Bill Text: IA HF2352 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act establishing the healthy Iowa program and including effective date provisions.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2018-02-14 - Introduced, referred to Human Resources. H.J. 269. [HF2352 Detail]
Download: Iowa-2017-HF2352-Introduced.html
House File 2352 - Introduced HOUSE FILE BY HUNTER and ANDERSON A BILL FOR 1 An Act establishing the healthy Iowa program and including 2 effective date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 5541YH (8) 87 pf/rj PAG LIN 1 1 Section 1. NEW SECTION. 135E.1 Findings and intent of the 1 2 general assembly. 1 3 1. The general assembly finds that all residents of the 1 4 state have the right to health care. 1 5 2. It is the intent of the general assembly: 1 6 a. To provide comprehensive universal single=payer health 1 7 care coverage and a health care cost control system for the 1 8 benefit of all residents of Iowa. 1 9 b. To establish the healthy Iowa program to provide 1 10 comprehensive, universal health coverage for every Iowa 1 11 resident funded by broad=based sources of revenue. 1 12 c. That the state obtain waivers and other approvals 1 13 relating to the Medicaid program, the healthy and well kids 1 14 in Iowa program, Medicare, the federal Patient Protection and 1 15 Affordable Care Act, and any other federally regulated programs 1 16 related to the provision of health care so that any federal 1 17 funds and other subsidies that would otherwise be available to 1 18 the state, Iowa residents, and Iowa health care providers, is 1 19 instead paid by the federal government to the state of Iowa and 1 20 deposited in the healthy Iowa trust fund. 1 21 d. That the state incorporates health care coverage of 1 22 Iowa residents who are employed in other jurisdictions into 1 23 the waivers and other approvals involving federally regulated 1 24 programs related to the provision of health care. 1 25 e. That any funds obtained under waivers and other approvals 1 26 involving federally regulated programs related to the provision 1 27 of health care be used for health coverage that provides health 1 28 benefits equal to or exceeding the health benefits provided 1 29 under those programs, as well as other program modifications, 1 30 including elimination of cost sharing and insurance premiums. 1 31 f. That the healthy Iowa program replaces the Medicaid 1 32 program, the healthy and well kids in Iowa program, Medicare, 1 33 coverage provided through the federal Patient Protection and 1 34 Affordable Care Act, and any other federally regulated programs 1 35 relating to the provision of health care, and that those 2 1 programs are merged into the healthy Iowa program, which will 2 2 operate as a true single=payer program. 2 3 g. That, even if all necessary waivers and approvals are not 2 4 obtained, the state maximize the approvals received and pool 2 5 multiple sources of funding to the greatest extent possible, 2 6 to make the provision of health care coverage and health care 2 7 under the healthy Iowa program as seamless as possible. 2 8 h. To extend the current benefits and current health care 2 9 coverage provided under the healthy and well kids in Iowa 2 10 program to all Iowa residents. 2 11 i. That the healthy Iowa program addresses the high cost 2 12 of prescription drugs to ensure that prescription drugs are 2 13 affordable for patients. 2 14 j. That neither health information technology nor clinical 2 15 practice guidelines limit the effective exercise of the 2 16 professional judgment of health care providers. 2 17 k. That health care providers be authorized to override 2 18 health information technology or clinical practice guidelines 2 19 if it is consistent with the treating health care provider's 2 20 determination of medical necessity and if, in the professional 2 21 judgment of the health care provider, it is in the best 2 22 interest of the patient and consistent with the patient's 2 23 wishes. 2 24 l. To develop a revenue plan for the healthy Iowa program, 2 25 in consultation with appropriate stakeholders, taking into 2 26 consideration anticipated federal revenue available for the 2 27 program. 2 28 m. To require that all federal revenue received for the 2 29 healthy Iowa program be deposited in an account within the 2 30 healthy Iowa trust fund to be known as the healthy Iowa trust 2 31 fund account. 2 32 Sec. 2. NEW SECTION. 135E.2 Definitions. 2 33 As used in this chapter, unless the context otherwise 2 34 requires: 2 35 1. "Affiliation" means any of the following: 3 1 a. A financial interest. 3 2 b. A position of governance, including membership on a board 3 3 of directors, regardless of compensation. 3 4 c. A relationship through which compensation is received. 3 5 d. A relationship for the provision of services as a 3 6 regulated lobbyist. 3 7 2. "Affordable Care Act" means the federal Patient 3 8 Protection and Affordable Care Act (Pub. L. No. 111=148), as 3 9 amended by the federal Health Care and Education Reconciliation 3 10 Act of 2010 (Pub. L. No. 111=152), and any amendments to, or 3 11 regulations or guidance issued under, those Acts. 3 12 3. "Allied health practitioner" means a group of health 3 13 professionals who apply their expertise to prevent disease 3 14 transmission; diagnose, treat, and rehabilitate people of all 3 15 ages and in all specialties; and, with a range of technical and 3 16 support staff, deliver direct patient care, rehabilitation, 3 17 treatment, diagnosis, and health improvement interventions to 3 18 restore and maintain optimal physical, sensory, psychological, 3 19 cognitive, and social functions. "Allied health practitioner" 3 20 includes but is not limited to audiologists, physical 3 21 therapists, occupational therapists, social workers, and 3 22 radiographers. 3 23 4. "Board" means the healthy Iowa board which adopts rules 3 24 and establishes policy for and directs the agency regarding the 3 25 healthy Iowa program. 3 26 5. "Care coordination" means services provided by a care 3 27 coordinator under the healthy Iowa program. 3 28 6. "Care coordinator" means an individual or entity approved 3 29 by the healthy Iowa board to provide care coordination. 3 30 7. "Carrier" means carrier as defined in section 513B.2. 3 31 8. "Director" means the director of the healthy Iowa 3 32 program. 3 33 9. "Essential community provider" means a person or entity 3 34 acting as a safety net clinic, safety net health care provider, 3 35 or rural hospital. 4 1 10. "Federally matched public health program" means the 4 2 Medicaid program or the healthy and well kids in Iowa program 4 3 established in section 514I.3. 4 4 11. "Fund" means the healthy Iowa trust fund. 4 5 12. "Health care provider" means any of the following: 4 6 a. A person who is licensed, certified, registered, or 4 7 authorized to practice a health care profession in the state 4 8 pursuant to chapter 147A, 148, 148A, 148B, 148C, 148E, 148F, 4 9 148G, 149, 151, 152, 152A, 152B, 153, 154, 154A, 154B, 154C, 4 10 154D, 154F, 155, or 155A, who practices the profession in which 4 11 they are licensed, certified, registered, or authorized, and 4 12 who provides a health care service in this state. 4 13 b. A health care entity licensed under title IV that employs 4 14 or utilizes the health care services of a person described 4 15 in paragraph "a", including but not limited to a hospital 4 16 licensed pursuant to chapter 135B, a health care facility 4 17 licensed pursuant to chapter 135C, a subacute mental health 4 18 care facility licensed pursuant to chapter 135G, a psychiatric 4 19 medical institution for children licensed pursuant to chapter 4 20 135H, a hospice program licensed pursuant to chapter 135J, an 4 21 entity providing emergency medical services pursuant to chapter 4 22 147A, and a pharmacy licensed pursuant to chapter 155A. 4 23 13. "Health care service" means any health care service, 4 24 including care coordination that is included as a benefit under 4 25 the healthy Iowa program. 4 26 14. "Health maintenance organization" means a health 4 27 maintenance organization as defined in section 514B.1. 4 28 15. "Healthy Iowa agency" means the healthy Iowa agency 4 29 created in this chapter as an independent agency to provide 4 30 comprehensive, universal single=payer health care coverage 4 31 and a health care cost control system for the benefit of all 4 32 residents of Iowa, and to implement the healthy Iowa program. 4 33 16. "Healthy Iowa program" means the healthy Iowa program 4 34 created in this chapter to provide comprehensive, universal 4 35 single=payer health care coverage. 5 1 17. "Implementation period" means the period during which 5 2 the healthy Iowa program is subject to special eligibility and 5 3 financing provisions until the healthy Iowa program is fully 5 4 implemented. 5 5 18. "Long=term care" means long=term care, treatment, 5 6 maintenance, or services as defined by the healthy Iowa board. 5 7 19. "Medicaid" means the Medicaid program established under 5 8 chapter 249A. 5 9 20. "Medicare" means the program established pursuant to 5 10 Tit. XVIII of the federal Social Security Act, 42 U.S.C. {1395 5 11 et seq. 5 12 21. "Member" means an individual who is enrolled in the 5 13 healthy Iowa program. 5 14 22. "Out=of=state health care service" means a health 5 15 care service provided in person under any of the following 5 16 circumstances: 5 17 a. It is medically necessary that the health care service be 5 18 provided while the member is physically outside of this state 5 19 for a period of time not exceed ninety days. 5 20 b. It is clinically appropriate and necessary that the 5 21 health care service is provided outside this state because the 5 22 health care service can only be provided by a particular health 5 23 care provider physically located outside of this state. 5 24 23. "Participating health care provider" means an individual 5 25 or entity that is a health care provider qualified pursuant to 5 26 section 135E.15 that provides health care services to members 5 27 under the healthy Iowa program. 5 28 24. "Prescription drugs" means a controlled substance 5 29 requiring a prescription as defined in section 124.101, 5 30 subsection 5. 5 31 25. "Resident" means an individual, without regard to that 5 32 individual's immigration status, whose primary place of abode 5 33 is in this state and who meets the Iowa residence requirements 5 34 adopted by the healthy Iowa board. 5 35 Sec. 3. NEW SECTION. 135E.3 Healthy Iowa agency and program 6 1 ==== created. 6 2 1. A healthy Iowa agency is created as an independent 6 3 agency which shall be responsible for the planning, 6 4 development, implementation, and regulation of the provision of 6 5 comprehensive, universal single=payer health care coverage in 6 6 this state under the healthy Iowa program and of a health care 6 7 cost control system for the benefit of all residents. 6 8 2. The purposes of the healthy Iowa agency include all of 6 9 the following: 6 10 a. To create the healthy Iowa program. 6 11 b. To provide comprehensive, universal single=payer health 6 12 care services for all residents. 6 13 c. To provide a health care cost control system for the 6 14 benefit of all residents. 6 15 d. To provide choice of and access to health care 6 16 coordinators and health care providers for all residents. 6 17 e. To provide broad=based public financing of health care 6 18 services for all residents. 6 19 f. To establish mechanisms for participating health care 6 20 providers to collectively negotiate with the healthy Iowa 6 21 program regarding any matter relating to the administration 6 22 of the healthy Iowa program, including but not limited to 6 23 rates of payment for health care services, rates of payment 6 24 for prescription drugs and nonprescription drugs, and payment 6 25 methodologies. 6 26 g. To ensure transparency and accountability of the healthy 6 27 Iowa program to the public. 6 28 h. To provide for the collection of data to promote 6 29 transparency, assess adherence to patient care standards 6 30 established under this chapter, compare patient outcomes, and 6 31 review utilization of health care services reimbursed through 6 32 the healthy Iowa program. 6 33 3. This chapter and any rule or policy adopted under this 6 34 chapter shall not be construed, is not intended as, and shall 6 35 not imply, a change or impact in any way on the authority of any 7 1 of the following: 7 2 a. The authority of a licensing board or other agencies of 7 3 this state otherwise has relative to the provision of health 7 4 care services or health care providers under law. 7 5 b. The authority the healthy Iowa program, the healthy Iowa 7 6 board, a licensing board, the department of public health, or 7 7 the department of inspections and appeals has to establish or 7 8 revise licensure standards for health care providers. 7 9 c. The authority the healthy Iowa program has to carry out 7 10 any function not authorized by waivers. 7 11 d. The authority an employer has to create an employment 7 12 benefit or to require, prohibit, or limit the provision of any 7 13 employment benefit. 7 14 4. This chapter shall not be construed to allow the healthy 7 15 Iowa program, other agencies of this state, local agencies, 7 16 or public employees, acting under color of law, to provide or 7 17 disclose to anyone, including but not limited to the federal 7 18 government, any personally identifiable information obtained 7 19 by the healthy Iowa program, including but not limited to a 7 20 person's religious beliefs, practices, or affiliation, national 7 21 origin, ethnicity, or immigration status, for law enforcement 7 22 or immigration purposes. 