Pursuant to the authority of Iowa Code section 17A.4 and 2017 Iowa Acts, House File 516, the Voter Registration Commission hereby gives Notice of Intended Action to amend Chapter 2, “Voter Registration Forms, Acceptability, Registration Dates, and Effective Dates,” Chapter 3, “Lists of Registered Voters,” Chapter 5, “Election Registers,” and Chapter 7, “Voter Registration Mailing Address Maintenance,” Iowa Administrative Code.    These proposed amendments are necessary because of the enactment of 2017 Iowa Acts, House File 516, by the General Assembly. The Commission has determined that because of this newly enacted law, the following amendments are necessary to keep the administrative rules in compliance with the Iowa Code. House File 516 makes significant changes to elections in the state of Iowa, creating the need to update Chapters 2, 3, 5, and 7, which are chapters that contain voter registration rules of the Iowa Administrative Code.    Any interested person may make written suggestions or comments on the proposed amendments on or before September 19, 2017. Written suggestions or comments should be directed to Eric R. Gookin, Election Administrator, Office of the Secretary of State, First Floor, Lucas State Office Building, Des Moines, Iowa 50319.    Persons who want to convey their views orally should contact the Secretary of State’s office by telephone at (515)281-0145 or in person at the Secretary of State’s office on the first floor of the Lucas State Office Building.    A public hearing will be held on October 16, 2017, at 3 p.m. at the Secretary of State’s office, on the first floor of the Lucas State Office Building, 321 East 12th Street, Des Moines, Iowa.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement 2017 Iowa Acts, House File 516.    The following amendments are proposed.

    Pursuant to the authority of Iowa Code section 96.11, the Director of Workforce Development Department hereby gives Notice of Intended Action to amend Chapter 23, “Employer’s Contribution and Charges,” and Chapter 24, “Claims and Benefits,” Iowa Administrative Code.    These proposed amendments update, clarify and simplify the procedures by which claimants and employers interact with Iowa Workforce Development. The amendments also bring the rules up to date by reflecting changes in technology and efficiencies developed within the agency since the affected rules were adopted. The agency needs to have administrative rules that address these changes.    Any interested person may make written or oral suggestions or comments on the proposed amendments on or before September 19, 2017, by sending them to David J. Steen, Attorney, Iowa Workforce Development, 1000 East Grand Avenue, Des Moines, Iowa 50319-0209. Comments may be sent electronically to david.steen@iwd.iowa.gov.    These amendments do not have any fiscal impact on the State of Iowa.    Waiver provisions do not apply to this rule making.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapter 96.    The following amendments are proposed.

    Pursuant to the authority of Iowa Code chapters 505, 513C, and 514E, the Insurance Division hereby adopts Chapter 82, “Iowa Stopgap Measure,” Iowa Administrative Code.    The rules in Chapter 82 are intended to implement a program developed by the Insurance Division, the Iowa Stopgap Measure, which was designed to provide an innovative solution to temporarily stabilize Iowa’s individual health insurance market. The Iowa Stopgap Measure was first submitted by the Insurance Division on June 7, 2017, to the Centers for Medicare and Medicaid Services (CMS) as a waiver application under Section 1332 of the Patient Protection and Affordable Care Act (ACA) (42 U.S.C. Section 18052). The Insurance Division continues to work with CMS to develop the waiver application and will be finalizing the application for submittal by the end of August 2017.     The instability of Iowa’s individual ACA-compliant market was first marked with the liquidation of CoOportunity Health, Inc., which began with an order of rehabilitation on December 23, 2014, and the market has seen continued instability. On April 25, 2016, UnitedHealthcare notified the Insurance Division that it would not offer individual ACA-compliant plans in 2017. Then, on March 30, 2017, Wellmark, Inc. and Wellmark Health Plan of Iowa, Inc. notified the Insurance Division that they would not offer individual ACA-compliant plans in 2018. On April 6, 2017, Aetna, Inc. notified the Insurance Division that it would not offer individual ACA-compliant plans in 2018. Finally, before Iowa’s rate filing deadline, June 19, 2017, Wellmark Value Health, Wellmark Synergy Health and Gundersen Health Plan, Inc. informed the Insurance Division that they will not offer individual ACA-compliant plans in 2018.     On June 19, 2017, Medica, a Minnesota-based health insurance company that first sold individual health insurance policies in Iowa in 2016, filed ACA-compliant plans for approval by the Insurance Division to be available on the ACA-compliant individual health insurance marketplace in 2018 in all of Iowa’s 99 counties. The premium rates that Medica filed with the Insurance Division have an average increase of 43.5 percent over Medica’s 2017 rates. No other carriers filed rates for the ACA-compliant individual health insurance marketplace for 2018.     The premium rates filed by Medica will drive healthier, younger, and middle-aged individuals out of the market, which will sink Iowa’s market further into collapse. This dramatic proposed premium rate increase will mean that, for some consumers, premiums will increase almost 100 percent from their current 2017 premium rates. It is likely that many individuals who are not currently receiving federal subsidies (those whose household income is above 400 percent of federal poverty level) will be unable to afford the cost of the Medica rates as filed and thus will drop from the market. The Insurance Division estimates that the health insurance premium costs for a family of four with a total household income at this federal poverty level (which is approximately $98,000) would be almost $24,000 under the rates filed by Medica for 2018. These rates simply are not affordable for a working class family or small business owner. It is plausible that individuals could refuse a promotion, quit a primary or secondary job, or take other steps to lower their household income in order to be eligible for federal subsidies. These rates will directly impact the ability of small business owners, the majority of whom participate in the individual commercial health insurance market, to continue to sustain and grow their own businesses.     Governor Kim Reynolds asked the Insurance Division to develop a solution to provide temporary stability to the individual health insurance market and ensure that the approximately 72,000 Iowans currently covered through the individual health insurance market would have coverage options for 2018. The Insurance Division, in response to its directive from the Governor and under the authority of Iowa Code chapters 505, 513C and 514E, developed the Iowa Stopgap Measure as a proposed Section 1332 application to CMS and the Department of the Treasury to waive certain provisions of the ACA.     The federal government, through CMS and the Department of the Treasury, has the authority under Section 1332 of the ACA to grant to a state a waiver to implement innovative strategies to provide the state’s residents with access to high-quality, affordable health coverage. These waivers allow states to implement innovative ways to provide access to quality health care that: (1) are at least as comprehensive and affordable as would be provided absent a waiver; (2) provide coverage to a comparable number of residents of the state as would be provided coverage absent a waiver; and (3) do not increase the federal deficit.     