Bill Text: IA HF2009 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to reimbursement for services provided in an emergency department to Medicaid members.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-01-23 - Subcommittee Meeting: 01/28/2020 8:30AM House Lounge. [HF2009 Detail]
Download: Iowa-2019-HF2009-Introduced.html
House
File
2009
-
Introduced
HOUSE
FILE
2009
BY
BRECKENRIDGE
A
BILL
FOR
An
Act
relating
to
reimbursement
for
services
provided
in
an
1
emergency
department
to
Medicaid
members.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
MEDICAID
——
REIMBURSEMENT
FOR
EMERGENCY
1
DEPARTMENT
SERVICES.
2
1.
Reimbursement
provided
under
both
Medicaid
3
fee-for-service
and
managed
care
administration
for
services
4
delivered
in
an
emergency
department
shall
comply
with
all
of
5
the
following:
6
a.
Reimbursement
shall
be
based
on
the
services
provided
as
7
indicated
by
the
patient’s
presenting
symptoms
and
not
solely
8
on
the
patient’s
eventual
or
final
diagnosis.
9
b.
Reimbursement
shall
reflect
the
prudent
layperson
10
standard
relative
to
the
definition
of
an
emergency
medical
11
condition
pursuant
to
24
C.F.R.
§2590.715-2719A(b)(4)(i).
12
c.
Reimbursement
shall
not
be
denied,
including
13
retroactively
denied,
restricted,
or
down-coded
based
on
a
14
policy
of
selective
emergency
services
coverage.
For
the
15
purposes
of
this
subsection,
“policy
of
selective
emergency
16
services
coverage”
means
any
practice
making
reimbursement
for
17
emergency
services
dependent
upon
a
determination
of
whether
18
an
injury,
symptom,
complaint,
or
other
presenting
condition
19
strictly
constitutes
an
emergency
medical
condition.
20
2.
The
department
of
human
services
shall
adopt
rules
21
pursuant
to
chapter
17A
to
administer
this
section.
Any
22
contract
the
department
enters
into
with
a
managed
care
23
organization
shall
require
the
managed
care
organization
to
24
comply
with
this
section
and
the
rules
adopted
under
this
25
section.
26
EXPLANATION
27
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
28
the
explanation’s
substance
by
the
members
of
the
general
assembly.
29
This
bill
relates
to
reimbursement
of
services
delivered
30
in
an
emergency
department
under
the
Medicaid
program.
The
31
bill
requires
that
reimbursement
provided
under
both
Medicaid
32
fee-for-service
and
managed
care
administration
for
services
33
delivered
in
an
emergency
department
shall
comply
with
all
of
34
the
following:
35
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2
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2009
1.
Be
based
on
the
services
provided
as
indicated
by
the
1
patient’s
presenting
symptoms
and
not
on
the
patient’s
eventual
2
or
final
diagnosis.
3
2.
Reflect
the
prudent
layperson
standard
relative
to
the
4
definition
of
an
emergency
medical
condition
under
federal
5
law
which
provides
that
an
emergency
medical
condition
means
6
a
medical
condition
manifesting
itself
by
acute
symptoms
of
7
sufficient
severity
(including
severe
pain)
so
that
a
prudent
8
layperson,
who
possesses
an
average
knowledge
of
health
and
9
medicine,
could
reasonably
expect
the
absence
of
immediate
10
medical
attention
to
result
in
placing
the
health
of
an
11
individual
(or,
with
respect
to
a
pregnant
woman,
the
health
12
of
the
woman
or
her
unborn
child)
in
serious
jeopardy;
serious
13
impairment
to
bodily
functions;
or
serious
dysfunction
of
any
14
bodily
organ
or
part.
15
3.
Shall
not
be
denied
including
retroactively
denied,
16
restricted,
reduced,
or
down-coded
based
on
a
“policy
of
17
selective
emergency
services
coverage”
which
means
any
practice
18
of
making
reimbursement
for
emergency
services
dependent
upon
19
a
determination
of
whether
an
injury,
symptom,
complaint,
or
20
other
presenting
condition
strictly
constitutes
an
emergency
21
medical
condition.
22
The
bill
requires
the
department
of
human
services
to
23
adopt
administrative
rules
and
provides
that
any
contract
the
24
department
enters
into
with
a
managed
care
organization
shall
25
require
the
managed
care
organization
to
comply
with
the
bill
26
and
the
rules
adopted
under
the
bill.
27
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