Bill Text: IA HF2483 | 2017-2018 | 87th General Assembly | Amended

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Bill Title: A bill for an act relating to programs and activities under the purview of the department of human services. (Formerly HSB 680.)

Spectrum: Committee Bill

Status: (Engrossed - Dead) 2018-04-25 - Fiscal note. [HF2483 Detail]

Download: Iowa-2017-HF2483-Amended.html

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House File 2483 - Reprinted




                                 HOUSE FILE       
                                 BY  COMMITTEE ON
                                     APPROPRIATIONS

                                 (SUCCESSOR TO HSB 680)
       (As Amended and Passed by the House April 23, 2018)

                                      A BILL FOR

  1 An Act relating to programs and activities under the purview of
  2    the department of human services.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    HF 2483 (4) 87
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PAG LIN



  1  1                           DIVISION I
  1  2                  SHARING OF INCARCERATION DATA
  1  3    Section 1.  Section 249A.38, Code 2018, is amended to read
  1  4 as follows:
  1  5    249A.38  Inmates of public institutions ==== suspension or
  1  6 termination of medical assistance.
  1  7    1.  The following conditions shall apply to Following the
  1  8 first thirty days of commitment, the department shall suspend
  1  9 the eligibility of an individual who is an inmate of a public
  1 10 institution as defined in 42 C.F.R. {435.1010, who is enrolled
  1 11 in the medical assistance program at the time of commitment to
  1 12 the public institution, and who remains eligible for medical
  1 13 assistance as an individual except for the individual's
  1 14 institutional status:
  1 15    a.  The department shall suspend the individual's
  1 16 eligibility for up to the initial twelve months of the period
  1 17 of commitment. The department shall delay the suspension
  1 18 of eligibility for a period of up to the first thirty days
  1 19 of commitment if such delay is approved by the centers for
  1 20 Medicare and Medicaid services of the United States department
  1 21 of health and human services. If such delay is not approved,
  1 22 the department shall suspend eligibility during the entirety
  1 23 of the initial twelve months of the period of commitment.
  1 24 Claims submitted on behalf of the individual under the medical
  1 25 assistance program for covered services provided during the
  1 26 delay period shall only be reimbursed if federal financial
  1 27 participation is applicable to such claims. 
  1 28    b.  The department shall terminate an individual's
  1 29 eligibility following a twelve=month period of suspension
  1 30 of the individual's eligibility under paragraph "a", during
  1 31 the period of the individual's commitment to the public
  1 32 institution.
  1 33    2.  a.  A public institution shall provide the department and
  1 34 the social security administration with a monthly report of the
  1 35 individuals who are committed to the public institution and of
  2  1 the individuals who are discharged from the public institution.
  2  2 The monthly report to the department shall include the date
  2  3 of commitment or the date of discharge, as applicable, of
  2  4 each individual committed to or discharged from the public
  2  5 institution during the reporting period. The monthly report
  2  6 shall be made through the reporting system created by the
  2  7 department for public, nonmedical institutions to report inmate
  2  8 populations.  Any medical assistance expenditures, including
  2  9 but not limited to monthly managed care capitation payments,
  2 10 provided on behalf of an individual who is an inmate of a
  2 11 public institution but is not reported to the department
  2 12 in accordance with this subsection, shall be the financial
  2 13 responsibility of the respective public institution.
  2 14    b.  The department shall provide a public institution with
  2 15 the forms necessary to be used by the individual in expediting
  2 16 restoration of the individual's medical assistance benefits
  2 17 upon discharge from the public institution.
  2 18    3.  This section applies to individuals as specified in
