maintenance
organization
or
an
20
organized
delivery
system
authorized
to
operate
in
this
state
21
with
respect
to
health
maintenance
organization
or
organized
22
delivery
system
activities.
23
Sec.
37.
Section
513B.2,
subsection
8,
paragraph
k,
Code
24
2017,
is
amended
by
striking
the
paragraph.
25
Sec.
38.
Section
513B.5,
Code
2017,
is
amended
to
read
as
26
follows:
27
513B.5
Provisions
on
renewability
of
coverage.
28
1.
Health
insurance
coverage
subject
to
this
chapter
is
29
renewable
with
respect
to
all
eligible
employees
or
their
30
dependents,
at
the
option
of
the
small
employer,
except
for
one
31
or
more
of
the
following
reasons:
32
a.
The
health
insurance
coverage
sponsor
fails
to
pay,
or
to
33
make
timely
payment
of,
premiums
or
contributions
pursuant
to
34
the
terms
of
the
health
insurance
coverage.
35
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b.
The
health
insurance
coverage
sponsor
performs
an
1
act
or
practice
constituting
fraud
or
makes
an
intentional
2
misrepresentation
of
a
material
fact
under
the
terms
of
the
3
coverage.
4
c.
Noncompliance
with
the
carrier’s
or
organized
delivery
5
system’s
minimum
participation
requirements.
6
d.
Noncompliance
with
the
carrier’s
or
organized
delivery
7
system’s
employer
contribution
requirements.
8
e.
A
decision
by
the
carrier
or
organized
delivery
system
9
to
discontinue
offering
a
particular
type
of
health
insurance
10
coverage
in
the
state’s
small
employer
market.
Health
11
insurance
coverage
may
be
discontinued
by
the
carrier
or
12
organized
delivery
system
in
that
market
only
if
the
carrier
or
13
organized
delivery
system
does
all
of
the
following:
14
(1)
Provides
advance
notice
of
its
decision
to
discontinue
15
such
plan
to
the
commissioner
or
director
of
public
health
.
16
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
17
no
less
than
three
days
prior
to
the
notice
provided
for
in
18
subparagraph
(2)
to
affected
small
employers,
participants,
and
19
beneficiaries.
20
(2)
Provides
notice
of
its
decision
not
to
renew
such
21
plan
to
all
affected
small
employers,
participants,
and
22
beneficiaries
no
less
than
ninety
days
prior
to
the
nonrenewal
23
of
the
plan.
24
(3)
Offers
to
each
plan
sponsor
of
the
discontinued
25
coverage,
the
option
to
purchase
any
other
coverage
currently
26
offered
by
the
carrier
or
organized
delivery
system
to
other
27
employers
in
this
state.
28
(4)
Acts
uniformly,
in
opting
to
discontinue
the
coverage
29
and
in
offering
the
option
under
subparagraph
(3),
without
30
regard
to
the
claims
experience
of
the
sponsors
under
the
31
discontinued
coverage
or
to
a
health
status-related
factor
32
relating
to
any
participants
or
beneficiaries
covered
or
new
33
participants
or
beneficiaries
who
may
become
eligible
for
the
34
coverage.
35
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f.
A
decision
by
the
carrier
or
organized
delivery
system
to
1
discontinue
offering
and
to
cease
to
renew
all
of
its
health
2
insurance
coverage
delivered
or
issued
for
delivery
to
small
3
employers
in
this
state.
A
carrier
or
organized
delivery
4
system
making
such
decision
shall
do
all
of
the
following:
5
(1)
Provide
advance
notice
of
its
decision
to
discontinue
6
such
coverage
to
the
commissioner
or
director
of
public
health
.
7
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
8
no
less
than
three
days
prior
to
the
notice
provided
for
in
9
subparagraph
(2)
to
affected
small
employers,
participants,
and
10
beneficiaries.
11
(2)
Provide
notice
of
its
decision
not
to
renew
such
12
coverage
to
all
affected
small
employers,
participants,
and
13
beneficiaries
no
less
than
one
hundred
eighty
days
prior
to
the
14
nonrenewal
of
the
coverage.
15
(3)
Discontinue
all
health
insurance
coverage
issued
or
16
delivered
for
issuance
to
small
employers
in
this
state
and
17
cease
renewal
of
such
coverage.
18
g.
The
membership
of
an
employer
in
an
association,
which
19
is
the
basis
for
the
coverage
which
is
provided
through
such
20
association,
ceases,
but
only
if
the
termination
of
coverage
21
under
this
paragraph
occurs
uniformly
without
regard
to
22
any
health
status-related
factor
relating
to
any
covered
23
individual.
24
h.
The
commissioner
or
director
of
public
health
finds
that
25
the
continuation
of
the
coverage
is
not
in
the
best
interests
26
of
the
policyholders
or
certificate
holders,
or
would
impair
27
the
carrier’s
or
organized
delivery
system’s
ability
to
meet
28
its
contractual
obligations.
29
i.
At
the
time
of
coverage
renewal,
a
carrier
or
organized
30
delivery
system
may
modify
the
health
insurance
coverage
for
31
a
product
offered
under
group
health
insurance
coverage
in
32
the
small
group
market,
for
coverage
that
is
available
in
33
such
market
other
than
only
through
one
or
more
bona
fide
34
associations,
if
such
modification
is
consistent
with
the
laws
35
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393
of
this
state,
and
is
effective
on
a
uniform
basis
among
group
1
health
insurance
coverage
with
that
product.
2
2.
A
carrier
or
organized
delivery
system
that
elects
not
to
3
renew
health
insurance
coverage
under
subsection
1
,
paragraph
4
“f”
,
shall
not
write
any
new
business
in
the
small
employer
5
market
in
this
state
for
a
period
of
five
years
after
the
date
6
of
notice
to
the
commissioner
or
director
of
public
health
.
7
3.
This
section
,
with
respect
to
a
carrier
or
organized
8
delivery
system
doing
business
in
one
established
geographic
9
service
area
of
the
state,
applies
only
to
such
carrier’s
or
10
organized
delivery
system’s
operations
in
that
service
area.
11
Sec.
39.
Section
513B.6,
unnumbered
paragraph
1,
Code
2017,
12
is
amended
to
read
as
follows:
13
A
small
employer
carrier
or
organized
delivery
system
shall
14
make
reasonable
disclosure
in
solicitation
and
sales
materials
15
provided
to
small
employers
of
all
of
the
following:
16
Sec.
40.
Section
513B.6,
subsection
2,
Code
2017,
is
amended
17
to
read
as
follows:
18
2.
The
provisions
concerning
the
small
employer
carrier’s
19
or
organized
delivery
system’s
right
to
change
premium
rates
20
and
factors,
including
case
characteristics,
which
affect
21
changes
in
premium
rates.
22
Sec.
41.
Section
513B.7,
Code
2017,
is
amended
to
read
as
23
follows:
24
513B.7
Maintenance
of
records.
25
1.
A
small
employer
carrier
or
organized
delivery
system
26
shall
maintain
at
its
principal
place
of
business
a
complete
27
and
detailed
description
of
its
rating
practices
and
renewal
28
underwriting
practices,
including
information
and
documentation
29
which
demonstrate
that
its
rating
methods
and
practices
are
30
based
upon
commonly
accepted
actuarial
assumptions
and
are
in
31
accordance
with
sound
actuarial
principles.
32
2.
A
small
employer
carrier
or
organized
delivery
system
33
shall
file
each
March
1
with
the
commissioner
or
the
director
34
of
public
health
an
actuarial
certification
that
the
small
35
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393
employer
carrier
or
organized
delivery
system
is
in
compliance
1
with
this
section
and
that
the
rating
methods
of
the
small
2
employer
carrier
or
organized
delivery
system
are
actuarially
3
sound.
A
copy
of
the
certification
shall
be
retained
by
the
4
small
employer
carrier
or
organized
delivery
system
at
its
5
principal
place
of
business.
6
3.
A
small
employer
carrier
or
organized
delivery
system
7
shall
make
the
information
and
documentation
described
in
8
subsection
1
available
to
the
commissioner
or
the
director
of
9
public
health
upon
request.
The
information
is
not
a
public
10
record
or
otherwise
subject
to
disclosure
under
chapter
22
,
11
and
is
considered
proprietary
and
trade
secret
information
12
and
is
not
subject
to
disclosure
by
the
commissioner
or
the
13
director
of
public
health
to
persons
outside
of
the
division
or
14
department
except
as
agreed
to
by
the
small
employer
carrier
or
15
organized
delivery
system
or
as
ordered
by
a
court
of
competent
16
jurisdiction.
17
Sec.
42.
Section
513B.9A,
subsection
1,
unnumbered
18
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
19
A
carrier
or
organized
delivery
system
offering
group
health
20
insurance
coverage
shall
not
establish
rules
for
eligibility,
21
including
continued
eligibility,
of
an
individual
to
enroll
22
under
the
terms
of
the
coverage
based
on
any
of
the
following
23
health
status-related
factors
in
relation
to
the
individual
or
24
a
dependent
of
the
individual:
25
Sec.
43.
Section
513B.9A,
subsection
4,
paragraph
a,
Code
26
2017,
is
amended
to
read
as
follows:
27
a.
A
carrier
or
organized
delivery
system
offering
health
28
insurance
coverage
shall
not
require
an
individual,
as
a
29
condition
of
enrollment
or
continued
enrollment
under
the
30
coverage,
to
pay
a
premium
or
contribution
which
is
greater
31
than
a
premium
or
contribution
for
a
similarly
situated
32
individual
enrolled
in
the
coverage
on
the
basis
of
a
health
33
status-related
factor
in
relation
to
the
individual
or
to
a
34
dependent
of
an
individual
enrolled
under
the
coverage.
35
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393
Sec.
44.
Section
513B.9A,
subsection
4,
paragraph
b,
1
subparagraph
(2),
Code
2017,
is
amended
to
read
as
follows:
2
(2)
Prevent
a
carrier
or
organized
delivery
system
3
offering
group
health
insurance
coverage
from
establishing
4
premium
discounts
or
rebates
or
modifying
otherwise
applicable
5
copayments
or
deductibles
in
return
for
adherence
to
programs
6
of
health
promotion
and
disease
prevention.
7
Sec.
45.
Section
513B.10,
Code
2017,
is
amended
to
read
as
8
follows:
9
513B.10
Availability
of
coverage.
10
1.
a.
A
carrier
or
an
organized
delivery
system
that
offers
11
health
insurance
coverage
in
the
small
group
market
shall
12
accept
every
small
employer
that
applies
for
health
insurance
13
coverage
and
shall
accept
for
enrollment
under
such
coverage
14
every
eligible
individual
who
applies
for
enrollment
during
the
15
period
in
which
the
individual
first
becomes
eligible
to
enroll
16
under
the
terms
of
the
health
insurance
coverage
and
shall
not
17
place
any
restriction
which
is
inconsistent
with
eligibility
18
rules
established
under
this
chapter
.
19
b.
A
carrier
or
organized
delivery
system
that
offers
health
20
insurance
coverage
in
the
small
group
market
through
a
network
21
plan
may
do
either
of
the
following:
22
(1)
Limit
employers
that
may
apply
for
such
coverage
to
23
those
with
eligible
individuals
who
live,
work,
or
reside
in
24
the
service
area
for
such
network
plan.
