Text: SSB3139            Text: SSB3141


Senate Study Bill 3140

SENATE FILE BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON RAGAN) Passed Senate, Date Passed House, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act relating to health care reform in Iowa including the Iowa 2 health care coverage exchange; medical homes; prevention and 3 chronic care management; the Iowa health information 4 technology system; health care quality, consumer information, 5 strategic planning, and resource development; and the 6 certificate of need program. 7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 8 TLSB 6443XC 82 9 av:pf/rj/8 PAG LIN 1 1 DIVISION I 1 2 IOWA HEALTH CARE COVERAGE EXCHANGE 1 3 Section 1. NEW SECTION. 514M.1 SHORT TITLE. 1 4 This chapter shall be known and may be cited as the "Iowa 1 5 Health Care Coverage for All Act". 1 6 Sec. 2. NEW SECTION. 514M.2 DECLARATION OF INTENT. 1 7 It is the intent of the general assembly in enacting this 1 8 chapter, as funding becomes available, to progress toward 1 9 achievement of the goal that all Iowans have health care 1 10 coverage with the following priorities: 1 11 1. The goal that all children in the state have qualified 1 12 health care coverage which meets certain standards of quality 1 13 and affordability with the following priorities: 1 14 a. Covering all children who are declared eligible for 1 15 medical assistance, the state children's health insurance 1 16 program, and hawk=i by December 31, 2009. 1 17 b. Subsidizing qualified health care coverage, which meets 1 18 certain standards of quality and affordability, for the 1 19 remaining uninsured children up to eighteen years of age under 1 20 a sliding scale based on family income by December 31, 2009. 1 21 c. Moving toward a future requirement that all parents 1 22 must provide proof of qualified health care coverage which 1 23 meets certain standards of quality and affordability for their 1 24 children. 1 25 2. The goal that all Iowans have qualified health care 1 26 coverage which meets certain standards of quality and 1 27 affordability with the following priorities: 1 28 a. Continuing to expand options for individuals who are 1 29 dually eligible for Medicare and medical assistance, typically 1 30 the chronically disabled, by utilizing evidence=based medical 1 31 treatments. 1 32 b. Facilitating coverage of uninsured health and long=term 1 33 care workers and child care workers with qualified health care 1 34 coverage which meets certain standards of quality and 1 35 affordability. 2 1 c. Maximizing eligibility of low=income adults eighteen 2 2 years of age and older for public health care coverage. 2 3 d. Subsidizing qualified health care coverage, which meets 2 4 certain standards of quality and affordability, for the 2 5 remaining low=income adults. 2 6 e. Moving toward a future requirement that all Iowans must 2 7 provide proof of qualified health care coverage which meets 2 8 certain standards of quality and affordability. 2 9 3. The goal of decreasing health care costs and health 2 10 care coverage costs by: 2 11 a. Instituting insurance reforms that assure the 2 12 availability of private insurance coverage for all Iowans by 2 13 addressing issues involving guaranteed availability and 2 14 issuance of insurance to applicants, preexisting condition 2 15 exclusions, portability, and allowable or required pooling and 2 16 rating classifications. 2 17 b. Requiring every child who has public health care 2 18 coverage or is insured by a plan created by the Iowa health 2 19 care coverage exchange to have a medical home. 2 20 c. Establishing a statewide telehealth system. 2 21 d. Implementing cost containment strategies such as 2 22 disease management programs, advance medical directives, 2 23 initiatives such as end=of=life planning, transparency in 2 24 health care cost and quality information, and an expanded 2 25 certificate of need process. 2 26 Sec. 3. NEW SECTION. 514M.3 DEFINITIONS. 2 27 For the purposes of this chapter, unless the context 2 28 otherwise requires: 2 29 1. "Board" means the board of directors of the Iowa health 2 30 care coverage exchange. 2 31 2. "Carrier" means an entity subject to the insurance laws 2 32 and regulations of this state, or subject to the jurisdiction 2 33 of the commissioner, that contracts or offers to contract to 2 34 provide, deliver, arrange for, pay for, or reimburse any of 2 35 the costs of health care services, including an insurance 3 1 company offering sickness and accident plans, a health 3 2 maintenance organization, a nonprofit health service 3 3 corporation, or any other entity providing a plan of health 3 4 insurance, health benefits, or health services. 3 5 3. "Commissioner" means the commissioner of insurance. 3 6 4. "Creditable coverage" means health benefits or coverage 3 7 provided to an individual under any of the following: 3 8 a. A group health plan. 3 9 b. Health insurance coverage. 3 10 c. Part A or Part B Medicare pursuant to Title XVIII of 3 11 the federal Social Security Act. 3 12 d. Medicaid pursuant to Title XIX of the federal Social 3 13 Security Act, other than coverage consisting solely of 3 14 benefits under section 1928 of that Act. 3 15 e. 10 U.S.C. ch. 55. 3 16 f. A health or medical care program provided through the 3 17 Indian health service or a tribal organization. 3 18 g. A state health benefits risk pool. 3 19 h. A health plan offered under 5 U.S.C. ch. 89. 3 20 i. A public health plan as defined under federal 3 21 regulations. 3 22 j. A health benefit plan under section 5(e) of the federal 3 23 Peace Corps Act, 22 U.S.C. } 2504(e). 3 24 k. An organized delivery system licensed by the director 3 25 of public health. 3 26 l. A short=term limited duration policy. 3 27 5. "Director" means the director of the department of 3 28 revenue. 3 29 6. "Exchange" means the Iowa health care coverage 3 30 exchange. 3 31 7. "Executive director" means the executive director of 3 32 the Iowa health care coverage exchange. 3 33 8. a. "Group health plan" means an employee welfare 3 34 benefit plan as defined in section 3(1) of the federal 3 35 Employee Retirement Income Security Act of 1974, to the extent 4 1 that the plan provides medical care including items and 4 2 services paid for as medical care to employees or their 4 3 dependents as defined under the terms of the plan directly or 4 4 through insurance, reimbursement, or otherwise. 4 5 b. For purposes of this subsection, "medical care" means 4 6 amounts paid for any of the following: 4 7 (1) The diagnosis, cure, mitigation, treatment, or 4 8 prevention of disease, or amounts paid for the purpose of 4 9 affecting a structure or function of the body. 4 10 (2) Transportation primarily for and essential to medical 4 11 care referred to in subparagraph (1). 4 12 (3) Insurance covering medical care referred to in 4 13 subparagraph (1) or (2). 4 14 c. For purposes of this subsection, a partnership which 4 15 establishes and maintains a plan, fund, or program to provide 4 16 medical care to present or former partners in the partnership 4 17 or to their dependents directly or through insurance, 4 18 reimbursement, or other method, which would not be an employee 4 19 benefit welfare plan but for this paragraph, shall be treated 4 20 as an employee benefit welfare plan which is a group health 4 21 plan. 4 22 (1) For purposes of a group health plan, an employer 4 23 includes the partnership in relation to any partner. 4 24 (2) For purposes of a group health plan, the term 4 25 "participant" also includes both of the following: 4 26 (a) An individual who is a partner in relation to a 4 27 partnership which maintains a group health plan. 4 28 (b) An individual who is a self=employed individual in 4 29 connection with a group health plan maintained by the 4 30 self=employed individual where one or more employees are 4 31 participants, if the individual is or may become eligible to 4 32 receive a benefit under the plan or the individual's 4 33 beneficiaries may be eligible to receive a benefit. 4 34 9. a. "Health insurance coverage" means benefits 4 35 consisting of health care provided directly, through 5 1 insurance, reimbursement, or otherwise and including items and 5 2 services paid for as health care under a hospital or health 5 3 service policy or certificate, hospital or health service plan 5 4 contract, or health maintenance organization contract offered 5 5 by a carrier. 5 6 b. "Health insurance coverage" does not include any of the 5 7 following: 5 8 (1) Coverage for accident=only or disability income 5 9 insurance. 5 10 (2) Coverage issued as a supplement to liability 5 11 insurance. 5 12 (3) Liability insurance, including general liability 5 13 insurance and automobile liability insurance. 5 14 (4) Workers' compensation or similar insurance. 5 15 (5) Automobile medical=payment insurance. 5 16 (6) Credit=only insurance. 5 17 (7) Coverage for on=site medical clinic care. 5 18 (8) Other similar insurance coverage, specified in federal 5 19 regulations, under which benefits for medical care are 5 20 secondary or incidental to other insurance coverage or 5 21 benefits. 5 22 c. "Health insurance coverage" does not include benefits 5 23 provided under a separate policy as follows: 5 24 (1) Limited scope dental or vision benefits. 5 25 (2) Benefits for long=term care, nursing home care, home 5 26 health care, or community=based care. 5 27 (3) Any other similar limited benefits as provided by rule 5 28 of the commissioner. 5 29 d. "Health insurance coverage" does not include benefits 5 30 offered as independent noncoordinated benefits as follows: 5 31 (1) Coverage only for a specified disease or illness. 5 32 (2) A hospital indemnity or other fixed indemnity 5 33 insurance. 5 34 e. "Health insurance coverage" does not include Medicare 5 35 supplemental health insurance as defined under } 1882(g)(1) of 6 1 the federal Social Security Act, coverage supplemental to the 6 2 coverage provided under 10 U.S.C. ch. 55, and similar 6 3 supplemental coverage provided to individuals under group 6 4 health insurance coverage. 6 5 f. "Group health insurance coverage" means health 6 6 insurance coverage offered in connection with a group health 6 7 plan. 6 8 10. "Qualified health care coverage" means creditable 6 9 coverage which meets minimum standards of quality and 6 10 affordability as defined by the board. 6 11 11. "Resident" means a person who is a resident of this 6 12 state for state income tax purposes. 6 13 12. "Secretary" means the secretary of the board of the 6 14 Iowa health care coverage exchange. 6 15 Sec. 4. NEW SECTION. 514M.4 IOWA HEALTH CARE COVERAGE 6 16 EXCHANGE == BOARD. 6 17 1. CREATION == PUBLIC INSTRUMENTALITY. The Iowa health 6 18 care coverage exchange is created and constitutes a public 6 19 instrumentality and agency of the state exercising public and 6 20 essential governmental functions to undertake programs which 6 21 assist in attainment of the goal of achieving qualified health 6 22 care coverage for all Iowans. The exchange shall operate 6 23 under a plan of operation established and approved under 6 24 section 514M.5. 6 25 2. BOARD OF DIRECTORS. The powers of the exchange shall 6 26 be vested in and exercised by the board of directors of the 6 27 exchange. 6 28 a. The board of directors consists of the following 6 29 persons who are voting members unless otherwise provided: 6 30 (1) The two most recent former governors, or if one or 6 31 both of them are unable or unwilling to serve, a person or 6 32 persons appointed by the governor. 6 33 (2) The commissioner of insurance, or a designee. 6 34 (3) The director of human services, or a designee. 6 35 (4) Five members appointed by the governor, subject to 7 1 confirmation by the senate: 7 2 (a) An actuary who is a member in good standing of the 7 3 American academy of actuaries. 7 4 (b) A health economist. 7 5 (c) A consumer. 7 6 (d) A representative of organized labor. 7 7 (e) A representative of an organization of employers. 7 8 (5) Four members of the general assembly, one appointed by 7 9 the speaker of the house of representatives, one appointed by 7 10 the minority leader of the house of representatives, one 7 11 appointed by the majority leader of the senate, and one 7 12 appointed by the minority leader of the senate who shall be ex 7 13 officio, nonvoting members of the board. 7 14 (6) A person who shall serve as the secretary of the 7 15 board, appointed by the board and who shall be an ex officio, 7 16 nonvoting member of the board. 7 17 b. Each member of the board appointed by the governor 7 18 shall be a resident of this state and not more than three 7 19 members shall be members of the same political party. 7 20 c. The members of the board appointed by the governor 7 21 shall be appointed for terms of six years beginning and ending 7 22 as provided in section 69.19. Such member of the board is 7 23 eligible for reappointment. The governor shall fill a vacancy 7 24 for the remainder of the unexpired term. Such member of the 7 25 board may be removed by the governor for misfeasance, 7 26 malfeasance, or willful neglect of duty or other cause after 7 27 notice and a public hearing unless the notice and hearing are 7 28 waived by the member in writing. 7 29 d. The members of the board shall annually elect one 7 30 voting member as chairperson and one as vice chairperson. 7 31 e. A majority of the voting members of the board 7 32 constitutes a quorum. The affirmative vote of a majority of 7 33 its voting members is necessary for any action taken by the 7 34 board. The majority shall not include a member who has a 7 35 conflict of interest and a statement by a member of a conflict 8 1 of interest is conclusive for this purpose. A vacancy in the 8 2 membership of the board does not impair the right of a quorum 8 3 to exercise the rights and perform the duties of the board. 8 4 An action taken by the board under this chapter may be 8 5 authorized by resolution at a regular or special meeting and 8 6 each resolution shall take effect immediately and need not be 8 7 published or posted. Meetings of the board shall be held at 8 8 the call of the chairperson or at the request of a majority of 8 9 the board's voting members. 8 10 f. The members of the board shall not receive compensation 8 11 for the performance of their duties as members but each member 8 12 shall be paid necessary expenses while engaged in the 8 13 performance of duties of the exchange. 8 14 g. The members of the board shall give bond as required 8 15 for public officers in chapter 64. 8 16 h. The members of the board are subject to and are 8 17 officials within the meaning of chapter 68B. 8 18 3. EXECUTIVE DIRECTOR. The voting members of the board 8 19 shall appoint an executive director, subject to confirmation 8 20 by the senate, to supervise the administrative affairs and 8 21 general management and operations of the exchange. The board 8 22 may appoint an assistant executive director, and other 8 23 officers as the members of the board determine. The officers 8 24 shall not be members of the board, shall serve at the pleasure 8 25 of the voting members of the board, and shall receive 8 26 compensation as fixed by the board. 8 27 4. SECRETARY. The secretary of the board shall keep a 8 28 record of the proceedings of the board and shall be custodian 8 29 of all books, documents, and papers filed with the board, and 8 30 the minute book or journal of the board. The secretary shall 8 31 serve at the pleasure of the board, and shall receive 8 32 compensation as fixed by the board. 8 33 Sec. 5. NEW SECTION. 514M.5 BOARD POWERS == DUTIES. 8 34 The board shall have broad authority to accomplish the 8 35 purposes of this chapter, including but not limited to: 9 1 1. Developing a plan of operation for the exchange 9 2 pursuant to rules adopted under chapter 17A that includes but 9 3 is not limited to the following: 9 4 a. Establishing procedures for operations of the exchange. 9 5 b. Establishing procedures for communications with the 9 6 executive director. 9 7 c. Establishing procedures for the selection and approval 9 8 of qualified health care coverage to be offered through the 9 9 exchange. 9 10 d. Establishing procedures for the enrollment of eligible 9 11 individuals and groups. 9 12 e. Establishing procedures for appeals of eligibility 9 13 decisions for the Iowa choice care program. 9 14 f. Establishing a plan for operating a health insurance 9 15 service center to provide eligible individuals and groups with 9 16 information on the exchange and for managing exchange 9 17 enrollment. 9 18 g. Establishing and managing a system of collecting all 9 19 premium payments made by, or on behalf of, individuals 9 20 obtaining health insurance through the exchange, including any 9 21 premium payments made by enrollees, employees, unions, or 9 22 other organizations. 9 23 h. Establishing and managing a system of remitting premium 9 24 assistance payments to carriers. 9 25 i. Establishing a plan for publicizing the existence of 9 26 the exchange and the exchange's requirements and enrollment 9 27 procedures. 9 28 j. Developing criteria for determining that certain 9 29 qualified health care coverage shall no longer be made 9 30 available through the exchange, and developing a plan to 9 31 decertify and remove exchange approval from certain qualified 9 32 health care coverage. 9 33 k. Developing criteria for plans eligible for premium 9 34 assistance payments through the Iowa choice care program. 9 35 2. Establishing by rules adopted under chapter 17A what 10 1 constitutes qualified health care coverage which meets certain 10 2 standards of quality and affordability by: 10 3 a. Setting parameters for what is affordable by creating 10 4 an affordability schedule that is conservative to prevent harm 10 5 to people who are struggling financially and that utilizes a 10 6 progressive scale of subsidization by the state that decreases 10 7 as incomes increase and requires people with very low incomes 10 8 to pay only small amounts for health care coverage with no 10 9 financial penalties. 10 10 b. Establishing a program to subsidize health care 10 11 coverage on a sliding scale based on income for low=income 10 12 uninsured individuals and families with incomes below three 10 13 hundred percent of the federal poverty level as determined by 10 14 the most recently revised poverty income guidelines published 10 15 by the United States department of health and human services 10 16 using the following priorities for subsidization of the cost 10 17 of such coverage by income level as funding becomes available: 10 18 (1) Less than one hundred percent of federal poverty level 10 19 == one hundred percent of the cost subsidized. 10 20 (2) One hundred percent to less than one hundred fifty 10 21 percent of the federal poverty level == eighty percent of the 10 22 cost subsidized. 10 23 (3) One hundred fifty percent to less than two hundred 10 24 percent of the federal poverty level == sixty percent of the 10 25 cost subsidized. 10 26 (4) Two hundred percent to less than two hundred fifty 10 27 percent of the federal poverty level == forty percent of the 10 28 cost subsidized. 10 29 (5) Two hundred fifty percent to less than three hundred 10 30 percent of the federal poverty level == twenty percent of the 10 31 cost subsidized. 10 32 c. Defining what constitutes qualified health care 10 33 coverage. For purposes of this definition, the board may 10 34 consider requirements for coverage and benefits that include 10 35 but are not limited to: 11 1 (1) No underwriting requirements and no preexisting 11 2 condition exclusions. 11 3 (2) Portability. 11 4 (3) Coverage of physical, behavioral, dental health and 11 5 vision services, and prescription drugs. 11 6 (4) Copayments and deductibles that do not exceed 11 7 specified amounts. No copayments or deductibles for wellness, 11 8 prevention, and chronic disease management services. 11 9 (5) No reimbursement of providers for an otherwise covered 11 10 service if the service is required solely on account of the 11 11 provider's avoidable medical error. 11 12 (6) If coverage of an insured's dependents is included, 11 13 coverage of those unmarried dependents up to twenty=five years 11 14 of age. 11 15 (7) A requirement that all insureds have a medical home. 11 16 (8) Coverage of wellness, prevention, and chronic disease 11 17 management services including without limitation physical and 11 18 psychosocial screenings for children which satisfy the early 11 19 periodic screening, diagnosis, and treatment standards of the 11 20 medical assistance program. 11 21 (9) Coverage of emergency mental health services when 11 22 provided by a certified emergency mental health services 11 23 provider. 