Bill Text: IA HF555 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to Medicaid managed care including the provision of certain services and payment for services.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced - Dead) 2019-02-28 - Introduced, referred to Human Resources. H.J. 374. [HF555 Detail]
Download: Iowa-2019-HF555-Introduced.html
House
File
555
-
Introduced
HOUSE
FILE
555
BY
HEDDENS
,
STAED
,
FORBES
,
HUNTER
,
GASKILL
,
KRESSIG
,
JACOBY
,
and
WINCKLER
A
BILL
FOR
An
Act
relating
to
Medicaid
managed
care
including
the
1
provision
of
certain
services
and
payment
for
services.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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555
Section
1.
MEDICAID
MANAGED
CARE
——
DISCHARGE
PLANNING
AND
1
PLACEMENT
——
REIMBURSEMENT
OF
SERVICES
PROVIDED
IN
GOOD
FAITH
2
——
INTEREST
ON
LATE
PAYMENTS
AND
OTHER
PAYMENTS
——
SUPPORTS
3
INTENSITY
SCALE
ADMINISTRATION.
4
1.
The
department
of
human
services
shall
contractually
5
require
a
Medicaid
managed
care
organization
and
the
Medicaid
6
managed
care
organization’s
case
managers,
not
individual
7
providers
of
services,
to
be
responsible
for
the
discharge
8
planning
and
relocation
to
an
appropriate
alternative
placement
9
of
a
Medicaid
member
transitioning
from
one
level
of
care
or
10
placement
to
another.
The
Medicaid
managed
care
organization
11
shall
have
appropriate
processes
in
place
to
reduce
disruption
12
to
the
Medicaid
member
during
the
discharge
planning
and
13
relocation
processes.
14
2.
The
department
of
human
services
shall
contractually
15
prohibit
a
Medicaid
managed
care
organization
from
denying
16
payment
for
services
rendered
by
a
Medicaid
provider
who,
17
in
good
faith,
provides
services
to
a
Medicaid
member
in
18
accordance
with
a
service
plan
and
reimbursement
agreement.
19
Additionally,
under
such
circumstances,
payments
shall
not
20
be
recouped
by
the
department
or
a
Medicaid
managed
care
21
organization
if,
subsequent
to
the
provision
of
such
services,
22
the
Medicaid
managed
care
organization
or
the
department
23
determines
that
the
member
was
not
eligible
for
such
services
24
and
if
the
provider
of
services
is
able
to
demonstrate,
based
25
on
the
information
available
to
the
provider,
that
the
services
26
were
authorized
at
the
time
the
services
were
rendered.
27
3.
The
department
of
human
services
shall
contractually
28
require
that
a
Medicaid
managed
care
organization
that
fails
29
to
pay,
deny,
or
settle
a
clean
claim
in
full
within
the
time
30
frame
established
by
the
contract
shall
pay
the
Medicaid
31
provider
claimant
interest
equal
to
twelve
percent
per
annum
32
on
the
total
amount
of
the
claim
ultimately
authorized.
33
Additionally,
if
a
claim
is
ultimately
found
to
be
incorrectly
34
denied
or
underpaid
through
an
appeals
process
or
audit,
35
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a
Medicaid
managed
care
organization
shall
pay
a
Medicaid
1
provider
claimant,
in
addition
to
the
amount
determined
to
be
2
owed,
interest
of
twenty
percent
per
annum
on
the
total
amount
3
of
the
claim
ultimately
authorized
as
calculated
from
fifteen
4
calendar
days
after
the
date
the
claim
was
submitted.
5
4.
The
department
of
human
services
shall
contract
with
6
an
independent
third
party
to
administer
a
conflict-free
7
uniform
supports
intensity
scale
assessment
for
persons
with
8
an
intellectual
disability
or
developmental
disability.
The
9
assessment
tool
shall
include
an
evaluation
of
the
functional
10
skills
and
abilities
of
the
Medicaid
member
at
the
following
11
three
levels:
without
the
provision
of
any
supports
and
12
services,
with
the
provision
of
the
current
level
of
supports
13
and
services,
and
with
the
provision
of
additional
supports
14
and
services
to
assist
the
member
in
reaching
the
member’s
15
full
potential.