25
(2)
Deny
such
coverage
to
such
employers
within
the
service
26
area
of
such
plan
if
the
carrier
or
organized
delivery
system
27
has
demonstrated
to
the
applicable
state
authority
both
of
the
28
following:
29
(a)
The
carrier
or
organized
delivery
system
will
not
have
30
the
capacity
to
deliver
services
adequately
to
enrollees
of
any
31
additional
groups
because
of
its
obligations
to
existing
group
32
contract
holders
and
enrollees.
33
(b)
The
carrier
or
organized
delivery
system
is
applying
34
this
subparagraph
uniformly
to
all
employers
without
regard
to
35
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the
claims
experience
of
those
employers
and
their
employees
1
and
their
dependents,
or
any
health
status-related
factor
2
relating
to
such
employees
or
dependents.
3
c.
A
carrier
or
organized
delivery
system
,
upon
denying
4
health
insurance
coverage
in
any
service
area
pursuant
to
5
paragraph
“b”
,
subparagraph
(2),
shall
not
offer
coverage
in
the
6
small
group
market
within
such
service
area
for
a
period
of
one
7
hundred
eighty
days
after
the
date
such
coverage
is
denied.
8
d.
A
carrier
or
organized
delivery
system
may
deny
health
9
insurance
coverage
in
the
small
group
market
if
the
issuer
has
10
demonstrated
to
the
commissioner
or
director
of
public
health
11
both
of
the
following:
12
(1)
The
carrier
or
organized
delivery
system
does
not
have
13
the
financial
reserves
necessary
to
underwrite
additional
14
coverage.
15
(2)
The
carrier
or
organized
delivery
system
is
applying
the
16
provisions
of
this
paragraph
uniformly
to
all
employers
in
the
17
small
group
market
in
this
state
consistent
with
state
law
and
18
without
regard
to
the
claims
experience
of
those
employers
and
19
the
employees
and
dependents
of
such
employers,
or
any
health
20
status-related
factor
relating
to
such
employees
and
their
21
dependents.
22
e.
A
carrier
or
organized
delivery
system
,
upon
denying
23
health
insurance
coverage
pursuant
to
paragraph
“d”
,
shall
not
24
offer
coverage
in
connection
with
health
insurance
coverages
25
in
the
small
group
market
in
this
state
for
a
period
of
one
26
hundred
eighty
days
after
the
date
such
coverage
is
denied
or
27
until
the
carrier
or
organized
delivery
system
has
demonstrated
28
to
the
commissioner
or
director
of
public
health
that
the
29
carrier
or
organized
delivery
system
has
sufficient
financial
30
reserves
to
underwrite
additional
coverage,
whichever
is
later.
31
The
commissioner
or
director
may
provide
for
the
application
of
32
this
paragraph
on
a
service
area-specific
basis.
33
f.
Paragraph
“a”
shall
not
be
construed
to
preclude
34
a
carrier
or
organized
delivery
system
from
establishing
35
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employer
contribution
rules
or
group
participation
rules
for
1
the
offering
of
health
insurance
coverage
in
the
small
group
2
market.
3
2.
A
carrier
or
organized
delivery
system
,
subject
to
4
subsection
1
,
shall
issue
health
insurance
coverage
to
an
5
eligible
small
employer
that
applies
for
the
coverage
and
6
agrees
to
make
the
required
premium
payments
and
satisfy
the
7
other
reasonable
provisions
of
the
health
insurance
coverage
8
not
inconsistent
with
this
chapter
.
A
carrier
or
organized
9
delivery
system
is
not
required
to
issue
health
insurance
10
coverage
to
a
self-employed
individual
who
is
covered
by,
or
is
11
eligible
for
coverage
under,
health
insurance
coverage
offered
12
by
an
employer.
13
3.
Health
insurance
coverage
for
small
employers
shall
14
satisfy
all
of
the
following:
15
a.
A
carrier
or
organized
delivery
system
offering
group
16
health
insurance
coverage,
with
respect
to
a
participant
or
17
beneficiary,
may
impose
a
preexisting
condition
exclusion
only
18
as
follows:
19
(1)
The
exclusion
relates
to
a
condition,
whether
physical
20
or
mental,
regardless
of
the
cause
of
the
condition,
for
21
which
medical
advice,
diagnosis,
care,
or
treatment
was
22
recommended
or
received
within
the
six-month
period
ending
on
23
the
enrollment
date.
However,
genetic
information
shall
not
be
24
treated
as
a
condition
under
this
subparagraph
in
the
absence
25
of
a
diagnosis
of
the
condition
related
to
such
information.
26
(2)
The
exclusion
extends
for
a
period
of
not
more
than
27
twelve
months,
or
eighteen
months
in
the
case
of
a
late
28
enrollee,
after
the
enrollment
date.
29
(3)
The
period
of
any
such
preexisting
condition
exclusion
30
is
reduced
by
the
aggregate
of
the
periods
of
creditable
31
coverage
applicable
to
the
participant
or
beneficiary
as
of
the
32
enrollment
date.
33
b.
A
carrier
or
organized
delivery
system
offering
group
34
health
insurance
coverage
shall
not
impose
any
preexisting
35
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condition
exclusion
as
follows:
1
(1)
In
the
case
of
a
child
who
is
adopted
or
placed
for
2
adoption
before
attaining
eighteen
years
of
age
and
who,
as
of
3
the
last
day
of
the
thirty-day
period
beginning
on
the
date
4
of
the
adoption
or
placement
for
adoption,
is
covered
under
5
creditable
coverage.
This
subparagraph
shall
not
apply
to
6
coverage
before
the
date
of
such
adoption
or
placement
for
7
adoption.
8
(2)
In
the
case
of
an
individual
who,
as
of
the
last
day
9
of
the
thirty-day
period
beginning
with
the
date
of
birth,
is
10
covered
under
creditable
coverage.
11
(3)
Relating
to
pregnancy
as
a
preexisting
condition.
12
c.
A
carrier
or
organized
delivery
system
shall
waive
13
any
waiting
period
applicable
to
a
preexisting
condition
14
exclusion
or
limitation
period
with
respect
to
particular
15
services
under
health
insurance
coverage
for
the
period
16
of
time
an
individual
was
covered
by
creditable
coverage,
17
provided
that
the
creditable
coverage
was
continuous
to
a
18
date
not
more
than
sixty-three
days
prior
to
the
effective
19
date
of
the
new
coverage.
Any
period
that
an
individual
20
is
in
a
waiting
period
for
any
coverage
under
group
health
21
insurance
coverage,
or
is
in
an
affiliation
period,
shall
not
22
be
taken
into
account
in
determining
the
period
of
continuous
23
coverage.
A
health
maintenance
organization
that
does
not
24
use
preexisting
condition
limitations
in
any
of
its
health
25
insurance
coverage
may
impose
an
affiliation
period.
For
26
purposes
of
this
section
,
“affiliation
period”
means
a
period
27
of
time
not
to
exceed
sixty
days
for
new
entrants
and
not
to
28
exceed
ninety
days
for
late
enrollees
during
which
no
premium
29
shall
be
collected
and
coverage
issued
is
not
effective,
so
30
long
as
the
affiliation
period
is
applied
uniformly,
without
31
regard
to
any
health
status-related
factors.
This
paragraph
32
does
not
preclude
application
of
a
waiting
period
applicable
33
to
all
new
enrollees
under
the
health
insurance
coverage,
34
provided
that
any
carrier
or
organized
delivery
system-imposed
35
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carrier-imposed
waiting
period
is
no
longer
than
sixty
days
and
1
is
used
in
lieu
of
a
preexisting
condition
exclusion.
2
d.
Health
insurance
coverage
may
exclude
coverage
for
late
3
enrollees
for
preexisting
conditions
for
a
period
not
to
exceed
4
eighteen
months.
5
e.
(1)
Requirements
used
by
a
carrier
or
organized
delivery
6
system
in
determining
whether
to
provide
coverage
to
a
small
7
employer
shall
be
applied
uniformly
among
all
small
employers
8
applying
for
coverage
or
receiving
coverage
from
the
carrier
9
or
organized
delivery
system
.
10
(2)
In
applying
minimum
participation
requirements
with
11
respect
to
a
small
employer,
a
carrier
or
organized
delivery
12
system
shall
not
consider
employees
or
dependents
who
have
13
other
creditable
coverage
in
determining
whether
the
applicable
14
percentage
of
participation
is
met.
15
(3)
A
carrier
or
organized
delivery
system
shall
not
16
increase
any
requirement
for
minimum
employee
participation
17
or
modify
any
requirement
for
minimum
employer
contribution
18
applicable
to
a
small
employer
at
any
time
after
the
small
19
employer
has
been
accepted
for
coverage.
20
f.
(1)
If
a
carrier
or
organized
delivery
system
offers
21
coverage
to
a
small
employer,
the
carrier
or
organized
delivery
22
system
shall
offer
coverage
to
all
eligible
employees
of
the
23
small
employer
and
the
employees’
dependents.
A
carrier
or
24
organized
delivery
system
shall
not
offer
coverage
to
only
25
certain
individuals
or
dependents
in
a
small
employer
group
or
26
to
only
part
of
the
group.
27
(2)
Except
as
provided
under
paragraphs
“a”
and
“d”
,
a
28
carrier
or
organized
delivery
system
shall
not
modify
health
29
insurance
coverage
with
respect
to
a
small
employer
or
any
30
eligible
employee
or
dependent
through
riders,
endorsements,
or
31
other
means,
to
restrict
or
exclude
coverage
or
benefits
for
32
certain
diseases,
medical
conditions,
or
services
otherwise
33
covered
by
the
health
insurance
coverage.
34
g.
A
carrier
or
organized
delivery
system
offering
coverage
35
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through
a
network
plan
shall
not
be
required
to
offer
coverage
1
or
accept
applications
pursuant
to
subsection
1
with
respect
to
2
a
small
employer
where
any
of
the
following
apply
applies
:
3
(1)
The
small
employer
does
not
have
eligible
individuals
4
who
live,
work,
or
reside
in
the
service
area
for
the
network
5
plan.
6
(2)
The
small
employer
does
have
eligible
individuals
who
7
live,
work,
or
reside
in
the
service
area
for
the
network
plan,
8
but
the
carrier
or
organized
delivery
system
,
if
required,
has
9
demonstrated
to
the
commissioner
or
the
director
of
public
10
health
that
it
will
not
have
the
capacity
to
deliver
services
11
adequately
to
enrollees
of
any
additional
groups
because
of
its
12
obligations
to
existing
group
contract
holders
and
enrollees
13
and
that
it
is
applying
the
requirements
of
this
lettered
14
paragraph
uniformly
to
all
employers
without
regard
to
the
15
claims
experience
of
those
employers
and
their
employees
and
16
the
employees’
dependents,
or
any
health
status-related
factor
17
relating
to
such
employees
and
dependents.
