Senate File 2356
RELATING TO THE HEALTH CARE INCLUDING IOWACARE PROGRAM
PROVISIONS AND THE CREATION OF AN IOWA INSURANCE INFORMATION
EXCHANGE TO PROMOTE TRANSPARENCY, QUALITY, SEAMLESSNESS, AND
INFORMED CHOICES RELATIVE TO HEALTH CARE COVERAGE.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
IOWACARE PROGRAM AND OTHER HEALTH CARE OPTIONS
Section 1. Section 249J.7, Code 2009, is amended to read as
249J.7 Expansion population provider network.
1. a. Expansion population members shall only be eligible
to receive expansion population services through a provider
included in the expansion population provider network. Except
as otherwise provided in this chapter, the expansion population
provider network shall be limited to a publicly owned acute
care teaching hospital located in a county with a population
over three hundred fifty thousand, the university of Iowa
hospitals and clinics,
and the state hospitals for persons with
mental illness designated pursuant to section 226.1 with the
exception of the programs at such state hospitals for persons
with mental illness that provide substance abuse treatment,
serve gero=psychiatric patients, or treat sexually violent
predators and a regional provider network utilizing the
federally qualified health centers or federally qualified
health center look=alikes in the state, to provide primary care
b. (1) The department shall develop a plan to phase=in
the regional provider network by determining the most highly
underserved areas on a statewide and regional basis, and
targeting these areas for prioritization in implementing the
regional provider network. In developing the phase=in plan
the department shall consult with the medical assistance
projections and assessment council created in section 249J.20.
Any plan developed shall be approved by the council prior
to implementation. The phase=in of the regional provider
network shall be implemented in a manner that ensures that
program expenditures do not exceed budget neutrality limits and
funded program capacity, and that ensures compliance with the
eligibility maintenance of effort requirements of the federal
American Recovery and Reinvestment Act of 2009.
(2) Payment shall only be made to designated participating
primary care providers for eligible primary care services
provided to a member.
(3) The department shall adopt rules pursuant to chapter
17A, in collaboration with the medical home advisory council
created pursuant to section 135.159, specifying requirements
for medical homes including certification, with which regional
provider network participating providers shall comply, as
(4) The department may also designate other private
providers and hospitals to participate in the regional provider
network, to provide primary and specialty care, subject to the
availability of funds.
(5) Notwithstanding any provision to the contrary, the
department shall develop a methodology to reimburse regional
provider network participating providers designated under this
c. Tertiary care shall be provided to eligible expansion
population members residing in any county in the state at the
university of Iowa hospitals and clinics.
d. Until such time as the publicly owned acute care
teaching hospital located in a county with a population over
three hundred fifty thousand notifies the department that
such hospital has reached service capacity, the hospital and
the university of Iowa hospitals and clinics shall remain the
only expansion population providers for the residents of such
2. Expansion population services provided to expansion
population members by providers included in the expansion
population provider network the publicly owned acute care
teaching hospital located in a county with a population
over three hundred fifty thousand and the university of Iowa
hospitals and clinics shall be payable at the full benefit
3. Providers included in the expansion population provider
network shall submit clean claims within twenty days of the
date of provision of an expansion population service to an
expansion population member.
4. Unless otherwise prohibited by law, a provider under
the expansion population provider network may deny care to
an individual who refuses to apply for coverage under the
5. Notwithstanding the provision of section 347.16,
subsection 2, requiring the provision of free care and
treatment to the persons described in that subsection, the
publicly owned acute care teaching hospital described in
subsection 1 may require any sick or injured person seeking
care or treatment at that hospital to be subject to financial
participation, including but not limited to copayments
or premiums, and may deny nonemergent care or treatment
to any person who refuses to be subject to such financial
6. The department shall utilize certified public
expenditures at the university of Iowa hospitals and clinics
to maximize the availability of state funding to provide
necessary access to both local primary and specialty physician
care to expansion population members. The resulting savings
to the state shall be utilized to reimburse physician services
provided to expansion population members at the university of
Iowa college of medicine, to reimburse providers designated
to participate in the regional provider network for services
provided to expansion population members, and for deposit in
the nonparticipating provider reimbursement fund created in
section 249J.24A to be used in accordance with the purposes and
requirements of the fund.
7. The department shall adopt rules to establish clinical
transfer protocols to be used by providers included in the
expansion population provider network.
