Senate File 2256 - Introduced SENATE FILE 2256 BY GARRETT A BILL FOR An Act relating to a pilot program to allow the Medicaid 1 program to act as a third-party payor under direct primary 2 care agreements. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5783XS (2) 88 pf/rh

S.F. 2256 Section 1. DIRECT PRIMARY CARE AGREEMENTS —— MEDICAID —— 1 PILOT PROGRAM. The department of human services shall submit 2 any Medicaid state plan amendment or waiver request necessary 3 to the centers for Medicare and Medicaid services of the United 4 States department of health and human services for approval 5 to implement a pilot program relating to direct primary care 6 agreements in accordance with chapter 135N and as specified in 7 this section. The request shall authorize the department to 8 develop and oversee a pilot program beginning January 1, 2021, 9 and ending December 31, 2026, to allow Medicaid members in 10 specified categories to receive primary care health services, 11 as defined in section 135N.1, through a direct primary care 12 arrangement, with Medicaid acting as the third-party payor for 13 such services. The eligible Medicaid member categories shall 14 include childless adults, children under seven years of age, 15 children seven years of age through eighteen years of age, 16 parents, pregnant women, the elderly, and individuals with 17 disabilities. 18 EXPLANATION 19 The inclusion of this explanation does not constitute agreement with 20 the explanation’s substance by the members of the general assembly. 21 This bill requires the department of human services (DHS) 22 to submit any Medicaid state plan amendment or waiver request 23 necessary to the centers for Medicare and Medicaid services 24 of the United States department of health and human services 25 for approval to implement a pilot program relating to direct 26 primary care agreements as specified in the bill. The request 27 shall authorize DHS to develop and oversee a pilot program 28 beginning January 1, 2021, and ending December 31, 2026, to 29 allow Medicaid members in specified categories to receive 30 primary care health services through a direct primary care 31 arrangement with Medicaid acting as the third-party payor for 32 such services. The eligible Medicaid member categories shall 33 include childless adults, children under seven years of age, 34 children seven years of age through 18 years of age, parents, 35 -1- LSB 5783XS (2) 88 pf/rh 1/ 2

S.F. 2256 pregnant women, the elderly, and individuals with disabilities. 1 Direct primary care agreements are authorized under Code 2 chapter 135N. Such agreements are agreements between a 3 direct provider and a direct patient, or the direct patient’s 4 representative, in which the direct provider agrees to provide 5 primary care health services for a specified period of time to 6 the direct patient for a direct service charge. Code chapter 7 135N authorizes a direct provider to accept payment of a 8 direct service charge for a direct patient either directly or 9 indirectly from a third party. Under the bill, the Medicaid 10 program would act as the third-party payor. 11 -2- LSB 5783XS (2) 88 pf/rh 2/ 2