The
assessment
tool
shall
include
a
narrative
16
portion
to
more
fully
reflect
and
identify
the
unique
supports
17
and
service
needs
and
concerns
of
the
member
as
well
as
the
18
member’s
family
and
caregivers.
19
EXPLANATION
20
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
21
the
explanation’s
substance
by
the
members
of
the
general
assembly.
22
This
bill
includes
provisions
relating
to
Medicaid
23
managed
care
including
discharge
planning
and
relocation
24
responsibilities,
reimbursement
of
services
provided
in
good
25
faith,
interest
on
late
and
other
payments,
and
supports
26
intensity
scale
assessment
administration.
27
The
bill
requires
the
department
of
human
services
(DHS)
28
to
contractually
require
a
Medicaid
managed
care
organization
29
(MCO)
and
the
MCO’s
case
managers,
not
individual
providers
30
of
services,
to
be
responsible
for
the
discharge
planning
31
and
relocation
to
an
appropriate
alternative
placement
of
32
a
Medicaid
member
transitioning
from
one
level
of
care
or
33
placement
to
another.
The
MCO
shall
have
appropriate
processes
34
in
place
to
reduce
disruption
to
the
Medicaid
member
during
the
35
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3
H.F.
555
discharge
planning
and
relocation
processes.
1
The
bill
requires
DHS
to
also
contractually
prohibit
an
2
MCO
from
denying
payment
for
services
rendered
by
a
Medicaid
3
provider
who,
in
good
faith,
provides
services
to
a
Medicaid
4
member
in
accordance
with
a
service
plan
and
reimbursement
5
agreement.
The
bill
also
prohibits
recoupment
of
payments
if,
6
subsequent
to
the
provision
of
such
services,
the
MCO
or
DHS
7
determines
that
the
member
was
not
eligible
for
such
services
8
and
if
the
provider
of
services
is
able
to
demonstrate,
based
9
on
the
information
available
to
the
provider,
that
the
services
10
were
authorized
at
the
time
the
services
were
rendered.
11
The
bill
requires
DHS
to
contractually
require
that
an
MCO
12
that
fails
to
pay,
deny,
or
settle
a
clean
claim
in
full
within
13
the
time
frame
established
by
the
contract
to
pay
the
Medicaid
14
provider
claimant
interest
equal
to
12
percent
per
annum
on
the
15
total
amount
of
the
claim
ultimately
authorized.
Additionally,
16
if
a
claim
is
ultimately
found
to
be
incorrectly
denied
or
17
underpaid
through
an
appeals
process
or
audit,
an
MCO
shall
18
pay
a
Medicaid
provider
claimant,
in
addition
to
the
amount
19
determined
to
be
owed,
interest
of
20
percent
per
annum
on
the
20
total
amount
of
the
claim
ultimately
authorized
as
calculated
21
from
15
calendar
days
after
the
date
the
claim
was
submitted.
22
The
bill
requires
DHS
to
contract
with
an
independent
third
23
party
to
administer
a
conflict-free
uniform
supports
intensity
24
scale
assessment
for
persons
with
an
intellectual
disability
or
25
developmental
disability.
The
assessment
tool
shall
include
26
an
evaluation
of
the
functional
skills
and
abilities
of
the
27
Medicaid
member
at
three
levels:
without
the
provision
of
any
28
supports
and
services,
with
the
provision
of
the
current
level
29
of
supports
and
services,
and
with
the
provision
of
additional
30
supports
and
services
to
assist
the
member
in
reaching
the
31
member’s
full
potential.
The
assessment
tool
shall
include
a
32
narrative
portion
to
more
fully
reflect
and
identify
the
unique
33
supports
and
service
needs
and
concerns
of
the
member
as
well
34
as
the
member’s
family
and
caregivers.
35
-3-
LSB
2125YH
(4)
88
pf/rh
3/
3
