SF 2356 (LSB 5392SV (7) 83)

SENATE FILE 2356

BY  COMMITTEE ON HUMAN RESOURCES

(SUCCESSOR TO SF 2092)

(As Amended and Passed by the Senate 2010-03-01)

A BILL FOR

An Act relating to health reform in Iowa by providing for options for health care coverage including a premium assistance program study and IowaCare program changes and creating an Iowa insurance information exchange.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
PREMIUM ASSISTANCE PROGRAM AND IOWACARE PROGRAM CHANGES
    Section 1.
  PREMIUM ASSISTANCE PROGRAM —— STUDY 

—— REPORT.
  The legislative council is requested to establish an interim study committee to evaluate options for establishing a premium assistance program to provide health care coverage to individuals nineteen through sixty-four years of age who have family incomes above two hundred percent but not in excess of three hundred percent of the federal poverty level. The committee shall be comprised of members representing the interests of Iowa insurers, independent insurance agents, large and small employers, health care providers, and consumers. In addition, the commissioner of insurance, director of human services, and director of public health, or a designee of each, shall act as ex officio, nonvoting members of the committee. The committee shall submit a report, including its findings and recommendations, to the general assembly by December 15, 2010.
    Sec. 2.  Section 249J.7, Code 2009, is amended to read as follows:
   249J.7  Expansion population provider network.
   1.  a.  Expansion population members shall only be eligible to receive expansion population services through a provider included in the expansion population provider network. Except as otherwise provided in this chapter, the expansion population provider network shall be limited to a publicly owned acute care teaching hospital located in a county with a population over three hundred fifty thousand, the university of Iowa hospitals and clinics, and the state hospitals for persons with mental illness designated pursuant to section 226.1 with the exception of the programs at such state hospitals for persons with mental illness that provide substance abuse treatment, serve gero-psychiatric patients, or treat sexually violent predators and a regional provider network utilizing the federally qualified health centers or federally qualified health center look-alikes in the state, to provide primary care to members. 
   b.  (1)  The department shall develop a plan to phase-in the regional provider network by determining the most highly underserved areas on a statewide and regional basis, and targeting these areas for prioritization in implementing the regional provider network.
   (2)  Payment shall only be made to designated participating primary care providers for eligible primary care services provided to a member.
   (3)  The department shall adopt rules pursuant to chapter 17A, in collaboration with the medical home advisory council created pursuant to section 135.159, specifying requirements for medical homes including certification, with which regional provider network participating providers shall comply, as appropriate.
   (4)  The department may also designate other private providers and hospitals to participate in the regional provider network, to provide primary and specialty care, subject to the availability of funds.
   (5)  Notwithstanding any provision to the contrary, the department shall develop a methodology to reimburse regional provider network participating providers designated under this subsection.
   c.  Tertiary care shall be provided to eligible expansion population members residing in any county in the state at the university of Iowa hospitals and clinics.
   d.  Until such time as the publicly owned acute care teaching hospital located in a county with a population over three hundred fifty thousand notifies the department that such hospital has reached service capacity or has exceeded the statutorily authorized amount of funding as determined and appropriated on an annual basis, the hospital and the university of Iowa hospitals and clinics shall remain the only expansion population providers for the residents of such county.
   2.  Expansion population services provided to expansion population members by providers included in the expansion population provider network the publicly owned acute care teaching hospital located in a county with a population over three hundred fifty thousand and the university of Iowa hospitals and clinics shall be payable at the full benefit recipient rates.
   3.  Providers included in the expansion population provider network shall submit clean claims within twenty days of the date of provision of an expansion population service to an expansion population member.
   4.  Unless otherwise prohibited by law, a provider under the expansion population provider network may deny care to an individual who refuses to apply for coverage under the expansion population.
   5.  Notwithstanding the provision of section 347.16, subsection 2, requiring the provision of free care and treatment to the persons described in that subsection, the publicly owned acute care teaching hospital described in subsection 1 may require any sick or injured person seeking care or treatment at that hospital to be subject to financial participation, including but not limited to copayments or premiums, and may deny nonemergent care or treatment to any person who refuses to be subject to such financial participation.
   6.  The department shall utilize certified public expenditures at the university of Iowa hospitals and clinics to maximize the availability of state funding to provide necessary access to both local primary and specialty physician care to expansion population members. The resulting savings to the state shall be utilized to reimburse physician services provided to expansion population members at the university of Iowa college of medicine, to reimburse providers designated to participate in the regional provider network for services provided to expansion population members, and for deposit in the nonparticipating provider reimbursement fund created in section 249J.24A to be used in accordance with the purposes and requirements of the fund.
   7.  The department shall adopt rules to establish clinical transfer protocols to be used by providers included in the expansion population provider network.
    Sec. 3.  Section 249J.24A, Code Supplement 2009, is amended by adding the following new subsection:
   NEW SUBSECTION.  5.  Notwithstanding any provision to the contrary, moneys in the fund may also be used in accordance with the methodology developed by the department for reimbursement of nonparticipating providers in the IowaCare plus program’s regional provider network established pursuant to section 217A.6. However, prioritization in allocation of moneys within the fund shall be to provide reimbursement to nonparticipating providers as defined in this section.
    Sec. 4.  Section 263.18, subsection 4, Code 2009, is amended to read as follows:
   4.  The physicians and surgeons on the staff of the university of Iowa hospitals and clinics who care for patients provided for in this section may charge for the medical services provided under such rules, regulations, and plans approved by the state board of regents. However, a physician or surgeon who provides treatment or care for an expansion population member pursuant to chapter 249J shall not charge or only receive any compensation for the treatment or care except the salary or compensation fixed by the state board of regents to be paid from the hospital fund provided in accordance with section 249J.7.
    Sec. 5.  REVIEW OF MEDICAL TRANSPORTATION COSTS FOR IOWACARE.  The department of human services shall review the costs of transportation to and from a provider included in the expansion population provider network under the IowaCare program. The department shall report the results of the review to the general assembly by December 15, 2010.
    Sec. 6.  DIABETES —— PLAN FOR COORDINATION OF CARE.  The department of public health shall work with all appropriate entities to develop a plan for coordination of care for individuals with diabetes who receive care through community health centers, rural health clinics, free clinics, and other members of the Iowa collaborative safety net provider network established pursuant to section 135.153, as determined by the department. The plan may include provisions to establish a diabetic registry, to provide access to medically necessary drugs through entities such as the Iowa prescription drug corporation, and to collect data as necessary to assist the affected medical providers in tracking and improving the care of their patients with diabetes, while also informing future public policy decision makers regarding improved care for individuals with diabetes, notwithstanding an individual’s health care coverage status or choice of health care provider.
    Sec. 7.  IOWACARE —— EXTENSION OF WAIVER.  The department of human services shall amend the extension proposal for the IowaCare section 1115 demonstration waiver and shall submit applicable state plan amendments under the medical assistance program to provide expansion population services through the expansion population network pursuant to section 249J.7, as amended by this Act, within the budget neutrality cap and subject to availability of state matching funds.

