HF 2297 (LSB 5418HV (1) 89)

HOUSE FILE 2297

BY  COMMITTEE ON COMMERCE

(SUCCESSOR TO HSB 585)

A BILL FOR

An Act relating to the medical assistance and hawk-i programs, and managed care organizations.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  505.34  Medical assistance and hawk-i programs —— applicability of subtitle.
   1.  The medical assistance program under chapter 249A and the healthy and well kids in Iowa (hawk-i) program under chapter 514I shall not be subject to this subtitle unless otherwise provided by law.
   2.  A managed care organization acting pursuant to a contract with the department of human services to administer the medical assistance program under chapter 249A, or the healthy and well kids in the Iowa (hawk-i) program under chapter 514I, shall not be subject to this subtitle unless otherwise provided by law.
    Sec. 2.  Section 514B.32, Code 2022, is amended by adding the following new subsection:
   NEW SUBSECTION.  5.  The provisions of this chapter shall be applicable to a managed care organization acting pursuant to a contract with the department of human services to administer the medical assistance program under chapter 249A, or the healthy and well kids in Iowa (hawk-i) program under chapter 514I, only with respect to licensure and solvency standards as evidenced by the managed care organization obtaining and maintaining a certificate of authority, and maintaining compliance with the solvency standards set forth in this chapter.
    Sec. 3.  Section 514I.2, subsection 9, Code 2022, is amended to read as follows:
   9.  “Participating insurer” means any of the following: 
   a.  An entity licensed by the division of insurance of the department of commerce to provide health insurance in Iowa that has contracted with the department to provide health insurance coverage to eligible children under this chapter.
   b.  A managed care organization acting pursuant to a contract with the department of human services to administer the hawk-i program.
    Sec. 4.  Section 514I.5, subsection 9, Code 2022, is amended to read as follows:
   9.  The hawk-i board shall monitor the capacity of Medicaid managed care organizations acting pursuant to a contract with the department to administer the hawk-i program to specifically and appropriately address the unique needs of children and children’s health delivery.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the medical assistance and hawk-i programs, and managed care organizations (MCOs).
   The bill provides that the medical assistance program and the hawk-i program, and MCOs acting pursuant to a contract with the department of human services (department) to administer either program, shall not be subject to Code Title XIII, subtitle I (insurance and regulated regulation), unless otherwise provided by law. 
   The bill clarifies that the provisions of Code chapter 514B are applicable to an MCO acting pursuant to a contract with the department to administer the medical assistance program or the hawk-i program only with respect to licensure and solvency standards as evidenced by the MCO obtaining and maintaining a certificate of authority, and maintaining compliance with the solvency standards set forth in the Code chapter. 
   The bill adds an MCO acting pursuant to a contract with the department to administer the hawk-i program to the definition of “participating insurer” for purposes of Code chapter 514I.2.
   The bill makes conforming changes to Code section 514I.5.