S.F. 480 DIVISION I 1 OFFICE OF HEALTH POLICY 2 Section 1. Section 135.163, Code 2011, is amended to read 3 as follows: 4 135.163 Health and long-term care access Office of health 5 policy . 6 1. The An office of health policy is created in the 7 department shall coordinate to integrate public and private 8 efforts to develop in formulating and implementing a state 9 health policy agenda. The department shall coordinate the 10 efforts of appropriate divisions within the department to 11 support the work of the office. The state health policy agenda 12 shall accomplish all of the following: 13 a. Develop and maintain an appropriate health care delivery 14 infrastructure and a stable, well-qualified, diverse, and 15 sustainable health care workforce in this state. The health 16 care delivery infrastructure and the health care workforce 17 shall address the broad spectrum of health care needs of Iowans 18 throughout their lifespan including long-term care needs. 19 b. Establish a methodology and process to achieve cultural 20 transformation that emphasizes health and wellness by removing 21 barriers across the spectrum of personal, professional, and 22 community constructs to empower individual behavioral and 23 systemic change. 24 c. Provide for the collection, analysis, and use of cost 25 and quality data to inform decisions by individual consumers, 26 businesses, and policymakers in determining the most effective 27 and efficient use of resources in arriving at economically 28 sustainable health care outcomes. 29 2. The office shall be staffed by a coordinator who is 30 a health economist. The coordinator may utilize existing 31 councils and workgroups as necessary and shall establish 32 a technical advisory council to assist in the development 33 of policy priorities and the strategic plan described in 34 subsection 3. The technical advisory council shall include 35 -1- SF 480 (8) 84 pf/rj 1/ 15

S.F. 480 but is not limited to representatives of the university of 1 Iowa college of public health and the university of Iowa 2 public policy center, health planners, health care consumers, 3 health care purchasers, state and local agencies that regulate 4 entities involved in health care, health care providers, and 5 health care facilities. 6 3. The department office of health policy shall, at a 7 minimum, do all of the following: 8 1. a. Develop a strategic plan for health care delivery 9 infrastructure and health care workforce resources in this 10 state in accordance with section 135.164 . The office shall 11 act as an ongoing resource to the health facilities council in 12 evaluating and updating the certificate of need program. 13 2. b. Provide for the continuous collection of data to 14 provide a basis for health care strategic planning and health 15 care policymaking decision making by individual consumers, 16 businesses, and policymakers . 17 3. Make recommendations regarding the health care delivery 18 infrastructure and the health care workforce that assist 19 in monitoring current needs, predicting future trends, and 20 informing policymaking. 21 c. Develop and implement a blueprint to make Iowa one of the 22 healthiest states by the year 2014. 23 Sec. 2. Section 135.164, Code 2011, is amended to read as 24 follows: 25 135.164 Strategic plan. 26 1. Development of a strategic plan. The office 27 shall develop a strategic plan for health care delivery 28 infrastructure and health care workforce resources . The 29 strategic plan shall describe the existing health care system, 30 describe and provide a rationale for the desired health 31 care system, provide an action plan for implementation of 32 changes necessary to achieve the desired health care system , 33 and provide methods to evaluate the system. The plan shall 34 incorporate expenditure control methods and integrate criteria 35 -2- SF 480 (8) 84 pf/rj 2/ 15

S.F. 480 for evidence-based health care. The department office shall 1 do all of the following in developing the strategic plan for 2 health care delivery infrastructure and health care workforce 3 resources : 4 a. Conduct strategic health planning activities related to 5 preparation of the strategic plan. 6 b. Develop a computerized system for accessing, analyzing, 7 and disseminating data relevant to strategic health planning. 8 The department office may enter into data sharing agreements 9 and contractual arrangements necessary to obtain or disseminate 10 relevant data. 11 c. Conduct research and analysis or arrange for research 12 and analysis projects to be conducted by public or private 13 organizations to further the development of the strategic plan. 14 d. Establish a technical advisory committee to assist in 15 the development of the strategic plan. The members of the 16 committee may include but are not limited to health economists, 17 representatives of the university of Iowa college of public 18 health, health planners, representatives of health care 19 purchasers, representatives of state and local agencies that 20 regulate entities involved in health care, representatives 21 of health care providers and health care facilities, and 22 consumers. 23 2. Guiding principles. The strategic plan shall include 24 statewide health planning policies and goals related to the 25 availability of health care facilities and services, the 26 availability of appropriate health care workforce resources, 27 health and wellness promotion, the quality of care, and the 28 cost of care. The policies and goals shall be based on the 29 following principles: 30 a. That a strategic health planning process, responsive to 31 changing health and social needs and conditions, is essential 32 to the health, safety, and welfare of Iowans. The process 33 shall be reviewed and updated as necessary to ensure that the 34 strategic plan addresses all of the following: 35 -3- SF 480 (8) 84 pf/rj 3/ 15

