Bill Text: IA SF2147 | 2021-2022 | 89th General Assembly | Introduced
Bill Title: A bill for an act relating to the validation of Medicaid managed care organization encounter data, providing an appropriation, and providing an effective date.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2022-02-01 - Subcommittee: Garrett, Johnson, and Ragan. S.J. 180. [SF2147 Detail]
Download: Iowa-2021-SF2147-Introduced.html
Senate
File
2147
-
Introduced
SENATE
FILE
2147
BY
RAGAN
and
MATHIS
A
BILL
FOR
An
Act
relating
to
the
validation
of
Medicaid
managed
care
1
organization
encounter
data,
providing
an
appropriation,
and
2
providing
an
effective
date.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
TLSB
5793XS
(5)
89
pf/rh
S.F.
2147
Section
1.
MEDICAID
MANAGED
CARE
ORGANIZATION
ENCOUNTER
1
DATA
VALIDATION
AUDIT
——
REQUEST
FOR
PROPOSALS.
The
department
2
of
human
services
and
the
auditor
of
state
shall
jointly
3
design
and
issue
a
request
for
proposals
to
contract
for
the
4
performance
of
a
third-party
audit
to
validate
encounter
data
5
collected
and
reported
by
Medicaid
managed
care
organizations
6
to
the
department.
The
audit
shall
be
designed
to
determine
7
if
Medicaid
managed
care
organizations
are
providing
encounter
8
data
that,
at
a
minimum,
is
complete,
accurate,
consistent,
9
and
timely
and
that
complies
with
federal
and
contractual
10
requirements
related
to
the
collection
and
reporting
of
11
encounter
data.
The
audit
shall
also
be
designed
to
determine
12
whether
the
type
and
quality
of
the
encounter
data
collected,
13
at
a
minimum,
strengthens
the
state’s
capacity
for
federal
14
compliance
and
managed
care
program
oversight
and
program
15
integrity;
for
quality
measurement,
monitoring,
and
reporting;
16
for
capitation
rate
setting;
and
for
policymaking
and
decision
17
support.
The
department
and
the
auditor
of
state
shall
18
jointly
evaluate
the
third-party
proposals
received,
select
19
and
contract
with
the
third-party
auditor
by
July
1,
2022,
and
20
monitor
and
review
the
third-party
auditor’s
audit
and
report
21
which
shall
be
submitted
jointly
to
the
department
and
the
22
auditor
of
state
no
later
than
December
15,
2022.
23
Sec.
2.
MEDICAID
MANAGED
CARE
ORGANIZATION
ENCOUNTER
DATA
24
VALIDATION
AUDIT
——
APPROPRIATION.
There
is
appropriated
25
from
the
general
fund
of
the
state
to
the
department
of
human
26
services
and
the
auditor
of
state
the
following
amount
or
27
so
much
thereof
as
is
necessary
to
be
used
for
the
purposes
28
designated:
29
For
a
request
for
proposals
process
and
resulting
third-
30
party
audit
to
validate
encounter
data
collected
and
reported
31
by
Medicaid
managed
care
organizations
as
provided
in
this
Act:
32
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
250,000
33
A
portion
of
the
moneys
appropriated
under
this
section
may
34
be
used
by
the
department
of
human
services
and
the
auditor
of
35
-1-
LSB
5793XS
(5)
89
pf/rh
1/
3
S.F.
2147
state
for
administrative
expenses
related
to
the
request
for
1
proposals
process
and
the
audit
as
provided
in
this
Act.
The
2
department
of
human
services
shall
seek
and
obtain
any
Medicaid
3
matching
funds
available
to
defray
the
costs
of
the
requests
4
for
proposals
process
and
audit.
5
Sec.
3.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
6
importance,
takes
effect
upon
enactment.
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
requires
the
department
of
human
services
(DHS)
11
and
the
auditor
of
state
(auditor)
to
jointly
design
and
12
issue
a
request
for
proposals
(RFP)
for
the
performance
of
a
13
third-party
audit
to
validate
encounter
data
collected
and
14
reported
by
Medicaid
managed
care
organizations
(MCOs)
to
15
DHS.
The
audit
shall
be
designed
to
determine
if
the
MCOs
16
are
providing
encounter
data
that,
at
a
minimum,
is
complete,
17
accurate,
consistent,
and
timely
and
that
complies
with
federal
18
and
contractual
requirements
related
to
the
collection
and
19
reporting
of
encounter
data.
The
audit
shall
also
be
designed
20
to
determine
whether
the
type
and
quality
of
the
encounter
data
21
collected,
at
a
minimum,
strengthens
the
state’s
capacity
for
22
federal
compliance
and
for
managed
care
program
oversight
and
23
program
integrity;
for
quality
measurement,
monitoring,
and
24
reporting;
for
capitation
rate
setting;
and
for
policymaking
25
and
decision
support.
DHS
and
the
auditor
shall
jointly
26
evaluate
third-party
proposals
received,
select
and
contract
27
with
the
third-party
auditor
by
July
1,
2022,
and
monitor
and
28
review
the
third-party
auditor’s
audit
and
report
which
shall
29
be
submitted
jointly
to
DHS
and
the
auditor
no
later
than
30
December
15,
2022.
31
The
bill
appropriates
$250,000
from
the
general
fund
of
32
the
state
to
DHS
and
the
auditor
for
the
RFP
process
and
the
33
resulting
third-party
audit
as
provided
in
the
bill.
A
portion
34
of
the
moneys
appropriated
may
be
used
by
DHS
and
the
auditor
35
-2-
LSB
5793XS
(5)
89
pf/rh
2/
3