SF 85 (LSB 1191XS (1) 91)

SENATE FILE 85

BY  PETERSEN

A BILL FOR

An Act creating a health equity program and fund, and providing an appropriation.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  135.196  Health equity program —— fund —— standing appropriation.
   1.  The department shall establish a health equity program to improve menstrual and post-menstrual health by providing for reimbursement of the costs associated with the provision of covered services and treatments related to menstrual and post-menstrual health conditions not otherwise covered by a third-party payor. The department shall promote the program statewide and shall limit program administrative costs to no more than four percent of the funds appropriated for the program on an annual basis.
   2.  a.  The department shall adopt rules pursuant to chapter 17A to administer the program and to specify the types of services and treatments covered under the program, informed by evidence-based data from menstrual and post-menstrual health experts including but not limited to those who practice in the fields of obstetrics and gynecology, family practice, internal medicine, and urology. The covered services and treatments shall include but are not limited to hormone treatments, urinary tract treatments, vaginal estrogens, nerve therapies, and other services and treatments that alleviate illness, injury, conditions, diseases or symptoms related to periods, fibroids, endometriosis, perimenopause, menopause, incontinence, atrophic vaginitis, and other hormone-related conditions.
   b.  Covered services and treatments shall include health care services, treatments, supplies, and drugs needed to treat a menstrual or post-menstrual illness, injury, condition, disease, or its symptoms that meet any of the following criteria:
   (1)  Comply with standard medical practice.
   (2)  Are approved by the United States food and drug administration including for off-label use when supported by appropriate medical records.
   (3)  Are recommended or preferred by the patient’s provider and supported by appropriate medical records.
   3.  The department shall establish a process for registration of participating providers eligible to receive reimbursement through the health equity program fund. A health care provider shall be eligible for participation if the provider is deemed qualified and in good standing by the provider’s respective health-related profession board.
   4.  A participating provider shall be reimbursed for a covered service or treatment through the health equity program fund within ten days of submission of a billing statement. If applicable, the billing statement shall confirm that the patient is uninsured or that the service or treatment is not covered by the patient’s insurer.
   5.  The amount billed by the participating provider shall not exceed the actual cost incurred by the provider in delivering the covered service or treatment. Reimbursement for a covered service or treatment shall be paid directly to the participating provider and such payment shall be considered payment in full. The health equity program shall be the payor of last resort.
   6.  If sufficient program funds are not available to reimburse all billings submitted by participating providers, the department shall place a participating provider on a reimbursement waiting list in the order the participating provider’s billing statement was received. 
   7.  This section shall not be construed as granting an entitlement to reimbursement for any covered service or treatment provided by a participating provider.
   8.  a.  A health equity program fund is created in the state treasury under the control of the department. The fund includes but is not limited to amounts appropriated by the general assembly and other moneys available from federal or private sources which are to be used for purposes of this section. Notwithstanding section 8.33, funds remaining in the fund at the end of each fiscal year shall not revert to the general fund of the state but shall remain in the health equity program fund. Moneys in the fund are appropriated to the department for purposes of the health equity program.
   b.  There is appropriated from the general fund of the state to the health equity program fund a sum which reflects the total equivalent of all state revenue expended for genitourinary agents for state employees under the group insurance plan for public employees pursuant to chapter 509A, between July 1, 2002, and June 30, 2022.
   c.  For the purposes of this subsection:
   (1)  “Genitourinary agents” means medicines used to treat conditions of the reproductive organs and excretory system or urinary tract.
   (2)  “Period products” includes but is not limited to tampons, period pads, and period cups for use in connection with the menstrual cycle.
   8.  The department shall submit an annual report to the governor and the general assembly regarding the status of the program and fund including the balance remaining in the fund, the number of participating providers, the total amount billed per participating provider, the covered services and treatments for which reimbursement was provided in the previous year, and any recommendations for changes to the program or fund.
    Sec. 2.  CODE EDITOR DIRECTIVE.  The Code editor may designate section 135.196, as enacted in this Act, as a new subchapter within chapter 135, entitled “HEALTH EQUITY PROGRAM AND FUND”.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill requires the department of health and human services (HHS) to establish a health equity program (program) to improve menstrual and post-menstrual health by providing for reimbursement of the costs associated with the provision of covered services and treatments related to menstrual and post-menstrual health conditions not otherwise covered by a third-party payor. The department shall promote the program statewide and limit program administrative costs to no more than 4 percent of the funds appropriated for the program on an annual basis.
   The bill requires HHS to adopt administrative rules to administer the program and specify the types of services and treatments covered under the program, and requires that the covered services and treatments shall include health care services, treatments, supplies, and drugs needed to treat a menstrual or post-menstrual illness, injury, condition, disease, or its symptoms that comply with standard medical practice, or are approved by the United States food and drug administration or are recommended or preferred by the patient’s provider and supported by appropriate medical records.
   The department shall establish a process for the registration of participating providers eligible to receive reimbursement through the program. A participating provider shall be reimbursed for a covered service or treatment through the program fund within 10 days of submission of a billing statement, and if applicable, the billing statement shall confirm that the patient is uninsured or that the service or treatment is not covered by the patient’s insurer. The amount billed by the participating provider shall not exceed the actual cost incurred by the provider in delivering the covered service or treatment. Reimbursement shall be paid directly to the participating provider and such payment shall be considered payment in full. The program shall be the payor of last resort. If sufficient program funds are not available to cover all of the billings submitted, HHS shall place a participating provider on a reimbursement waiting list in the order the participating provider’s billing statement was received. 
   The provisions of the bill are not to be construed as granting an entitlement to reimbursement for any covered service or treatment provided by a participating provider.
   The bill creates a health equity program fund under the control of HHS. The fund includes amounts appropriated by the general assembly and other moneys available from federal or private sources. Moneys in the fund at the end of each fiscal year shall not revert but remain in the fund. Moneys in the fund are appropriated to HHS for the purposes of the program. There is appropriated from the general fund of the state to the program fund a sum which reflects the total equivalent of all state revenue expended for genitourinary agents for state employees under the group insurance plan for public employees pursuant to Code chapter 509A, for the fiscal period between July 1, 2002, and June 30, 2022. The department shall submit an annual report to the governor and the general assembly regarding the status of the program and fund including the balance remaining in the fund, the number of participating providers, the total amount billed per participating provider, the covered services and treatments for which reimbursement was provided in the previous year, and any recommendations for changes to the program or fund. 
   The bill defines “genitourinary agents” and “period products”.