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House File 393 - IntroducedA Bill ForAn Act 1relating to programs and activities under the purview
2of the department of public health, and including effective
3date provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2Program Flexibility and Efficiencies
3 Section 1. Section 125.59, subsection 1, paragraph b, Code
42017, is amended to read as follows:
5b. If the transferred amount for this subsection exceeds
6grant requests funded to the ten thousand dollar maximum, the
7Iowa department of public health may use the remainder for
8activities and public information resources that align with
9best practices for substance-related disorder prevention or to
10increase grants pursuant to subsection 2.
11 Sec. 2. Section 135.11, subsection 31, Code 2017, is amended
12by striking the subsection.
13 Sec. 3. Section 135.150, subsection 2, Code 2017, is amended
14to read as follows:
152. The department shall report semiannually annually to the
16general assembly’s standing committees on government oversight
17regarding the operation of the gambling treatment program.
18The report shall include but is not limited to information on
19the moneys expended and grants awarded for operation of the
20gambling treatment program.
21DIVISION II
22Medical home and Patient-centered health advisory council
23 Sec. 4. Section 135.15, Code 2017, is amended by adding the
24following new subsection:
25 NEW SUBSECTION. 6. For the purposes of this section,
26“dental home” means a network of individualized care based on
27risk assessment, which includes oral health education, dental
28screenings, preventive services, diagnostic services, treatment
29services, and emergency services.
30 Sec. 5. Section 135.159, Code 2017, is amended by striking
31the section and inserting in lieu thereof the following:
32135.159 Patient-centered health advisory council.
331. The department shall establish a patient-centered health
34advisory council which shall include but is not limited to
35all of the following members, selected by their respective
-1-1organizations, and any other members the department determines
2necessary:
3a. The director of human services, or the director’s
4designee.
5b. The commissioner of insurance, or the commissioner’s
6designee.
7c. A representative of the federation of Iowa insurers.
8d. A representative of the Iowa dental association.
9e. A representative of the Iowa nurses association.
10f. A physician and an osteopathic physician licensed
11pursuant to chapter 148 who are family physicians and members
12of the Iowa academy of family physicians.
13g. A health care consumer.
14h. A representative of the Iowa collaborative safety net
15provider network established pursuant to section 135.153.
16i. A representative of the Iowa developmental disabilities
17council.
18j. A representative of the Iowa chapter of the American
19academy of pediatrics.
20k. A representative of the child and family policy center.
21l. A representative of the Iowa pharmacy association.
22m. A representative of the Iowa chiropractic society.
23n. A representative of the university of Iowa college of
24public health.
25o. A certified palliative care physician.
262. The patient-centered health advisory council may utilize
27the assistance of other relevant public health and health care
28expertise when necessary to carry out the council’s purposes
29and responsibilities.
303. A public member of the patient-centered health advisory
31council shall receive reimbursement for actual expenses
32incurred while serving in the member’s official capacity
33only if the member is not eligible for reimbursement by the
34organization the member represents.
354. The purposes of the patient-centered health advisory
-2-1council shall include all of the following:
2a. To serve as a resource on emerging health care
3transformation initiatives in Iowa.
4b. To convene stakeholders in Iowa to streamline efforts
5that support state-level and community-level integration and
6focus on reducing fragmentation of the health care system.
7c. To encourage partnerships and synergy between community
8health care partners in the state who are working on new
9system-level models to provide better health care at lower
10costs by focusing on shifting from volume-based to value-based
11health care.
12d. To lead discussions on the transformation of the
13health care system to a patient-centered infrastructure that
14integrates and coordinates services and supports to address
15social determinants of health and to meet population health
16goals.
17e. To provide a venue for education and information
18gathering for stakeholders and interested parties to learn
19about emerging health care initiatives across the state.
20f. To develop recommendations for submission to the
21department related to health care transformation issues.
22 Sec. 6. Section 249N.2, subsections 15 and 19, Code 2017,
23are amended to read as follows:
2415. “Medical home” means medical home as defined in
25section 135.157. a team approach to providing health care that
26originates in a primary care setting; fosters a partnership
27among the patient, the personal provider, and other health care
28professionals, and where appropriate, the patient’s family;
29utilizes the partnership to access and integrate all medical
30and nonmedical health-related services across all elements of
31the health care system and the patient’s community as needed by
32the patient and the patient’s family to achieve maximum health
33potential; maintains a centralized, comprehensive record of all
34health-related services to promote continuity of care; and has
35all of the following characteristics:
-3- 1a. A personal provider.
2b. A provider-directed team-based medical practice.
3c. Whole person orientation.
4d. Coordination and integration of care.
5e. Quality and safety.
6f. Enhanced access to health care.
7g. A payment system that appropriately recognizes the added
8value provided to patients who have a patient-centered medical
9home.
1019. “Primary medical provider” means the personal provider
11as defined in section 135.157 trained to provide first contact
12and continuous and comprehensive care to a member, chosen by
13a member or to whom a member is assigned under the Iowa health
14and wellness plan.
15 Sec. 7. Section 249N.2, Code 2017, is amended by adding the
16following new subsections:
17 NEW SUBSECTION. 17A. “Personal provider” means the
18patient’s first point of contact in the health care system
19with a primary care provider who identifies the patient’s
20health-related needs and, working with a team of health
21care professionals and providers of medical and nonmedical
22health-related services, provides for and coordinates
23appropriate care to address the health-related needs
24identified.
25 NEW SUBSECTION. 18A. “Primary care provider” includes but
26is not limited to any of the following licensed or certified
27health care professionals who provide primary care:
28a. A physician who is a family or general practitioner, a
29pediatrician, an internist, an obstetrician, or a gynecologist.
30b. An advanced registered nurse practitioner.
31c. A physician assistant.
32d. A chiropractor.
33 Sec. 8. Section 249N.6, subsection 2, paragraph c, Code
342017, is amended to read as follows:
35c. The department shall develop a mechanism for primary
-4-1medical providers, medical homes, and participating accountable
2care organizations to jointly facilitate member care
3coordination. The Iowa health and wellness plan shall provide
4for reimbursement of care coordination services provided
5under the plan consistent with the reimbursement methodology
6developed pursuant to section 135.159.
7 Sec. 9. Section 249N.6, subsection 3, paragraph a, Code
82017, is amended to read as follows:
9a. The department shall provide procedures for accountable
10care organizations that emerge through local markets to
11participate in the Iowa health and wellness plan provider
12network. Such accountable care organizations shall incorporate
13the medical home as defined and specified in chapter 135,
14division XXII, as a foundation and shall emphasize whole-person
15orientation and coordination and integration of both clinical
16services and nonclinical community and social supports that
17address social determinants of health. A participating
18accountable care organization shall enter into a contract with
19the department to ensure the coordination and management of the
20health of attributed members, to produce quality health care
21outcomes, and to control overall cost.
22 Sec. 10. PALLIATIVE CARE REVIEW — PATIENT-CENTERED HEALTH
23ADVISORY COUNCIL. The patient-centered health advisory council
24shall review the current level of public awareness regarding
25and the availability of palliative care services in the state
26and shall submit a report to the governor and the general
27assembly by December 31, 2017, including the council’s findings
28and providing recommendations to increase public awareness
29and reduce barriers to access to palliative care services
30throughout the state.
31 Sec. 11. REPEAL. Sections 135.157 and 135.158, Code 2017,
32are repealed.
33DIVISION III
34workforce programming
35 Sec. 12. Section 84A.11, subsection 4, Code 2017, is amended
-5-1to read as follows:
24. The nursing workforce data clearinghouse shall be
3established and maintained in a manner consistent with the
4health care delivery infrastructure and health care workforce
5resources strategic plan developed pursuant to section 135.164
6 135.163.
7 Sec. 13. Section 135.107, subsection 3, Code 2017, is
8amended to read as follows:
93. The center for rural health and primary care shall
10establish a primary care provider recruitment and retention
11endeavor, to be known as PRIMECARRE. The endeavor shall
12include a health care workforce and community support grant
13program, and a primary care provider loan repayment program,
14and a primary care provider community scholarship program. The
15endeavor shall be developed and implemented in a manner to
16promote and accommodate local creativity in efforts to recruit
17and retain health care professionals to provide services in
18the locality. The focus of the endeavor shall be to promote
19and assist local efforts in developing health care provider
20recruitment and retention programs. The center for rural
21health and primary care may enter into an agreement with the
22college student aid commission for the administration of the
23center’s grant and loan repayment programs.
24a. Community Health care workforce and community support
25 grant program.
26(1) The center for rural health and primary care shall adopt
27rules establishing an flexible application process processes
28based upon the department’s strategic plan to be used by the
29center to establish a grant assistance program as provided
30in this paragraph “a”, and establishing the criteria to be
31used in evaluating the applications. Selection criteria
32shall include a method for prioritizing grant applications
33based on illustrated efforts to meet the health care provider
34needs of the locality and surrounding area. Such assistance
35may be in the form of a forgivable loan, grant, or other
-6-1nonfinancial assistance as deemed appropriate by the center.
2An application submitted shall may contain a commitment of at
3least a dollar-for-dollar match of matching funds for the grant
4assistance. Application may be made for assistance by a single
5community or group of communities or in response to programs
6recommended in the strategic plan to address health workforce
7shortages.
8(2) Grants awarded under the program shall be subject to the
9following limitations:
10(a) Ten thousand dollars for a single community or region
11with a population of ten thousand or less. An award shall not
12be made under this program to a community with a population of
13more than ten thousand.
14(b) An amount not to exceed one dollar per capita for a
15region in which the population exceeds ten thousand. For
16purposes of determining the amount of a grant for a region,
17the population of the region shall not include the population
18of any community with a population of more than ten thousand
19located in the region awarded to rural, underserved areas or
20special populations as identified by the department’s strategic
21plan or evidence-based documentation.
22b. Primary care provider loan repayment program.
23(1) A primary care provider loan repayment program is
24established to increase the number of health professionals
25practicing primary care in federally designated health
26professional shortage areas of the state. Under the program,
27loan repayment may be made to a recipient for educational
28expenses incurred while completing an accredited health
29education program directly related to obtaining credentials
30necessary to practice the recipient’s health profession.
31(2) The center for rural health and primary care shall adopt
32rules relating to the establishment and administration of the
33primary care provider loan repayment program. Rules adopted
34pursuant to this paragraph shall provide, at a minimum, for all
35of the following:
-7- 1(a) Determination of eligibility requirements and
2qualifications of an applicant to receive loan repayment under
3the program, including but not limited to years of obligated
4service, clinical practice requirements, and residency
5requirements. One year of obligated service shall be provided
6by the applicant in exchange for each year of loan repayment,
7unless federal requirements otherwise require. Loan repayment
8under the program shall not be approved for a health provider
9whose license or certification is restricted by a medical
10regulatory authority of any jurisdiction of the United States,
11other nations, or territories.
12(b) Identification of federally designated health
13professional shortage areas of the state and prioritization of
14such areas according to need.
15(c) Determination of the amount and duration of the loan
16repayment an applicant may receive, giving consideration to the
17availability of funds under the program, and the applicant’s
18outstanding educational loans and professional credentials.
19(d) Determination of the conditions of loan repayment
20applicable to an applicant.
21(e) Enforcement of the state’s rights under a loan repayment
22program contract, including the commencement of any court
23action.
24(f) Cancellation of a loan repayment program contract for
25reasonable cause unless federal requirements otherwise require.
26(g) Participation in federal programs supporting repayment
27of loans of health care providers and acceptance of gifts,
28grants, and other aid or amounts from any person, association,
29foundation, trust, corporation, governmental agency, or other
30entity for the purposes of the program.
31(h) Upon availability of state funds, determination of
32eligibility criteria and qualifications for participating
33communities and applicants not located in federally designated
34shortage areas.
35(i) Other rules as necessary.
-8- 1(3) The center for rural health and primary care may enter
2into an agreement under chapter 28E with the college student
3aid commission for the administration of this program.
4c. Primary care provider community scholarship program.
5(1) A primary care provider community scholarship program
6is established to recruit and to provide scholarships to train
7primary health care practitioners in federally designated
8health professional shortage areas of the state. Under
9the program, scholarships may be awarded to a recipient for
10educational expenses incurred while completing an accredited
11health education program directly related to obtaining the
12credentials necessary to practice the recipient’s health
13profession.
14(2) The department shall adopt rules relating to the
15establishment and administration of the primary care provider
16community scholarship program. Rules adopted pursuant to
17this paragraph shall provide, at a minimum, for all of the
18following:
19(a) Determination of eligibility requirements and
20qualifications of an applicant to receive scholarships under
21the program, including but not limited to years of obligated
22service, clinical practice requirements, and residency
23requirements. One year of obligated service shall be provided
24by the applicant in exchange for each year of scholarship
25receipt, unless federal requirements otherwise require.
26(b) Identification of federally designated health
27professional shortage areas of the state and prioritization of
28such areas according to need.
29(c) Determination of the amount of the scholarship an
30applicant may receive.
31(d) Determination of the conditions of scholarship to be
32awarded to an applicant.
33(e) Enforcement of the state’s rights under a scholarship
34contract, including the commencement of any court action.
35(f) Cancellation of a scholarship contract for reasonable
-9-1cause.
2(g) Participation in federal programs supporting
3scholarships for health care providers and acceptance of gifts,
4grants, and other aid or amounts from any person, association,
5foundation, trust, corporation, governmental agency, or other
6entity for the purposes of the program.
7(h) Upon availability of state funds, determination of
8eligibility criteria and qualifications for participating
9communities and applicants not located in federally designated
10shortage areas.
11(i) Other rules as necessary.
12(3) The center for rural health and primary care may enter
13into an agreement under chapter 28E with the college student
14aid commission for the administration of this program.
15 Sec. 14. Section 135.107, subsection 4, paragraphs a, b, and
16c, Code 2017, are amended to read as follows:
17a. Eligibility under any of the programs established under
18the primary care provider recruitment and retention endeavor
19shall be based upon a community health services assessment
20completed under subsection 2, paragraph “a”. A community
21or region, as applicable, shall submit a letter of intent
22to conduct a community health services assessment and to
23apply for assistance under this subsection. The letter shall
24be in a form and contain information as determined by the
25center. A letter of intent shall be submitted to the center by
26January 1 preceding the fiscal year for which an application
27for assistance is to be made. Participation in a community
28health services assessment process shall be documented by the
29community or region.
30b. Assistance under this subsection shall not be granted
31until such time as the community or region making application
32has completed the a community health services assessment and
33adopted a long-term community health services assessment and
34developmental plan. In addition to any other requirements, a
35developmental an applicant’s plan shall include, to the extent
-10-1possible, a clear commitment to informing high school students
2of the health care opportunities which may be available to such
3students.
4c. The center for rural health and primary care shall
5seek additional assistance and resources from other state
6departments and agencies, federal agencies and grant programs,
7private organizations, and any other person, as appropriate.
8The center is authorized and directed to accept on behalf of
9the state any grant or contribution, federal or otherwise,
10made to assist in meeting the cost of carrying out the purpose
11of this subsection. All federal grants to and the federal
12receipts of the center are appropriated for the purpose set
13forth in such federal grants or receipts. Funds appropriated
14by the general assembly to the center for implementation of
15this subsection shall first be used for securing any available
16federal funds requiring a state match, with remaining funds
17being used for the health care workforce and community support
18 grant program.
19 Sec. 15. Section 135.107, subsection 5, paragraph a, Code
202017, is amended to read as follows:
21a. There is established an advisory committee to the
22center for rural health and primary care consisting of one
23representative, approved by the respective agency, of each
24of the following agencies: the department of agriculture
25and land stewardship, the Iowa department of public health,
26the department of inspections and appeals, the a national or
27regional institute for rural health policy, the rural health
28resource center, the institute of agricultural medicine
29and occupational health, and the Iowa state association of
30counties. The governor shall appoint two representatives
31of consumer groups active in rural health issues and a
32representative of each of two farm organizations active within
33the state, a representative of an agricultural business in
34the state, a representative of a critical needs hospital,
35a practicing rural family physician, a practicing rural
-11-1physician assistant, a practicing rural advanced registered
2nurse practitioner, and a rural health practitioner who is
3not a physician, physician assistant, or advanced registered
4nurse practitioner, as members of the advisory committee. The
5advisory committee shall also include as members two state
6representatives, one appointed by the speaker of the house of
7representatives and one by the minority leader of the house,
8and two state senators, one appointed by the majority leader of
9the senate and one by the minority leader of the senate.
10 Sec. 16. Section 135.163, Code 2017, is amended to read as
11follows:
12135.163 Health and long-term care access.
13The department shall coordinate public and private efforts
14to develop and maintain an appropriate health care delivery
15infrastructure and a stable, well-qualified, diverse, and
16sustainable health care workforce in this state. The health
17care delivery infrastructure and the health care workforce
18shall address the broad spectrum of health care needs of Iowans
19throughout their lifespan including long-term care needs. The
20department shall, at a minimum, do all of the following:
211. Develop a strategic plan for health care delivery
22infrastructure and health care workforce resources in this
23state.
242. Provide for the continuous collection of data to provide
25a basis for health care strategic planning and health care
26policymaking.
273. Make recommendations regarding the health care delivery
28infrastructure and the health care workforce that assist
29in monitoring current needs, predicting future trends, and
30informing policymaking.
31 Sec. 17. Section 135.175, subsection 1, paragraph b, Code
322017, is amended to read as follows:
33b. A health care workforce shortage fund is created in
34the state treasury as a separate fund under the control of
35the department, in cooperation with the entities identified
-12-1in this section as having control over the accounts within
2the fund. The fund and the accounts within the fund shall
3be controlled and managed in a manner consistent with the
4principles specified and the strategic plan developed pursuant
5to sections section 135.163 and 135.164.
6 Sec. 18. Section 135.175, subsections 6 and 7, Code 2017,
7are amended to read as follows:
86. a. Moneys in the fund and the accounts in the fund shall
9only be appropriated in a manner consistent with the principles
10specified and the strategic plan developed pursuant to sections
11 section 135.163 and 135.164 to support the medical residency
12training state matching grants program, the fulfilling Iowa’s
13need for dentists matching grant program, and to provide
14funding for state health care workforce shortage programs as
15provided in this section.
16b. State programs that may receive funding from the fund
17and the accounts in the fund, if specifically designated for
18the purpose of drawing down federal funding, are the primary
19care recruitment and retention endeavor (PRIMECARRE), the Iowa
20affiliate of the national rural recruitment and retention
21network, the oral and health delivery systems bureau of the
22department, the primary care office and shortage designation
23program, and the state office of rural health, and the Iowa
24health workforce center, administered through the oral and
25health delivery systems bureau of health care access of the
26department of public health; the area health education centers
27programs at Des Moines university — osteopathic medical center
28and the university of Iowa; the Iowa collaborative safety net
29provider network established pursuant to section 135.153; any
30entity identified by the federal government entity through
31which federal funding for a specified health care workforce
32shortage initiative is received; and a program developed in
33accordance with the strategic plan developed by the department
34of public health in accordance with sections section 135.163
35and 135.164.
-13- 1c. State appropriations to the fund shall be allocated in
2equal amounts to each of the accounts within the fund, unless
3otherwise specified in the appropriation or allocation. Any
4federal funding received for the purposes of addressing state
5health care workforce shortages shall be deposited in the
6health care workforce shortage national initiatives account,
7unless otherwise specified by the source of the funds, and
8shall be used as required by the source of the funds. If use
9of the federal funding is not designated, the funds shall be
10used in accordance with the strategic plan developed by the
11department of public health in accordance with sections section
12 135.163 and 135.164, or to address workforce shortages as
13otherwise designated by the department of public health. Other
14sources of funding shall be deposited in the fund or account
15and used as specified by the source of the funding.
167. No more than five percent of the moneys in any of the
17accounts within the fund, not to exceed one hundred thousand
18dollars in each account, shall be used for administrative
19purposes, unless otherwise provided by the appropriation,
20allocation, or source of the funds.
21 Sec. 19. REPEAL. Sections 135.164 and 135.180, Code 2017,
22are repealed.
23DIVISION IV
24unfunded OR outdated program PROVISIONS
25 Sec. 20. Section 135.11, subsection 25, Code 2017, is
26amended by striking the subsection.
27 Sec. 21. Section 135.141, subsection 2, paragraph c, Code
282017, is amended by striking the paragraph.
29 Sec. 22. Section 135.141, subsection 2, paragraph e, Code
302017, is amended to read as follows:
31e. For the purpose of paragraphs “c” and paragraph “d”,
32an employee or agent of the department may enter into and
33examine any premises containing potentially dangerous agents
34with the consent of the owner or person in charge of the
35premises or, if the owner or person in charge of the premises
-14-1refuses admittance, with an administrative search warrant
2obtained under section 808.14. Based on findings of the risk
3assessment and examination of the premises, the director may
4order reasonable safeguards or take any other action reasonably
5necessary to protect the public health pursuant to rules
6adopted to administer this subsection.
7 Sec. 23. Section 901B.1, subsection 4, paragraph a, Code
82017, is amended to read as follows:
9a. The district department of correctional services shall
10place an individual committed to it under section 907.3 to the
11sanction and level of supervision which is appropriate to the
12individual based upon a current risk assessment evaluation.
13Placements may be to levels two and three of the corrections
14continuum. The district department may, with the approval of
15the Iowa department of public health and the department of
16corrections, place an individual in a level three substance
17abuse treatment facility established pursuant to section
18135.130, to assist the individual in complying with a condition
19of probation. The district department may, with the approval
20of the department of corrections, place an individual in a
21level four violator facility established pursuant to section
22904.207 only as a penalty for a violation of a condition
23imposed under this section.
24 Sec. 24. REPEAL. Sections 135.26, 135.29, 135.130, and
25135.152, Code 2017, are repealed.
26DIVISION V
27miscellaneous provisions
28 Sec. 25. Section 135A.2, subsection 6, Code 2017, is amended
29to read as follows:
306. “Local board of health” means a county or district board
31of health the same as defined in section 137.102.