DIVISION II
IOWA INSURANCE INFORMATION EXCHANGE
    Sec. 8.  NEW SECTION.  505.32  Iowa insurance information exchange.
   1.  Purposes.  The purposes of this section include but are not limited to providing an information clearinghouse where all Iowans can obtain information about health care coverage that is available in the state including comparisons of benefits, premiums, and out-of-pocket costs and where the uninsured can receive assistance regarding health care coverage.
   2.  Definitions.  As used in this section, unless the context otherwise requires:
   a.  “Board” means the advisory board of the Iowa insurance information exchange.
   b.  “Carrier” means an insurer providing accident and sickness insurance under chapter 509, 514, or 514A and includes a health maintenance organization established under chapter 514B if payments received by the health maintenance organization are considered premiums pursuant to section 514B.31 and are taxed under chapter 432. “Carrier” also includes a corporation which becomes a mutual insurer pursuant to section 514.23 and any other person as defined in section 4.1, who is or may become liable for the tax imposed by chapter 432.
   c.  “Commissioner” means the commissioner of insurance.
   d.  “Creditable coverage” means the same as defined in section 513B.2.
   e.  “Exchange” means the Iowa insurance information exchange.
   f.  “Group health plan” means the same as defined in section 513B.2.
   g.  “Health care services” means services, the coverage of which is authorized under chapter 509, 514, 514A, or 514B and includes services for the purposes of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
   h.  “Health insurance” means accident and sickness insurance authorized by chapter 509, 514, or 514A.
   i.(1)  “Health insurance coverage” means health insurance coverage offered to individuals.
   (2)  “Health insurance coverage” does not include any of the following:
   (a)  Coverage for accident-only or disability income insurance.
   (b)  Coverage issued as a supplement to liability insurance.
   (c)  Liability insurance, including general liability insurance and automobile liability insurance.
   (d)  Workers’ compensation or similar insurance.
   (e)  Automobile medical-payment insurance.
   (f)  Credit-only insurance.
   (g)  Coverage for on-site medical clinic care.
   (h)  Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance coverage or benefits.
   (3)  “Health insurance coverage” does not include benefits provided under a separate policy as follows:
   (a)  Limited-scope dental or vision benefits.
   (b)  Benefits for long-term care, nursing home care, home health care, or community-based care.
   (c)  Any other similar limited benefits as provided by rule of the commissioner.
   (4)  “Health insurance coverage” does not include benefits offered as independent noncoordinated benefits as follows:
   (a)  Coverage only for a specified disease or illness.
   (b)  A hospital indemnity or other fixed indemnity insurance.
   (5)  “Health insurance coverage” does not include Medicare supplemental health insurance as defined under section 1882(g)(1) of the federal Social Security Act, coverage supplemental to the coverage provided under 10 U.S.C. ch. 55 and similar supplemental coverage provided to coverage under group health insurance coverage.
   j.  “Medical assistance program” means the federal-state assistance program established under Tit. XIX of the federal Social Security Act and chapter 249A.
   k.  “Medicare” means the federal government health insurance program established under Tit. XVIII of the federal Social Security Act.
   l.  “Organized delivery system” means an organized delivery system as licensed by the director of public health.
   3.  Iowa insurance information exchange established

