Bill Text: IA SF313 | 2011-2012 | 84th General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: A bill for an act relating to medical assistance program-related provisions. (Formerly SSB 1100.) Effective 7-1-11.

Sponsorship: Committee Bill

Status: (Passed) 2011-12-31 - END OF 2011 ACTIONS [SF313 Detail]

Download: Iowa-2011-SF313-Enrolled.html

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Senate File 313
AN ACT
RELATING TO MEDICAL ASSISTANCE PROGRAM-RELATED PROVISIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
MEDICAL ASSISTANCE —— GENERAL PROVISIONS
Section 1. Section 8A.504, subsection 1, paragraph c,
subparagraph (1), Code 2011, is amended to read as follows:
(1) Any debt, which is assigned to the department of human
services, or which is owed to the department of human services

Senate File 313, p. 2
for unpaid premiums under section 249A.3, subsection 2,
paragraph “a” , subparagraph (1), or section 249J.8, subsection
1, or which the child support recovery unit is otherwise
attempting to collect, or which the foster care recovery unit
of the department of human services is attempting to collect
on behalf of a child receiving foster care provided by the
department of human services.
Sec. 2. Section 217.34, Code 2011, is amended to read as
follows:
217.34 Debt setoff.
The investigations division of the department of inspections
and appeals and the department of human services shall provide
assistance to set off against a person’s or provider’s income
tax refund or rebate any debt which has accrued through written
contract, nonpayment of premiums pursuant to section 249A.3,
subsection 2, paragraph “a” , subparagraph (1), or section
249J.8, subsection 1, subrogation, departmental recoupment
procedures, or court judgment and which is in the form of a
liquidated sum due and owing the department of human services.
The department of inspections and appeals, with approval of the
department of human services, shall adopt rules under chapter
17A necessary to assist the department of administrative
services in the implementation of the setoff under section
8A.504 in regard to money owed to the state for public
assistance overpayments or nonpayment of premiums as specified
in this section . The department of human services shall adopt
rules under chapter 17A necessary to assist the department of
administrative services in the implementation of the setoff
under section 8A.504 , in regard to collections by the child
support recovery unit and the foster care recovery unit.
Sec. 3. Section 249A.3, subsection 2, paragraph a,
subparagraph (1), Code 2011, is amended to read as follows:
(1) (a) As allowed under 42 U.S.C.
§ 1396a(a)(10)(A)(ii)(XIII), individuals with disabilities,
who are less than sixty-five years of age, who are members of
families whose income is less than two hundred fifty percent of
the most recently revised official poverty guidelines published
by the United States department of health and human services
for the family, who have earned income and who are eligible for
medical assistance or additional medical assistance under this
section if earnings are disregarded. As allowed by 42 U.S.C.
§ 1396a(r)(2), unearned income shall also be disregarded in
determining whether an individual is eligible for assistance

Senate File 313, p. 3
under this subparagraph. For the purposes of determining the
amount of an individual’s resources under this subparagraph
and as allowed by 42 U.S.C. § 1396a(r)(2), a maximum of ten
thousand dollars of available resources shall be disregarded,
and any additional resources held in a retirement account, in a
medical savings account, or in any other account approved under
rules adopted by the department shall also be disregarded.
(b) Individuals eligible for assistance under this
subparagraph, whose individual income exceeds one hundred
fifty percent of the official poverty guidelines published
by the United States department of health and human services
for an individual, shall pay a premium. The amount of the
premium shall be based on a sliding fee schedule adopted by
rule of the department and shall be based on a percentage of
the individual’s income. The maximum premium payable by an
individual whose income exceeds one hundred fifty percent of
the official poverty guidelines shall be commensurate with
the cost of state employees’ group health insurance in this
state. The payment to and acceptance by an automated case
management system or the department of the premium required
under this subparagraph shall not automatically confer initial
or continuing program eligibility on an individual. A premium
paid to and accepted by the department’s premium payment
process that is subsequently determined to be untimely or to
have been paid on behalf of an individual ineligible for the
program shall be refunded to the remitter in accordance with
rules adopted by the department. Any unpaid premium shall be a
debt owed the department.
Sec. 4. Section 249J.6, subsection 2, paragraph b, Code
2011, is amended to read as follows:
b. Refusal of an expansion population member to participate
in a comprehensive medical examination or any health risk
assessment implemented by the department shall not be a basis
for ineligibility for or disenrollment from the expansion
population. Refusal of an expansion population member to
participate in a comprehensive medical examination or other
preventative health service shall not negatively affect the
calculation of performance payments for an expansion population
network provider medical home.
Sec. 5. Section 249J.6, subsection 3, Code 2011, is amended
to read as follows:
3. Expansion population members , including members assigned
to an expansion population network provider medical home, shall

