House File 841
PAG LIN
1 1 HOUSE FILE 841
1 2
1 3 AN ACT
1 4 RELATING TO HEALTH CARE REFORM, INCLUDING PROVISIONS RELATING
1 5 TO THE MEDICAL ASSISTANCE PROGRAM, PROVIDING APPROPRIATIONS,
1 6 PROVIDING EFFECTIVE DATES, AND PROVIDING FOR RETROACTIVE
1 7 APPLICABILITY.
1 8
1 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 10
1 11 DIVISION I
1 12 IOWACARE
1 13 Section 1. NEW SECTION. 249J.1 TITLE.
1 14 This chapter shall be known and may be cited as the
1 15 "Iowacare Act".
1 16 Sec. 2. NEW SECTION. 249J.2 FEDERAL FINANCIAL
1 17 PARTICIPATION == CONTINGENT IMPLEMENTATION.
1 18 This chapter shall be implemented only to the extent that
1 19 federal matching funds are available for nonfederal
1 20 expenditures under this chapter. The department shall not
1 21 expend funds under this chapter, including but not limited to
1 22 expenditures for reimbursement of providers and program
1 23 administration, if appropriated nonfederal funds are not
1 24 matched by federal financial participation.
1 25 Sec. 3. NEW SECTION. 249J.3 DEFINITIONS.
1 26 As used in this chapter, unless the context otherwise
1 27 requires:
1 28 1. "Clean claim" means a claim submitted by a provider
1 29 included in the expansion population provider network that may
1 30 be adjudicated as paid or denied.
1 31 2. "Department" means the department of human services.
1 32 3. "Director" means the director of human services.
1 33 4. "Expansion population" means the individuals who are
1 34 eligible solely for benefits under the medical assistance
1 35 program waiver as provided in this chapter.
2 1 5. "Full benefit dually eligible Medicare Part D
2 2 beneficiary" means a person who is eligible for coverage for
2 3 Medicare Part D drugs and is simultaneously eligible for full
2 4 medical assistance benefits pursuant to chapter 249A, under
2 5 any category of eligibility.
2 6 6. "Full benefit recipient" means an adult who is eligible
2 7 for full medical assistance benefits pursuant to chapter 249A
2 8 under any category of eligibility.
2 9 7. "Iowa Medicaid enterprise" means the centralized
2 10 medical assistance program infrastructure, based on a business
2 11 enterprise model, and designed to foster collaboration among
2 12 all program stakeholders by focusing on quality, integrity,
2 13 and consistency.
2 14 8. "Medical assistance" or "Medicaid" means payment of all
2 15 or part of the costs of care and services provided to an
2 16 individual pursuant to chapter 249A and Title XIX of the
2 17 federal Social Security Act.
2 18 9. "Medicare Part D" means the Medicare Part D program
2 19 established pursuant to the Medicare Prescription Drug,
2 20 Improvement, and Modernization Act of 2003, Pub. L. No. 108=
2 21 173.
2 22 10. "Minimum data set" means the minimum data set
2 23 established by the centers for Medicare and Medicaid services
2 24 of the United States department of health and human services
2 25 for nursing home resident assessment and care screening.
2 26 11. "Nursing facility" means a nursing facility as defined
2 27 in section 135C.1.
2 28 12. "Public hospital" means a hospital licensed pursuant
2 29 to chapter 135B and governed pursuant to chapter 145A, 226,
2 30 347, 347A, or 392.
2 31 Sec. 4. NEW SECTION. 249J.4 PURPOSE.
2 32 It is the purpose of this chapter to propose a variety of
2 33 initiatives to increase the efficiency, quality, and
2 34 effectiveness of the health care system; to increase access to
2 35 appropriate health care; to provide incentives to consumers to
3 1 engage in responsible health care utilization and personal
3 2 health care management; to reward providers based on quality
3 3 of care and improved service delivery; and to encourage the
3 4 utilization of information technology, to the greatest extent
3 5 possible, to reduce fragmentation and increase coordination of
3 6 care and quality outcomes.
3 7 DIVISION II
3 8 MEDICAID EXPANSION
3 9 Sec. 5. NEW SECTION. 249J.5 EXPANSION POPULATION
3 10 ELIGIBILITY.
3 11 1. Except as otherwise provided in this chapter, an
3 12 individual nineteen through sixty=four years of age shall be
3 13 eligible solely for the expansion population benefits
3 14 described in this chapter when provided through the expansion
3 15 population provider network as described in this chapter, if
3 16 the individual meets all of the following conditions:
3 17 a. The individual is not eligible for coverage under the
3 18 medical assistance program in effect on or after April 1,
3 19 2005.
3 20 b. The individual has a family income at or below two
3 21 hundred percent of the federal poverty level as defined by the
3 22 most recently revised poverty income guidelines published by
3 23 the United States department of health and human services.
3 24 c. The individual fulfills all other conditions of
3 25 participation for the expansion population described in this
3 26 chapter, including requirements relating to personal financial
3 27 responsibility.
3 28 2. Individuals otherwise eligible solely for family
3 29 planning benefits authorized under the medical assistance
3 30 family planning services waiver, effective January 1, 2005, as
3 31 described in 2004 Iowa Acts, chapter 1175, section 116,
3 32 subsection 8, may also be eligible for expansion population
3 33 benefits provided through the expansion population provider
3 34 network.
3 35 3. Individuals with family incomes below three hundred
4 1 percent of the federal poverty level as defined by the most
4 2 recently revised poverty income guidelines published by the
4 3 United States department of health and human services shall
4 4 also be eligible for obstetrical and newborn care under the
4 5 expansion population if deductions for the medical expenses of
4 6 all family members would reduce the family income to two
4 7 hundred percent of the federal poverty level or below. Such
4 8 individuals shall be eligible for the same benefits as those
4 9 provided to individuals eligible under section 135.152.
4 10 Eligible individuals may choose to receive the appropriate
4 11 level of care at any licensed hospital or health care
4 12 facility, with the exception of individuals in need of such
4 13 care residing in the counties of Cedar, Clinton, Iowa,
4 14 Johnson, Keokuk, Louisa, Muscatine, Scott, and Washington, who
4 15 shall be provided care at the university of Iowa hospitals and
4 16 clinics.
4 17 4. Enrollment for the expansion population may be limited,
4 18 closed, or reduced and the scope and duration of expansion
4 19 population services provided may be limited, reduced, or
4 20 terminated if the department determines that federal medical
4 21 assistance program matching funds or appropriated state funds
4 22 will not be available to pay for existing or additional
4 23 enrollment.
4 24 5. Eligibility for the expansion population shall not
4 25 include individuals who have access to group health insurance,
4 26 unless the reason for not accessing group health insurance is
4 27 allowed by rule of the department.
4 28 6. Each expansion population member shall provide to the
4 29 department all insurance information required by the health
4 30 insurance premium payment program.
4 31 7. The department shall contract with the county general
4 32 assistance directors to perform intake functions for the
4 33 expansion population, but only at the discretion of the
4 34 individual county general assistance director.
4 35 8. If the department provides intake services at the
5 1 location of a provider included in the expansion population
5 2 provider network, the department shall consider subcontracting
5 3 with local nonprofit agencies to promote greater understanding
5 4 between providers, under the medical assistance program and
5 5 included in the expansion population provider network, and
5 6 their recipients and members.
5 7 Sec. 6. NEW SECTION. 249J.6 EXPANSION POPULATION
5 8 BENEFITS.
5 9 1. Beginning July 1, 2005, the expansion population shall
5 10 be eligible for all of the following expansion population
5 11 services:
5 12 a. Inpatient hospital procedures described in the
5 13 diagnostic related group codes or other applicable inpatient
5 14 hospital reimbursement methods designated by the department.
5 15 b. Outpatient hospital services described in the
5 16 ambulatory patient groupings or noninpatient services
5 17 designated by the department.
5 18 c. Physician and advanced registered nurse practitioner
5 19 services described in the current procedural terminology codes
5 20 specified by the department.
5 21 d. Dental services described in the dental codes specified
5 22 by the department.
5 23 e. Limited pharmacy benefits provided by an expansion
5 24 population provider network hospital pharmacy and solely
5 25 related to an appropriately billed expansion population
5 26 service.
5 27 f. Transportation to and from an expansion population
5 28 provider network provider only if the provider offers such
5 29 transportation services or the transportation is provided by a
5 30 volunteer.
5 31 2. a. Beginning no later than March 1, 2006, within
5 32 ninety days of enrollment in the expansion population, each
5 33 expansion population member shall participate, in conjunction
5 34 with receiving a single comprehensive medical examination and
5 35 completing a personal health improvement plan, in a health
6 1 risk assessment coordinated by a health consortium
6 2 representing providers, consumers, and medical education
6 3 institutions. An expansion population member who enrolls in
6 4 the expansion population prior to March 1, 2006, shall
6 5 participate in the health risk assessment, receive the single
6 6 comprehensive medical examination, and complete the personal
6 7 health improvement plan by June 1, 2006. The criteria for the
6 8 health risk assessment, the comprehensive medical examination
6 9 and the personal health improvement plan shall be developed
6 10 and applied in a manner that takes into consideration cultural
6 11 variations that may exist within the expansion population.
6 12 b. The health risk assessment shall be a web=based
6 13 electronic system capable of capturing and integrating basic
6 14 data to provide an individualized personal health improvement
6 15 plan for each expansion population member. The health risk
6 16 assessment shall provide a preliminary diagnosis of current
6 17 and prospective health conditions and recommendations for
6 18 improving health conditions with an individualized wellness
6 19 program. The health risk assessment shall be made available
6 20 to the expansion population member and the provider specified
6 21 in paragraph "c" who performs the comprehensive medical
6 22 examination and provides the individualized personal health
6 23 improvement plan.
6 24 c. The single comprehensive medical examination and
6 25 personal health improvement plan may be provided by an
6 26 expansion population provider network physician, advanced
6 27 registered nurse practitioner, or physician assistant or any
6 28 other physician, advanced registered nurse practitioner, or
6 29 physician assistant, available to any full benefit recipient
6 30 including but not limited to such providers available through
6 31 a free clinic or rural health clinic under a contract with the
6 32 department to provide these services, through federally
6 33 qualified health centers that employ a physician, or through
6 34 any other nonprofit agency qualified or deemed to be qualified
6 35 by the department to perform these services.
7 1 3. Beginning no later than July 1, 2006, expansion
7 2 population members shall be provided all of the following:
7 3 a. Access to a pharmacy assistance clearinghouse program
7 4 to match expansion population members with free or discounted
7 5 prescription drug programs provided by the pharmaceutical
7 6 industry.
7 7 b. Access to a medical information hotline, accessible
7 8 twenty=four hours per day, seven days per week, to assist
7 9 expansion population members in making appropriate choices
7 10 about the use of emergency room and other health care
7 11 services.
7 12 4. Membership in the expansion population shall not
7 13 preclude an expansion population member from eligibility for
7 14 services not covered under the expansion population for which
7 15 the expansion population member is otherwise entitled under
7 16 state or federal law.
7 17 5. Members of the expansion population shall not be
7 18 considered full benefit dually eligible Medicare Part D
7 19 beneficiaries for the purposes of calculating the state's
7 20 payment under Medicare Part D, until such time as the
7 21 expansion population is eligible for all of the same benefits
7 22 as full benefit recipients under the medical assistance
7 23 program.
7 24 Sec. 7. NEW SECTION. 249J.7 EXPANSION POPULATION
7 25 PROVIDER NETWORK.
7 26 1. Expansion population members shall only be eligible to
7 27 receive expansion population services through a provider
7 28 included in the expansion population provider network. Except
7 29 as otherwise provided in this chapter, the expansion
7 30 population provider network shall be limited to a publicly
7 31 owned acute care teaching hospital located in a county with a
7 32 population over three hundred fifty thousand, the university
7 33 of Iowa hospitals and clinics, and the state hospitals for
7 34 persons with mental illness designated pursuant to section
7 35 226.1 with the exception of the programs at such state
8 1 hospitals for persons with mental illness that provide
8 2 substance abuse treatment, serve gero=psychiatric patients, or
8 3 treat sexually violent predators.