7 23 5. This chapter shall not be construed to allow law 7 24 enforcement agencies to use healthy Iowa program moneys, 7 25 facilities, property, equipment, or personnel to investigate, 7 26 enforce, or assist in the investigation or enforcement of any 7 27 criminal, civil, or administrative violation or warrant for a 7 28 violation of any requirement that individuals register with the 7 29 federal government or any federal agency based on religion, 7 30 national origin, ethnicity, or immigration status. 7 31 Sec. 4. NEW SECTION. 135E.4 Healthy Iowa board ==== created. 7 32 1. A healthy Iowa board is created consisting of the 7 33 following voting members: 7 34 a. Four public members appointed by the governor, subject 7 35 to confirmation by the senate. 8 1 b. Two public members appointed by the senate majority 8 2 leader subject to section 2.32A. 8 3 c. Two public members appointed by the speaker of the house 8 4 of representatives subject to section 2.32A. 8 5 2. The director of human services or the director's designee 8 6 shall serve as an ex officio member of the board. 8 7 3. The voting members shall serve four=year staggered 8 8 terms. A vacancy shall be filled for the unexpired portion of 8 9 the term and in the same manner as the original appointment. 8 10 Any member may be reappointed for an additional term. 8 11 4. Members of the board shall not receive compensation as a 8 12 member of the board but are entitled to receive reimbursement 8 13 of actual expenses incurred in the discharge of their duties. 8 14 Public members of the board are also eligible to receive 8 15 compensation as provided in section 7E.6. 8 16 5. In making appointments under this section, an appointing 8 17 authority shall do all of the following: 8 18 a. Assure that the appointee has demonstrated and 8 19 acknowledged expertise in health care. 8 20 b. Consider the expertise of the other members of the 8 21 board and attempt to make appointments so that the board's 8 22 composition reflects a diversity of expertise in various 8 23 aspects of health care services. 8 24 c. Consider the cultural, ethnic, and geographical diversity 8 25 of this state so that the board's composition reflects the 8 26 communities of this state. 8 27 d. Assure that the board's composition is comprised of all 8 28 of the following: 8 29 (1) At least one representative of a labor organization 8 30 representing registered nurses. 8 31 (2) At least one representative of the general public. 8 32 (3) At least one representative of a labor organization not 8 33 representing registered nurses. 8 34 (4) At least one representative of the health care provider 8 35 community. 9 1 6. The board shall determine the time, location, and 9 2 frequency of the board's meetings. Five members of the board 9 3 constitute a quorum and the affirmative vote of a majority of 9 4 the voting members is necessary for any substantive action to 9 5 be taken by the board. 9 6 7. The members of the board shall elect a chairperson on an 9 7 annual basis from among the membership of the board. 9 8 8. A member of the board may be removed for incompetence, 9 9 misconduct, or failure to perform the duties of the position. 9 10 9. The board shall approve all contracts entered into 9 11 pursuant to this chapter. All contracts entered into pursuant 9 12 to this chapter shall be made available to the public. 9 13 10. The board may receive and accept grants, loans, or 9 14 advances of moneys from any person and may receive and accept 9 15 from any source contributions of moneys, property, labor, or 9 16 any other thing of value, to be held, used, and applied for the 9 17 purposes of the healthy Iowa program. 9 18 11. A member of the board shall do all of the following: 9 19 a. Meet the requirements of this chapter and all applicable 9 20 state and federal laws and regulations. 9 21 b. Serve the public interest of the individuals, employers, 9 22 and taxpayers seeking health care coverage through the healthy 9 23 Iowa healthy Iowa program. 9 24 c. Ensure the sound operation and fiscal solvency of the 9 25 healthy Iowa program. 9 26 12. A member of the board, within the two=year period 9 27 immediately preceding the member's appointment, while serving 9 28 on the board, and for two years immediately after the end 9 29 of the member's term, and staff of the board, shall not be 9 30 employed or have been employed in any capacity by, a consultant 9 31 to a member of the board of, have an affiliation with, receive 9 32 compensation from, or otherwise be a representative of any of 9 33 the following: 9 34 a. A health care provider, unless the member or staff 9 35 practices a health care profession as an employee of another 10 1 health care provider. 10 2 b. A pharmaceutical company. 10 3 c. A medical equipment company. 10 4 d. An insurance company. 10 5 e. A carrier, an insurance producer, a third=party 10 6 administrator, a managed care organization, or any other person 10 7 contracting directly with the healthy Iowa program. 10 8 f. A member, a board member, or an employee of a trade 10 9 association of health care facilities, health clinics, health 10 10 care providers, carriers, insurance producers, third=party 10 11 administrators, managed care organizations, or any association 10 12 of entities in a position to contract directly with the 10 13 healthy Iowa program, unless the member or employee receives no 10 14 compensation for rendering services as a health care provider 10 15 and does not have an ownership interest in a health care 10 16 practice. 10 17 13. A member of the board shall perform the member's duties 10 18 in good faith, in the manner the member reasonably believes 10 19 to be in the best interest of the healthy Iowa program, and 10 20 without intentional or reckless disregard of the care an 10 21 ordinarily prudent person in a like position would use under 10 22 similar circumstances. A member of the board who performs the 10 23 member's duties in accordance with the standards specified in 10 24 this subsection shall not be liable personally for actions 10 25 taken as a member when performed in good faith, without intent 10 26 to defraud, and in connection with the administration of this 10 27 chapter or actions or conduct related to this chapter. 10 28 14. A member of the board shall be subject to chapter 68B. 10 29 In addition to the disclosures required pursuant to chapter 10 30 68B, a member of the board shall disclose to the board and 10 31 to the public any relationship that the member has with a 10 32 health care provider, pharmaceutical company, medical equipment 10 33 company, insurance company, carrier, insurance producer, 10 34 third=party administrator, managed care organization, or other 10 35 entity in an industry involved in matters likely to come before 11 1 the board. 11 2 15. On all matters that come before the board, a member 11 3 shall do all of the following: 11 4 a. Adhere strictly to the conflict of interest provisions 11 5 of section 68B.2A. 11 6 b. Provide full disclosure to the board and the public on 11 7 any matter that gives rise to a potential conflict of interest 11 8 and the manner in which the member will comply with public 11 9 disclosure required by chapter 68B and rules adopted pursuant 11 10 to chapter 68B to avoid any conflict of interest or appearance 11 11 of a conflict of interest. 11 12 16. A member of the board shall not have an interest, direct 11 13 or indirect, in a contract for the purchase of goods, including 11 14 materials and profits, or for the performance of services for 11 15 the healthy Iowa program. A contract entered into in violation 11 16 of this section is voidable. 11 17 Sec. 5. NEW SECTION. 135E.5 Director ==== appointment. 11 18 1. a. The board shall appoint a director of the healthy 11 19 Iowa program. 11 20 b. The director shall serve at the pleasure of the board. 11 21 c. The board shall determine the appropriate compensation 11 22 for the director. 11 23 2. Under the direction of and with the approval of the 11 24 board, the director shall administer this chapter. The 11 25 director shall do all of the following: 11 26 a. Act as the chief administrative officer of the healthy 11 27 Iowa program, including the healthy Iowa trust fund. 11 28 b. Direct, organize, administer, and manage the internal 11 29 operations of the healthy Iowa program and the board, and 11 30 establish guidelines and procedures to promote the orderly and 11 31 efficient administration of the healthy Iowa agency. 11 32 c. Perform all duties necessary to comply with and carry out 11 33 the provisions of this chapter, other state law, and federal 11 34 law. 11 35 d. Recommend to the board proposed rules necessary to 12 1 administer the healthy Iowa program. 12 2 e. Prepare a budget for the healthy Iowa program and prepare 12 3 reports as required by law. 12 4 f. Present the healthy Iowa agency's proposed budget to the 12 5 board prior to December 31 of each year. 12 6 g. Appoint the administrators within the healthy Iowa 12 7 program. 12 8 h. Provide for the receipt and disbursement of federal 12 9 moneys allocated to the state and its political subdivisions 12 10 for health care services and coverage purposes. 12 11 i. Include in the healthy Iowa program's annual budget all 12 12 estimated federal funds to be received or allocated to the 12 13 healthy Iowa program. 12 14 j. Employ, or designate another to employ, personnel 12 15 as necessary to carry out the duties and responsibilities 12 16 prescribed under this chapter consistent with the merit system 12 17 provisions of chapter 8A, subchapter IV. 12 18 k. As necessary, retain as independent contractors 12 19 attorneys, financial consultants, and any other professionals 12 20 or consultants necessary to carry out the planning, 12 21 development, and operations of the healthy Iowa program and the 12 22 provisions of this chapter. 12 23 3. The director or the director's designee shall 12 24 give preference in hiring under this section to all 12 25 individuals displaced or unemployed as a direct result of the 12 26 implementation of the healthy Iowa program. 12 27 Sec. 6. NEW SECTION. 135E.6 Board and director ==== duties 12 28 ==== powers. 12 29 1. Subject to any limitations under this chapter or other 12 30 applicable law, the enumeration of specific powers in this 12 31 chapter is not intended to restrict the board's power to take 12 32 any lawful action that the board determines is necessary 12 33 or convenient to carry out the functions authorized by the 12 34 Affordable Care Act and consistent with the purposes of the 12 35 healthy Iowa program. 13 1 2. The board shall do all of the following: 13 2 a. Adopt rules pursuant to chapter 17A to implement and 13 3 administer this chapter. 13 4 b. Consult with and solicit input from the healthy Iowa 13 5 advisory committee and any other person as the board determines 13 6 appropriate. 13 7 c. Promote the public understanding and awareness of 13 8 available benefits and options through the healthy Iowa 13 9 program. 13 10 d. Avoid jeopardizing federal financial participation in the 13 11 programs that are incorporated into the healthy Iowa program. 13 12 e. Ensure that there is adequate funding to meet the health 13 13 care service needs of residents and to compensate health care 13 14 providers that participate in the healthy Iowa program. 13 15 f. Evaluate requests for capital expenses required to meet 13 16 the health care service needs of residents. 13 17 g. Approve the benefits provided by the healthy Iowa 13 18 program. 13 19 h. Evaluate the performance of the healthy Iowa program. 13 20 i. Evaluate and make recommendations to the general assembly 13 21 on any legislation related to the healthy Iowa program. 13 22 j. Guarantee that mechanisms for public feedback are 13 23 accessible and nondiscriminatory. 13 24 k. Develop a plan to coordinate the activities of the 13 25 healthy Iowa program with the activities of the department of 13 26 public health's bureau of health planning and the department 13 27 of human services' mental health planning and advisory council 13 28 to ensure appropriate planning for the effective delivery and 13 29 equitable distribution of health care services throughout the 13 30 state. 13 31 l. Provide grants from moneys in the healthy Iowa trust 13 32 fund or moneys otherwise appropriated for this purpose to the 13 33 health planning programs established by the bureau of health 13 34 planning of the department of public health or the mental 13 35 health planning and advisory council of the department of human 14 1 services to support the operation of those health planning 14 2 programs. 14 3 m. Allocate moneys from the healthy Iowa trust fund 14 4 or moneys otherwise appropriated for this purpose to the 14 5 department of human services or the department of education 14 6 workforce training and economic development fund to be used for 14 7 all of the following purposes: 14 8 (1) A program for retraining and assisting job transition 14 9 for individuals employed or previously employed in the fields 14 10 of health insurance, health care service plans, and other 14 11 third=party payments for health care services. 