Text: HF2538
Text: HF2540
House File 2539
AN ACT
RELATING TO HEALTH CARE REFORM INCLUDING HEALTH CARE COVERAGE
INTENDED FOR CHILDREN AND ADULTS, HEALTH INFORMATION TECH-
NOLOGY, LONG-TERM LIVING PLANNING AND PATIENT AUTONOMY IN
HEALTH CARE, PREEXISTING CONDITIONS AND DEPENDENT CHILDREN
COVERAGE, MEDICAL HOMES, PREVENTION AND CHRONIC CARE MANAGE-
MENT, DISEASE PREVENTION AND WELLNESS INITIATIVES, HEALTH
CARE TRANSPARENCY, HEALTH CARE ACCESS, THE DIRECT CARE WORK-
FORCE, MAKING APPROPRIATIONS, AND INCLUDING EFFECTIVE DATE
AND APPLICABILITY PROVISIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
HEALTH CARE COVERAGE INTENT
Section 1. DECLARATION OF INTENT.
1. It is the intent of the general assembly to progress
toward achievement of the goal that all Iowans have health
care coverage with the following priorities:
a. The goal that all children in the state have health
care coverage which meets certain standards of quality and
affordability with the following priorities:
(1) Covering all children who are declared eligible for
the medical assistance program or the hawk=i program pursuant
to chapter 514I no later than January 1, 2011.
(2) Building upon the current hawk=i program by creating a
hawk=i expansion program to provide coverage to children who
meet the hawk=i program's eligibility criteria but whose
income is at or below three hundred percent of the federal
poverty level, beginning July 1, 2009.
(3) If federal reauthorization of the state children's
health insurance program provides sufficient federal
allocations to the state and authorization to cover such
children as an option under the state children's health
insurance program, requiring the department of human services
to expand coverage under the state children's health insurance
program to cover children with family incomes at or below
three hundred percent of the federal poverty level, with
appropriate cost sharing established for families with incomes
above two hundred percent of the federal poverty level.
b. The goal that the Iowa comprehensive health insurance
association, in consultation with the Iowa choice health care
coverage advisory council established in section 514E.6,
develop a comprehensive plan to first cover all children
without health care coverage that utilizes and modifies
existing public programs including the medical assistance
program, the hawk=i program, and the hawk=i expansion program,
and then to provide access to private unsubsidized,
affordable, qualified health care coverage for children,
adults, and families, who are not otherwise eligible for
health care coverage through public programs, that is
available for purchase by January 1, 2010.
c. The goal of decreasing health care costs and health
care coverage costs by instituting health insurance reforms
that assure the availability of private health insurance
coverage for Iowans by addressing issues involving guaranteed
availability and issuance to applicants, preexisting condition
exclusions, portability, and allowable or required pooling and
rating classifications.
DIVISION II
HAWK=I AND MEDICAID EXPANSION
Sec. 2. Section 249A.3, subsection 1, paragraph l, Code
Supplement 2007, is amended to read as follows:
l. Is an infant whose income is not more than two hundred
percent of the federal poverty level, as defined by the most
recently revised income guidelines published by the United
States department of health and human services. Additionally,
effective July 1, 2009, medical assistance shall be provided
to an infant whose family income is at or below three hundred
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, if
otherwise eligible.
Sec. 3. Section 249A.3, Code Supplement 2007, is amended
by adding the following new subsection:
NEW SUBSECTION. 14. Once initial eligibility for the
family medical assistance program=related medical assistance
is determined for a child described under subsection 1,
paragraphs "b", "f", "g", "j", "k", "l", or "n" or under
subsection 2, paragraphs "e", "f", or "h", the department
shall provide continuous eligibility for a period of up to
twelve months, until the child's next annual review of
eligibility under the medical assistance program, if the child
would otherwise be determined ineligible due to excess
countable income but otherwise remains eligible.
Sec. 4. NEW SECTION. 422.12K INCOME TAX FORM ==
INDICATION OF DEPENDENT CHILD HEALTH CARE COVERAGE.
1. The director shall draft the income tax form to allow
beginning with the tax returns for tax year 2008, a person who
files an individual or joint income tax return with the
department under section 422.13 to indicate the presence or
absence of health care coverage for each dependent child for
whom an exemption is claimed.
2. Beginning with the income tax return for tax year 2008,
a person who files an individual or joint income tax return
with the department under section 422.13, may report on the
income tax return, in the form required, the presence or
absence of health care coverage for each dependent child for
whom an exemption is claimed.
a. If the taxpayer indicates on the income tax return that
a dependent child does not have health care coverage, and the
income of the taxpayer's tax return does not exceed the
highest level of income eligibility standard for the medical
assistance program pursuant to chapter 249A or the hawk=i
program pursuant to chapter 514I, the department shall send a
notice to the taxpayer indicating that the dependent child may
be eligible for the medical assistance program or the hawk=i
program and providing information about how to enroll in the
programs.
b. Notwithstanding any other provision of law to the
contrary, a taxpayer shall not be subject to a penalty for not
providing the information required under this section.
c. The department shall consult with the department of
human services in developing the tax return form and the
information to be provided to tax filers under this section.
3. The department, in cooperation with the department of
human services, shall adopt rules pursuant to chapter 17A to
administer this section, including rules defining "health care
coverage" for the purpose of indicating its presence or
absence on the tax form.
4. The department, in cooperation with the department of
human services, shall report, annually, to the governor and
the general assembly all of the following:
a. The number of Iowa families, by income level, claiming
the state income tax exemption for dependent children.
b. The number of Iowa families, by income level, claiming
the state income tax exemption for dependent children who also
indicate the presence or absence of health care coverage for
the dependent children.
c. The effect of the reporting requirements and provision
of information requirements under this section on the number
and percentage of children in the state who are uninsured.
Sec. 5. Section 514I.1, subsection 4, Code 2007, is
amended to read as follows:
4. It is the intent of the general assembly that the
hawk=i program be an integral part of the continuum of health
insurance coverage and that the program be developed and
implemented in such a manner as to facilitate movement of
families between health insurance providers and to facilitate
the transition of families to private sector health insurance
coverage. It is the intent of the general assembly in
developing such continuum of health insurance coverage and in
facilitating such transition, that beginning July 1, 2009, the
department implement the hawk=i expansion program.
Sec. 6. Section 514I.1, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 5. It is the intent of the general
assembly that if federal reauthorization of the state
children's health insurance program provides sufficient
federal allocations to the state and authorization to cover
such children as an option under the state children's health
insurance program, the department shall expand coverage under
the state children's health insurance program to cover
children with family incomes at or below three hundred percent
of the federal poverty level.
Sec. 7. Section 514I.2, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 7A. "Hawk=i expansion program" or "hawk=i
expansion" means the healthy and well kids in Iowa expansion
program created in section 514I.12 to provide health insurance
to children who meet the hawk=i program eligibility criteria
pursuant to section 514I.8, with the exception of the family
income criteria, and whose family income is at or below three
hundred 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.
Sec. 8. Section 514I.5, subsection 7, paragraph d, Code
Supplement 2007, is amended to read as follows:
d. Develop, with the assistance of the department, an
outreach plan, and provide for periodic assessment of the
effectiveness of the outreach plan. The plan shall provide
outreach to families of children likely to be eligible for
assistance under the program, to inform them of the
availability of and to assist the families in enrolling
children in the program. The outreach efforts may include,
but are not limited to, solicitation of cooperation from
programs, agencies, and other persons who are likely to have
contact with eligible children, including but not limited to
those associated with the educational system, and the
development of community plans for outreach and marketing.
Other state agencies shall assist the department in data
collection related to outreach efforts to potentially eligible
children and their families.
Sec. 9. Section 514I.5, subsection 7, Code Supplement
2007, is amended by adding the following new paragraph:
NEW PARAGRAPH. l. Develop options and recommendations to
allow children eligible for the hawk=i or hawk=i expansion
program to participate in qualified employer=sponsored health
plans through a premium assistance program. The options and
recommendations shall ensure reasonable alignment between the
benefits and costs of the hawk=i and hawk=i expansion programs
and the employer=sponsored health plans consistent with
federal law. The options and recommendations shall be
completed by January 1, 2009, and submitted to the governor
and the general assembly for consideration as part of the
hawk=i and hawk=i expansion programs.
Sec. 10. Section 514I.7, subsection 2, paragraph a, Code
2007, is amended to read as follows:
a. Determine individual eligibility for program enrollment
based upon review of completed applications and supporting
documentation. The administrative contractor shall not enroll
a child who has group health coverage or any child who has
dropped coverage in the previous six months, unless the
coverage was involuntarily lost or unless the reason for
dropping coverage is allowed by rule of the board.
Sec. 11. Section 514I.8, subsection 1, Code 2007, is
amended to read as follows:
1. Effective July 1, 1998, and notwithstanding any medical
assistance program eligibility criteria to the contrary,
medical assistance shall be provided to, or on behalf of, an
eligible child under the age of nineteen whose family income
does not exceed one hundred thirty=three 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. Additionally,
effective July 1, 2000, and notwithstanding any medical
assistance program eligibility criteria to the contrary,
medical assistance shall be provided to, or on behalf of, an
eligible infant whose family income does not exceed two
hundred 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.
Effective July 1, 2009, and notwithstanding any medical
assistance program eligibility criteria to the contrary,
medical assistance shall be provided to, or on behalf of, an
eligible infant whose family income is at or below three
hundred 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.
Sec. 12. Section 514I.10, subsection 2, Code 2007, is
amended to read as follows:
2. Cost sharing for eligible children whose family income
equals or exceeds one hundred fifty percent but does not
exceed two hundred percent of the federal poverty level may
include a premium or copayment amount which does not exceed
five percent of the annual family income. The amount of any
premium or the copayment amount shall be based on family
income and size.
Sec. 13. Section 514I.11, subsections 1 and 3, Code 2007,
are amended to read as follows:
1. A hawk=i trust fund is created in the state treasury
under the authority of the department of human services, in
which all appropriations and other revenues of the program and
the hawk=i expansion program such as grants, contributions,
and participant payments shall be deposited and used for the
purposes of the program and the hawk=i expansion program. The
moneys in the fund shall not be considered revenue of the
state, but rather shall be funds of the program.
3. Moneys in the fund are appropriated to the department
and shall be used to offset any program and hawk=i expansion
program costs.
Sec. 14. NEW SECTION. 514I.12 HAWK=I EXPANSION PROGRAM.
1. All children less than nineteen years of age who meet
the hawk=i program eligibility criteria pursuant to section
514I.8, with the exception of the family income criteria, and
whose family income is at or below three hundred percent of
the federal poverty level, shall be eligible for the hawk=i
expansion program.
2. To the greatest extent possible, the provisions of
section 514I.4, relating to the director and department duties
and powers, section 514I.5 relating to the hawk=i board,
section 514I.6 relating to participating insurers, and section
514I.7 relating to the administrative contractor shall apply
to the hawk=i expansion program. The department shall adopt
any rules necessary, pursuant to chapter 17A, and shall amend
any existing contracts to facilitate the application of such
sections to the hawk=i expansion program.
3. The hawk=i board shall establish by rule pursuant to
chapter 17A, the cost=sharing amounts, criteria for
modification of the cost=sharing amounts, and graduated
premiums for children under the hawk=i expansion program.
Sec. 15. MAXIMIZATION OF ENROLLMENT AND RETENTION ==
MEDICAL ASSISTANCE AND HAWK=I PROGRAMS.
1. The department of human services, in collaboration with
the department of education, the department of public health,
the division of insurance of the department of commerce, the
hawk=i board, consumers who are not recipients of or advocacy
groups representing recipients of the medical assistance or
hawk-i program, the covering kids and families coalition, and
the covering kids now task force, shall develop a plan to
maximize enrollment and retention of eligible children in the
hawk=i and medical assistance programs. In developing the
plan, the collaborative shall review, at a minimum, all of the
following strategies:
a. Streamlined enrollment in the hawk=i and medical
assistance programs. The collaborative shall identify
information and documentation that may be shared across
departments and programs to simplify the determination of
eligibility or eligibility factors, and any interagency
agreements necessary to share information consistent with
state and federal confidentiality and other applicable
requirements.
b. Conditional eligibility for the hawk=i and medical
assistance programs.
c. Expedited renewal for the hawk=i and medical assistance
programs.
