Bill Text: IA SSB1031 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to programs and activities under the purview of the department of public health, and including effective date provisions.
Spectrum: Committee Bill
Status: (N/A - Dead) 2017-01-27 - Subcommittee: Costello, Segebart, and Mathis. [SSB1031 Detail]
Download: Iowa-2017-SSB1031-Introduced.html
Senate
Study
Bill
1031
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
SEGEBART)
A
BILL
FOR
An
Act
relating
to
programs
and
activities
under
the
purview
1
of
the
department
of
public
health,
and
including
effective
2
date
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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S.F.
_____
DIVISION
I
1
PROGRAM
FLEXIBILITY
AND
EFFICIENCIES
2
Section
1.
Section
125.59,
subsection
1,
paragraph
b,
Code
3
2017,
is
amended
to
read
as
follows:
4
b.
If
the
transferred
amount
for
this
subsection
exceeds
5
grant
requests
funded
to
the
ten
thousand
dollar
maximum,
the
6
Iowa
department
of
public
health
may
use
the
remainder
for
7
activities
and
public
information
resources
that
align
with
8
best
practices
for
substance-related
disorder
prevention
or
to
9
increase
grants
pursuant
to
subsection
2
.
10
Sec.
2.
Section
135.11,
subsection
31,
Code
2017,
is
amended
11
by
striking
the
subsection.
12
Sec.
3.
Section
135.150,
subsection
2,
Code
2017,
is
amended
13
to
read
as
follows:
14
2.
The
department
shall
report
semiannually
annually
to
the
15
general
assembly’s
standing
committees
on
government
oversight
16
regarding
the
operation
of
the
gambling
treatment
program.
17
The
report
shall
include
but
is
not
limited
to
information
on
18
the
moneys
expended
and
grants
awarded
for
operation
of
the
19
gambling
treatment
program.
20
DIVISION
II
21
MEDICAL
HOME
AND
PATIENT-CENTERED
HEALTH
ADVISORY
COUNCIL
22
Sec.
4.
Section
135.159,
Code
2017,
is
amended
by
striking
23
the
section
and
inserting
in
lieu
thereof
the
following:
24
135.159
Patient-centered
health
advisory
council.
25
1.
The
department
shall
establish
a
patient-centered
health
26
advisory
council
which
shall
include
but
is
not
limited
to
27
all
of
the
following
members,
selected
by
their
respective
28
organizations,
and
any
other
members
the
department
determines
29
necessary:
30
a.
The
director
of
human
services,
or
the
director’s
31
designee.
32
b.
The
commissioner
of
insurance,
or
the
commissioner’s
33
designee.
34
c.
A
representative
of
the
federation
of
Iowa
insurers.
35
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d.
A
representative
of
the
Iowa
dental
association.
1
e.
A
representative
of
the
Iowa
nurses
association.
2
f.
A
physician
and
an
osteopathic
physician
licensed
3
pursuant
to
chapter
148
who
are
family
physicians
and
members
4
of
the
Iowa
academy
of
family
physicians.
5
g.
A
health
care
consumer.
6
h.
A
representative
of
the
Iowa
collaborative
safety
net
7
provider
network
established
pursuant
to
section
135.153.
8
i.
A
representative
of
the
Iowa
developmental
disabilities
9
council.
10
j.
A
representative
of
the
Iowa
chapter
of
the
American
11
academy
of
pediatrics.
12
k.
A
representative
of
the
child
and
family
policy
center.
13
l.
A
representative
of
the
Iowa
pharmacy
association.
14
m.
A
representative
of
the
Iowa
chiropractic
society.
15
n.
A
representative
of
the
university
of
Iowa
college
of
16
public
health.
17
2.
The
patient-centered
health
advisory
council
may
utilize
18
the
assistance
of
other
relevant
public
health
and
health
care
19
expertise
when
necessary
to
carry
out
the
council’s
purposes
20
and
responsibilities.
21
3.
A
public
member
of
the
patient-centered
health
advisory
22
council
shall
receive
reimbursement
for
actual
expenses
23
incurred
while
serving
in
the
member’s
official
capacity
24
only
if
the
member
is
not
eligible
for
reimbursement
by
the
25
organization
the
member
represents.
26
4.
The
purposes
of
the
patient-centered
health
advisory
27
council
shall
include
all
of
the
following:
28
a.
To
serve
as
a
resource
on
emerging
health
care
29
transformation
initiatives
in
Iowa.