Senate File 313, p. 4
be provided access to an IowaCare nurse helpline, accessible
twenty-four hours per day, seven days per week, to assist
expansion population members in making appropriate choices
about the use of emergency room and other health care services.
Sec. 6. Section 249J.7, subsection 1, paragraph c, Code
2011, is amended to read as follows:
c. (1) Tertiary care shall only be provided to eligible
expansion population members residing in any county in the
state at the university of Iowa hospitals and clinics.
(2) Secondary care shall be provided by the publicly
owned acute care teaching hospital located in a county with a
population over three hundred fifty thousand and the university
of Iowa hospitals and clinics, based on county of residence,
only to the extent specified in the phase-in of the regional
provider network designated by the department.
Sec. 7. Section 249J.8, subsection 1, Code 2011, is amended
to read as follows:
1. a. Each The total monthly premium and other cost-sharing
for an expansion population member whose family income exceeds
one hundred fifty percent of the federal poverty level as
defined by the most recently revised poverty income guidelines
published by the United States department of health and human
services shall pay a monthly premium not to exceed one-twelfth
of five percent of the member’s annual family income regardless
of the number of expansion population members in the household.
The department shall adopt rules to establish a premium
schedule in accordance with this subsection that is calculated
based on a member’s family income for each ten percent
increment of the federal poverty level .
b. Each An expansion population member whose family income
is equal to or less than one hundred fifty percent of the
federal poverty level as defined by the most recently revised
poverty income guidelines published by the United States
department of health and human services shall not be subject to
payment of a monthly premium.
c. All premiums shall be paid on by the last day of the
month of coverage.
d. The department shall deduct the amount of any monthly
premiums paid by an expansion population member for benefits
under the healthy and well kids in Iowa program when computing
the amount of monthly premiums owed under this subsection .
e. An expansion population member shall respond to the
monthly premium notices either through timely payment or a

Senate File 313, p. 5
request for a hardship exemption during the entire period of
the member’s enrollment.
f. Regardless of the length of enrollment, the member
is subject to payment of the premium for a minimum of four
consecutive months. However, an expansion population member
who complies with the requirement of payment of the premium
for a minimum of four consecutive months during a consecutive
twelve-month period of enrollment shall be deemed to have
complied with this requirement for the subsequent consecutive
twelve-month period of enrollment and shall only be subject to
payment of the monthly premium on a month-by-month basis.
g. Timely payment of premiums , including any arrearages
accrued from prior enrollment, is a condition of receiving any
expansion population services. An expansion population member
who does not provide timely payment within sixty days of the
date the premium is due is subject to disenrollment.
h. Any unpaid premiums are a debt owed to the department.
i. The payment to and acceptance by an automated case
management system or the department of the premium required
under this subsection shall not automatically confer initial or
continuing program eligibility on an individual.
j. A premium paid to and accepted by the department’s
premium payment process that is subsequently determined to
be untimely or to have been paid on behalf of an individual
ineligible for the program shall be refunded to the remitter in
accordance with rules adopted by the department.
k. Premiums collected under this subsection shall be
deposited in the premiums subaccount of the account for health
care transformation created pursuant to section 249J.23 .
l. An expansion population member shall also pay the same
copayments required of other adult recipients of medical
assistance.
Sec. 8. Section 249J.14, subsection 5, Code 2011, is amended
to read as follows:
5. Dental home for children.
a. The department shall enter into an interagency agreement
with the department of public health for infrastructure
development and oral health coordination services for
recipients of medical assistance to increase access to dental
care for medical assistance recipients.
b. By December 31, 2011 July 1, 2013 , every recipient
of medical assistance who is a child twelve years of age or
younger shall have a designated dental home and shall be