11 24 (10) Premium discounts for nonsmokers and for insureds who 11 25 successfully lose weight through participation in a diet and 11 26 exercise program prescribed by a qualified health care 11 27 professional. 11 28 (11) A requirement that all participating health care 11 29 providers: 11 30 (a) Utilize electronic prescriptions. 11 31 (b) Utilize electronic medical records. 11 32 (c) Provide rate schedules to the board for all services 11 33 offered. 11 34 3. Collaborating with carriers to do the following, 11 35 including but not limited to: 12 1 a. Assuring the availability of private qualified health 12 2 insurance coverage to all Iowans by designing solutions to 12 3 issues related to guaranteed issuance of insurance, 12 4 preexisting condition exclusions, portability, and allowable 12 5 pooling and rating classifications. 12 6 b. Formulating principles that ensure fair and appropriate 12 7 practices related to issues involving individual qualified 12 8 health insurance coverage policies such as recision and 12 9 preexisting condition clauses, and that provide for a binding 12 10 third=party review process to resolve disputes related to such 12 11 issues. 12 12 c. Designing affordable, portable qualified health 12 13 insurance coverage plans that meet the needs of low=income 12 14 populations. 12 15 4. Designing a health care coverage program called Iowa 12 16 choice care which offers private qualified health care 12 17 coverage through the exchange, whose purchase is publicly 12 18 subsidized on a sliding scale based on income for low=income 12 19 individuals and families who do not meet eligibility 12 20 guidelines for any other public health care program, and which 12 21 provides affordable, unsubsidized qualified health care 12 22 coverage options for purchase by any other person who wishes 12 23 to purchase them, including individuals, families, and 12 24 employees of small businesses. The subsidized portion of the 12 25 Iowa choice care program may be implemented incrementally as 12 26 funding becomes available. 12 27 5. Designing a subsidy program for payment of premiums for 12 28 qualified health care coverage by low=income people that 12 29 complements, not supplants, the medical assistance program. 12 30 The subsidy program may include subsidizing an employee's 12 31 purchase of health care insurance offered by that person's 12 32 employer. 12 33 6. Implementing initiatives such as uniform health care 12 34 insurance applications and other standardized administrative 12 35 procedures that make the purchase of health care insurance 13 1 easier and lower administrative costs such as determining what 13 2 constitutes an equitable administrative formula for carriers. 13 3 7. Encouraging initiatives that allow portability of 13 4 health care insurance between employers for part=time workers, 13 5 persons who work more than one job, seasonal workers, or 13 6 people who change jobs. 13 7 8. Controlling health insurance coverage premiums by 13 8 establishing what constitutes reasonable rates, to ensure 13 9 affordability of coverage. 13 10 9. Studying the ramifications of requiring each employer 13 11 with more than ten employees in this state to adopt and 13 12 maintain a cafeteria plan that satisfies section 125 of the 13 13 federal Internal Revenue Code of 1986, and the rules and 13 14 regulations promulgated by the board. 13 15 10. Determining each applicant's eligibility to purchase 13 16 health care insurance offered by the exchange, including 13 17 eligibility for premium assistance payments. 13 18 11. Seeking and receiving any grant funding from the 13 19 federal government, departments, or agencies of this state, 13 20 and private foundations. 13 21 12. Contracting with professional service firms as may be 13 22 necessary, and fixing their compensation. 13 23 13. Contracting with companies which provide third=party 13 24 administrative and billing services for insurance products. 13 25 14. Maintaining an office at such place or places in this 13 26 state as it may designate. 13 27 15. Employing persons necessary to carry out the duties of 13 28 the exchange. 13 29 16. Entering into agreements with the department of 13 30 revenue, the department of human services, the division of 13 31 insurance, and any other state agencies the board deems 13 32 necessary to implement its duties under this chapter. 13 33 17. Creating, in collaboration with the department of 13 34 revenue, a form for the department to distribute to every 13 35 person to whom it distributes information regarding personal 14 1 income tax liability, including every person who filed a 14 2 personal income tax return in the most recent calendar year, 14 3 informing the recipient of the requirements, if any, to 14 4 establish and maintain qualified health care coverage. 14 5 18. Designing a premium schedule to be published by the 14 6 exchange by December 1 of each year, which accounting for 14 7 maximum pricing in all rating factors with an exception for 14 8 age, includes the lowest premium on the market for which an 14 9 individual would be eligible for qualified health care 14 10 coverage. The schedule shall publish premiums allowing 14 11 variance for age and rate basis type. 14 12 19. Developing and implementing a plan and corresponding 14 13 timeline detailing action steps toward implementing this 14 14 chapter, by rules adopted pursuant to chapter 17A, as provided 14 15 in section 514M.8. 14 16 20. Commissioning a study to examine and model the effect 14 17 of merging the individual and small group health insurance 14 18 markets in this state. 14 19 21. Commissioning a study to examine and model the effect 14 20 of merging the Iowa comprehensive health insurance association 14 21 and the Iowa health care coverage exchange fund or modifying 14 22 the association to improve accessibility to qualified health 14 23 care coverage at reasonably affordable rates prior to complete 14 24 implementation of health care coverage of all Iowans. 14 25 22. Considering changing grouping and rating 14 26 classifications, including age rating, to better reflect 14 27 principles of equity, fairness, and cost=sharing, and that 14 28 best facilitate the goal of achieving quality, affordable 14 29 health care coverage for all Iowans. 14 30 Sec. 6. NEW SECTION. 514M.6 ANNUAL REPORT. 14 31 The board shall keep an accurate account of all the 14 32 activities of the exchange and of all its receipts and 14 33 expenditures and shall annually make a report thereof as of 14 34 the end of its fiscal year to the governor and the general 14 35 assembly. 15 1 Sec. 7. NEW SECTION. 514M.7 HEALTH CARE COVERAGE 15 2 EXCHANGE FUND == APPROPRIATION. 15 3 The health care coverage exchange fund is created in the 15 4 state treasury as a separate fund under the control of the 15 5 exchange. All moneys collected from premiums paid for health 15 6 care plans offered by the exchange, and any other moneys that 15 7 are appropriated or transferred to the fund shall be credited 15 8 to the fund. All moneys credited to the fund are appropriated 15 9 and available to the exchange to be used for the purposes set 15 10 forth in this chapter. Notwithstanding section 8.33, any 15 11 balance in the fund on June 30 of each fiscal year shall not 15 12 revert to the general fund of the state, but shall be 15 13 available for purposes set forth in this chapter in subsequent 15 14 fiscal years. 15 15 Sec. 8. NEW SECTION. 514M.8 HEALTH CARE COVERAGE FOR ALL 15 16 == TRANSITION == IMPLEMENTATION. 15 17 1. The board shall design and implement a program, as 15 18 funding becomes available, including a timetable and 15 19 procedures for implementation, to progress toward achieving 15 20 the goal that all children in this state have qualified health 15 21 care coverage, by maximizing the use of state and private 15 22 financial support as follows: 15 23 a. As funding becomes available, all children who are 15 24 eligible for medical assistance, Medicaid expansion, and 15 25 hawk=i shall have coverage by December 31, 2009. Parents of 15 26 such children shall provide proof that each child has 15 27 qualified health care coverage at a time and in a manner as 15 28 specified by the board by rule. Implementation of this 15 29 requirement may include a reporting requirement on Iowa income 15 30 tax returns or during school registration. 15 31 b. As funding becomes available, the state may provide a 15 32 subsidy to assist with the purchase of qualified health care 15 33 coverage for the remaining uninsured children up to eighteen 15 34 years of age using a sliding scale based on family income by 15 35 December 31, 2009. Parents of such children who are eligible 16 1 for subsidies shall provide proof that each child has 16 2 qualified health care coverage, at a time and in a manner as 16 3 specified by the board by rule. Implementation of this 16 4 requirement may include a reporting requirement on Iowa income 16 5 tax returns or during school registration. 16 6 c. All parents of children up to eighteen years of age may 16 7 be required to provide proof that each child has qualified 16 8 health care coverage, at a time and in a manner as specified 16 9 by the board by rule. Implementation of this requirement may 16 10 include a reporting requirement on Iowa income tax returns or 16 11 during school registration. 16 12 2. The board shall design and implement a program, 16 13 including a timetable and procedures for implementation after 16 14 all children have qualified health care coverage, to work 16 15 toward achieving the goal that all adults in the state have 16 16 qualified health care coverage as follows: 16 17 a. The state may continue to expand options for 16 18 individuals who are dually eligible for Medicare and medical 16 19 assistance by utilizing evidence=based medical treatment. 16 20 b. As funding becomes available, the state may provide a 16 21 subsidy to assist uninsured health and long=term care workers 16 22 and child care workers with the purchase of qualified health 16 23 care coverage. The board shall define "health and long=term 16 24 care workers" and "child care workers" by rule. A health or 16 25 long=term care worker or child care worker who is eligible for 16 26 the subsidy shall provide proof of qualified health care 16 27 coverage, at a time and in a manner as specified by the board 16 28 by rule. Implementation of this requirement may include a 16 29 reporting requirement on Iowa income tax returns. 16 30 c. As funding becomes available, the state may provide a 16 31 subsidy to assist with the purchase of qualified health care 16 32 coverage by the remaining uninsured adults using a sliding 16 33 scale based on income. A person who is eligible for the 16 34 subsidy shall provide proof of qualified health care coverage, 16 35 at a time and in a manner as specified by the board by rule. 17 1 Implementation of this requirement may include a reporting 17 2 requirement on Iowa income tax returns. 17 3 d. All adults may be required to provide proof of 17 4 qualified health care coverage, at a time and in a manner as 17 5 specified by the board by rule. Implementation of this 17 6 requirement may include a reporting requirement on Iowa income 17 7 tax returns. 17 8 3. An adult or parent of a child who is required to 17 9 provide proof of qualified health care coverage of the adult 17 10 or child and does not do so, may automatically be assigned and 17 11 enrolled in the appropriate coverage offered by the exchange 17 12 at a cost and in a time and manner determined by the board by 17 13 rule. 17 14 4. The board shall collaborate with carriers to institute 17 15 health insurance reforms that may become effective before 17 16 qualified health care coverage for all Iowans has been 17 17 achieved. Such reforms may include: 17 18 a. Carriers may enroll any applicant rated up to two 17 19 hundred percent of standard premium rates at a maximum premium 17 20 rate of one hundred fifty percent of the standard premium 17 21 rate. 17 22 b. Any applicant rated at over two hundred percent of 17 23 standard premium rates may be enrolled in a plan offered by 17 24 the state, such as the Iowa comprehensive health insurance 17 25 association or the Iowa health care coverage exchange fund or 17 26 a combination thereof at one hundred fifty percent of standard 17 27 premium rates with the state subsidizing any cost over that 17 28 amount. 17 29 c. Carriers may offer open enrollment periods where any 17 30 applicant may enroll with no preexisting conditions 17 31 exclusions. 17 32 d. Carriers may guarantee issuance of insurance with no 17 33 preexisting condition exclusions if the applicant was covered 17 34 by creditable coverage that was continuous to a date not more 17 35 than sixty=three days prior to the effective date of the new 18 1 coverage. 18 2 DIVISION II 18 3 MEDICAL HOME 18 4 DIVISION XXI 18 5 MEDICAL HOME 18 6 Sec. 9. NEW SECTION. 135.154 DEFINITIONS. 18 7 As used in this chapter, unless the context otherwise 18 8 requires: 18 9 1. "Department" means the department of public health. 18 10 2. "Health care professional" means a person who is 18 11 licensed, certified, or otherwise authorized or permitted by 18 12 the law of this state to administer health care in the 18 13 ordinary course of business or in the practice of a 18 14 profession. 18 15 3. "Medical home" means a team approach to providing 18 16 health care that originates in a primary care setting; fosters 18 17 a partnership among the patient, the primary care physician 18 18 and other health care professionals, and where appropriate, 18 19 the patient's family; utilizes the partnership to access all 18 20 medical and nonmedical health=related services needed by the 18 21 patient and the patient's family to achieve maximum health 18 22 potential; maintains a centralized, comprehensive record of 18 23 all health=related services to promote continuity of care; and 18 24 has all of the characteristics specified in section 135.155. 18 25 4. "Medical home commission" or "commission" means the 18 26 medical home commission created in section 135.156. 18 27 5. "National committee for quality assurance" means the 18 28 nationally recognized, independent nonprofit organization that 18 29 measures the quality and performance of health care and health 18 30 care plans in the United States; provides accreditation, 18 31 certification, and recognition programs for health care plans 18 32 and programs; and is recognized in Iowa as an accrediting 18 33 organization for commercial and Medicaid=managed care 18 34 organizations. 18 35 6. "Nonphysician primary care professionals" means 19 1 providers of health care other than physicians who render some 19 2 primary care services including nurse practitioners, physician 19 3 assistants, and other health care professionals. 19 4 7. "Personal provider" means the patient's first point of 19 5 contact in the health care system with a primary care provider 19 6 who identifies the patient's health needs, and, working with a 19 7 team of health care professionals, provides for and 19 8 coordinates appropriate care to address the health needs 19 9 identified. 19 10 8. "Primary care" means health care which emphasizes 19 11 providing for a patient's general health needs and utilizes 19 12 collaboration with other health care professionals and 19 13 consultation or referral as appropriate to meet the needs 19 14 identified. "Primary care" is usually provided by general and 19 15 family practitioners, internists, obstetricians, 19 16 pediatricians, and certain nonprimary care professionals who 19 17 are specifically trained for and skilled in comprehensive 19 18 first contact and continuing care for persons with any 19 19 undiagnosed sign, symptom, or health concern not limited by 19 20 problem origin, organ system, or diagnosis. "Primary care" 19 21 includes health promotion, disease prevention, health 19 22 maintenance, counseling, patient education, and diagnosis and 19 23 treatment of acute and chronic illnesses. "Primary care" also 19 24 provides patient advocacy in the health care system to 19 25 accomplish cost=effective care through coordination of health 19 26 care services, promotion of effective communication with 19 27 patients, and encouragement of the role of the patient as a 19 28 partner in health care. 19 29 9. "Primary care physician" means a generalist physician 19 30 who is specifically trained to provide primary care at the 19 31 point of first contact, and takes continuing responsibility 19 32 for providing the patient's care. 19 33 Sec. 10. NEW SECTION. 135.155 MEDICAL HOME PURPOSES == 19 34 CHARACTERISTICS. 19 35 1. The purposes of a medical home are the following: 20 1 a. To reduce disparities in health care access, delivery, 20 2 and health care outcomes. 20 3 b. To improve quality of health care and lower health care 20 4 costs, thereby creating savings to allow more Iowans to have 20 5 health care coverage and to provide for the sustainability of 20 6 the health care system. 20 7 c. To provide a tangible method to document if each Iowan 20 8 has access to health care. 20 9 2. A medical home has all of the following 20 10 characteristics: 20 11 a. A personal provider. Each patient has an ongoing 20 12 relationship with a personal provider trained to provide first 20 13 contact and continuous and comprehensive care. 20 14 b. A provider=directed medical practice. The personal 20 15 provider leads a team of individuals at the practice level who 20 16 collectively take responsibility for the ongoing health care 20 17 of patients. 20 18 c. Whole person orientation. The personal provider is 20 19 responsible for providing for all of a patient's health care 20 20 needs or taking responsibility for appropriately arranging 20 21 health care by other qualified health care professionals. 20 22 This responsibility includes health care at all stages of life 20 23 including provision of acute care, chronic care, preventive 20 24 services, and end=of=life care. 20 25 d. Coordination and integration of care. Care is 20 26 coordinated and integrated across all elements of the complex 20 27 health care system and the patient's community. Care is 20 28 facilitated by registries, information technology, health 20 29 information exchanges, and other means to assure that patients 20 30 get the indicated care when and where they need and want the 20 31 care in a culturally and linguistically appropriate manner. 20 32 e. Quality and safety. The following are quality and 20 33 safety components of the medical home: 20 34 (1) Provider=directed medical practices advocate for their 20 35 patients to support the attainment of optimal, 21 1 patient=centered outcomes that are defined by a care planning 21 2 process driven by a compassionate, robust partnership between 21 3 providers, the patient, and the patient's family. 21 4 (2) Evidence=based medicine and clinical decision=support 21 5 tools guide decision making. 21 6 (3) Providers in the medical practice accept 21 7 accountability for continuous quality improvement through 21 8 voluntary engagement in performance measurement and 21 9 improvement. 21 10 (4) Patients actively participate in decision making and 21 11 feedback is sought to ensure that the patients' expectations 21 12 are being met. 21 13 (5) Information technology is utilized appropriately to 21 14 support optimal patient care, performance measurement, patient 21 15 education, and enhanced communication. 21 16 (6) Practices participate in a voluntary recognition 21 17 process conducted by an appropriate nongovernmental entity to 21 18 demonstrate that the practice has the capabilities to provide 21 19 patient=centered services consistent with the medical home 21 20 model. 21 21 (7) Patients and families participate in quality 21 22 improvement activities at the practice level. 21 23 f. Enhanced access to health care. Enhanced access to 21 24 health care is available through systems such as open 21 25 scheduling, expanded hours, and new options for communication 21 26 between the patient, the patient's personal provider, and 21 27 practice staff. 21 28 g. Payment. The payment system appropriately recognizes 21 29 the added value provided to patients who have a 21 30 patient=centered medical home. The payment structure 21 31 framework of the medical home provides all of the following: 21 32 (1) Reflects the value of provider and nonprovider staff 21 33 and patient=centered care management work that is in addition 21 34 to the face=to=face visit. 21 35 (2) Pays for services associated with coordination of 22 1 health care both within a given practice and between 22 2 consultants, ancillary providers, and community resources. 