18
(3)
A
carrier
or
organized
delivery
system
,
upon
denying
19
health
insurance
coverage
in
a
service
area
pursuant
to
20
subparagraph
(2),
shall
not
offer
coverage
in
the
small
21
employer
market
within
such
service
area
for
a
period
of
one
22
hundred
eighty
days
after
the
coverage
is
denied.
23
4.
A
carrier
or
organized
delivery
system
shall
not
be
24
required
to
offer
coverage
to
small
employers
pursuant
to
25
subsection
1
for
any
period
of
time
where
the
commissioner
or
26
director
of
public
health
determines
that
the
acceptance
of
the
27
offers
by
small
employers
in
accordance
with
subsection
1
would
28
place
the
carrier
or
organized
delivery
system
in
a
financially
29
impaired
condition.
30
5.
A
carrier
or
organized
delivery
system
shall
not
be
31
required
to
provide
coverage
to
small
employers
pursuant
to
32
subsection
1
if
the
carrier
or
organized
delivery
system
elects
33
not
to
offer
new
coverage
to
small
employers
in
this
state.
34
However,
a
carrier
or
organized
delivery
system
that
elects
not
35
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393
to
offer
new
coverage
to
small
employers
under
this
subsection
1
shall
be
allowed
to
maintain
its
existing
policies
in
the
2
state,
subject
to
the
requirements
of
section
513B.5
.
3
6.
A
carrier
or
organized
delivery
system
that
elects
not
to
4
offer
new
coverage
to
small
employers
pursuant
to
subsection
5
5
shall
provide
notice
to
the
commissioner
or
director
of
public
6
health
and
is
prohibited
from
writing
new
business
in
the
small
7
employer
market
in
this
state
for
a
period
of
five
years
from
8
the
date
of
notice
to
the
commissioner
or
director
.
9
Sec.
46.
Section
513C.3,
subsection
5,
Code
2017,
is
amended
10
to
read
as
follows:
11
5.
“Carrier”
means
any
entity
that
provides
individual
12
health
benefit
plans
in
this
state.
For
purposes
of
this
13
chapter
,
carrier
includes
an
insurance
company,
a
group
14
hospital
or
medical
service
corporation,
a
fraternal
benefit
15
society,
a
health
maintenance
organization,
and
any
other
16
entity
providing
an
individual
plan
of
health
insurance
17
or
health
benefits
subject
to
state
insurance
regulation.
18
“Carrier”
does
not
include
an
organized
delivery
system.
19
Sec.
47.
Section
513C.3,
subsection
7,
Code
2017,
is
amended
20
by
striking
the
subsection.
21
Sec.
48.
Section
513C.3,
subsection
9,
Code
2017,
is
amended
22
to
read
as
follows:
23
9.
“Established
service
area”
means
a
geographic
area,
24
as
approved
by
the
commissioner
and
based
upon
the
carrier’s
25
certificate
of
authority
to
transact
business
in
this
state,
26
within
which
the
carrier
is
authorized
to
provide
coverage
or
27
a
geographic
area,
as
approved
by
the
director
and
based
upon
28
the
organized
delivery
system’s
license
to
transact
business
29
in
this
state,
within
which
the
organized
delivery
system
is
30
authorized
to
provide
coverage
.
31
Sec.
49.
Section
513C.3,
subsection
12,
Code
2017,
is
32
amended
by
striking
the
subsection.
33
Sec.
50.
Section
513C.3,
subsection
15,
paragraph
a,
34
subparagraph
(3),
Code
2017,
is
amended
by
striking
the
35
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393
subparagraph.
1
Sec.
51.
Section
513C.3,
subsection
18,
Code
2017,
is
2
amended
to
read
as
follows:
3
18.
“Restricted
network
provision”
means
a
provision
of
an
4
individual
health
benefit
plan
that
conditions
the
payment
5
of
benefits,
in
whole
or
in
part,
on
the
use
of
health
care
6
providers
that
have
entered
into
a
contractual
arrangement
with
7
the
carrier
or
the
organized
delivery
system
to
provide
health
8
care
services
to
covered
individuals.
9
Sec.
52.
Section
513C.5,
subsection
1,
unnumbered
paragraph
10
1,
Code
2017,
is
amended
to
read
as
follows:
11
Premium
rates
for
any
block
of
individual
health
benefit
12
plan
business
issued
on
or
after
January
1,
1996,
or
the
date
13
rules
are
adopted
by
the
commissioner
of
insurance
and
the
14
director
of
public
health
and
become
effective,
whichever
15
date
is
later,
by
a
carrier
subject
to
this
chapter
shall
be
16
limited
to
the
composite
effect
of
allocating
costs
among
the
17
following:
18
Sec.
53.
Section
513C.6,
Code
2017,
is
amended
to
read
as
19
follows:
20
513C.6
Provisions
on
renewability
of
coverage.
21
1.
An
individual
health
benefit
plan
subject
to
this
22
chapter
is
renewable
with
respect
to
an
eligible
individual
or
23
dependents,
at
the
option
of
the
individual,
except
for
one
or
24
more
of
the
following
reasons:
25
a.
The
individual
fails
to
pay,
or
to
make
timely
payment
26
of,
premiums
or
contributions
pursuant
to
the
terms
of
the
27
individual
health
benefit
plan.
28
b.
The
individual
performs
an
act
or
practice
constituting
29
fraud
or
makes
an
intentional
misrepresentation
of
a
material
30
fact
under
the
terms
of
the
individual
health
benefit
plan.
31
c.
A
decision
by
the
individual
carrier
or
organized
32
delivery
system
to
discontinue
offering
a
particular
type
33
of
individual
health
benefit
plan
in
the
state’s
individual
34
insurance
market.
An
individual
health
benefit
plan
may
be
35
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discontinued
by
the
carrier
or
organized
delivery
system
in
1
that
market
with
the
approval
of
the
commissioner
or
the
2
director
and
only
if
the
carrier
or
organized
delivery
system
3
does
all
of
the
following:
4
(1)
Provides
advance
notice
of
its
decision
to
discontinue
5
such
plan
to
the
commissioner
or
director
.
Notice
to
the
6
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
7
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
8
to
affected
individuals.
9
(2)
Provides
notice
of
its
decision
not
to
renew
such
plan
10
to
all
affected
individuals
no
less
than
ninety
days
prior
11
to
the
nonrenewal
date
of
any
discontinued
individual
health
12
benefit
plans.
13
(3)
Offers
to
each
individual
of
the
discontinued
plan
the
14
option
to
purchase
any
other
health
plan
currently
offered
by
15
the
carrier
or
organized
delivery
system
to
individuals
in
this
16
state.
17
(4)
Acts
uniformly
in
opting
to
discontinue
the
plan
and
18
in
offering
the
option
under
subparagraph
(3),
without
regard
19
to
the
claims
experience
of
any
affected
eligible
individual
20
or
beneficiary
under
the
discontinued
plan
or
to
a
health
21
status-related
factor
relating
to
any
covered
individuals
or
22
beneficiaries
who
may
become
eligible
for
the
coverage.
23
d.
A
decision
by
the
carrier
or
organized
delivery
system
24
to
discontinue
offering
and
to
cease
to
renew
all
of
its
25
individual
health
benefit
plans
delivered
or
issued
for
26
delivery
to
individuals
in
this
state.
A
carrier
or
organized
27
delivery
system
making
such
decision
shall
do
all
of
the
28
following:
29
(1)
Provide
advance
notice
of
its
decision
to
discontinue
30
such
plan
to
the
commissioner
or
director
.
Notice
to
the
31
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
32
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
33
to
affected
individuals.
34
(2)
Provide
notice
of
its
decision
not
to
renew
such
plan
35
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to
all
individuals
and
to
the
commissioner
or
director
in
each
1
state
in
which
an
individual
under
the
discontinued
plan
is
2
known
to
reside,
no
less
than
one
hundred
eighty
days
prior
to
3
the
nonrenewal
of
the
plan.
4
e.
The
commissioner
or
director
finds
that
the
continuation
5
of
the
coverage
is
not
in
the
best
interests
of
the
6
individuals,
or
would
impair
the
carrier’s
or
organized
7
delivery
system’s
ability
to
meet
its
contractual
obligations.
8
2.
At
the
time
of
coverage
renewal,
a
carrier
or
organized
9
delivery
system
may
modify
the
health
insurance
coverage
for
10
a
policy
form
offered
to
individuals
in
the
individual
market
11
so
long
as
such
modification
is
consistent
with
state
law
and
12
effective
on
a
uniform
basis
among
all
individuals
with
that
13
policy
form.
14
3.
An
individual
carrier
or
organized
delivery
system
that
15
elects
not
to
renew
an
individual
health
benefit
plan
under
16
subsection
1
,
paragraph
“d”
,
shall
not
write
any
new
business
in
17
the
individual
market
in
this
state
for
a
period
of
five
years
18
after
the
date
of
notice
to
the
commissioner
or
director
.
19
4.
This
section
,
with
respect
to
a
carrier
or
organized
20
delivery
system
doing
business
in
one
established
geographic
21
service
area
of
the
state,
applies
only
to
such
carrier’s
or
22
organized
delivery
system’s
operations
in
that
service
area.
23
5.
A
carrier
or
organized
delivery
system
offering
coverage
24
through
a
network
plan
is
not
required
to
renew
or
continue
in
25
force
coverage
or
to
accept
applications
from
an
individual
who
26
no
longer
resides
or
lives
in,
or
is
no
longer
employed
in,
27
the
service
area
of
such
carrier
or
organized
delivery
system
,
28
or
no
longer
resides
or
lives
in,
or
is
no
longer
employed
29
in,
a
service
area
for
which
the
carrier
is
authorized
to
do
30
business,
but
only
if
coverage
is
not
offered
or
terminated
31
uniformly
without
regard
to
health
status-related
factors
of
a
32
covered
individual.
33
6.
A
carrier
or
organized
delivery
system
offering
coverage
34
through
a
bona
fide
association
is
not
required
to
renew
or
35
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continue
in
force
coverage
or
to
accept
applications
from
an
1
individual
through
an
association
if
the
membership
of
the
2
individual
in
the
association
on
which
the
basis
of
coverage
3
is
provided
ceases,
but
only
if
the
coverage
is
not
offered
or
4
terminated
under
this
paragraph
uniformly
without
regard
to
5
health
status-related
factors
of
a
covered
individual.
6
7.
An
individual
who
has
coverage
as
a
dependent
under
a
7
basic
or
standard
health
benefit
plan
may,
when
that
individual
8
is
no
longer
a
dependent
under
such
coverage,
elect
to
continue
9
coverage
under
the
basic
or
standard
health
benefit
plan
if
10
the
individual
so
elects
immediately
upon
termination
of
the
11
coverage
under
which
the
individual
was
covered
as
a
dependent.
12
Sec.
54.
Section
513C.7,
subsection
1,
Code
2017,
is
amended
13
to
read
as
follows:
14
1.
a.
(1)
A
carrier
shall
file
with
the
commissioner,
in
15
a
form
and
manner
prescribed
by
the
commissioner,
the
basic
16
or
standard
health
benefit
plan.
A
basic
or
standard
health
17
benefit
plan
filed
pursuant
to
this
paragraph
may
be
used
by
18
a
carrier
beginning
thirty
days
after
it
is
filed
unless
the
19
commissioner
disapproves
of
its
use.
