Text: SF295            Text: SF297
Complete Bill History


Senate File 296

SENATE FILE BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 71) (As Amended and Passed by the Senate March 26, 2013) A BILL FOR 1 An Act relating to integrated care models for the delivery 2 of health care, including but not limited to required 3 utilization of a medical home by individuals currently and 4 newly eligible for coverage under the Medicaid program and 5 including effective date provisions. 6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: SF 296 (4) 85 pf/rj/jh PAG LIN 1 1 Section 1. Section 135.157, subsections 4 and 6, Code 2013, 1 2 are amended to read as follows: 1 3 4. "Medical home" means a team approach to providing health 1 4 care that originates in a primary care setting; fosters a 1 5 partnership among the patient, the personal provider, and 1 6 other health care professionals, and where appropriate, the 1 7 patient's family; utilizes the partnership to access and 1 8 integrate all medical and nonmedical health=related services 1 9 across all elements of the health care system and the patient's 1 10 community as needed by the patient and the patient's family 1 11 to achieve maximum health potential; maintains a centralized, 1 12 comprehensive record of all health=related services to 1 13 promote continuity of care; and has all of the characteristics 1 14 specified in section 135.158. 1 15 6. "Personal provider" means the patient's first point of 1 16 contact in the health care system with a primary care provider 1 17 who identifies the patient's health health=related needs and, 1 18 working with a team of health care professionals and providers 1 19 of medical and nonmedical health=related services, provides 1 20 for and coordinates appropriate care to address the health 1 21 health=related needs identified. 1 22 Sec. 2. Section 135.158, subsection 2, paragraphs b, c, and 1 23 d, Code 2013, are amended to read as follows: 1 24 b. A provider=directed team=based medical practice. The 1 25 personal provider leads a team of individuals at the practice 1 26 level who collectively take responsibility for the ongoing 1 27 health care health=related needs of patients. 1 28 c. Whole person orientation. The personal provider is 1 29 responsible for providing for all of a patient's health care 1 30 health=related needs or taking responsibility for appropriately 1 31 arranging health care for health=related services provided 1 32 by other qualified health care professionals and providers 1 33 of medical and nonmedical health=related services. This 1 34 responsibility includes health health=related care at all 1 35 stages of life including provision of preventive care, 2 1 acute care, chronic care, preventive services long=term 2 2 care, transitional care between providers and settings, and 2 3 end=of=life care. This responsibility includes whole=person 2 4 care consisting of physical health care including but not 2 5 limited to oral, vision, and other specialty care, pharmacy 2 6 management, and behavioral health care. 2 7 d. Coordination and integration of care. Care is 2 8 coordinated and integrated across all elements of the 2 9 complex health care system and the patient's community. Care 2 10 coordination and integration provides linkages to community 2 11 and social supports to address social determinants of health, 2 12 to engage and support patients in managing their own health, 2 13 and to track the progress of these community and social 2 14 supports in providing whole=person care. Care is facilitated 2 15 by registries, information technology, health information 2 16 exchanges, and other means to assure that patients receive the 2 17 indicated care when and where they need and want the care in a 2 18 culturally and linguistically appropriate manner. 2 19 Sec. 3. Section 135.159, subsections 1, 9, and 11, Code 2 20 2013, are amended to read as follows: 2 21 1. The department shall administer the medical home system. 2 22 The department shall collaborate with the department of human 2 23 services in administering medical homes under the medical 2 24 assistance program. The department shall adopt rules pursuant 2 25 to chapter 17A necessary to administer the medical home system, 2 26 and shall collaborate with the department of human services in 2 27 adopting rules for medical homes under the medical assistance 2 28 program. 