32 Sec. 26. REPEAL. Section 135.132, Code 2017, is repealed.
33DIVISION VI
34iowa health information network
35 Sec. 27. Section 136.3, subsection 13, Code 2017, is amended
-15-1by striking the subsection.
2 Sec. 28. EFFECTIVE DATE. This division of this Act
3takes effect upon the assumption of the administration and
4governance, including but not limited to the assumption of the
5assets and liabilities, of the Iowa health information network
6by the designated entity as defined in 2015 Iowa Acts, ch.73,
7section 2. The department of public health shall notify the
8Code editor of the date of such assumption by the designated
9entity.
10DIVISION VII
11ORGANIZED DELIVERY SYSTEMS
12 Sec. 29. Section 135H.3, subsection 2, Code 2017, is amended
13to read as follows:
142. If a child is diagnosed with a biologically based mental
15illness as defined in section 514C.22 and meets the medical
16assistance program criteria for admission to a psychiatric
17medical institution for children, the child shall be deemed
18to meet the acuity criteria for medically necessary inpatient
19benefits under a group policy, contract, or plan providing
20for third-party payment or prepayment of health, medical, and
21surgical coverage benefits issued by a carrier, as defined in
22section 513B.2, or by an organized delivery system authorized
23under 1993 Iowa Acts, ch.158, that is subject to section
24514C.22. Such medically necessary benefits shall not be
25excluded or denied as care that is substantially custodial in
26nature under section 514C.22, subsection 8, paragraph “b”.
27 Sec. 30. Section 505.32, subsection 2, paragraph h, Code
282017, is amended by striking the paragraph.
29 Sec. 31. Section 505.32, subsection 4, paragraph b,
30subparagraphs (1) and (2), Code 2017, are amended to read as
31follows:
32(1) The commissioner may establish methodologies to provide
33uniform and consistent side-by-side comparisons of the health
34care coverage options that are offered by carriers, organized
35delivery systems, and public programs in this state including
-16-1but not limited to benefits covered and not covered, the amount
2of coverage for each service, including copays and deductibles,
3administrative costs, and any prior authorization requirements
4for coverage.
5(2) The commissioner may require each carrier, organized
6delivery system, and public program in this state to describe
7each health care coverage option offered by that carrier,
8organized delivery system, or public program in a manner
9so that the various options can be compared as provided in
10subparagraph (1).
11 Sec. 32. Section 507B.4, subsection 1, Code 2017, is amended
12to read as follows:
131. For purposes of subsection 3, paragraph “p”, “insurer”
14means an entity providing a plan of health insurance, health
15care benefits, or health care services, or an entity subject
16to the jurisdiction of the commissioner performing utilization
17review, including an insurance company offering sickness and
18accident plans, a health maintenance organization, an organized
19delivery system authorized under 1993 Iowa Acts, ch.158, and
20licensed by the department of public health, a nonprofit health
21service corporation, a plan established pursuant to chapter
22509A for public employees, or any other entity providing a
23plan of health insurance, health care benefits, or health care
24services. However, “insurer” does not include an entity that
25sells disability income or long-term care insurance.
26 Sec. 33. Section 507B.4A, subsection 2, paragraph a, Code
272017, is amended to read as follows:
28a. An insurer providing accident and sickness insurance
29under chapter 509, 514, or 514A; a health maintenance
30organization; an organized delivery system authorized under
311993 Iowa Acts, ch.158, and licensed by the department of
32public health; or another entity providing health insurance or
33health benefits subject to state insurance regulation shall
34either accept and pay or deny a clean claim.
35 Sec. 34. Section 509.3A, subsection 11, Code 2017, is
-17-1amended by striking the subsection.
2 Sec. 35. Section 509.19, subsection 2, paragraph d, Code
32017, is amended by striking the paragraph.
4 Sec. 36. Section 509A.6, Code 2017, is amended to read as
5follows:
6509A.6 Contract with insurance carrier, or health maintenance
7organization, or organized delivery system.
8The governing body may contract with a nonprofit corporation
9operating under the provisions of this chapter or chapter
10514 or with any insurance company having a certificate of
11authority to transact an insurance business in this state with
12respect of a group insurance plan, which may include life,
13accident, health, hospitalization and disability insurance
14during period of active service of such employees, with the
15right of any employee to continue such life insurance in force
16after termination of active service at such employee’s sole
17expense; may contract with a nonprofit corporation operating
18under and governed by the provisions of this chapter or chapter
19514 with respect of any hospital or medical service plan; and
20may contract with a health maintenance organization or an
21organized delivery system authorized to operate in this state
22with respect to health maintenance organization or organized
23delivery system activities.
24 Sec. 37. Section 513B.2, subsection 8, paragraph k, Code
252017, is amended by striking the paragraph.
26 Sec. 38. Section 513B.5, Code 2017, is amended to read as
27follows:
28513B.5 Provisions on renewability of coverage.
291. Health insurance coverage subject to this chapter is
30renewable with respect to all eligible employees or their
31dependents, at the option of the small employer, except for one
32or more of the following reasons:
33a. The health insurance coverage sponsor fails to pay, or to
34make timely payment of, premiums or contributions pursuant to
35the terms of the health insurance coverage.
-18- 1b. The health insurance coverage sponsor performs an
2act or practice constituting fraud or makes an intentional
3misrepresentation of a material fact under the terms of the
4coverage.
5c. Noncompliance with the carrier’s or organized delivery
6system’s minimum participation requirements.
7d. Noncompliance with the carrier’s or organized delivery
8system’s employer contribution requirements.
9e. A decision by the carrier or organized delivery system
10 to discontinue offering a particular type of health insurance
11coverage in the state’s small employer market. Health
12insurance coverage may be discontinued by the carrier or
13organized delivery system in that market only if the carrier or
14organized delivery system does all of the following:
15(1) Provides advance notice of its decision to discontinue
16such plan to the commissioner or director of public health.
17Notice to the commissioner or director, at a minimum, shall be
18no less than three days prior to the notice provided for in
19subparagraph (2) to affected small employers, participants, and
20beneficiaries.
21(2) Provides notice of its decision not to renew such
22plan to all affected small employers, participants, and
23beneficiaries no less than ninety days prior to the nonrenewal
24of the plan.
25(3) Offers to each plan sponsor of the discontinued
26coverage, the option to purchase any other coverage currently
27offered by the carrier or organized delivery system to other
28employers in this state.
29(4) Acts uniformly, in opting to discontinue the coverage
30and in offering the option under subparagraph (3), without
31regard to the claims experience of the sponsors under the
32discontinued coverage or to a health status-related factor
33relating to any participants or beneficiaries covered or new
34participants or beneficiaries who may become eligible for the
35coverage.
-19- 1f. A decision by the carrier or organized delivery system to
2discontinue offering and to cease to renew all of its health
3insurance coverage delivered or issued for delivery to small
4employers in this state. A carrier or organized delivery
5system making such decision shall do all of the following:
6(1) Provide advance notice of its decision to discontinue
7such coverage to the commissioner or director of public health.
8Notice to the commissioner or director, at a minimum, shall be
9no less than three days prior to the notice provided for in
10subparagraph (2) to affected small employers, participants, and
11beneficiaries.
12(2) Provide notice of its decision not to renew such
13coverage to all affected small employers, participants, and
14beneficiaries no less than one hundred eighty days prior to the
15nonrenewal of the coverage.
16(3) Discontinue all health insurance coverage issued or
17delivered for issuance to small employers in this state and
18cease renewal of such coverage.
19g. The membership of an employer in an association, which
20is the basis for the coverage which is provided through such
21association, ceases, but only if the termination of coverage
22under this paragraph occurs uniformly without regard to
23any health status-related factor relating to any covered
24individual.
25h. The commissioner or director of public health finds that
26the continuation of the coverage is not in the best interests
27of the policyholders or certificate holders, or would impair
28the carrier’s or organized delivery system’s ability to meet
29its contractual obligations.
30i. At the time of coverage renewal, a carrier or organized
31delivery system may modify the health insurance coverage for
32a product offered under group health insurance coverage in
33the small group market, for coverage that is available in
34such market other than only through one or more bona fide
35associations, if such modification is consistent with the laws
-20-1of this state, and is effective on a uniform basis among group
2health insurance coverage with that product.
32. A carrier or organized delivery system that elects not to
4renew health insurance coverage under subsection 1, paragraph
5“f”, shall not write any new business in the small employer
6market in this state for a period of five years after the date
7of notice to the commissioner or director of public health.
83. This section, with respect to a carrier or organized
9delivery system doing business in one established geographic
10service area of the state, applies only to such carrier’s or
11organized delivery system’s operations in that service area.
12 Sec. 39. Section 513B.6, unnumbered paragraph 1, Code 2017,
13is amended to read as follows:
14A small employer carrier or organized delivery system shall
15make reasonable disclosure in solicitation and sales materials
16provided to small employers of all of the following:
17 Sec. 40. Section 513B.6, subsection 2, Code 2017, is amended
18to read as follows:
192. The provisions concerning the small employer carrier’s
20or organized delivery system’s right to change premium rates
21and factors, including case characteristics, which affect
22changes in premium rates.
23 Sec. 41. Section 513B.7, Code 2017, is amended to read as
24follows:
25513B.7 Maintenance of records.
261. A small employer carrier or organized delivery system
27 shall maintain at its principal place of business a complete
28and detailed description of its rating practices and renewal
29underwriting practices, including information and documentation
30which demonstrate that its rating methods and practices are
31based upon commonly accepted actuarial assumptions and are in
32accordance with sound actuarial principles.
332. A small employer carrier or organized delivery system
34 shall file each March 1 with the commissioner or the director
35of public health an actuarial certification that the small
-21-1employer carrier or organized delivery system is in compliance
2with this section and that the rating methods of the small
3employer carrier or organized delivery system are actuarially
4sound. A copy of the certification shall be retained by the
5small employer carrier or organized delivery system at its
6principal place of business.
73. A small employer carrier or organized delivery system
8 shall make the information and documentation described in
9subsection 1 available to the commissioner or the director of
10public health upon request. The information is not a public
11record or otherwise subject to disclosure under chapter 22,
12and is considered proprietary and trade secret information
13and is not subject to disclosure by the commissioner or the
14director of public health to persons outside of the division or
15department except as agreed to by the small employer carrier or
16organized delivery system or as ordered by a court of competent
17jurisdiction.
18 Sec. 42. Section 513B.9A, subsection 1, unnumbered
19paragraph 1, Code 2017, is amended to read as follows:
20A carrier or organized delivery system offering group health
21insurance coverage shall not establish rules for eligibility,
22including continued eligibility, of an individual to enroll
23under the terms of the coverage based on any of the following
24health status-related factors in relation to the individual or
25a dependent of the individual:
26 Sec. 43. Section 513B.9A, subsection 4, paragraph a, Code
272017, is amended to read as follows:
28a. A carrier or organized delivery system offering health
29insurance coverage shall not require an individual, as a
30condition of enrollment or continued enrollment under the
31coverage, to pay a premium or contribution which is greater
32than a premium or contribution for a similarly situated
33individual enrolled in the coverage on the basis of a health
34status-related factor in relation to the individual or to a
35dependent of an individual enrolled under the coverage.
-22-1 Sec. 44. Section 513B.9A, subsection 4, paragraph b,
2subparagraph (2), Code 2017, is amended to read as follows:
3(2) Prevent a carrier or organized delivery system
4 offering group health insurance coverage from establishing
5premium discounts or rebates or modifying otherwise applicable
6copayments or deductibles in return for adherence to programs
7of health promotion and disease prevention.
8 Sec. 45. Section 513B.10, Code 2017, is amended to read as
9follows:
10513B.10 Availability of coverage.
111. a. A carrier or an organized delivery system that offers
12health insurance coverage in the small group market shall
13accept every small employer that applies for health insurance
14coverage and shall accept for enrollment under such coverage
15every eligible individual who applies for enrollment during the
16period in which the individual first becomes eligible to enroll
17under the terms of the health insurance coverage and shall not
18place any restriction which is inconsistent with eligibility
19rules established under this chapter.
20b. A carrier or organized delivery system that offers health
21insurance coverage in the small group market through a network
22plan may do either of the following:
23(1) Limit employers that may apply for such coverage to
24those with eligible individuals who live, work, or reside in
25the service area for such network plan.
26(2) Deny such coverage to such employers within the service
27area of such plan if the carrier or organized delivery system
28 has demonstrated to the applicable state authority both of the
29following:
30(a) The carrier or organized delivery system will not have
31the capacity to deliver services adequately to enrollees of any
32additional groups because of its obligations to existing group
33contract holders and enrollees.
34(b) The carrier or organized delivery system is applying
35this subparagraph uniformly to all employers without regard to
-23-1the claims experience of those employers and their employees
2and their dependents, or any health status-related factor
3relating to such employees or dependents.
4c. A carrier or organized delivery system, upon denying
5health insurance coverage in any service area pursuant to
6paragraph “b”, subparagraph (2), shall not offer coverage in the
7small group market within such service area for a period of one
8hundred eighty days after the date such coverage is denied.
9d. A carrier or organized delivery system may deny health
10insurance coverage in the small group market if the issuer has
11demonstrated to the commissioner or director of public health
12 both of the following:
13(1) The carrier or organized delivery system does not have
14the financial reserves necessary to underwrite additional
15coverage.
16(2) The carrier or organized delivery system is applying the
17provisions of this paragraph uniformly to all employers in the
18small group market in this state consistent with state law and
19without regard to the claims experience of those employers and
20the employees and dependents of such employers, or any health
21status-related factor relating to such employees and their
22dependents.
23e. A carrier or organized delivery system, upon denying
24health insurance coverage pursuant to paragraph “d”, shall not
25offer coverage in connection with health insurance coverages
26in the small group market in this state for a period of one
27hundred eighty days after the date such coverage is denied or
28until the carrier or organized delivery system has demonstrated
29to the commissioner or director of public health that the
30carrier or organized delivery system has sufficient financial
31reserves to underwrite additional coverage, whichever is later.
32The commissioner or director may provide for the application of
33this paragraph on a service area-specific basis.
34f. Paragraph “a” shall not be construed to preclude
35a carrier or organized delivery system from establishing
-24-1employer contribution rules or group participation rules for
2the offering of health insurance coverage in the small group
3market.
42. A carrier or organized delivery system, subject to
5subsection 1, shall issue health insurance coverage to an
6eligible small employer that applies for the coverage and
7agrees to make the required premium payments and satisfy the
8other reasonable provisions of the health insurance coverage
9not inconsistent with this chapter. A carrier or organized
10delivery system is not required to issue health insurance
11coverage to a self-employed individual who is covered by, or is
12eligible for coverage under, health insurance coverage offered
13by an employer.
143. Health insurance coverage for small employers shall
15satisfy all of the following:
16a. A carrier or organized delivery system offering group
17health insurance coverage, with respect to a participant or
18beneficiary, may impose a preexisting condition exclusion only
19as follows:
20(1) The exclusion relates to a condition, whether physical
21or mental, regardless of the cause of the condition, for
22which medical advice, diagnosis, care, or treatment was
23recommended or received within the six-month period ending on
24the enrollment date. However, genetic information shall not be
25treated as a condition under this subparagraph in the absence
26of a diagnosis of the condition related to such information.
27(2) The exclusion extends for a period of not more than
28twelve months, or eighteen months in the case of a late
29enrollee, after the enrollment date.
30(3) The period of any such preexisting condition exclusion
31is reduced by the aggregate of the periods of creditable
32coverage applicable to the participant or beneficiary as of the
33enrollment date.
34b. A carrier or organized delivery system offering group
35health insurance coverage shall not impose any preexisting
-25-1condition exclusion as follows:
2(1) In the case of a child who is adopted or placed for
3adoption before attaining eighteen years of age and who, as of
4the last day of the thirty-day period beginning on the date
5of the adoption or placement for adoption, is covered under
6creditable coverage. This subparagraph shall not apply to
7coverage before the date of such adoption or placement for
8adoption.
9(2) In the case of an individual who, as of the last day
10of the thirty-day period beginning with the date of birth, is
11covered under creditable coverage.
12(3) Relating to pregnancy as a preexisting condition.
13c. A carrier or organized delivery system shall waive
14any waiting period applicable to a preexisting condition
15exclusion or limitation period with respect to particular
16services under health insurance coverage for the period
17of time an individual was covered by creditable coverage,
18provided that the creditable coverage was continuous to a
19date not more than sixty-three days prior to the effective
20date of the new coverage. Any period that an individual
21is in a waiting period for any coverage under group health
22insurance coverage, or is in an affiliation period, shall not
23be taken into account in determining the period of continuous
24coverage. A health maintenance organization that does not
25use preexisting condition limitations in any of its health
26insurance coverage may impose an affiliation period. For
27purposes of this section, “affiliation period” means a period
28of time not to exceed sixty days for new entrants and not to
29exceed ninety days for late enrollees during which no premium
30shall be collected and coverage issued is not effective, so
31long as the affiliation period is applied uniformly, without
32regard to any health status-related factors. This paragraph
33does not preclude application of a waiting period applicable
34to all new enrollees under the health insurance coverage,
35provided that any carrier or organized delivery system-imposed
-26-1 carrier-imposed waiting period is no longer than sixty days and
2is used in lieu of a preexisting condition exclusion.
3d. Health insurance coverage may exclude coverage for late
4enrollees for preexisting conditions for a period not to exceed
5eighteen months.
6e. (1) Requirements used by a carrier or organized delivery
7system in determining whether to provide coverage to a small
8employer shall be applied uniformly among all small employers
9applying for coverage or receiving coverage from the carrier
10or organized delivery system.
11(2) In applying minimum participation requirements with
12respect to a small employer, a carrier or organized delivery
13system shall not consider employees or dependents who have
14other creditable coverage in determining whether the applicable
15percentage of participation is met.
16(3) A carrier or organized delivery system shall not
17increase any requirement for minimum employee participation
18or modify any requirement for minimum employer contribution
19applicable to a small employer at any time after the small
20employer has been accepted for coverage.
21f. (1) If a carrier or organized delivery system offers
22coverage to a small employer, the carrier or organized delivery
23system shall offer coverage to all eligible employees of the
24small employer and the employees’ dependents. A carrier or
25organized delivery system shall not offer coverage to only
26certain individuals or dependents in a small employer group or
27to only part of the group.
28(2) Except as provided under paragraphs “a” and “d”, a
29carrier or organized delivery system shall not modify health
30insurance coverage with respect to a small employer or any
31eligible employee or dependent through riders, endorsements, or
32other means, to restrict or exclude coverage or benefits for
33certain diseases, medical conditions, or services otherwise
34covered by the health insurance coverage.
35g. A carrier or organized delivery system offering coverage
-27-1through a network plan shall not be required to offer coverage
2or accept applications pursuant to subsection 1 with respect to
3a small employer where any of the following apply applies:
4(1) The small employer does not have eligible individuals
5who live, work, or reside in the service area for the network
6plan.
7(2) The small employer does have eligible individuals who
8live, work, or reside in the service area for the network plan,
9but the carrier or organized delivery system, if required, has
10demonstrated to the commissioner or the director of public
11health that it will not have the capacity to deliver services
12adequately to enrollees of any additional groups because of its
13obligations to existing group contract holders and enrollees
14and that it is applying the requirements of this lettered
15paragraph uniformly to all employers without regard to the
16claims experience of those employers and their employees and
17the employees’ dependents, or any health status-related factor
18relating to such employees and dependents.
19(3) A carrier or organized delivery system, upon denying
20health insurance coverage in a service area pursuant to
21subparagraph (2), shall not offer coverage in the small
22employer market within such service area for a period of one
23hundred eighty days after the coverage is denied.
244. A carrier or organized delivery system shall not be
25required to offer coverage to small employers pursuant to
26subsection 1 for any period of time where the commissioner or
27director of public health determines that the acceptance of the
28offers by small employers in accordance with subsection 1 would
29place the carrier or organized delivery system in a financially
30impaired condition.
315. A carrier or organized delivery system shall not be
32required to provide coverage to small employers pursuant to
33subsection 1 if the carrier or organized delivery system elects
34not to offer new coverage to small employers in this state.
35However, a carrier or organized delivery system that elects not
-28-1to offer new coverage to small employers under this subsection
2shall be allowed to maintain its existing policies in the
3state, subject to the requirements of section 513B.5.
46. A carrier or organized delivery system that elects not to
5offer new coverage to small employers pursuant to subsection 5
6shall provide notice to the commissioner or director of public
7health and is prohibited from writing new business in the small
8employer market in this state for a period of five years from
9the date of notice to the commissioner or director.
10 Sec. 46. Section 513C.3, subsection 5, Code 2017, is amended
11to read as follows:
125. “Carrier” means any entity that provides individual
13health benefit plans in this state. For purposes of this
14chapter, carrier includes an insurance company, a group
15hospital or medical service corporation, a fraternal benefit
16society, a health maintenance organization, and any other
17entity providing an individual plan of health insurance
18or health benefits subject to state insurance regulation.
19“Carrier” does not include an organized delivery system.
20 Sec. 47. Section 513C.3, subsection 7, Code 2017, is amended
21by striking the subsection.
22 Sec. 48. Section 513C.3, subsection 9, Code 2017, is amended
23to read as follows:
249. “Established service area” means a geographic area,
25as approved by the commissioner and based upon the carrier’s
26certificate of authority to transact business in this state,
27within which the carrier is authorized to provide coverage or
28a geographic area, as approved by the director and based upon
29the organized delivery system’s license to transact business
30in this state, within which the organized delivery system is
31authorized to provide coverage.
32 Sec. 49. Section 513C.3, subsection 12, Code 2017, is
33amended by striking the subsection.
34 Sec. 50. Section 513C.3, subsection 15, paragraph a,
35subparagraph (3), Code 2017, is amended by striking the
-29-1subparagraph.
2 Sec. 51. Section 513C.3, subsection 18, Code 2017, is
3amended to read as follows:
418. “Restricted network provision” means a provision of an
5individual health benefit plan that conditions the payment
6of benefits, in whole or in part, on the use of health care
7providers that have entered into a contractual arrangement with
8the carrier or the organized delivery system to provide health
9care services to covered individuals.