2. Following completion of the review the department of
human services shall compile the plan which shall address all
of the following relative to implementation of the strategies
specified in subsection 1:
a. Federal limitations and quantifying of the risk of
federal disallowance.
b. Any necessary amendment of state law or rule.
c. Budgetary implications and cost=benefit analyses.
d. Any medical assistance state plan amendments, waivers,
or other federal approval necessary.
e. An implementation time frame.
3. The department of human services shall submit the plan
to the governor and the general assembly no later than
December 1, 2008.
Sec. 16. MEDICAL ASSISTANCE, HAWK=I, AND HAWK=I EXPANSION
PROGRAMS == COVERING CHILDREN == APPROPRIATION. There is
appropriated from the general fund of the state to the
department of human services for the designated fiscal years,
the following amounts, or so much thereof as is necessary, for
the purpose designated:
To cover children as provided in this Act under the medical
assistance, hawk=i, and hawk=i expansion programs and outreach
under the current structure of the programs:
FY 2008=2009 ..................................... $ 4,800,000
FY 2009=2010 ..................................... $ 14,800,000
FY 2010=2011 ..................................... $ 24,800,000
DIVISION III
IOWA CHOICE HEALTH CARE COVERAGE
AND ADVISORY COUNCIL
Sec. 17. Section 514E.1, Code 2007, is amended by adding
the following new subsections:
NEW SUBSECTION. 14A. "Iowa choice health care coverage
advisory council" or "advisory council" means the advisory
council created in section 514E.6.
NEW SUBSECTION. 21. "Qualified health care coverage"
means creditable coverage which meets minimum standards of
quality and affordability as determined by the association by
rule.
Sec. 18. Section 514E.2, subsection 3, unnumbered
paragraph 1, Code 2007, is amended to read as follows:
The association shall submit to the commissioner a plan of
operation for the association and any amendments necessary or
suitable to assure the fair, reasonable, and equitable
administration of the association. The plan of operation
shall include provisions for the development of a
comprehensive health care coverage plan as provided in section
514E.5. In developing the comprehensive plan the association
shall give deference to the recommendations made by the
advisory council as provided in section 514E.6, subsection 1.
The association shall approve or disapprove but shall not
modify recommendations made by the advisory council.
Recommendations that are approved shall be included in the
plan of operation submitted to the commissioner.
Recommendations that are disapproved shall be submitted to the
commissioner with reasons for the disapproval. The plan of
operation becomes effective upon approval in writing by the
commissioner prior to the date on which the coverage under
this chapter must be made available. After notice and
hearing, the commissioner shall approve the plan of operation
if the plan is determined to be suitable to assure the fair,
reasonable, and equitable administration of the association,
and provides for the sharing of association losses, if any, on
an equitable and proportionate basis among the member
carriers. If the association fails to submit a suitable plan
of operation within one hundred eighty days after the
appointment of the board of directors, or if at any later time
the association fails to submit suitable amendments to the
plan, the commissioner shall adopt, pursuant to chapter 17A,
rules necessary to implement this section. The rules shall
continue in force until modified by the commissioner or
superseded by a plan submitted by the association and approved
by the commissioner. In addition to other requirements, the
plan of operation shall provide for all of the following:
Sec. 19. NEW SECTION. 514E.5 IOWA CHOICE HEALTH CARE
COVERAGE.
1. The association, in consultation with the Iowa choice
health care coverage advisory council, shall develop a
comprehensive health care coverage plan to provide health care
coverage to all children without such coverage, that utilizes
and modifies existing public programs including the medical
assistance program, hawk=i program, and hawk=i expansion
program, and to provide access to private unsubsidized,
affordable, qualified health care coverage to children who are
not otherwise eligible for health care coverage through public
programs.
2. The comprehensive plan developed by the association and
the advisory council, shall also consider and recommend
options to provide access to private unsubsidized, affordable,
qualified health care coverage to all Iowa children less than
nineteen years of age with a family income that is more than
three hundred percent of the federal poverty level and to
adults and families who are not otherwise eligible for health
care coverage through public programs.
3. As part of the comprehensive plan developed, the
association, in consultation with the advisory council, shall
define what constitutes qualified health care coverage for
children less than nineteen years of age. For the purposes of
this definition and for designing health care coverage options
for children, the association, in consultation with the
advisory council, shall recommend the benefits to be included
in such coverage and shall explore the value of including
coverage for the treatment of mental and behavioral disorders.
The association and the advisory council shall perform a cost
analysis as part of their consideration of benefit options.
The association and the advisory council shall also consider
whether to include coverage of the following benefits:
a. Inpatient hospital services including medical,
surgical, intensive care unit, mental health, and substance
abuse services.
b. Nursing care services including skilled nursing
facility services.
c. Outpatient hospital services including emergency room,
surgery, lab, and x=ray services and other services.
d. Physician services, including surgical and medical,
office visits, newborn care, well=baby and well=child care,
immunizations, urgent care, specialist care, allergy testing
and treatment, mental health visits, and substance abuse
visits.
e. Ambulance services.
f. Physical therapy.
g. Speech therapy.
h. Durable medical equipment.
i. Home health care.
j. Hospice services.
k. Prescription drugs.
l. Dental services including preventive services.
m. Medically necessary hearing services.
n. Vision services including corrective lenses.
o. No underwriting requirements and no preexisting
condition exclusions.
p. Chiropractic services.
4. As part of the comprehensive plan developed, the
association, in consultation with the advisory council, shall
consider and recommend affordable health care coverage options
for purchase for children less than nineteen years of age with
a family income that is more than three hundred percent of the
federal poverty level, with the goal of including health care
coverage options for which the contribution requirement for
all cost=sharing expenses is no more than two percent of
family income per each child covered, up to a maximum of six
and one=half percent of family income per family. The
association, in consultation with the advisory council, shall
also consider and recommend whether such health care coverage
options should require a copayment for services received in an
amount determined by the association.
5. As part of the comprehensive plan, the association, in
consultation with the advisory council, shall define what
constitutes qualified health care coverage for adults and
families who are not eligible for a public program. The
association, in consultation with the advisory council, shall
develop and recommend affordable health care coverage options
for purchase by such adults and families that provide a
selection of health benefit plans and standardized benefits
with the goal of including health care coverage options for
which the contribution requirement for all cost=sharing
expenses is no more than six and one=half percent of family
income.
6. As part of the comprehensive plan the association and
the advisory council may collaborate with health insurance
carriers to do the following, including but not limited to:
a. Design solutions to issues relating to guaranteed
issuance of insurance, preexisting condition exclusions,
portability, and allowable pooling and rating classifications.
b. Formulate principles that ensure fair and appropriate
practices relating to issues involving individual health care
policies such as recision and preexisting condition clauses,
and that provide for a binding third=party review process to
resolve disputes related to such issues.
c. Design affordable, portable health care coverage
options for low=income children, adults, and families.
d. Design a proposed premium schedule for health care
coverage options that are recommended which includes the
development of rating factors that are consistent with market
conditions.
e. Design protocols to limit the transfer from
employer=sponsored or other private health care coverage to
state=developed health care coverage plans.
7. The association shall submit the comprehensive plan
required by this section to the governor and the general
assembly by December 15, 2008. The appropriations to cover
children under the medical assistance, hawk=i, and hawk=i
expansion programs as provided in this Act and to provide
related outreach for fiscal year 2009=2010 and fiscal year
2010=2011 are contingent upon enactment of a comprehensive
plan during the 2009 regular session of the Eighty=third
General Assembly that provides health care coverage for all
children in the state. Enactment of a comprehensive plan
shall include a determination of what the prospects are of
federal action which may impact the comprehensive plan and the
fiscal impact of the comprehensive plan on the state budget.
Sec. 20. NEW SECTION. 514E.6 IOWA CHOICE HEALTH CARE
COVERAGE ADVISORY COUNCIL.
1. The Iowa choice health care coverage advisory council
is created for the purpose of assisting the association with
developing a comprehensive health care coverage plan as
provided in section 514E.5. The advisory council shall make
recommendations concerning the design and implementation of
the comprehensive plan including but not limited to a
definition of what constitutes qualified health care coverage,
suggestions for the design of health care coverage options,
and implementation of a health care coverage reporting
requirement.
2. The advisory council consists of the following persons
who are voting members unless otherwise provided:
a. The two most recent former governors, or if one or both
of them are unable or unwilling to serve, a person or persons
appointed by the governor.
b. Seven members appointed by the director of public
health:
(1) A representative of the federation of Iowa insurers.
(2) A health economist who resides in Iowa.
(3) Two consumers, one of whom shall be a representative
of a children's advocacy organization and one of whom shall be
a member of a minority.
(4) A representative of organized labor.
(5) A representative of an organization of employers.
(6) A representative of the Iowa association of health
underwriters.
c. The following members shall be ex officio, nonvoting
members of the council:
(1) The commissioner of insurance, or a designee.
(2) The director of human services, or a designee.
(3) The director of public health, or a designee.
(4) Four members of the general assembly, one appointed by
the speaker of the house of representatives, one appointed by
the minority leader of the house of representatives, one
appointed by the majority leader of the senate, and one
appointed by the minority leader of the senate.
3. The members of the council appointed by the director of
public health shall be appointed for terms of six years
beginning and ending as provided in section 69.19. Such a
member of the board is eligible for reappointment. The
director shall fill a vacancy for the remainder of the
unexpired term.
4. The members of the council shall annually elect one
voting member as chairperson and one as vice chairperson.
Meetings of the council shall be held at the call of the
chairperson or at the request of a majority of the council's
members.
5. The members of the council shall not receive
compensation for the performance of their duties as members
but each member shall be paid necessary expenses while engaged
in the performance of duties of the council. Any legislative
member shall be paid the per diem and expenses specified in
section 2.10.
6. The members of the council are subject to and are
officials within the meaning of chapter 68B.
DIVISION IV
HEALTH INSURANCE OVERSIGHT
Sec. 21. Section 505.8, Code Supplement 2007, is amended
by adding the following new subsection:
NEW SUBSECTION. 5A. The commissioner shall have
regulatory authority over health benefit plans and adopt rules
under chapter 17A as necessary, to promote the uniformity,
cost efficiency, transparency, and fairness of such plans for
physicians licensed under chapters 148, 150, and 150A, and
hospitals licensed under chapter 135B, for the purpose of
maximizing administrative efficiencies and minimizing
administrative costs of health care providers and health
insurers.
Sec. 22. HEALTH INSURANCE OVERSIGHT == APPROPRIATION.
There is appropriated from the general fund of the state to
the insurance division of the department of commerce for the
fiscal year beginning July 1, 2008, and ending June 30, 2009,
the following amount, or so much thereof as is necessary, for
the purpose designated:
For identification and regulation of procedures and
practices related to health care as provided in section 505.8,
subsection 5A:
.................................................. $ 80,000
DIVISION V
IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
DIVISION XXI
IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
Sec. 23. NEW SECTION. 135.154 DEFINITIONS.
As used in this division, unless the context otherwise
requires:
1. "Board" means the state board of health created
pursuant to section 136.1.
2. "Department" means the department of public health.
3. "Health care professional" means a person who is
licensed, certified, or otherwise authorized or permitted by
the law of this state to administer health care in the
ordinary course of business or in the practice of a
profession.