20
(2)
b.
The
commissioner
may
at
any
time,
after
providing
21
notice
and
an
opportunity
for
a
hearing
to
the
carrier,
22
disapprove
the
continued
use
by
a
carrier
of
a
basic
or
23
standard
health
benefit
plan
on
the
grounds
that
the
plan
does
24
not
meet
the
requirements
of
this
chapter
.
25
b.
(1)
An
organized
delivery
system
shall
file
with
the
26
director,
in
a
form
and
manner
prescribed
by
the
director,
27
the
basic
or
standard
health
benefit
plan
to
be
used
by
the
28
organized
delivery
system.
A
basic
or
standard
health
benefit
29
plan
filed
pursuant
to
this
paragraph
may
be
used
by
the
30
organized
delivery
system
beginning
thirty
days
after
it
is
31
filed
unless
the
director
disapproves
of
its
use.
32
(2)
The
director
may
at
any
time,
after
providing
notice
and
33
an
opportunity
for
a
hearing
to
the
organized
delivery
system,
34
disapprove
the
continued
use
by
an
organized
delivery
system
of
35
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a
basic
or
standard
health
benefit
plan
on
the
grounds
that
the
1
plan
does
not
meet
the
requirements
of
this
chapter
.
2
Sec.
55.
Section
513C.7,
subsection
3,
Code
2017,
is
amended
3
to
read
as
follows:
4
3.
A
carrier
or
an
organized
delivery
system
shall
not
5
modify
a
basic
or
standard
health
benefit
plan
with
respect
6
to
an
individual
or
dependent
through
riders,
endorsements,
7
or
other
means
to
restrict
or
exclude
coverage
for
certain
8
diseases
or
medical
conditions
otherwise
covered
by
the
health
9
benefit
plan.
10
Sec.
56.
Section
513C.9,
subsections
1,
2,
3,
6,
and
8,
Code
11
2017,
are
amended
to
read
as
follows:
12
1.
A
carrier
,
an
organized
delivery
system,
or
an
agent
13
shall
not
do
either
of
the
following:
14
a.
Encourage
or
direct
individuals
to
refrain
from
15
filing
an
application
for
coverage
with
the
carrier
or
the
16
organized
delivery
system
because
of
the
health
status,
claims
17
experience,
industry,
occupation,
or
geographic
location
of
the
18
individuals.
19
b.
Encourage
or
direct
individuals
to
seek
coverage
from
20
another
carrier
or
another
organized
delivery
system
because
of
21
the
health
status,
claims
experience,
industry,
occupation,
or
22
geographic
location
of
the
individuals.
23
2.
Subsection
1
,
paragraph
“a”
,
shall
not
apply
with
respect
24
to
information
provided
by
a
carrier
or
an
organized
delivery
25
system
or
an
agent
to
an
individual
regarding
the
established
26
geographic
service
area
of
the
carrier
or
the
organized
27
delivery
system,
or
the
restricted
network
provision
of
the
28
carrier
or
the
organized
delivery
system
.
29
3.
A
carrier
or
an
organized
delivery
system
shall
not,
30
directly
or
indirectly,
enter
into
any
contract,
agreement,
or
31
arrangement
with
an
agent
that
provides
for,
or
results
in,
the
32
compensation
paid
to
an
agent
for
a
sale
of
a
basic
or
standard
33
health
benefit
plan
to
vary
because
of
the
health
status
or
34
permitted
rating
characteristics
of
the
individual
or
the
35
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individual’s
dependents.
1
6.
Denial
by
a
carrier
or
an
organized
delivery
system
of
an
2
application
for
coverage
from
an
individual
shall
be
in
writing
3
and
shall
state
the
reason
or
reasons
for
the
denial.
4
8.
If
a
carrier
or
an
organized
delivery
system
enters
into
5
a
contract,
agreement,
or
other
arrangement
with
a
third-party
6
administrator
to
provide
administrative,
marketing,
or
other
7
services
related
to
the
offering
of
individual
health
benefit
8
plans
in
this
state,
the
third-party
administrator
is
subject
9
to
this
section
as
if
it
were
a
carrier
or
an
organized
10
delivery
system
.
11
Sec.
57.
Section
513C.10,
subsection
1,
paragraph
a,
Code
12
2017,
is
amended
to
read
as
follows:
13
a.
All
persons
that
provide
health
benefit
plans
in
this
14
state
including
insurers
providing
accident
and
sickness
15
insurance
under
chapter
509
,
514
,
or
514A
,
whether
on
an
16
individual
or
group
basis;
fraternal
benefit
societies
17
providing
hospital,
medical,
or
nursing
benefits
under
chapter
18
512B
;
and
health
maintenance
organizations,
organized
delivery
19
systems,
other
entities
providing
health
insurance
or
health
20
benefits
subject
to
state
insurance
regulation,
and
all
other
21
insurers
as
designated
by
the
board
of
directors
of
the
Iowa
22
comprehensive
health
insurance
association
with
the
approval
of
23
the
commissioner
shall
be
members
of
the
association.
24
Sec.
58.
Section
513C.10,
subsection
2,
paragraph
a,
Code
25
2017,
is
amended
to
read
as
follows:
26
a.
Rates
for
basic
and
standard
coverages
as
provided
in
27
this
chapter
shall
be
determined
by
each
carrier
or
organized
28
delivery
system
as
the
product
of
a
basic
and
standard
factor
29
and
the
lowest
rate
available
for
issuance
by
that
carrier
or
30
organized
delivery
system
adjusted
for
rating
characteristics
31
and
benefits.
Basic
and
standard
factors
shall
be
established
32
annually
by
the
Iowa
comprehensive
health
insurance
association
33
board
with
the
approval
of
the
commissioner.
Multiple
basic
34
and
standard
factors
for
a
distinct
grouping
of
basic
and
35
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393
standard
policies
may
be
established.
A
basic
and
standard
1
factor
is
limited
to
a
minimum
value
defined
as
the
ratio
2
of
the
average
of
the
lowest
rate
available
for
issuance
and
3
the
maximum
rate
allowable
by
law
divided
by
the
lowest
rate
4
available
for
issuance.
A
basic
and
standard
factor
is
limited
5
to
a
maximum
value
defined
as
the
ratio
of
the
maximum
rate
6
allowable
by
law
divided
by
the
lowest
rate
available
for
7
issuance.
The
maximum
rate
allowable
by
law
and
the
lowest
8
rate
available
for
issuance
is
determined
based
on
the
rate
9
restrictions
under
this
chapter
.
For
policies
written
after
10
January
1,
2002,
rates
for
the
basic
and
standard
coverages
11
as
provided
in
this
chapter
shall
be
calculated
using
the
12
basic
and
standard
factors
and
shall
be
no
lower
than
the
13
maximum
rate
allowable
by
law.
However,
to
maintain
assessable
14
loss
assessments
at
or
below
one
percent
of
total
health
15
insurance
premiums
or
payments
as
determined
in
accordance
16
with
subsection
6
,
the
Iowa
comprehensive
health
insurance
17
association
board
with
the
approval
of
the
commissioner
may
18
increase
the
value
for
any
basic
and
standard
factor
greater
19
than
the
maximum
value.
20
Sec.
59.
Section
513C.10,
subsections
3,
4,
7,
8,
9,
and
10,
21
Code
2017,
are
amended
to
read
as
follows:
22
3.
Following
the
close
of
each
calendar
year,
the
23
association,
in
conjunction
with
the
commissioner,
shall
24
require
each
carrier
or
organized
delivery
system
to
report
25
the
amount
of
earned
premiums
and
the
associated
paid
losses
26
for
all
basic
and
standard
plans
issued
by
the
carrier
or
27
organized
delivery
system
.
The
reporting
of
these
amounts
must
28
be
certified
by
an
officer
of
the
carrier
or
organized
delivery
29
system
.
30
4.
The
board
shall
develop
procedures
and
assessment
31
mechanisms
and
make
assessments
and
distributions
as
required
32
to
equalize
the
individual
carrier
and
organized
delivery
33
system
gains
or
losses
so
that
each
carrier
or
organized
34
delivery
system
receives
the
same
ratio
of
paid
claims
to
35
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ninety
percent
of
earned
premiums
as
the
aggregate
of
all
1
basic
and
standard
plans
insured
by
all
carriers
and
organized
2
delivery
systems
in
the
state.
3
7.
The
board
shall
develop
procedures
for
distributing
4
the
assessable
loss
assessments
to
each
carrier
and
organized
5
delivery
system
in
proportion
to
the
carrier’s
and
organized
6
delivery
system’s
respective
share
of
premium
for
basic
and
7
standard
plans
to
the
statewide
total
premium
for
all
basic
and
8
standard
plans.
9
8.
The
board
shall
ensure
that
procedures
for
collecting
10
and
distributing
assessments
are
as
efficient
as
possible
11
for
carriers
and
organized
delivery
systems
.
The
board
may
12
establish
procedures
which
combine,
or
offset,
the
assessment
13
from,
and
the
distribution
due
to,
a
carrier
or
organized
14
delivery
system
.
15
9.
A
carrier
or
an
organized
delivery
system
may
16
petition
the
association
board
to
seek
remedy
from
writing
a
17
significantly
disproportionate
share
of
basic
and
standard
18
policies
in
relation
to
total
premiums
written
in
this
state
19
for
health
benefit
plans.
Upon
a
finding
that
a
carrier
or
20
organized
delivery
system
has
written
a
disproportionate
share,
21
the
board
may
agree
to
compensate
the
carrier
or
organized
22
delivery
system
either
by
paying
to
the
carrier
or
organized
23
delivery
system
an
additional
fee
not
to
exceed
two
percent
24
of
earned
premiums
from
basic
and
standard
policies
for
that
25
carrier
or
organized
delivery
system
or
by
petitioning
the
26
commissioner
or
director,
as
appropriate,
for
remedy.
27
10.
a.
The
commissioner,
upon
a
finding
that
the
acceptance
28
of
the
offer
of
basic
and
standard
coverage
by
individuals
29
pursuant
to
this
chapter
would
place
the
carrier
in
a
30
financially
impaired
condition,
shall
not
require
the
carrier
31
to
offer
coverage
or
accept
applications
for
any
period
of
time
32
the
financial
impairment
is
deemed
to
exist.
33
b.
The
director,
upon
a
finding
that
the
acceptance
of
the
34
offer
of
basic
and
standard
coverage
by
individuals
pursuant
35
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393
to
this
chapter
would
place
the
organized
delivery
system
in
a
1
financially
impaired
condition,
shall
not
require
the
organized
2
delivery
system
to
offer
coverage
or
accept
applications
for
3
any
period
of
time
the
financial
impairment
is
deemed
to
exist.
4
Sec.
60.
Section
514A.3B,
subsection
3,
paragraph
k,
Code
5
2017,
is
amended
by
striking
the
paragraph.
6
Sec.
61.
Section
514B.25A,
Code
2017,
is
amended
to
read
as
7
follows:
8
514B.25A
Insolvency
protection
——
assessment.
9
1.
