Print
House File 446 - IntroducedA Bill ForAn Act 1relating to substance use disorder treatment and
2behavioral health services and reimbursement, and including
3effective date provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2Integrated provider network providers — reimbursement
3 Section 1. INTEGRATED PROVIDER NETWORK PROVIDERS —
4MEDICAID PROVIDERS — REIMBURSEMENT. The department of
5human services shall establish an integrated provider network
6provider as a participating provider type under the Medicaid
7program consistent with the community mental health system
8provider type. The department shall reimburse the integrated
9network provider type consistent with the Medicaid community
10mental health center enhanced fee schedule beginning January
111, 2022.
12 Sec. 2. EMERGENCY RULES. The department may adopt emergency
13rules under section 17A.4, subsection 3, and section 17A.5,
14subsection 2, paragraph “b”, to administer the provisions of
15this division. Any rules adopted in accordance with this
16section shall also be published as a notice of intended action
17as provided in section 17A.4.
18 Sec. 3. EFFECTIVE DATE. This division of this Act, being
19deemed of immediate importance, takes effect upon enactment.
20DIVISION II
21substance use disorder TREATMENT SERVICES and Behavioral health
22services providers — reimbursements
23 Sec. 4. SUBSTANCE USE DISORDER TREATMENT SERVICES AND
24BEHAVIORAL HEALTH SERVICES PROVIDERS — REIMBURSEMENTS.
251. The department of public health in collaboration
26with the department of human services shall review and make
27recommendations for Medicaid 1915(b)(3) waiver reimbursement
28rates for substance use disorder intensive outpatient and
29residential treatment services using a projected cost report
30agreed upon by the departments and the integrated provider
31network providers. The departments shall establish time frames
32for release of the agreed-upon projected cost report form to
33providers and the deadline for submission of the completed
34projected cost reports by providers to the departments, in
35order to allow sufficient time for review and the making of
-1-1recommended adjustments to the Medicaid 1915(b)(3) waiver
2reimbursement rates for Medicaid integrated provider network
3providers beginning July 1, 2022.
42. The department of public health in collaboration with
5the department of human services and behavioral health services
6providers shall review reimbursement rates for behavioral
7health services and Medicaid 1915(b)(3) waiver services using
8the projected cost report agreed upon by the departments and
9the integrated provider network providers. The departments
10shall establish time frames for release of the agreed-upon
11projected cost report form to behavioral health services
12providers and the deadline for submission of the completed
13projected cost reports by behavioral health services providers
14to the departments, in order to allow sufficient time for the
15departments to review and make recommended adjustments to
16the Medicaid 1915(b)(3) waiver reimbursement rates and the
17behavioral health services fee schedule beginning July 1, 2022.
183. The department of public health, in collaboration with
19the department of human services, shall establish an ongoing
20plan for regular review of reimbursements for providers of
21substance use disorder treatment services and behavioral health
22services and provide information to the governor and the
23general assembly in a timely manner to allow for the provision
24of appropriate funding for any change in reimbursements.
25 Sec. 5. EMERGENCY RULES. The department may adopt emergency
26rules under section 17A.4, subsection 3, and section 17A.5,
27subsection 2, paragraph “b”, to administer the provisions of
28this division. Any rules adopted in accordance with this
29section shall also be published as a notice of intended action
30as provided in section 17A.4.
31 Sec. 6. EFFECTIVE DATE. This division of this Act, being
32deemed of immediate importance, takes effect upon enactment.
33DIVISION III
34Medication-assisted treatment
35 Sec. 7. MEDICATION-ASSISTED TREATMENT — PRIOR
-2-1AUTHORIZATION PROHIBITED. The department of human services
2shall adopt rules pursuant to chapter 17A that prohibit prior
3authorization for medication-assisted treatment under both
4Medicaid fee-for-service or managed care administration.
5The department of human services shall also include this
6prohibition in any contract entered into with a Medicaid
7managed care organization. For the purposes of this
8section, “medication-assisted treatment” means the medically
9monitored use of certain substance use disorder medications in
10combination with other treatment services.
11 Sec. 8. EMERGENCY RULES. The department may adopt emergency
12rules under section 17A.4, subsection 3, and section 17A.5,
13subsection 2, paragraph “b”, to administer the provisions of
14this division. Any rules adopted in accordance with this
15section shall also be published as a notice of intended action
16as provided in section 17A.4.