The Iowa Stopgap Measure is designed to facilitate the implementation of a reinsurance program, a per-member, per-month premium credit mechanism, and a standardized health benefits plan to be offered to all eligible Iowa consumers for the plan year 2018. Iowa’s waiver application asks CMS to use the Insurance Division and the existing Iowa Individual Health Benefit Reinsurance Association (IIHBRA) as administrators of a pass-through of the federal funding that would be allocated to Iowa consumers via the existing Advanced Premium Tax Credit (APTC) and Cost-Sharing Reduction (CSR) funding under the ACA to be used by Iowa for a reinsurance program and per-member, per-month premium credits. That is, federal funds allocated by CMS would be paid to the Insurance Division or IIHBRA, and the Insurance Division would, in compliance with the Iowa Stopgap Measure, disburse the funds accordingly. The Insurance Division intends that this program will be completely funded by the federal funds allocated to Iowa.     The Insurance Division has been working diligently with CMS to develop and finalize the waiver application, which will be submitted in mid-August. The Insurance Division developed the Iowa Stopgap Measure, with advice and support from several insurance companies and other entities, to establish conditions which would support reentry of insurance carriers into the individual health insurance market and at rates that are affordable to consumers. The Iowa Stopgap Measure has three primary means of doing this.     First, it implements a reinsurance program under the IIHBRA to support the costs associated with consumers enrolled in the Iowa Stopgap Measure who have annual claims costs of over $100,000. Providing support for these high-cost claimants will help the carriers keep monthly premium rates down for all consumers under the Iowa Stopgap Measure.     Second, the Iowa Stopgap Measure will replace the current premium subsidy structure with a per-member, per-month premium credit that will be available for all eligible Iowa consumers based on their age and income. These credits will be paid directly to the carriers via funds paid by the federal government and passed through the Insurance Division or the Iowa Comprehensive Health Association (HIPIOWA), and are intended to keep monthly costs low to entice young and healthy individuals back into the market.     Third, the Iowa Stopgap Measure would allow for a single, standard health benefits plan to be offered to all eligible Iowa consumers for the plan year 2018. Having a single, standard health benefits plan that provides coverage for all of the essential health benefits defined by the ACA as well as all Iowa-mandated benefits ensures that consumers will be able to purchase coverage as comprehensive as that which is currently offered in the individual health insurance market. The use of a single plan also provides administrative simplicity, which, given the implementation timeline, is critical to entice health insurance carriers back to the market.     In compliance with Iowa Code section 17A.4(3), these rules are filed emergency because immediate adoption of the rules is necessary to implement the Iowa Stopgap Measure in time for the 2018 open enrollment period beginning on November 1, 2017, and delays caused by the notice and public participation requirements of Iowa Code section 17A.4 would be contrary to public interest. The Insurance Division finds that the availability and affordability of individual commercial health insurance is critical for the greater public interest, and the necessity of ensuring that coverage will be available in 2018 requires these rules to be immediately implemented.    Insurance carriers who will participate in the Iowa Stopgap Measure will need several months to prepare the application procedures and internal processes necessary to facilitate the purchase of coverage for all enrollees prior to the open enrollment date of November 1, 2017. The insurance carriers also need to prepare plan documents, develop the electronic application, finalize coverage networks, and file the rates and forms for Insurance Division review and approval. The Insurance Division needs to work with various entities to coordinate the eligibility verification process, develop a consumer education program, coordinate funding mechanisms with the federal government, and review and approve all rate and form filings made by carriers who want to participate in the program. Review of filings by the staff at the Insurance Division is a process that takes several weeks to complete for each carrier and filing.     The Insurance Division made its proposal for the Iowa Stopgap Measure public on June 12, 2017, opened a formal public and tribal comment period on July 13, 2017, and accepted public comments on the Iowa Stopgap Measure in writing by mail and through a Web form through August 14, 2017. These materials are all available on the Insurance Division’s Web site at https://iid.iowa.gov/press-releases/iowa-seeks-federal-approval-of-health-insurance-stopgap-measure and https://iid.iowa.gov/press-releases/notice-of-public-hearings-for-iowa-stopgap-measure. As part of the formal public comment period, the Insurance Division held three public hearings on the Iowa Stopgap Measure (in Council Bluffs on July 19, 2017; in Des Moines on August 2, 2017; and in Cedar Rapids on August 10, 2017).     The Insurance Division submitted these rules to the Administrative Rules Review Committee, seeking its approval that the situation described above constitutes good cause that notice and publication would be unnecessary, impracticable, or contrary to public interest, as required by Iowa Code section 17A.4(3)“a,” such that the provisions of Iowa Code section 17A.4(1) would be inapplicable. In compliance with Iowa Code section 17A.4(3), the Administrative Rules Review Committee at its August 4, 2017, meeting reviewed the Insurance Division’s findings and the rules and approved the emergency adoption.     The Insurance Division also finds, pursuant to Iowa Code section 17A.5(2)“b”(2), that the situation described above proves (as required by section 17A.5(2)“b”(2)) that, because of imminent peril to the public health, safety, or welfare (as required by section 17A.5(2)“b”(1)(c)), the normal effective date of the rules, 35 days after publication, should be waived and these rules should be made effective on August 4, 2017, to allow for the Insurance Division to move forward and implement the Iowa Stopgap Measure in order to allow interested insurance carriers sufficient time to set up and prepare the Iowa Stopgap Measure and allow consumers to purchase the standard plan during the open enrollment period to have coverage starting January 1, 2018.     As the Iowa Stopgap Measure, upon approval by CMS, would utilize federal funding that would be allocated to Iowa consumers via the premium tax credit mechanism of the ACA, no state moneys will be used for the premium credits or reinsurance program. If the Iowa Stopgap Measure is not approved by CMS, the Iowa Stopgap Measure will not be implemented. The Insurance Division, and several other state agencies, may use existing state resources for implementation of the Iowa Stopgap Measure should it be approved.     The Insurance Division adopted these rules on August 4, 2017.     After analysis and review of this rule making, no impact to jobs has been found.     These rules do not include a provision for the waiver of the rules because the Insurance Division’s general waiver provisions in 191—Chapter 4 apply.     These rules are intended primarily to allow for implementation of the Iowa Stopgap Measure that has been developed by the Insurance Division upon request by the Governor. The Insurance Commissioner has filed these rules under his rule-making authority of Iowa Code chapters 505, 513C, and 514E.    These rules became effective on August 4, 2017. If CMS does not approve the Iowa Stopgap Measure, it will not be funded and there will be no coverage available under these rules.     These rules are intended to implement Iowa Code chapters 505, 513C, and 514E.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 20.6(5), the Public Employment Relations Board hereby amends Chapter 1, “General Provisions,” Chapter 2, “General Practice and Hearing Procedures,” and Chapter 4, “Bargaining Unit and Bargaining Representative Determination”; rescinds Chapter 5, “Elections,” and adopts a new chapter with the same title; and amends Chapter 6, “Negotiations and Negotiability Disputes,” Chapter 7, “Impasse Procedures,” Chapter 8, “Internal Conduct of Employee Organizations,” Chapter 11, “State Employee Appeals of Grievance Decisions and Disciplinary Actions,” and Chapter 16, “Electronic Document Management System,” Iowa Administrative Code.    