Upon
a
health
maintenance
organization
or
organized
10
delivery
system
authorized
to
do
business
in
this
state
and
11
licensed
by
the
director
of
public
health
being
declared
12
insolvent
by
the
district
court,
the
commissioner
may
levy
an
13
assessment
on
each
health
maintenance
organization
or
organized
14
delivery
system
doing
business
in
this
state
and
licensed
by
15
the
director
of
public
health,
as
applicable
,
to
pay
claims
16
for
uncovered
expenditures
for
enrollees.
The
commissioner
17
shall
not
assess
an
amount
in
any
one
calendar
year
which
is
18
more
than
two
percent
of
the
aggregate
premium
written
by
each
19
health
maintenance
organization
or
organized
delivery
system
.
20
2.
The
commissioner
may
use
funds
obtained
through
an
21
assessment
under
subsection
1
to
pay
claims
for
uncovered
22
expenditures
for
enrollees
of
an
insolvent
health
maintenance
23
organization
or
organized
delivery
system
and
administrative
24
costs.
The
commissioner,
by
rule,
may
prescribe
the
time,
25
manner,
and
form
for
filing
claims
under
this
section
.
The
26
commissioner
may
require
claims
to
be
allowed
by
an
ancillary
27
receiver
or
the
domestic
receiver
or
liquidator.
28
3.
a.
A
receiver
or
liquidator
of
an
insolvent
health
29
maintenance
organization
or
organized
delivery
system
shall
30
allow
a
claim
in
the
proceeding
in
an
amount
equal
to
uncovered
31
expenditures
and
administrative
costs
paid
under
this
section
.
32
b.
A
person
receiving
benefits
under
this
section
for
33
uncovered
expenditures
is
deemed
to
have
assigned
the
rights
34
under
the
covered
health
care
plan
certificates
to
the
35
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393
commissioner
to
the
extent
of
the
benefits
received.
The
1
commissioner
may
require
an
assignment
of
such
rights
by
a
2
payee,
enrollee,
or
beneficiary,
to
the
commissioner
as
a
3
condition
precedent
to
the
receipt
of
such
benefits.
The
4
commissioner
is
subrogated
to
these
rights
against
the
assets
5
of
the
insolvent
health
maintenance
organization
or
organized
6
delivery
system
that
are
held
by
a
receiver
or
liquidator
of
7
a
foreign
jurisdiction.
8
c.
The
assigned
subrogation
rights
of
the
commissioner
and
9
allowed
claims
under
this
subsection
have
the
same
priority
10
against
the
assets
of
the
insolvent
health
maintenance
11
organization
or
organized
delivery
system
as
those
claims
of
12
persons
entitled
to
receive
benefits
under
this
section
or
for
13
similar
expenses
in
the
receivership
or
liquidation.
14
4.
If
funds
assessed
under
subsection
1
are
unused
15
following
the
completion
of
the
liquidation
of
an
insolvent
16
health
maintenance
organization
or
organized
delivery
system
,
17
the
commissioner
shall
distribute
the
remaining
amounts,
if
18
such
amounts
are
not
de
minimis,
to
the
health
maintenance
19
organizations
or
organized
delivery
systems
that
were
assessed.
20
5.
The
aggregate
coverage
of
uncovered
expenditures
under
21
this
section
shall
not
exceed
three
hundred
thousand
dollars
22
with
respect
to
one
individual.
Continuation
of
coverage
23
shall
cease
after
the
lesser
of
one
year
after
the
health
24
maintenance
organization
or
organized
delivery
system
is
25
terminated
by
insolvency
or
the
remaining
term
of
the
contract.
26
The
commissioner
may
provide
continuation
of
coverage
on
a
27
reasonable
basis,
including,
but
not
limited
to,
continuation
28
of
the
health
maintenance
organization
or
organized
delivery
29
system
contract
or
substitution
of
indemnity
coverage
in
a
form
30
as
determined
by
the
commissioner.
31
6.
The
commissioner
may
waive
an
assessment
of
a
health
32
maintenance
organization
or
organized
delivery
system
if
such
33
organization
or
system
is
impaired
financially
or
would
be
34
impaired
financially
as
a
result
of
such
assessment.
A
health
35
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393
maintenance
organization
or
organized
delivery
system
that
1
fails
to
pay
an
assessment
within
thirty
days
after
notice
of
2
the
assessment
is
subject
to
a
civil
forfeiture
of
not
more
3
than
one
thousand
dollars
for
each
day
the
failure
continues,
4
and
suspension
or
revocation
of
its
certificate
of
authority.
5
An
action
taken
by
the
commissioner
to
enforce
an
assessment
6
under
this
section
may
be
appealed
by
the
health
maintenance
7
organization
or
organized
delivery
system
pursuant
to
chapter
8
17A
.
9
Sec.
62.
Section
514C.10,
subsection
2,
paragraph
e,
Code
10
2017,
is
amended
by
striking
the
paragraph.
11
Sec.
63.
Section
514C.11,
Code
2017,
is
amended
to
read
as
12
follows:
13
514C.11
Services
provided
by
licensed
physician
assistants
14
and
licensed
advanced
registered
nurse
practitioners.
15
1.
Notwithstanding
section
514C.6
,
a
policy
or
contract
16
providing
for
third-party
payment
or
prepayment
of
health
or
17
medical
expenses
shall
include
a
provision
for
the
payment
of
18
necessary
medical
or
surgical
care
and
treatment
provided
by
19
a
physician
assistant
licensed
pursuant
to
chapter
148C
,
or
20
provided
by
an
advanced
registered
nurse
practitioner
licensed
21
pursuant
to
chapter
152
and
performed
within
the
scope
of
the
22
license
of
the
licensed
physician
assistant
or
the
licensed
23
advanced
registered
nurse
practitioner
if
the
policy
or
24
contract
would
pay
for
the
care
and
treatment
if
the
care
and
25
treatment
were
provided
by
a
person
engaged
in
the
practice
26
of
medicine
and
surgery
or
osteopathic
medicine
and
surgery
27
under
chapter
148
.
The
policy
or
contract
shall
provide
that
28
policyholders
and
subscribers
under
the
policy
or
contract
may
29
reject
the
coverage
for
services
which
may
be
provided
by
a
30
licensed
physician
assistant
or
licensed
advanced
registered
31
nurse
practitioner
if
the
coverage
is
rejected
for
all
32
providers
of
similar
services.
A
policy
or
contract
subject
33
to
this
section
shall
not
impose
a
practice
or
supervision
34
restriction
which
is
inconsistent
with
or
more
restrictive
than
35
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the
restriction
already
imposed
by
law.
1
2.
This
section
applies
to
services
provided
under
a
policy
2
or
contract
delivered,
issued
for
delivery,
continued,
or
3
renewed
in
this
state
on
or
after
July
1,
1996,
and
to
an
4
existing
policy
or
contract,
on
the
policy’s
or
contract’s
5
anniversary
or
renewal
date,
or
upon
the
expiration
of
the
6
applicable
collective
bargaining
contract,
if
any,
whichever
7
is
later.
This
section
does
not
apply
to
policyholders
or
8
subscribers
eligible
for
coverage
under
Tit.
XVIII
of
the
9
federal
Social
Security
Act
or
any
similar
coverage
under
a
10
state
or
federal
government
plan.
11
3.
For
the
purposes
of
this
section
,
third-party
payment
or
12
prepayment
includes
an
individual
or
group
policy
of
accident
13
or
health
insurance
or
individual
or
group
hospital
or
health
14
care
service
contract
issued
pursuant
to
chapter
509
,
514
,
or
15
514A
,
an
individual
or
group
health
maintenance
organization
16
contract
issued
and
regulated
under
chapter
514B
,
an
organized
17
delivery
system
contract
regulated
under
rules
adopted
by
the
18
director
of
public
health,
or
a
preferred
provider
organization
19
contract
regulated
pursuant
to
chapter
514F
.
20
4.
Nothing
in
this
section
shall
be
interpreted
to
require
21
an
individual
or
group
health
maintenance
organization
,
an
22
organized
delivery
system,
or
a
preferred
provider
organization
23
or
arrangement
to
provide
payment
or
prepayment
for
services
24
provided
by
a
licensed
physician
assistant
or
licensed
advanced
25
registered
nurse
practitioner
unless
the
physician
assistant’s
26
supervising
physician,
the
physician-physician
assistant
team,
27
the
advanced
registered
nurse
practitioner,
or
the
advanced
28
registered
nurse
practitioner’s
collaborating
physician
has
29
entered
into
a
contract
or
other
agreement
to
provide
services
30
with
the
individual
or
group
health
maintenance
organization
,
31
the
organized
delivery
system,
or
the
preferred
provider
32
organization
or
arrangement.
33
Sec.
64.
Section
514C.13,
subsection
1,
paragraph
h,
Code
34
2017,
is
amended
by
striking
the
paragraph.
35
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393
Sec.
65.
Section
514C.13,
subsection
2,
Code
2017,
is
1
amended
to
read
as
follows:
2
2.
A
carrier
or
organized
delivery
system
which
offers
to
3
a
small
employer
a
limited
provider
network
plan
to
provide
4
health
care
services
or
benefits
to
the
small
employer’s
5
employees
shall
also
offer
to
the
small
employer
a
point
of
6
service
option
to
the
limited
provider
network
plan.
7
Sec.
66.
Section
514C.13,
subsection
3,
unnumbered
8
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
9
A
carrier
or
organized
delivery
system
which
offers
to
a
10
large
employer
a
limited
provider
network
plan
to
provide
11
health
care
services
or
benefits
to
the
large
employer’s
12
employees
shall
also
offer
to
the
large
employer
one
or
more
13
of
the
following:
14
Sec.
67.
Section
514C.14,
subsections
1
and
3,
Code
2017,
15
are
amended
to
read
as
follows:
16
1.
Except
as
provided
under
subsection
2
or
3
,
a
carrier,
17
as
defined
in
section
513B.2
,
an
organized
delivery
system
18
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
19
pursuant
to
chapter
509A
for
public
employees,
which
terminates
20
its
contract
with
a
participating
health
care
provider,
21
shall
continue
to
provide
coverage
under
the
contract
to
a
22
covered
person
in
the
second
or
third
trimester
of
pregnancy
23
for
continued
care
from
such
health
care
provider.
Such
24
persons
may
continue
to
receive
such
treatment
or
care
through
25
postpartum
care
related
to
the
child
birth
and
delivery.
26
Payment
for
covered
benefits
and
benefit
levels
shall
be
27
according
to
the
terms
and
conditions
of
the
contract.
28
3.
A
carrier
,
organized
delivery
system,
or
a
plan
29
established
under
chapter
509A
,
which
terminates
the
contract
30
of
a
participating
health
care
provider
for
cause
shall
not
31
be
liable
to
pay
for
health
care
services
provided
by
the
32
health
care
provider
to
a
covered
person
following
the
date
of
33
termination.
34
Sec.
68.
Section
514C.15,
Code
2017,
is
amended
to
read
as
35
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57
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393
follows:
1
514C.15
Treatment
options.