14 12 (2) A program for retraining and assisting job transition 14 13 for those individuals employed or previously employed in 14 14 fields providing services to health care providers to address 14 15 the needs of third=party payers for health care services, 14 16 whose jobs may be or have been ended as a result of the 14 17 implementation of the healthy Iowa program. 14 18 n. Organize, administer, and market the healthy Iowa program 14 19 and program services as a single=payer program under the name 14 20 "Healthy Iowa" or any other name as the board determines. 14 21 o. Sue, be sued, plead, and be impleaded. 14 22 p. Apply for, accept, and expend federal, state, or private 14 23 moneys or contracts for the implementation of the healthy Iowa 14 24 program or other state or federal health care programs for 14 25 residents. 14 26 q. Maintain an office at a place designated by the board. 14 27 r. Create subcommittees from among its members. 14 28 s. Establish divisions and subdivisions within the healthy 14 29 Iowa program. 14 30 t. Make agreements with a grantor or payor of moneys, 14 31 property, or services, including agreements to perform any 14 32 study, plan, demonstration, or project. 14 33 u. Enter into any agreements, contracts, or memoranda 14 34 of understanding and execute the instruments necessary or 14 35 convenient to manage its own affairs and carry out the purposes 15 1 of this chapter, including but not limited to contracts with 15 2 health care providers and care coordinators. 15 3 v. Share information with relevant state entities, 15 4 consistent with the confidentiality provisions in this chapter, 15 5 necessary for the administration of the healthy Iowa program. 15 6 w. Subject to the limitations of this chapter, exercise any 15 7 other power that is reasonably necessary or convenient to carry 15 8 out the purposes of this chapter. 15 9 x. Adopt rules pursuant to chapter 17A regarding residency 15 10 requirements under the healthy Iowa program. In adopting 15 11 such rules, the board shall be guided by the principles and 15 12 requirements set forth in the Medicaid program without regard 15 13 to immigration status. 15 14 y. Contract with not=for=profit organizations to provide any 15 15 of the following: 15 16 (1) Assistance to consumers in the selection of a care 15 17 coordinator, enrollment, obtaining of health care services, 15 18 disenrollment, and other matters relating to the healthy Iowa 15 19 program. 15 20 (2) Assistance to health care providers providing, seeking, 15 21 or considering whether to provide health care services under 15 22 the healthy Iowa program. 15 23 z. Delegate to the director any of its duties under this 15 24 section subject to all of the following: 15 25 (1) The board shall ensure that any entity under a contract 15 26 or other agreement with the healthy Iowa program complies with 15 27 the provisions of this chapter when performing services on 15 28 behalf of the healthy Iowa program. 15 29 (2) The operations of the healthy Iowa program are subject 15 30 to the provisions of this chapter whether the operations are 15 31 performed directly by the healthy Iowa program or through an 15 32 entity under a contract or other agreement with the healthy 15 33 Iowa program. 15 34 Sec. 7. NEW SECTION. 135E.7 Healthy Iowa program ==== 15 35 implementation ==== coordination with other health care coverage. 16 1 1. The board shall determine the date of implementation of 16 2 the healthy Iowa program when individuals may begin enrolling 16 3 in the healthy Iowa program and the date the implementation 16 4 period ends. 16 5 2. An insurer, carrier, or health maintenance organization 16 6 shall not offer benefits or cover any services for which 16 7 coverage is offered to individuals under the healthy Iowa 16 8 program. 16 9 3. An insurer, carrier, or health maintenance organization 16 10 that is issued a certificate of authority by the commissioner 16 11 of insurance may offer only the following: 16 12 a. Benefits that do not duplicate the health care services 16 13 covered by the healthy Iowa program. 16 14 b. Benefits available to individuals and their families who 16 15 are employed or self=employed in this state but who are not 16 16 residents. 16 17 c. Benefits available during the implementation period 16 18 to individuals who enroll or may enroll in the healthy Iowa 16 19 program. 16 20 4. This chapter shall not prohibit a resident who is 16 21 employed outside this state from choosing to receive health 16 22 insurance benefits through the resident's employer and from 16 23 opting out of participation in the healthy Iowa program. 16 24 5. After the end of the implementation period, board members 16 25 shall enroll as members of the healthy Iowa program. 16 26 6. a. No later than July 1, 2020, the board shall develop 16 27 a proposal, consistent with the principles of this chapter, 16 28 for provision by the healthy Iowa program of long=term care 16 29 coverage, including the development of a proposal, consistent 16 30 with the principles of this chapter, for its funding. 16 31 b. In developing the proposal required in paragraph "a", 16 32 the board shall consult with a special advisory committee, 16 33 appointed by the chairperson of the board, that includes 16 34 representatives of consumers and potential consumers of 16 35 long=term care, providers of long=term care, members of 17 1 organized labor, and other interested parties. 17 2 7. The board shall develop proposals for all of the 17 3 following: 17 4 a. Accommodating employer retiree health benefits for people 17 5 who have been members of the healthy Iowa program but live as 17 6 retirees outside this state. 17 7 b. Accommodating employer retiree health benefits for people 17 8 who earned or accrued those benefits while residing in this 17 9 state prior to the implementation of the healthy Iowa program 17 10 and who live as retirees outside this state. 17 11 c. For healthy Iowa program coverage of health care services 17 12 covered under the state workers' compensation law, including 17 13 whether and how to continue funding for those health care 17 14 services under the workers' compensation law and whether and 17 15 how to incorporate an element of experience rating. 17 16 Sec. 8. NEW SECTION. 135E.8 Data collection. 17 17 1. The board shall require and enforce the collection 17 18 and availability of all of the following data to promote 17 19 transparency, assess adherence to patient care standards, 17 20 compare patient outcomes, and review utilization of health care 17 21 services paid for by the healthy Iowa program: 17 22 a. Inpatient discharge data, including acuity and risk of 17 23 mortality. 17 24 b. Emergency department, ambulatory surgery, and other 17 25 outpatient department data, including charge data, length of 17 26 stay, and patients' unit of observation. 17 27 c. Hospital annual financial data, including all of the 17 28 following: 17 29 (1) Community benefits by hospital in dollar value. 17 30 (2) Number of employees and classification by hospital 17 31 unit. 17 32 (3) Number of hours worked by hospital unit. 17 33 (4) Employee wage information by job title and hospital 17 34 unit. 17 35 (5) Number of registered nurses per staffed bed by hospital 18 1 unit. 18 2 (6) Type and value of health information technology. 18 3 (7) Annual spending on health information technology, 18 4 including purchases, upgrades, and maintenance. 18 5 d. Physician services and office visits, including charge 18 6 data. 18 7 e. Prescription drug cost and charge data for prescription 18 8 drugs prescribed and dispensed through hospitals or a 18 9 physician's office. 18 10 2. Data collected under subsection 1 shall be reported 18 11 to the healthy Iowa program and to the public health data 18 12 management program of the department of public health. 18 13 3. The board shall make all disclosed data collected under 18 14 subsection 1 publicly available and searchable through an 18 15 internet site and through the department of public health's 18 16 public health data management program. 18 17 4. The board shall, directly and through grants to 18 18 not=for=profit entities, conduct programs using data collected 18 19 through the healthy Iowa program to promote and protect public, 18 20 environmental, and occupational health, including cooperation 18 21 with other data collection and research programs of the 18 22 department of public health consistent with this chapter and 18 23 otherwise applicable law. 18 24 5. Prior to the end of the healthy Iowa program 18 25 implementation period, the board shall provide for the 18 26 collection and availability of all of the following data on the 18 27 number of patients served by hospitals and the dollar value of 18 28 the care provided, at cost, for all of the following categories 18 29 of data items: 18 30 a. Patients receiving charity care. 18 31 b. Contractual adjustments of county and indigent programs, 18 32 including traditional and managed care. 18 33 c. Bad debt. 18 34 6. The healthy Iowa program, any state or local agency, 18 35 or any public employee acting under color of law shall not 19 1 provide or disclose to anyone, including but not limited to the 19 2 federal government, any personally identifiable information 19 3 obtained under this section, including but not limited to a 19 4 person's religious beliefs, practices, or affiliation, national 19 5 origin, ethnicity, or immigration status for law enforcement 19 6 or immigration purposes. 19 7 Sec. 9. NEW SECTION. 135E.9 Healthy Iowa advisory committee 19 8 ==== established. 19 9 1. A healthy Iowa advisory committee for the healthy Iowa 19 10 program is established. 19 11 2. The healthy Iowa advisory committee shall consist of all 19 12 of the following voting members: 19 13 a. (1) Four physicians who are board certified in the 19 14 individual's specialty, at least one of whom shall be a 19 15 psychiatrist. 19 16 (2) The physician members shall include all of the 19 17 following: 19 18 (a) One physician appointed by the senate majority leader. 19 19 (b) One physician appointed by the governor. 19 20 (c) Two physicians appointed by the speaker of the house of 19 21 representatives who are primary care providers. 19 22 b. Two registered nurses appointed by the senate majority 19 23 leader. 19 24 c. One licensed allied health practitioner appointed by the 19 25 speaker of the house of representatives. 19 26 d. One mental health care provider appointed by the senate 19 27 majority leader. 19 28 e. One dentist appointed by the governor. 19 29 f. One representative of private hospitals appointed by the 19 30 governor. 19 31 g. One representative of public hospitals appointed by the 19 32 governor. 19 33 h. (1) Four consumers of health care services. 19 34 (2) The consumer members shall include all of the following, 19 35 one of whom shall be a person with a disability: 20 1 (a) Two consumers appointed by the governor. 20 2 (b) One consumer appointed by the senate majority leader who 20 3 is a healthy Iowa program member and who is sixty=five years of 20 4 age or older. 20 5 (c) One consumer appointed by the speaker of the house of 20 6 representatives. 20 7 i. One representative of organized labor appointed by the 20 8 speaker of the house of representatives. 20 9 j. One representative of community providers appointed by 20 10 the senate majority leader. 20 11 k. One member of organized labor appointed by the senate 20 12 majority leader. 20 13 l. One representative of a business that employs less than 20 14 twenty=five people, appointed by the governor. 20 15 m. One representative of a business that employs more than 20 16 two hundred fifty people, appointed by the speaker of the house 20 17 of representatives. 20 18 n. One pharmacist appointed by the speaker of the house of 20 19 representatives. 20 20 3. Appointed members, except for consumer members, shall 20 21 have worked in the field they represent for a period of at 20 22 least two years prior to being appointed. 20 23 4. Members shall serve four=year staggered terms. A vacancy 20 24 shall be filled for the unexpired portion of the term and in 20 25 the same manner as the original appointment. Any member may 20 26 be reappointed for an additional term, but shall not serve for 20 27 more than two consecutive full terms. 20 28 5. Members shall not receive compensation as a member 20 29 but are entitled to receive reimbursement of actual expenses 20 30 incurred in the discharge of their duties. Public members are 20 31 also eligible to receive compensation as provided in section 20 32 7E.6. 20 33 6. In making appointments of members under this section, the 20 34 appointing authority shall make good=faith efforts to ensure 20 35 that their appointments, as a whole, reflect, to the greatest 21 1 extent feasible, the social and geographic diversity of this 21 2 state. 21 3 7. The healthy Iowa advisory committee shall advise the 21 4 board on all matters of policy related to the healthy Iowa 21 5 program. 21 6 8. a. The healthy Iowa advisory committee shall meet at 21 7 least six times per year in a place convenient to the public 21 8 in accordance with chapter 21 and records of the healthy 21 9 Iowa advisory committee shall be subject to the open records 21 10 requirements of chapter 22. 21 11 b. Eleven members of the healthy Iowa advisory committee 21 12 constitute a quorum and the affirmative vote of at least twelve 21 13 voting members is necessary for any substantive action to be 21 14 taken. 21 15 9. The healthy Iowa advisory committee shall elect a 21 16 chairperson from among its membership who shall serve two years 21 17 and who may be reelected as chairperson for an additional two 21 18 years. 