S.F. 480 (1) Promoting and maintaining the health of all Iowans. 1 (2) Providing accessible health care services through the 2 maintenance of an adequate appropriate and sustainable supply 3 of health facilities and an adequate a competent workforce 4 reserve . 5 (3) Controlling excessive increases in costs. 6 (4) Applying specific quality criteria and population 7 health indicators. 8 (5) Recognizing prevention and wellness as priorities in 9 health care programs to improve quality and reduce costs and 10 promoting prevention and wellness across all sectors to improve 11 individual well-being and health outcomes, while reducing human 12 and financial costs . 13 (6) Addressing periodic priority issues including disaster 14 planning, public health threats, and public safety dilemmas. 15 (7) Coordinating health care delivery and resource 16 development efforts among state agencies including those tasked 17 with facility, services, and professional provider licensure; 18 state and federal reimbursement; health service utilization 19 data systems; and others. 20 (8) Recognizing long-term care as an integral component of 21 the health care delivery infrastructure and as an essential 22 service provided by the health care workforce. 23 b. That both consumers and providers throughout the state 24 must be involved in the health planning process, outcomes of 25 which shall be clearly articulated and available for public 26 review and use. 27 c. That the supply of a health care service has a 28 substantial impact on utilization of the service, independent 29 of the effectiveness, medical necessity, or appropriateness of 30 the particular health care service for a particular individual. 31 d. That given that health care resources are not unlimited, 32 the impact of any new health care service or facility on 33 overall health expenditures in this state must be considered. 34 e. That excess capacity of health care services and 35 -4- SF 480 (8) 84 pf/rj 4/ 15

S.F. 480 facilities places an increased economic burden on the public. 1 f. That the likelihood that a requested new health care 2 facility, service, or equipment will improve health care 3 quality and outcomes must be considered. 4 g. That development and ongoing maintenance of current and 5 accurate health care information and statistics related to cost 6 and quality of health care and projections of the need for 7 health care facilities and services are necessary to developing 8 an effective health care planning strategy. 9 h. That the certificate of need program as a component 10 of the health care planning regulatory process must balance 11 considerations of access to quality care at a reasonable 12 cost for all Iowans, optimal use of existing health care 13 resources, fostering of expenditure control, and elimination of 14 unnecessary duplication of health care facilities and services, 15 while supporting improved health care outcomes. 16 i. That strategic health care planning must be concerned 17 with the stability of the health care system, encompassing 18 health care financing, quality, and the availability of 19 information and services for all residents. 20 3. Components of the strategic plan. The health care 21 delivery infrastructure and health care workforce resources 22 strategic plan developed by the department office shall include 23 all of the following: 24 a. Assessment and objectives. A health care system 25 assessment and objectives component that does all of the 26 following: 27 (1) Describes state and regional population demographics, 28 health status indicators, and trends in health status and 29 health care needs. 30 (2) Identifies key policy objectives for the state health 31 care system related to access to care, health care outcomes, 32 quality, and cost-effectiveness. 33 b. Certificate of need determinations. A health care 34 facilities and services plan that assesses the demand for 35 -5- SF 480 (8) 84 pf/rj 5/ 15

