Bill Text: IA HF2462 | 2017-2018 | 87th General Assembly | Amended

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Bill Title: A bill for an act relating to programs and activities under the purview of the department of human services. (Formerly HSB 632.)

Spectrum: Committee Bill

Status: (Engrossed - Dead) 2018-03-20 - Subcommittee: Costello, Bolkcom, and Shipley. S.J. 725. [HF2462 Detail]

Download: Iowa-2017-HF2462-Amended.html

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House File 2462 - Reprinted




                                 HOUSE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO HSB 632)
       (As Amended and Passed by the House March 8, 2018)

                                      A BILL FOR

  1 An Act relating to programs and activities under the purview of
  2    the department of human services.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    HF 2462 (5) 87
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PAG LIN



  1  1                           DIVISION I
  1  2        HEALTHY AND WELL KIDS IN IOWA ==== DIRECTOR DUTIES
  1  3    Section 1.  Section 514I.4, subsection 5, Code 2018, is
  1  4 amended by adding the following new paragraphs:
  1  5    NEW PARAGRAPH.  d.  Collect and track monthly family premiums
  1  6 to assure that payments are current.
  1  7    NEW PARAGRAPH.  e.  Verify the number of program enrollees
  1  8 with each participating insurer for determination of the amount
  1  9 of premiums to be paid to each participating insurer.
  1 10    Sec. 2.  Section 514I.7, subsection 2, paragraphs g and i,
  1 11 Code 2018, are amended by striking the paragraphs.
  1 12                           DIVISION II
  1 13                  SHARING OF INCARCERATION DATA
  1 14    Sec. 3.  Section 249A.38, Code 2018, is amended to read as
  1 15 follows:
  1 16    249A.38  Inmates of public institutions ==== suspension or
  1 17 termination of medical assistance.
  1 18    1.  The following conditions shall apply to Following the
  1 19 first thirty days of commitment, the department shall suspend
  1 20 the eligibility of an individual who is an inmate of a public
  1 21 institution as defined in 42 C.F.R. {435.1010, who is enrolled
  1 22 in the medical assistance program at the time of commitment to
  1 23 the public institution, and who remains eligible for medical
  1 24 assistance as an individual except for the individual's
  1 25 institutional status:
  1 26    a.  The department shall suspend the individual's
  1 27 eligibility for up to the initial twelve months of the period
  1 28 of commitment. The department shall delay the suspension
  1 29 of eligibility for a period of up to the first thirty days
  1 30 of commitment if such delay is approved by the centers for
  1 31 Medicare and Medicaid services of the United States department
  1 32 of health and human services. If such delay is not approved,
  1 33 the department shall suspend eligibility during the entirety
  1 34 of the initial twelve months of the period of commitment.
  1 35 Claims submitted on behalf of the individual under the medical
  2  1 assistance program for covered services provided during the
  2  2 delay period shall only be reimbursed if federal financial
  2  3 participation is applicable to such claims. 
  2  4    b.  The department shall terminate an individual's
  2  5 eligibility following a twelve=month period of suspension
  2  6 of the individual's eligibility under paragraph "a", during
  2  7 the period of the individual's commitment to the public
  2  8 institution.
  2  9    2.  a.  A public institution shall provide the department and
  2 10 the social security administration with a monthly report of the
  2 11 individuals who are committed to the public institution and of
  2 12 the individuals who are discharged from the public institution.
  2 13 The monthly report to the department shall include the date
  2 14 of commitment or the date of discharge, as applicable, of
  2 15 each individual committed to or discharged from the public
  2 16 institution during the reporting period. The monthly report
  2 17 shall be made through the reporting system created by the
  2 18 department for public, nonmedical institutions to report inmate
  2 19 populations.  Any medical assistance expenditures, including
  2 20 but not limited to monthly managed care capitation payments,
  2 21 provided on behalf of an individual who is an inmate of a
  2 22 public institution but is not reported to the department
  2 23 in accordance with this subsection, shall be the financial
  2 24 responsibility of the respective public institution.
  2 25    b.  The department shall provide a public institution with
  2 26 the forms necessary to be used by the individual in expediting
  2 27 restoration of the individual's medical assistance benefits
  2 28 upon discharge from the public institution.
  2 29    3.  This section applies to individuals as specified in
  2 30 subsection 1 on or after January 1, 2012. 
  2 31    4.  3.  The department may adopt rules pursuant to chapter
  2 32 17A to implement this section.
  2 33                          DIVISION III
  2 34                 MEDICAID PROGRAM ADMINISTRATION
  2 35    Sec. 4.  MEDICAID PROGRAM ADMINISTRATION.
  3  1    1.  PROVIDER PROCESSES AND PROCEDURES.
