House Study Bill 52 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON MEYER) A BILL FOR An Act relating to the establishment of tiered reimbursement 1 rates for pediatric outpatient services under the Medicaid 2 program. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1535YC (3) 90 pf/rh

H.F. _____ Section 1. MEDICAID TIERED REIMBURSEMENT RATES —— 1 PEDIATRIC OUTPATIENT SERVICES. The department of health and 2 human services shall implement a tiered rate reimbursement 3 methodology for pediatric outpatient care under the Medicaid 4 program based on patient acuity. The reimbursement rates may 5 incorporate code modifiers to reflect the extended time and 6 increased intensity required of a pediatric provider to address 7 complex trauma, complexity of a child’s family environment, and 8 other factors affecting a child as recommended by pediatric 9 providers and advocates. 10 EXPLANATION 11 The inclusion of this explanation does not constitute agreement with 12 the explanation’s substance by the members of the general assembly. 13 This bill requires the department of health and human 14 services to implement a tiered rate reimbursement methodology 15 for pediatric outpatient care under the Medicaid program based 16 on patient acuity. The reimbursement rates may incorporate 17 code modifiers to reflect the extended time and increased 18 intensity required of a pediatric provider to address complex 19 trauma, complexity of a child’s family environment, and other 20 factors affecting a child as recommended by pediatric providers 21 and advocates. 22 -1- LSB 1535YC (3) 90 pf/rh 1/ 1