Senate File 389 - Reprinted
SENATE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO SF 48)
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to health care, health care providers, and health
2 care coverage, providing penalties, and providing retroactive
3 and other effective dates.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
5 TLSB 1747SV 83
6 pf/rj/14
PAG LIN
1 1 DIVISION I
1 2 IOWA CHOICE INSURANCE EXCHANGE
1 3 Section 1. NEW SECTION. 514M.1 SHORT TITLE.
1 4 This chapter shall be known and may be cited as the "Iowa
1 5 Choice Insurance Exchange Act".
1 6 Sec. 2. NEW SECTION. 514M.2 PURPOSE.
1 7 It is the purpose of this chapter to:
1 8 1. Ensure that all children in the state who are not
1 9 eligible for public programs have affordable, quality health
1 10 care coverage with the following priorities:
1 11 a. As funding becomes available, provide subsidized
1 12 coverage which meets certain standards of quality and
1 13 affordability to the remaining uninsured children less than
1 14 nineteen years of age under a sliding scale based on family
1 15 income.
1 16 b. Move towards a future requirement that all parents of
1 17 children must provide proof of qualified health care coverage
1 18 for their children which meets certain standards of quality
1 19 and affordability.
1 20 2. Ensure that all Iowans have qualified health care
1 21 coverage which meets certain standards of quality and
1 22 affordability with the following priorities:
1 23 a. Continue to expand options for individuals who are
1 24 dually eligible for Medicare and Medicaid, typically the
1 25 chronically disabled, by utilizing evidence=based medical
1 26 treatments.
1 27 b. Ensure that all health and long=term care workers have
1 28 qualified health care coverage which meets certain standards
1 29 of quality and affordability.
1 30 c. Maximize eligibility of low=income adults nineteen
1 31 years of age and older for public health care coverage.
1 32 d. As funding becomes available, provide subsidized
1 33 coverage which meets certain standards of quality and
1 34 affordability to the remaining low=income adults.
1 35 e. Move towards a future requirement that all Iowans must
2 1 provide proof of qualified health care coverage which meets
2 2 certain standards of quality and affordability.
2 3 3. Decrease health care costs and health care coverage
2 4 costs by:
2 5 a. Instituting insurance reforms that assure the
2 6 availability of private insurance coverage for all Iowans by
2 7 addressing issues involving guaranteed availability and issue
2 8 of insurance to applicants; preexisting condition exclusions;
2 9 portability; and allowable or required pooling and rating
2 10 classifications.
2 11 b. Requiring every child who has public health care
2 12 coverage or is insured by a plan created by the Iowa health
2 13 care coverage exchange to have a medical home as defined in
2 14 section 135.157.
2 15 4. Develop a program to offer health care coverage under
2 16 the state health or medical group insurance plan to nonstate
2 17 public employees, including employees of counties, cities,
2 18 schools, and community colleges, and employees of nonprofit
2 19 employers and small employers and to pool such employees with
2 20 the state plan.
2 21 Sec. 3. NEW SECTION. 514M.3 DEFINITIONS.
2 22 As used in this chapter, unless the context otherwise
2 23 requires:
2 24 1. "Board" means the board of directors of the Iowa choice
2 25 insurance exchange.
2 26 2. "Carrier" means an insurer providing accident and
2 27 sickness insurance under chapter 509, 514, or 514A and
2 28 includes a health maintenance organization established under
2 29 chapter 514B if payments received by the health maintenance
2 30 organization are considered premiums pursuant to section
2 31 514B.31 and are taxed under chapter 432. "Carrier" also
2 32 includes a corporation which becomes a mutual insurer pursuant
2 33 to section 514.23 and any other person as defined in section
2 34 4.1, subsection 20, who is or may become liable for the tax
2 35 imposed by chapter 432.
3 1 3. "Commissioner" means the commissioner of insurance.
3 2 4. "Creditable coverage" means health benefits or coverage
3 3 provided to an individual under any of the following:
3 4 a. A group health plan.
3 5 b. Health insurance coverage.
3 6 c. Part A or part B Medicare pursuant to Title XVIII of
3 7 the federal Social Security Act.
3 8 d. Medicaid pursuant to Title XIX of the federal Social
3 9 Security Act, other than coverage consisting solely of
3 10 benefits under section 1928 of that Act.
3 11 e. 10 U.S.C. ch. 55.
3 12 f. A health or medical care program provided through the
3 13 Indian health service or a tribal organization.
3 14 g. A state health benefits risk pool.
3 15 h. A health plan offered under 5 U.S.C. ch. 89.
3 16 i. A public health plan as defined under federal
3 17 regulations.
3 18 j. A health benefit plan under section 5(e) of the federal
3 19 Peace Corps Act, 22 U.S.C. } 2504(e).
3 20 k. An organized delivery system licensed by the director
3 21 of public health.
3 22 l. The hawk=i program authorized by chapter 514I.
3 23 5. "Director" means the director of revenue.
3 24 6. "Exchange" means the Iowa choice insurance exchange.
3 25 7. "Executive director" means the executive director of
3 26 the Iowa choice insurance exchange.
3 27 8. "Federal poverty level" means the most recently revised
3 28 income guidelines published by the United States department of
3 29 health and human services.
3 30 9. a. "Group health plan" means an employee welfare
3 31 benefit plan as defined in section 3(1) of the federal
3 32 Employee Retirement Income Security Act of 1974, to the extent
3 33 that the plan provides medical care including items and
3 34 services paid for as medical care to employees or their
3 35 dependents as defined under the terms of the plan directly or
4 1 through insurance, reimbursement, or otherwise.
4 2 b. For purposes of this subsection, "medical care" means
4 3 amounts paid for any of the following:
4 4 (1) The diagnosis, cure, mitigation, treatment, or
4 5 prevention of disease, or amounts paid for the purpose of
4 6 affecting a structure or function of the body.
4 7 (2) Transportation primarily for and essential to medical
4 8 care referred to in subparagraph (1).
4 9 (3) Insurance covering medical care referred to in
4 10 subparagraph (1) or (2).
4 11 c. For purposes of this subsection, the following apply:
4 12 (1) A plan, fund, or program established or maintained by
4 13 a partnership which, but for this subsection, would not be an
4 14 employee welfare benefit plan, shall be treated as an employee
4 15 welfare benefit plan which is a group health plan to the
4 16 extent that the plan, fund, or program provides medical care,
4 17 including items and services paid for as medical care for
4 18 present or former partners in the partnership or to the
4 19 dependents of such partners, as defined under the terms of the
4 20 plan, fund, or program, either directly or through insurance,
4 21 reimbursement, or otherwise.
4 22 (2) With respect to a group health plan, the term
4 23 "employer" includes a partnership with respect to a partner.
4 24 (3) With respect to a group health plan, the term
4 25 "participant" includes the following:
4 26 (a) With respect to a group health plan maintained by a
4 27 partnership, an individual who is a partner in the
4 28 partnership.
4 29 (b) With respect to a group health plan maintained by a
4 30 self=employed individual under which one or more of the
4 31 self=employed individual's employees are participants, the
4 32 self=employed individual, if that individual is, or may
4 33 become, eligible to receive benefits under the plan or the
4 34 individual's dependents may be eligible to receive benefits
4 35 under the plan.
5 1 10. "Health care services" means services, the coverage of
5 2 which is authorized under chapter 509, 514, 514A, or 514B as
5 3 limited by benefit plans established by the exchange's board
5 4 of directors, with the approval of the commissioner and
5 5 includes services for the purposes of preventing, alleviating,
5 6 curing, or healing human illness, injury, or physical
5 7 disability.
5 8 11. "Health insurance" means accident and sickness
5 9 insurance authorized by chapter 509, 514, or 514A.
5 10 12. a. "Health insurance coverage" means health insurance
5 11 coverage offered to individuals, including group conversion
5 12 coverage.
5 13 b. "Health insurance coverage" does not include any of the
5 14 following:
5 15 (1) Coverage for accident=only or disability income
5 16 insurance.
5 17 (2) Coverage issued as a supplement to liability
5 18 insurance.
5 19 (3) Liability insurance, including general liability
5 20 insurance and automobile liability insurance.
5 21 (4) Workers' compensation or similar insurance.
5 22 (5) Automobile medical=payment insurance.
5 23 (6) Credit=only insurance.
5 24 (7) Coverage for on=site medical clinic care.
5 25 (8) Other similar insurance coverage, specified in federal
5 26 regulations, under which benefits for medical care are
5 27 secondary or incidental to other insurance coverage or
5 28 benefits.
5 29 c. "Health insurance coverage" does not include benefits
5 30 provided under a separate policy as follows:
5 31 (1) Limited=scope dental or vision benefits.
5 32 (2) Benefits for long=term care, nursing home care, home
5 33 health care, or community=based care.
5 34 (3) Any other similar limited benefits as provided by rule
5 35 of the commissioner.
6 1 d. "Health insurance coverage" does not include benefits
6 2 offered as independent noncoordinated benefits as follows:
6 3 (1) Coverage only for a specified disease or illness.
6 4 (2) A hospital indemnity or other fixed indemnity
6 5 insurance.
6 6 e. "Health insurance coverage" does not include Medicare
6 7 supplemental health insurance as defined under section
6 8 1882(g)(1) of the federal Social Security Act, coverage
6 9 supplemental to the coverage provided under 10 U.S.C. ch. 55
6 10 and similar supplemental coverage provided to coverage under
6 11 group health insurance coverage.
6 12 13. "Insured" means an individual who is provided
6 13 qualified health care coverage under a policy, which policy
6 14 may include dependents and other covered persons.
6 15 14. "Medical assistance program" means the federal=state
6 16 assistance program established under Title XIX of the federal
6 17 Social Security Act and chapter 249A.
6 18 15. "Medicare" means the federal government health
6 19 insurance program established under Title XVIII of the federal
6 20 Social Security Act.
6 21 16. "Organized delivery system" means an organized
6 22 delivery system as licensed by the director of public health.
6 23 17. "Policy" means a contract, policy, or plan of health
6 24 insurance.
6 25 18. "Policy year" means a consecutive twelve=month period
6 26 during which a policy provides or obligates the carrier to
6 27 provide health insurance.
6 28 19. "Qualified health care coverage" means creditable
6 29 coverage which meets minimum standards of quality and
6 30 affordability as determined by the board by rule.
6 31 20. "Resident" means a person who is a resident of this
6 32 state for state income tax purposes.
6 33 Sec. 4. NEW SECTION. 514M.4 IOWA CHOICE INSURANCE
6 34 EXCHANGE CREATED == BOARD OF DIRECTORS.
6 35 1. The Iowa choice insurance exchange is created as a
7 1 nonprofit corporation under the purview of the insurance
7 2 division of the department of commerce.
7 3 a. All carriers and all organized delivery systems
7 4 licensed by the director of public health providing health
7 5 insurance or health care services in Iowa, whether on an
7 6 individual or group basis, and all other insurers designated
7 7 by the exchange's board of directors and approved by the
7 8 commissioner shall be members of the exchange.
7 9 b. The exchange shall operate under a plan of operation
7 10 established and approved under section 514M.5 and shall
7 11 exercise its powers through a board of directors established
7 12 under this section.
7 13 2. The board of directors of the exchange shall consist of
7 14 the following members:
7 15 a. Persons who are voting members of the board appointed
7 16 by the governor and subject to confirmation by the senate:
7 17 (1) A practicing physician licensed to practice medicine
7 18 and surgery or osteopathic medicine and surgery.
7 19 (2) A practicing nurse licensed as a registered nurse or a
7 20 licensed practical nurse or vocational nurse.
7 21 (3) A representative of the federation of Iowa insurers.
7 22 (4) A health economist who resides in Iowa.
7 23 (5) A health benefit manager.
7 24 (6) A consumer who is a representative of a children's
7 25 advocacy organization.
7 26 (7) A consumer who is a representative of the state's
7 27 adult uninsured population.
7 28 (8) A consumer who is a member of a racial or ethnic
7 29 minority group.
7 30 (9) A representative of organized labor.
7 31 (10) A representative of an organization of small
7 32 businesses.
7 33 (11) A representative of the alliance of nonprofit
7 34 agencies.
7 35 b. Persons who are ex officio, nonvoting members of the
8 1 board:
8 2 (1) The commissioner of insurance, or a designee.
8 3 (2) The director of human services, or a designee.
8 4 (3) The director of public health, or a designee.
8 5 (4) The director of the department of administrative
8 6 services, or a designee.
8 7 (5) Four members of the general assembly, one appointed by
8 8 the speaker of the house of representatives, one appointed by
8 9 the minority leader of the house of representatives, one
8 10 appointed by the majority leader of the senate, and one
8 11 appointed by the minority leader of the senate.
8 12 c. Each member of the board appointed by the governor
8 13 shall be a resident of this state and the composition of
8 14 voting members of the board shall be in compliance with
8 15 sections 69.16, 69.16A, and 69.16C.
8 16 d. The voting members of the board shall be appointed for
8 17 terms of six years within thirty days after the effective date
8 18 of this division of this Act and by December 15 of each year
8 19 thereafter. A member of the board is eligible for
8 20 reappointment. The governor shall fill a vacancy for the
8 21 remainder of the unexpired term. A member of the board may be
8 22 removed by the governor for misfeasance, malfeasance, or
8 23 willful neglect of duty or other cause after notice and a
8 24 public hearing unless the notice and hearing are waived by the
8 25 member in writing.
8 26 e. The voting members of the board shall annually elect
8 27 one of the members as chairperson and one as vice chairperson.
8 28 f. A majority of the voting members of the board
8 29 constitutes a quorum. The affirmative vote of a majority of
8 30 the voting members is necessary for any action taken by the
8 31 board. The majority shall not include a member who has a
8 32 conflict of interest and a statement by a member of a conflict
8 33 of interest is conclusive for this purpose. A vacancy in the
8 34 voting membership of the board does not impair the right of a
8 35 quorum to exercise the rights and perform the duties of the
9 1 board. An action taken by the board under this chapter may be
9 2 authorized by resolution at a regular or special meeting and
9 3 each resolution shall take effect immediately and need not be
9 4 published or posted. Meetings of the board shall be held at
9 5 the call of the chairperson or at the request of a majority of
9 6 the voting members.
9 7 g. Members of the board may be reimbursed from the moneys
9 8 of the exchange for expenses incurred by them as members, but
9 9 shall not be otherwise compensated by the exchange for their
9 10 services.
9 11 h. The voting members of the board shall give bond as
9 12 required for public officers in chapter 64.
9 13 i. The members of the board are subject to and are
9 14 officials within the meaning of chapter 68B.
9 15 j. All employees of the exchange are exempt from chapter
9 16 8A, subchapter IV, and chapter 97B.
9 17 3. The voting members of the board shall appoint an
9 18 executive director to supervise the administrative affairs and
9 19 general management and operations of the exchange. The
9 20 executive director shall not be a member of the board, shall
9 21 serve at the pleasure of the board, and shall receive
9 22 compensation as fixed by the board. The executive director of
9 23 the board shall keep a record of the proceedings of the board
9 24 and shall be custodian of all books, documents, and papers
9 25 filed with the board, the minute book or journal of the board,
9 26 and the official seal of the board. The executive director
9 27 may cause copies to be made of minutes and other records and
9 28 documents of the board and may give certificates under the
9 29 official seal of the board that the copies are true copies,
9 30 and persons dealing with the board may rely upon the
9 31 certificates.
