Bill Text: IA SF296 | 2013-2014 | 85th General Assembly | Amended
Bill Title: A bill for an act relating to integrated care models for the delivery of health care, including but not limited to required utilization of a medical home by individuals currently and newly eligible for coverage under the Medicaid program and including effective date provisions. (Formerly SF 71.)
Spectrum: Committee Bill
Status: (Engrossed - Dead) 2013-12-31 - END OF 2013 ACTIONS [SF296 Detail]
Download: Iowa-2013-SF296-Amended.html
Senate
File
296
-
Reprinted
SENATE
FILE
296
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
SF
71)
(As
Amended
and
Passed
by
the
Senate
March
26,
2013
)
A
BILL
FOR
An
Act
relating
to
integrated
care
models
for
the
delivery
1
of
health
care,
including
but
not
limited
to
required
2
utilization
of
a
medical
home
by
individuals
currently
and
3
newly
eligible
for
coverage
under
the
Medicaid
program
and
4
including
effective
date
provisions.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
6
SF
296
(3)
85
pf/rj/jh
S.F.
296
Section
1.
Section
135.157,
subsections
4
and
6,
Code
2013,
1
are
amended
to
read
as
follows:
2
4.
“Medical
home”
means
a
team
approach
to
providing
health
3
care
that
originates
in
a
primary
care
setting;
fosters
a
4
partnership
among
the
patient,
the
personal
provider,
and
5
other
health
care
professionals,
and
where
appropriate,
the
6
patient’s
family;
utilizes
the
partnership
to
access
and
7
integrate
all
medical
and
nonmedical
health-related
services
8
across
all
elements
of
the
health
care
system
and
the
patient’s
9
community
as
needed
by
the
patient
and
the
patient’s
family
10
to
achieve
maximum
health
potential;
maintains
a
centralized,
11
comprehensive
record
of
all
health-related
services
to
12
promote
continuity
of
care;
and
has
all
of
the
characteristics
13
specified
in
section
135.158
.
14
6.
“Personal
provider”
means
the
patient’s
first
point
of
15
contact
in
the
health
care
system
with
a
primary
care
provider
16
who
identifies
the
patient’s
health
health-related
needs
and,
17
working
with
a
team
of
health
care
professionals
and
providers
18
of
medical
and
nonmedical
health-related
services
,
provides
19
for
and
coordinates
appropriate
care
to
address
the
health
20
health-related
needs
identified.
21
Sec.
2.
Section
135.158,
subsection
2,
paragraphs
b,
c,
and
22
d,
Code
2013,
are
amended
to
read
as
follows:
23
b.
A
provider-directed
team-based
medical
practice.
The
24
personal
provider
leads
a
team
of
individuals
at
the
practice
25
level
who
collectively
take
responsibility
for
the
ongoing
26
health
care
health-related
needs
of
patients.
27
c.
Whole
person
orientation.
The
personal
provider
is
28
responsible
for
providing
for
all
of
a
patient’s
health
care
29
health-related
needs
or
taking
responsibility
for
appropriately
30
arranging
health
care
for
health-related
services
provided
31
by
other
qualified
health
care
professionals
and
providers
32
of
medical
and
nonmedical
health-related
services
.
This
33
responsibility
includes
health
health-related
care
at
all
34
stages
of
life
including
provision
of
preventive
care,
35
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296
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acute
care,
chronic
care,
preventive
services
long-term
1
care,
transitional
care
between
providers
and
settings
,
and
2
end-of-life
care.
This
responsibility
includes
whole-person
3
care
consisting
of
physical
health
care
including
but
not
4
limited
to
oral,
vision,
and
other
specialty
care,
pharmacy
5
management,
and
behavioral
health
care.
6
d.
Coordination
and
integration
of
care.
Care
is
7
coordinated
and
integrated
across
all
elements
of
the
8
complex
health
care
system
and
the
patient’s
community.
