Bill Text: IA SF2230 | 2011-2012 | 84th General Assembly | Introduced
Bill Title: A bill for an act relating to health care cost containment measures and providing for a fee. (See SF 2337.)
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-04-12 - Fiscal note. SCS. [SF2230 Detail]
Download: Iowa-2011-SF2230-Introduced.html
Senate
File
2230
-
Introduced
SENATE
FILE
2230
BY
HATCH
A
BILL
FOR
An
Act
relating
to
health
care
cost
containment
measures
and
1
providing
for
a
fee.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
5004SS
(2)
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pf/nh
S.F.
2230
Section
1.
Section
505.8,
Code
Supplement
2011,
is
amended
1
by
adding
the
following
new
subsection:
2
NEW
SUBSECTION
.
6A.
The
commissioner
shall
establish
3
a
bureau,
to
be
known
as
the
“health
insurance
and
cost
4
containment
bureau”
,
as
provided
in
section
505.20.
5
Sec.
2.
NEW
SECTION
.
505.20
Health
insurance
and
cost
6
containment
bureau
——
advisory
board.
7
1.
a.
The
commissioner
shall
establish
a
bureau,
to
be
8
known
as
the
“health
insurance
and
cost
containment
bureau”
,
for
9
the
purpose
of
creating
methodologies
to
hold
health
carriers
10
accountable
for
the
fair
treatment
of
health
care
providers
and
11
developing
affordability
standards
for
health
carriers
that
12
direct
carriers
to
promote
improved
accessibility,
quality,
and
13
affordability
of
health
care.
14
b.
The
commissioner
shall
employ
professional
and
clerical
15
staff
to
carry
out
the
purposes
and
functions
of
the
bureau.
16
c.
The
commissioner
shall
adopt
rules
under
chapter
17A,
in
17
collaboration
with
the
health
insurance
and
cost
containment
18
advisory
board,
to
administer
and
implement
the
purposes
and
19
functions
of
the
bureau.
20
2.
a.
A
health
insurance
and
cost
containment
advisory
21
board
is
created
to
assist
the
commissioner
in
carrying
out
22
the
purposes
of
the
bureau.
The
advisory
board
shall
consist
23
of
seven
voting
members
and
seven
nonvoting
members.
The
24
voting
members
shall
be
appointed
by
the
governor,
subject
to
25
confirmation
by
the
senate.
The
governor
shall
designate
one
26
voting
member
as
chairperson
and
one
as
vice
chairperson.
27
b.
The
voting
members
of
the
advisory
board
shall
be
28
appointed
by
the
governor
as
follows:
29
(1)
Two
persons
who
represent
the
interests
of
small
30
business
from
nominations
made
to
the
governor
by
nationally
31
recognized
groups
that
represent
the
interests
of
small
32
business.
33
(2)
Two
persons
who
represent
the
interests
of
consumers
34
from
nominations
made
to
the
governor
by
nationally
recognized
35
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groups
that
represent
the
interests
of
consumers.
1
(3)
One
person
who
is
an
insurance
producer
licensed
under
2
chapter
522B.
3
(4)
One
person
who
is
a
health
care
actuary
or
economist
4
with
expertise
in
health
insurance.
5
(5)
One
person
who
is
a
health
care
provider.
6
c.
The
nonvoting
members
are
as
follows:
7
(1)
The
commissioner
of
insurance
or
the
commissioner’s
8
designee.
9
(2)
The
director
of
human
services
or
the
director’s
10
designee.
11
(3)
The
director
of
public
health
or
the
director’s
12
designee.
13
(4)
Four
members
of
the
general
assembly,
one
appointed
14
by
the
speaker
of
the
house
of
representatives,
one
appointed
15
by
the
minority
leader
of
the
house
of
representatives,
16
one
appointed
by
the
majority
leader
of
the
senate,
and
one
17
appointed
by
the
minority
leader
of
the
senate.
18
d.
Meetings
of
the
advisory
board
shall
be
held
at
the
call
19
of
the
chairperson
or
upon
the
request
of
at
least
two
voting
20
members.
Four
voting
members
shall
constitute
a
quorum
and
the
21
affirmative
vote
of
four
voting
members
shall
be
necessary
for
22
any
action
taken
by
the
advisory
board.