Senate File 313, p. 6
provided with the dental screenings, preventive services,
diagnostic services, treatment services, and emergency services
as defined under the early and periodic screening, diagnostic,
and treatment program.
Sec. 9. Section 249J.24A, subsection 1, Code 2011, is
amended to read as follows:
1. A nonparticipating provider may be reimbursed for
covered expansion population services provided to an
expansion population member by a nonparticipating provider
if the nonparticipating provider contacts the appropriate
participating provider prior to providing covered services to
verify consensus regarding one of the following courses of
action if any of the following conditions is met :
a. If the nonparticipating provider and the participating
provider agree that the medical status of the expansion
population member indicates it is medically possible to
postpone provision of services, the nonparticipating provider
shall direct the expansion population member to the appropriate
participating provider for services.
b. a. If the nonparticipating provider and the
participating provider agree determines that the medical
status of the expansion population member indicates it is not
medically possible advisable to postpone provision of services,
the nonparticipating provider shall provide medically necessary
services.
c. b. If the nonparticipating provider and the
participating provider agree that transfer of the expansion
population member is not possible due to lack of available
inpatient capacity, the nonparticipating provider shall provide
medically necessary services.
d. c. If the medical status of the expansion population
member indicates a medical emergency and the nonparticipating
provider is not able to contact the appropriate participating
provider prior to providing medically necessary services, the
nonparticipating provider shall document the medical emergency
and inform the appropriate participating provider immediately
after the member has been stabilized of any covered services
provided.
Sec. 10. Section 249J.24A, subsection 2, paragraph a, Code
2011, is amended to read as follows:
a. If the nonparticipating provider meets the requirements
specified in subsection 1 , the nonparticipating provider shall
be reimbursed for covered expansion population services ,

Senate File 313, p. 7
limited to emergency and other inpatient hospital services
provided to the expansion population member up to the point
of transfer to another provider, discharge, or transfer to
another level of care, through the nonparticipating provider
reimbursement fund in accordance with rules adopted by the
department of human services. However, any funds received
from participating providers, appropriated to participating
providers, or deposited in the IowaCare account pursuant to
section 249J.24 , shall not be transferred or appropriated to
the nonparticipating provider reimbursement fund or otherwise
used to reimburse nonparticipating providers.
Sec. 11. Section 514I.5, subsection 3, Code 2011, is amended
to read as follows:
3. Members appointed by the governor shall serve two-year
staggered terms as designated by the governor, and legislative
members of the board shall serve two-year terms. The filling
of positions reserved for the public representatives,
vacancies, membership terms, payment of compensation and
expenses, and removal of the members are governed by chapter
69 . Members of the board are entitled to receive reimbursement
of actual expenses incurred in the discharge of their duties.
Public members of the board are also eligible to receive
compensation as provided in section 7E.6 . A majority of the
voting members constitutes a quorum and the affirmative vote
of a majority of the voting members is necessary for any
substantive action to be taken by the board. The members
shall select a chairperson on an annual basis from among the
membership of the board.
Sec. 12. REGIONAL PROVIDER NETWORK —— ALTERNATIVE PROVIDER
—— PILOT. The department of human services shall consult with
providers of primary care services in regional provider network
areas established pursuant to section 249J.7 to determine if
the option of establishing an alternative provider location
is feasible. The department may implement a pilot program
establishing an alternative provider location in an established
regional provider network area experiencing capacity issues
during the fiscal year beginning July 1, 2011, if the
department determines that this option would most appropriately
address such capacity issues and provide better access to care
for expansion population members in the area. Any such pilot
program shall be implemented within funds available under the
existing appropriation for the regional provider network and
any alternative provider location shall be subject to the

Senate File 313, p. 8
requirements applicable to an expansion population provider
pursuant to chapter 249J.
______________________________
JOHN P. KIBBIE
President of the Senate
______________________________
KRAIG PAULSEN
Speaker of the House
I hereby certify that this bill originated in the Senate and
is known as Senate File 313, Eighty-fourth General Assembly.
______________________________
MICHAEL E. MARSHALL
Secretary of the Senate
Approved _______________, 2011
______________________________
TERRY E. BRANSTAD
Governor