Care
9
coordination
and
integration
provides
linkages
to
community
10
and
social
supports
to
address
social
determinants
of
health,
11
to
engage
and
support
patients
in
managing
their
own
health,
12
and
to
track
the
progress
of
these
community
and
social
13
supports
in
providing
whole-person
care.
Care
is
facilitated
14
by
registries,
information
technology,
health
information
15
exchanges,
and
other
means
to
assure
that
patients
receive
the
16
indicated
care
when
and
where
they
need
and
want
the
care
in
a
17
culturally
and
linguistically
appropriate
manner.
18
Sec.
3.
Section
135.159,
subsections
1,
9,
and
11,
Code
19
2013,
are
amended
to
read
as
follows:
20
1.
The
department
shall
administer
the
medical
home
system.
21
The
department
shall
collaborate
with
the
department
of
human
22
services
in
administering
medical
homes
under
the
medical
23
assistance
program.
The
department
shall
adopt
rules
pursuant
24
to
chapter
17A
necessary
to
administer
the
medical
home
system
,
25
and
shall
collaborate
with
the
department
of
human
services
in
26
adopting
rules
for
medical
homes
under
the
medical
assistance
27
program
.
28
9.
The
department
shall
coordinate
the
requirements
and
29
activities
of
the
medical
home
system
with
the
requirements
30
and
activities
of
the
dental
home
for
children
as
described
31
in
section
249J.14
,
and
shall
recommend
financial
incentives
32
for
dentists
and
nondental
providers
to
promote
oral
health
33
care
coordination
through
preventive
dental
intervention,
early
34
identification
of
oral
disease
risk,
health
care
coordination
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296
and
data
tracking,
treatment,
chronic
care
management,
1
education
and
training,
parental
guidance,
and
oral
health
2
promotions
for
children.
Additionally,
the
department
shall
3
establish
requirements
for
the
medical
home
system
to
provide
4
linkages
to
accessible
dental
homes
for
adults
and
older
5
individuals.
6
11.
Implementation
phases
.
7
a.
Initial
implementation
shall
require
participation
8
in
the
medical
home
system
of
children
The
department
shall
9
collaborate
with
the
department
of
human
services
to
make
10
medical
homes
accessible
to
the
greatest
extent
possible
to
all
11
of
the
following
no
later
than
January
1,
2015:
12
(1)
Children
who
are
recipients
of
full
benefits
under
the
13
medical
assistance
program.
The
department
shall
work
with
14
the
department
of
human
services
and
shall
recommend
to
the
15
general
assembly
a
reimbursement
methodology
to
compensate
16
providers
participating
under
the
medical
assistance
program
17
for
participation
in
the
medical
home
system.
18
b.
The
department
shall
work
with
the
department
of
human
19
services
to
expand
the
medical
home
system
to
adults
20
(2)
Adults
who
are
recipients
of
full
benefits
under
the
21
medical
assistance
program
and
the
expansion
population
under
22
the
IowaCare
program.
The
department
shall
work
with
including
23
those
adults
who
are
recipients
of
medical
assistance
under
24
section
249A.3,
subsection
1,
paragraph
“v”
.
25
(3)
Medicare
and
dually
eligible
Medicare
and
medical
26
assistance
program
recipients,
to
the
extent
approved
by
the
27
centers
for
Medicare
and
Medicaid
services
of
the
United
States
28
department
of
health
and
human
services
to
allow
Medicare
29
recipients
to
utilize
the
medical
home
system
.
30
c.
b.
The
department
shall
work
with
the
department
of
31
administrative
services
to
allow
state
employees
to
utilize
the
32
medical
home
system.
33
d.
c.
The
department
shall
work
with
insurers
and
34
self-insured
companies,
if
requested,
to
make
the
medical
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home
system
available
to
individuals
with
private
health
care
1
coverage.
2
d.