4. "Health information technology" means the application
of information processing, involving both computer hardware
and software, that deals with the storage, retrieval, sharing,
and use of health care information, data, and knowledge for
communication, decision making, quality, safety, and
efficiency of clinical practice, and may include but is not
limited to:
a. An electronic health record that electronically
compiles and maintains health information that may be derived
from multiple sources about the health status of an individual
and may include a core subset of each care delivery
organization's electronic medical record such as a continuity
of care record or a continuity of care document, computerized
physician order entry, electronic prescribing, or clinical
decision support.
b. A personal health record through which an individual
and any other person authorized by the individual can maintain
and manage the individual's health information.
c. An electronic medical record that is used by health
care professionals to electronically document, monitor, and
manage health care delivery within a care delivery
organization, is the legal record of the patient's encounter
with the care delivery organization, and is owned by the care
delivery organization.
d. A computerized provider order entry function that
permits the electronic ordering of diagnostic and treatment
services, including prescription drugs.
e. A decision support function to assist physicians and
other health care providers in making clinical decisions by
providing electronic alerts and reminders to improve
compliance with best practices, promote regular screenings and
other preventive practices, and facilitate diagnoses and
treatments.
f. Tools to allow for the collection, analysis, and
reporting of information or data on adverse events, the
quality and efficiency of care, patient satisfaction, and
other health care=related performance measures.
5. "Interoperability" means the ability of two or more
systems or components to exchange information or data in an
accurate, effective, secure, and consistent manner and to use
the information or data that has been exchanged and includes
but is not limited to:
a. The capacity to connect to a network for the purpose of
exchanging information or data with other users.
b. The ability of a connected, authenticated user to
demonstrate appropriate permissions to participate in the
instant transaction over the network.
c. The capacity of a connected, authenticated user to
access, transmit, receive, and exchange usable information
with other users.
6. "Recognized interoperability standard" means
interoperability standards recognized by the office of the
national coordinator for health information technology of the
United States department of health and human services.
Sec. 24. NEW SECTION. 135.155 IOWA ELECTRONIC HEALTH ==
PRINCIPLES == GOALS.
1. Health information technology is rapidly evolving so
that it can contribute to the goals of improving access to and
quality of health care, enhancing efficiency, and reducing
costs.
2. To be effective, the health information technology
system shall comply with all of the following principles:
a. Be patient=centered and market=driven.
b. Be based on approved standards developed with input
from all stakeholders.
c. Protect the privacy of consumers and the security and
confidentiality of all health information.
d. Promote interoperability.
e. Ensure the accuracy, completeness, and uniformity of
data.
3. Widespread adoption of health information technology is
critical to a successful health information technology system
and is best achieved when all of the following occur:
a. The market provides a variety of certified products
from which to choose in order to best fit the needs of the
user.
b. The system provides incentives for health care
professionals to utilize the health information technology and
provides rewards for any improvement in quality and efficiency
resulting from such utilization.
c. The system provides protocols to address critical
problems.
d. The system is financed by all who benefit from the
improved quality, efficiency, savings, and other benefits that
result from use of health information technology.
Sec. 25. NEW SECTION. 135.156 ELECTRONIC HEALTH
INFORMATION == DEPARTMENT DUTIES == ADVISORY COUNCIL ==
EXECUTIVE COMMITTEE.
1. a. The department shall direct a public and private
collaborative effort to promote the adoption and use of health
information technology in this state in order to improve
health care quality, increase patient safety, reduce health
care costs, enhance public health, and empower individuals and
health care professionals with comprehensive, real=time
medical information to provide continuity of care and make the
best health care decisions. The department shall provide
coordination for the development and implementation of an
interoperable electronic health records system, telehealth
expansion efforts, the health information technology
infrastructure, and other health information technology
initiatives in this state. The department shall be guided by
the principles and goals specified in section 135.155.
b. All health information technology efforts shall
endeavor to represent the interests and meet the needs of
consumers and the health care sector, protect the privacy of
individuals and the confidentiality of individuals'
information, promote physician best practices, and make
information easily accessible to the appropriate parties. The
system developed shall be consumer=driven, flexible, and
expandable.
2. a. An electronic health information advisory council
is established which shall consist of the representatives of
entities involved in the electronic health records system task
force established pursuant to section 217.41A, Code 2007, a
pharmacist, a licensed practicing physician, a consumer who is
a member of the state board of health, a representative of the
state's Medicare quality improvement organization, the
executive director of the Iowa communications network, a
representative of the private telecommunications industry, a
representative of the Iowa collaborative safety net provider
network created in section 135.153, a nurse informaticist from
the university of Iowa, and any other members the department
or executive committee of the advisory council determines
necessary and appoints to assist the department or executive
committee at various stages of development of the electronic
health information system. Executive branch agencies shall
also be included as necessary to assist in the duties of the
department and the executive committee. Public members of the
advisory council shall receive reimbursement for actual
expenses incurred while serving in their official capacity
only if they are not eligible for reimbursement by the
organization that they represent. Any legislative members
shall be paid the per diem and expenses specified in section
2.10.
b. An executive committee of the electronic health
information advisory council is established. Members of the
executive committee of the advisory council shall receive
reimbursement for actual expenses incurred while serving in
their official capacity only if they are not eligible for
reimbursement by the organization that they represent. The
executive committee shall consist of the following members:
(1) Three members, each of whom is the chief information
officer of one of the three largest private health care
systems in the state.
(2) One member who is the chief information officer of the
university of Iowa hospitals and clinics, or the chief
information officer's designee, selected by the director of
the university of Iowa hospitals and clinics.
(3) One member who is a representative of a rural hospital
who is a member of the Iowa hospital association, selected by
the Iowa hospital association.
(4) One member who is a consumer member of the state board
of health, selected by the state board of health.
(5) One member who is a licensed practicing physician,
selected by the Iowa medical society.
(6) One member who is licensed to practice nursing,
selected by the Iowa nurses association.
(7) One representative of an insurance carrier selected by
the federation of Iowa insurers.
3. The executive committee, with the technical assistance
of the advisory council and the support of the department
shall do all of the following:
a. Develop a statewide health information technology plan
by July 1, 2009. In developing the plan, the executive
committee shall seek the input of providers, payers, and
consumers. Standards and policies developed for the plan
shall promote and be consistent with national standards
developed by the office of the national coordinator for health
information technology of the United States department of
health and human services and shall address or provide for all
of the following:
(1) The effective, efficient, statewide use of electronic
health information in patient care, health care policymaking,
clinical research, health care financing, and continuous
quality improvement. The executive committee shall recommend
requirements for interoperable electronic health records in
this state including a recognized interoperability standard.
(2) Education of the public and health care sector about
the value of health information technology in improving
patient care, and methods to promote increased support and
collaboration of state and local public health agencies,
health care professionals, and consumers in health information
technology initiatives.
(3) Standards for the exchange of health care information.
(4) Policies relating to the protection of privacy of
patients and the security and confidentiality of patient
information.
(5) Policies relating to information ownership.
(6) Policies relating to governance of the various facets
of the health information technology system.
(7) A single patient identifier or alternative mechanism
to share secure patient information. If no alternative
mechanism is acceptable to the executive committee, all health
care professionals shall utilize the mechanism selected by the
executive committee by July 1, 2010.
(8) A standard continuity of care record and other issues
related to the content of electronic transmissions. All
health care professionals shall utilize the standard
continuity of care record by July 1, 2010.
(9) Requirements for electronic prescribing.
(10) Economic incentives and support to facilitate
participation in an interoperable system by health care
professionals.
b. Identify existing and potential health information
technology efforts in this state, regionally, and nationally,
and integrate existing efforts to avoid incompatibility
between efforts and avoid duplication.
c. Coordinate public and private efforts to provide the
network backbone infrastructure for the health information
technology system. In coordinating these efforts, the
executive committee shall do all of the following:
(1) Develop policies to effectuate the logical
cost=effective usage of and access to the state=owned network,
and support of telecommunication carrier products, where
applicable.
(2) Consult with the Iowa communications network, private
fiberoptic networks, and any other communications entity to
seek collaboration, avoid duplication, and leverage
opportunities in developing a network backbone.
(3) Establish protocols to ensure compliance with any
applicable federal standards.
(4) Determine costs for accessing the network at a level
that provides sufficient funding for the network.
d. Promote the use of telemedicine.
(1) Examine existing barriers to the use of telemedicine
and make recommendations for eliminating these barriers.
(2) Examine the most efficient and effective systems of
technology for use and make recommendations based on the
findings.
e. Address the workforce needs generated by increased use
of health information technology.
f. Recommend rules to be adopted in accordance with
chapter 17A to implement all aspects of the statewide health
information technology plan and the network.
g. Coordinate, monitor, and evaluate the adoption, use,
interoperability, and efficiencies of the various facets of
health information technology in this state.
h. Seek and apply for any federal or private funding to
assist in the implementation and support of the health
information technology system and make recommendations for
funding mechanisms for the ongoing development and maintenance
costs of the health information technology system.
i. Identify state laws and rules that present barriers to
the development of the health information technology system
and recommend any changes to the governor and the general
assembly.
4. Recommendations and other activities resulting from the
work of the department or the executive committee shall be
presented to the board for action or implementation.
Sec. 26. Section 8D.13, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 20. Access shall be offered to the Iowa
hospital association only for the purposes of collection,
maintenance, and dissemination of health and financial data
for hospitals and for hospital education services. The Iowa
hospital association shall be responsible for all costs
associated with becoming part of the network, as determined by
the commission.
Sec. 27. Section 136.3, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 11. Perform those duties authorized
pursuant to section 135.156.
Sec. 28. Section 217.41A, Code 2007, is repealed.
Sec. 29. IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM ==
APPROPRIATION. There is appropriated from the general fund of
the state to the department of public health for the fiscal
year beginning July 1, 2008, and ending June 30, 2009, the
following amount, or so much thereof as is necessary, for the
purpose designated:
For administration of the Iowa health information
technology system, and for not more than the following
full=time equivalent positions:
.................................................. $ 190,600
............................................... FTEs 2.00
DIVISION VI
LONG=TERM LIVING PLANNING AND
PATIENT AUTONOMY IN HEALTH CARE
Sec. 30. NEW SECTION. 231.62 END=OF=LIFE CARE
INFORMATION.
1. The department shall consult with the Iowa medical
society, the Iowa end=of=life coalition, the Iowa hospice
organization, the university of Iowa palliative care program,
and other health care professionals whose scope of practice
includes end=of=life care to develop educational and
patient=centered information on end=of=life care for
terminally ill patients and health care professionals.
2. For the purposes of this section, "end=of=life care"
means care provided to meet the physical, psychological,
social, spiritual, and practical needs of terminally ill
patients and their caregivers.
Sec. 31. END=OF=LIFE CARE INFORMATION == APPROPRIATION.
There is appropriated from the general fund of the state to
the department of elder affairs for the fiscal year beginning
July 1, 2008, and ending June 30, 2009, the following amount,
or so much thereof as is necessary, for the purpose
designated:
For activities associated with the end=of=life care
information requirements of this division:
.................................................. $ 10,000
Sec. 32. LONG=TERM LIVING PLANNING TOOLS == PUBLIC
EDUCATION CAMPAIGN. The legal services development and
substitute decision maker programs of the department of elder
affairs, in collaboration with other appropriate agencies and
interested parties, shall research existing long=term living
planning tools that are designed to increase quality of life
and contain health care costs and recommend a public education
campaign strategy on long=term living to the general assembly
by January 1, 2009.
Sec. 33. LONG=TERM CARE OPTIONS PUBLIC EDUCATION CAMPAIGN.
The department of elder affairs, in collaboration with the
insurance division of the department of commerce, shall
implement a long=term care options public education campaign.
The campaign may utilize such tools as the "Own Your Future
Planning Kit" administered by the centers for Medicare and
Medicaid services, the administration on aging, and the office
of the assistant secretary for planning and evaluation of the
United States department of health and human services, and
other tools developed through the aging and disability
resource center program of the administration on aging and the
centers for Medicare and Medicaid services designed to promote
health and independence as Iowans age, assist older Iowans in
making informed choices about the availability of long=term
care options, including alternatives to facility=based care,
and to streamline access to long=term care.