30
b.
To
convene
stakeholders
in
Iowa
to
streamline
efforts
31
that
support
state-level
and
community-level
integration
and
32
focus
on
reducing
fragmentation
of
the
health
care
system.
33
c.
To
encourage
partnerships
and
synergy
between
community
34
health
care
partners
in
the
state
who
are
working
on
new
35
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system-level
models
to
provide
better
health
care
at
lower
1
costs
by
focusing
on
shifting
from
volume-based
to
value-based
2
health
care.
3
d.
To
lead
discussions
on
the
transformation
of
the
4
health
care
system
to
a
patient-centered
infrastructure
that
5
integrates
and
coordinates
services
and
supports
to
address
6
social
determinants
of
health
and
to
meet
population
health
7
goals.
8
e.
To
provide
a
venue
for
education
and
information
9
gathering
for
stakeholders
and
interested
parties
to
learn
10
about
emerging
health
care
initiatives
across
the
state.
11
f.
To
develop
recommendations
for
submission
to
the
12
department
related
to
health
care
transformation
issues.
13
Sec.
5.
Section
136.3,
subsection
13,
Code
2017,
is
amended
14
to
read
as
follows:
15
13.
Perform
those
duties
authorized
pursuant
to
sections
16
section
135.156
and
135.159
and
other
provisions
of
law.
17
Sec.
6.
Section
249N.2,
subsections
15
and
19,
Code
2017,
18
are
amended
to
read
as
follows:
19
15.
“Medical
home”
means
medical
home
as
defined
in
20
section
135.157
.
a
team
approach
to
providing
health
care
that
21
originates
in
a
primary
care
setting;
fosters
a
partnership
22
among
the
patient,
the
personal
provider,
and
other
health
care
23
professionals,
and
where
appropriate,
the
patient’s
family;
24
utilizes
the
partnership
to
access
and
integrate
all
medical
25
and
nonmedical
health-related
services
across
all
elements
of
26
the
health
care
system
and
the
patient’s
community
as
needed
by
27
the
patient
and
the
patient’s
family
to
achieve
maximum
health
28
potential;
maintains
a
centralized,
comprehensive
record
of
all
29
health-related
services
to
promote
continuity
of
care;
and
has
30
all
of
the
following
characteristics:
31
a.
A
personal
provider.
32
b.
A
provider-directed
team-based
medical
practice.
33
c.
Whole
person
orientation.
34
d.
Coordination
and
integration
of
care.
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e.
Quality
and
safety.
1
f.
Enhanced
access
to
health
care.
2
g.
A
payment
system
that
appropriately
recognizes
the
added
3
value
provided
to
patients
who
have
a
patient-centered
medical
4
home.
5
19.
“Primary
medical
provider”
means
the
personal
provider
6
as
defined
in
section
135.157
trained
to
provide
first
contact
7
and
continuous
and
comprehensive
care
to
a
member,
chosen
by
8
a
member
or
to
whom
a
member
is
assigned
under
the
Iowa
health
9
and
wellness
plan.
10
Sec.
7.
Section
249N.2,
Code
2017,
is
amended
by
adding
the
11
following
new
subsection:
12
NEW
SUBSECTION
.
17A.
“Personal
provider”
means
the
13
patient’s
first
point
of
contact
in
the
health
care
system
14
with
a
primary
care
provider
who
identifies
the
patient’s
15
health-related
needs
and,
working
with
a
team
of
health
16
care
professionals
and
providers
of
medical
and
nonmedical
17
health-related
services,
provides
for
and
coordinates
18
appropriate
care
to
address
the
health-related
needs
19
identified.
20
Sec.
8.
Section
249N.6,
subsection
2,
paragraph
c,
Code
21
2017,
is
amended
to
read
as
follows:
22
c.
The
department
shall
develop
a
mechanism
for
primary
23
medical
providers,
medical
homes,
and
participating
accountable
24
care
organizations
to
jointly
facilitate
member
care
25
coordination.
The
Iowa
health
and
wellness
plan
shall
provide
26
for
reimbursement
of
care
coordination
services
provided
27
under
the
plan
consistent
with
the
reimbursement
methodology
28
developed
pursuant
to
section
135.159
.
29
Sec.
9.
Section
249N.6,
subsection
3,
paragraph
a,
Code
30
2017,
is
amended
to
read
as
follows:
31
a.
