Bill Text: IA SF154 | 2021-2022 | 89th General Assembly | Introduced
Bill Title: A bill for an act relating to reimbursement of hospitals for days awaiting placement through private insurance and the Medicaid program.
Spectrum: Partisan Bill (Democrat 9-0)
Status: (Introduced - Dead) 2021-01-27 - Subcommittee: Costello, Edler, and Mathis. S.J. 173. [SF154 Detail]
Download: Iowa-2021-SF154-Introduced.html
Senate
File
154
-
Introduced
SENATE
FILE
154
BY
MATHIS
,
RAGAN
,
KINNEY
,
J.
SMITH
,
CELSI
,
GIDDENS
,
TRONE
GARRIOTT
,
BOULTON
,
and
QUIRMBACH
A
BILL
FOR
An
Act
relating
to
reimbursement
of
hospitals
for
days
awaiting
1
placement
through
private
insurance
and
the
Medicaid
2
program.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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154
Section
1.
NEW
SECTION
.
514C.2A
Days
awaiting
placement
1
in
a
hospital
——
reimbursement.
2
1.
For
the
purposes
of
this
section:
3
a.
“Days
awaiting
placement”
means
the
days
during
which
4
a
covered
individual
no
longer
meets
acute
care
criteria
for
5
stay
in
a
hospital,
has
been
verified
to
require
placement
in
a
6
lower-level
facility
which
may
not
be
immediately
located,
and
7
is
awaiting
placement
at
the
lower-level
facility.
8
b.
“Lower-level
facility”
means
a
facility
that
is
able
9
to
provide
adequate,
available,
and
accessible
services
and
10
supports,
including
but
not
limited
to
mental
health
services
11
and
supports,
to
meet
the
covered
individual’s
needs
as
12
specified
in
the
covered
individual’s
discharge
plan.
13
2.
Notwithstanding
the
uniformity
of
treatment
requirements
14
of
section
514C.6,
a
policy,
contract,
or
plan
providing
15
for
third-party
payment
or
prepayment
of
health
or
medical
16
expenses
that
provides
hospital
benefits
shall
not
deny
17
reimbursement
for
the
continuation
of
all
higher-level
18
services,
including
but
not
limited
to
inpatient
care,
provided
19
to
a
covered
individual
during
a
days
awaiting
placement
20
period.
Reimbursement
shall
be
provided
to
a
hospital
for
each
21
day
a
covered
individual
remains
in
the
care
of
the
hospital
22
while
awaiting
placement
in
a
lower-level
facility.
23
3.
For
a
hospital
to
receive
days
awaiting
placement
24
reimbursement
under
this
section,
all
of
the
following
criteria
25
must
be
met:
26
a.
The
covered
individual
has
a
diagnosed
condition
that
27
required
an
acute
inpatient
level
of
care.
28
b.
The
covered
individual
no
longer
meets
continued
29
stay
criteria
for
the
acute
inpatient
level
of
care
and
30
requires
placement
in
a
lower-level
facility,
but
barriers
to
31
implementation
of
the
discharge
plan
exist
that
are
beyond
the
32
control
of
the
hospital.
33
c.
The
carrier
as
defined
in
section
513B.2
has
authorized
34
placement
in
the
lower-level
facility
sought
under
the
35
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discharge
plan.
1
d.
The
hospital
is
making
every
reasonable
effort
to
2
continue
to
actively
work
to
identify
resources
to
implement
3
the
discharge
plan
in
a
timely
manner
and
documents
the
4
reasonable
efforts
taken.
5
4.
This
section
applies
to
the
following
classes
of
6
third-party
payment
provider
policies,
contracts,
or
plans
7
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
8
state
on
or
after
January
1,
2022:
9
a.
Individual
or
group
accident
and
sickness
insurance
10
providing
coverage
on
an
expense-incurred
basis.
11
b.
An
individual
or
group
hospital
or
medical
service
12
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
13
c.
An
individual
or
group
health
maintenance
organization
14
contract
regulated
under
chapter
514B.
15
d.
A
plan
established
pursuant
to
chapter
509A
for
public
16
employees.
17
5.
This
section
shall
not
apply
to
accident-only,
specified
18
disease,
short-term
hospital
or
medical,
hospital
confinement
19
indemnity,
credit,
dental,
vision,
Medicare
supplement,
20
long-term
care,
basic
hospital
and
medical-surgical
expense
21
coverage
as
defined
by
the
commissioner
of
insurance,
22
disability
income
insurance
coverage,
coverage
issued
as
a
23
supplement
to
liability
insurance,
workers’
compensation
or
24
similar
insurance,
or
automobile
medical
payment
insurance.
25
6.
This
section
shall
not
apply
to
the
medical
assistance
26
program
pursuant
to
chapter
249A,
including
to
a
managed
care
27
organization
acting
pursuant
to
a
contract
with
the
department
28
of
human
services
to
provide
coverage
to
medical
assistance
29
program
members,
or
to
the
hawk-i
program
pursuant
to
chapter
30
514I.
