House File 841  Corrected Engrossed Copy 4/22/05 - Reprinted



                                       HOUSE FILE       
                                       BY  GIPP and MURPHY


    Passed House, Date               Passed Senate, Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         
                 Approved                            

                                      A BILL FOR

  1 An Act relating to health care reform, including provisions
  2    relating to the medical assistance program, providing
  3    appropriations, providing effective dates, and providing for
  4    retroactive applicability.
  5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  6 TLSB 3523HH 81
  7 pf/gg/14

PAG LIN



  1  1                           DIVISION I
  1  2                            IOWACARE
  1  3    Section 1.  NEW SECTION.  249J.1  TITLE.
  1  4    This chapter shall be known and may be cited as the
  1  5 "Iowacare Act".
  1  6    Sec. 2.  NEW SECTION.  249J.2  FEDERAL FINANCIAL
  1  7 PARTICIPATION == CONTINGENT IMPLEMENTATION.
  1  8    This chapter shall be implemented only to the extent that
  1  9 federal matching funds are available for nonfederal
  1 10 expenditures under this chapter.  The department shall not
  1 11 expend funds under this chapter, including but not limited to
  1 12 expenditures for reimbursement of providers and program
  1 13 administration, if appropriated nonfederal funds are not
  1 14 matched by federal financial participation.
  1 15    Sec. 3.  NEW SECTION.  249J.3  DEFINITIONS.
  1 16    As used in this chapter, unless the context otherwise
  1 17 requires:
  1 18    1.  "Clean claim" means a claim submitted by a provider
  1 19 included in the expansion population provider network that may
  1 20 be adjudicated as paid or denied.
  1 21    2.  "Department" means the department of human services.
  1 22    3.  "Director" means the director of human services.
  1 23    4.  "Expansion population" means the individuals who are
  1 24 eligible solely for benefits under the medical assistance
  1 25 program waiver as provided in this chapter.
  1 26    5.  "Full benefit dually eligible Medicare Part D
  1 27 beneficiary" means a person who is eligible for coverage for
  1 28 Medicare Part D drugs and is simultaneously eligible for full
  1 29 medical assistance benefits pursuant to chapter 249A, under
  1 30 any category of eligibility.
  1 31    6.  "Full benefit recipient" means an adult who is eligible
  1 32 for full medical assistance benefits pursuant to chapter 249A
  1 33 under any category of eligibility.
  1 34    7.  "Iowa Medicaid enterprise" means the centralized
  1 35 medical assistance program infrastructure, based on a business
  2  1 enterprise model, and designed to foster collaboration among
  2  2 all program stakeholders by focusing on quality, integrity,
  2  3 and consistency.
  2  4    8.  "Medical assistance" or "Medicaid" means payment of all
  2  5 or part of the costs of care and services provided to an
  2  6 individual pursuant to chapter 249A and Title XIX of the
  2  7 federal Social Security Act.
  2  8    9.  "Medicare Part D" means the Medicare Part D program
  2  9 established pursuant to the Medicare Prescription Drug,
  2 10 Improvement, and Modernization Act of 2003, Pub. L. No.  108=
  2 11 173.
  2 12    10.  "Minimum data set" means the minimum data set
  2 13 established by the centers for Medicare and Medicaid services
  2 14 of the United States department of health and human services
  2 15 for nursing home resident assessment and care screening.
  2 16    11.  "Nursing facility" means a nursing facility as defined
  2 17 in section 135C.1.
  2 18    12.  "Public hospital" means a hospital licensed pursuant
  2 19 to chapter 135B and governed pursuant to chapter 145A, 226,
  2 20 347, 347A, or 392.
  2 21    Sec. 4.  NEW SECTION.  249J.4  PURPOSE.
  2 22    It is the purpose of this chapter to propose a variety of
  2 23 initiatives to increase the efficiency, quality, and
  2 24 effectiveness of the health care system; to increase access to
  2 25 appropriate health care; to provide incentives to consumers to
  2 26 engage in responsible health care utilization and personal
  2 27 health care management; to reward providers based on quality
  2 28 of care and improved service delivery; and to encourage the
  2 29 utilization of information technology, to the greatest extent
  2 30 possible, to reduce fragmentation and increase coordination of
  2 31 care and quality outcomes.
  2 32                           DIVISION II
  2 33                       MEDICAID EXPANSION
  2 34    Sec. 5.  NEW SECTION.  249J.5  EXPANSION POPULATION
  2 35 ELIGIBILITY.
  3  1    1.  Except as otherwise provided in this chapter, an
  3  2 individual nineteen through sixty=four years of age shall be
  3  3 eligible solely for the expansion population benefits
  3  4 described in this chapter when provided through the expansion
  3  5 population provider network as described in this chapter, if
  3  6 the individual meets all of the following conditions:
  3  7    a.  The individual is not eligible for coverage under the
  3  8 medical assistance program in effect on April 1, 2005.
  3  9    b.  The individual has a family income at or below two
  3 10 hundred percent of the federal poverty level as defined by the
  3 11 most recently revised poverty income guidelines published by
  3 12 the United States department of health and human services.
  3 13    c.  The individual fulfills all other conditions of
  3 14 participation for the expansion population described in this
  3 15 chapter, including requirements relating to personal financial
  3 16 responsibility.
  3 17    2.  Individuals otherwise eligible solely for family
  3 18 planning benefits authorized under the medical assistance
  3 19 family planning services waiver, effective January 1, 2005, as
  3 20 described in 2004 Iowa Acts, chapter 1175, section 116,
  3 21 subsection 8, may also be eligible for expansion population
  3 22 benefits provided through the expansion population provider
  3 23 network.
  3 24    3.  Individuals with family incomes below three hundred
  3 25 percent of the federal poverty level as defined by the most
  3 26 recently revised poverty income guidelines published by the
  3 27 United States department of health and human services shall
  3 28 also be eligible for obstetrical and newborn care under the
  3 29 expansion population if deductions for the medical expenses of
  3 30 all family members would reduce the family income to two
  3 31 hundred percent of the federal poverty level or below.  Such
  3 32 individuals shall be eligible for the same benefits as those
  3 33 provided to individuals eligible under section 135.152.
  3 34 Eligible individuals may choose to receive the appropriate
  3 35 level of care at any licensed hospital or health care
  4  1 facility, with the exception of individuals in need of such
  4  2 care residing in the counties of Cedar, Clinton, Iowa,
  4  3 Johnson, Keokuk, Louisa, Muscatine, Scott, and Washington, who
  4  4 shall be provided care at the university of Iowa hospitals and
  4  5 clinics.
  4  6    4.  Enrollment for the expansion population may be limited,
  4  7 closed, or reduced and the scope and duration of expansion
  4  8 population services provided may be limited, reduced, or
  4  9 terminated if the department determines that federal medical
  4 10 assistance program matching funds or appropriated state funds
  4 11 will not be available to pay for existing or additional
  4 12 enrollment.
  4 13    5.  Eligibility for the expansion population shall not
  4 14 include individuals who have access to group health insurance,
  4 15 unless the reason for not accessing group health insurance is
  4 16 allowed by rule of the department.
  4 17    6.  Each expansion population member shall provide to the
  4 18 department all insurance information required by the health
  4 19 insurance premium payment program.
  4 20    7.  The department shall contract with the county general
  4 21 assistance directors to perform intake functions for the
  4 22 expansion population, but only at the discretion of the
  4 23 individual county general assistance director.
  4 24    8.  If the department provides intake services at the
  4 25 location of a provider included in the expansion population
  4 26 provider network, the department shall consider subcontracting
  4 27 with local nonprofit agencies to promote greater understanding
  4 28 between providers, under the medical assistance program and
  4 29 included in the expansion population provider network, and
  4 30 their recipients and members.
  4 31    Sec. 6.  NEW SECTION.  249J.6  EXPANSION POPULATION
  4 32 BENEFITS.
  4 33    1.  Beginning July 1, 2005, the expansion population shall
  4 34 be eligible for all of the following expansion population
  4 35 services:
  5  1    a.  Inpatient hospital procedures described in the
  5  2 diagnostic related group codes or other applicable inpatient
  5  3 hospital reimbursement methods designated by the department.
  5  4    b.  Outpatient hospital services described in the
  5  5 ambulatory patient groupings or noninpatient services
  5  6 designated by the department.
  5  7    c.  Physician and advanced registered nurse practitioner
  5  8 services described in the current procedural terminology codes
  5  9 specified by the department.
  5 10    d.  Dental services described in the dental codes specified
  5 11 by the department.
  5 12    e.  Limited pharmacy benefits provided by an expansion
  5 13 population provider network hospital pharmacy and solely
  5 14 related to an appropriately billed expansion population
  5 15 service.
  5 16    f.  Transportation to and from an expansion population
  5 17 provider network provider only if the provider offers such
  5 18 transportation services or the transportation is provided by a
  5 19 volunteer.
  5 20    2.  a.  Beginning no later than March 1, 2006, within
  5 21 ninety days of enrollment in the expansion population, each
  5 22 expansion population member shall participate, in conjunction
  5 23 with receiving a single comprehensive medical examination and
  5 24 completing a personal health improvement plan, in a health
  5 25 risk assessment coordinated by a health consortium
  5 26 representing providers, consumers, and medical education
  5 27 institutions.  An expansion population member who enrolls in
  5 28 the expansion population prior to March 1, 2006, shall
  5 29 participate in the health risk assessment, receive the single
  5 30 comprehensive medical examination, and complete the personal
  5 31 health improvement plan by June 1, 2006.  The criteria for the
  5 32 comprehensive medical examination and the personal health
  5 33 improvement plan shall be developed and applied in a manner
  5 34 that takes into consideration cultural variations that may
  5 35 exist within the expansion population.
  6  1    b.  The health risk assessment shall be a web=based
  6  2 electronic system capable of capturing and integrating basic
  6  3 data to provide an individualized personal health improvement
  6  4 plan for each expansion population member.  The health risk
  6  5 assessment shall provide a preliminary diagnosis of current
  6  6 and prospective health conditions and recommendations for
  6  7 improving health conditions with an individualized wellness
  6  8 program.  The health risk assessment shall be made available
  6  9 to the expansion population member and the provider specified
  6 10 in paragraph "c" who performs the comprehensive medical
  6 11 examination and provides the individualized personal health
  6 12 improvement plan.
  6 13    c.  The single comprehensive medical examination and
  6 14 personal health improvement plan may be provided by an
  6 15 expansion population provider network physician, advanced
  6 16 registered nurse practitioner, or physician assistant or any
  6 17 other physician, advanced registered nurse practitioner, or
  6 18 physician assistant, available to any full benefit recipient
  6 19 including but not limited to such providers available through
  6 20 a free clinic under a contract with the department to provide
  6 21 these services, through federally qualified health centers or
  6 22 rural health clinics that employ a physician, or through any
  6 23 other nonprofit agency qualified or deemed to be qualified by
  6 24 the department to perform these services.
  6 25    3.  Beginning no later than July 1, 2006, expansion
  6 26 population members shall be provided all of the following:
  6 27    a.  Access to a pharmacy assistance clearinghouse program
  6 28 to match expansion population members with free or discounted
  6 29 prescription drug programs provided by the pharmaceutical
  6 30 industry.
  6 31    b.  Access to a medical information hotline, accessible
  6 32 twenty=four hours per day, seven days per week, to assist
  6 33 expansion population members in making appropriate choices
  6 34 about the use of emergency room and other health care
  6 35 services.
  7  1    4.  Membership in the expansion population shall not
  7  2 preclude an expansion population member from eligibility for
  7  3 services not covered under the expansion population for which
  7  4 the expansion population member is otherwise entitled under
  7  5 state or federal law.
  7  6    5.  Members of the expansion population shall not be
  7  7 considered full benefit dually eligible Medicare Part D
  7  8 beneficiaries for the purposes of calculating the state's
  7  9 payment under Medicare Part D, until such time as the
  7 10 expansion population is eligible for all of the same benefits
  7 11 as full benefit recipients under the medical assistance
  7 12 program.
  7 13    Sec. 7.  NEW SECTION.  249J.7  EXPANSION POPULATION
  7 14 PROVIDER NETWORK.
