Senate File 2356 - Reprinted SENATE FILE 2356 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 2092) (As Amended and Passed by the Senate March 1, 2010 ) A BILL FOR An Act relating to health reform in Iowa by providing for 1 options for health care coverage including a premium 2 assistance program study and IowaCare program changes and 3 creating an Iowa insurance information exchange. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 SF 2356 (7) 83 pf:av/rj/jh

S.F. 2356 DIVISION I 1 PREMIUM ASSISTANCE PROGRAM AND IOWACARE PROGRAM CHANGES 2 Section 1. PREMIUM ASSISTANCE PROGRAM —— STUDY 3 —— REPORT. The legislative council is requested to establish 4 an interim study committee to evaluate options for establishing 5 a premium assistance program to provide health care coverage 6 to individuals nineteen through sixty-four years of age who 7 have family incomes above two hundred percent but not in 8 excess of three hundred percent of the federal poverty level. 9 The committee shall be comprised of members representing the 10 interests of Iowa insurers, independent insurance agents, large 11 and small employers, health care providers, and consumers. In 12 addition, the commissioner of insurance, director of human 13 services, and director of public health, or a designee of each, 14 shall act as ex officio, nonvoting members of the committee. 15 The committee shall submit a report, including its findings and 16 recommendations, to the general assembly by December 15, 2010. 17 Sec. 2. Section 249J.7, Code 2009, is amended to read as 18 follows: 19 249J.7 Expansion population provider network. 20 1. a. Expansion population members shall only be eligible 21 to receive expansion population services through a provider 22 included in the expansion population provider network. Except 23 as otherwise provided in this chapter, the expansion population 24 provider network shall be limited to a publicly owned acute 25 care teaching hospital located in a county with a population 26 over three hundred fifty thousand, the university of Iowa 27 hospitals and clinics, and the state hospitals for persons 28 with mental illness designated pursuant to section 226.1 with 29 the exception of the programs at such state hospitals for 30 persons with mental illness that provide substance abuse 31 treatment, serve gero-psychiatric patients, or treat sexually 32 violent predators and a regional provider network utilizing 33 the federally qualified health centers or federally qualified 34 health center look-alikes in the state , to provide primary care 35 -1- SF 2356 (7) 83 pf:av/rj/jh 1/ 13

S.F. 2356 to members. 1 b. (1) The department shall develop a plan to phase-in 2 the regional provider network by determining the most highly 3 underserved areas on a statewide and regional basis, and 4 targeting these areas for prioritization in implementing the 5 regional provider network. 6 (2) Payment shall only be made to designated participating 7 primary care providers for eligible primary care services 8 provided to a member. 9 (3) The department shall adopt rules pursuant to chapter 10 17A, in collaboration with the medical home advisory council 11 created pursuant to section 135.159, specifying requirements 12 for medical homes including certification, with which regional 13 provider network participating providers shall comply, as 14 appropriate. 15 (4) The department may also designate other private 16 providers and hospitals to participate in the regional provider 17 network, to provide primary and specialty care, subject to the 18 availability of funds. 19 (5) Notwithstanding any provision to the contrary, the 20 department shall develop a methodology to reimburse regional 21 provider network participating providers designated under this 22 subsection. 23 c. Tertiary care shall be provided to eligible expansion 24 population members residing in any county in the state at the 25 university of Iowa hospitals and clinics. 26 d. Until such time as the publicly owned acute care 27 teaching hospital located in a county with a population over 28 three hundred fifty thousand notifies the department that 29 such hospital has reached service capacity or has exceeded 30 the statutorily authorized amount of funding as determined 31 and appropriated on an annual basis, the hospital and the 32 university of Iowa hospitals and clinics shall remain the 33 only expansion population providers for the residents of such 34 county. 35 -2- SF 2356 (7) 83 pf:av/rj/jh 2/ 13