Sec. 2. Section 263.18, subsection 4, Code 2009, is amended
to read as follows:
4. The physicians and surgeons on the staff of the
university of Iowa hospitals and clinics who care for patients
provided for in this section may charge for the medical
services provided under such rules, regulations, and plans
approved by the state board of regents. However, a physician
or surgeon who provides treatment or care for an expansion
population member pursuant to chapter 249J shall not charge
or only receive any compensation for the treatment or care
except the salary or compensation fixed by the state board
of regents to be paid from the hospital fund provided in
accordance with section 249J.7.
Sec. 3. REVIEW OF MEDICAL TRANSPORTATION COSTS FOR
IOWACARE. The department of human services shall review the
costs of transportation to and from a provider included in
the expansion population provider network under the IowaCare
program. The department shall report the results of the review
to the general assembly by December 15, 2010.
Sec. 4. DIABETES == PLAN FOR COORDINATION OF CARE. The
department of public health shall work with all appropriate
entities to develop a plan for coordination of care for
individuals with diabetes who receive care through community
health centers, rural health clinics, free clinics, and other
members of the Iowa collaborative safety net provider network
established pursuant to section 135.153, as determined by the
department. The plan may include provisions to establish a
diabetic registry, to provide access to medically necessary
drugs through entities such as the Iowa prescription drug
corporation, and to collect data as necessary to assist the
affected medical providers in tracking and improving the care
of their patients with diabetes, while also informing future
public policy decision makers regarding improved care for
individuals with diabetes, notwithstanding an individual's
health care coverage status or choice of health care provider.
Sec. 5. IOWACARE == EXTENSION OF WAIVER. The department
of human services shall amend the extension proposal for the
IowaCare section 1115 demonstration waiver and shall submit
applicable state plan amendments under the medical assistance
program to provide expansion population services through the
expansion population network pursuant to section 249J.7, as
amended by this Act, within the budget neutrality cap and
subject to availability of state matching funds.
Sec. 6. IOWACARE POPULATION == OPTIMIZATION OF SERVICE
DELIVERY AND OUTCOMES. The publicly owned acute care teaching
hospital located in a county with a population over three
hundred fifty thousand, the federally qualified health center
located in such county, and the university of Iowa hospitals
and clinics shall actively collaborate to optimize effective
and efficient delivery of services that result in the best
possible outcomes for IowaCare members.
IOWA INSURANCE INFORMATION EXCHANGE
Sec. 7. NEW SECTION. 505.32 Iowa insurance information
1. Purpose. The purpose of this section is to establish
an information clearinghouse where all Iowans can obtain
information about health care coverage that is available
in this state including availability of care delivered by
safety=net providers and comparisons of benefits, premiums, and
2. Definitions. As used in this section, unless the context
a. "Carrier" means an insurer providing accident and
sickness insurance under chapter 509, 514, or 514A and
includes a health maintenance organization established under
chapter 514B if payments received by the health maintenance
organization are considered premiums pursuant to section
514B.31 and are taxed under chapter 432. "Carrier" also
includes a corporation which becomes a mutual insurer pursuant
to section 514.23 and any other person as defined in section
4.1, subsection 20, who is or may become liable for the tax
imposed by chapter 432.
b. "Commissioner" means the commissioner of insurance.
c. "Creditable coverage" means the same as defined in
d. "Exchange" means the Iowa insurance information exchange.
e. "Health insurance" means accident and sickness insurance
authorized by chapter 509, 514, or 514A.
f. (1) "Health insurance coverage" means health insurance
coverage offered to individuals.
(2) "Health insurance coverage" does not include any of the
(a) Coverage for accident=only, or disability income
(b) Coverage issued as a supplement to liability insurance.
(c) Liability insurance, including general liability
insurance and automobile liability insurance.
(d) Workers' compensation or similar insurance.
(e) Automobile medical=payment insurance.
(f) Credit=only insurance.
(g) Coverage for on=site medical clinic care.
(h) Other similar insurance coverage, specified in
federal regulations, under which benefits for medical care
are secondary or incidental to other insurance coverage or
(3) "Health insurance coverage" does not include benefits
provided under a separate policy as follows:
(a) Limited=scope dental or vision benefits.
(b) Benefits for long=term care, nursing home care, home
health care, or community=based care.
(c) Any other similar limited benefits as provided by rule
of the commissioner.