2
A
carrier,
as
defined
in
section
513B.2
,
;
an
organized
3
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
4
and
licensed
by
the
director
of
public
health;
or
a
plan
5
established
pursuant
to
chapter
509A
for
public
employees,
6
shall
not
prohibit
a
participating
provider
from,
or
penalize
a
7
participating
provider
for,
doing
either
of
the
following:
8
1.
Discussing
treatment
options
with
a
covered
individual,
9
notwithstanding
the
carrier’s,
organized
delivery
system’s,
or
10
plan’s
position
on
such
treatment
option.
11
2.
Advocating
on
behalf
of
a
covered
individual
within
12
a
review
or
grievance
process
established
by
the
carrier
,
13
organized
delivery
system,
or
chapter
509A
plan,
or
established
14
by
a
person
contracting
with
the
carrier
,
organized
delivery
15
system,
or
chapter
509A
plan.
16
Sec.
69.
Section
514C.16,
subsection
1,
Code
2017,
is
17
amended
to
read
as
follows:
18
1.
A
carrier,
as
defined
in
section
513B.2
,
;
an
organized
19
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
20
and
licensed
by
the
director
of
public
health;
or
a
plan
21
established
pursuant
to
chapter
509A
for
public
employees,
22
which
provides
coverage
for
emergency
services,
is
responsible
23
for
charges
for
emergency
services
provided
to
a
covered
24
individual,
including
services
furnished
outside
any
25
contractual
provider
network
or
preferred
provider
network.
26
Coverage
for
emergency
services
is
subject
to
the
terms
and
27
conditions
of
the
health
benefit
plan
or
contract.
28
Sec.
70.
Section
514C.17,
subsections
1
and
3,
Code
2017,
29
are
amended
to
read
as
follows:
30
1.
Except
as
provided
under
subsection
2
or
3
,
if
a
carrier,
31
as
defined
in
section
513B.2
,
an
organized
delivery
system
32
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
33
pursuant
to
chapter
509A
for
public
employees,
terminates
its
34
contract
with
a
participating
health
care
provider,
a
covered
35
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393
individual
who
is
undergoing
a
specified
course
of
treatment
1
for
a
terminal
illness
or
a
related
condition,
with
the
2
recommendation
of
the
covered
individual’s
treating
physician
3
licensed
under
chapter
148
may
continue
to
receive
coverage
for
4
treatment
received
from
the
covered
individual’s
physician
for
5
the
terminal
illness
or
a
related
condition,
for
a
period
of
6
up
to
ninety
days.
Payment
for
covered
benefits
and
benefit
7
levels
shall
be
according
to
the
terms
and
conditions
of
the
8
contract.
9
3.
Notwithstanding
subsections
1
and
2
,
a
carrier
,
10
organized
delivery
system,
or
a
plan
established
under
chapter
11
509A
which
terminates
the
contract
of
a
participating
health
12
care
provider
for
cause
shall
not
be
required
to
cover
health
13
care
services
provided
by
the
health
care
provider
to
a
covered
14
person
following
the
date
of
termination.
15
Sec.
71.
Section
514C.18,
subsection
2,
paragraph
a,
16
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
17
subparagraph.
18
Sec.
72.
Section
514C.19,
subsection
7,
paragraph
a,
19
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
20
subparagraph.
21
Sec.
73.
Section
514C.20,
subsection
3,
paragraph
f,
Code
22
2017,
is
amended
by
striking
the
paragraph.
23
Sec.
74.
Section
514C.21,
subsection
2,
paragraph
d,
Code
24
2017,
is
amended
by
striking
the
paragraph.
25
Sec.
75.
Section
514C.22,
subsection
1,
unnumbered
26
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
27
Notwithstanding
the
uniformity
of
treatment
requirements
of
28
section
514C.6
,
a
group
policy,
contract,
or
plan
providing
29
for
third-party
payment
or
prepayment
of
health,
medical,
and
30
surgical
coverage
benefits
issued
by
a
carrier,
as
defined
in
31
section
513B.2
,
or
by
an
organized
delivery
system
authorized
32
under
1993
Iowa
Acts,
ch.
158,
shall
provide
coverage
benefits
33
for
treatment
of
a
biologically
based
mental
illness
if
either
34
of
the
following
is
satisfied:
35
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57
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393
Sec.
76.
Section
514C.22,
subsection
6,
Code
2017,
is
1
amended
to
read
as
follows:
2
6.
A
carrier
,
organized
delivery
system,
or
plan
3
established
pursuant
to
chapter
509A
may
manage
the
benefits
4
provided
through
common
methods
including,
but
not
limited
to,
5
providing
payment
of
benefits
or
providing
care
and
treatment
6
under
a
capitated
payment
system,
prospective
reimbursement
7
rate
system,
utilization
control
system,
incentive
system
for
8
the
use
of
least
restrictive
and
least
costly
levels
of
care,
9
a
preferred
provider
contract
limiting
choice
of
specific
10
providers,
or
any
other
system,
method,
or
organization
11
designed
to
assure
services
are
medically
necessary
and
12
clinically
appropriate.
13
Sec.
77.
Section
514C.25,
subsection
2,
paragraph
a,
14
subparagraph
(5),
Code
2017,
is
amended
by
striking
the
15
subparagraph.
16
Sec.
78.
Section
514C.26,
subsection
5,
paragraph
a,
17
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
18
subparagraph.
19
Sec.
79.
Section
514C.27,
subsection
1,
unnumbered
20
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
21
Notwithstanding
the
uniformity
of
treatment
requirements
22
of
section
514C.6
,
a
group
policy
or
contract
providing
for
23
third-party
payment
or
prepayment
of
health
or
medical
expenses
24
issued
by
a
carrier,
as
defined
in
section
513B.2
,
or
by
an
25
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
26
158
,
shall
provide
coverage
benefits
to
an
insured
who
is
a
27
veteran
for
treatment
of
mental
illness
and
substance
abuse
if
28
either
of
the
following
is
satisfied:
29
Sec.
80.
Section
514C.27,
subsection
6,
Code
2017,
is
30
amended
to
read
as
follows:
31
6.
A
carrier
,
organized
delivery
system,
or
plan
32
established
pursuant
to
chapter
509A
may
manage
the
benefits
33
provided
through
common
methods
including
but
not
limited
to
34
providing
payment
of
benefits
or
providing
care
and
treatment
35
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57
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393
under
a
capitated
payment
system,
prospective
reimbursement
1
rate
system,
utilization
control
system,
incentive
system
for
2
the
use
of
least
restrictive
and
least
costly
levels
of
care,
3
a
preferred
provider
contract
limiting
choice
of
specific
4
providers,
or
any
other
system,
method,
or
organization
5
designed
to
assure
services
are
medically
necessary
and
6
clinically
appropriate.
7
Sec.
81.
Section
514C.29,
subsection
2,
paragraph
e,
Code
8
2017,
is
amended
by
striking
the
paragraph.
9
Sec.
82.
Section
514C.30,
subsection
2,
paragraph
e,
Code
10
2017,
is
amended
by
striking
the
paragraph.
11
Sec.
83.
Section
514E.1,
subsection
6,
paragraph
k,
Code
12
2017,
is
amended
by
striking
the
paragraph.
13
Sec.
84.
Section
514E.1,
subsection
17,
Code
2017,
is
14
amended
by
striking
the
subsection.
15
Sec.
85.
Section
514E.2,
subsection
1,
paragraph
a,
Code
16
2017,
is
amended
to
read
as
follows:
17
a.
All
carriers
and
all
organized
delivery
systems
licensed
18
by
the
director
of
public
health
providing
health
insurance
or
19
health
care
services
in
Iowa,
whether
on
an
individual
or
group
20
basis,
and
all
other
insurers
designated
by
the
association’s
21
board
of
directors
and
approved
by
the
commissioner
shall
be
22
members
of
the
association.
23
Sec.
86.
Section
514E.2,
subsection
2,
paragraph
a,
24
subparagraph
(3),
Code
2017,
is
amended
to
read
as
follows:
25
(3)
Two
members
selected
by
the
members
of
the
association,
26
one
of
whom
shall
be
a
representative
from
a
corporation
27
operating
pursuant
to
chapter
514
on
July
1,
1989,
or
28
any
successor
in
interest,
and
one
of
whom
shall
be
a
29
representative
of
an
organized
delivery
system
or
an
insurer
30
providing
coverage
pursuant
to
chapter
509
or
514A
.
31
Sec.
87.
Section
514E.7,
subsection
1,
paragraph
a,
32
subparagraphs
(1)
and
(2),
Code
2017,
are
amended
to
read
as
33
follows:
34
(1)
A
notice
of
rejection
or
refusal
to
issue
substantially
35
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393
similar
insurance
for
health
reasons
by
one
carrier
or
1
organized
delivery
system
.
2
(2)
A
refusal
by
a
carrier
or
organized
delivery
system
to
3
issue
insurance
except
at
a
rate
exceeding
the
plan
rate.
4
Sec.
88.
Section
514E.7,
subsection
1,
paragraph
b,
Code
5
2017,
is
amended
to
read
as
follows:
6
b.
A
rejection
or
refusal
by
a
carrier
or
organized
delivery
7
system
offering
only
stoploss,
excess
of
loss,
or
reinsurance
8
coverage
with
respect
to
an
applicant
under
paragraph
“a”
,
9
subparagraphs
(1)
and
(2)
,
is
not
sufficient
evidence
for
10
purposes
of
this
subsection
.
11
Sec.
89.
Section
514E.9,
Code
2017,
is
amended
to
read
as
12
follows:
13
514E.9
Rules.
14
Pursuant
to
chapter
17A
,
the
commissioner
and
the
director
15
of
public
health
shall
adopt
rules
to
provide
for
disclosure
16
by
carriers
and
organized
delivery
systems
of
the
availability
17
of
insurance
coverage
from
the
association,
and
to
otherwise
18
implement
this
chapter
.
19
Sec.
90.
Section
514E.11,
Code
2017,
is
amended
to
read
as
20
follows:
21
514E.11
Notice
of
association
policy.
22
Every
carrier,
including
a
health
maintenance
organization
23
subject
to
chapter
514B
and
an
organized
delivery
system
,
24
authorized
to
provide
health
care
insurance
or
coverage
for
25
health
care
services
in
Iowa,
shall
provide
a
notice
of
the
26
availability
of
coverage
by
the
association
to
any
person
27
who
receives
a
rejection
of
coverage
for
health
insurance
28
or
health
care
services,
or
a
rate
for
health
insurance
or
29
coverage
for
health
care
services
that
will
exceed
the
rate
of
30
an
association
policy,
and
that
person
is
eligible
to
apply
31
for
health
insurance
provided
by
the
association.
Application
32
for
the
health
insurance
shall
be
on
forms
prescribed
by
the
33
association’s
board
of
directors
and
made
available
to
the
34
carriers
and
organized
delivery
systems
and
other
entities
35
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393
providing
health
care
insurance
or
coverage
for
health
care
1
services
regulated
by
the
commissioner.
2
Sec.
91.
Section
514F.5,
Code
2017,
is
amended
to
read
as
3
follows:
4
514F.5
Experimental
treatment
review.
5
1.