These amendments are in response to the sweeping changes in public sector collective bargaining under Iowa Code chapter 20 contained in 2017 Iowa Acts, House File 291, which became effective upon the bill’s enactment on February 17, 2017. House File 291 introduced many concepts and requirements which are completely new to the preexisting Iowa Code chapter 20 processes, including the requirement that the agency conduct “retention and recertification” elections among employees in represented bargaining units as early as June 1 but not later than November 1, 2017; the requirement that employee organizations pay fees to cover the cost of certification, decertification, and retention and recertification elections; the authority of the agency to contract with a vendor to conduct certification, decertification, and retention and recertification elections on behalf of the agency; the distinction between bargaining units in which 30 percent or more of the employees are “public safety employees” and other bargaining units; the limitation on the ability of Iowa Code section 20.22 arbitrators to award “base wage” increases in excess of amounts specified in House File 291; and the requirement that the agency appoint a certified shorthand reporter to report state employee grievance and discipline resolution proceedings and to tax to a party the cost of the reporter’s services and a transcript requested by the agency. House File 291 also altered many aspects of concepts and requirements which previously existed, including changes to the scope of bargaining applicable to both public safety and non-public safety bargaining units; changes concerning when petitions seeking the decertification of a certified employee organization may be filed and the timelines for the conduct of decertification elections, and changes to the criteria Iowa Code section 20.22 arbitrators must and cannot consider in resolving bargaining impasses involving non-public safety bargaining units.    The purpose of these amendments is to update the agency’s rules to reflect and implement the provisions of House File 291. A major portion of the amendments involve Chapter 5, “Elections.” Due to the breadth of the amendments to Iowa Code chapter 20, the agency determined that it was impracticable to amend Chapter 5 on a rule-by-rule basis and that a reorganization of the chapter was necessary in order to present the rules in a logical and understandable fashion. Accordingly, Item 13 rescinds existing Chapter 5 and replaces it with a reorganized chapter which reflects the changes responsive to House File 291, even though many of the rules contained in that chapter are identical, or nearly identical, to those contained in existing Chapter 5. As has been the case in other instances where significant statutory changes are implemented, many of the amendments constitute technical, conforming amendments to other rules which were necessitated by the reorganization of the chapter.    Pursuant to Iowa Code section 17A.4(3), the Public Employment Relations Board finds that notice and public participation are impracticable and contrary to the public interest because there are currently no processes in place through which the agency can, among other things, conduct the required retention and recertification elections, impose or collect election fees from the employee organizations involved, resolve disputes as to whether a given bargaining unit is a public safety unit or not, or tax the cost of certified shorthand reporters and transcripts in state employee grievance and disciplinary action proceedings. Because House File 291 potentially requires that retention and recertification elections for over 600 bargaining units be conducted between June 1, 2017, and November 1, 2017, insufficient time exists for rule making to be completed pursuant to the normal rule-making process prior to the date upon which retention and recertification election proceedings must be commenced and elections conducted.     In compliance with Iowa Code section 17A.4(3)“a,” the Administrative Rules Review Committee, at its August 4, 2017, meeting, reviewed the agency’s determination and this rule making and approved emergency adoption.    Pursuant to Iowa Code section 17A.5(2)“b”(1)(b), the agency also finds that the normal effective date of these amendments, 35 days after publication, should be waived and the amendments made effective August 10, 2017, because the rules confer a benefit to members of the public by establishing procedures which implement the requirements of 2017 Iowa Acts, House File 291, consistent with the time periods contemplated by that legislation.     Although a draft of these amendments was posted on the agency’s Web site and distributed by e-mail for the information of the regulated community, and a number of changes to that draft were made in response to comments received from representatives of both labor and management, these amendments are also published herein under Notice of Intended Action as ARC 3277C to allow for further public comment.    Although the implementation of 2017 Iowa Acts, House File 291, will cause an increase in the expenditure of funds by the agency and affected persons, due primarily to the need for the agency to contract with a vendor to conduct elections on the agency’s behalf and the requirement that these costs be paid by the employee organizations involved, the agency does not anticipate that these expenditures will exceed $100,000 per year or $500,000 within five years.    These rules do not provide for a waiver of their terms, but are instead subject to the agency’s general waiver provisions found at rule 621—1.9(17A,20).    The Public Employment Relations Board adopted these amendments on August 10, 2017.    After analysis and review of these amendments, and consideration of anecdotal information concerning the effects of the implementation of amendments to public sector collective bargaining in the State of Wisconsin which are similar in many respects to the amendments contained in 2017 Iowa Acts, House File 291, the agency anticipates that the amendments to Iowa Code chapter 20 may reduce the number of private sector jobs or potential job opportunities for individuals in the private sector who provide legal or support services to labor organizations or public employers in Iowa, although the extent of any such reduction cannot be reasonably determined.    These amendments are intended to implement Iowa Code chapter 20 as amended by 2017 Iowa Acts, House File 291.    These amendments became effective August 10, 2017.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 8A.104(5), the Department of Administrative Services hereby amends Chapter 100, “Capitol Complex Operations,” Iowa Administrative Code.    These amendments address the possession of pistols and revolvers and the use of fireworks on the Capitol Complex in relation to 2017 Iowa Acts, House File 517 and Senate File 489.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3177C on July 5, 2017. These amendments were also Adopted and Filed Emergency and published as ARC 3179C on July 5, 2017. A public hearing was held on July 25, 2017. No comments from the public were received. These amendments are identical to those published under Notice of Intended Action and Adopted and Filed Emergency.    The Department of Administrative Services will not grant waivers under the provisions of these rules, other than as may be allowed under Chapter 9 of the Department’s rules concerning waivers.    The Department of Administrative Services adopted these amendments on August 9, 2017.    After analysis and review of this rule making, it is undeterminable how rules that implement 2017 Iowa Acts, House File 517, section 33, would affect jobs in the private sector. It is undeterminable how rules that implement Iowa Code section 8A.322(3) in relationship to 2017 Iowa Acts, Senate File 489, would affect jobs in the private sector.     These amendments are intended to implement Iowa Code section 8A.322 as amended by 2017 Iowa Acts, House File 517, and the provisions resulting from 2017 Iowa Acts, Senate File 489.    These amendments will become effective October 4, 2017, at which time the Adopted and Filed Emergency amendments are hereby rescinded.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 199.11, the Department of Agriculture and Land Stewardship hereby amends Chapter 40, “Agricultural Seeds,” Iowa Administrative Code.    