23
e.
The
voting
members
of
the
advisory
board
shall
be
24
appointed
for
staggered
terms
of
three
years
within
sixty
days
25
after
the
effective
date
of
this
Act
and
by
December
15
of
26
each
year
thereafter.
The
initial
terms
of
the
voting
members
27
of
the
advisory
board
shall
be
staggered
at
the
discretion
28
of
the
governor.
A
voting
member
of
the
board
is
eligible
29
for
reappointment.
The
governor
shall
fill
a
vacancy
on
the
30
board
in
the
same
manner
as
the
original
appointment
for
the
31
remainder
of
the
term.
32
f.
Voting
members
of
the
advisory
board
may
be
reimbursed
33
from
the
moneys
collected
from
assessment
fees
for
the
34
administration
of
the
bureau
and
the
advisory
board
pursuant
35
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to
subsection
7,
for
actual
and
necessary
expenses
incurred
in
1
the
performance
of
their
duties,
but
shall
not
be
otherwise
2
compensated
for
their
services.
3
g.
It
shall
be
the
duty
of
the
advisory
board
to
assist
the
4
bureau
in
carrying
out
the
purposes
and
functions
of
the
bureau
5
by
making
recommendations
for
the
creation
of
methodologies
6
that
hold
health
carriers
in
the
state
accountable
for
the
fair
7
treatment
of
health
care
providers
and
developing
affordability
8
standards
for
health
carriers
that
direct
such
carriers
to
9
promote
improved
accessibility,
quality,
and
affordability
of
10
health
care.
The
advisory
board
shall
also
offer
input
to
the
11
commissioner
regarding
proposed
rules,
the
operation
of
the
12
bureau,
and
any
other
topics
relevant
to
administering
and
13
implementing
the
purposes
and
functions
of
the
bureau.
14
3.
a.
Health
care
affordability
efforts
shall
initially
15
focus
on
the
primary
care
level
of
care
in
an
effort
to
create
a
16
stronger
primary
care
system
and
greater
supply
of
more
highly
17
compensated
primary
care
providers
by
targeting
more
funding
to
18
primary
care.
19
b.
Beginning
on
December
31,
2013,
and
each
year
thereafter,
20
each
health
carrier
shall
report
to
the
bureau,
in
a
format
21
and
including
information
as
required
by
the
commissioner
by
22
rule,
the
carrier’s
proportion
of
medical
expense
paid
for
23
primary
care
for
the
previous
twelve
months
and
the
proportion
24
of
medical
expense
to
be
allocated
to
primary
care
for
the
25
succeeding
twelve
months
beginning
on
January
1,
2014,
and
each
26
year
thereafter.
The
proportion
of
medical
expense
paid
for
27
primary
care
shall
increase
by
at
least
one
percentage
point
28
per
year
for
five
years
beginning
on
January
1,
2014.
29
c.
Each
health
carrier
shall
submit
a
plan
to
the
bureau
30
each
year
in
a
format
and
including
information
as
required
by
31
the
commissioner
by
rule,
that
demonstrates
how
the
increase
in
32
spending
for
primary
care
will
be
accomplished.
The
increase
33
in
spending
for
primary
care
shall
be
accomplished
without
34
contributing
to
an
increase
in
premiums.
35
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4.
Each
health
carrier
shall
support
the
implementation
1
of
the
medical
home
system
as
developed
and
implemented
by
2
the
department
of
public
health
and
the
medical
home
system
3
advisory
council
pursuant
to
sections
135.157,
135.158,
and
4
135.159,
by
implementing
the
phase
of
the
medical
home
system
5
pursuant
to
section
135.159,
subsection
11,
that
involves
6
insurers
and
self-insured
companies
in
making
the
medical
7
home
system
available
to
individuals
with
private
health
care
8
coverage.
The
health
insurance
and
cost
containment
advisory
9
board
shall
work
collaboratively
with
the
medical
home
system
10
advisory
council
to
implement
this
phase.
In
addition
to
the
11
reimbursement
methodologies
and
incentives
for
participation
12
in
the
medical
home
system
described
in
section
135.159,
13
subsection
8,
the
advisory
board
and
the
medical
home
system
14
advisory
council
shall
review
additional
payment
and
system
15
reforms
to
support
the
expanded
implementation
of
the
medical
16
home
system
including
but
not
limited
to
all
of
the
following:
17
a.