The
department
shall
assist
the
department
of
human
3
services
in
developing
a
reimbursement
methodology
to
4
compensate
providers
participating
under
the
medical
assistance
5
program
as
a
medical
home.
6
e.
Any
integrated
care
model
implemented
on
or
after
July
1,
7
2013,
that
delivers
health
care
to
medical
assistance
program
8
recipients
shall
incorporate
medical
homes
as
its
foundation.
9
The
medical
home
shall
act
as
the
catalyst
in
any
such
10
integrated
care
model
to
ensure
compliance
with
the
purposes,
11
characteristics,
and
implementation
plan
requirements
specified
12
in
sections
135.158
and
135.159,
including
an
emphasis
on
whole
13
person
orientation
and
coordination
and
integration
of
both
14
clinical
services
and
nonclinical
community
and
social
supports
15
that
address
social
determinants
of
health.
16
Sec.
4.
Section
249A.3,
subsection
1,
Code
2013,
is
amended
17
by
adding
the
following
new
paragraphs:
18
NEW
PARAGRAPH
.
v.
Beginning
January
1,
2014,
in
19
accordance
with
section
1902(a)(10)(A)(i)(VIII)
of
the
20
federal
Social
Security
Act,
as
codified
in
42
U.S.C.
§
21
1396a(a)(10)(A)(i)(VIII),
is
an
individual
who
is
nineteen
22
years
of
age
or
older
and
under
sixty-five
years
of
age;
is
23
not
pregnant;
is
not
entitled
to
or
enrolled
for
Medicare
24
benefits
under
part
A,
or
enrolled
for
Medicare
benefits
under
25
part
B,
of
Tit.
XVIII
of
the
federal
Social
Security
Act;
is
26
not
otherwise
described
in
section
1902(a)(10)(A)(i)
of
the
27
federal
Social
Security
Act;
is
not
exempt
pursuant
to
section
28
1902(k)(3),
as
codified
in
42
U.S.C.
§
1396a(k)(3),
and
whose
29
income
as
determined
under
1902(e)(14)
of
the
federal
Social
30
Security
Act,
as
codified
in
42
U.S.C.
§
1396a(e)(14),
does
31
not
exceed
one
hundred
thirty-three
percent
of
the
poverty
32
line
as
defined
in
section
2110(c)(5)
of
the
federal
Social
33
Security
Act,
as
codified
in
42
U.S.C.
§
1397jj(c)(5),
for
the
34
applicable
family
size.
Notwithstanding
any
provision
to
the
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contrary,
individuals
eligible
for
medical
assistance
under
1
this
paragraph
shall
receive
coverage
for
benefits
pursuant
2
to
42
U.S.C.
§
1396u-7(b)(1)(D)
which
are
at
a
minimum
those
3
included
in
the
medical
assistance
state
plan
benefit
package
4
for
individuals
otherwise
eligible
under
this
subsection
1,
and
5
adjusted
as
necessary
to
provide
the
essential
health
benefits
6
as
required
pursuant
to
section
1302
of
the
federal
Patient
7
Protection
and
Affordable
Care
Act,
Pub.
L.
No.
111-148,
and
8
as
approved
by
the
United
States
secretary
of
health
and
human
9
services.
If
the
methodology
for
calculating
the
federal
10
medical
assistance
percentage
for
newly
eligible
individuals
11
under
this
paragraph,
as
provided
in
42
U.S.C.
§
1396d(y),
12
is
modified
through
federal
law
or
regulation
before
January
13
1,
2020,
in
a
manner
that
reduces
the
percentage
of
federal
14
assistance
to
the
state,
the
department
of
human
services
shall
15
implement
an
alternative
plan
as
specified
in
the
medical
16
assistance
state
plan
for
coverage
of
the
affected
population.
17
NEW
PARAGRAPH
.
w.
Beginning
January
1,
2014,
is
an
18
individual
who
meets
all
of
the
following
requirements:
19
(1)
Is
under
twenty-six
years
of
age.
