Bill Text: IA HF2205 | 2017-2018 | 87th General Assembly | Introduced

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Bill Title: A bill for an act relating to the use of step therapy protocols, including step therapy override protocols, under the Medicaid program.

Spectrum: Partisan Bill (Democrat 18-0)

Status: (Introduced - Dead) 2018-02-02 - Introduced, referred to Human Resources. H.J. 198. [HF2205 Detail]

Download: Iowa-2017-HF2205-Introduced.html

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House File 2205 - Introduced




                                 HOUSE FILE       
                                 BY  MASCHER, HUNTER,
                                     KACENA, NIELSEN,
                                     JACOBY, OLSON,
                                     KRESSIG, FORBES,
                                     BROWN=POWERS, GAINES,
                                     ANDERSON, WINCKLER,
                                     LENSING, GASKILL,
                                     KURTH, KEARNS,
                                     T. TAYLOR, and STAED

                                      A BILL FOR

  1 An Act relating to the use of step therapy protocols, including
  2    step therapy override protocols, under the Medicaid program.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 5677YH (3) 87
    pf/rh

PAG LIN



  1  1    Section 1.  Section 514F.7, subsection 1, paragraph h, Code
  1  2 2018, is amended to read as follows:
  1  3    h.  "Health carrier" means an entity subject to the
  1  4 insurance laws and regulations of this state, or subject
  1  5 to the jurisdiction of the commissioner, including an
  1  6 insurance company offering sickness and accident plans, a
  1  7 health maintenance organization, a nonprofit health service
  1  8 corporation, a plan established pursuant to chapter 509A
  1  9 for public employees, or any other entity providing a plan
  1 10 of health insurance, health care benefits, or health care
  1 11 services. "Health carrier" does not include includes a managed
  1 12 care organization as defined in 441 IAC 73.1 when the managed
  1 13 care organization is acting pursuant to a contract with the
  1 14 Iowa department of human services to provide services to
  1 15 Medicaid recipients.
  1 16    Sec. 2.  MEDICAID MANAGED CARE AND FEE=FOR=SERVICE == USE
  1 17 OF STEP THERAPY PROTOCOLS.  The department of human services
  1 18 shall adopt rules pursuant to chapter 17A and shall amend
  1 19 Medicaid managed care contracts to require application of step
  1 20 therapy protocols, including step therapy override protocols,
  1 21 as specified in section 514F.7, under both the Medicaid
  1 22 fee=for=service and the managed care reimbursement and delivery
  1 23 systems.
  1 24                           EXPLANATION
  1 25 The inclusion of this explanation does not constitute agreement with
  1 26 the explanation's substance by the members of the general assembly.
  1 27    This bill directs the department of human services (DHS)
  1 28 to adopt administrative rules and to amend Medicaid managed
  1 29 care contracts to require the use of step therapy protocols,
  1 30 including step therapy override protocols, as specified in
  1 31 Code section 514F.7, under both Medicaid fee=for=service and
  1 32 managed care reimbursement and delivery systems.  The bill
  1 33 also amends Code section 514F.7 to eliminate the exclusion
  1 34 from the definition of "health carrier" of Medicaid managed
  1 35 care organizations, thereby requiring Medicaid managed care
  2  1 organizations as health carriers to use step therapy protocols
  2  2 for Medicaid members.
       LSB 5677YH (3) 87
       pf/rh