9 32 4. The exchange shall be considered a governmental body
9 33 for the purposes of chapter 21 and a government body for the
9 34 purposes of chapter 22.
9 35 5. The voting members of the board may hire independent
10 1 consultants, as they deem necessary, to assist them in
10 2 carrying out the provisions of this chapter.
10 3 Sec. 5. NEW SECTION. 514M.5 PLAN OF OPERATION ==
10 4 ASSESSMENTS.
10 5 1. The exchange shall be organized as a nonprofit
10 6 corporation and shall submit to the commissioner a plan of
10 7 operation for the exchange and any amendments necessary or
10 8 suitable to assure the fair, reasonable, and equitable
10 9 administration of the exchange within ninety days after the
10 10 appointment of the board of directors. The plan of operation
10 11 shall include provisions for the development of a
10 12 comprehensive health care coverage plan as provided in section
10 13 514M.6. After notice and hearing, the commissioner shall
10 14 approve the plan of operation if the plan is determined to be
10 15 suitable to assure the fair, reasonable, and equitable
10 16 administration of the exchange, and provides for the sharing
10 17 of exchange losses, if any, on an equitable and proportionate
10 18 basis among the member carriers. In addition to other
10 19 requirements, the plan of operation shall provide for all of
10 20 the following:
10 21 a. The handling and accounting of assets and moneys of the
10 22 exchange.
10 23 b. The amount and method of reimbursing members of the
10 24 board.
10 25 c. Regular times and places for meetings of the board.
10 26 d. Records to be kept of all financial transactions, and
10 27 the annual fiscal reporting to the commissioner.
10 28 e. The periodic advertising of the general availability of
10 29 health insurance coverage from the exchange.
10 30 f. Additional provisions necessary or proper for the
10 31 execution of the powers and duties of the exchange.
10 32 2. The exchange has the general powers and authority
10 33 enumerated by this section and executed in accordance with the
10 34 plan of operation approved by the commissioner under
10 35 subsection 1. The exchange has the general powers and
11 1 authority granted under the laws of this state to carriers
11 2 licensed to issue health insurance coverage.
11 3 3. Following the close of each calendar year, the exchange
11 4 shall determine the net premiums and payments, the expenses of
11 5 administration, and the incurred losses of the exchange for
11 6 the year. The exchange shall certify the amount of any net
11 7 loss for the preceding calendar year to the commissioner and
11 8 director of revenue. Any loss shall be assessed by the
11 9 exchange to all members of the exchange in proportion to their
11 10 respective shares of total health insurance premiums or
11 11 payments for subscriber contracts received in Iowa during the
11 12 second preceding calendar year, or with paid losses in the
11 13 year, coinciding with or ending during the calendar year or on
11 14 any other equitable basis as provided in the plan of
11 15 operation. In sharing losses, the exchange may abate or defer
11 16 in any part the assessment of a member, if, in the opinion of
11 17 the board, payment of the assessment would endanger the
11 18 ability of the member to fulfill its contractual obligations.
11 19 The exchange may also provide for an initial or interim
11 20 assessment against members of the exchange if necessary to
11 21 assure the financial capability of the exchange to meet the
11 22 incurred or estimated claims expenses or operating expenses of
11 23 the exchange until the next calendar year is completed. Net
11 24 gains, if any, must be held at interest to offset future
11 25 losses or allocated to reduce future premiums.
11 26 a. For purposes of this subsection, "total health
11 27 insurance premiums" and "payments for subscriber contracts"
11 28 include, without limitation, premiums or other amounts paid to
11 29 or received by a member for individual and group health plan
11 30 coverage provided under any chapter of the Code or Acts, and
11 31 "paid losses" includes, without limitation, claims paid by a
11 32 member operating on a self=funded basis for individual and
11 33 group health plan coverage provided under any chapter of the
11 34 Code or Acts.
11 35 b. For purposes of calculating and conducting the
12 1 assessment under this subsection, the exchange shall have the
12 2 express authority to require members to report on an annual
12 3 basis each member's total health insurance premiums and
12 4 payments for subscriber contracts and paid losses. A member
12 5 is liable for its share of the assessment calculated in
12 6 accordance with this section regardless of whether it
12 7 participates in the individual insurance market.
12 8 4. The exchange shall conduct annual audits to assure the
12 9 general accuracy of the financial data submitted to the
12 10 exchange, and the exchange shall have an annual audit of its
12 11 operations, made by an independent certified public
12 12 accountant.
12 13 5. The exchange is subject to examination by the
12 14 commissioner. Not later than April 30 of each year, the board
12 15 shall submit to the commissioner a financial report for the
12 16 preceding calendar year in a form approved by the
12 17 commissioner.
12 18 6. The exchange is subject to oversight by the legislative
12 19 fiscal committee of the legislative council. Not later than
12 20 April 30 of each year, the board shall submit to the governor,
12 21 the speaker of the house of representatives, the majority
12 22 leader of the senate, and the legislative fiscal committee a
12 23 financial report, including enrollment information, for the
12 24 preceding year in a form approved by the committee.
12 25 7. All policy forms issued by the exchange must be filed
12 26 with and approved by the commissioner before their use.
12 27 8. The exchange is exempt from payment of all fees and all
12 28 taxes levied by this state or any of its political
12 29 subdivisions.
12 30 9. The exchange shall develop and implement a plan of
12 31 operation and corresponding timeline detailing action steps
12 32 toward implementing this chapter, by rules adopted pursuant to
12 33 chapter 17A as provided in section 514M.7.
12 34 Sec. 6. NEW SECTION. 514M.6 IOWA CHOICE INSURANCE
12 35 EXCHANGE COMPREHENSIVE HEALTH CARE COVERAGE PLAN.
13 1 1. The exchange, in collaboration with the Iowa Medicaid
13 2 enterprise and the hawk=i board, shall develop a comprehensive
13 3 health care coverage plan to provide health care coverage to
13 4 all children without such coverage, that utilizes and modifies
13 5 existing public programs including the medical assistance
13 6 program and hawk=i program and maximizes the ability of the
13 7 state to obtain federal funding and reimbursement for such
13 8 programs. The comprehensive health care coverage plan shall
13 9 provide for the coordination of a children's health care
13 10 network in the state that acts as a resource for consumers to
13 11 transition seamlessly among public and private health care
13 12 coverage options, including but not limited to medical
13 13 assistance, hawk=i, and Iowa choice care programs. The plan
13 14 shall also provide access to private unsubsidized, affordable,
13 15 qualified health care coverage to children who are not
13 16 otherwise eligible for health care coverage through public
13 17 programs.
13 18 2. The comprehensive health care coverage plan developed
13 19 by the exchange shall also consider and recommend options to
13 20 provide access to private, affordable, qualified health care
13 21 coverage to all Iowa children less than nineteen years of age
13 22 with a family income that is more than three hundred percent
13 23 of the federal poverty level and to adults and families with a
13 24 family income that is up to four hundred percent of the
13 25 federal poverty level who are not otherwise eligible for
13 26 health care coverage through public programs. As part of the
13 27 comprehensive plan, the exchange shall design and implement a
13 28 health care coverage program called Iowa choice which offers
13 29 private qualified health care coverage through the exchange
13 30 with options to purchase at least three levels of benefits
13 31 including a gold plan which offers a comprehensive benefits
13 32 package, a silver plan which offers a medium benefits package,
13 33 and a bronze plan which offers a basic benefits package. The
13 34 Iowa choice care plans shall be available for purchase by
13 35 individuals and families. The purchase of Iowa choice health
14 1 care coverage may be publicly subsidized for low=income
14 2 individuals and families who do not meet eligibility
14 3 guidelines for any other public program. The subsidy program
14 4 may include subsidizing an employee's purchase of health
14 5 insurance offered by that person's employer.
14 6 3. The comprehensive health care coverage plan developed
14 7 by the exchange shall also consider and recommend options to
14 8 offer a program to provide coverage under the state health or
14 9 medical group insurance plan to nonstate public employees,
14 10 including employees of counties, cities, schools, and
14 11 community colleges, and employees of nonprofit employers and
14 12 small employers and to pool such employees with the state
14 13 plan. The program developed shall allow employees and
14 14 officials of such employers who apply for coverage to be
14 15 covered under the state plan under the same conditions that
14 16 state employees are covered under the state plan and not be
14 17 denied coverage on the basis of risk, cost, preexisting
14 18 conditions, or other factors not applicable to state
14 19 employees. The plan may include options for the coverage of
14 20 such employees and officials under the state plan that include
14 21 but are not limited to the following:
14 22 a. Criteria for participation in and withdrawal from the
14 23 program.
14 24 b. Minimum participation intervals.
14 25 c. Collaboration with the department of administrative
14 26 services to develop coverage options for coverage from vendors
14 27 other than those providing coverage to state employees and
14 28 under plans different from those available to state employees,
14 29 that meet minimum standards of quality and affordability.
14 30 d. Application and enrollment procedures.
14 31 e. Premium rates and procedures for the payment of
14 32 premiums by participants.
14 33 4. The exchange shall have broad authority to accomplish
14 34 the purposes of this chapter, including but not limited to:
14 35 a. Establishing, by rule, what constitutes qualified
15 1 health care coverage within parameters set by statute which
15 2 may include consideration of the following factors:
15 3 (1) Setting parameters for what is affordable by creating
15 4 an affordability schedule that is conservative to prevent harm
15 5 to people who are struggling financially and that utilizes a
15 6 progressive scale of subsidization by the state that decreases
15 7 as incomes increase and requires people with very low incomes
15 8 to pay only small amounts for health care coverage with no
15 9 financial penalties.
15 10 (2) Setting the maximum limit for affordability of
15 11 coverage at approximately six and one=half percent of an
15 12 individual's or family's income, including consideration of
15 13 assets held.
15 14 b. Establishing what constitutes qualified health care
15 15 coverage which meets certain standards of quality and
15 16 affordability. For purposes of defining qualified health care
15 17 coverage, the board may consider requirements for coverage and
15 18 benefits that include but are not limited to:
15 19 (1) No underwriting requirements and no preexisting
15 20 condition exclusions.
15 21 (2) Portability.
15 22 (3) Coverage of physical, behavioral, and dental health
15 23 services, vision services, and prescription drugs.
15 24 (4) Copayments and deductibles that do not exceed
15 25 specified amounts, with no copayments or deductibles for
15 26 wellness, prevention, disease, and chronic care management
15 27 services.
15 28 (5) No reimbursement of providers for an otherwise covered
15 29 service if the service is required solely on account of the
15 30 provider's avoidable medical error.
15 31 (6) A requirement that all insureds have a medical home.
15 32 (7) Coverage of wellness, prevention, disease management,
15 33 and chronic care management services including, without
15 34 limitation, physical and psycho=social screenings for children
15 35 which satisfy the Medicaid early periodic screening,
16 1 diagnosis, and treatment standards.
16 2 (8) Coverage of emergency mental health services when
16 3 provided by a state=certified emergency mental health services
16 4 provider.
16 5 (9) Incentives for participating health care providers
16 6 who:
16 7 (a) Utilize electronic prescriptions.
16 8 (b) Utilize electronic medical records.
16 9 (c) Provide rate schedules to the board of all services
16 10 provided.
16 11 c. Establishing threshold requirements for a future
16 12 mandate to provide health care coverage that must be met by
16 13 parents of children less than nineteen years of age with
16 14 family incomes greater than three hundred percent of the
16 15 federal poverty level.
16 16 d. Establishing criteria for determining each applicant's
16 17 eligibility to purchase health insurance offered by the
16 18 exchange, including eligibility for premium assistance
16 19 payments.
16 20 e. Collaborating with carriers to do the following,
16 21 including but not limited to:
16 22 (1) Assuring the availability of private health insurance
16 23 coverage to all Iowans by designing solutions to issues
16 24 related to guaranteed issuance of insurance, preexisting
16 25 condition exclusions, portability, and allowable pooling and
16 26 rating classifications.
16 27 (2) Formulating principles that ensure fair and
16 28 appropriate practices related to issues involving individual
16 29 health insurance policies such as recision and preexisting
16 30 condition clauses, and that provide for a binding third=party
16 31 review process to resolve disputes related to such issues.
16 32 (3) Designing affordable, portable health insurance plans
16 33 that meet the needs of low=income populations.
16 34 5. The exchange shall conduct a study of pharmacy benefits
16 35 managers in the state to review all of the following:
17 1 a. Transparency and disclosure arrangements between
17 2 pharmacy benefits managers and covered entities.
17 3 b. Confidentiality protections for information disclosed
17 4 to covered entities and remedies for unauthorized disclosure.
17 5 c. The ability of covered entities to audit pharmacy
17 6 benefits managers.
17 7 d. Appropriate remedies for covered entities to enforce a
17 8 provision of or for a violation of a provision of chapter
17 9 510B.
17 10 6. The exchange shall make recommendations for uniform
17 11 insurance applications, uniform billing and coding procedures
17 12 in Iowa choice plans, and other standardized administrative
17 13 procedures that make the purchase of insurance easier and
17 14 lower administrative costs for all health insurance that is
17 15 sold in the state.
17 16 7. The exchange shall study the ramifications of requiring
17 17 each employer with more than ten employees in the state to
17 18 adopt and maintain a cafeteria plan that satisfies section 125
17 19 of the federal Internal Revenue Code of 1986, and the rules
17 20 adopted by the exchange.
17 21 8. The exchange shall operate a health insurance service
17 22 center that collects and distributes information to consumers
17 23 about all health insurance policies, contracts, and plans
17 24 available in the state and provides information to eligible
17 25 Iowans about the exchange.
17 26 9. The exchange shall establish criteria for insurance
17 27 producers licensed under chapter 522B to sell private health
17 28 care coverage offered through the exchange, including the
17 29 amount of commission which may be earned for sales of such
17 30 coverage.
17 31 10. The exchange shall provide for an exemption from any
17 32 health benefit coverage requirements of this chapter that
17 33 conflict with a person's genuine and sincerely held religious
17 34 belief.
17 35 Sec. 7. NEW SECTION. 514M.7 RULES.
18 1 The commissioner and the board shall adopt rules pursuant
18 2 to chapter 17A, to implement the provisions of this chapter.
18 3 Sec. 8. NEW SECTION. 514M.8 IOWA CHOICE INSURANCE
18 4 EXCHANGE FUND ESTABLISHED.
18 5 1. The Iowa choice insurance exchange fund is created in
18 6 the state treasury as a separate fund under the control of the
18 7 exchange. There shall be credited to the fund all moneys
18 8 collected from premiums paid for health care plans offered by
18 9 the exchange, and any other funds that are appropriated or
18 10 transferred to the fund. All moneys deposited or paid into
18 11 the fund shall only be appropriated to the exchange to be used
18 12 for the purposes set forth in this chapter.
18 13 2. Notwithstanding section 8.33, any balance in the fund
18 14 on June 30 of each fiscal year shall not revert to the general
18 15 fund of the state, but shall be available for purposes of this
18 16 chapter in subsequent fiscal years.
18 17 Sec. 9. NEW SECTION. 514M.9 COLLECTIVE ACTION ==
18 18 IMMUNITY.
18 19 Neither the participation by carriers or members in the
18 20 exchange, the establishment of rates, forms, or procedures for
18 21 coverage issued by the exchange, nor any joint or collective
18 22 action required by this chapter shall be the basis of any
18 23 legal civil action, or criminal liability against the exchange
18 24 or members of it either jointly or separately.