20
(2)
Was
in
foster
care
under
the
responsibility
of
the
state
21
on
the
date
of
attaining
eighteen
years
of
age
or
such
higher
22
age
to
which
foster
care
is
provided.
23
(3)
Was
enrolled
in
the
medical
assistance
program
under
24
this
chapter
while
in
such
foster
care.
25
Sec.
5.
Section
249A.3,
subsection
2,
paragraph
a,
26
subparagraph
(9),
Code
2013,
is
amended
by
striking
the
27
subparagraph.
28
Sec.
6.
Section
249J.26,
subsection
2,
Code
2013,
is
amended
29
to
read
as
follows:
30
2.
This
chapter
is
repealed
October
December
31,
2013.
31
Sec.
7.
Section
249J.26,
Code
2013,
is
amended
by
adding
the
32
following
new
subsection:
33
NEW
SUBSECTION
.
3.
The
department
shall
prepare
a
plan
for
34
the
transition
of
expansion
population
members
to
other
health
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care
coverage
options
beginning
January
1,
2014.
The
options
1
shall
include
the
option
of
coverage
through
the
medical
2
assistance
program
as
provided
in
section
249A.3,
subsection
1,
3
paragraph
“v”
,
relating
to
coverage
for
adults
who
are
nineteen
4
years
of
age
or
older
and
under
sixty-five
years
of
age,
and
5
the
option
of
coverage
through
the
health
benefits
exchange
6
established
pursuant
to
the
federal
Patient
Protection
and
7
Affordable
Care
Act,
Pub.
L.
No.
111-148,
as
amended
by
the
8
federal
Health
Care
and
Education
Reconciliation
Act
of
2010,
9
Pub.
L.
No.
111-152.
To
the
greatest
extent
possible,
the
plan
10
shall
maintain
and
incorporate
utilization
of
the
existing
11
medical
home
and
service
delivery
structure
as
developed
12
under
this
chapter,
including
the
utilization
of
federally
13
qualified
health
centers,
public
hospitals,
and
other
safety
14
net
providers,
in
providing
access
to
care.
The
department
15
shall
submit
the
plan
to
the
governor
and
the
general
assembly
16
no
later
than
September
1,
2013.
17
Sec.
8.
ADVISORY
COUNCIL
FOR
STATE
INNOVATION
MODEL
18
INITIATIVE.
19
1.
No
later
than
thirty
days
after
the
effective
date
of
20
this
Act,
the
legislative
council
shall
establish
a
legislative
21
advisory
council
to
guide
the
development
of
the
design
22
model
and
implementation
plan
for
the
state
innovation
model
23
grant
awarded
by
the
Centers
for
Medicare
and
Medicaid
of
24
the
United
States
department
of
health
and
human
services.
25
The
legislative
advisory
council
shall
consist
of
members
26
of
the
general
assembly,
members
of
the
governor’s
advisory
27
committee
who
developed
the
grant
proposal,
and
representatives
28
of
consumers
and
health
care
providers,
appointed
by
the
29
legislative
council
as
necessary
to
ensure
that
the
process
is
30
comprehensive
and
provides
ample
opportunity
for
the
variety
of
31
stakeholders
to
participate
in
the
process.
32
2.
The
legislative
advisory
council
shall
provide
oversight
33
throughout
the
process,
shall
receive
periodic
progress
reports
34
from
the
department
of
human
services,
and
shall
approve
any
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integrated
care
model
and
implementation
strategies
for
the
1
medical
assistance
program
presented
by
the
department
of
human
2
services,
and
shall
prepare
proposed
legislation
to
implement
3
the
model
and
the
strategies
prior
to
its
submission
to
the
4
general
assembly
for
approval
during
the
2014
session
of
the
5
general
assembly.
6
3.