8 4 2. Expansion population services provided to expansion
8 5 population members by providers included in the expansion
8 6 population provider network shall be payable at the full
8 7 benefit recipient rates.
8 8 3. Providers included in the expansion population provider
8 9 network shall submit clean claims within twenty days of the
8 10 date of provision of an expansion population service to an
8 11 expansion population member.
8 12 4. Unless otherwise prohibited by law, a provider under
8 13 the expansion population provider network may deny care to an
8 14 individual who refuses to apply for coverage under the
8 15 expansion population.
8 16 5. Notwithstanding the provision of section 347.16,
8 17 subsection 2, requiring the provision of free care and
8 18 treatment to the persons described in that subsection, the
8 19 publicly owned acute care teaching hospital described in
8 20 subsection 1 may require any sick or injured person seeking
8 21 care or treatment at that hospital to be subject to financial
8 22 participation, including but not limited to copayments or
8 23 premiums, and may deny nonemergent care or treatment to any
8 24 person who refuses to be subject to such financial
8 25 participation.
8 26 Sec. 8. NEW SECTION. 249J.8 EXPANSION POPULATION MEMBERS
8 27 == FINANCIAL PARTICIPATION.
8 28 1. Beginning July 1, 2005, each expansion population
8 29 member whose family income equals or exceeds one hundred
8 30 percent of the federal poverty level as defined by the most
8 31 recently revised poverty income guidelines published by the
8 32 United States department of health and human services shall
8 33 pay a monthly premium not to exceed one=twelfth of five
8 34 percent of the member's annual family income, and each
8 35 expansion population member whose family income is less than
9 1 one hundred percent of the federal poverty level as defined by
9 2 the most recently revised poverty income guidelines published
9 3 by the United States department of health and human services
9 4 shall pay a monthly premium not to exceed one=twelfth of two
9 5 percent of the member's annual family income. All premiums
9 6 shall be paid on the last day of the month of coverage. The
9 7 department shall deduct the amount of any monthly premiums
9 8 paid by an expansion population member for benefits under the
9 9 healthy and well kids in Iowa program when computing the
9 10 amount of monthly premiums owed under this subsection. An
9 11 expansion population member shall pay the monthly premium
9 12 during the entire period of the member's enrollment. However,
9 13 regardless of the length of enrollment, the member is subject
9 14 to payment of the premium for a minimum of four consecutive
9 15 months. Timely payment of premiums, including any arrearages
9 16 accrued from prior enrollment, is a condition of receiving any
9 17 expansion population services. Premiums collected under this
9 18 subsection shall be deposited in the premiums subaccount of
9 19 the account for health care transformation created pursuant to
9 20 section 249J.22. An expansion population member shall also
9 21 pay the same copayments required of other adult recipients of
9 22 medical assistance.
9 23 2. The department may reduce the required out=of=pocket
9 24 expenditures for an individual expansion population member
9 25 based upon the member's increased wellness activities such as
9 26 smoking cessation or compliance with the personal health
9 27 improvement plan completed by the member. The department
9 28 shall also waive the required out=of=pocket expenditures for
9 29 an individual expansion population member based upon a
9 30 hardship that would accrue from imposing such required
9 31 expenditures.
9 32 3. The department shall submit to the governor and the
9 33 general assembly by March 15, 2006, a design for each of the
9 34 following:
9 35 a. An insurance cost subsidy program for expansion
10 1 population members who have access to employer health
10 2 insurance plans, provided that the design shall require that
10 3 no less than fifty percent of the cost of such insurance shall
10 4 be paid by the employer.
10 5 b. A health care account program option for individuals
10 6 eligible for enrollment in the expansion population. The
10 7 health care account program option shall be available only to
10 8 adults who have been enrolled in the expansion population for
10 9 at least twelve consecutive calendar months. Under the health
10 10 care account program option, the individual would agree to
10 11 exchange one year's receipt of benefits under the expansion
10 12 population, to which the individual would otherwise be
10 13 entitled, for a credit to obtain any medical assistance
10 14 program covered service up to a specified amount. The balance
10 15 in the health care account at the end of the year, if any,
10 16 would be available for withdrawal by the individual.
10 17 4. The department shall track the impact of the out=of=
10 18 pocket expenditures on patient enrollment and shall report the
10 19 findings on at least a quarterly basis to the medical
10 20 assistance projections and assessment council established
10 21 pursuant to section 249J.19. The findings shall include
10 22 estimates of the number of expansion population members
10 23 complying with payment of required out=of=pocket expenditures,
10 24 the number of expansion population members not complying with
10 25 payment of required out=of=pocket expenditures and the reasons
10 26 for noncompliance, any impact as a result of the out=of=pocket
10 27 requirements on the provision of services to the populations
10 28 previously served, the administrative time and cost associated
10 29 with administering the out=of=pocket requirements, and the
10 30 benefit to the state resulting from the out=of=pocket
10 31 expenditures. To the extent possible, the department shall
10 32 track the income level of the member, the health condition of
10 33 the member, and the family status of the member relative to
10 34 the out=of=pocket information.
10 35 Sec. 9. NEW SECTION. 249J.9 FUTURE EXPANSION POPULATION,
11 1 BENEFITS, AND PROVIDER NETWORK GROWTH.
11 2 1. POPULATION. The department shall contract with the
11 3 division of insurance of the department of commerce or another
11 4 appropriate entity to track, on an annual basis, the number of
11 5 uninsured and underinsured Iowans, the cost of private market
11 6 insurance coverage, and other barriers to access to private
11 7 insurance for Iowans. Based on these findings and available
11 8 funds, the department shall make recommendations, annually, to
11 9 the governor and the general assembly regarding further
11 10 expansion of the expansion population.
11 11 2. BENEFITS.
11 12 a. The department shall not provide services to expansion
11 13 population members that are in addition to the services
11 14 originally designated by the department pursuant to section
11 15 249J.6, without express authorization provided by the general
11 16 assembly.
11 17 b. The department, upon the recommendation of the
11 18 clinicians advisory panel established pursuant to section
11 19 249J.17, may change the scope and duration of any of the
11 20 available expansion population services, but this subsection
11 21 shall not be construed to authorize the department to make
11 22 expenditures in excess of the amount appropriated for benefits
11 23 for the expansion population.
11 24 3. EXPANSION POPULATION PROVIDER NETWORK.
11 25 a. The department shall not expand the expansion
11 26 population provider network unless the department is able to
11 27 pay for expansion population services provided by such
11 28 providers at the full benefit recipient rates.
11 29 b. The department may limit access to the expansion
11 30 population provider network by the expansion population to the
11 31 extent the department deems necessary to meet the financial
11 32 obligations to each provider under the expansion population
11 33 provider network. This subsection shall not be construed to
11 34 authorize the department to make any expenditure in excess of
11 35 the amount appropriated for benefits for the expansion
12 1 population.
12 2 Sec. 10. NEW SECTION. 249J.10 MAXIMIZATION OF FUNDING
12 3 FOR INDIGENT PATIENTS.
12 4 1. Unencumbered certified local matching funds may be used
12 5 to cover the state share of the cost of services for the
12 6 expansion population.
12 7 2. The department of human services shall include in its
12 8 annual budget submission, recommendations relating to a
12 9 disproportionate share hospital and graduate medical education
12 10 allocation plan that maximizes the availability of federal
12 11 funds for payments to hospitals for the care and treatment of
12 12 indigent patients.
12 13 3. If state and federal law and regulations so provide and
12 14 if federal disproportionate share hospital funds and graduate
12 15 medical education funds are available under Title XIX of the
12 16 federal Social Security Act, federal disproportionate share
12 17 hospital funds and graduate medical education funds shall be
12 18 distributed as specified by the department.
12 19 DIVISION III
12 20 REBALANCING LONG=TERM CARE
12 21 Sec. 11. NEW SECTION. 249J.11 NURSING FACILITY LEVEL OF
12 22 CARE DETERMINATION FOR FACILITY=BASED AND COMMUNITY=BASED
12 23 SERVICES.
12 24 The department shall amend the medical assistance state
12 25 plan to provide for all of the following:
12 26 1. That nursing facility level of care services under the
12 27 medical assistance program shall be available to an individual
12 28 admitted to a nursing facility on or after July 1, 2005, who
12 29 meets eligibility criteria for the medical assistance program
12 30 pursuant to section 249A.3, if the individual also meets any
12 31 of the following criteria:
12 32 a. Based upon the minimum data set, the individual
12 33 requires limited assistance, extensive assistance, or has
12 34 total dependence on assistance, provided by the physical
12 35 assistance of one or more persons, with three or more
13 1 activities of daily living as defined by the minimum data set,
13 2 section G, entitled "physical functioning and structural
13 3 problems".
13 4 b. Based on the minimum data set, the individual requires
13 5 the establishment of a safe, secure environment due to
13 6 moderate or severe impairment of cognitive skills for daily
13 7 decision making.
13 8 c. The individual has established a dependency requiring
13 9 residency in a medical institution for more than one year.
13 10 2. That an individual admitted to a nursing facility prior
13 11 to July 1, 2005, and an individual applying for home and
13 12 community=based services waiver services at the nursing
13 13 facility level of care on or after July 1, 2005, who meets the
13 14 eligibility criteria for the medical assistance program
13 15 pursuant to section 249A.3, shall also meet any of the
13 16 following criteria:
13 17 a. Based on the minimum data set, the individual requires
13 18 supervision, or limited assistance, provided on a daily basis
13 19 by the physical assistance of at least one person, for
13 20 dressing and personal hygiene activities of daily living as
13 21 defined by the minimum data set, section G, entitled "physical
13 22 functioning and structural problems".
13 23 b. Based on the minimum data set, the individual requires
13 24 the establishment of a safe, secure environment due to
13 25 modified independence or moderate impairment of cognitive
13 26 skills for daily decision making.
13 27 3. That, beginning July 1, 2005, if nursing facility level
13 28 of care is determined to be medically necessary for an
13 29 individual and the individual meets the nursing facility level
13 30 of care requirements for home and community=based services
13 31 waiver services under subsection 2, but appropriate home and
13 32 community=based services are not available to the individual
13 33 in the individual's community at the time of the determination
13 34 or the provision of available home and community=based
13 35 services to meet the skilled care requirements of the
14 1 individual is not cost=effective, the criteria for admission
14 2 of the individual to a nursing facility for nursing facility
14 3 level of care services shall be the criteria in effect on June
14 4 30, 2005. The department of human services shall establish
14 5 the standard for determining cost=effectiveness of home and
14 6 community=based services under this subsection.
14 7 4. The department shall develop a process to allow
14 8 individuals identified under subsection 3 to be served under
14 9 the home and community=based services waiver at such time as
14 10 appropriate home and community=based services become available
14 11 in the individual's community.
14 12 Sec. 12. NEW SECTION. 249J.12 SERVICES FOR PERSONS WITH
14 13 MENTAL RETARDATION OR DEVELOPMENTAL DISABILITIES.
14 14 1. The department, in cooperation with the Iowa state
14 15 association of counties, the Iowa association of community
14 16 providers, the governor's developmental disabilities council,
14 17 and other interested parties, shall develop a plan for a case=
14 18 mix adjusted reimbursement system under the medical assistance
14 19 program for both institution=based and community=based
14 20 services for persons with mental retardation or developmental
14 21 disabilities for submission to the general assembly by January
14 22 1, 2007. The department shall not implement the case=mix
14 23 adjusted reimbursement system plan without express
14 24 authorization by the general assembly.
14 25 2. The department, in consultation with the Iowa state
14 26 association of counties, the Iowa association of community
14 27 providers, the governor's developmental disabilities council,
14 28 and other interested parties, shall develop a plan for
14 29 submission to the governor and the general assembly no later
14 30 than July 1, 2007, to enhance alternatives for community=based
14 31 care for individuals who would otherwise require care in an
14 32 intermediate care facility for persons with mental
14 33 retardation. The plan shall not be implemented without
14 34 express authorization by the general assembly.