This amendment updates the federal code reference for agricultural seeds.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3152C on July 5, 2017. No comments were received from the public. The adopted amendment is identical to the noticed amendment.    After analysis and review of this rule making, no adverse impact on jobs has been found.    This amendment is intended to implement Iowa Code chapter 199.    This amendment will become effective October 4, 2017.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 256.7(5), the State Board of Education hereby amends Chapter 21, “Community Colleges,” Iowa Administrative Code.    The amendments to Chapter 21 incorporate changes to the rules which establish basic requirements for certificate, diploma, and degree programs and instructional courses for drinking drivers, both offered by community colleges. Regarding subrule 21.2(9), changes include updating terminology from technical “specialty component” to technical “core” and establishing a minimum technical core course requirement for diplomas. Regarding rule 281—21.32(321J), changes include an increase in tuition fees for an instructional course for drinking drivers offered by community colleges to $140 and an increase in the administrative fee collected by the Department to $15 for individuals enrolled in an Iowa instructional course for drinking drivers and to $37.50 for individuals enrolled in an out-of-state instructional course for drinking drivers. The fee adjustments reflect the recommendation of a drinking drivers instruction course advisory committee and reflect the cost of providing such courses.    An agencywide waiver provision is provided in 281—Chapter 4.    Notice of Intended Action was published in the June 7, 2017, Iowa Administrative Bulletin as ARC 3087C. Public comments were allowed until 4:30 p.m. on June 27, 2017. A public hearing was held on that date. No one attended the public hearing. One letter in support of the amendments was received. These amendments are identical to those published under Notice.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapter 260C.    These amendments will become effective October 4, 2017.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 256.7(5), the State Board of Education hereby amends Chapter 33, “Educating the Homeless,” Iowa Administrative Code.    The revised Chapter 33 incorporates changes to the McKinney-Vento Homeless Assistance Act (42 U.S.C. § 11431, et seq.), as reauthorized in December 2015 by the Every Student Succeeds Act (ESSA). The amendments as a result of ESSA include modifying the requirements of the State Plan to include procedures that ensure that homeless students have equal access to the same free, appropriate public education, including a public preschool education, as provided to other students. This equal access includes removing barriers that prevent students from accessing academic or extracurricular activities because of their homelessness. Other amendments include removal of “awaiting foster care placement” from the definition of “homeless child or youth,” revisions to the definition of “school of origin,” and clarifications regarding required transportation for the school of origin.    An agencywide waiver provision is provided in 281—Chapter 4.    Notice of Intended Action was published in the June 7, 2017, Iowa Administrative Bulletin as ARC 3089C. Public comments were allowed until 4:30 p.m. on June 27, 2017. A public hearing was held on that date. No one attended the public hearing, and no comments were received. These amendments are identical to those published under Notice.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement the provisions of the McKinney-Vento Homeless Assistance Act (42 U.S.C. § 11431, et seq.), as reauthorized in December 2015 by the Every Student Succeeds Act (ESSA).    These amendments will become effective October 4, 2017.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 256.7(5), the State Board of Education hereby amends Chapter 61, “Iowa Reading Research Center,” Iowa Administrative Code.    The Iowa Reading Research Center had been charged with adopting program criteria and guidelines for an intensive summer literacy program required by Iowa Code section 279.68. 2017 Iowa Acts, House File 642, enacted during the 2017 session of the General Assembly and signed into law by the Governor, repealed Iowa Code sections 279.68(1)“c” and 279.68(2)“e,” thereby eliminating the requirement that school districts offer an intensive summer literacy program. This amendment reflects the statutory change that school districts are no longer required to offer an intensive summer literacy program, but maintains certain program criteria and guidelines for voluntary intensive summer literacy programs that school districts may choose to offer in meeting the requirements of Iowa Code section 279.68(2)“a”(6).    An agencywide waiver provision is provided in 281—Chapter 4.    Notice of Intended Action was published in the July 5, 2017, Iowa Administrative Bulletin as ARC 3148C. Public comments were allowed until 4:30 p.m. on July 25, 2017. A public hearing was held on that date. No one attended the public hearing, and no public comments were received. This amendment is identical to that published under Notice of Intended Action.     After analysis and review of this rule making, no impact on jobs has been found.    This amendment is intended to implement Iowa Code sections 256.7(31) and 256.9(49)“c” and Iowa Code section 279.68 as amended by 2017 Iowa Acts, House File 642.    This amendment will become effective October 4, 2017.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 256.7(5), the State Board of Education hereby amends Chapter 62, “State Standards for Progression in Reading,” Iowa Administrative Code.    Iowa Code section 279.68, regarding the successful progression for early readers, was amended substantially by 2017 Iowa Acts, House File 642, during the 2017 Legislative Session of the Iowa General Assembly.    Item 1 of the amendments is a technical change not brought about by 2017 Iowa Acts, House File 642. This change to Chapter 62 is necessary because the alternate assessment currently available is not also suitable for universal screening or progress monitoring.    Iowa Code section 279.68(1)“a” is amended by 2017 Iowa Acts, House File 642, section 27, to ensure that school districts continue to provide intensive reading instruction beyond grade three until the student is reading at grade level. Item 2 of the amendments reflects that statutory change.    Iowa Code sections 279.68(1)“c” and 279.68(2)“e,” which would have required school districts, beginning May 1, 2018, to offer an intensive summer reading program for students persistently at risk in reading by the end of grade three, are repealed by 2017 Iowa Acts, House File 642, sections 28 and 29. Item 3 of the amendments reflects that statutory change.    Iowa Code sections 279.68(3) and 279.68(5), regarding the promotion to grade four of students persistently at risk in reading by the end of grade three, are repealed by 2017 Iowa Acts, House File 642, section 30. Item 4 of the amendments reflects that statutory change.    Items 5 and 6 of the amendments make clarifying changes based upon the amendments to Iowa Code section 279.68 made by 2017 Iowa Acts, House File 642.    An agencywide waiver provision is provided in 281—Chapter 4.    Notice of Intended Action was published in the July 5, 2017, Iowa Administrative Bulletin as ARC 3149C. Public comments were allowed until 4:30 p.m. on July 25, 2017. A public hearing was held on that date. No one attended the public hearing, and no public comments were received. These amendments are identical to those published under Notice of Intended Action.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 279.68 as amended by 2017 Iowa Acts, House File 642.    These amendments will become effective October 4, 2017.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(5), the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.    These amendments implement the cost-containment strategy to adjust the Iowa Medicaid anesthesia conversion factor to be equal to the calendar year 2017 Medicare anesthesia conversion factor as adjusted for the state, and converted to a per-minute amount. Each January 1, thereafter, the Department shall apply the applicable Medicare anesthesia conversion factor as adjusted for the state, and converted to a per-minute amount.