17 Sec. 9. EFFECTIVE DATE. This division of this Act, being
18deemed of immediate importance, takes effect upon enactment.
19DIVISION IV
20Substance use disorder ADVISORY panel
21 Sec. 10. SUBSTANCE USE DISORDER ADVISORY PANEL. The
22department of public health in collaboration with the
23department of human services shall establish a substance use
24disorder advisory panel to review access to substance use
25disorder services and to resolve barriers to access. The
26members of the advisory panel shall include but are not
27limited to representatives of hospital-affiliated substance use
28disorder treatment programs, the integrated provider network,
29and others with interest or expertise in substance use disorder
30treatment services and reimbursement.
31DIVISION V
32Medicaid waiver opportunities
33 Sec. 11. MEDICAID WAIVER OPPORTUNITIES. The department of
34human services in collaboration with the department of public
35health shall review opportunities including application for
-3-1the federal Medicaid 1115 demonstration waiver or amendments
2to the existing federal Medicaid 1915(b) waiver to enhance
3access to and reimbursement for substance use disorder
4treatment services. The departments shall report findings and
5recommendations to the governor and the general assembly by
6October 1, 2021.
7EXPLANATION
8The inclusion of this explanation does not constitute agreement with
9the explanation’s substance by the members of the general assembly.
10This bill relates to reimbursement rates for providers of
11substance use disorder treatment services and behavioral health
12services.
13Division I of the bill requires the department of human
14services (DHS) to establish an integrated provider network
15provider as a participating provider type under the Medicaid
16program consistent with the community mental health system
17provider type. The division requires DHS to reimburse
18the integrated network provider type consistent with the
19Medicaid community mental health center enhanced fee schedule
20beginning January 1, 2022. The division provides for emergency
21rulemaking and takes effect upon enactment.
22Division II of the bill relates to reimbursement rates
23for providers of substance use disorder treatment services
24and behavioral health services. The division requires the
25department of public health (DPH), in collaboration with DHS,
26to review and make recommendations for Medicaid 1915(b)(3)
27waiver reimbursement rates for substance use disorder intensive
28outpatient and residential treatment services using a projected
29cost report agreed upon by the departments and the integrated
30provider network providers. The departments are required
31to establish time frames for release of the agreed-upon
32projected cost report form to providers and the deadline for
33submission of the completed projected cost reports by providers
34to the departments, to allow sufficient time for review and
35adjustments to reimbursement rates for Medicaid integrated
-4-1provider network service providers beginning July 1, 2022.
2The division also requires DPH, in collaboration with DHS and
3behavioral health services providers, to review reimbursement
4rates for behavioral health services and Medicaid 1915(b)(3)
5waiver services using the projected cost report agreed
6upon. Again, the departments shall establish time frames and
7deadlines for the cost reports to allow sufficient time for
8the departments to review and make recommended adjustments to
9the reimbursement rates and the behavioral health services fee
10schedule beginning July 1, 2022. The division directs DPH
11in collaboration with DHS to establish an ongoing plan for
12regular review of reimbursements for providers of substance
13use disorder treatment services and behavioral health services
14and to provide information to the governor and the general
15assembly in a timely manner to allow for the provision of
16appropriate funding for any change in reimbursements. The
17division provides for emergency rulemaking and takes effect
18upon enactment.
19Division III of the bill requires DHS to adopt
20administrative rules to prohibit prior authorization for
21the provision of medication-assisted treatment under either
22Medicaid fee-for-service or managed care administration.
23The division also requires DHS to include this prohibition
24in any contract entered into with a Medicaid managed care
25organization. Under the division, “medication-assisted
26treatment” means the medically monitored use of certain
27substance use disorder medications in combination with other
28treatment services. The division provides for emergency
29rulemaking and takes effect upon enactment.
30Division IV of the bill requires DPH in collaboration
31with DHS to establish an advisory panel to review access to
32substance use disorder services and to resolve barriers to
33access. The members of the advisory panel include but are not
34limited to representatives of hospital-affiliated substance use
35disorder treatment programs, the integrated provider network,
-5-1and others with interest or expertise in substance use disorder
2treatment services and reimbursement.
3Division V of the bill directs DHS in collaboration with
4DPH to review opportunities including application for a
5federal Medicaid 1115 demonstration waiver or amendments
6to the existing federal Medicaid 1915(b) waiver to enhance
7access to and reimbursement for substance use disorder
8treatment services. The departments shall report findings and
9recommendations to the governor and the general assembly by
10October 1, 2021.