  7 15    1.  Expansion population members shall only be eligible to
  7 16 receive expansion population services through a provider
  7 17 included in the expansion population provider network.  Except
  7 18 as otherwise provided in this chapter, the expansion
  7 19 population provider network shall be limited to a publicly
  7 20 owned acute care teaching hospital located in a county with a
  7 21 population over three hundred fifty thousand, the university
  7 22 of Iowa hospitals and clinics, and the state hospitals for
  7 23 persons with mental illness designated pursuant to section
  7 24 226.1 with the exception of the programs at such state
  7 25 hospitals for persons with mental illness that provide
  7 26 substance abuse treatment, serve gero=psychiatric patients, or
  7 27 treat sexually violent predators.
  7 28    2.  Expansion population services provided to expansion
  7 29 population members by providers included in the expansion
  7 30 population provider network shall be payable at the full
  7 31 benefit recipient rates.
  7 32    3.  Providers included in the expansion population provider
  7 33 network shall submit clean claims within ten days of the date
  7 34 of provision of an expansion population service to an
  7 35 expansion population member.
  8  1    4.  Unless otherwise prohibited by law, a provider under
  8  2 the expansion population provider network may deny care to an
  8  3 individual who refuses to apply for coverage under the
  8  4 expansion population.
  8  5    5.  Notwithstanding the provision of section 347.16,
  8  6 subsection 2, requiring the provision of free care and
  8  7 treatment to the persons described in that subsection, the
  8  8 publicly owned acute care teaching hospital described in
  8  9 subsection 1 may require any sick or injured person seeking
  8 10 care or treatment at that hospital to be subject to financial
  8 11 participation, including but not limited to copayments or
  8 12 premiums, and may deny nonemergent care or treatment to any
  8 13 person who refuses to be subject to such financial
  8 14 participation.
  8 15    Sec. 8.  NEW SECTION.  249J.8  EXPANSION POPULATION MEMBERS
  8 16 == FINANCIAL PARTICIPATION.
  8 17    1.  Beginning July 1, 2005, each expansion population
  8 18 member shall pay a monthly premium not to exceed one=twelfth
  8 19 of five percent of the member's annual family income to be
  8 20 paid on the last day of the month of coverage.  The department
  8 21 shall deduct the amount of any monthly premiums paid by an
  8 22 expansion population member for benefits under the healthy and
  8 23 well kids in Iowa program when computing the amount of monthly
  8 24 premiums owed under this subsection.  An expansion population
  8 25 member shall pay the monthly premium during the entire period
  8 26 of the member's enrollment.  However, regardless of the length
  8 27 of enrollment, the member is subject to payment of the premium
  8 28 for a minimum of four consecutive months.  Timely payment of
  8 29 premiums, including any arrearages accrued from prior
  8 30 enrollment, is a condition of receiving any expansion
  8 31 population services.  Premiums collected under this subsection
  8 32 shall be deposited in the premiums subaccount of the account
  8 33 for health care transformation created pursuant to section
  8 34 249J.22.  An expansion population member shall also pay the
  8 35 same copayments required of other adult recipients of medical
  9  1 assistance.
  9  2    2.  The department may reduce the required out=of=pocket
  9  3 expenditures for an individual expansion population member
  9  4 based upon the member's increased wellness activities such as
  9  5 smoking cessation or compliance with the personal health
  9  6 improvement plan completed by the member.
  9  7    3.  The department shall submit to the governor and the
  9  8 general assembly by March 15, 2006, a design for each of the
  9  9 following:
  9 10    a.  An insurance cost subsidy program for expansion
  9 11 population members who have access to employer health
  9 12 insurance plans, provided that the design shall require that
  9 13 no less than fifty percent of the cost of such insurance shall
  9 14 be paid by the employer.
  9 15    b.  A health care account program option for individuals
  9 16 eligible for enrollment in the expansion population.  The
  9 17 health care account program option shall be available only to
  9 18 adults who have been enrolled in the expansion population for
  9 19 at least twelve consecutive calendar months.  Under the health
  9 20 care account program option, the individual would agree to
  9 21 exchange one year's receipt of benefits under the expansion
  9 22 population, to which the individual would otherwise be
  9 23 entitled, for a credit to obtain any medical assistance
  9 24 program covered service up to a specified amount.  The balance
  9 25 in the health care account at the end of the year, if any,
  9 26 would be available for withdrawal by the individual.
  9 27    Sec. 9.  NEW SECTION.  249J.9  FUTURE EXPANSION POPULATION,
  9 28 BENEFITS, AND PROVIDER NETWORK GROWTH.
  9 29    1.  POPULATION.  The department shall contract with the
  9 30 division of insurance of the department of commerce or another
  9 31 appropriate entity to track, on an annual basis, the number of
  9 32 uninsured and underinsured Iowans, the cost of private market
  9 33 insurance coverage, and other barriers to access to private
  9 34 insurance for Iowans.  Based on these findings and available
  9 35 funds, the department shall make recommendations, annually, to
 10  1 the governor and the general assembly regarding further
 10  2 expansion of the expansion population.
 10  3    2.  BENEFITS.
 10  4    a.  The department shall not provide services to expansion
 10  5 population members that are in addition to the services
 10  6 originally designated by the department pursuant to section
 10  7 249J.6, without express authorization provided by the general
 10  8 assembly.
 10  9    b.  The department, upon the recommendation of the
 10 10 clinicians advisory panel established pursuant to section
 10 11 249J.17, may change the scope and duration of any of the
 10 12 available expansion population services, but this subsection
 10 13 shall not be construed to authorize the department to make
 10 14 expenditures in excess of the amount appropriated for benefits
 10 15 for the expansion population.
 10 16    3.  EXPANSION POPULATION PROVIDER NETWORK.
 10 17    a.  The department shall not expand the expansion
 10 18 population provider network unless the department is able to
 10 19 pay for expansion population services provided by such
 10 20 providers at the full benefit recipient rates.
 10 21    b.  The department may limit access to the expansion
 10 22 population provider network by the expansion population to the
 10 23 extent the department deems necessary to meet the financial
 10 24 obligations to each provider under the expansion population
 10 25 provider network.  This subsection shall not be construed to
 10 26 authorize the department to make any expenditure in excess of
 10 27 the amount appropriated for benefits for the expansion
 10 28 population.
 10 29    Sec. 10.  NEW SECTION.  249J.10  MAXIMIZATION OF FUNDING
 10 30 FOR INDIGENT PATIENTS.
 10 31    1.  Unencumbered certified local matching funds may be used
 10 32 to cover the state share of the cost of services for the
 10 33 expansion population.
 10 34    2.  The department of human services shall include in its
 10 35 annual budget submission, recommendations relating to a
 11  1 disproportionate share hospital and graduate medical education
 11  2 allocation plan that maximizes the availability of federal
 11  3 funds for payments to hospitals for the care and treatment of
 11  4 indigent patients.
 11  5    3.  If state and federal law and regulations so provide and
 11  6 if federal disproportionate share hospital funds and graduate
 11  7 medical education funds are available under Title XIX of the
 11  8 federal Social Security Act, federal disproportionate share
 11  9 hospital funds and graduate medical education funds shall be
 11 10 distributed as specified by the department.
 11 11                          DIVISION III
 11 12                   REBALANCING LONG=TERM CARE
 11 13    Sec. 11.  NEW SECTION.  249J.11  NURSING FACILITY LEVEL OF
 11 14 CARE DETERMINATION FOR FACILITY=BASED AND COMMUNITY=BASED
 11 15 SERVICES.
 11 16    The department shall amend the medical assistance state
 11 17 plan to provide for all of the following:
 11 18    1.  That nursing facility level of care services under the
 11 19 medical assistance program shall be available to an individual
 11 20 admitted to a nursing facility on or after July 1, 2005, who
 11 21 meets eligibility criteria for the medical assistance program
 11 22 pursuant to section 249A.3, if the individual also meets any
 11 23 of the following criteria:
 11 24    a.  Based upon the minimum data set, the individual
 11 25 requires limited assistance, extensive assistance, or has
 11 26 total dependence on assistance, provided by the physical
 11 27 assistance of one or more persons, with three or more
 11 28 activities of daily living as defined by the minimum data set,
 11 29 section G, entitled "physical functioning and structural
 11 30 problems".
 11 31    b.  Based on the minimum data set, the individual requires
 11 32 the establishment of a safe, secure environment due to
 11 33 moderate or severe impairment of cognitive skills for daily
 11 34 decision making.
 11 35    c.  The individual has established a dependency requiring
 12  1 residency in a medical institution for more than one year.
 12  2    2.  That an individual admitted to a nursing facility prior
 12  3 to July 1, 2005, and an individual applying for home and
 12  4 community=based services waiver services at the nursing
 12  5 facility level of care on or after July 1, 2005, who meets the
 12  6 eligibility criteria for the medical assistance program
 12  7 pursuant to section 249A.3, shall also meet any of the
 12  8 following criteria:
 12  9    a.  Based on the minimum data set, the individual requires
 12 10 supervision, or limited assistance, provided on a daily basis
 12 11 by the physical assistance of at least one person, for
 12 12 dressing and personal hygiene activities of daily living as
 12 13 defined by the minimum data set, section G, entitled "physical
 12 14 functioning and structural problems".
 12 15    b.  Based on the minimum data set, the individual requires
 12 16 the establishment of a safe, secure environment due to
 12 17 modified independence or moderate impairment of cognitive
 12 18 skills for daily decision making.
 12 19    3.  That, beginning July 1, 2005, if nursing facility level
 12 20 of care is determined to be medically necessary for an
 12 21 individual and the individual meets the nursing facility level
 12 22 of care requirements for home and community=based services
 12 23 waiver services under subsection 2, but appropriate home and
 12 24 community=based services are not available to the individual
 12 25 in the individual's community at the time of the determination
 12 26 or the provision of available home and community=based
 12 27 services to meet the skilled care requirements of the
 12 28 individual is not cost=effective, the criteria for admission
 12 29 of the individual to a nursing facility for nursing facility
 12 30 level of care services shall be the criteria in effect on June
 12 31 30, 2005.  The department of human services shall establish
 12 32 the standard for determining cost=effectiveness of home and
 12 33 community=based services under this subsection.
 12 34    4.  The department shall develop a process to allow
 12 35 individuals identified under subsection 3 to be served under
 13  1 the home and community=based services waiver at such time as
 13  2 appropriate home and community=based services become available
 13  3 in the individual's community.
 13  4    Sec. 12.  NEW SECTION.  249J.12  SERVICES FOR PERSONS WITH
 13  5 MENTAL RETARDATION OR DEVELOPMENTAL DISABILITIES.
 13  6    1.  The department, in cooperation with the Iowa state
 13  7 association of counties, the Iowa association of community
 13  8 providers, the governor's developmental disabilities council,
 13  9 and other interested parties, shall develop a plan for a case=
 13 10 mix adjusted reimbursement system under the medical assistance
 13 11 program for both institution=based and community=based
 13 12 services for persons with mental retardation or developmental
 13 13 disabilities for submission to the general assembly by January
 13 14 1, 2007.  The department shall not implement the case=mix
 13 15 adjusted reimbursement system plan without express
 13 16 authorization by the general assembly.
 13 17    2.  The department, in consultation with the Iowa state
 13 18 association of counties, the Iowa association of community
 13 19 providers, the governor's developmental disabilities council,
 13 20 and other interested parties, shall develop a plan for
 13 21 submission to the governor and the general assembly no later
 13 22 than July 1, 2007, to enhance alternatives for community=based
 13 23 care for individuals who would otherwise require care in an
 13 24 intermediate care facility for persons with mental
 13 25 retardation.  The plan shall not be implemented without
 13 26 express authorization by the general assembly.
 13 27    Sec. 13.  NEW SECTION.  249J.13  CHILDREN'S MENTAL HEALTH
 13 28 WAIVER SERVICES.
 13 29    The department shall provide medical assistance waiver
 13 30 services to not more than three hundred children who meet the
 13 31 eligibility criteria for the medical assistance program
 13 32 pursuant to section 249A.3 and also meet both of the following
 13 33 criteria:
 13 34    1.  The child requires behavioral health care services and
 13 35 qualifies for the level of care provided by a psychiatric
 14  1 medical institution for children.
 14  2    2.  The child requires treatment to cure or alleviate a
 14  3 serious mental illness or disorder, or emotional damage as
 14  4 evidenced by severe anxiety, depression, withdrawal, or
 14  5 untoward aggressive behavior toward the child's self or
 14  6 others.