2 29 9. The department shall coordinate the requirements and 2 30 activities of the medical home system with the requirements 2 31 and activities of the dental home for children as described 2 32 in section 249J.14, and shall recommend financial incentives 2 33 for dentists and nondental providers to promote oral health 2 34 care coordination through preventive dental intervention, early 2 35 identification of oral disease risk, health care coordination 3 1 and data tracking, treatment, chronic care management, 3 2 education and training, parental guidance, and oral health 3 3 promotions for children. Additionally, the department shall 3 4 establish requirements for the medical home system to provide 3 5 linkages to accessible dental homes for adults and older 3 6 individuals. 3 7 11. Implementation phases. 3 8 a. Initial implementation shall require participation 3 9 in the medical home system of children The department shall 3 10 collaborate with the department of human services to make 3 11 medical homes accessible to the greatest extent possible to all 3 12 of the following no later than January 1, 2015: 3 13 (1) Children who are recipients of full benefits under the 3 14 medical assistance program. The department shall work with 3 15 the department of human services and shall recommend to the 3 16 general assembly a reimbursement methodology to compensate 3 17 providers participating under the medical assistance program 3 18 for participation in the medical home system. 3 19 b. The department shall work with the department of human 3 20 services to expand the medical home system to adults 3 21 (2) Adults who are recipients of full benefits under the 3 22 medical assistance program and the expansion population under 3 23 the IowaCare program. The department shall work with including 3 24 those adults who are recipients of medical assistance under 3 25 section 249A.3, subsection 1, paragraph "v". 3 26 (3) Medicare and dually eligible Medicare and medical 3 27 assistance program recipients, to the extent approved by the 3 28 centers for Medicare and Medicaid services of the United States 3 29 department of health and human services to allow Medicare 3 30 recipients to utilize the medical home system. 3 31 c. b. The department shall work with the department of 3 32 administrative services to allow state employees to utilize the 3 33 medical home system. 3 34 d. c. The department shall work with insurers and 3 35 self=insured companies, if requested, to make the medical 4 1 home system available to individuals with private health care 4 2 coverage. 4 3 d. The department shall assist the department of human 4 4 services in developing a reimbursement methodology to 4 5 compensate providers participating under the medical assistance 4 6 program as a medical home. 4 7 e. Any integrated care model implemented on or after July 1, 4 8 2013, that delivers health care to medical assistance program 4 9 recipients shall incorporate medical homes as its foundation. 4 10 The medical home shall act as the catalyst in any such 4 11 integrated care model to ensure compliance with the purposes, 4 12 characteristics, and implementation plan requirements specified 4 13 in sections 135.158 and 135.159, including an emphasis on whole 4 14 person orientation and coordination and integration of both 4 15 clinical services and nonclinical community and social supports 4 16 that address social determinants of health. 4 17 Sec. 4. Section 249A.3, subsection 1, Code 2013, is amended 4 18 by adding the following new paragraphs: 4 19 NEW PARAGRAPH. v. Beginning January 1, 2014, in 4 20 accordance with section 1902(a)(10)(A)(i)(VIII) of the 4 21 federal Social Security Act, as codified in 42 U.S.C. { 4 22 1396a(a)(10)(A)(i)(VIII), is an individual who is nineteen 4 23 years of age or older and under sixty=five years of age; is 4 24 not pregnant; is not entitled to or enrolled for Medicare 4 25 benefits under part A, or enrolled for Medicare benefits under 4 26 part B, of Tit. XVIII of the federal Social Security Act; is 4 27 not otherwise described in section 1902(a)(10)(A)(i) of the 4 28 federal Social Security Act; is not exempt pursuant to section 4 29 1902(k)(3), as codified in 42 U.S.C. { 1396a(k)(3), and whose 4 30 income as determined under 1902(e)(14) of the federal Social 4 31 Security Act, as codified in 42 U.S.C. { 1396a(e)(14), does 4 32 not exceed one hundred thirty=three percent of the poverty 4 33 line as defined in section 2110(c)(5) of the federal Social 4 34 Security Act, as codified in 42 U.S.C. { 1397jj(c)(5), for the 4 35 applicable family size. Notwithstanding any provision to the 5 1 contrary, individuals eligible for medical assistance under 5 2 this paragraph shall receive coverage for benefits pursuant 5 3 to 42 U.S.C. { 1396u=7(b)(1)(D) which are at a minimum those 5 4 included in the medical assistance state plan benefit package 5 5 for individuals otherwise eligible under this subsection 1, and 5 6 adjusted as necessary to provide the essential health benefits 5 7 as required pursuant to section 1302 of the federal Patient 5 8 Protection and Affordable Care Act, Pub. L. No. 111=148, and 5 9 as approved by the United States secretary of health and human 5 10 services. If the methodology for calculating the federal 5 11 medical assistance percentage for newly eligible individuals 5 12 under this paragraph, as provided in 42 U.S.C. { 1396d(y), 5 13 is modified through federal law or regulation before January 5 14 1, 2020, in a manner that reduces the percentage of federal 5 15 assistance to the state, the department of human services shall 5 16 implement an alternative plan as specified in the medical 5 17 assistance state plan for coverage of the affected population. 