Bill Text: IA SF2117 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to substance use disorder services and reimbursement, and including effective date provisions.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-02-06 - Subcommittee: Edler, Costello, and Ragan. S.J. 239. [SF2117 Detail]
Download: Iowa-2019-SF2117-Introduced.html
Senate
File
2117
-
Introduced
SENATE
FILE
2117
BY
RAGAN
A
BILL
FOR
An
Act
relating
to
substance
use
disorder
services
and
1
reimbursement,
and
including
effective
date
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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DIVISION
I
1
INTEGRATED
PROVIDER
NETWORK
PROVIDERS
——
REIMBURSEMENT
2
Section
1.
INTEGRATED
PROVIDER
NETWORK
PROVIDERS
——
3
MEDICAID
PROVIDERS
——
REIMBURSEMENT.
The
department
of
4
human
services
shall
establish
an
integrated
provider
network
5
provider
as
a
participating
provider
type
under
the
Medicaid
6
program
comparable
to
the
integrated
provider
network
providers
7
under
contract
with
the
department
of
public
health.
The
8
department
shall
designate
and
utilize
the
Medicaid
community
9
mental
health
center
enhanced
fee
schedule
as
the
minimum
10
reimbursement
for
services
provided
by
Medicaid
integrated
11
provider
network
providers.
12
Sec.
2.
EMERGENCY
RULES.
The
department
may
adopt
emergency
13
rules
under
section
17A.4,
subsection
3,
and
section
17A.5,
14
subsection
2,
paragraph
“b”,
to
administer
the
provisions
of
15
this
division.
Any
rules
adopted
in
accordance
with
this
16
section
shall
also
be
published
as
a
notice
of
intended
action
17
as
provided
in
section
17A.4.
18
Sec.
3.
EFFECTIVE
DATE.
This
division
of
this
Act,
being
19
deemed
of
immediate
importance,
takes
effect
upon
enactment.
20
DIVISION
II
21
BEHAVIORAL
HEALTH
SERVICES
——
REIMBURSEMENT
22
Sec.
4.
SUBSTANCE
USE
DISORDER
——
INTENSIVE
OUTPATIENT
AND
23
RESIDENTIAL
TREATMENT
——
REIMBURSEMENT.
24
1.
For
the
fiscal
year
beginning
July
1,
2020,
the
25
department
of
human
services
shall
establish
reimbursement
26
rates
for
substance
use
disorder
intensive
outpatient
and
27
residential
treatment
services
provided
under
a
Medicaid
28
1915(b)(3)
waiver
equal
to
the
reimbursement
rates
provided
29
for
the
same
services
under
the
substance
abuse
prevention
and
30
treatment
block
grant
awarded
by
the
United
States
department
31
of
health
and
human
services
substance
abuse
and
mental
health
32
services
administration
and
administered
by
the
department
of
33
public
health.
34
2.
The
department
of
public
health
in
collaboration
35
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2117
with
the
department
of
human
services
shall
review
and
make
1
recommendations
for
Medicaid
1915(b)(3)
waiver
reimbursement
2
rates
for
substance
use
disorder
intensive
outpatient
and
3
residential
treatment
services
using
a
projected
cost
report
4
agreed
upon
by
the
departments
and
the
integrated
provider
5
network
providers.
The
departments
shall
establish
time
frames
6
for
release
of
the
agreed-upon
projected
cost
report
form
to
7
providers
and
the
deadline
for
submission
of
the
completed
8
projected
cost
reports
by
providers
to
the
departments,
in
9
order
to
allow
sufficient
time
for
review
and
the
making
of
10
recommended
adjustments
to
the
Medicaid
1915(b)(3)
waiver
11
reimbursement
rates
for
Medicaid
integrated
provider
network
12
providers
effective
January
1,
2021.
13
3.
The
department
of
public
health
in
collaboration
with
the
14
department
of
human
services
and
behavioral
health
providers
15
shall
review
reimbursement
rates
for
behavioral
health
services
16
and
Medicaid
1915(b)(3)
waiver
services
using
the
projected
17
cost
report
agreed
upon
by
the
departments
and
the
integrated
18
provider
network
providers.
The
departments
shall
establish
19
time
frames
for
release
of
the
agreed-upon
projected
cost
20
report
form
to
behavioral
health
providers
and
the
deadline
21
for
submission
of
the
completed
projected
cost
reports
by
22
behavioral
health
providers
to
the
departments,
in
order
to
23
allow
sufficient
time
for
the
departments
to
review
and
make
24
recommended
adjustments
to
the
Medicaid
1915(b)(3)
waiver
25
reimbursement
rates
and
the
behavioral
health
services
fee
26
schedule
effective
July
1,
2021.