Sec. 34. LONG=TERM CARE OPTIONS PUBLIC EDUCATION CAMPAIGN
== APPROPRIATION. There is appropriated from the general fund
of the state to the department of elder affairs for the fiscal
year beginning July 1, 2008, and ending June 30, 2009, the
following amount, or so much thereof as is necessary, for the
purpose designated:
For activities associated with the long=term care options
public education campaign requirements of this division:
.................................................. $ 75,000
Sec. 35. HOME AND COMMUNITY=BASED SERVICES PUBLIC
EDUCATION CAMPAIGN. The department of elder affairs shall
work with other public and private agencies to identify
resources that may be used to continue the work of the aging
and disability resource center established by the department
through the aging and disability resource center grant program
efforts of the administration on aging and the centers for
Medicare and Medicaid services of the United States department
of health and human services, beyond the federal grant period
ending September 30, 2008.
Sec. 36. PATIENT AUTONOMY IN HEALTH CARE DECISIONS PILOT
PROJECT.
1. The department of public health shall establish a
two=year community coalition for patient treatment wishes
across the health care continuum pilot project, beginning July
1, 2008, and ending June 30, 2010, in a county with a
population of between fifty thousand and one hundred thousand.
The pilot project shall utilize the process based upon the
national physicians orders for life sustaining treatment
program initiative, including use of a standardized physician
order for scope of treatment form. The process shall require
validation of the physician order for scope of treatment form
by the signature of an individual other than the patient or
the patient's legal representative who is not an employee of
the patient's physician. The pilot project may include
applicability to chronically ill, frail, and elderly or
terminally ill individuals in hospitals licensed pursuant to
chapter 135B, nursing facilities or residential care
facilities licensed pursuant to chapter 135C, or hospice
programs as defined in section 135J.1.
2. The department of public health shall convene an
advisory council, consisting of representatives of entities
with interest in the pilot project, including but not limited
to the Iowa hospital association, the Iowa medical society,
organizations representing health care facilities,
representatives of health care providers, and the Iowa trial
lawyers association, to develop recommendations for expanding
the pilot project statewide. The advisory council shall
report its findings and recommendations, including
recommendations for legislation, to the governor and the
general assembly by January 1, 2010.
3. The pilot project shall not alter the rights of
individuals who do not execute a physician order for scope of
treatment.
a. If an individual is a qualified patient as defined in
section 144A.2, the individual's declaration executed under
chapter 144A shall control health care decision making for the
individual in accordance with chapter 144A. A physician order
for scope of treatment shall not supersede a declaration
executed pursuant to chapter 144A. If an individual has not
executed a declaration pursuant to chapter 144A, health care
decision making relating to life=sustaining procedures for the
individual shall be governed by section 144A.7.
b. If an individual has executed a durable power of
attorney for health care pursuant to chapter 144B, the
individual's durable power of attorney for health care shall
control health care decision making for the individual in
accordance with chapter 144B. A physician order for scope of
treatment shall not supersede a durable power of attorney for
health care executed pursuant to chapter 144B.
c. In the absence of actual notice of the revocation of a
physician order for scope of treatment, a physician, health
care provider, or any other person who complies with a
physician order for scope of treatment shall not be subject to
liability, civil or criminal, for actions taken under this
section which are in accordance with reasonable medical
standards. Any physician, health care provider, or other
person against whom criminal or civil liability is asserted
because of conduct in compliance with this section may
interpose the restriction on liability in this paragraph as an
absolute defense.
DIVISION VII
HEALTH CARE COVERAGE
Sec. 37. NEW SECTION. 505.31 REIMBURSEMENT ACCOUNTS.
The commissioner of insurance shall assist employers with
twenty=five or fewer employees with implementing and
administering plans under section 125 of the Internal Revenue
Code, including medical expense reimbursement accounts and
dependent care accounts. The commissioner shall provide
information about the assistance available to small employers
on the insurance division's internet site.
Sec. 38. Section 509.3, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 8. A provision that the insurer will
permit continuation of existing coverage for an unmarried
child of an insured or enrollee who so elects, at least
through the policy anniversary date on or after the date the
child marries, ceases to be a resident of this state, or
attains the age of twenty=five years old, whichever occurs
first, or so long as the unmarried child maintains full=time
status as a student in an accredited institution of
postsecondary education.
Sec. 39. NEW SECTION. 509A.13B CONTINUATION OF DEPENDENT
COVERAGE.
If a governing body, a county board of supervisors, or a
city council has procured accident or health care coverage for
its employees under this chapter such coverage shall permit
continuation of existing coverage for an unmarried child of an
insured or enrollee who so elects, at least through the policy
anniversary date on or after the date the child marries,
ceases to be a resident of this state, or attains the age of
twenty=five years old, whichever occurs first, or so long as
the unmarried child maintains full=time status as a student in
an accredited institution of postsecondary education.
Sec. 40. Section 513C.7, subsection 2, paragraph a, Code
2007, is amended to read as follows:
a. The individual basic or standard health benefit plan
shall not deny, exclude, or limit benefits for a covered
individual for losses incurred more than twelve months
following the effective date of the individual's coverage due
to a preexisting condition. A preexisting condition shall not
be defined more restrictively than any of the following:
(1) a. A condition that would cause an ordinarily prudent
person to seek medical advice, diagnosis, care, or treatment
during the twelve months immediately preceding the effective
date of coverage.
(2) b. A condition for which medical advice, diagnosis,
care, or treatment was recommended or received during the
twelve months immediately preceding the effective date of
coverage.
(3) c. A pregnancy existing on the effective date of
coverage.
Sec. 41. Section 513C.7, subsection 2, paragraph b, Code
2007, is amended by striking the paragraph.
Sec. 42. NEW SECTION. 514A.3B ADDITIONAL REQUIREMENTS.
1. An insurer which accepts an individual for coverage
under an individual policy or contract of accident and health
insurance shall waive any time period applicable to a
preexisting condition exclusion or limitation period
requirement of the policy or contract with respect to
particular services in an individual health benefit plan for
the period of time the individual was previously covered by
qualifying previous coverage as defined in section 513C.3 that
provided benefits with respect to such services, provided that
the qualifying previous coverage was continuous to a date not
more than sixty=three days prior to the effective date of the
new policy or contract. Any days of coverage provided to an
individual pursuant to chapter 249A or 514I, or Medicare
coverage provided pursuant to Title XVIII of the federal
Social Security Act, do not constitute qualifying previous
coverage. Such days of chapter 249A or 514I or Medicare
coverage shall be counted as part of the maximum
sixty=three=day grace period and shall not constitute a basis
for the waiver of any preexisting condition exclusion or
limitation period.
2. An insurer issuing an individual policy or contract of
accident and health insurance which provides coverage for
children of the insured shall permit continuation of existing
coverage for an unmarried child of an insured or enrollee who
so elects, at least through the policy anniversary date on or
after the date the child marries, ceases to be a resident of
this state, or attains the age of twenty=five years old,
whichever occurs first, or so long as the unmarried child
maintains full=time status as a student in an accredited
institution of postsecondary education.
Sec. 43. APPLICABILITY. This division of this Act applies
to policies or contracts of accident and health insurance
delivered or issued for delivery or continued or renewed in
this state on or after July 1, 2008.
DIVISION VIII
MEDICAL HOME
DIVISION XXII
MEDICAL HOME
Sec. 44. NEW SECTION. 135.157 DEFINITIONS.
As used in this chapter, unless the context otherwise
requires:
1. "Board" means the state board of health created
pursuant to section 136.1.
2. "Department" means the department of public health.
3. "Health care professional" means a person who is
licensed, certified, or otherwise authorized or permitted by
the law of this state to administer health care in the
ordinary course of business or in the practice of a
profession.
4. "Medical home" means a team approach to providing
health care that originates in a primary care setting; fosters
a partnership among the patient, the personal provider, and
other health care professionals, and where appropriate, the
patient's family; utilizes the partnership to access all
medical and nonmedical health=related services needed by the
patient and the patient's family to achieve maximum health
potential; maintains a centralized, comprehensive record of
all health=related services to promote continuity of care; and
has all of the characteristics specified in section 135.158.
5. "National committee for quality assurance" means the
nationally recognized, independent nonprofit organization that
measures the quality and performance of health care and health
care plans in the United States; provides accreditation,
certification, and recognition programs for health care plans
and programs; and is recognized in Iowa as an accrediting
organization for commercial and Medicaid=managed care
organizations.
6. "Personal provider" means the patient's first point of
contact in the health care system with a primary care provider
who identifies the patient's health needs, and, working with a
team of health care professionals, provides for and
coordinates appropriate care to address the health needs
identified.
7. "Primary care" means health care which emphasizes
providing for a patient's general health needs and utilizes
collaboration with other health care professionals and
consultation or referral as appropriate to meet the needs
identified.
8. "Primary care provider" means any of the following who
provide primary care and meet certification standards:
a. A physician who is a family or general practitioner, a
pediatrician, an internist, an obstetrician, or a
gynecologist.
b. An advanced registered nurse practitioner.
c. A physician assistant.
d. A chiropractor licensed pursuant to chapter 151.
Sec. 45. NEW SECTION. 135.158 MEDICAL HOME PURPOSES ==
CHARACTERISTICS.
1. The purposes of a medical home are the following:
a. To reduce disparities in health care access, delivery,
and health care outcomes.
b. To improve quality of health care and lower health care
costs, thereby creating savings to allow more Iowans to have
health care coverage and to provide for the sustainability of
the health care system.
c. To provide a tangible method to document if each Iowan
has access to health care.
2. A medical home has all of the following
characteristics:
a. A personal provider. Each patient has an ongoing
relationship with a personal provider trained to provide first
contact and continuous and comprehensive care.
b. A provider=directed medical practice. The personal
provider leads a team of individuals at the practice level who
collectively take responsibility for the ongoing health care
of patients.
c. Whole person orientation. The personal provider is
responsible for providing for all of a patient's health care
needs or taking responsibility for appropriately arranging
health care by other qualified health care professionals.
This responsibility includes health care at all stages of life
including provision of acute care, chronic care, preventive
services, and end=of=life care.
d. Coordination and integration of care. Care is
coordinated and integrated across all elements of the complex
health care system and the patient's community. Care is
facilitated by registries, information technology, health
information exchanges, and other means to assure that patients
receive the indicated care when and where they need and want
the care in a culturally and linguistically appropriate
manner.
e. Quality and safety. The following are quality and
safety components of the medical home:
(1) Provider=directed medical practices advocate for their
patients to support the attainment of optimal,
patient=centered outcomes that are defined by a care planning
process driven by a compassionate, robust partnership between
providers, the patient, and the patient's family.
(2) Evidence=based medicine and clinical decision=support
tools guide decision making.
(3) Providers in the medical practice accept
accountability for continuous quality improvement through
voluntary engagement in performance measurement and
improvement.
(4) Patients actively participate in decision making and
feedback is sought to ensure that the patients' expectations
are being met.
(5) Information technology is utilized appropriately to
support optimal patient care, performance measurement, patient
education, and enhanced communication.
(6) Practices participate in a voluntary recognition
process conducted by an appropriate nongovernmental entity to
demonstrate that the practice has the capabilities to provide
patient=centered services consistent with the medical home
model.
(7) Patients and families participate in quality
improvement activities at the practice level.
f. Enhanced access to health care. Enhanced access to
health care is available through systems such as open
scheduling, expanded hours, and new options for communication
between the patient, the patient's personal provider, and
practice staff.
g. Payment. The payment system appropriately recognizes
the added value provided to patients who have a
patient=centered medical home. The payment structure
framework of the medical home provides all of the following:
(1) Reflects the value of provider and nonprovider staff
and patient=centered care management work that is in addition
to the face=to=face visit.
(2) Pays for services associated with coordination of
health care both within a given practice and between
consultants, ancillary providers, and community resources.
(3) Supports adoption and use of health information
technology for quality improvement.
(4) Supports provision of enhanced communication access
such as secure electronic mail and telephone consultation.
(5) Recognizes the value of provider work associated with
remote monitoring of clinical data using technology.
(6) Allows for separate fee=for=service payments for
face=to=face visits. Payments for health care management
services that are in addition to the face=to=face visit do not
result in a reduction in the payments for face=to=face visits.
(7) Recognizes case mix differences in the patient
population being treated within the practice.
(8) Allows providers to share in savings from reduced
hospitalizations associated with provider=guided health care
management in the office setting.