Rewarding
high-quality,
low-cost
providers.
18
b.
Creating
participant
incentives
to
receive
care
from
19
high-quality,
low-cost
providers.
20
c.
Fostering
collaboration
among
providers
to
reduce
cost
21
shifting
from
one
part
of
the
health
care
continuum
to
another.
22
d.
Creating
incentives
for
providing
health
care
in
the
23
least
restrictive,
most
appropriate
setting.
24
e.
Creating
incentives
to
promote
diversity
in
the
size,
25
geographic
location,
and
accessibility
of
practices
designated
26
as
medical
homes
throughout
the
state.
27
5.
Each
health
carrier
shall
demonstrate
by
December
31,
28
2013,
implementation
of
incentives
consistent
with
the
efforts
29
of
the
department
of
public
health
and
the
electronic
health
30
information
advisory
council
and
executive
committee
pursuant
31
to
section
135.156
to
promote
adoption
of
electronic
health
32
records
by
health
care
providers
at
all
levels
of
the
health
33
care
continuum.
Health
carriers
shall
submit
a
report
to
34
the
bureau
by
December
31,
2014,
concerning
the
incentive
35
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2230
programs
that
have
been
implemented
in
a
format
and
including
1
information
as
required
by
the
commissioner
by
rule.
2
6.
Each
health
carrier
shall
participate
in
efforts
3
regarding
comprehensive
delivery
system
reform,
including
4
payment
reform,
in
coordination
with
other
payers
and
health
5
care
providers.
6
a.
As
an
initial
step
to
inform
such
efforts,
the
bureau
7
and
advisory
board
shall
develop
a
plan
to
implement
an
8
all-payer
claims
database
by
December
31,
2013,
to
provide
9
for
the
collection
and
analysis
of
claims
data
from
multiple
10
payers
of
health
care
delivered
at
all
levels
including
but
not
11
limited
to
primary
care,
specialist
care,
outpatient
surgery,
12
inpatient
stays,
laboratory
testing,
and
pharmacy
data.
The
13
plan
shall
provide
for
development
and
implementation
of
a
14
database
that
complies
with
any
applicable
requirements
of
the
15
federal
Act
and
that
most
effectively
and
efficiently
provides
16
data
to
determine
health
care
utilization
patterns
and
rates;
17
identify
gaps
in
prevention
and
health
promotion
services;
18
evaluate
access
to
care;
assist
with
benefit
design
and
19
planning;
analyze
statewide
and
local
health
care
expenditures
20
by
provider,
employer,
and
geography;
inform
the
development
21
of
payment
systems
for
providers;
and
establish
clinical
22
guidelines
related
to
quality,
safety,
and
continuity
of
care.
23
The
bureau
shall
submit
the
plan
to
the
general
assembly
by
24
December
31,
2012,
including
statutory
changes
necessary
to
25
collect
and
use
such
data,
a
standard
means
of
collecting
26
the
data,
an
implementation
and
maintenance
schedule,
and
a
27
proposed
budget
and
financing
options
for
the
database.
28
b.
The
bureau
and
advisory
board
shall
also
recommend
a
29
provider
payment
system
plan
to
reform
the
health
care
provider
30
payment
system
beyond
primary
care
providers,
including
but
31
not
limited
to
specialty
care,
hospital,
and
long-term
care
32
providers,
as
an
effective
way
to
promote
coordination
of
care,
33
lower
costs,
and
improve
quality.
34
7.
a.
Funding
to
operate
the
bureau
and
the
advisory
board
35
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shall
come
from
federal
and
private
grants
and
from
assessment
1
fees
charged
to
health
carriers.
The
commissioner
shall
charge
2
an
assessment
fee
to
all
health
carriers
in
this
state,
as
3
necessary
to
support
the
activities
and
operations
of
the
4
bureau
and
the
advisory
board
as
provided
under
this
section.
5
No
state
funding
shall
be
appropriated
or
allocated
for
the
6
operation
or
administration
of
the
bureau
or
the
advisory
7
board.
