Bill Text: IA HF83 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A bill for an act relating to integrated care models for the delivery of health care, including but not limited to required utilization of a medical home by individuals currently and newly eligible for coverage under the Medicaid program and including effective date provisions.
Spectrum: Partisan Bill (Democrat 27-0)
Status: (Introduced - Dead) 2013-12-31 - END OF 2013 ACTIONS [HF83 Detail]
Download: Iowa-2013-HF83-Introduced.html
House
File
83
-
Introduced
HOUSE
FILE
83
BY
HEDDENS
,
WESSEL-KROESCHELL
,
ISENHART
,
MURPHY
,
BERRY
,
GASKILL
,
HUNTER
,
WOOD
,
COHOON
,
DAWSON
,
M.
SMITH
,
BEARINGER
,
KRESSIG
,
T.
TAYLOR
,
STAED
,
MASCHER
,
OURTH
,
WINCKLER
,
STUTSMAN
,
THEDE
,
H.
MILLER
,
ANDERSON
,
STECKMAN
,
HANSON
,
LENSING
,
OLDSON
,
and
THOMAS
A
BILL
FOR
An
Act
relating
to
integrated
care
models
for
the
delivery
1
of
health
care,
including
but
not
limited
to
required
2
utilization
of
a
medical
home
by
individuals
currently
and
3
newly
eligible
for
coverage
under
the
Medicaid
program
and
4
including
effective
date
provisions.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
6
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Section
1.
Section
135.157,
subsections
4
and
6,
Code
2013,
1
are
amended
to
read
as
follows:
2
4.
“Medical
home”
means
a
team
approach
to
providing
health
3
care
that
originates
in
a
primary
care
setting;
fosters
a
4
partnership
among
the
patient,
the
personal
provider,
and
5
other
health
care
professionals,
and
where
appropriate,
the
6
patient’s
family;
utilizes
the
partnership
to
access
and
7
integrate
all
medical
and
nonmedical
health-related
services
8
across
all
elements
of
the
health
care
system
and
the
patient’s
9
community
as
needed
by
the
patient
and
the
patient’s
family
10
to
achieve
maximum
health
potential;
maintains
a
centralized,
11
comprehensive
record
of
all
health-related
services
to
12
promote
continuity
of
care;
and
has
all
of
the
characteristics
13
specified
in
section
135.158
.
14
6.
“Personal
provider”
means
the
patient’s
first
point
of
15
contact
in
the
health
care
system
with
a
primary
care
provider
16
who
identifies
the
patient’s
health
health-related
needs
and,
17
working
with
a
team
of
health
care
professionals
and
providers
18
of
medical
and
nonmedical
health-related
services
,
provides
19
for
and
coordinates
appropriate
care
to
address
the
health
20
health-related
needs
identified.
21
Sec.
2.
Section
135.158,
subsection
2,
paragraphs
b,
c,
and
22
d,
Code
2013,
are
amended
to
read
as
follows:
23
b.
A
provider-directed
team-based
medical
practice.
The
24
personal
provider
leads
a
team
of
individuals
at
the
practice
25
level
who
collectively
take
responsibility
for
the
ongoing
26
health
care
health-related
needs
of
patients.
27
c.
Whole
person
orientation.
The
personal
provider
is
28
responsible
for
providing
for
all
of
a
patient’s
health
care
29
health-related
needs
or
taking
responsibility
for
appropriately
30
arranging
health
care
for
health-related
services
provided
31
by
other
qualified
health
care
professionals
and
providers
32
of
medical
and
nonmedical
health-related
services
.
This
33
responsibility
includes
health
health-related
care
at
all
34
stages
of
life
including
provision
of
preventive
care,
35
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acute
care,
chronic
care,
preventive
services
long-term
1
care,
transitional
care
between
providers
and
settings
,
and
2
end-of-life
care.
This
responsibility
includes
whole-person
3
care
consisting
of
physical
health
care
including
but
not
4
limited
to
oral,
vision,
and
other
specialty
care,
pharmacy
5
management,
and
behavioral
health
care.
6
d.
Coordination
and
integration
of
care.
Care
is
7
coordinated
and
integrated
across
all
elements
of
the
8
complex
health
care
system
and
the
patient’s
community.
Care
9
coordination
and
integration
provides
linkages
to
community
10
and
social
supports
to
address
social
determinants
of
health,
11
to
engage
and
support
patients
in
managing
their
own
health,
12
and
to
track
the
progress
of
these
community
and
social
13
supports
in
providing
whole-person
care.