(9) Allows for additional payments for achieving
measurable and continuous quality improvements.
Sec. 46. NEW SECTION. 135.159 MEDICAL HOME SYSTEM ==
ADVISORY COUNCIL == DEVELOPMENT AND IMPLEMENTATION.
1. The department shall administer the medical home
system. The department shall adopt rules pursuant to chapter
17A necessary to administer the medical home system.
2. a. The department shall establish an advisory council
which shall include but is not limited to all of the following
members, selected by their respective organizations, and any
other members the department determines necessary to assist in
the department's duties at various stages of development of
the medical home system:
(1) The director of human services, or the director's
designee.
(2) The commissioner of insurance, or the commissioner's
designee.
(3) A representative of the federation of Iowa insurers.
(4) A representative of the Iowa dental association.
(5) A representative of the Iowa nurses association.
(6) A physician licensed pursuant to chapter 148 and a
physician licensed pursuant to chapter 150 who are family
physicians and members of the Iowa academy of family
physicians.
(7) A health care consumer.
(8) A representative of the Iowa collaborative safety net
provider network established pursuant to section 135.153.
(9) A representative of the governor's developmental
disabilities council.
(10) A representative of the Iowa chapter of the American
academy of pediatrics.
(11) A representative of the child and family policy
center.
(12) A representative of the Iowa pharmacy association.
(13) A representative of the Iowa chiropractic society.
(14) A representative of the university of Iowa college of
public health.
b. Public members of the advisory council shall receive
reimbursement for actual expenses incurred while serving in
their official capacity only if they are not eligible for
reimbursement by the organization that they represent.
3. The department shall develop a plan for implementation
of a statewide medical home system. The department, in
collaboration with parents, schools, communities, health
plans, and providers, shall endeavor to increase healthy
outcomes for children and adults by linking the children and
adults with a medical home, identifying health improvement
goals for children and adults, and linking reimbursement
strategies to increasing healthy outcomes for children and
adults. The plan shall provide that the medical home system
shall do all of the following:
a. Coordinate and provide access to evidence=based health
care services, emphasizing convenient, comprehensive primary
care and including preventive, screening, and well=child
health services.
b. Provide access to appropriate specialty care and
inpatient services.
c. Provide quality=driven and cost=effective health care.
d. Provide access to pharmacist=delivered medication
reconciliation and medication therapy management services,
where appropriate.
e. Promote strong and effective medical management
including but not limited to planning treatment strategies,
monitoring health outcomes and resource use, sharing
information, and organizing care to avoid duplication of
service. The plan shall provide that in sharing information,
the priority shall be the protection of the privacy of
individuals and the security and confidentiality of the
individual's information. Any sharing of information required
by the medical home system shall comply and be consistent with
all existing state and federal laws and regulations relating
to the confidentiality of health care information and shall be
subject to written consent of the patient.
f. Emphasize patient and provider accountability.
g. Prioritize local access to the continuum of health care
services in the most appropriate setting.
h. Establish a baseline for medical home goals and
establish performance measures that indicate a child or adult
has an established and effective medical home. For children,
these goals and performance measures may include but are not
limited to childhood immunizations rates, well=child care
utilization rates, care management for children with chronic
illnesses, emergency room utilization, and oral health service
utilization.
i. For children, coordinate with and integrate guidelines,
data, and information from existing newborn and child health
programs and entities, including but not limited to the
healthy opportunities to experience, success=healthy families
Iowa program, the community empowerment program, the center
for congenital and inherited disorders screening and health
care programs, standards of care for pediatric health
guidelines, the office of multicultural health established in
section 135.12, the oral health bureau established in section
135.15, and other similar programs and services.
4. The department shall develop an organizational
structure for the medical home system in this state. The
organizational structure plan shall integrate existing
resources, provide a strategy to coordinate health care
services, provide for monitoring and data collection on
medical homes, provide for training and education to health
care professionals and families, and provide for transition of
children to the adult medical care system. The organizational
structure may be based on collaborative teams of stakeholders
throughout the state such as local public health agencies, the
collaborative safety net provider network established in
section 135.153, or a combination of statewide organizations.
Care coordination may be provided through regional offices or
through individual provider practices. The organizational
structure may also include the use of telemedicine resources,
and may provide for partnering with pediatric and family
practice residency programs to improve access to preventive
care for children. The organizational structure shall also
address the need to organize and provide health care to
increase accessibility for patients including using venues
more accessible to patients and having hours of operation that
are conducive to the population served.
5. The department shall adopt standards and a process to
certify medical homes based on the national committee for
quality assurance standards. The certification process and
standards shall provide mechanisms to monitor performance and
to evaluate, promote, and improve the quality of health of and
health care delivered to patients through a medical home. The
mechanism shall require participating providers to monitor
clinical progress and performance in meeting applicable
standards and to provide information in a form and manner
specified by the department. The evaluation mechanism shall
be developed with input from consumers, providers, and payers.
At a minimum the evaluation shall determine any increased
quality in health care provided and any decrease in cost
resulting from the medical home system compared with other
health care delivery systems. The standards and process shall
also include a mechanism for other ancillary service providers
to become affiliated with a certified medical home.
6. The department shall adopt education and training
standards for health care professionals participating in the
medical home system.
7. The department shall provide for system simplification
through the use of universal referral forms, internet=based
tools for providers, and a central medical home internet site
for providers.
8. The department shall recommend a reimbursement
methodology and incentives for participation in the medical
home system to ensure that providers enter and remain
participating in the system. In developing the
recommendations for incentives, the department shall consider,
at a minimum, providing incentives to promote wellness,
prevention, chronic care management, immunizations, health
care management, and the use of electronic health records. In
developing the recommendations for the reimbursement system,
the department shall analyze, at a minimum, the feasibility of
all of the following:
a. Reimbursement under the medical assistance program to
promote wellness and prevention, provide care coordination,
and provide chronic care management.
b. Increasing reimbursement to Medicare levels for certain
wellness and prevention services, chronic care management, and
immunizations.
c. Providing reimbursement for primary care services by
addressing the disparities between reimbursement for specialty
services and primary care services.
d. Increased funding for efforts to transform medical
practices into certified medical homes, including emphasizing
the implementation of the use of electronic health records.
e. Targeted reimbursement to providers linked to health
care quality improvement measures established by the
department.
f. Reimbursement for specified ancillary support services
such as transportation for medical appointments and other such
services.
g. Providing reimbursement for medication reconciliation
and medication therapy management service, where appropriate.
9. The department shall coordinate the requirements and
activities of the medical home system with the requirements
and activities of the dental home for children as described in
section 249J.14, subsection 7, and shall recommend financial
incentives for dentists and nondental providers to promote
oral health care coordination through preventive dental
intervention, early identification of oral disease risk,
health care coordination and data tracking, treatment, chronic
care management, education and training, parental guidance,
and oral health promotions for children.
10. The department shall integrate the recommendations and
policies developed by the prevention and chronic care
management advisory council into the medical home system.
11. Implementation phases.
a. Initial implementation shall require participation in
the medical home system of children who are recipients of full
benefits under the medical assistance program. The department
shall work with the department of human services and shall
recommend to the general assembly a reimbursement methodology
to compensate providers participating under the medical
assistance program for participation in the medical home
system.
b. The department shall work with the department of human
services to expand the medical home system to adults who are
recipients of full benefits under the medical assistance
program and the expansion population under the IowaCare
program. The department shall work with the centers for
Medicare and Medicaid services of the United States department
of health and human services to allow Medicare recipients to
utilize the medical home system.
c. The department shall work with the department of
administrative services to allow state employees to utilize
the medical home system.
d. The department shall work with insurers and
self=insured companies, if requested, to make the medical home
system available to individuals with private health care
coverage.
12. The department shall provide oversight for all
certified medical homes. The department shall review the
progress of the medical home system and recommend improvements
to the system, as necessary.
13. The department shall annually evaluate the medical
home system and make recommendations to the governor and the
general assembly regarding improvements to and continuation of
the system.
14. Recommendations and other activities resulting from
the duties authorized for the department under this section
shall require approval by the board prior to any subsequent
action or implementation.
Sec. 47. Section 136.3, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 12. Perform those duties authorized
pursuant to section 135.159.
Sec. 48. Section 249J.14, subsection 7, Code 2007, is
amended to read as follows:
7. DENTAL HOME FOR CHILDREN. By July 1, 2008 December 31,
2010, every recipient of medical assistance who is a child
twelve years of age or younger shall have a designated dental
home and shall be provided with the dental screenings, and
preventive care identified in the oral health standards
services, diagnostic services, treatment services, and
emergency services as defined under the early and periodic
screening, diagnostic, and treatment program.
Sec. 49. MEDICAL HOME SYSTEM == APPROPRIATION. There is
appropriated from the general fund of the state to the
department of public health for the fiscal year beginning July
1, 2008, and ending June 30, 2009, the following amount, or so
much thereof as is necessary, for the purpose designated:
For activities associated with the medical home system
requirements of this division and for not more than the
following full=time equivalent positions:
.................................................. $ 165,600
............................................... FTEs 4.00
DIVISION IX
PREVENTION AND CHRONIC CARE MANAGEMENT
DIVISION XXIII
PREVENTION AND CHRONIC CARE MANAGEMENT
Sec. 50. NEW SECTION. 135.160 DEFINITIONS.
For the purpose of this division, unless the context
otherwise requires:
1. "Board" means the state board of health created
pursuant to section 136.1.
2. "Chronic care" means health care services provided by a
health care professional for an established clinical condition
that is expected to last a year or more and that requires
ongoing clinical management attempting to restore the
individual to highest function, minimize the negative effects
of the chronic condition, and prevent complications related to
the chronic condition.
3. "Chronic care information system" means approved
information technology to enhance the development and
communication of information to be used in providing chronic
care, including clinical, social, and economic outcomes of
chronic care.
4. "Chronic care management" means a system of coordinated
health care interventions and communications for individuals
with chronic conditions, including significant patient
self=care efforts, systemic supports for the health care
professional and patient relationship, and a chronic care plan
emphasizing prevention of complications utilizing
evidence=based practice guidelines, patient empowerment
strategies, and evaluation of clinical, humanistic, and
economic outcomes on an ongoing basis with the goal of
improving overall health.
5. "Chronic care plan" means a plan of care between an
individual and the individual's principal health care
professional that emphasizes prevention of complications
through patient empowerment including but not limited to
providing incentives to engage the patient in the patient's
own care and in clinical, social, or other interventions
designed to minimize the negative effects of the chronic
condition.
6. "Chronic care resources" means health care
professionals, advocacy groups, health departments, schools of
public health and medicine, health plans, and others with
expertise in public health, health care delivery, health care
financing, and health care research.
7. "Chronic condition" means an established clinical
condition that is expected to last a year or more and that
requires ongoing clinical management.
8. "Department" means the department of public health.
9. "Director" means the director of public health.
10. "Eligible individual" means a resident of this state
who has been diagnosed with a chronic condition or is at an
elevated risk for a chronic condition and who is a recipient
of medical assistance, is a member of the expansion population
pursuant to chapter 249J, or is an inmate of a correctional
institution in this state.
11. "Health care professional" means health care
professional as defined in section 135.157.
12. "Health risk assessment" means screening by a health
care professional for the purpose of assessing an individual's
health, including tests or physical examinations and a survey
or other tool used to gather information about an individual's
health, medical history, and health risk factors during a
health screening.
Sec. 51. NEW SECTION. 135.161 PREVENTION AND CHRONIC
CARE MANAGEMENT INITIATIVE == ADVISORY COUNCIL.
1. The director, in collaboration with the prevention and
chronic care management advisory council, shall develop a
state initiative for prevention and chronic care management.
The state initiative consists of the state's plan for
developing a chronic care organizational structure for
prevention and chronic care management, including coordinating
the efforts of health care professionals and chronic care
resources to promote the health of residents and the
prevention and management of chronic conditions, developing
and implementing arrangements for delivering prevention
services and chronic care management, developing significant
patient self=care efforts, providing systemic support for the
health care professional=patient relationship and options for
channeling chronic care resources and support to health care
professionals, providing for community development and
outreach and education efforts, and coordinating information
technology initiatives with the chronic care information
system.