 14  7    Sec. 14.  CASE MANAGEMENT FOR THE FRAIL ELDERLY.
 14  8    1.  The department of human services shall submit a medical
 14  9 assistance state plan amendment to the centers for Medicare
 14 10 and Medicaid services of the United States department of
 14 11 health and human services to provide for inclusion of case
 14 12 management for the frail elderly as a medical assistance
 14 13 covered service.  The department of human services shall
 14 14 develop the medical assistance state plan amendment in
 14 15 consultation with the department of elder affairs.
 14 16    2.  If the medical assistance state plan amendment is
 14 17 approved, the department of elder affairs shall use existing
 14 18 funding for case management as nonfederal matching funds.  The
 14 19 department of elder affairs, in consultation with the
 14 20 department of human services, shall determine the amount of
 14 21 current funding that would be eligible for use as nonfederal
 14 22 matching funds so that sufficient funding is retained to
 14 23 provide case management services for frail elders who are not
 14 24 eligible for the medical assistance program.
 14 25    The department shall establish a reimbursement rate for
 14 26 case management for the frail elderly such that the amount of
 14 27 state funding necessary to pay for such case management does
 14 28 not exceed the amount appropriated to the department of elder
 14 29 affairs for case management for the frail elderly in the
 14 30 fiscal year beginning July 1, 2005.  All state and federal
 14 31 funds appropriated or received for case management for the
 14 32 frail elderly shall be used for services to clients eligible
 14 33 for medical assistance.  Any state savings realized from case
 14 34 management for the frail elderly shall be used to expand
 14 35 services to the frail elderly.
 15  1    3.  The department of human services in consultation with
 15  2 the department of elder affairs shall determine whether case
 15  3 management for the frail elderly should continue to be
 15  4 provided through a sole source contract or if a request for
 15  5 proposals process should be initiated to provide the services.
 15  6 The departments shall submit their recommendation to the
 15  7 general assembly by January 1, 2006.
 15  8                           DIVISION IV
 15  9                  HEALTH PROMOTION PARTNERSHIPS
 15 10    Sec. 15.  NEW SECTION.  249J.14  HEALTH PROMOTION
 15 11 PARTNERSHIPS.
 15 12    1.  SERVICES FOR ADULTS AT STATE MENTAL HEALTH INSTITUTES.
 15 13 Beginning July 1, 2005, inpatient and outpatient hospital
 15 14 services at the state hospitals for persons with mental
 15 15 illness designated pursuant to section 226.1 shall be covered
 15 16 services under the medical assistance program.
 15 17    2.  DIETARY COUNSELING.  By July 1, 2006, the department
 15 18 shall design and begin implementation of a strategy to provide
 15 19 dietary counseling and support to child and adult recipients
 15 20 of medical assistance and to expansion population members to
 15 21 assist these recipients and members in avoiding excessive
 15 22 weight gain or loss and to assist in development of personal
 15 23 weight loss programs for recipients and members determined by
 15 24 the recipient's or member's health care provider to be
 15 25 clinically overweight.
 15 26    3.  ELECTRONIC MEDICAL RECORDS.  By October 1, 2006, the
 15 27 department shall develop a practical strategy for expanding
 15 28 utilization of electronic medical recordkeeping by providers
 15 29 under the medical assistance program and the expansion
 15 30 population provider network.  The plan shall focus, initially,
 15 31 on medical assistance program recipients and expansion
 15 32 population members whose quality of care would be
 15 33 significantly enhanced by the availability of electronic
 15 34 medical recordkeeping.
 15 35    4.  PROVIDER INCENTIVE PAYMENT PROGRAMS.  By January 1,
 16  1 2007, the department shall design and implement a provider
 16  2 incentive payment program for providers under the medical
 16  3 assistance program and providers included in the expansion
 16  4 population provider network based upon evaluation of public
 16  5 and private sector models.
 16  6    5.  HEALTH ASSESSMENT FOR MEDICAL ASSISTANCE RECIPIENTS
 16  7 WITH MENTAL RETARDATION OR DEVELOPMENTAL DISABILITIES.  The
 16  8 department shall work with the university of Iowa colleges of
 16  9 medicine, dentistry, nursing, pharmacy, and public health, and
 16 10 the university of Iowa hospitals and clinics to determine
 16 11 whether the physical and dental health of recipients of
 16 12 medical assistance who are persons with mental retardation or
 16 13 developmental disabilities are being regularly and fully
 16 14 addressed and to identify barriers to such care.  The
 16 15 department shall report the department's findings to the
 16 16 governor and the general assembly by January 1, 2007.
 16 17    6.  SMOKING CESSATION.  The department shall implement a
 16 18 program with the goal of reducing smoking among recipients of
 16 19 medical assistance who are children to less than one percent
 16 20 and among recipients of medical assistance and expansion
 16 21 population members who are adults to less than ten percent, by
 16 22 July 1, 2007.
 16 23    7.  DENTAL HOME FOR CHILDREN.  By July 1, 2008, every
 16 24 recipient of medical assistance who is a child twelve years of
 16 25 age or younger shall have a designated dental home and shall
 16 26 be provided with the dental screenings and preventive care
 16 27 identified in the oral health standards under the early and
 16 28 periodic screening, diagnostic, and treatment program.
 16 29    8.  REPORTS.  The department shall report on a quarterly
 16 30 basis to the medical assistance projections and assessment
 16 31 council established pursuant to section 249J.19 and the
 16 32 council created pursuant to section 249A.4, subsection 8,
 16 33 regarding the health promotion partnerships described in this
 16 34 section.  To the greatest extent feasible, and if applicable
 16 35 to a data set, the date reported shall include demographic
 17  1 information concerning the population served including but not
 17  2 limited to factors, such as race and economic status, as
 17  3 specified by the department.
 17  4    Sec. 16.  NEW SECTION.  249J.14A  TASK FORCE ON INDIGENT
 17  5 CARE.
 17  6    1.  The department shall convene a task force on indigent
 17  7 care to identify any growth in uncompensated care due to the
 17  8 implementation of this chapter and to identify any local funds
 17  9 that are being used to pay for uncompensated care that could
 17 10 be maximized through a match with federal funds.
 17 11    2.  Any public, governmental or nongovernmental, private,
 17 12 for=profit, or not=for=profit health services provider or
 17 13 payor, whether or not enrolled in the medical assistance
 17 14 program, and any organization of such providers or payors, may
 17 15 become a member of the task force.  Membership on the task
 17 16 force shall require that an entity agree to provide accurate,
 17 17 written information and data relating to each of the following
 17 18 items for the fiscal year of the entity ending on or before
 17 19 June 30, 2005, and for each fiscal year thereafter during
 17 20 which the entity is a member:
 17 21    a.  The definition of indigent care used by the member for
 17 22 purposes of reporting the data described in this subsection.
 17 23    b.  The actual cost of indigent care as determined under
 17 24 Medicare principles of accounting or any accounting standard
 17 25 used by the member to report the member's financial status to
 17 26 its governing body, owner, members, creditors, or the public.
 17 27    c.  The usual and customary charge that would otherwise be
 17 28 applied by the member to the indigent care provided.
 17 29    d.  The number of individuals and the age, sex, and county
 17 30 of residence of the individuals receiving indigent care
 17 31 reported by the member and a description of the care provided.
 17 32    e.  To the extent practical, the health status of the
 17 33 individuals receiving the indigent care reported by the
 17 34 member.
 17 35    f.  The funding source of payment for the indigent care
 18  1 including revenue from property tax or other tax revenue,
 18  2 local funding, and other sources.
 18  3    g.  The extent to which any part of the cost of indigent
 18  4 care reported by the member was paid for by the individual on
 18  5 a sliding fee scale or other basis, by an insurer, or by
 18  6 another third=party payor.
 18  7    h.  The means by which the member covered any of the costs
 18  8 of indigent care not covered by those sources described in
 18  9 paragraph "g".
 18 10    3.  The department shall convene the task force for a
 18 11 minimum of eight meetings during the fiscal year beginning
 18 12 July 1, 2005, and during each fiscal year thereafter.  For the
 18 13 fiscal year beginning July 1, 2005, the department shall
 18 14 convene at least six of the required  meetings prior to March
 18 15 1, 2006.  The meetings shall be held in geographically
 18 16 balanced venues throughout the state that are representative
 18 17 of distinct rural, urban, and suburban areas.
 18 18    4.  The department shall provide the medical assistance
 18 19 projections and assessment council created pursuant to section
 18 20 249J.19 with all of the following, at intervals established by
 18 21 the council:
 18 22    a.  A  list of the members of the task force.
 18 23    b.  A copy of  each member's written submissions of data
 18 24 and information to the task force.
 18 25    c.  A copy of the data submitted by each member.
 18 26    d.  Any observations or recommendations of the task force
 18 27 regarding the data.
 18 28    e.  Any observations and recommendations of the department
 18 29 regarding the data.
 18 30    5.  The task force shall transmit an initial, preliminary
 18 31 report of its efforts and findings to the governor and the
 18 32 general assembly by March 1, 2006.  The task force shall
 18 33 submit an annual report to the governor and the general
 18 34 assembly by December 31 of each year.
 18 35    6.  The department shall, to the extent practical, assist
 19  1 task force members in assembling and reporting the data
 19  2 required of members, by programming the department's systems
 19  3 to accept, but not pay, claims reported on standard medical
 19  4 assistance claims forms for the indigent care provided by the
 19  5 members.
 19  6    7.  All meetings of the task force shall comply with
 19  7 chapter 21.
 19  8    8.  Information and data provided by a member to the task
 19  9 force shall be protected to the extent required under the
 19 10 federal Health Insurance Portability and Accountability Act of
 19 11 1996.
 19 12    9.  Costs associated with the work of the task force and
 19 13 with the required activities of members shall not be eligible
 19 14 for federal matching funds.
 19 15                           DIVISION V
 19 16                    IOWA MEDICAID ENTERPRISE
 19 17    Sec. 17.  NEW SECTION.  249J.15  COST AND QUALITY
 19 18 PERFORMANCE EVALUATION.
 19 19    Beginning July 1, 2005, the department shall contract with
 19 20 an independent consulting firm to do all of the following:
 19 21    1.  Annually evaluate and compare the cost and quality of
 19 22 care provided by the medical assistance program and through
 19 23 the expansion population with the cost and quality of care
 19 24 available through private insurance and managed care
 19 25 organizations doing business in the state.
 19 26    2.  Annually evaluate the improvements by the medical
 19 27 assistance program and the expansion population in the cost
 19 28 and quality of services provided to Iowans over the cost and
 19 29 quality of care provided in the prior year.
 19 30    Sec. 18.  NEW SECTION.  249J.16  OPERATIONS == PERFORMANCE
 19 31 EVALUATION.
 19 32    Beginning July 1, 2006, the department shall submit a
 19 33 report of the results of an evaluation of the performance of
 19 34 each component of the Iowa Medicaid enterprise using the
 19 35 performance standards contained in the contracts with the Iowa
 20  1 Medicaid enterprise partners.
 20  2    Sec. 19.  NEW SECTION.  249J.17  CLINICIANS ADVISORY PANEL
 20  3 == CLINICAL MANAGEMENT.
 20  4    1.  Beginning July 1, 2005, the medical director of the
 20  5 Iowa Medicaid enterprise, with the approval of the
 20  6 administrator of the division of medical services of the
 20  7 department, shall assemble and act as chairperson for a
 20  8 clinicians advisory panel to recommend to the department
 20  9 clinically appropriate health care utilization management and
 20 10 coverage decisions for the medical assistance program and the
 20 11 expansion population which are not otherwise addressed by the
 20 12 Iowa medical assistance drug utilization review commission
 20 13 created pursuant to section 249A.24 or the medical assistance
 20 14 pharmaceutical and therapeutics committee established pursuant
 20 15 to section 249A.20A.  The meetings shall be conducted in
 20 16 accordance with chapter 21 and shall be open to the public
 20 17 except to the extent necessary to prevent the disclosure of
 20 18 confidential medical information.
 20 19    2.  The medical director of the Iowa Medicaid enterprise
 20 20 shall report on a quarterly basis to the medical assistance
 20 21 projections and assessment council established pursuant to
 20 22 section 249J.19 and the council created pursuant to section
 20 23 249A.4, subsection 8, any recommendations made by the panel
 20 24 and adopted by rule of the department pursuant to chapter 17A
 20 25 regarding clinically appropriate health care utilization
 20 26 management and coverage under the medical assistance program
 20 27 and the expansion population.