Care
is
facilitated
14
by
registries,
information
technology,
health
information
15
exchanges,
and
other
means
to
assure
that
patients
receive
the
16
indicated
care
when
and
where
they
need
and
want
the
care
in
a
17
culturally
and
linguistically
appropriate
manner.
18
Sec.
3.
Section
135.159,
subsections
1,
9,
and
11,
Code
19
2013,
are
amended
to
read
as
follows:
20
1.
The
department
shall
administer
the
medical
home
system.
21
The
department
shall
collaborate
with
the
department
of
human
22
services
in
administering
medical
homes
under
the
medical
23
assistance
program.
The
department
shall
adopt
rules
pursuant
24
to
chapter
17A
necessary
to
administer
the
medical
home
system
,
25
and
shall
collaborate
with
the
department
of
human
services
in
26
adopting
rules
for
medical
homes
under
the
medical
assistance
27
program
.
28
9.
The
department
shall
coordinate
the
requirements
and
29
activities
of
the
medical
home
system
with
the
requirements
30
and
activities
of
the
dental
home
for
children
as
described
31
in
section
249J.14
,
and
shall
recommend
financial
incentives
32
for
dentists
and
nondental
providers
to
promote
oral
health
33
care
coordination
through
preventive
dental
intervention,
early
34
identification
of
oral
disease
risk,
health
care
coordination
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and
data
tracking,
treatment,
chronic
care
management,
1
education
and
training,
parental
guidance,
and
oral
health
2
promotions
for
children.
Additionally,
the
department
shall
3
establish
requirements
for
the
medical
home
system
to
provide
4
linkages
to
accessible
dental
homes
for
adults
and
older
5
individuals.
6
11.
Implementation
phases
.
7
a.
Initial
implementation
shall
No
later
than
July
1,
2014,
8
the
department
shall
collaborate
with
the
department
of
human
9
services
to
require
participation
in
the
medical
home
system
of
10
children
all
of
the
following:
11
(1)
Children
who
are
recipients
of
full
benefits
under
the
12
medical
assistance
program.
The
department
shall
work
with
13
the
department
of
human
services
and
shall
recommend
to
the
14
general
assembly
a
reimbursement
methodology
to
compensate
15
providers
participating
under
the
medical
assistance
program
16
for
participation
in
the
medical
home
system.
17
b.
(2)
The
department
shall
work
with
the
department
of
18
human
services
to
expand
the
medical
home
system
to
adults
19
Adults
who
are
recipients
of
full
benefits
under
the
medical
20
assistance
program
and
the
expansion
population
under
the
21
IowaCare
program
including
those
adults
who
are
recipients
of
22
benefits
under
section
249A.3,
subsection
1,
paragraph
“v”
,
in
23
accordance
with
the
federal
Patient
Protection
and
Affordable
24
Care
Act,
Pub.
L.
No.
111-148,
§
2001,
as
amended
by
the
25
federal
Health
Care
and
Education
Reconciliation
Act
of
2010,
26
Pub.
L.
No.
111-152
.
27
(3)
The
department
shall
work
with
Medicare
and
dually
28
eligible
Medicare
and
Medicaid
recipients,
to
the
extent
29
approved
by
the
centers
for
Medicare
and
Medicaid
services
of
30
the
United
States
department
of
health
and
human
services
to
31
allow
Medicare
recipients
to
utilize
the
medical
home
system
.
32
c.
b.
The
department
shall
work
with
the
department
of
33
administrative
services
to
allow
state
employees
to
utilize
the
34
medical
home
system.
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d.
c.
The
department
shall
work
with
insurers
and
1
self-insured
companies,
if
requested,
to
make
the
medical
2
home
system
available
to
individuals
with
private
health
care
3
coverage.
4
Sec.
4.
Section
249A.3,
subsection
1,
Code
2013,
is
amended
5
by
adding
the
following
new
paragraph:
6
NEW
PARAGRAPH
.
v.
Beginning
January
1,
2014,
is
an
7
individual
who
is
nineteen
years
of
age
or
older
and
under
8
age
sixty-five;
is
not
pregnant;
is
not
entitled
to
or
9
enrolled
for
Medicare
benefits
under
part
A,
or
enrolled
10
for
Medicare
benefits
under
part
B,
of
Tit.
