House Study Bill 585 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON LUNDGREN) A BILL FOR An Act relating to the medical assistance and hawk-i programs, 1 and managed care organizations. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5418YC (3) 89 ko/rn
H.F. _____ Section 1. NEW SECTION . 505.34 Medical assistance and 1 hawk-i programs —— applicability of subtitle. 2 1. The medical assistance program under chapter 249A and the 3 healthy and well kids in Iowa (hawk-i) program under chapter 4 514I shall not be subject to this subtitle unless otherwise 5 provided by law. 6 2. A managed care organization acting pursuant to a contract 7 with the department of human services to administer the medical 8 assistance program under chapter 249A, or the healthy and well 9 kids in the Iowa (hawk-i) program under chapter 514I, shall not 10 be subject to this subtitle unless otherwise provided by law. 11 Sec. 2. Section 514B.32, Code 2022, is amended by adding the 12 following new subsection: 13 NEW SUBSECTION . 5. The provisions of this chapter shall be 14 applicable to a managed care organization acting pursuant to a 15 contract with the department of human services to administer 16 the medical assistance program under chapter 249A, or the 17 healthy and well kids in Iowa (hawk-i) program under chapter 18 514I, only with respect to licensure and solvency standards 19 as evidenced by the managed care organization obtaining 20 and maintaining a certificate of authority, and maintaining 21 compliance with the solvency standards set forth in this 22 chapter. 23 Sec. 3. Section 514I.2, subsection 9, Code 2022, is amended 24 to read as follows: 25 9. “Participating insurer” means any of the following: 26 a. An entity licensed by the division of insurance of the 27 department of commerce to provide health insurance in Iowa that 28 has contracted with the department to provide health insurance 29 coverage to eligible children under this chapter . 30 b. A managed care organization acting pursuant to a contract 31 with the department of human services to administer the hawk-i 32 program. 33 Sec. 4. Section 514I.5, subsection 9, Code 2022, is amended 34 to read as follows: 35 -1- LSB 5418YC (3) 89 ko/rn 1/ 2
H.F. _____ 9. The hawk-i board shall monitor the capacity of Medicaid 1 managed care organizations acting pursuant to a contract with 2 the department to administer the hawk-i program to specifically 3 and appropriately address the unique needs of children and 4 children’s health delivery. 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 relates to the medical assistance and hawk-i 9 programs, and managed care organizations (MCOs). 10 The bill provides that the medical assistance program and 11 the hawk-i program, and MCOs acting pursuant to a contract with 12 the department of human services (department) to administer 13 either program, shall not be subject to Code Title XIII, 14 subtitle I (insurance and regulated regulation), unless 15 otherwise provided by law. 16 The bill clarifies that the provisions of Code chapter 514B 17 are applicable to an MCO acting pursuant to a contract with 18 the department to administer the medical assistance program or 19 the hawk-i program only with respect to licensure and solvency 20 standards as evidenced by the MCO obtaining and maintaining a 21 certificate of authority, and maintaining compliance with the 22 solvency standards set forth in the Code chapter. 23 The bill adds an MCO acting pursuant to a contract with the 24 department to administer the hawk-i program to the definition 25 of “participating insurer” for purposes of Code chapter 514I.2. 26 The bill makes conforming changes to Code section 514I.5. 27 -2- LSB 5418YC (3) 89 ko/rn 2/ 2