-6-pf/rh
2behavioral health services and reimbursement, and including
3effective date provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2Integrated provider network providers — reimbursement
3 Section 1. INTEGRATED PROVIDER NETWORK PROVIDERS —
4MEDICAID PROVIDERS — REIMBURSEMENT. The department of
5human services shall establish an integrated provider network
6provider as a participating provider type under the Medicaid
7program consistent with the community mental health system
8provider type. The department shall reimburse the integrated
9network provider type consistent with the Medicaid community
10mental health center enhanced fee schedule beginning January
111, 2022.
12 Sec. 2. EMERGENCY RULES. The department may adopt emergency
13rules under section 17A.4, subsection 3, and section 17A.5,
14subsection 2, paragraph “b”, to administer the provisions of
15this division. Any rules adopted in accordance with this
16section shall also be published as a notice of intended action
17as provided in section 17A.4.
18 Sec. 3. EFFECTIVE DATE. This division of this Act, being
19deemed of immediate importance, takes effect upon enactment.
20DIVISION II
21substance use disorder TREATMENT SERVICES and Behavioral health
22services providers — reimbursements
23 Sec. 4. SUBSTANCE USE DISORDER TREATMENT SERVICES AND
24BEHAVIORAL HEALTH SERVICES PROVIDERS — REIMBURSEMENTS.
251. The department of public health in collaboration
26with the department of human services shall review and make
27recommendations for Medicaid 1915(b)(3) waiver reimbursement
28rates for substance use disorder intensive outpatient and
29residential treatment services using a projected cost report
30agreed upon by the departments and the integrated provider
31network providers. The departments shall establish time frames
32for release of the agreed-upon projected cost report form to
33providers and the deadline for submission of the completed
34projected cost reports by providers to the departments, in
35order to allow sufficient time for review and the making of
-1-1recommended adjustments to the Medicaid 1915(b)(3) waiver
2reimbursement rates for Medicaid integrated provider network
3providers beginning July 1, 2022.
42. The department of public health in collaboration with
5the department of human services and behavioral health services
6providers shall review reimbursement rates for behavioral
7health services and Medicaid 1915(b)(3) waiver services using
8the projected cost report agreed upon by the departments and
9the integrated provider network providers. The departments
10shall establish time frames for release of the agreed-upon
11projected cost report form to behavioral health services
12providers and the deadline for submission of the completed
13projected cost reports by behavioral health services providers
14to the departments, in order to allow sufficient time for the
15departments to review and make recommended adjustments to
16the Medicaid 1915(b)(3) waiver reimbursement rates and the
17behavioral health services fee schedule beginning July 1, 2022.
183. The department of public health, in collaboration with
19the department of human services, shall establish an ongoing
20plan for regular review of reimbursements for providers of
21substance use disorder treatment services and behavioral health
22services and provide information to the governor and the
23general assembly in a timely manner to allow for the provision
24of appropriate funding for any change in reimbursements.
25 Sec. 5. EMERGENCY RULES. The department may adopt emergency
26rules under section 17A.4, subsection 3, and section 17A.5,
27subsection 2, paragraph “b”, to administer the provisions of
28this division. Any rules adopted in accordance with this
29section shall also be published as a notice of intended action
30as provided in section 17A.4.
31 Sec. 6. EFFECTIVE DATE. This division of this Act, being
32deemed of immediate importance, takes effect upon enactment.
33DIVISION III
34Medication-assisted treatment
35 Sec. 7. MEDICATION-ASSISTED TREATMENT — PRIOR
-2-1AUTHORIZATION PROHIBITED. The department of human services
2shall adopt rules pursuant to chapter 17A that prohibit prior
3authorization for medication-assisted treatment under both
4Medicaid fee-for-service or managed care administration.
5The department of human services shall also include this
6prohibition in any contract entered into with a Medicaid
7managed care organization. For the purposes of this
8section, “medication-assisted treatment” means the medically
9monitored use of certain substance use disorder medications in
10combination with other treatment services.
11 Sec. 8. EMERGENCY RULES. The department may adopt emergency
12rules under section 17A.4, subsection 3, and section 17A.5,
13subsection 2, paragraph “b”, to administer the provisions of
14this division. Any rules adopted in accordance with this
15section shall also be published as a notice of intended action
16as provided in section 17A.4.
17 Sec. 9. EFFECTIVE DATE. This division of this Act, being
18deemed of immediate importance, takes effect upon enactment.