 20 28    3.  The medical director of the Iowa Medicaid enterprise
 20 29 shall prepare an annual report summarizing the recommendations
 20 30 made by the panel and adopted by rule of the department
 20 31 regarding clinically appropriate health care utilization
 20 32 management and coverage under the medical assistance program
 20 33 and the expansion population.
 20 34    Sec. 20.  NEW SECTION.  249J.18  HEALTH CARE SERVICES
 20 35 PRICING AND REIMBURSEMENT OF PROVIDERS.
 21  1    The department shall annually collect data on third=party
 21  2 payor rates in the state and, as appropriate, the usual and
 21  3 customary charges of health care providers, including the
 21  4 reimbursement rates paid to providers and by third=party
 21  5 payors participating in the medical assistance program and
 21  6 through the expansion population.  The department shall
 21  7 consult with the division of insurance of the department of
 21  8 commerce in adopting administrative rules specifying the
 21  9 reporting format and guaranteeing the confidentiality of the
 21 10 information provided by the providers and third=party payors.
 21 11 The department shall review the data and make recommendations
 21 12 to the governor and the general assembly regarding pricing
 21 13 changes and reimbursement rates annually by January 1.  Any
 21 14 recommended pricing changes or changes in reimbursement rates
 21 15 shall not be implemented without express authorization by the
 21 16 general assembly.
 21 17                           DIVISION VI
 21 18                           GOVERNANCE
 21 19    Sec. 21.  NEW SECTION.  249J.19  MEDICAL ASSISTANCE
 21 20 PROJECTIONS AND ASSESSMENT COUNCIL.
 21 21    1.  A medical assistance projections and assessment council
 21 22 is created consisting of the following members:
 21 23    a.  The co=chairpersons and ranking members of the
 21 24 legislative joint appropriations subcommittee on health and
 21 25 human services, or a member of the appropriations subcommittee
 21 26 designated by the co=chairperson or ranking member.
 21 27    b.  The chairpersons and ranking members of the human
 21 28 resources committees of the senate and the house of
 21 29 representatives, or a member of the committee designated by
 21 30 the chairperson or ranking member.
 21 31    c.  The chairpersons and ranking members of the
 21 32 appropriations committees of the senate and the house of
 21 33 representatives, or a member of the committee designated by
 21 34 the chairperson or ranking member.
 21 35    2.  The council shall meet as often as deemed necessary,
 22  1 but shall meet at least quarterly.  The council may use
 22  2 sources of information deemed appropriate, and the department
 22  3 and other agencies of state government shall provide
 22  4 information to the council as requested.  The legislative
 22  5 services agency shall provide staff support to the council.
 22  6    3.  The council shall select a chairperson, annually, from
 22  7 its membership.  A majority of the members of the council
 22  8 shall constitute a quorum.
 22  9    4.  The council shall do all of the following:
 22 10    a.  Make quarterly cost projections for the medical
 22 11 assistance program and the expansion population.
 22 12    b.  Review quarterly reports on all initiatives under this
 22 13 chapter, including those provisions in the design,
 22 14 development, and implementation phases, and make additional
 22 15 recommendations for medical assistance program and expansion
 22 16 population reform on an annual basis.
 22 17    c.  Review annual audited financial statements relating to
 22 18 the expansion population submitted by the providers included
 22 19 in the expansion population provider network.
 22 20    d.  Review quarterly reports on the success of the Iowa
 22 21 Medicaid enterprise based upon the contractual performance
 22 22 measures for each Iowa Medicaid enterprise partner.
 22 23    e.  Assure that the expansion population is managed at all
 22 24 times within funding limitations.  In assuring such
 22 25 compliance, the council shall assume that supplemental funding
 22 26 will not be available for coverage of services provided to the
 22 27 expansion population.
 22 28    5.  The department of human services, the department of
 22 29 management, and the legislative services agency shall utilize
 22 30 a joint process to arrive at an annual consensus projection
 22 31 for medical assistance program and expansion population
 22 32 expenditures for submission to the council.  By December 15 of
 22 33 each fiscal year, the council shall agree to a projection of
 22 34 expenditures for the fiscal year beginning the following July
 22 35 1, based upon the consensus projection submitted.
 23  1                          DIVISION VII
 23  2        ENHANCING THE FEDERAL=STATE FINANCIAL PARTNERSHIP
 23  3    Sec. 22.  NEW SECTION.  249J.20  PAYMENTS TO HEALTH CARE
 23  4 PROVIDERS BASED ON ACTUAL COSTS.
 23  5    Payments, including graduate medical education payments,
 23  6 under the medical assistance program and the expansion
 23  7 population to each public hospital and each public nursing
 23  8 facility shall not exceed the actual medical assistance costs
 23  9 of each such facility reported on the Medicare hospital and
 23 10 hospital health care complex cost report submitted to the
 23 11 centers for Medicare and Medicaid services of the United
 23 12 States department of health and human services.  Each public
 23 13 hospital and each public nursing facility shall retain one
 23 14 hundred percent of the medical assistance payments earned
 23 15 under state reimbursement rules.  State reimbursement rules
 23 16 may provide for reimbursement at less than actual cost.
 23 17    Sec. 23.  NEW SECTION.  249J.21  INDEPENDENT ANNUAL AUDIT.
 23 18    The department shall contract with a certified public
 23 19 accountant to provide an analysis, on an annual basis, to the
 23 20 governor and the general assembly regarding compliance of the
 23 21 Iowa medical assistance program with each of the following:
 23 22    1.  That the state has not instituted any new provider
 23 23 taxes as defined by the centers for Medicare and Medicaid
 23 24 services of the United States department of health and human
 23 25 services.
 23 26    2.  That public hospitals and public nursing facilities are
 23 27 not paid more than the actual costs of care for medical
 23 28 assistance program and disproportionate share hospital program
 23 29 recipients based upon Medicare program principles of
 23 30 accounting and cost reporting.
 23 31    3.  That the state is not recycling federal funds provided
 23 32 under Title XIX of the Social Security Act as defined by the
 23 33 centers for Medicare and Medicaid services of the United
 23 34 States department of health and human services.
 23 35    Sec. 24.  NEW SECTION.  249J.22  ACCOUNT FOR HEALTH CARE
 24  1 TRANSFORMATION.
 24  2    1.  An account for health care transformation is created in
 24  3 the state treasury under the authority of the department.
 24  4 Moneys received through the physician payment adjustment as
 24  5 described in 2003 Iowa Acts, chapter 112, section 11,
 24  6 subsection 1, and through the adjustment to hospital payments
 24  7 to provide an increased base rate to offset the high costs
 24  8 incurred for providing services to medical assistance patients
 24  9 as described in 2004 Iowa Acts, chapter 1175, section 86,
 24 10 subsection 2, paragraph "b", shall be deposited in the
 24 11 account.  The account shall include a separate premiums
 24 12 subaccount.  Revenue generated through payment of premiums by
 24 13 expansion population members as required pursuant to section
 24 14 249J.8 shall be deposited in the separate premiums subaccount
 24 15 within the account.
 24 16    2.  Moneys in the account shall be separate from the
 24 17 general fund of the state and shall not be considered part of
 24 18 the general fund of the state.  The moneys deposited in the
 24 19 account are not subject to section 8.33 and shall not be
 24 20 transferred, used, obligated, appropriated, or otherwise
 24 21 encumbered, except to provide for the purposes specified in
 24 22 this section.  Notwithstanding section 12C.7, subsection 2,
 24 23 interest or earnings on moneys deposited in the account shall
 24 24 be credited to the account.
 24 25    3.  Moneys deposited in the account for health care
 24 26 transformation shall be used only as provided in
 24 27 appropriations from the account for the costs associated with
 24 28 certain services provided to the expansion population pursuant
 24 29 to section 249J.6, certain initiatives to be designed pursuant
 24 30 to section 249J.8, the case=mix adjusted reimbursement system
 24 31 for persons with mental retardation or developmental
 24 32 disabilities pursuant to section 249J.12, certain health
 24 33 promotion partnership activities pursuant to section 249J.14,
 24 34 the cost and quality performance evaluation pursuant to
 24 35 section 249J.15, auditing requirements pursuant to section
 25  1 249J.21, the provision of additional indigent patient care and
 25  2 treatment, and administrative costs associated with this
 25  3 chapter.
 25  4    Sec. 25.  NEW SECTION.  249J.23  IOWACARE ACCOUNT.
 25  5    1.  An Iowacare account is created in the state treasury
 25  6 under the authority of the department of human services.
 25  7 Moneys appropriated from the general fund of the state to the
 25  8 account, moneys received as federal financial participation
 25  9 funds under the expansion population provisions of this
 25 10 chapter and credited to the account, moneys received for
 25 11 disproportionate share hospitals and credited to the account,
 25 12 moneys received for graduate medical education and credited to
 25 13 the account, proceeds transferred from the county treasurer as
 25 14 specified in subsection 6, and moneys from any other source
 25 15 credited to the account shall be deposited in the account.
 25 16 Moneys deposited in or credited to the account shall be used
 25 17 only as provided in appropriations or distributions from the
 25 18 account for the purposes specified in the appropriation or
 25 19 distribution.  Moneys in the account shall be appropriated to
 25 20 the university of Iowa hospitals and clinics, to a publicly
 25 21 owned acute care teaching hospital located in a county with a
 25 22 population over three hundred fifty thousand, and to the state
 25 23 hospitals for persons with mental illness designated pursuant
 25 24 to section 226.1 for the purposes provided in the federal law
 25 25 making the funds available or as specified in the state
 25 26 appropriation and shall be distributed as determined by the
 25 27 department.
 25 28    2.  The account shall be separate from the general fund of
 25 29 the state and shall not be considered part of the general fund
 25 30 of the state.  The moneys in the account shall not be
 25 31 considered revenue of the state, but rather shall be funds of
 25 32 the account.  The moneys in the account are not subject to
 25 33 section 8.33 and shall not be transferred, used, obligated,
 25 34 appropriated, or otherwise encumbered, except to provide for
 25 35 the purposes of this chapter.  Notwithstanding section 12C.7,
 26  1 subsection 2, interest or earnings on moneys deposited in the
 26  2 account shall be credited to the account.
 26  3    3.  The department shall adopt rules pursuant to chapter
 26  4 17A to administer the account.
 26  5    4.  The treasurer of state shall provide a quarterly report
 26  6 of activities and balances of the account to the director.
 26  7    5.  Notwithstanding section 262.28, payments to be made to
 26  8 participating public hospitals under this section shall be
 26  9 made on a prospective basis in twelve equal monthly
 26 10 installments.  After the close of the fiscal year, the
 26 11 department shall determine the amount of the payments
 26 12 attributable to the state general fund, federal financial
 26 13 participation funds collected for expansion population
 26 14 services, graduate medical education funds, and
 26 15 disproportionate share hospital funds, based on claims data
 26 16 and actual expenditures.
 26 17    6.  Notwithstanding any provision to the contrary, from
 26 18 each semiannual collection of taxes levied under section 347.7
 26 19 for which the collection is performed after July 1, 2005, the
 26 20 county treasurer of a county with a population over three
 26 21 hundred fifty thousand in which a publicly owned acute care
 26 22 teaching hospital is located shall transfer the proceeds
 26 23 collected pursuant to section 347.7 in a total amount of
 26 24 thirty=four million dollars annually, which would otherwise be
 26 25 distributed to the county hospital, to the treasurer of state
 26 26 for deposit in the Iowacare account under this section.  The
 26 27 board of trustees of the acute care teaching hospital
 26 28 identified in this subsection and the department shall execute
 26 29 an agreement under chapter 28E by July 1, 2005, and annually
 26 30 by July 1, thereafter, to specify the requirements relative to
 26 31 transfer of the proceeds and the distribution of moneys to the
 26 32 hospital from the Iowacare account.  The agreement may also
 26 33 include a provision allowing such hospital to limit access to
 26 34 such hospital by expansion population members based on
 26 35 residency of the member, if such provision reflects the policy
 27  1 of such hospital regarding indigent patients existing on April
 27  2 1, 2005, as adopted by its board of hospital trustees pursuant
 27  3 to section 347.14, subsection 4.