The
department
shall
provide
procedures
for
accountable
32
care
organizations
that
emerge
through
local
markets
to
33
participate
in
the
Iowa
health
and
wellness
plan
provider
34
network.
Such
accountable
care
organizations
shall
incorporate
35
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the
medical
home
as
defined
and
specified
in
chapter
135,
1
division
XXII
,
as
a
foundation
and
shall
emphasize
whole-person
2
orientation
and
coordination
and
integration
of
both
clinical
3
services
and
nonclinical
community
and
social
supports
that
4
address
social
determinants
of
health.
A
participating
5
accountable
care
organization
shall
enter
into
a
contract
with
6
the
department
to
ensure
the
coordination
and
management
of
the
7
health
of
attributed
members,
to
produce
quality
health
care
8
outcomes,
and
to
control
overall
cost.
9
Sec.
10.
REPEAL.
Sections
135.157
and
135.158,
Code
2017,
10
are
repealed.
11
DIVISION
III
12
WORKFORCE
PROGRAMMING
13
Sec.
11.
Section
84A.11,
subsection
4,
Code
2017,
is
amended
14
to
read
as
follows:
15
4.
The
nursing
workforce
data
clearinghouse
shall
be
16
established
and
maintained
in
a
manner
consistent
with
the
17
health
care
delivery
infrastructure
and
health
care
workforce
18
resources
strategic
plan
developed
pursuant
to
section
135.164
19
135.163
.
20
Sec.
12.
Section
135.107,
subsection
3,
Code
2017,
is
21
amended
to
read
as
follows:
22
3.
The
center
for
rural
health
and
primary
care
shall
23
establish
a
primary
care
provider
recruitment
and
retention
24
endeavor,
to
be
known
as
PRIMECARRE.
The
endeavor
shall
25
include
a
health
care
workforce
and
community
support
grant
26
program
,
and
a
primary
care
provider
loan
repayment
program
,
27
and
a
primary
care
provider
community
scholarship
program
.
28
The
endeavor
shall
be
developed
and
implemented
in
a
manner
29
to
promote
and
accommodate
local
creativity
in
efforts
to
30
recruit
and
retain
health
care
professionals
to
provide
31
services
in
the
locality.
The
focus
of
the
endeavor
shall
32
be
to
promote
and
assist
local
efforts
in
developing
health
33
care
provider
recruitment
and
retention
programs.
The
center
34
for
rural
health
and
primary
care
may
enter
into
an
agreement
35
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under
chapter
28E
with
the
college
student
aid
commission
for
1
the
administration
of
the
center’s
grant
and
loan
repayment
2
programs.
3
a.
Community
Health
care
workforce
and
community
support
4
grant
program.
5
(1)
The
center
for
rural
health
and
primary
care
shall
adopt
6
rules
establishing
an
flexible
application
process
processes
7
based
upon
the
department’s
strategic
plan
to
be
used
by
the
8
center
to
establish
a
grant
assistance
program
as
provided
9
in
this
paragraph
“a”
,
and
establishing
the
criteria
to
be
10
used
in
evaluating
the
applications.
Selection
criteria
11
shall
include
a
method
for
prioritizing
grant
applications
12
based
on
illustrated
efforts
to
meet
the
health
care
provider
13
needs
of
the
locality
and
surrounding
area.
Such
assistance
14
may
be
in
the
form
of
a
forgivable
loan,
grant,
or
other
15
nonfinancial
assistance
as
deemed
appropriate
by
the
center.
16
An
application
submitted
shall
may
contain
a
commitment
of
at
17
least
a
dollar-for-dollar
match
of
matching
funds
for
the
grant
18
assistance.
Application
may
be
made
for
assistance
by
a
single
19
community
or
group
of
communities
or
in
response
to
programs
20
recommended
in
the
strategic
plan
to
address
health
workforce
21
shortages
.
22
(2)
Grants
awarded
under
the
program
shall
be
subject
to
the
23
following
limitations:
24
(a)
Ten
thousand
dollars
for
a
single
community
or
region
25
with
a
population
of
ten
thousand
or
less.
An
award
shall
not
26
be
made
under
this
program
to
a
community
with
a
population
of
27
more
than
ten
thousand.
28
(b)
An
amount
not
to
exceed
one
dollar
per
capita
for
a
29
region
in
which
the
population
exceeds
ten
thousand.
