Bill Text: IA SF2207 | 2017-2018 | 87th General Assembly | Introduced

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Bill Title: A bill for an act relating to the administration and evaluation of health homes for individuals with serious and persistent mental illness and for persons with chronic conditions under Medicaid managed care, and including effective date provisions.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2018-02-08 - Subcommittee: Segebart, Chelgren, and Ragan. S.J. 278. [SF2207 Detail]

Download: Iowa-2017-SF2207-Introduced.html

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Senate File 2207 - Introduced




                                 SENATE FILE       
                                 BY  RAGAN and MATHIS

                                      A BILL FOR

  1 An Act relating to the administration and evaluation of
  2    health homes for individuals with serious and persistent
  3    mental illness and for persons with chronic conditions
  4    under Medicaid managed care, and including effective date
  5    provisions.
  6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 6078XS (9) 87
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PAG LIN



  1  1    Section 1.  MEDICAID PROGRAM == HEALTH HOMES ==
  1  2 ADMINISTRATION AND EVALUATION.
  1  3    1.  The department of human services shall adopt rules
  1  4 pursuant to chapter 17A and shall amend existing Medicaid
  1  5 managed care contracts to ensure all of the following:
  1  6    a.  That integrated health homes for persons with serious
  1  7 and persistent mental illness (SPMI integrated health homes)
  1  8 with a Medicaid managed care organization acting as the lead
  1  9 entity are administered in a manner that reflects the criteria
  1 10 established for SPMI integrated health homes and that meets
  1 11 the specifications of the Medicaid state plan amendment (SPA),
  1 12 IA=16=013.
  1 13    b.  That health homes for persons with two or more chronic
  1 14 conditions (chronic condition health homes) are administered
  1 15 in a manner that reflects the criteria established for chronic
  1 16 condition health homes and that meet the specifications of the
  1 17 Medicaid SPA, IA=16=012.
  1 18    c.  That care coordination provided by SPMI integrated
  1 19 health homes be provided as an integral component of the
  1 20 integrated health home's team of health professionals and that
  1 21 care coordination provided by chronic condition health homes be
  1 22 provided by a dedicated care coordinator defined as a member
  1 23 of the health home provider, and not directly by a managed
  1 24 care organization through the use of internal or contracted
  1 25 resources of the managed care organization.
  1 26    2.  a.  The Iowa Medicaid enterprise shall provide
  1 27 administrative oversight for  SPMI health homes and chronic
  1 28 condition health homes, and shall require managed care
  1 29 organizations to share data with the Iowa Medicaid enterprise
  1 30 as the department deems necessary for the evaluation of certain
  1 31 factors including but not limited to patient enrollment,
  1 32 patient outcomes, and claims submission and payment.
  1 33    b.  The department shall amend the health home state plan
  1 34 amendments and Medicaid managed care contracts, as necessary,
  1 35 to provide that under the risk=based managed care delivery
  2  1 system, the state shall reimburse health homes directly and not
  2  2 include health home payments in the managed care capitation
  2  3 rate.
  2  4    Sec. 2.  EFFECTIVE DATE.  This Act, being deemed of immediate
  2  5 importance, takes effect upon enactment.
  2  6                           EXPLANATION
  2  7 The inclusion of this explanation does not constitute agreement with
  2  8 the explanation's substance by the members of the general assembly.
  2  9    This bill requires the department of human services (DHS)
  2 10 to adopt administrative rules and amend existing Medicaid
  2 11 managed care contracts to ensure that integrated health homes
  2 12 for persons with serious and persistent mental illness (SPMI
  2 13 integrated health homes) and health homes for persons with
  2 14 two or more chronic conditions (chronic condition health
  2 15 homes) are administered in a manner that reflects the criteria
  2 16 established, and meet the specifications of the Medicaid state
  2 17 plan amendment, for the respective type of health home.  The
  2 18 bill specifies that the care coordination provided by the SPMI
  2 19 integrated health homes be provided as an integral component
  2 20 of the integrated health home's team of health professionals
  2 21 and that care coordination provided by chronic condition health
  2 22 homes be provided by a dedicated care coordinator defined as
  2 23 a member of the health home provider, and not directly by
  2 24 a managed care organization through the use of internal or
  2 25 contracted resources of the managed care organization.
  2 26    The bill requires the Iowa Medicaid enterprise (IME) to
  2 27 provide administrative oversight for the health homes, and to
  2 28 require managed care organizations to share data with the IME
  2 29 as DHS deems necessary for the evaluation of certain factors
  2 30 including but not limited to patient enrollment, patient
  2 31 outcomes, and claims submission and payment. The bill also
  2 32 requires DHS to amend the health home state plan amendments and
  2 33 Medicaid managed care contracts, as necessary, to provide that
  2 34 under the risk=based managed care delivery system, the state
  2 35 shall reimburse health homes directly and not include health
  3  1 home payments in the managed care capitation rate.
  3  2    The bill takes effect upon enactment.
       LSB 6078XS (9) 87
       pf/rh