House File 625 - Introduced HOUSE FILE 625 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HSB 183) A BILL FOR An Act relating to the integration of Medicaid and healthy 1 and well kids in Iowa program eligibility, payment, and 2 administrative functions under the department of human 3 services. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1230HV (1) 88 pf/rh

H.F. 625 Section 1. Section 514I.2, subsection 1, Code 2019, is 1 amended by striking the subsection. 2 Sec. 2. Section 514I.4, subsection 3, Code 2019, is amended 3 by striking the subsection. 4 Sec. 3. Section 514I.4, subsection 5, Code 2019, is amended 5 to read as follows: 6 5. The department shall do or shall provide for all of the 7 following: 8 a. Determine eligibility for program enrollment as 9 prescribed by federal law and regulation, using policies and 10 procedures adopted by rule of the department pursuant to 11 chapter 17A. The department shall not enroll a child who has 12 group health coverage unless expressly authorized by such 13 rules. 14 b. Enroll qualifying children in the program with 15 maintenance of a supporting eligibility file or database. 16 c. Utilize the department’s eligibility system to maintain 17 eligibility files with pertinent eligibility determination and 18 ongoing enrollment information including but not limited to 19 data regarding beneficiaries, enrollment dates, disenrollments, 20 and annual financial redeterminations. 21 d. Provide for administrative oversight and monitoring of 22 federal requirements. 23 e. Perform annual financial reviews of eligibility for each 24 beneficiary. 25 f. Collect and track monthly family premiums to assure that 26 payments are current. 27 g. Notify each participating insurer of new program 28 enrollees who are enrolled by the department in that 29 participating insurer’s plan. 30 h. Verify the number of program enrollees with each 31 participating insurer for determination of the amount of 32 premiums to be paid to each participating insurer. 33 i. Maintain data for the purpose of quality assurance 34 reports as required by rule of the board. 35 -1- LSB 1230HV (1) 88 pf/rh 1/ 3

H.F. 625 a. j. (1) Establish the family cost sharing amounts for 1 children of families with incomes of one hundred fifty percent 2 or more but not exceeding two hundred percent of the federal 3 poverty level, of not less than ten dollars per individual 4 and twenty dollars per family, if not otherwise prohibited by 5 federal law, with the approval of the board. 6 (2) Establish for children of families with incomes 7 exceeding two hundred percent but not exceeding three hundred 8 percent of the federal poverty level, family cost sharing 9 amounts, and graduated premiums based on a rationally developed 10 sliding fee schedule, in accordance with federal law, with the 11 approval of the board. 12 b. k. Perform annual, random reviews of enrollee 13 applications to ensure compliance with program eligibility and 14 enrollment policies. Quality assurance reports shall be made 15 to the board and the department based upon the data maintained 16 by the administrative contractor department . 17 c. l. Perform other duties as determined by the department 18 with the approval of the board. 19 Sec. 4. Section 514I.5, subsection 2, Code 2019, is amended 20 by striking the subsection. 21 Sec. 5. Section 514I.5, subsection 7, paragraph a, Code 22 2019, is amended by striking the paragraph. 23 Sec. 6. Section 514I.5, subsection 8, paragraph b, Code 24 2019, is amended by striking the paragraph. 25 Sec. 7. Section 514I.5, subsection 8, paragraphs h and k, 26 Code 2019, are amended to read as follows: 27 h. Conflict of interest provisions applicable to the 28 administrative contractor and participating insurers , and 29 between public members of the board and the administrative 30 contractor and participating insurers. 31 k. The data to be maintained by the administrative 32 contractor department including data to be collected for the 33 purposes of quality assurance reports. 34 Sec. 8. Section 514I.6, subsection 4, unnumbered paragraph 35 -2- LSB 1230HV (1) 88 pf/rh 2/ 3

H.F. 625 1, Code 2019, is amended to read as follows: 1 Provide the administrative contractor department with all 2 of the following information pertaining to the participating 3 insurer’s plan: 4 Sec. 9. REPEAL. Section 514I.7, Code 2019, is repealed. 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 integrates Medicaid and healthy and well kids in 9 Iowa (hawk-i) program eligibility, payment, and administrative 10 functions by eliminating the utilization of an administrative 11 contractor under the hawk-i program and transferring the duties 12 of the administrative contractor to the department of human 13 services. 14 -3- LSB 1230HV (1) 88 pf/rh 3/ 3