—— advisory board.
   a.  An Iowa insurance information exchange is established in the insurance division of the department of commerce under the purview of the commissioner of insurance.
   b.  The exchange shall exercise its powers in consultation with the advisory board established under this subsection.
   c.  The advisory board of the exchange shall consist of the following members:
   (1)  The following persons who are voting members of the board appointed by the governor and subject to confirmation by the senate:
   (a)  A health care academic with a background in economics, law, or public health.
   (b)  An executive of a carrier.
   (c)  A health benefits manager of a company.
   (d)  A health care analyst representing a public or private employee bargaining unit.
   (e)  A health care analyst representing an organized consumer group.
   (f)  A health care provider.
   (g)  An insurance agent.
   (2)  The following persons who are ex officio, nonvoting members of the board:
   (a)  The commissioner of insurance, or a designee.
   (b)  The Iowa Medicaid director, or a designee.
   (c)  Four members of the general assembly, one appointed by the speaker of the house of representatives, one appointed by the minority leader of the house of representatives, one appointed by the majority leader of the senate, and one appointed by the minority leader of the senate.
   d.  Each member of the board appointed by the governor shall be a resident of this state and the composition of voting members of the board shall be in compliance with sections 69.16, 69.16A, and 69.16C.
   e.  The voting members of the board shall be appointed for terms of six years beginning and ending as provided in section 69.19. A member of the board is eligible for reappointment. The governor shall fill a vacancy for the remainder of the unexpired term. A member of the board may be removed by the governor for misfeasance, malfeasance, or willful neglect of duty or other cause after notice and a public hearing unless the notice and hearing are waived by the member in writing.
   f.  The voting members of the board shall annually elect one of the members as chairperson and one as vice chairperson.
   g.  A majority of the voting members of the board constitutes a quorum. The affirmative vote of a majority of the voting members is necessary for any action taken by the board. The majority shall not include a member who has a conflict of interest and a statement by a member of a conflict of interest is conclusive for this purpose. A vacancy in the voting membership of the board does not impair the right of a quorum to exercise the rights and perform the duties of the board. An action taken by the board under this section may be authorized by resolution at a regular or special meeting and each resolution may take effect immediately and need not be published or posted. Meetings of the board shall be held at the call of the chairperson or at the request of a majority of the voting members.
   h.  Members of the board may be reimbursed from the moneys of the exchange for expenses incurred by them as members, but shall not be otherwise compensated by the exchange for their services.
   i.  The members of the board are subject to and are officials within the meaning of chapter 68B.
   j.  The board shall consult with and provide recommendations to assist the commissioner in carrying out the powers and duties of the exchange set forth in subsection 5.
   k.  The commissioner shall provide administrative and technical support to the board in carrying out its duties under this section.
   4.  Plan of operation.
   a.  The commissioner, in consultation with the board, shall establish a plan of operation for the exchange that assures the fair, reasonable, and equitable administration of the exchange, within ninety days after the appointment of the board. In addition to other requirements, the plan of operation shall provide for all of the following:
   (1)  The handling and accounting of assets and moneys of the exchange.
   (2)  The amount and method of reimbursing expenses of the members of the board.
   (3)  Regular times and places for meetings of the board.
   (4)  Records to be kept of all financial transactions, and an annual fiscal report of the costs of administering the exchange to be delivered to the general assembly by December 15 of each year.
   (5)  The periodic advertising of the general availability of health coverage information and assistance from the exchange.
   (6)  Additional provisions necessary or proper for the execution of the powers and duties of the exchange.
   b.  The exchange has the general powers and authority enumerated by this subsection and pursuant to subsection 5 and executed in accordance with the plan of operation established by the commissioner under paragraph “a”.