18 25 Sec. 10. NEW SECTION. 514M.10 COMPREHENSIVE HEALTH CARE
18 26 COVERAGE PLAN == IMPLEMENTATION.
18 27 1. The comprehensive health care coverage plan developed
18 28 by the exchange pursuant to section 514M.6 shall be provided
18 29 to the commissioner for review and recommendations and shall
18 30 then be forwarded along with such recommendations to the
18 31 general assembly no later than February 15, 2010.
18 32 2. The comprehensive health care coverage plan shall
18 33 become effective upon approval by the general assembly.
18 34 3. Upon approval by the general assembly, the
18 35 comprehensive health care coverage plan shall be implemented
19 1 by the board by rules adopted pursuant to chapter 17A. The
19 2 administrative rules review committee shall provide oversight
19 3 of the rules through the administrative rulemaking process.
19 4 COORDINATING AMENDMENTS
19 5 Sec. 11. Section 21.2, subsection 1, Code 2009, is amended
19 6 by adding the following new paragraph:
19 7 NEW PARAGRAPH. i. A nonprofit corporation established
19 8 pursuant to chapter 514M.
19 9 Sec. 12. Section 22.1, subsection 1, Code 2009, is amended
19 10 to read as follows:
19 11 1. The term "government body" means this state, or any
19 12 county, city, township, school corporation, political
19 13 subdivision, tax=supported district, nonprofit corporation
19 14 other than a fair conducting a fair event as provided in
19 15 chapter 174, whose facilities or indebtedness are supported in
19 16 whole or in part with property tax revenue and which is
19 17 licensed to conduct pari=mutuel wagering pursuant to chapter
19 18 99D, nonprofit corporation established pursuant to chapter
19 19 514M, or other entity of this state, or any branch,
19 20 department, board, bureau, commission, council, committee,
19 21 official, or officer of any of the foregoing or any employee
19 22 delegated the responsibility for implementing the requirements
19 23 of this chapter.
19 24 Sec. 13. Section 514E.1, subsections 15 and 22, Code 2009,
19 25 are amended by striking the subsections.
19 26 Sec. 14. Section 514E.2, subsection 3, unnumbered
19 27 paragraph 1, Code 2009, is amended to read as follows:
19 28 The association shall submit to the commissioner a plan of
19 29 operation for the association and any amendments necessary or
19 30 suitable to assure the fair, reasonable, and equitable
19 31 administration of the association. The plan of operation
19 32 shall include provisions for the development of a
19 33 comprehensive health care coverage plan as provided in section
19 34 514E.5. In developing the comprehensive plan the association
19 35 shall give deference to the recommendations made by the
20 1 advisory council as provided in section 514E.6, subsection 1.
20 2 The association shall approve or disapprove but shall not
20 3 modify recommendations made by the advisory council.
20 4 Recommendations that are approved shall be included in the
20 5 plan of operation submitted to the commissioner.
20 6 Recommendations that are disapproved shall be submitted to the
20 7 commissioner with reasons for the disapproval. The plan of
20 8 operation becomes effective upon approval in writing by the
20 9 commissioner prior to the date on which the coverage under
20 10 this chapter must be made available. After notice and
20 11 hearing, the commissioner shall approve the plan of operation
20 12 if the plan is determined to be suitable to assure the fair,
20 13 reasonable, and equitable administration of the association,
20 14 and provides for the sharing of association losses, if any, on
20 15 an equitable and proportionate basis among the member
20 16 carriers. If the association fails to submit a suitable plan
20 17 of operation within one hundred eighty days after the
20 18 appointment of the board of directors, or if at any later time
20 19 the association fails to submit suitable amendments to the
20 20 plan, the commissioner shall adopt, pursuant to chapter 17A,
20 21 rules necessary to implement this section. The rules shall
20 22 continue in force until modified by the commissioner or
20 23 superseded by a plan submitted by the association and approved
20 24 by the commissioner. In addition to other requirements, the
20 25 plan of operation shall provide for all of the following:
20 26 Sec. 15. Sections 514E.5 and 514E.6, Code 2009, are
20 27 repealed.
20 28 Sec. 16. EFFECTIVE DATE. This division of this Act, being
20 29 deemed of immediate importance, takes effect upon enactment.
20 30 DIVISION II
20 31 HEALTH CARE COVERAGE OF ADULT CHILDREN
20 32 Sec. 17. Section 422.7, Code 2009, is amended by adding
20 33 the following new subsection:
20 34 NEW SUBSECTION. 29A. If the health benefits coverage or
20 35 insurance of the taxpayer includes coverage of a nonqualified
21 1 tax dependent as determined by the federal internal revenue
21 2 service, subtract, to the extent included, the amount of the
21 3 value of such coverage attributable to the nonqualified tax
21 4 dependent.
21 5 Sec. 18. Section 509.3, subsection 8, Code 2009, is
21 6 amended to read as follows:
21 7 8. A provision that the insurer will permit continuation
21 8 of existing coverage or reenrollment in previously existing
21 9 coverage for an individual who meets the requirements of
21 10 section 513B.2, subsection 14, paragraph "a", "b", "c", "d",
21 11 or "e", and who is an unmarried child of an insured or
21 12 enrollee who so elects, at least through the policy
21 13 anniversary date on or after the date the child marries,
21 14 ceases to be a resident of this state, or attains the age of
21 15 twenty=five years old, whichever occurs first, or so long as
21 16 the unmarried child maintains full=time status as a student in
21 17 an accredited institution of postsecondary education.
21 18 In addition to the provisions required in subsections 1
21 19 through 7, the commissioner shall require provisions through
21 20 the adoption of rules implementing the federal Health
21 21 Insurance Portability and Accountability Act, Pub. L. No.
21 22 104=191.
21 23 Sec. 19. Section 509A.13B, Code 2009, is amended to read
21 24 as follows:
21 25 509A.13B CONTINUATION OF DEPENDENT COVERAGE OF CHILDREN ==
21 26 CONTINUATION OR REENROLLMENT.
21 27 If a governing body, a county board of supervisors, or a
21 28 city council has procured accident or health care coverage for
21 29 its employees under this chapter such coverage shall permit
21 30 continuation of existing coverage or reenrollment in
21 31 previously existing coverage for an individual who meets the
21 32 requirements of section 513B.2, subsection 14, paragraph "a",
21 33 "b", "c", or "e", and who is an unmarried child of an insured
21 34 or enrollee who so elects, at least through the policy
21 35 anniversary date on or after the date the child marries,
22 1 ceases to be a resident of this state, or attains the age of
22 2 twenty=five years old, whichever occurs first, or so long as
22 3 the unmarried child maintains full=time status as a student in
22 4 an accredited institution of postsecondary education.
22 5 Sec. 20. Section 514A.3B, subsection 2, Code 2009, is
22 6 amended to read as follows:
22 7 2. An insurer issuing an individual policy or contract of
22 8 accident and health insurance which provides coverage for
22 9 children of the insured shall permit continuation of existing
22 10 coverage or reenrollment in previously existing coverage for
22 11 an individual who meets the requirements of section 513B.2,
22 12 subsection 14, paragraph "a", "b", "c", "d", or "e", and who
22 13 is an unmarried child of an insured or enrollee who so elects,
22 14 at least through the policy anniversary date on or after the
22 15 date the child marries, ceases to be a resident of this state,
22 16 or attains the age of twenty=five years old, whichever occurs
22 17 first, or so long as the unmarried child maintains full=time
22 18 status as a student in an accredited institution of
22 19 postsecondary education.
22 20 Sec. 21. NEW SECTION. 514B.9A COVERAGE OF CHILDREN ==
22 21 CONTINUATION OR REENROLLMENT.
22 22 A health maintenance organization which provides health
22 23 care coverage pursuant to an individual or group health
22 24 maintenance organization contract regulated under this chapter
22 25 for children of an enrollee shall permit continuation of
22 26 existing coverage or reenrollment in previously existing
22 27 coverage for an individual who meets the requirements of
22 28 section 513B.2, subsection 14, paragraph "a", "b", "c", "d",
22 29 or "e", and who is an unmarried child of an enrollee who so
22 30 elects, at least through the policy anniversary date on or
22 31 after the date the child marries, ceases to be a resident of
22 32 this state, or attains the age of twenty=five years old,
22 33 whichever occurs first, or so long as the unmarried child
22 34 maintains full=time status as a student in an accredited
22 35 institution of postsecondary education.
23 1 Sec. 22. APPLICABILITY. The sections of this Act amending
23 2 section 509.3, subsection 8, 509A.13B, and 514A.3B, subsection
23 3 2, and enacting section 514B.9A, apply to policies, contracts,
23 4 or plans of accident and health insurance delivered, issued
23 5 for delivery, continued, or renewed in this state on or after
23 6 July 1, 2009.
23 7 Sec. 23. RETROACTIVE APPLICABILITY DATE. The section of
23 8 this Act enacting section 422.7, subsection 29A, applies
23 9 retroactively to January 1, 2009, for tax years beginning on
23 10 or after that date.
23 11 DIVISION III
23 12 MEDICAL ASSISTANCE AND HAWK=I PROVISIONS
23 13 COVERAGE FOR ALL INCOME=ELIGIBLE CHILDREN
23 14 Sec. 24. NEW SECTION. 249A.3A MEDICAL ASSISTANCE == ALL
23 15 INCOME=ELIGIBLE CHILDREN.
23 16 The department shall provide medical assistance to
23 17 individuals under nineteen years of age who meet the income
23 18 eligibility requirements for the state medical assistance
23 19 program and for whom federal financial participation is or
23 20 becomes available for the cost of such assistance.
23 21 Sec. 25. NEW SECTION. 514I.8A HAWK=I == ALL
23 22 INCOME=ELIGIBLE CHILDREN.
23 23 The department shall provide coverage to individuals under
23 24 nineteen years of age who meet the income eligibility
23 25 requirements for the hawk=i program and for whom federal
23 26 financial participation is or becomes available for the cost
23 27 of such coverage.
23 28 REQUIRED APPLICATION FOR DEPENDENT CHILD HEALTH CARE COVERAGE
23 29 Sec. 26. Section 422.12M, Code 2009, is amended to read as
23 30 follows:
23 31 422.12M INCOME TAX FORM == INDICATION OF DEPENDENT CHILD
23 32 HEALTH CARE COVERAGE.
23 33 1. The director shall draft the income tax form to allow
23 34 require beginning with the tax returns for tax year 2008 2010,
23 35 a person who files an individual or joint income tax return
24 1 with the department under section 422.13 to indicate the
24 2 presence or absence of health care coverage for each dependent
24 3 child for whom an exemption is claimed.
24 4 2. Beginning with the income tax return for tax year 2008
24 5 2010, a person who files an individual or joint income tax
24 6 return with the department under section 422.13, may shall
24 7 report on the income tax return, in the form required, the
24 8 presence or absence of health care coverage for each dependent
24 9 child for whom an exemption is claimed.
24 10 a. If the taxpayer indicates on the income tax return that
24 11 a dependent child does not have health care coverage, and the
24 12 income of the taxpayer's tax return does not exceed the
24 13 highest level of income eligibility standard for the medical
24 14 assistance program pursuant to chapter 249A or the hawk=i
24 15 program pursuant to chapter 514I, the department shall send a
24 16 notice to the taxpayer indicating that the dependent child may
24 17 be eligible for the medical assistance program or the hawk=i
24 18 program and providing information to the taxpayer about how to
24 19 enroll the dependent child in the programs appropriate
24 20 program. The taxpayer shall submit an application for the
24 21 appropriate program within ninety days of receipt of the
24 22 enrollment information.
24 23 b. Notwithstanding any other provision of law to the
24 24 contrary, a taxpayer shall not be subject to a penalty for not
24 25 providing the information required under this section.
24 26 c. b. The department shall consult with the department of
24 27 human services in developing the tax return form and the
24 28 information to be provided to tax filers under this section.
24 29 3. The department, in cooperation with the department of
24 30 human services, shall adopt rules pursuant to chapter 17A to
24 31 administer this section, including rules defining "health care
24 32 coverage" for the purpose of indicating its presence or
24 33 absence on the tax form and enforcement provisions relating to
24 34 the required indication of a dependent child's health care
24 35 coverage status on the tax form and the required application
25 1 for an appropriate program as specified in this section.
25 2 4. The department, in cooperation with the department of
25 3 human services, shall report, annually, to the governor and
25 4 the general assembly all of the following:
25 5 a. The number of Iowa families, by income level, claiming
25 6 the state income tax exemption for dependent children.
25 7 b. The number of Iowa families, by income level, claiming
25 8 the state income tax exemption for dependent children who also
25 9 and whether they indicate the presence or absence of health
25 10 care coverage for the dependent children.
25 11 c. The effect of the reporting requirements and provision
25 12 of information requirements required under this section on the
25 13 number and percentage of children in the state who are
25 14 uninsured.
25 15 d. The number of those indicating the absence of coverage
25 16 who comply or do not comply with the requirement for
25 17 application for an appropriate program, and any enforcement
25 18 action taken.
25 19 PREGNANT WOMEN INCOME ELIGIBILITY FOR MEDICAID
25 20 Sec. 27. Section 249A.3, subsection 1, paragraph l, Code
25 21 2009, is amended to read as follows:
25 22 l. (1) Is an infant whose income is not more than two
25 23 hundred percent of the federal poverty level, as defined by
25 24 the most recently revised income guidelines published by the
25 25 United States department of health and human services.
25 26 (2) Additionally, effective July 1, 2009, medical
25 27 assistance shall be provided to an a pregnant woman or infant
25 28 whose family income is at or below three hundred percent of
25 29 the federal poverty level, as defined by the most recently
25 30 revised poverty income guidelines published by the United
25 31 States department of health and human services, if otherwise
25 32 eligible.
25 33 Sec. 28. Section 514I.8, subsection 1, Code 2009, is
25 34 amended to read as follows:
25 35 1. Effective July 1, 1998, and notwithstanding any medical
26 1 assistance program eligibility criteria to the contrary,
26 2 medical assistance shall be provided to, or on behalf of, an
26 3 eligible child under the age of nineteen whose family income
26 4 does not exceed one hundred thirty=three percent of the
26 5 federal poverty level, as defined by the most recently revised
26 6 poverty income guidelines published by the United States
26 7 department of health and human services. Additionally,
26 8 effective July 1, 2000, and notwithstanding any medical
26 9 assistance program eligibility criteria to the contrary,
26 10 medical assistance shall be provided to, or on behalf of, an
26 11 eligible infant whose family income does not exceed two
26 12 hundred percent of the federal poverty level, as defined by
26 13 the most recently revised poverty income guidelines published
26 14 by the United States department of health and human services.
26 15 Effective July 1, 2009, and notwithstanding any medical
26 16 assistance program eligibility criteria to the contrary,
26 17 medical assistance shall be provided to, or on behalf of, a
26 18 pregnant woman or an eligible child who is an infant and whose
26 19 family income is at or below three hundred percent of the
26 20 federal poverty level, as defined by the most recently revised
26 21 poverty income guidelines published by the United States
26 22 department of health and human services.