10 Sec. 52. Section 513C.5, subsection 1, unnumbered paragraph
111, Code 2017, is amended to read as follows:
12Premium rates for any block of individual health benefit
13plan business issued on or after January 1, 1996, or the date
14rules are adopted by the commissioner of insurance and the
15director of public health and become effective, whichever
16date is later, by a carrier subject to this chapter shall be
17limited to the composite effect of allocating costs among the
18following:
19 Sec. 53. Section 513C.6, Code 2017, is amended to read as
20follows:
21513C.6 Provisions on renewability of coverage.
221. An individual health benefit plan subject to this
23chapter is renewable with respect to an eligible individual or
24dependents, at the option of the individual, except for one or
25more of the following reasons:
26a. The individual fails to pay, or to make timely payment
27of, premiums or contributions pursuant to the terms of the
28individual health benefit plan.
29b. The individual performs an act or practice constituting
30fraud or makes an intentional misrepresentation of a material
31fact under the terms of the individual health benefit plan.
32c. A decision by the individual carrier or organized
33delivery system to discontinue offering a particular type
34of individual health benefit plan in the state’s individual
35insurance market. An individual health benefit plan may be
-30-1discontinued by the carrier or organized delivery system in
2that market with the approval of the commissioner or the
3director and only if the carrier or organized delivery system
4 does all of the following:
5(1) Provides advance notice of its decision to discontinue
6such plan to the commissioner or director. Notice to the
7commissioner or director, at a minimum, shall be no less than
8three days prior to the notice provided for in subparagraph (2)
9to affected individuals.
10(2) Provides notice of its decision not to renew such plan
11to all affected individuals no less than ninety days prior
12to the nonrenewal date of any discontinued individual health
13benefit plans.
14(3) Offers to each individual of the discontinued plan the
15option to purchase any other health plan currently offered by
16the carrier or organized delivery system to individuals in this
17state.
18(4) Acts uniformly in opting to discontinue the plan and
19in offering the option under subparagraph (3), without regard
20to the claims experience of any affected eligible individual
21or beneficiary under the discontinued plan or to a health
22status-related factor relating to any covered individuals or
23beneficiaries who may become eligible for the coverage.
24d. A decision by the carrier or organized delivery system
25 to discontinue offering and to cease to renew all of its
26individual health benefit plans delivered or issued for
27delivery to individuals in this state. A carrier or organized
28delivery system making such decision shall do all of the
29following:
30(1) Provide advance notice of its decision to discontinue
31such plan to the commissioner or director. Notice to the
32commissioner or director, at a minimum, shall be no less than
33three days prior to the notice provided for in subparagraph (2)
34to affected individuals.
35(2) Provide notice of its decision not to renew such plan
-31-1to all individuals and to the commissioner or director in each
2state in which an individual under the discontinued plan is
3known to reside, no less than one hundred eighty days prior to
4the nonrenewal of the plan.
5e. The commissioner or director finds that the continuation
6of the coverage is not in the best interests of the
7individuals, or would impair the carrier’s or organized
8delivery system’s ability to meet its contractual obligations.
92. At the time of coverage renewal, a carrier or organized
10delivery system may modify the health insurance coverage for
11a policy form offered to individuals in the individual market
12so long as such modification is consistent with state law and
13effective on a uniform basis among all individuals with that
14policy form.
153. An individual carrier or organized delivery system that
16elects not to renew an individual health benefit plan under
17subsection 1, paragraph “d”, shall not write any new business in
18the individual market in this state for a period of five years
19after the date of notice to the commissioner or director.
204. This section, with respect to a carrier or organized
21delivery system doing business in one established geographic
22service area of the state, applies only to such carrier’s or
23organized delivery system’s operations in that service area.
245. A carrier or organized delivery system offering coverage
25through a network plan is not required to renew or continue in
26force coverage or to accept applications from an individual who
27no longer resides or lives in, or is no longer employed in,
28the service area of such carrier or organized delivery system,
29or no longer resides or lives in, or is no longer employed
30in, a service area for which the carrier is authorized to do
31business, but only if coverage is not offered or terminated
32uniformly without regard to health status-related factors of a
33covered individual.
346. A carrier or organized delivery system offering coverage
35through a bona fide association is not required to renew or
-32-1continue in force coverage or to accept applications from an
2individual through an association if the membership of the
3individual in the association on which the basis of coverage
4is provided ceases, but only if the coverage is not offered or
5terminated under this paragraph uniformly without regard to
6health status-related factors of a covered individual.
77. An individual who has coverage as a dependent under a
8basic or standard health benefit plan may, when that individual
9is no longer a dependent under such coverage, elect to continue
10coverage under the basic or standard health benefit plan if
11the individual so elects immediately upon termination of the
12coverage under which the individual was covered as a dependent.
13 Sec. 54. Section 513C.7, subsection 1, Code 2017, is amended
14to read as follows:
151. a. (1) A carrier shall file with the commissioner, in
16a form and manner prescribed by the commissioner, the basic
17or standard health benefit plan. A basic or standard health
18benefit plan filed pursuant to this paragraph may be used by
19a carrier beginning thirty days after it is filed unless the
20commissioner disapproves of its use.
21(2) b. The commissioner may at any time, after providing
22notice and an opportunity for a hearing to the carrier,
23disapprove the continued use by a carrier of a basic or
24standard health benefit plan on the grounds that the plan does
25not meet the requirements of this chapter.
26b. (1) An organized delivery system shall file with the
27director, in a form and manner prescribed by the director,
28the basic or standard health benefit plan to be used by the
29organized delivery system. A basic or standard health benefit
30plan filed pursuant to this paragraph may be used by the
31organized delivery system beginning thirty days after it is
32filed unless the director disapproves of its use.
33(2) The director may at any time, after providing notice and
34an opportunity for a hearing to the organized delivery system,
35disapprove the continued use by an organized delivery system of
-33-1a basic or standard health benefit plan on the grounds that the
2plan does not meet the requirements of this chapter.
3 Sec. 55. Section 513C.7, subsection 3, Code 2017, is amended
4to read as follows:
53. A carrier or an organized delivery system shall not
6modify a basic or standard health benefit plan with respect
7to an individual or dependent through riders, endorsements,
8or other means to restrict or exclude coverage for certain
9diseases or medical conditions otherwise covered by the health
10benefit plan.
11 Sec. 56. Section 513C.9, subsections 1, 2, 3, 6, and 8, Code
122017, are amended to read as follows:
131. A carrier, an organized delivery system, or an agent
14shall not do either of the following:
15a. Encourage or direct individuals to refrain from
16filing an application for coverage with the carrier or the
17organized delivery system because of the health status, claims
18experience, industry, occupation, or geographic location of the
19individuals.
20b. Encourage or direct individuals to seek coverage from
21another carrier or another organized delivery system because of
22the health status, claims experience, industry, occupation, or
23geographic location of the individuals.
242. Subsection 1, paragraph “a”, shall not apply with respect
25to information provided by a carrier or an organized delivery
26system or an agent to an individual regarding the established
27geographic service area of the carrier or the organized
28delivery system, or the restricted network provision of the
29carrier or the organized delivery system.
303. A carrier or an organized delivery system shall not,
31directly or indirectly, enter into any contract, agreement, or
32arrangement with an agent that provides for, or results in, the
33compensation paid to an agent for a sale of a basic or standard
34health benefit plan to vary because of the health status or
35permitted rating characteristics of the individual or the
-34-1individual’s dependents.
26. Denial by a carrier or an organized delivery system of an
3application for coverage from an individual shall be in writing
4and shall state the reason or reasons for the denial.
58. If a carrier or an organized delivery system enters into
6a contract, agreement, or other arrangement with a third-party
7administrator to provide administrative, marketing, or other
8services related to the offering of individual health benefit
9plans in this state, the third-party administrator is subject
10to this section as if it were a carrier or an organized
11delivery system.
12 Sec. 57. Section 513C.10, subsection 1, paragraph a, Code
132017, is amended to read as follows:
14a. All persons that provide health benefit plans in this
15state including insurers providing accident and sickness
16insurance under chapter 509, 514, or 514A, whether on an
17individual or group basis; fraternal benefit societies
18providing hospital, medical, or nursing benefits under chapter
19512B; and health maintenance organizations, organized delivery
20systems, other entities providing health insurance or health
21benefits subject to state insurance regulation, and all other
22insurers as designated by the board of directors of the Iowa
23comprehensive health insurance association with the approval of
24the commissioner shall be members of the association.
25 Sec. 58. Section 513C.10, subsection 2, paragraph a, Code
262017, is amended to read as follows:
27a. Rates for basic and standard coverages as provided in
28this chapter shall be determined by each carrier or organized
29delivery system as the product of a basic and standard factor
30and the lowest rate available for issuance by that carrier or
31organized delivery system adjusted for rating characteristics
32and benefits. Basic and standard factors shall be established
33annually by the Iowa comprehensive health insurance association
34board with the approval of the commissioner. Multiple basic
35and standard factors for a distinct grouping of basic and
-35-1standard policies may be established. A basic and standard
2factor is limited to a minimum value defined as the ratio
3of the average of the lowest rate available for issuance and
4the maximum rate allowable by law divided by the lowest rate
5available for issuance. A basic and standard factor is limited
6to a maximum value defined as the ratio of the maximum rate
7allowable by law divided by the lowest rate available for
8issuance. The maximum rate allowable by law and the lowest
9rate available for issuance is determined based on the rate
10restrictions under this chapter. For policies written after
11January 1, 2002, rates for the basic and standard coverages
12as provided in this chapter shall be calculated using the
13basic and standard factors and shall be no lower than the
14maximum rate allowable by law. However, to maintain assessable
15loss assessments at or below one percent of total health
16insurance premiums or payments as determined in accordance
17with subsection 6, the Iowa comprehensive health insurance
18association board with the approval of the commissioner may
19increase the value for any basic and standard factor greater
20than the maximum value.
21 Sec. 59. Section 513C.10, subsections 3, 4, 7, 8, 9, and 10,
22Code 2017, are amended to read as follows:
233. Following the close of each calendar year, the
24association, in conjunction with the commissioner, shall
25require each carrier or organized delivery system to report
26the amount of earned premiums and the associated paid losses
27for all basic and standard plans issued by the carrier or
28organized delivery system. The reporting of these amounts must
29be certified by an officer of the carrier or organized delivery
30system.
314. The board shall develop procedures and assessment
32mechanisms and make assessments and distributions as required
33to equalize the individual carrier and organized delivery
34system gains or losses so that each carrier or organized
35delivery system receives the same ratio of paid claims to
-36-1ninety percent of earned premiums as the aggregate of all
2basic and standard plans insured by all carriers and organized
3delivery systems in the state.
47. The board shall develop procedures for distributing
5the assessable loss assessments to each carrier and organized
6delivery system in proportion to the carrier’s and organized
7delivery system’s respective share of premium for basic and
8standard plans to the statewide total premium for all basic and
9standard plans.
108. The board shall ensure that procedures for collecting
11and distributing assessments are as efficient as possible
12for carriers and organized delivery systems. The board may
13establish procedures which combine, or offset, the assessment
14from, and the distribution due to, a carrier or organized
15delivery system.
169. A carrier or an organized delivery system may
17petition the association board to seek remedy from writing a
18significantly disproportionate share of basic and standard
19policies in relation to total premiums written in this state
20for health benefit plans. Upon a finding that a carrier or
21organized delivery system has written a disproportionate share,
22the board may agree to compensate the carrier or organized
23delivery system either by paying to the carrier or organized
24delivery system an additional fee not to exceed two percent
25of earned premiums from basic and standard policies for that
26carrier or organized delivery system or by petitioning the
27commissioner or director, as appropriate, for remedy.
2810. a. The commissioner, upon a finding that the acceptance
29of the offer of basic and standard coverage by individuals
30pursuant to this chapter would place the carrier in a
31financially impaired condition, shall not require the carrier
32to offer coverage or accept applications for any period of time
33the financial impairment is deemed to exist.
34b. The director, upon a finding that the acceptance of the
35offer of basic and standard coverage by individuals pursuant
-37-1to this chapter would place the organized delivery system in a
2financially impaired condition, shall not require the organized
3delivery system to offer coverage or accept applications for
4any period of time the financial impairment is deemed to exist.
5 Sec. 60. Section 514A.3B, subsection 3, paragraph k, Code
62017, is amended by striking the paragraph.
7 Sec. 61. Section 514B.25A, Code 2017, is amended to read as
8follows:
9514B.25A Insolvency protection — assessment.
101. Upon a health maintenance organization or organized
11delivery system authorized to do business in this state and
12licensed by the director of public health being declared
13insolvent by the district court, the commissioner may levy an
14assessment on each health maintenance organization or organized
15delivery system doing business in this state and licensed by
16the director of public health, as applicable, to pay claims
17for uncovered expenditures for enrollees. The commissioner
18shall not assess an amount in any one calendar year which is
19more than two percent of the aggregate premium written by each
20health maintenance organization or organized delivery system.
212. The commissioner may use funds obtained through an
22assessment under subsection 1 to pay claims for uncovered
23expenditures for enrollees of an insolvent health maintenance
24organization or organized delivery system and administrative
25costs. The commissioner, by rule, may prescribe the time,
26manner, and form for filing claims under this section. The
27commissioner may require claims to be allowed by an ancillary
28receiver or the domestic receiver or liquidator.
293. a. A receiver or liquidator of an insolvent health
30maintenance organization or organized delivery system shall
31allow a claim in the proceeding in an amount equal to uncovered
32expenditures and administrative costs paid under this section.
33b. A person receiving benefits under this section for
34uncovered expenditures is deemed to have assigned the rights
35under the covered health care plan certificates to the
-38-1commissioner to the extent of the benefits received. The
2commissioner may require an assignment of such rights by a
3payee, enrollee, or beneficiary, to the commissioner as a
4condition precedent to the receipt of such benefits. The
5commissioner is subrogated to these rights against the assets
6of the insolvent health maintenance organization or organized
7delivery system that are held by a receiver or liquidator of
8a foreign jurisdiction.
9c. The assigned subrogation rights of the commissioner and
10allowed claims under this subsection have the same priority
11against the assets of the insolvent health maintenance
12organization or organized delivery system as those claims of
13persons entitled to receive benefits under this section or for
14similar expenses in the receivership or liquidation.
154. If funds assessed under subsection 1 are unused
16following the completion of the liquidation of an insolvent
17health maintenance organization or organized delivery system,
18the commissioner shall distribute the remaining amounts, if
19such amounts are not de minimis, to the health maintenance
20organizations or organized delivery systems that were assessed.
215. The aggregate coverage of uncovered expenditures under
22this section shall not exceed three hundred thousand dollars
23with respect to one individual. Continuation of coverage
24shall cease after the lesser of one year after the health
25maintenance organization or organized delivery system is
26terminated by insolvency or the remaining term of the contract.
27The commissioner may provide continuation of coverage on a
28reasonable basis, including, but not limited to, continuation
29of the health maintenance organization or organized delivery
30system contract or substitution of indemnity coverage in a form
31as determined by the commissioner.
326. The commissioner may waive an assessment of a health
33maintenance organization or organized delivery system if such
34organization or system is impaired financially or would be
35impaired financially as a result of such assessment. A health
-39-1maintenance organization or organized delivery system that
2fails to pay an assessment within thirty days after notice of
3the assessment is subject to a civil forfeiture of not more
4than one thousand dollars for each day the failure continues,
5and suspension or revocation of its certificate of authority.
6An action taken by the commissioner to enforce an assessment
7under this section may be appealed by the health maintenance
8organization or organized delivery system pursuant to chapter
917A.
10 Sec. 62. Section 514C.10, subsection 2, paragraph e, Code
112017, is amended by striking the paragraph.
12 Sec. 63. Section 514C.11, Code 2017, is amended to read as
13follows:
14514C.11 Services provided by licensed physician assistants
15and licensed advanced registered nurse practitioners.
161. Notwithstanding section 514C.6, a policy or contract
17providing for third-party payment or prepayment of health or
18medical expenses shall include a provision for the payment of
19necessary medical or surgical care and treatment provided by
20a physician assistant licensed pursuant to chapter 148C, or
21provided by an advanced registered nurse practitioner licensed
22pursuant to chapter 152 and performed within the scope of the
23license of the licensed physician assistant or the licensed
24advanced registered nurse practitioner if the policy or
25contract would pay for the care and treatment if the care and
26treatment were provided by a person engaged in the practice
27of medicine and surgery or osteopathic medicine and surgery
28under chapter 148. The policy or contract shall provide that
29policyholders and subscribers under the policy or contract may
30reject the coverage for services which may be provided by a
31licensed physician assistant or licensed advanced registered
32nurse practitioner if the coverage is rejected for all
33providers of similar services. A policy or contract subject
34to this section shall not impose a practice or supervision
35restriction which is inconsistent with or more restrictive than
-40-1the restriction already imposed by law.
22. This section applies to services provided under a policy
3or contract delivered, issued for delivery, continued, or
4renewed in this state on or after July 1, 1996, and to an
5existing policy or contract, on the policy’s or contract’s
6anniversary or renewal date, or upon the expiration of the
7applicable collective bargaining contract, if any, whichever
8is later. This section does not apply to policyholders or
9subscribers eligible for coverage under Tit.XVIII of the
10federal Social Security Act or any similar coverage under a
11state or federal government plan.
123. For the purposes of this section, third-party payment or
13prepayment includes an individual or group policy of accident
14or health insurance or individual or group hospital or health
15care service contract issued pursuant to chapter 509, 514, or
16514A, an individual or group health maintenance organization
17contract issued and regulated under chapter 514B, an organized
18delivery system contract regulated under rules adopted by the
19director of public health, or a preferred provider organization
20contract regulated pursuant to chapter 514F.
214. Nothing in this section shall be interpreted to require
22an individual or group health maintenance organization, an
23organized delivery system, or a preferred provider organization
24or arrangement to provide payment or prepayment for services
25provided by a licensed physician assistant or licensed advanced
26registered nurse practitioner unless the physician assistant’s
27supervising physician, the physician-physician assistant team,
28the advanced registered nurse practitioner, or the advanced
29registered nurse practitioner’s collaborating physician has
30entered into a contract or other agreement to provide services
31with the individual or group health maintenance organization,
32the organized delivery system, or the preferred provider
33organization or arrangement.
34 Sec. 64. Section 514C.13, subsection 1, paragraph h, Code
352017, is amended by striking the paragraph.
-41-1 Sec. 65. Section 514C.13, subsection 2, Code 2017, is
2amended to read as follows:
32. A carrier or organized delivery system which offers to
4a small employer a limited provider network plan to provide
5health care services or benefits to the small employer’s
6employees shall also offer to the small employer a point of
7service option to the limited provider network plan.
8 Sec. 66. Section 514C.13, subsection 3, unnumbered
9paragraph 1, Code 2017, is amended to read as follows:
10A carrier or organized delivery system which offers to a
11large employer a limited provider network plan to provide
12health care services or benefits to the large employer’s
13employees shall also offer to the large employer one or more
14of the following:
15 Sec. 67. Section 514C.14, subsections 1 and 3, Code 2017,
16are amended to read as follows:
171. Except as provided under subsection 2 or 3, a carrier,
18as defined in section 513B.2, an organized delivery system
19authorized under 1993 Iowa Acts, ch.158, or a plan established
20pursuant to chapter 509A for public employees, which terminates
21its contract with a participating health care provider,
22shall continue to provide coverage under the contract to a
23covered person in the second or third trimester of pregnancy
24for continued care from such health care provider. Such
25persons may continue to receive such treatment or care through
26postpartum care related to the child birth and delivery.
27Payment for covered benefits and benefit levels shall be
28according to the terms and conditions of the contract.
293. A carrier, organized delivery system, or a plan
30established under chapter 509A, which terminates the contract
31of a participating health care provider for cause shall not
32be liable to pay for health care services provided by the
33health care provider to a covered person following the date of
34termination.
35 Sec. 68. Section 514C.15, Code 2017, is amended to read as
-42-1follows:
2514C.15 Treatment options.
3A carrier, as defined in section 513B.2,; an organized
4delivery system authorized under 1993 Iowa Acts, ch.158,
5and licensed by the director of public health; or a plan
6established pursuant to chapter 509A for public employees,
7shall not prohibit a participating provider from, or penalize a
8participating provider for, doing either of the following:
91. Discussing treatment options with a covered individual,
10notwithstanding the carrier’s, organized delivery system’s, or
11plan’s position on such treatment option.
122. Advocating on behalf of a covered individual within
13a review or grievance process established by the carrier,
14organized delivery system, or chapter 509A plan, or established
15by a person contracting with the carrier, organized delivery
16system, or chapter 509A plan.
17 Sec. 69. Section 514C.16, subsection 1, Code 2017, is
18amended to read as follows:
191. A carrier, as defined in section 513B.2,; an organized
20delivery system authorized under 1993 Iowa Acts, ch.158,
21and licensed by the director of public health; or a plan
22established pursuant to chapter 509A for public employees,
23which provides coverage for emergency services, is responsible
24for charges for emergency services provided to a covered
25individual, including services furnished outside any
26contractual provider network or preferred provider network.
27Coverage for emergency services is subject to the terms and
28conditions of the health benefit plan or contract.
29 Sec. 70. Section 514C.17, subsections 1 and 3, Code 2017,
30are amended to read as follows:
311. Except as provided under subsection 2 or 3, if a carrier,
32as defined in section 513B.2, an organized delivery system
33authorized under 1993 Iowa Acts, ch.158, or a plan established
34pursuant to chapter 509A for public employees, terminates its
35contract with a participating health care provider, a covered
-43-1individual who is undergoing a specified course of treatment
2for a terminal illness or a related condition, with the
3recommendation of the covered individual’s treating physician
4licensed under chapter 148 may continue to receive coverage for
5treatment received from the covered individual’s physician for
6the terminal illness or a related condition, for a period of
7up to ninety days. Payment for covered benefits and benefit
8levels shall be according to the terms and conditions of the
9contract.