For
30
purposes
of
determining
the
amount
of
a
grant
for
a
region,
31
the
population
of
the
region
shall
not
include
the
population
32
of
any
community
with
a
population
of
more
than
ten
thousand
33
located
in
the
region
awarded
to
rural,
underserved
areas
or
34
special
populations
as
identified
by
the
department’s
strategic
35
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plan
or
evidence-based
documentation
.
1
b.
Primary
care
provider
loan
repayment
program.
2
(1)
A
primary
care
provider
loan
repayment
program
is
3
established
to
increase
the
number
of
health
professionals
4
practicing
primary
care
in
federally
designated
health
5
professional
shortage
areas
of
the
state.
Under
the
program,
6
loan
repayment
may
be
made
to
a
recipient
for
educational
7
expenses
incurred
while
completing
an
accredited
health
8
education
program
directly
related
to
obtaining
credentials
9
necessary
to
practice
the
recipient’s
health
profession.
10
(2)
The
center
for
rural
health
and
primary
care
shall
adopt
11
rules
relating
to
the
establishment
and
administration
of
the
12
primary
care
provider
loan
repayment
program.
Rules
adopted
13
pursuant
to
this
paragraph
shall
provide,
at
a
minimum,
for
all
14
of
the
following:
15
(a)
Determination
of
eligibility
requirements
and
16
qualifications
of
an
applicant
to
receive
loan
repayment
under
17
the
program,
including
but
not
limited
to
years
of
obligated
18
service,
clinical
practice
requirements,
and
residency
19
requirements.
One
year
of
obligated
service
shall
be
provided
20
by
the
applicant
in
exchange
for
each
year
of
loan
repayment,
21
unless
federal
requirements
otherwise
require.
Loan
repayment
22
under
the
program
shall
not
be
approved
for
a
health
provider
23
whose
license
or
certification
is
restricted
by
a
medical
24
regulatory
authority
of
any
jurisdiction
of
the
United
States,
25
other
nations,
or
territories.
26
(b)
Identification
of
federally
designated
health
27
professional
shortage
areas
of
the
state
and
prioritization
of
28
such
areas
according
to
need.
29
(c)
Determination
of
the
amount
and
duration
of
the
loan
30
repayment
an
applicant
may
receive,
giving
consideration
to
the
31
availability
of
funds
under
the
program,
and
the
applicant’s
32
outstanding
educational
loans
and
professional
credentials.
33
(d)
Determination
of
the
conditions
of
loan
repayment
34
applicable
to
an
applicant.
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(e)
Enforcement
of
the
state’s
rights
under
a
loan
repayment
1
program
contract,
including
the
commencement
of
any
court
2
action.
3
(f)
Cancellation
of
a
loan
repayment
program
contract
for
4
reasonable
cause
unless
federal
requirements
otherwise
require
.
5
(g)
Participation
in
federal
programs
supporting
repayment
6
of
loans
of
health
care
providers
and
acceptance
of
gifts,
7
grants,
and
other
aid
or
amounts
from
any
person,
association,
8
foundation,
trust,
corporation,
governmental
agency,
or
other
9
entity
for
the
purposes
of
the
program.
10
(h)
Upon
availability
of
state
funds,
determination
of
11
eligibility
criteria
and
qualifications
for
participating
12
communities
and
applicants
not
located
in
federally
designated
13
shortage
areas.
14
(i)
Other
rules
as
necessary.
15
(3)
The
center
for
rural
health
and
primary
care
may
enter
16
into
an
agreement
under
chapter
28E
with
the
college
student
17
aid
commission
for
the
administration
of
this
program.
18
c.
Primary
care
provider
community
scholarship
program.
19
(1)
A
primary
care
provider
community
scholarship
program
20
is
established
to
recruit
and
to
provide
scholarships
to
train
21
primary
health
care
practitioners
in
federally
designated
22
health
professional
shortage
areas
of
the
state.
Under
23
the
program,
scholarships
may
be
awarded
to
a
recipient
for
24
educational
expenses
incurred
while
completing
an
accredited
25
health
education
program
directly
related
to
obtaining
the
26
credentials
necessary
to
practice
the
recipient’s
health
27
profession.
28
(2)
The
department
shall
adopt
rules
relating
to
the
29
establishment
and
administration
of
the
primary
care
provider
30
community
scholarship
program.