26 23 IMPROVING ACCESS AND RETENTION
26 24 Sec. 29. Section 249A.4, Code 2009, is amended by adding
26 25 the following new subsection:
26 26 NEW SUBSECTION. 16. Implement the premium assistance
26 27 program options described under the federal Children's Health
26 28 Insurance Program Reauthorization Act of 2009, Pub. L. No.
26 29 111=3, for the medical assistance program. The department may
26 30 adopt rules as necessary to administer these options.
26 31 Sec. 30. NEW SECTION. 509.3A CREDITABLE COVERAGE.
26 32 For the purposes of any policies of group accident or
26 33 health insurance or combination of such policies issued in
26 34 this state, "creditable coverage" means health benefits or
26 35 coverage provided to an individual under any of the following:
27 1 1. A group health plan.
27 2 2. Health insurance coverage.
27 3 3. Part A or Part B Medicare pursuant to Title XVIII of
27 4 the federal Social Security Act.
27 5 4. Medicaid pursuant to Title XIX of the federal Social
27 6 Security Act, other than coverage consisting solely of
27 7 benefits under section 1928 of that Act.
27 8 5. 10 U.S.C. ch. 55.
27 9 6. A health or medical care program provided through the
27 10 Indian health service or a tribal organization.
27 11 7. A state health benefits risk pool.
27 12 8. A health plan offered under 5 U.S.C. ch. 89.
27 13 9. A public health plan as defined under federal
27 14 regulations.
27 15 10. A health benefit plan under section 5(e) of the
27 16 federal Peace Corps Act, 22 U.S.C. } 2504(e).
27 17 11. An organized delivery system licensed by the director
27 18 of public health.
27 19 12. A short=term limited duration policy.
27 20 13. The hawk=i program authorized by chapter 514I.
27 21 Sec. 31. Section 513B.2, subsection 8, Code 2009, is
27 22 amended by adding the following new paragraph:
27 23 NEW PARAGRAPH. m. The hawk=i program authorized by
27 24 chapter 514I.
27 25 Sec. 32. Section 514A.3B, subsection 1, Code 2009, is
27 26 amended to read as follows:
27 27 1. An insurer which accepts an individual for coverage
27 28 under an individual policy or contract of accident and health
27 29 insurance shall waive any time period applicable to a
27 30 preexisting condition exclusion or limitation period
27 31 requirement of the policy or contract with respect to
27 32 particular services in an individual health benefit plan for
27 33 the period of time the individual was previously covered by
27 34 qualifying previous coverage as defined in section 513C.3, by
27 35 chapter 249A or 514I, or by Medicare coverage provided
28 1 pursuant to Title XVIII of the federal Social Security Act
28 2 that provided benefits with respect to such services, provided
28 3 that the qualifying previous coverage was continuous to a date
28 4 not more than sixty=three days prior to the effective date of
28 5 the new policy or contract. Any days of coverage provided to
28 6 an individual pursuant to chapter 249A or 514I, or Medicare
28 7 coverage provided pursuant to Title XVIII of the federal
28 8 Social Security Act, do not constitute qualifying previous
28 9 coverage. Such days of chapter 249A or 514I or Medicare
28 10 coverage shall be counted as part of the maximum
28 11 sixty=three=day grace period and shall not constitute a basis
28 12 for the waiver of any preexisting condition exclusion or
28 13 limitation period.
28 14 Sec. 33. Section 514A.3B, Code 2009, is amended by adding
28 15 the following new subsection:
28 16 NEW SUBSECTION. 3. For the purposes of any policies of
28 17 accident and sickness insurance issued in this state,
28 18 "creditable coverage" means health benefits or coverage
28 19 provided to an individual under any of the following:
28 20 a. A group health plan.
28 21 b. Health insurance coverage.
28 22 c. Part A or Part B Medicare pursuant to Title XVIII of
28 23 the federal Social Security Act.
28 24 d. Medicaid pursuant to Title XIX of the federal Social
28 25 Security Act, other than coverage consisting solely of
28 26 benefits under section 1928 of that Act.
28 27 e. 10 U.S.C. ch. 55.
28 28 f. A health or medical care program provided through the
28 29 Indian health service or a tribal organization.
28 30 g. A state health benefits risk pool.
28 31 h. A health plan offered under 5 U.S.C. ch. 89.
28 32 i. A public health plan as defined under federal
28 33 regulations.
28 34 j. A health benefit plan under section 5(e) of the federal
28 35 Peace Corps Act, 22 U.S.C. } 2504(e).
29 1 k. An organized delivery system licensed by the director
29 2 of public health.
29 3 l. A short=term limited duration policy.
29 4 m. The hawk=i program authorized by chapter 514I.
29 5 Sec. 34. Section 514E.5, subsections 1 and 7, Code 2009,
29 6 are amended to read as follows:
29 7 1. The association, in consultation with the Iowa choice
29 8 health care coverage advisory council, shall develop a
29 9 comprehensive health care coverage plan to provide health care
29 10 coverage to all children without such coverage, that utilizes
29 11 and modifies existing public programs including the medical
29 12 assistance program, and hawk=i program, and hawk=i expansion
29 13 program, and to provide access to private unsubsidized,
29 14 affordable, qualified health care coverage to children who are
29 15 not otherwise eligible for health care coverage through public
29 16 programs.
29 17 7. The association shall submit the comprehensive plan
29 18 required by this section to the governor and the general
29 19 assembly by December 15, 2008. The appropriations to cover
29 20 children under the medical assistance, and hawk=i, and hawk=i
29 21 expansion programs as provided in this Act and to provide
29 22 related outreach for fiscal year 2009=2010 and fiscal year
29 23 2010=2011 are contingent upon enactment of a comprehensive
29 24 plan during the 2009 regular session of the Eighty=third
29 25 General Assembly that provides health care coverage for all
29 26 children in the state. Enactment of a comprehensive plan
29 27 shall include a determination of what the prospects are of
29 28 federal action which may impact the comprehensive plan and the
29 29 fiscal impact of the comprehensive plan on the state budget.
29 30 Sec. 35. Section 514I.1, subsection 4, Code 2009, is
29 31 amended to read as follows:
29 32 4. It is the intent of the general assembly that the
29 33 hawk=i program be an integral part of the continuum of health
29 34 insurance coverage and that the program be developed and
29 35 implemented in such a manner as to facilitate movement of
30 1 families between health insurance providers and to facilitate
30 2 the transition of families to private sector health insurance
30 3 coverage. It is the intent of the general assembly in
30 4 developing such continuum of health insurance coverage and in
30 5 facilitating such transition, that beginning July 1, 2009, the
30 6 department implement the hawk=i expansion program.
30 7 Sec. 36. Section 514I.2, subsection 8, Code 2009, is
30 8 amended by striking the subsection.
30 9 Sec. 37. Section 514I.3, Code 2009, is amended by adding
30 10 the following new subsection:
30 11 NEW SUBSECTION. 6. Health care coverage provided under
30 12 this chapter in accordance with Title XXI of the federal
30 13 Social Security Act shall be recognized as prior creditable
30 14 coverage for the purposes of private individual and group
30 15 health insurance coverage.
30 16 Sec. 38. Section 514I.4, subsection 2, Code 2009, is
30 17 amended to read as follows:
30 18 2. a. The director, with the approval of the board, may
30 19 contract with participating insurers to provide dental=only
30 20 services.
30 21 b. The director, with the approval of the board, may
30 22 contract with participating insurers to provide the
30 23 supplemental dental=only coverage to otherwise eligible
30 24 children who have private health care coverage as specified in
30 25 the federal Children's Health Insurance Program
30 26 Reauthorization Act of 2009, Pub. L. No. 111=3.
30 27 Sec. 39. Section 514I.4, subsection 5, paragraphs a and b,
30 28 Code 2009, are amended to read as follows:
30 29 a. Develop a joint program application form not to exceed
30 30 two pages in length, which is consistent with the rules of the
30 31 board, which is easy to understand, complete, and concise, and
30 32 which, to the greatest extent possible, coordinates with the
30 33 supplemental forms, and the same application and renewal
30 34 verification process for both the hawk=i and medical
30 35 assistance program programs.
31 1 b. (1) Establish the family cost sharing amounts for
31 2 children of families with incomes of one hundred fifty percent
31 3 or more but not exceeding two hundred percent of the federal
31 4 poverty level, of not less than ten dollars per individual and
31 5 twenty dollars per family, if not otherwise prohibited by
31 6 federal law, with the approval of the board.
31 7 (2) Establish for children of families with incomes
31 8 exceeding two hundred percent but not exceeding three hundred
31 9 percent of the federal poverty level, family cost=sharing
31 10 amounts, criteria for modification of the cost=sharing
31 11 amounts, and graduated premiums, in accordance with federal
31 12 law, with the approval of the board.
31 13 Sec. 40. Section 514I.5, subsection 7, paragraph l, Code
31 14 2009, is amended to read as follows:
31 15 l. Develop options and recommendations to allow children
31 16 eligible for the hawk=i or hawk=i expansion program to
31 17 participate in qualified employer=sponsored health plans
31 18 through a premium assistance program. The options and
31 19 recommendations shall ensure reasonable alignment between the
31 20 benefits and costs of the hawk=i and hawk=i expansion programs
31 21 program and the employer=sponsored health plans consistent
31 22 with federal law. The options and recommendations shall be
31 23 completed by January 1, 2009, and submitted to the governor
31 24 and the general assembly for consideration as part of the
31 25 hawk=i and hawk=i expansion programs. In addition, the board
31 26 shall implement the premium assistance program options
31 27 described under the federal Children's Health Insurance
31 28 Program Reauthorization Act of 2009, Pub. L. No. 111=3, for
31 29 the hawk=i program.
31 30 Sec. 41. Section 514I.5, subsection 8, paragraph e, Code
31 31 2009, is amended by adding the following new subparagraph:
31 32 NEW SUBPARAGRAPH. (15) Translation and interpreter
31 33 services as specified pursuant to the federal Children's
31 34 Health Insurance Program Reauthorization Act of 2009, Pub. L.
31 35 No. 111=3.
32 1 Sec. 42. Section 514I.5, subsection 8, paragraph g, Code
32 2 2009, is amended to read as follows:
32 3 g. Presumptive eligibility criteria for the program.
32 4 Beginning July 1, 2009, presumptive eligibility shall be
32 5 provided for eligible children.
32 6 Sec. 43. Section 514I.5, subsection 9, Code 2009, is
32 7 amended to read as follows:
32 8 9. a. The hawk=i board may provide approval to the
32 9 director to contract with participating insurers to provide
32 10 dental=only services. In determining whether to provide such
32 11 approval to the director, the board shall take into
32 12 consideration the impact on the overall program of single
32 13 source contracting for dental services.
32 14 b. The hawk=i board may provide approval to the director
32 15 to contract with participating insurers to provide the
32 16 supplemental dental=only coverage to otherwise eligible
32 17 children who have private health care coverage as specified in
32 18 the federal Children's Health Insurance Program
32 19 Reauthorization Act of 2009, Pub. L. No. 111=3.
32 20 Sec. 44. Section 514I.6, subsections 2 and 3, Code 2009,
32 21 are amended to read as follows:
32 22 2. Provide or reimburse accessible, quality medical or
32 23 dental services.
32 24 3. Require that any plan provided by the participating
32 25 insurer establishes and maintains a conflict management system
32 26 that includes methods for both preventing and resolving
32 27 disputes involving the health or dental care needs of eligible
32 28 children, and a process for resolution of such disputes.
32 29 Sec. 45. Section 514I.6, subsection 4, paragraph a, Code
32 30 2009, is amended to read as follows:
32 31 a. A list of providers of medical or dental services under
32 32 the plan.
32 33 Sec. 46. Section 514I.7, subsection 2, paragraph d, Code
32 34 2009, is amended to read as follows:
32 35 d. Monitor and assess the medical and dental care provided
33 1 through or by participating insurers as well as complaints and
33 2 grievances.
33 3 Sec. 47. Section 514I.8, subsection 2, paragraph c, Code
33 4 2009, is amended to read as follows:
33 5 c. Is a member of a family whose income does not exceed
33 6 two three hundred percent of the federal poverty level, as
33 7 defined in 42 U.S.C. } 9902(2), including any revision
33 8 required by such section, and in accordance with the federal
33 9 Children's Health Insurance Program Reauthorization Act of
33 10 2009, Pub. L. No. 111=3.
33 11 Sec. 48. Section 514I.10, Code 2009, is amended by adding
33 12 the following new subsection:
33 13 NEW SUBSECTION. 2A. Cost sharing for an eligible child
33 14 whose family income exceeds two hundred percent but does not
33 15 exceed three hundred percent of the federal poverty level may
33 16 include copayments and graduated premium amounts which do not
33 17 exceed the limitations of federal law.
33 18 Sec. 49. Section 514I.11, subsections 1 and 3, Code 2009,
33 19 are amended to read as follows:
33 20 1. A hawk=i trust fund is created in the state treasury
33 21 under the authority of the department of human services, in
33 22 which all appropriations and other revenues of the program and
33 23 the hawk=i expansion program such as grants, contributions,
33 24 and participant payments shall be deposited and used for the
33 25 purposes of the program and the hawk=i expansion program. The
33 26 moneys in the fund shall not be considered revenue of the
33 27 state, but rather shall be funds of the program.
33 28 3. Moneys in the fund are appropriated to the department
33 29 and shall be used to offset any program and hawk=i expansion
33 30 program costs.
33 31 Sec. 50. MEDICAL ASSISTANCE PROGRAM == PROGRAMMATIC AND
33 32 PROCEDURAL PROVISIONS. The department of human services shall
33 33 adopt rules pursuant to chapter 17A to provide for all of the
33 34 following:
33 35 1. To allow for the submission of one pay stub per
34 1 employer by an individual as verification of earned income for
34 2 the medical assistance program when it is indicative of future
34 3 income.
34 4 2. To allow for an averaging of three years of income for
34 5 self=employed families to establish eligibility for the
34 6 medical assistance program.
34 7 3. To extend the period for annual renewal by medical
34 8 assistance members by mailing the renewal form to the member
34 9 on the first day of the month prior to the month of renewal.
34 10 4. To provide for all of the following in accordance with
34 11 the requirements for qualification for the performance bonus
34 12 payments described under the federal Children's Health
34 13 Insurance Program Reauthorization Act of 2009, Pub. L. No.
34 14 111=3:
34 15 a. Utilization of joint applications and supplemental
34 16 forms, and the same application and renewal verification
34 17 processes for the medical assistance and hawk=i programs.
34 18 b. Implementation of administrative or paperless
34 19 verification at renewal for the medical assistance program.
34 20 c. Utilization of presumptive eligibility when determining
34 21 a child's eligibility for the medical assistance program.
34 22 d. Utilization of the express lane option, including
34 23 utilization of other public program databases to reach and
34 24 enroll children in the medical assistance program.
34 25 5. To provide translation and interpretation services
34 26 under the medical assistance program as specified pursuant to
34 27 the federal Children's Health Insurance Program
34 28 Reauthorization Act of 2009, Pub. L. No. 111=3.
34 29 Sec. 51. HAWK=I PROGRAM == PROGRAMMATIC AND PROCEDURAL
34 30 PROVISIONS. The hawk=i board, in consultation with the
34 31 department of human services, shall adopt rules pursuant to
34 32 chapter 17A to provide for all of the following:
34 33 1. To allow for the submission of one pay stub per
34 34 employer by an individual as verification of earned income for
34 35 the hawk=i program when it is indicative of future income.