14 35 Sec. 13. NEW SECTION. 249J.13 CHILDREN'S MENTAL HEALTH
15 1 WAIVER SERVICES.
15 2 The department shall provide medical assistance waiver
15 3 services to not more than three hundred children who meet the
15 4 eligibility criteria for the medical assistance program
15 5 pursuant to section 249A.3, and also meet the criteria
15 6 specified in section 234.7, subsection 2, if enacted in the
15 7 2005 legislative session.
15 8 Sec. 14. CASE MANAGEMENT FOR THE FRAIL ELDERLY.
15 9 1. The department of human services shall submit an
15 10 amendment to the home and community=based services waiver for
15 11 the elderly to the centers for Medicare and Medicaid services
15 12 of the United States department of health and human services
15 13 to provide for inclusion of case management as a medical
15 14 assistance covered service. The department of human services
15 15 shall develop the amendment in collaboration with the
15 16 department of elder affairs.
15 17 2. If the request for an amendment to the waiver is
15 18 approved, the department of elder affairs shall use existing
15 19 funding for case management as nonfederal matching funds. The
15 20 department of elder affairs, in collaboration with the
15 21 department of human services, shall determine the amount of
15 22 existing funding that would be eligible for use as nonfederal
15 23 matching funds so that sufficient funding is retained to also
15 24 provide case management services for frail elders who are not
15 25 eligible for the medical assistance program.
15 26 3. The department of human services, in collaboration with
15 27 the department of elder affairs, shall establish a
15 28 reimbursement rate for case management for the frail elderly
15 29 such that the amount of state funding necessary to pay for
15 30 such case management does not exceed the amount appropriated
15 31 to the department of elder affairs for case management for the
15 32 frail elderly in the fiscal year beginning July 1, 2005. Any
15 33 state savings realized from including case management under
15 34 the home and community=based services waiver for the elderly
15 35 shall be used for services for the frail elderly and for
16 1 substitute decision=making services to eligible individuals
16 2 pursuant to chapter 231E, if enacted by the Eighty=first
16 3 General Assembly.
16 4 4. The department of human services, in collaboration with
16 5 the department of elder affairs, shall determine whether case
16 6 management for the frail elderly should continue to be
16 7 provided through a sole source contract or if a request for
16 8 proposals process should be initiated to provide the services.
16 9 The departments shall submit their recommendations to the
16 10 general assembly by January 1, 2006.
16 11 DIVISION IV
16 12 HEALTH PROMOTION PARTNERSHIPS
16 13 Sec. 15. NEW SECTION. 249J.14 HEALTH PROMOTION
16 14 PARTNERSHIPS.
16 15 1. SERVICES FOR ADULTS AT STATE MENTAL HEALTH INSTITUTES.
16 16 Beginning July 1, 2005, inpatient and outpatient hospital
16 17 services at the state hospitals for persons with mental
16 18 illness designated pursuant to section 226.1 shall be covered
16 19 services under the medical assistance program.
16 20 2. DIETARY COUNSELING. By July 1, 2006, the department
16 21 shall design and begin implementation of a strategy to provide
16 22 dietary counseling and support to child and adult recipients
16 23 of medical assistance and to expansion population members to
16 24 assist these recipients and members in avoiding excessive
16 25 weight gain or loss and to assist in development of personal
16 26 weight loss programs for recipients and members determined by
16 27 the recipient's or member's health care provider to be
16 28 clinically overweight.
16 29 3. ELECTRONIC MEDICAL RECORDS. By October 1, 2006, the
16 30 department shall develop a practical strategy for expanding
16 31 utilization of electronic medical recordkeeping by providers
16 32 under the medical assistance program and the expansion
16 33 population provider network. The plan shall focus, initially,
16 34 on medical assistance program recipients and expansion
16 35 population members whose quality of care would be
17 1 significantly enhanced by the availability of electronic
17 2 medical recordkeeping.
17 3 4. PROVIDER INCENTIVE PAYMENT PROGRAMS. By January 1,
17 4 2007, the department shall design and implement a provider
17 5 incentive payment program for providers under the medical
17 6 assistance program and providers included in the expansion
17 7 population provider network based upon evaluation of public
17 8 and private sector models.
17 9 5. HEALTH ASSESSMENT FOR MEDICAL ASSISTANCE RECIPIENTS
17 10 WITH MENTAL RETARDATION OR DEVELOPMENTAL DISABILITIES. The
17 11 department shall work with the university of Iowa colleges of
17 12 medicine, dentistry, nursing, pharmacy, and public health, and
17 13 the university of Iowa hospitals and clinics to determine
17 14 whether the physical and dental health of recipients of
17 15 medical assistance who are persons with mental retardation or
17 16 developmental disabilities are being regularly and fully
17 17 addressed and to identify barriers to such care. The
17 18 department shall report the department's findings to the
17 19 governor and the general assembly by January 1, 2007.
17 20 6. SMOKING CESSATION. The department, in collaboration
17 21 with Iowa department of public health programs relating to
17 22 tobacco use prevention and cessation, shall implement a
17 23 program with the goal of reducing smoking among recipients of
17 24 medical assistance who are children to less than one percent
17 25 and among recipients of medical assistance and expansion
17 26 population members who are adults to less than ten percent, by
17 27 July 1, 2007.
17 28 7. DENTAL HOME FOR CHILDREN. By July 1, 2008, every
17 29 recipient of medical assistance who is a child twelve years of
17 30 age or younger shall have a designated dental home and shall
17 31 be provided with the dental screenings and preventive care
17 32 identified in the oral health standards under the early and
17 33 periodic screening, diagnostic, and treatment program.
17 34 8. REPORTS. The department shall report on a quarterly
17 35 basis to the medical assistance projections and assessment
18 1 council established pursuant to section 249J.19 and the
18 2 council created pursuant to section 249A.4, subsection 8,
18 3 regarding the health promotion partnerships described in this
18 4 section. To the greatest extent feasible, and if applicable
18 5 to a data set, the data reported shall include demographic
18 6 information concerning the population served including but not
18 7 limited to factors, such as race and economic status, as
18 8 specified by the department.
18 9 Sec. 16. NEW SECTION. 249J.14A TASK FORCE ON INDIGENT
18 10 CARE.
18 11 1. The department shall convene a task force on indigent
18 12 care to identify any growth in uncompensated care due to the
18 13 implementation of this chapter and to identify any local funds
18 14 that are being used to pay for uncompensated care that could
18 15 be maximized through a match with federal funds.
18 16 2. Any public, governmental or nongovernmental, private,
18 17 for=profit, or not=for=profit health services provider or
18 18 payor, whether or not enrolled in the medical assistance
18 19 program, and any organization of such providers or payors, may
18 20 become a member of the task force. Membership on the task
18 21 force shall require that an entity agree to provide accurate,
18 22 written information and data relating to each of the following
18 23 items for the fiscal year of the entity ending on or before
18 24 June 30, 2005, and for each fiscal year thereafter during
18 25 which the entity is a member:
18 26 a. The definition of indigent care used by the member for
18 27 purposes of reporting the data described in this subsection.
18 28 b. The actual cost of indigent care as determined under
18 29 Medicare principles of accounting or any accounting standard
18 30 used by the member to report the member's financial status to
18 31 its governing body, owner, members, creditors, or the public.
18 32 c. The usual and customary charge that would otherwise be
18 33 applied by the member to the indigent care provided.
18 34 d. The number of individuals and the age, sex, and county
18 35 of residence of the individuals receiving indigent care
19 1 reported by the member and a description of the care provided.
19 2 e. To the extent practical, the health status of the
19 3 individuals receiving the indigent care reported by the
19 4 member.
19 5 f. The funding source of payment for the indigent care
19 6 including revenue from property tax or other tax revenue,
19 7 local funding, and other sources.
19 8 g. The extent to which any part of the cost of indigent
19 9 care reported by the member was paid for by the individual on
19 10 a sliding fee scale or other basis, by an insurer, or by
19 11 another third=party payor.
19 12 h. The means by which the member covered any of the costs
19 13 of indigent care not covered by those sources described in
19 14 paragraph "g".
19 15 3. The department shall convene the task force for a
19 16 minimum of eight meetings during the fiscal year beginning
19 17 July 1, 2005, and during each fiscal year thereafter. For the
19 18 fiscal year beginning July 1, 2005, the department shall
19 19 convene at least six of the required meetings prior to March
19 20 1, 2006. The meetings shall be held in geographically
19 21 balanced venues throughout the state that are representative
19 22 of distinct rural, urban, and suburban areas.
19 23 4. The department shall provide the medical assistance
19 24 projections and assessment council created pursuant to section
19 25 249J.19 with all of the following, at intervals established by
19 26 the council:
19 27 a. A list of the members of the task force.
19 28 b. A copy of each member's written submissions of data and
19 29 information to the task force.
19 30 c. A copy of the data submitted by each member.
19 31 d. Any observations or recommendations of the task force
19 32 regarding the data.
19 33 e. Any observations and recommendations of the department
19 34 regarding the data.
19 35 5. The task force shall transmit an initial, preliminary
20 1 report of its efforts and findings to the governor and the
20 2 general assembly by March 1, 2006. The task force shall
20 3 submit an annual report to the governor and the general
20 4 assembly by December 31 of each year.
20 5 6. The department shall, to the extent practical, assist
20 6 task force members in assembling and reporting the data
20 7 required of members, by programming the department's systems
20 8 to accept, but not pay, claims reported on standard medical
20 9 assistance claims forms for the indigent care provided by the
20 10 members.
20 11 7. All meetings of the task force shall comply with
20 12 chapter 21.
20 13 8. Information and data provided by a member to the task
20 14 force shall be protected to the extent required under the
20 15 federal Health Insurance Portability and Accountability Act of
20 16 1996.
20 17 9. The department shall inform the members of the task
20 18 force that costs associated with the work of the task force
20 19 and with the required activities of members may not be
20 20 eligible for federal matching funds.
20 21 DIVISION V
20 22 IOWA MEDICAID ENTERPRISE
20 23 Sec. 17. NEW SECTION. 249J.15 COST AND QUALITY
20 24 PERFORMANCE EVALUATION.
20 25 Beginning July 1, 2005, the department shall contract with
20 26 an independent consulting firm to do all of the following:
20 27 1. Annually evaluate and compare the cost and quality of
20 28 care provided by the medical assistance program and through
20 29 the expansion population with the cost and quality of care
20 30 available through private insurance and managed care
20 31 organizations doing business in the state.
20 32 2. Annually evaluate the improvements by the medical
20 33 assistance program and the expansion population in the cost
20 34 and quality of services provided to Iowans over the cost and
20 35 quality of care provided in the prior year.
21 1 Sec. 18. NEW SECTION. 249J.16 OPERATIONS == PERFORMANCE
21 2 EVALUATION.
21 3 Beginning July 1, 2006, the department shall submit a
21 4 report of the results of an evaluation of the performance of
21 5 each component of the Iowa Medicaid enterprise using the
21 6 performance standards contained in the contracts with the Iowa
21 7 Medicaid enterprise partners.
21 8 Sec. 19. NEW SECTION. 249J.17 CLINICIANS ADVISORY PANEL
21 9 == CLINICAL MANAGEMENT.
21 10 1. Beginning July 1, 2005, the medical director of the
21 11 Iowa Medicaid enterprise, with the approval of the
21 12 administrator of the division of medical services of the
21 13 department, shall assemble and act as chairperson for a
21 14 clinicians advisory panel to recommend to the department
21 15 clinically appropriate health care utilization management and
21 16 coverage decisions for the medical assistance program and the
21 17 expansion population which are not otherwise addressed by the
21 18 Iowa medical assistance drug utilization review commission
21 19 created pursuant to section 249A.24 or the medical assistance
21 20 pharmaceutical and therapeutics committee established pursuant
21 21 to section 249A.20A. The meetings shall be conducted in
21 22 accordance with chapter 21 and shall be open to the public
21 23 except to the extent necessary to prevent the disclosure of
21 24 confidential medical information.