19DIVISION IV
20Substance use disorder ADVISORY panel
21 Sec. 10. SUBSTANCE USE DISORDER ADVISORY PANEL. The
22department of public health in collaboration with the
23department of human services shall establish a substance use
24disorder advisory panel to review access to substance use
25disorder services and to resolve barriers to access. The
26members of the advisory panel shall include but are not
27limited to representatives of hospital-affiliated substance use
28disorder treatment programs, the integrated provider network,
29and others with interest or expertise in substance use disorder
30treatment services and reimbursement.
31DIVISION V
32Medicaid waiver opportunities
33 Sec. 11. MEDICAID WAIVER OPPORTUNITIES. The department of
34human services in collaboration with the department of public
35health shall review opportunities including application for
-3-1the federal Medicaid 1115 demonstration waiver or amendments
2to the existing federal Medicaid 1915(b) waiver to enhance
3access to and reimbursement for substance use disorder
4treatment services. The departments shall report findings and
5recommendations to the governor and the general assembly by
6October 1, 2021.
7EXPLANATION
8The inclusion of this explanation does not constitute agreement with
9the explanation’s substance by the members of the general assembly.
10This bill relates to reimbursement rates for providers of
11substance use disorder treatment services and behavioral health
12services.
13Division I of the bill requires the department of human
14services (DHS) to establish an integrated provider network
15provider as a participating provider type under the Medicaid
16program consistent with the community mental health system
17provider type. The division requires DHS to reimburse
18the integrated network provider type consistent with the
19Medicaid community mental health center enhanced fee schedule
20beginning January 1, 2022. The division provides for emergency
21rulemaking and takes effect upon enactment.
22Division II of the bill relates to reimbursement rates
23for providers of substance use disorder treatment services
24and behavioral health services. The division requires the
25department of public health (DPH), in collaboration with DHS,
26to review and make recommendations for Medicaid 1915(b)(3)
27waiver reimbursement rates for substance use disorder intensive
28outpatient and residential treatment services using a projected
29cost report agreed upon by the departments and the integrated
30provider network providers. The departments are required
31to establish time frames for release of the agreed-upon
32projected cost report form to providers and the deadline for
33submission of the completed projected cost reports by providers
34to the departments, to allow sufficient time for review and
35adjustments to reimbursement rates for Medicaid integrated
-4-1provider network service providers beginning July 1, 2022.
2The division also requires DPH, in collaboration with DHS and
3behavioral health services providers, to review reimbursement
4rates for behavioral health services and Medicaid 1915(b)(3)
5waiver services using the projected cost report agreed
6upon. Again, the departments shall establish time frames and
7deadlines for the cost reports to allow sufficient time for
8the departments to review and make recommended adjustments to
9the reimbursement rates and the behavioral health services fee
10schedule beginning July 1, 2022. The division directs DPH
11in collaboration with DHS to establish an ongoing plan for
12regular review of reimbursements for providers of substance
13use disorder treatment services and behavioral health services
14and to provide information to the governor and the general
15assembly in a timely manner to allow for the provision of
16appropriate funding for any change in reimbursements. The
17division provides for emergency rulemaking and takes effect
18upon enactment.
19Division III of the bill requires DHS to adopt
20administrative rules to prohibit prior authorization for
21the provision of medication-assisted treatment under either
22Medicaid fee-for-service or managed care administration.
23The division also requires DHS to include this prohibition
24in any contract entered into with a Medicaid managed care
25organization. Under the division, “medication-assisted
26treatment” means the medically monitored use of certain
27substance use disorder medications in combination with other
28treatment services. The division provides for emergency
29rulemaking and takes effect upon enactment.
30Division IV of the bill requires DPH in collaboration
31with DHS to establish an advisory panel to review access to
32substance use disorder services and to resolve barriers to
33access. The members of the advisory panel include but are not
34limited to representatives of hospital-affiliated substance use
35disorder treatment programs, the integrated provider network,
-5-1and others with interest or expertise in substance use disorder
2treatment services and reimbursement.
3Division V of the bill directs DHS in collaboration with
4DPH to review opportunities including application for a
5federal Medicaid 1115 demonstration waiver or amendments
6to the existing federal Medicaid 1915(b) waiver to enhance
7access to and reimbursement for substance use disorder
8treatment services. The departments shall report findings and
9recommendations to the governor and the general assembly by
10October 1, 2021.
-6-pf/rh