The
department
of
human
services
shall
develop
the
7
integrated
care
model
based
on
the
goals
and
strategies
8
included
in
the
state
innovation
model
grant
application
to
9
improve
patient
outcomes
and
satisfaction,
while
lowering
10
costs,
as
follows:
11
a.
Goals:
12
(1)
Ensure
the
coordination
of
health
care
delivery
for
13
medical
assistance
program
recipients
to
address
the
entire
14
spectrum
of
an
individual’s
physical,
behavioral,
and
mental
15
health
needs
by
targeting
at
a
minimum
population
health,
16
prevention,
health
promotion,
chronic
disease
management,
17
disability,
and
long-term
care.
18
(2)
Emphasize
whole
person
orientation
and
coordination
and
19
integration
of
both
clinical
and
nonclinical
care
and
supports,
20
to
provide
individuals
with
the
necessary
tools
to
address
21
determinants
of
health
and
to
empower
individuals
to
be
full
22
participants
in
their
own
health.
The
health
care
delivery
23
model
shall
focus
on
addressing
population
health
through
24
primary
and
team-based
care
that
incorporates
the
attributes
of
25
a
medical
home
as
specified
in
chapter
135,
division
XXII.
26
(3)
Ensure
accessibility
of
medical
assistance
program
27
recipients
to
an
adequate
and
qualified
workforce
by
most
28
efficiently
utilizing
the
skills
of
the
available
workforce.
29
(4)
Incorporate
appropriate
incentives
that
focus
on
30
quality
outcomes
and
patient
satisfaction,
to
move
from
31
volume-based
to
value-based
purchasing.
32
(5)
Provide
for
alignment
of
payment
methods
and
quality
33
across
health
care
payers
to
ensure
a
unified
set
of
outcomes
34
and
to
recognize,
through
reimbursement,
all
participants
in
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the
integrated
system
of
care.
1
b.
Strategies
and
model
designs:
2
(1)
A
strategy
to
implement
a
multipayer
integrated
3
care
model
methodology
across
primary
health
care
payers
4
in
the
state,
by
aligning
performance
measures,
utilizing
5
a
shared
savings
or
other
accountable
payment
methodology,
6
and
integrating
an
information
technology
platform
to
7
support
the
integrated
care
model.
The
strategy
shall
8
ensure
statewide
adoption
of
integrated
care
for
the
medical
9
assistance
population;
explore
the
role
of
managed
care
10
plans
and
expansion
of
managed
care
in
the
medical
assistance
11
program
as
part
of
the
integrated
care
model;
address
the
12
special
circumstances
of
areas
of
the
state
that
are
rural,
13
underserved,
or
have
higher
rates
of
health
disparities;
and
14
seek
the
participation
of
the
Medicare
population
in
the
15
integrated
care
model.
16
(2)
A
strategy
to
incorporate
long-term
care
and
behavioral
17
health
services
for
the
medical
assistance
population
into
the
18
integrated
care
model,
through
integration
of
community
health
19
and
community
prevention
activities.
20
(3)
A
strategy
to
address
population
health
and
health
21
promotion,
by
investing
in
approaches
to
influence
modifiable
22
determinants
of
health
such
as
access
to
health
care,
healthy
23
behaviors,
socioeconomic
factors,
and
the
physical
environment
24
that
collectively
impact
the
health
of
the
community.
The
25
strategy
shall
address
the
underlying,
pervasive,
and
26
multifaceted
socioeconomic
impediments
that
medical
assistance
27
recipients
face
in
being
full
participants
in
their
own
health.
28
(4)
A
multiphase
strategy
to
implement
a
statewide
29
integrated
care
model
to
maximize
access
to
health
care
for
30
medical
assistance
program
recipients
in
all
areas
of
the
31
state.
The
strategy
shall
incorporate
flexible
integrated
32
care
model
options
and
accountable
payment
methodologies
33
for
participation
by
various
types
of
providers
including
34
individual
providers,
safety
net
providers,
and
nonprofit
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and
public
providers
that
have
long
experience
in
caring
for
1
vulnerable
populations,
into
the
integrated
system.