(4) "Health insurance coverage" does not include benefits
offered as independent noncoordinated benefits as follows:
(a) Coverage only for a specified disease or illness.
(b) A hospital indemnity or other fixed indemnity
(5) "Health insurance coverage" does not include Medicare
supplemental health insurance as defined under section
1882(g)(1) of the federal Social Security Act, coverage
supplemental to the coverage provided under 10 U.S.C. ch. 55
and similar supplemental coverage provided to coverage under
group health insurance coverage.
g. "Legislative health care coverage commission" or
"commission" means the legislative health care coverage
commission created in 2009 Iowa Acts, ch. 118, section 1.
h. "Medicare" means the federal government health insurance
program established under Tit. XVIII of the federal Social
i. "Organized delivery system" means an organized delivery
system as licensed by the director of public health.
3. Iowa insurance information exchange established. An Iowa
insurance information exchange is established in the insurance
division of the department of commerce under the authority of
the commissioner of insurance.
a. The commissioner, in collaboration with the legislative
health care coverage commission, shall develop a plan of
operation for the exchange within one hundred eighty days from
the effective date of this section. The plan shall create an
information clearinghouse that provides resources where Iowans
can obtain information about health care coverage that is
available in the state.
b. The commissioner shall keep records of all financial
transactions related to the establishment and operation of
the exchange and shall deliver an annual fiscal report of the
costs of administering the exchange to the general assembly by
December 15 of each year.
4. Powers and duties of exchange.
a. The commissioner shall report on the status of the
exchange at all regular meetings of the legislative health
care coverage commission, including progress in developing and
implementing the exchange operationally, resources available
through the exchange, information about utilization of the
resources offered by the exchange, including demographic
information that illustrates how and by whom the exchange is
being utilized, and the costs of implementing and operating the
exchange. The commissioner may make recommendations to the
commission for including but not limited to the following:
(1) Promotion of greater transparency in providing quality
data on health care providers and health care coverage plans
and in providing data on the cost of medical care that is
easily accessible to the public.
(2) Statutory options that improve seamlessness in the
health care system in this state.
(3) Funding opportunities to increase health care coverage
in the state, particularly for individuals who have been denied
access to health insurance coverage.
b. The commissioner shall implement and maintain information
on the insurance division internet site that is easily
accessible and available to consumers and purchasers of health
insurance coverage regarding each carrier licensed to do
business in this state. The information provided shall be
understandable to consumers and purchasers of health insurance
coverage and shall include but is not limited to information
regarding plan design, premium rate filings and approvals,
health care cost information, and any other information
specific to this state that the commissioner determines may
be beneficial to consumers and purchasers of health insurance
coverage. The commissioner may contract with outside vendors
and entities to assist in providing this information on the
c. The exchange shall provide information about all public
and private health care coverage that is available in this
state including the cost to the public, and comparisons of
benefits, premiums, and out=of=pocket costs.
(1) The commissioner may establish methodologies to provide
uniform and consistent side=by=side comparisons of the health
care coverage options that are offered by carriers, organized
delivery systems, and public programs in this state including
but not limited to benefits covered and not covered, the amount
of coverage for each service, including copays and deductibles,
administrative costs, and any prior authorization requirements
(2) The commissioner may require each carrier, organized
delivery system, and public program in this state to describe
each health care coverage option offered by that carrier,
organized delivery system, or public program in a manner
so that the various options can be compared as provided in
d. The commissioner shall provide ongoing information to
taxpayers about the costs of public health care programs to the
state, including the administrative costs of the programs and
the percentage and source of state and federal funding for the
programs, utilizing information provided by the department of
human services and the department of public health.
e. The exchange may provide information to assist Iowans
with making an informed choice when selecting health care
f. The commissioner may utilize independent consultants,
as deemed necessary, to assist in carrying out the powers and
duties of the exchange.
g. The commissioner may periodically advertise the general
availability of health care coverage information available from
5. Rules. The commissioner shall adopt rules pursuant to
chapter 17A to implement the provisions of this section.
JOHN P. KIBBIE
President of the Senate
PATRICK J. MURPHY
Speaker of the House
I hereby certify that this bill originated in the Senate and
is known as Senate File 2356, Eighty=third General Assembly.
MICHAEL E. MARSHALL
Secretary of the Senate
Approved , 2010
CHESTER J. CULVER