2. The director may accept grants and donations and shall
apply for any federal, state, or private grants available to
fund the initiative. Any grants or donations received shall
be placed in a separate fund in the state treasury and used
exclusively for the initiative or as federal law directs.
3. a. The director shall establish and convene an
advisory council to provide technical assistance to the
director in developing a state initiative that integrates
evidence=based prevention and chronic care management
strategies into the public and private health care systems,
including the medical home system. Public members of the
advisory council shall receive their actual and necessary
expenses incurred in the performance of their duties and may
be eligible to receive compensation as provided in section
7E.6.
b. The advisory council shall elicit input from a variety
of health care professionals, health care professional
organizations, community and nonprofit groups, insurers,
consumers, businesses, school districts, and state and local
governments in developing the advisory council's
recommendations.
c. The advisory council shall submit initial
recommendations to the director for the state initiative for
prevention and chronic care management no later than July 1,
2009. The recommendations shall address all of the following:
(1) The recommended organizational structure for
integrating prevention and chronic care management into the
private and public health care systems. The organizational
structure recommended shall align with the organizational
structure established for the medical home system developed
pursuant to division XXII. The advisory council shall also
review existing prevention and chronic care management
strategies used in the health insurance market and in private
and public programs and recommend ways to expand the use of
such strategies throughout the health insurance market and in
the private and public health care systems.
(2) A process for identifying leading health care
professionals and existing prevention and chronic care
management programs in the state, and coordinating care among
these health care professionals and programs.
(3) A prioritization of the chronic conditions for which
prevention and chronic care management services should be
provided, taking into consideration the prevalence of specific
chronic conditions and the factors that may lead to the
development of chronic conditions; the fiscal impact to state
health care programs of providing care for the chronic
conditions of eligible individuals; the availability of
workable, evidence=based approaches to chronic care for the
chronic condition; and public input into the selection
process. The advisory council shall initially develop
consensus guidelines to address the two chronic conditions
identified as having the highest priority and shall also
specify a timeline for inclusion of additional specific
chronic conditions in the initiative.
(4) A method to involve health care professionals in
identifying eligible patients for prevention and chronic care
management services, which includes but is not limited to the
use of a health risk assessment.
(5) The methods for increasing communication between
health care professionals and patients, including patient
education, patient self=management, and patient follow=up
plans.
(6) The educational, wellness, and clinical management
protocols and tools to be used by health care professionals,
including management guideline materials for health care
delivery.
(7) The use and development of process and outcome
measures and benchmarks, aligned to the greatest extent
possible with existing measures and benchmarks such as the
best in class estimates utilized in the national healthcare
quality report of the agency for health care research and
quality of the United States department of health and human
services, to provide performance feedback for health care
professionals and information on the quality of health care,
including patient satisfaction and health status outcomes.
(8) Payment methodologies to align reimbursements and
create financial incentives and rewards for health care
professionals to utilize prevention services, establish
management systems for chronic conditions, improve health
outcomes, and improve the quality of health care, including
case management fees, payment for technical support and data
entry associated with patient registries, and the cost of
staff coordination within a medical practice.
(9) Methods to involve public and private groups, health
care professionals, insurers, third=party administrators,
associations, community and consumer groups, and other
entities to facilitate and sustain the initiative.
(10) Alignment of any chronic care information system or
other information technology needs with other health care
information technology initiatives.
(11) Involvement of appropriate health resources and
public health and outcomes researchers to develop and
implement a sound basis for collecting data and evaluating the
clinical, social, and economic impact of the initiative,
including a determination of the impact on expenditures and
prevalence and control of chronic conditions.
(12) Elements of a marketing campaign that provides for
public outreach and consumer education in promoting prevention
and chronic care management strategies among health care
professionals, health insurers, and the public.
(13) A method to periodically determine the percentage of
health care professionals who are participating, the success
of the empowerment=of=patients approach, and any results of
health outcomes of the patients participating.
(14) A means of collaborating with the health professional
licensing boards pursuant to chapter 147 to review prevention
and chronic care management education provided to licensees,
as appropriate, and recommendations regarding education
resources and curricula for integration into existing and new
education and training programs.
4. Following submission of initial recommendations to the
director for the state initiative for prevention and chronic
care management by the advisory council, the director shall
submit the state initiative to the board for approval.
Subject to approval of the state initiative by the board, the
department shall initially implement the state initiative
among the population of eligible individuals. Following
initial implementation, the director shall work with the
department of human services, insurers, health care
professional organizations, and consumers in implementing the
initiative beyond the population of eligible individuals as an
integral part of the health care delivery system in the state.
The advisory council shall continue to review and make
recommendations to the director regarding improvements to the
initiative. Any recommendations are subject to approval by
the board.
Sec. 52. NEW SECTION. 135.162 CLINICIANS ADVISORY PANEL.
1. The director shall convene a clinicians advisory panel
to advise and recommend to the department clinically
appropriate, evidence=based best practices regarding the
implementation of the medical home as defined in section
135.157 and the prevention and chronic care management
initiative pursuant to section 135.161. The director shall
act as chairperson of the advisory panel.
2. The clinicians advisory panel shall consist of nine
members representing licensed medical health care providers
selected by their respective professional organizations.
Terms of members shall begin and end as provided in section
69.19. Any vacancy shall be filled in the same manner as
regular appointments are made for the unexpired portion of the
regular term. Members shall serve terms of three years. A
member is eligible for reappointment for three successive
terms.
3. The clinicians advisory panel shall meet on a quarterly
basis to receive updates from the director regarding strategic
planning and implementation progress on the medical home and
the prevention and chronic care management initiative and
shall provide clinical consultation to the department
regarding the medical home and the initiative.
Sec. 53. Section 136.3, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 13. Perform those duties authorized
pursuant to section 135.161.
Sec. 54. PREVENTION AND CHRONIC CARE MANAGEMENT ==
APPROPRIATION. There is appropriated from the general fund of
the state to the department of public health for the fiscal
year beginning July 1, 2008, and ending June 30, 2009, the
following amount, or so much thereof as is necessary, for the
purpose designated:
For activities associated with the prevention and chronic
care management requirements of this division:
.................................................. $ 190,500
DIVISION X
FAMILY OPPORTUNITY ACT
Sec. 55. 2007 Iowa Acts, chapter 218, section 126,
subsection 1, is amended to read as follows:
1. The provision in this division of this Act relating to
eligibility for certain persons with disabilities under the
medical assistance program shall only be implemented if the
department of human services determines that funding is
available in appropriations made in this Act, in combination
with federal allocations to the state, for the state
children's health insurance program, in excess of the amount
needed to cover the current and projected enrollment under the
state children's health insurance program beginning January 1,
2009. If such a determination is made, the department of
human services shall transfer funding from the appropriations
made in this Act for the state children's health insurance
program, not otherwise required for that program, to the
appropriations made in this Act for medical assistance, as
necessary, to implement such provision of this division of
this Act.
DIVISION XI
MEDICAL ASSISTANCE QUALITY IMPROVEMENT
Sec. 56. NEW SECTION. 249A.36 MEDICAL ASSISTANCE QUALITY
IMPROVEMENT COUNCIL.
1. A medical assistance quality improvement council is
established. The council shall evaluate the clinical outcomes
and satisfaction of consumers and providers with the medical
assistance program. The council shall coordinate efforts with
the cost and quality performance evaluation completed pursuant
to section 249J.16.
2. a. The council shall consist of seven voting members
appointed by the majority leader of the senate, the minority
leader of the senate, the speaker of the house, and the
minority leader of the house of representatives. At least one
member of the council shall be a consumer and at least one
member shall be a medical assistance program provider. An
individual who is employed by a private or nonprofit
organization that receives one million dollars or more in
compensation or reimbursement from the department, annually,
is not eligible for appointment to the council. The members
shall serve terms of two years beginning and ending as
provided in section 69.19, and appointments shall comply with
sections 69.16 and 69.16A. Members shall receive
reimbursement for actual expenses incurred while serving in
their official capacity and may also be eligible to receive
compensation as provided in section 7E.6. Vacancies shall be
filled by the original appointing authority and in the manner
of the original appointment. A person appointed to fill a
vacancy shall serve only for the unexpired portion of the
term.
b. The members shall select a chairperson, annually, from
among the membership. The council shall meet at least
quarterly and at the call of the chairperson. A majority of
the members of the council constitutes a quorum. Any action
taken by the council must be adopted by the affirmative vote
of a majority of its voting membership.
c. The department shall provide administrative support and
necessary supplies and equipment for the council.
3. The council shall consult with and advise the Iowa
Medicaid enterprise in establishing a quality assessment and
improvement process.
a. The process shall be consistent with the health plan
employer data and information set developed by the national
committee for quality assurance and with the consumer
assessment of health care providers and systems developed by
the agency for health care research and quality of the United
States department of health and human services. The council
shall also coordinate efforts with the Iowa healthcare
collaborative and the state's Medicare quality improvement
organization to create consistent quality measures.
b. The process may utilize as a basis the medical
assistance and state children's health insurance quality
improvement efforts of the centers for Medicare and Medicaid
services of the United States department of health and human
services.
c. The process shall include assessment and evaluation of
both managed care and fee=for=service programs, and shall be
applicable to services provided to adults and children.
d. The initial process shall be developed and implemented
by December 31, 2008, with the initial report of results to be
made available to the public by June 30, 2009. Following the
initial report, the council shall submit a report of results
to the governor and the general assembly, annually, in
January.
DIVISION XII
HEALTH AND LONG=TERM CARE ACCESS
DIVISION XXIV
Sec. 57. NEW SECTION. 135.163 HEALTH AND LONG=TERM CARE
ACCESS.
The department shall coordinate public and private efforts
to develop and maintain an appropriate health care delivery
infrastructure and a stable, well=qualified, diverse, and
sustainable health care workforce in this state. The health
care delivery infrastructure and the health care workforce
shall address the broad spectrum of health care needs of
Iowans throughout their lifespan including long=term care
needs. The department shall, at a minimum, do all of the
following:
1. Develop a strategic plan for health care delivery
infrastructure and health care workforce resources in this
state.
2. Provide for the continuous collection of data to
provide a basis for health care strategic planning and health
care policymaking.
3. Make recommendations regarding the health care delivery
infrastructure and the health care workforce that assist in
monitoring current needs, predicting future trends, and
informing policymaking.
Sec. 58. NEW SECTION. 135.164 STRATEGIC PLAN.
1. The strategic plan for health care delivery
infrastructure and health care workforce resources shall
describe the existing health care system, describe and provide
a rationale for the desired health care system, provide an
action plan for implementation, and provide methods to
evaluate the system. The plan shall incorporate expenditure
control methods and integrate criteria for evidence=based
health care. The department shall do all of the following in
developing the strategic plan for health care delivery
infrastructure and health care workforce resources:
a. Conduct strategic health planning activities related to
preparation of the strategic plan.
b. Develop a computerized system for accessing, analyzing,
and disseminating data relevant to strategic health planning.
The department may enter into data sharing agreements and
contractual arrangements necessary to obtain or disseminate
relevant data.
c. Conduct research and analysis or arrange for research
and analysis projects to be conducted by public or private
organizations to further the development of the strategic
plan.
d. Establish a technical advisory committee to assist in
the development of the strategic plan. The members of the
committee may include but are not limited to health
economists, representatives of the university of Iowa college
of public health, health planners, representatives of health
care purchasers, representatives of state and local agencies
that regulate entities involved in health care,
representatives of health care providers and health care
facilities, and consumers.
2. The strategic plan shall include statewide health
planning policies and goals related to the availability of
health care facilities and services, the quality of care, and
the cost of care. The policies and goals shall be based on
the following principles:
a. That a strategic health planning process, responsive to
changing health and social needs and conditions, is essential
to the health, safety, and welfare of Iowans. The process
shall be reviewed and updated as necessary to ensure that the
strategic plan addresses all of the following:
(1) Promoting and maintaining the health of all Iowans.