The
assessment
shall
provide
for
the
sharing
of
bureau
8
and
advisory
board
expenses
on
an
equitable
and
proportionate
9
basis
among
health
carriers
in
the
state
as
provided
in
this
10
subsection.
11
b.
Following
the
close
of
each
calendar
year,
the
12
commissioner
shall
determine
the
expenses
for
operation
and
13
administration
of
the
bureau
and
the
advisory
board.
The
14
expenses
incurred
shall
be
assessed
by
the
commissioner
to
15
all
health
carriers
in
proportion
to
their
respective
shares
16
of
total
health
insurance
premiums
or
payments
for
subscriber
17
contracts
received
in
Iowa
during
the
second
preceding
calendar
18
year,
or
with
paid
losses
in
the
year,
coinciding
with
or
19
ending
during
the
calendar
year
or
on
any
other
equitable
basis
20
as
provided
by
rule.
In
sharing
expenses,
the
commissioner
21
may
abate
or
defer
in
any
part
the
assessment
of
a
health
22
carrier,
if,
in
the
opinion
of
the
commissioner,
payment
of
the
23
assessment
would
endanger
the
ability
of
the
health
carrier
to
24
fulfill
its
contractual
obligations.
The
commissioner
may
also
25
provide
for
an
initial
or
interim
assessment
against
health
26
carriers
if
necessary
to
assure
the
financial
capability
of
27
the
commissioner
to
meet
the
incurred
or
estimated
operating
28
expenses
of
the
bureau
and
the
advisory
board
until
the
next
29
calendar
year
is
completed.
30
c.
For
purposes
of
this
subsection,
“total
health
insurance
31
premiums”
and
“payments
for
subscriber
contracts”
include,
32
without
limitation,
premiums
or
other
amounts
paid
to
or
33
received
by
a
health
carrier
for
individual
and
group
health
34
plan
care
coverage
provided
under
any
chapter
of
the
Code
or
35
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Acts,
and
“paid
losses”
includes,
without
limitation,
claims
1
paid
by
a
health
carrier
operating
on
a
self-funded
basis
for
2
individual
and
group
health
plan
care
coverage
provided
under
3
any
chapter
of
the
Code
or
Acts.
For
purposes
of
calculating
4
and
conducting
the
assessment,
the
commissioner
shall
have
5
the
express
authority
to
require
health
carriers
to
report
on
6
an
annual
basis
each
health
carrier’s
total
health
insurance
7
premiums
and
payments
for
subscriber
contracts
and
paid
losses.
8
A
health
carrier
is
liable
for
its
share
of
the
assessment
9
calculated
in
accordance
with
this
subsection
regardless
of
10
whether
it
participates
in
the
individual
insurance
market.
11
8.
The
commissioner
shall
keep
an
accurate
accounting
of
12
all
activities,
receipts,
and
expenditures
of
the
bureau
and
13
advisory
board
and
annually
submit
to
the
governor,
the
general
14
assembly,
and
the
public,
a
report
concerning
such
accounting.
15
9.
The
bureau
and
the
advisory
board
shall
coordinate
their
16
activities
with
the
Iowa
Medicaid
enterprise
of
the
department
17
of
human
services,
the
department
of
revenue,
the
department
of
18
public
health,
and
the
insurance
division
of
the
department
of
19
commerce
to
ensure
that
the
state
fulfills
the
requirements
of
20
the
federal
Act
and
to
ensure
that
in
the
event
that
a
health
21
insurance
exchange
is
established
in
the
state,
the
functions
22
and
activities
of
the
bureau
and
the
advisory
board
can
be
23
seamlessly
integrated
into
the
exchange.
24
10.
As
used
in
this
section,
unless
the
context
otherwise
25
requires:
26
a.
“Advisory
board”
means
the
health
insurance
and
cost
27
containment
advisory
board.
28
b.
“Bureau”
means
the
health
insurance
and
cost
containment
29
bureau.
30
c.
“Commissioner”
means
the
commissioner
of
insurance.
31
d.
“Federal
Act”
means
the
federal
Patient
Protection
and
32
Affordable
Care
Act,
Pub.
L.
No.
111-148,
as
amended
by
the
33
federal
Health
Care
and
Education
Reconciliation
Act
of
2010,
34
Pub.