21 19 10. Members shall not use for personal benefit any 21 20 information that is filed with, or obtained by, the healthy 21 21 Iowa advisory committee and that is not generally available to 21 22 the public. 21 23 11. A member shall perform the member's duties in good 21 24 faith, in the manner the member reasonably believes to be in 21 25 the best interest of the healthy Iowa program, and without 21 26 intentional or reckless disregard of the care an ordinarily 21 27 prudent person in a like position would use under similar 21 28 circumstances. A member who performs the member's duties in 21 29 accordance with this subsection shall not be liable personally 21 30 for actions taken as a member when done in good faith, without 21 31 intent to defraud, and in connection with the administration of 21 32 this chapter or actions or conduct related to this chapter. 21 33 12. A member shall be subject to the provisions of chapter 21 34 68B. In addition to the disclosures required pursuant to 21 35 chapter 68B, a member shall disclose to the healthy Iowa 22 1 advisory committee and to the public any relationship 22 2 that the member has with a health care provider, health 22 3 clinic, pharmaceutical company, medical equipment company, 22 4 insurance company, carrier, insurance producer, third=party 22 5 administrator, managed care organization, or other entity in an 22 6 industry involved in matters likely to come before the healthy 22 7 Iowa advisory committee. 22 8 13. On all matters that come before the healthy Iowa 22 9 advisory committee, members shall do all of the following: 22 10 a. Adhere strictly to the conflict of interest provisions 22 11 of section 68B.2A. 22 12 b. Provide full disclosure to the healthy Iowa advisory 22 13 committee and the public on any matter that gives rise to a 22 14 potential conflict of interest and the manner in which the 22 15 member will comply with public disclosure required by chapter 22 16 68B and rules adopted pursuant to chapter 68B to avoid any 22 17 conflict of interest or appearance of a conflict of interest. 22 18 14. A member shall not have an interest, direct or indirect, 22 19 in a contract for the purchase of goods, including materials 22 20 and profits, and the performance of services for the healthy 22 21 Iowa program or the healthy Iowa advisory committee. A 22 22 contract entered into in violation of this section is void. 22 23 15. A member may be removed for incompetence, misconduct, or 22 24 failure to perform the duties of the position. 22 25 Sec. 10. NEW SECTION. 135E.10 Eligibility and enrollment 22 26 ==== generally. 22 27 1. Each resident is eligible and entitled to enroll as a 22 28 member in and receive benefits for health care services covered 22 29 by the healthy Iowa program. 22 30 2. A member shall not pay any fee, payment, or other charge 22 31 for enrolling in or being a member. 22 32 3. A participating health care provider or participating 22 33 care coordinator shall not do any of the following: 22 34 a. Require members to pay any premium, copayment, 22 35 coinsurance, deductible, or any other form of cost sharing for 23 1 any covered health care services. 23 2 b. Use preexisting medical conditions to determine the 23 3 eligibility of a member to receive benefits for health care 23 4 services covered by the program. 23 5 c. Refuse to provide health care services to a member 23 6 on the basis of age, citizenship, claims experience, color, 23 7 creed, familial status, gender identity, genetic information, 23 8 geography, health status, immigration status, marital status, 23 9 medical condition, medical history, mental disability, military 23 10 or veteran status, national origin, physical disability, 23 11 primary language, race, receipt of health care, religion, sex, 23 12 sexual orientation, or source of income. 23 13 d. A college, university, or other institution of higher 23 14 education in this state may purchase coverage under the healthy 23 15 Iowa program for a student, or a student's dependent, who is 23 16 not a resident. 23 17 Sec. 11. NEW SECTION. 135E.11 Eligibility and enrollment ==== 23 18 cross border employees. 23 19 1. If a resident is employed outside this state by an 23 20 employer that is subject to the laws of this state, the 23 21 employer and resident shall pay any payroll premium adopted 23 22 under this chapter as if the employment were in this state. 23 23 2. If a resident is employed outside this state by an 23 24 employer that is not subject to the laws of this state, 23 25 either the employer and resident may comply with any payroll 23 26 premium adopted under this chapter as if the employee were 23 27 employed in this state, or the resident shall pay the payroll 23 28 premium adopted under this chapter as if the resident were 23 29 self=employed in this state. 23 30 3. Any payroll premium adopted under this chapter applies 23 31 to all of the following: 23 32 a. A resident of another state employed in this state. 23 33 b. A resident of another state self=employed in this state. 23 34 4. a. A resident who is employed outside this state 23 35 may choose to receive health insurance benefits through the 24 1 resident's employer and opt out of participation in the healthy 24 2 Iowa program. 24 3 b. The board shall develop and implement rules establishing 24 4 procedures for state residents employed outside this state to 24 5 opt out of participation in the healthy Iowa program. 24 6 5. If any provision of this section or application of the 24 7 provision to any person or circumstance is held to violate the 24 8 federal Employee Retirement Income Security Act of 1974 in any 24 9 court of competent jurisdiction, the provision or application 24 10 found invalid shall be null and void and the invalidity shall 24 11 not affect other provisions or any other application of this 24 12 chapter that can be given effect without the invalid provision 24 13 or application. 24 14 Sec. 12. NEW SECTION. 135E.12 Health benefit credit. 24 15 1. a. If an individual who is a resident of another state 24 16 is employed in this state, the individual and the individual's 24 17 employer may be eligible for a credit against any payroll 24 18 premium payment requirement adopted under this chapter that the 24 19 individual or the individual's employer would otherwise pay 24 20 relative to that individual. 24 21 b. The credit available under this subsection shall be for 24 22 the amount spent on health benefits for the individual that 24 23 would otherwise be covered by the healthy Iowa program if that 24 24 individual were a member of the healthy Iowa program. 24 25 c. The credit available under this subsection shall be 24 26 distributed between the individual and employer in the same 24 27 proportion as the actual spending by each for the health 24 28 benefits. 24 29 d. An employer and employee may apply their respective 24 30 portion of the credit available under this subsection to their 24 31 respective portion of any payroll premium payment requirement 24 32 adopted under this chapter. 24 33 2. a. If an individual who is a resident of another state 24 34 is self=employed in this state, the individual is eligible 24 35 for a credit against any payroll premium payment requirement 25 1 adopted under this chapter that the individual would otherwise 25 2 pay. 25 3 b. Credit taken under this subsection shall be in the 25 4 amount that the individual spends on health benefits that 25 5 would otherwise be covered by the healthy Iowa program if the 25 6 individual were a member of the healthy Iowa program. 25 7 3. a. The credit available for non=employment=based 25 8 spending by an individual under subsection 2 is limited to 25 9 spending for health benefits. 25 10 b. An individual shall not be eligible for credit under 25 11 subsection 2 for out=of=pocket health care services spending. 25 12 4. Credit under this section is available regardless of 25 13 the cost or comprehensiveness of the health benefits, and 25 14 regardless of the form of the health benefits. 25 15 5. a. An employer or individual is eligible for credit 25 16 under this section only against payroll premiums payment 25 17 requirement adopted under this chapter. 25 18 b. An employer or individual shall not apply any health 25 19 benefits spending in excess of the payroll premium payment 25 20 requirement to other tax liability. 25 21 6. If any provision of this section or application of the 25 22 provision to any person or circumstance is held to violate the 25 23 federal Employee Retirement Income Security Act in any court 25 24 of competent jurisdiction, the provision or the application 25 25 found invalid shall be null and void and the invalidity shall 25 26 not affect other provisions or any other application of this 25 27 chapter that can be given effect without the invalid provision 25 28 or application. 25 29 Sec. 13. NEW SECTION. 135E.13 Covered benefits. 25 30 1. a. All members are eligible to receive covered health 25 31 care services benefits under the program. 25 32 b. Covered health care services benefits under the program 25 33 include all medical care that is medically necessary as 25 34 determined by the member's treating physician in accordance 25 35 with the program standards established in section 135E.19 and 26 1 by the board. 26 2 c. A member's treating physician shall be a person 26 3 licensed to engage in the practice of medicine and surgery or 26 4 osteopathic medicine and surgery pursuant to chapter 148. 26 5 2. Covered health care services benefits for members 26 6 include but are not limited to all of the following: 26 7 a. Licensed inpatient and licensed outpatient medical and 26 8 health care facility services. 26 9 b. Inpatient and outpatient health care services. 26 10 c. Diagnostic imaging, laboratory services, and other 26 11 diagnostic and evaluative services. 26 12 d. Medical equipment, appliances, and assistive technology, 26 13 including prosthetics, eyeglasses, and hearing aids and 26 14 the repair, technical support, and customization needed for 26 15 individual use. 26 16 e. Inpatient and outpatient rehabilitative care. 26 17 f. Emergency care services. 26 18 g. Emergency transportation. 26 19 h. Necessary transportation for health care services for 26 20 persons with disabilities or who may qualify as low=income. 26 21 i. Child and adult immunizations and preventive care. 26 22 j. Health and wellness education. 26 23 k. Hospice care. 26 24 l. Care in a skilled nursing facility. 26 25 m. Home health care, including home health care provided in 26 26 an assisted living facility. 26 27 n. Mental health services. 26 28 o. Substance abuse treatment. 26 29 p. Dental care. 26 30 q. Vision care. 26 31 r. Prescription drugs. 26 32 s. Pediatric care. 26 33 t. Prenatal and postnatal care. 26 34 u. Podiatric care. 26 35 v. Chiropractic care. 27 1 w. Acupuncture. 27 2 x. Therapies that are shown by the United States national 27 3 institutes of health, national center for complementary and 27 4 integrative health to be safe and effective. 27 5 y. Blood and blood products. 27 6 z. Dialysis. 27 7 aa. Adult day care. 27 8 ab. Rehabilitative and habilitative services. 27 9 ac. Ancillary health care or social services previously 27 10 covered by integrated health homes as determined under Iowa 27 11 Medicaid enterprise administrative rules and as designated 27 12 under 42 U.S.C. {1396w=4. 27 13 ad. Case management and care coordination. 27 14 ae. Language interpretation and translation for health care 27 15 services, including sign language and braille or other services 27 16 needed for individuals with communication barriers. 27 17 af. Health care and long=term supportive services covered 27 18 under Medicaid or the healthy and well kids in Iowa program on 27 19 June 30, 2017. 27 20 ag. All of the following health care services required 27 21 to be covered under any of the following provisions, without 27 22 regard to whether the member would otherwise be eligible for or 27 23 covered by the program or source referred to: 27 24 (1) The healthy and well kids in Iowa program pursuant to 27 25 chapter 514I. 27 26 (2) The Medicaid program. 27 27 (3) The federal Medicare program pursuant to Tit. XVIII of 27 28 the federal Social Security Act, 42 U.S.C. {1395 et seq. 27 29 (4) A health maintenance organization as defined in section 27 30 514B.1. 27 31 (5) A managed health care program as defined by rule of 27 32 the department of human services, including health maintenance 27 33 organizations, prepaid health plans, the Medicaid patient 27 34 access to service system, Iowa plan for behavioral health, 27 35 programs of all=inclusive care for the elderly, Iowa health 28 1 link, and the Iowa health and wellness plan. 28 2 ah. Any additional health care services authorized by the 28 3 board. 28 4 ai. All essential health benefits mandated by the Affordable 28 5 Care Act as of January 1, 2017. 28 6 Sec. 14. NEW SECTION. 135E.14 Covered benefits ==== 28 7 additions. 28 8 1. The board, on a regular basis, shall evaluate whether 28 9 covered benefits under the healthy Iowa program should be 28 10 improved or adjusted to promote the health of beneficiaries, 28 11 account for changes in medical practice or new information from 28 12 medical research, or respond to other relevant developments in 28 13 health science. In carrying out this duty, the board shall 28 14 consult with the persons described in subsection 2 on all of 28 15 the following: 28 16 a. Identifying specific complementary and integrative 28 17 medicine practices that, on the basis of research findings or 28 18 promising clinical interventions, are appropriate to include as 28 19 benefits under the healthy Iowa program package. 