(2) Providing accessible health care services through the
maintenance of an adequate supply of health facilities and an
adequate workforce.
(3) Controlling excessive increases in costs.
(4) Applying specific quality criteria and population
health indicators.
(5) Recognizing prevention and wellness as priorities in
health care programs to improve quality and reduce costs.
(6) Addressing periodic priority issues including disaster
planning, public health threats, and public safety dilemmas.
(7) Coordinating health care delivery and resource
development efforts among state agencies including those
tasked with facility, services, and professional provider
licensure; state and federal reimbursement; health service
utilization data systems; and others.
(8) Recognizing long=term care as an integral component of
the health care delivery infrastructure and as an essential
service provided by the health care workforce.
b. That both consumers and providers throughout the state
must be involved in the health planning process, outcomes of
which shall be clearly articulated and available for public
review and use.
c. That the supply of a health care service has a
substantial impact on utilization of the service, independent
of the effectiveness, medical necessity, or appropriateness of
the particular health care service for a particular
individual.
d. That given that health care resources are not
unlimited, the impact of any new health care service or
facility on overall health expenditures in this state must be
considered.
e. That excess capacity of health care services and
facilities places an increased economic burden on the public.
f. That the likelihood that a requested new health care
facility, service, or equipment will improve health care
quality and outcomes must be considered.
g. That development and ongoing maintenance of current and
accurate health care information and statistics related to
cost and quality of health care and projections of the need
for health care facilities and services are necessary to
developing an effective health care planning strategy.
h. That the certificate of need program as a component of
the health care planning regulatory process must balance
considerations of access to quality care at a reasonable cost
for all Iowans, optimal use of existing health care resources,
fostering of expenditure control, and elimination of
unnecessary duplication of health care facilities and
services, while supporting improved health care outcomes.
i. That strategic health care planning must be concerned
with the stability of the health care system, encompassing
health care financing, quality, and the availability of
information and services for all residents.
3. The health care delivery infrastructure and health care
workforce resources strategic plan developed by the department
shall include all of the following:
a. A health care system assessment and objectives
component that does all of the following:
(1) Describes state and regional population demographics,
health status indicators, and trends in health status and
health care needs.
(2) Identifies key policy objectives for the state health
care system related to access to care, health care outcomes,
quality, and cost=effectiveness.
b. A health care facilities and services plan that
assesses the demand for health care facilities and services to
inform state health care planning efforts and direct
certificate of need determinations, for those facilities and
services subject to certificate of need. The plan shall
include all of the following:
(1) An inventory of each geographic region's existing
health care facilities and services.
(2) Projections of the need for each category of health
care facility and service, including those subject to
certificate of need.
(3) Policies to guide the addition of new or expanded
health care facilities and services to promote the use of
quality, evidence=based, cost=effective health care delivery
options, including any recommendations for criteria,
standards, and methods relevant to the certificate of need
review process.
(4) An assessment of the availability of health care
providers, public health resources, transportation
infrastructure, and other considerations necessary to support
the needed health care facilities and services in each region.
c. A health care data resources plan that identifies data
elements necessary to properly conduct planning activities and
to review certificate of need applications, including data
related to inpatient and outpatient utilization and outcomes
information, and financial and utilization information related
to charity care, quality, and cost. The plan shall provide
all of the following:
(1) An inventory of existing data resources, both public
and private, that store and disclose information relevant to
the health care planning process, including information
necessary to conduct certificate of need activities. The plan
shall identify any deficiencies in the inventory of existing
data resources and the data necessary to conduct comprehensive
health care planning activities. The plan may recommend that
the department be authorized to access existing data sources
and conduct appropriate analyses of such data or that other
agencies expand their data collection activities as statutory
authority permits. The plan may identify any computing
infrastructure deficiencies that impede the proper storage,
transmission, and analysis of health care planning data.
(2) Recommendations for increasing the availability of
data related to health care planning to provide greater
community involvement in the health care planning process and
consistency in data used for certificate of need applications
and determinations. The plan shall also integrate the
requirements for annual reports by hospitals and health care
facilities pursuant to section 135.75, the provisions relating
to analyses and studies by the department pursuant to section
135.76, the data compilation provisions of section 135.78, and
the provisions for contracts for assistance with analyses,
studies, and data pursuant to section 135.83.
d. An assessment of emerging trends in health care
delivery and technology as they relate to access to health
care facilities and services, quality of care, and costs of
care. The assessment shall recommend any changes to the scope
of health care facilities and services covered by the
certificate of need program that may be warranted by these
emerging trends. In addition, the assessment may recommend
any changes to criteria used by the department to review
certificate of need applications, as necessary.
e. A rural health care resources plan to assess the
availability of health resources in rural areas of the state,
assess the unmet needs of these communities, and evaluate how
federal and state reimbursement policies can be modified, if
necessary, to more efficiently and effectively meet the health
care needs of rural communities. The plan shall consider the
unique health care needs of rural communities, the adequacy of
the rural health care workforce, and transportation needs for
accessing appropriate care.
f. A health care workforce resources plan to assure a
competent, diverse, and sustainable health care workforce in
Iowa and to improve access to health care in underserved areas
and among underserved populations. The plan shall include the
establishment of an advisory council to inform and advise the
department and policymakers regarding issues relevant to the
health care workforce in Iowa. The health care workforce
resources plan shall recognize long=term care as an essential
service provided by the health care workforce.
4. The department shall submit the initial statewide
health care delivery infrastructure and resources strategic
plan to the governor and the general assembly by January 1,
2010, and shall submit an updated strategic plan to the
governor and the general assembly every two years thereafter.
Sec. 59. HEALTH CARE ACCESS == APPROPRIATION. There is
appropriated from the general fund of the state to the
department of public health for the fiscal year beginning July
1, 2008, and ending June 30, 2009, the following amount, or so
much thereof as is necessary, for the purpose designated:
For activities associated with the health care access
requirements of this division, and for not more than the
following full=time equivalent positions:
.................................................. $ 172,200
............................................... FTEs 3.00
DIVISION XIII
PREVENTION AND WELLNESS
INITIATIVES
Sec. 60. Section 135.27, Code 2007, is amended by striking
the section and inserting in lieu thereof the following:
135.27 IOWA HEALTHY COMMUNITIES INITIATIVE == GRANT
PROGRAM.
1. PROGRAM GOALS. The department shall establish a grant
program to energize local communities to transform the
existing culture into a culture that promotes healthy
lifestyles and leads collectively, community by community, to
a healthier state. The grant program shall expand an existing
healthy communities initiative to assist local boards of
health, in collaboration with existing community resources, to
build community capacity in addressing the prevention of
chronic disease that results from risk factors including
overweight and obesity conditions.
2. DISTRIBUTION OF GRANTS. The department shall
distribute the grants on a competitive basis and shall support
the grantee communities in planning and developing wellness
strategies and establishing methodologies to sustain the
strategies. Grant criteria shall be consistent with the
existing statewide initiative between the department and the
department's partners that promotes increased opportunities
for physical activity and healthy eating for Iowans of all
ages, or its successor, and the statewide comprehensive plan
developed by the existing statewide initiative to increase
physical activity, improve nutrition, and promote healthy
behaviors. Grantees shall demonstrate an ability to maximize
local, state, and federal resources effectively and
efficiently.
3. DEPARTMENTAL SUPPORT. The department shall provide
support to grantees including capacity=building strategies,
technical assistance, consultation, and ongoing evaluation.
4. ELIGIBILITY. Local boards of health representing a
coalition of health care providers and community and private
organizations are eligible to submit applications.
Sec. 61. NEW SECTION. 135.27A GOVERNOR'S COUNCIL ON
PHYSICAL FITNESS AND NUTRITION.
1. A governor's council on physical fitness and nutrition
is established consisting of twelve members appointed by the
governor who have expertise in physical activity, physical
fitness, nutrition, and promoting healthy behaviors. At least
one member shall be a representative of elementary and
secondary physical education professionals, at least one
member shall be a health care professional, at least one
member shall be a registered dietician, at least one member
shall be recommended by the department of elder affairs, and
at least one member shall be an active nutrition or fitness
professional. In addition, at least one member shall be a
member of a racial or ethnic minority. The governor shall
select a chairperson for the council. Members shall serve
terms of three years beginning and ending as provided in
section 69.19. Appointments are subject to sections 69.16 and
69.16A. Members are entitled to receive reimbursement for
actual expenses incurred while engaged in the performance of
official duties. A member of the council may also be eligible
to receive compensation as provided in section 7E.6.
2. The council shall assist in developing a strategy for
implementation of the statewide comprehensive plan developed
by the existing statewide initiative to increase physical
activity, improve physical fitness, improve nutrition, and
promote healthy behaviors. The strategy shall include
specific components relating to specific populations and
settings including early childhood, educational, local
community, worksite wellness, health care, and older Iowans.
The initial draft of the implementation plan shall be
submitted to the governor and the general assembly by December
1, 2008.
3. The council shall assist the department in establishing
and promoting a best practices internet site. The internet
site shall provide examples of wellness best practices for
individuals, communities, workplaces, and schools and shall
include successful examples of both evidence=based and
nonscientific programs as a resource.
4. The council shall provide oversight for the governor's
physical fitness challenge. The governor's physical fitness
challenge shall be administered by the department and shall
provide for the establishment of partnerships with communities
or school districts to offer the physical fitness challenge
curriculum to elementary and secondary school students. The
council shall develop the curriculum, including benchmarks and
rewards, for advancing the school wellness policy through the
challenge.
Sec. 62. IOWA HEALTHY COMMUNITIES INITIATIVE ==
APPROPRIATION. There is appropriated from the general fund of
the state to the department of public health for the fiscal
year beginning July 1, 2008, and ending June 30, 2009, the
following amount, or so much thereof as is necessary, for the
purpose designated:
For Iowa healthy communities initiative grants distributed
beginning January 1, 2009, and for not more than the following
full=time equivalent positions:
.................................................. $ 900,000
............................................... FTEs 3.00
Sec. 63. GOVERNOR'S COUNCIL ON PHYSICAL FITNESS AND
NUTRITION == APPROPRIATION. There is appropriated from the
general fund of the state to the department of public health
for the fiscal period beginning July 1, 2008, and ending June
30, 2009, the following amount, or so much thereof as is
necessary, for the purpose designated:
For the governor's council on physical fitness:
.................................................. $ 112,100
Sec. 64. SMALL BUSINESS QUALIFIED WELLNESS PROGRAM TAX
CREDIT == PLAN. The department of public health, in
consultation with the insurance division of the department of
commerce and the department of revenue, shall develop a plan
to provide a tax credit to small businesses that provide
qualified wellness programs to improve the health of their
employees. The plan shall include specification of what
constitutes a small business for the purposes of the qualified
wellness program, the minimum standards for use by a small
business in establishing a qualified wellness program, the
criteria and a process for certification of a small business
qualified wellness program, and the process for claiming a
small business qualified wellness program tax credit. The
department of public health shall submit the plan including
any recommendations for changes in law to implement a small
business qualified wellness program tax credit to the governor
and the general assembly by December 15, 2008.
DIVISION XIV
HEALTH CARE TRANSPARENCY
DIVISION XXV
HEALTH CARE TRANSPARENCY
Sec. 65. NEW SECTION. 135.165 HEALTH CARE TRANSPARENCY
== REPORTING REQUIREMENTS == HOSPITALS AND NURSING FACILITIES.
Each hospital and nursing facility in this state that is
recognized by the Internal Revenue Code as a nonprofit
organization or entity shall submit to the department of
public health and the legislative services agency, annually, a
copy of the hospital's internal revenue service form 990,
including but not limited to schedule J or any successor
schedule that provides compensation information for certain
officers, directors, trustees, and key employees, information
about the highest compensated employees, and information
regarding revenues, expenses, excess or surplus revenues, and
reserves within ninety days following the due date for filing
the hospital's or nursing facility's return for the taxable
year.