2
(5)
Implement
a
stakeholder
process.
In
addition
to
the
3
oversight
and
input
provided
by
the
legislative
advisory
4
council,
the
department
shall
hold
public
local
listening
5
sessions
throughout
the
state,
collaborate
with
consumer
groups
6
and
provider
groups,
and
partner
with
other
state
agencies
such
7
as
the
department
on
aging
and
the
department
of
public
health
8
to
elicit
input
and
feedback
on
the
model
design.
9
(6)
Develop
a
multipayer
approach
including
the
medical
10
assistance
and
children’s
health
insurance
programs,
private
11
payers,
and
Medicare.
12
(7)
Oversee
the
administration
of
the
model
design
project.
13
(8)
Engage
providers
beyond
the
large
integrated
health
14
systems
to
maximize
access
to
all
levels
of
care
within
an
15
integrated
model
program
by
medical
assistance
recipients.
16
4.
The
department
shall
submit
proposed
legislation
17
specifying
the
model
design
and
implementation
plan
to
the
18
advisory
council
no
later
than
December
15,
2013.
19
Sec.
9.
LEGISLATIVE
COMMISSION
ON
INTEGRATED
CARE
MODELS.
20
1.
a.
A
legislative
commission
on
integrated
care
models
21
is
created
for
the
2013
Legislative
Interim.
The
legislative
22
services
agency
shall
provide
staffing
assistance
to
the
23
commission.
24
b.
The
commission
shall
include
10
members
of
the
general
25
assembly,
three
appointed
by
the
majority
leader
of
the
senate,
26
two
appointed
by
the
minority
leader
of
the
senate,
three
27
appointed
by
the
speaker
of
the
house
of
representatives,
28
and
two
appointed
by
the
minority
leader
of
the
house
of
29
representatives.
30
c.
The
commission
shall
include
members
of
the
public
31
appointed
by
the
legislative
council
who
represent
consumers,
32
health
care
providers,
hospitals
and
health
systems,
and
other
33
entities
with
interest
or
expertise
related
to
integrated
care
34
models.
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d.
The
commission
shall
include
as
ex
officio
members,
the
1
director
of
human
services,
the
commissioner
of
insurance,
the
2
director
of
public
health,
and
the
attorney
general,
or
the
3
individual’s
designee.
4
2.
The
chairpersons
of
the
commission
shall
be
those
members
5
of
the
general
assembly
so
appointed
by
the
majority
leader
of
6
the
senate
and
the
speaker
of
the
house
of
representatives.
7
Legislative
members
of
the
commission
are
eligible
for
per
diem
8
and
reimbursement
of
actual
expenses
as
provided
in
section
9
2.10.
Consumers
appointed
to
the
commission,
are
entitled
10
to
receive
a
per
diem
as
specified
in
section
7E.6
for
each
11
day
spent
in
performance
of
duties
as
members,
and
shall
be
12
reimbursed
for
all
actual
and
necessary
expenses
incurred
in
13
the
performance
of
duties
as
members
of
the
commission.
14
3.
The
commission
shall
do
all
of
the
following:
15
a.
Review
and
make
recommendations
relating
to
the
16
formation
and
operation
of
integrated
care
models
in
the
17
state.
The
models
shall
include
any
care
delivery
model
that
18
integrates
providers
and
incorporates
a
financial
incentive
19
to
improve
patient
health
outcomes,
improve
care,
and
reduce
20
costs.
Integrated
care
models
include
but
are
not
limited
21
to
patient-centered
medical
homes,
health
homes,
accountable
22
care
organizations
(ACOs),
ACO-like
models,
community
and
23
regional
care
networks,
and
other
integrated
and
accountable
24
care
delivery
models
that
utilize
value-based
financing
25
methodologies
and
emphasize
person-centered,
coordinated,
and
26
comprehensive
care.
