House File 207 - Introduced HOUSE FILE 207 BY MASCHER A BILL FOR An Act relating to the use of step therapy protocols, including 1 step therapy override protocols, under the Medicaid program. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2090YH (1) 88 pf/rh

H.F. 207 Section 1. Section 514F.7, subsection 1, paragraph h, Code 1 2019, is amended to read as follows: 2 h. “Health carrier” means an entity subject to the 3 insurance laws and regulations of this state, or subject 4 to the jurisdiction of the commissioner, including an 5 insurance company offering sickness and accident plans, a 6 health maintenance organization, a nonprofit health service 7 corporation, a plan established pursuant to chapter 509A 8 for public employees, or any other entity providing a plan 9 of health insurance, health care benefits, or health care 10 services. “Health carrier” does not include includes a managed 11 care organization as defined in 441 IAC 73.1 when the managed 12 care organization is acting pursuant to a contract with the 13 Iowa department of human services to provide services to 14 Medicaid recipients. 15 Sec. 2. MEDICAID MANAGED CARE AND FEE-FOR-SERVICE —— USE 16 OF STEP THERAPY PROTOCOLS. The department of human services 17 shall adopt rules pursuant to chapter 17A and shall amend 18 Medicaid managed care contracts to require application of step 19 therapy protocols, including step therapy override protocols, 20 as specified in section 514F.7, under both the Medicaid 21 fee-for-service and the managed care reimbursement and delivery 22 systems. 23 EXPLANATION 24 The inclusion of this explanation does not constitute agreement with 25 the explanation’s substance by the members of the general assembly. 26 This bill directs the department of human services (DHS) 27 to adopt administrative rules and to amend Medicaid managed 28 care contracts to require the use of step therapy protocols, 29 including step therapy override protocols, as specified in 30 Code section 514F.7, under both Medicaid fee-for-service and 31 managed care reimbursement and delivery systems. The bill 32 also amends Code section 514F.7 to eliminate the exclusion 33 from the definition of “health carrier” of Medicaid managed 34 care organizations, thereby requiring Medicaid managed care 35 -1- LSB 2090YH (1) 88 pf/rh 1/ 2

H.F. 207 organizations as health carriers to use step therapy protocols 1 for Medicaid members. 2 -2- LSB 2090YH (1) 88 pf/rh 2/ 2