S.F. 480 health care facilities and services to inform state health care 1 planning efforts and direct certificate of need determinations 2 for those facilities and services subject to certificate of 3 need. The plan shall include all of the following: 4 (1) An inventory of each geographic region’s existing 5 health care facilities and services. 6 (2) Projections of the need for each category of health care 7 facility and service, including those subject to certificate 8 of need. 9 (3) Policies to guide the addition of new or expanded health 10 care facilities and services to promote the use of quality, 11 evidence-based, cost-effective health care delivery options, 12 including any recommendations for criteria, standards, and 13 methods relevant to the certificate of need review process. 14 (4) An assessment of the availability of health 15 care providers, public health resources, transportation 16 infrastructure, and other considerations necessary to support 17 the needed health care facilities and services in each region . 18 c. Data resources. A health care data resources plan that 19 identifies data elements necessary to properly conduct planning 20 activities and to review certificate of need applications, 21 including data related to inpatient and outpatient utilization 22 and outcomes information, and financial and utilization 23 information related to charity care, quality, and cost. The 24 plan shall provide all of the following: 25 (1) An inventory of existing data resources, both public 26 and private, that store and disclose information relevant 27 to the health care planning process, including information 28 necessary to conduct certificate of need activities. The plan 29 shall identify any deficiencies in the inventory of existing 30 data resources and the data necessary to conduct comprehensive 31 health care planning activities. The plan may recommend that 32 the department office be authorized to access existing data 33 sources and conduct appropriate analyses of such data or 34 that other agencies expand their data collection activities 35 -6- SF 480 (8) 84 pf/rj 6/ 15

S.F. 480 as statutory authority permits. The plan may identify any 1 computing information technology infrastructure deficiencies 2 that impede the proper storage, transmission, and analysis of 3 health care planning data. 4 (2) Recommendations for increasing the availability of data 5 related to health care planning to provide greater community 6 involvement in the health care planning process and consistency 7 in data used for certificate of need applications and 8 determinations. The plan shall also integrate the requirements 9 for annual reports by hospitals and health care facilities 10 pursuant to section 135.75 , the provisions relating to analyses 11 and studies by the department pursuant to section 135.76 , 12 the data compilation provisions of section 135.78 , and the 13 provisions for contracts for assistance with analyses, studies, 14 and data pursuant to section 135.83 . 15 d. e. Evaluation of trends. An assessment of emerging 16 trends in health care delivery and technology as they relate to 17 access to health care facilities and services, quality of care, 18 and costs of care. The assessment shall recommend any changes 19 to the scope of health care facilities and services covered by 20 the certificate of need program that may be warranted by these 21 emerging trends. In addition, the assessment may recommend 22 any changes to criteria used by the department to review 23 certificate of need applications, as necessary. 24 e. f. Rural health care resources plan. A rural health care 25 resources plan to assess the availability of health resources 26 in rural areas of the state, assess the unmet needs of these 27 communities, and evaluate how federal and state reimbursement 28 policies can be modified, if necessary, to more efficiently and 29 effectively meet the health care needs of rural communities. 30 The plan shall consider the unique health care needs of rural 31 communities, the adequacy of the rural health care workforce, 32 and transportation needs for accessing appropriate care. 33 f. g. Workforce resources plan. A health care workforce 34 resources plan to assure a competent, diverse, and sustainable 35 -7- SF 480 (8) 84 pf/rj 7/ 15

S.F. 480 health care workforce in Iowa and to improve access to health 1 care in underserved areas and among underserved populations. 2 The plan shall include the establishment of an advisory council 3 to inform and advise the department and policymakers regarding 4 issues relevant to the health care workforce in Iowa. The 5 health care workforce resources plan shall recognize long-term 6 care as an essential service provided by the health care 7 workforce. 8 h. Blueprint for a healthy Iowa. A blueprint for a 9 healthy Iowa to provide a methodology and process for cultural 10 transformation that emphasizes health and wellness by removing 11 barriers across the spectrum of personal, professional, and 12 community constructs to empower individual behavioral and 13 systemic change. The blueprint shall provide for coordination 14 of existing public and private health and wellness initiatives 15 and shall include recommendations for replication of health and 16 wellness initiatives for which evidence-based success has been 17 demonstrated. 18 i. Long-term living plan. A long-term living plan that 19 reflects the intent specified in section 231F.1 in a manner 20 that most effectively and efficiently meets the needs of 21 Iowa’s population. The plan may include recommendations 22 for modification of requirements for certificate of need 23 determinations, health care workforce requirements, and funding 24 to promote the specified intent. 25 4. The department shall submit the initial statewide health 26 care delivery infrastructure and resources strategic plan to 27 the governor and the general assembly by January 1, 2010, and 28 shall submit an updated strategic plan to the governor and the 29 general assembly every two years thereafter. 30 4. The office shall develop a timeline for completion and 31 submission of the various components of the strategic plan to 32 the governor and the general assembly and shall submit the 33 proposed timeline to the governor and the general assembly by 34 October 1, 2011. 35 -8- SF 480 (8) 84 pf/rj 8/ 15

