HSB 621 (LSB 5344YC (12) 91)

HOUSE FILE _____ 

BY  (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON HARRIS)

A BILL FOR

An Act relating to reporting requirements for the department of health and human services for shelter care, qualified residential treatment providers, and medical assistance provider reimbursement rates.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 235.2, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  9.  Upon implementation by the department of a uniform cost report for shelter care and qualified residential treatment providers, the department shall biennially conduct a review of shelter care and qualified residential treatment provider costs compared to current shelter care and qualified residential treatment provider rates. On or before October 1 of the calendar year immediately succeeding the calendar year in which the review is conducted, the department shall submit a report to the governor and the general assembly detailing the results of the department’s review and recommendations for rate adjustments.
    Sec. 2.  Section 249A.4, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  15.  a.  Conduct an annual review of provider reimbursement rates for all medical and health services provided pursuant to this chapter. The department shall compare each provider reimbursement rate to the reimbursement rates for all of the following:
   (1)  Medicaid programs in states contiguous to Iowa.
   (2)  Medicaid programs in states with populations comparable to Iowa as based on the most recent decennial census released by the United States census bureau.
   (3)  The federal Medicare program, if applicable.
   b.  The department shall submit an annual report that summarizes the department’s review under paragraph “a” to the general assembly on or before December 1.
    Sec. 3.  NEW SECTION.  249A.32C  Home and community-based service waivers —— provider rate limits.
   1.  For purposes of this section:
   a.  “Consumer” means the same as defined in section 249A.29.
   b.  “Provider” means the same as defined in section 249A.29.
   c.  “Waiver” means the same as defined in section 249A.29.
   2.  a.  Beginning July 1, 2026, the department, with input from the public, providers, and other stakeholders, shall conduct a review at least biennially of provider reimbursement rates for all services rendered under a waiver during the period of review specified by the department. The review shall include but is not limited to all of the following:
   (1)  Aggregate cost to the state to reimburse providers for services rendered to consumers under a waiver.
   (2)  Utilization of services available to consumers.
   (3)  The demonstrated capacity of providers to meet consumer demand for services with available resources and indicators of need for increased resources.
   b.  Based upon the review pursuant to paragraph “a”, the department shall develop proposed rate models and related changes to departmental policy and procedures. The department shall submit a report to the general assembly on or before December 31 of the year in which the review is completed and must include proposed rate models, the projected fiscal impact of implementing the proposed rate models including documentation supporting the actuarial soundness of the proposed rate models, and the proposed changes to the department’s policies and procedures.
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 reporting requirements for the department of health and human services (HHS) for shelter care, qualified residential treatment providers, and medical assistance provider reimbursement rates.
   The bill requires that upon implementation of a uniform cost report for shelter care and qualified residential treatment providers, HHS shall biennially conduct a rate review. On or before October 1 of the calendar year following completion of the review, HHS shall report the results of the review and provide recommendations for rate adjustments to the governor and the general assembly. 
   The bill requires HHS to conduct an annual review of rates for all medical and health services provided under the medical assistance program. HHS shall compare each rate to the rates for Medicaid programs in states contiguous to Iowa, in states with populations comparable to Iowa, and to the federal Medicare program, if applicable. The bill requires HHS to submit an annual report to the general assembly that summarizes the review.
   The bill requires HHS, with input from the public, providers, and other stakeholders, to conduct a review at least biennially beginning on July 1, 2026, of rates for services rendered under home and community-based services waivers (waivers) during the period of review specified by HHS; the review shall include the aggregate cost to the state and consumer utilization of waivers, along with the demonstrated capacity of providers to meet consumer demand for services with available resources and indicators of need for more resources. The bill requires HHS to use the findings of the review to develop proposed rate models and related changes to HHS policies and procedures. The bill defines “consumer”, “provider”, and “waiver”.
   The bill requires HHS to submit to the general assembly, on or before December 31 of the year that the review is completed, a report detailing the proposed rate models, the fiscal impact of implementing such rates with documents supporting the actuarial soundness of the models, and the proposed changes to HHS policies and procedures.