  2 19 subsection 1 on or after January 1, 2012. 
  2 20    4.  3.  The department may adopt rules pursuant to chapter
  2 21 17A to implement this section.
  2 22                           DIVISION II
  2 23                 MEDICAID PROGRAM ADMINISTRATION
  2 24    Sec. 2.  MEDICAID PROGRAM ADMINISTRATION.
  2 25    1.  PROVIDER PROCESSES AND PROCEDURES.
  2 26    a.  When all of the required documents and other information
  2 27 necessary to process a claim have been received by a managed
  2 28 care organization, the managed care organization shall
  2 29 either provide payment to the claimant within the timelines
  2 30 specified in the managed care contract or, if the managed
  2 31 care organization is denying the claim in whole or in part,
  2 32 shall provide notice to the claimant including the reasons for
  2 33 such denial consistent with national industry best practice
  2 34 guidelines.
  2 35    b.  If a managed care organization discovers that a claims
  3  1 payment barrier is the result of a managed care organization's
  3  2 identified system configuration error, the managed care
  3  3 organization shall correct such error and shall fully and
  3  4 accurately reprocess the claims affected by the error within
  3  5 thirty days of such discovery or within a time frame approved
  3  6 by the department.  For the purposes of this paragraph,
  3  7 "configuration error" means an error in provider data, an
  3  8 incorrect fee schedule, or an incorrect claims edit.
  3  9    c.  The department of human services shall provide for
  3 10 the development and require the use of standardized Medicaid
  3 11 provider enrollment forms to be used by the department and
  3 12 uniform Medicaid provider credentialing standards to be used
  3 13 by managed care organizations.  The credentialing process is
  3 14 deemed to begin when the managed care organization has received
  3 15 all necessary credentialing materials from the provider and is
  3 16 deemed to have ended when written communication is mailed or
  3 17 faxed to the provider notifying the provider of the managed
  3 18 care organization's decision.
  3 19    d.  A managed care organization shall provide written notice
  3 20 to all affected individuals at least sixty days prior to a
  3 21 significant change in administrative procedures relating to
  3 22 the scope or coverage of benefits, billings and collections
  3 23 provisions, provider network provisions, member or provider
  3 24 services, prior authorization requirements, or any other terms
  3 25 of a managed care contract or agreement as determined by the
  3 26 department of human services.  A managed care organization may
  3 27 comply with the requirement of providing written notice under
  3 28 this paragraph by posting such written notice on the managed
  3 29 care organization's internet site.
  3 30    e.  The department of human services shall engage dedicated
  3 31 provider relations staff to assist Medicaid providers in
  3 32 resolving billing conflicts with managed care organizations
  3 33 including those involving denied claims, technical omissions,
  3 34 or incomplete information.  If the provider relations staff
  3 35 observe trends evidencing fraudulent claims or improper
  4  1 reimbursement, the staff shall forward such evidence to the
  4  2 department of human services for further review.
  4  3    f.  The department of human services shall adopt rules
  4  4 pursuant to chapter 17A to require the inclusion by a managed
  4  5 care organization of advanced registered nurse practitioners
  4  6 and physician assistants as primary care providers for the
  4  7 purposes of population health management.
  4  8    2.  MEMBER SERVICES AND PROCESSES.
  4  9    a.  If a Medicaid member prevails on appeal regarding the
  4 10 provision of services, the services subject to the appeal
  4 11 shall be extended for a period of time determined by the
  4 12 director of human services. However, services shall not be
  4 13 extended if there is a change in the member's condition that
  4 14 warrants a change in services as determined by the member's
  4 15 interdisciplinary team, there is a change in the member's
  4 16 eligibility status as determined by the department of human
  4 17 services, or the member voluntarily withdraws from services.