L.
No.
111-152,
and
any
amendments
thereto,
or
regulations
35
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or
guidance
issued
under
those
Acts.
1
e.
“Health
care
provider”
means
a
physician
who
is
licensed
2
under
chapter
148,
or
a
person
who
is
licensed
as
a
physician
3
assistant
under
chapter
148C
or
as
an
advanced
registered
nurse
4
practitioner.
5
f.
“Health
carrier”
means
an
entity
subject
to
the
insurance
6
laws
and
rules
of
this
state,
or
subject
to
the
jurisdiction
7
of
the
commissioner,
that
contracts
or
offers
to
contract
to
8
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
9
the
costs
of
health
care
services,
including
an
insurance
10
company
offering
sickness
and
accident
plans,
a
health
11
maintenance
organization,
a
nonprofit
hospital
or
health
12
service
corporation,
or
any
other
entity
providing
a
plan
of
13
health
insurance,
health
benefits,
or
health
services.
14
g.
(1)
“Health
insurance”
means
benefits
consisting
15
of
health
care
provided
directly,
through
insurance
or
16
reimbursement,
or
otherwise,
and
including
items
and
services
17
paid
for
as
health
care
under
a
hospital
or
health
service
18
policy
or
certificate,
hospital
or
health
service
plan
19
contract,
or
health
maintenance
organization
contract
offered
20
by
a
carrier.
21
(2)
“Health
insurance”
does
not
include
any
of
the
22
following:
23
(a)
Coverage
for
accident-only
or
disability
income
24
insurance.
25
(b)
Coverage
issued
as
a
supplement
to
liability
insurance.
26
(c)
Liability
insurance,
including
general
liability
27
insurance
and
automobile
liability
insurance.
28
(d)
Workers’
compensation
or
similar
insurance.
29
(e)
Automobile
medical-payment
insurance.
30
(f)
Credit-only
insurance.
31
(g)
Coverage
for
on-site
medical
clinic
care.
32
(h)
Other
similar
insurance
coverage,
specified
in
33
federal
regulations,
under
which
benefits
for
medical
care
34
are
secondary
or
incidental
to
other
insurance
coverage
or
35
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benefits.
1
(3)
“Health
insurance”
does
not
include
benefits
provided
2
under
a
separate
policy
as
follows:
3
(a)
Limited
scope
dental
or
vision
benefits.
4
(b)
Benefits
for
long-term
care,
nursing
home
care,
home
5
health
care,
or
community-based
care.
6
(c)
Any
other
similar
limited
benefits
as
provided
by
rule
7
of
the
commissioner.
8
(4)
“Health
insurance”
does
not
include
benefits
offered
as
9
independent
noncoordinated
benefits
as
follows:
10
(a)
Coverage
only
for
a
specified
disease
or
illness.
11
(b)
A
hospital
indemnity
or
other
fixed
indemnity
12
insurance.
13
(5)
“Health
insurance”
does
not
include
Medicare
14
supplemental
health
insurance
as
defined
under
section
15
1882(g)(1)
of
the
federal
Social
Security
Act,
coverage
16
supplemental
to
the
coverage
provided
under
10
U.S.C.
ch.
55,
17
or
similar
supplemental
coverage
provided
to
coverage
under
18
group
health
insurance
coverage.
19
(6)
“Group
health
insurance
coverage”
means
health
insurance
20
offered
in
connection
with
a
group
health
plan.
21
Sec.
3.
NEW
SECTION
.
513B.16
Premium
rate
increases
——
22
public
hearing
and
comment.
23
1.
All
health
insurance
carriers
licensed
to
do
business
24
in
the
state
under
this
chapter
shall
immediately
notify
the
25
commissioner
and
policyholders
of
any
proposed
rate
increase
26
exceeding
the
average
annual
health
spending
growth
rate
stated
27
in
the
most
recent
national
health
expenditure
projection
28
published
by
the
centers
for
Medicare
and
Medicaid
services
of
29
the
United
States
department
of
health
and
human
services,
at
30
least
ninety
days
prior
to
the
effective
date
of
the
increase.