XVIII
of
the
11
federal
Social
Security
Act;
is
not
otherwise
described
in
12
section
1902a(a)(10)(A)(i)
of
the
federal
Social
Security
13
Act;
and
whose
income
is
at
or
below
one
hundred
thirty-three
14
percent
of
the
federal
poverty
level
as
defined
by
the
most
15
recently
revised
poverty
income
guidelines
published
by
the
16
United
States
department
of
health
and
human
services
for
the
17
applicable
family
size
and
as
calculated
in
accordance
with
18
the
federal
Patient
Protection
and
Affordable
Care
Act,
Pub.
19
L.
No.
111-148,
§
2001,
as
amended
by
the
federal
Health
Care
20
and
Education
Reconciliation
Act
of
2010,
Pub.
L.
No.
111-152.
21
Individuals
eligible
for
medical
assistance
under
this
22
paragraph
shall
receive
benefits
which
are
at
a
minimum
those
23
included
in
the
medical
assistance
state
plan
benefit
package
24
offered
in
the
state,
to
be
adjusted
as
necessary
to
provide
25
essential
health
benefits
as
required
pursuant
to
section
1302
26
of
the
federal
Patient
Protection
and
Affordable
Care
Act,
Pub.
27
L.
No.
111-148,
and
as
approved
by
the
United
States
secretary
28
of
health
and
human
services.
29
Sec.
5.
Section
249J.26,
subsection
2,
Code
2013,
is
amended
30
to
read
as
follows:
31
2.
This
chapter
is
repealed
October
December
31,
2013.
The
32
department
shall
prepare
a
plan
for
the
transition
of
expansion
33
population
members
to
other
health
care
coverage
options.
34
The
options
shall
include
the
option
of
coverage
through
the
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medical
assistance
program
as
provided
in
section
249A.3,
1
subsection
1,
paragraph
“v”
,
relating
to
coverage
for
adults
who
2
are
nineteen
years
of
age
or
older
and
under
age
sixty-five,
3
and
the
option
of
coverage
through
the
health
benefits
exchange
4
established
pursuant
to
the
federal
Patient
Protection
and
5
Affordable
Care
Act,
Pub.
L.
No.
111-148,
as
amended
by
the
6
federal
Health
Care
and
Education
Reconciliation
Act
of
2010,
7
Pub.
L.
No.
111-152.
To
the
greatest
extent
possible,
the
plan
8
shall
maintain
and
incorporate
utilization
of
the
existing
9
medical
home
and
service
delivery
structure
as
developed
10
under
this
chapter,
including
the
utilization
of
federally
11
qualified
health
centers,
public
hospitals,
and
other
safety
12
net
providers,
in
providing
access
to
care.
The
department
13
shall
submit
the
plan
to
the
governor
and
the
general
assembly
14
no
later
than
September
1,
2013.
15
Sec.
6.
LEGISLATIVE
COMMISSION
ON
INTEGRATED
CARE
MODELS.
16
1.
No
later
than
thirty
days
after
the
effective
date
17
of
this
Act,
the
legislative
council
shall
establish
a
18
legislative
commission
to
review
and
make
recommendations
19
relating
to
the
formation
and
operation
of
integrated
care
20
models
(ICMs)
in
the
state.
The
models
include
any
care
21
delivery
model
that
integrates
providers
and
incorporates
a
22
financial
incentive
to
improve
patient
health
outcomes,
improve
23
care,
and
reduce
costs.
Integrated
care
models
include
but
24
are
not
limited
to
patient-centered
medical
homes
or
health
25
homes,
accountable
care
organizations
(ACOs),
ACO-like
models,
26
community
and
regional
care
networks,
and
other
integrated
and
27
accountable
delivery
models
that
utilize
value-based
financing
28
methodologies
and
emphasize
person-centered,
coordinated,
and
29
comprehensive
care.
30
2.
a.
In
developing
the
recommendations,
the
legislative
31
commission
shall
review
models
created
in
other
states
that
32
integrate
both
clinical
services
and
nonclinical
community
33
and
social
supports
utilizing
patient-centered
medical
homes
34
and
community
care
teams
as
basic
components.
These
models
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may
include
but
are
not
limited
to
the
ACO
demonstration
1
program
based
on
the
Camden
Coalition
of
Healthcare
Providers
2
in
Camden,
New
Jersey;
the
Medical
Home
Network
in
Chicago,
3
Illinois;
the
Health
Commons
model
in
New
Mexico;
the
4
Accountable
Care
Collaborative
in
Colorado;
Community
Care
of
5
North
Carolina,
in
North
Carolina;
the
Blueprint
for
Health
and
6
the
Community
Health
Teams
in
Vermont;
and
the
Coordinated
Care
7
Organizations
in
Oregon.