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3164C on July 5, 2017. These amendments were also Adopted and Filed Emergency and published as ARC 3158C on the same date and became effective July 1, 2017. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action and Adopted and Filed Emergency.    The Council on Human Services adopted these amendments on August 9, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(5).    These amendments will become effective October 4, 2017, at which time the Adopted and Filed Emergency amendments are hereby rescinded.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(4), the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.    This amendment implements the cost-containment strategy to adjust the inpatient diagnostic related group (DRG) cost outlier threshold formula to be the greater of two times the statewide average DRG payment for that case, or the hospital’s individual DRG payment for that case plus $75,000. The current formula is the greater of two times the statewide average DRG payment for the case, or the hospital’s individual DRG payment for the case plus $16,000.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3166C on July 5, 2017. This amendment was also Adopted and Filed Emergency and published as ARC 3161C on the same date and became effective July 1, 2017. The Department received comments from one respondent. A summary of the respondent’s comments and the Department’s responses are shown in the paragraphs below. This amendment is identical to that published under Notice of Intended Action and Adopted and Filed Emergency.    Comment 1: The respondent stated that while the public notice and the informational letter state that this change in reimbursement for DRG cost outlier payments will be effective July 1, 2017, the proposed effective date does not align with the language approved by the Legislature in 2017 Iowa Acts, House File (HF) 653.    Department response 1: Pursuant to HF 653, section 12(15)(b), the effective date of these changes is July 1, 2017. While section 12(15)(b) also provides that “[i]f federal approval is required, the strategy shall be implemented effective upon receipt of federal approval,” such does not affect the intended July 1, 2017, effective date specified by the Legislature. This is because the State Plan Amendment (SPA) submitted to the federal Centers for Medicare and Medicaid Services (CMS) requested a July 1, 2017, effective date, consistent with the Legislature’s directive in HF 653. Once approved by CMS, the changes in the SPA would be effective back to the requested July 1, 2017, effective date. Finally, section 12(15)(c) of HF 653 provides authorization for the Department to adopt emergency rules to implement this change, relative to the July 1, 2017, effective date, as specified by the Legislature. The Department is unable to change the amendment based on the respondent’s comment.    Comment 2: The respondent stated that the legislation requests federal approval of the $75,000 threshold amount for these outlier claims and that this is a far higher threshold to obtain than the current $16,000 amount and will result in hospitals treating the most complex Medicaid patients in the state not being adequately compensated for the care that is provided. The respondent requested that CMS consider a more reasonable outlier threshold, similar to that of Medicare.    Department response 2: These changes were enacted during the 87th Session of the Iowa General Assembly in HF 653, section 12(15)(a)(4), which specifies a cost outlier threshold of $75,000. The Department is unable to change the amendment based on the respondent’s comment.    The Council on Human Services adopted this amendment on August 9, 2017.    This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    This amendment is intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(4).    This amendment will become effective October 4, 2017, at which time the Adopted and Filed Emergency amendment is hereby rescinded.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(3), the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.    This amendment reimplements the cost-containment strategy to adjust Medicaid reimbursement rates for physician services rendered in facility settings (e.g., hospitals), by applying a “site of service” differential to reflect the difference between the cost of physician services when provided in a health facility setting and the cost of physician services when provided in a physician’s office. It should be noted that the strategy in this amendment was originally legislatively mandated in 2011 as a directed/mandated cost-containment strategy at that time. However, the Legislature “nullified” the original mandate in 2012, based on provider complaints about reduced payments in facility settings.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3165C on July 5, 2017. This amendment was also Adopted and Filed Emergency and published as ARC 3162C on the same date and became effective July 1, 2017. This amendment is identical to that published under Notice of Intended Action and Adopted and Filed Emergency.    The Department received comments from a total of 17 respondents. All, with one exception, were from community mental health centers (CMHCs), staff from CMHCs, and associations representing CMHCs and various practitioners who practice/work at CMHCs. The only non-CMHC-affiliated comment received was from the father of a 27-year-old man who has been a patient at one of the main CMHCs that submitted comments. The father did not specify any particular proposed rule provision or request a change thereto but, instead, spoke generally about the potential impact the site of service (SoS) rule change could have on already scarce psychiatric services in the state. Generally speaking, the comments from the respondents all identified the same issues and concerns related to this amendment. At this time, the Department will not change the amendment based on the public comments received from the respondents.    Comment 1: A respondent stated that paragraph 79.1(7)“b” specifies that the Department intends to apply an SoS differential to physician services and asked the Department to clarify that this is being applied to physician services only and not to services provided by mid-level practitioners, such as physician assistants (PAs) and advanced registered nurse practitioners (ARNPs).    Department response 1: To the extent subrule 79.1(7) is limited to “physicians,” new paragraph “b” would also be limited to physicians and would not be applied to mid-level practitioners, such as PAs and/or ARNPs. The only exceptions would be the following:     1. Since PAs are not able to bill and be paid directly for services under Iowa Medicaid, any services rendered by PAs would be billed under their supervising/employing physician or clinic. Therefore, to the extent a PA service rendered in a facility setting is billed by the supervising/employing physician or clinic, and since the physician or clinic would be a “physician” provider type, such service would be subject to the SoS differential.     2. The only circumstance where services rendered by an ARNP in a facility setting would be subject to the SoS reduction would be if the ARNP was not otherwise separately enrolled (i.e., as an ARNP provider type) and such services were billed by the ARNP’s employing physician or clinic. Under both federal and state laws and regulations, ARNPs are able to enroll and bill as independent practitioners, so most ARNPs do enroll and bill under their own provider numbers. Where that is the case, the ARNP would not be subject to the SoS reductions for services rendered in a facility setting.    Comment 2: A respondent commented that the Department is referencing place of service (POS) codes in paragraph 79.1(7)“b” that match Medicare’s list of “facilities” and expressed concern about the inclusion of code POS 53 – community mental health center. The respondent stated that under Medicare definitions, Iowa CHMCs are not considered facilities, do not use POS 53 as the billing code for Medicare, and are not subject to Medicare.    