21 25 2. The medical director of the Iowa Medicaid enterprise
21 26 shall report on a quarterly basis to the medical assistance
21 27 projections and assessment council established pursuant to
21 28 section 249J.19 and the council created pursuant to section
21 29 249A.4, subsection 8, any recommendations made by the panel
21 30 and adopted by rule of the department pursuant to chapter 17A
21 31 regarding clinically appropriate health care utilization
21 32 management and coverage under the medical assistance program
21 33 and the expansion population.
21 34 3. The medical director of the Iowa Medicaid enterprise
21 35 shall prepare an annual report summarizing the recommendations
22 1 made by the panel and adopted by rule of the department
22 2 regarding clinically appropriate health care utilization
22 3 management and coverage under the medical assistance program
22 4 and the expansion population.
22 5 Sec. 20. NEW SECTION. 249J.18 HEALTH CARE SERVICES
22 6 PRICING AND REIMBURSEMENT OF PROVIDERS.
22 7 The department shall annually collect data on third=party
22 8 payor rates in the state and, as appropriate, the usual and
22 9 customary charges of health care providers, including the
22 10 reimbursement rates paid to providers and by third=party
22 11 payors participating in the medical assistance program and
22 12 through the expansion population. The department shall
22 13 consult with the division of insurance of the department of
22 14 commerce in adopting administrative rules specifying the
22 15 reporting format and guaranteeing the confidentiality of the
22 16 information provided by the providers and third=party payors.
22 17 The department shall review the data and make recommendations
22 18 to the governor and the general assembly regarding pricing
22 19 changes and reimbursement rates annually by January 1. Any
22 20 recommended pricing changes or changes in reimbursement rates
22 21 shall not be implemented without express authorization by the
22 22 general assembly.
22 23 DIVISION VI
22 24 GOVERNANCE
22 25 Sec. 21. NEW SECTION. 249J.19 MEDICAL ASSISTANCE
22 26 PROJECTIONS AND ASSESSMENT COUNCIL.
22 27 1. A medical assistance projections and assessment council
22 28 is created consisting of the following members:
22 29 a. The co=chairpersons and ranking members of the
22 30 legislative joint appropriations subcommittee on health and
22 31 human services, or a member of the appropriations subcommittee
22 32 designated by the co=chairperson or ranking member.
22 33 b. The chairpersons and ranking members of the human
22 34 resources committees of the senate and the house of
22 35 representatives, or a member of the committee designated by
23 1 the chairperson or ranking member.
23 2 c. The chairpersons and ranking members of the
23 3 appropriations committees of the senate and the house of
23 4 representatives, or a member of the committee designated by
23 5 the chairperson or ranking member.
23 6 2. The council shall meet as often as deemed necessary,
23 7 but shall meet at least quarterly. The council may use
23 8 sources of information deemed appropriate, and the department
23 9 and other agencies of state government shall provide
23 10 information to the council as requested. The legislative
23 11 services agency shall provide staff support to the council.
23 12 3. The council shall select a chairperson, annually, from
23 13 its membership. A majority of the members of the council
23 14 shall constitute a quorum.
23 15 4. The council shall do all of the following:
23 16 a. Make quarterly cost projections for the medical
23 17 assistance program and the expansion population.
23 18 b. Review quarterly reports on all initiatives under this
23 19 chapter, including those provisions in the design,
23 20 development, and implementation phases, and make additional
23 21 recommendations for medical assistance program and expansion
23 22 population reform on an annual basis.
23 23 c. Review annual audited financial statements relating to
23 24 the expansion population submitted by the providers included
23 25 in the expansion population provider network.
23 26 d. Review quarterly reports on the success of the Iowa
23 27 Medicaid enterprise based upon the contractual performance
23 28 measures for each Iowa Medicaid enterprise partner.
23 29 e. Assure that the expansion population is managed at all
23 30 times within funding limitations. In assuring such
23 31 compliance, the council shall assume that supplemental funding
23 32 will not be available for coverage of services provided to the
23 33 expansion population.
23 34 5. The department of human services, the department of
23 35 management, and the legislative services agency shall utilize
24 1 a joint process to arrive at an annual consensus projection
24 2 for medical assistance program and expansion population
24 3 expenditures for submission to the council. By December 15 of
24 4 each fiscal year, the council shall agree to a projection of
24 5 expenditures for the fiscal year beginning the following July
24 6 1, based upon the consensus projection submitted.
24 7 DIVISION VII
24 8 ENHANCING THE FEDERAL=STATE FINANCIAL PARTNERSHIP
24 9 Sec. 22. NEW SECTION. 249J.20 PAYMENTS TO HEALTH CARE
24 10 PROVIDERS BASED ON ACTUAL COSTS.
24 11 Payments, including graduate medical education payments,
24 12 under the medical assistance program and the expansion
24 13 population to each public hospital and each public nursing
24 14 facility shall not exceed the actual medical assistance costs
24 15 of each such facility reported on the Medicare hospital and
24 16 hospital health care complex cost report submitted to the
24 17 centers for Medicare and Medicaid services of the United
24 18 States department of health and human services. Each public
24 19 hospital and each public nursing facility shall retain one
24 20 hundred percent of the medical assistance payments earned
24 21 under state reimbursement rules. State reimbursement rules
24 22 may provide for reimbursement at less than actual cost.
24 23 Sec. 23. NEW SECTION. 249J.21 INDEPENDENT ANNUAL AUDIT.
24 24 The department shall contract with a certified public
24 25 accountant to provide an analysis, on an annual basis, to the
24 26 governor and the general assembly regarding compliance of the
24 27 Iowa medical assistance program with each of the following:
24 28 1. That the state has not instituted any new provider
24 29 taxes as defined by the centers for Medicare and Medicaid
24 30 services of the United States department of health and human
24 31 services.
24 32 2. That public hospitals and public nursing facilities are
24 33 not paid more than the actual costs of care for medical
24 34 assistance program and disproportionate share hospital program
24 35 recipients based upon Medicare program principles of
25 1 accounting and cost reporting.
25 2 3. That the state is not recycling federal funds provided
25 3 under Title XIX of the Social Security Act as defined by the
25 4 centers for Medicare and Medicaid services of the United
25 5 States department of health and human services.
25 6 Sec. 24. NEW SECTION. 249J.22 ACCOUNT FOR HEALTH CARE
25 7 TRANSFORMATION.
25 8 1. An account for health care transformation is created in
25 9 the state treasury under the authority of the department.
25 10 Moneys received through the physician payment adjustment as
25 11 described in 2003 Iowa Acts, chapter 112, section 11,
25 12 subsection 1, and through the adjustment to hospital payments
25 13 to provide an increased base rate to offset the high costs
25 14 incurred for providing services to medical assistance patients
25 15 as described in 2004 Iowa Acts, chapter 1175, section 86,
25 16 subsection 2, paragraph "b", shall be deposited in the
25 17 account. The account shall include a separate premiums
25 18 subaccount. Revenue generated through payment of premiums by
25 19 expansion population members as required pursuant to section
25 20 249J.8 shall be deposited in the separate premiums subaccount
25 21 within the account.
25 22 2. Moneys in the account shall be separate from the
25 23 general fund of the state and shall not be considered part of
25 24 the general fund of the state. The moneys deposited in the
25 25 account are not subject to section 8.33 and shall not be
25 26 transferred, used, obligated, appropriated, or otherwise
25 27 encumbered, except to provide for the purposes specified in
25 28 this section. Notwithstanding section 12C.7, subsection 2,
25 29 interest or earnings on moneys deposited in the account shall
25 30 be credited to the account.
25 31 3. Moneys deposited in the account for health care
25 32 transformation shall be used only as provided in
25 33 appropriations from the account for the costs associated with
25 34 certain services provided to the expansion population pursuant
25 35 to section 249J.6, certain initiatives to be designed pursuant
26 1 to section 249J.8, the case=mix adjusted reimbursement system
26 2 for persons with mental retardation or developmental
26 3 disabilities pursuant to section 249J.12, certain health
26 4 promotion partnership activities pursuant to section 249J.14,
26 5 the cost and quality performance evaluation pursuant to
26 6 section 249J.15, auditing requirements pursuant to section
26 7 249J.21, the provision of additional indigent patient care and
26 8 treatment, and administrative costs associated with this
26 9 chapter.
26 10 Sec. 25. NEW SECTION. 249J.23 IOWACARE ACCOUNT.
26 11 1. An Iowacare account is created in the state treasury
26 12 under the authority of the department of human services.
26 13 Moneys appropriated from the general fund of the state to the
26 14 account, moneys received as federal financial participation
26 15 funds under the expansion population provisions of this
26 16 chapter and credited to the account, moneys received for
26 17 disproportionate share hospitals and credited to the account,
26 18 moneys received for graduate medical education and credited to
26 19 the account, proceeds transferred from the county treasurer as
26 20 specified in subsection 6, and moneys from any other source
26 21 credited to the account shall be deposited in the account.
26 22 Moneys deposited in or credited to the account shall be used
26 23 only as provided in appropriations or distributions from the
26 24 account for the purposes specified in the appropriation or
26 25 distribution. Moneys in the account shall be appropriated to
26 26 the university of Iowa hospitals and clinics, to a publicly
26 27 owned acute care teaching hospital located in a county with a
26 28 population over three hundred fifty thousand, and to the state
26 29 hospitals for persons with mental illness designated pursuant
26 30 to section 226.1 for the purposes provided in the federal law
26 31 making the funds available or as specified in the state
26 32 appropriation and shall be distributed as determined by the
26 33 department.
26 34 2. The account shall be separate from the general fund of
26 35 the state and shall not be considered part of the general fund
27 1 of the state. The moneys in the account shall not be
27 2 considered revenue of the state, but rather shall be funds of
27 3 the account. The moneys in the account are not subject to
27 4 section 8.33 and shall not be transferred, used, obligated,
27 5 appropriated, or otherwise encumbered, except to provide for
27 6 the purposes of this chapter. Notwithstanding section 12C.7,
27 7 subsection 2, interest or earnings on moneys deposited in the
27 8 account shall be credited to the account.
27 9 3. The department shall adopt rules pursuant to chapter
27 10 17A to administer the account.
27 11 4. The treasurer of state shall provide a quarterly report
27 12 of activities and balances of the account to the director.
27 13 5. Notwithstanding section 262.28 or any provision of this
27 14 chapter to the contrary, payments to be made to participating
27 15 public hospitals under this section shall be made on a
27 16 prospective basis in twelve equal monthly installments based
27 17 upon the amount appropriated or allocated, as applicable to a
27 18 specific public hospital, in a specific fiscal year. After
27 19 the close of the fiscal year, the department shall determine
27 20 the amount of the payments attributable to the state general
27 21 fund, federal financial participation funds collected for
27 22 expansion population services, graduate medical education
27 23 funds, and disproportionate share hospital funds, based on
27 24 claims data and actual expenditures.
27 25 6. Notwithstanding any provision to the contrary, from
27 26 each semiannual collection of taxes levied under section 347.7
27 27 for which the collection is performed after July 1, 2005, the
27 28 county treasurer of a county with a population over three
27 29 hundred fifty thousand in which a publicly owned acute care
27 30 teaching hospital is located shall transfer the proceeds
27 31 collected pursuant to section 347.7 in a total amount of
27 32 thirty=four million dollars annually, which would otherwise be
27 33 distributed to the county hospital, to the treasurer of state
27 34 for deposit in the Iowacare account under this section. The
27 35 board of trustees of the acute care teaching hospital
28 1 identified in this subsection and the department shall execute
28 2 an agreement under chapter 28E by July 1, 2005, and annually
28 3 by July 1, thereafter, to specify the requirements relative to
28 4 transfer of the proceeds and the distribution of moneys to the
28 5 hospital from the Iowacare account. The agreement shall
28 6 include provisions relating to exceptions to the deadline for
28 7 submission of clean claims as required pursuant to section
28 8 249J.7 and provisions relating to data reporting requirements
28 9 regarding the expansion population. The agreement may also
28 10 include a provision allowing such hospital to limit access to
28 11 such hospital by expansion population members based on
28 12 residency of the member, if such provision reflects the policy
28 13 of such hospital regarding indigent patients existing on April
28 14 1, 2005, as adopted by its board of hospital trustees pursuant
28 15 to section 347.14, subsection 4. Notwithstanding the
28 16 specified amount of proceeds to be transferred under this
28 17 subsection, if the amount allocated that does not require
28 18 federal matching funds under an appropriation in a subsequent
28 19 fiscal year to such hospital for medical and surgical
28 20 treatment of indigent patients, for provision of services to
28 21 expansion population members, and for medical education, is
28 22 reduced from the amount allocated that does not require
28 23 federal matching funds under the appropriation for the fiscal
28 24 year beginning July 1, 2005, the amount of proceeds required
28 25 to be transferred under this subsection in that subsequent
28 26 fiscal year shall be reduced in the same amount as the amount
28 27 allocated that does not require federal matching funds under
28 28 that appropriation.