31
Such
notice
shall
specify
the
rate
increase
proposed
that
is
32
applicable
to
each
policyholder
and
shall
include
ranking
and
33
quantification
of
those
factors
that
are
responsible
for
the
34
amount
of
the
rate
increase
proposed.
The
notice
shall
include
35
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information
about
how
the
policyholder
can
contact
the
consumer
1
advocate
for
assistance.
2
2.
The
commissioner
shall
hold
a
public
hearing
at
least
3
thirty
days
before
the
proposed
rate
increase
is
to
take
4
effect.
5
3.
The
consumer
advocate
shall
solicit
public
comments
on
6
each
proposed
health
insurance
rate
increase
if
the
increase
7
exceeds
the
average
annual
health
spending
growth
rate
as
8
provided
in
subsection
1,
and
shall
post
without
delay
during
9
the
normal
business
hours
of
the
division,
all
comments
10
received
on
the
insurance
division’s
internet
site
prior
to
the
11
effective
date
of
the
increase.
12
4.
The
consumer
advocate
shall
present
the
public
13
testimony,
if
any,
and
public
comments
received,
for
14
consideration
by
the
commissioner
prior
to
the
effective
date
15
of
the
increase.
16
EXPLANATION
17
This
bill
relates
to
health
care
cost
containment
measures.
18
The
bill
requires
the
commissioner
of
insurance
to
establish
19
a
health
insurance
and
cost
containment
bureau
within
20
the
insurance
division
which
is
responsible
for
creating
21
methodologies
to
hold
health
carriers
accountable
for
the
fair
22
treatment
of
health
care
providers
and
developing
affordability
23
standards
for
health
insurance
carriers
that
direct
carriers
24
to
promote
improved
accessibility,
quality,
and
affordability
25
of
health
care.
26
A
health
insurance
and
cost
containment
advisory
board
27
is
also
created
to
assist
the
commissioner
of
insurance
in
28
carrying
out
the
purposes
of
the
new
bureau.
The
advisory
29
board
is
comprised
of
seven
voting
members
appointed
by
the
30
governor,
subject
to
confirmation
by
the
senate,
and
seven
31
nonvoting
members.
The
members
shall
be
appointed
within
60
32
days
after
the
effective
date
of
the
bill.
The
voting
members
33
are
to
represent
small
business,
consumers,
and
insurance
34
producers,
and
shall
include
a
health
care
actuary
or
economist
35
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with
expertise
in
health
insurance
and
a
health
care
provider.
1
The
nonvoting
members
are
the
commissioner
of
insurance,
the
2
director
of
human
services,
and
the
director
of
public
health,
3
or
their
designees,
and
four
members
of
the
general
assembly
4
appointed
by
majority
and
minority
leaders
in
the
house
of
5
representatives
and
the
senate.
6
Health
care
affordability
efforts
must
initially
focus
on
7
primary
care
to
create
a
stronger
primary
care
system
and
8
a
greater
supply
of
more
highly
compensated
primary
care
9
providers
by
targeting
more
funding
to
primary
care.
Beginning
10
on
December
31,
2013,
and
each
year
thereafter,
each
health
11
insurance
carrier
in
the
state
is
required
to
report
to
the
12
bureau
the
carrier’s
proportion
of
medical
expense
paid
for
13
primary
care
for
the
previous
12
months
and
the
proportion
14
of
medical
expense
to
be
allocated
to
primary
care
for
the
15
succeeding
12
months
beginning
on
January
1,
2014,
and
each
16
year
thereafter.
The
proportion
of
medical
expense
paid
for
17
primary
care
must
increase
by
at
least
one
percentage
point
18
per
year
for
five
years
beginning
on
January
1,
2014.
Health
19
insurance
carriers
are
also
required
to
submit
a
plan
that
20
demonstrates
how
the
increase
in
spending
for
primary
care
21
will
be
accomplished
without
contributing
to
an
increase
in
22
premiums.
23
Health
insurance
carriers
are
required
to
support
the
24
implementation
of
the
phase
of
the
medical
home
system
as
25
developed
and
implemented
by
the
department
of
public
health
26
that
involves
making
the
medical
home
system
available
27
to
individuals
with
private
health
care
coverage.