22 3 (3) Supports adoption and use of health information 22 4 technology for quality improvement. 22 5 (4) Supports provision of enhanced communication access 22 6 such as secure electronic mail and telephone consultation. 22 7 (5) Recognizes the value of physician work associated with 22 8 remote monitoring of clinical data using technology. 22 9 (6) Allows for separate fee=for=service payments for 22 10 face=to=face visits. Payments for health care management 22 11 services that are in addition to the face=to=face visit do not 22 12 result in a reduction in the payments for face=to=face visits. 22 13 (7) Recognizes case mix differences in the patient 22 14 population being treated within the practice. 22 15 (8) Allows providers to share in savings from reduced 22 16 hospitalizations associated with provider=guided health care 22 17 management in the office setting. 22 18 (9) Allows for additional payments for achieving 22 19 measurable and continuous quality improvements. 22 20 Sec. 11. NEW SECTION. 135.156 MEDICAL HOME COMMISSION. 22 21 1. A medical home commission is created consisting of the 22 22 following members: 22 23 a. The director of public health, or the director's 22 24 designee, who shall act as chairperson of the commission. 22 25 b. The director of human services, or the director's 22 26 designee. 22 27 c. The commissioner of insurance, or the commissioner's 22 28 designee. 22 29 d. A representative of health insurers. 22 30 e. A representative of the Iowa dental association. 22 31 f. A representative of the Iowa nurses association. 22 32 g. A family physician who is a member of the Iowa academy 22 33 of family physicians. 22 34 h. A health care consumer. 22 35 i. A representative of the Iowa collaborative safety net 23 1 provider network established pursuant to section 135.153. 23 2 2. a. Members of the commission from the organizations 23 3 specified in subsection 1 shall be selected by the respective 23 4 organization. Terms of public members of the commission shall 23 5 begin and end as provided by section 69.19. Any vacancy shall 23 6 be filled in the same manner as regular appointments are made 23 7 for the unexpired portion of the regular term. Public members 23 8 shall serve terms of three years. A member is eligible for 23 9 reappointment for two successive terms. 23 10 b. Public members of the commission shall receive their 23 11 actual and necessary expenses incurred in the performance of 23 12 their duties and may be eligible to receive compensation as 23 13 provided in section 7E.6. 23 14 c. The commission shall meet at least quarterly and in 23 15 accordance with rules adopted by the commission. 23 16 d. A majority of the members of the commission constitutes 23 17 a quorum. Any action taken by the commission must be adopted 23 18 by the affirmative vote of a majority of its voting 23 19 membership. 23 20 e. The commission is located for administrative purposes 23 21 within the division of health promotion and chronic disease 23 22 management within the department. The commission shall 23 23 coordinate efforts with other divisions, bureaus, and offices 23 24 within the department including but not limited to the office 23 25 of multicultural health established in section 135.12 and oral 23 26 health bureau established in section 135.15, in order to avoid 23 27 duplication of efforts. The department shall provide office 23 28 space, staff assistance, administrative support, and necessary 23 29 supplies and equipment to the commission. 23 30 3. The commission may adopt rules pursuant to chapter 17A 23 31 to administer the programs of the commission. 23 32 Sec. 12. NEW SECTION. 135.157 MEDICAL HOME SYSTEM == 23 33 DEVELOPMENT AND IMPLEMENTATION. 23 34 1. The commission shall develop a plan for implementation 23 35 of a statewide medical home system. The initial phase shall 24 1 focus on providing a medical home for children, beginning with 24 2 those children who are recipients of medical assistance or the 24 3 hawk=i program, and expanding to children covered through the 24 4 exchange created pursuant to section 514M.4. The second phase 24 5 shall focus on providing a medical home to the expansion 24 6 population under the IowaCare program and to adult recipients 24 7 of medical assistance. The third phase shall focus on 24 8 providing a medical home to adults covered through the 24 9 exchange created pursuant to section 514M.4. The commission, 24 10 in collaboration with parents, schools, communities, health 24 11 plans, and providers, shall endeavor to increase healthy 24 12 outcomes for children and adults by linking the children and 24 13 adults with a medical home, identifying health improvement 24 14 goals for children and adults, and linking reimbursement 24 15 strategies to increasing healthy outcomes for children and 24 16 adults. The plan shall provide that the medical home system 24 17 shall do all of the following: 24 18 a. Coordinate and provide access to evidence=based health 24 19 care services, emphasizing convenient, comprehensive primary 24 20 care and including preventive, screening, and well=child 24 21 health services. 24 22 b. Provide access to appropriate specialty care and 24 23 in=patient services. 24 24 c. Provide quality=driven and cost=effective health care. 24 25 d. Promote strong and effective medical management 24 26 including but not limited to planning treatment strategies, 24 27 monitoring health outcomes and resource use, sharing 24 28 information, and organizing care to avoid duplication of 24 29 service. 24 30 e. Emphasize patient and provider accountability. 24 31 f. Prioritize local access to the continuum of health care 24 32 services in the most appropriate setting. 24 33 g. Establish a baseline for medical home goals and 24 34 establish performance measures that indicate a child or adult 24 35 has an established and effective medical home. For children, 25 1 these goals and performance measures may include but are not 25 2 limited to childhood immunizations rates, well=child care 25 3 utilization rates, care management for children with chronic 25 4 illnesses, emergency room utilization, and preventive oral 25 5 health service utilization. 25 6 h. For children, coordinate with and integrate guidelines, 25 7 data, and information from existing newborn and child health 25 8 programs and entities, including but not limited to the 25 9 healthy opportunities to experience, success=healthy families 25 10 Iowa program, the community empowerment program, the center 25 11 for congenital and inherited disorders screening and health 25 12 care programs, standards of care for pediatric health 25 13 guidelines, the office of multicultural health established in 25 14 section 135.12, the oral health bureau established in section 25 15 135.15, and other similar programs and services. 25 16 2. The commission shall develop an organizational 25 17 structure for the medical home system in this state. The 25 18 organizational structure plan shall integrate existing 25 19 resources, provide a strategy to coordinate health care 25 20 services, provide for monitoring and data collection on 25 21 medical homes, provide for training and education to health 25 22 care professionals and families, and provide for transition of 25 23 children to the adult medical care system. The organizational 25 24 structure may be based on collaborative teams of stakeholders 25 25 throughout the state such as local public health agencies, the 25 26 collaborative safety net provider network established in 25 27 section 135.153, or a combination of statewide organizations. 25 28 Care coordination may be provided through regional offices or 25 29 through individual provider practices. The organizational 25 30 structure may also include the use of telemedicine resources, 25 31 and may provide for partnering with pediatric and family 25 32 practice residency programs to improve access to preventive 25 33 care for children. The organizational structure shall also 25 34 address the need to organize and provide health care to 25 35 increase accessibility for patients including using venues 26 1 more accessible to patients and having hours of operation that 26 2 are conducive to the population served. 26 3 3. The commission shall adopt standards and a process to 26 4 certify medical homes based on the national committee for 26 5 quality assurance standards. The certification process and 26 6 standards shall provide mechanisms to monitor performance and 26 7 to evaluate, promote, and improve the quality of health of and 26 8 health care delivered to patients through a medical home. The 26 9 mechanism shall require participating providers to monitor 26 10 clinical progress and performance in meeting applicable 26 11 standards and to provide information in a form and manner 26 12 specified by the commission. The evaluation mechanism shall 26 13 be developed with input from consumers, providers, and payers. 26 14 At a minimum the evaluation shall determine any increased 26 15 quality in health care provided and any decrease in cost 26 16 resulting from the medical home system compared with other 26 17 health care delivery systems. The standards and process shall 26 18 also include a mechanism for other ancillary service providers 26 19 to become affiliated with a certified medical home. 26 20 4. The commission shall adopt education and training 26 21 standards for health care professionals participating in the 26 22 medical home system. 26 23 5. The commission shall provide for system simplification 26 24 through the use of universal referral forms, internet=based 26 25 tools for providers, and a central medical home internet site 26 26 for providers. 26 27 6. The commission shall determine a rate of reimbursement 26 28 and recommend incentives for participation in the medical home 26 29 system to ensure that providers enter and remain participating 26 30 in the system. In adopting the incentives, the commission 26 31 shall consider, at a minimum, providing incentives to promote 26 32 wellness, prevention, chronic care management, immunizations, 26 33 health care management, and the use of electronic health 26 34 records. In developing the reimbursement system and 26 35 incentives, the commission shall analyze, at a minimum, the 27 1 feasibility of all of the following: 27 2 a. Reimbursement under the medical assistance program to 27 3 promote wellness and prevention, provide care coordination, 27 4 and provide chronic care management. 27 5 b. Increasing reimbursement to Medicare levels for certain 27 6 wellness and prevention services, chronic care management, and 27 7 immunizations. 27 8 c. Providing reimbursement for primary care services by 27 9 addressing the disparities between reimbursement for specialty 27 10 services and primary care services. 27 11 d. Increased funding for efforts to transform medical 27 12 practices into certified medical homes, including emphasizing 27 13 the implementation of the use of electronic health records. 27 14 e. Targeted reimbursement to providers linked to health 27 15 care quality improvement measures established by the 27 16 commission. 27 17 f. Reimbursement for specified ancillary support services 27 18 such as transportation for medical appointments and other such 27 19 services. 27 20 7. The commission shall coordinate the requirements and 27 21 activities of the medical home system with the requirements 27 22 and activities of the dental home for children as described in 27 23 section 249J.14, subsection 7, and shall recommend financial 27 24 incentives for dentists and nondental providers to promote 27 25 oral health care coordination through preventive dental 27 26 intervention, early identification of oral disease risk, 27 27 health care coordination and data tracking, treatment, chronic 27 28 care management, education and training, parental guidance, 27 29 and oral health promotions for children. 27 30 8. The commission shall integrate the recommendations and 27 31 policies developed by the prevention and chronic care 27 32 management advisory council into the medical home system. 27 33 9. Implementation phases. 27 34 a. Initial implementation shall require participation in 27 35 the medical home system of children who are recipients of the 28 1 medical assistance or the hawk=i programs and children who 28 2 have health insurance coverage through the exchange created in 28 3 section 514M.4. The commission shall develop an enhanced 28 4 reimbursement methodology for recipients of medical assistance 28 5 and hawk=i to compensate providers who participate in the 28 6 medical home system. The department of human services shall 28 7 submit any state plan amendments or request any waivers 28 8 necessary from the centers for Medicare and Medicaid services 28 9 of the United States department of health and human services 28 10 for approval of the reimbursement methodology. The commission 28 11 shall work with the exchange to develop an enhanced 28 12 reimbursement methodology for children covered through the 28 13 exchange to compensate providers who participate in the 28 14 medical home system. 28 15 b. The commission shall work with the department of human 28 16 services and with the exchange to expand the medical home 28 17 system to adult recipients of medical assistance, the 28 18 expansion population under the IowaCare program, and adults 28 19 covered through the exchange. The commission shall work with 28 20 the centers for Medicare and Medicaid services of the United 28 21 States department of health and human services to allow 28 22 Medicare recipients to utilize the medical home system. 28 23 c. The commission shall work with the department of 28 24 administrative services to allow state employees to utilize 28 25 the medical home system. 28 26 d. The commission shall work with insurers and 28 27 self=insured companies, if requested, to make the medical home 28 28 system available to individuals with private health care 28 29 coverage. 28 30 10. The commission shall provide oversight for all 28 31 certified medical homes. The commission shall review the 28 32 progress of the medical home system at each meeting and 28 33 recommend improvements to the system, as necessary. 28 34 11. The commission shall annually evaluate the medical 28 35 home system and make recommendations to the governor and the 29 1 general assembly regarding improvements to and continuation of 29 2 the system. 29 3 Sec. 13. Section 249J.14, subsection 7, Code 2007, is 29 4 amended to read as follows: 29 5 7. DENTAL HOME FOR CHILDREN. By July 1, 2008, every Every 29 6 recipient of medical assistance who is a child twelve years of 29 7 age or younger shall have a designated dental home and shall 29 8 be provided with the dental screenings and preventive care 29 9 identified in the oral health standards services as defined 29 10 under the early and periodic screening, diagnostic, and 29 11 treatment program. 29 12 DIVISION III 29 13 PREVENTION AND CHRONIC CARE MANAGEMENT 29 14 DIVISION XXII 29 15 PREVENTION AND CHRONIC CARE MANAGEMENT 29 16 Sec. 14. NEW SECTION. 135.158 DEFINITIONS. 29 17 For the purpose of this division, unless the context 29 18 otherwise requires: 29 19 1. "Chronic care" means health care services provided by a 29 20 health care professional for an established clinical condition 29 21 that is expected to last a year or more and that requires 29 22 ongoing clinical management attempting to restore the 29 23 individual to highest function, minimize the negative effects 29 24 of the chronic condition, and prevent complications related to 29 25 the chronic condition. 29 26 2. "Chronic care information system" means approved 29 27 information technology to enhance the development and 29 28 communication of information to be used in providing chronic 29 29 care, including clinical, social, and economic outcomes of 29 30 chronic care. 29 31 3. "Chronic care management" means a system of coordinated 29 32 health care interventions and communications for individuals 29 33 with chronic conditions, including significant patient 29 34 self=care efforts, systemic supports for the health care 29 35 professional and patient relationship, and a chronic care plan 30 1 emphasizing prevention of complications utilizing 30 2 evidence=based practice guidelines, patient empowerment 30 3 strategies, and evaluation of clinical, humanistic, and 30 4 economic outcomes on an ongoing basis with the goal of 30 5 improving overall health. 30 6 4. "Chronic care plan" means a plan of care between an 30 7 individual and the individual's principal health care 30 8 professional that emphasizes prevention of complications 30 9 through patient empowerment including but not limited to 30 10 providing incentives to engage the patient in the patient's 30 11 own care and in clinical, social, or other interventions 30 12 designed to minimize the negative effects of the chronic 30 13 condition. 30 14 5. "Chronic care resources" means health care 30 15 professionals, advocacy groups, health departments, schools of 30 16 public health and medicine, health plans, and others with 30 17 expertise in public health, health care delivery, health care 30 18 financing, and health care research. 30 19 6. "Chronic condition" means an established clinical 30 20 condition that is expected to last a year or more and that 30 21 requires ongoing clinical management. 30 22 7. "Department" means the department of public health. 30 23 8. "Director" means the director of public health. 30 24 9. "Eligible individual" means a resident of this state 30 25 who has been diagnosed with a chronic condition or is at an 30 26 elevated risk for a chronic condition and who is a recipient 30 27 of medical assistance or hawk=i, is a member of the expansion 30 28 population pursuant to chapter 249J, is an inmate of a 30 29 correctional institution in this state, or is an individual 30 30 who has qualified health care coverage through the exchange 30 31 created in section 514M.4. 30 32 10. "Health care professional" means health care 30 33 professional as defined in section 135.154. 30 34 11. "Health risk assessment" means screening by a health 30 35 care professional for the purpose of assessing an individual's 31 1 health, including tests or physical examinations and a survey 31 2 or other tool used to gather information about an individual's 31 3 health, medical history, and health risk factors during a 31 4 health screening. 31 5 12. "State initiative for prevention and chronic care 31 6 management" or "state initiative" means the state's plan for 31 7 developing a chronic care organizational structure for 31 8 prevention and chronic care management, including coordinating 31 9 the efforts of health care professionals and chronic care 31 10 resources to promote the health of residents and the 31 11 prevention and management of chronic conditions, developing 31 12 and implementing arrangements for delivering prevention 31 13 services and chronic care management, developing significant 31 14 patient self=care efforts, providing systemic support for the 31 15 health care professional=patient relationship and options for 31 16 channeling chronic care resources and support to health care 31 17 professionals, providing for community development and 31 18 outreach and education efforts, and coordinating information 31 19 technology initiatives with the chronic care information 31 20 system. 31 21 Sec. 15. NEW SECTION. 135.159 PREVENTION AND CHRONIC 31 22 CARE MANAGEMENT INITIATIVE == ADVISORY COUNCIL. 31 23 1. The director, in collaboration with the prevention and 31 24 chronic care management advisory council, shall develop a 31 25 state initiative for prevention and chronic care management. 31 26 2. The director may accept grants and donations and shall 31 27 apply for any federal, state, or private grants available to 31 28 fund the initiative. Any grants or donations received shall 31 29 be placed in a separate fund in the state treasury and used 31 30 exclusively for the initiative. 31 31 3. The director shall establish and convene an advisory 31 32 council to provide technical assistance to the director in 31 33 developing a state initiative that integrates evidence=based 31 34 prevention and chronic care management strategies into the 31 35 public and private health care systems, including the medical 32 1 home system. The advisory council, at a minimum, shall 32 2 include all of the following members: 32 3 a. The director of human services, or the director's 32 4 designee. 32 5 b. The director of the department of elder affairs, or the 32 6 director's designee. 32 7 c. The commissioner of insurance, or the commissioner's 32 8 designee. 