103. Notwithstanding subsections 1 and 2, a carrier,
11organized delivery system, or a plan established under chapter
12509A which terminates the contract of a participating health
13care provider for cause shall not be required to cover health
14care services provided by the health care provider to a covered
15person following the date of termination.
16 Sec. 71. Section 514C.18, subsection 2, paragraph a,
17subparagraph (6), Code 2017, is amended by striking the
18subparagraph.
19 Sec. 72. Section 514C.19, subsection 7, paragraph a,
20subparagraph (6), Code 2017, is amended by striking the
21subparagraph.
22 Sec. 73. Section 514C.20, subsection 3, paragraph f, Code
232017, is amended by striking the paragraph.
24 Sec. 74. Section 514C.21, subsection 2, paragraph d, Code
252017, is amended by striking the paragraph.
26 Sec. 75. Section 514C.22, subsection 1, unnumbered
27paragraph 1, Code 2017, is amended to read as follows:
28Notwithstanding the uniformity of treatment requirements of
29section 514C.6, a group policy, contract, or plan providing
30for third-party payment or prepayment of health, medical, and
31surgical coverage benefits issued by a carrier, as defined in
32section 513B.2, or by an organized delivery system authorized
33under 1993 Iowa Acts, ch.158, shall provide coverage benefits
34for treatment of a biologically based mental illness if either
35of the following is satisfied:
-44-1 Sec. 76. Section 514C.22, subsection 6, Code 2017, is
2amended to read as follows:
36. A carrier, organized delivery system, or plan
4established pursuant to chapter 509A may manage the benefits
5provided through common methods including, but not limited to,
6providing payment of benefits or providing care and treatment
7under a capitated payment system, prospective reimbursement
8rate system, utilization control system, incentive system for
9the use of least restrictive and least costly levels of care,
10a preferred provider contract limiting choice of specific
11providers, or any other system, method, or organization
12designed to assure services are medically necessary and
13clinically appropriate.
14 Sec. 77. Section 514C.25, subsection 2, paragraph a,
15subparagraph (5), Code 2017, is amended by striking the
16subparagraph.
17 Sec. 78. Section 514C.26, subsection 5, paragraph a,
18subparagraph (6), Code 2017, is amended by striking the
19subparagraph.
20 Sec. 79. Section 514C.27, subsection 1, unnumbered
21paragraph 1, Code 2017, is amended to read as follows:
22Notwithstanding the uniformity of treatment requirements
23of section 514C.6, a group policy or contract providing for
24third-party payment or prepayment of health or medical expenses
25issued by a carrier, as defined in section 513B.2, or by an
26organized delivery system authorized under 1993 Iowa Acts, ch.
27158, shall provide coverage benefits to an insured who is a
28veteran for treatment of mental illness and substance abuse if
29either of the following is satisfied:
30 Sec. 80. Section 514C.27, subsection 6, Code 2017, is
31amended to read as follows:
326. A carrier, organized delivery system, or plan
33established pursuant to chapter 509A may manage the benefits
34provided through common methods including but not limited to
35providing payment of benefits or providing care and treatment
-45-1under a capitated payment system, prospective reimbursement
2rate system, utilization control system, incentive system for
3the use of least restrictive and least costly levels of care,
4a preferred provider contract limiting choice of specific
5providers, or any other system, method, or organization
6designed to assure services are medically necessary and
7clinically appropriate.
8 Sec. 81. Section 514C.29, subsection 2, paragraph e, Code
92017, is amended by striking the paragraph.
10 Sec. 82. Section 514C.30, subsection 2, paragraph e, Code
112017, is amended by striking the paragraph.
12 Sec. 83. Section 514E.1, subsection 6, paragraph k, Code
132017, is amended by striking the paragraph.
14 Sec. 84. Section 514E.1, subsection 17, Code 2017, is
15amended by striking the subsection.
16 Sec. 85. Section 514E.2, subsection 1, paragraph a, Code
172017, is amended to read as follows:
18a. All carriers and all organized delivery systems licensed
19by the director of public health providing health insurance or
20health care services in Iowa, whether on an individual or group
21basis, and all other insurers designated by the association’s
22board of directors and approved by the commissioner shall be
23members of the association.
24 Sec. 86. Section 514E.2, subsection 2, paragraph a,
25subparagraph (3), Code 2017, is amended to read as follows:
26(3) Two members selected by the members of the association,
27one of whom shall be a representative from a corporation
28operating pursuant to chapter 514 on July 1, 1989, or
29any successor in interest, and one of whom shall be a
30representative of an organized delivery system or an insurer
31providing coverage pursuant to chapter 509 or 514A.
32 Sec. 87. Section 514E.7, subsection 1, paragraph a,
33subparagraphs (1) and (2), Code 2017, are amended to read as
34follows:
35(1) A notice of rejection or refusal to issue substantially
-46-1similar insurance for health reasons by one carrier or
2organized delivery system.
3(2) A refusal by a carrier or organized delivery system to
4issue insurance except at a rate exceeding the plan rate.
5 Sec. 88. Section 514E.7, subsection 1, paragraph b, Code
62017, is amended to read as follows:
7b. A rejection or refusal by a carrier or organized delivery
8system offering only stoploss, excess of loss, or reinsurance
9coverage with respect to an applicant under paragraph “a”,
10 subparagraphs (1) and (2), is not sufficient evidence for
11purposes of this subsection.
12 Sec. 89. Section 514E.9, Code 2017, is amended to read as
13follows:
14514E.9 Rules.
15Pursuant to chapter 17A, the commissioner and the director
16of public health shall adopt rules to provide for disclosure
17by carriers and organized delivery systems of the availability
18of insurance coverage from the association, and to otherwise
19implement this chapter.
20 Sec. 90. Section 514E.11, Code 2017, is amended to read as
21follows:
22514E.11 Notice of association policy.
23Every carrier, including a health maintenance organization
24subject to chapter 514B and an organized delivery system,
25authorized to provide health care insurance or coverage for
26health care services in Iowa, shall provide a notice of the
27availability of coverage by the association to any person
28who receives a rejection of coverage for health insurance
29or health care services, or a rate for health insurance or
30coverage for health care services that will exceed the rate of
31an association policy, and that person is eligible to apply
32for health insurance provided by the association. Application
33for the health insurance shall be on forms prescribed by the
34association’s board of directors and made available to the
35carriers and organized delivery systems and other entities
-47-1providing health care insurance or coverage for health care
2services regulated by the commissioner.
3 Sec. 91. Section 514F.5, Code 2017, is amended to read as
4follows:
5514F.5 Experimental treatment review.
61. A carrier, as defined in section 513B.2, an organized
7delivery system authorized under 1993 Iowa Acts, ch.158, or a
8plan established pursuant to chapter 509A for public employees,
9that limits coverage for experimental medical treatment, drugs,
10or devices, shall develop and implement a procedure to evaluate
11experimental medical treatments and shall submit a description
12of the procedure to the division of insurance. The procedure
13shall be in writing and must describe the process used to
14determine whether the carrier, organized delivery system,
15 or chapter 509A plan will provide coverage for new medical
16technologies and new uses of existing technologies. The
17procedure, at a minimum, shall require a review of information
18from appropriate government regulatory agencies and published
19scientific literature concerning new medical technologies, new
20uses of existing technologies, and the use of external experts
21in making decisions. A carrier, organized delivery system,
22 or chapter 509A plan shall include appropriately licensed
23or qualified professionals in the evaluation process. The
24procedure shall provide a process for a person covered under
25a plan or contract to request a review of a denial of coverage
26because the proposed treatment is experimental. A review of
27a particular treatment need not be reviewed more than once a
28year.
292. A carrier, organized delivery system, or chapter 509A
30plan that limits coverage for experimental treatment, drugs, or
31devices shall clearly disclose such limitations in a contract,
32policy, or certificate of coverage.
33 Sec. 92. Section 514I.2, subsection 10, Code 2017, is
34amended to read as follows:
3510. “Participating insurer” means any entity licensed by the
-48-1division of insurance of the department of commerce to provide
2health insurance in Iowa or an organized delivery system
3licensed by the director of public health that has contracted
4with the department to provide health insurance coverage to
5eligible children under this chapter.
6 Sec. 93. Section 514J.102, subsection 24, Code 2017, is
7amended to read as follows:
824. “Health carrier” means an entity subject to the
9insurance laws and regulations of this state, or subject
10to the jurisdiction of the commissioner, including an
11insurance company offering sickness and accident plans, a
12health maintenance organization, a nonprofit health service
13corporation, a plan established pursuant to chapter 509A
14for public employees, or any other entity providing a plan
15of health insurance, health care benefits, or health care
16services. “Health carrier” includes, for purposes of this
17chapter, an organized delivery system.
18 Sec. 94. Section 514J.102, subsection 29, Code 2017, is
19amended by striking the subsection.
20 Sec. 95. Section 514K.1, subsection 1, unnumbered paragraph
211, Code 2017, is amended to read as follows:
22A health maintenance organization, an organized delivery
23system, or an insurer using a preferred provider arrangement
24shall provide to each of its enrollees at the time of
25enrollment, and shall make available to each prospective
26enrollee upon request, written information as required by rules
27adopted by the commissioner and the director of public health.
28The information required by rule shall include, but not be
29limited to, all of the following:
30 Sec. 96. Section 514K.1, subsection 2, Code 2017, is amended
31to read as follows:
322. The commissioner and the director shall annually publish
33a consumer guide providing a comparison by plan on performance
34measures, network composition, and other key information to
35enable consumers to better understand plan differences.
-49-1 Sec. 97. Section 514L.1, subsection 3, Code 2017, is amended
2to read as follows:
33. “Provider of third-party payment or prepayment of
4prescription drug expenses” or “provider” means a provider of an
5individual or group policy of accident or health insurance or
6an individual or group hospital or health care service contract
7issued pursuant to chapter 509, 514, or 514A, a provider of a
8plan established pursuant to chapter 509A for public employees,
9a provider of an individual or group health maintenance
10organization contract issued and regulated under chapter 514B,
11a provider of an organized delivery system contract regulated
12under rules adopted by the director of public health, a
13provider of a preferred provider contract issued pursuant to
14chapter 514F, a provider of a self-insured multiple employer
15welfare arrangement, and any other entity providing health
16insurance or health benefits which provide for payment or
17prepayment of prescription drug expenses coverage subject to
18state insurance regulation.
19 Sec. 98. Section 514L.2, subsection 1, paragraph a,
20unnumbered paragraph 1, Code 2017, is amended to read as
21follows:
22A provider of third-party payment or prepayment of
23prescription drug expenses, including the provider’s agents or
24contractors and pharmacy benefits managers, that issues a card
25or other technology for claims processing and an administrator
26of the payor, excluding administrators of self-funded employer
27sponsored health benefit plans qualified under the federal
28Employee Retirement Income Security Act of 1974, shall issue
29to its insureds a card or other technology containing uniform
30prescription drug information. The commissioner of insurance
31shall adopt rules for the uniform prescription drug information
32card or technology applicable to those entities subject to
33regulation by the commissioner of insurance. The director of
34public health shall adopt rules for the uniform prescription
35drug information card or technology applicable to organized
-50-1delivery systems. The rules shall require at least both of the
2following regarding the card or technology:
3 Sec. 99. Section 521F.2, subsection 7, Code 2017, is amended
4to read as follows:
57. “Health organization” means a health maintenance
6organization, limited service organization, dental or vision
7plan, hospital, medical and dental indemnity or service
8corporation or other managed care organization licensed under
9chapter 514, or 514B, or 1993 Iowa Acts, ch.158, or any other
10entity engaged in the business of insurance, risk transfer,
11or risk retention, that is subject to the jurisdiction of the
12commissioner of insurance or the director of public health.
13“Health organization” does not include an insurance company
14licensed to transact the business of insurance under chapter
15508, 515, or 520, and which is otherwise subject to chapter
16521E.
17 Sec. 100. 1993 Iowa Acts, chapter 158, section 4, is amended
18to read as follows:
19SEC. 4. EMERGENCY RULES. Pursuant to sections 1, and 2, and
203 of this Act, the commissioner of insurance or the director of
21public health shall adopt administrative rules under section
2217A.4, subsection 2, and section 17A.5, subsection 2, paragraph
23“b”, to implement the provisions of this Act and the rules
24shall become effective immediately upon filing, unless a later
25effective date is specified in the rules. Any rules adopted in
26accordance with the provisions of this section shall also be
27published as notice of intended action as provided in section
2817A.4.
29 Sec. 101. REPEAL. Section 135.120, Code 2017, is repealed.
30 Sec. 102. REPEAL. 1993 Iowa Acts, chapter 158, section 3,
31is repealed.
32 Sec. 103. CODE EDITOR’S DIRECTIVE. The Code editor shall
33correct and eliminate any references to the term “organized
34delivery system” or other forms of the term anywhere else in
35the Iowa Code or Iowa Code Supplement, in any bills awaiting
-51-1codification, in this Act, and in any bills enacted by the
2Eighty-seventh General Assembly, 2017 Regular Session, or any
3extraordinary session.
4EXPLANATION
5The inclusion of this explanation does not constitute agreement with
6the explanation’s substance by the members of the general assembly.
7This bill relates to programs and activities under the
8purview of the department of public health (DPH).
9Division I of the bill relates to program funding
10flexibility and reporting.
11The bill provides that if the amount of estimated moneys to
12be received from certain liquor fees and retail beer permit
13fees that is transferred to DPH annually for grants to counties
14operating a substance abuse program exceeds grant requests,
15in addition to using the remainder for grants to entities to
16operate a substance abuse prevention program, DPH may also use
17the remainder for activities and public information resources
18that align with best practices for substance-related disorder
19prevention.
20The bill eliminates the requirement under Code section
21135.11, subsection 31, that DPH report to the chairpersons and
22ranking members of the joint appropriations subcommittee on
23health and human services, the legislative services agency, the
24legislative caucus staffs, and the department of management
25within 60 calendar days of applying for or renewing a federal
26grant which requires a state match or maintenance of effort
27and has a value of over $100,000, including a listing of
28the federal funding source and the potential need for the
29commitment of state funding in the present or future.
30The bill amends Code section 135.150 to require DPH to report
31annually rather than semiannually to the general assembly’s
32standing committees on government oversight regarding
33the operation of the gambling treatment program including
34information on the moneys expended and grants awarded for
35operation of the program.
-52- 1Division II of the bill relates to medical home and the
2patient-centered health advisory council.
3The bill amends provisions relating to medical homes.
4Code sections 135.157 and 135.158, providing definitions and
5describing the purposes and characteristics of medical homes,
6are repealed by the bill. Code section 135.159 provides
7parameters for the development and implementation of a medical
8home system in the state, as well as the establishment of the
9patient-centered health advisory council. The bill amends
10Code section 135.159 to provide for the continuation of the
11patient-centered health advisory council and to revise the
12purposes of the council.
13The bill also makes conforming changes throughout the Code,
14including those relative to the definitions of “dental home”,
15“medical home”, “personal provider”, “primary care provider”,
16and “primary medical provider”, due to elimination of certain
17definitions and concepts based upon the repeal of Code sections
18135.157 and 135.158.
19Division III of the bill includes provisions relating to
20workforce programming.
21The bill amends Code section 135.107 relating to the center
22for rural health and primary care. Of the programs that
23constitute the primary care provider recruitment and retention
24endeavor or PRIMECARRE, the bill eliminates the primary care
25provider community scholarship program, but retains the primary
26care loan repayment program and the community grant program
27that is renamed the health care workforce and community support
28grant program. The bill amends the application and matching
29funds requirements for a grant under the health care workforce
30and community support grant program and specifies that the
31target areas for awarding of such grants are rural, underserved
32areas or special populations identified by the department’s
33strategic plan or evidence-based documentation.
34The bill provides that the primary care provider loan
35repayment program may cancel a loan repayment program contract
-53-1for reasonable cause unless federal requirements otherwise
2require and provides that the center for rural health and
3primary care may enter into an agreement with the college
4student aid commission for administration of the center’s grant
5and loan repayment programs.
6The bill eliminates the requirement that a community or
7region applying for assistance under any of the programs
8established under PRIMECARRE submit a letter of intent to
9conduct a community health services assessment and instead
10requires that the community or region shall document
11participation in the community health services assessment. In
12addition to any other requirements, an applicant’s plan is
13also to include, to the extent possible, a clear commitment to
14informing high school students of the health care opportunities
15which may be available to such students.
16The bill removes the representation by the obsolete rural
17health resource center on the advisory committee to the center
18for rural health and primary care and corrects the reference to
19a national or regional institute for rural health policy.
20The bill eliminates the reference to “long-term care” in
21Code section 135.163 which directs DPH to coordinate public and
22private efforts to develop and maintain an appropriate health
23care delivery infrastructure and a stable, well-qualified,
24diverse, and sustainable health care workforce in this state.
25Under this section, DPH is required, at a minimum, to develop
26a strategic plan for health care delivery infrastructure and
27health care workforce resources in this state; provide for
28the continuous collection of data to provide a basis for
29health care strategic planning and health care policymaking;
30and make recommendations regarding the health care delivery
31infrastructure and the health care workforce that assist
32in monitoring current needs, predicting future trends, and
33informing policymaking.
34The bill amends Code section 135.175 relating to the health
35care workforce support initiative, the workforce shortage fund,
-54-1and the accounts within the fund. The bill provides that
2state programs that may receive moneys from the fund or the
3accounts in the fund, if specifically designated for drawing
4down federal funding, include PRIMECARRE, the Iowa affiliate
5of the national rural recruitment and retention network, the
6oral and health delivery systems bureau of the department,
7the primary care office and shortage designation program, and
8the state office of rural health, but eliminates inclusion of
9the Iowa health workforce center, the area health education
10centers programs at Des Moines university osteopathic medical
11center and the university of Iowa, and the Iowa collaborative
12safety net provider network as potential recipients. The bill
13also eliminates the requirement that state appropriations to
14the fund shall be allocated in equal amounts to each of the
15accounts within the fund, unless otherwise specified in the
16appropriation or allocation, and eliminates the restriction
17that moneys in each of the accounts in the fund used for
18administrative purposes are not to exceed $100,000 in each
19account, but retains the limitation that no more than 5 percent
20of the moneys in any of the accounts within the fund shall be
21used for administrative purposes unless otherwise provided in
22the appropriation, allocation, or source of the funds.
23The bill repeals Code section 135.164 which relates to the
24health care delivery infrastructure and health care workforce
25resources strategic plan to be developed by DPH including the
26specific elements of the strategic plan and the requirements
27for developing the strategic plan.
28The bill repeals Code section 135.180, the mental health
29professional shortage area program, which provides stipends to
30support psychiatrist positions with an emphasis on securing and
31retaining medical directors at community mental health centers
32designated under Code chapter 230A and hospital psychiatric
33units that are located in mental health professional shortage
34areas.
35Division IV of the bill relates to unfunded or outdated
-55-1program provisions.
2The bill eliminates the provision under Code section 135.11
3requiring DPH to establish and administer a substance abuse
4treatment facility for persons on probation, repeals Code
5section 135.130, and strikes the conforming provision in Code
6section 901B.1. The substance abuse treatment facility for
7persons on probation was authorized in 2001 but was never
8established.
9The bill strikes the directive in Code section 135.141 for
10the division of acute disease prevention and emergency response
11of DPH to conduct and maintain a statewide risk assessment
12of any present or potential danger to the public health from
13biological agents.
14The bill repeals Code section 135.26 establishing the
15automated external defibrillator (AED) grant program to provide
16matching fund grants to local boards of health, community
17organizations, or cities to implement AED programs.
18The bill repeals Code section 135.29, relating to local
19substitute medical decision-making boards, which authorized
20each county to establish and fund a local substituted medical
21decision-making board to act as a substitute decision maker for
22patients incapable of making their own medical care decisions
23if no other substitute decision maker is available to act.
24The bill repeals Code section 135.120, relating to the
25taxation of organized delivery systems (ODSs). 1993 Iowa
26Acts, chapter 158, section 3, directs DPH to adopt rules and a
27licensing procedure for the establishment of ODSs. The bill
28only eliminates the provision for taxation of ODSs, not all
29other provisions relating to ODSs.
30The bill repeals Code section 135.152, the statewide
31obstetrical and newborn indigent patient care program. The
32program acts as a payer of last resort for eligible individuals
33but has not been utilized since 2009 due to other options
34for coverage including through the Medicaid program and the
35Affordable Care Act for otherwise eligible individuals.
-56- 1Division V includes miscellaneous provisions.
2The bill amends the definition of “local board of health” in
3Code section 135A.2 under the public health modernization Act
4to be consistent with the definition under Code chapter 137,
5relating to local boards of health.
6The bill repeals Code section 135.132, the interagency
7pharmaceuticals bulk purchasing council. The provision was
8enacted in 2003, but the council was never established.
9Division VI relates to the Iowa health information
10network. Legislation was enacted in 2015 Iowa Acts, chapter
1173, to provide for the future assumption of the Iowa health
12information network by a designated entity. The bill
13includes a conforming change that would take effect upon
14future assumption of the Iowa health information network by a
15designated entity.
16Division VII relates to organized delivery systems that are
17regulated by DPH. Organized delivery systems were created
18pursuant to 1993 Iowa Acts, chapter 158. Rules adopted
19under the provision define an organized delivery system as
20“an organization with defined governance that is responsible
21for delivering or arranging to deliver the full range of
22health care services covered under a standard benefit plan
23and is accountable to the public for the cost, quality and
24access of its services and for the effect of its services
25on their health.” (641 IAC 201.2) An organization operating
26as an organized delivery system is required to assume risk
27and be subject to solvency standards. The bill eliminates
28all references to organized delivery systems in the Code and
29repeals the provision in the Acts authorizing the establishment
30of organized delivery systems. The most recent application for
31licensure was received by DPH in 1998. Since being authorized
32in 1993, only two entities applied for licensure as organized
33delivery systems and both of these entities have since ceased
34operations.
