Bill Text: IA SF2035 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to health care coverage including the establishment of a healthy Iowans for a public option and the administration of the Medicaid program, and including effective date provisions.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Introduced - Dead) 2018-01-16 - Subcommittee: Chelgren, Chapman, and Jochum. S.J. 109. [SF2035 Detail]
Download: Iowa-2017-SF2035-Introduced.html
Senate File 2035 - Introduced SENATE FILE BY McCOY, JOCHUM, HORN, TAYLOR, and DOTZLER A BILL FOR 1 An Act relating to health care coverage including the 2 establishment of a healthy Iowans for a public option and 3 the administration of the Medicaid program, and including 4 effective date provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 5017XS (5) 87 pf/rj PAG LIN 1 1 DIVISION I 1 2 LEGISLATIVE INTENT 1 3 Section 1. LEGISLATIVE INTENT. The Medicaid program has 1 4 been utilized and expanded in a bipartisan manner since its 1 5 inception to provide a health care safety net to seniors in 1 6 nursing facilities, to people with disabilities living in 1 7 the community, to pregnant women and children, and to poor 1 8 and working class families. The federal Patient Protection 1 9 and Affordable Care Act provided many opportunities for 1 10 improvement in health care and health care coverage, including 1 11 an opportunity for further expansion of the Medicaid program 1 12 to additional populations. It is the intent of the general 1 13 assembly to establish a public health care coverage safety net 1 14 by utilizing a Medicaid program buy=in option to counteract the 1 15 effects of inadequate private competition and make affordable 1 16 health care coverage accessible to those Iowans without 1 17 individual health care coverage. 1 18 DIVISION II 1 19 HEALTHY IOWANS FOR A PUBLIC OPTION == ESTABLISHMENT 1 20 Sec. 2. HEALTHY IOWANS FOR A PUBLIC OPTION. 1 21 1. The department of human services shall apply to the 1 22 secretary of the United States department of health and human 1 23 services for any necessary waiver pursuant to 42 U.S.C. {1315 1 24 or 42 U.S.C. {18052, to do all of the following: 1 25 a. Allow the department of human services to establish and 1 26 administer the healthy Iowans for a public option to provide 1 27 coverage to individuals who are eligible for and enroll in the 1 28 healthy Iowans for a public option established in this section. 1 29 The department may make coverage through the healthy Iowans 1 30 for a public option available for purchase through the Iowa 1 31 state=federal partnership marketplace created pursuant to the 1 32 federal Patient Protection and Affordable Care Act as defined 1 33 in section 249N.2. 1 34 b. Allow an individual who is determined eligible for 1 35 advanced premium tax credits and cost=sharing reductions 2 1 pursuant to 45 C.F.R. {155.305 to use such credits and 2 2 reductions to purchase coverage through the healthy Iowans for 2 3 a public option. 2 4 2. If the secretary of the United States department 2 5 of health and human services grants the necessary waivers 2 6 requested under this section, the department of human services 2 7 shall do all of the following: 2 8 a. Establish the healthy Iowans for a public option 2 9 to provide coverage for individuals who are not otherwise 2 10 eligible for the Medicaid program and who do not have access to 2 11 affordable employer=sponsored health care coverage. Coverage 2 12 under the healthy Iowans for a public option shall provide the 2 13 same benefits as those specified for Iowa health and wellness 2 14 plan members under section 249N.5. 2 15 b. Administer the healthy Iowans for a public option through 2 16 the Iowa Medicaid enterprise. The duties of the Iowa Medicaid 2 17 enterprise may include determining member eligibility for the 2 18 program using policies and procedures adopted by rule of the 2 19 department pursuant to chapter 17A; maintaining eligibility 2 20 files with pertinent eligibility determination and ongoing 2 21 enrollment information; providing periodic reports to the 2 22 department for administrative oversight and monitoring of 2 23 compliance with federal requirements; and maintaining data for 2 24 the purpose of quality assurance reports as required by rule 2 25 of the department. 2 26 3. If the secretary of the United States department 2 27 of health and human services grants the necessary waivers 2 28 requested under this section, the department of human services 2 29 may make the healthy Iowans for a public option available on 2 30 the Iowa state=federal partnership marketplace created pursuant 2 31 to the federal Patient Protection and Affordable Care Act as 2 32 defined in section 249N.2. 