32 9 d. A representative of the Iowa medical society. 32 10 e. A representative of the Iowa hospital association. 32 11 f. A representative of health insurers. 32 12 g. A medical social worker or home care professional. 32 13 h. A patient advocate. 32 14 i. A primary care physician. 32 15 j. A pharmacist. 32 16 k. A specialist in public health and epidemiology. 32 17 l. An expert in health outcomes research. 32 18 m. A representative of an entity that is taking a leading 32 19 role in health information technology. 32 20 n. A representative of the Iowa college of public health 32 21 at the university of Iowa. 32 22 o. A representative of Des Moines university == 32 23 osteopathic medical center. 32 24 4. a. Members of the advisory council from the 32 25 organizations specified in subsection 3 shall be selected by 32 26 the respective organization. Terms of the public members 32 27 shall begin and end as provided by section 69.19. Any vacancy 32 28 shall be filled in the same manner as regular appointments are 32 29 made for the unexpired portion of the regular term. Public 32 30 members shall serve terms of three years. A public member is 32 31 eligible for reappointment for two successive terms. 32 32 b. Public members shall receive their actual and necessary 32 33 expenses incurred in the performance of their duties and may 32 34 be eligible to receive compensation as provided in section 32 35 7E.6. 33 1 c. The advisory council shall meet at least quarterly and 33 2 in accordance with the rules adopted by the advisory council. 33 3 d. A majority of the voting members of the advisory 33 4 council constitutes a quorum. Any action taken by the 33 5 advisory council must be adopted by the affirmative vote of a 33 6 majority of its membership. 33 7 e. The advisory council is located for administrative 33 8 purposes within the division of health promotion and chronic 33 9 disease management within the department. The department 33 10 shall provide administrative support to the advisory council. 33 11 5. The advisory council shall elicit input from a variety 33 12 of health care professionals, health care professional 33 13 organizations, community and nonprofit groups, insurers, 33 14 consumers, businesses, school districts, and state and local 33 15 governments in developing the advisory council's 33 16 recommendations. 33 17 6. The advisory council shall submit initial 33 18 recommendations to the director for the state initiative for 33 19 prevention and chronic care management no later than July 1, 33 20 2009. The recommendations shall address all of the following: 33 21 a. The recommended organizational structure for 33 22 integrating prevention and chronic care management into the 33 23 private and public health care systems. The organizational 33 24 structure recommended shall align with the organizational 33 25 structure established for the medical home system developed 33 26 pursuant to division XXI. The advisory council shall also 33 27 review existing prevention and chronic care management 33 28 strategies used in the health insurance market and in private 33 29 and public programs and recommend ways to expand the use of 33 30 such strategies throughout the health insurance market and in 33 31 the private and public health care systems. 33 32 b. A process for identifying leading health care 33 33 professionals and existing prevention and chronic care 33 34 management programs in the state, and coordinating care among 33 35 these health care professionals and programs. 34 1 c. A prioritization of the chronic conditions for which 34 2 prevention and chronic care management services should be 34 3 provided, taking into consideration the prevalence of specific 34 4 chronic conditions and the factors that may lead to the 34 5 development of chronic conditions; the fiscal impact to state 34 6 health care programs of providing care for the chronic 34 7 conditions of eligible individuals; the availability of 34 8 workable, evidence=based approaches to chronic care for the 34 9 chronic condition; and public input into the selection 34 10 process. The advisory council shall initially develop 34 11 consensus guidelines to address the two chronic conditions 34 12 identified as having the highest priority and shall also 34 13 specify a timeline for inclusion of additional specific 34 14 chronic conditions in the initiative. 34 15 d. A method to involve health care professionals in 34 16 identifying eligible patients for prevention and chronic care 34 17 management services, which includes but is not limited to the 34 18 use of a uniform health risk assessment. 34 19 e. The methods for increasing communication between health 34 20 care professionals and patients, including patient education, 34 21 patient self=management, and patient follow=up plans. 34 22 f. The educational, wellness, and clinical management 34 23 protocols and tools to be used by health care professionals, 34 24 including management guideline materials for health care 34 25 delivery. 34 26 g. The use and development of process and outcome measures 34 27 and benchmarks, aligned to the greatest extent possible with 34 28 existing measures and benchmarks such as the best in class 34 29 estimates utilized in the national healthcare quality report 34 30 of the agency for health care research and quality of the 34 31 United States department of health and human services, to 34 32 provide performance feedback for health care professionals and 34 33 information on the quality of health care, including patient 34 34 satisfaction and health status outcomes. 34 35 h. Payment methodologies to align reimbursements and 35 1 create financial incentives and rewards for health care 35 2 professionals to utilize prevention services, establish 35 3 management systems for chronic conditions, improve health 35 4 outcomes, and improve the quality of health care, including 35 5 case management fees, payment for technical support and data 35 6 entry associated with patient registries, and the cost of 35 7 staff coordination within a medical practice. 35 8 i. Methods to involve public and private groups, health 35 9 care professionals, insurers, third=party administrators, 35 10 associations, community and consumer groups, and other 35 11 entities to facilitate and sustain the initiative. 35 12 j. Alignment of any chronic care information system or 35 13 other information technology needs with other health care 35 14 information technology initiatives. 35 15 k. Involvement of appropriate health resources and public 35 16 health and outcomes researchers to develop and implement a 35 17 sound basis for collecting data and evaluating the clinical, 35 18 social, and economic impact of the initiative, including a 35 19 determination of the impact on expenditures and prevalence and 35 20 control of chronic conditions. 35 21 l. Elements of a marketing campaign that provides for 35 22 public outreach and consumer education in promoting prevention 35 23 and chronic care management strategies among health care 35 24 professionals, health insurers, and the public. 35 25 m. A method to periodically determine the percentage of 35 26 health care professionals who are participating, the success 35 27 of the empowerment=of=patients approach, and any results of 35 28 health outcomes of the patients participating. 35 29 n. A means of collaborating with the bureau of 35 30 professional licensure within the department to review 35 31 prevention and chronic care management education provided to 35 32 licensees, as appropriate, and recommendations regarding 35 33 education resources and curricula for integration into 35 34 existing and new education and training programs. 35 35 6. The director of human services shall obtain any federal 36 1 waivers or state plan amendments necessary to implement the 36 2 prevention and chronic care management initiative within the 36 3 medical assistance, hawk=i, and IowaCare populations. 36 4 7. Following submission of the initial recommendations by 36 5 January 1, 2009, and initial implementation among the 36 6 population of eligible individuals, the director shall work 36 7 with the department of human services, insurers, health care 36 8 professional organizations, and consumers in implementing the 36 9 initiative beyond the population of eligible individuals as an 36 10 integral part of the health care delivery system in this 36 11 state. The advisory council shall continue to review and make 36 12 recommendations to the director regarding improvements in the 36 13 initiative. 36 14 Sec. 16. NEW SECTION. 8A.440 PREVENTION AND CHRONIC CARE 36 15 MANAGEMENT == HEALTH BENEFIT PLAN. 36 16 The department shall include in any request for proposals 36 17 for the administration of the health benefit plans for state 36 18 employees a request for a description of any prevention and 36 19 chronic care management program provided by the entity 36 20 offering the health benefit plan. The department shall also 36 21 work with the department of public health regarding how and 36 22 when to align the state employees' health benefit plan with 36 23 the provisions developed for the prevention and chronic care 36 24 management initiative created in chapter 135, division XXII. 36 25 DIVISION IV 36 26 IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM 36 27 Sec. 17. NEW SECTION. 8.70 DEFINITIONS. 36 28 As used in this division, unless the context otherwise 36 29 requires: 36 30 1. "Health care professional" means health care 36 31 professional as defined in section 135.154. 36 32 2. "Health information technology" means the application 36 33 of information processing, involving both computer hardware 36 34 and software, that deals with the storage, retrieval, sharing, 36 35 and use of health care information, data, and knowledge for 37 1 communication, decision making, quality, safety, and 37 2 efficiency of clinical practice, and may include but is not 37 3 limited to: 37 4 a. An electronic health record that electronically 37 5 compiles and maintains health information that may be derived 37 6 from multiple sources about the health status of an individual 37 7 and may include a core subset of each care delivery 37 8 organization's electronic medical record such as a continuity 37 9 of care record or a continuity of care document, computerized 37 10 physician order entry, electronic prescribing, or clinical 37 11 decision support. 37 12 b. A personal health record through which an individual 37 13 and any other person authorized by the individual can maintain 37 14 and manage the individual's health information. 37 15 c. An electronic medical record that is used by health 37 16 care professionals to electronically document, monitor, and 37 17 manage health care delivery within a care delivery 37 18 organization, is the legal record of the patient's encounter 37 19 with the care delivery organization, and is owned by the care 37 20 delivery organization. 37 21 d. A computerized provider order entry function that 37 22 permits the electronic ordering of diagnostic and treatment 37 23 services, including prescription drugs. 37 24 e. A decision support function to assist physicians and 37 25 other health care providers in making clinical decisions by 37 26 providing electronic alerts and reminders to improve 37 27 compliance with best practices, promote regular screenings and 37 28 other preventive practices, and facilitate diagnoses and 37 29 treatments. 37 30 f. An error notification function that generates a warning 37 31 when an order is entered that is likely to lead to a 37 32 significant adverse outcome for individuals. 37 33 g. Tools to allow for the collection, analysis, and 37 34 reporting of information or data on adverse events, the 37 35 quality and efficiency of care, patient satisfaction, and 38 1 other health care=related performance measures. 38 2 3. "Interoperability" means the ability of two or more 38 3 systems or components to exchange information or data in an 38 4 accurate, effective, secure, and consistent manner and to use 38 5 the information or data that has been exchanged and includes 38 6 but is not limited to: 38 7 a. The capacity to connect to a network for the purpose of 38 8 exchanging information or data with other users. 38 9 b. The ability of a connected, authenticated user to 38 10 demonstrate appropriate permissions to participate in the 38 11 instant transaction over the network. 38 12 c. The capacity of a connected, authenticated user to 38 13 access, transmit, receive, and exchange usable information 38 14 with other users. 38 15 4. "Recognized interoperability standard" means 38 16 interoperability standards recognized by the office of the 38 17 national coordinator for health information technology of the 38 18 United States department of health and human services. 38 19 Sec. 18. NEW SECTION. 8.71 IOWA ELECTRONIC HEALTH == 38 20 PRINCIPLES == GOALS. 38 21 1. Health information technology is rapidly evolving so 38 22 that it can contribute to the goal of improving access to and 38 23 quality of health care, enhancing efficiency, and reducing 38 24 costs. 38 25 2. To be effective, the health information technology 38 26 system shall comply with all of the following principles: 38 27 a. Be patient=centered and market=driven. 38 28 b. Be based on approved standards developed with input 38 29 from all stakeholders. 38 30 c. Protect the privacy of consumers and the security and 38 31 confidentiality of all health information. 38 32 d. Promote interoperability. 38 33 e. Ensure the accuracy, completeness, and uniformity of 38 34 data. 38 35 3. Widespread adoption of health information technology is 39 1 critical to a successful health information technology system 39 2 and is best achieved when all of the following occur: 39 3 a. The market provides a variety of certified products 39 4 from which to choose in order to best fit the needs of the 39 5 user. 39 6 b. The system provides incentives for health care 39 7 professionals to utilize the health information technology and 39 8 provides rewards for any improvement in quality and efficiency 39 9 resulting from such utilization. 39 10 c. The system provides protocols to address critical 39 11 problems. 39 12 d. The system is financed by all who benefit from the 39 13 improved quality, efficiency, savings, and other benefits that 39 14 result from use of health information technology. 39 15 Sec. 19. NEW SECTION. 8.72 IOWA ELECTRONIC HEALTH 39 16 INFORMATION COMMISSION. 39 17 1. a. An electronic health information commission is 39 18 created as a public and private collaborative effort to 39 19 promote the adoption and use of health information technology 39 20 in this state in order to improve health care quality, 39 21 increase patient safety, reduce health care costs, enhance 39 22 public health, and empower individuals and health care 39 23 professionals with comprehensive, real=time medical 39 24 information to provide continuity of care and make the best 39 25 health care decisions. The commission shall provide oversight 39 26 for the development, implementation, and coordination of an 39 27 interoperable electronic health records system, telehealth 39 28 expansion efforts, the health information technology 39 29 infrastructure, and other health information technology 39 30 initiatives in this state. 39 31 b. All health information technology efforts shall 39 32 endeavor to represent the interests and meet the needs of 39 33 consumers and the health care sector, protect the privacy of 39 34 individuals and the confidentiality of individuals' 39 35 information, promote physician best practices, and make 40 1 information easily accessible to the appropriate parties. The 40 2 system developed shall be consumer=driven, flexible, and 40 3 expandable. 40 4 2. The commission shall consist of the following voting 40 5 members: 40 6 a. Individuals with broad experience and vision in health 40 7 care and health technology and one member representing the 40 8 health care consumer. The voting members shall be appointed 40 9 by the governor, subject to confirmation by the senate. The 40 10 voting members shall include all of the following: 40 11 (1) The director of the Iowa communications network. 40 12 (2) Two members who are the chief information officers of 40 13 the two largest private health care systems. 40 14 (3) One member who is the chief information officer of a 40 15 public health care system. 40 16 (4) A representative of the private telecommunications 40 17 industry. 40 18 (5) A representative of a rural hospital that is a member 40 19 of the Iowa hospital association. 40 20 (6) A consumer advocate. 40 21 (7) A representative of the Iowa safety net provider 40 22 network created in section 135.153. 40 23 3. a. The members shall select a chairperson, annually, 40 24 from among the membership, and shall serve terms of three 40 25 years beginning and ending as provided in section 69.19. 40 26 Voting member appointments shall comply with sections 69.16 40 27 and 69.16A. Vacancies shall be filled by the original 40 28 appointing authority and in the manner of the original 40 29 appointments. Members shall receive reimbursement for actual 40 30 expenses incurred while serving in their official capacity and 40 31 voting members may also be eligible to receive compensation as 40 32 provided in section 7E.6. A person appointed to fill a 40 33 vacancy for a member shall serve only for the unexpired 40 34 portion of the term. A member is eligible for reappointment 40 35 for two successive terms. 41 1 b. The commission shall meet at the call of the 41 2 chairperson. A majority of the voting members of the 41 3 commission constitutes a quorum. Any action taken by the 41 4 commission must be adopted by the affirmative vote of a 41 5 majority of its voting membership. 41 6 c. The commission is located for administrative purposes 41 7 within the department of management. The department shall 41 8 provide office space, staff assistance, administrative 41 9 support, and necessary supplies and equipment for the 41 10 commission. 41 11 4. The commission shall do all of the following: 41 12 a. Establish an advisory council which shall consist of 41 13 the representatives of entities involved in the electronic 41 14 health records system task force established pursuant to 41 15 section 217.41A, Code 2007, and any other members the 41 16 commission determines necessary to assist in the commission's 41 17 duties including but not limited to consumers and consumer 41 18 advocacy organizations; physicians and health care 41 19 professionals; leadership of community hospitals and major 41 20 integrated health care delivery networks; state agencies 41 21 including the department of public health, the department of 41 22 human services, the department of elder affairs, the division 41 23 of insurance of the department of commerce, and the office of 41 24 the attorney general; health plans and health insurers; legal 41 25 experts; academics and ethicists; business leaders; and 41 26 professional associations. 41 27 b. Adopt a statewide health information technology plan by 41 28 January 1, 2009. In developing the plan, the commission shall 41 29 seek the input of providers, payers, and consumers. Standards 41 30 and policies developed for the plan shall promote and be 41 31 consistent with national standards developed by the office of 41 32 the national coordinator for health information technology of 41 33 the United States department of health and human services and 41 34 shall address or provide for all of the following: 41 35 (1) The effective, efficient, statewide use of electronic 42 1 health information in patient care, health care policymaking, 42 2 clinical research, health care financing, and continuous 42 3 quality improvement. The commission shall adopt requirements 42 4 for interoperable electronic health records in this state 42 5 including a recognized interoperability standard. 42 6 (2) Education of the public and health care sector about 42 7 the value of health information technology in improving 42 8 patient care, and methods to promote increased support and 42 9 collaboration of state and local public health agencies, 42 10 health care professionals, and consumers in health information 42 11 technology initiatives. 42 12 (3) Uniform standards for the exchange of health care 42 13 information and interoperable electronic health records. 42 14 (4) Policies relating to the protection of privacy of 42 15 patients and the security and confidentiality of patient 42 16 information. 42 17 (5) Policies relating to information ownership. 42 18 (6) Policies relating to governance of the various facets 42 19 of the health information technology system. 