-57-pf/nh
2of the department of public health, and including effective
3date provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2Program Flexibility and Efficiencies
3 Section 1. Section 125.59, subsection 1, paragraph b, Code
42017, is amended to read as follows:
5b. If the transferred amount for this subsection exceeds
6grant requests funded to the ten thousand dollar maximum, the
7Iowa department of public health may use the remainder for
8activities and public information resources that align with
9best practices for substance-related disorder prevention or to
10increase grants pursuant to subsection 2.
11 Sec. 2. Section 135.11, subsection 31, Code 2017, is amended
12by striking the subsection.
13 Sec. 3. Section 135.150, subsection 2, Code 2017, is amended
14to read as follows:
152. The department shall report semiannually annually to the
16general assembly’s standing committees on government oversight
17regarding the operation of the gambling treatment program.
18The report shall include but is not limited to information on
19the moneys expended and grants awarded for operation of the
20gambling treatment program.
21DIVISION II
22Medical home and Patient-centered health advisory council
23 Sec. 4. Section 135.15, Code 2017, is amended by adding the
24following new subsection:
25 NEW SUBSECTION. 6. For the purposes of this section,
26“dental home” means a network of individualized care based on
27risk assessment, which includes oral health education, dental
28screenings, preventive services, diagnostic services, treatment
29services, and emergency services.
30 Sec. 5. Section 135.159, Code 2017, is amended by striking
31the section and inserting in lieu thereof the following:
32135.159 Patient-centered health advisory council.
331. The department shall establish a patient-centered health
34advisory council which shall include but is not limited to
35all of the following members, selected by their respective
-1-1organizations, and any other members the department determines
2necessary:
3a. The director of human services, or the director’s
4designee.
5b. The commissioner of insurance, or the commissioner’s
6designee.
7c. A representative of the federation of Iowa insurers.
8d. A representative of the Iowa dental association.
9e. A representative of the Iowa nurses association.
10f. A physician and an osteopathic physician licensed
11pursuant to chapter 148 who are family physicians and members
12of the Iowa academy of family physicians.
13g. A health care consumer.
14h. A representative of the Iowa collaborative safety net
15provider network established pursuant to section 135.153.
16i. A representative of the Iowa developmental disabilities
17council.
18j. A representative of the Iowa chapter of the American
19academy of pediatrics.
20k. A representative of the child and family policy center.
21l. A representative of the Iowa pharmacy association.
22m. A representative of the Iowa chiropractic society.
23n. A representative of the university of Iowa college of
24public health.
25o. A certified palliative care physician.
262. The patient-centered health advisory council may utilize
27the assistance of other relevant public health and health care
28expertise when necessary to carry out the council’s purposes
29and responsibilities.
303. A public member of the patient-centered health advisory
31council shall receive reimbursement for actual expenses
32incurred while serving in the member’s official capacity
33only if the member is not eligible for reimbursement by the
34organization the member represents.
354. The purposes of the patient-centered health advisory
-2-1council shall include all of the following:
2a. To serve as a resource on emerging health care
3transformation initiatives in Iowa.
4b. To convene stakeholders in Iowa to streamline efforts
5that support state-level and community-level integration and
6focus on reducing fragmentation of the health care system.
7c. To encourage partnerships and synergy between community
8health care partners in the state who are working on new
9system-level models to provide better health care at lower
10costs by focusing on shifting from volume-based to value-based
11health care.
12d. To lead discussions on the transformation of the
13health care system to a patient-centered infrastructure that
14integrates and coordinates services and supports to address
15social determinants of health and to meet population health
16goals.
17e. To provide a venue for education and information
18gathering for stakeholders and interested parties to learn
19about emerging health care initiatives across the state.
20f. To develop recommendations for submission to the
21department related to health care transformation issues.
22 Sec. 6. Section 249N.2, subsections 15 and 19, Code 2017,
23are amended to read as follows:
2415. “Medical home” means medical home as defined in
25section 135.157. a team approach to providing health care that
26originates in a primary care setting; fosters a partnership
27among the patient, the personal provider, and other health care
28professionals, and where appropriate, the patient’s family;
29utilizes the partnership to access and integrate all medical
30and nonmedical health-related services across all elements of
31the health care system and the patient’s community as needed by
32the patient and the patient’s family to achieve maximum health
33potential; maintains a centralized, comprehensive record of all
34health-related services to promote continuity of care; and has
35all of the following characteristics:
-3- 1a. A personal provider.
2b. A provider-directed team-based medical practice.
3c. Whole person orientation.
4d. Coordination and integration of care.
5e. Quality and safety.
6f. Enhanced access to health care.
7g. A payment system that appropriately recognizes the added
8value provided to patients who have a patient-centered medical
9home.
1019. “Primary medical provider” means the personal provider
11as defined in section 135.157 trained to provide first contact
12and continuous and comprehensive care to a member, chosen by
13a member or to whom a member is assigned under the Iowa health
14and wellness plan.
15 Sec. 7. Section 249N.2, Code 2017, is amended by adding the
16following new subsections:
17 NEW SUBSECTION. 17A. “Personal provider” means the
18patient’s first point of contact in the health care system
19with a primary care provider who identifies the patient’s
20health-related needs and, working with a team of health
21care professionals and providers of medical and nonmedical
22health-related services, provides for and coordinates
23appropriate care to address the health-related needs
24identified.
25 NEW SUBSECTION. 18A. “Primary care provider” includes but
26is not limited to any of the following licensed or certified
27health care professionals who provide primary care:
28a. A physician who is a family or general practitioner, a
29pediatrician, an internist, an obstetrician, or a gynecologist.
30b. An advanced registered nurse practitioner.
31c. A physician assistant.
32d. A chiropractor.
33 Sec. 8. Section 249N.6, subsection 2, paragraph c, Code
342017, is amended to read as follows:
35c. The department shall develop a mechanism for primary
-4-1medical providers, medical homes, and participating accountable
2care organizations to jointly facilitate member care
3coordination. The Iowa health and wellness plan shall provide
4for reimbursement of care coordination services provided
5under the plan consistent with the reimbursement methodology
6developed pursuant to section 135.159.
7 Sec. 9. Section 249N.6, subsection 3, paragraph a, Code
82017, is amended to read as follows:
9a. The department shall provide procedures for accountable
10care organizations that emerge through local markets to
11participate in the Iowa health and wellness plan provider
12network. Such accountable care organizations shall incorporate
13the medical home as defined and specified in chapter 135,
14division XXII, as a foundation and shall emphasize whole-person
15orientation and coordination and integration of both clinical
16services and nonclinical community and social supports that
17address social determinants of health. A participating
18accountable care organization shall enter into a contract with
19the department to ensure the coordination and management of the
20health of attributed members, to produce quality health care
21outcomes, and to control overall cost.
22 Sec. 10. PALLIATIVE CARE REVIEW — PATIENT-CENTERED HEALTH
23ADVISORY COUNCIL. The patient-centered health advisory council
24shall review the current level of public awareness regarding
25and the availability of palliative care services in the state
26and shall submit a report to the governor and the general
27assembly by December 31, 2017, including the council’s findings
28and providing recommendations to increase public awareness
29and reduce barriers to access to palliative care services
30throughout the state.
31 Sec. 11. REPEAL. Sections 135.157 and 135.158, Code 2017,
32are repealed.
33DIVISION III
34workforce programming
35 Sec. 12. Section 84A.11, subsection 4, Code 2017, is amended
-5-1to read as follows:
24. The nursing workforce data clearinghouse shall be
3established and maintained in a manner consistent with the
4health care delivery infrastructure and health care workforce
5resources strategic plan developed pursuant to section 135.164
6 135.163.
7 Sec. 13. Section 135.107, subsection 3, Code 2017, is
8amended to read as follows:
93. The center for rural health and primary care shall
10establish a primary care provider recruitment and retention
11endeavor, to be known as PRIMECARRE. The endeavor shall
12include a health care workforce and community support grant
13program, and a primary care provider loan repayment program,
14and a primary care provider community scholarship program. The
15endeavor shall be developed and implemented in a manner to
16promote and accommodate local creativity in efforts to recruit
17and retain health care professionals to provide services in
18the locality. The focus of the endeavor shall be to promote
19and assist local efforts in developing health care provider
20recruitment and retention programs. The center for rural
21health and primary care may enter into an agreement with the
22college student aid commission for the administration of the
23center’s grant and loan repayment programs.
24a. Community Health care workforce and community support
25 grant program.
26(1) The center for rural health and primary care shall adopt
27rules establishing an flexible application process processes
28based upon the department’s strategic plan to be used by the
29center to establish a grant assistance program as provided
30in this paragraph “a”, and establishing the criteria to be
31used in evaluating the applications. Selection criteria
32shall include a method for prioritizing grant applications
33based on illustrated efforts to meet the health care provider
34needs of the locality and surrounding area. Such assistance
35may be in the form of a forgivable loan, grant, or other
-6-1nonfinancial assistance as deemed appropriate by the center.
2An application submitted shall may contain a commitment of at
3least a dollar-for-dollar match of matching funds for the grant
4assistance. Application may be made for assistance by a single
5community or group of communities or in response to programs
6recommended in the strategic plan to address health workforce
7shortages.
8(2) Grants awarded under the program shall be subject to the
9following limitations:
10(a) Ten thousand dollars for a single community or region
11with a population of ten thousand or less. An award shall not
12be made under this program to a community with a population of
13more than ten thousand.
14(b) An amount not to exceed one dollar per capita for a
15region in which the population exceeds ten thousand. For
16purposes of determining the amount of a grant for a region,
17the population of the region shall not include the population
18of any community with a population of more than ten thousand
19located in the region awarded to rural, underserved areas or
20special populations as identified by the department’s strategic
21plan or evidence-based documentation.
22b. Primary care provider loan repayment program.
23(1) A primary care provider loan repayment program is
24established to increase the number of health professionals
25practicing primary care in federally designated health
26professional shortage areas of the state. Under the program,
27loan repayment may be made to a recipient for educational
28expenses incurred while completing an accredited health
29education program directly related to obtaining credentials
30necessary to practice the recipient’s health profession.
31(2) The center for rural health and primary care shall adopt
32rules relating to the establishment and administration of the
33primary care provider loan repayment program. Rules adopted
34pursuant to this paragraph shall provide, at a minimum, for all
35of the following:
-7- 1(a) Determination of eligibility requirements and
2qualifications of an applicant to receive loan repayment under
3the program, including but not limited to years of obligated
4service, clinical practice requirements, and residency
5requirements. One year of obligated service shall be provided
6by the applicant in exchange for each year of loan repayment,
7unless federal requirements otherwise require. Loan repayment
8under the program shall not be approved for a health provider
9whose license or certification is restricted by a medical
10regulatory authority of any jurisdiction of the United States,
11other nations, or territories.
12(b) Identification of federally designated health
13professional shortage areas of the state and prioritization of
14such areas according to need.
15(c) Determination of the amount and duration of the loan
16repayment an applicant may receive, giving consideration to the
17availability of funds under the program, and the applicant’s
18outstanding educational loans and professional credentials.
19(d) Determination of the conditions of loan repayment
20applicable to an applicant.
21(e) Enforcement of the state’s rights under a loan repayment
22program contract, including the commencement of any court
23action.
24(f) Cancellation of a loan repayment program contract for
25reasonable cause unless federal requirements otherwise require.
26(g) Participation in federal programs supporting repayment
27of loans of health care providers and acceptance of gifts,
28grants, and other aid or amounts from any person, association,
29foundation, trust, corporation, governmental agency, or other
30entity for the purposes of the program.
31(h) Upon availability of state funds, determination of
32eligibility criteria and qualifications for participating
33communities and applicants not located in federally designated
34shortage areas.
35(i) Other rules as necessary.
-8- 1(3) The center for rural health and primary care may enter
2into an agreement under chapter 28E with the college student
3aid commission for the administration of this program.
4c. Primary care provider community scholarship program.
5(1) A primary care provider community scholarship program
6is established to recruit and to provide scholarships to train
7primary health care practitioners in federally designated
8health professional shortage areas of the state. Under
9the program, scholarships may be awarded to a recipient for
10educational expenses incurred while completing an accredited
11health education program directly related to obtaining the
12credentials necessary to practice the recipient’s health
13profession.
14(2) The department shall adopt rules relating to the
15establishment and administration of the primary care provider
16community scholarship program. Rules adopted pursuant to
17this paragraph shall provide, at a minimum, for all of the
18following:
19(a) Determination of eligibility requirements and
20qualifications of an applicant to receive scholarships under
21the program, including but not limited to years of obligated
22service, clinical practice requirements, and residency
23requirements. One year of obligated service shall be provided
24by the applicant in exchange for each year of scholarship
25receipt, unless federal requirements otherwise require.
26(b) Identification of federally designated health
27professional shortage areas of the state and prioritization of
28such areas according to need.
29(c) Determination of the amount of the scholarship an
30applicant may receive.
31(d) Determination of the conditions of scholarship to be
32awarded to an applicant.
33(e) Enforcement of the state’s rights under a scholarship
34contract, including the commencement of any court action.
35(f) Cancellation of a scholarship contract for reasonable
-9-1cause.
2(g) Participation in federal programs supporting
3scholarships for health care providers and acceptance of gifts,
4grants, and other aid or amounts from any person, association,
5foundation, trust, corporation, governmental agency, or other
6entity for the purposes of the program.
7(h) Upon availability of state funds, determination of
8eligibility criteria and qualifications for participating
9communities and applicants not located in federally designated
10shortage areas.
11(i) Other rules as necessary.
12(3) The center for rural health and primary care may enter
13into an agreement under chapter 28E with the college student
14aid commission for the administration of this program.
15 Sec. 14. Section 135.107, subsection 4, paragraphs a, b, and
16c, Code 2017, are amended to read as follows:
17a. Eligibility under any of the programs established under
18the primary care provider recruitment and retention endeavor
19shall be based upon a community health services assessment
20completed under subsection 2, paragraph “a”. A community
21or region, as applicable, shall submit a letter of intent
22to conduct a community health services assessment and to
23apply for assistance under this subsection. The letter shall
24be in a form and contain information as determined by the
25center. A letter of intent shall be submitted to the center by
26January 1 preceding the fiscal year for which an application
27for assistance is to be made. Participation in a community
28health services assessment process shall be documented by the
29community or region.
30b. Assistance under this subsection shall not be granted
31until such time as the community or region making application
32has completed the a community health services assessment and
33adopted a long-term community health services assessment and
34developmental plan. In addition to any other requirements, a
35developmental an applicant’s plan shall include, to the extent
-10-1possible, a clear commitment to informing high school students
2of the health care opportunities which may be available to such
3students.
4c. The center for rural health and primary care shall
5seek additional assistance and resources from other state
6departments and agencies, federal agencies and grant programs,
7private organizations, and any other person, as appropriate.
8The center is authorized and directed to accept on behalf of
9the state any grant or contribution, federal or otherwise,
10made to assist in meeting the cost of carrying out the purpose
11of this subsection. All federal grants to and the federal
12receipts of the center are appropriated for the purpose set
13forth in such federal grants or receipts. Funds appropriated
14by the general assembly to the center for implementation of
15this subsection shall first be used for securing any available
16federal funds requiring a state match, with remaining funds
17being used for the health care workforce and community support
18 grant program.
19 Sec. 15. Section 135.107, subsection 5, paragraph a, Code
202017, is amended to read as follows:
21a. There is established an advisory committee to the
22center for rural health and primary care consisting of one
23representative, approved by the respective agency, of each
24of the following agencies: the department of agriculture
25and land stewardship, the Iowa department of public health,
26the department of inspections and appeals, the a national or
27regional institute for rural health policy, the rural health
28resource center, the institute of agricultural medicine
29and occupational health, and the Iowa state association of
30counties. The governor shall appoint two representatives
31of consumer groups active in rural health issues and a
32representative of each of two farm organizations active within
33the state, a representative of an agricultural business in
34the state, a representative of a critical needs hospital,
35a practicing rural family physician, a practicing rural
-11-1physician assistant, a practicing rural advanced registered
2nurse practitioner, and a rural health practitioner who is
3not a physician, physician assistant, or advanced registered
4nurse practitioner, as members of the advisory committee. The
5advisory committee shall also include as members two state
6representatives, one appointed by the speaker of the house of
7representatives and one by the minority leader of the house,
8and two state senators, one appointed by the majority leader of
9the senate and one by the minority leader of the senate.
10 Sec. 16. Section 135.163, Code 2017, is amended to read as
11follows:
12135.163 Health and long-term care access.
13The department shall coordinate public and private efforts
14to develop and maintain an appropriate health care delivery
15infrastructure and a stable, well-qualified, diverse, and
16sustainable health care workforce in this state. The health
17care delivery infrastructure and the health care workforce
18shall address the broad spectrum of health care needs of Iowans
19throughout their lifespan including long-term care needs. The
20department shall, at a minimum, do all of the following:
211. Develop a strategic plan for health care delivery
22infrastructure and health care workforce resources in this
23state.
242. Provide for the continuous collection of data to provide
25a basis for health care strategic planning and health care
26policymaking.
273. Make recommendations regarding the health care delivery
28infrastructure and the health care workforce that assist
29in monitoring current needs, predicting future trends, and
30informing policymaking.
31 Sec. 17. Section 135.175, subsection 1, paragraph b, Code
322017, is amended to read as follows:
33b. A health care workforce shortage fund is created in
34the state treasury as a separate fund under the control of
35the department, in cooperation with the entities identified
-12-1in this section as having control over the accounts within
2the fund. The fund and the accounts within the fund shall
3be controlled and managed in a manner consistent with the
4principles specified and the strategic plan developed pursuant
5to sections section 135.163 and 135.164.
6 Sec. 18. Section 135.175, subsections 6 and 7, Code 2017,
7are amended to read as follows:
86. a. Moneys in the fund and the accounts in the fund shall
9only be appropriated in a manner consistent with the principles
10specified and the strategic plan developed pursuant to sections
11 section 135.163 and 135.164 to support the medical residency
12training state matching grants program, the fulfilling Iowa’s
13need for dentists matching grant program, and to provide
14funding for state health care workforce shortage programs as
15provided in this section.
16b. State programs that may receive funding from the fund
17and the accounts in the fund, if specifically designated for
18the purpose of drawing down federal funding, are the primary
19care recruitment and retention endeavor (PRIMECARRE), the Iowa
20affiliate of the national rural recruitment and retention
21network, the oral and health delivery systems bureau of the
22department, the primary care office and shortage designation
23program, and the state office of rural health, and the Iowa
24health workforce center, administered through the oral and
25health delivery systems bureau of health care access of the
26department of public health; the area health education centers
27programs at Des Moines university — osteopathic medical center
28and the university of Iowa; the Iowa collaborative safety net
29provider network established pursuant to section 135.153; any
30entity identified by the federal government entity through
31which federal funding for a specified health care workforce
32shortage initiative is received; and a program developed in
33accordance with the strategic plan developed by the department
34of public health in accordance with sections section 135.163
35and 135.164.
-13- 1c. State appropriations to the fund shall be allocated in
2equal amounts to each of the accounts within the fund, unless
3otherwise specified in the appropriation or allocation. Any
4federal funding received for the purposes of addressing state
5health care workforce shortages shall be deposited in the
6health care workforce shortage national initiatives account,
7unless otherwise specified by the source of the funds, and
8shall be used as required by the source of the funds. If use
9of the federal funding is not designated, the funds shall be
10used in accordance with the strategic plan developed by the
11department of public health in accordance with sections section
12 135.163 and 135.164, or to address workforce shortages as
13otherwise designated by the department of public health. Other
14sources of funding shall be deposited in the fund or account
15and used as specified by the source of the funding.
167. No more than five percent of the moneys in any of the
17accounts within the fund, not to exceed one hundred thousand
18dollars in each account, shall be used for administrative
19purposes, unless otherwise provided by the appropriation,
20allocation, or source of the funds.
21 Sec. 19. REPEAL. Sections 135.164 and 135.180, Code 2017,
22are repealed.
23DIVISION IV
24unfunded OR outdated program PROVISIONS
25 Sec. 20. Section 135.11, subsection 25, Code 2017, is
26amended by striking the subsection.
27 Sec. 21. Section 135.141, subsection 2, paragraph c, Code
282017, is amended by striking the paragraph.
29 Sec. 22. Section 135.141, subsection 2, paragraph e, Code
302017, is amended to read as follows:
31e. For the purpose of paragraphs “c” and paragraph “d”,
32an employee or agent of the department may enter into and
33examine any premises containing potentially dangerous agents
34with the consent of the owner or person in charge of the
35premises or, if the owner or person in charge of the premises
-14-1refuses admittance, with an administrative search warrant
2obtained under section 808.14. Based on findings of the risk
3assessment and examination of the premises, the director may
4order reasonable safeguards or take any other action reasonably
5necessary to protect the public health pursuant to rules
6adopted to administer this subsection.
7 Sec. 23. Section 901B.1, subsection 4, paragraph a, Code
82017, is amended to read as follows:
9a. The district department of correctional services shall
10place an individual committed to it under section 907.3 to the
11sanction and level of supervision which is appropriate to the
12individual based upon a current risk assessment evaluation.
13Placements may be to levels two and three of the corrections
14continuum. The district department may, with the approval of
15the Iowa department of public health and the department of
16corrections, place an individual in a level three substance
17abuse treatment facility established pursuant to section
18135.130, to assist the individual in complying with a condition
19of probation. The district department may, with the approval
20of the department of corrections, place an individual in a
21level four violator facility established pursuant to section
22904.207 only as a penalty for a violation of a condition
23imposed under this section.
24 Sec. 24. REPEAL. Sections 135.26, 135.29, 135.130, and
25135.152, Code 2017, are repealed.
26DIVISION V
27miscellaneous provisions
28 Sec. 25. Section 135A.2, subsection 6, Code 2017, is amended
29to read as follows:
306. “Local board of health” means a county or district board
31of health the same as defined in section 137.102.