27
b.
Review
integrated
care
models
created
in
other
states
28
that
integrate
both
clinical
services
and
nonclinical
community
29
and
social
supports
utilizing
patient-centered
medical
homes
30
and
community
care
teams
as
basic
components
to
determine
the
31
feasibility
of
adapting
any
of
these
models
as
a
statewide
32
system
in
Iowa.
These
models
may
include
but
are
not
limited
33
to
the
ACO
demonstration
program
based
on
the
Camden
Coalition
34
of
Healthcare
Providers
in
Camden,
New
Jersey;
the
Medical
35
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Home
Network
in
Chicago,
Illinois;
the
Health
Commons
model
in
1
New
Mexico;
the
Accountable
Care
Collaborative
in
Colorado;
2
Community
Care
of
North
Carolina,
in
North
Carolina;
the
3
Blueprint
for
Health
and
the
Community
Health
Teams
in
Vermont;
4
and
the
Coordinated
Care
Organizations
in
Oregon.
5
c.
Recommend
the
best
means
of
providing
care
through
6
integrated
delivery
models
throughout
the
state
including
to
7
vulnerable
populations
and
how
best
to
incorporate
safety
net
8
providers,
including
but
not
limited
to
federally
qualified
9
health
centers,
rural
health
clinics,
community
mental
health
10
centers,
public
hospitals,
and
other
nonprofit
and
public
11
providers
that
have
long
experience
in
caring
for
vulnerable
12
populations,
into
the
integrated
system.
13
d.
Review
the
progress
of
the
development
of
medical
14
homes
as
specified
in
chapter
135,
division
XXII
in
the
15
state
and
make
recommendations
for
development
of
a
statewide
16
infrastructure
of
actual
and
virtual
medical
homes
to
act
as
17
the
foundation
for
integrated
care
models.
18
e.
Review
opportunities
under
the
federal
Patient
19
Protection
and
Affordable
Care
Act
(Affordable
Care
Act),
20
Pub.
L.
No.
11-148,
as
amended,
for
the
development
of
21
integrated
care
models
including
the
Medicare
Shared
Savings
22
Program
for
accountable
care
organizations,
community-based
23
collaborative
care
networks
that
include
safety
net
providers,
24
and
consumer-operated
and
oriented
plans.
The
legislative
25
commission
shall
also
review
existing
and
proposed
integrated
26
care
models
in
the
state
including
commercial
models
and
those
27
developed
or
proposed
under
the
Affordable
Care
Act
including
28
the
Medicare
Shared
Savings
Program
and
the
Pioneer
ACO
to
29
determine
the
opportunities
for
expansion
or
replication.
30
f.
Address
the
issues
relative
to
integrated
care
models
31
including
those
relating
to
consumer
protection
including
32
those
that
relate
to
confidentiality,
quality
assurance,
33
grievance
procedures,
and
appeals
of
patient
care
decisions;
34
payment
methodologies,
multipayer
alignment,
coordination
35
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of
funding
streams,
and
financing
methods
that
support
full
1
integration
of
clinical
and
nonclinical
services
and
providers;
2
organizational,
management,
and
governing
structures;
3
access,
quality,
outcomes,
utilization,
and
other
appropriate
4
performance
standards;
patient
attribution
or
assignment
5
models;
health
information
exchange,
data
reporting,
and
6
infrastructure
standards;
and
regulatory
issues
including
7
clinical
integration
limitations,
physician
self-referral,
8
anti-kickback
provisions,
gain-sharing,
beneficiary
9
inducements,
antitrust
issues,
tax
exemption
issues,
and
10
application
of
insurance
regulations.
11
4.
The
legislative
commission
may
request
from
any
state
12
agency
or
official
information
and
assistance
as
needed
to
13
perform
the
review
and
make
recommendations.
14
5.