28 29 7. The state board of regents, on behalf of the university
28 30 of Iowa hospitals and clinics, and the department shall
28 31 execute an agreement under chapter 28E by July 1, 2005, and
28 32 annually by July 1, thereafter, to specify the requirements
28 33 relating to distribution of moneys to the hospital from the
28 34 Iowacare account. The agreement shall include provisions
28 35 relating to exceptions to the deadline for submission of clean
29 1 claims as required pursuant to section 249J.7 and provisions
29 2 relating to data reporting requirements regarding the
29 3 expansion population.
29 4 8. The state and any county utilizing the acute care
29 5 teaching hospital located in a county with a population over
29 6 three hundred fifty thousand for mental health services prior
29 7 to July 1, 2005, shall annually enter into an agreement with
29 8 such hospital to pay a per diem amount that is not less than
29 9 the per diem amount paid for those mental health services in
29 10 effect for the fiscal year beginning July 1, 2004, for each
29 11 individual including each expansion population member
29 12 accessing mental health services at that hospital on or after
29 13 July 1, 2005. Any payment made under such agreement for an
29 14 expansion population member pursuant to this chapter, shall be
29 15 considered by the department to be payment by a third=party
29 16 payor.
29 17 DIVISION VIII
29 18 LIMITATIONS
29 19 Sec. 26. NEW SECTION. 249J.24 LIMITATIONS.
29 20 1. The provisions of this chapter shall not be construed,
29 21 are not intended as, and shall not imply a grant of
29 22 entitlement for services to individuals who are eligible for
29 23 assistance under this chapter or for utilization of services
29 24 that do not exist or are not otherwise available on the
29 25 effective date of this Act. Any state obligation to provide
29 26 services pursuant to this chapter is limited to the extent of
29 27 the funds appropriated or distributed for the purposes of this
29 28 chapter.
29 29 2. The provisions of this chapter shall not be construed
29 30 and are not intended to affect the provision of services to
29 31 recipients of medical assistance existing on the effective
29 32 date of this Act.
29 33 Sec. 27. NEW SECTION. 249J.25 AUDIT == FUTURE REPEAL.
29 34 1. The state auditor shall complete an audit of the
29 35 provisions implemented pursuant to this chapter during the
30 1 fiscal year beginning July 1, 2009, and shall submit the
30 2 results of the audit to the governor and the general assembly
30 3 by January 1, 2010.
30 4 2. This chapter is repealed June 30, 2010.
30 5 Sec. 28. IMPLEMENTATION COSTS. Payment of any one=time
30 6 costs specifically associated with the implementation of
30 7 chapter 249J, as enacted in this Act, shall be made in the
30 8 manner specified by, and at the discretion of, the department.
30 9 DIVISION IX
30 10 CORRESPONDING PROVISIONS
30 11 Sec. 29. Section 97B.52A, subsection 1, paragraph c, Code
30 12 2005, is amended to read as follows:
30 13 c. For a member whose first month of entitlement is July
30 14 2000 or later, the member does not return to any employment
30 15 with a covered employer until the member has qualified for at
30 16 least one calendar month of retirement benefits, and the
30 17 member does not return to covered employment until the member
30 18 has qualified for no fewer than four calendar months of
30 19 retirement benefits. For purposes of this paragraph,
30 20 effective July 1, 2000, any employment with a covered employer
30 21 does not include employment as an elective official or member
30 22 of the general assembly if the member is not covered under
30 23 this chapter for that employment. For purposes of determining
30 24 a bona fide retirement under this paragraph and for a member
30 25 whose first month of entitlement is July 2004 or later, but
30 26 before July 2006, covered employment does not include
30 27 employment as a licensed health care professional by a public
30 28 hospital as defined in section 249I.3 249J.3, with the
30 29 exception of public hospitals governed pursuant to chapter
30 30 226.
30 31 Sec. 30. Section 218.78, subsection 1, Code 2005, is
30 32 amended to read as follows:
30 33 1. All institutional receipts of the department of human
30 34 services, including funds received from client participation
30 35 at the state resource centers under section 222.78 and at the
31 1 state mental health institutes under section 230.20, shall be
31 2 deposited in the general fund except for reimbursements for
31 3 services provided to another institution or state agency, for
31 4 receipts deposited in the revolving farm fund under section
31 5 904.706, for deposits into the medical assistance fund under
31 6 section 249A.11, for any deposits into the medical assistance
31 7 fund of any medical assistance payments received through the
31 8 expansion population program pursuant to chapter 249J, and
31 9 rentals charged to employees or others for room, apartment, or
31 10 house and meals, which shall be available to the institutions.
31 11 Sec. 31. Section 230.20, subsection 2, paragraph a, Code
31 12 2005, is amended to read as follows:
31 13 a. The superintendent shall certify to the department the
31 14 billings to each county for services provided to patients
31 15 chargeable to the county during the preceding calendar
31 16 quarter. The county billings shall be based on the average
31 17 daily patient charge and other service charges computed
31 18 pursuant to subsection 1, and the number of inpatient days and
31 19 other service units chargeable to the county. However, a
31 20 county billing shall be decreased by an amount equal to
31 21 reimbursement by a third party payor or estimation of such
31 22 reimbursement from a claim submitted by the superintendent to
31 23 the third party payor for the preceding calendar quarter.
31 24 When the actual third party payor reimbursement is greater or
31 25 less than estimated, the difference shall be reflected in the
31 26 county billing in the calendar quarter the actual third party
31 27 payor reimbursement is determined. For the purposes of this
31 28 paragraph, "third=party payor reimbursement" does not include
31 29 reimbursement provided under chapter 249J.
31 30 Sec. 32. Section 230.20, subsections 5 and 6, Code 2005,
31 31 are amended to read as follows:
31 32 5. An individual statement shall be prepared for a patient
31 33 on or before the fifteenth day of the month following the
31 34 month in which the patient leaves the mental health institute,
31 35 and a general statement shall be prepared at least quarterly
32 1 for each county to which charges are made under this section.
32 2 Except as otherwise required by sections 125.33 and 125.34 the
32 3 general statement shall list the name of each patient
32 4 chargeable to that county who was served by the mental health
32 5 institute during the preceding month or calendar quarter, the
32 6 amount due on account of each patient, and the specific dates
32 7 for which any third party payor reimbursement received by the
32 8 state is applied to the statement and billing, and the county
32 9 shall be billed for eighty percent of the stated charge for
32 10 each patient specified in this subsection. For the purposes
32 11 of this subsection, "third=party payor reimbursement" does not
32 12 include reimbursement provided under chapter 249J. The
32 13 statement prepared for each county shall be certified by the
32 14 department and a duplicate statement shall be mailed to the
32 15 auditor of that county.
32 16 6. All or any reasonable portion of the charges incurred
32 17 for services provided to a patient, to the most recent date
32 18 for which the charges have been computed, may be paid at any
32 19 time by the patient or by any other person on the patient's
32 20 behalf. Any payment so made by the patient or other person,
32 21 and any federal financial assistance received pursuant to
32 22 Title XVIII or XIX of the federal Social Security Act for
32 23 services rendered to a patient, shall be credited against the
32 24 patient's account and, if the charges so paid as described in
32 25 this subsection have previously been billed to a county,
32 26 reflected in the mental health institute's next general
32 27 statement to that county. However, any payment made under
32 28 chapter 249J shall not be reflected in the mental health
32 29 institute's next general statement to that county.
32 30 Sec. 33. Section 249A.11, Code 2005, is amended to read as
32 31 follows:
32 32 249A.11 PAYMENT FOR PATIENT CARE SEGREGATED.
32 33 A state resource center or mental health institute, upon
32 34 receipt of any payment made under this chapter for the care of
32 35 any patient, shall segregate an amount equal to that portion
33 1 of the payment which is required by law to be made from
33 2 nonfederal funds except for any nonfederal funds received
33 3 through the expansion population program pursuant to chapter
33 4 249J which shall be deposited in the Iowacare account created
33 5 pursuant to section 249J.23. The money segregated shall be
33 6 deposited in the medical assistance fund of the department of
33 7 human services.
33 8 Sec. 34. Section 249H.4, Code 2005, is amended by adding
33 9 the following new subsection:
33 10 NEW SUBSECTION. 7. The director shall amend the medical
33 11 assistance state plan to eliminate the mechanism to secure
33 12 funds based on skilled nursing facility prospective payment
33 13 methodologies under the medical assistance program and to
33 14 terminate agreements entered into with public nursing
33 15 facilities under this chapter, effective June 30, 2005.
33 16 Sec. 35. 2004 Iowa Acts, chapter 1175, section 86,
33 17 subsection 2, paragraph b, unnumbered paragraph 2, and
33 18 subparagraphs (1), (2), and (3), are amended to read as
33 19 follows:
33 20 Of the amount appropriated in this lettered paragraph,
33 21 $25,950,166 shall be considered encumbered and shall not be
33 22 expended for any purpose until January 1, 2005.
33 23 (1) However, if If the department of human services
33 24 adjusts hospital payments to provide an increased base rate to
33 25 offset the high cost incurred for providing services to
33 26 medical assistance patients on or prior to January July 1,
33 27 2005, a portion of the amount specified in this unnumbered
33 28 paragraph equal to the increased Medicaid payment shall revert
33 29 to the general fund of the state. Notwithstanding section
33 30 8.54, subsection 7, the amount required to revert under this
33 31 subparagraph shall not be considered to be appropriated for
33 32 purposes of the state general fund expenditure limitation for
33 33 the fiscal year beginning July 1, 2004.
33 34 (2) If the adjustment described in subparagraph (1) to
33 35 increase the base rate is not made prior to January 1, 2005,
34 1 the amount specified in this unnumbered paragraph shall no
34 2 longer be considered encumbered, may be expended, and shall be
34 3 available for the purposes originally specified be transferred
34 4 by the university of Iowa hospitals and clinics to the medical
34 5 assistance fund of the department of human services. Of the
34 6 amount transferred, an amount equal to the federal share of
34 7 the payments shall be transferred to the account for health
34 8 care transformation created in section 249J.22.
34 9 (3) (2) Any incremental increase in the base rate made
34 10 pursuant to subparagraph (1) shall not be used in determining
34 11 the university of Iowa hospital and clinics disproportionate
34 12 share rate or when determining the statewide average base rate
34 13 for purposes of calculating indirect medical education rates.
34 14 Sec. 36. 2003 Iowa Acts, chapter 112, section 11,
34 15 subsection 1, is amended to read as follows:
34 16 1. For the fiscal year years beginning July 1, 2003, and
34 17 ending June 30, 2004, and beginning July 1, 2004, and for each
34 18 fiscal year thereafter ending June 30, 2005, the department of
34 19 human services shall institute a supplemental payment
34 20 adjustment applicable to physician services provided to
34 21 medical assistance recipients at publicly owned acute care
34 22 teaching hospitals. The adjustment shall generate
34 23 supplemental payments to physicians which are equal to the
34 24 difference between the physician's charge and the physician's
34 25 fee schedule under the medical assistance program. To the
34 26 extent of the supplemental payments, a qualifying hospital
34 27 shall, after receipt of the payments, transfer to the
34 28 department of human services an amount equal to the actual
34 29 supplemental payments that were made in that month. The
34 30 department of human services shall deposit these payments in
34 31 the department's medical assistance account. The department
34 32 of human services shall amend the medical assistance state
34 33 plan as necessary to implement this section. The department
34 34 may adopt emergency rules to implement this section. The
34 35 department of human services shall amend the medical
35 1 assistance state plan to eliminate this provision effective
35 2 June 30, 2005.