8
b.
The
legislative
commission
shall
specifically
focus
9
on
recommending
the
best
means
of
providing
care
through
10
integrated
delivery
models
throughout
the
state
including
to
11
vulnerable
populations
and
how
best
to
incorporate
safety
net
12
providers,
including
but
not
limited
to
federally
qualified
13
health
centers,
rural
health
clinics,
community
mental
health
14
centers,
public
hospitals,
and
other
nonprofit
and
public
15
providers
that
have
long
experience
in
caring
for
vulnerable
16
populations,
into
the
integrated
system.
17
c.
The
legislative
commission
shall
review
opportunities
18
under
the
federal
Patient
Protection
and
Affordable
Care
Act
19
(Affordable
Care
Act),
Pub.
L.
No.
11-148,
as
amended,
for
20
the
development
of
ICMs
including
the
Medicare
Shared
Savings
21
program
for
accountable
care
organizations,
community-based
22
collaborative
care
networks
that
include
safety
net
providers,
23
consumer-operated
and
oriented
plans,
and
opportunities
24
through
the
Center
for
Medicare
and
Medicaid
Innovation
25
(CMI)
established
pursuant
to
section
3021
of
the
Affordable
26
Care
Act.
The
legislative
commission
shall
also
review
27
existing
and
proposed
integrated
care
models
in
the
state
28
including
commercial
models
and
those
developed
or
proposed
29
under
the
Accountable
Care
Act
including
the
Medicare
Shared
30
Savings
Program,
the
Pioneer
ACO,
and
the
application
for
31
the
multipayer
Medicaid
ACO
developed
through
the
CMI
State
32
Innovation
Models
Initiative.
33
d.
The
legislative
commission
shall
address
the
issues
34
relative
to
ICMs
including
those
relating
to
consumer
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protection
including
those
that
relate
to
confidentiality,
1
quality
assurance,
grievance
procedures,
and
appeals
of
patient
2
care
decisions;
payment
methodologies,
multipayer
alignment,
3
coordination
of
funding
streams,
and
financing
methods
that
4
support
full
integration
of
clinical
and
nonclinical
services
5
and
providers;
organizational,
management,
and
governing
6
structures;
access,
quality,
outcomes,
utilization,
and
7
other
appropriate
performance
standards;
patient
attribution
8
or
assignment
models;
health
information
exchange,
data,
9
reporting,
and
infrastructure
standards;
and
regulatory
10
issues
including
clinical
integration
limitations,
physician
11
self-referral,
antikickback
provisions,
gain-sharing,
12
beneficiary
inducements,
antitrust
issues,
tax
exemption
13
issues,
and
application
of
insurance
regulations.
14
3.
The
legislative
commission
shall
consult
with
advocates
15
representing
patients,
health
care
providers,
health
care
16
payers,
and
other
appropriate
parties
in
developing
the
17
recommendations
relating
to
ICMs.
18
4.
The
legislative
commission
may
request
from
any
state
19
agency
or
official
information
and
assistance
as
needed
to
20
perform
the
review
and
make
recommendations.
21
5.
The
legislative
commission
shall
submit
a
final
report
22
summarizing
the
legislative
commission’s
activities,
analyzing
23
the
issues
reviewed,
and
making
recommendations
to
the
governor
24
and
the
general
assembly
by
September
1,
2013.
25
Sec.
7.
MEDICAID
STATE
PLAN.
26
1.
The
department
of
human
services
shall
amend
the
medical
27
assistance
state
plan
to
reflect
the
required
provision
of
a
28
medical
home
to
medical
assistance
recipients
as
provided
in
29
this
Act.
30
2.
The
department
of
human
services
shall
amend
the
medical
31
assistance
state
plan
to
provide
for
coverage
of
adults
up
to
32
133
percent
of
the
federal
poverty
level
as
provided
in
this
33
Act
and
in
accordance
with
the
federal
Patient
Protection
and
34
Affordable
Care
Act,
Pub.
L.
No.
111-148,
§
2001,
as
amended
35
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by
the
federal
Health
Care
and
Education
Reconciliation
Act
of
1
2010,
Pub.
L.
No.
111-152.
2
3.