 27  4    7.  The state board of regents, on behalf of the university
 27  5 of Iowa hospitals and clinics, and the department shall
 27  6 execute an agreement under chapter 28E by July 1, 2005, and
 27  7 annually by July 1, thereafter, to specify the requirements
 27  8 relating to distribution of moneys to the hospital from the
 27  9 Iowacare account.
 27 10    8.  The state and any county utilizing the acute care
 27 11 teaching hospital located in a county with a population over
 27 12 three hundred fifty thousand for mental health services prior
 27 13 to July 1, 2005, shall annually enter into an agreement with
 27 14 such hospital to pay a per diem amount that is not less than
 27 15 the per diem amount paid for those mental health services in
 27 16 effect for the fiscal year beginning July 1, 2004, for each
 27 17 individual including each expansion population member
 27 18 accessing mental health services at that hospital on or after
 27 19 July 1, 2005.  Any payment made under such agreement for an
 27 20 expansion population member pursuant to this chapter, shall be
 27 21 considered by the department to be payment by a third=party
 27 22 payor.
 27 23                          DIVISION VIII
 27 24                           LIMITATIONS
 27 25    Sec. 26.  NEW SECTION.  249J.24  LIMITATIONS.
 27 26    1.  The provisions of this chapter shall not be construed,
 27 27 are not intended as, and shall not imply a grant of
 27 28 entitlement for services to individuals who are eligible for
 27 29 assistance under this chapter or for utilization of services
 27 30 that do not exist or are not otherwise available on the
 27 31 effective date of this Act.  Any state obligation to provide
 27 32 services pursuant to this chapter is limited to the extent of
 27 33 the funds appropriated or distributed for the purposes of this
 27 34 chapter.
 27 35    2.  The provisions of this chapter shall not be construed
 28  1 and are not intended to affect the provision of services to
 28  2 recipients of medical assistance existing on the effective
 28  3 date of this Act.
 28  4    Sec. 27.  NEW SECTION.  249J.25  AUDIT == FUTURE REPEAL.
 28  5    1.  The state auditor shall complete an audit of the
 28  6 provisions implemented pursuant to this chapter during the
 28  7 fiscal year beginning July 1, 2009, and shall submit the
 28  8 results of the audit to the governor and the general assembly
 28  9 by January 1, 2010.
 28 10    2.  This chapter is repealed June 30, 2010.
 28 11    Sec. 28.  IMPLEMENTATION COSTS.  Payment of any one=time
 28 12 costs specifically associated with the implementation of
 28 13 chapter 249J, as enacted in this Act, shall be made in the
 28 14 manner specified by, and at the discretion of, the department.
 28 15                           DIVISION IX
 28 16                    CORRESPONDING PROVISIONS
 28 17    Sec. 29.  Section 97B.52A, subsection 1, paragraph c, Code
 28 18 2005, is amended to read as follows:
 28 19    c.  For a member whose first month of entitlement is July
 28 20 2000 or later, the member does not return to any employment
 28 21 with a covered employer until the member has qualified for at
 28 22 least one calendar month of retirement benefits, and the
 28 23 member does not return to covered employment until the member
 28 24 has qualified for no fewer than four calendar months of
 28 25 retirement benefits.  For purposes of this paragraph,
 28 26 effective July 1, 2000, any employment with a covered employer
 28 27 does not include employment as an elective official or member
 28 28 of the general assembly if the member is not covered under
 28 29 this chapter for that employment.  For purposes of determining
 28 30 a bona fide retirement under this paragraph and for a member
 28 31 whose first month of entitlement is July 2004 or later, but
 28 32 before July 2006, covered employment does not include
 28 33 employment as a licensed health care professional by a public
 28 34 hospital as defined in section 249I.3 249J.3, with the
 28 35 exception of public hospitals governed pursuant to chapter
 29  1 226.
 29  2    Sec. 30.  Section 218.78, subsection 1, Code 2005, is
 29  3 amended to read as follows:
 29  4    1.  All institutional receipts of the department of human
 29  5 services, including funds received from client participation
 29  6 at the state resource centers under section 222.78 and at the
 29  7 state mental health institutes under section 230.20, shall be
 29  8 deposited in the general fund except for reimbursements for
 29  9 services provided to another institution or state agency, for
 29 10 receipts deposited in the revolving farm fund under section
 29 11 904.706, for deposits into the medical assistance fund under
 29 12 section 249A.11, for any deposits into the medical assistance
 29 13 fund of any medical assistance payments received through the
 29 14 expansion population program pursuant to chapter 249J, and
 29 15 rentals charged to employees or others for room, apartment, or
 29 16 house and meals, which shall be available to the institutions.
 29 17    Sec. 31.  Section 230.20, subsection 2, paragraph a, Code
 29 18 2005, is amended to read as follows:
 29 19    a.  The superintendent shall certify to the department the
 29 20 billings to each county for services provided to patients
 29 21 chargeable to the county during the preceding calendar
 29 22 quarter.  The county billings shall be based on the average
 29 23 daily patient charge and other service charges computed
 29 24 pursuant to subsection 1, and the number of inpatient days and
 29 25 other service units chargeable to the county.  However, a
 29 26 county billing shall be decreased by an amount equal to
 29 27 reimbursement by a third party payor or estimation of such
 29 28 reimbursement from a claim submitted by the superintendent to
 29 29 the third party payor for the preceding calendar quarter.
 29 30 When the actual third party payor reimbursement is greater or
 29 31 less than estimated, the difference shall be reflected in the
 29 32 county billing in the calendar quarter the actual third party
 29 33 payor reimbursement is determined.  For the purposes of this
 29 34 paragraph, "third=party payor reimbursement" does not include
 29 35 reimbursement provided under chapter 249J.
 30  1    Sec. 32.  Section 230.20, subsections 5 and 6, Code 2005,
 30  2 are amended to read as follows:
 30  3    5.  An individual statement shall be prepared for a patient
 30  4 on or before the fifteenth day of the month following the
 30  5 month in which the patient leaves the mental health institute,
 30  6 and a general statement shall be prepared at least quarterly
 30  7 for each county to which charges are made under this section.
 30  8 Except as otherwise required by sections 125.33 and 125.34 the
 30  9 general statement shall list the name of each patient
 30 10 chargeable to that county who was served by the mental health
 30 11 institute during the preceding month or calendar quarter, the
 30 12 amount due on account of each patient, and the specific dates
 30 13 for which any third party payor reimbursement received by the
 30 14 state is applied to the statement and billing, and the county
 30 15 shall be billed for eighty percent of the stated charge for
 30 16 each patient specified in this subsection.  For the purposes
 30 17 of this subsection, "third=party payor reimbursement" does not
 30 18 include reimbursement provided under chapter 249J.  The
 30 19 statement prepared for each county shall be certified by the
 30 20 department and a duplicate statement shall be mailed to the
 30 21 auditor of that county.
 30 22    6.  All or any reasonable portion of the charges incurred
 30 23 for services provided to a patient, to the most recent date
 30 24 for which the charges have been computed, may be paid at any
 30 25 time by the patient or by any other person on the patient's
 30 26 behalf.  Any payment so made by the patient or other person,
 30 27 and any federal financial assistance received pursuant to
 30 28 Title XVIII or XIX of the federal Social Security Act for
 30 29 services rendered to a patient, shall be credited against the
 30 30 patient's account and, if the charges so paid as described in
 30 31 this subsection have previously been billed to a county,
 30 32 reflected in the mental health institute's next general
 30 33 statement to that county.  However, any payment made under
 30 34 chapter 249J shall not be reflected in the mental health
 30 35 institute's next general statement to that county.
 31  1    Sec. 33.  Section 249A.11, Code 2005, is amended to read as
 31  2 follows:
 31  3    249A.11  PAYMENT FOR PATIENT CARE SEGREGATED.
 31  4    A state resource center or mental health institute, upon
 31  5 receipt of any payment made under this chapter for the care of
 31  6 any patient, shall segregate an amount equal to that portion
 31  7 of the payment which is required by law to be made from
 31  8 nonfederal funds except for any nonfederal funds received
 31  9 through the expansion population program pursuant to chapter
 31 10 249J which shall be deposited in the Iowacare account created
 31 11 pursuant to section 249J.23.  The money segregated shall be
 31 12 deposited in the medical assistance fund of the department of
 31 13 human services.
 31 14    Sec. 34.  Section 249H.4, Code 2005, is amended by adding
 31 15 the following new subsection:
 31 16    NEW SUBSECTION.  7.  The director shall amend the medical
 31 17 assistance state plan to eliminate the mechanism to secure
 31 18 funds based on skilled nursing facility prospective payment
 31 19 methodologies under the medical assistance program and to
 31 20 terminate agreements entered into with public nursing
 31 21 facilities under this chapter, effective June 30, 2005.
 31 22    Sec. 35.  2004 Iowa Acts, chapter 1175, section 86,
 31 23 subsection 2, paragraph b, unnumbered paragraph 2, and
 31 24 subparagraphs (1), (2), and (3), are amended to read as
 31 25 follows:
 31 26    Of the amount appropriated in this lettered paragraph,
 31 27 $25,950,166 shall be considered encumbered and shall not be
 31 28 expended for any purpose until January 1, 2005.
 31 29    (1)  However, if If the department of human services
 31 30 adjusts hospital payments to provide an increased base rate to
 31 31 offset the high cost incurred for providing services to
 31 32 medical assistance patients on or prior to January July 1,
 31 33 2005, a portion of the amount specified in this unnumbered
 31 34 paragraph equal to the increased Medicaid payment shall revert
 31 35 to the general fund of the state.  Notwithstanding section
 32  1 8.54, subsection 7, the amount required to revert under this
 32  2 subparagraph shall not be considered to be appropriated for
 32  3 purposes of the state general fund expenditure limitation for
 32  4 the fiscal year beginning July 1, 2004.
 32  5    (2)  If the adjustment described in subparagraph (1) to
 32  6 increase the base rate is not made prior to January 1, 2005,
 32  7 the amount specified in this unnumbered paragraph shall no
 32  8 longer be considered encumbered, may be expended, and shall be
 32  9 available for the purposes originally specified be transferred
 32 10 by the university of Iowa hospitals and clinics to the medical
 32 11 assistance fund of the department of human services.  Of the
 32 12 amount transferred, an amount equal to the federal share of
 32 13 the payments shall be transferred to the account for health
 32 14 care transformation created in section 249J.22.
 32 15    (3)  (2)  Any incremental increase in the base rate made
 32 16 pursuant to subparagraph (1) shall not be used in determining
 32 17 the university of Iowa hospital and clinics disproportionate
 32 18 share rate or when determining the statewide average base rate
 32 19 for purposes of calculating indirect medical education rates.
 32 20    Sec. 36.  2003 Iowa Acts, chapter 112, section 11,
 32 21 subsection 1, is amended to read as follows:
 32 22    1.  For the fiscal year years beginning July 1, 2003, and
 32 23 ending June 30, 2004, and beginning July 1, 2004, and for each
 32 24 fiscal year thereafter ending June 30, 2005, the department of
 32 25 human services shall institute a supplemental payment
 32 26 adjustment applicable to physician services provided to
 32 27 medical assistance recipients at publicly owned acute care
 32 28 teaching hospitals.  The adjustment shall generate
 32 29 supplemental payments to physicians which are equal to the
 32 30 difference between the physician's charge and the physician's
 32 31 fee schedule under the medical assistance program.  To the
 32 32 extent of the supplemental payments, a qualifying hospital
 32 33 shall, after receipt of the payments, transfer to the
 32 34 department of human services an amount equal to the actual
 32 35 supplemental payments that were made in that month.  The
 33  1 department of human services shall deposit these payments in
 33  2 the department's medical assistance account.  The department
 33  3 of human services shall amend the medical assistance state
 33  4 plan as necessary to implement this section.  The department
 33  5 may adopt emergency rules to implement this section.  The
 33  6 department of human services shall amend the medical
 33  7 assistance state plan to eliminate this provision effective
 33  8 June 30, 2005.
 33  9    Sec. 37.  TRANSITION FROM INSTITUTIONAL SETTINGS TO HOME
 33 10 AND COMMUNITY=BASED SERVICES.  The department, in consultation
 33 11 with provider and consumer organizations, shall explore
 33 12 additional opportunities under the medical assistance program
 33 13 to assist individuals in transitioning from institutional
 33 14 settings to home and community=based services.  The department
 33 15 shall report any opportunities identified to the governor and
 33 16 the general assembly by December 31, 2005.