32 Sec. 26. REPEAL. Section 135.132, Code 2017, is repealed.
33DIVISION VI
34iowa health information network
35 Sec. 27. Section 136.3, subsection 13, Code 2017, is amended
-15-1by striking the subsection.
2 Sec. 28. EFFECTIVE DATE. This division of this Act
3takes effect upon the assumption of the administration and
4governance, including but not limited to the assumption of the
5assets and liabilities, of the Iowa health information network
6by the designated entity as defined in 2015 Iowa Acts, ch.73,
7section 2. The department of public health shall notify the
8Code editor of the date of such assumption by the designated
9entity.
10DIVISION VII
11ORGANIZED DELIVERY SYSTEMS
12 Sec. 29. Section 135H.3, subsection 2, Code 2017, is amended
13to read as follows:
142. If a child is diagnosed with a biologically based mental
15illness as defined in section 514C.22 and meets the medical
16assistance program criteria for admission to a psychiatric
17medical institution for children, the child shall be deemed
18to meet the acuity criteria for medically necessary inpatient
19benefits under a group policy, contract, or plan providing
20for third-party payment or prepayment of health, medical, and
21surgical coverage benefits issued by a carrier, as defined in
22section 513B.2, or by an organized delivery system authorized
23under 1993 Iowa Acts, ch.158, that is subject to section
24514C.22. Such medically necessary benefits shall not be
25excluded or denied as care that is substantially custodial in
26nature under section 514C.22, subsection 8, paragraph “b”.
27 Sec. 30. Section 505.32, subsection 2, paragraph h, Code
282017, is amended by striking the paragraph.
29 Sec. 31. Section 505.32, subsection 4, paragraph b,
30subparagraphs (1) and (2), Code 2017, are amended to read as
31follows:
32(1) The commissioner may establish methodologies to provide
33uniform and consistent side-by-side comparisons of the health
34care coverage options that are offered by carriers, organized
35delivery systems, and public programs in this state including
-16-1but not limited to benefits covered and not covered, the amount
2of coverage for each service, including copays and deductibles,
3administrative costs, and any prior authorization requirements
4for coverage.
5(2) The commissioner may require each carrier, organized
6delivery system, and public program in this state to describe
7each health care coverage option offered by that carrier,
8organized delivery system, or public program in a manner
9so that the various options can be compared as provided in
10subparagraph (1).
11 Sec. 32. Section 507B.4, subsection 1, Code 2017, is amended
12to read as follows:
131. For purposes of subsection 3, paragraph “p”, “insurer”
14means an entity providing a plan of health insurance, health
15care benefits, or health care services, or an entity subject
16to the jurisdiction of the commissioner performing utilization
17review, including an insurance company offering sickness and
18accident plans, a health maintenance organization, an organized
19delivery system authorized under 1993 Iowa Acts, ch.158, and
20licensed by the department of public health, a nonprofit health
21service corporation, a plan established pursuant to chapter
22509A for public employees, or any other entity providing a
23plan of health insurance, health care benefits, or health care
24services. However, “insurer” does not include an entity that
25sells disability income or long-term care insurance.
26 Sec. 33. Section 507B.4A, subsection 2, paragraph a, Code
272017, is amended to read as follows:
28a. An insurer providing accident and sickness insurance
29under chapter 509, 514, or 514A; a health maintenance
30organization; an organized delivery system authorized under
311993 Iowa Acts, ch.158, and licensed by the department of
32public health; or another entity providing health insurance or
33health benefits subject to state insurance regulation shall
34either accept and pay or deny a clean claim.
35 Sec. 34. Section 509.3A, subsection 11, Code 2017, is
-17-1amended by striking the subsection.
2 Sec. 35. Section 509.19, subsection 2, paragraph d, Code
32017, is amended by striking the paragraph.
4 Sec. 36. Section 509A.6, Code 2017, is amended to read as
5follows:
6509A.6 Contract with insurance carrier, or health maintenance
7organization, or organized delivery system.
8The governing body may contract with a nonprofit corporation
9operating under the provisions of this chapter or chapter
10514 or with any insurance company having a certificate of
11authority to transact an insurance business in this state with
12respect of a group insurance plan, which may include life,
13accident, health, hospitalization and disability insurance
14during period of active service of such employees, with the
15right of any employee to continue such life insurance in force
16after termination of active service at such employee’s sole
17expense; may contract with a nonprofit corporation operating
18under and governed by the provisions of this chapter or chapter
19514 with respect of any hospital or medical service plan; and
20may contract with a health maintenance organization or an
21organized delivery system authorized to operate in this state
22with respect to health maintenance organization or organized
23delivery system activities.
24 Sec. 37. Section 513B.2, subsection 8, paragraph k, Code
252017, is amended by striking the paragraph.
26 Sec. 38. Section 513B.5, Code 2017, is amended to read as
27follows:
28513B.5 Provisions on renewability of coverage.
291. Health insurance coverage subject to this chapter is
30renewable with respect to all eligible employees or their
31dependents, at the option of the small employer, except for one
32or more of the following reasons:
33a. The health insurance coverage sponsor fails to pay, or to
34make timely payment of, premiums or contributions pursuant to
35the terms of the health insurance coverage.
-18- 1b. The health insurance coverage sponsor performs an
2act or practice constituting fraud or makes an intentional
3misrepresentation of a material fact under the terms of the
4coverage.
5c. Noncompliance with the carrier’s or organized delivery
6system’s minimum participation requirements.
7d. Noncompliance with the carrier’s or organized delivery
8system’s employer contribution requirements.
9e. A decision by the carrier or organized delivery system
10 to discontinue offering a particular type of health insurance
11coverage in the state’s small employer market. Health
12insurance coverage may be discontinued by the carrier or
13organized delivery system in that market only if the carrier or
14organized delivery system does all of the following:
15(1) Provides advance notice of its decision to discontinue
16such plan to the commissioner or director of public health.
17Notice to the commissioner or director, at a minimum, shall be
18no less than three days prior to the notice provided for in
19subparagraph (2) to affected small employers, participants, and
20beneficiaries.
21(2) Provides notice of its decision not to renew such
22plan to all affected small employers, participants, and
23beneficiaries no less than ninety days prior to the nonrenewal
24of the plan.
25(3) Offers to each plan sponsor of the discontinued
26coverage, the option to purchase any other coverage currently
27offered by the carrier or organized delivery system to other
28employers in this state.
29(4) Acts uniformly, in opting to discontinue the coverage
30and in offering the option under subparagraph (3), without
31regard to the claims experience of the sponsors under the
32discontinued coverage or to a health status-related factor
33relating to any participants or beneficiaries covered or new
34participants or beneficiaries who may become eligible for the
35coverage.
-19- 1f. A decision by the carrier or organized delivery system to
2discontinue offering and to cease to renew all of its health
3insurance coverage delivered or issued for delivery to small
4employers in this state. A carrier or organized delivery
5system making such decision shall do all of the following:
6(1) Provide advance notice of its decision to discontinue
7such coverage to the commissioner or director of public health.
8Notice to the commissioner or director, at a minimum, shall be
9no less than three days prior to the notice provided for in
10subparagraph (2) to affected small employers, participants, and
11beneficiaries.
12(2) Provide notice of its decision not to renew such
13coverage to all affected small employers, participants, and
14beneficiaries no less than one hundred eighty days prior to the
15nonrenewal of the coverage.
16(3) Discontinue all health insurance coverage issued or
17delivered for issuance to small employers in this state and
18cease renewal of such coverage.
19g. The membership of an employer in an association, which
20is the basis for the coverage which is provided through such
21association, ceases, but only if the termination of coverage
22under this paragraph occurs uniformly without regard to
23any health status-related factor relating to any covered
24individual.
25h. The commissioner or director of public health finds that
26the continuation of the coverage is not in the best interests
27of the policyholders or certificate holders, or would impair
28the carrier’s or organized delivery system’s ability to meet
29its contractual obligations.
30i. At the time of coverage renewal, a carrier or organized
31delivery system may modify the health insurance coverage for
32a product offered under group health insurance coverage in
33the small group market, for coverage that is available in
34such market other than only through one or more bona fide
35associations, if such modification is consistent with the laws
-20-1of this state, and is effective on a uniform basis among group
2health insurance coverage with that product.
32. A carrier or organized delivery system that elects not to
4renew health insurance coverage under subsection 1, paragraph
5“f”, shall not write any new business in the small employer
6market in this state for a period of five years after the date
7of notice to the commissioner or director of public health.
83. This section, with respect to a carrier or organized
9delivery system doing business in one established geographic
10service area of the state, applies only to such carrier’s or
11organized delivery system’s operations in that service area.
12 Sec. 39. Section 513B.6, unnumbered paragraph 1, Code 2017,
13is amended to read as follows:
14A small employer carrier or organized delivery system shall
15make reasonable disclosure in solicitation and sales materials
16provided to small employers of all of the following:
17 Sec. 40. Section 513B.6, subsection 2, Code 2017, is amended
18to read as follows:
192. The provisions concerning the small employer carrier’s
20or organized delivery system’s right to change premium rates
21and factors, including case characteristics, which affect
22changes in premium rates.
23 Sec. 41. Section 513B.7, Code 2017, is amended to read as
24follows:
25513B.7 Maintenance of records.
261. A small employer carrier or organized delivery system
27 shall maintain at its principal place of business a complete
28and detailed description of its rating practices and renewal
29underwriting practices, including information and documentation
30which demonstrate that its rating methods and practices are
31based upon commonly accepted actuarial assumptions and are in
32accordance with sound actuarial principles.
332. A small employer carrier or organized delivery system
34 shall file each March 1 with the commissioner or the director
35of public health an actuarial certification that the small
-21-1employer carrier or organized delivery system is in compliance
2with this section and that the rating methods of the small
3employer carrier or organized delivery system are actuarially
4sound. A copy of the certification shall be retained by the
5small employer carrier or organized delivery system at its
6principal place of business.
73. A small employer carrier or organized delivery system
8 shall make the information and documentation described in
9subsection 1 available to the commissioner or the director of
10public health upon request. The information is not a public
11record or otherwise subject to disclosure under chapter 22,
12and is considered proprietary and trade secret information
13and is not subject to disclosure by the commissioner or the
14director of public health to persons outside of the division or
15department except as agreed to by the small employer carrier or
16organized delivery system or as ordered by a court of competent
17jurisdiction.
18 Sec. 42. Section 513B.9A, subsection 1, unnumbered
19paragraph 1, Code 2017, is amended to read as follows:
20A carrier or organized delivery system offering group health
21insurance coverage shall not establish rules for eligibility,
22including continued eligibility, of an individual to enroll
23under the terms of the coverage based on any of the following
24health status-related factors in relation to the individual or
25a dependent of the individual:
26 Sec. 43. Section 513B.9A, subsection 4, paragraph a, Code
272017, is amended to read as follows:
28a. A carrier or organized delivery system offering health
29insurance coverage shall not require an individual, as a
30condition of enrollment or continued enrollment under the
31coverage, to pay a premium or contribution which is greater
32than a premium or contribution for a similarly situated
33individual enrolled in the coverage on the basis of a health
34status-related factor in relation to the individual or to a
35dependent of an individual enrolled under the coverage.
-22-1 Sec. 44. Section 513B.9A, subsection 4, paragraph b,
2subparagraph (2), Code 2017, is amended to read as follows:
3(2) Prevent a carrier or organized delivery system
4 offering group health insurance coverage from establishing
5premium discounts or rebates or modifying otherwise applicable
6copayments or deductibles in return for adherence to programs
7of health promotion and disease prevention.
8 Sec. 45. Section 513B.10, Code 2017, is amended to read as
9follows:
10513B.10 Availability of coverage.
111. a. A carrier or an organized delivery system that offers
12health insurance coverage in the small group market shall
13accept every small employer that applies for health insurance
14coverage and shall accept for enrollment under such coverage
15every eligible individual who applies for enrollment during the
16period in which the individual first becomes eligible to enroll
17under the terms of the health insurance coverage and shall not
18place any restriction which is inconsistent with eligibility
19rules established under this chapter.
20b. A carrier or organized delivery system that offers health
21insurance coverage in the small group market through a network
22plan may do either of the following:
23(1) Limit employers that may apply for such coverage to
24those with eligible individuals who live, work, or reside in
25the service area for such network plan.
26(2) Deny such coverage to such employers within the service
27area of such plan if the carrier or organized delivery system
28 has demonstrated to the applicable state authority both of the
29following:
30(a) The carrier or organized delivery system will not have
31the capacity to deliver services adequately to enrollees of any
32additional groups because of its obligations to existing group
33contract holders and enrollees.
34(b) The carrier or organized delivery system is applying
35this subparagraph uniformly to all employers without regard to
-23-1the claims experience of those employers and their employees
2and their dependents, or any health status-related factor
3relating to such employees or dependents.
4c. A carrier or organized delivery system, upon denying
5health insurance coverage in any service area pursuant to
6paragraph “b”, subparagraph (2), shall not offer coverage in the
7small group market within such service area for a period of one
8hundred eighty days after the date such coverage is denied.
9d. A carrier or organized delivery system may deny health
10insurance coverage in the small group market if the issuer has
11demonstrated to the commissioner or director of public health
12 both of the following:
13(1) The carrier or organized delivery system does not have
14the financial reserves necessary to underwrite additional
15coverage.
16(2) The carrier or organized delivery system is applying the
17provisions of this paragraph uniformly to all employers in the
18small group market in this state consistent with state law and
19without regard to the claims experience of those employers and
20the employees and dependents of such employers, or any health
21status-related factor relating to such employees and their
22dependents.
23e. A carrier or organized delivery system, upon denying
24health insurance coverage pursuant to paragraph “d”, shall not
25offer coverage in connection with health insurance coverages
26in the small group market in this state for a period of one
27hundred eighty days after the date such coverage is denied or
28until the carrier or organized delivery system has demonstrated
29to the commissioner or director of public health that the
30carrier or organized delivery system has sufficient financial
31reserves to underwrite additional coverage, whichever is later.
32The commissioner or director may provide for the application of
33this paragraph on a service area-specific basis.
34f. Paragraph “a” shall not be construed to preclude
35a carrier or organized delivery system from establishing
-24-1employer contribution rules or group participation rules for
2the offering of health insurance coverage in the small group
3market.
42. A carrier or organized delivery system, subject to
5subsection 1, shall issue health insurance coverage to an
6eligible small employer that applies for the coverage and
7agrees to make the required premium payments and satisfy the
8other reasonable provisions of the health insurance coverage
9not inconsistent with this chapter. A carrier or organized
10delivery system is not required to issue health insurance
11coverage to a self-employed individual who is covered by, or is
12eligible for coverage under, health insurance coverage offered
13by an employer.
143. Health insurance coverage for small employers shall
15satisfy all of the following:
16a. A carrier or organized delivery system offering group
17health insurance coverage, with respect to a participant or
18beneficiary, may impose a preexisting condition exclusion only
19as follows:
20(1) The exclusion relates to a condition, whether physical
21or mental, regardless of the cause of the condition, for
22which medical advice, diagnosis, care, or treatment was
23recommended or received within the six-month period ending on
24the enrollment date. However, genetic information shall not be
25treated as a condition under this subparagraph in the absence
26of a diagnosis of the condition related to such information.
27(2) The exclusion extends for a period of not more than
28twelve months, or eighteen months in the case of a late
29enrollee, after the enrollment date.
30(3) The period of any such preexisting condition exclusion
31is reduced by the aggregate of the periods of creditable
32coverage applicable to the participant or beneficiary as of the
33enrollment date.
34b. A carrier or organized delivery system offering group
35health insurance coverage shall not impose any preexisting
-25-1condition exclusion as follows:
2(1) In the case of a child who is adopted or placed for
3adoption before attaining eighteen years of age and who, as of
4the last day of the thirty-day period beginning on the date
5of the adoption or placement for adoption, is covered under
6creditable coverage. This subparagraph shall not apply to
7coverage before the date of such adoption or placement for
8adoption.
9(2) In the case of an individual who, as of the last day
10of the thirty-day period beginning with the date of birth, is
11covered under creditable coverage.
12(3) Relating to pregnancy as a preexisting condition.
13c. A carrier or organized delivery system shall waive
14any waiting period applicable to a preexisting condition
15exclusion or limitation period with respect to particular
16services under health insurance coverage for the period
17of time an individual was covered by creditable coverage,
18provided that the creditable coverage was continuous to a
19date not more than sixty-three days prior to the effective
20date of the new coverage. Any period that an individual
21is in a waiting period for any coverage under group health
22insurance coverage, or is in an affiliation period, shall not
23be taken into account in determining the period of continuous
24coverage. A health maintenance organization that does not
25use preexisting condition limitations in any of its health
26insurance coverage may impose an affiliation period. For
27purposes of this section, “affiliation period” means a period
28of time not to exceed sixty days for new entrants and not to
29exceed ninety days for late enrollees during which no premium
30shall be collected and coverage issued is not effective, so
31long as the affiliation period is applied uniformly, without
32regard to any health status-related factors. This paragraph
33does not preclude application of a waiting period applicable
34to all new enrollees under the health insurance coverage,
35provided that any carrier or organized delivery system-imposed
-26-1 carrier-imposed waiting period is no longer than sixty days and
2is used in lieu of a preexisting condition exclusion.
3d. Health insurance coverage may exclude coverage for late
4enrollees for preexisting conditions for a period not to exceed
5eighteen months.
6e. (1) Requirements used by a carrier or organized delivery
7system in determining whether to provide coverage to a small
8employer shall be applied uniformly among all small employers
9applying for coverage or receiving coverage from the carrier
10or organized delivery system.
11(2) In applying minimum participation requirements with
12respect to a small employer, a carrier or organized delivery
13system shall not consider employees or dependents who have
14other creditable coverage in determining whether the applicable
15percentage of participation is met.
16(3) A carrier or organized delivery system shall not
17increase any requirement for minimum employee participation
18or modify any requirement for minimum employer contribution
19applicable to a small employer at any time after the small
20employer has been accepted for coverage.
21f. (1) If a carrier or organized delivery system offers
22coverage to a small employer, the carrier or organized delivery
23system shall offer coverage to all eligible employees of the
24small employer and the employees’ dependents. A carrier or
25organized delivery system shall not offer coverage to only
26certain individuals or dependents in a small employer group or
27to only part of the group.
28(2) Except as provided under paragraphs “a” and “d”, a
29carrier or organized delivery system shall not modify health
30insurance coverage with respect to a small employer or any
31eligible employee or dependent through riders, endorsements, or
32other means, to restrict or exclude coverage or benefits for
33certain diseases, medical conditions, or services otherwise
34covered by the health insurance coverage.
35g. A carrier or organized delivery system offering coverage
-27-1through a network plan shall not be required to offer coverage
2or accept applications pursuant to subsection 1 with respect to
3a small employer where any of the following apply applies:
4(1) The small employer does not have eligible individuals
5who live, work, or reside in the service area for the network
6plan.
7(2) The small employer does have eligible individuals who
8live, work, or reside in the service area for the network plan,
9but the carrier or organized delivery system, if required, has
10demonstrated to the commissioner or the director of public
11health that it will not have the capacity to deliver services
12adequately to enrollees of any additional groups because of its
13obligations to existing group contract holders and enrollees
14and that it is applying the requirements of this lettered
15paragraph uniformly to all employers without regard to the
16claims experience of those employers and their employees and
17the employees’ dependents, or any health status-related factor
18relating to such employees and dependents.
19(3) A carrier or organized delivery system, upon denying
20health insurance coverage in a service area pursuant to
21subparagraph (2), shall not offer coverage in the small
22employer market within such service area for a period of one
23hundred eighty days after the coverage is denied.
244. A carrier or organized delivery system shall not be
25required to offer coverage to small employers pursuant to
26subsection 1 for any period of time where the commissioner or
27director of public health determines that the acceptance of the
28offers by small employers in accordance with subsection 1 would
29place the carrier or organized delivery system in a financially
30impaired condition.
315. A carrier or organized delivery system shall not be
32required to provide coverage to small employers pursuant to
33subsection 1 if the carrier or organized delivery system elects
34not to offer new coverage to small employers in this state.
35However, a carrier or organized delivery system that elects not
-28-1to offer new coverage to small employers under this subsection
2shall be allowed to maintain its existing policies in the
3state, subject to the requirements of section 513B.5.
46. A carrier or organized delivery system that elects not to
5offer new coverage to small employers pursuant to subsection 5
6shall provide notice to the commissioner or director of public
7health and is prohibited from writing new business in the small
8employer market in this state for a period of five years from
9the date of notice to the commissioner or director.
10 Sec. 46. Section 513C.3, subsection 5, Code 2017, is amended
11to read as follows:
125. “Carrier” means any entity that provides individual
13health benefit plans in this state. For purposes of this
14chapter, carrier includes an insurance company, a group
15hospital or medical service corporation, a fraternal benefit
16society, a health maintenance organization, and any other
17entity providing an individual plan of health insurance
18or health benefits subject to state insurance regulation.
19“Carrier” does not include an organized delivery system.
20 Sec. 47. Section 513C.3, subsection 7, Code 2017, is amended
21by striking the subsection.
22 Sec. 48. Section 513C.3, subsection 9, Code 2017, is amended
23to read as follows:
249. “Established service area” means a geographic area,
25as approved by the commissioner and based upon the carrier’s
26certificate of authority to transact business in this state,
27within which the carrier is authorized to provide coverage or
28a geographic area, as approved by the director and based upon
29the organized delivery system’s license to transact business
30in this state, within which the organized delivery system is
31authorized to provide coverage.
32 Sec. 49. Section 513C.3, subsection 12, Code 2017, is
33amended by striking the subsection.
34 Sec. 50. Section 513C.3, subsection 15, paragraph a,
35subparagraph (3), Code 2017, is amended by striking the
-29-1subparagraph.
2 Sec. 51. Section 513C.3, subsection 18, Code 2017, is
3amended to read as follows:
418. “Restricted network provision” means a provision of an
5individual health benefit plan that conditions the payment
6of benefits, in whole or in part, on the use of health care
7providers that have entered into a contractual arrangement with
8the carrier or the organized delivery system to provide health
9care services to covered individuals.