42 20 (7) A single patient identifier to share secure patient 42 21 information. All health care professionals shall utilize the 42 22 single patient identifier by January 1, 2010. 42 23 (8) A standard continuity of care record and other issues 42 24 related to the content of electronic transmissions. All 42 25 health care professionals shall utilize the standard 42 26 continuity of care record by January 1, 2010. 42 27 (9) Requirements for electronic prescribing. 42 28 (10) Economic incentives and support to facilitate 42 29 participation in an interoperable system by health care 42 30 professionals. 42 31 c. Identify existing and potential health information 42 32 technology efforts in this state, regionally, and nationally, 42 33 and integrate existing efforts to avoid incompatibility 42 34 between efforts and avoid duplication. 42 35 d. Coordinate public and private efforts to provide the 43 1 network backbone infrastructure for the health information 43 2 technology system. In coordinating these efforts, the 43 3 commission shall do all of the following: 43 4 (1) Adopt policies to effectuate the logical cost 43 5 effective usage of and access to the state=owned network, and 43 6 support of telecommunication carrier products, where 43 7 applicable. 43 8 (2) Complete a memorandum of understanding by January 1, 43 9 2009, with the Iowa communications network for governmental 43 10 access usage, with private fiber optic networks for core 43 11 backbone usage of private fiber optic networks, and with any 43 12 other communications entity for state=subsidized usage of the 43 13 communications entity's products to access any backbone 43 14 network. 43 15 (3) Establish protocols to ensure compliance with any 43 16 applicable federal standards. 43 17 (4) Determine costs for accessing the network at a level 43 18 that provides sufficient funding for the network. 43 19 e. Promote the use of telemedicine. 43 20 (1) Examine existing barriers to the use of telemedicine 43 21 and make recommendations for eliminating these barriers. 43 22 (2) Examine the most efficient and effective systems of 43 23 technology for use and make recommendations based on the 43 24 findings. 43 25 f. Address the workforce needs generated by increased use 43 26 of health information technology. 43 27 g. Adopt rules in accordance with chapter 17A to implement 43 28 all aspects of the statewide plan and the network. 43 29 h. Coordinate, monitor, and evaluate the adoption, use, 43 30 interoperability, and efficiencies of the various facets of 43 31 health information technology in this state. 43 32 i. Seek and apply for any federal or private funding to 43 33 assist in the implementation and support of the health 43 34 information technology system and make recommendations for 43 35 funding mechanisms for the ongoing development and maintenance 44 1 costs of the health information technology system. 44 2 j. Identify state laws and rules that present barriers to 44 3 the development of the health information technology system 44 4 and recommend any changes to the governor and the general 44 5 assembly. 44 6 Sec. 20. Section 217.41A, Code 2007, is repealed. 44 7 DIVISION V 44 8 LONG=TERM CARE PLANNING AND ADVANCE MEDICAL DIRECTIVES 44 9 Sec. 21. Section 144A.11, Code 2007, is amended by adding 44 10 the following new subsections: 44 11 NEW SUBSECTION. 7. A hospital or health care provider 44 12 shall establish a nonjudicial means of resolving disputes 44 13 arising out of a disagreement over compliance with a 44 14 declaration or out=of=hospital do=not=resuscitate order. 44 15 NEW SUBSECTION. 8. A hospital or health care provider 44 16 shall utilize the physician orders for life=sustaining 44 17 treatment form reflecting the declaration of a patient and 44 18 shall ensure that the form accompanies any patient who is 44 19 comatose, incompetent, or otherwise physically or mentally 44 20 incapable of communication if the patient is transferred to 44 21 another facility. The department shall create a standardized 44 22 physician orders for life=sustaining treatment form to be used 44 23 by hospitals and other health care providers in this state and 44 24 shall adopt rules for the use of the form. 44 25 Sec. 22. Section 144B.12, Code 2007, is amended by adding 44 26 the following new subsection: 44 27 NEW SUBSECTION. 5. A health care provider shall establish 44 28 a nonjudicial means of resolving disputes arising out of a 44 29 disagreement over compliance with a durable power of attorney 44 30 for health care. 44 31 Sec. 23. NEW SECTION. 147.28B PALLIATIVE CARE == 44 32 PROMOTION. 44 33 1. For the purposes of this section, "palliative care" 44 34 means the active total care of patients whose prognosis is 44 35 limited due to progressive, advanced disease. The purpose of 45 1 such care is to alleviate pain and other distressing symptoms, 45 2 and to enhance the quality of life, not to hasten or postpone 45 3 death. 45 4 2. The board of medicine, the board of nursing, and other 45 5 boards for whom palliative care is within the profession's 45 6 scope of practice shall do all of the following: 45 7 a. Develop and advance scientific understanding of 45 8 palliative care. 45 9 b. Collect and disseminate protocols and evidence=based 45 10 practices regarding palliative care, with priority given to 45 11 pain management for terminally ill patients, and make such 45 12 information available to public and private health care 45 13 programs and providers, medical or other health professional 45 14 schools, hospice organizations, and the general public. 45 15 3. The board of medicine, the board of nursing, and other 45 16 boards for whom palliative care is within the profession's 45 17 scope of practice shall work with medical or other health 45 18 professional schools, residency training programs and other 45 19 graduate programs in the health professions, entities 45 20 providing continuing medical education, hospices, and other 45 21 appropriate programs and entities to include in the curriculum 45 22 information and education on the use of palliative care. 45 23 Sec. 24. NEW SECTION. 514C.23 HOSPICE CARE COVERAGE. 45 24 1. Notwithstanding the uniformity of treatment 45 25 requirements of section 514C.6, a policy or contract providing 45 26 for third=party payment or prepayment of health or medical 45 27 expenses shall provide coverage benefits for the costs 45 28 associated with the provision of core services, as defined in 45 29 section 135J.1, provided by a licensed hospice program. 45 30 2. a. This section applies to the following classes of 45 31 third=party payment provider contracts or policies delivered, 45 32 issued for delivery, continued, or renewed in this state on or 45 33 after July 1, 2008: 45 34 (1) Individual or group accident and sickness insurance 45 35 providing coverage on an expense=incurred basis. 46 1 (2) An individual or group hospital or medical service 46 2 contract issued pursuant to chapter 509, 514, or 514A. 46 3 (3) An individual or group health maintenance organization 46 4 contract regulated under chapter 514B. 46 5 (4) Any other entity engaged in the business of insurance, 46 6 risk transfer, or risk retention, which is subject to the 46 7 jurisdiction of the commissioner. 46 8 (5) A plan established pursuant to chapter 509A for public 46 9 employees. 46 10 (6) An organized delivery system licensed by the director 46 11 of public health. 46 12 b. This section shall not apply to accident=only, 46 13 specified disease, short=term hospital or medical, hospital 46 14 confinement indemnity, credit, dental, vision, Medicare 46 15 supplement, long=term care, basic hospital and 46 16 medical=surgical expense coverage as defined by the 46 17 commissioner, disability income insurance coverage, coverage 46 18 issued as a supplement to liability insurance, workers' 46 19 compensation or similar insurance, or automobile medical= 46 20 payment insurance. 46 21 Sec. 25. LONG=TERM LIVING PLANNING TOOLS == PUBLIC 46 22 EDUCATION CAMPAIGN. The legal services development and 46 23 substitute decision maker programs of the department of elder 46 24 affairs, in collaboration with other appropriate agencies and 46 25 interested parties, shall research existing long=term living 46 26 planning tools that are designed to increase quality of life 46 27 and contain health care costs and recommend a public education 46 28 campaign strategy on long=term living to the general assembly 46 29 by January 1, 2009. 46 30 Sec. 26. LONG=TERM CARE OPTIONS PUBLIC EDUCATION CAMPAIGN. 46 31 The department of elder affairs, in collaboration with the 46 32 insurance division of the department of commerce, shall 46 33 implement a long=term care options public education campaign. 46 34 The campaign may utilize such tools as the "Own Your Future 46 35 Planning Kit" administered by the centers for Medicare and 47 1 Medicaid services, the administration on aging, and the office 47 2 of the assistant secretary for planning and evaluation of the 47 3 United States department of health and human services, and 47 4 other tools developed through the aging and disability 47 5 resource center program of the administration on aging and the 47 6 centers for Medicare and Medicaid services designed to promote 47 7 health and independence as Iowans age, assist older Iowans in 47 8 making informed choices about the availability of long=term 47 9 care options, including alternatives to facility=based care, 47 10 and to streamline access to long=term care. 47 11 Sec. 27. HOME AND COMMUNITY=BASED SERVICES PUBLIC 47 12 EDUCATION CAMPAIGN. The department of elder affairs shall 47 13 work with other public and private agencies to identify 47 14 resources that may be used to continue the work of the aging 47 15 and disability resource center established by the department 47 16 through the aging and disability resource center grant program 47 17 efforts of the administration on aging and the centers for 47 18 Medicare and Medicaid services of the United States department 47 19 of health and human services, beyond the federal grant period 47 20 ending September 30, 2008. 47 21 DIVISION VI 47 22 DIVISION OF HEALTH CARE QUALITY, CONSUMER INFORMATION, 47 23 STRATEGIC PLANNING, AND RESOURCE DEVELOPMENT 47 24 DIVISION V 47 25 DIVISION OF HEALTH CARE QUALITY, CONSUMER INFORMATION, 47 26 STRATEGIC PLANNING, AND RESOURCE DEVELOPMENT 47 27 Sec. 28. NEW SECTION. 135.45 DIVISION OF HEALTH CARE 47 28 QUALITY, CONSUMER INFORMATION, STRATEGIC PLANNING, AND 47 29 RESOURCE DEVELOPMENT. 47 30 A division of health care quality, consumer information, 47 31 strategic planning, and resource development is created in the 47 32 department of public health. The division shall include, at a 47 33 minimum, the following bureaus: 47 34 1. The bureau of health care quality and consumer 47 35 information. 48 1 2. The bureau of health care strategic planning and 48 2 resource development. 48 3 BUREAU OF HEALTH CARE QUALITY AND CONSUMER INFORMATION 48 4 Sec. 29. NEW SECTION. 135.46 BUREAU OF HEALTH CARE 48 5 QUALITY AND CONSUMER INFORMATION == DUTIES. 48 6 A bureau of health care quality and consumer information is 48 7 created to provide better coordination of health care delivery 48 8 information to improve the public health, inform policy 48 9 analysis, and provide transparency of consumer health 48 10 information. The bureau, at a minimum, shall do all of the 48 11 following: 48 12 1. Develop data collection requirements, collect data, and 48 13 administer an internet=based consumer guide to health care 48 14 relating to price, quality, safety, and other aspects of the 48 15 health care delivery system to promote quality care that is 48 16 safe, effective, patient=centered, timely, efficient, and 48 17 equitable, and to empower individuals to make economically 48 18 sound and medically appropriate decisions regarding their 48 19 personal health. 48 20 2. Develop and implement cost=containment measures that 48 21 help to contain costs while improving quality in the health 48 22 care system. 48 23 3. Provide for coordination of public and private 48 24 cost=containment, quality, and safety efforts in this state. 48 25 4. Carry out other health care price, quality, and 48 26 safety=related research as directed by the governor and the 48 27 general assembly. 48 28 Sec. 30. NEW SECTION. 135.47 IOWA HEALTH QUALITY AND 48 29 COST=CONTAINMENT COLLABORATIVE. 48 30 1. The bureau shall convene an Iowa health quality and 48 31 cost=containment collaborative to develop a process and the 48 32 infrastructure to provide price, quality, safety, and other 48 33 appropriate information to consumers. The collaborative shall 48 34 include but is not limited to all of the following members: 48 35 a. The director of public health, or the director's 49 1 designee, who shall serve as chairperson of the collaborative. 49 2 b. A representative of the university of Iowa college of 49 3 public health. 49 4 c. A representative of Des Moines university=osteopathic 49 5 medical center. 49 6 d. A representative of health care consumers. 49 7 e. The president of the Iowa healthcare collaborative. 49 8 f. A representative of the Iowa health buyers' alliance. 49 9 g. A representative of the long=term care industry. 49 10 2. The department of public health shall provide 49 11 administrative support to the collaborative. Public members 49 12 shall receive reimbursement for actual expenses incurred while 49 13 engaged in the performance of official duties. 49 14 3. The collaborative shall review efforts of other states, 49 15 the federal government, and private entities to identify 49 16 meaningful tools to measure prices, safety, and the delivery 49 17 of quality care, determine specific information and a format 49 18 for publishing the information that is most useful to the 49 19 consumer including contextual information and explanations 49 20 that the public can easily understand, and to identify 49 21 cost=containment strategies that also result in improved 49 22 health care quality. Following the collaborative's review, 49 23 the collaborative shall do all of the following: 49 24 a. Facilitate the disclosure of price, quality, and safety 49 25 information by supporting and expanding existing public and 49 26 private efforts and by identifying and recommending ways to 49 27 eliminate barriers to such disclosure. 49 28 b. Develop for implementation by July 1, 2009, a method 49 29 for hospitals, health care providers, long=term care 49 30 providers, insurers, and health care plans to collaborate in 49 31 providing consumers with the usual and customary charges for a 49 32 specified health service and specifically what the charges 49 33 include and the factors that may cause the charges to vary, a 49 34 good faith estimate of the actual billed charge and the amount 49 35 for which the consumer may be personally liable for a 50 1 specified health care service based on a consumer's specific 50 2 health care coverage, and, if the consumer does not have 50 3 health care coverage, providing a good faith estimate of the 50 4 average allowable reimbursement the provider accepts as 50 5 payment from such private third=party payers for the service 50 6 specified and the estimated amount for which the noncovered 50 7 consumer would be personally liable to pay. 50 8 c. Develop for implementation by July 1, 2010, 50 9 requirements for the identification, collection, 50 10 standardization, sharing, and public disclosure of pricing, 50 11 quality, and patient safety data from hospitals and health 50 12 care providers in this state. 50 13 d. Develop for implementation by July 1, 2009, uniform 50 14 billing practices including uniform claim forms, billing 50 15 codes, and compatible electronic or other data interchange 50 16 standards for use by health care providers and payers in their 50 17 health care claims, health care encounters, and electronic or 50 18 other data interchange activities. 50 19 e. Develop and direct the department of human services to 50 20 utilize quality and safety standards as a basis for increased 50 21 provider reimbursement under the medical assistance, hawk=i, 50 22 and IowaCare programs. 50 23 f. Develop cost=containment strategies. Cost containment 50 24 strategies may include but are not limited to modification of 50 25 health care reimbursement methodologies to reward quality, 50 26 incorporate evidence=based standards and promote best 50 27 practices, to direct individuals into quality health care 50 28 delivery, to encourage primary care, and to utilize 50 29 telemedicine and health information technology. 50 30 g. Establish a health and wellness strategies consortium 50 31 to act as a catalyst in advancing voluntarily adopted 50 32 strategies to improve quality of care, increase access to 50 33 services, reduce disparities in health care delivery and 50 34 contain costs while emphasizing population health and 50 35 wellness. The core membership of the consortium shall include 51 1 representatives of health care purchasers, payers, and 51 2 providers. The consortium shall direct strategies for health 51 3 care payers and providers to adopt which may include but are 51 4 not limited to: 51 5 (1) Strategies to promote wellness which may include: 51 6 (a) Providing smoking cessation programs as a standard 51 7 health care benefit including reimbursement for treatment and 51 8 support services. 51 9 (b) Providing obesity prevention services as a standard 51 10 health care benefit. 51 11 (c) Increasing immunization rates for pneumococcal and 51 12 influenza which may include approving an administration fee 51 13 for all qualified providers of influenza and pneumococcal 51 14 vaccinations. 51 15 (d) Providing health care benefit incentives for consumers 51 16 who participate in wellness programs. 51 17 (e) Assuring that health care coverage for children 51 18 includes primary, preventive, and developmental health 51 19 services. 51 20 (2) Strategies to contain health care costs which may 51 21 include: 51 22 (a) Promoting adoption of health information technology 51 23 through provider incentives. 51 24 (b) Considering a four=tier prescription drug copayment 51 25 system within a prescription drug benefit that includes a zero 51 26 copayment tier for select medications to improve patient 51 27 compliance. 51 28 (c) Providing a standard medication therapy management 51 29 program as a prescription drug benefit to optimize high=risk 51 30 patient's medication outcomes. 51 31 (d) Investigating whether pooled purchasing for 51 32 prescription drug benefits, such as a common statewide 51 33 preferred drug list, would decrease costs. 51 34 (3) Strategies to increase the public's role and 51 35 responsibility in personal health care choices and decisions 52 1 which may include: 52 2 (a) Creating a public awareness campaign to educate 52 3 consumers on smart health care choices and promoting value= 52 4 based purchasing. 52 5 (b) Promoting public reporting of quality and performance 52 6 measures that support a value=based purchasing system. 52 7 (4) Implementation strategies which may include piloting 52 8 the various wellness, cost=containment, and public involvement 52 9 strategies utilizing publicly funded health care coverage 52 10 groups such as the medical assistance program, state of Iowa 52 11 employee group health plans, and regents institutions health 52 12 care plans, consistent with collective bargaining agreements 52 13 in effect. 52 14 h. Identify the process and time frames for implementation 52 15 of any initiatives, identify any barriers to implementation of 52 16 initiatives, and recommend any changes in law or rules 52 17 necessary to eliminate the barriers and implement the 52 18 initiatives. 52 19 Sec. 31. NEW SECTION. 135.48 ESTIMATE OF CHARGES. 52 20 A health care provider, including a hospital, prior to 52 21 provision of medical services, shall provide a patient, upon 52 22 request, a reasonable estimate of charges for such services. 52 23 The information provided shall explain the methodology in 52 24 determining the estimate and shall state that the estimate 52 25 does not preclude the health care provider from exceeding the 52 26 estimate or making additional charges based on changes in the 52 27 patient's condition, treatment needs, or third=party payer 52 28 requirements. The department shall develop a form to be used 52 29 by a health care provider, including a hospital, in providing 52 30 the information required by this section. For the purposes of 52 31 this section, "health care provider" means "health care 52 32 professional" as defined in section 135.154. 52 33 BUREAU OF HEALTH CARE STRATEGIC PLANNING AND RESOURCE 52 34 DEVELOPMENT 52 35 Sec. 32. NEW SECTION. 