 33 17    Sec. 38.  CORRESPONDING DIRECTIVES TO DEPARTMENT.  The
 33 18 department shall do all of the following:
 33 19    1.  Withdraw the request for the waiver and the medical
 33 20 assistance state plan amendment submitted to the centers for
 33 21 Medicare and Medicaid services of the United States department
 33 22 of health and human services regarding the nursing facility
 33 23 quality assurance assessment as directed pursuant to 2003 Iowa
 33 24 Acts, chapter 112, section 4, 2003 Iowa Acts, chapter 179,
 33 25 section 162, and 2004 Iowa Acts, chapter 1085, sections 8, 10,
 33 26 and 11.
 33 27    2.  Amend the medical assistance state plan to eliminate
 33 28 the mechanism to secure funds based on hospital inpatient and
 33 29 outpatient prospective payment methodologies under the medical
 33 30 assistance program, effective June 30, 2005.
 33 31    3.  Amend the medical assistance state plan to eliminate
 33 32 the mechanisms to receive supplemental disproportionate share
 33 33 hospital and graduate medical education funds as originally
 33 34 submitted, effective June 30, 2005.
 33 35    4.  Amend the medical assistance state plan amendment to
 34  1 adjust hospital payments to provide an increased base rate to
 34  2 offset the high cost incurred for providing services to
 34  3 medical assistance patients at the university of Iowa
 34  4 hospitals and clinics as originally submitted based upon the
 34  5 specifications of 2004 Iowa Acts, chapter 1175, section 86,
 34  6 subsection 2, paragraph "b", unnumbered paragraph 2, and
 34  7 subparagraphs (1),(2), and (3), to be approved for the fiscal
 34  8 year beginning July 1 2004, and ending June 30, 2005, only,
 34  9 and to be eliminated June 30, 2005.
 34 10    5.  Amend the medical assistance state plan amendment to
 34 11 establish a physician payment adjustment from the university
 34 12 of Iowa hospitals and clinics, as originally submitted as
 34 13 described in 2003 Iowa Acts, chapter 112, section 11,
 34 14 subsection 1, to be approved for the state fiscal years
 34 15 beginning July 1, 2003, and ending June 30, 2004, and
 34 16 beginning July 1, 2004, and ending June 30, 2005, and to be
 34 17 eliminated effective June 30, 2005.
 34 18    6.  Amend the medical assistance state plan to eliminate
 34 19 the mechanism to secure funds based on skilled nursing
 34 20 facility prospective payment methodologies under the medical
 34 21 assistance program, effective June 30, 2005.
 34 22    7.  Request a waiver from the centers for Medicare and
 34 23 Medicaid services of the United States department of health
 34 24 and human services of the provisions relating to the early and
 34 25 periodic screening, diagnostic, and treatment program
 34 26 requirements as described in section 1905(a)(5) of the federal
 34 27 Social Security Act relative to the expansion population.
 34 28    Sec. 39.  Chapter 249I, Code 2005, is repealed.
 34 29    Sec. 40.  Sections 249A.20B and 249A.34, Code 2005, are
 34 30 repealed.
 34 31    Sec. 41.  2003 Iowa Acts, chapter 112, section 4, 2003 Iowa
 34 32 Acts, chapter 179, section 162, and 2004 Iowa Acts, chapter
 34 33 1085, section 8, and section 10, subsection 5, are repealed.
 34 34                           DIVISION X
 34 35                       PHARMACY COPAYMENTS
 35  1    Sec. 42.  COPAYMENTS FOR PRESCRIPTION DRUGS UNDER THE
 35  2 MEDICAL ASSISTANCE PROGRAM.  The department of human services
 35  3 shall require recipients of medical assistance to pay the
 35  4 following copayments on each prescription filled for a covered
 35  5 prescription drug, including each refill of such prescription,
 35  6 as follows:
 35  7    1.  A copayment of $1 for each covered nonpreferred generic
 35  8 prescription drug.
 35  9    2.  A copayment of $1 for each covered preferred brand=
 35 10 name or generic prescription drug.
 35 11    3.  A copayment of $1 for each covered nonpreferred brand=
 35 12 name prescription drug for which the cost to the state is up
 35 13 to and including $25.
 35 14    4.  A copayment of $2 for each covered nonpreferred brand=
 35 15 name prescription drug for which the cost to the state is more
 35 16 than $25 and up to and including $50.
 35 17    5.  A copayment of $3 for each covered nonpreferred brand=
 35 18 name prescription drug for which the cost to the state is more
 35 19 than $50.
 35 20                           DIVISION XI
 35 21       MEDICAL AND SURGICAL TREATMENT OF INDIGENT PERSONS
 35 22        AND OBSTETRICAL AND NEWBORN INDIGENT PATIENT CARE
 35 23    Sec. 43.  NEW SECTION.  135.152  STATEWIDE OBSTETRICAL AND
 35 24 NEWBORN INDIGENT PATIENT CARE PROGRAM.
 35 25    1.  The department shall establish a statewide obstetrical
 35 26 and newborn indigent patient care program to provide
 35 27 obstetrical and newborn care to medically indigent residents
 35 28 of this state at the appropriate and necessary level, at a
 35 29 licensed hospital or health care facility closest and most
 35 30 available to the residence of the indigent individual.
 35 31    2.  The department shall administer the program, and
 35 32 appropriations by the general assembly for the program shall
 35 33 be allocated to the obstetrical and newborn patient care fund
 35 34 within the department to be utilized for the obstetrical and
 35 35 newborn indigent patient care program.
 36  1    3.  The department shall adopt administrative rules
 36  2 pursuant to chapter 17A to administer the program.
 36  3    4.  The department shall establish a patient quota formula
 36  4 for determining the maximum number of obstetrical and newborn
 36  5 patients eligible for the program, annually, from each county.
 36  6 The formula used shall be based upon the annual appropriation
 36  7 for the program, the average number of live births in each
 36  8 county for the most recent three=year period, and the per
 36  9 capita income for each county for the most recent year.  The
 36 10 formula shall also provide for reassignment of an unused
 36 11 county quota allotment on April 1 of each year.
 36 12    5.  a.  The department, in collaboration with the
 36 13 department of human services and the Iowa state association of
 36 14 counties, shall adopt rules pursuant to chapter 17A to
 36 15 establish minimum standards for eligibility for obstetrical
 36 16 and newborn care, including physician examinations, medical
 36 17 testing, ambulance services, and inpatient transportation
 36 18 services under the program.  The minimum standards shall
 36 19 provide that the individual is not otherwise eligible for
 36 20 assistance under the medical assistance program or for
 36 21 assistance under the medically needy program without a spend=
 36 22 down requirement pursuant to chapter 249A, or for expansion
 36 23 population benefits pursuant to chapter 249J.  If the
 36 24 individual is eligible for assistance pursuant to chapter 249A
 36 25 or 249J, or if the individual is eligible for maternal and
 36 26 child health care services covered by a maternal and child
 36 27 health program, the obstetrical and newborn indigent patient
 36 28 care program shall not provide the assistance, care, or
 36 29 covered services provided under the other program.
 36 30    b.  The minimum standards for eligibility shall provide
 36 31 eligibility for persons with family incomes at or below one
 36 32 hundred eighty=five percent of the federal poverty level as
 36 33 defined by the most recently revised poverty income guidelines
 36 34 published by the United States department of health and human
 36 35 services, and shall provide, but shall not be limited to
 37  1 providing, eligibility for uninsured and underinsured persons
 37  2 financially unable to pay for necessary obstetrical and
 37  3 newborn care.  The minimum standards may include a spend=down
 37  4 provision.  The resource standards shall be set at or above
 37  5 the resource standards under the federal supplemental security
 37  6 income program.  The resource exclusions allowed under the
 37  7 federal supplemental security income program shall be allowed
 37  8 and shall include resources necessary for self=employment.
 37  9    c.  The department in cooperation with the department of
 37 10 human services, shall develop a standardized application form
 37 11 for the program and shall coordinate the determination of
 37 12 eligibility for the medical assistance and medically needy
 37 13 programs under chapter 249A, the medical assistance expansion
 37 14 under chapter 249J, and the obstetrical and newborn indigent
 37 15 patient care program.
 37 16    6.  The department shall establish application procedures
 37 17 and procedures for certification of an individual for
 37 18 obstetrical and newborn care under this section.
 37 19    7.  An individual certified for obstetrical and newborn
 37 20 care under this division may choose to receive the appropriate
 37 21 level of care at any licensed hospital or health care
 37 22 facility.
 37 23    8.  The obstetrical and newborn care costs of an individual
 37 24 certified for such care under this division at a licensed
 37 25 hospital or health care facility or from licensed physicians
 37 26 shall be paid by the department from the obstetrical and
 37 27 newborn patient care fund.
 37 28    9.  All providers of services to obstetrical and newborn
 37 29 patients under this division shall agree to accept as full
 37 30 payment the reimbursements allowable under the medical
 37 31 assistance program established pursuant to chapter 249A,
 37 32 adjusted for intensity of care.
 37 33    10.  The department shall establish procedures for payment
 37 34 for providers of services to obstetrical and newborn patients
 37 35 under this division from the obstetrical and newborn patient
 38  1 care fund.  All billings from such providers shall be
 38  2 submitted directly to the department.  However, payment shall
 38  3 not be made unless the requirements for application and
 38  4 certification for care pursuant to this division and rules
 38  5 adopted by the department are met.
 38  6    11.  Moneys encumbered prior to June 30 of a fiscal year
 38  7 for a certified eligible pregnant woman scheduled to deliver
 38  8 in the next fiscal year shall not revert from the obstetrical
 38  9 and newborn patient care fund to the general fund of the
 38 10 state.  Moneys allocated to the obstetrical and newborn
 38 11 patient care fund shall not be transferred nor voluntarily
 38 12 reverted from the fund within a given fiscal year.
 38 13    Sec. 44.  Section 135B.31, Code 2005, is amended to read as
 38 14 follows:
 38 15    135B.31  EXCEPTIONS.
 38 16    Nothing in this This division is not intended or should and
 38 17 shall not affect in any way that the obligation of public
 38 18 hospitals under chapter 347 or municipal hospitals, as well as
 38 19 the state hospital at Iowa City, to provide medical or
 38 20 obstetrical and newborn care for indigent persons under
 38 21 chapter 255 or 255A, wherein medical care or treatment is
 38 22 provided by hospitals of that category to patients of certain
 38 23 entitlement, nor to the operation by the state of mental or
 38 24 other hospitals authorized by law.  Nothing herein This
 38 25 division shall not in any way affect or limit the practice of
 38 26 dentistry or the practice of oral surgery by a dentist.
 38 27    Sec. 45.  Section 144.13A, subsection 3, Code 2005, is
 38 28 amended to read as follows:
 38 29    3.  If the person responsible for the filing of the
 38 30 certificate of birth under section 144.13 is not the parent,
 38 31 the person is entitled to collect the fee from the parent.
 38 32 The fee shall be remitted to the state registrar.  If the
 38 33 expenses of the birth are reimbursed under the medical
 38 34 assistance program established by chapter 249A, or paid for
 38 35 under the statewide indigent patient care program established
 39  1 by chapter 255, or paid for under the obstetrical and newborn
 39  2 indigent patient care program established by chapter 255A, or
 39  3 if the parent is indigent and unable to pay the expenses of
 39  4 the birth and no other means of payment is available to the
 39  5 parent, the registration fee and certified copy fee are
 39  6 waived.  If the person responsible for the filing of the
 39  7 certificate is not the parent, the person is discharged from
 39  8 the duty to collect and remit the fee under this section if
 39  9 the person has made a good faith effort to collect the fee
 39 10 from the parent.
 39 11    Sec. 46.  Section 249A.4, subsection 12, Code 2005, is
 39 12 amended by striking the subsection.
 39 13            UNIVERSITY OF IOWA HOSPITALS AND CLINICS
 39 14    Sec. 47.  NEW SECTION.  263.18  TREATMENT OF PATIENTS ==
 39 15 USE OF EARNINGS FOR NEW FACILITIES.