The
28
advisory
board
shall
collaborate
with
the
medical
home
29
system
advisory
council
to
implement
this
phase
and
to
review
30
additional
payment
and
system
reforms
to
support
the
expanded
31
implementation
of
the
medical
home
system.
32
Health
insurance
carriers
are
required
to
demonstrate
by
33
December
31,
2013,
implementation
of
incentives
consistent
34
with
the
efforts
of
the
department
of
public
health
and
the
35
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electronic
health
information
advisory
council
and
executive
1
committee
to
promote
adoption
of
electronic
health
records
2
by
health
care
providers
at
all
levels
of
the
health
care
3
continuum.
Health
carriers
shall
submit
a
report
to
the
bureau
4
by
December
31,
2014,
concerning
the
incentive
programs
that
5
have
been
implemented.
6
Health
insurance
carriers
are
required
to
participate
in
7
efforts
to
achieve
comprehensive
system
reform,
including
8
payment
reform,
in
coordination
with
other
payers
and
health
9
care
providers.
To
inform
such
efforts,
the
health
insurance
10
and
cost
containment
bureau
and
advisory
board
shall
develop
a
11
plan
to
implement
an
all-payer
claims
database
by
December
31,
12
2013,
that
provides
for
the
collection
and
analysis
of
claims
13
data
from
multiple
payers
of
health
care
delivered
at
all
14
levels.
The
planned
database
shall
comply
with
all
applicable
15
requirements
of
the
federal
Patient
Protection
and
Affordable
16
Care
Act.
The
bureau
shall
submit
the
plan
to
the
general
17
assembly
by
December
31,
2012.
The
bureau
and
the
advisory
18
board
shall
also
recommend
a
provider
payment
system
plan
to
19
reform
the
health
care
provider
payment
system
beyond
primary
20
care
providers.
21
Funding
to
operate
the
new
bureau
and
advisory
board
shall
22
come
from
federal
and
private
grants
and
from
assessment
fees
23
charged
to
health
insurance
carriers
as
provided
in
the
bill.
24
No
state
funding
shall
be
appropriated
for
the
operation
or
25
administration
of
the
bureau
or
the
advisory
board.
26
The
commissioner
is
required
to
keep
an
accurate
accounting
27
of
all
activities,
receipts,
and
expenditures
of
the
bureau
and
28
advisory
board
and
annually
submit
a
report
of
such
accounting
29
to
the
governor,
the
general
assembly,
and
the
public.
30
The
bureau
and
the
advisory
board
shall
coordinate
their
31
activities
with
the
Iowa
Medicaid
enterprise
of
the
department
32
of
human
services,
the
department
of
revenue,
the
department
33
of
public
health,
and
the
insurance
division
of
the
department
34
of
commerce
to
ensure
that
the
state
fulfills
the
requirements
35
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of
the
federal
Patient
Protection
and
Affordable
Care
Act
and
1
to
ensure
that
in
the
event
a
health
insurance
exchange
is
2
established
in
the
state,
the
functions
and
activities
of
the
3
bureau
and
the
advisory
board
can
be
seamlessly
integrated
into
4
the
exchange.
5
The
bill
also
requires
that
all
health
insurance
carriers
6
licensed
in
the
state
to
provide
health
insurance
to
small
7
employers
with
two
to
50
employees
must
immediately
notify
8
the
commissioner
and
policyholders
of
any
proposed
rate
9
increase
exceeding
the
average
annual
health
spending
growth
10
rate
stated
in
the
most
recent
national
health
expenditure
11
projection
published
by
the
centers
for
Medicare
and
Medicaid
12
services
of
the
United
States
department
of
health
and
human
13
services,
at
least
90
days
prior
to
the
effective
date
of
the
14
increase.
The
notice
must
specify
the
rate
increase
applicable
15
to
each
policyholder
and
rank
and
quantify
the
factors
that
are
16
responsible
for
the
amount
of
the
rate
increase
proposed.
The
17
commissioner
is
required
to
hold
a
public
hearing
at
least
30
18
days
before
a
proposed
rate
increase
is
to
take
effect.
The
19
consumer
advocate
must
solicit
public
comments
on
each
proposed
20
small
employer
health
insurance
rate
increase
and
post
the
21
comments
on
the
insurance
division’s
internet
site.
22
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