27
4.
The
department
of
public
health
in
collaboration
with
the
28
department
of
human
services
shall
establish
an
ongoing
plan
29
for
regular
review
of
reimbursement
for
substance
use
disorder
30
treatment
and
to
provide
information
to
the
governor
and
the
31
general
assembly
in
a
timely
manner
to
allow
for
provision
of
32
appropriate
funding
for
any
change
in
reimbursement.
33
Sec.
5.
EMERGENCY
RULES.
The
department
may
adopt
emergency
34
rules
under
section
17A.4,
subsection
3,
and
section
17A.5,
35
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2117
subsection
2,
paragraph
“b”,
to
administer
the
provisions
of
1
this
division.
Any
rules
adopted
in
accordance
with
this
2
section
shall
also
be
published
as
a
notice
of
intended
action
3
as
provided
in
section
17A.4.
4
Sec.
6.
EFFECTIVE
DATE.
This
division
of
this
Act,
being
5
deemed
of
immediate
importance,
takes
effect
upon
enactment.
6
DIVISION
III
7
MEDICATION-ASSISTED
TREATMENT
8
Sec.
7.
MEDICATION-ASSISTED
TREATMENT
——
PRIOR
9
AUTHORIZATION
PROHIBITED.
The
department
of
human
services
10
shall
adopt
rules
pursuant
to
chapter
17A
that
prohibit
prior
11
authorization
for
medication-assisted
treatment
under
both
12
Medicaid
fee-for-service
or
managed
care
administration.
13
The
department
of
human
services
shall
also
include
this
14
prohibition
in
any
contract
entered
into
with
a
Medicaid
15
managed
care
organization.
For
the
purposes
of
this
16
section,
“medication-assisted
treatment”
means
the
medically
17
monitored
use
of
certain
substance
use
disorder
medications
in
18
combination
with
other
treatment
services.
19
Sec.
8.
EMERGENCY
RULES.
The
department
may
adopt
emergency
20
rules
under
section
17A.4,
subsection
3,
and
section
17A.5,
21
subsection
2,
paragraph
“b”,
to
administer
the
provisions
of
22
this
division.
Any
rules
adopted
in
accordance
with
this
23
section
shall
also
be
published
as
a
notice
of
intended
action
24
as
provided
in
section
17A.4.
25
Sec.
9.
EFFECTIVE
DATE.
This
division
of
this
Act,
being
26
deemed
of
immediate
importance,
takes
effect
upon
enactment.
27
DIVISION
IV
28
SUBSTANCE
USE
DISORDER
ADVISORY
PANEL
29
Sec.
10.
SUBSTANCE
USE
DISORDER
ADVISORY
PANEL.
The
30
department
of
public
health
in
collaboration
with
the
31
department
of
human
services
shall
establish
a
substance
use
32
disorder
advisory
panel
to
review
access
to
substance
use
33
disorder
services
and
to
resolve
barriers
to
access.
The
34
members
of
the
advisory
panel
shall
include
but
are
not
35
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2117
limited
to
representatives
of
hospital-affiliated
substance
use
1
disorder
treatment
programs,
the
integrated
provider
network,
2
and
others
with
interest
or
expertise
in
substance
use
disorder
3
treatment
services
and
reimbursement.
4
DIVISION
V
5
MEDICAID
WAIVER
REQUIREMENTS
6
Sec.
11.
MEDICAID
WAIVER
REQUIREMENTS.
The
department
7
of
human
services
in
collaboration
with
the
department
of
8
public
health
shall
amend
the
existing
federal
Medicaid
1915(b)
9
waiver
or
shall
apply
for
a
federal
Medicaid
1115
demonstration
10
waiver
to
enhance
access
to
and
increase
reimbursement
for
11
substance
use
disorder
treatment
services,
including
but
not
12
limited
to
outpatient
substance
abuse
treatment
services,
13
intensive
outpatient
substance
abuse
treatment
services,
and
14
residential
treatment
services.
The
departments
shall
submit
a
15
progress
report
regarding
receipt
of
federal
approval
of
any
16
waiver
amendment
or
application
to
the
governor
and
the
general
17
assembly
by
October
1,
2020.
18
EXPLANATION
19
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
20
the
explanation’s
substance
by
the
members
of
the
general
assembly.
21
This
bill
relates
to
substance
use
disorder
services
and
22
reimbursement.
23
Division
I
of
the
bill
requires
the
department
of
human
24
services
(DHS)
to
establish
an
integrated
provider
network
25
provider
as
a
participating
provider
type
under
the
Medicaid
26
program
comparable
to
the
integrated
provider
network
providers
27
under
contract
with
the
department
of
public
health
(DPH).