135.49 BUREAU OF HEALTH CARE 53 1 STRATEGIC PLANNING AND RESOURCE DEVELOPMENT. 53 2 A bureau of health care strategic planning and resource 53 3 development is created to coordinate public and private 53 4 efforts to develop and maintain an appropriate health care 53 5 delivery infrastructure and a stable, well=qualified, diverse, 53 6 and sustainable health care workforce in this state. The 53 7 bureau shall, at a minimum, do all of the following: 53 8 1. Develop a strategic plan for health care delivery 53 9 infrastructure and health care workforce resources in this 53 10 state. 53 11 2. Provide for the continuous collection of data to 53 12 provide a basis for health care strategic planning and health 53 13 care policymaking. 53 14 3. Make recommendations regarding the health care delivery 53 15 infrastructure and the workforce that assist in monitoring 53 16 current needs, predicting future trends, and informing 53 17 policymaking. 53 18 4. Administer the certificate of need program and provide 53 19 support to the health care strategic planning council 53 20 established in section 135.62. 53 21 Sec. 33. NEW SECTION. 135.50 STRATEGIC PLAN. 53 22 1. The strategic plan for health care delivery 53 23 infrastructure and health care workforce resources shall 53 24 describe the existing health care system, describe and provide 53 25 a rationale for the desired health care system, provide an 53 26 action plan for implementation, and provide methods to 53 27 evaluate the system. The plan shall incorporate expenditure 53 28 control methods and integrate criteria for evidence=based 53 29 health care. The bureau of health care strategic planning and 53 30 resource development shall do all of the following in 53 31 developing the strategic plan for health care delivery 53 32 infrastructure and health care workforce resources: 53 33 a. Conduct strategic health planning activities related to 53 34 preparation of the strategic plan. 53 35 b. Develop a computerized system for accessing, analyzing, 54 1 and disseminating data relevant to strategic health planning. 54 2 The bureau may enter into data sharing agreements and 54 3 contractual arrangements necessary to obtain or disseminate 54 4 relevant data. 54 5 c. Conduct research and analysis or arrange for research 54 6 and analysis projects to be conducted by public or private 54 7 organizations to further the development of the strategic 54 8 plan. 54 9 d. Establish a technical advisory committee to assist in 54 10 the development of the strategic plan. The members of the 54 11 committee may include but are not limited to health 54 12 economists, health planners, representatives of health care 54 13 purchasers, representatives of state and local agencies that 54 14 regulate entities involved in health care, representatives of 54 15 health care providers and health care facilities, and 54 16 consumers. 54 17 2. The strategic plan shall include statewide health 54 18 planning policies and goals related to the availability of 54 19 health care facilities and services, the quality of care, and 54 20 the cost of care. The policies and goals shall be based on 54 21 the following principles: 54 22 a. That a strategic health planning process, responsive to 54 23 changing health and social needs and conditions, is essential 54 24 to the health, safety, and welfare of Iowans. The process 54 25 shall be reviewed and updated as necessary to ensure that the 54 26 strategic plan addresses all of the following: 54 27 (1) Promoting and maintaining the health of all Iowans. 54 28 (2) Providing accessible health care services through the 54 29 maintenance of an adequate supply of health facilities and an 54 30 adequate workforce. 54 31 (3) Controlling excessive increases in costs. 54 32 (4) Applying specific quality criteria and population 54 33 health indicators. 54 34 (5) Recognizing prevention and wellness as priorities in 54 35 health care programs to improve quality and reduce costs. 55 1 (6) Addressing periodic priority issues including disaster 55 2 planning, public health threats, and public safety dilemmas. 55 3 (7) Coordinating health care delivery and resource 55 4 development efforts among state agencies including those 55 5 tasked with facility, services, and professional provider 55 6 licensure; state and federal reimbursement; health service 55 7 utilization data systems; and others. 55 8 b. That both consumers and providers throughout the state 55 9 must be involved in the health planning process, outcomes of 55 10 which shall be clearly articulated and available for public 55 11 review and use. 55 12 c. That the supply of a health care service has a 55 13 substantial impact on utilization of the service, independent 55 14 of the effectiveness, medical necessity, or appropriateness of 55 15 the particular health care service for a particular 55 16 individual. 55 17 d. That given that health care resources are not 55 18 unlimited, the impact of any new health care service or 55 19 facility on overall health expenditures in this state must be 55 20 considered. 55 21 e. That excess capacity of health care services and 55 22 facilities places an increased economic burden on the public. 55 23 f. That the likelihood that a requested new health care 55 24 facility, service, or equipment will improve health care 55 25 quality and outcomes must be considered. 55 26 g. That development and ongoing maintenance of current and 55 27 accurate health care information and statistics related to 55 28 cost and quality of health care and projections of the need 55 29 for health care facilities and services are necessary to 55 30 developing an effective health care planning strategy. 55 31 h. That the certificate of need program as a component of 55 32 the health care planning regulatory process must balance 55 33 considerations of access to quality care at a reasonable cost 55 34 for all Iowans, optimal use of existing health care resources, 55 35 fostering of expenditure control, and elimination of 56 1 unnecessary duplication of health care facilities and 56 2 services, while supporting improved health care outcomes. 56 3 i. That strategic health care planning must be concerned 56 4 with the stability of the health care system, encompassing 56 5 health care financing, quality, and the availability of 56 6 information and services for all residents. 56 7 3. The health care delivery infrastructure and resources 56 8 strategic plan developed by the bureau shall include all of 56 9 the following: 56 10 a. A health care system assessment and objectives 56 11 component that does all of the following: 56 12 (1) Describes state and regional population demographics, 56 13 health status indicators, and trends in health status and 56 14 health care needs. 56 15 (2) Identifies key policy objectives for the state health 56 16 care system related to access to care, health care outcomes, 56 17 quality, and cost=effectiveness. 56 18 b. A health care facilities and services plan that 56 19 assesses the demand for health care facilities and services to 56 20 inform state health care planning efforts and direct 56 21 certificate of need determinations, for those facilities and 56 22 services subject to certificate of need. The plan shall 56 23 include all of the following: 56 24 (1) An inventory of each geographic region's existing 56 25 health care facilities and services. 56 26 (2) Projections of the need for each category of health 56 27 care facility and service, including those subject to 56 28 certificate of need. 56 29 (3) Policies to guide the addition of new or expanded 56 30 health care facilities and services to promote the use of 56 31 quality, evidence=based, cost=effective health care delivery 56 32 options, including any recommendations for criteria, 56 33 standards, and methods relevant to the certificate of need 56 34 review process. 56 35 (4) An assessment of the availability of health care 57 1 providers, public health resources, transportation 57 2 infrastructure, and other considerations necessary to support 57 3 the needed health care facilities and services in each region. 57 4 c. (1) A health care data resources plan that identifies 57 5 data elements necessary to properly conduct planning 57 6 activities and to review certificate of need applications, 57 7 including data related to inpatient and outpatient utilization 57 8 and outcomes information, and financial and utilization 57 9 information related to charity care, quality, and cost. 57 10 (2) The plan shall inventory existing data resources, both 57 11 public and private, that store and disclose information 57 12 relevant to the health care planning process, including 57 13 information necessary to conduct certificate of need 57 14 activities. The plan shall identify any deficiencies in the 57 15 inventory of existing data resources and the data necessary to 57 16 conduct comprehensive health care planning activities. The 57 17 plan may recommend that the bureau be authorized to access 57 18 existing data sources and conduct appropriate analyses of such 57 19 data or that other agencies expand their data collection 57 20 activities as statutory authority permits. The plan may 57 21 identify any computing infrastructure deficiencies that impede 57 22 the proper storage, transmission, and analysis of health care 57 23 planning data. 57 24 (3) The plan shall provide recommendations for increasing 57 25 the availability of data related to health care planning to 57 26 provide greater community involvement in the health care 57 27 planning process and consistency in data used for certificate 57 28 of need applications and determinations. The plan shall also 57 29 integrate the requirements for annual reports by hospitals and 57 30 health care facilities pursuant to section 135.75, the 57 31 provisions relating to analyses and studies by the department 57 32 pursuant to section 135.76, the data compilation provisions of 57 33 section 135.78, and the provisions for contracts for 57 34 assistance with analyses, studies, and data pursuant to 57 35 section 135.83. 58 1 d. An assessment of emerging trends in health care 58 2 delivery and technology as they relate to access to health 58 3 care facilities and services, quality of care, and costs of 58 4 care. The assessment shall recommend any changes to the scope 58 5 of health care facilities and services covered by the 58 6 certificate of need program that may be warranted by these 58 7 emerging trends. In addition, the assessment may recommend 58 8 any changes to criteria used by the department to review 58 9 certificate of need applications, as necessary. 58 10 e. A rural health resources plan to assess the 58 11 availability of health resources in rural areas of the state, 58 12 assess the unmet needs of these communities, and evaluate how 58 13 federal and state reimbursement policies can be modified, if 58 14 necessary, to more efficiently and effectively meet the health 58 15 care needs of rural communities. The plan shall consider the 58 16 unique health care needs of rural communities, the adequacy of 58 17 the rural health workforce, and transportation needs for 58 18 accessing appropriate care. 58 19 f. A health care workforce resources plan to assure a 58 20 competent, diverse, and sustainable health care workforce in 58 21 Iowa and to improve access to health care in underserved areas 58 22 and among underserved populations. The plan shall include the 58 23 establishment of an advisory council to inform and advise the 58 24 bureau, the department, and policymakers regarding issues 58 25 relevant to the health care workforce in Iowa. 58 26 4. The bureau shall submit the initial statewide health 58 27 care delivery infrastructure and resources strategic plan to 58 28 the governor and the general assembly by January 1, 2010, and 58 29 shall submit an updated strategic plan to the governor and the 58 30 general assembly every two years thereafter. 58 31 DIVISION VII 58 32 CERTIFICATE OF NEED PROGRAM 58 33 Sec. 34. Section 68B.35, subsection 2, paragraph e, Code 58 34 2007, is amended to read as follows: 58 35 e. Members of the state banking council, the ethics and 59 1 campaign disclosure board, the credit union review board, the 59 2 economic development board, the employment appeal board, the 59 3 environmental protection commission, the health facilities 59 4 care strategic planning council, the Iowa finance authority, 59 5 the Iowa public employees' retirement system investment board, 59 6 the board of the Iowa lottery authority, the natural resource 59 7 commission, the board of parole, the petroleum underground 59 8 storage tank fund board, the public employment relations 59 9 board, the state racing and gaming commission, the state board 59 10 of regents, the tax review board, the transportation 59 11 commission, the office of consumer advocate, the utilities 59 12 board, the Iowa telecommunications and technology commission, 59 13 and any full=time members of other boards and commissions as 59 14 defined under section 7E.4 who receive an annual salary for 59 15 their service on the board or commission. The Iowa ethics and 59 16 campaign disclosure board shall conduct an annual review to 59 17 determine if members of any other board, commission, or 59 18 authority should file a statement and shall require the filing 59 19 of a statement pursuant to rules adopted pursuant to chapter 59 20 17A. 59 21 Sec. 35. Section 97B.1A, subsection 8, paragraph a, 59 22 subparagraph (8), Code 2007, is amended to read as follows: 59 23 (8) Members of the state transportation commission, the 59 24 board of parole, and the state health facilities care 59 25 strategic planning council. 59 26 Sec. 36. Section 135.61, subsection 1, paragraph d, code 59 27 2007, is amended to read as follows: 59 28 d. Each institutional health facility or health 59 29 maintenance organization which, prior to receipt of the 59 30 application by the department bureau, has formally indicated 59 31 to the department bureau pursuant to this division an intent 59 32 to furnish in the future institutional health services similar 59 33 to the new institutional health service proposed in the 59 34 application. 59 35 Sec. 37. Section 135.61, Code 2007, is amended by adding 60 1 the following new subsection: 60 2 NEW SUBSECTION. 2A. "Bureau" means the bureau of health 60 3 care strategic planning and resource development created 60 4 pursuant to section 135.49. 60 5 Sec. 38. Section 135.61, subsection 4, Code 2007, is 60 6 amended to read as follows: 60 7 4. "Council" means the state health facilities care 60 8 strategic planning council established by this division. 60 9 Sec. 39. Section 135.61, subsection 18, paragraph d, Code 60 10 2007, is amended to read as follows: 60 11 d. A permanent change in the bed capacity, as determined 60 12 by the department bureau, of an institutional health facility. 60 13 For purposes of this paragraph, a change is permanent if it is 60 14 intended to be effective for one year or more. 60 15 Sec. 40. NEW SECTION. 135.61A PURPOSES OF CERTIFICATE OF 60 16 NEED PROGRAM. 60 17 The purposes of the certificate of need program are to 60 18 facilitate access to quality care at a reasonable cost for all 60 19 Iowans, to encourage optimal use of existing health care 60 20 resources, to foster expenditure control, to support quality 60 21 improvement efforts, and to prevent unnecessary duplication of 60 22 institutional health facilities, health services, and health 60 23 care equipment. In order to determine if the program is 60 24 complying with the purposes established, regular evaluation of 60 25 the impact of the certificate of need program on health care 60 26 expenditures, access, quality, and innovation must exist. 60 27 Sec. 41. Section 135.62, Code 2007, is amended to read as 60 28 follows: 60 29 135.62 DEPARTMENT BUREAU TO ADMINISTER DIVISION == HEALTH 60 30 FACILITIES CARE STRATEGIC PLANNING COUNCIL ESTABLISHED == 60 31 APPOINTMENTS == POWERS AND DUTIES. 60 32 1. This division shall be administered by the department 60 33 bureau. The director shall employ or cause to be employed the 60 34 necessary persons to discharge the duties imposed on the 60 35 department bureau by this division. 61 1 2. There is established a state health facilities care 61 2 strategic planning council consisting of five seven persons 61 3 appointed by the governor, one of whom shall be a health 61 4 economist, one of whom shall be an actuary, and at least one 61 5 of whom shall be a health care consumer. The council shall be 61 6 within the department bureau for administrative and budgetary 61 7 purposes. 61 8 a. QUALIFICATIONS. The members of the council shall be 61 9 chosen so that the council as a whole is broadly 61 10 representative of various geographical areas of the state, and 61 11 no more than three four of its members are affiliated with the 61 12 same political party. Each council member shall be a person 61 13 who has demonstrated by prior activities an informed concern 61 14 for the planning and delivery of health services. No member 61 15 of the council, nor any spouse of a member, shall during the 61 16 time that member is serving on the council meet either of the 61 17 following prohibitions: 61 18 (1) Be a health care provider, nor be otherwise directly 61 19 or indirectly engaged in the delivery of health care services 61 20 nor, or have a material financial interest in the providing or 61 21 delivery of health services; nor. 61 22 (2) Serve as a member of any board or other policymaking 61 23 or advisory body of an institutional health facility, a health 61 24 maintenance organization, or any health or hospital insurer. 61 25 b. APPOINTMENTS. Terms of council members shall be six 61 26 years, beginning and ending as provided in section 69.19. A 61 27 member shall be appointed in each odd=numbered year to succeed 61 28 each member whose term expires in that year. Vacancies shall 61 29 be filled by the governor for the balance of the unexpired 61 30 term. Each appointment to the council is subject to 61 31 confirmation by the senate. A council member is ineligible 61 32 for appointment to a second consecutive term, unless first 61 33 appointed to an unexpired term of three years or less. 61 34 The governor shall designate one of the council members as 61 35 chairperson. That designation may be changed not later than 62 1 July 1 of any odd=numbered year, effective on the date of the 62 2 organizational meeting held in that year under paragraph "c" 62 3 of this subsection. 62 4 c. MEETINGS. The council shall hold an organizational 62 5 meeting in July of each odd=numbered year, or as soon 62 6 thereafter as the new appointee or appointees are confirmed 62 7 and have qualified. Other meetings shall be held as necessary 62 8 to enable the council to expeditiously discharge its duties. 62 9 Meeting dates shall be set upon adjournment or by call of the 62 10 chairperson upon five days' notice to the other members. Each 62 11 member of the council shall receive a per diem as specified in 62 12 section 7E.6 and reimbursement for actual expenses while 62 13 engaged in official duties. 62 14 d. DUTIES. The council shall: 62 15 (1) Make the final decision, as required by section 62 16 135.69, with respect to each application for a certificate of 62 17 need accepted by the department bureau. 62 18 (2) Determine and adopt such policies as are authorized by 62 19 law and are deemed necessary to the efficient discharge of its 62 20 duties under this division. 62 21 (3) Have authority to direct staff personnel of the 62 22 department or bureau assigned to conduct formal or summary 62 23 reviews of applications for certificates of need. 62 24 (4) Advise and counsel with the director or administrator 62 25 concerning the provisions of this division, and the policies 62 26 and procedures adopted by the department or bureau pursuant to 62 27 this division. 62 28 (5) Review and approve, prior to promulgation, all rules 62 29 adopted by the department under this division. 