Department response 2: CMHCs billing for services under the CMHC provider category will not have payments cut back for the SoS differential in cases where the service is provided at place of service 53 (CMHC). In these cases, under Medicaid, there is no separate facility bill-to account for the overhead, and therefore no SoS differential will be applied, consistent with the intent of the policy.     Comment 3: Noting that, for Iowa Medicaid, accredited CMHCs do use code 53 in box 24 of the CMS-1500 claim form, a respondent expressed concern that with Iowa’s adoption of the Medicare facilities list, CMHCs in Iowa will be subject to an SoS differential for Medicaid purposes that they are not subject to for Medicare and stated that, should this be the case, Iowa CMHCs will experience reductions in payments that do not occur with Medicare and that will result in reduction to access of psychiatric services, which are already in short supply in Iowa. The respondent requested that POS 53 be removed from Iowa Medicaid’s facilities list for the purpose of applying SoS differentials and that Iowa CMHCs be treated by Medicaid as they are by Medicare for the purpose of this policy change.    Department response 3: CMHCs billing for services under the CMHC provider category will not have payments cut back for the SoS differential in cases where the service is provided at place of service 53 (CMHC). In these cases, under Medicaid, there is no separate facility bill-to account for the overhead, and therefore no SoS differential will be applied, consistent with the intent of the policy.     Comment 4: A respondent commented that for the entities defined as “facilities” under Medicare, there are methods for them to recoup some of the SoS differential as bad debt through cost reporting but that Iowa’s CMHCs are not defined as a “facility” by Medicare and do not have this option and will, therefore, be put at an extreme financial disadvantage should the SoS differential be applied. The respondent stated that this will only serve to further limit timely access to mental health services for Iowa’s Medicaid population.    Department response 4: Please refer to Department responses 2 and 3.    Comment 5: A respondent commented that the POS code list in paragraph 79.1(7)“b” is the same as the Medicare list of “facilities,” that POS 53 is for CMHCs, and that, according to Medicare definitions, Iowa CMHCs are not considered a “facility” (unless the CMHC is hospital-based or meets a different set of criteria than Iowa requires) and do not use POS 53 as the POS billing code for Medicare and are not subject to the SoS differential under Medicare. The respondent explained that the respondent’s CMHC is not eligible to bill a “facility” fee and a professional fee, as is the case with Medicare-defined facilities and that, for Iowa Medicaid, POS 53 is used in box 24b on the CMS-1500 claim form for CMHCs that are accredited and established by Iowa Code definitions for CMHCs.    Department response 5: Please refer to Department responses 2 and 3.    Comment 6: A respondent commented that based on experience with Medicare and SoS codes for telehealth, CMHC providers have experienced a 25 to 30 percent rate reduction for these services and that, should POS 53 become subject to the SoS differential, Iowa CMHCs could experience a significant reduction in payment for services, thus resulting in reducing staff psychiatry time and a reduction of access to psychiatric services, which are already in short supply in Iowa. The respondent requested that POS 53 (CMHC) be removed from the list of facility codes for the purposes of applying the SoS differential.    Department response 6: Please refer to Department responses 2 and 3.    Comment 7: A respondent commented that information on proposed paragraph 79.1(7)“b” indicates that the intent was to decrease rates for physicians that provide services in a “facility,” as defined as a (facility) POS by Medicare and that CMHCs are defined under Medicare as a “group practice,” not a facility (unless the CMHC meets a different set of criteria than Iowa requires). The respondent further commented that the respondent’s CMHC does not use POS 53 when it bills Medicare, that the respondent does not bill a separate facility fee and is not subject to the SoS differential payment under Medicare, and that, under Iowa Medicaid, CMHCs are categorized as a POS 53 (different than under Medicare). The respondent believes that the POS 53 (CMHC) should not be included as an SoS that is subject to the decreased physician rates under Iowa Medicaid rules and stated that the respondent’s CMHC does not have the ability to charge additional fees as a Medicare-defined “facility” would.    Department response 7: Please refer to Department responses 2 and 3.    Comment 8: A respondent stated the belief that there would be serious unintended consequences to penalizing CMHCs by making them subject to the proposed SoS rule, that CMHCs already serve a high percentage of individuals on Medicaid, and that, with the tremendous need to have outpatient mental health services available to individuals in our communities, this SoS differential for CMHCs would drastically reduce the availability of psychiatric services. The respondent commented further that the availability of outpatient mental health care (through CMHCs) is essential in keeping individuals out of higher cost services, such as the emergency room or inpatient care settings.    Department response 8: Please refer to Department responses 2 and 3.    Comment 9: A respondent expressed concerned that the proposed rule is an unintended consequence of using the Medicare list of facilities to include CMHCs (POS 53). The respondent commented that according to Medicare definitions, Iowa CMHCs are not considered a “facility” (unless the CMHC is a hospital-based CMHC or meets a different set of criteria than Iowa requires), do not use 53 as the POS billing code for Medicare and are not subject to the SoS differential, and that the respondent is not eligible to bill a “facility” fee and a professional fee as is the case with Medicare-defined facilities. The respondent also pointed out that for Iowa Medicaid, code 53 is used in box 24b of the CMS-1500 claim for CMHCs that are accredited and established by Iowa Administrative Code definitions for CMHCs (Chapter 24).    Department response 9: Please refer to Department responses 2 and 3.    Comment 10: A respondent commented that for entities that are “facilities” under Medicare, there is a method for them to recoup some of this rate through a cost report reconciliation process but that Iowa CMHCs do not have that option as they are not a “facility” as defined by Medicare. The respondent commented that by using the facility list from Medicare, Iowa CMHCs are put in a category that does not apply and for which the rule should not apply.    Department response 10: Please refer to Department responses 2 and 3.    Comment 11: A respondent commented that based on the respondent’s experience with Medicare and the SoS code for telehealth, providers have experienced a 25 to 30 percent rate reduction for these services and that, should SoS code 53 become an SoS differential, Iowa’s CMHCs could experience a significant reduction in payment for these services, thus resulting in their having to reduce staff and reduce access to psychiatric services, which are already a critical shortage area in Iowa.    Department response 11: Please refer to Department responses 2 and 3.    Comment 12: A respondent commented that the respondent’s organization has worked diligently to “expand” access to psychiatric services via telehealth in response to the growing demand for these services and that the proposed rule would severely limit the ability of the respondent’s organization to provide this crucial service, resulting in longer waiting lists for psychiatric services with negative consequences to clients and their families, not to mention a likely increased reliance upon hospital emergency departments and mental health units, the most costly services in Iowa’s system of care.    