28 20 b. Identifying barriers to the effective provision and 28 21 integration of such practices into the delivery of health care, 28 22 and identifying mechanisms for overcoming such barriers. 28 23 2. The board shall consult with all of the following when 28 24 carrying out the requirements of subsection 1: 28 25 a. Institutions of higher education, private research 28 26 institutes, and individual researchers with extensive 28 27 experience in complementary and alternative medicine and the 28 28 integration of such practices into the delivery of health care. 28 29 b. Nationally recognized providers of complementary and 28 30 integrative medicine. 28 31 c. Such other officials, entities, and individuals with 28 32 expertise in complementary and integrative medicine as the 28 33 board determines appropriate. 28 34 3. a. Health care providers and members may petition the 28 35 board to improve or adjust covered benefits under the healthy 29 1 Iowa program. 29 2 b. The board shall develop and adopt rules pursuant to 29 3 chapter 17A establishing procedures for members to petition the 29 4 board to improve or adjust covered benefits under the healthy 29 5 Iowa program. 29 6 Sec. 15. NEW SECTION. 135E.15 Delivery of care ==== 29 7 participating health care providers. 29 8 1. Any health care provider is qualified to participate in 29 9 the healthy Iowa program if the health care provider meets all 29 10 of the following criteria: 29 11 a. The health care provider is licensed to practice in this 29 12 state and is otherwise in good standing. 29 13 b. The health care provider's services are performed while 29 14 physically present in this state. 29 15 c. The health care provider agrees to accept program rates 29 16 as payment in full for all covered health care services. 29 17 2. The board shall establish and maintain procedures and 29 18 standards for recognizing health care providers located outside 29 19 this state for purposes of providing coverage under the program 29 20 for members who require out=of=state health care services while 29 21 the member is physically outside this state for a period of 29 22 time not to exceed ninety days. 29 23 3. Any health care provider qualified to participate under 29 24 this section may provide covered health care services under the 29 25 healthy Iowa program as long as the health care provider is 29 26 legally authorized to perform the health care service for the 29 27 individual and under the circumstances involved. 29 28 4. A member may choose to receive health care services 29 29 under the healthy Iowa program from any participating provider, 29 30 consistent with all of the following: 29 31 a. Provisions of this section. 29 32 b. The willingness or availability of the health care 29 33 provider. 29 34 c. Provisions of this chapter prohibiting discrimination 29 35 against members. 30 1 d. The appropriate clinically relevant circumstances and 30 2 standards. 30 3 5. The board may establish and maintain procedures for 30 4 member enrollment and disenrollment with participating health 30 5 care providers that are health maintenance organizations, group 30 6 medical practices, or essential community providers that offer 30 7 comprehensive services. 30 8 6. a. Participating health care providers shall not use 30 9 health information technology or clinical practice guidelines 30 10 that limit the effective exercise of the professional judgment 30 11 of a physician or registered nurse. 30 12 b. A physician or registered nurse may override health 30 13 information technology and clinical practice guidelines if all 30 14 of the following criteria are met: 30 15 (1) It is consistent with the treating physician's or 30 16 registered nurse's determination of medical necessity. 30 17 (2) In the professional judgment of the treating physician 30 18 or registered nurse, it is in the best interest of the patient 30 19 and consistent with the patient's wishes. 30 20 7. The board shall establish and maintain procedures and 30 21 standards for recognizing health care providers located outside 30 22 this state for purposes of providing coverage under the healthy 30 23 Iowa program for health care services provided outside this 30 24 state under the healthy Iowa program. 30 25 Sec. 16. NEW SECTION. 135E.16 Delivery of care ==== care 30 26 coordination. 30 27 1. Care coordinators shall provide care coordination, 30 28 including administrative tracking and medical recordkeeping 30 29 services, to members. 30 30 2. a. Care coordinators may employ or utilize the services 30 31 of other individuals or entities to assist in providing care 30 32 coordination for a member, consistent with rules adopted by the 30 33 board and consistent with the statutory requirements for care 30 34 coordinator licensure. 30 35 b. Care coordinators shall give preference, when employing 31 1 or utilizing the services of other individuals, to those 31 2 individuals who have transitioned out of employment due to 31 3 displacement resulting from implementation of the healthy Iowa 31 4 program. 31 5 3. Care coordinators shall comply with all federal and 31 6 state privacy laws, including but not limited to the federal 31 7 Health Insurance Portability and Accountability Act of 31 8 1996, Pub. L. No. 104=191, 42 U.S.C. {1320d et seq. and its 31 9 implementing regulations, and the disclosure of mental health 31 10 and psychological information requirements of chapter 228. 31 11 4. A referral from a care coordinator is not required for a 31 12 member to receive health care services from any participating 31 13 health care provider. 31 14 5. A care coordinator may be an individual or entity 31 15 approved by the board that is any of the following: 31 16 a. A health care provider that is any of the following: 31 17 (1) The member's primary care provider. 31 18 (2) The member's provider of primary gynecological care. 31 19 (3) At the option of a member who has a chronic condition 31 20 that requires specialty care, a specialist health care provider 31 21 who regularly and continually provides treatment to the member 31 22 for that condition. 31 23 b. An entity licensed as any of the following: 31 24 (1) A hospital licensed pursuant to chapter 135B. 31 25 (2) A limited service organization established under the 31 26 requirements of section 514B.33. 31 27 (3) An outpatient surgical facility, as defined in section 31 28 135.61, certified as an ambulatory surgical center under the 31 29 federal Medicare program or under the Medicaid program. 31 30 (4) An organized outpatient health facility as defined in 31 31 section 135.61. 31 32 (5) A licensed subacute care facility for persons with 31 33 serious and persistent mental illness as defined in section 31 34 135G.1. 31 35 (6) A licensed psychiatric medical institution for children 32 1 as defined in section 135H.1. 32 2 (7) A entity certified by the department of human services 32 3 to provide home and community=based services, including 32 4 habilitation services, the program of all=inclusive care for 32 5 the elderly, home health services, private duty nursing and 32 6 personal care programs, or targeted case management. 32 7 (8) A medical care ambulance service or nontransport 32 8 service that has received authorization from the department 32 9 pursuant to section 147A.5. 32 10 (9) A health maintenance organization as defined in section 32 11 514B.1. 32 12 (10) A licensed nursing facility as defined in section 32 13 135C.1. 32 14 (11) A licensed nursing home as defined in section 155.1. 32 15 (12) A licensed residential care facility as defined in 32 16 section 135C.1. 32 17 (13) A licensed intermediate care facility for persons with 32 18 an intellectual disability as defined in section 135C.1. 32 19 (14) A licensed intermediate care facility for persons with 32 20 mental illness as defined in section 135C.1. 32 21 (15) A licensed health care facility that provides adult day 32 22 services as defined in section 135C.1. 32 23 (16) A licensed health care facility that provides 32 24 rehabilitative services as defined in section 135C.1. 32 25 (17) A facility that provides hospice care under a licensed 32 26 hospice program as defined in section 135J.1. 32 27 (18) A licensed boarding home as defined in section 135O.1. 32 28 (19) A certified assisted living program as defined in 32 29 section 231C.2. 32 30 (20) A designated community mental health center as defined 32 31 in section 230A.102. 32 32 (21) A certified elder group home as defined in section 32 33 231B.1. 32 34 c. (1) A Taft=Hartley health and welfare fund, with respect 32 35 to its members and their family members. 33 1 (2) This provision does not preclude a Taft=Hartley health 33 2 and welfare fund from becoming a care coordinator under 33 3 paragraph "d". 33 4 d. Any not=for=profit or governmental entity approved by the 33 5 healthy Iowa board. 33 6 6. a. (1) A healthy Iowa program member shall enroll with 33 7 a healthy Iowa care coordinator prior to receiving health care 33 8 services. 33 9 (2) A member shall enroll with a care coordinator within 33 10 sixty days of enrollment in the healthy Iowa program. 33 11 (3) The healthy Iowa program shall only reimburse a health 33 12 care provider for services if the member is enrolled with a 33 13 care coordinator at the time the health care services are 33 14 provided. 33 15 b. If a member receives health care services before choosing 33 16 a care coordinator, the healthy Iowa program shall assist the 33 17 member, when appropriate, in choosing a care coordinator. 33 18 c. A member shall remain enrolled with a care coordinator 33 19 until the member becomes enrolled with a different care 33 20 coordinator or ceases to be a member. 33 21 d. A member may change the member's care coordinator based 33 22 on rules applicable to selecting a primary medical provider 33 23 or a medical home under the Iowa health and wellness program 33 24 pursuant to chapter 249N. 33 25 7. This section shall not be interpreted to authorize 33 26 any individual to engage in any act in violation of the 33 27 individual's professional licensure under title IV. 33 28 8. An individual or entity shall not act as a care 33 29 coordinator unless the health care services included in care 33 30 coordination are within the individual's professional scope of 33 31 practice or within the entity's legal authority. 33 32 9. a. The board shall adopt rules pursuant to chapter 33 33 17A regarding and including but not limited to all of the 33 34 following: 33 35 (1) Procedures and standards for an individual or entity 34 1 to be approved as a care coordinator under the healthy Iowa 34 2 program. 34 3 (2) Procedures and standards relating to the limitation, 34 4 suspension, or revocation of an individual's approval as a care 34 5 coordinator based on a determination that the individual or 34 6 entity is incompetent to be a care coordinator. 34 7 (3) Procedures and standards relating to the limitation, 34 8 suspension, or revocation of the approval of an individual's 34 9 or entity's approval as a care coordinator based on an 34 10 exhibited course of conduct that is inconsistent with healthy 34 11 Iowa program standards and regulations or that exhibits an 34 12 unwillingness to meet those standards and regulations. 34 13 (4) Procedures and standards relating to the limitation, 34 14 suspension, or revocation of approval of an individual or 34 15 entity as a care coordinator based on a determination that the 34 16 individual or entity is a potential threat to the public health 34 17 or safety. 34 18 b. The rules adopted by the board under this subsection 34 19 shall be consistent with professional practice, licensure 34 20 standards, and regulations established pursuant to title IV, 34 21 title VI, and title XIII, as applicable. 34 22 c. In developing and implementing rules or standards for 34 23 the approval of care coordinators for individuals receiving 34 24 chronic mental health care services, the board shall consult 34 25 with the division of mental health and disability services of 34 26 the department of human services. 34 27 10. To maintain approval under the program, a care 34 28 coordinator shall do all of the following: 34 29 a. Renew the person's status as a care coordinator every 34 30 three years pursuant to rules adopted by the board. 34 31 b. Provide the healthy Iowa program any data required by the 34 32 department of human services or the department of public health 34 33 and as required by the board that would enable the board to 34 34 evaluate the impact of care coordinators on quality, outcomes, 34 35 and cost of health care. 35 1 11. This chapter shall not be construed to alter the 35 2 professional practice of health care providers or their 35 3 licensure standards established pursuant to title IV. 35 4 12. a. Care coordinators shall not use health information 35 5 technology or clinical practice guidelines that limit the 35 6 effective exercise of the professional judgment of physicians 35 7 and registered nurses. 35 8 b. Physicians and registered nurses may override health 35 9 information technology and clinical practice guidelines if all 35 10 of the following criteria are met: 35 11 (1) It is consistent with the treating physician's 35 12 determination of medical necessity. 