House File 60 - IntroducedA Bill ForAn Act 1relating to health care administrative simplification.
2BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1   Section 1.  HEALTH CARE ADMINISTRATIVE SIMPLIFICATION —
2COMMISSIONER OF INSURANCE WORKGROUP.
   31.  During the fiscal year beginning July 1, 2019, the work
4group convened by the commissioner of insurance, annually,
5pursuant to section 505.8, subsection 18, shall consider ways
6to bring about greater standardization, streamlining and
7simplification of health care administrative transactions,
8increased electronic exchanges of administrative data, and
9reduced administrative costs and burdens. Specifically, the
10work group shall consider the work of other states regarding
11health care administrative simplification including the
12Minnesota administrative uniformity committee and the Minnesota
13health care administrative simplification initiative and make
14recommendations regarding all of the following:
   15a.  Uniform, HIPAA-compliant health care electronic data
16interchange standards for health care transactions including
17all of the following:
   18(1)  Eligibility verifications submitted by health care
19providers to health insurance carriers to confirm a patient’s
20medical insurance coverage and benefits to facilitate proper
21billing.
   22(2)  Claims submitted by health care providers to health
23insurance carriers for payment for health care services
24provided.
   25(3)  Remittance advices submitted by health insurance
26carriers to health care providers to explain any adjustments to
27claims and corresponding payments.
   28(4)  Acknowledgments indicating that one party has received
29an exchange submitted by another party.
   30b.  A HIPAA-compliant, single, uniform companion guide for
31the electronic exchange of patient eligibility verifications,
32claims, remittance advices, and acknowledgments by all health
33care providers and health insurance carriers.
   34c.  Unique identification numbers to be used by health care
35providers, health insurance carriers, and patients, including
-1-1applicable privacy standards to protect the identity of the
2individual subject of the data exchanged.
   3d.  A uniform explanation of benefits document.
   4e.  Best practices to be incorporated by health care
5providers and health insurance carriers to reduce the cost of
6providing health insurance coverage and health care services
7in the state.
   82.  The work group shall report its findings and
9recommendations, including any changes in law or administrative
10rules, in the annual report filed with the general assembly
11pursuant to section 505.18.
   123.  For the purposes of this section:
   13a.  “Health care provider” means the same as defined in
14section 135P.1.
   15b.  “Health insurance carrier” means “carrier” as defined in
16section 514C.13.
   17c.  “HIPAA” means the federal Health Insurance Portability
18and Accountability Act of 1996, Pub.L. No.104-191, 110 Stat.
191936 (1996).
20EXPLANATION
21The inclusion of this explanation does not constitute agreement with
22the explanation’s substance by the members of the general assembly.
   23This bill directs the work group convened by the
24commissioner of insurance, annually, during the fiscal year
25beginning July 1, 2019, to consider ways to bring about
26greater standardization, streamlining and simplification of
27health care administrative transactions, increased electronic
28exchanges of administrative data, and reduced administrative
29costs and burdens. Specifically, the work group is directed
30to consider the work of other states regarding health care
31administrative simplification including the Minnesota
32administrative uniformity committee and the Minnesota health
33care administrative simplification initiative and make
34recommendations regarding uniform, health care electronic
35data interchange standards that comply with the federal
-2-1Health Insurance Portability and Accountability Act of 1996
2(HIPAA) for health care transactions including eligibility
3verifications, claims, remittance advices, and acknowledgments;
4a HIPAA-compliant, single, uniform companion guide for the
5electronic exchange of patient eligibility verifications,
6claims, remittance advices, and acknowledgments; unique
7identification numbers to be used by health care providers,
8health insurance carriers, and patients, including applicable
9privacy standards to protect the identity of the individual
10subject of the data exchanged; a uniform explanation of
11benefits document; and best practices to be incorporated by
12health care providers and health insurance carriers to reduce
13the cost of providing health insurance coverage and health care
14services in the state.
   15The work group is directed to report its findings and
16recommendations, including any changes in law or administrative
17rules, in the annual report filed with the general assembly.
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