35 3 Sec. 37. TRANSITION FROM INSTITUTIONAL SETTINGS TO HOME
35 4 AND COMMUNITY=BASED SERVICES. The department, in consultation
35 5 with provider and consumer organizations, shall explore
35 6 additional opportunities under the medical assistance program
35 7 to assist individuals in transitioning from institutional
35 8 settings to home and community=based services. The department
35 9 shall report any opportunities identified to the governor and
35 10 the general assembly by December 31, 2005.
35 11 Sec. 38. CORRESPONDING DIRECTIVES TO DEPARTMENT. The
35 12 department shall do all of the following:
35 13 1. Withdraw the request for the waiver and the medical
35 14 assistance state plan amendment submitted to the centers for
35 15 Medicare and Medicaid services of the United States department
35 16 of health and human services regarding the nursing facility
35 17 quality assurance assessment as directed pursuant to 2003 Iowa
35 18 Acts, chapter 112, section 4, 2003 Iowa Acts, chapter 179,
35 19 section 162, and 2004 Iowa Acts, chapter 1085, sections 8, 10,
35 20 and 11.
35 21 2. Amend the medical assistance state plan to eliminate
35 22 the mechanism to secure funds based on hospital inpatient and
35 23 outpatient prospective payment methodologies under the medical
35 24 assistance program, effective June 30, 2005.
35 25 3. Amend the medical assistance state plan to eliminate
35 26 the mechanisms to receive supplemental disproportionate share
35 27 hospital and graduate medical education funds as originally
35 28 submitted, effective June 30, 2005.
35 29 4. Amend the medical assistance state plan amendment to
35 30 adjust hospital payments to provide an increased base rate to
35 31 offset the high cost incurred for providing services to
35 32 medical assistance patients at the university of Iowa
35 33 hospitals and clinics as originally submitted based upon the
35 34 specifications of 2004 Iowa Acts, chapter 1175, section 86,
35 35 subsection 2, paragraph "b", unnumbered paragraph 2, and
36 1 subparagraphs (1), (2), and (3), to be approved for the fiscal
36 2 year beginning July 1, 2004, and ending June 30, 2005, only,
36 3 and to be eliminated June 30, 2005.
36 4 5. Amend the medical assistance state plan amendment to
36 5 establish a physician payment adjustment from the university
36 6 of Iowa hospitals and clinics, as originally submitted as
36 7 described in 2003 Iowa Acts, chapter 112, section 11,
36 8 subsection 1, to be approved for the state fiscal years
36 9 beginning July 1, 2003, and ending June 30, 2004, and
36 10 beginning July 1, 2004, and ending June 30, 2005, and to be
36 11 eliminated effective June 30, 2005.
36 12 6. Amend the medical assistance state plan to eliminate
36 13 the mechanism to secure funds based on skilled nursing
36 14 facility prospective payment methodologies under the medical
36 15 assistance program, effective June 30, 2005.
36 16 7. Request a waiver from the centers for Medicare and
36 17 Medicaid services of the United States department of health
36 18 and human services of the provisions relating to the early and
36 19 periodic screening, diagnostic, and treatment program
36 20 requirements as described in section 1905(a)(5) of the federal
36 21 Social Security Act relative to the expansion population.
36 22 Sec. 39. Chapter 249I, Code 2005, is repealed.
36 23 Sec. 40. Sections 249A.20B and 249A.34, Code 2005, are
36 24 repealed.
36 25 Sec. 41. 2003 Iowa Acts, chapter 112, section 4, 2003 Iowa
36 26 Acts, chapter 179, section 162, and 2004 Iowa Acts, chapter
36 27 1085, section 8, and section 10, subsection 5, are repealed.
36 28 DIVISION X
36 29 PHARMACY COPAYMENTS
36 30 Sec. 42. COPAYMENTS FOR PRESCRIPTION DRUGS UNDER THE
36 31 MEDICAL ASSISTANCE PROGRAM. The department of human services
36 32 shall require recipients of medical assistance to pay the
36 33 following copayments on each prescription filled for a covered
36 34 prescription drug, including each refill of such prescription,
36 35 as follows:
37 1 1. A copayment of $1 for each covered nonpreferred generic
37 2 prescription drug.
37 3 2. A copayment of $1 for each covered preferred brand=
37 4 name or generic prescription drug.
37 5 3. A copayment of $1 for each covered nonpreferred brand=
37 6 name prescription drug for which the cost to the state is up
37 7 to and including $25.
37 8 4. A copayment of $2 for each covered nonpreferred brand=
37 9 name prescription drug for which the cost to the state is more
37 10 than $25 and up to and including $50.
37 11 5. A copayment of $3 for each covered nonpreferred brand=
37 12 name prescription drug for which the cost to the state is more
37 13 than $50.
37 14 DIVISION XI
37 15 MEDICAL AND SURGICAL TREATMENT OF INDIGENT PERSONS
37 16 AND OBSTETRICAL AND NEWBORN INDIGENT PATIENT CARE
37 17 Sec. 43. NEW SECTION. 135.152 STATEWIDE OBSTETRICAL AND
37 18 NEWBORN INDIGENT PATIENT CARE PROGRAM.
37 19 1. The department shall establish a statewide obstetrical
37 20 and newborn indigent patient care program to provide
37 21 obstetrical and newborn care to medically indigent residents
37 22 of this state at the appropriate and necessary level, at a
37 23 licensed hospital or health care facility closest and most
37 24 available to the residence of the indigent individual.
37 25 2. The department shall administer the program, and
37 26 appropriations by the general assembly for the program shall
37 27 be allocated to the obstetrical and newborn patient care fund
37 28 within the department to be utilized for the obstetrical and
37 29 newborn indigent patient care program.
37 30 3. The department shall adopt administrative rules
37 31 pursuant to chapter 17A to administer the program.
37 32 4. The department shall establish a patient quota formula
37 33 for determining the maximum number of obstetrical and newborn
37 34 patients eligible for the program, annually, from each county.
37 35 The formula used shall be based upon the annual appropriation
38 1 for the program, the average number of live births in each
38 2 county for the most recent three=year period, and the per
38 3 capita income for each county for the most recent year. The
38 4 formula shall also provide for reassignment of an unused
38 5 county quota allotment on April 1 of each year.
38 6 5. a. The department, in collaboration with the
38 7 department of human services and the Iowa state association of
38 8 counties, shall adopt rules pursuant to chapter 17A to
38 9 establish minimum standards for eligibility for obstetrical
38 10 and newborn care, including physician examinations, medical
38 11 testing, ambulance services, and inpatient transportation
38 12 services under the program. The minimum standards shall
38 13 provide that the individual is not otherwise eligible for
38 14 assistance under the medical assistance program or for
38 15 assistance under the medically needy program without a spend=
38 16 down requirement pursuant to chapter 249A, or for expansion
38 17 population benefits pursuant to chapter 249J. If the
38 18 individual is eligible for assistance pursuant to chapter 249A
38 19 or 249J, or if the individual is eligible for maternal and
38 20 child health care services covered by a maternal and child
38 21 health program, the obstetrical and newborn indigent patient
38 22 care program shall not provide the assistance, care, or
38 23 covered services provided under the other program.
38 24 b. The minimum standards for eligibility shall provide
38 25 eligibility for persons with family incomes at or below one
38 26 hundred eighty=five percent of the federal poverty level as
38 27 defined by the most recently revised poverty income guidelines
38 28 published by the United States department of health and human
38 29 services, and shall provide, but shall not be limited to
38 30 providing, eligibility for uninsured and underinsured persons
38 31 financially unable to pay for necessary obstetrical and
38 32 newborn care. The minimum standards may include a spend=down
38 33 provision. The resource standards shall be set at or above
38 34 the resource standards under the federal supplemental security
38 35 income program. The resource exclusions allowed under the
39 1 federal supplemental security income program shall be allowed
39 2 and shall include resources necessary for self=employment.
39 3 c. The department in cooperation with the department of
39 4 human services, shall develop a standardized application form
39 5 for the program and shall coordinate the determination of
39 6 eligibility for the medical assistance and medically needy
39 7 programs under chapter 249A, the medical assistance expansion
39 8 under chapter 249J, and the obstetrical and newborn indigent
39 9 patient care program.
39 10 6. The department shall establish application procedures
39 11 and procedures for certification of an individual for
39 12 obstetrical and newborn care under this section.
39 13 7. An individual certified for obstetrical and newborn
39 14 care under this division may choose to receive the appropriate
39 15 level of care at any licensed hospital or health care
39 16 facility.
39 17 8. The obstetrical and newborn care costs of an individual
39 18 certified for such care under this division at a licensed
39 19 hospital or health care facility or from licensed physicians
39 20 shall be paid by the department from the obstetrical and
39 21 newborn patient care fund.
39 22 9. All providers of services to obstetrical and newborn
39 23 patients under this division shall agree to accept as full
39 24 payment the reimbursements allowable under the medical
39 25 assistance program established pursuant to chapter 249A,
39 26 adjusted for intensity of care.
39 27 10. The department shall establish procedures for payment
39 28 for providers of services to obstetrical and newborn patients
39 29 under this division from the obstetrical and newborn patient
39 30 care fund. All billings from such providers shall be
39 31 submitted directly to the department. However, payment shall
39 32 not be made unless the requirements for application and
39 33 certification for care pursuant to this division and rules
39 34 adopted by the department are met.
39 35 11. Moneys encumbered prior to June 30 of a fiscal year
40 1 for a certified eligible pregnant woman scheduled to deliver
40 2 in the next fiscal year shall not revert from the obstetrical
40 3 and newborn patient care fund to the general fund of the
40 4 state. Moneys allocated to the obstetrical and newborn
40 5 patient care fund shall not be transferred nor voluntarily
40 6 reverted from the fund within a given fiscal year.
40 7 Sec. 44. Section 135B.31, Code 2005, is amended to read as
40 8 follows:
40 9 135B.31 EXCEPTIONS.
40 10 Nothing in this This division is not intended or should and
40 11 shall not affect in any way that the obligation of public
40 12 hospitals under chapter 347 or municipal hospitals, as well as
40 13 the state hospital at Iowa City, to provide medical or
40 14 obstetrical and newborn care for indigent persons under
40 15 chapter 255 or 255A, wherein medical care or treatment is
40 16 provided by hospitals of that category to patients of certain
40 17 entitlement, nor to the operation by the state of mental or
40 18 other hospitals authorized by law. Nothing herein This
40 19 division shall not in any way affect or limit the practice of
40 20 dentistry or the practice of oral surgery by a dentist.
40 21 Sec. 45. Section 144.13A, subsection 3, Code 2005, is
40 22 amended to read as follows:
40 23 3. If the person responsible for the filing of the
40 24 certificate of birth under section 144.13 is not the parent,
40 25 the person is entitled to collect the fee from the parent.
40 26 The fee shall be remitted to the state registrar. If the
40 27 expenses of the birth are reimbursed under the medical
40 28 assistance program established by chapter 249A, or paid for
40 29 under the statewide indigent patient care program established
40 30 by chapter 255, or paid for under the obstetrical and newborn
40 31 indigent patient care program established by chapter 255A, or
40 32 if the parent is indigent and unable to pay the expenses of
40 33 the birth and no other means of payment is available to the
40 34 parent, the registration fee and certified copy fee are
40 35 waived. If the person responsible for the filing of the
41 1 certificate is not the parent, the person is discharged from
41 2 the duty to collect and remit the fee under this section if
41 3 the person has made a good faith effort to collect the fee
41 4 from the parent.
41 5 Sec. 46. Section 249A.4, subsection 12, Code 2005, is
41 6 amended by striking the subsection.