35 1 2. To allow for an averaging of three years of income for
35 2 self=employed families to establish eligibility for the hawk=i
35 3 program.
35 4 3. To provide for all of the following in accordance with
35 5 the requirements for qualification for the performance bonus
35 6 payments described under the federal Children's Health
35 7 Insurance Program Reauthorization Act of 2009, Pub. L. No.
35 8 111=3:
35 9 a. Utilization of joint applications and supplemental
35 10 forms, and the same application and renewal verification
35 11 processes for the hawk=i and medical assistance programs.
35 12 b. Implementation of administrative or paperless
35 13 verification at renewal for the hawk=i program.
35 14 c. Utilization of presumptive eligibility when determining
35 15 a child's eligibility for the hawk=i program.
35 16 d. Utilization of the express lane option, including
35 17 utilization of other public program databases to reach and
35 18 enroll children in the hawk=i program.
35 19 Sec. 52. DEMONSTRATION GRANTS == CHIPRA. The department
35 20 of human services in cooperation with the department of public
35 21 health and other appropriate agencies, shall apply for grants
35 22 available under the Children's Health Insurance Program
35 23 Reauthorization Act of 2009, Pub. L. No. 111=3, to promote
35 24 outreach activities and quality child health outcomes under
35 25 the medical assistance and hawk=i programs.
35 26 Sec. 53. Section 514I.12, Code 2009, is repealed.
35 27 Sec. 54. EFFECTIVE DATE. The section of this division of
35 28 this Act amending section 422.12M, takes effect July 1, 2010.
35 29 DIVISION IV
35 30 VOLUNTEER HEALTH CARE PROVIDERS
35 31 Sec. 55. Section 135.24, Code 2009, is amended to read as
35 32 follows:
35 33 135.24 VOLUNTEER HEALTH CARE PROVIDER PROGRAM ESTABLISHED
35 34 == IMMUNITY FROM CIVIL LIABILITY.
35 35 1. The director shall establish within the department a
36 1 program to provide to eligible hospitals, clinics, free
36 2 clinics, field dental clinics, health care provider offices,
36 3 or other health care facilities, health care referral
36 4 programs, or charitable organizations, free medical, dental,
36 5 chiropractic, pharmaceutical, nursing, optometric,
36 6 psychological, social work, behavioral science, podiatric,
36 7 physical therapy, occupational therapy, respiratory therapy,
36 8 and emergency medical care services given on a voluntary basis
36 9 by health care providers. A participating health care
36 10 provider shall register with the department and obtain from
36 11 the department a list of eligible, participating hospitals,
36 12 clinics, free clinics, field dental clinics, health care
36 13 provider offices, or other health care facilities, health care
36 14 referral programs, or charitable organizations.
36 15 2. The department, in consultation with the department of
36 16 human services, shall adopt rules to implement the volunteer
36 17 health care provider program which shall include the
36 18 following:
36 19 a. Procedures for registration of health care providers
36 20 deemed qualified by the board of medicine, the board of
36 21 physician assistants, the dental board, the board of nursing,
36 22 the board of chiropractic, the board of psychology, the board
36 23 of social work, the board of behavioral science, the board of
36 24 pharmacy, the board of optometry, the board of podiatry, the
36 25 board of physical and occupational therapy, the board of
36 26 respiratory care, and the Iowa department of public health, as
36 27 applicable.
36 28 b. Procedures for registration of free clinics, and field
36 29 dental clinics, and health care provider offices.
36 30 c. Criteria for and identification of hospitals, clinics,
36 31 free clinics, field dental clinics, health care provider
36 32 offices, or other health care facilities, health care referral
36 33 programs, or charitable organizations, eligible to participate
36 34 in the provision of free medical, dental, chiropractic,
36 35 pharmaceutical, nursing, optometric, psychological, social
37 1 work, behavioral science, podiatric, physical therapy,
37 2 occupational therapy, respiratory therapy, or emergency
37 3 medical care services through the volunteer health care
37 4 provider program. A free clinic, a field dental clinic, a
37 5 health care provider office, a health care facility, a health
37 6 care referral program, a charitable organization, or a health
37 7 care provider participating in the program shall not bill or
37 8 charge a patient for any health care provider service provided
37 9 under the volunteer health care provider program.
37 10 d. Identification of the services to be provided under the
37 11 program. The services provided may include, but shall not be
37 12 limited to, obstetrical and gynecological medical services,
37 13 psychiatric services provided by a physician licensed under
37 14 chapter 148, dental services provided under chapter 153, or
37 15 other services provided under chapter 147A, 148A, 148B, 148C,
37 16 149, 151, 152, 152B, 152E, 154, 154B, 154C, 154D, 154F, or
37 17 155A.
37 18 3. A health care provider providing free care under this
37 19 section shall be considered an employee of the state under
37 20 chapter 669, shall be afforded protection as an employee of
37 21 the state under section 669.21, and shall not be subject to
37 22 payment of claims arising out of the free care provided under
37 23 this section through the health care provider's own
37 24 professional liability insurance coverage, provided that the
37 25 health care provider has done all of the following:
37 26 a. Registered with the department pursuant to subsection
37 27 1.
37 28 b. Provided medical, dental, chiropractic, pharmaceutical,
37 29 nursing, optometric, psychological, social work, behavioral
37 30 science, podiatric, physical therapy, occupational therapy,
37 31 respiratory therapy, or emergency medical care services
37 32 through a hospital, clinic, free clinic, field dental clinic,
37 33 health care provider office, or other health care facility,
37 34 health care referral program, or charitable organization
37 35 listed as eligible and participating by the department
38 1 pursuant to subsection 1.
38 2 4. A free clinic providing free care under this section
38 3 shall be considered a state agency solely for the purposes of
38 4 this section and chapter 669 and shall be afforded protection
38 5 under chapter 669 as a state agency for all claims arising
38 6 from the provision of free care by a health care provider
38 7 registered under subsection 3 who is providing services at the
38 8 free clinic in accordance with this section or from the
38 9 provision of free care by a health care provider who is
38 10 covered by adequate medical malpractice insurance as
38 11 determined by the department, if the free clinic has
38 12 registered with the department pursuant to subsection 1.
38 13 5. A field dental clinic providing free care under this
38 14 section shall be considered a state agency solely for the
38 15 purposes of this section and chapter 669 and shall be afforded
38 16 protection under chapter 669 as a state agency for all claims
38 17 arising from the provision of free care by a health care
38 18 provider registered under subsection 3 who is providing
38 19 services at the field dental clinic in accordance with this
38 20 section or from the provision of free care by a health care
38 21 provider who is covered by adequate medical malpractice
38 22 insurance, as determined by the department, if the field
38 23 dental clinic has registered with the department pursuant to
38 24 subsection 1.
38 25 5A. A health care provider office providing free care
38 26 under this section shall be considered a state agency solely
38 27 for the purposes of this section and chapter 669 and shall be
38 28 afforded protection under chapter 669 as a state agency for
38 29 all claims arising from the provision of free care by a health
38 30 care provider registered under subsection 3 who is providing
38 31 services at the health care provider office in accordance with
38 32 this section or from the provision of free care by a health
38 33 care provider who is covered by adequate medical malpractice
38 34 insurance, as determined by the department, if the health care
38 35 provider office has registered with the department pursuant to
39 1 subsection 1.
39 2 6. For the purposes of this section:
39 3 a. "Charitable organization" means a charitable
39 4 organization within the meaning of section 501(c)(3) of the
39 5 Internal Revenue Code.
39 6 b. "Field dental clinic" means a dental clinic temporarily
39 7 or periodically erected at a location utilizing mobile dental
39 8 equipment, instruments, or supplies, as necessary, to provide
39 9 dental services.
39 10 c. "Free clinic" means a facility, other than a hospital
39 11 or health care provider's office which is exempt from taxation
39 12 under section 501(c)(3) of the Internal Revenue Code and which
39 13 has as its sole purpose the provision of health care services
39 14 without charge to individuals who are otherwise unable to pay
39 15 for the services.
39 16 d. "Health care provider" means a physician licensed under
39 17 chapter 148, a chiropractor licensed under chapter 151, a
39 18 physical therapist licensed pursuant to chapter 148A, an
39 19 occupational therapist licensed pursuant to chapter 148B, a
39 20 podiatrist licensed pursuant to chapter 149, a physician
39 21 assistant licensed and practicing under a supervising
39 22 physician pursuant to chapter 148C, a licensed practical
39 23 nurse, a registered nurse, or an advanced registered nurse
39 24 practitioner licensed pursuant to chapter 152 or 152E, a
39 25 respiratory therapist licensed pursuant to chapter 152B, a
39 26 dentist, dental hygienist, or dental assistant registered or
39 27 licensed to practice under chapter 153, an optometrist
39 28 licensed pursuant to chapter 154, a psychologist licensed
39 29 pursuant to chapter 154B, a social worker licensed pursuant to
39 30 chapter 154C, a mental health counselor or a marital and
39 31 family therapist licensed pursuant to chapter 154D,* a
39 32 pharmacist licensed pursuant to chapter 155A, or an emergency
39 33 medical care provider certified pursuant to chapter 147A.
39 34 e. "Health care provider office" means the private office
39 35 or clinic of an individual health care provider or group of
40 1 health care providers but does not include a field dental
40 2 clinic, a free clinic, or a hospital.
40 3 DIVISION V
40 4 HEALTH CARE WORKFORCE SUPPORT INITIATIVE
40 5 Sec. 56. Section 135.11, Code 2009, is amended by adding
40 6 the following new subsection:
40 7 NEW SUBSECTION. 32. Administer the portion of the
40 8 workforce shortage initiative established in section 261.128
40 9 relating to the medical residency training state matching
40 10 grants program.
40 11 Sec. 57. Section 135.153, subsection 2, Code 2009, is
40 12 amended to read as follows:
40 13 2. a. The network shall form a governing group which
40 14 includes two individuals each representing community health
40 15 centers, rural health clinics, free clinics, maternal and
40 16 child health centers, the expansion population provider
40 17 network as described in chapter 249J, local boards of health
40 18 that provide direct services, the state board of health, Iowa
40 19 family planning network agencies, child health specialty
40 20 clinics, and other safety net providers.
40 21 b. The governing group shall administer the portion of the
40 22 workforce shortage initiative established in section 261.128
40 23 relating to the safety net provider recruitment and retention
40 24 initiatives program.
40 25 Sec. 58. Section 261.2, Code 2009, is amended by adding
40 26 the following new subsection:
40 27 NEW SUBSECTION. 10. Administer the portions of the health
40 28 care workforce support initiative established in section
40 29 261.128 relating to the health care professional incentive
40 30 payment program and the nursing workforce shortage initiative.
40 31 Sec. 59. Section 261.23, subsection 1, Code 2009, is
40 32 amended to read as follows:
40 33 1. A registered nurse and nurse educator loan forgiveness
40 34 program is established to be administered by the commission.
40 35 The program shall consist of loan forgiveness for eligible
41 1 federally guaranteed loans for registered nurses and nurse
41 2 educators who practice or teach in this state. For purposes
41 3 of this section, unless the context otherwise requires, "nurse
41 4 educator" means a registered nurse who holds a master's degree
41 5 or doctorate degree and is employed as a faculty member who
41 6 teaches nursing as provided in 655 IAC 2.6(152) at a community
41 7 college, an accredited private institution, or an institution
41 8 of higher education governed by the state board of regents.
41 9 Sec. 60. Section 261.23, subsection 2, paragraph c, Code
41 10 2009, is amended to read as follows:
41 11 c. Complete and return, on a form approved by the
41 12 commission, an affidavit of practice verifying that the
41 13 applicant is a registered nurse practicing in this state or a
41 14 nurse educator teaching at a community college, an accredited
41 15 private institution, or an institution of higher learning
41 16 governed by the state board of regents.
41 17 Sec. 61. NEW SECTION. 261.128 HEALTH CARE WORKFORCE
41 18 SUPPORT INITIATIVE == WORKFORCE SHORTAGE FUND.
41 19 1. HEALTH CARE WORKFORCE SHORTAGE FUND == ACCOUNTS.
41 20 a. (1) A health care workforce shortage fund is created
41 21 in the state treasury as a separate fund under the control of
41 22 the department of public health, in cooperation with the
41 23 entities identified in this section as having control over the
41 24 accounts within the fund. The fund and the accounts within
41 25 the fund shall be controlled and managed in a manner
41 26 consistent with the principles specified and the strategic
41 27 plan developed pursuant to sections 135.163 and 135.164.
41 28 (2) The fund and the accounts within the fund shall
41 29 consist of moneys appropriated from the general fund of the
41 30 state for the health care workforce support initiative; moneys
41 31 received from the federal government for the purposes of
41 32 addressing the health care workforce shortage; contributions,
41 33 grants, and other moneys from communities and health care
41 34 employers; and moneys from any other public or private source
41 35 available.
42 1 (3) The department of public health and any entity
42 2 identified in this section as having control over any of the
42 3 accounts within the fund may receive contributions, grants,
42 4 and in=kind contributions to support the purposes of the fund
42 5 and the accounts within the fund.
42 6 b. The fund and the accounts within the fund shall be
42 7 separate from the general fund of the state and shall not be
42 8 considered part of the general fund of the state. The moneys
42 9 in the fund and the accounts within the fund shall not be
42 10 considered revenue of the state, but rather shall be moneys of
42 11 the fund or the accounts. The moneys in the fund and the
42 12 accounts within the fund are not subject to section 8.33 and
42 13 shall not be transferred, used, obligated, appropriated, or
42 14 otherwise encumbered, except to provide for the purposes of
42 15 this section. Notwithstanding section 12C.7, subsection 2,
42 16 interest or earnings on moneys deposited in the fund shall be
42 17 credited to the fund and the accounts within the fund.
42 18 c. The fund shall consist of the following accounts:
42 19 (1) The medical residency training account. The medical
42 20 residency training account shall be under the control of the
42 21 department of public health and the moneys in the account
42 22 shall be used for the purposes of the medical residency
42 23 training state matching grants program as specified in this
42 24 section. Moneys in the account shall consist of moneys
42 25 received by the fund or the account and specifically dedicated
42 26 to the medical residency training account and for the purposes
42 27 of such account.
42 28 (2) The health care professional and nurse workforce
42 29 shortage initiative account. The health care professional and
42 30 nurse workforce shortage initiative account shall be under the
42 31 control of the commission and the moneys in the account shall
42 32 be used for the purposes of the health care professional
42 33 incentive payment program and the nurse workforce shortage
42 34 initiative as specified in this section. Moneys in the
42 35 account shall consist of moneys received by the fund or the
43 1 account and specifically dedicated to the health care
43 2 professional and nurse workforce shortage initiative account
43 3 and for the purposes of the account.
43 4 (3) The safety net provider network workforce shortage
43 5 account. The safety net provider network workforce shortage
43 6 account shall be under the control of the governing group of
43 7 the Iowa collaborative safety net provider network and the
43 8 moneys in the account shall be used for the purposes of the
43 9 safety net provider recruitment and retention initiatives
43 10 program as specified in this section. Moneys in the account
43 11 shall consist of moneys received by the fund or the account
43 12 and specifically dedicated to the safety net provider network
43 13 workforce shortage account and for the purposes of the
43 14 account.