  3  2    a.  When all of the required documents and other information
  3  3 necessary to process a claim have been received by a managed
  3  4 care organization, the managed care organization shall
  3  5 either provide payment to the claimant within the timelines
  3  6 specified in the managed care contract or, if the managed
  3  7 care organization is denying the claim in whole or in part,
  3  8 shall provide notice to the claimant including the reasons for
  3  9 such denial consistent with national industry best practice
  3 10 guidelines.
  3 11    b.  If a managed care organization discovers that a claims
  3 12 payment barrier is the result of a managed care organization's
  3 13 identified system configuration error, the managed care
  3 14 organization shall correct such error and shall fully and
  3 15 accurately reprocess the claims affected by the error within
  3 16 ninety days of such discovery.  For the purposes of this
  3 17 paragraph, "configuration error" means an error in provider
  3 18 data, an incorrect fee schedule, or an incorrect claims edit.
  3 19    c.  The department of human services shall provide for
  3 20 the development and require the use of standardized Medicaid
  3 21 provider enrollment forms to be used by the department and
  3 22 uniform Medicaid provider credentialing standards to be used
  3 23 by managed care organizations.  The credentialing process is
  3 24 deemed to begin when the managed care organization has received
  3 25 all necessary credentialing materials from the provider and is
  3 26 deemed to have ended when written communication is mailed or
  3 27 faxed to the provider notifying the provider of the managed
  3 28 care organization's decision.
  3 29    2.  MEMBER SERVICES AND PROCESSES.
  3 30    a.  If a Medicaid member prevails in a review by a managed
  3 31 care organization or on appeal regarding the provision
  3 32 of services, the services subject to the review or appeal
  3 33 shall be extended for a period of time determined by the
  3 34 director of human services. However, services shall not be
  3 35 extended if there is a change in the member's condition that
  4  1 warrants a change in services as determined by the member's
  4  2 interdisciplinary team, there is a change in the member's
  4  3 eligibility status as determined by the department of human
  4  4 services, or the member voluntarily withdraws from services.
  4  5    b.  If a Medicaid member is receiving court=ordered services
  4  6 or treatment for a substance=related disorder pursuant to
  4  7 chapter 125 or for a mental illness pursuant to chapter 229,
  4  8 such services or treatment shall be provided and reimbursed
  4  9 for an initial period of five days before a managed care
  4 10 organization may apply medical necessity criteria to determine
  4 11 the most appropriate services, treatment, or placement for the
  4 12 Medicaid member.
  4 13    c.  The department of human services shall review and have
  4 14 approval authority for a Medicaid member's level of care
  4 15 reassessment that indicates a decrease in the level of care.
  4 16 A managed care organization shall comply with the findings of
  4 17 the departmental review and approval of such level of care
  4 18 reassessment.  If a level of care reassessment indicates there
  4 19 is no change in a Medicaid member's level of care needs, the
  4 20 Medicaid member's existing level of care shall be continued.  A
  4 21 managed care organization shall maintain and make available to
  4 22 the department of human services all documentation relating to
  4 23 a Medicaid member's level of care assessment.
  4 24    d.  The department of human services shall maintain and
  4 25 update Medicaid member eligibility files in a timely manner
  4 26 consistent with national industry best practices.
  4 27    3.  MEDICAID PROGRAM REVIEW AND OVERSIGHT.
  4 28    a.  (1)  The department of human services shall facilitate a
  4 29 workgroup, in collaboration with representatives of the managed
  4 30 care organizations and health home providers, to review the
  4 31 health home programs.  The review shall include all of the
  4 32 following:
  4 33    (a)  An analysis of the state plan amendments applicable to
  4 34 health homes.
  4 35    (b)  An analysis of the current health home system, including
  5  1 the rationale for any recommended changes.
  5  2    (c)  The development of a clear and consistent delivery
  5  3 model linked to program=determined outcomes and data reporting
  5  4 requirements.
  5  5    (d)  A work plan to be used in communicating with
  5  6 stakeholders regarding the administration and operation of the
  5  7 health home programs.
  5  8    (2)  The department of human services shall submit a report
  5  9 of the workgroup's findings and recommendations by December
  5 10 15, 2018, to the governor and to the Eighty=eighth General
  5 11 Assembly, 2019 session, for consideration.
  5 12    b.  The department of human services, in collaboration
  5 13 with Medicaid providers and managed care organizations, shall
  5 14 initiate a review process to determine the effectiveness of
  5 15 prior authorizations used by the managed care organizations
  5 16 with the goal of making adjustments based on relevant