S.F. 480 Sec. 3. EFFECTIVE UPON ENACTMENT. This division of this 1 Act, being deemed of immediate importance, takes effect upon 2 enactment. 3 DIVISION II 4 MEDICATION THERAPY MANAGEMENT 5 Sec. 4. NEW SECTION . 135P.1 Medication therapy management. 6 1. As used in this chapter, unless the context otherwise 7 requires: 8 a. “Eligible employee” means an employee of the state 9 including an employee of the state board of regents or 10 institutions under the state board of regents for whom group 11 health plans are established pursuant to chapter 509A providing 12 for third-party payment or prepayment for health or medical 13 expenses, and employees of a governmental subdivision for whom 14 the governmental subdivision provides for third-party payment 15 or prepayment for health or medical expenses. 16 b. “Medication therapy management” means a systematic 17 process performed by a licensed pharmacist, designed to 18 optimize therapeutic outcomes through improved medication use 19 and reduced risk of adverse drug events, including all of the 20 following services: 21 (1) A medication therapy review and in-person consultation 22 relating to all medications, vitamins, and herbal supplements 23 currently being taken by an eligible individual. 24 (2) A medication action plan, subject to the limitations 25 specified in this section, communicated to the individual and 26 the individual’s primary care physician or other appropriate 27 prescriber to address safety issues, inconsistencies, 28 duplicative therapy, omissions, and medication costs. The 29 medication action plan may include recommendations to the 30 prescriber for changes in drug therapy. 31 (3) Documentation and follow-up to ensure consistent levels 32 of pharmacy services and positive outcomes. 33 2. a. The department of administrative services shall, and 34 the state board of regents and governmental subdivisions at 35 -9- SF 480 (8) 84 pf/rj 9/ 15

S.F. 480 the election of the state board of regents or the governmental 1 subdivision respectively may, utilize a request for proposals 2 process to contract for the provision of medication therapy 3 management services for eligible employees who meet any of the 4 following criteria: 5 (1) An individual who takes four or more prescription drugs 6 to treat or prevent two or more chronic medical conditions. 7 (2) An individual with a prescription drug therapy problem 8 who is identified by the prescribing physician or other 9 appropriate prescriber, and referred to a pharmacist for 10 medication therapy management services. 11 (3) An individual who meets other criteria established by 12 the third-party payment provider contract, policy, or plan. 13 b. For any contract for medication therapy management 14 services for eligible employees of the state under the purview 15 of the department of administrative services all of the 16 following shall apply: 17 (1) The department shall utilize an advisory committee 18 comprised of an equal number of physicians and pharmacists to 19 provide advice and oversight regarding the contract and the 20 evaluation processes. The department shall appoint the members 21 of the advisory committee from designees of the Iowa pharmacy 22 association, the Iowa medical society, and the Iowa osteopathic 23 medical association. 24 (2) The contract shall require the contractor to provide 25 annual reports to the general assembly detailing the costs, 26 savings, estimated cost avoidance and return on investment, and 27 patient outcomes related to the medication therapy management 28 services provided. The contractor shall guarantee demonstrated 29 annual savings, including any savings associated with cost 30 avoidance at least equal to the contract’s costs with any 31 shortfall amount refunded to the state. The department and the 32 contractor shall agree on the terms, conditions, and applicable 33 measurement standards associated with the demonstration of 34 savings. The department shall verify that the demonstrated 35 -10- SF 480 (8) 84 pf/rj 10/ 15