5 18 NEW PARAGRAPH. w. Beginning January 1, 2014, is an 5 19 individual who meets all of the following requirements: 5 20 (1) Is under twenty=six years of age. 5 21 (2) Was in foster care under the responsibility of the state 5 22 on the date of attaining eighteen years of age or such higher 5 23 age to which foster care is provided. 5 24 (3) Was enrolled in the medical assistance program under 5 25 this chapter while in such foster care. 5 26 Sec. 5. Section 249A.3, subsection 2, paragraph a, 5 27 subparagraph (9), Code 2013, is amended by striking the 5 28 subparagraph. 5 29 Sec. 6. Section 249J.26, subsection 2, Code 2013, is amended 5 30 to read as follows: 5 31 2. This chapter is repealed October December 31, 2013. 5 32 Sec. 7. Section 249J.26, Code 2013, is amended by adding the 5 33 following new subsection: 5 34 NEW SUBSECTION. 3. The department shall prepare a plan for 5 35 the transition of expansion population members to other health 6 1 care coverage options beginning January 1, 2014. The options 6 2 shall include the option of coverage through the medical 6 3 assistance program as provided in section 249A.3, subsection 1, 6 4 paragraph "v", relating to coverage for adults who are nineteen 6 5 years of age or older and under sixty=five years of age, and 6 6 the option of coverage through the health benefits exchange 6 7 established pursuant to the federal Patient Protection and 6 8 Affordable Care Act, Pub. L. No. 111=148, as amended by the 6 9 federal Health Care and Education Reconciliation Act of 2010, 6 10 Pub. L. No. 111=152. To the greatest extent possible, the plan 6 11 shall maintain and incorporate utilization of the existing 6 12 medical home and service delivery structure as developed 6 13 under this chapter, including the utilization of federally 6 14 qualified health centers, public hospitals, and other safety 6 15 net providers, in providing access to care. The department 6 16 shall submit the plan to the governor and the general assembly 6 17 no later than September 1, 2013. 6 18 Sec. 8. ADVISORY COUNCIL FOR STATE INNOVATION MODEL 6 19 INITIATIVE. 6 20 1. No later than thirty days after the effective date of 6 21 this Act, the legislative council shall establish a legislative 6 22 advisory council to guide the development of the design 6 23 model and implementation plan for the state innovation model 6 24 grant awarded by the Centers for Medicare and Medicaid of 6 25 the United States department of health and human services. 6 26 The legislative advisory council shall consist of members 6 27 of the general assembly, members of the governor's advisory 6 28 committee who developed the grant proposal, and representatives 6 29 of consumers and health care providers, appointed by the 6 30 legislative council as necessary to ensure that the process is 6 31 comprehensive and provides ample opportunity for the variety of 6 32 stakeholders to participate in the process. 6 33 2. The legislative advisory council shall provide oversight 6 34 throughout the process, shall receive periodic progress reports 6 35 from the department of human services, and shall approve any 7 1 integrated care model and implementation strategies for the 7 2 medical assistance program presented by the department of human 7 3 services, and shall prepare proposed legislation to implement 7 4 the model and the strategies prior to its submission to the 7 5 general assembly for approval during the 2014 session of the 7 6 general assembly. 