Senate File 2147 - Introduced SENATE FILE 2147 BY RAGAN and MATHIS A BILL FOR An Act relating to the validation of Medicaid managed care 1 organization encounter data, providing an appropriation, and 2 providing an effective date. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5793XS (5) 89 pf/rh

S.F. 2147 Section 1. MEDICAID MANAGED CARE ORGANIZATION ENCOUNTER 1 DATA VALIDATION AUDIT —— REQUEST FOR PROPOSALS. The department 2 of human services and the auditor of state shall jointly 3 design and issue a request for proposals to contract for the 4 performance of a third-party audit to validate encounter data 5 collected and reported by Medicaid managed care organizations 6 to the department. The audit shall be designed to determine 7 if Medicaid managed care organizations are providing encounter 8 data that, at a minimum, is complete, accurate, consistent, 9 and timely and that complies with federal and contractual 10 requirements related to the collection and reporting of 11 encounter data. The audit shall also be designed to determine 12 whether the type and quality of the encounter data collected, 13 at a minimum, strengthens the state’s capacity for federal 14 compliance and managed care program oversight and program 15 integrity; for quality measurement, monitoring, and reporting; 16 for capitation rate setting; and for policymaking and decision 17 support. The department and the auditor of state shall 18 jointly evaluate the third-party proposals received, select 19 and contract with the third-party auditor by July 1, 2022, and 20 monitor and review the third-party auditor’s audit and report 21 which shall be submitted jointly to the department and the 22 auditor of state no later than December 15, 2022. 23 Sec. 2. MEDICAID MANAGED CARE ORGANIZATION ENCOUNTER DATA 24 VALIDATION AUDIT —— APPROPRIATION. There is appropriated 25 from the general fund of the state to the department of human 26 services and the auditor of state the following amount or 27 so much thereof as is necessary to be used for the purposes 28 designated: 29 For a request for proposals process and resulting third- 30 party audit to validate encounter data collected and reported 31 by Medicaid managed care organizations as provided in this Act: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 250,000 33 A portion of the moneys appropriated under this section may 34 be used by the department of human services and the auditor of 35 -1- LSB 5793XS (5) 89 pf/rh 1/ 3

S.F. 2147 state for administrative expenses related to the request for 1 proposals process and the audit as provided in this Act. The 2 department of human services shall seek and obtain any Medicaid 3 matching funds available to defray the costs of the requests 4 for proposals process and audit. 5 Sec. 3. EFFECTIVE DATE. This Act, being deemed of immediate 6 importance, takes effect upon enactment. 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill requires the department of human services (DHS) 11 and the auditor of state (auditor) to jointly design and 12 issue a request for proposals (RFP) for the performance of a 13 third-party audit to validate encounter data collected and 14 reported by Medicaid managed care organizations (MCOs) to 15 DHS. The audit shall be designed to determine if the MCOs 16 are providing encounter data that, at a minimum, is complete, 17 accurate, consistent, and timely and that complies with federal 18 and contractual requirements related to the collection and 19 reporting of encounter data. The audit shall also be designed 20 to determine whether the type and quality of the encounter data 21 collected, at a minimum, strengthens the state’s capacity for 22 federal compliance and for managed care program oversight and 23 program integrity; for quality measurement, monitoring, and 24 reporting; for capitation rate setting; and for policymaking 25 and decision support. DHS and the auditor shall jointly 26 evaluate third-party proposals received, select and contract 27 with the third-party auditor by July 1, 2022, and monitor and 28 review the third-party auditor’s audit and report which shall 29 be submitted jointly to DHS and the auditor no later than 30 December 15, 2022. 31 The bill appropriates $250,000 from the general fund of 32 the state to DHS and the auditor for the RFP process and the 33 resulting third-party audit as provided in the bill. A portion 34 of the moneys appropriated may be used by DHS and the auditor 35 -2- LSB 5793XS (5) 89 pf/rh 2/ 3

S.F. 2147 for administrative expenses related to the RFP process and the 1 audit. DHS shall seek and obtain any Medicaid matching funds 2 available to defray the costs of the RFP and audit. 3 The bill takes effect upon enactment. 4 -3- LSB 5793XS (5) 89 pf/rh 3/ 3