Department response 12: Code POS 02 is defined as “the location where health services and health related services are provided or received, through a telecommunication system.” POS 02 is used to report that a billed service was furnished as a telehealth service from a distant site. The only portion that is considered telehealth services is when the patient was present and interacting with the distant site’s physician or practitioner. An originating site is the location of a Medicaid member at the time the telehealth service is furnished. Originating sites can include physician offices, hospitals, critical access hospitals (CAHs), rural health clinics, federally qualified health centers, hospital-based or CAH-based renal dialysis centers, skilled nursing facilities, and CMHCs. The “telehealth” POS code (i.e., “02”) would not be used by an originating site that can bill a facility fee; instead, the originating site would continue to use the POS code that applies to the type of facility where the patient is located.     Beyond the foregoing, it is noted that Iowa Medicaid does not reimburse telehealth services in the same way as Medicare. In fact, Iowa Medicaid does not allow separate or additional payment for the various telehealth “technical” component-type services. Instead, Iowa Medicaid reimburses telehealth services the same as if the service were rendered in a face-to-face setting. Iowa Medicaid policy regarding telehealth is addressed in the Department’s rule 441—78.55(249A), which provides as follows:441—78.55(249A) Services rendered via telehealth. An in-person contact between a health care professional and a patient is not required as a prerequisite for payment for otherwise-covered services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided, as well as being in accordance with provisions under rule 653—13.11(147,148,272C). Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement.     It is important to emphasize that CMHCs billing for services under the CMHC provider category will not have payments cut back for the SoS differential, in cases where the service is provided at POS 02 (telehealth). In these cases, under Medicaid, there is no separate facility bill-to account for the overhead, and therefore no SoS cut would be taken, consistent with the intent of this policy.    Comment 13: A respondent noted that one of the SoS codes referenced in the informational letter for this rule is 02, telehealth, and commented that telehealth services at CMHCs are provided by either employees or contract staff, that those services are billed by the CMHC (which is the same as a physician office), with the CMHC tax ID, as part of the CMHC services, that thus the CMHC incurs all cost associated with delivery of the physician services, and that the services are not billed as a separate physician practice. The respondent commented that a reduction in reimbursement for telehealth services at CMHCs will likely result in the reduction of providing telehealth service, which will reduce access for patients, primarily in rural areas. The respondent also commented that if telehealth services are reduced due to this cost-containment strategy, the result will be longer wait times for patients to see an on-site psychiatrist, of which there is a short supply, and requested that the Department not require CMHCs to use 02, telehealth, as an SoS.    Department response 13: Please refer to Department response 12. In addition, it is noted that there will be no reduction in reimbursement for services rendered via telehealth, since the services are already paid at the same reimbursement rate as if the services were rendered face to face.    Comment 14: A respondent commented that CMHCs have begun to use telehealth services out of necessity to keep up with the demand for outpatient psychiatry over the past two years, that the cost of providing telehealth services is higher than having an on-site provider, and that, if CMHCs are required to use a POS 02 for telehealth services in their outpatient setting and be subject to the rate reduction under this cost-containment measure, it will make telehealth services unaffordable for CMHCs to provide. The respondent also commented that since telehealth is used in mostly rural areas, it may eliminate the ability to see a medication provider close to home. The respondent stated that if this is implemented, CMHCs will be forced to reduce their telehealth services, reducing capacity for individuals to receive care in the most cost-effective setting, and will likely result in increased use of emergency rooms. The respondent commented that when providing telehealth services, the CMHC pays for the provider and all of the costs associated with the service and that the CMHC “owns” the service. The respondent expressed the understanding that independent telehealth providers should be reimbursed less if they were “owning” the service, but that such is not the case for CMHCs in Iowa. The respondent commented that this could be clarified by not requiring CMHCs to use the POS 02 for their telehealth services.    Department response 14: Please refer to Department responses 12 and 13.    Comment 15: A respondent commented that the cost-containment strategy that the respondent is most concerned with is the SoS differential payment, which would reduce Medicaid payments for physician services provided in a “facility setting.” The respondent commented that while CMHCs are not considered “facilities” by Medicare, they have been included in Iowa’s list of facilities that will receive reduced Medicaid payments for physician services and that mental health centers are not allowed to recoup this reduction in payment by charging a facility fee, however. With regard to POS 53 (CMHC), the respondent noted that, according to Medicare definitions, Iowa CMHCs are not considered a “facility” and do not use POS 53 as the POS billing code for Medicare and are not subject to the SoS differential and that, since Iowa CMHCs are not a facility with Medicare, they do not bill a facility fee. The respondent commented that it appears as though CMHCs should not appear on this list and that, should the rule be implemented and the SoS differential be imposed, CMHCs could experience a significant reduction in payment for services, which in turn could result in reducing psychiatry time, which in turn reduces access to psychiatric services, which are already in short supply in Iowa, particularly in rural Iowa. The respondent requested that POS 53 be removed from the list of facility site codes for the purpose of applying SoS differential.    Department response 15: Please refer to Department responses 2 and 3.    The Council on Human Services adopted this amendment on August 9, 2017.    This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    This amendment is intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(3).    This amendment will become effective October 4, 2017, at which time the Adopted and Filed Emergency amendment is hereby rescinded.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(1), the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.    This amendment implements a cost-containment strategy to adjust the reimbursement policy in order to eliminate the primary care physician rate increase originally authorized by the federal Health Care and Education Reconciliation Act of 2010, Section 1202, Pub. L. No. 111-152, 42 U.S.C. §1396a(a)(13)(C), that allows qualified primary care physicians to receive the greater of the Medicare rate or Medicaid rate for a specified set of “primary care” current procedural terminology (CPT) procedure codes.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3167C on July 5, 2017. This amendment was also Adopted and Filed Emergency and published as ARC 3160C on the same date and became effective July 1, 2017. The Department received no comments during the public comment period. This amendment is identical to that published under Notice of Intended Action and Adopted and Filed Emergency.    The Council on Human Services adopted this amendment on August 9, 2017.    This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    This amendment is intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(1).    This amendment will become effective October 4, 2017, at which time the Adopted and Filed Emergency amendment is hereby rescinded.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(2), the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” and Chapter 80, “Procedure and Method of Payment,” Iowa Administrative Code.    