43 15 (4) The health care workforce shortage national
43 16 initiatives account. The health care workforce shortage
43 17 national initiatives account shall be under the control of the
43 18 state entity identified for receipt of the federal funds by
43 19 the federal government entity through which the federal
43 20 funding is available for a specified health care workforce
43 21 shortage initiative. Moneys in the account shall consist of
43 22 moneys received by the fund or the account and specifically
43 23 dedicated to the health care workforce shortage national
43 24 initiatives account and for a specified health care workforce
43 25 shortage initiative.
43 26 d. (1) Moneys in the fund and the accounts in the fund
43 27 shall only be appropriated in a manner consistent with the
43 28 principles specified and the strategic plan developed pursuant
43 29 to sections 135.163 and 135.164 to support the medical
43 30 residency training state matching grants program, the health
43 31 care professional incentive payment program, the nurse
43 32 educator incentive payment and nursing faculty fellowship
43 33 programs, the safety net recruitment and retention initiatives
43 34 program, for national health care workforce shortage
43 35 initiatives, and to provide funding for state health care
44 1 workforce shortage programs as provided in this section.
44 2 (2) State programs that may receive funding from the fund
44 3 and the accounts in the fund, if specifically designated for
44 4 the purpose of drawing down federal funding, are the primary
44 5 care recruitment and retention endeavor (PRIMECARRE), the Iowa
44 6 affiliate of the national rural recruitment and retention
44 7 network, the primary care office shortage designation program,
44 8 the state office of rural health, and the Iowa health
44 9 workforce center, administered through the bureau of health
44 10 care access of the department of public health; the area
44 11 health education centers programs at Des Moines university ==
44 12 osteopathic medical center and the university of Iowa; the
44 13 Iowa collaborative safety net provider network established
44 14 pursuant to section 135.153; any entity identified by the
44 15 federal government entity through which federal funding for a
44 16 specified health care workforce shortage initiative is
44 17 received; and a program developed in accordance with the
44 18 strategic plan developed by the department of public health in
44 19 accordance with sections 135.163 and 135.164.
44 20 (3) State appropriations to the fund shall be allocated in
44 21 equal amounts to each of the accounts within the fund, unless
44 22 otherwise specified in the appropriation or allocation. Any
44 23 federal funding received for the purposes of addressing state
44 24 health care workforce shortages shall be deposited in the
44 25 health care workforce shortage national initiatives account,
44 26 unless otherwise specified by the source of the funds, and
44 27 shall be used as required by the source of the funds. If use
44 28 of the federal funding is not designated, twenty=five percent
44 29 of such funding shall be deposited in the safety net provider
44 30 network workforce shortage account to be used for the purposes
44 31 of the account and the remainder of the funds shall be used in
44 32 accordance with the strategic plan developed by the department
44 33 of public health in accordance with sections 135.163 and
44 34 135.164, or to address workforce shortages as otherwise
44 35 designated by the department of public health. Other sources
45 1 of funding shall be deposited in the fund or account and used
45 2 as specified by the source of the funding.
45 3 e. No more than five percent of the moneys in any of the
45 4 accounts within the fund, not to exceed one hundred thousand
45 5 dollars in each account, shall be used for administrative
45 6 purposes, unless otherwise provided by the source of the
45 7 funds.
45 8 2. MEDICAL RESIDENCY TRAINING STATE MATCHING GRANTS
45 9 PROGRAM.
45 10 a. The department of public health shall establish a
45 11 medical residency training state matching grants program to
45 12 provide matching state funding to sponsors of accredited
45 13 graduate medical education residency programs in this state to
45 14 establish, expand, or support medical residency training
45 15 programs. For the purposes of this section, unless the
45 16 context otherwise requires, "accredited" means a graduate
45 17 medical education program approved by the accreditation
45 18 council for graduate medical education or the American
45 19 osteopathic association. The grant funds may be used to
45 20 support medical residency programs through any of the
45 21 following:
45 22 (1) The establishment of new or alternative campus
45 23 accredited medical residency training programs. For the
45 24 purposes of this subparagraph, "new or alternative campus
45 25 accredited medical residency training program" means a program
45 26 that is accredited by a recognized entity approved for such
45 27 purpose by the accreditation council for graduate medical
45 28 education or the American osteopathic association with the
45 29 exception that a new medical residency training program that,
45 30 by reason of an insufficient period of operation is not
45 31 eligible for accreditation on or before the date of submission
45 32 of an application for a grant, may be deemed accredited if the
45 33 accreditation council for graduate medical education or the
45 34 American osteopathic association finds, after consultation
45 35 with the appropriate accreditation entity, that there is
46 1 reasonable assurance that the program will meet the
46 2 accreditation standards of the entity prior to the date of
46 3 graduation of the initial class in the program.
46 4 (2) The provision of new residency positions within
46 5 existing accredited medical residency or fellowship training
46 6 programs.
46 7 (3) The funding of residency positions which are in excess
46 8 of the federal residency cap. For the purposes of this
46 9 subparagraph, "in excess of the federal residency cap" means a
46 10 residency position for which no federal Medicare funding is
46 11 available because the residency position is a position beyond
46 12 the cap for residency positions established by the federal
46 13 Balanced Budget Act of 1997, Pub. L. No. 105=33.
46 14 b. The department of public health shall adopt rules
46 15 pursuant to chapter 17A to provide for all of the following:
46 16 (1) Eligibility requirements for and qualifications of a
46 17 sponsor of an accredited graduate medical education residency
46 18 program to receive a grant. The requirements and
46 19 qualifications shall include but are not limited to all of the
46 20 following:
46 21 (a) Only a sponsor that establishes a dedicated fund to
46 22 support a residency program that meets the specifications of
46 23 this subsection shall be eligible to receive a matching grant.
46 24 (b) A sponsor shall demonstrate through documented
46 25 financial information as prescribed by rule of the department
46 26 of public health, that funds have been reserved by the sponsor
46 27 in the amount required to provide matching funds for each
46 28 residency proposed in the request for state matching funds.
46 29 (c) A sponsor shall demonstrate through objective evidence
46 30 as prescribed by rule of the department of public health, a
46 31 need for such residency program in the state.
46 32 (2) The application process for the grant.
46 33 (3) Criteria for preference in awarding of the grants,
46 34 including preference in the residency specialty.
46 35 (4) Determination of the amount of a grant. The total
47 1 amount of a grant awarded to a sponsor shall be limited to no
47 2 more than twenty=five percent of the amount that the sponsor
47 3 has demonstrated through documented financial information has
47 4 been reserved by the sponsor for each residency sponsored for
47 5 the purpose of the residency program.
47 6 (5) The maximum award of grant funds to a particular
47 7 individual sponsor per year. An individual sponsor shall not
47 8 receive more than twenty=five percent of the state matching
47 9 funds available each year to support the program.
47 10 (6) Use of the funds awarded. Funds may be used to pay
47 11 the costs of establishing, expanding, or supporting an
47 12 accredited graduate medical education program as specified in
47 13 this section, including but not limited to the costs
47 14 associated with residency stipends and physician faculty
47 15 stipends.
47 16 3. HEALTH CARE PROFESSIONAL INCENTIVE PAYMENT PROGRAM.
47 17 a. The commission shall establish a health care
47 18 professional incentive payment program to recruit and retain
47 19 health care professionals in this state.
47 20 b. The commission shall administer the incentive payment
47 21 program with the assistance of Des Moines university ==
47 22 osteopathic medical center. From funds appropriated from the
47 23 health care professional and nurse workforce shortage
47 24 initiative account of the health care workforce shortage fund
47 25 for the purposes of the program, the commission shall pay a
47 26 fee to Des Moines university == osteopathic medical center for
47 27 the administration of the program.
47 28 c. The commission, with the assistance of Des Moines
47 29 university == osteopathic medical center, shall adopt rules
47 30 pursuant to chapter 17A, relating to the establishment and
47 31 administration of the health care professional incentive
47 32 payment program. The rules adopted shall address all of the
47 33 following:
47 34 (1) Eligibility and qualification requirements for a
47 35 health care professional, a community, and a health care
48 1 employer to participate in the incentive payment program. Any
48 2 community in the state and all health care specialties shall
48 3 be considered for participation. However, health care
48 4 employers located in and communities that are designated as
48 5 medically underserved areas or populations or that are
48 6 designated as health professional shortage areas by the health
48 7 resources and services administration of the United States
48 8 department of health and human services shall have first
48 9 priority in the awarding of incentive payments.
48 10 (a) To be eligible, a health care professional at a
48 11 minimum must not have any unserved obligations to a federal,
48 12 state, or local government or other entity that would prevent
48 13 compliance with obligations under the agreement for the
48 14 incentive payment; must have a current and unrestricted
48 15 license to practice the professional's respective profession;
48 16 and must be able to begin full=time clinical practice upon
48 17 signing an agreement for an incentive payment.
48 18 (b) To be eligible, a community must provide a clinical
48 19 setting for full=time practice of a health care professional
48 20 and must provide a fifty thousand dollar matching contribution
48 21 for a physician and a fifteen thousand dollar matching
48 22 contribution for any other health care professional to receive
48 23 an equal amount of state matching funds.
48 24 (c) To be eligible, a health care employer must provide a
48 25 clinical setting for a full=time practice of a health care
48 26 professional and must provide a fifty thousand dollar matching
48 27 contribution for a physician and a fifteen thousand dollar
48 28 matching contribution for any other health care professional
48 29 to receive an equal amount of state matching funds.
48 30 (2) The process for awarding incentive payments. The
48 31 commission shall receive recommendations from the department
48 32 of public health regarding selection of incentive payment
48 33 recipients. The process shall require each recipient to enter
48 34 into an agreement with the commission that specifies the
48 35 obligations of the recipient and the commission prior to
49 1 receiving the incentive payment.
49 2 (3) Public awareness regarding the program including
49 3 notification of potential health care professionals,
49 4 communities, and health care employers about the program and
49 5 dissemination of applications to appropriate entities.
49 6 (4) Measures regarding all of the following:
49 7 (a) The amount of the incentive payment and the specifics
49 8 of obligated service for an incentive payment recipient. An
49 9 incentive payment recipient shall agree to provide service in
49 10 full=time clinical practice for a minimum of four years. If
49 11 an incentive payment recipient is sponsored by a community or
49 12 health care employer, the obligated service shall be provided
49 13 in the sponsoring community or health care employer location.
49 14 An incentive payment recipient sponsored by a health care
49 15 employer shall agree to provide health care services as
49 16 specified in an employment agreement with the sponsoring
49 17 health care employer.
49 18 (b) Determination of the conditions of the incentive
49 19 payment applicable to an incentive payment recipient. At the
49 20 time of approval for participation in the program, an
49 21 incentive payment recipient shall be required to submit proof
49 22 of indebtedness incurred as the result of obtaining loans to
49 23 pay for educational costs resulting in a degree in health
49 24 sciences. For the purposes of this subparagraph division,
49 25 "indebtedness" means debt incurred from obtaining a government
49 26 or commercial loan for actual costs paid for tuition,
49 27 reasonable education expenses, and reasonable living expenses
49 28 related to the graduate, undergraduate, or associate education
49 29 of a health care professional.
49 30 (c) Enforcement of the state's rights under an incentive
49 31 payment agreement, including the commencement of any court
49 32 action. A recipient who fails to fulfill the requirements of
49 33 the incentive payment agreement is subject to repayment of the
49 34 incentive payment in an amount equal to the amount of the
49 35 incentive payment. A recipient who fails to meet the
50 1 requirements of the incentive payment agreement may also be
50 2 subject to repayment of moneys advanced by a community or
50 3 health care employer as provided in any agreement with the
50 4 community or employer.
50 5 (d) A process for monitoring compliance with eligibility
50 6 requirements, obligated service provisions, and use of funds
50 7 by recipients to verify eligibility of recipients and to
50 8 ensure that state, federal, and other matching funds are used
50 9 in accordance with program requirements.
50 10 (e) The use of the funds received. Any portion of the
50 11 incentive payment that is attributable to federal funds shall
50 12 be used as required by the federal entity providing the funds.
50 13 Any portion of the incentive payment that is attributable to
50 14 state funds shall first be used toward payment of any
50 15 outstanding loan indebtedness of the recipient. The remaining
50 16 portion of the incentive payment shall be used as specified in
50 17 the incentive payment agreement.
50 18 d. A recipient is responsible for reporting on federal
50 19 income tax forms any amount received through the program, to
50 20 the extent required by federal law. Incentive payments
50 21 received through the program by a recipient in compliance with
50 22 the requirements of the incentive payment program are exempt
50 23 from state income taxation.
50 24 5. NURSING WORKFORCE SHORTAGE INITIATIVE.
50 25 a. NURSE EDUCATOR INCENTIVE PAYMENT PROGRAM.
50 26 (1) The commission shall establish a nurse educator
50 27 incentive payment program. For the purposes of this
50 28 paragraph, "nurse educator" means a registered nurse who holds
50 29 a master's degree or doctorate degree and is employed as a
50 30 faculty member who teaches nursing in a nursing education
50 31 program as provided in 655 IAC 2.6 at a community college, an
50 32 accredited private institution, or an institution of higher
50 33 education governed by the state board of regents.
50 34 (2) The program shall consist of incentive payments to
50 35 recruit and retain nurse educators. The program shall provide
51 1 for incentive payments of up to twenty thousand dollars for a
51 2 nurse educator who remains teaching in a qualifying teaching
51 3 position for a period of not less than four consecutive
51 4 academic years.
51 5 (3) The nurse educator and the commission shall enter into
51 6 an agreement specifying the obligations of the nurse educator
51 7 and the commission. If the nurse educator leaves the
51 8 qualifying teaching position prior to teaching for four
51 9 consecutive academic years, the nurse educator shall be liable
51 10 to repay the incentive payment amount to the state, plus
51 11 interest as specified by rule. However, if the nurse educator
51 12 leaves the qualifying teaching position involuntarily, the
51 13 nurse educator shall be liable to repay only a pro rata amount
51 14 of the incentive payment based on incompleted years of
51 15 service.
51 16 (4) The commission, in consultation with the department of
51 17 public health, shall adopt rules pursuant to chapter 17A
51 18 relating to the establishment and administration of the nurse
51 19 educator incentive payment program. The rules shall include
51 20 provisions specifying what constitutes a qualifying teaching
51 21 position.
51 22 b. NURSING FACULTY FELLOWSHIP PROGRAM.
51 23 (1) The commission shall establish a nursing faculty
51 24 fellowship program to provide funds to nursing schools in the
51 25 state, including but not limited to nursing schools located at
51 26 community colleges, for fellowships for individuals employed
51 27 in qualifying positions on the nursing faculty. The program
51 28 shall be designed to assist nursing schools in filling
51 29 vacancies in qualifying positions throughout the state.
51 30 (2) The commission, in consultation with the department of
51 31 public health and in cooperation with nursing schools
51 32 throughout the state, shall develop a distribution formula
51 33 which shall provide that no more than thirty percent of the
51 34 available moneys are awarded to a single nursing school.
51 35 Additionally, the program shall limit funding for a qualifying
52 1 position in a nursing school to no more than ten thousand
52 2 dollars per year for up to three years.
52 3 (3) The commission, in consultation with the department of
52 4 public health, shall adopt rules pursuant to chapter 17A to
52 5 administer the program. The rules shall include provisions
52 6 specifying what constitutes a qualifying position at a nursing
52 7 school.