31
7.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
32
chapter
17A
as
necessary
to
administer
this
section.
33
Sec.
2.
DAYS
AWAITING
PLACEMENT
——
MEDICAID
REIMBURSEMENT.
34
1.
Under
both
fee-for-service
and
managed
care
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154
administration
of
the
Medicaid
program,
a
hospital
shall
not
1
be
denied
reimbursement
based
on
failure
to
meet
medical
2
necessity
for
the
continuation
of
all
higher-level
services,
3
including
but
not
limited
to
inpatient
care,
provided
to
a
4
Medicaid-eligible
member
during
a
days
awaiting
placement
5
period.
Reimbursement
shall
be
provided
to
a
hospital
for
6
each
day
a
Medicaid-eligible
member
remains
in
the
care
of
the
7
hospital
while
awaiting
placement
in
a
lower-level
facility.
8
2.
For
a
hospital
to
receive
days
awaiting
placement
9
reimbursement
under
this
section,
all
of
the
following
criteria
10
must
be
met:
11
a.
The
Medicaid-eligible
member
has
a
diagnosed
condition
12
that
required
an
acute
inpatient
level
of
care.
13
b.
The
Medicaid-eligible
member
no
longer
meets
continued
14
stay
criteria
for
the
acute
inpatient
level
of
care
and
15
requires
placement
in
a
lower-level
facility,
but
barriers
to
16
implementation
of
the
discharge
plan
exist
that
are
beyond
the
17
control
of
the
hospital.
18
c.
The
department
of
human
services
or
managed
care
19
organization
has
authorized
placement
in
the
lower-level
20
facility
sought
under
the
discharge
plan.
21
d.
The
hospital
is
making
every
reasonable
effort
to
22
continue
to
actively
work
to
identify
resources
to
implement
23
the
discharge
plan
in
a
timely
manner
and
documents
the
24
reasonable
efforts
taken.
However,
if
the
Medicaid-eligible
25
member
is
covered
through
a
managed
care
organization,
the
26
managed
care
organization,
rather
than
the
hospital,
shall
27
be
responsible
for
identifying
and
obtaining
the
lower-level
28
facility
placement.
29
3.
For
the
purposes
of
this
section:
30
a.
“Days
awaiting
placement”
means
the
days
during
which
a
31
Medicaid-eligible
member
no
longer
meets
acute
care
criteria
32
for
stay
in
a
hospital,
has
been
verified
to
require
placement
33
in
a
lower-level
facility
which
may
not
be
immediately
located,
34
and
is
awaiting
placement
at
the
lower-level
facility.
35
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154
b.
“Lower-level
facility”
means
a
facility
that
is
able
1
to
provide
adequate,
available,
and
accessible
services
and
2
supports,
including
but
not
limited
to
mental
health
services
3
and
supports,
to
meet
the
Medicaid-eligible
member’s
needs
as
4
specified
in
the
member’s
discharge
plan.
5
4.
The
department
of
human
services
shall
adopt
rules
6
pursuant
to
chapter
17A
to
administer
this
section.
7
EXPLANATION
8
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
9
the
explanation’s
substance
by
the
members
of
the
general
assembly.
10
This
bill
relates
to
reimbursement
for
services
provided
by
11
a
hospital
during
a
days
awaiting
placement
period.
12
The
bill
provides
that
under
private
insurance
and
13
fee-for-service
and
managed
care
administration
of
Medicaid,
a
14
hospital
shall
not
be
denied
reimbursement
for
the
continuation
15
of
all
higher-level
services,
including
but
not
limited
16
to
inpatient
care,
provided
to
a
covered
individual
or
17
Medicaid-eligible
member,
respectively,
during
a
days
awaiting
18
placement
period.
Reimbursement
shall
be
provided
to
a
19
hospital
for
each
day
a
covered
individual
or
Medicaid-eligible
20
member
remains
in
the
care
of
the
hospital
while
awaiting
21
placement
in
a
lower-level
facility.
22
The
bill
defines
”days
awaiting
placement”
as
the
days
23
during
which
a
covered
individual
or
Medicaid-eligible
member
24
no
longer
meets
acute
care
criteria
for
stay
in
a
hospital,
has
25
been
verified
to
require
placement
in
a
lower-level
facility
26
which
may
not
be
immediately
located,
and
is
awaiting
placement
27
at
the
lower-level
facility.
“Lower-level
facility”
is
defined
28
as
a
facility
that
is
able
to
provide
adequate,
available,
and
29
accessible
services
and
supports,
including
but
not
limited
30
to
mental
health
services
and
supports,
to
meet
a
covered
31
individual’s
or
Medicaid-eligible
member’s
needs
as
specified
32
in
the
covered
individual’s
or
Medicaid-eligible
member’s
33
discharge
plan.
34
The
bill
provides
the
criteria
that
must
be
met
by
a
hospital
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