7 7 3. The department of human services shall develop the 7 8 integrated care model based on the goals and strategies 7 9 included in the state innovation model grant application to 7 10 improve patient outcomes and satisfaction, while lowering 7 11 costs, as follows: 7 12 a. Goals: 7 13 (1) Ensure the coordination of health care delivery for 7 14 medical assistance program recipients to address the entire 7 15 spectrum of an individual's physical, behavioral, and mental 7 16 health needs by targeting at a minimum population health, 7 17 prevention, health promotion, chronic disease management, 7 18 disability, and long=term care. 7 19 (2) Emphasize whole person orientation and coordination and 7 20 integration of both clinical and nonclinical care and supports, 7 21 to provide individuals with the necessary tools to address 7 22 determinants of health and to empower individuals to be full 7 23 participants in their own health. The health care delivery 7 24 model shall focus on addressing population health through 7 25 primary and team=based care that incorporates the attributes of 7 26 a medical home as specified in chapter 135, division XXII. 7 27 (3) Ensure accessibility of medical assistance program 7 28 recipients to an adequate and qualified workforce by most 7 29 efficiently utilizing the skills of the available workforce. 7 30 (4) Incorporate appropriate incentives that focus on 7 31 quality outcomes and patient satisfaction, to move from 7 32 volume=based to value=based purchasing. 7 33 (5) Provide for alignment of payment methods and quality 7 34 across health care payers to ensure a unified set of outcomes 7 35 and to recognize, through reimbursement, all participants in 8 1 the integrated system of care. 8 2 b. Strategies and model designs: 8 3 (1) A strategy to implement a multipayer integrated 8 4 care model methodology across primary health care payers 8 5 in the state, by aligning performance measures, utilizing 8 6 a shared savings or other accountable payment methodology, 8 7 and integrating an information technology platform to 8 8 support the integrated care model. The strategy shall 8 9 ensure statewide adoption of integrated care for the medical 8 10 assistance population; explore the role of managed care 8 11 plans and expansion of managed care in the medical assistance 8 12 program as part of the integrated care model; address the 8 13 special circumstances of areas of the state that are rural, 8 14 underserved, or have higher rates of health disparities; and 8 15 seek the participation of the Medicare population in the 8 16 integrated care model. 8 17 (2) A strategy to incorporate long=term care and behavioral 8 18 health services for the medical assistance population into the 8 19 integrated care model, through integration of community health 8 20 and community prevention activities. 8 21 (3) A strategy to address population health and health 8 22 promotion, by investing in approaches to influence modifiable 8 23 determinants of health such as access to health care, healthy 8 24 behaviors, socioeconomic factors, and the physical environment 8 25 that collectively impact the health of the community. The 8 26 strategy shall address the underlying, pervasive, and 8 27 multifaceted socioeconomic impediments that medical assistance 8 28 recipients face in being full participants in their own health. 8 29 (4) A multiphase strategy to implement a statewide 8 30 integrated care model to maximize access to health care for 8 31 medical assistance program recipients in all areas of the 8 32 state. The strategy shall incorporate flexible integrated 8 33 care model options and accountable payment methodologies 8 34 for participation by various types of providers including 8 35 individual providers, safety net providers, and nonprofit 9 1 and public providers that have long experience in caring for 9 2 vulnerable populations, into the integrated system. 9 3 (5) Implement a stakeholder process. In addition to the 9 4 oversight and input provided by the legislative advisory 9 5 council, the department shall hold public local listening 9 6 sessions throughout the state, collaborate with consumer groups 9 7 and provider groups, and partner with other state agencies such 9 8 as the department on aging and the department of public health 9 9 to elicit input and feedback on the model design. 9 10 (6) Develop a multipayer approach including the medical 9 11 assistance and children's health insurance programs, private 9 12 payers, and Medicare. 9 13 (7) Oversee the administration of the model design project. 9 14 (8) Engage providers beyond the large integrated health 9 15 systems to maximize access to all levels of care within an 9 16 integrated model program by medical assistance recipients. 9 17 4. The department shall submit proposed legislation 9 18 specifying the model design and implementation plan to the 9 19 advisory council no later than December 15, 2013. 9 20 Sec. 9. LEGISLATIVE COMMISSION ON INTEGRATED CARE MODELS. 9 21 1. a. A legislative commission on integrated care models 9 22 is created for the 2013 Legislative Interim. The legislative 9 23 services agency shall provide staffing assistance to the 9 24 commission. 