A
carrier,
as
defined
in
section
513B.2
,
an
organized
6
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
7
plan
established
pursuant
to
chapter
509A
for
public
employees,
8
that
limits
coverage
for
experimental
medical
treatment,
drugs,
9
or
devices,
shall
develop
and
implement
a
procedure
to
evaluate
10
experimental
medical
treatments
and
shall
submit
a
description
11
of
the
procedure
to
the
division
of
insurance.
The
procedure
12
shall
be
in
writing
and
must
describe
the
process
used
to
13
determine
whether
the
carrier
,
organized
delivery
system,
14
or
chapter
509A
plan
will
provide
coverage
for
new
medical
15
technologies
and
new
uses
of
existing
technologies.
The
16
procedure,
at
a
minimum,
shall
require
a
review
of
information
17
from
appropriate
government
regulatory
agencies
and
published
18
scientific
literature
concerning
new
medical
technologies,
new
19
uses
of
existing
technologies,
and
the
use
of
external
experts
20
in
making
decisions.
A
carrier
,
organized
delivery
system,
21
or
chapter
509A
plan
shall
include
appropriately
licensed
22
or
qualified
professionals
in
the
evaluation
process.
The
23
procedure
shall
provide
a
process
for
a
person
covered
under
24
a
plan
or
contract
to
request
a
review
of
a
denial
of
coverage
25
because
the
proposed
treatment
is
experimental.
A
review
of
26
a
particular
treatment
need
not
be
reviewed
more
than
once
a
27
year.
28
2.
A
carrier
,
organized
delivery
system,
or
chapter
509A
29
plan
that
limits
coverage
for
experimental
treatment,
drugs,
or
30
devices
shall
clearly
disclose
such
limitations
in
a
contract,
31
policy,
or
certificate
of
coverage.
32
Sec.
92.
Section
514I.2,
subsection
10,
Code
2017,
is
33
amended
to
read
as
follows:
34
10.
“Participating
insurer”
means
any
entity
licensed
by
the
35
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87
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57
H.F.
393
division
of
insurance
of
the
department
of
commerce
to
provide
1
health
insurance
in
Iowa
or
an
organized
delivery
system
2
licensed
by
the
director
of
public
health
that
has
contracted
3
with
the
department
to
provide
health
insurance
coverage
to
4
eligible
children
under
this
chapter
.
5
Sec.
93.
Section
514J.102,
subsection
24,
Code
2017,
is
6
amended
to
read
as
follows:
7
24.
“Health
carrier”
means
an
entity
subject
to
the
8
insurance
laws
and
regulations
of
this
state,
or
subject
9
to
the
jurisdiction
of
the
commissioner,
including
an
10
insurance
company
offering
sickness
and
accident
plans,
a
11
health
maintenance
organization,
a
nonprofit
health
service
12
corporation,
a
plan
established
pursuant
to
chapter
509A
13
for
public
employees,
or
any
other
entity
providing
a
plan
14
of
health
insurance,
health
care
benefits,
or
health
care
15
services.
“Health
carrier”
includes,
for
purposes
of
this
16
chapter
,
an
organized
delivery
system.
17
Sec.
94.
Section
514J.102,
subsection
29,
Code
2017,
is
18
amended
by
striking
the
subsection.
19
Sec.
95.
Section
514K.1,
subsection
1,
unnumbered
paragraph
20
1,
Code
2017,
is
amended
to
read
as
follows:
21
A
health
maintenance
organization
,
an
organized
delivery
22
system,
or
an
insurer
using
a
preferred
provider
arrangement
23
shall
provide
to
each
of
its
enrollees
at
the
time
of
24
enrollment,
and
shall
make
available
to
each
prospective
25
enrollee
upon
request,
written
information
as
required
by
rules
26
adopted
by
the
commissioner
and
the
director
of
public
health
.
27
The
information
required
by
rule
shall
include,
but
not
be
28
limited
to,
all
of
the
following:
29
Sec.
96.
Section
514K.1,
subsection
2,
Code
2017,
is
amended
30
to
read
as
follows:
31
2.
The
commissioner
and
the
director
shall
annually
publish
32
a
consumer
guide
providing
a
comparison
by
plan
on
performance
33
measures,
network
composition,
and
other
key
information
to
34
enable
consumers
to
better
understand
plan
differences.
35
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49/
57
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393
Sec.
97.
Section
514L.1,
subsection
3,
Code
2017,
is
amended
1
to
read
as
follows:
2
3.
“Provider
of
third-party
payment
or
prepayment
of
3
prescription
drug
expenses”
or
“provider”
means
a
provider
of
an
4
individual
or
group
policy
of
accident
or
health
insurance
or
5
an
individual
or
group
hospital
or
health
care
service
contract
6
issued
pursuant
to
chapter
509
,
514
,
or
514A
,
a
provider
of
a
7
plan
established
pursuant
to
chapter
509A
for
public
employees,
8
a
provider
of
an
individual
or
group
health
maintenance
9
organization
contract
issued
and
regulated
under
chapter
514B
,
10
a
provider
of
an
organized
delivery
system
contract
regulated
11
under
rules
adopted
by
the
director
of
public
health,
a
12
provider
of
a
preferred
provider
contract
issued
pursuant
to
13
chapter
514F
,
a
provider
of
a
self-insured
multiple
employer
14
welfare
arrangement,
and
any
other
entity
providing
health
15
insurance
or
health
benefits
which
provide
for
payment
or
16
prepayment
of
prescription
drug
expenses
coverage
subject
to
17
state
insurance
regulation.
18
Sec.
98.
Section
514L.2,
subsection
1,
paragraph
a,
19
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
20
follows:
21
A
provider
of
third-party
payment
or
prepayment
of
22
prescription
drug
expenses,
including
the
provider’s
agents
or
23
contractors
and
pharmacy
benefits
managers,
that
issues
a
card
24
or
other
technology
for
claims
processing
and
an
administrator
25
of
the
payor,
excluding
administrators
of
self-funded
employer
26
sponsored
health
benefit
plans
qualified
under
the
federal
27
Employee
Retirement
Income
Security
Act
of
1974,
shall
issue
28
to
its
insureds
a
card
or
other
technology
containing
uniform
29
prescription
drug
information.
The
commissioner
of
insurance
30
shall
adopt
rules
for
the
uniform
prescription
drug
information
31
card
or
technology
applicable
to
those
entities
subject
to
32
regulation
by
the
commissioner
of
insurance.
The
director
of
33
public
health
shall
adopt
rules
for
the
uniform
prescription
34
drug
information
card
or
technology
applicable
to
organized
35
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delivery
systems.
The
rules
shall
require
at
least
both
of
the
1
following
regarding
the
card
or
technology:
2
Sec.
99.
Section
521F.2,
subsection
7,
Code
2017,
is
amended
3
to
read
as
follows:
4
7.
“Health
organization”
means
a
health
maintenance
5
organization,
limited
service
organization,
dental
or
vision
6
plan,
hospital,
medical
and
dental
indemnity
or
service
7
corporation
or
other
managed
care
organization
licensed
under
8
chapter
514
,
or
514B
,
or
1993
Iowa
Acts,
ch.
158
,
or
any
other
9
entity
engaged
in
the
business
of
insurance,
risk
transfer,
10
or
risk
retention,
that
is
subject
to
the
jurisdiction
of
the
11
commissioner
of
insurance
or
the
director
of
public
health
.
12
“Health
organization”
does
not
include
an
insurance
company
13
licensed
to
transact
the
business
of
insurance
under
chapter
14
508
,
515
,
or
520
,
and
which
is
otherwise
subject
to
chapter
15
521E
.
16
Sec.
100.
1993
Iowa
Acts,
chapter
158,
section
4,
is
amended
17
to
read
as
follows:
18
SEC.
4.
EMERGENCY
RULES.
Pursuant
to
sections
1
,
and
2
,
and
19
3
of
this
Act,
the
commissioner
of
insurance
or
the
director
of
20
public
health
shall
adopt
administrative
rules
under
section
21
17A.4,
subsection
2,
and
section
17A.5,
subsection
2,
paragraph
22
“b”,
to
implement
the
provisions
of
this
Act
and
the
rules
23
shall
become
effective
immediately
upon
filing,
unless
a
later
24
effective
date
is
specified
in
the
rules.
Any
rules
adopted
in
25
accordance
with
the
provisions
of
this
section
shall
also
be
26
published
as
notice
of
intended
action
as
provided
in
section
27
17A.4.
28
Sec.
101.
REPEAL.
Section
135.120,
Code
2017,
is
repealed.
29
Sec.
102.
REPEAL.
1993
Iowa
Acts,
chapter
158,
section
3,
30
is
repealed.
31
Sec.
103.
CODE
EDITOR’S
DIRECTIVE.
The
Code
editor
shall
32
correct
and
eliminate
any
references
to
the
term
“organized
33
delivery
system”
or
other
forms
of
the
term
anywhere
else
in
34
the
Iowa
Code
or
Iowa
Code
Supplement,
in
any
bills
awaiting
35
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codification,
in
this
Act,
and
in
any
bills
enacted
by
the
1
Eighty-seventh
General
Assembly,
2017
Regular
Session,
or
any
2
extraordinary
session.
3
EXPLANATION
4
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
5
the
explanation’s
substance
by
the
members
of
the
general
assembly.
6
This
bill
relates
to
programs
and
activities
under
the
7
purview
of
the
department
of
public
health
(DPH).
8
Division
I
of
the
bill
relates
to
program
funding
9
flexibility
and
reporting.
10
The
bill
provides
that
if
the
amount
of
estimated
moneys
to
11
be
received
from
certain
liquor
fees
and
retail
beer
permit
12
fees
that
is
transferred
to
DPH
annually
for
grants
to
counties
13
operating
a
substance
abuse
program
exceeds
grant
requests,
14
in
addition
to
using
the
remainder
for
grants
to
entities
to
15
operate
a
substance
abuse
prevention
program,
DPH
may
also
use
16
the
remainder
for
activities
and
public
information
resources
17
that
align
with
best
practices
for
substance-related
disorder
18
prevention.
19
The
bill
eliminates
the
requirement
under
Code
section
20
135.11,
subsection
31,
that
DPH
report
to
the
chairpersons
and
21
ranking
members
of
the
joint
appropriations
subcommittee
on
22
health
and
human
services,
the
legislative
services
agency,
the
23
legislative
caucus
staffs,
and
the
department
of
management
24
within
60
calendar
days
of
applying
for
or
renewing
a
federal
25
grant
which
requires
a
state
match
or
maintenance
of
effort
26
and
has
a
value
of
over
$100,000,
including
a
listing
of
27
the
federal
funding
source
and
the
potential
need
for
the
28
commitment
of
state
funding
in
the
present
or
future.
29
The
bill
amends
Code
section
135.150
to
require
DPH
to
report
30
annually
rather
than
semiannually
to
the
general
assembly’s
31
standing
committees
on
government
oversight
regarding
32
the
operation
of
the
gambling
treatment
program
including
33
information
on
the
moneys
expended
and
grants
awarded
for
34
operation
of
the
program.
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Division
II
of
the
bill
relates
to
medical
home
and
the
1
patient-centered
health
advisory
council.
2
The
bill
amends
provisions
relating
to
medical
homes.
