H.F. 149 Section 1. NEW SECTION . 249A.22 Dental provider assessment 1 program —— imposition —— collection —— credit and use —— monetary 2 penalties —— civil actions. 3 1. For the purposes of this section: 4 a. “Dental provider” means and includes but is not limited 5 to a dentist, endodontist, oral and maxillofacial surgeon, 6 orthodontist, periodontist, or prosthodontist operating as an 7 individual or as any other legal entity transacting business 8 in the state. 9 b. “Gross revenue” means all revenue reported by the dental 10 provider for patient care, but does not include contractual 11 adjustments, bad debt, Medicare revenue, or revenue derived 12 from sources other than dental provider operations including 13 but not limited to nonoperating revenue and other operating 14 revenue. 15 c. “Nonoperating revenue” means income from activities not 16 relating directly to the day-to-day operations of a dental 17 provider such as gains from disposal of a dental provider’s 18 assets, dividends, and interests from security investments, 19 gifts, grants, and endowments. 20 d. “Other operating revenue” means income from nonpatient 21 care services. 22 e. “Transacting business in the state” with reference to 23 a dental provider means that the dental provider maintains 24 contacts with or presence in the state of Iowa sufficient to 25 permit taxation of gross revenues received for patient services 26 under the United States Constitution. 27 2. A dental provider assessment is imposed on each dental 28 provider transacting business in the state to be used to 29 promote access to health care services for Iowans, including 30 those served by the Medicaid program. 31 3. The assessment rate shall be calculated as one and 32 one-half percent of the dental provider’s gross revenue. 33 4. The assessment shall be paid by each dental provider 34 to the department on a quarterly basis. A dental provider 35 -1- LSB 1144YH (5) 90 pf/rh 1/ 5

H.F. 149 shall submit the assessment amount no later than thirty days 1 following the end of each calendar quarter. 2 5. The department shall collect the assessment imposed 3 and shall credit all revenues collected to the state medical 4 assistance appropriation. This revenue may be used only for 5 services for which federal financial participation under the 6 Medicaid program is available to match state funds. 7 6. If the department determines that a dental provider 8 has underpaid or overpaid the assessment, the department 9 shall notify the dental provider of the amount of the unpaid 10 assessment or refund due. Such payment or refund shall be due 11 or refunded within thirty days of the issuance of the notice. 12 7. A dental provider that fails to pay the assessment 13 within the time frame specified in this section shall pay, in 14 addition to the outstanding assessment, a penalty in the amount 15 of one and five-tenths percent of the assessment amount owed 16 for each month or portion of each month the payment is overdue. 17 However, if the department determines that good cause is shown 18 for failure to comply with payment of the assessment, the 19 department shall waive the penalty or a portion of the penalty. 20 8. If an assessment has not been received by the department 21 by the last day of the third month after the payment is due, the 22 department shall suspend payment due the dental provider under 23 the Medicaid program including payments made on behalf of the 24 Medicaid program by a Medicaid managed care contractor. 25 9. The assessment imposed under this section constitutes 26 a debt due and owing the state and may be collected by civil 27 action, including but not limited to the filing of tax liens, 28 and any other method provided for by law. 29 10. If the federal government fully funds Iowa’s Medicaid 30 program, if federal financial participation to match the 31 assessments made under this section becomes unavailable under 32 federal law, if federal law changes to negatively impact the 33 assessment program as determined by the department, or if a 34 federal audit determines the assessment program is invalid, the 35 -2- LSB 1144YH (5) 90 pf/rh 2/ 5

H.F. 149 department shall terminate the imposition of the assessment 1 and the program beginning on the date the federal statutory, 2 regulatory, or interpretive change takes effect. 3 11. The department may adopt rules pursuant to chapter 17A 4 to administer this section. 5 Sec. 2. DIRECTIVES TO DEPARTMENT OF HEALTH AND HUMAN 6 SERVICES. Upon enactment of this Act, the department of 7 health and human services shall request any Medicaid waivers 8 or Medicaid state plan amendments necessary to implement this 9 Act from the centers for Medicare and Medicaid services of the 10 United States department of health and human services. 11 Sec. 3. CONTINGENCY PROVISIONS. 12 1. The dental provider assessment created in this Act shall 13 not be imposed or collected until the department of health and 14 human services has received approval of the assessment from the 15 centers for Medicare and Medicaid services of the United States 16 department of health and human services, and no sooner than 17 July 1, 2024. 18 2. The department of health and human services shall notify 19 the Code editor upon receipt of the approval specified in this 20 section from the centers for Medicare and Medicaid services of 21 the United States department of health and human services. 22 Sec. 4. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 23 immediate importance, takes effect upon enactment. 24 Sec. 5. CONTINGENT IMPLEMENTATION. The department of 25 health and human services shall only implement this Act if 26 the department receives approval of the requests relating to 27 any waivers or Medicaid state plan amendments necessary to 28 implement this Act. 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill creates a dental provider assessment program and 33 imposes a provider assessment on dental providers transacting 34 business in the state. 35 -3- LSB 1144YH (5) 90 pf/rh 3/ 5

H.F. 149 The bill provides definitions for the purposes of the bill 1 including “dental provider”, “gross revenue”, “nonoperating 2 revenue”, “other operating revenue”, and “transacting business 3 in the state”. 4 The bill imposes a dental provider assessment on each dental 5 provider transacting business in the state to be used to 6 promote access to health care services for Iowans, including 7 those served by the Medicaid program. The assessment rate 8 shall be calculated as one and one-half percent of the dental 9 provider’s gross revenue. 10 The assessment shall be paid by each dental provider to the 11 department of health and human services (HHS or the department) 12 on a quarterly basis, and not later than 30 days following the 13 end of each calendar quarter. 14 The department shall collect the assessment imposed and 15 shall credit all revenues collected to the state Medicaid 16 appropriation. The revenue shall be used only for services 17 for which federal financial participation under the Medicaid 18 program is available to match state funds. 19 The bill includes provisions relating to underpayments and 20 overpayments of the assessment. If a dental provider fails to 21 pay the assessment within the time frame specified in the bill, 22 in addition to the outstanding assessment, a penalty in the 23 amount of one and five-tenths percent of the assessment amount 24 is owed for each month or portion of each month the payment is 25 overdue. The department may waive the penalty or a portion of 26 the penalty for good cause shown. The department shall suspend 27 payment due the dental provider under the Medicaid program if 28 an assessment has not been received by HHS by the last day 29 of the third month after the payment is due. The assessment 30 constitutes a debt due and owing the state and may be collected 31 by civil action, including but not limited to the filing of tax 32 liens, and any other method provided for by law. 33 If certain circumstances occur, including if federal 34 financial participation to match the assessments becomes 35 -4- LSB 1144YH (5) 90 pf/rh 4/ 5

H.F. 149 unavailable under federal law or if the assessment is 1 determined to be invalid, HHS shall terminate the program and 2 the imposition of the assessment beginning on the date the 3 federal statutory, regulatory, or interpretive change takes 4 effect. 5 The department may adopt administrative rules to administer 6 the bill. 7 The bill includes directives to HHS and contingency 8 provisions. The department is directed, upon enactment of 9 the bill, to request any federal waivers or Medicaid state 10 plan amendments necessary to implement the bill. The dental 11 provider assessment shall not be imposed or collected until HHS 12 receives necessary federal approval, and not prior to July 1, 13 2024. The department shall notify the Code editor upon receipt 14 of the federal approval. 15 The bill takes effect upon enactment but shall only be 16 implemented if HHS receives the federal approval specified in 17 the bill. 18 -5- LSB 1144YH (5) 90 pf/rh 5/ 5