Senate File 2207 - Introduced SENATE FILE 2207 BY RAGAN and MATHIS A BILL FOR An Act relating to the administration and evaluation of 1 health homes for individuals with serious and persistent 2 mental illness and for persons with chronic conditions 3 under Medicaid managed care, and including effective date 4 provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 6078XS (9) 87 pf/rh

S.F. 2207 Section 1. MEDICAID PROGRAM —— HEALTH HOMES —— 1 ADMINISTRATION AND EVALUATION. 2 1. The department of human services shall adopt rules 3 pursuant to chapter 17A and shall amend existing Medicaid 4 managed care contracts to ensure all of the following: 5 a. That integrated health homes for persons with serious 6 and persistent mental illness (SPMI integrated health homes) 7 with a Medicaid managed care organization acting as the lead 8 entity are administered in a manner that reflects the criteria 9 established for SPMI integrated health homes and that meets 10 the specifications of the Medicaid state plan amendment (SPA), 11 IA-16-013. 12 b. That health homes for persons with two or more chronic 13 conditions (chronic condition health homes) are administered 14 in a manner that reflects the criteria established for chronic 15 condition health homes and that meet the specifications of the 16 Medicaid SPA, IA-16-012. 17 c. That care coordination provided by SPMI integrated 18 health homes be provided as an integral component of the 19 integrated health home’s team of health professionals and that 20 care coordination provided by chronic condition health homes be 21 provided by a dedicated care coordinator defined as a member 22 of the health home provider, and not directly by a managed 23 care organization through the use of internal or contracted 24 resources of the managed care organization. 25 2. a. The Iowa Medicaid enterprise shall provide 26 administrative oversight for SPMI health homes and chronic 27 condition health homes, and shall require managed care 28 organizations to share data with the Iowa Medicaid enterprise 29 as the department deems necessary for the evaluation of certain 30 factors including but not limited to patient enrollment, 31 patient outcomes, and claims submission and payment. 32 b. The department shall amend the health home state plan 33 amendments and Medicaid managed care contracts, as necessary, 34 to provide that under the risk-based managed care delivery 35 -1- LSB 6078XS (9) 87 pf/rh 1/ 3

S.F. 2207 system, the state shall reimburse health homes directly and not 1 include health home payments in the managed care capitation 2 rate. 3 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 4 importance, takes effect upon enactment. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill requires the department of human services (DHS) 9 to adopt administrative rules and amend existing Medicaid 10 managed care contracts to ensure that integrated health homes 11 for persons with serious and persistent mental illness (SPMI 12 integrated health homes) and health homes for persons with 13 two or more chronic conditions (chronic condition health 14 homes) are administered in a manner that reflects the criteria 15 established, and meet the specifications of the Medicaid state 16 plan amendment, for the respective type of health home. The 17 bill specifies that the care coordination provided by the SPMI 18 integrated health homes be provided as an integral component 19 of the integrated health home’s team of health professionals 20 and that care coordination provided by chronic condition health 21 homes be provided by a dedicated care coordinator defined as 22 a member of the health home provider, and not directly by 23 a managed care organization through the use of internal or 24 contracted resources of the managed care organization. 25 The bill requires the Iowa Medicaid enterprise (IME) to 26 provide administrative oversight for the health homes, and to 27 require managed care organizations to share data with the IME 28 as DHS deems necessary for the evaluation of certain factors 29 including but not limited to patient enrollment, patient 30 outcomes, and claims submission and payment. The bill also 31 requires DHS to amend the health home state plan amendments and 32 Medicaid managed care contracts, as necessary, to provide that 33 under the risk-based managed care delivery system, the state 34 shall reimburse health homes directly and not include health 35 -2- LSB 6078XS (9) 87 pf/rh 2/ 3

S.F. 2207 home payments in the managed care capitation rate. 1 The bill takes effect upon enactment. 2 -3- LSB 6078XS (9) 87 pf/rh 3/ 3