 39 16    1.  The university of Iowa hospitals and clinics
 39 17 authorities may at their discretion receive patients into the
 39 18 hospital for medical, obstetrical, or surgical treatment or
 39 19 hospital care.  The university of Iowa hospitals and clinics
 39 20 ambulances and ambulance personnel may be used for the
 39 21 transportation of such patients at a reasonable charge if
 39 22 specialized equipment is required.
 39 23    2.  The university of Iowa hospitals and clinics
 39 24 authorities shall collect from the person or persons liable
 39 25 for support of such patients reasonable charges for hospital
 39 26 care and service and deposit payment of the charges with the
 39 27 treasurer of the university for the use and benefit of the
 39 28 university of Iowa hospitals and clinics.
 39 29    3.  Earnings of the university of Iowa hospitals and
 39 30 clinics shall be administered so as to increase, to the
 39 31 greatest extent possible, the services available for patients,
 39 32 including acquisition, construction, reconstruction,
 39 33 completion, equipment, improvement, repair, and remodeling of
 39 34 medical buildings and facilities, additions to medical
 39 35 buildings and facilities, and the payment of principal and
 40  1 interest on bonds issued to finance the cost of medical
 40  2 buildings and facilities as authorized by the provisions of
 40  3 chapter 263A.
 40  4    4.  The physicians and surgeons on the staff of the
 40  5 university of Iowa hospitals and clinics who care for patients
 40  6 provided for in this section may charge for the medical
 40  7 services provided under such rules, regulations, and plans
 40  8 approved by the state board of regents.  However, a physician
 40  9 or surgeon who provides treatment or care for an expansion
 40 10 population member pursuant to chapter 249J shall not charge or
 40 11 receive any compensation for the treatment or care except the
 40 12 salary or compensation fixed by the state board of regents to
 40 13 be paid from the hospital fund.
 40 14    Sec. 48.  NEW SECTION.  263.19  PURCHASES.
 40 15    Any purchase in excess of ten thousand dollars, of
 40 16 materials, appliances, instruments, or supplies by the
 40 17 university of Iowa hospitals and clinics, when the price of
 40 18 the materials, appliances, instruments, or supplies to be
 40 19 purchased is subject to competition, shall be made pursuant to
 40 20 open competitive quotations, and all contracts for such
 40 21 purchases shall be subject to chapter 72.  However, purchases
 40 22 may be made through a hospital group purchasing organization
 40 23 provided that the university of Iowa hospitals and clinics is
 40 24 a member of the organization.
 40 25    Sec. 49.  NEW SECTION.  263.20  COLLECTING AND SETTLING
 40 26 CLAIMS FOR CARE.
 40 27    Whenever a patient or person legally liable for the
 40 28 patient's care at the university of Iowa hospitals and clinics
 40 29 has insurance, an estate, a right of action against others, or
 40 30 other assets, the university of Iowa hospitals and clinics,
 40 31 through the facilities of the office of the attorney general,
 40 32 may file claims, institute or defend suit in court, and use
 40 33 other legal means available to collect accounts incurred for
 40 34 the care of the patient, and may compromise, settle, or
 40 35 release such actions under the rules and procedures prescribed
 41  1 by the president of the university and the office of the
 41  2 attorney general.  If a county has paid any part of such
 41  3 patient's care, a pro rata amount collected, after deduction
 41  4 for cost of collection, shall be remitted to the county and
 41  5 the balance shall be credited to the hospital fund.
 41  6    Sec. 50.  NEW SECTION.  263.21  TRANSFER OF PATIENTS FROM
 41  7 STATE INSTITUTIONS.
 41  8    The director of the department of human services, in
 41  9 respect to institutions under the director's control, the
 41 10 administrator of any of the divisions of the department, in
 41 11 respect to the institutions under the administrator's control,
 41 12 the director of the department of corrections, in respect to
 41 13 the institutions under the department's control, and the state
 41 14 board of regents, in respect to the Iowa braille and sight
 41 15 saving school and the Iowa school for the deaf, may send any
 41 16 inmate, student, or patient of an institution, or any person
 41 17 committed or applying for admission to an institution, to the
 41 18 university of Iowa hospitals and clinics for treatment and
 41 19 care.  The department of human services, the department of
 41 20 corrections, and the state board of regents shall respectively
 41 21 pay the traveling expenses of such patient, and when necessary
 41 22 the traveling expenses of an attendant for the patient, out of
 41 23 funds appropriated for the use of the institution from which
 41 24 the patient is sent.
 41 25    Sec. 51.  NEW SECTION.  263.22  MEDICAL CARE FOR PAROLEES
 41 26 AND PERSONS ON WORK RELEASE.
 41 27    The director of the department of corrections may send
 41 28 former inmates of the institutions provided for in section
 41 29 904.102, while on parole or work release, to the university of
 41 30 Iowa hospitals and clinics for treatment and care.  The
 41 31 director may pay the traveling expenses of any such patient,
 41 32 and when necessary the traveling expenses of an attendant of
 41 33 the patient, out of funds appropriated for the use of the
 41 34 department of corrections.
 41 35    Sec. 52.  Section 271.6, Code 2005, is amended to read as
 42  1 follows:
 42  2    271.6  INTEGRATED TREATMENT OF UNIVERSITY HOSPITAL
 42  3 PATIENTS.
 42  4    The authorities of the Oakdale campus may authorize
 42  5 patients for admission to the hospital on the Oakdale campus
 42  6 who are referred from the university hospitals and who shall
 42  7 retain the same status, classification, and authorization for
 42  8 care which they had at the university hospitals.  Patients
 42  9 referred from the university hospitals to the Oakdale campus
 42 10 shall be deemed to be patients of the university hospitals.
 42 11 Chapters 255 and 255A and the The operating policies of the
 42 12 university hospitals shall apply to the patients and to the
 42 13 payment for their care the same as the provisions apply to
 42 14 patients who are treated on the premises of the university
 42 15 hospitals.
 42 16    Sec. 53.  Section 331.381, subsection 9, Code 2005, is
 42 17 amended by striking the subsection.
 42 18    Sec. 54.  Section 331.502, subsection 17, Code 2005, is
 42 19 amended by striking the subsection.
 42 20    Sec. 55.  Section 331.552, subsection 13, Code 2005, is
 42 21 amended to read as follows:
 42 22    13.  Make transfer payments to the state for school
 42 23 expenses for blind and deaf children, and support of persons
 42 24 with mental illness, and hospital care for the indigent as
 42 25 provided in sections 230.21, 255.26, 269.2, and 270.7.
 42 26    Sec. 56.  Section 331.653, subsection 26, Code 2005, is
 42 27 amended by striking the subsection.
 42 28    Sec. 57.  Section 331.756, subsection 53, Code 2005, is
 42 29 amended by striking the subsection.
 42 30    Sec. 58.  Section 602.8102, subsection 48, Code 2005, is
 42 31 amended by striking the subsection.
 42 32    Sec. 59.  Chapters 255 and 255A, Code 2005, are repealed.
 42 33    Sec. 60.  OBLIGATIONS TO INDIGENT PATIENTS.  The provisions
 42 34 of this Act shall not be construed and are not intended to
 42 35 change, reduce, or affect the obligation of the university of
 43  1 Iowa hospitals and clinics existing on April 1, 2005, to
 43  2 provide care or treatment at the university of Iowa hospitals
 43  3 and clinics to indigent patients and to any inmate, student,
 43  4 patient, or former inmate of a state institution as specified
 43  5 in sections 263.21 and 263.22 as enacted in this Act, with the
 43  6 exception of the specific obligation to committed indigent
 43  7 patients as specified pursuant to section 255.16, Code 2005,
 43  8 repealed in this Act.
 43  9    Sec. 61.  INMATES, STUDENTS, PATIENTS, AND FORMER INMATES
 43 10 OF STATE INSTITUTIONS == REVIEW.
 43 11    1.  The director of human services shall convene a
 43 12 workgroup comprised of the director, the director of the
 43 13 department of corrections, the president of the state board of
 43 14 regents, and a representative of the university of Iowa
 43 15 hospitals and clinics to review the provision of treatment and
 43 16 care to the inmates, students, patients, and former inmates
 43 17 specified in sections 263.21 and 263.22, as enacted in this
 43 18 Act.  The review shall determine all of the following:
 43 19    a.  The actual cost to the university of Iowa hospitals and
 43 20 clinics to provide care and treatment to the inmates,
 43 21 students, patients, and former inmates on an annual basis.
 43 22 The actual cost shall be determined utilizing Medicare cost
 43 23 accounting principles.
 43 24    b.  The number of inmates, students, patients, and former
 43 25 inmates provided treatment at the university of Iowa hospitals
 43 26 and clinics, annually.
 43 27    c.  The specific types of treatment and care provided to
 43 28 the inmates, students, patients, and former inmates.
 43 29    d.  The existing sources of revenue that may be available
 43 30 to pay for the costs of providing care and treatment to the
 43 31 inmates, students, patients, and former inmates.
 43 32    e.  The cost to the department of human services, the Iowa
 43 33 department of corrections, and the state board of regents to
 43 34 provide transportation and staffing relative to provision of
 43 35 care and treatment to the inmates, students, patients, and
 44  1 former inmates at the university of Iowa hospitals and
 44  2 clinics.
 44  3    f.  The effect of any proposed alternatives for provision
 44  4 of care and treatment for inmates, students, patients, or
 44  5 former inmates, including the proposed completion of the
 44  6 hospital unit at the Iowa state penitentiary at Fort Madison.
 44  7    2.  The workgroup shall submit a report of its findings to
 44  8 the governor and the general assembly no later than December
 44  9 31, 2005.  The report shall also include any recommendations
 44 10 for improvement in the provision of care and treatment to
 44 11 inmates, students, patients, and former inmates, under the
 44 12 control of the department of human services, the Iowa
 44 13 department of corrections, and the state board of regents.
 44 14                          DIVISION XII
 44 15                    STATE MEDICAL INSTITUTION
 44 16    Sec. 62.  NEW SECTION.  218A.1  STATE MEDICAL INSTITUTION.
 44 17    1.  All of the following shall be collectively designated
 44 18 as a single state medical institution:
 44 19    a.  The mental health institute, Mount Pleasant, Iowa.
 44 20    b.  The mental health institute, Independence, Iowa.
 44 21    c.  The mental health institute, Clarinda, Iowa.
 44 22    d.  The mental health institute, Cherokee, Iowa.
 44 23    e.  The Glenwood state resource center.
 44 24    f.  The Woodward state resource center.
 44 25    2.  Necessary portions of the institutes and resource
 44 26 centers shall remain licensed as separate hospitals and as
 44 27 separate intermediate care facilities for persons with mental
 44 28 retardation, and the locations and operations of the
 44 29 institutes and resource centers shall not be subject to
 44 30 consolidation to comply with this chapter.
 44 31    3.  The state medical institution shall qualify for
 44 32 payments described in subsection 4 for the fiscal period
 44 33 beginning July 1, 2005, and ending June 30, 2010, if the state
 44 34 medical institution and the various parts of the institution
 44 35 comply with the requirements for payment specified in
 45  1 subsection 4, and all of the following conditions are met:
 45  2    a.  The total number of beds in the state medical
 45  3 institution licensed as hospital beds is less than fifty
 45  4 percent of the total number of all state medical institution
 45  5 beds.  In determining compliance with this requirement,
 45  6 however, any reduction in the total number of beds that occurs
 45  7 as the result of reduction in census due to an increase in
 45  8 utilization of home and community=based services shall not be
 45  9 considered.
 45 10    b.  An individual is appointed by the director of human
 45 11 services to serve as the director of the state medical
 45 12 institution and an individual is appointed by the director of
 45 13 human services to serve as medical director of the state
 45 14 medical institution.  The individual appointed to serve as the
 45 15 director of the state medical institution may also be an
 45 16 employee of the department of human services or of a component
 45 17 part of the state medical institution.  The individual
 45 18 appointed to serve as medical director of the state medical
 45 19 institution may also serve as the medical director of one of
 45 20 the component parts of the state medical institution.