The
legislative
commission
shall
submit
a
final
report
15
summarizing
the
legislative
commission’s
review
and
making
16
recommendations
to
the
governor
and
the
general
assembly
by
17
December
15,
2013.
18
Sec.
10.
MEDICAID
STATE
PLAN.
19
1.
The
department
of
human
services
shall
amend
the
medical
20
assistance
state
plan
to
reflect
the
provisions
relating
to
the
21
provision
of
a
medical
home
to
medical
assistance
recipients
22
as
provided
in
this
Act.
23
2.
The
department
of
human
services
shall
amend
the
medical
24
assistance
state
plan
to
provide
for
coverage
of
adults
up
to
25
133
percent
of
the
federal
poverty
level
as
provided
pursuant
26
to
section
249A.3,
subsection
1,
paragraph
“v”,
as
enacted
in
27
this
Act,
beginning
January
1,
2014.
The
state
plan
amendment
28
shall
include
a
provision
specifying
that
if
the
methodology
29
for
calculating
the
federal
medical
assistance
percentage
for
30
newly
eligible
individuals
under
section
249A.3,
subsection
1,
31
paragraph
“v”,
as
provided
in
42
U.S.C.
§
1396d(y),
is
modified
32
through
federal
law
or
regulation
before
January
1,
2020,
in
33
a
manner
that
reduces
the
percentage
of
federal
assistance
to
34
the
state,
the
department
of
human
services
shall
implement
35
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an
alternative
plan
for
coverage
of
the
affected
population,
1
to
the
extent
necessary,
so
that
state
expenditures
remain
2
budget
neutral
under
the
modified
federal
medical
assistance
3
percentage
relative
to
the
percentage
specified
for
the
same
4
fiscal
year
under
section
42
U.S.C.
§
1396d(y).
The
state
plan
5
amendment
shall
provide
that
implementation
by
the
department
6
of
human
services
of
any
alternative
plan
for
coverage
of
7
the
affected
population
is
subject
to
prior
approval
of
the
8
implementation
by
statute.
9
3.
The
department
of
human
services
shall
amend
the
medical
10
assistance
state
plan
to
provide
that
the
benchmark
benefit
11
plan
provided
to
the
newly
covered
adults
under
the
medical
12
assistance
program
is
the
option
provided
pursuant
to
42
U.S.C.
13
§
1396u-7(b)(1)(D)
which
is
at
a
minimum
the
coverage
included
14
in
the
medical
assistance
state
plan
benefit
package
for
15
individuals
otherwise
eligible
under
section
249A.3,
subsection
16
1,
and
adjusted
as
necessary
to
provide
the
essential
health
17
benefits
as
required
pursuant
to
section
1302
of
the
federal
18
Patient
Protection
and
Affordable
Care
Act,
Pub.
L.
No.
19
111-148,
and
as
approved
by
the
United
States
secretary
of
20
health
and
human
services.
21
Sec.
11.
ADOPTION
OF
RULES.
The
department
of
human
22
services
shall
adopt
emergency
rules
pursuant
to
section
17A.4,
23
subsection
3,
and
section
17A.5,
subsection
2,
paragraph
“b”,
24
as
necessary
to
implement
the
provisions
of
this
Act,
and
25
the
rules
shall
be
effective
immediately
upon
filing
unless
26
a
later
date
is
specified
in
the
rules.
Any
rules
adopted
27
in
accordance
with
this
section
shall
also
be
published
as
a
28
notice
of
intended
action
as
provided
in
section
17A.4.
29
Sec.
12.
EFFECTIVE
DATE.
The
following
provision
or
30
provisions
of
this
Act
take
effect
December
31,
2013:
31
1.
The
section
of
this
Act
amending
section
249A.3,
32
subsection
2,
paragraph
“a”,
subparagraph
(9).
33
Sec.
13.
EFFECTIVE
UPON
ENACTMENT.
With
the
exception
of
34
the
section
of
this
Act
amending
section
249A.3,
subsection
35
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