3
Code
sections
135.157
and
135.158,
providing
definitions
and
4
describing
the
purposes
and
characteristics
of
medical
homes,
5
are
repealed
by
the
bill.
Code
section
135.159
provides
6
parameters
for
the
development
and
implementation
of
a
medical
7
home
system
in
the
state,
as
well
as
the
establishment
of
the
8
patient-centered
health
advisory
council.
The
bill
amends
9
Code
section
135.159
to
provide
for
the
continuation
of
the
10
patient-centered
health
advisory
council
and
to
revise
the
11
purposes
of
the
council.
12
The
bill
also
makes
conforming
changes
throughout
the
Code,
13
including
those
relative
to
the
definitions
of
“dental
home”,
14
“medical
home”,
“personal
provider”,
“primary
care
provider”,
15
and
“primary
medical
provider”,
due
to
elimination
of
certain
16
definitions
and
concepts
based
upon
the
repeal
of
Code
sections
17
135.157
and
135.158.
18
Division
III
of
the
bill
includes
provisions
relating
to
19
workforce
programming.
20
The
bill
amends
Code
section
135.107
relating
to
the
center
21
for
rural
health
and
primary
care.
Of
the
programs
that
22
constitute
the
primary
care
provider
recruitment
and
retention
23
endeavor
or
PRIMECARRE,
the
bill
eliminates
the
primary
care
24
provider
community
scholarship
program,
but
retains
the
primary
25
care
loan
repayment
program
and
the
community
grant
program
26
that
is
renamed
the
health
care
workforce
and
community
support
27
grant
program.
The
bill
amends
the
application
and
matching
28
funds
requirements
for
a
grant
under
the
health
care
workforce
29
and
community
support
grant
program
and
specifies
that
the
30
target
areas
for
awarding
of
such
grants
are
rural,
underserved
31
areas
or
special
populations
identified
by
the
department’s
32
strategic
plan
or
evidence-based
documentation.
33
The
bill
provides
that
the
primary
care
provider
loan
34
repayment
program
may
cancel
a
loan
repayment
program
contract
35
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for
reasonable
cause
unless
federal
requirements
otherwise
1
require
and
provides
that
the
center
for
rural
health
and
2
primary
care
may
enter
into
an
agreement
with
the
college
3
student
aid
commission
for
administration
of
the
center’s
grant
4
and
loan
repayment
programs.
5
The
bill
eliminates
the
requirement
that
a
community
or
6
region
applying
for
assistance
under
any
of
the
programs
7
established
under
PRIMECARRE
submit
a
letter
of
intent
to
8
conduct
a
community
health
services
assessment
and
instead
9
requires
that
the
community
or
region
shall
document
10
participation
in
the
community
health
services
assessment.
In
11
addition
to
any
other
requirements,
an
applicant’s
plan
is
12
also
to
include,
to
the
extent
possible,
a
clear
commitment
to
13
informing
high
school
students
of
the
health
care
opportunities
14
which
may
be
available
to
such
students.
15
The
bill
removes
the
representation
by
the
obsolete
rural
16
health
resource
center
on
the
advisory
committee
to
the
center
17
for
rural
health
and
primary
care
and
corrects
the
reference
to
18
a
national
or
regional
institute
for
rural
health
policy.
19
The
bill
eliminates
the
reference
to
“long-term
care”
in
20
Code
section
135.163
which
directs
DPH
to
coordinate
public
and
21
private
efforts
to
develop
and
maintain
an
appropriate
health
22
care
delivery
infrastructure
and
a
stable,
well-qualified,
23
diverse,
and
sustainable
health
care
workforce
in
this
state.
24
Under
this
section,
DPH
is
required,
at
a
minimum,
to
develop
25
a
strategic
plan
for
health
care
delivery
infrastructure
and
26
health
care
workforce
resources
in
this
state;
provide
for
27
the
continuous
collection
of
data
to
provide
a
basis
for
28
health
care
strategic
planning
and
health
care
policymaking;
29
and
make
recommendations
regarding
the
health
care
delivery
30
infrastructure
and
the
health
care
workforce
that
assist
31
in
monitoring
current
needs,
predicting
future
trends,
and
32
informing
policymaking.
33
The
bill
amends
Code
section
135.175
relating
to
the
health
34
care
workforce
support
initiative,
the
workforce
shortage
fund,
35
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393
and
the
accounts
within
the
fund.
The
bill
provides
that
1
state
programs
that
may
receive
moneys
from
the
fund
or
the
2
accounts
in
the
fund,
if
specifically
designated
for
drawing
3
down
federal
funding,
include
PRIMECARRE,
the
Iowa
affiliate
4
of
the
national
rural
recruitment
and
retention
network,
the
5
oral
and
health
delivery
systems
bureau
of
the
department,
6
the
primary
care
office
and
shortage
designation
program,
and
7
the
state
office
of
rural
health,
but
eliminates
inclusion
of
8
the
Iowa
health
workforce
center,
the
area
health
education
9
centers
programs
at
Des
Moines
university
osteopathic
medical
10
center
and
the
university
of
Iowa,
and
the
Iowa
collaborative
11
safety
net
provider
network
as
potential
recipients.
The
bill
12
also
eliminates
the
requirement
that
state
appropriations
to
13
the
fund
shall
be
allocated
in
equal
amounts
to
each
of
the
14
accounts
within
the
fund,
unless
otherwise
specified
in
the
15
appropriation
or
allocation,
and
eliminates
the
restriction
16
that
moneys
in
each
of
the
accounts
in
the
fund
used
for
17
administrative
purposes
are
not
to
exceed
$100,000
in
each
18
account,
but
retains
the
limitation
that
no
more
than
5
percent
19
of
the
moneys
in
any
of
the
accounts
within
the
fund
shall
be
20
used
for
administrative
purposes
unless
otherwise
provided
in
21
the
appropriation,
allocation,
or
source
of
the
funds.
22
The
bill
repeals
Code
section
135.164
which
relates
to
the
23
health
care
delivery
infrastructure
and
health
care
workforce
24
resources
strategic
plan
to
be
developed
by
DPH
including
the
25
specific
elements
of
the
strategic
plan
and
the
requirements
26
for
developing
the
strategic
plan.
27
The
bill
repeals
Code
section
135.180,
the
mental
health
28
professional
shortage
area
program,
which
provides
stipends
to
29
support
psychiatrist
positions
with
an
emphasis
on
securing
and
30
retaining
medical
directors
at
community
mental
health
centers
31
designated
under
Code
chapter
230A
and
hospital
psychiatric
32
units
that
are
located
in
mental
health
professional
shortage
33
areas.
34
Division
IV
of
the
bill
relates
to
unfunded
or
outdated
35
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program
provisions.
1
The
bill
eliminates
the
provision
under
Code
section
135.11
2
requiring
DPH
to
establish
and
administer
a
substance
abuse
3
treatment
facility
for
persons
on
probation,
repeals
Code
4
section
135.130,
and
strikes
the
conforming
provision
in
Code
5
section
901B.1.
The
substance
abuse
treatment
facility
for
6
persons
on
probation
was
authorized
in
2001
but
was
never
7
established.
8
The
bill
strikes
the
directive
in
Code
section
135.141
for
9
the
division
of
acute
disease
prevention
and
emergency
response
10
of
DPH
to
conduct
and
maintain
a
statewide
risk
assessment
11
of
any
present
or
potential
danger
to
the
public
health
from
12
biological
agents.
13
The
bill
repeals
Code
section
135.26
establishing
the
14
automated
external
defibrillator
(AED)
grant
program
to
provide
15
matching
fund
grants
to
local
boards
of
health,
community
16
organizations,
or
cities
to
implement
AED
programs.
17
The
bill
repeals
Code
section
135.29,
relating
to
local
18
substitute
medical
decision-making
boards,
which
authorized
19
each
county
to
establish
and
fund
a
local
substituted
medical
20
decision-making
board
to
act
as
a
substitute
decision
maker
for
21
patients
incapable
of
making
their
own
medical
care
decisions
22
if
no
other
substitute
decision
maker
is
available
to
act.
23
The
bill
repeals
Code
section
135.120,
relating
to
the
24
taxation
of
organized
delivery
systems
(ODSs).
1993
Iowa
25
Acts,
chapter
158,
section
3,
directs
DPH
to
adopt
rules
and
a
26
licensing
procedure
for
the
establishment
of
ODSs.
The
bill
27
only
eliminates
the
provision
for
taxation
of
ODSs,
not
all
28
other
provisions
relating
to
ODSs.
29
The
bill
repeals
Code
section
135.152,
the
statewide
30
obstetrical
and
newborn
indigent
patient
care
program.
The
31
program
acts
as
a
payer
of
last
resort
for
eligible
individuals
32
but
has
not
been
utilized
since
2009
due
to
other
options
33
for
coverage
including
through
the
Medicaid
program
and
the
34
Affordable
Care
Act
for
otherwise
eligible
individuals.
35
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Division
V
includes
miscellaneous
provisions.
1
The
bill
amends
the
definition
of
“local
board
of
health”
in
2
Code
section
135A.2
under
the
public
health
modernization
Act
3
to
be
consistent
with
the
definition
under
Code
chapter
137,
4
relating
to
local
boards
of
health.
5
The
bill
repeals
Code
section
135.132,
the
interagency
6
pharmaceuticals
bulk
purchasing
council.
The
provision
was
7
enacted
in
2003,
but
the
council
was
never
established.
8
Division
VI
relates
to
the
Iowa
health
information
9
network.
Legislation
was
enacted
in
2015
Iowa
Acts,
chapter
10
73,
to
provide
for
the
future
assumption
of
the
Iowa
health
11
information
network
by
a
designated
entity.
The
bill
12
includes
a
conforming
change
that
would
take
effect
upon
13
future
assumption
of
the
Iowa
health
information
network
by
a
14
designated
entity.
15
Division
VII
relates
to
organized
delivery
systems
that
are
16
regulated
by
DPH.
Organized
delivery
systems
were
created
17
pursuant
to
1993
Iowa
Acts,
chapter
158.
Rules
adopted
18
under
the
provision
define
an
organized
delivery
system
as
19
“an
organization
with
defined
governance
that
is
responsible
20
for
delivering
or
arranging
to
deliver
the
full
range
of
21
health
care
services
covered
under
a
standard
benefit
plan
22
and
is
accountable
to
the
public
for
the
cost,
quality
and
23
access
of
its
services
and
for
the
effect
of
its
services
24
on
their
health.”
(641
IAC
201.2)
An
organization
operating
25
as
an
organized
delivery
system
is
required
to
assume
risk
26
and
be
subject
to
solvency
standards.
The
bill
eliminates
27
all
references
to
organized
delivery
systems
in
the
Code
and
28
repeals
the
provision
in
the
Acts
authorizing
the
establishment
29
of
organized
delivery
systems.
The
most
recent
application
for
30
licensure
was
received
by
DPH
in
1998.
Since
being
authorized
31
in
1993,
only
two
entities
applied
for
licensure
as
organized
32
delivery
systems
and
both
of
these
entities
have
since
ceased
33
operations.
34
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LSB
1675HV
(3)
87
pf/nh
57/
57