35 13 (2) In the professional judgment of the treating physician 35 14 or registered nurse, it is in the best interest of the patient 35 15 and consistent with the patient's wishes. 35 16 Sec. 17. NEW SECTION. 135E.17 Rates and payment 35 17 methodologies. 35 18 1. a. The board shall adopt rules pursuant to chapter 17A 35 19 regarding contracting and establishing payment methodologies 35 20 for covered health care services and care coordination provided 35 21 to members under the healthy Iowa program by participating 35 22 providers and care coordinators. 35 23 b. The board may adopt a variety of payment methodologies, 35 24 including those established on a demonstration basis. 35 25 c. All payment rates under the healthy Iowa program shall be 35 26 reasonable and reasonably related to the cost of efficiently 35 27 providing the health care service and ensuring an adequate and 35 28 accessible supply of health care services. 35 29 2. a. Health care services provided to members under the 35 30 healthy Iowa program, with the exception of care coordination, 35 31 shall be paid for on a fee=for=service basis unless and until 35 32 the board establishes another payment methodology. 35 33 b. A rebuttable presumption exists that the Medicare rate of 35 34 reimbursement constitutes a reasonable fee=for=service payment 35 35 rate. 36 1 3. Notwithstanding subsection 2, health maintenance 36 2 organizations, essential community providers, and group 36 3 medical practices that provide comprehensive, coordinated 36 4 services shall be reimbursed on the basis of a capitated system 36 5 operating budget or a noncapitated system operating budget. 36 6 4. a. Payment for health care services established under 36 7 this chapter shall be considered payment in full. 36 8 b. A participating health care provider shall not charge any 36 9 rate in excess of the payment established under this chapter 36 10 for any health care service provided to a member and shall not 36 11 solicit or accept payment from any member or third party for 36 12 any health care service, except as provided under federal law. 36 13 c. This section does not preclude the healthy Iowa program 36 14 from acting as a primary or secondary payer in conjunction with 36 15 another third=party payer when permitted by federal law. 36 16 5. a. The board may adopt rules pursuant to chapter 36 17 17A to provide payment methodologies for the payment of 36 18 capital=related expenses for specifically identified capital 36 19 expenditures incurred by not=for=profit or governmental 36 20 entities that are health care entities licensed under title IV, 36 21 including but not limited to hospitals, health care facilities, 36 22 subacute mental health care facilities, psychiatric medical 36 23 institutions for children, entities providing licensed hospice 36 24 programs, and entities providing emergency medical care. 36 25 b. Any capital=related expense generated by a capital 36 26 expenditure that requires prior approval by the board shall not 36 27 be paid unless such prior approval has been received. 36 28 c. Approval of a capital expenditure shall be based on 36 29 achievement of the program standards described in section 36 30 135E.19. 36 31 6. Payment methodologies and rates shall include a distinct 36 32 component of reimbursement for direct and indirect graduate 36 33 medical education. 36 34 7. a. The board shall adopt rules pursuant to chapter 36 35 17A regarding payment methodologies and procedures to pay for 37 1 health care services provided to a member while the member is 37 2 located outside this state for a period of time not to exceed 37 3 ninety days except as provided in paragraph "b". 37 4 b. (1) The board may adopt rules pursuant to chapter 17A 37 5 regarding payment methodologies and procedures to pay for 37 6 health care services provided to a member while the member is 37 7 outside this state for a period of time not to exceed ninety 37 8 days if it is medically necessary as determined by the member's 37 9 treating physician in accordance with the program standards 37 10 established in section 135E.19 and by the board. 37 11 (2) A member's treating physician is a person licensed to 37 12 engage in the practice of medicine and surgery or osteopathic 37 13 medicine and surgery pursuant to chapter 148. 37 14 Sec. 18. NEW SECTION. 135E.18 Rate negotiations. 37 15 1. The healthy Iowa program shall engage in good=faith 37 16 negotiations with health care provider representatives under 37 17 chapter 135F to develop all of the following: 37 18 a. Rates of payment for health care services. 37 19 b. Rates of payment for prescription and nonprescription 37 20 drugs. 37 21 c. Payment methodologies. 37 22 2. Rate negotiations shall be conducted annually through a 37 23 single entity on behalf of the entire program for prescription 37 24 and nonprescription drugs. 37 25 3. a. The board shall establish a prescription drug 37 26 formulary system, which shall discourage the use of 37 27 ineffective, dangerous, or excessively costly medications when 37 28 better alternatives are available. 37 29 b. The formulary established under this subsection shall 37 30 promote the use of generic medications to the greatest extent 37 31 possible. 37 32 c. Clinicians and patients may petition the board to add 37 33 new pharmaceuticals or to remove ineffective or dangerous 37 34 medications from the formulary. 37 35 d. The board shall adopt rules pursuant to chapter 17A 38 1 regarding the use of off=formulary medications which allow for 38 2 patient access but do not compromise the formulary. 38 3 Sec. 19. NEW SECTION. 135E.19 Program standards. 38 4 1. The healthy Iowa program shall establish a single 38 5 standard of safe, therapeutic health care services for all 38 6 residents. 38 7 2. The board shall adopt rules pursuant to chapter 17A to 38 8 establish requirements and standards for the program and for 38 9 care coordinators and health care providers, consistent with 38 10 this chapter and consistent with the applicable professional 38 11 practice and licensure standards for health care providers, 38 12 health care facilities, and health care professionals 38 13 established in title IV, title VI, and title XIII, as 38 14 applicable. The rules adopted under this subsection shall 38 15 address all of the following: 38 16 a. Requirements and standards for the scope, quality, and 38 17 accessibility of health care services. 38 18 b. Requirements and standards for interactions between 38 19 health care providers and members. 38 20 c. Requirements and standards for interactions between care 38 21 coordinators and health care providers, including credentialing 38 22 and participation in health care organization networks, and 38 23 terms, methods, and rates of payment. 38 24 3. The board shall adopt rules pursuant to chapter 17A to 38 25 establish requirements and standards to promote all of the 38 26 following: 38 27 a. Simplification, transparency, uniformity, and fairness in 38 28 health care provider credentialing and participation in health 38 29 care organization networks, referrals, payment procedures and 38 30 rates, claims processing, and approval of health care services, 38 31 as applicable. 38 32 b. In=person primary and preventive care, care coordination, 38 33 efficient and effective health care services, quality 38 34 assurance, and promotion of public, environmental, and 38 35 occupational health. 39 1 c. Elimination of health care disparities, including 39 2 geographic disparities, racial disparities, income=based 39 3 disparities, gender=based disparities, sex=based disparities, 39 4 and other disparities. 39 5 d. Nondiscrimination with respect to members and health 39 6 care providers on the basis of age, citizenship, claims 39 7 experience, color, creed, familial status, gender identity, 39 8 genetic information, geography, health status, immigration 39 9 status, marital status, medical condition, medical history, 39 10 mental disability, military or veteran status, national origin, 39 11 physical disability, primary language, race, receipt of health 39 12 care, religion, sex, sexual orientation, or source of income. 39 13 e. Provision of health care services under the healthy 39 14 Iowa program that is appropriate to the patient's clinically 39 15 relevant circumstances. 39 16 f. Accessibility of care coordination and health care 39 17 services, including accessibility for people with disabilities 39 18 and people with limited ability to speak or understand English. 39 19 g. Providing care coordination and health care services in 39 20 a culturally competent manner. 39 21 4. The board shall adopt rules pursuant to chapter 17A to 39 22 establish requirements and standards, to the extent authorized 39 23 by federal law, for replacing and merging with the healthy 39 24 Iowa program any health care services and ancillary services 39 25 currently provided by other programs, including but not limited 39 26 to Medicare, the Affordable Care Act, and federally matched 39 27 public health programs. 39 28 5. a. Any participating health care provider or care 39 29 coordinator that is organized as a for=profit entity shall meet 39 30 the same requirements and standards as entities organized as 39 31 not=for=profit entities. 39 32 b. Payments under the program to for=profit entities shall 39 33 not be calculated to accommodate the generation of profit, 39 34 excess revenue, revenue for dividends, or other return on 39 35 investment or the payment of taxes that would not be paid by a 40 1 not=for=profit entity. 40 2 6. a. A participating health care provider shall do all of 40 3 the following: 40 4 (1) Furnish information as required by the department of 40 5 public health, including the public health data management 40 6 program. 40 7 (2) Permit examination of information by the healthy Iowa 40 8 program as may be reasonably required for purposes of reviewing 40 9 accessibility and utilization of health care services, quality 40 10 assurance, cost containment, the making of payments, and 40 11 statistical or other studies of the operation of the healthy 40 12 Iowa program or for protection and promotion of public, 40 13 environmental, and occupational health. 40 14 b. The board shall use data collected under this subsection 40 15 to ensure that clinical practices meet the utilization, 40 16 quality, and access standards of the healthy Iowa program. 40 17 7. In developing requirements and standards and making 40 18 other policy determinations under this chapter, the board 40 19 shall consult with representatives of members, health care 40 20 providers, care coordinators, health care organizations, labor 40 21 organizations representing health care provider employees, and 40 22 other interested parties. 40 23 Sec. 20. NEW SECTION. 135E.20 Advocacy for necessary health 40 24 care. 40 25 1. As part of a health care provider's duty to exercise 40 26 a professional standard of care when evaluating a patient's 40 27 medical condition, a participating health care provider under 40 28 the healthy Iowa program shall do all of the following: 40 29 a. Advocate for medically necessary health care services for 40 30 the provider's patients. 40 31 b. Act in the exclusive interest of patients. 40 32 2. Consistent with subsection 1 and with professional 40 33 standards of care under title IV, a patient's treating 40 34 physician or health care provider is responsible for the 40 35 determination of the health care services medically necessary 41 1 for the patient. 41 2 3. Consistent with subsection 1 and with professional 41 3 standards of care under title IV, title VI, and title XIII, 41 4 care coordinators and health care providers shall use 41 5 reasonable care and diligence in safeguarding their patients 41 6 and shall not impair any health care provider's duty to 41 7 advocate for medically appropriate health care services for 41 8 patients. 41 9 4. Consistent with subsection 1 and with professional 41 10 standards of care under title IV, title VI, and title XIII, any 41 11 pecuniary interest or relationship of a physician or health 41 12 care provider, including any interest or relationship disclosed 41 13 or reported under this section, that impairs the physician's or 41 14 health care provider's ability to provide medically necessary 41 15 health care services to a patient violates the physician's or 41 16 health care provider's duty to advocate for medically necessary 41 17 health care services for patients. 41 18 5. A health care provider violates the duty to provide 41 19 medically necessary care services under this section if the 41 20 health care provider accepts any bonus, incentive payment, or 41 21 compensation based on any of the following: 41 22 a. A patient's utilization of health care services. 41 23 b. The financial results of any other health care provider 41 24 or care coordinator with which the health care provider or 41 25 care coordinator has a pecuniary interest or contractual 41 26 relationship, including employment or other compensation=based 41 27 relationship. 41 28 c. The financial results of any health maintenance 41 29 organization, essential community providers, or group medical 41 30 practices that receives capitated payments from the healthy 41 31 Iowa program. 41 32 6. To evaluate and review compliance by participating 41 33 health care providers and care coordinators under the healthy 41 34 Iowa program, participating health care providers and care 41 35 coordinators shall report, at least annually, to the department 42 1 of public health's public health data management program all 42 2 of the following: 42 3 a. Any beneficial interest in or compensation arrangement 42 4 with an entity to which the participating health care provider 42 5 referred a patient. 