9 25 b. The commission shall include 10 members of the general 9 26 assembly, three appointed by the majority leader of the senate, 9 27 two appointed by the minority leader of the senate, three 9 28 appointed by the speaker of the house of representatives, 9 29 and two appointed by the minority leader of the house of 9 30 representatives. 9 31 c. The commission shall include members of the public 9 32 appointed by the legislative council who represent consumers, 9 33 health care providers, hospitals and health systems, and other 9 34 entities with interest or expertise related to integrated care 9 35 models. 10 1 d. The commission shall include as ex officio members, the 10 2 director of human services, the commissioner of insurance, the 10 3 director of public health, and the attorney general, or the 10 4 individual's designee. 10 5 2. The chairpersons of the commission shall be those members 10 6 of the general assembly so appointed by the majority leader of 10 7 the senate and the speaker of the house of representatives. 10 8 Legislative members of the commission are eligible for per diem 10 9 and reimbursement of actual expenses as provided in section 10 10 2.10. Consumers appointed to the commission, are entitled 10 11 to receive a per diem as specified in section 7E.6 for each 10 12 day spent in performance of duties as members, and shall be 10 13 reimbursed for all actual and necessary expenses incurred in 10 14 the performance of duties as members of the commission. 10 15 3. The commission shall do all of the following: 10 16 a. Review and make recommendations relating to the 10 17 formation and operation of integrated care models in the 10 18 state. The models shall include any care delivery model that 10 19 integrates providers and incorporates a financial incentive 10 20 to improve patient health outcomes, improve care, and reduce 10 21 costs. Integrated care models include but are not limited 10 22 to patient=centered medical homes, health homes, accountable 10 23 care organizations (ACOs), ACO=like models, community and 10 24 regional care networks, and other integrated and accountable 10 25 care delivery models that utilize value=based financing 10 26 methodologies and emphasize person=centered, coordinated, and 10 27 comprehensive care. 10 28 b. Review integrated care models created in other states 10 29 that integrate both clinical services and nonclinical community 10 30 and social supports utilizing patient=centered medical homes 10 31 and community care teams as basic components to determine the 10 32 feasibility of adapting any of these models as a statewide 10 33 system in Iowa. These models may include but are not limited 10 34 to the ACO demonstration program based on the Camden Coalition 10 35 of Healthcare Providers in Camden, New Jersey; the Medical 11 1 Home Network in Chicago, Illinois; the Health Commons model in 11 2 New Mexico; the Accountable Care Collaborative in Colorado; 11 3 Community Care of North Carolina, in North Carolina; the 11 4 Blueprint for Health and the Community Health Teams in Vermont; 11 5 and the Coordinated Care Organizations in Oregon. 11 6 c. Recommend the best means of providing care through 11 7 integrated delivery models throughout the state including to 11 8 vulnerable populations and how best to incorporate safety net 11 9 providers, including but not limited to federally qualified 11 10 health centers, rural health clinics, community mental health 11 11 centers, public hospitals, and other nonprofit and public 11 12 providers that have long experience in caring for vulnerable 11 13 populations, into the integrated system. 11 14 d. Review the progress of the development of medical 11 15 homes as specified in chapter 135, division XXII in the 11 16 state and make recommendations for development of a statewide 11 17 infrastructure of actual and virtual medical homes to act as 11 18 the foundation for integrated care models. 11 19 e. Review opportunities under the federal Patient 11 20 Protection and Affordable Care Act (Affordable Care Act), 11 21 Pub. L. No. 11=148, as amended, for the development of 11 22 integrated care models including the Medicare Shared Savings 11 23 Program for accountable care organizations, community=based 11 24 collaborative care networks that include safety net providers, 11 25 and consumer=operated and oriented plans. The legislative 11 26 commission shall also review existing and proposed integrated 11 27 care models in the state including commercial models and those 11 28 developed or proposed under the Affordable Care Act including 11 29 the Medicare Shared Savings Program and the Pioneer ACO to 11 30 determine the opportunities for expansion or replication. 