62 30 Sec. 42. Section 135.63, subsection 1, Code 2007, is 62 31 amended to read as follows: 62 32 1. A new institutional health service or changed 62 33 institutional health service shall not be offered or developed 62 34 in this state without prior application to the department 62 35 bureau for and receipt of a certificate of need, pursuant to 63 1 this division. The application shall be made upon forms 63 2 furnished or prescribed by the department or bureau and shall 63 3 contain such information as the department or bureau may 63 4 require under this division. The application shall be 63 5 accompanied by a fee equivalent to three=tenths of one percent 63 6 of the anticipated cost of the project with a minimum fee of 63 7 six hundred dollars and a maximum fee of twenty=one thousand 63 8 dollars. The fee shall be remitted by the department or 63 9 bureau to the treasurer of state, who shall place it in the 63 10 general fund of the state. If an application is voluntarily 63 11 withdrawn within thirty calendar days after submission, 63 12 seventy=five percent of the application fee shall be refunded; 63 13 if the application is voluntarily withdrawn more than thirty 63 14 but within sixty days after submission, fifty percent of the 63 15 application fee shall be refunded; if the application is 63 16 withdrawn voluntarily more than sixty days after submission, 63 17 twenty=five percent of the application fee shall be refunded. 63 18 Notwithstanding the required payment of an application fee 63 19 under this subsection, an applicant for a new institutional 63 20 health service or a changed institutional health service 63 21 offered or developed by an intermediate care facility for 63 22 persons with mental retardation or an intermediate care 63 23 facility for persons with mental illness as defined pursuant 63 24 to section 135C.1 is exempt from payment of the application 63 25 fee. 63 26 Sec. 43. Section 135.63, subsection 2, paragraphs g, h, k, 63 27 1, and p, Code 2007, are amended to read as follows: 63 28 g. A reduction in bed capacity of an institutional health 63 29 facility, notwithstanding any provision in this division to 63 30 the contrary, if all of the following conditions exist: 63 31 (1) The institutional health facility reports to the 63 32 department bureau the number and type of beds reduced on a 63 33 form prescribed by the department or bureau at least thirty 63 34 days before the reduction. In the case of a health care 63 35 facility, the new bed total must be consistent with the number 64 1 of licensed beds at the facility. In the case of a hospital, 64 2 the number of beds must be consistent with bed totals reported 64 3 to the department of inspections and appeals for purposes of 64 4 licensure and certification. 64 5 (2) The institutional health facility reports the new bed 64 6 total on its next annual report to the department bureau. 64 7 If these conditions are not met, the institutional health 64 8 facility is subject to review as a "new institutional health 64 9 service" or "changed institutional health service" under 64 10 section 135.61, subsection 18, paragraph "d", and subject to 64 11 sanctions under section 135.73. If the institutional health 64 12 facility reestablishes the deleted beds at a later time, 64 13 review as a "new institutional health service" or "changed 64 14 institutional health service" is required pursuant to section 64 15 135.61, subsection 18, paragraph "d". 64 16 h. The deletion of one or more health services, previously 64 17 offered on a regular basis by an institutional health facility 64 18 or health maintenance organization, notwithstanding any 64 19 provision of this division to the contrary, if all of the 64 20 following conditions exist: 64 21 (1) The institutional health facility or health 64 22 maintenance organization reports to the department bureau the 64 23 deletion of the service or services at least thirty days 64 24 before the deletion on a form prescribed by the department or 64 25 bureau. 64 26 (2) The institutional health facility or health 64 27 maintenance organization reports the deletion of the service 64 28 or services on its next annual report to the department 64 29 bureau. 64 30 If these conditions are not met, the institutional health 64 31 facility or health maintenance organization is subject to 64 32 review as a "new institutional health service" or "changed 64 33 institutional health service" under section 135.61, subsection 64 34 18, paragraph "f", and subject to sanctions under section 64 35 135.73. 65 1 If the institutional health facility or health maintenance 65 2 organization reestablishes the deleted service or services at 65 3 a later time, review as a "new institutional health service" 65 4 or "changed institutional health service" may be required 65 5 pursuant to section 135.61, subsection 18. 65 6 k. The redistribution of beds by a hospital within the 65 7 acute care category of bed usage, notwithstanding any 65 8 provision in this division to the contrary, if all of the 65 9 following conditions exist: 65 10 (1) The hospital reports to the department bureau the 65 11 number and type of beds to be redistributed on a form 65 12 prescribed by the department or bureau at least thirty days 65 13 before the redistribution. 65 14 (2) The hospital reports the new distribution of beds on 65 15 its next annual report to the department bureau. 65 16 If these conditions are not met, the redistribution of beds 65 17 by the hospital is subject to review as a new institutional 65 18 health service or changed institutional health service 65 19 pursuant to section 135.61, subsection 18, paragraph "d", and 65 20 is subject to sanctions under section 135.73. 65 21 l. The replacement or modernization of any institutional 65 22 health facility if the replacement or modernization does not 65 23 add new health services or additional bed capacity for 65 24 existing health services, and does not relocate the 65 25 institutional health facility to any other site, 65 26 notwithstanding any provision in this division to the 65 27 contrary. 65 28 p. The conversion of an existing number of beds by an 65 29 intermediate care facility for persons with mental retardation 65 30 to a smaller facility environment, including but not limited 65 31 to a community=based environment which does not result in an 65 32 increased number of beds, notwithstanding any provision in 65 33 this division to the contrary, including subsection 4, if all 65 34 of the following conditions exist: 65 35 (1) The intermediate care facility for persons with mental 66 1 retardation reports the number and type of beds to be 66 2 converted on a form prescribed by the department or bureau at 66 3 least thirty days before the conversion. 66 4 (2) The intermediate care facility for persons with mental 66 5 retardation reports the conversion of beds on its next annual 66 6 report to the department bureau. 66 7 Sec. 44. Section 135.63, subsection 4, unnumbered 66 8 paragraph 1, Code 2007, is amended to read as follows: 66 9 A copy of the application shall be sent to the department 66 10 of human services at the time the application is submitted to 66 11 the Iowa department of public health bureau. The department 66 12 bureau shall not process applications for and the council 66 13 shall not consider a new or changed institutional health 66 14 service for an intermediate care facility for persons with 66 15 mental retardation unless both of the following conditions are 66 16 met: 66 17 Sec. 45. Section 135.64, subsection 1, unnumbered 66 18 paragraph 1, Code 2007, is amended to read as follows: 66 19 In determining whether a certificate of need shall be 66 20 issued, the department bureau and council shall consider the 66 21 following: 66 22 Sec. 46. Section 135.64, subsection 1, Code 2007, is 66 23 amended by adding the following new paragraphs before 66 24 paragraph a: 66 25 NEW PARAGRAPH. 0a. The relationship of the proposed 66 26 institutional health service to the statewide health care 66 27 delivery infrastructure and resources strategic plan developed 66 28 by the bureau pursuant to section 135.50. 66 29 NEW PARAGRAPH. 1a. Whether the proposed institutional 66 30 health service promotes wellness and prevention, will improve 66 31 quality, and will reduce health care costs. 66 32 Sec. 47. Section 135.64, subsection 1, paragraphs c, g, h, 66 33 i, and r, Code 2007, are amended to read as follows: 66 34 c. The need specific health care needs of the population 66 35 served or to be served by the proposed institutional health 67 1 services for those services, the extent to which the proposed 67 2 institutional health services will substantially address these 67 3 specific health care needs, and the projected positive impact 67 4 that the proposed institutional health services will have on 67 5 the health status indicators of the population to be served. 67 6 g. The relationship of the proposed institutional health 67 7 services to the state health care delivery infrastructure and 67 8 health care workforce resources strategic plan and to the 67 9 existing health care system of the area in which those 67 10 services are proposed to be provided. 67 11 h. The appropriate and efficient use or prospective use of 67 12 the proposed institutional health service, and of any existing 67 13 similar services, including but not limited to a consideration 67 14 of the capacity of the sponsor's facility to provide the 67 15 proposed service, and possible sharing or cooperative 67 16 arrangements among existing facilities and providers; and 67 17 whether there is a substantial risk that the proposed 67 18 institutional health services will result in inappropriate 67 19 increases in service utilization or the cost of health care 67 20 services. 67 21 i. The availability of resources, including, but not 67 22 limited to, health care providers, management personnel, and 67 23 funds for capital and operating needs, to provide the proposed 67 24 institutional health services and the possible alternative 67 25 uses of those resources to provide other health services; the 67 26 impact of the proposed institutional health services on total 67 27 health care expenditures and total health care workforce 67 28 resources taking into consideration both the costs and 67 29 benefits of the proposed institutional health services and the 67 30 competing demands in the local service area statewide for 67 31 available financial and human resources for health care; and 67 32 the impact on existing and proposed institutional and other 67 33 educational training programs for health care providers at the 67 34 student, internship, and residency training levels. 67 35 r. The recommendations of staff personnel of the 68 1 department or bureau assigned to the area of certificate of 68 2 need, concerning the application, if requested by the council. 68 3 Sec. 48. Section 135.64, subsection 1, Code 2007, is 68 4 amended by adding the following new paragraph: 68 5 NEW PARAGRAPH. ee. Whether the proposed institutional 68 6 health services will provide demonstrable improvements in 68 7 quality and outcome measures applicable to the institutional 68 8 health services proposed. 68 9 Sec. 49. Section 135.64, subsection 2, unnumbered 68 10 paragraph 1, Code 2007, is amended to read as follows: 68 11 In addition to the findings required with respect to any of 68 12 the criteria listed in subsection 1 of this section, the 68 13 council shall grant a certificate of need for a new 68 14 institutional health service or changed institutional health 68 15 service only if it finds in writing, on the basis of data 68 16 submitted to it by the department or bureau, that: 68 17 Sec. 50. Section 135.65, Code 2007, is amended to read as 68 18 follows: 68 19 135.65 LETTER OF INTENT TO PRECEDE APPLICATION == REVIEW 68 20 AND COMMENT. 68 21 1. Before applying for a certificate of need, the sponsor 68 22 of a proposed new institutional health service or changed 68 23 institutional health service shall submit to the department 68 24 bureau a letter of intent to offer or develop a service 68 25 requiring a certificate of need. The letter shall be 68 26 submitted as soon as possible after initiation of the 68 27 applicant's planning process, and in any case not less than 68 28 thirty days before applying for a certificate of need and 68 29 before substantial expenditures to offer or develop the 68 30 service are made. The letter shall include a brief 68 31 description of the proposed new or changed service, its 68 32 location, and its estimated cost. 68 33 2. Upon request of the sponsor of the proposed new or 68 34 changed service, the department bureau shall make a 68 35 preliminary review of the letter for the purpose of informing 69 1 the sponsor of the project of any factors which may appear 69 2 likely to result in denial of a certificate of need, based on 69 3 the criteria for evaluation of applications in section 135.64. 69 4 A comment by the department bureau under this section shall 69 5 not constitute a final decision. 69 6 Sec. 51. Section 135.66, Code 2007, is amended to read as 69 7 follows: 69 8 135.66 PROCEDURE UPON RECEIPT OF APPLICATION == PUBLIC 69 9 NOTIFICATION. 69 10 1. Within fifteen business days after receipt of an 69 11 application for a certificate of need, the department bureau 69 12 shall examine the application for form and completeness and 69 13 accept or reject it. An application shall be rejected only if 69 14 it fails to provide all information required by the department 69 15 bureau pursuant to section 135.63, subsection 1. The 69 16 department bureau shall promptly return to the applicant any 69 17 rejected application, with an explanation of the reasons for 69 18 its rejection. 69 19 2. Upon acceptance of an application for a certificate of 69 20 need, the department bureau shall promptly undertake to notify 69 21 all affected persons in writing that formal review of the 69 22 application has been initiated. Notification to those 69 23 affected persons who are consumers or third=party payers or 69 24 other payers for health services may be provided by 69 25 distribution of the pertinent information to the news media. 69 26 3. Each application accepted by the department bureau 69 27 shall be formally reviewed for the purpose of furnishing to 69 28 the council the information necessary to enable it to 69 29 determine whether or not to grant the certificate of need. A 69 30 formal review shall consist at a minimum of the following 69 31 steps: 69 32 a. Evaluation of the application against the criteria 69 33 specified in section 135.64. 69 34 b. A public hearing on the application, to be held prior 69 35 to completion of the evaluation required by paragraph "a", 70 1 shall be conducted by the council. 70 2 4. When a hearing is to be held pursuant to subsection 3, 70 3 paragraph "b", the department bureau shall give at least ten 70 4 days' notice of the time and place of the hearing. At the 70 5 hearing, any affected person or that person's designated 70 6 representative shall have the opportunity to present 70 7 testimony. 70 8 Sec. 52. Section 135.67, unnumbered paragraph 1, Code 70 9 2007, is amended to read as follows: 70 10 The department bureau may waive the letter of intent 70 11 procedures prescribed by section 135.65 and substitute a 70 12 summary review procedure, which shall be established by rules 70 13 of the department, when it accepts an application for a 70 14 certificate of need for a project which meets any of the 70 15 criteria in subsections 1 through 5: 70 16 Sec. 53. Section 135.67, subsections 3 and 5, Code 2007, 70 17 are amended to read as follows: 70 18 3. A project which will not change the existing bed 70 19 capacity of the applicant's facility or service, as determined 70 20 by the department bureau, by more than ten percent or ten 70 21 beds, whichever is less, over a two=year period. 70 22 5. Any other project for which the applicant proposes and 70 23 the department bureau agrees to summary review. 70 24 Sec. 54. Section 135.67, unnumbered paragraph 2, Code 70 25 2007, is amended to read as follows: 70 26 The department's bureau's decision to disallow a summary 70 27 review shall be binding upon the applicant. 70 28 Sec. 55. Section 135.68, Code 2007, is amended to read as 70 29 follows: 70 30 135.68 STATUS REPORTS ON REVIEW IN PROGRESS. 70 31 While formal review of an application for a certificate of 70 32 need is in progress, the department bureau shall upon request 70 33 inform any affected person of the status of the review, any 70 34 findings which have been made in the course of the review, and 70 35 any other appropriate information concerning the review. 71 1 Sec. 56. Section 135.69, unnumbered paragraph 1, Code 71 2 2007, is amended to read as follows: 71 3 The department bureau shall complete its formal review of 71 4 the application within ninety days after acceptance of the 71 5 application, except as otherwise provided by section 135.72, 71 6 subsection 4. Upon completion of the formal review, the 71 7 council shall approve or deny the application. The council 71 8 shall issue written findings stating the basis for its 71 9 decision on the application, and the department bureau shall 71 10 send copies of the council's decision and the written findings 71 11 supporting the decision to the applicant and to any other 71 12 person who so requests. 71 13 Sec. 57. Section 135.71, Code 2007, is amended to read as 71 14 follows: 71 15 135.71 PERIOD FOR WHICH CERTIFICATE IS VALID == EXTENSION 71 16 OR REVOCATION. 71 17 A certificate of need shall be valid for a maximum of one 71 18 year from the date of issuance. Upon the expiration of the 71 19 certificate, or at any earlier time while the certificate is 71 20 valid the holder thereof shall provide the department bureau 71 21 such information on the development of the project covered by 71 22 the certificate as the department bureau may request. The 71 23 council shall determine at the end of the certification period 71 24 whether sufficient progress is being made on the development 71 25 of the project. The certificate of need may be extended by 71 26 the council for additional periods of time as are reasonably 71 27 necessary to expeditiously complete the project, but may be 71 28 revoked by the council at the end of the first or any 71 29 subsequent certification period for insufficient progress in 71 30 developing the project. 71 31 Upon expiration of certificate of need, and prior to 71 32 extension thereof, any affected person shall have the right to 71 33 submit to the department bureau information which may be 71 34 relevant to the question of granting an extension. The 71 35 department bureau may call a public hearing for this purpose. 72 1 Sec. 58. Section 135.72, subsection 4, Code 2007, is 72 2 amended to read as follows: 72 3 4. Criteria for determining when it is not feasible to 72 4 complete formal review of an application for a certificate of 72 5 need within the time limits specified in section 135.69. The 72 6 rules adopted under this subsection shall include criteria for 72 7 determining whether an application proposes introduction of 72 8 technologically innovative equipment, and if so, procedures to 72 9 be followed in reviewing the application. However, a rule 72 10 adopted under this subsection shall not permit a deferral of 72 11 more than sixty days beyond the time when a decision is 72 12 required under section 135.69, unless both the applicant and 72 13 the department bureau agree to a longer deferment. 72 14 Sec. 59. Section 135.74, subsections 1 and 2, Code 2007, 72 15 are amended to read as follows: 72 16 1. The department, after study and in consultation with 72 17 the bureau of health care quality and consumer information and 72 18 any advisory committees which may be established pursuant to 72 19 law, shall promulgate by rule pursuant to chapter 17A uniform 72 20 methods of financial reporting, including such allocation 72 21 methods as may be prescribed, by which hospitals and health 72 22 care facilities shall respectively record their revenues, 72 23 expenses, other income, other outlays, assets and liabilities, 72 24 and units of service, according to functional activity center. 72 25 These uniform methods of financial reporting shall not 72 26 preclude a hospital or health care facility from using any 72 27 accounting methods for its own purposes provided these 72 28 accounting methods can be reconciled to the uniform methods of 72 29 financial reporting prescribed by the department and can be 72 30 audited for validity and completeness. Each hospital and each 72 31 health care facility shall adopt the appropriate system for 72 32 its fiscal year, effective upon such date as the department 72 33 shall direct. In determining the effective date for reporting 72 34 requirements, the department shall consider both the immediate 72 35 need for uniform reporting of information to effectuate the 73 1 purposes of this division and the administrative and economic 73 2 difficulties which hospitals and health care facilities may 73 3 encounter in complying with the uniform financial reporting 73 4 requirement, but the effective date shall not be later than 73 5 January 1, 1980. 73 6 2. In establishing uniform methods of financial reporting, 73 7 the department shall consider all of the following: 73 8 a. The existing systems of accounting and reporting 73 9 currently utilized by hospitals and health care facilities;. 