42 6 b. Any membership, proprietary interest, or co=ownership in 42 7 any form in or with a clinical or bioanalytical laboratory. 42 8 c. Any payments to a clinical or bioanalytical laboratory 42 9 for a test or test series for a patient. 42 10 d. Any profit=sharing arrangement with a clinical or 42 11 bioanalytical laboratory. 42 12 e. Any contracts or subcontracts entered into that contain 42 13 incentive plans, involve general payments such as capitation 42 14 payments or shared risk agreements, and are not tied to 42 15 specific medical decisions involving specific members or groups 42 16 of members with similar medical conditions. Such contracts 42 17 and subcontracts include those entered into with a health 42 18 maintenance organization or group practice. 42 19 f. Any bonus, incentive agreements, or compensation 42 20 arrangements with any other participating health care provider, 42 21 care coordinator, health maintenance organization, or group 42 22 medical practice under the healthy Iowa program. 42 23 g. Any offer, delivery, receipt, or acceptance of rebates, 42 24 refunds, commission, preference, patronage dividend, discount, 42 25 or other consideration for a referral made when treating a 42 26 member of a health maintenance organization, to another health 42 27 care provider in the same group practice as the referring 42 28 health care provider, or made for in=office ancillary services 42 29 or tests that are furnished by the referring health care 42 30 provider, a person in the same group practice as the referring 42 31 health care provider, or an individual employed or supervised 42 32 by the referring health care provider. 42 33 h. Any other referral or relationship that the board finds 42 34 necessary to disclose to meet the purposes of this section. 42 35 7. The board may adopt rules pursuant to chapter 17A as 43 1 necessary to implement and enforce this section and may adopt 43 2 such rules to expand reporting requirements under this section. 43 3 Sec. 21. NEW SECTION. 135E.21 Federal waivers. 43 4 1. The board shall seek all federal waivers and other 43 5 federal approvals and arrangements and submit federal state 43 6 plan amendments as necessary to operate the healthy Iowa 43 7 program consistent with this chapter. 43 8 2. a. The board and, as appropriate, the director of human 43 9 services, shall apply to the United States secretary of health 43 10 and human services or other appropriate federal official for 43 11 all waivers of requirements, and make other arrangements under 43 12 Medicare, any federally matched public health program, the 43 13 Affordable Care Act, and any other federal programs pertaining 43 14 to the provision of health care that provide federal funds for 43 15 payment for health care services that are necessary to: 43 16 (1) Enable all members to receive all benefits through the 43 17 healthy Iowa program. 43 18 (2) Enable the state to implement this chapter. 43 19 (3) Allow the state to receive and deposit all federal 43 20 payments under those programs, including funds that may 43 21 be provided in lieu of premium tax credits, cost=sharing 43 22 subsidies, and small business tax credits, in the state 43 23 treasury to the credit of the healthy Iowa trust fund. 43 24 (4) Use moneys deposited in the healthy Iowa trust fund 43 25 for the healthy Iowa program and other provisions under this 43 26 chapter. 43 27 b. To the greatest extent possible, the board shall 43 28 negotiate arrangements with the federal government to ensure 43 29 that federal payments are paid to the healthy Iowa program in 43 30 place of federal funding of, or tax benefits for, federally 43 31 matched public health programs or federal health programs. 43 32 c. (1) The board may require members or applicants to 43 33 provide information necessary for the healthy Iowa program to 43 34 comply with any waiver or arrangement under this chapter. 43 35 (2) Information provided by members to the board for the 44 1 purposes of this paragraph shall not be used for any other 44 2 purpose. 44 3 d. The board may take any additional actions necessary to 44 4 effectively implement the healthy Iowa program to the maximum 44 5 extent possible as a single=payer program consistent with this 44 6 chapter. 44 7 3. a. The board may take actions consistent with this 44 8 chapter to enable the healthy Iowa program to administer 44 9 Medicare in this state. 44 10 b. The healthy Iowa program shall do all of the following: 44 11 (1) Be a provider of Medicare part B supplemental insurance 44 12 coverage. 44 13 (2) Provide premium assistance drug coverage under Medicare 44 14 part D for eligible members of the healthy Iowa program. 44 15 4. The board may waive or modify the applicability of any 44 16 provisions of this section relating to any federally matched 44 17 public health program or Medicare, as necessary, to do any of 44 18 the following: 44 19 a. Implement any waiver arrangement under this section. 44 20 b. Maximize the federal benefits to the healthy Iowa program 44 21 under this section. 44 22 5. a. The board may apply for coverage for, and enroll, 44 23 any eligible member under any federally matched public health 44 24 program or Medicare. 44 25 b. Enrollment in a federally matched public health program 44 26 or Medicare shall not cause any member to lose any health care 44 27 services provided by the healthy Iowa program or diminish any 44 28 right the member would otherwise have. 44 29 6. The board shall take necessary action to incorporate 44 30 health care coverage of residents who are employed in another 44 31 state into waivers and other approvals applied for or obtained 44 32 under this section. 44 33 7. a. The board shall take necessary action to reduce or 44 34 eliminate a member's coinsurance, cost=sharing, or premium 44 35 obligations or to increase the likelihood of an individual's 45 1 eligibility for any federal financial support related to 45 2 Medicare or the Affordable Care Act. 45 3 b. The board may act under paragraph "a" only upon a 45 4 finding approved by the board that the action does all of the 45 5 following: 45 6 (1) Helps to increase the number of members who are eligible 45 7 for and enrolled in federally matched public health programs, 45 8 or for any program to reduce or eliminate an individual's 45 9 coinsurance, cost=sharing, or premium obligations or increase 45 10 an individual's eligibility for any federal financial support 45 11 related to Medicare or the Affordable Care Act. 45 12 (2) Does not diminish any individual's access to any health 45 13 care service or right the individual would otherwise have. 45 14 (3) Is in the interest of the healthy Iowa program. 45 15 (4) Does not require or has received any necessary federal 45 16 waivers or approvals to ensure federal financial participation. 45 17 c. Action that the board may take under paragraph "a" may 45 18 include any of the following: 45 19 (1) An increase to the income eligibility level related to 45 20 Medicare or the Affordable Care Act. 45 21 (2) An increase to resource retention or an elimination of 45 22 the resource test for eligibility related to Medicare or the 45 23 Affordable Care Act. 45 24 (3) Simplification of any procedural or documentation 45 25 requirement for enrollment related to Medicare or the 45 26 Affordable Care Act. 45 27 (4) An increase in the benefits for any federally matched 45 28 public health program and for any program in order to reduce or 45 29 eliminate an individual's coinsurance, cost=sharing, or premium 45 30 obligations or increase an individual's eligibility for any 45 31 federal financial support related to Medicare or the Affordable 45 32 Care Act. 45 33 d. Board actions under this subsection shall not apply to 45 34 eligibility for payment for long=term care. 45 35 8. To enable the board to apply for coverage for, and 46 1 enroll, any eligible member under any federally matched public 46 2 health program or Medicare, the board may require that all 46 3 members or applicants provide the information necessary to 46 4 enable the board to determine whether the applicant is eligible 46 5 for a federally matched public health program or for Medicare, 46 6 or any program or benefit under Medicare. 46 7 9. As a condition of continued eligibility for health 46 8 care services under the healthy Iowa program, a member who is 46 9 eligible for benefits under Medicare shall enroll in Medicare, 46 10 including parts A, B, and D. 46 11 10. a. The healthy Iowa program shall provide premium 46 12 assistance for all members enrolling in a Medicare part D drug 46 13 coverage plan under {1860D of Tit. XVIII of the federal Social 46 14 Security Act, 42 U.S.C. {1395w=101 et seq. 46 15 b. Premium assistance required under paragraph "a" is 46 16 limited to the low=income benchmark premium amount established 46 17 by the centers for Medicare and Medicaid services of the United 46 18 States department of health and human services and any other 46 19 amount the federal agency establishes under its de minimis 46 20 premium policy, except that those payments made on behalf of 46 21 members enrolled in a Medicare advantage plan may exceed the 46 22 low=income benchmark premium amount if determined to be cost 46 23 effective to the healthy Iowa program. 46 24 11. a. If the board has reasonable grounds to believe that 46 25 a member may be eligible for an income=related subsidy under 46 26 {1860D=14 of Tit. XVIII of the federal Social Security Act, 42 46 27 U.S.C. {1395w=114, the member shall be required to provide and 46 28 authorize the healthy Iowa program to obtain any information or 46 29 documentation required to establish the member's eligibility 46 30 for that subsidy. 46 31 b. The board shall attempt to obtain as much of the 46 32 information and documentation required by paragraph "a" as 46 33 possible. 46 34 12. a. The healthy Iowa program shall make a reasonable 46 35 effort to notify members of their obligations under this 47 1 section. 47 2 b. After a reasonable effort has been made to contact the 47 3 member, the member shall be notified in writing that the member 47 4 has sixty days to provide the required information. 47 5 c. If the required information is not provided within the 47 6 sixty=day period, the member's coverage under the healthy Iowa 47 7 program may be terminated. 47 8 d. Information provided by members to the board for the 47 9 purposes of this section shall not be used for any other 47 10 purpose. 47 11 13. The board shall assume responsibility for all benefits 47 12 and health care services paid for by the federal government 47 13 with those funds. 47 14 Sec. 22. NEW SECTION. 135E.22 Healthy Iowa trust fund ==== 47 15 special fund created. 47 16 1. A special fund is created in the state treasury, separate 47 17 and apart from all other public moneys or funds of this state, 47 18 to be known as the healthy Iowa trust fund. The fund shall 47 19 consist of all of the following: 47 20 a. All moneys appropriated by the state to the fund. 47 21 b. All moneys received from the federal government, as 47 22 the result of any waiver of requirements granted or other 47 23 arrangements agreed to by the federal government for health 47 24 care programs. 47 25 c. All moneys transferred to the fund attributable to state 47 26 and federal financial participation in Medicaid, the healthy 47 27 and well kids in Iowa program, and Medicare. 47 28 d. All receipts and revenue after January 1, 2018, as a 47 29 result of the collection of taxes or other moneys, as provided 47 30 by law, shall also be deposited in the healthy Iowa trust fund. 47 31 e. All federal and state moneys received for purposes of the 47 32 provision of services authorized under Tit. XX of the federal 47 33 Social Security Act, 42 U.S.C. {1397 et seq., but are provided 47 34 under the healthy Iowa program. 47 35 f. All moneys received from other federal programs that 48 1 provide moneys for the payment of health care services that are 48 2 provided under this chapter. 48 3 g. All moneys paid by the state that are equivalent to those 48 4 amounts that are paid on behalf of residents under Medicare, 48 5 any federally matched public health program, or the Affordable 48 6 Care Act for health benefits that are equivalent to health 48 7 benefits covered under the healthy Iowa program. 48 8 2. All moneys in the fund shall be deposited, administered, 48 9 and disbursed, in the same manner and under the same conditions 48 10 and requirements as is provided by law for special funds in 48 11 the state treasury. The moneys credited to the fund are not 48 12 subject to section 8.33 and shall not be transferred, used, 48 13 obligated, appropriated, or otherwise encumbered except as 48 14 provided in this section. Moneys deposited into the fund are 48 15 appropriated and made available to the healthy Iowa program to 48 16 be used only for the following purposes established by this 48 17 chapter: 48 18 a. To implement the purposes of the healthy Iowa program. 48 19 b. To be used by the healthy Iowa program for the payment of 48 20 claims or reimbursement of member benefits. 