10 Sec. 52. Section 513C.5, subsection 1, unnumbered paragraph
111, Code 2017, is amended to read as follows:
12Premium rates for any block of individual health benefit
13plan business issued on or after January 1, 1996, or the date
14rules are adopted by the commissioner of insurance and the
15director of public health and become effective, whichever
16date is later, by a carrier subject to this chapter shall be
17limited to the composite effect of allocating costs among the
18following:
19 Sec. 53. Section 513C.6, Code 2017, is amended to read as
20follows:
21513C.6 Provisions on renewability of coverage.
221. An individual health benefit plan subject to this
23chapter is renewable with respect to an eligible individual or
24dependents, at the option of the individual, except for one or
25more of the following reasons:
26a. The individual fails to pay, or to make timely payment
27of, premiums or contributions pursuant to the terms of the
28individual health benefit plan.
29b. The individual performs an act or practice constituting
30fraud or makes an intentional misrepresentation of a material
31fact under the terms of the individual health benefit plan.
32c. A decision by the individual carrier or organized
33delivery system to discontinue offering a particular type
34of individual health benefit plan in the state’s individual
35insurance market. An individual health benefit plan may be
-30-1discontinued by the carrier or organized delivery system in
2that market with the approval of the commissioner or the
3director and only if the carrier or organized delivery system
4 does all of the following:
5(1) Provides advance notice of its decision to discontinue
6such plan to the commissioner or director. Notice to the
7commissioner or director, at a minimum, shall be no less than
8three days prior to the notice provided for in subparagraph (2)
9to affected individuals.
10(2) Provides notice of its decision not to renew such plan
11to all affected individuals no less than ninety days prior
12to the nonrenewal date of any discontinued individual health
13benefit plans.
14(3) Offers to each individual of the discontinued plan the
15option to purchase any other health plan currently offered by
16the carrier or organized delivery system to individuals in this
17state.
18(4) Acts uniformly in opting to discontinue the plan and
19in offering the option under subparagraph (3), without regard
20to the claims experience of any affected eligible individual
21or beneficiary under the discontinued plan or to a health
22status-related factor relating to any covered individuals or
23beneficiaries who may become eligible for the coverage.
24d. A decision by the carrier or organized delivery system
25 to discontinue offering and to cease to renew all of its
26individual health benefit plans delivered or issued for
27delivery to individuals in this state. A carrier or organized
28delivery system making such decision shall do all of the
29following:
30(1) Provide advance notice of its decision to discontinue
31such plan to the commissioner or director. Notice to the
32commissioner or director, at a minimum, shall be no less than
33three days prior to the notice provided for in subparagraph (2)
34to affected individuals.
35(2) Provide notice of its decision not to renew such plan
-31-1to all individuals and to the commissioner or director in each
2state in which an individual under the discontinued plan is
3known to reside, no less than one hundred eighty days prior to
4the nonrenewal of the plan.
5e. The commissioner or director finds that the continuation
6of the coverage is not in the best interests of the
7individuals, or would impair the carrier’s or organized
8delivery system’s ability to meet its contractual obligations.
92. At the time of coverage renewal, a carrier or organized
10delivery system may modify the health insurance coverage for
11a policy form offered to individuals in the individual market
12so long as such modification is consistent with state law and
13effective on a uniform basis among all individuals with that
14policy form.
153. An individual carrier or organized delivery system that
16elects not to renew an individual health benefit plan under
17subsection 1, paragraph “d”, shall not write any new business in
18the individual market in this state for a period of five years
19after the date of notice to the commissioner or director.
204. This section, with respect to a carrier or organized
21delivery system doing business in one established geographic
22service area of the state, applies only to such carrier’s or
23organized delivery system’s operations in that service area.
245. A carrier or organized delivery system offering coverage
25through a network plan is not required to renew or continue in
26force coverage or to accept applications from an individual who
27no longer resides or lives in, or is no longer employed in,
28the service area of such carrier or organized delivery system,
29or no longer resides or lives in, or is no longer employed
30in, a service area for which the carrier is authorized to do
31business, but only if coverage is not offered or terminated
32uniformly without regard to health status-related factors of a
33covered individual.
346. A carrier or organized delivery system offering coverage
35through a bona fide association is not required to renew or
-32-1continue in force coverage or to accept applications from an
2individual through an association if the membership of the
3individual in the association on which the basis of coverage
4is provided ceases, but only if the coverage is not offered or
5terminated under this paragraph uniformly without regard to
6health status-related factors of a covered individual.
77. An individual who has coverage as a dependent under a
8basic or standard health benefit plan may, when that individual
9is no longer a dependent under such coverage, elect to continue
10coverage under the basic or standard health benefit plan if
11the individual so elects immediately upon termination of the
12coverage under which the individual was covered as a dependent.
13 Sec. 54. Section 513C.7, subsection 1, Code 2017, is amended
14to read as follows:
151. a. (1) A carrier shall file with the commissioner, in
16a form and manner prescribed by the commissioner, the basic
17or standard health benefit plan. A basic or standard health
18benefit plan filed pursuant to this paragraph may be used by
19a carrier beginning thirty days after it is filed unless the
20commissioner disapproves of its use.
21(2) b. The commissioner may at any time, after providing
22notice and an opportunity for a hearing to the carrier,
23disapprove the continued use by a carrier of a basic or
24standard health benefit plan on the grounds that the plan does
25not meet the requirements of this chapter.
26b. (1) An organized delivery system shall file with the
27director, in a form and manner prescribed by the director,
28the basic or standard health benefit plan to be used by the
29organized delivery system. A basic or standard health benefit
30plan filed pursuant to this paragraph may be used by the
31organized delivery system beginning thirty days after it is
32filed unless the director disapproves of its use.
33(2) The director may at any time, after providing notice and
34an opportunity for a hearing to the organized delivery system,
35disapprove the continued use by an organized delivery system of
-33-1a basic or standard health benefit plan on the grounds that the
2plan does not meet the requirements of this chapter.
3 Sec. 55. Section 513C.7, subsection 3, Code 2017, is amended
4to read as follows:
53. A carrier or an organized delivery system shall not
6modify a basic or standard health benefit plan with respect
7to an individual or dependent through riders, endorsements,
8or other means to restrict or exclude coverage for certain
9diseases or medical conditions otherwise covered by the health
10benefit plan.
11 Sec. 56. Section 513C.9, subsections 1, 2, 3, 6, and 8, Code
122017, are amended to read as follows:
131. A carrier, an organized delivery system, or an agent
14shall not do either of the following:
15a. Encourage or direct individuals to refrain from
16filing an application for coverage with the carrier or the
17organized delivery system because of the health status, claims
18experience, industry, occupation, or geographic location of the
19individuals.
20b. Encourage or direct individuals to seek coverage from
21another carrier or another organized delivery system because of
22the health status, claims experience, industry, occupation, or
23geographic location of the individuals.
242. Subsection 1, paragraph “a”, shall not apply with respect
25to information provided by a carrier or an organized delivery
26system or an agent to an individual regarding the established
27geographic service area of the carrier or the organized
28delivery system, or the restricted network provision of the
29carrier or the organized delivery system.
303. A carrier or an organized delivery system shall not,
31directly or indirectly, enter into any contract, agreement, or
32arrangement with an agent that provides for, or results in, the
33compensation paid to an agent for a sale of a basic or standard
34health benefit plan to vary because of the health status or
35permitted rating characteristics of the individual or the
-34-1individual’s dependents.
26. Denial by a carrier or an organized delivery system of an
3application for coverage from an individual shall be in writing
4and shall state the reason or reasons for the denial.
58. If a carrier or an organized delivery system enters into
6a contract, agreement, or other arrangement with a third-party
7administrator to provide administrative, marketing, or other
8services related to the offering of individual health benefit
9plans in this state, the third-party administrator is subject
10to this section as if it were a carrier or an organized
11delivery system.
12 Sec. 57. Section 513C.10, subsection 1, paragraph a, Code
132017, is amended to read as follows:
14a. All persons that provide health benefit plans in this
15state including insurers providing accident and sickness
16insurance under chapter 509, 514, or 514A, whether on an
17individual or group basis; fraternal benefit societies
18providing hospital, medical, or nursing benefits under chapter
19512B; and health maintenance organizations, organized delivery
20systems, other entities providing health insurance or health
21benefits subject to state insurance regulation, and all other
22insurers as designated by the board of directors of the Iowa
23comprehensive health insurance association with the approval of
24the commissioner shall be members of the association.
25 Sec. 58. Section 513C.10, subsection 2, paragraph a, Code
262017, is amended to read as follows:
27a. Rates for basic and standard coverages as provided in
28this chapter shall be determined by each carrier or organized
29delivery system as the product of a basic and standard factor
30and the lowest rate available for issuance by that carrier or
31organized delivery system adjusted for rating characteristics
32and benefits. Basic and standard factors shall be established
33annually by the Iowa comprehensive health insurance association
34board with the approval of the commissioner. Multiple basic
35and standard factors for a distinct grouping of basic and
-35-1standard policies may be established. A basic and standard
2factor is limited to a minimum value defined as the ratio
3of the average of the lowest rate available for issuance and
4the maximum rate allowable by law divided by the lowest rate
5available for issuance. A basic and standard factor is limited
6to a maximum value defined as the ratio of the maximum rate
7allowable by law divided by the lowest rate available for
8issuance. The maximum rate allowable by law and the lowest
9rate available for issuance is determined based on the rate
10restrictions under this chapter. For policies written after
11January 1, 2002, rates for the basic and standard coverages
12as provided in this chapter shall be calculated using the
13basic and standard factors and shall be no lower than the
14maximum rate allowable by law. However, to maintain assessable
15loss assessments at or below one percent of total health
16insurance premiums or payments as determined in accordance
17with subsection 6, the Iowa comprehensive health insurance
18association board with the approval of the commissioner may
19increase the value for any basic and standard factor greater
20than the maximum value.
21 Sec. 59. Section 513C.10, subsections 3, 4, 7, 8, 9, and 10,
22Code 2017, are amended to read as follows:
233. Following the close of each calendar year, the
24association, in conjunction with the commissioner, shall
25require each carrier or organized delivery system to report
26the amount of earned premiums and the associated paid losses
27for all basic and standard plans issued by the carrier or
28organized delivery system. The reporting of these amounts must
29be certified by an officer of the carrier or organized delivery
30system.
314. The board shall develop procedures and assessment
32mechanisms and make assessments and distributions as required
33to equalize the individual carrier and organized delivery
34system gains or losses so that each carrier or organized
35delivery system receives the same ratio of paid claims to
-36-1ninety percent of earned premiums as the aggregate of all
2basic and standard plans insured by all carriers and organized
3delivery systems in the state.
47. The board shall develop procedures for distributing
5the assessable loss assessments to each carrier and organized
6delivery system in proportion to the carrier’s and organized
7delivery system’s respective share of premium for basic and
8standard plans to the statewide total premium for all basic and
9standard plans.
108. The board shall ensure that procedures for collecting
11and distributing assessments are as efficient as possible
12for carriers and organized delivery systems. The board may
13establish procedures which combine, or offset, the assessment
14from, and the distribution due to, a carrier or organized
15delivery system.
169. A carrier or an organized delivery system may
17petition the association board to seek remedy from writing a
18significantly disproportionate share of basic and standard
19policies in relation to total premiums written in this state
20for health benefit plans. Upon a finding that a carrier or
21organized delivery system has written a disproportionate share,
22the board may agree to compensate the carrier or organized
23delivery system either by paying to the carrier or organized
24delivery system an additional fee not to exceed two percent
25of earned premiums from basic and standard policies for that
26carrier or organized delivery system or by petitioning the
27commissioner or director, as appropriate, for remedy.
2810. a. The commissioner, upon a finding that the acceptance
29of the offer of basic and standard coverage by individuals
30pursuant to this chapter would place the carrier in a
31financially impaired condition, shall not require the carrier
32to offer coverage or accept applications for any period of time
33the financial impairment is deemed to exist.
34b. The director, upon a finding that the acceptance of the
35offer of basic and standard coverage by individuals pursuant
-37-1to this chapter would place the organized delivery system in a
2financially impaired condition, shall not require the organized
3delivery system to offer coverage or accept applications for
4any period of time the financial impairment is deemed to exist.
5 Sec. 60. Section 514A.3B, subsection 3, paragraph k, Code
62017, is amended by striking the paragraph.
7 Sec. 61. Section 514B.25A, Code 2017, is amended to read as
8follows:
9514B.25A Insolvency protection — assessment.
101. Upon a health maintenance organization or organized
11delivery system authorized to do business in this state and
12licensed by the director of public health being declared
13insolvent by the district court, the commissioner may levy an
14assessment on each health maintenance organization or organized
15delivery system doing business in this state and licensed by
16the director of public health, as applicable, to pay claims
17for uncovered expenditures for enrollees. The commissioner
18shall not assess an amount in any one calendar year which is
19more than two percent of the aggregate premium written by each
20health maintenance organization or organized delivery system.
212. The commissioner may use funds obtained through an
22assessment under subsection 1 to pay claims for uncovered
23expenditures for enrollees of an insolvent health maintenance
24organization or organized delivery system and administrative
25costs. The commissioner, by rule, may prescribe the time,
26manner, and form for filing claims under this section. The
27commissioner may require claims to be allowed by an ancillary
28receiver or the domestic receiver or liquidator.
293. a. A receiver or liquidator of an insolvent health
30maintenance organization or organized delivery system shall
31allow a claim in the proceeding in an amount equal to uncovered
32expenditures and administrative costs paid under this section.
33b. A person receiving benefits under this section for
34uncovered expenditures is deemed to have assigned the rights
35under the covered health care plan certificates to the
-38-1commissioner to the extent of the benefits received. The
2commissioner may require an assignment of such rights by a
3payee, enrollee, or beneficiary, to the commissioner as a
4condition precedent to the receipt of such benefits. The
5commissioner is subrogated to these rights against the assets
6of the insolvent health maintenance organization or organized
7delivery system that are held by a receiver or liquidator of
8a foreign jurisdiction.
9c. The assigned subrogation rights of the commissioner and
10allowed claims under this subsection have the same priority
11against the assets of the insolvent health maintenance
12organization or organized delivery system as those claims of
13persons entitled to receive benefits under this section or for
14similar expenses in the receivership or liquidation.
154. If funds assessed under subsection 1 are unused
16following the completion of the liquidation of an insolvent
17health maintenance organization or organized delivery system,
18the commissioner shall distribute the remaining amounts, if
19such amounts are not de minimis, to the health maintenance
20organizations or organized delivery systems that were assessed.
215. The aggregate coverage of uncovered expenditures under
22this section shall not exceed three hundred thousand dollars
23with respect to one individual. Continuation of coverage
24shall cease after the lesser of one year after the health
25maintenance organization or organized delivery system is
26terminated by insolvency or the remaining term of the contract.
27The commissioner may provide continuation of coverage on a
28reasonable basis, including, but not limited to, continuation
29of the health maintenance organization or organized delivery
30system contract or substitution of indemnity coverage in a form
31as determined by the commissioner.
326. The commissioner may waive an assessment of a health
33maintenance organization or organized delivery system if such
34organization or system is impaired financially or would be
35impaired financially as a result of such assessment. A health
-39-1maintenance organization or organized delivery system that
2fails to pay an assessment within thirty days after notice of
3the assessment is subject to a civil forfeiture of not more
4than one thousand dollars for each day the failure continues,
5and suspension or revocation of its certificate of authority.
6An action taken by the commissioner to enforce an assessment
7under this section may be appealed by the health maintenance
8organization or organized delivery system pursuant to chapter
917A.
10 Sec. 62. Section 514C.10, subsection 2, paragraph e, Code
112017, is amended by striking the paragraph.
12 Sec. 63. Section 514C.11, Code 2017, is amended to read as
13follows:
14514C.11 Services provided by licensed physician assistants
15and licensed advanced registered nurse practitioners.
161. Notwithstanding section 514C.6, a policy or contract
17providing for third-party payment or prepayment of health or
18medical expenses shall include a provision for the payment of
19necessary medical or surgical care and treatment provided by
20a physician assistant licensed pursuant to chapter 148C, or
21provided by an advanced registered nurse practitioner licensed
22pursuant to chapter 152 and performed within the scope of the
23license of the licensed physician assistant or the licensed
24advanced registered nurse practitioner if the policy or
25contract would pay for the care and treatment if the care and
26treatment were provided by a person engaged in the practice
27of medicine and surgery or osteopathic medicine and surgery
28under chapter 148. The policy or contract shall provide that
29policyholders and subscribers under the policy or contract may
30reject the coverage for services which may be provided by a
31licensed physician assistant or licensed advanced registered
32nurse practitioner if the coverage is rejected for all
33providers of similar services. A policy or contract subject
34to this section shall not impose a practice or supervision
35restriction which is inconsistent with or more restrictive than
-40-1the restriction already imposed by law.
22. This section applies to services provided under a policy
3or contract delivered, issued for delivery, continued, or
4renewed in this state on or after July 1, 1996, and to an
5existing policy or contract, on the policy’s or contract’s
6anniversary or renewal date, or upon the expiration of the
7applicable collective bargaining contract, if any, whichever
8is later. This section does not apply to policyholders or
9subscribers eligible for coverage under Tit.XVIII of the
10federal Social Security Act or any similar coverage under a
11state or federal government plan.
123. For the purposes of this section, third-party payment or
13prepayment includes an individual or group policy of accident
14or health insurance or individual or group hospital or health
15care service contract issued pursuant to chapter 509, 514, or
16514A, an individual or group health maintenance organization
17contract issued and regulated under chapter 514B, an organized
18delivery system contract regulated under rules adopted by the
19director of public health, or a preferred provider organization
20contract regulated pursuant to chapter 514F.
214. Nothing in this section shall be interpreted to require
22an individual or group health maintenance organization, an
23organized delivery system, or a preferred provider organization
24or arrangement to provide payment or prepayment for services
25provided by a licensed physician assistant or licensed advanced
26registered nurse practitioner unless the physician assistant’s
27supervising physician, the physician-physician assistant team,
28the advanced registered nurse practitioner, or the advanced
29registered nurse practitioner’s collaborating physician has
30entered into a contract or other agreement to provide services
31with the individual or group health maintenance organization,
32the organized delivery system, or the preferred provider
33organization or arrangement.
34 Sec. 64. Section 514C.13, subsection 1, paragraph h, Code
352017, is amended by striking the paragraph.
-41-1 Sec. 65. Section 514C.13, subsection 2, Code 2017, is
2amended to read as follows:
32. A carrier or organized delivery system which offers to
4a small employer a limited provider network plan to provide
5health care services or benefits to the small employer’s
6employees shall also offer to the small employer a point of
7service option to the limited provider network plan.
8 Sec. 66. Section 514C.13, subsection 3, unnumbered
9paragraph 1, Code 2017, is amended to read as follows:
10A carrier or organized delivery system which offers to a
11large employer a limited provider network plan to provide
12health care services or benefits to the large employer’s
13employees shall also offer to the large employer one or more
14of the following:
15 Sec. 67. Section 514C.14, subsections 1 and 3, Code 2017,
16are amended to read as follows:
171. Except as provided under subsection 2 or 3, a carrier,
18as defined in section 513B.2, an organized delivery system
19authorized under 1993 Iowa Acts, ch.158, or a plan established
20pursuant to chapter 509A for public employees, which terminates
21its contract with a participating health care provider,
22shall continue to provide coverage under the contract to a
23covered person in the second or third trimester of pregnancy
24for continued care from such health care provider. Such
25persons may continue to receive such treatment or care through
26postpartum care related to the child birth and delivery.
27Payment for covered benefits and benefit levels shall be
28according to the terms and conditions of the contract.
293. A carrier, organized delivery system, or a plan
30established under chapter 509A, which terminates the contract
31of a participating health care provider for cause shall not
32be liable to pay for health care services provided by the
33health care provider to a covered person following the date of
34termination.
35 Sec. 68. Section 514C.15, Code 2017, is amended to read as
-42-1follows:
2514C.15 Treatment options.
3A carrier, as defined in section 513B.2,; an organized
4delivery system authorized under 1993 Iowa Acts, ch.158,
5and licensed by the director of public health; or a plan
6established pursuant to chapter 509A for public employees,
7shall not prohibit a participating provider from, or penalize a
8participating provider for, doing either of the following:
91. Discussing treatment options with a covered individual,
10notwithstanding the carrier’s, organized delivery system’s, or
11plan’s position on such treatment option.
122. Advocating on behalf of a covered individual within
13a review or grievance process established by the carrier,
14organized delivery system, or chapter 509A plan, or established
15by a person contracting with the carrier, organized delivery
16system, or chapter 509A plan.
17 Sec. 69. Section 514C.16, subsection 1, Code 2017, is
18amended to read as follows:
191. A carrier, as defined in section 513B.2,; an organized
20delivery system authorized under 1993 Iowa Acts, ch.158,
21and licensed by the director of public health; or a plan
22established pursuant to chapter 509A for public employees,
23which provides coverage for emergency services, is responsible
24for charges for emergency services provided to a covered
25individual, including services furnished outside any
26contractual provider network or preferred provider network.
27Coverage for emergency services is subject to the terms and
28conditions of the health benefit plan or contract.
29 Sec. 70. Section 514C.17, subsections 1 and 3, Code 2017,
30are amended to read as follows:
311. Except as provided under subsection 2 or 3, if a carrier,
32as defined in section 513B.2, an organized delivery system
33authorized under 1993 Iowa Acts, ch.158, or a plan established
34pursuant to chapter 509A for public employees, terminates its
35contract with a participating health care provider, a covered
-43-1individual who is undergoing a specified course of treatment
2for a terminal illness or a related condition, with the
3recommendation of the covered individual’s treating physician
4licensed under chapter 148 may continue to receive coverage for
5treatment received from the covered individual’s physician for
6the terminal illness or a related condition, for a period of
7up to ninety days. Payment for covered benefits and benefit
8levels shall be according to the terms and conditions of the
9contract.