   c.  The exchange shall develop and implement the plan of operation and corresponding timeline detailing action steps toward implementing this section, by rules adopted pursuant to chapter 17A as provided in subsection 6.
   5.  Powers and duties of exchange.
   a.  The exchange shall develop a system that provides a portal where uninsured Iowans can receive assistance in how to obtain public or private health care coverage. The department of human services shall determine the eligibility of uninsured Iowans for public programs and provide assistance with enrollment in the appropriate public programs. The exchange shall provide assistance with how to obtain private health insurance coverage that meets certain standards of quality and affordability to uninsured Iowans who are not eligible for or do not wish to enroll in public programs. The exchange, in consultation with the department of human services and the board, shall develop a methodology to create a seamless system that allows individuals to move between public and private health care coverage, including increasing opportunities for obtaining creditable coverage.
   b.  The exchange shall establish three categories of benefits including basic or catastrophic benefits, an intermediate level of benefits, and comprehensive benefits coverage, that meet affordability limits established pursuant to 2009 Iowa Acts ch. 118, section 1, subsection 4, paragraph “c”.
   c.  (1)  The exchange shall establish an information clearinghouse to provide information to all Iowans about all public and private health care coverage that is available in the state including comparisons of benefits, premiums, and out-of-pocket costs.
   (2)  The exchange may establish standards to provide uniform and consistent information about the health care coverage options offered by each carrier and public program that includes but is not limited to what benefits are covered and not covered, the amount of coverage for each service, including copays and deductibles, and any prior authorization requirements for coverage.
   (3)  The exchange may require each carrier, organized delivery system, and public program to categorize and describe the category of benefits to which each health care coverage option offered by a carrier, organized delivery system, or public program belongs as set forth in paragraph “b”.
   (4)  The exchange shall provide ongoing information to taxpayers about the costs of public health care programs to the state, including the percentage and source of state and federal funding for the programs.
   (5)  The exchange may provide counseling to assist Iowans with making an informed choice when selecting health care coverage.
   d.  The exchange shall encourage or develop the use of common definitions for quality of care and pricing of health care services and develop and implement methodologies that provide quality and cost data on health care services and health care coverage offered in the state that is meaningful to consumers, patients, and purchasers.
   e.  The commissioner may hire independent consultants, as deemed necessary, to assist in carrying out the powers and duties of the exchange.
   f.  The exchange shall collaborate with, including but not limited to the board, the department of human services, the department of public health, health care providers, members of an organized consumer-purchaser group, members of the Iowa collaborative safety net provider network, and carriers to carry out the duties of the exchange including dissemination of information about the services offered by the exchange to the public.
   6.  Rules.  The commissioner shall adopt rules pursuant to chapter 17A to implement the provisions of this section.
   7.  Iowa insurance information exchange fund created.
   a.  An Iowa insurance information exchange fund is created in the state treasury as a separate fund under the control of the exchange. All moneys appropriated or transferred to the fund shall be credited to the fund. All moneys deposited or paid into the fund shall only be appropriated to the exchange to be used for the purposes set forth in this section.
   b.  Notwithstanding section 8.33, any balance in the fund on June 30 of each fiscal year shall not revert to the general fund of the state, but shall be available for purposes of this section in subsequent fiscal years. Notwithstanding section 12C.7, interest earnings on moneys in the fund shall be credited to the fund.
    Sec. 9.  INITIAL MEMBERS OF ADVISORY BOARD OF THE IOWA INSURANCE INFORMATION EXCHANGE.  The initial voting members of the advisory board of the Iowa insurance information exchange shall be appointed within thirty days after the effective date of this division of this Act.