41 7 UNIVERSITY OF IOWA HOSPITALS AND CLINICS
41 8 Sec. 47. NEW SECTION. 263.18 TREATMENT OF PATIENTS ==
41 9 USE OF EARNINGS FOR NEW FACILITIES.
41 10 1. The university of Iowa hospitals and clinics
41 11 authorities may at their discretion receive patients into the
41 12 hospital for medical, obstetrical, or surgical treatment or
41 13 hospital care. The university of Iowa hospitals and clinics
41 14 ambulances and ambulance personnel may be used for the
41 15 transportation of such patients at a reasonable charge if
41 16 specialized equipment is required.
41 17 2. The university of Iowa hospitals and clinics
41 18 authorities shall collect from the person or persons liable
41 19 for support of such patients reasonable charges for hospital
41 20 care and service and deposit payment of the charges with the
41 21 treasurer of the university for the use and benefit of the
41 22 university of Iowa hospitals and clinics.
41 23 3. Earnings of the university of Iowa hospitals and
41 24 clinics shall be administered so as to increase, to the
41 25 greatest extent possible, the services available for patients,
41 26 including acquisition, construction, reconstruction,
41 27 completion, equipment, improvement, repair, and remodeling of
41 28 medical buildings and facilities, additions to medical
41 29 buildings and facilities, and the payment of principal and
41 30 interest on bonds issued to finance the cost of medical
41 31 buildings and facilities as authorized by the provisions of
41 32 chapter 263A.
41 33 4. The physicians and surgeons on the staff of the
41 34 university of Iowa hospitals and clinics who care for patients
41 35 provided for in this section may charge for the medical
42 1 services provided under such rules, regulations, and plans
42 2 approved by the state board of regents. However, a physician
42 3 or surgeon who provides treatment or care for an expansion
42 4 population member pursuant to chapter 249J shall not charge or
42 5 receive any compensation for the treatment or care except the
42 6 salary or compensation fixed by the state board of regents to
42 7 be paid from the hospital fund.
42 8 Sec. 48. NEW SECTION. 263.19 PURCHASES.
42 9 Any purchase in excess of ten thousand dollars, of
42 10 materials, appliances, instruments, or supplies by the
42 11 university of Iowa hospitals and clinics, when the price of
42 12 the materials, appliances, instruments, or supplies to be
42 13 purchased is subject to competition, shall be made pursuant to
42 14 open competitive quotations, and all contracts for such
42 15 purchases shall be subject to chapter 72. However, purchases
42 16 may be made through a hospital group purchasing organization
42 17 provided that the university of Iowa hospitals and clinics is
42 18 a member of the organization.
42 19 Sec. 49. NEW SECTION. 263.20 COLLECTING AND SETTLING
42 20 CLAIMS FOR CARE.
42 21 Whenever a patient or person legally liable for the
42 22 patient's care at the university of Iowa hospitals and clinics
42 23 has insurance, an estate, a right of action against others, or
42 24 other assets, the university of Iowa hospitals and clinics,
42 25 through the facilities of the office of the attorney general,
42 26 may file claims, institute or defend suit in court, and use
42 27 other legal means available to collect accounts incurred for
42 28 the care of the patient, and may compromise, settle, or
42 29 release such actions under the rules and procedures prescribed
42 30 by the president of the university and the office of the
42 31 attorney general. If a county has paid any part of such
42 32 patient's care, a pro rata amount collected, after deduction
42 33 for cost of collection, shall be remitted to the county and
42 34 the balance shall be credited to the hospital fund.
42 35 Sec. 50. NEW SECTION. 263.21 TRANSFER OF PATIENTS FROM
43 1 STATE INSTITUTIONS.
43 2 The director of the department of human services, in
43 3 respect to institutions under the director's control, the
43 4 administrator of any of the divisions of the department, in
43 5 respect to the institutions under the administrator's control,
43 6 the director of the department of corrections, in respect to
43 7 the institutions under the department's control, and the state
43 8 board of regents, in respect to the Iowa braille and sight
43 9 saving school and the Iowa school for the deaf, may send any
43 10 inmate, student, or patient of an institution, or any person
43 11 committed or applying for admission to an institution, to the
43 12 university of Iowa hospitals and clinics for treatment and
43 13 care. The department of human services, the department of
43 14 corrections, and the state board of regents shall respectively
43 15 pay the traveling expenses of such patient, and when necessary
43 16 the traveling expenses of an attendant for the patient, out of
43 17 funds appropriated for the use of the institution from which
43 18 the patient is sent.
43 19 Sec. 51. NEW SECTION. 263.22 MEDICAL CARE FOR PAROLEES
43 20 AND PERSONS ON WORK RELEASE.
43 21 The director of the department of corrections may send
43 22 former inmates of the institutions provided for in section
43 23 904.102, while on parole or work release, to the university of
43 24 Iowa hospitals and clinics for treatment and care. The
43 25 director may pay the traveling expenses of any such patient,
43 26 and when necessary the traveling expenses of an attendant of
43 27 the patient, out of funds appropriated for the use of the
43 28 department of corrections.
43 29 Sec. 52. Section 271.6, Code 2005, is amended to read as
43 30 follows:
43 31 271.6 INTEGRATED TREATMENT OF UNIVERSITY HOSPITAL
43 32 PATIENTS.
43 33 The authorities of the Oakdale campus may authorize
43 34 patients for admission to the hospital on the Oakdale campus
43 35 who are referred from the university hospitals and who shall
44 1 retain the same status, classification, and authorization for
44 2 care which they had at the university hospitals. Patients
44 3 referred from the university hospitals to the Oakdale campus
44 4 shall be deemed to be patients of the university hospitals.
44 5 Chapters 255 and 255A and the The operating policies of the
44 6 university hospitals shall apply to the patients and to the
44 7 payment for their care the same as the provisions apply to
44 8 patients who are treated on the premises of the university
44 9 hospitals.
44 10 Sec. 53. Section 331.381, subsection 9, Code 2005, is
44 11 amended by striking the subsection.
44 12 Sec. 54. Section 331.502, subsection 17, Code 2005, is
44 13 amended by striking the subsection.
44 14 Sec. 55. Section 331.552, subsection 13, Code 2005, is
44 15 amended to read as follows:
44 16 13. Make transfer payments to the state for school
44 17 expenses for blind and deaf children, and support of persons
44 18 with mental illness, and hospital care for the indigent as
44 19 provided in sections 230.21, 255.26, 269.2, and 270.7.
44 20 Sec. 56. Section 331.653, subsection 26, Code 2005, is
44 21 amended by striking the subsection.
44 22 Sec. 57. Section 331.756, subsection 53, Code 2005, is
44 23 amended by striking the subsection.
44 24 Sec. 58. Section 602.8102, subsection 48, Code 2005, is
44 25 amended by striking the subsection.
44 26 Sec. 59. Chapters 255 and 255A, Code 2005, are repealed.
44 27 Sec. 60. OBLIGATIONS TO INDIGENT PATIENTS. The provisions
44 28 of this Act shall not be construed and are not intended to
44 29 change, reduce, or affect the obligation of the university of
44 30 Iowa hospitals and clinics existing on April 1, 2005, to
44 31 provide care or treatment at the university of Iowa hospitals
44 32 and clinics to indigent patients and to any inmate, student,
44 33 patient, or former inmate of a state institution as specified
44 34 in sections 263.21 and 263.22 as enacted in this Act, with the
44 35 exception of the specific obligation to committed indigent
45 1 patients as specified pursuant to section 255.16, Code 2005,
45 2 repealed in this Act.
45 3 Sec. 61. INMATES, STUDENTS, PATIENTS, AND FORMER INMATES
45 4 OF STATE INSTITUTIONS == REVIEW.
45 5 1. The director of human services shall convene a
45 6 workgroup comprised of the director, the director of the
45 7 department of corrections, the president of the state board of
45 8 regents, and a representative of the university of Iowa
45 9 hospitals and clinics to review the provision of treatment and
45 10 care to the inmates, students, patients, and former inmates
45 11 specified in sections 263.21 and 263.22, as enacted in this
45 12 Act. The review shall determine all of the following:
45 13 a. The actual cost to the university of Iowa hospitals and
45 14 clinics to provide care and treatment to the inmates,
45 15 students, patients, and former inmates on an annual basis.
45 16 The actual cost shall be determined utilizing Medicare cost
45 17 accounting principles.
45 18 b. The number of inmates, students, patients, and former
45 19 inmates provided treatment at the university of Iowa hospitals
45 20 and clinics, annually.
45 21 c. The specific types of treatment and care provided to
45 22 the inmates, students, patients, and former inmates.
45 23 d. The existing sources of revenue that may be available
45 24 to pay for the costs of providing care and treatment to the
45 25 inmates, students, patients, and former inmates.
45 26 e. The cost to the department of human services, the Iowa
45 27 department of corrections, and the state board of regents to
45 28 provide transportation and staffing relative to provision of
45 29 care and treatment to the inmates, students, patients, and
45 30 former inmates at the university of Iowa hospitals and
45 31 clinics.
45 32 f. The effect of any proposed alternatives for provision
45 33 of care and treatment for inmates, students, patients, or
45 34 former inmates, including the proposed completion of the
45 35 hospital unit at the Iowa state penitentiary at Fort Madison.
46 1 2. The workgroup shall submit a report of its findings to
46 2 the governor and the general assembly no later than December
46 3 31, 2005. The report shall also include any recommendations
46 4 for improvement in the provision of care and treatment to
46 5 inmates, students, patients, and former inmates, under the
46 6 control of the department of human services, the Iowa
46 7 department of corrections, and the state board of regents.
46 8 DIVISION XII
46 9 STATE MEDICAL INSTITUTION
46 10 Sec. 62. NEW SECTION. 218A.1 STATE MEDICAL INSTITUTION.
46 11 1. All of the following shall be collectively designated
46 12 as a single state medical institution:
46 13 a. The mental health institute, Mount Pleasant, Iowa.
46 14 b. The mental health institute, Independence, Iowa.
46 15 c. The mental health institute, Clarinda, Iowa.
46 16 d. The mental health institute, Cherokee, Iowa.
46 17 e. The Glenwood state resource center.
46 18 f. The Woodward state resource center.
46 19 2. Necessary portions of the institutes and resource
46 20 centers shall remain licensed as separate hospitals and as
46 21 separate intermediate care facilities for persons with mental
46 22 retardation, and the locations and operations of the
46 23 institutes and resource centers shall not be subject to
46 24 consolidation to comply with this chapter.
46 25 3. The state medical institution shall qualify for
46 26 payments described in subsection 4 for the fiscal period
46 27 beginning July 1, 2005, and ending June 30, 2010, if the state
46 28 medical institution and the various parts of the institution
46 29 comply with the requirements for payment specified in
46 30 subsection 4, and all of the following conditions are met:
46 31 a. The total number of beds in the state medical
46 32 institution licensed as hospital beds is less than fifty
46 33 percent of the total number of all state medical institution
46 34 beds. In determining compliance with this requirement,
46 35 however, any reduction in the total number of beds that occurs
47 1 as the result of reduction in census due to an increase in
47 2 utilization of home and community=based services shall not be
47 3 considered.
47 4 b. An individual is appointed by the director of human
47 5 services to serve as the director of the state medical
47 6 institution and an individual is appointed by the director of
47 7 human services to serve as medical director of the state
47 8 medical institution. The individual appointed to serve as the
47 9 director of the state medical institution may also be an
47 10 employee of the department of human services or of a component
47 11 part of the state medical institution. The individual
47 12 appointed to serve as medical director of the state medical
47 13 institution may also serve as the medical director of one of
47 14 the component parts of the state medical institution.