  4 18    b.  If a Medicaid member is receiving court=ordered services
  4 19 or treatment for a substance=related disorder pursuant to
  4 20 chapter 125 or for a mental illness pursuant to chapter 229,
  4 21 such services or treatment shall be provided and reimbursed
  4 22 for an initial period of three days before a managed care
  4 23 organization may apply medical necessity criteria to determine
  4 24 the most appropriate services, treatment, or placement for the
  4 25 Medicaid member.
  4 26    c.  The department of human services shall review and have
  4 27 approval authority for level of care reassessments for Medicaid
  4 28 long=term services and supports (LTSS) population members that
  4 29 indicate a decrease in the level of care. A managed care
  4 30 organization shall comply with the findings of the departmental
  4 31 review and approval of such level of care reassessments.  If
  4 32 a level of care reassessment indicates there is no change in
  4 33 a Medicaid LTSS population member's level of care needs, the
  4 34 Medicaid LTSS population member's existing level of care shall
  4 35 be continued.  A managed care organization shall maintain
  5  1 and make available to the department of human services all
  5  2 documentation relating to a Medicaid LTSS population member's
  5  3 level of care assessment.
  5  4    d.  The department of human services shall maintain and
  5  5 update Medicaid member eligibility files in a timely manner
  5  6 consistent with national industry best practices.
  5  7    3.  MEDICAID PROGRAM REVIEW AND OVERSIGHT.
  5  8    a.  (1)  The department of human services shall facilitate a
  5  9 workgroup, in collaboration with representatives of the managed
  5 10 care organizations and health home providers, to review the
  5 11 health home programs.  The review shall include all of the
  5 12 following:
  5 13    (a)  An analysis of the state plan amendments applicable to
  5 14 health homes.
  5 15    (b)  An analysis of the current health home system, including
  5 16 the rationale for any recommended changes.
  5 17    (c)  The development of a clear and consistent delivery
  5 18 model linked to program=determined outcomes and data reporting
  5 19 requirements.
  5 20    (d)  A work plan to be used in communicating with
  5 21 stakeholders regarding the administration and operation of the
  5 22 health home programs.
  5 23    (2)  The department of human services shall submit a report
  5 24 of the workgroup's findings and recommendations by December
  5 25 15, 2018, to the governor and to the Eighty=eighth General
  5 26 Assembly, 2019 session, for consideration.
  5 27    (3)  The workgroup and the workgroup's activities shall
  5 28 not affect the department's authority to apply or enforce the
  5 29 Medicaid state plan amendment relative to health homes.
  5 30    b.  The department of human services, in collaboration
  5 31 with Medicaid providers and managed care organizations, shall
  5 32 initiate a review process to determine the effectiveness of
  5 33 prior authorizations used by the managed care organizations
  5 34 with the goal of making adjustments based on relevant
  5 35 service costs and member outcomes data utilizing existing
  6  1 industry=accepted standards.  Prior authorization policies
  6  2 shall comply with existing rules, guidelines, and procedures
  6  3 developed by the centers for Medicare and Medicaid services of
  6  4 the United States department of health and human services.
  6  5    c.  The department of human services shall enter into a
  6  6 contract with an independent auditor to perform an audit of a
  6  7 random sample of small dollar claims paid to or denied Medicaid
  6  8 long=term services and supports providers during the first
  6  9 quarter of the 2018 calendar year.  The department of human
  6 10 services shall submit a report of the findings of the audit to
  6 11 the governor and the general assembly by December 15, 2018.
  6 12 The department may take any action specified in the managed
  6 13 care contract relative to any claim the auditor determines to
  6 14 be incorrectly paid or denied, subject to appeal by the managed
  6 15 care organization to the director of human services.  For the
  6 16 purposes of this paragraph, "small dollar claims" means those
  6 17 claims less than or equal to two thousand five hundred dollars.