52 8 (4) In determining eligibility for a fellowship, the
52 9 commission shall consider all of the following:
52 10 (a) The length of time a qualifying position has gone
52 11 unfilled at a nursing school.
52 12 (b) Documented recruiting efforts by a nursing school.
52 13 (c) The geographic location of a nursing school.
52 14 (d) The type of nursing program offered at the nursing
52 15 school, including associate, bachelor's, master's, or doctoral
52 16 degrees in nursing, and the need for the specific nursing
52 17 program in the state.
52 18 6. SAFETY NET PROVIDER RECRUITMENT AND RETENTION
52 19 INITIATIVES PROGRAM. The department of public health in
52 20 accordance with efforts pursuant to sections 135.163 and
52 21 135.164 and in cooperation with the Iowa collaborative safety
52 22 net provider network governing group as described in section
52 23 135.153, shall establish and administer a safety net provider
52 24 recruitment and retention initiatives program to address the
52 25 health care workforce shortage relative to safety net
52 26 providers. The department of public health in cooperation
52 27 with the governing group shall adopt rules pursuant to chapter
52 28 17A to implement and administer such program.
52 29 7. ANNUAL REPORT. The department of public health, in
52 30 cooperation with the entities identified in this section as
52 31 having control over any of the accounts within the fund shall
52 32 submit an annual report to the governor and the general
52 33 assembly regarding the status of the health care workforce
52 34 support initiative, including the balance remaining in and
52 35 appropriations from the health care workforce shortage fund
53 1 and the accounts within the fund.
53 2 Sec. 62. HEALTH CARE WORKFORCE INITIATIVES == FEDERAL
53 3 FUNDING. The department of public health shall work with the
53 4 department of workforce development and health care
53 5 stakeholders to apply for federal moneys allocated in the
53 6 federal American Recovery and Reinvestment Act of 2009 for
53 7 health care workforce initiatives that are available through a
53 8 competitive grant process administered by the health resources
53 9 and services administration of the United States department of
53 10 health and human services or the United States department of
53 11 health and human services. Any federal moneys received shall
53 12 be deposited in the health care workforce shortage fund
53 13 created in section 261.128 of this Act and shall be used for
53 14 the purposes specified for the fund and for the purposes
53 15 specified in the federal American Recovery and Reinvestment
53 16 Act of 2009.
53 17 Sec. 63. Sections 261.19 and 261.19B, Code 2009, are
53 18 repealed.
53 19 Sec. 64. CODE EDITOR DIRECTIVE. The Code editor shall
53 20 create a new division in chapter 261 codifying section
53 21 261.128, as enacted in this Act, as the health care workforce
53 22 support initiative.
53 23 DIVISION VI
53 24 PHARMACEUTICAL=RELATED INITIATIVES
53 25 MEDICATION THERAPY MANAGEMENT
53 26 Sec. 65. MEDICATION THERAPY MANAGEMENT == FINDINGS,
53 27 DIRECTIVE, REPORT.
53 28 1. The general assembly finds all of the following:
53 29 a. The utilization and reimbursement of pharmaceutical
53 30 case management services under the medical assistance program
53 31 has resulted in the successful management of chronic disease
53 32 states of medical assistance program recipients in a
53 33 cost=effective manner.
53 34 b. The utilization of pharmaceutical case management or
53 35 medication therapy management is consistent with the concept
54 1 of a medical home, as defined in section 135.157.
54 2 c. The success and cost=effectiveness of medication
54 3 therapy management in public programs such as the medical
54 4 assistance and federal Medicare programs could also be
54 5 realized through private health care coverage and should be a
54 6 covered benefit under individual and group health insurance
54 7 policies, contracts, and plans.
54 8 2. Based upon these findings, the general assembly directs
54 9 all health insurers in the state subject to regulation by the
54 10 commissioner of insurance to examine the feasibility and
54 11 efficacy of including medication therapy management as a
54 12 covered benefit under individual and group health insurance
54 13 policies, contracts, and plans.
54 14 a. If the health insurer determines the inclusion of
54 15 medication therapy management as a covered benefit to be
54 16 feasible and efficacious, the general assembly encourages the
54 17 insurer to provide such coverage by January 1, 2010.
54 18 b. If the health insurer determines that inclusion of
54 19 medication therapy management as a covered benefit is not
54 20 feasible and efficacious, and does not provide coverage under
54 21 the health insurer's policies, contracts, or plans by January
54 22 1, 2010, the health insurer shall submit, to the chairpersons
54 23 of the committees on human resources of the senate and house
54 24 of representatives by January 1, 2010, a written report
54 25 detailing the health insurer's examination and analysis of the
54 26 issue and any reasons and supporting data for not including
54 27 medication therapy management as a covered benefit.
54 28 3. For the purposes of this section, "medication therapy
54 29 management" means pharmaceutical case management services as
54 30 provided under the medical assistance program in accordance
54 31 with 441 IAC 78.47.
54 32 EVIDENCE=BASED PRESCRIPTION DRUG EDUCATION PROGRAM
54 33 Sec. 66. NEW SECTION. 155B.1 DEFINITIONS.
54 34 As used in this chapter, unless the context otherwise
54 35 requires:
55 1 1. "Board" means the board of pharmacy.
55 2 2. "Department" means the department of public health.
55 3 3. "Prescription drug" means prescription drug as defined
55 4 in section 155A.3.
55 5 Sec. 67. NEW SECTION. 155B.2 EVIDENCE=BASED PRESCRIPTION
55 6 DRUG EDUCATION PROGRAM.
55 7 1. The board shall establish and administer an
55 8 evidence=based prescription drug education program designed to
55 9 provide health care professionals who are licensed to
55 10 prescribe or dispense prescription drugs with information and
55 11 education regarding the therapeutic and cost=effective
55 12 utilization of prescription drugs.
55 13 2. a. In establishing and administering the program, the
55 14 board shall request input and collaboration from physicians,
55 15 pharmacists, private insurers, hospitals, pharmacy benefits
55 16 managers, the medical assistance drug utilization review
55 17 commission, medical and pharmacy schools, and other entities
55 18 providing evidence=based education to health care
55 19 professionals that are licensed to prescribe or dispense
55 20 prescription drugs. To the greatest extent possible, the
55 21 information regarding the therapeutic and cost=effective
55 22 utilization of prescription drugs shall be gender, race,
55 23 ethnicity, and age specific.
55 24 b. The board may contract with an Iowa=based college of
55 25 pharmacy to provide technical and clinical support to the
55 26 board in establishing and administering the program.
55 27 3. The department shall seek funding from nongovernmental
55 28 health foundations or other nonprofit charitable foundations
55 29 to establish and administer the program. Implementation of
55 30 the program is subject to receipt of such funding. The
55 31 department shall establish and collect fees from private
55 32 payors for participation in the program. Fees received from
55 33 private payors shall be deposited in the general fund of the
55 34 state and the amounts received shall be appropriated to the
55 35 department for the purposes of administering the program.
56 1 GIFTS TO HEALTH CARE PRACTITIONERS
56 2 Sec. 68. NEW SECTION. 155C.1 PURPOSES.
56 3 The purposes of this chapter are to improve the public
56 4 health and the quality of prescribing and medical decision
56 5 making; promote consumer access to information relating to
56 6 medical care and gifts; reduce the inappropriate influence of
56 7 gifts and payments on provider medical decisions; limit annual
56 8 increases in the cost of health care; and assist the state in
56 9 its role as a purchaser of health care services and an
56 10 administrator of health care programs by enabling the state to
56 11 determine the effect of gifts on the cost, utilization, and
56 12 delivery of health care services.
56 13 Sec. 69. NEW SECTION. 155C.2 DEFINITIONS.
56 14 As used in this chapter, unless the context otherwise
56 15 requires:
56 16 1. "Biologic" means a biological product as defined in 42
56 17 U.S.C. } 262.
56 18 2. "Bona fide clinical trial" means any research project
56 19 that prospectively assigns human subjects to intervention and
56 20 comparison groups to study the cause and effect relationship
56 21 between a medical intervention and a health outcome.
56 22 3. "Department" means the department of administrative
56 23 services.
56 24 4. "Gift" means a payment, fee, food, entertainment,
56 25 travel, honorarium, subscription, advance, service, subsidy,
56 26 economic benefit, or anything of value provided, unless
56 27 consideration of equal or greater value is received, and
56 28 includes anything of value provided to a health care
56 29 practitioner for less than market value. "Gift" does not
56 30 include product samples or negotiated rebates or discounts.
56 31 5. "Health care practitioner" means a health care
56 32 professional who is licensed to prescribe prescription drugs,
56 33 biologics, or medical devices, or a partnership or corporation
56 34 consisting of such health care professionals, or an officer,
56 35 employee, agent, or contractor of such a health care
57 1 professional acting in the course of employment, agency, or
57 2 contract related to or supportive of the provision of health
57 3 care by the health care professional.
57 4 6. "Manufacturer" means a person engaged in the
57 5 manufacturing, preparing, propagating, compounding,
57 6 processing, packaging, repackaging, distributing, or labeling
57 7 of prescription drugs, biologics, or medical devices.
57 8 7. "Medical device" means device as defined in section
57 9 155A.3.
57 10 8. "Prescription drug" means prescription drug as defined
57 11 in section 155A.3.
57 12 9. "Significant educational, scientific, or policy=making
57 13 conference or seminar" means an educational, scientific, or
57 14 policy=making conference or seminar that meets both of the
57 15 following requirements:
57 16 a. Is accredited by the accreditation council for
57 17 continuing medical education or a comparable organization.
57 18 b. Offers continuing medical education credit, features
57 19 multiple presenters on scientific research, or is authorized
57 20 by the sponsoring association to recommend or make policy.
57 21 10. "State health care program" means a program for which
57 22 the state purchases prescription drugs, biologics, or medical
57 23 devices, including but not limited to the medical assistance
57 24 program, or a state employee, corrections, or retirement
57 25 system program.
57 26 11. "Wholesaler" means wholesaler as defined in section
57 27 155A.3.
57 28 Sec. 70. NEW SECTION. 155C.3 GIFTS TO HEALTH CARE
57 29 PRACTITIONERS PROHIBITED.
57 30 1. A manufacturer or wholesaler, or a manufacturer's or
57 31 wholesaler's agent, who participates in a state health care
57 32 program shall not offer or give any gift to a health care
57 33 practitioner.
57 34 2. Notwithstanding subsection 1, the following gifts are
57 35 not prohibited but shall be disclosed pursuant to section
58 1 155C.4:
58 2 a. Payment to the sponsor of a significant educational,
58 3 scientific, or policy=making conference or seminar if the
58 4 payment is not made directly to a health care practitioner;
58 5 the payment is used solely for bona fide educational purposes;
58 6 and all conference or seminar activities are objective, free
58 7 from industry influence, and do not promote specific products.
58 8 b. Reasonable honoraria and payment of the reasonable
58 9 expenses of a health care practitioner who serves on the
58 10 faculty at a significant educational, scientific, or
58 11 policy=making conference or seminar pursuant to an explicit
58 12 contract with specific deliverables which are restricted to
58 13 scientific issues, not marketing efforts, and the content of
58 14 any presentation, including slides and written materials, are
58 15 determined by the health care practitioners.
58 16 c. Compensation for the substantial professional or
58 17 consulting services of a health care practitioner in
58 18 connection with a bona fide clinical trial pursuant to an
58 19 explicit contract with specific deliverables which are
58 20 restricted to scientific issues, not marketing efforts.
58 21 Sec. 71. NEW SECTION. 155C.4 DISCLOSURE OF EXEMPTED
58 22 GIFTS.
58 23 1. a. Annually, on or before December 1, every
58 24 manufacturer or wholesaler of prescription drugs, biologics,
58 25 or medical devices that participates in a state health care
58 26 program shall disclose to the department, the value, nature,
58 27 purpose, and recipient of any gift not prohibited in section
58 28 155C.3, which is provided by the manufacturer or wholesaler,
58 29 directly or through its agents, to any health care
58 30 practitioner or any other person in this state authorized to
58 31 prescribe, dispense, or purchase prescription drugs,
58 32 biologics, or medical devices in this state.
58 33 b. For each expenditure, the manufacturer or wholesaler
58 34 shall also identify the recipient and the recipient's address,
58 35 credentials, institutional affiliation, and state board or
59 1 drug enforcement agency numbers.
59 2 2. Each manufacturer or wholesaler subject to the
59 3 provisions of this section shall also disclose to the
59 4 department the name and address of the individual responsible
59 5 for the manufacturer's or wholesaler's compliance with this
59 6 section, or if this information has been previously reported,
59 7 any changes in the name or address of the individual
59 8 responsible for the manufacturer's or wholesaler's compliance
59 9 with this section.
59 10 3. The report shall be accompanied by payment of a fee, to
59 11 be established by rule of the department, to defray
59 12 administrative costs.
59 13 4. The department shall make all disclosed data publicly
59 14 available and easily searchable on its internet site.
59 15 Sec. 72. NEW SECTION. 155C.5 DEPARTMENTAL REPORTS.
59 16 The department shall provide an annual report to the
59 17 governor and the general assembly on or before January 15,
59 18 containing an analysis of the data submitted to the department
59 19 under section 155C.4. The report shall include all of the
59 20 following:
59 21 1. Information on gifts required to be disclosed under
59 22 section 155C.4, which shall be presented in aggregate form and
59 23 by selected types of health care practitioners or individual
59 24 health care practitioners, as prioritized each year by the
59 25 department and analyzed to determine whether prescribing
59 26 patterns by these health care practitioners reimbursed by the
59 27 state health care programs may reflect manufacturer's or
59 28 wholesaler's influence.
59 29 2. Information on violations and enforcement actions
59 30 brought pursuant to this chapter.
59 31 Sec. 73. NEW SECTION. 155C.6 PUBLIC RECORDS.
59 32 1. The information required to be submitted pursuant to
59 33 section 155C.4, and the data and reports compiled by the
59 34 department pursuant to section 155C.5, are public records.
59 35 2. Notwithstanding any other provision of law to the
60 1 contrary, the identity of health care practitioners and other
60 2 recipients of gifts, payments, and materials required to be
60 3 reported in this section do not constitute confidential
60 4 information or trade secrets.
60 5 Sec. 74. NEW SECTION. 155C.7 ENFORCEMENT == RULES.
60 6 1. The department may bring an action for injunctive
60 7 relief, costs, and attorneys fees, and to impose a civil
60 8 penalty of no more than ten thousand dollars per violation on
60 9 a manufacturer or wholesaler that fails to comply with any
60 10 provision of this chapter.
60 11 2. The department shall adopt rules as necessary to
60 12 administer this chapter.
60 13 DATA MINING
60 14 Sec. 75. NEW SECTION. 155D.1 PURPOSES.
60 15 The purposes of this chapter are the following:
60 16 1. To safeguard the confidentiality of prescribing
60 17 information, protect the integrity of the doctor=patient
60 18 relationship, maintain the integrity and public trust in the
60 19 medical profession, combat vexatious and harassing sales
60 20 practices, restrain undue influence exerted by pharmaceutical
60 21 industry marketing representatives over prescribing decisions,
60 22 and further the state interest in improving the quality and
60 23 lowering the cost of health care.
60 24 2. To ensure the confidentiality of data held by a state
60 25 agency which could be used directly or indirectly to identify
60 26 a patient or a health care professional licensed to prescribe
60 27 drugs, biologics, or medical devices.