S.F. 2356 2. Expansion population services provided to expansion 1 population members by providers included in the expansion 2 population provider network the publicly owned acute care 3 teaching hospital located in a county with a population 4 over three hundred fifty thousand and the university of Iowa 5 hospitals and clinics shall be payable at the full benefit 6 recipient rates. 7 3. Providers included in the expansion population provider 8 network shall submit clean claims within twenty days of the 9 date of provision of an expansion population service to an 10 expansion population member. 11 4. Unless otherwise prohibited by law, a provider under 12 the expansion population provider network may deny care to 13 an individual who refuses to apply for coverage under the 14 expansion population. 15 5. Notwithstanding the provision of section 347.16, 16 subsection 2, requiring the provision of free care and 17 treatment to the persons described in that subsection, the 18 publicly owned acute care teaching hospital described in 19 subsection 1 may require any sick or injured person seeking 20 care or treatment at that hospital to be subject to financial 21 participation, including but not limited to copayments 22 or premiums, and may deny nonemergent care or treatment 23 to any person who refuses to be subject to such financial 24 participation. 25 6. The department shall utilize certified public 26 expenditures at the university of Iowa hospitals and clinics 27 to maximize the availability of state funding to provide 28 necessary access to both local primary and specialty physician 29 care to expansion population members. The resulting savings 30 to the state shall be utilized to reimburse physician services 31 provided to expansion population members at the university of 32 Iowa college of medicine, to reimburse providers designated 33 to participate in the regional provider network for services 34 provided to expansion population members, and for deposit in 35 -3- SF 2356 (7) 83 pf:av/rj/jh 3/ 13

S.F. 2356 the nonparticipating provider reimbursement fund created in 1 section 249J.24A to be used in accordance with the purposes and 2 requirements of the fund. 3 7. The department shall adopt rules to establish clinical 4 transfer protocols to be used by providers included in the 5 expansion population provider network. 6 Sec. 3. Section 249J.24A, Code Supplement 2009, is amended 7 by adding the following new subsection: 8 NEW SUBSECTION . 5. Notwithstanding any provision to the 9 contrary, moneys in the fund may also be used in accordance 10 with the methodology developed by the department for 11 reimbursement of nonparticipating providers in the IowaCare 12 plus program’s regional provider network established pursuant 13 to section 217A.6. However, prioritization in allocation of 14 moneys within the fund shall be to provide reimbursement to 15 nonparticipating providers as defined in this section. 16 Sec. 4. Section 263.18, subsection 4, Code 2009, is amended 17 to read as follows: 18 4. The physicians and surgeons on the staff of the 19 university of Iowa hospitals and clinics who care for patients 20 provided for in this section may charge for the medical 21 services provided under such rules, regulations, and plans 22 approved by the state board of regents. However, a physician 23 or surgeon who provides treatment or care for an expansion 24 population member pursuant to chapter 249J shall not charge 25 or only receive any compensation for the treatment or care 26 except the salary or compensation fixed by the state board 27 of regents to be paid from the hospital fund provided in 28 accordance with section 249J.7 . 29 Sec. 5. REVIEW OF MEDICAL TRANSPORTATION COSTS FOR 30 IOWACARE. The department of human services shall review the 31 costs of transportation to and from a provider included in 32 the expansion population provider network under the IowaCare 33 program. The department shall report the results of the review 34 to the general assembly by December 15, 2010. 35 -4- SF 2356 (7) 83 pf:av/rj/jh 4/ 13

S.F. 2356 Sec. 6. DIABETES —— PLAN FOR COORDINATION OF CARE. The 1 department of public health shall work with all appropriate 2 entities to develop a plan for coordination of care for 3 individuals with diabetes who receive care through community 4 health centers, rural health clinics, free clinics, and other 5 members of the Iowa collaborative safety net provider network 6 established pursuant to section 135.153, as determined by the 7 department. The plan may include provisions to establish a 8 diabetic registry, to provide access to medically necessary 9 drugs through entities such as the Iowa prescription drug 10 corporation, and to collect data as necessary to assist the 11 affected medical providers in tracking and improving the care 12 of their patients with diabetes, while also informing future 13 public policy decision makers regarding improved care for 14 individuals with diabetes, notwithstanding an individual’s 15 health care coverage status or choice of health care provider. 16 Sec. 7. IOWACARE —— EXTENSION OF WAIVER. The department 17 of human services shall amend the extension proposal for the 18 IowaCare section 1115 demonstration waiver and shall submit 19 applicable state plan amendments under the medical assistance 20 program to provide expansion population services through the 21 expansion population network pursuant to section 249J.7, as 22 amended by this Act, within the budget neutrality cap and 23 subject to availability of state matching funds. 24 DIVISION II 25 IOWA INSURANCE INFORMATION EXCHANGE 26 Sec. 8. NEW SECTION . 505.32 Iowa insurance information 27 exchange. 28 1. Purposes. The purposes of this section include but are 29 not limited to providing an information clearinghouse where all 30 Iowans can obtain information about health care coverage that 31 is available in the state including comparisons of benefits, 32 premiums, and out-of-pocket costs and where the uninsured can 33 receive assistance regarding health care coverage. 34 2. Definitions. As used in this section, unless the context 35 -5- SF 2356 (7) 83 pf:av/rj/jh 5/ 13