2 33 4. The department of human services shall adopt rules 2 34 pursuant to chapter 17A as necessary to administer this 2 35 section. 3 1 DIVISION III 3 2 TERMINATION OF MEDICAID MANAGED CARE CONTRACTS 3 3 Sec. 3. TERMINATION OF MEDICAID MANAGED CARE CONTRACTS == 3 4 TRANSITION TO ADMINISTRATION BY IOWA MEDICAID ENTERPRISE == 3 5 EFFECTIVE DATE. The department of human services shall, upon 3 6 the effective date of this division of this Act, terminate 3 7 the contracts executed with managed care organizations to 3 8 administer the Iowa high quality health care initiative 3 9 as established by the department, in accordance with the 3 10 termination provisions of the contracts. The termination 3 11 shall include a transition period to ensure that health care 3 12 delivery and coverage for affected Medicaid members is not 3 13 disrupted. The department of human services shall seek any 3 14 Medicaid state plan and waiver amendments necessary to complete 3 15 the transition and, upon completion of the transition, shall 3 16 instead administer the Medicaid program under alternative 3 17 value=based payment methodologies to promote quality and 3 18 efficiency, investment in patient=centered, integrated, primary 3 19 and preventive care, improved health care outcomes, innovation 3 20 and integration in the organization and delivery of health 3 21 care, and health care cost containment and minimization of 3 22 administrative costs. 3 23 Sec. 4. EFFECTIVE UPON ENACTMENT. This division of this 3 24 Act, being deemed of immediate importance, takes effect upon 3 25 enactment. 3 26 EXPLANATION 3 27 The inclusion of this explanation does not constitute agreement with 3 28 the explanation's substance by the members of the general assembly. 3 29 This bill relates to the provision of health insurance 3 30 coverage in the state. 3 31 Division I of the bill provides legislative intent to 3 32 establish a public health care coverage safety net by utilizing 3 33 a Medicaid program buy=in option to counteract the effects of 3 34 inadequate private competition and make affordable health care 3 35 coverage accessible to those Iowans without individual health 4 1 care coverage. 4 2 Division II of the bill provides for the establishment of 4 3 healthy Iowans for a public option. The bill directs the 4 4 department of human services (DHS) to apply to the secretary 4 5 of the United States department of health and human services 4 6 for any necessary federal waivers relative to the Medicaid 4 7 program and the federal Patient Protection and Affordable Care 4 8 Act (ACA) to allow DHS to establish and administer the healthy 4 9 Iowans for a public option to provide coverage to individuals 4 10 who are eligible for and enroll in the healthy Iowans for 4 11 a public option established in the bill, and to allow an 4 12 individual who is determined eligible for advanced premium tax 4 13 credits and cost=sharing reductions under the ACA to use such 4 14 credits and reductions to purchase coverage through the healthy 4 15 Iowans for a public option. 4 16 The bill provides that if the necessary waivers are granted 4 17 by the secretary of the United States department of health 4 18 and human services, DHS shall establish and administer the 4 19 healthy Iowans for a public option through the Iowa Medicaid 4 20 enterprise. The department may make coverage through the 4 21 healthy Iowans for a public option available for purchase 4 22 through the Iowa state=federal partnership marketplace created 4 23 pursuant to the ACA. Coverage under the healthy Iowans for a 4 24 public option includes the same benefits as those specified for 4 25 Iowa health and wellness plan members under Code chapter 249N. 4 26 The bill directs DHS to adopt rules pursuant to Code chapter 4 27 17A as necessary to administer the bill. 4 28 Division III of the bill requires DHS, upon the effective 4 29 date of Division III of the bill, to terminate the contracts 4 30 executed with managed care organizations to administer the 4 31 Iowa high quality health care initiative as established by 4 32 DHS, in accordance with the termination provisions of the 4 33 contracts. The termination shall include a transition period 4 34 to ensure that health care delivery and coverage for affected 4 35 Medicaid members is not disrupted. DHS is directed to seek 5 1 any Medicaid state plan and waiver amendments necessary to 5 2 complete the transition and, upon completion of the transition, 5 3 to instead administer the Medicaid program under alternative 5 4 payment methodologies to promote quality and efficiency, 5 5 patient=centered, integrated, primary and preventive care, and 5 6 innovation and integration in the organization and delivery of 5 7 health care. 5 8 Division III of the bill takes effect upon enactment. LSB 5017XS (5) 87 pf/rj