48 21 c. To be used by the healthy Iowa program for the payment, 48 22 in accordance with any agreement with the federal government, 48 23 of amounts required to obtain federal waivers and such other 48 24 purposes under the healthy Iowa program as may be authorized 48 25 by law. 48 26 3. The treasurer of state is the custodian and trustee of 48 27 the fund and shall administer the fund in accordance with the 48 28 purposes of the healthy Iowa program. It is the duty of the 48 29 treasurer of state to do all of the following: 48 30 a. To hold the trust funds. 48 31 b. To disburse the trust funds upon warrants drawn by the 48 32 director of the healthy Iowa program. 48 33 4. The healthy Iowa program shall administer the healthy 48 34 Iowa trust fund and shall also administer all other provisions 48 35 of this section. 49 1 5. All moneys in the fund, except moneys received 49 2 pursuant to federal waivers entered into pursuant to section 49 3 135E.21, which are received from the federal government 49 4 shall be expended solely for the purposes and in the amounts 49 5 found necessary by the board for the proper and efficient 49 6 administration of this chapter and any federal waivers or 49 7 agreements. 49 8 6. Moneys deposited in the fund shall not be loaned to, or 49 9 borrowed by, any other special fund or the general fund of the 49 10 state, or a county general fund or any other county fund. 49 11 7. The board shall establish and maintain a reserve fund in 49 12 the healthy Iowa trust fund. 49 13 8. The board or staff of the board shall not utilize any 49 14 moneys intended for the administrative and operational expenses 49 15 of the board for staff retreats, promotional giveaways, 49 16 excessive executive compensation, or promotion of federal or 49 17 state legislative or regulatory modifications. 49 18 9. a. A healthy Iowa federal funds account is created 49 19 within the fund. 49 20 b. All federal moneys received shall be placed into the 49 21 healthy Iowa federal funds account. 49 22 Sec. 23. NEW SECTION. 135E.23 Severability. 49 23 If any provision of this chapter or its application to any 49 24 person or circumstance is held invalid, the invalidity does 49 25 not affect other provisions or application of this chapter 49 26 which can be given effect without the invalid provision or 49 27 application, and to this end the provisions of this chapter are 49 28 severable. 49 29 Sec. 24. NEW SECTION. 135E.24 Relation to other laws. 49 30 This chapter does not preempt or prevail over and is 49 31 not meant to be construed to preempt or prevail over any 49 32 ordinances, resolutions, or other actions of a local government 49 33 or rules or actions of a state agency that are consistent with 49 34 this chapter or that provide more protections and benefits to 49 35 residents of this state than this chapter or are more stringent 50 1 than this chapter. 50 2 Sec. 25. NEW SECTION. 135F.1 Definitions. 50 3 As used in this chapter, unless the context otherwise 50 4 requires: 50 5 1. a. "Health care provider" means a person who meets all 50 6 of the following criteria: 50 7 (1) Is licensed, certified, registered, or authorized to 50 8 practice a health care profession in the state pursuant to 50 9 chapter 147A, 148, 148A, 148B, 148C, 148E, 148F, 148G, 149, 50 10 151, 152, 152A, 152B, 152C, 153, 154, 154A, 154B, 154C, 154D, 50 11 154F, 155, or 155A. 50 12 (2) Is an approved health care provider under the healthy 50 13 Iowa program created in chapter 135E. 50 14 (3) Is an individual who does any of the following: 50 15 (a) Practices the profession in which that person is 50 16 licensed, certified, registered, or authorized to practice 50 17 in the state as a health care provider or as an independent 50 18 contractor. 50 19 (b) Is an owner, officer, shareholder, or proprietor of a 50 20 health care provider. 50 21 (c) Is an entity that employs or utilizes health care 50 22 providers to provide health care services under the healthy 50 23 Iowa program. 50 24 b. "Health care provider" does not include an individual who 50 25 practices as an employee of another health care provider. 50 26 2. "Health care provider representative" means a third party 50 27 that is authorized by a health care provider to negotiate 50 28 on behalf of the health care provider with the healthy Iowa 50 29 program over terms and conditions of participation affecting 50 30 those health care providers. 50 31 Sec. 26. NEW SECTION. 135F.2 Collective negotiation 50 32 authorized. 50 33 1. Health care providers may meet and communicate for the 50 34 purpose of collectively negotiating with the healthy Iowa 50 35 program on any matter relating to the healthy Iowa program 51 1 including but not limited to rates of payment for health care 51 2 services, rates of payment for prescription and nonprescription 51 3 drugs, and payment methodologies. 51 4 2. This chapter shall not be construed, is not intended to 51 5 be construed, and shall not imply any of the following: 51 6 a. To allow or authorize an alteration of the terms of the 51 7 internal and external review procedures set forth in law. 51 8 b. To allow a strike by health care providers related to the 51 9 collective negotiations under the healthy Iowa program. 51 10 c. To allow or authorize terms or conditions of 51 11 participation that would impede the ability of the healthy 51 12 Iowa program to obtain or retain accreditation by the national 51 13 committee for quality assurance or a similar body, or to comply 51 14 with applicable state or federal law. 51 15 Sec. 27. NEW SECTION. 135F.3 Collective negotiation ==== 51 16 requirements. 51 17 1. A health care provider representative is the only party 51 18 authorized to negotiate with the healthy Iowa program on behalf 51 19 of the health care providers as a group. 51 20 2. A health care provider shall be bound by the terms 51 21 and conditions negotiated by the health care provider 51 22 representative. 51 23 3. Health care providers have the right during collective 51 24 negotiations under this chapter to communicate with other 51 25 health care providers regarding the terms and conditions of 51 26 participation to be negotiated with the healthy Iowa program 51 27 and to communicate with health care provider representatives. 51 28 4. The healthy Iowa program may communicate or negotiate 51 29 with the health care provider representative, and may offer 51 30 and provide different terms and conditions of participation to 51 31 individual competing health care providers. 51 32 5. This section shall not be construed, is not intended to 51 33 be construed to, and shall not imply any of the following: 51 34 a. An effect on or limitation to the right of a health care 51 35 provider or group of health care providers to collectively 52 1 petition a governmental entity for a change in a law, rule, or 52 2 regulation. 52 3 b. An effect on or limitation to collective bargaining 52 4 on the part of a health care provider with the health care 52 5 provider's employer or any other lawful collective bargaining. 52 6 6. Before engaging in collective negotiations with the 52 7 healthy Iowa program on behalf of health care providers, a 52 8 health care provider representative shall file with the board, 52 9 in the manner prescribed by the board, all of the following 52 10 information: 52 11 a. The name of the representative. 52 12 b. The representative's plan of operation. 52 13 c. The representative's procedures to ensure compliance with 52 14 this chapter. 52 15 7. a. A person who acts as the representative of 52 16 negotiating parties under this chapter shall pay a fee to the 52 17 board to act as a representative. 52 18 b. The board shall set fees in amounts deemed reasonable 52 19 and necessary to cover the costs incurred by the board in 52 20 administering this chapter. 52 21 Sec. 28. NEW SECTION. 135F.4 Health care providers ==== 52 22 prohibited collective action. 52 23 1. This chapter shall not authorize competing health care 52 24 providers to act in concert in response to discussions or 52 25 negotiations of a health care provider representative with the 52 26 healthy Iowa program, except as authorized by other law. 52 27 2. A health care provider representative shall not 52 28 negotiate any agreement that excludes, limits the participation 52 29 or reimbursement of, or otherwise limits the scope of health 52 30 care services to be provided by any health care provider or 52 31 group of health care providers with respect to the performance 52 32 of health care services that are within the health care 52 33 provider's scope of practice, license, registration, or 52 34 certification. 52 35 Sec. 29. NEW SECTION. 135F.5 Severability. 53 1 If any provision of this chapter or its application to any 53 2 person or circumstance is held invalid, the invalidity does 53 3 not affect other provisions or application of this chapter 53 4 which can be given effect without the invalid provision or 53 5 application, and to this end the provisions of this chapter are 53 6 severable. 53 7 Sec. 30. NEW SECTION. 135F.6 Relation to other laws. 53 8 This chapter does not preempt or prevail over and is 53 9 not meant to be construed to preempt or prevail over any 53 10 ordinances, resolutions, or other actions of a local government 53 11 or rules or actions of a state agency that are consistent with 53 12 this chapter or that provide more protections and benefits to 53 13 Iowa residents than this chapter or are more stringent than 53 14 this chapter. 53 15 Sec. 31. EFFECTIVE DATE. This Act, being deemed of 53 16 immediate importance, takes effect upon enactment. 53 17 Sec. 32. CONTINGENT IMPLEMENTATION. Implementation of this 53 18 Act is contingent upon sufficient revenue in the healthy Iowa 53 19 trust fund to bear the costs of implementing the healthy Iowa 53 20 program, as determined by the director of human services. The 53 21 director of human services shall notify the secretary of the 53 22 senate, the chief clerk of the house of representatives, and 53 23 the Iowa Code editor, in writing when the healthy Iowa trust 53 24 fund has sufficient revenue to bear the costs of implementing 53 25 this Act. The department of human services shall publish a 53 26 copy of the notice on its internet site. 53 27 EXPLANATION 53 28 The inclusion of this explanation does not constitute agreement with 53 29 the explanation's substance by the members of the general assembly. 53 30 This bill creates new Code chapter 135E, establishing the 53 31 healthy Iowa program, which provides comprehensive, universal 53 32 single=payer health care coverage and a health care cost 53 33 control system for all residents of Iowa. The bill provides 53 34 that all residents of the state are eligible to be members of 53 35 the healthy Iowa program and are eligible to receive health 54 1 care services benefits under the program. The bill requires 54 2 that the healthy Iowa program provide all members of the 54 3 program with certain health care services, and incorporate the 54 4 health care benefits and standards of other existing federal 54 5 and state programs. The bill prohibits health care providers 54 6 participating in the healthy Iowa program from refusing to 54 7 provide services to a member on the basis of certain protected 54 8 categories. The bill establishes the healthy Iowa board and 54 9 public advisory committee. 54 10 The bill provides that health care coverage under the 54 11 healthy Iowa program shall not be subject to coinsurance, 54 12 deductibles, or copayments. The bill prohibits certain 54 13 insurers, nonprofit health service plans, and health 54 14 maintenance organizations from offering benefits that duplicate 54 15 the services covered by the program. The bill prohibits health 54 16 insurers from offering health benefits covering any health care 54 17 service for which coverage is offered to individuals under 54 18 the healthy Iowa program, except as otherwise provided, and 54 19 prohibits a participating health care provider from imposing 54 20 charges directly on healthy Iowa members. 54 21 The bill provides for approval of participating health 54 22 care providers and care coordinators under the program and 54 23 provides for enrollment of residents in the program. The bill 54 24 also provides that healthy Iowa program members may choose a 54 25 participating health care provider and requires that members 54 26 select a care coordinator. 54 27 The bill specifies healthy Iowa program standards and 54 28 payment for health care services and care coordination, and 54 29 requires that the program provide reimbursements to certain 54 30 members. The bill establishes a health benefit credit for 54 31 certain employers and residents. 54 32 The bill establishes the healthy Iowa trust fund as a special 54 33 fund for the purpose of implementing the program and its 54 34 purposes. The bill requires the board and the department of 54 35 human services to apply to the federal government for waivers 55 1 and other approvals relating to federally regulated health care 55 2 programs. 55 3 The bill also creates new chapter 135F providing for 55 4 collective negotiations between health care providers and 55 5 the healthy Iowa program. The bill authorizes health care 55 6 providers to collectively negotiate with the program for 55 7 rates of payment for health care services, rates of payment 55 8 for prescription and nonprescription drugs, and payment 55 9 methodologies using a third=party representative. 55 10 Implementation of the bill is contingent upon sufficient 55 11 revenue in the healthy Iowa trust fund to bear the costs of 55 12 implementing the healthy Iowa program as determined by the 55 13 director of human services. LSB 5541YH (8) 87 pf/rj