11 31 f. Address the issues relative to integrated care models 11 32 including those relating to consumer protection including 11 33 those that relate to confidentiality, quality assurance, 11 34 grievance procedures, and appeals of patient care decisions; 11 35 payment methodologies, multipayer alignment, coordination 12 1 of funding streams, and financing methods that support full 12 2 integration of clinical and nonclinical services and providers; 12 3 organizational, management, and governing structures; 12 4 access, quality, outcomes, utilization, and other appropriate 12 5 performance standards; patient attribution or assignment 12 6 models; health information exchange, data reporting, and 12 7 infrastructure standards; and regulatory issues including 12 8 clinical integration limitations, physician self=referral, 12 9 anti=kickback provisions, gain=sharing, beneficiary 12 10 inducements, antitrust issues, tax exemption issues, and 12 11 application of insurance regulations. 12 12 4. The legislative commission may request from any state 12 13 agency or official information and assistance as needed to 12 14 perform the review and make recommendations. 12 15 5. The legislative commission shall submit a final report 12 16 summarizing the legislative commission's review and making 12 17 recommendations to the governor and the general assembly by 12 18 December 15, 2013. 12 19 Sec. 10. MEDICAID STATE PLAN. 12 20 1. The department of human services shall amend the medical 12 21 assistance state plan to reflect the provisions relating to the 12 22 provision of a medical home to medical assistance recipients 12 23 as provided in this Act. 12 24 2. The department of human services shall amend the medical 12 25 assistance state plan to provide for coverage of adults up to 12 26 133 percent of the federal poverty level as provided pursuant 12 27 to section 249A.3, subsection 1, paragraph "v", as enacted in 12 28 this Act, beginning January 1, 2014. The state plan amendment 12 29 shall include a provision specifying that if the methodology 12 30 for calculating the federal medical assistance percentage for 12 31 newly eligible individuals under section 249A.3, subsection 1, 12 32 paragraph "v", as provided in 42 U.S.C. { 1396d(y), is modified 12 33 through federal law or regulation before January 1, 2020, in 12 34 a manner that reduces the percentage of federal assistance to 12 35 the state, the department of human services shall implement 13 1 an alternative plan for coverage of the affected population, 13 2 to the extent necessary, so that state expenditures remain 13 3 budget neutral under the modified federal medical assistance 13 4 percentage relative to the percentage specified for the same 13 5 fiscal year under section 42 U.S.C. { 1396d(y). The state plan 13 6 amendment shall provide that implementation by the department 13 7 of human services of any alternative plan for coverage of 13 8 the affected population is subject to prior approval of the 13 9 implementation by statute. 13 10 3. The department of human services shall amend the medical 13 11 assistance state plan to provide that the benchmark benefit 13 12 plan provided to the newly covered adults under the medical 13 13 assistance program is the option provided pursuant to 42 U.S.C. 13 14 { 1396u=7(b)(1)(D) which is at a minimum the coverage included 13 15 in the medical assistance state plan benefit package for 13 16 individuals otherwise eligible under section 249A.3, subsection 13 17 1, and adjusted as necessary to provide the essential health 13 18 benefits as required pursuant to section 1302 of the federal 13 19 Patient Protection and Affordable Care Act, Pub. L. No. 13 20 111=148, and as approved by the United States secretary of 13 21 health and human services. 13 22 Sec. 11. ADOPTION OF RULES. The department of human 13 23 services shall adopt emergency rules pursuant to section 17A.4, 13 24 subsection 3, and section 17A.5, subsection 2, paragraph "b", 13 25 as necessary to implement the provisions of this Act, and 13 26 the rules shall be effective immediately upon filing unless 13 27 a later date is specified in the rules. Any rules adopted 13 28 in accordance with this section shall also be published as a 13 29 notice of intended action as provided in section 17A.4. 13 30 Sec. 12. EFFECTIVE DATE. The following provision or 13 31 provisions of this Act take effect December 31, 2013: 13 32 1. The section of this Act amending section 249A.3, 13 33 subsection 2, paragraph "a", subparagraph (9). 13 34 Sec. 13. EFFECTIVE UPON ENACTMENT. With the exception of 13 35 the section of this Act amending section 249A.3, subsection 14 1 2, paragraph "a", subparagraph (9), this Act, being deemed of 14 2 immediate importance, takes effect upon enactment. SF 296 (4) 85 pf/rj/jh
Text: SF295            Text: SF297 Complete Bill History