Senate File 2140 - Introduced SENATE FILE 2140 BY MATHIS A BILL FOR An Act relating to the provision of an appeals process for 1 Medicaid managed care members following a supports intensity 2 scale assessment, and including effective date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6117XS (3) 87 pf/rn

S.F. 2140 Section 1. MEDICAID MANAGED CARE —— SUPPORTS INTENSITY 1 SCALE ASSESSMENT OF MEDICAID MEMBER —— APPEALS PROCESS —— 2 EXPEDITED FIRST-LEVEL REVIEW. The department of human services 3 shall adopt rules pursuant to chapter 17A and shall amend 4 any existing Medicaid managed care contracts to provide an 5 appeals process, in accordance with contested case proceedings 6 pursuant to chapter 17A, for Medicaid managed care (Medicaid) 7 members for whom an assessment utilizing the supports intensity 8 scale (SIS) is required. The appeals process may be utilized 9 if the Medicaid member, the Medicaid member’s authorized 10 representative, or a provider who is acting on behalf of 11 the Medicaid member, disagrees with the results of the SIS 12 assessment or disputes the accuracy of the resulting score, 13 believes the SIS assessment does not adequately reflect the 14 member’s needs, or if the member’s needs change. The process 15 shall provide that following an SIS assessment, the Medicaid 16 member, the Medicaid member’s authorized representative, or 17 a provider who is acting on behalf of the Medicaid member, 18 may appeal the results of the assessment to the department 19 at any time, following the exhaustion of the expedited 20 Medicaid managed care organization first-level review process, 21 when the Medicaid member, the Medicaid member’s authorized 22 representative, or a provider who is acting on behalf of the 23 Medicaid member, is dissatisfied with the notice of decision 24 resulting from such review. The rules adopted and the 25 amendment to any Medicaid managed care contract shall require 26 that the expedited first-level review be completed and the 27 notice of decision be issued by the managed care organization 28 within thirty days of receipt by the managed care organization 29 of the request for a first-level review. 30 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 31 importance, takes effect upon enactment. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -1- LSB 6117XS (3) 87 pf/rn 1/ 2

S.F. 2140 This bill relates to the provision of an appeals process 1 relating to the results of assessments of Medicaid managed care 2 members utilizing the supports intensity scale (SIS). The 3 bill requires the department of human services (DHS) to adopt 4 administrative rules and amend any existing Medicaid managed 5 care contracts to provide an appeals process, in accordance 6 with contested case proceedings pursuant to Code chapter 7 17A, for Medicaid managed care (Medicaid) members for whom 8 an assessment utilizing the SIS assessment is required. The 9 process may be utilized if the Medicaid member, the Medicaid 10 member’s authorized representative, or a provider who is acting 11 on behalf of the Medicaid member, disagrees with the results 12 of the assessment or disputes the accuracy of the resulting 13 score, believes the assessment does not adequately reflect 14 the member’s needs, or if the member’s needs change. The 15 appeals process may be utilized following the exhaustion of 16 the expedited Medicaid managed care organization’s first-level 17 review process. 18 The bill takes effect upon enactment. 19 -2- LSB 6117XS (3) 87 pf/rn 2/ 2