103. Notwithstanding subsections 1 and 2, a carrier,
11organized delivery system, or a plan established under chapter
12509A which terminates the contract of a participating health
13care provider for cause shall not be required to cover health
14care services provided by the health care provider to a covered
15person following the date of termination.
16 Sec. 71. Section 514C.18, subsection 2, paragraph a,
17subparagraph (6), Code 2017, is amended by striking the
18subparagraph.
19 Sec. 72. Section 514C.19, subsection 7, paragraph a,
20subparagraph (6), Code 2017, is amended by striking the
21subparagraph.
22 Sec. 73. Section 514C.20, subsection 3, paragraph f, Code
232017, is amended by striking the paragraph.
24 Sec. 74. Section 514C.21, subsection 2, paragraph d, Code
252017, is amended by striking the paragraph.
26 Sec. 75. Section 514C.22, subsection 1, unnumbered
27paragraph 1, Code 2017, is amended to read as follows:
28Notwithstanding the uniformity of treatment requirements of
29section 514C.6, a group policy, contract, or plan providing
30for third-party payment or prepayment of health, medical, and
31surgical coverage benefits issued by a carrier, as defined in
32section 513B.2, or by an organized delivery system authorized
33under 1993 Iowa Acts, ch.158, shall provide coverage benefits
34for treatment of a biologically based mental illness if either
35of the following is satisfied:
-44-1 Sec. 76. Section 514C.22, subsection 6, Code 2017, is
2amended to read as follows:
36. A carrier, organized delivery system, or plan
4established pursuant to chapter 509A may manage the benefits
5provided through common methods including, but not limited to,
6providing payment of benefits or providing care and treatment
7under a capitated payment system, prospective reimbursement
8rate system, utilization control system, incentive system for
9the use of least restrictive and least costly levels of care,
10a preferred provider contract limiting choice of specific
11providers, or any other system, method, or organization
12designed to assure services are medically necessary and
13clinically appropriate.
14 Sec. 77. Section 514C.25, subsection 2, paragraph a,
15subparagraph (5), Code 2017, is amended by striking the
16subparagraph.
17 Sec. 78. Section 514C.26, subsection 5, paragraph a,
18subparagraph (6), Code 2017, is amended by striking the
19subparagraph.
20 Sec. 79. Section 514C.27, subsection 1, unnumbered
21paragraph 1, Code 2017, is amended to read as follows:
22Notwithstanding the uniformity of treatment requirements
23of section 514C.6, a group policy or contract providing for
24third-party payment or prepayment of health or medical expenses
25issued by a carrier, as defined in section 513B.2, or by an
26organized delivery system authorized under 1993 Iowa Acts, ch.
27158, shall provide coverage benefits to an insured who is a
28veteran for treatment of mental illness and substance abuse if
29either of the following is satisfied:
30 Sec. 80. Section 514C.27, subsection 6, Code 2017, is
31amended to read as follows:
326. A carrier, organized delivery system, or plan
33established pursuant to chapter 509A may manage the benefits
34provided through common methods including but not limited to
35providing payment of benefits or providing care and treatment
-45-1under a capitated payment system, prospective reimbursement
2rate system, utilization control system, incentive system for
3the use of least restrictive and least costly levels of care,
4a preferred provider contract limiting choice of specific
5providers, or any other system, method, or organization
6designed to assure services are medically necessary and
7clinically appropriate.
8 Sec. 81. Section 514C.29, subsection 2, paragraph e, Code
92017, is amended by striking the paragraph.
10 Sec. 82. Section 514C.30, subsection 2, paragraph e, Code
112017, is amended by striking the paragraph.
12 Sec. 83. Section 514E.1, subsection 6, paragraph k, Code
132017, is amended by striking the paragraph.
14 Sec. 84. Section 514E.1, subsection 17, Code 2017, is
15amended by striking the subsection.
16 Sec. 85. Section 514E.2, subsection 1, paragraph a, Code
172017, is amended to read as follows:
18a. All carriers and all organized delivery systems licensed
19by the director of public health providing health insurance or
20health care services in Iowa, whether on an individual or group
21basis, and all other insurers designated by the association’s
22board of directors and approved by the commissioner shall be
23members of the association.
24 Sec. 86. Section 514E.2, subsection 2, paragraph a,
25subparagraph (3), Code 2017, is amended to read as follows:
26(3) Two members selected by the members of the association,
27one of whom shall be a representative from a corporation
28operating pursuant to chapter 514 on July 1, 1989, or
29any successor in interest, and one of whom shall be a
30representative of an organized delivery system or an insurer
31providing coverage pursuant to chapter 509 or 514A.
32 Sec. 87. Section 514E.7, subsection 1, paragraph a,
33subparagraphs (1) and (2), Code 2017, are amended to read as
34follows:
35(1) A notice of rejection or refusal to issue substantially
-46-1similar insurance for health reasons by one carrier or
2organized delivery system.
3(2) A refusal by a carrier or organized delivery system to
4issue insurance except at a rate exceeding the plan rate.
5 Sec. 88. Section 514E.7, subsection 1, paragraph b, Code
62017, is amended to read as follows:
7b. A rejection or refusal by a carrier or organized delivery
8system offering only stoploss, excess of loss, or reinsurance
9coverage with respect to an applicant under paragraph “a”,
10 subparagraphs (1) and (2), is not sufficient evidence for
11purposes of this subsection.
12 Sec. 89. Section 514E.9, Code 2017, is amended to read as
13follows:
14514E.9 Rules.
15Pursuant to chapter 17A, the commissioner and the director
16of public health shall adopt rules to provide for disclosure
17by carriers and organized delivery systems of the availability
18of insurance coverage from the association, and to otherwise
19implement this chapter.
20 Sec. 90. Section 514E.11, Code 2017, is amended to read as
21follows:
22514E.11 Notice of association policy.
23Every carrier, including a health maintenance organization
24subject to chapter 514B and an organized delivery system,
25authorized to provide health care insurance or coverage for
26health care services in Iowa, shall provide a notice of the
27availability of coverage by the association to any person
28who receives a rejection of coverage for health insurance
29or health care services, or a rate for health insurance or
30coverage for health care services that will exceed the rate of
31an association policy, and that person is eligible to apply
32for health insurance provided by the association. Application
33for the health insurance shall be on forms prescribed by the
34association’s board of directors and made available to the
35carriers and organized delivery systems and other entities
-47-1providing health care insurance or coverage for health care
2services regulated by the commissioner.
3 Sec. 91. Section 514F.5, Code 2017, is amended to read as
4follows:
5514F.5 Experimental treatment review.
61. A carrier, as defined in section 513B.2, an organized
7delivery system authorized under 1993 Iowa Acts, ch.158, or a
8plan established pursuant to chapter 509A for public employees,
9that limits coverage for experimental medical treatment, drugs,
10or devices, shall develop and implement a procedure to evaluate
11experimental medical treatments and shall submit a description
12of the procedure to the division of insurance. The procedure
13shall be in writing and must describe the process used to
14determine whether the carrier, organized delivery system,
15 or chapter 509A plan will provide coverage for new medical
16technologies and new uses of existing technologies. The
17procedure, at a minimum, shall require a review of information
18from appropriate government regulatory agencies and published
19scientific literature concerning new medical technologies, new
20uses of existing technologies, and the use of external experts
21in making decisions. A carrier, organized delivery system,
22 or chapter 509A plan shall include appropriately licensed
23or qualified professionals in the evaluation process. The
24procedure shall provide a process for a person covered under
25a plan or contract to request a review of a denial of coverage
26because the proposed treatment is experimental. A review of
27a particular treatment need not be reviewed more than once a
28year.
292. A carrier, organized delivery system, or chapter 509A
30plan that limits coverage for experimental treatment, drugs, or
31devices shall clearly disclose such limitations in a contract,
32policy, or certificate of coverage.
33 Sec. 92. Section 514I.2, subsection 10, Code 2017, is
34amended to read as follows:
3510. “Participating insurer” means any entity licensed by the
-48-1division of insurance of the department of commerce to provide
2health insurance in Iowa or an organized delivery system
3licensed by the director of public health that has contracted
4with the department to provide health insurance coverage to
5eligible children under this chapter.
6 Sec. 93. Section 514J.102, subsection 24, Code 2017, is
7amended to read as follows:
824. “Health carrier” means an entity subject to the
9insurance laws and regulations of this state, or subject
10to the jurisdiction of the commissioner, including an
11insurance company offering sickness and accident plans, a
12health maintenance organization, a nonprofit health service
13corporation, a plan established pursuant to chapter 509A
14for public employees, or any other entity providing a plan
15of health insurance, health care benefits, or health care
16services. “Health carrier” includes, for purposes of this
17chapter, an organized delivery system.
18 Sec. 94. Section 514J.102, subsection 29, Code 2017, is
19amended by striking the subsection.
20 Sec. 95. Section 514K.1, subsection 1, unnumbered paragraph
211, Code 2017, is amended to read as follows:
22A health maintenance organization, an organized delivery
23system, or an insurer using a preferred provider arrangement
24shall provide to each of its enrollees at the time of
25enrollment, and shall make available to each prospective
26enrollee upon request, written information as required by rules
27adopted by the commissioner and the director of public health.
28The information required by rule shall include, but not be
29limited to, all of the following:
30 Sec. 96. Section 514K.1, subsection 2, Code 2017, is amended
31to read as follows:
322. The commissioner and the director shall annually publish
33a consumer guide providing a comparison by plan on performance
34measures, network composition, and other key information to
35enable consumers to better understand plan differences.
-49-1 Sec. 97. Section 514L.1, subsection 3, Code 2017, is amended
2to read as follows:
33. “Provider of third-party payment or prepayment of
4prescription drug expenses” or “provider” means a provider of an
5individual or group policy of accident or health insurance or
6an individual or group hospital or health care service contract
7issued pursuant to chapter 509, 514, or 514A, a provider of a
8plan established pursuant to chapter 509A for public employees,
9a provider of an individual or group health maintenance
10organization contract issued and regulated under chapter 514B,
11a provider of an organized delivery system contract regulated
12under rules adopted by the director of public health, a
13provider of a preferred provider contract issued pursuant to
14chapter 514F, a provider of a self-insured multiple employer
15welfare arrangement, and any other entity providing health
16insurance or health benefits which provide for payment or
17prepayment of prescription drug expenses coverage subject to
18state insurance regulation.
19 Sec. 98. Section 514L.2, subsection 1, paragraph a,
20unnumbered paragraph 1, Code 2017, is amended to read as
21follows:
22A provider of third-party payment or prepayment of
23prescription drug expenses, including the provider’s agents or
24contractors and pharmacy benefits managers, that issues a card
25or other technology for claims processing and an administrator
26of the payor, excluding administrators of self-funded employer
27sponsored health benefit plans qualified under the federal
28Employee Retirement Income Security Act of 1974, shall issue
29to its insureds a card or other technology containing uniform
30prescription drug information. The commissioner of insurance
31shall adopt rules for the uniform prescription drug information
32card or technology applicable to those entities subject to
33regulation by the commissioner of insurance. The director of
34public health shall adopt rules for the uniform prescription
35drug information card or technology applicable to organized
-50-1delivery systems. The rules shall require at least both of the
2following regarding the card or technology:
3 Sec. 99. Section 521F.2, subsection 7, Code 2017, is amended
4to read as follows:
57. “Health organization” means a health maintenance
6organization, limited service organization, dental or vision
7plan, hospital, medical and dental indemnity or service
8corporation or other managed care organization licensed under
9chapter 514, or 514B, or 1993 Iowa Acts, ch.158, or any other
10entity engaged in the business of insurance, risk transfer,
11or risk retention, that is subject to the jurisdiction of the
12commissioner of insurance or the director of public health.
13“Health organization” does not include an insurance company
14licensed to transact the business of insurance under chapter
15508, 515, or 520, and which is otherwise subject to chapter
16521E.
17 Sec. 100. 1993 Iowa Acts, chapter 158, section 4, is amended
18to read as follows:
19SEC. 4. EMERGENCY RULES. Pursuant to sections 1, and 2, and
203 of this Act, the commissioner of insurance or the director of
21public health shall adopt administrative rules under section
2217A.4, subsection 2, and section 17A.5, subsection 2, paragraph
23“b”, to implement the provisions of this Act and the rules
24shall become effective immediately upon filing, unless a later
25effective date is specified in the rules. Any rules adopted in
26accordance with the provisions of this section shall also be
27published as notice of intended action as provided in section
2817A.4.
29 Sec. 101. REPEAL. Section 135.120, Code 2017, is repealed.
30 Sec. 102. REPEAL. 1993 Iowa Acts, chapter 158, section 3,
31is repealed.
32 Sec. 103. CODE EDITOR’S DIRECTIVE. The Code editor shall
33correct and eliminate any references to the term “organized
34delivery system” or other forms of the term anywhere else in
35the Iowa Code or Iowa Code Supplement, in any bills awaiting
-51-1codification, in this Act, and in any bills enacted by the
2Eighty-seventh General Assembly, 2017 Regular Session, or any
3extraordinary session.
4EXPLANATION
5The inclusion of this explanation does not constitute agreement with
6the explanation’s substance by the members of the general assembly.
7This bill relates to programs and activities under the
8purview of the department of public health (DPH).
9Division I of the bill relates to program funding
10flexibility and reporting.
11The bill provides that if the amount of estimated moneys to
12be received from certain liquor fees and retail beer permit
13fees that is transferred to DPH annually for grants to counties
14operating a substance abuse program exceeds grant requests,
15in addition to using the remainder for grants to entities to
16operate a substance abuse prevention program, DPH may also use
17the remainder for activities and public information resources
18that align with best practices for substance-related disorder
19prevention.
20The bill eliminates the requirement under Code section
21135.11, subsection 31, that DPH report to the chairpersons and
22ranking members of the joint appropriations subcommittee on
23health and human services, the legislative services agency, the
24legislative caucus staffs, and the department of management
25within 60 calendar days of applying for or renewing a federal
26grant which requires a state match or maintenance of effort
27and has a value of over $100,000, including a listing of
28the federal funding source and the potential need for the
29commitment of state funding in the present or future.
30The bill amends Code section 135.150 to require DPH to report
31annually rather than semiannually to the general assembly’s
32standing committees on government oversight regarding
33the operation of the gambling treatment program including
34information on the moneys expended and grants awarded for
35operation of the program.
-52- 1Division II of the bill relates to medical home and the
2patient-centered health advisory council.
3The bill amends provisions relating to medical homes.
4Code sections 135.157 and 135.158, providing definitions and
5describing the purposes and characteristics of medical homes,
6are repealed by the bill. Code section 135.159 provides
7parameters for the development and implementation of a medical
8home system in the state, as well as the establishment of the
9patient-centered health advisory council. The bill amends
10Code section 135.159 to provide for the continuation of the
11patient-centered health advisory council and to revise the
12purposes of the council.
13The bill also makes conforming changes throughout the Code,
14including those relative to the definitions of “dental home”,
15“medical home”, “personal provider”, “primary care provider”,
16and “primary medical provider”, due to elimination of certain
17definitions and concepts based upon the repeal of Code sections
18135.157 and 135.158.
19Division III of the bill includes provisions relating to
20workforce programming.
21The bill amends Code section 135.107 relating to the center
22for rural health and primary care. Of the programs that
23constitute the primary care provider recruitment and retention
24endeavor or PRIMECARRE, the bill eliminates the primary care
25provider community scholarship program, but retains the primary
26care loan repayment program and the community grant program
27that is renamed the health care workforce and community support
28grant program. The bill amends the application and matching
29funds requirements for a grant under the health care workforce
30and community support grant program and specifies that the
31target areas for awarding of such grants are rural, underserved
32areas or special populations identified by the department’s
33strategic plan or evidence-based documentation.
34The bill provides that the primary care provider loan
35repayment program may cancel a loan repayment program contract
-53-1for reasonable cause unless federal requirements otherwise
2require and provides that the center for rural health and
3primary care may enter into an agreement with the college
4student aid commission for administration of the center’s grant
5and loan repayment programs.
6The bill eliminates the requirement that a community or
7region applying for assistance under any of the programs
8established under PRIMECARRE submit a letter of intent to
9conduct a community health services assessment and instead
10requires that the community or region shall document
11participation in the community health services assessment. In
12addition to any other requirements, an applicant’s plan is
13also to include, to the extent possible, a clear commitment to
14informing high school students of the health care opportunities
15which may be available to such students.
16The bill removes the representation by the obsolete rural
17health resource center on the advisory committee to the center
18for rural health and primary care and corrects the reference to
19a national or regional institute for rural health policy.
20The bill eliminates the reference to “long-term care” in
21Code section 135.163 which directs DPH to coordinate public and
22private efforts to develop and maintain an appropriate health
23care delivery infrastructure and a stable, well-qualified,
24diverse, and sustainable health care workforce in this state.
25Under this section, DPH is required, at a minimum, to develop
26a strategic plan for health care delivery infrastructure and
27health care workforce resources in this state; provide for
28the continuous collection of data to provide a basis for
29health care strategic planning and health care policymaking;
30and make recommendations regarding the health care delivery
31infrastructure and the health care workforce that assist
32in monitoring current needs, predicting future trends, and
33informing policymaking.
34The bill amends Code section 135.175 relating to the health
35care workforce support initiative, the workforce shortage fund,
-54-1and the accounts within the fund. The bill provides that
2state programs that may receive moneys from the fund or the
3accounts in the fund, if specifically designated for drawing
4down federal funding, include PRIMECARRE, the Iowa affiliate
5of the national rural recruitment and retention network, the
6oral and health delivery systems bureau of the department,
7the primary care office and shortage designation program, and
8the state office of rural health, but eliminates inclusion of
9the Iowa health workforce center, the area health education
10centers programs at Des Moines university osteopathic medical
11center and the university of Iowa, and the Iowa collaborative
12safety net provider network as potential recipients. The bill
13also eliminates the requirement that state appropriations to
14the fund shall be allocated in equal amounts to each of the
15accounts within the fund, unless otherwise specified in the
16appropriation or allocation, and eliminates the restriction
17that moneys in each of the accounts in the fund used for
18administrative purposes are not to exceed $100,000 in each
19account, but retains the limitation that no more than 5 percent
20of the moneys in any of the accounts within the fund shall be
21used for administrative purposes unless otherwise provided in
22the appropriation, allocation, or source of the funds.
23The bill repeals Code section 135.164 which relates to the
24health care delivery infrastructure and health care workforce
25resources strategic plan to be developed by DPH including the
26specific elements of the strategic plan and the requirements
27for developing the strategic plan.
28The bill repeals Code section 135.180, the mental health
29professional shortage area program, which provides stipends to
30support psychiatrist positions with an emphasis on securing and
31retaining medical directors at community mental health centers
32designated under Code chapter 230A and hospital psychiatric
33units that are located in mental health professional shortage
34areas.
35Division IV of the bill relates to unfunded or outdated
-55-1program provisions.
2The bill eliminates the provision under Code section 135.11
3requiring DPH to establish and administer a substance abuse
4treatment facility for persons on probation, repeals Code
5section 135.130, and strikes the conforming provision in Code
6section 901B.1. The substance abuse treatment facility for
7persons on probation was authorized in 2001 but was never
8established.
9The bill strikes the directive in Code section 135.141 for
10the division of acute disease prevention and emergency response
11of DPH to conduct and maintain a statewide risk assessment
12of any present or potential danger to the public health from
13biological agents.
14The bill repeals Code section 135.26 establishing the
15automated external defibrillator (AED) grant program to provide
16matching fund grants to local boards of health, community
17organizations, or cities to implement AED programs.
18The bill repeals Code section 135.29, relating to local
19substitute medical decision-making boards, which authorized
20each county to establish and fund a local substituted medical
21decision-making board to act as a substitute decision maker for
22patients incapable of making their own medical care decisions
23if no other substitute decision maker is available to act.
24The bill repeals Code section 135.120, relating to the
25taxation of organized delivery systems (ODSs). 1993 Iowa
26Acts, chapter 158, section 3, directs DPH to adopt rules and a
27licensing procedure for the establishment of ODSs. The bill
28only eliminates the provision for taxation of ODSs, not all
29other provisions relating to ODSs.
30The bill repeals Code section 135.152, the statewide
31obstetrical and newborn indigent patient care program. The
32program acts as a payer of last resort for eligible individuals
33but has not been utilized since 2009 due to other options
34for coverage including through the Medicaid program and the
35Affordable Care Act for otherwise eligible individuals.
-56- 1Division V includes miscellaneous provisions.
2The bill amends the definition of “local board of health” in
3Code section 135A.2 under the public health modernization Act
4to be consistent with the definition under Code chapter 137,
5relating to local boards of health.
6The bill repeals Code section 135.132, the interagency
7pharmaceuticals bulk purchasing council. The provision was
8enacted in 2003, but the council was never established.
9Division VI relates to the Iowa health information
10network. Legislation was enacted in 2015 Iowa Acts, chapter
1173, to provide for the future assumption of the Iowa health
12information network by a designated entity. The bill
13includes a conforming change that would take effect upon
14future assumption of the Iowa health information network by a
15designated entity.
16Division VII relates to organized delivery systems that are
17regulated by DPH. Organized delivery systems were created
18pursuant to 1993 Iowa Acts, chapter 158. Rules adopted
19under the provision define an organized delivery system as
20“an organization with defined governance that is responsible
21for delivering or arranging to deliver the full range of
22health care services covered under a standard benefit plan
23and is accountable to the public for the cost, quality and
24access of its services and for the effect of its services
25on their health.” (641 IAC 201.2) An organization operating
26as an organized delivery system is required to assume risk
27and be subject to solvency standards. The bill eliminates
28all references to organized delivery systems in the Code and
29repeals the provision in the Acts authorizing the establishment
30of organized delivery systems. The most recent application for
31licensure was received by DPH in 1998. Since being authorized
32in 1993, only two entities applied for licensure as organized
33delivery systems and both of these entities have since ceased
34operations.
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