  6 18                          DIVISION III
  6 19               MEDICAID PROGRAM PHARMACY COPAYMENT
  6 20    Sec. 3.  2005 Iowa Acts, chapter 167, section 42, is amended
  6 21 to read as follows:
  6 22    SEC. 42.  COPAYMENTS FOR PRESCRIPTION DRUGS UNDER THE
  6 23 MEDICAL ASSISTANCE PROGRAM.  The department of human services
  6 24 shall require recipients of medical assistance to pay the
  6 25 following copayments a copayment of $1 on each prescription
  6 26 filled for a covered prescription drug, including each refill
  6 27 of such prescription, as follows:
  6 28    1.  A copayment of $1 on each prescription filled for each
  6 29 covered nonpreferred generic prescription drug.
  6 30    2.  A copayment of $1 for each covered preferred brand=name
  6 31 or generic prescription drug.
  6 32    3.  A copayment of $1 for each covered nonpreferred
  6 33 brand=name prescription drug for which the cost to the state is
  6 34 up to and including $25.
  6 35    4.  A copayment of $2 for each covered nonpreferred
  7  1 brand=name prescription drug for which the cost to the state is
  7  2 more than $25 and up to and including $50.
  7  3    5.  A copayment of $3 for each covered nonpreferred
  7  4 brand=name prescription drug for which the cost to the state
  7  5 is more than $50.
  7  6                           DIVISION IV
  7  7               MEDICAL ASSISTANCE ADVISORY COUNCIL
  7  8    Sec. 4.  Section 249A.4B, subsection 2, paragraph a,
  7  9 subparagraphs (27) and (28), Code 2018, are amended by striking
  7 10 the subparagraphs.
  7 11    Sec. 5.  MEDICAL ASSISTANCE ADVISORY COUNCIL ==== REVIEW OF
  7 12 MEDICAID MANAGED CARE REPORT DATA.  The executive committee
  7 13 of the medical assistance advisory council shall review
  7 14 the data collected and analyzed for inclusion in periodic
  7 15 reports to the general assembly, including but not limited
  7 16 to the information and data specified in 2016 Iowa Acts,
  7 17 chapter 1139, section 93, to determine which data points and
  7 18 information should be included and analyzed to more accurately
  7 19 identify trends and issues with, and promote the effective and
  7 20 efficient administration of, Medicaid managed care for all
  7 21 stakeholders.  At a minimum, the areas of focus shall include
  7 22 consumer protection, provider network access and safeguards,
  7 23 outcome achievement, and program integrity. The executive
  7 24 committee shall report its findings and recommendations to the
  7 25 medical assistance advisory council for review and comment by
  7 26 October 1, 2018, and shall submit a final report of findings
  7 27 and recommendations to the governor and the general assembly by
  7 28 December 31, 2018.
  7 29                           DIVISION V
  7 30  TARGETED CASE MANAGEMENT AND INPATIENT PSYCHIATRIC SERVICES
  7 31                          REIMBURSEMENT
  7 32    Sec. 6.  Section 249A.31, Code 2018, is amended to read as
  7 33 follows:
  7 34    249A.31  Cost=based reimbursement.
  7 35    1.  Providers of individual case management services for
  8  1 persons with an intellectual disability, a developmental
  8  2 disability, or chronic mental illness shall receive cost=based
  8  3 reimbursement for one hundred percent of the reasonable
  8  4 costs for the provision of the services in accordance with
  8  5 standards adopted by the mental health and disability services
  8  6 commission pursuant to section 225C.6.  Effective July 1, 2018,
  8  7 targeted case management services shall be reimbursed based
  8  8 on a statewide fee schedule amount developed by rule of the
  8  9 department pursuant to chapter 17A.
  8 10    2.  Effective July 1, 2010 2014, the department shall apply
  8 11 a cost=based reimbursement methodology for reimbursement of
  8 12 psychiatric medical institution for children providers of
  8 13 inpatient psychiatric services for individuals under twenty=one
  8 14 years of age shall be reimbursed as follows:
  8 15    a.  For non=state=owned providers, services shall be
  8 16 reimbursed according to a fee schedule without reconciliation.
  8 17    b.  For state=owned providers, services shall be reimbursed
  8 18 at one hundred percent of the actual and allowable cost of
  8 19 providing the service.
       HF 2483 (4) 87
       pf/rh/md