60 28 3. To ensure compliance with federal Medicaid law and
60 29 regulations prohibiting the disclosure and use of Medicaid
60 30 data except to administer the Medicaid program, and to ensure
60 31 that data held by the department of human services or its
60 32 agents that could directly or indirectly identify patients or
60 33 health care professionals licensed to prescribe products be
60 34 kept confidential.
60 35 4. To regulate the monitoring of prescribing practices
61 1 solely for commercial marketing purposes by entities selling
61 2 prescribed products, and not to regulate monitoring for other
61 3 uses, such as quality control, research unrelated to
61 4 marketing, or use by governments or other entities not in the
61 5 business of selling health care products.
61 6 Sec. 76. NEW SECTION. 155D.2 DEFINITIONS.
61 7 As used in this chapter, unless the context otherwise
61 8 requires:
61 9 1. "Biologic" means a biological product as defined in 42
61 10 U.S.C. } 262.
61 11 2. "Bona fide clinical trial" means a research project
61 12 that prospectively assigns human subjects to intervention and
61 13 comparison groups to study the cause and effect relationship
61 14 between a medical intervention and a health outcome.
61 15 3. "Individual identifying information" means information
61 16 which directly or indirectly identifies a prescriber or a
61 17 patient, and the information is derived from or relates to a
61 18 prescription for any prescribed product.
61 19 4. "Marketing" means an activity by a company or an agent
61 20 of the company making or selling prescribed products intended
61 21 to influence prescribing or purchasing choices of the
61 22 company's prescribed products, including but not limited to
61 23 any of the following:
61 24 a. Advertising, publicizing, promoting, or sharing
61 25 information about a prescribed product.
61 26 b. Identifying individuals to receive a message promoting
61 27 use of a particular prescribed product, including but not
61 28 limited to an advertisement, brochure, or contact by a sales
61 29 representative.
61 30 c. Planning the substance of a sales representative visit
61 31 or communication or the substance of an advertisement or other
61 32 promotional message or document.
61 33 d. Evaluating or compensating sales representatives.
61 34 e. Identifying individuals to receive any form of gift,
61 35 product sample, consultancy, or any other item, service,
62 1 compensation, or employment of value.
62 2 f. Advertising or promoting prescribed products directly
62 3 to patients.
62 4 5. "Medicaid program" means the medical assistance program
62 5 administered as specified under chapter 249A.
62 6 6. "Pharmacy" means pharmacy as defined in section 155A.3.
62 7 7. "Prescription drug" means prescription drug as defined
62 8 in section 155A.3.
62 9 8. "Prescribed product" means a biologic, prescription
62 10 drug, or a medical device.
62 11 9. "Prescriber" means a health care practitioner who is
62 12 licensed to prescribe prescription drugs, biologics, or
62 13 medical devices in this state.
62 14 10. "Regulated record" means information or documentation
62 15 from a prescription written by a prescriber doing business in
62 16 this state or a prescription dispensed in this state.
62 17 11. "State health care program" means a program for which
62 18 the state purchases prescribed products, including but not
62 19 limited to a state employee, corrections, or retirement system
62 20 program, but does not include the medical assistance program.
62 21 Sec. 77. NEW SECTION. 155D.3 PRIVACY PROVISIONS.
62 22 1. a. A person, including a state health care program,
62 23 shall not knowingly disclose or use regulated records that
62 24 include individual identifying information for the marketing
62 25 of a prescribed product.
62 26 b. The department of human services shall ensure that the
62 27 department, its employees, and agents, comply with the
62 28 limitations on redisclosure or use of medical assistance
62 29 program prescription information as provided for under state
62 30 and federal law and applicable federal regulations, and shall
62 31 have policies and procedures to ensure compliance with such
62 32 state and federal laws and federal regulations.
62 33 2. a. Regulated records containing individual identifying
62 34 information may be disclosed, sold, transferred, exchanged, or
62 35 used only for nonmarketing purposes including but not limited
63 1 to:
63 2 (1) Activities related to filling a valid prescription,
63 3 including but not limited to the dispensing of a prescribed
63 4 product to a patient or to the patient's authorized
63 5 representative; the transmission of regulated record
63 6 information between an authorized prescriber and a pharmacy;
63 7 the transfer of regulated record information between
63 8 pharmacies; the transfer of regulated records that may occur
63 9 if pharmacy ownership is changed or transferred; and pharmacy
63 10 reimbursement.
63 11 (2) Law enforcement purposes as otherwise authorized or
63 12 required by statute or court order.
63 13 (3) Research including but not limited to bona fide
63 14 clinical trials, postmarketing surveillance research, product
63 15 safety studies, population=based public health research, and
63 16 research regarding the effects of health care practitioner
63 17 prescribing practices, and statistical reports if individual
63 18 identifing information is not published, redisclosed, or used
63 19 to identify or contact individuals.
63 20 (4) Product safety evaluations, product recalls and
63 21 specific risk management plans, as identified or requested by
63 22 the federal food and drug administration, or its successor
63 23 agency.
63 24 (5) Pharmacy reimbursement, formulary compliance, case
63 25 management related to the diagnosis, treatment, or management
63 26 of illness for a specific patient, including but not limited
63 27 to care management educational communications provided to a
63 28 patient about the patient's health condition, adherence to a
63 29 prescribed course of therapy, or other information about the
63 30 product being dispensed, treatment options, or clinical
63 31 trials.
63 32 (6) Utilization review by the state, by a health care
63 33 provider, or by the patient's insurance provider for health
63 34 care services, including but not limited to determining
63 35 compliance with the terms of coverage or medical necessity.
64 1 (7) The collection and analysis of product utilization
64 2 data for health care quality improvement purposes, including
64 3 but not limited to development of evidence=based treatment
64 4 guidelines or health care performance effectiveness and
64 5 efficiency measures, promoting compliance with evidence=based
64 6 treatment guidelines or health care performance measures, and
64 7 providing prescribers with information that details their
64 8 practices relative to their peers to encourage prescribing
64 9 consistent with evidence=based practice.
64 10 (8) The collection and dissemination of product
64 11 utilization data to promote transparency in evaluating
64 12 performance related to the health care quality improvement
64 13 measures.
64 14 (9) The transfer of product utilization data to and
64 15 through secure electronic health record or personal health
64 16 record systems.
64 17 (10) Use by any government agency or government agency
64 18 sponsored program in carrying out its functions, or by any
64 19 private person acting on behalf of a federal, state, or local
64 20 agency in carrying out its functions.
64 21 (11) Use in connection with any civil, criminal,
64 22 administrative, or arbitral proceeding in any federal, state,
64 23 or local court or agency or before any self=regulatory body,
64 24 including but not limited to the service of process,
64 25 investigation in anticipation of litigation, and the execution
64 26 or enforcement of judgments and orders, or pursuant to an
64 27 order of a federal, state, or local court.
64 28 b. An authorized recipient of regulated records containing
64 29 individual identifying information may resell, reuse, or
64 30 redisclose the information only as permitted under paragraph
64 31 "a".
64 32 c. An authorized recipient of regulated records that
64 33 resells, reuses, or rediscloses individual identifying
64 34 information covered by this chapter shall maintain for a
64 35 period of five years, records identifying each person or
65 1 entity that receives the information and the permitted purpose
65 2 for which the information will be used. The authorized
65 3 recipient shall make such records available to any person upon
65 4 request.
65 5 3. This section shall not be interpreted to prohibit
65 6 conduct involving the collection, use, transfer, or sale of
65 7 regulated records for marketing purposes if all of the
65 8 following conditions apply:
65 9 a. The data is aggregated.
65 10 b. The data does not contain individually identifying
65 11 information.
65 12 c. There is no reasonable basis to believe that the data
65 13 can be used to obtain individually identifying information.
65 14 4. This section shall not prevent any person from
65 15 disclosing individual identifying information to the
65 16 identified individual if the information does not include
65 17 protected information pertaining to any other person.
65 18 Sec. 78. NEW SECTION. 155D.4 CIVIL PENALTY ==
65 19 ENFORCEMENT == RULEMAKING.
65 20 1. Any person who knowingly fails to comply with the
65 21 requirements of this chapter or rules adopted pursuant to this
65 22 chapter by using or disclosing regulated records in a manner
65 23 not authorized by this chapter or rules adopted pursuant to
65 24 this chapter is subject to a civil penalty of not more than
65 25 fifty thousand dollars per violation. Each disclosure of a
65 26 regulated record constitutes a separate violation.
65 27 2. The attorney general shall enforce payment of penalties
65 28 assessed under this section.
65 29 3. The board of pharmacy shall adopt rules to administer
65 30 this chapter including the assessment of penalties under this
65 31 section.
65 32 Sec. 79. NEW SECTION. 155D.5 CONSUMER FRAUD.
65 33 A violation of this chapter is an unfair or deceptive act
65 34 in trade or commerce and an unfair method of competition under
65 35 the consumer fraud Act, section 714.16.
66 1 DIVISION VII
66 2 HEALTH CARE TRANSPARENCY
66 3 Sec. 80. Section 135.11, Code 2009, is amended by adding
66 4 the following new subsection:
66 5 NEW SUBSECTION. 32. Establish an office of health care
66 6 reform to coordinate health care reform initiatives and
66 7 activities related to the medical home system advisory
66 8 council, the electronic health information advisory council
66 9 and executive committee, the prevention and chronic care
66 10 management advisory council, the direct care worker task
66 11 force, the health and long=term care access technical advisory
66 12 committee, the clinicians advisory panel, the long=term living
66 13 initiatives of the department of elder affairs, medical
66 14 assistance and hawk=i program expansions and initiatives,
66 15 prevention and wellness initiatives including but not limited
66 16 to those administered through the Iowa healthy communities
66 17 initiative pursuant to section 135.27 and through the
66 18 governor's council on physical fitness and nutrition, health
66 19 care transparency activities, and other health care
66 20 reform=related advisory bodies and activities to provide
66 21 direction and promote collaborative efforts among health care
66 22 providers involved in the initiatives and activities. The
66 23 office shall also monitor other state and federal health care
66 24 reform initiatives to promote further coordination and
66 25 collaboration of health care reform initiatives and
66 26 activities.
66 27 Sec. 81. Section 135.156, subsection 3, paragraph c,
66 28 subparagraph (2), Code 2009, is amended to read as follows:
66 29 (2) Consult with the Iowa communications network, private
66 30 fiberoptic networks, and any other communications entity to
66 31 seek collaboration, avoid duplication, and leverage
66 32 opportunities in developing a network backbone infrastructure.
66 33 The public and private entities involved shall structure the
66 34 public and private networks comprising the backbone
66 35 infrastructure in a manner that allows for seamless
67 1 interoperability between the networks.
67 2 Sec. 82. Section 135.165, Code 2009, is amended to read as
67 3 follows:
67 4 135.165 HEALTH CARE TRANSPARENCY == REPORTING REQUIREMENTS
67 5 == HOSPITALS AND NURSING FACILITIES.
67 6 1. Each hospital and nursing facility in this state that
67 7 is recognized by the Internal Revenue Code as a nonprofit
67 8 organization or entity shall submit to the department of
67 9 public health and the legislative services agency, annually, a
67 10 copy of the hospital's or nursing facility's internal revenue
67 11 service form 990, including but not limited to schedule J or
67 12 any successor schedule that provides compensation information
67 13 for certain officers, directors, trustees, and key employees,
67 14 information about the highest compensated employees, and
67 15 information regarding revenues, expenses, excess or surplus
67 16 revenues, and reserves within ninety days following the due
67 17 date for filing the hospital's or nursing facility's return
67 18 for the taxable year.
67 19 2. Each nursing facility in this state that is not
67 20 recognized by the Internal Revenue Code as a nonprofit
67 21 organization or entity shall submit to the department of
67 22 public health and the legislative services agency, annually,
67 23 the information required to be submitted by nonprofit nursing
67 24 facilities pursuant to subsection 1. The department of public
67 25 health, in cooperation with representatives of such nursing
67 26 facilities, shall adopt rules regarding the format for
67 27 submission of such information.
67 28 3. With regard to the collection of information to be
67 29 submitted pursuant to subsection 1 as applicable to each
67 30 public hospital in the state, the department of management
67 31 shall forward to the department of public health and the
67 32 legislative services agency, annually, the certified budget
67 33 for each public hospital.
67 34 Sec. 83. NEW SECTION. 135.166 HEALTH CARE DATA ==
67 35 COLLECTION FROM HOSPITALS.
68 1 1. The department of public health shall enter into a
68 2 memorandum of understanding to utilize the Iowa hospital
68 3 association to act as the department's intermediary in
68 4 collecting, maintaining, and disseminating hospital inpatient,
68 5 outpatient, and ambulatory information, as initially
68 6 authorized in 1996 Iowa Acts, chapter 1212, section 5,
68 7 subsection 1, paragraph "a", subparagraph (4) and 641 IAC
68 8 177.3.
68 9 2. The memorandum of understanding shall include but is
68 10 not limited to provisions that address the duties of the
68 11 department and the Iowa hospital association regarding the
68 12 collection, reporting, disclosure, storage, and
68 13 confidentiality of the data.
68 14 Sec. 84. HEALTH CARE QUALITY AND COST TRANSPARENCY ==
68 15 WORKGROUP.
68 16 1. The community advisory council established by the Iowa
68 17 healthcare collaborative referred to in section 135.40 shall
68 18 convene a health care quality and cost transparency workgroup
68 19 to develop recommendations for legislation and policies
68 20 regarding health care quality and cost including measures to
68 21 be utilized in providing transparency to consumers of health
68 22 care and health care coverage.
68 23 2. The workgroup shall do all of the following:
68 24 a. Review the approaches of other states in addressing
68 25 health care transparency information.
68 26 b. Develop and compile recommendations and strategies to
68 27 lower health care costs and health care coverage costs for
68 28 consumers and businesses.
68 29 c. Review and recommend health care quality and cost
68 30 measures to be reported by health plans, hospitals, and
68 31 physicians. Any measure recommended shall be evidence=based
68 32 and clinically important, reasonably feasible to implement,
68 33 and easily understood by the health care consumer.
68 34 d. Develop a plan for the collection, analysis, and
68 35 publishing of clinical data from physicians and health care
69 1 providers other than hospitals.
69 2 e. Develop a plan to collect and publish as a database,
69 3 consumer health care quality and cost information designed to
69 4 make available to consumers transparent health care cost
69 5 information, quality information including but not limited to
69 6 hospital infection rates, medication and surgical errors, and
69 7 such other information necessary to empower consumers,
69 8 including uninsured consumers, to make economically sound and
69 9 medically appropriate health care decisions.
69 10 3. The workgroup shall submit a written report of the
69 11 workgroup's findings, recommendations, and plans, to the
69 12 general assembly on or before December 15, 2009.
69 13 Sec. 85. MEMORANDUM OF UNDERSTANDING == IOWA HEALTHCARE
69 14 COLLABORATIVE. The department of public health shall enter
69 15 into a memorandum of understanding with the Iowa healthcare
69 16 collaborative referred to in section 135.40. The memorandum
69 17 of understanding shall include but is not limited to
69 18 specification of the duties of the Iowa healthcare
69 19 collaborative with respect to the utilization of funds
69 20 appropriated by the state.
69 21 SF 389
69 22 pf/rj/jh/26