S.F. 2356 otherwise requires: 1 a. “Board” means the advisory board of the Iowa insurance 2 information exchange. 3 b. “Carrier” means an insurer providing accident and 4 sickness insurance under chapter 509, 514, or 514A and 5 includes a health maintenance organization established under 6 chapter 514B if payments received by the health maintenance 7 organization are considered premiums pursuant to section 8 514B.31 and are taxed under chapter 432. “Carrier” also 9 includes a corporation which becomes a mutual insurer pursuant 10 to section 514.23 and any other person as defined in section 11 4.1, who is or may become liable for the tax imposed by chapter 12 432. 13 c. “Commissioner” means the commissioner of insurance. 14 d. “Creditable coverage” means the same as defined in 15 section 513B.2. 16 e. “Exchange” means the Iowa insurance information exchange. 17 f. “Group health plan” means the same as defined in section 18 513B.2. 19 g. “Health care services” means services, the coverage of 20 which is authorized under chapter 509, 514, 514A, or 514B and 21 includes services for the purposes of preventing, alleviating, 22 curing, or healing human illness, injury, or physical 23 disability. 24 h. “Health insurance” means accident and sickness insurance 25 authorized by chapter 509, 514, or 514A. 26 i. (1) “Health insurance coverage” means health insurance 27 coverage offered to individuals. 28 (2) “Health insurance coverage” does not include any of the 29 following: 30 (a) Coverage for accident-only or disability income 31 insurance. 32 (b) Coverage issued as a supplement to liability insurance. 33 (c) Liability insurance, including general liability 34 insurance and automobile liability insurance. 35 -6- SF 2356 (7) 83 pf:av/rj/jh 6/ 13

S.F. 2356 (d) Workers’ compensation or similar insurance. 1 (e) Automobile medical-payment insurance. 2 (f) Credit-only insurance. 3 (g) Coverage for on-site medical clinic care. 4 (h) Other similar insurance coverage, specified in 5 federal regulations, under which benefits for medical care 6 are secondary or incidental to other insurance coverage or 7 benefits. 8 (3) “Health insurance coverage” does not include benefits 9 provided under a separate policy as follows: 10 (a) Limited-scope dental or vision benefits. 11 (b) Benefits for long-term care, nursing home care, home 12 health care, or community-based care. 13 (c) Any other similar limited benefits as provided by rule 14 of the commissioner. 15 (4) “Health insurance coverage” does not include benefits 16 offered as independent noncoordinated benefits as follows: 17 (a) Coverage only for a specified disease or illness. 18 (b) A hospital indemnity or other fixed indemnity 19 insurance. 20 (5) “Health insurance coverage” does not include Medicare 21 supplemental health insurance as defined under section 22 1882(g)(1) of the federal Social Security Act, coverage 23 supplemental to the coverage provided under 10 U.S.C. ch. 55 24 and similar supplemental coverage provided to coverage under 25 group health insurance coverage. 26 j. “Medical assistance program” means the federal-state 27 assistance program established under Tit. XIX of the federal 28 Social Security Act and chapter 249A. 29 k. “Medicare” means the federal government health insurance 30 program established under Tit. XVIII of the federal Social 31 Security Act. 32 l. “Organized delivery system” means an organized delivery 33 system as licensed by the director of public health. 34 3. Iowa insurance information exchange established 35 -7- SF 2356 (7) 83 pf:av/rj/jh 7/ 13