  5 17 service costs and member outcomes data utilizing existing
  5 18 industry=accepted standards.  Prior authorization policies
  5 19 shall comply with existing rules, guidelines, and procedures
  5 20 developed by the centers for Medicare and Medicaid services of
  5 21 the United States department of health and human services.
  5 22    c.  The department of human services shall enter into a
  5 23 contract with an independent auditor to perform an audit of
  5 24 small dollar claims paid to or denied Medicaid long=term
  5 25 services and supports providers. The department may take any
  5 26 action specified in the managed care contract relative to
  5 27 any claim the auditor determines to be incorrectly paid or
  5 28 denied, subject to appeal by the managed care organization
  5 29 to the director of human services.  For the purposes of this
  5 30 paragraph, "small dollar claims" means those claims less than
  5 31 or equal to two thousand five hundred dollars.
  5 32                           DIVISION IV
  5 33               MEDICAID PROGRAM PHARMACY COPAYMENT
  5 34    Sec. 5.  2005 Iowa Acts, chapter 167, section 42, is amended
  5 35 to read as follows:
  6  1    SEC. 42.  COPAYMENTS FOR PRESCRIPTION DRUGS UNDER THE
  6  2 MEDICAL ASSISTANCE PROGRAM.  The department of human services
  6  3 shall require recipients of medical assistance to pay the
  6  4 following copayments a copayment of $1 on each prescription
  6  5 filled for a covered prescription drug, including each refill
  6  6 of such prescription, as follows:
  6  7    1.  A copayment of $1 on each prescription filled for each
  6  8 covered nonpreferred generic prescription drug.
  6  9    2.  A copayment of $1 for each covered preferred brand=name
  6 10 or generic prescription drug.
  6 11    3.  A copayment of $1 for each covered nonpreferred
  6 12 brand=name prescription drug for which the cost to the state is
  6 13 up to and including $25.
  6 14    4.  A copayment of $2 for each covered nonpreferred
  6 15 brand=name prescription drug for which the cost to the state is
  6 16 more than $25 and up to and including $50. 
  6 17    5.  A copayment of $3 for each covered nonpreferred
  6 18 brand=name prescription drug for which the cost to the state
  6 19 is more than $50.
  6 20                           DIVISION V
  6 21               MEDICAL ASSISTANCE ADVISORY COUNCIL
  6 22    Sec. 6.  Section 249A.4B, subsection 2, paragraph a,
  6 23 subparagraphs (27) and (28), Code 2018, are amended by striking
  6 24 the subparagraphs.
  6 25    Sec. 7.  MEDICAL ASSISTANCE ADVISORY COUNCIL == REVIEW OF
  6 26 MEDICAID MANAGED CARE REPORT DATA.  The executive committee
  6 27 of the medical assistance advisory council shall review
  6 28 the data collected and analyzed for inclusion in periodic
  6 29 reports to the general assembly, including but not limited
  6 30 to the information and data specified in 2016 Iowa Acts,
  6 31 chapter 1139, section 93, to determine which data points and
  6 32 information should be included and analyzed to more accurately
  6 33 identify trends and issues with, and promote the effective and
  6 34 efficient administration of, Medicaid managed care for all
  6 35 stakeholders.  At a minimum, the areas of focus shall include
  7  1 consumer protection, provider network access and safeguards,
  7  2 outcome achievement, and program integrity. The executive
  7  3 committee shall report its findings and recommendations to the
  7  4 medical assistance advisory council for review and comment by
  7  5 October 1, 2018, and shall submit a final report of findings
  7  6 and recommendations to the governor and the general assembly by
  7  7 December 31, 2018.
  7  8                           DIVISION VI
  7  9  TARGETED CASE MANAGEMENT AND INPATIENT PSYCHIATRIC SERVICES
  7 10                          REIMBURSEMENT
  7 11    Sec. 8.  Section 249A.31, Code 2018, is amended to read as
  7 12 follows:
  7 13    249A.31  Cost=based reimbursement.
  7 14    1.  Providers of individual case management services for
  7 15 persons with an intellectual disability, a developmental
  7 16 disability, or chronic mental illness shall receive cost=based
  7 17 reimbursement for one hundred percent of the reasonable
  7 18 costs for the provision of the services in accordance with
  7 19 standards adopted by the mental health and disability services
  7 20 commission pursuant to section 225C.6.  Effective July 1, 2018,
  7 21 targeted case management services shall be reimbursed based
  7 22 on a statewide fee schedule amount developed by rule of the
  7 23 department pursuant to chapter 17A.
  7 24    2.  Effective July 1, 2010 2014, the department shall apply
  7 25 a cost=based reimbursement methodology for reimbursement of
  7 26 psychiatric medical institution for children providers of
  7 27 inpatient psychiatric services for individuals under twenty=one
  7 28 years of age shall be reimbursed as follows:
  7 29    a.  For non=state=owned providers, services shall be
  7 30 reimbursed according to a fee schedule without reconciliation.
  7 31    b.  For state=owned providers, services shall be reimbursed
  7 32 at one hundred percent of the actual and allowable cost of
  7 33 providing the service.
       HF 2462 (5) 87
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