S.F. 480 savings reported by the contractor were attained in accordance 1 with the agreed upon measurement standards. The contractor 2 shall be prohibited from using the contractor’s employees to 3 provide the medication therapy management services and shall 4 instead be required to contract with licensed pharmacies, 5 pharmacists, or physicians. 6 c. The fees for pharmacist-delivered medication therapy 7 management services shall be separate from the reimbursement 8 for prescription drug product or dispensing services; shall 9 be determined by each third-party payment provider contract, 10 policy, or plan; and must be reasonable based on the resources 11 and time required to provide the service. 12 d. A fee shall be established for physician reimbursement 13 for services delivered for medication therapy management as 14 determined by each third-party payment provider contract, 15 policy, or plan, and must be reasonable based on the resources 16 and time required to provide the service. 17 e. If any part of the medication therapy management 18 plan developed by a pharmacist incorporates services which 19 are outside the pharmacist’s independent scope of practice 20 including the initiation of therapy, modification of dosages, 21 therapeutic interchange, or changes in drug therapy, the 22 express authorization of the individual’s physician or other 23 appropriate prescriber is required. 24 Sec. 5. APPLICATION. The department of administrative 25 services shall continue to contract for the provision of 26 medication therapy management services under the initial 27 contract entered into pursuant to 2010 Iowa Acts, chapter 1193, 28 section 166. Upon completion of the initial contract term, 29 the department shall utilize a request for proposals process 30 to subsequently contract for medication therapy management 31 services pursuant to section 135P.1 as enacted in this Act. 32 Sec. 6. EFFECTIVE UPON ENACTMENT. This division of this 33 Act, being deemed of immediate importance, takes effect upon 34 enactment. 35 -11- SF 480 (8) 84 pf/rj 11/ 15

S.F. 480 DIVISION III 1 DIRECTIVES FOR INTEGRATION OF PUBLIC AND PRIVATE PROGRAMS 2 Sec. 7. PLAN FOR SEAMLESS PUBLIC AND PRIVATE PROGRAM 3 INTEGRATION IN IOWA HEALTH BENEFIT EXCHANGE. The department 4 of human services, division of insurance of the department of 5 commerce, department of public health, department of revenue, 6 department of workforce development, and other appropriate 7 agencies, shall develop a plan to meet the requirements of the 8 federal Patient Protection and Affordable Care Act, Pub. L. 9 No. 111-148, relating to a health benefit exchange. The plan 10 shall address issues relating to eligibility determinations 11 for Medicaid, hawk-i, and tax credit subsidies; information 12 technology and process reengineering; necessary policy, 13 statutory, and regulatory changes; financing; and tools 14 and strategies necessary for implementation. The plan 15 shall provide for integration and seamless operation of the 16 eligibility system, which shall be housed within the department 17 of human services, with the Iowa health benefit exchange, if 18 created. The departments shall submit a joint plan to the 19 joint appropriations subcommittee on health and human services 20 by October 15, 2011. 21 Sec. 8. BENCHMARK PLAN DEVELOPMENT —— ANALYSIS OF INCLUSION 22 OF BEHAVIORAL HEALTH BENEFITS. The department of human 23 services shall analyze how the inclusion of behavioral health 24 benefits in a benchmark plan developed under the federal 25 Patient Protection and Affordable Care Act, Pub. L. No. 26 111-148, would impact the delivery and financing of behavioral 27 health services in the state. The department shall report its 28 findings to the joint appropriations subcommittee on health and 29 human services no later than sixty days following the receipt 30 of federal directives or regulations regarding requirements for 31 benchmark plans. 32 Sec. 9. FEDERAL FUNDING OPPORTUNITIES. The department 33 of human services, department of public health, division of 34 insurance of the department of commerce, and other affected 35 -12- SF 480 (8) 84 pf/rj 12/ 15