S.F. 2356 —— advisory board. 1 a. An Iowa insurance information exchange is established in 2 the insurance division of the department of commerce under the 3 purview of the commissioner of insurance. 4 b. The exchange shall exercise its powers in consultation 5 with the advisory board established under this subsection. 6 c. The advisory board of the exchange shall consist of the 7 following members: 8 (1) The following persons who are voting members of the 9 board appointed by the governor and subject to confirmation by 10 the senate: 11 (a) A health care academic with a background in economics, 12 law, or public health. 13 (b) An executive of a carrier. 14 (c) A health benefits manager of a company. 15 (d) A health care analyst representing a public or private 16 employee bargaining unit. 17 (e) A health care analyst representing an organized 18 consumer group. 19 (f) A health care provider. 20 (g) An insurance agent. 21 (2) The following persons who are ex officio, nonvoting 22 members of the board: 23 (a) The commissioner of insurance, or a designee. 24 (b) The Iowa Medicaid director, or a designee. 25 (c) Four members of the general assembly, one appointed 26 by the speaker of the house of representatives, one appointed 27 by the minority leader of the house of representatives, 28 one appointed by the majority leader of the senate, and one 29 appointed by the minority leader of the senate. 30 d. Each member of the board appointed by the governor shall 31 be a resident of this state and the composition of voting 32 members of the board shall be in compliance with sections 33 69.16, 69.16A, and 69.16C. 34 e. The voting members of the board shall be appointed for 35 -8- SF 2356 (7) 83 pf:av/rj/jh 8/ 13

S.F. 2356 terms of six years beginning and ending as provided in section 1 69.19. A member of the board is eligible for reappointment. 2 The governor shall fill a vacancy for the remainder of the 3 unexpired term. A member of the board may be removed by the 4 governor for misfeasance, malfeasance, or willful neglect of 5 duty or other cause after notice and a public hearing unless 6 the notice and hearing are waived by the member in writing. 7 f. The voting members of the board shall annually elect one 8 of the members as chairperson and one as vice chairperson. 9 g. A majority of the voting members of the board constitutes 10 a quorum. The affirmative vote of a majority of the voting 11 members is necessary for any action taken by the board. 12 The majority shall not include a member who has a conflict 13 of interest and a statement by a member of a conflict of 14 interest is conclusive for this purpose. A vacancy in the 15 voting membership of the board does not impair the right of a 16 quorum to exercise the rights and perform the duties of the 17 board. An action taken by the board under this section may be 18 authorized by resolution at a regular or special meeting and 19 each resolution may take effect immediately and need not be 20 published or posted. Meetings of the board shall be held at 21 the call of the chairperson or at the request of a majority of 22 the voting members. 23 h. Members of the board may be reimbursed from the moneys 24 of the exchange for expenses incurred by them as members, but 25 shall not be otherwise compensated by the exchange for their 26 services. 27 i. The members of the board are subject to and are officials 28 within the meaning of chapter 68B. 29 j. The board shall consult with and provide recommendations 30 to assist the commissioner in carrying out the powers and 31 duties of the exchange set forth in subsection 5. 32 k. The commissioner shall provide administrative and 33 technical support to the board in carrying out its duties under 34 this section. 35 -9- SF 2356 (7) 83 pf:av/rj/jh 9/ 13

S.F. 2356 4. Plan of operation. 1 a. The commissioner, in consultation with the board, shall 2 establish a plan of operation for the exchange that assures the 3 fair, reasonable, and equitable administration of the exchange, 4 within ninety days after the appointment of the board. In 5 addition to other requirements, the plan of operation shall 6 provide for all of the following: 7 (1) The handling and accounting of assets and moneys of the 8 exchange. 9 (2) The amount and method of reimbursing expenses of the 10 members of the board. 11 (3) Regular times and places for meetings of the board. 12 (4) Records to be kept of all financial transactions, and an 13 annual fiscal report of the costs of administering the exchange 14 to be delivered to the general assembly by December 15 of each 15 year. 16 (5) The periodic advertising of the general availability of 17 health coverage information and assistance from the exchange. 18 (6) Additional provisions necessary or proper for the 19 execution of the powers and duties of the exchange. 20 b. The exchange has the general powers and authority 21 enumerated by this subsection and pursuant to subsection 5 and 22 executed in accordance with the plan of operation established 23 by the commissioner under paragraph “a” . 24 c. The exchange shall develop and implement the plan of 25 operation and corresponding timeline detailing action steps 26 toward implementing this section, by rules adopted pursuant to 27 chapter 17A as provided in subsection 6. 28 5. Powers and duties of exchange. 29 a. The exchange shall develop a system that provides a 30 portal where uninsured Iowans can receive assistance in how to 31 obtain public or private health care coverage. The department 32 of human services shall determine the eligibility of uninsured 33 Iowans for public programs and provide assistance with 34 enrollment in the appropriate public programs. The exchange 35 -10- SF 2356 (7) 83 pf:av/rj/jh 10/ 13