 45 21    c.  A workgroup comprised of the director of human services
 45 22 or the director's designee, the director of the state medical
 45 23 institution, the directors of all licensed intermediate care
 45 24 facilities for persons with mental retardation in the state,
 45 25 and representatives of the Iowa state association of counties,
 45 26 the Iowa association of community providers, and other
 45 27 interested parties develops and presents a plan, for
 45 28 submission to the centers for Medicare and Medicaid services
 45 29 of the United States department of health and human services,
 45 30 to the general assembly no later than July 1, 2007, to reduce
 45 31 the number of individuals in intermediate care facilities for
 45 32 persons with mental retardation in the state and concurrently
 45 33 to increase the number of individuals with mental retardation
 45 34 and developmental disabilities in the state who have access to
 45 35 home and community=based services.  The plan shall include a
 46  1 proposal to redesign the home and community=based services
 46  2 waivers for persons with mental retardation and persons with
 46  3 brain injury under the medical assistance program.  The
 46  4 department shall not implement the plan without express
 46  5 authorization by the general assembly.
 46  6    4.  The department of human services shall submit a waiver
 46  7 to the centers for Medicare and Medicaid services of the
 46  8 United States department of health and human services to
 46  9 provide for all of the following:
 46 10    a.  Coverage under the medical assistance program, with
 46 11 appropriate federal matching funding, for inpatient and
 46 12 outpatient hospital services provided to eligible individuals
 46 13 by any part of the state medical institution that maintains a
 46 14 state license as a hospital.
 46 15    b.  Disproportionate share hospital payments for services
 46 16 provided by any part of the state medical institution that
 46 17 maintains a state license as a hospital.
 46 18    c.  Imposition of an assessment on intermediate care
 46 19 facilities for persons with mental retardation on any part of
 46 20 the state medical institution that provides intermediate care
 46 21 facility for persons with mental retardation services.
 46 22                          DIVISION XIII
 46 23               APPROPRIATIONS AND EFFECTIVE DATES
 46 24    Sec. 63.  APPROPRIATIONS FROM IOWACARE ACCOUNT.
 46 25    1.  There is appropriated from the Iowacare account created
 46 26 in section 249J.23 to the university of Iowa hospitals and
 46 27 clinics for the fiscal year beginning July 1, 2005, and ending
 46 28 June 30, 2006, the following amount, or so much thereof as is
 46 29 necessary, to be used for the purposes designated:
 46 30    For salaries, support, maintenance, equipment, and
 46 31 miscellaneous purposes, for the provision of medical and
 46 32 surgical treatment of indigent patients, for provision of
 46 33 services to recipients under the medical assistance program
 46 34 expansion population pursuant to chapter 249J, as enacted in
 46 35 this Act, and for medical education:
 47  1 .................................................. $ 27,284,584
 47  2    2.  There is appropriated from the Iowacare account created
 47  3 in section 249J.23 to a publicly owned acute care teaching
 47  4 hospital located in a county with a population over three
 47  5 hundred fifty thousand for the fiscal year beginning July 1,
 47  6 2005, and ending June 30, 2006, the following amount, or so
 47  7 much thereof as is necessary, to be used for the purposes
 47  8 designated:
 47  9    For the provision of medical and surgical treatment of
 47 10 indigent patients, for provision of services to recipients
 47 11 under the medical assistance program expansion population
 47 12 pursuant to chapter 249J, as enacted in this Act, and for
 47 13 medical education:
 47 14 .................................................. $ 40,000,000
 47 15    Notwithstanding any provision of this Act to the contrary,
 47 16 of the amount appropriated in this subsection, $36,000,000
 47 17 shall be allocated in twelve equal monthly payments as
 47 18 provided in section 249J.23, as enacted in this Act.  Any
 47 19 amount appropriated in this subsection in excess of
 47 20 $36,000,000 shall be allocated only if federal funds are
 47 21 available to match the amount allocated.
 47 22    3.  There is appropriated from the Iowacare account created
 47 23 in section 249J.23 to the state hospitals for persons with
 47 24 mental illness designated pursuant to section 226.1 for the
 47 25 fiscal year beginning July 1, 2005, and ending June 30, 2006,
 47 26 the following amounts, or so much thereof as is necessary, to
 47 27 be used for the purposes designated:
 47 28    a.  For the state mental health institute at Cherokee, for
 47 29 salaries, support, maintenance, full=time equivalent
 47 30 positions, and miscellaneous purposes including services to
 47 31 recipients under the medical assistance program expansion
 47 32 population pursuant to chapter 249J, as enacted in this Act:
 47 33 .................................................. $  9,098,425
 47 34    b.  For the state mental health institute at Clarinda, for
 47 35 salaries, support, maintenance, full=time equivalent
 48  1 positions, and miscellaneous purposes including services to
 48  2 recipients under the medical assistance program expansion
 48  3 population pursuant to chapter 249J, as enacted in this Act:
 48  4 .................................................. $  1,977,305
 48  5    c.  For the state mental health institute at Independence,
 48  6 for salaries, support, maintenance, full=time equivalent
 48  7 positions, and miscellaneous purposes including services to
 48  8 recipients under the medical assistance program expansion
 48  9 population pursuant to chapter 249J, as enacted in this Act:
 48 10 .................................................. $  9,045,894
 48 11    d.  For the state mental health institute at Mount
 48 12 Pleasant, for salaries, support, maintenance, full=time
 48 13 equivalent positions, and miscellaneous purposes including
 48 14 services to recipients under the medical assistance program
 48 15 expansion population designation pursuant to chapter 249J, as
 48 16 enacted in this Act:
 48 17 .................................................. $  5,752,587
 48 18    Sec. 64.  APPROPRIATIONS FROM ACCOUNT FOR HEALTH CARE
 48 19 TRANSFORMATION.  There is appropriated from the account for
 48 20 health care transformation created in section 249J.22, as
 48 21 enacted in this Act, to the department of human services, for
 48 22 the fiscal year beginning July 1, 2005, and ending June 30,
 48 23 2006, the following amounts, or so much thereof as is
 48 24 necessary, to be used for the purposes designated:
 48 25    1.  For the costs of medical examinations and development
 48 26 of personal health improvement plans for the expansion
 48 27 population pursuant to section 249J.6, as enacted in this Act:
 48 28 .................................................. $    136,500
 48 29    2.  For the provision of a medical information hotline for
 48 30 the expansion population as provided in section 249J.6, as
 48 31 enacted in this Act:
 48 32 .................................................. $    150,000
 48 33    3.  For the insurance cost subsidy program pursuant to
 48 34 section 249J.8, as enacted in this Act:
 48 35 .................................................. $    150,000
 49  1    4.  For the health care account program option pursuant to
 49  2 section 249J.8, as enacted in this Act:
 49  3 .................................................. $     50,000
 49  4    5.  For the use of electronic medical records by medical
 49  5 assistance program and expansion population provider network
 49  6 providers pursuant to section 249J.14, as enacted in this Act:
 49  7 .................................................. $    100,000
 49  8    6.  For other health partnership activities pursuant to
 49  9 section 249J.14, as enacted in this Act:
 49 10 .................................................. $    550,000
 49 11    7.  For the costs related to audits, performance
 49 12 evaluations, and studies required by this Act:
 49 13 .................................................. $    100,000
 49 14    8.  For administrative costs associated with this Act:
 49 15 .................................................. $    910,000
 49 16    Sec. 65.  TRANSFER FROM ACCOUNT FOR HEALTH CARE
 49 17 TRANSFORMATION.  There is transferred from the account for
 49 18 health care transformation created pursuant to section
 49 19 249J.22, as enacted in this Act, to the Iowacare account
 49 20 created in section 249J.23, as enacted in this Act, a total of
 49 21 $2,000,000 for the fiscal year beginning July 1, 2005, and
 49 22 ending June 30, 2006.
 49 23    Sec. 66.  EFFECTIVE DATES == CONTINGENT REDUCTION == RULES
 49 24 == RETROACTIVE APPLICABILITY.
 49 25    1.  The provisions of this Act requiring the department of
 49 26 human services to request waivers from the centers for
 49 27 Medicare and Medicaid services of the United States department
 49 28 of health and human services and to amend the medical
 49 29 assistance state plan, and the provisions relating to
 49 30 execution of chapter 28E agreements in section 249J.23, as
 49 31 enacted in this Act, being deemed of immediate importance,
 49 32 take effect upon enactment.
 49 33    2.  The remaining provisions of this Act, with the
 49 34 exception of the provisions described in subsection 1, shall
 49 35 not take effect unless the department of human services
 50  1 receives approval of all waivers and medical assistance state
 50  2 plan amendments required under this Act.  If all approvals are
 50  3 received, the remaining provisions of this Act shall take
 50  4 effect July 1, 2005, or on the date specified in the waiver or
 50  5 medical assistance state plan amendment for a particular
 50  6 provision.  The department of human services shall notify the
 50  7 Code editor of the date of receipt of the approvals.
 50  8    3.  If this Act is enacted and if the Eighty=first General
 50  9 Assembly enacts legislation appropriating moneys from the
 50 10 general fund of the state to the department of human services
 50 11 for the fiscal year beginning July 1, 2005, and ending June
 50 12 30, 2006, for the state hospitals for persons with mental
 50 13 illness designated pursuant to section 226.1, for salaries,
 50 14 support, maintenance, and miscellaneous purposes and for full=
 50 15 time equivalent positions, the appropriations shall be reduced
 50 16 in the following amounts and the amounts shall be transferred
 50 17 to the medical assistance fund of the department of human
 50 18 services to diminish the effect of intergovernmental transfer
 50 19 reductions:
 50 20    a.  For the state mental health institute at Cherokee:
 50 21 .................................................. $  9,098,425
 50 22    b.  For the state mental health institute at Clarinda:
 50 23 .................................................. $  1,977,305
 50 24    c.  For the state mental health institute at Independence:
 50 25 .................................................. $  9,045,894
 50 26    d.  For the state mental health institute at Mount
 50 27 Pleasant:
 50 28 .................................................. $  5,752,587
 50 29    4.  If this Act is enacted and if the Eighty=first General
 50 30 Assembly enacts legislation appropriating moneys from the
 50 31 general fund of the state to the state university of Iowa for
 50 32 the fiscal year beginning July 1, 2005, and ending June 30,
 50 33 2006, for the university hospitals for salaries, support,
 50 34 maintenance, equipment, and miscellaneous purposes and for
 50 35 medical and surgical treatment of indigent patients as
 51  1 provided in chapter 255, for medical education, and for full=
 51  2 time equivalent positions, the appropriation is reduced by
 51  3 $27,284,584 and the amount shall be transferred to the medical
 51  4 assistance fund of the department of human services to
 51  5 diminish the effect of intergovernmental transfer reductions.
 51  6    5.  If this Act is enacted, and if the Eighty=first General
 51  7 Assembly enacts 2005 Iowa Acts, House File 816, and 2005 Iowa
 51  8 Acts, House File 816 includes a provision relating to medical
 51  9 assistance supplemental amounts for disproportionate share
 51 10 hospital and indirect medical education, the provision in
 51 11 House File 816 shall not take effect.
 51 12    6.  If this Act is enacted, and if the Eighty=first General
 51 13 Assembly enacts 2005 Iowa Acts, House File 825, and 2005 Iowa
 51 14 Acts, House File 825, includes a provision appropriating
 51 15 moneys from the hospital trust fund created in section 249I.4
 51 16 to the department of human services for the fiscal year
 51 17 beginning July 1, 2005, and ending June 30, 2006, to be used
 51 18 to supplement the appropriations made for the medical
 51 19 assistance program for that fiscal year, the appropriation is
 51 20 reduced by $22,900,000.
 51 21    7.  The department of human services may adopt emergency
 51 22 rules pursuant to chapter 17A to implement and administer the
 51 23 provisions of this Act.
 51 24    8.  The department of human services may procure sole
 51 25 source contracts to implement any provision of this Act.  In
 51 26 addition to sole source contracting, the department may
 51 27 contract with local nonprofit agencies to provide services
 51 28 enumerated in this Act.  The department shall utilize
 51 29 nonprofit agencies to the greatest extent possible in the
 51 30 delivery of the programs and services enumerated in this Act
 51 31 to promote greater understanding between providers, under the
 51 32 medical assistance program and included in the expansion
 51 33 population provider network, and their recipients and members.
 51 34    9.  The provisions of this Act amending 2003 Iowa Acts,
 51 35 chapter 112, section 11, and repealing section 249A.20B, are
 52  1 retroactively applicable to May 2, 2003.
 52  2    10.  The section of this Act amending 2004 Iowa Acts,
 52  3 chapter 1175, section 86, is retroactively applicable to May
 52  4 17, 2004.
 52  5 HF 841
 52  6 pf/es/25