73 10 b. Differences among hospitals and health care facilities, 73 11 respectively, according to size, financial structure, methods 73 12 of payment for services, and scope, type and method of 73 13 providing services; and. 73 14 c. Other pertinent distinguishing factors. 73 15 Sec. 60. Section 135.75, subsection 1, Code 2007, is 73 16 amended to read as follows: 73 17 1. Each hospital and each health care facility shall 73 18 annually, after the close of its fiscal year, file with the 73 19 department all of the following: 73 20 a. A balance sheet detailing the assets, liabilities and 73 21 net worth of the hospital or health care facility;. 73 22 b. A statement of its the hospital's or health care 73 23 facility's income and expenses; and including but not limited 73 24 to expenses for salaries and other compensation for management 73 25 positions including the salary and compensation for the chief 73 26 executive officer and five other most highly compensated 73 27 positions, profit or excess revenues, and cash reserves. 73 28 c. Such other reports of the costs incurred in rendering 73 29 services as the department may prescribe. 73 30 Sec. 61. Section 135.76, Code 2007, is amended to read as 73 31 follows: 73 32 135.76 ANALYSES AND STUDIES BY DEPARTMENT BUREAU. 73 33 1. The department bureau of health care strategic planning 73 34 and resource development, in cooperation with the bureau of 73 35 health care quality and consumer information, shall from time 74 1 to time undertake analyses and studies relating to hospital 74 2 and health care facility costs and to the financial status of 74 3 hospitals or health care facilities, or both, which are 74 4 subject to the provisions of this division. It The bureau of 74 5 health care strategic planning and resource development shall 74 6 further also require the filing of information concerning the 74 7 total financial needs of each individual hospital or health 74 8 care facility and the resources currently or prospectively 74 9 available to meet these needs, including the effect of 74 10 proposals made by health systems agencies. The department 74 11 bureau shall also prepare and file such summaries and 74 12 compilations or other supplementary reports based on the 74 13 information filed with it the bureau as will, in its the 74 14 bureau's judgment, advance the purposes of this division and 74 15 the purposes of the bureau of health care quality and consumer 74 16 information. 74 17 2. The analyses and studies required by this section shall 74 18 be conducted with the objective of providing a basis for 74 19 determining whether or not regulation of hospital and health 74 20 care facility rates and charges by the state of Iowa is 74 21 necessary to protect the health or welfare of the people of 74 22 the state. 74 23 3. In conducting its the analyses and studies, the 74 24 department should bureau shall determine whether: 74 25 a. The rates charged and costs incurred by hospitals and 74 26 health care facilities are reasonably related to the services 74 27 offered by those respective groups of institutions. 74 28 b. Aggregate rates of hospitals and of health care 74 29 facilities are reasonably related to the aggregate costs 74 30 incurred by those respective groups of institutions. 74 31 c. Rates are set equitably among all purchasers or classes 74 32 of purchasers of hospital and of health care facility 74 33 services. 74 34 d. The rates for particular services, supplies or 74 35 materials established by hospitals and by health care 75 1 facilities are reasonable. Determination of reasonableness of 75 2 rates shall include consideration of a fair rate of return to 75 3 proprietary hospitals and health care facilities. 75 4 4. All data gathered and compiled and all reports prepared 75 5 under this section, except privileged medical information, 75 6 shall be open to public inspection. 75 7 Sec. 62. Section 135.78, Code 2007, is amended to read as 75 8 follows: 75 9 135.78 DATA TO BE COMPILED. 75 10 The department bureau of health care strategic planning and 75 11 resource development shall compile all relevant financial and 75 12 utilization data in order to have available the statistical 75 13 information necessary to properly monitor hospital and health 75 14 care facility charges and costs and to assist the bureau of 75 15 health care quality and consumer information. Such data shall 75 16 include necessary operating expenses, appropriate expenses 75 17 incurred for rendering services to patients who cannot or do 75 18 not pay, all properly incurred interest charges, and 75 19 reasonable depreciation expenses based on the expected useful 75 20 life of the property and equipment involved. The department 75 21 bureau of health care strategic planning and resource 75 22 development shall also obtain from each hospital and health 75 23 care facility a current rate schedule as well as any 75 24 subsequent amendments or modifications of that schedule as it 75 25 may require. In collection of the data required by this 75 26 section and sections 135.74 through 135.76, the department 75 27 bureau of health care strategic planning and resource 75 28 development, the bureau of health care quality and consumer 75 29 information, and other state agencies shall coordinate their 75 30 reporting requirements. 75 31 EXPLANATION 75 32 IOWA HEALTH CARE COVERAGE EXCHANGE. Division I of this 75 33 bill relates to the creation of the Iowa health care coverage 75 34 exchange in new Code chapter 514M with the intent to progress 75 35 toward achievement of the goal that all Iowans have health 76 1 care coverage, as funding becomes available. 76 2 Specified priorities for achievement of the goal are as 76 3 follows: 76 4 1. All Iowa children have qualified health care coverage 76 5 which meets certain standards of quality and affordability 76 6 beginning with covering all children who are eligible for 76 7 public coverage by December 31, 2009, subsidizing private 76 8 coverage for the remaining uninsured children up to 18 years 76 9 of age under a sliding scale based on family income by 76 10 December 31, 2009, and moving toward a future requirement that 76 11 all parents provide proof of qualified health care coverage 76 12 for their children. 76 13 2. All Iowans have qualified health care coverage which 76 14 meets certain standards of quality and affordability beginning 76 15 with continued expansion of options for individuals who are 76 16 dually eligible for Medicare and medical assistance, 76 17 facilitating coverage of uninsured health and long=term care 76 18 workers and child care workers, maximizing eligibility of 76 19 low=income adults 18 years of age and older for public health 76 20 care coverage, subsidizing coverage for the remaining 76 21 low=income adults, and moving toward a future requirement that 76 22 all Iowans must provide proof of qualified health care 76 23 coverage. 76 24 3. Health care costs and health care coverage costs are 76 25 decreased by instituting insurance reforms, requiring Iowa 76 26 children with public coverage to have a medical home, 76 27 establishing a statewide telehealth system, and implementing 76 28 cost=containment strategies. 76 29 The Iowa health care coverage exchange is created as a 76 30 state agency governed by a board of directors including the 76 31 following nine voting members: the two most recent former 76 32 governors (or if one or both of them are unable or unwilling 76 33 to serve, a person or persons appointed by the governor); the 76 34 commissioner of insurance; the director of human services; and 76 35 five members appointed by the governor subject to confirmation 77 1 by the senate; who represent specified groups; and including 77 2 the following five ex officio, nonvoting members: four members 77 3 of the general assembly and a secretary of the board. The 77 4 voting members of the board are also required to appoint an 77 5 executive director, subject to confirmation by the senate, to 77 6 supervise the administrative affairs and general management 77 7 and operations of the exchange. 77 8 The bill provides that the board has broad authority to 77 9 accomplish the purposes of the Code chapter including but not 77 10 limited to many specified powers and duties. The board is 77 11 required to make an annual report of its activities and 77 12 receipts and expenditures to the governor and general 77 13 assembly. A separate health care coverage exchange fund is 77 14 created in the state treasury under the control of the 77 15 exchange. Moneys collected from premiums paid for health care 77 16 plans offered by the exchange as well as any other moneys that 77 17 are appropriated or transferred to the fund are appropriated 77 18 to the fund and available to the exchange to carry out the 77 19 purposes of new Code chapter 514M. 77 20 The bill provides for transition provisions during 77 21 implementation of health care coverage for all Iowans. The 77 22 board is directed to design and implement a program, as 77 23 funding becomes available, including a timetable and 77 24 procedures for implementation, to progress toward achieving 77 25 the goal that all Iowans have qualified health care coverage. 77 26 The board is charged to define what constitutes such coverage, 77 27 including parameters of quality and affordability. 77 28 MEDICAL HOME. Division II of the bill relates to medical 77 29 homes. The bill provides definitions, including the 77 30 definition of a medical home which is a team approach to 77 31 providing health care that originates in a primary care 77 32 setting, and provides for continuity in and coordination of 77 33 care. The bill specifies the characteristics of a medical 77 34 home, and creates a medical home commission. The commission 77 35 is directed to develop a plan for implementation of a 78 1 statewide medical home system. Implementation is to take 78 2 place in phases, beginning with children who are recipients of 78 3 medical assistance (Medicaid) or the hawk=i program and 78 4 expanding to children covered through the exchange created in 78 5 the bill. The second phase would provide a medical home to 78 6 adults under the IowaCare program and adult recipients of 78 7 Medicaid. The third phase would provide for a medical home 78 8 for adults covered through the exchange. 78 9 The bill specifies the duties of the medical home 78 10 commission and the organizational structure for the medical 78 11 home system. The bill directs the commission to adopt 78 12 standards and a process to certify medical homes based on 78 13 national standards, to adopt education and training standards 78 14 for health care professionals participating in the medical 78 15 home system, to provide for system simplification, to 78 16 determine a rate of reimbursement and recommend incentives for 78 17 participation in the medical home system, and to coordinate 78 18 efforts with the dental home for children, and integrate the 78 19 recommendations of the prevention and chronic care management 78 20 advisory council into the medical home system. 78 21 In addition to the phased=in implementation, the bill also 78 22 directs the commission to work with the department of 78 23 administrative services to allow state employees to utilize 78 24 the medical home system, to work with the centers for Medicare 78 25 and Medicaid services of the United States department of 78 26 health and human services to allow Medicare recipients to 78 27 utilize the medical home system and to work with insurers and 78 28 self=insured companies to allow those with private insurance 78 29 to access the medical home system. The commission is directed 78 30 to provide oversight for the medical home system and to 78 31 evaluate and make recommendations regarding improvements to 78 32 and continuation of the medical home system. 78 33 PREVENTION AND CHRONIC CARE MANAGEMENT. Division III 78 34 relates to prevention and chronic care management. The bill 78 35 provides definitions relating to chronic conditions and 79 1 chronic care and for the state initiative for prevention and 79 2 chronic care management. 79 3 The bill creates an advisory council to assist the director 79 4 of public health in developing the state initiative. The 79 5 advisory council is directed to elicit input from a variety of 79 6 health care professionals, organizations, insurers, 79 7 businesses, and consumers and is to submit initial 79 8 recommendations to the director by July 1, 2009. The 79 9 recommendations are to address the organizational structure 79 10 for integrating chronic care management into the public and 79 11 private health care systems, a process for identifying leading 79 12 health care professionals and existing programs to coordinate 79 13 efforts, prioritization of chronic conditions, a method to 79 14 involve health care professionals in identifying individuals 79 15 with chronic conditions, methods to increase communication 79 16 between health care professionals and patients with chronic 79 17 conditions, protocols and tools for health care providers to 79 18 utilize, outcomes measures and benchmarks, payment 79 19 methodologies and incentives, ways to involve public and 79 20 private entities in facilitating and sustaining the 79 21 initiative, alignment of information technology, involvement 79 22 of health resources and researchers to collect data and 79 23 evaluate the initiative, a marketing campaign, a means of 79 24 determining participation in the initiative, and a means to 79 25 integrate chronic care management into education resources and 79 26 curricula for existing and new education and training 79 27 programs. 79 28 The bill provides that following initial recommendations 79 29 and implementation among the eligible population of 79 30 individuals (residents of the state who have been diagnosed 79 31 with a chronic condition or who are at elevated risk for a 79 32 chronic condition and who are recipients of medical 79 33 assistance, the hawk=i program, or IowaCare; an inmate of a 79 34 correctional institution; or an individual who has qualified 79 35 health care coverage through the exchange), the director is 80 1 required to work with various entities to implement the 80 2 initiative as an integral part of the health care delivery 80 3 system in the state. 80 4 The bill also directs the department of administrative 80 5 services to include in any request for proposals for the 80 6 administration of health benefit plans for state employees a 80 7 request for a description of any prevention and chronic care 80 8 management program provided by the entity offering the health 80 9 benefit plan. 80 10 IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM. Division IV 80 11 relates to the Iowa health information technology system. The 80 12 bill provides definitions, principles, and goals for the 80 13 system. The bill creates an electronic health information 80 14 commission as a public and private collaborative effort and 80 15 directs the commission to establish an advisory council to 80 16 assist the commission in its duties; to adopt a statewide 80 17 health information technology plan by January 1, 2009; to 80 18 identify existing efforts and integrate these efforts to avoid 80 19 incompatibility and duplication; to coordinate public and 80 20 private efforts to provide the network backbone; to promote 80 21 the use of telemedicine; to address the workforce needs 80 22 generated by increased use of health information technology; 80 23 to adopt necessary rules; to coordinate, monitor, and evaluate 80 24 the adoption, use, interoperability, and efficiencies of the 80 25 various facets of health information technology in the state; 80 26 to seek and apply for federal or private funding to assist in 80 27 implementing the system; and to identify state laws and rules 80 28 that present barriers to the development of the health 80 29 information technology system in the state. 80 30 The bill requires that by January 1, 2010, all health care 80 31 professionals utilize the patient identifier and continuity of 80 32 care record specified by the commission. 80 33 LONG=TERM CARE PLANNING AND ADVANCE MEDICAL DIRECTIVES. 80 34 Division V relates to long=term care planning and advance 80 35 medical directives. The bill provides that under the 81 1 life=sustaining procedures Act, the hospital or health care 81 2 provider is required to use a physician orders for 81 3 life=sustaining=treatment form reflecting the declaration of a 81 4 patient and to ensure that the form accompanies a patient who 81 5 is comatose, incompetent, or otherwise physically or mentally 81 6 incapable of communication if the patient is transferred to 81 7 another facility. 81 8 The bill also requires that under the life=sustaining 81 9 procedures Act and the durable power of attorney for health 81 10 care chapter hospitals and health care providers establish a 81 11 nonjudicial means of resolving disputes that arise out of a 81 12 disagreement over compliance with a declaration or 81 13 out=of=hospital do=not=resuscitate order or a durable power of 81 14 attorney for health care. 81 15 The bill includes provisions to promote the use of 81 16 palliative care and to mandate coverage benefits for the cost 81 17 of core services by a licensed hospice program in a policy or 81 18 contract providing third=party payment or prepayment of health 81 19 or medical expenses. 81 20 The bill directs programs within the department of elder 81 21 affairs and other appropriate agencies and interested parties 81 22 to collaborate in recommending a public education strategy on 81 23 long=term living. The bill also directs the department of 81 24 elder affairs in collaboration with the insurance division to 81 25 implement a long=term care options public education campaign. 81 26 The bill directs the department of elder affairs to work with 81 27 other public and private agencies to identify resources to use 81 28 to continue the work of the aging and disability resource 81 29 center. 81 30 DIVISION OF HEALTH CARE QUALITY, CONSUMER INFORMATION, 81 31 STRATEGIC PLANNING, AND RESOURCE DEVELOPMENT. Division VI 81 32 creates the division of health care quality, consumer 81 33 information, strategic planning, and resource development 81 34 within the department of public health and specifies two 81 35 bureaus within the division: the bureau of health care 82 1 quality and consumer information and the bureau of health care 82 2 strategic planning and resource development. 82 3 The bill requires the bureau of health care quality and 82 4 consumer information to provide better coordination of health 82 5 care delivery information to improve the public health, inform 82 6 policy analysis, and provide transparency of consumer health 82 7 information. The bill creates a health quality and 82 8 cost=containment collaborative to develop a process and the 82 9 infrastructure to provide price, quality, safety, and other 82 10 appropriate information to consumers. The bill designates the 82 11 members of the collaborative and specifies its duties. 82 12 The bill directs the bureau of health care strategic 82 13 planning and resource development to coordinate public and 82 14 private efforts to develop and maintain an appropriate health 82 15 care delivery infrastructure and a stable, well=qualified, 82 16 diverse, and sustainable health care workforce in the state. 82 17 One duty of the bureau is to develop a strategic plan for 82 18 health care delivery infrastructure and health care workforce 82 19 resources. The bureau is directed to establish a technical 82 20 advisory committee to assist in the development of the 82 21 strategic plan. The strategic plan is to include policies and 82 22 goals based on specified principles, a health care system 82 23 assessment and objectives component, a health care facilities 82 24 and services plan to assess the demand for health care 82 25 facilities and services, a health care data resources plan, an 82 26 assessment of emerging trends in health care delivery and 82 27 technology, a rural health resources plan, and a health care 82 28 workforce resources plan. 82 29 CERTIFICATE OF NEED PROGRAM. Division VII of the bill 82 30 amends the certificate of need program to reflect the change 82 31 of the health facilities council to the health care strategic 82 32 planning council as the oversight body for the certificate of 82 33 need program and to require the submission of additional 82 34 information by those entities subject to the certificate of 82 35 need program. 83 1 LSB 6443XC 82 83 2 av:pf/rj/8
Text: SSB3139            Text: SSB3141