S.F. 2356 shall provide assistance with how to obtain private health 1 insurance coverage that meets certain standards of quality and 2 affordability to uninsured Iowans who are not eligible for or 3 do not wish to enroll in public programs. The exchange, in 4 consultation with the department of human services and the 5 board, shall develop a methodology to create a seamless system 6 that allows individuals to move between public and private 7 health care coverage, including increasing opportunities for 8 obtaining creditable coverage. 9 b. The exchange shall establish three categories of benefits 10 including basic or catastrophic benefits, an intermediate level 11 of benefits, and comprehensive benefits coverage, that meet 12 affordability limits established pursuant to 2009 Iowa Acts ch. 13 118, section 1, subsection 4, paragraph “c” . 14 c. (1) The exchange shall establish an information 15 clearinghouse to provide information to all Iowans about all 16 public and private health care coverage that is available in 17 the state including comparisons of benefits, premiums, and 18 out-of-pocket costs. 19 (2) The exchange may establish standards to provide 20 uniform and consistent information about the health care 21 coverage options offered by each carrier and public program 22 that includes but is not limited to what benefits are covered 23 and not covered, the amount of coverage for each service, 24 including copays and deductibles, and any prior authorization 25 requirements for coverage. 26 (3) The exchange may require each carrier, organized 27 delivery system, and public program to categorize and describe 28 the category of benefits to which each health care coverage 29 option offered by a carrier, organized delivery system, or 30 public program belongs as set forth in paragraph “b” . 31 (4) The exchange shall provide ongoing information to 32 taxpayers about the costs of public health care programs to the 33 state, including the percentage and source of state and federal 34 funding for the programs. 35 -11- SF 2356 (7) 83 pf:av/rj/jh 11/ 13

S.F. 2356 (5) The exchange may provide counseling to assist Iowans 1 with making an informed choice when selecting health care 2 coverage. 3 d. The exchange shall encourage or develop the use of common 4 definitions for quality of care and pricing of health care 5 services and develop and implement methodologies that provide 6 quality and cost data on health care services and health care 7 coverage offered in the state that is meaningful to consumers, 8 patients, and purchasers. 9 e. The commissioner may hire independent consultants, as 10 deemed necessary, to assist in carrying out the powers and 11 duties of the exchange. 12 f. The exchange shall collaborate with, including but not 13 limited to the board, the department of human services, the 14 department of public health, health care providers, members 15 of an organized consumer-purchaser group, members of the Iowa 16 collaborative safety net provider network, and carriers to 17 carry out the duties of the exchange including dissemination 18 of information about the services offered by the exchange to 19 the public. 20 6. Rules. The commissioner shall adopt rules pursuant to 21 chapter 17A to implement the provisions of this section. 22 7. Iowa insurance information exchange fund created. 23 a. An Iowa insurance information exchange fund is created in 24 the state treasury as a separate fund under the control of the 25 exchange. All moneys appropriated or transferred to the fund 26 shall be credited to the fund. All moneys deposited or paid 27 into the fund shall only be appropriated to the exchange to be 28 used for the purposes set forth in this section. 29 b. Notwithstanding section 8.33, any balance in the fund 30 on June 30 of each fiscal year shall not revert to the general 31 fund of the state, but shall be available for purposes of 32 this section in subsequent fiscal years. Notwithstanding 33 section 12C.7, interest earnings on moneys in the fund shall 34 be credited to the fund. 35 -12- SF 2356 (7) 83 pf:av/rj/jh 12/ 13