HSB 183 (LSB 1230XD (2) 88)

SENATE/HOUSE FILE _____

BY  (PROPOSED DEPARTMENT OF HUMAN SERVICES BILL)

A BILL FOR

An Act relating to the integration of Medicaid and healthy and well kids in Iowa program eligibility, payment, and administrative functions under the department of human services.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 514I.2, subsection 1, Code 2019, is amended by striking the subsection.
    Sec. 2.  Section 514I.4, subsection 3, Code 2019, is amended by striking the subsection.
    Sec. 3.  Section 514I.4, subsection 5, Code 2019, is amended to read as follows:
   5.  The department shall do or shall provide for all of the following:
   a.  Determine eligibility for program enrollment as prescribed by federal law and regulation, using policies and procedures adopted by rule of the department pursuant to chapter 17A. The department shall not enroll a child who has group health coverage unless expressly authorized by such rules.
   b.  Enroll qualifying children in the program with maintenance of a supporting eligibility file or database.
   c.  Utilize the department’s eligibility system to maintain eligibility files with pertinent eligibility determination and ongoing enrollment information including but not limited to data regarding beneficiaries, enrollment dates, disenrollments, and annual financial redeterminations.
   d.  Provide for administrative oversight and monitoring of federal requirements.
   e.  Perform annual financial reviews of eligibility for each beneficiary.
   f.  Collect and track monthly family premiums to assure that payments are current.
   g.  Notify each participating insurer of new program enrollees who are enrolled by the department in that participating insurer’s plan.
   h.  Verify the number of program enrollees with each participating insurer for determination of the amount of premiums to be paid to each participating insurer.
   i.  Maintain data for the purpose of quality assurance reports as required by rule of the board.
   a.  j.  (1)  Establish the family cost sharing amounts for children of families with incomes of one hundred fifty percent or more but not exceeding two hundred percent of the federal poverty level, of not less than ten dollars per individual and twenty dollars per family, if not otherwise prohibited by federal law, with the approval of the board.
   (2)  Establish for children of families with incomes exceeding two hundred percent but not exceeding three hundred percent of the federal poverty level, family cost sharing amounts, and graduated premiums based on a rationally developed sliding fee schedule, in accordance with federal law, with the approval of the board.
   b.  k.  Perform annual, random reviews of enrollee applications to ensure compliance with program eligibility and enrollment policies. Quality assurance reports shall be made to the board and the department based upon the data maintained by the administrative contractor department.
   c.  l.  Perform other duties as determined by the department with the approval of the board.
    Sec. 4.  Section 514I.5, subsection 2, Code 2019, is amended by striking the subsection.
    Sec. 5.  Section 514I.5, subsection 7, paragraph a, Code 2019, is amended by striking the paragraph.
    Sec. 6.  Section 514I.5, subsection 8, paragraph b, Code 2019, is amended by striking the paragraph.
    Sec. 7.  Section 514I.5, subsection 8, paragraphs h and k, Code 2019, are amended to read as follows:
   h.  Conflict of interest provisions applicable to the administrative contractor and participating insurers, and between public members of the board and the administrative contractor and participating insurers.
   k.  The data to be maintained by the administrative contractor department including data to be collected for the purposes of quality assurance reports.
    Sec. 8.  Section 514I.6, subsection 4, unnumbered paragraph 1, Code 2019, is amended to read as follows:
   Provide the administrative contractor department with all of the following information pertaining to the participating insurer’s plan:
    Sec. 9.  REPEAL.  Section 514I.7, Code 2019, is repealed.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill integrates Medicaid and healthy and well kids in Iowa (hawk-i) program eligibility, payment, and administrative functions by eliminating the utilization of an administrative contractor under the hawk-i program and transferring the duties of the administrative contractor to the department of human services.