47 15 c. A workgroup comprised of the director of human services
47 16 or the director's designee, the director of the state medical
47 17 institution, the directors of all licensed intermediate care
47 18 facilities for persons with mental retardation in the state,
47 19 and representatives of the Iowa state association of counties,
47 20 the Iowa association of community providers, and other
47 21 interested parties develops and presents a plan, for
47 22 submission to the centers for Medicare and Medicaid services
47 23 of the United States department of health and human services,
47 24 to the general assembly no later than July 1, 2007, to reduce
47 25 the number of individuals in intermediate care facilities for
47 26 persons with mental retardation in the state and concurrently
47 27 to increase the number of individuals with mental retardation
47 28 and developmental disabilities in the state who have access to
47 29 home and community=based services. The plan shall include a
47 30 proposal to redesign the home and community=based services
47 31 waivers for persons with mental retardation and persons with
47 32 brain injury under the medical assistance program. The
47 33 department shall not implement the plan without express
47 34 authorization by the general assembly.
47 35 4. The department of human services shall submit a waiver
48 1 to the centers for Medicare and Medicaid services of the
48 2 United States department of health and human services to
48 3 provide for all of the following:
48 4 a. Coverage under the medical assistance program, with
48 5 appropriate federal matching funding, for inpatient and
48 6 outpatient hospital services provided to eligible individuals
48 7 by any part of the state medical institution that maintains a
48 8 state license as a hospital.
48 9 b. Disproportionate share hospital payments for services
48 10 provided by any part of the state medical institution that
48 11 maintains a state license as a hospital.
48 12 c. Imposition of an assessment on intermediate care
48 13 facilities for persons with mental retardation on any part of
48 14 the state medical institution that provides intermediate care
48 15 facility for persons with mental retardation services.
48 16 DIVISION XIII
48 17 APPROPRIATIONS AND EFFECTIVE DATES
48 18 Sec. 63. APPROPRIATIONS FROM IOWACARE ACCOUNT.
48 19 1. There is appropriated from the Iowacare account created
48 20 in section 249J.23 to the university of Iowa hospitals and
48 21 clinics for the fiscal year beginning July 1, 2005, and ending
48 22 June 30, 2006, the following amount, or so much thereof as is
48 23 necessary, to be used for the purposes designated:
48 24 For salaries, support, maintenance, equipment, and
48 25 miscellaneous purposes, for the provision of medical and
48 26 surgical treatment of indigent patients, for provision of
48 27 services to members of the expansion population pursuant to
48 28 chapter 249J, as enacted in this Act, and for medical
48 29 education:
48 30 .................................................. $ 27,284,584
48 31 2. There is appropriated from the Iowacare account created
48 32 in section 249J.23 to a publicly owned acute care teaching
48 33 hospital located in a county with a population over three
48 34 hundred fifty thousand for the fiscal year beginning July 1,
48 35 2005, and ending June 30, 2006, the following amount, or so
49 1 much thereof as is necessary, to be used for the purposes
49 2 designated:
49 3 For the provision of medical and surgical treatment of
49 4 indigent patients, for provision of services to members of the
49 5 expansion population pursuant to chapter 249J, as enacted in
49 6 this Act, and for medical education:
49 7 .................................................. $ 40,000,000
49 8 Notwithstanding any provision of this Act to the contrary,
49 9 of the amount appropriated in this subsection, $37,000,000
49 10 shall be allocated in twelve equal monthly payments as
49 11 provided in section 249J.23, as enacted in this Act. Any
49 12 amount appropriated in this subsection in excess of
49 13 $37,000,000 shall be allocated only if federal funds are
49 14 available to match the amount allocated.
49 15 3. There is appropriated from the Iowacare account created
49 16 in section 249J.23 to the state hospitals for persons with
49 17 mental illness designated pursuant to section 226.1 for the
49 18 fiscal year beginning July 1, 2005, and ending June 30, 2006,
49 19 the following amounts, or so much thereof as is necessary, to
49 20 be used for the purposes designated:
49 21 a. For the state mental health institute at Cherokee, for
49 22 salaries, support, maintenance, full=time equivalent
49 23 positions, and miscellaneous purposes including services to
49 24 members of the expansion population pursuant to chapter 249J,
49 25 as enacted in this Act:
49 26 .................................................. $ 9,098,425
49 27 b. For the state mental health institute at Clarinda, for
49 28 salaries, support, maintenance, full=time equivalent
49 29 positions, and miscellaneous purposes including services to
49 30 members of the expansion population pursuant to chapter 249J,
49 31 as enacted in this Act:
49 32 .................................................. $ 1,977,305
49 33 c. For the state mental health institute at Independence,
49 34 for salaries, support, maintenance, full=time equivalent
49 35 positions, and miscellaneous purposes including services to
50 1 members of the expansion population pursuant to chapter 249J,
50 2 as enacted in this Act:
50 3 .................................................. $ 9,045,894
50 4 d. For the state mental health institute at Mount
50 5 Pleasant, for salaries, support, maintenance, full=time
50 6 equivalent positions, and miscellaneous purposes including
50 7 services to members of the expansion population designation
50 8 pursuant to chapter 249J, as enacted in this Act:
50 9 .................................................. $ 5,752,587
50 10 Sec. 64. APPROPRIATIONS FROM ACCOUNT FOR HEALTH CARE
50 11 TRANSFORMATION. There is appropriated from the account for
50 12 health care transformation created in section 249J.22, as
50 13 enacted in this Act, to the department of human services, for
50 14 the fiscal year beginning July 1, 2005, and ending June 30,
50 15 2006, the following amounts, or so much thereof as is
50 16 necessary, to be used for the purposes designated:
50 17 1. For the costs of medical examinations and development
50 18 of personal health improvement plans for the expansion
50 19 population pursuant to section 249J.6, as enacted in this Act:
50 20 .................................................. $ 136,500
50 21 2. For the provision of a medical information hotline for
50 22 the expansion population as provided in section 249J.6, as
50 23 enacted in this Act:
50 24 .................................................. $ 150,000
50 25 3. For the insurance cost subsidy program pursuant to
50 26 section 249J.8, as enacted in this Act:
50 27 .................................................. $ 150,000
50 28 4. For the health care account program option pursuant to
50 29 section 249J.8, as enacted in this Act:
50 30 .................................................. $ 50,000
50 31 5. For the use of electronic medical records by medical
50 32 assistance program and expansion population provider network
50 33 providers pursuant to section 249J.14, as enacted in this Act:
50 34 .................................................. $ 100,000
50 35 6. For other health partnership activities pursuant to
51 1 section 249J.14, as enacted in this Act:
51 2 .................................................. $ 550,000
51 3 7. For the costs related to audits, performance
51 4 evaluations, and studies required by this Act:
51 5 .................................................. $ 100,000
51 6 8. For administrative costs associated with this Act:
51 7 .................................................. $ 910,000
51 8 Sec. 65. TRANSFER FROM ACCOUNT FOR HEALTH CARE
51 9 TRANSFORMATION. There is transferred from the account for
51 10 health care transformation created pursuant to section
51 11 249J.22, as enacted in this Act, to the Iowacare account
51 12 created in section 249J.23, as enacted in this Act, a total of
51 13 $2,000,000 for the fiscal year beginning July 1, 2005, and
51 14 ending June 30, 2006.
51 15 Sec. 66. EFFECTIVE DATES == CONTINGENT REDUCTION == RULES
51 16 == RETROACTIVE APPLICABILITY.
51 17 1. The provisions of this Act requiring the department of
51 18 human services to request waivers from the centers for
51 19 Medicare and Medicaid services of the United States department
51 20 of health and human services and to amend the medical
51 21 assistance state plan, and the provisions relating to
51 22 execution of chapter 28E agreements in section 249J.23, as
51 23 enacted in this Act, being deemed of immediate importance,
51 24 take effect upon enactment.
51 25 2. The remaining provisions of this Act, with the
51 26 exception of the provisions described in subsection 1, shall
51 27 not take effect unless the department of human services
51 28 receives approval of all waivers and medical assistance state
51 29 plan amendments required under this Act. If all approvals are
51 30 received, the remaining provisions of this Act shall take
51 31 effect July 1, 2005, or on the date specified in the waiver or
51 32 medical assistance state plan amendment for a particular
51 33 provision. The department of human services shall notify the
51 34 Code editor of the date of receipt of the approvals.
51 35 3. If this Act is enacted and if the Eighty=first General
52 1 Assembly enacts legislation appropriating moneys from the
52 2 general fund of the state to the department of human services
52 3 for the fiscal year beginning July 1, 2005, and ending June
52 4 30, 2006, for the state hospitals for persons with mental
52 5 illness designated pursuant to section 226.1, for salaries,
52 6 support, maintenance, and miscellaneous purposes and for full=
52 7 time equivalent positions, the appropriations shall be reduced
52 8 in the following amounts and the amounts shall be transferred
52 9 to the medical assistance fund of the department of human
52 10 services to diminish the effect of intergovernmental transfer
52 11 reductions:
52 12 a. For the state mental health institute at Cherokee:
52 13 .................................................. $ 9,098,425
52 14 b. For the state mental health institute at Clarinda:
52 15 .................................................. $ 1,977,305
52 16 c. For the state mental health institute at Independence:
52 17 .................................................. $ 9,045,894
52 18 d. For the state mental health institute at Mount
52 19 Pleasant:
52 20 .................................................. $ 5,752,587
52 21 4. If this Act is enacted and if the Eighty=first General
52 22 Assembly enacts legislation appropriating moneys from the
52 23 general fund of the state to the state university of Iowa for
52 24 the fiscal year beginning July 1, 2005, and ending June 30,
52 25 2006, for the university hospitals for salaries, support,
52 26 maintenance, equipment, and miscellaneous purposes and for
52 27 medical and surgical treatment of indigent patients as
52 28 provided in chapter 255, for medical education, and for full=
52 29 time equivalent positions, the appropriation is reduced by
52 30 $27,284,584 and the amount shall be transferred to the medical
52 31 assistance fund of the department of human services to
52 32 diminish the effect of intergovernmental transfer reductions.
52 33 5. If this Act is enacted, and if the Eighty=first General
52 34 Assembly enacts 2005 Iowa Acts, House File 816, and 2005 Iowa
52 35 Acts, House File 816 includes a provision relating to medical
53 1 assistance supplemental amounts for disproportionate share
53 2 hospital and indirect medical education, the provision in
53 3 House File 816 shall not take effect.
53 4 6. If this Act is enacted, and if the Eighty=first General
53 5 Assembly enacts 2005 Iowa Acts, House File 825, and 2005 Iowa
53 6 Acts, House File 825, includes a provision appropriating
53 7 moneys from the hospital trust fund created in section 249I.4
53 8 to the department of human services for the fiscal year
53 9 beginning July 1, 2005, and ending June 30, 2006, to be used
53 10 to supplement the appropriations made for the medical
53 11 assistance program for that fiscal year, the appropriation is
53 12 reduced by $22,900,000.
53 13 7. The department of human services may adopt emergency
53 14 rules pursuant to chapter 17A to implement and administer the
53 15 provisions of this Act.
53 16 8. The department of human services may procure sole
53 17 source contracts to implement any provision of this Act. In
53 18 addition to sole source contracting, the department may
53 19 contract with local nonprofit agencies to provide services
53 20 enumerated in this Act. The department shall utilize
53 21 nonprofit agencies to the greatest extent possible in the
53 22 delivery of the programs and services enumerated in this Act
53 23 to promote greater understanding between providers, under the
53 24 medical assistance program and included in the expansion
53 25 population provider network, and their recipients and members.
53 26 9. The provisions of this Act amending 2003 Iowa Acts,
53 27 chapter 112, section 11, and repealing section 249A.20B, are
53 28 retroactively applicable to May 2, 2003.
53 29 10. The section of this Act amending 2004 Iowa Acts,
53 30 chapter 1175, section 86, is retroactively applicable to May
53 31 17, 2004.
53 32
53 33
53 34
53 35 CHRISTOPHER C. RANTS
54 1 Speaker of the House
54 2
54 3
54 4
54 5 JOHN P. KIBBIE
54 6 President of the Senate
54 7
54 8 I hereby certify that this bill originated in the House and
54 9 is known as House File 841, Eighty=first General Assembly.
54 10
54 11
54 12
54 13 MARGARET THOMSON
54 14 Chief Clerk of the House
54 15 Approved , 2005
54 16
54 17
54 18
54 19 THOMAS J. VILSACK
54 20 Governor