28
The
bill
requires
DHS
to
designate
and
utilize
the
Medicaid
29
community
mental
health
center
enhanced
fee
schedule
as
30
the
minimum
reimbursement
for
services
provided
by
Medicaid
31
integrated
provider
network
providers.
The
division
provides
32
for
emergency
rulemaking
and
takes
effect
upon
enactment.
33
Division
II
of
the
bill
relates
to
reimbursement
of
34
behavioral
health
services.
The
bill
requires
that
for
35
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2117
the
fiscal
year
beginning
July
1,
2020,
DHS
shall
establish
1
reimbursement
rates
for
substance
use
disorder
intensive
2
outpatient
and
residential
treatment
services
provided
under
3
a
Medicaid
1915(b)(3)
waiver
equal
to
the
reimbursement
rates
4
provided
for
the
same
services
under
the
substance
abuse
5
prevention
and
treatment
block
grant
administered
by
DPH.
6
Additionally,
division
II
requires
DPH
in
collaboration
with
7
DHS
to
review
and
make
recommendations
for
Medicaid
1915(b)(3)
8
waiver
reimbursement
rates
for
substance
use
disorder
intensive
9
outpatient
and
residential
treatment
services
using
a
projected
10
cost
report
agreed
upon
by
the
departments
and
the
integrated
11
provider
network
providers.
The
departments
are
required
12
to
establish
time
frames
for
release
of
the
agreed-upon
13
projected
cost
report
form
to
providers
and
the
deadline
14
for
submission
of
the
completed
projected
cost
reports
by
15
providers
to
the
departments,
to
allow
sufficient
time
for
16
review
and
adjustments
to
reimbursement
rates
for
Medicaid
17
integrated
provider
network
service
providers
effective
January
18
1,
2021.
Division
II
also
requires
DPH
in
collaboration
with
19
DHS
and
behavioral
health
providers
to
review
reimbursement
20
rates
for
behavioral
health
services
and
Medicaid
1915(b)(3)
21
waiver
services
using
the
projected
cost
report
agreed
22
upon.
Again,
the
departments
shall
establish
time
frames
and
23
deadlines
for
the
cost
reports
to
allow
sufficient
time
for
24
the
departments
to
review
and
make
recommended
adjustments
to
25
the
reimbursement
rates
and
the
behavioral
health
services
26
fee
schedule
effective
July
1,
2021.
Finally,
the
division
27
directs
DPH
in
collaboration
with
DHS
to
establish
an
ongoing
28
plan
for
regular
review
of
reimbursement
for
substance
use
29
disorder
treatment
services
and
to
provide
information
to
the
30
governor
and
the
general
assembly
in
a
timely
manner
to
allow
31
for
provision
of
appropriate
funding
for
the
next
fiscal
year.
32
The
division
provides
for
emergency
rulemaking
and
takes
effect
33
upon
enactment.
34
Division
III
of
the
bill
requires
DHS
to
adopt
35
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2117
administrative
rules
to
prohibit
prior
authorization
for
1
the
provision
of
medication-assisted
treatment
under
either
2
Medicaid
fee-for-service
or
managed
care
administration.
3
The
division
also
requires
DHS
to
include
this
prohibition
4
in
any
contract
entered
into
with
a
Medicaid
managed
care
5
organization.
Under
the
division,
“medication-assisted
6
treatment”
means
the
medically
monitored
use
of
certain
7
substance
use
disorder
medications
in
combination
with
other
8
treatment
services.
The
division
provides
for
emergency
9
rulemaking
and
takes
effect
upon
enactment.
10
Division
IV
of
the
bill
requires
DPH
in
collaboration
11
with
DHS
to
establish
an
advisory
panel
to
review
access
to
12
substance
use
disorder
services
and
to
resolve
barriers
to
13
access.
The
members
of
the
advisory
panel
include
but
are
not
14
limited
to
representatives
of
hospital-affiliated
substance
use
15
disorder
treatment
programs,
the
integrated
provider
network,
16
and
others
with
interest
or
expertise
in
substance
use
disorder
17
treatment
services
and
reimbursement.
18
Division
V
of
the
bill
directs
DHS
in
collaboration
with
19
DPH
to
apply
for
a
federal
Medicaid
1115
demonstration
waiver
20
or
amend
the
existing
federal
Medicaid
1915(b)
waiver
to
21
enhance
access
to
and
reimbursement
for
substance
use
disorder
22
treatment
services.
The
departments
shall
report
progress
23
regarding
receipt
of
federal
approval
of
any
waiver
amendment
24
or
application
to
the
governor
and
the
general
assembly
by
25
October
1,
2020.
26
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