The
department
of
human
services
shall
amend
the
medical
3
assistance
state
plan
to
provide
that
the
benchmark
benefit
4
plan
provided
to
the
newly
covered
adults
under
the
medical
5
assistance
program
is
the
option
of
secretary-approved
coverage
6
which
is
at
a
minimum
the
Medicaid
state
plan
benefit
package
7
offered
in
the
state,
to
be
adjusted
as
necessary
to
provide
8
essential
health
benefits
as
required
pursuant
to
section
9
1302(b)
of
the
Patient
Protection
and
Affordable
Care
Act,
Pub.
10
L.
No.
111-148.
11
Sec.
8.
EFFECTIVE
UPON
ENACTMENT.
This
Act,
being
deemed
of
12
immediate
importance,
takes
effect
upon
enactment.
13
EXPLANATION
14
This
bill
relates
to
integrated
health
care
delivery
models.
15
The
bill
amends
provisions
relating
to
medical
homes
to
16
require
a
team-based,
multidisciplinary
approach
to
health
17
care
delivery.
The
bill
requires
the
department
of
human
18
services
(DHS)
to
collaborate
with
the
department
of
public
19
health
(DPH)
in
administering
medical
homes
under
the
Medicaid
20
program.
The
bill
amends
provisions
relating
to
implementation
21
of
medical
homes
in
the
state
by
requiring
all
children
and
22
adults
who
are
recipients
of
full
benefits
under
the
medical
23
assistance
program,
including
adults
up
to
133
percent
of
24
the
federal
poverty
level
who
are
eligible
under
the
federal
25
Patient
Protection
and
Affordable
Care
Act
(ACA),
Pub.
L.
No.
26
111-148,
§
2001,
as
amended
by
the
federal
Health
Care
and
27
Education
Reconciliation
Act
of
2010,
Pub.
L.
No.
111-152,
and
28
individuals
who
are
dually
eligible
to
the
extent
approved
by
29
the
centers
for
Medicare
and
Medicaid
services
of
the
United
30
States
department
of
health
and
human
services
(CMS),
to
31
participate
in
a
medical
home
not
later
than
July
1,
2014.
32
The
bill
does
not
amend
the
Code
provisions
directing
DPH
to
33
work
with
the
department
of
administrative
services
to
allow
34
state
employees
to
utilize
the
medical
home
system
and
to
work
35
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with
insurers
and
self-insured
companies,
if
requested,
to
make
1
the
medical
home
system
available
to
individuals
with
private
2
health
care
coverage.
3
The
bill
provides
for
Medicaid
eligibility
of
certain
adults
4
with
incomes
at
or
below
133
percent
of
the
federal
poverty
5
level
in
accordance
with
the
ACA.
Additionally,
the
bill
6
requires
that
these
newly
eligible
adults
receive
benefits
7
which
are
included
in
the
medical
assistance
state
plan
8
benefit
package
offered
in
the
state
as
adjusted
to
provide
9
the
essential
health
benefits
required
under
the
ACA,
and
as
10
approved
by
the
United
States
secretary
of
health
and
human
11
services.
12
The
bill
directs
the
legislative
council
to
establish
a
13
legislative
commission
to
review
and
make
recommendations
14
for
the
formation
and
operation
of
integrated
care
models
15
(ICM)
in
the
state.
The
bill
describes
ICMs
as
any
care
16
delivery
model
that
integrates
providers
and
incorporates
17
a
financial
incentive
to
improve
patient
health
outcomes,
18
improve
care,
and
reduce
costs.
ICMs
include
but
are
not
19
limited
to
patient-centered
medical
homes
or
health
homes,
20
accountable
care
organizations
(ACOs),
ACO-like
models,
and
21
other
integrated
and
accountable
health
delivery
models
that
22
utilize
value-based
financing
methodologies
and
emphasize
23
person-centered,
coordinated,
comprehensive
care.
The
24
legislative
commission
is
directed
to
consult
with
advocates
25
representing
patients,
health
care
providers,
health
care
26
payers,
and
other
appropriate
parties
in
developing
the
27
recommendations
for
ICMs;
to
specifically
address
certain
28
issues
to
review
existing
ICMs
in
other
states
as
well
as
29
those
existing
or
proposed
in
the
state
Medicare
Shared
30
Savings
Program,
the
Pioneer
ACO,
and
the
Center
for
31
Medicare
and
Medicaid
Innovation
State
Innovation
Models
32
Initiative
application
to
implement
a
multipayer
ACO
including
33
Medicaid.
The
legislative
commission
is
required
to
make
its
34
recommendations
to
the
governor
and
the
general
assembly
by
35
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