House Study Bill 598 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON COWNIE) A BILL FOR An Act relating to health care administrative simplification. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 5165YC (1) 87 pf/rh

H.F. _____ Section 1. HEALTH CARE ADMINISTRATIVE SIMPLIFICATION —— 1 COMMISSIONER OF INSURANCE WORKGROUP. 2 1. During the fiscal year beginning July 1, 2018, the work 3 group convened by the commissioner of insurance, annually, 4 pursuant to section 505.8, subsection 18, shall consider ways 5 to bring about greater standardization, streamlining and 6 simplification of health care administrative transactions, 7 increased electronic exchanges of administrative data, and 8 reduced administrative costs and burdens. Specifically, the 9 work group shall consider the work of other states regarding 10 health care administrative simplification including the 11 Minnesota administrative uniformity committee and the Minnesota 12 health care administrative simplification initiative and make 13 recommendations regarding all of the following: 14 a. Uniform, HIPPA-compliant health care electronic data 15 interchange standards for health care transactions including 16 all of the following: 17 (1) Eligibility verifications submitted by health care 18 providers to health insurance carriers to confirm a patient’s 19 medical insurance coverage and benefits to facilitate proper 20 billing. 21 (2) Claims submitted by health care providers to health 22 insurance carriers for payment for health care services 23 provided. 24 (3) Remittance advices submitted by health insurance 25 carriers to health care providers to explain any adjustments to 26 claims and corresponding payments. 27 (4) Acknowledgments indicating that one party has received 28 an exchange submitted by another party. 29 b. A HIPAA-compliant, single, uniform companion guide for 30 the electronic exchange of patient eligibility verifications, 31 claims, remittance advices, and acknowledgments by all health 32 care providers and health insurance carriers. 33 c. Unique identification numbers to be used by health care 34 providers, health insurance carriers, and patients, including 35 -1- LSB 5165YC (1) 87 pf/rh 1/ 3

H.F. _____ applicable privacy standards to protect the identity of the 1 individual subject of the data exchanged. 2 d. A uniform explanation of benefits document. 3 e. Best practices to be incorporated by health care 4 providers and health insurance carriers to reduce the cost of 5 providing health insurance coverage and health care services 6 in the state. 7 2. The work group shall report its findings and 8 recommendations, including any changes in law or administrative 9 rules, in the annual report filed with the general assembly 10 pursuant to section 505.18. 11 3. For the purposes of this section: 12 a. “Health care provider” means the same as defined in 13 section 135P.1. 14 b. “Health insurance carrier” means “carrier” as defined in 15 section 514C.13. 16 c. “HIPPA” means the federal Health Insurance Portability 17 and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 18 1936 (1996). 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill directs the work group convened by the 23 commissioner of insurance, annually, during the fiscal year 24 beginning July 1, 2018, to consider ways to bring about 25 greater standardization, streamlining and simplification of 26 health care administrative transactions, increased electronic 27 exchanges of administrative data, and reduced administrative 28 costs and burdens. Specifically, the work group is directed 29 to consider the work of other states regarding health care 30 administrative simplification including the Minnesota 31 administrative uniformity committee and the Minnesota health 32 care administrative simplification initiative and make 33 recommendations regarding uniform, health care electronic 34 data interchange standards that comply with the federal 35 -2- LSB 5165YC (1) 87 pf/rh 2/ 3

H.F. _____ Health Insurance Portability and Accountability Act of 1996 1 (HIPAA) for health care transactions including eligibility 2 verifications, claims, remittance advices, and acknowledgments; 3 a HIPAA-compliant, single, uniform companion guide for the 4 electronic exchange of patient eligibility verifications, 5 claims, remittance advices, and acknowledgments; unique 6 identification numbers to be used by health care providers, 7 health insurance carriers, and patients, including applicable 8 privacy standards to protect the identity of the individual 9 subject of the data exchanged; a uniform explanation of 10 benefits document; and best practices to be incorporated by 11 health care providers and health insurance carriers to reduce 12 the cost of providing health insurance coverage and health care 13 services in the state. 14 The work group is directed to report its findings and 15 recommendations, including any changes in law or administrative 16 rules, in the annual report filed with the general assembly. 17 -3- LSB 5165YC (1) 87 pf/rh 3/ 3