Sec. 66. Section 136.3, Code 2007, is amended by adding
the following new subsection:
NEW SUBSECTION. 14. To the greatest extent possible
integrate the efforts of the governing entities of the Iowa
health information technology system pursuant to division XXI,
the medical home pursuant to division XXII, the prevention and
chronic care management initiative pursuant to division XXIII,
and health and long=term care access pursuant to division
XXIV.
Sec. 67. HEALTH CARE QUALITY AND COST TRANSPARENCY ==
WORKGROUP.
1. A health care quality and cost transparency workgroup
is created to develop recommendations for legislation and
policies regarding health care quality and cost including
measures to be utilized in providing transparency to consumers
of health care and health care coverage. Membership of the
workgroup shall be determined by the legislative council in
consultation with the chairpersons and ranking members of the
joint appropriations subcommittee on health and human services
and the chairpersons and ranking members of the committees on
human resources of the senate and house of representatives.
Membership of the workgroup shall include but is not limited
to representatives of the Iowa healthcare collaborative, the
department of public health, the department of human services,
the insurance division of the department of commerce, the Iowa
hospital association, the Iowa medical society, the Iowa
health buyers alliance, the AARP Iowa chapter, the university
of Iowa public policy center, and other interested consumers,
advocates, purchasers, providers, and legislators. The
legislative services agency shall provide staffing assistance
to the workgroup.
2. The workgroup shall do all of the following:
a. Review the approaches of other states quality and cost
in addressing health care transparency information.
b. Develop and compile recommendations and strategies to
lower health care costs and health care coverage costs for
consumers and businesses.
c. Make recommendations, including any necessary
legislation, regarding reporting of health care quality and
cost measures. The measures recommended for adoption shall be
those measures endorsed by the national quality forum.
However, if an area of measurement is deemed important by the
workgroup, but the national quality forum has not endorsed
such area of measurement, the workgroup may recommend, in
order of priority, the measures of other national
accreditation organizations such as the national committee for
quality assurance, the joint commission, the centers for
Medicare and Medicaid services of the United States department
of health and human services, or the agency for healthcare
research and quality. Any measure recommended for adoption
shall be evidence=based and clinically important, reasonably
feasible to implement, and easily understood by the health
care consumer.
d. Make recommendations regarding the collection and
publishing of health care quality and cost measures. Measures
shall be collected from health plans, hospitals, and
physicians and published on a public internet site available
to the general public. The recommendations shall include how
the internet site will be maintained and utilization of a
format to ensure that the information provided is understood
by the health care consumer.
e. Submit a written report of all recommendations to the
general assembly on or before December 15, 2008.
3. The legislative council, pursuant to its authority in
section 2.42, may allocate to the workgroup funding from
moneys available to it in section 2.12 for the purpose of
providing expert support to the workgroup.
Sec. 68. EFFECTIVE DATE. The provision in this division
of this Act creating a health care quality and cost
transparency workgroup, being deemed of immediate importance,
takes effect upon enactment.
DIVISION XV
DIRECT CARE WORKFORCE
Sec. 69. DIRECT CARE WORKER ADVISORY COUNCIL == DUTIES ==
REPORT.
1. As used in this section, unless the context otherwise
requires:
a. "Department" means the department of public health.
b. "Direct care" means environmental or chore services,
health monitoring and maintenance, assistance with
instrumental activities of daily living, assistance with
personal care activities of daily living, personal care
support, or specialty skill services.
c. "Direct care worker" means an individual who directly
provides or assists a consumer in the care of the consumer by
providing direct care in a variety of settings which may or
may not require supervision of the direct care worker,
depending on the setting and the skills that the direct care
workers possess, based on education or certification.
d. "Director" means the director of public health.
2. A direct care worker advisory council shall be
appointed by the director and shall include representatives of
direct care workers, consumers of direct care services,
educators of direct care workers, other health professionals,
employers of direct care workers, and appropriate state
agencies.
3. Membership, terms of office, quorum, and expenses shall
be determined by the director in accordance with the
applicable provisions of section 135.11.
4. The direct care worker advisory council shall advise
the director regarding regulation and certification of direct
care workers, based on the work of the direct care workers
task force established pursuant to 2005 Iowa Acts, chapter 88,
and shall develop recommendations regarding but not limited to
all of the following:
a. Direct care worker classifications based on functions
and services provided by direct care workers.
b. Functions for each direct care worker classification.
c. An education and training orientation to be provided by
employers.
d. Education and training requirements for each direct
care worker classification.
e. The standard curriculum required for each direct care
worker classification.
f. Education and training equivalency standards for each
direct care worker classification.
g. Guidelines that allow individuals who are members of
the direct care workforce prior to the date of required
certification to be incorporated into the new regulatory
system.
h. Continuing education requirements for each direct care
worker classification.
i. Standards for direct care worker educators and
trainers.
j. Certification requirements for each direct care worker
classification.
k. Protections for the title "certified direct care
worker".
l. Standardized requirements for supervision of each
direct care worker classification, as applicable, and the
roles and responsibilities of supervisory positions.
m. Responsibility for maintenance of credentialing and
continuing education and training.
n. Provision of information to income maintenance workers
and case managers under the purview of the department of human
services about the education and training requirements for
direct care workers to provide the care and services to meet
consumer needs.
5. The direct care worker advisory council shall report
its recommendations to the director by November 30, 2008,
including recommendations for any changes in law or rules
necessary.
6. Implementation of certification of direct care workers
shall begin July 1, 2009.
Sec. 70. DIRECT CARE WORKER COMPENSATION ADVISORY
COMMITTEE == REVIEWS.
1. a. The general assembly recognizes that direct care
workers play a vital role and make a valuable contribution in
providing care to Iowans with a variety of needs in both
institutional and home and community=based settings.
Recruiting and retaining qualified, highly competent direct
care workers is a challenge across all employment settings.
High rates of employee vacancies and staff turnover threaten
the ability of providers to achieve the core mission of
providing safe and high quality support to Iowans.
b. It is the intent of the general assembly to address the
long=term care workforce shortage and turnover rates in order
to improve the quality of health care delivered in the
long=term care continuum by reviewing wages and other
compensation paid to direct care workers in the state.
c. It is the intent of the general assembly that the
initial review of and recommendations for improving wages and
other compensation paid to direct care workers focus on
nonlicensed direct care workers in the nursing facility
setting. However, following the initial review of wages and
other compensation paid to direct care workers in the nursing
facility setting, the department of human services shall
convene subsequent advisory committees with appropriate
representatives of public and private organizations and
consumers to review the wages and other compensation paid to
and turnover rates of the entire spectrum of direct care
workers in the various settings in which they are employed as
a means of demonstrating the general assembly's commitment to
ensuring a stable and quality direct care workforce in this
state.
2. The department of human services shall convene an
initial direct care worker compensation advisory committee to
develop recommendations for consideration by the general
assembly during the 2009 legislative session regarding wages
and other compensation paid to direct care workers in nursing
facilities. The committee shall consist of the following
members, selected by their respective organizations:
a. The director of human services, or the director's
designee.
b. The director of public health, or the director's
designee.
c. The director of the department of elder affairs, or the
director's designee.
d. The director of the department of inspections and
appeals, or the director's designee.
e. A representative of the Iowa caregivers association.
f. A representative of the Iowa health care association.
g. A representative of the Iowa association of homes and
services for the aging.
h. A representative of the AARP Iowa chapter.
3. The advisory committee shall also include two members
of the senate and two members of the house of representatives,
with not more than one member from each chamber being from the
same political party. The legislative members shall serve in
an ex officio, nonvoting capacity. The two senators shall be
appointed respectively by the majority leader of the senate
and the minority leader of the senate, and the two
representatives shall be appointed respectively by the speaker
of the house of representatives and the minority leader of the
house of representatives.
4. Public members of the committee shall receive actual
expenses incurred while serving in their official capacity and
may also be eligible to receive compensation as provided in
section 7E.6. Legislative members of the committee are
eligible for per diem and reimbursement of actual expenses as
provided in section 2.10.
5. The department of human services shall provide
administrative support to the committee and the director of
human services or the director's designee shall serve as
chairperson of the committee.
6. The department shall convene the committee no later
than July 1, 2008. Prior to the initial meeting, the
department of human services shall provide all members of the
committee with a detailed analysis of trends in wages and
other compensation paid to direct care workers.
7. The committee shall consider options related but not
limited to all of the following:
a. The shortening of the time delay between a nursing
facility's submittal of cost reports and receipt of the
reimbursement based upon these cost reports.
b. The targeting of appropriations to provide increases in
direct care worker compensation.
c. Creation of a nursing facility provider tax.
8. Any option considered by the committee shall be
consistent with federal law and regulations.
9. Following its deliberations, the committee shall submit
a report of its findings and recommendations regarding
improvement in direct care worker wages and other compensation
in the nursing facility setting to the governor and the
general assembly no later than December 12, 2008.
10. For the purposes of the initial review, "direct care
worker" means nonlicensed nursing facility staff who provide
hands=on care including but not limited to certified nurse
aides and medication aides.
Sec. 71. DIRECT CARE WORKER IN NURSING FACILITIES ==
TURNOVER REPORT. The department of human services shall
modify the nursing facility cost reports utilized for the
medical assistance program to capture data by the distinct
categories of nonlicensed direct care workers and other
employee categories for the purposes of documenting the
turnover rates of direct care workers and other employees of
nursing facilities. The department shall submit a report on
an annual basis to the governor and the general assembly which
provides an analysis of direct care worker and other nursing
facility employee turnover by individual nursing facility, a
comparison of the turnover rate in each individual nursing
facility with the state average, and an analysis of any
improvement or decline in meeting any accountability goals or
other measures related to turnover rates. The annual reports
shall also include any data available regarding turnover rate
trends, and other information the department deems
appropriate. The initial report shall be submitted no later
than December 1, 2008, and subsequent reports shall be
submitted no later than December 1, annually, thereafter.
Sec. 72. VOLUNTARY EMPLOYER=SPONSORED HEALTH CARE COVERAGE
DEMONSTRATION PROJECT == DIRECT CARE WORKERS.
1. a. The department of human services in collaboration
with the insurance division of the department of commerce
shall design a demonstration project to provide a health care
coverage premium assistance program for nonlicensed direct
care workers. Participation in the demonstration project
shall be offered to employers and nonlicensed direct care
workers on a voluntary basis.
b. The department in collaboration with the division shall
convene an advisory council consisting of representatives of
the Iowa caregivers association, the Iowa child and family
policy center, the Iowa association of homes and services for
the aging, the Iowa health care association, the federation of
Iowa insurers, the AARP Iowa chapter, the senior living
coordinating unit, and other public and private entities with
interest in the demonstration project to assist in designing
the project. The department in collaboration with the
division shall also review the experiences of other states and
the medical assistance premium assistance program in designing
the demonstration project.
c. The department and the division, in consultation with
the advisory council, shall establish criteria to determine
which nonlicensed direct care workers shall be eligible to
participate in the demonstration project, the coverage and
cost parameters of the health care coverage which an employer
shall provide to be eligible for participation in the project,
the minimum premium contribution required of an employer to be
eligible for participation in the project, income eligibility
parameters for direct care workers participating in the
project, minimum hours of work required of an employee to be
eligible for participation in the project, and maximum premium
cost limits for an employee participating in the project.
d. The project design shall allow up to 250 direct care
workers and their dependents to access health care coverage
sponsored by the direct care worker's employer.
e. To the extent possible, the design of the demonstration
project shall incorporate a medical home, wellness and
prevention services, and chronic care management.
2. The department and the division shall submit the design
for the demonstration project to the governor and the general
assembly for review by December 15, 2008. If the general
assembly enacts legislation to implement the demonstration
project and appropriates funding for the demonstration
project, the department in collaboration with the division
shall implement the demonstration project for an initial
two=year period.
Sec. 73. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
PATRICK J. MURPHY
Speaker of the House
JOHN P. KIBBIE
President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2539, Eighty=second General Assembly.
MARK BRANDSGARD
Chief Clerk of the House
Approved , 2008
CHESTER J. CULVER
Governor
Text: HF2538
Text: HF2540