S.F. 480 state agencies shall pursue federal funding opportunities under 1 the federal Patient Protection and Affordable Care Act, Pub. 2 L. No. 111-148, that are consistent with the state’s goals 3 and strategies and will provide a net benefit to the state, 4 including but not limited to funding relating to implementation 5 funding for the health benefit exchange and eligibility system 6 planning and implementation. The departments shall coordinate 7 efforts to the maximum extent possible and shall report their 8 activities on a monthly basis to the joint appropriations 9 subcommittee on health and human services. 10 Sec. 10. ALL-PAYER CLAIMS DATABASE PLAN. The department of 11 human services shall develop a plan to establish an all-payer 12 claims database to provide for the collection and analysis of 13 claims data from multiple payers of health care. The plan 14 shall establish the goals of the database which may include 15 but are not limited to determining health care utilization 16 patterns and rates; identifying gaps in prevention and health 17 promotion services; evaluating access to care; assisting with 18 benefit design and planning; analyzing statewide and local 19 health care expenditures by provider, employer, and geography; 20 informing the development of payment systems for providers; and 21 establishing clinical guidelines related to quality, safety, 22 and continuity of care. The plan shall identify a standard 23 means of data collection, statutory changes necessary to the 24 collection and use of the data, and the types of claims for 25 which collection of data is required which may include but are 26 not limited to eligibility data; provider information; medical 27 data; private and public medical, pharmacy, and dental claims 28 data; and other appropriate data. The plan shall also include 29 an implementation and maintenance schedule including a proposed 30 budget and funding plan and vision for the future. 31 Sec. 11. PROVIDER PAYMENT SYSTEM PLAN —— PILOT PROJECT. 32 1. The department of human services shall develop a provider 33 payment system plan to provide recommendations to reform the 34 health care provider payment system as an effective way to 35 -13- SF 480 (8) 84 pf/rj 13/ 15

S.F. 480 promote coordination of care, lower costs, and improve quality. 1 The plan shall provide analysis and recommendations regarding 2 but not limited to accountable care organizations, a global 3 payment system, or an episode of care payment system. 4 2. a. If an entity applies for certification from the 5 secretary of the United States department of health and 6 human services prior to January 1, 2012, and is subsequently 7 certified to administer an accountable care organization 8 pilot project, pursuant to the federal Patient Protection and 9 Accountability Act, Pub. L. No. 111-148, the department of 10 human services shall work with the entity to provide access to 11 the complete deidentified claims data of the medical assistance 12 recipients receiving health care services through the pilot 13 project for the purposes of identifying areas of utilization, 14 need, and potential cost savings to the medical assistance 15 program subject to all applicable state and federal laws and 16 regulations. The department may also employ new payment 17 models, information technology, and data analytics provisions 18 necessary to the administration of the pilot project. 19 b. The department of human services shall work with an 20 entity to administer an accountable care organization pilot 21 project, only if the centers for Medicare and Medicaid services 22 of the United States department of health and human services 23 approves participation of the medical assistance program in 24 the pilot project and the entity meets all of the following 25 requirements: 26 (1) At a minimum, includes the participation of a 27 prospective payment system hospital, ten primary care 28 physicians, a home health care practice, a palliative care 29 services, a hospice service, and a community mental health 30 center, all of which agree to be paid under a partial or global 31 payment for identified services. 32 (2) Requires all participating providers to utilize 33 electronic health records. 34 (3) Includes delivery of mental health services to 35 -14- SF 480 (8) 84 pf/rj 14/ 15

S.F. 480 recipients of medical assistance through collaboration with 1 the regional community mental health center, a federally 2 qualified health center, and at least one nursing facility as 3 consistent with any other law enacted by the Eighty-fourth 4 general assembly, 2011 session, that redesigns the mental 5 health delivery system in the state. 6 c. The entity certified to implement the pilot project shall 7 report to the joint appropriations subcommittee for health and 8 human services during the 2012 legislative session detailing 9 the progress and expected outcomes of the pilot project. 10 Sec. 12. EFFECTIVE UPON ENACTMENT. This division of this 11 Act, being deemed of immediate importance, takes effect upon 12 enactment. 13 -15- SF 480 (8) 84 pf/rj 15/ 15