These amendments implement the cost-containment strategy to ensure that total reimbursement for Medicare Part A and Part B crossover claims is limited to the Medicaid reimbursement rate.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3163C on July 5, 2017. These amendments were also Adopted and Filed Emergency and published as ARC 3159C on the same date and became effective July 1, 2017.    The Department received comments from seven respondents during the public comment period. The comments from the respondents and responses to the comments from the Department are as follows:     Comment 1: Six respondents asked that the Department exempt behavioral health services from this policy change. Two of the respondents also specifically requested to exempt community mental health centers (CMHCs).    Department response 1: The Department was unable to make changes to these amendments based on the comments of the respondents. These amendments are required by 2017 Iowa Acts, House File (HF) 653, enacted during the 87th Session of the Iowa General Assembly. The enacted legislation does not exempt behavioral health services or CMHCs.    Comment 2: One respondent did not believe the proposed effective date aligns with the language approved by the Legislature in HF 653.     Department response 2: The Department was unable to make changes to these amendments based on the comment of the respondent. The effective date of the Adopted and Filed Emergency amendments is July 1, 2017, and must be approved by the Centers for Medicare and Medicaid Services (CMS).    Comment 3: A respondent noted that the Department’s informational letter states that “Iowa Medicaid will calculate the Medicaid fee at 50 percent of the Medicare allowed amount for the [noncovered] service.” The respondent is seeking additional information about the 50 percent rate selection made by the Department.     Department response 3: The Department was unable to make changes to these amendments based on the comment of the respondent. The 50 percent rate is similar to how other state Medicaid agencies calculate a Medicaid allowed amount for noncovered Medicaid services.     Comment 4: One respondent requested clarification as to whether affected providers are allowed to bill the client the amount that will no longer be paid by Medicaid.    Department response 4: The Department was unable to make changes to these amendments based on the comment of the respondent. Section 4714 of the Balanced Budget Act of 1997 bars Medicare providers from billing a qualified Medicare beneficiary (QMB) under any circumstances. Medicare providers must accept the Medicare payment and Medicaid payment (if any) as payment in full for services rendered to a QMB.     Comment 5: A respondent commented that federal authority allows state Medicaid programs the option to use “lesser of” payment policies to pay for the patient liabilities for dual eligible, as it is proposed in this amended rule and that states, however, can choose the service types to which they apply these policies and are not obligated to apply them across the board and that other states have chosen this option.    Department response 5: The Department was unable to make changes to these amendments based on the comment of the respondent. The 50 percent rate applies across the board, similar to other states.     Technical change to the amendments: In the process of reviewing these amendments, the Department determined that a technical change to these amendments was necessary to ensure that the Department differentiates the processes for “fee-for-service” members and “managed care” members. Accordingly, paragraph 80.2(2)“h” in Item 2 has been rescinded and a new paragraph adopted in its place, and a new paragraph 80.2(2)“i” in Item 3 has been added.    New paragraph 80.2(2)“h” reads as follows:     “h. For fee-for-service members, providers billing claims for Medicare beneficiaries that do not cross over electronically to the Iowa Medicaid enterprise must submit the following electronically, in accordance with the All Providers, IV. Billing Iowa Medicaid manual, located at http://dhs.iowa.gov/sites/default/files/All-IV.pdf:     “(1) Form UB-04.    “(2) Form CMS-1500. The Explanation of Medicare Benefits (EOMB) is only required when requested by the Iowa Medicaid enterprise.”    New paragraph 80.2(2)“i” reads as follows:    “i. For managed care members, providers billing claims for Medicare beneficiaries that do not cross over electronically must submit the following electronically:    “(1) Form UB-04 and the Explanation of Medicare Benefits (EOMB); and    “(2) Form CMS-1500 and the Explanation of Medicare Benefits (EOMB).”    The Council on Human Services adopted these amendments on August 9, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be requested under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(2).    These amendments will become effective October 4, 2017, at which time the Adopted and Filed Emergency amendments are hereby rescinded.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 906.3, the Board of Parole hereby amends Chapter 2, “Agency Procedure for Rule Making,” Chapter 3, “Petitions for Rule Making,” Chapter 4, “Declaratory Orders,” Chapter 5, “Fair Information Practices,” Chapter 6, “Public Communications and Records,” Chapter 7, “Victim Notification,” Chapter 8, “Parole and Work Release Considerations,” Chapter 10, “Parole and Work Release Supervision,” Chapter 11, “Parole Revocation,” Chapter 14, “Executive Clemency,” Chapter 15, “Appeal of Decisions,” and Chapter 16, “Waiver and Variance Rules,” Iowa Administrative Code.    All of the agency’s rules were reviewed as part of the comprehensive five-year review required under Iowa Code section 17A.7. These adopted amendments are designed to eliminate outdated or redundant rules, as well as eliminate any rules that are inconsistent or incompatible with statutes or other rules. The adopted amendments also reflect changes to conform the rules to current, more efficient practices.    The adopted amendments to Chapters 2, 3, 4, and 16 are nonsubstantive corrections to change the title of the designated official from “Executive Director” to “Chairperson.”    The adopted amendments to Chapters 5, 6, and 7 reflect updated communication methods and changes to interview proceedings.    The adopted amendments to Chapters 8 and 14 are necessary to bring the rules into conformity with recent changes in the law regarding juveniles serving life sentences. The amendments also update the rules to reflect that hearings are now conducted via videoconferencing and that neither the Board, victims, nor spectators are present at the correctional institutions during the interviews. After reviewing public comment, subrule 8.6(4) was revised so as to reduce the number of inmates excepted from the annual review requirement.     The adopted amendments to Chapter 11 are designed to make the revocation hearing process more efficient while ensuring that parolees receive due process. The amendments reflect the Board’s current practice of utilizing the Iowa Corrections Offender Network (ICON) for submitting reports rather than using the mail. Many of the changes were a result of a collaborative effort with the Department of Corrections, Community-Based Corrections, and the Iowa State Sheriffs’ and Deputies’ Association.    The adopted amendments to Chapter 15 are designed to clarify the appeals process, as well as to eliminate redundant rules.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3117C on June 21, 2017. A public hearing was held on July 11, 2017, at the Board of Parole, 510 East 12th Street, Des Moines, Iowa, and written comments were accepted through July 11, 2017. The Board received one comment during the public comment period. There are several changes from the amendments published under Notice of Intended Action. One change, in subrule 8.6(4), is in response to the public comment. The subrule was revised so as to reduce the number of inmates excepted from the annual review requirement. The other changes, in subrule 7.6(5), paragraph 8.14(3)“f,” and subparagraph 8.14(4)“h”(2), involve nonsubstantive, grammatical changes that do not impact the meaning of the rules.     After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapters 17A, 904A, 906, 908, and 915.    These amendments will become effective on October 4, 2017.     The following amendments are adopted.