Rules
adopted
pursuant
to
31
this
paragraph
shall
provide,
at
a
minimum,
for
all
of
the
32
following:
33
(a)
Determination
of
eligibility
requirements
and
34
qualifications
of
an
applicant
to
receive
scholarships
under
35
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the
program,
including
but
not
limited
to
years
of
obligated
1
service,
clinical
practice
requirements,
and
residency
2
requirements.
One
year
of
obligated
service
shall
be
provided
3
by
the
applicant
in
exchange
for
each
year
of
scholarship
4
receipt,
unless
federal
requirements
otherwise
require.
5
(b)
Identification
of
federally
designated
health
6
professional
shortage
areas
of
the
state
and
prioritization
of
7
such
areas
according
to
need.
8
(c)
Determination
of
the
amount
of
the
scholarship
an
9
applicant
may
receive.
10
(d)
Determination
of
the
conditions
of
scholarship
to
be
11
awarded
to
an
applicant.
12
(e)
Enforcement
of
the
state’s
rights
under
a
scholarship
13
contract,
including
the
commencement
of
any
court
action.
14
(f)
Cancellation
of
a
scholarship
contract
for
reasonable
15
cause.
16
(g)
Participation
in
federal
programs
supporting
17
scholarships
for
health
care
providers
and
acceptance
of
gifts,
18
grants,
and
other
aid
or
amounts
from
any
person,
association,
19
foundation,
trust,
corporation,
governmental
agency,
or
other
20
entity
for
the
purposes
of
the
program.
21
(h)
Upon
availability
of
state
funds,
determination
of
22
eligibility
criteria
and
qualifications
for
participating
23
communities
and
applicants
not
located
in
federally
designated
24
shortage
areas.
25
(i)
Other
rules
as
necessary.
26
(3)
The
center
for
rural
health
and
primary
care
may
enter
27
into
an
agreement
under
chapter
28E
with
the
college
student
28
aid
commission
for
the
administration
of
this
program.
29
Sec.
13.
Section
135.107,
subsection
4,
paragraphs
a,
b,
and
30
c,
Code
2017,
are
amended
to
read
as
follows:
31
a.
Eligibility
under
any
of
the
programs
established
under
32
the
primary
care
provider
recruitment
and
retention
endeavor
33
shall
be
based
upon
a
community
health
services
assessment
34
completed
under
subsection
2
,
paragraph
“a”
.
A
community
35
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_____
or
region,
as
applicable,
shall
submit
a
letter
of
intent
1
to
conduct
a
community
health
services
assessment
and
to
2
apply
for
assistance
under
this
subsection
.
The
letter
shall
3
be
in
a
form
and
contain
information
as
determined
by
the
4
center.
A
letter
of
intent
shall
be
submitted
to
the
center
by
5
January
1
preceding
the
fiscal
year
for
which
an
application
6
for
assistance
is
to
be
made.
Participation
in
a
community
7
health
services
assessment
process
shall
be
documented
by
the
8
community
or
region.
9
b.
Assistance
under
this
subsection
shall
not
be
granted
10
until
such
time
as
the
community
or
region
making
application
11
has
completed
the
a
community
health
services
assessment
and
12
adopted
a
long-term
community
health
services
assessment
and
13
developmental
plan.
In
addition
to
any
other
requirements,
a
14
developmental
an
applicant’s
plan
shall
include
,
to
the
extent
15
possible,
a
clear
commitment
to
informing
high
school
students
16
of
the
health
care
opportunities
which
may
be
available
to
such
17
students.
18
c.
The
center
for
rural
health
and
primary
care
shall
19
seek
additional
assistance
and
resources
from
other
state
20
departments
and
agencies,
federal
agencies
and
grant
programs,
21
private
organizations,
and
any
other
person,
as
appropriate.
22
The
center
is
authorized
and
directed
to
accept
on
behalf
of
23
the
state
any
grant
or
contribution,
federal
or
otherwise,
24
made
to
assist
in
meeting
the
cost
of
carrying
out
the
purpose
25
of
this
subsection
.
All
federal
grants
to
and
the
federal
26
receipts
of
the
center
are
appropriated
for
the
purpose
set
27
forth
in
such
federal
grants
or
receipts.
Funds
appropriated
28
by
the
general
assembly
to
the
center
for
implementation
of
29
this
subsection
shall
first
be
used
for
securing
any
available
30
federal
funds
requiring
a
state
match,
with
remaining
funds
31
being
used
for
the
health
care
workforce
and
community
support
32
grant
program.
33
Sec.
14.
Section
135.107,
subsection
5,
paragraph
a,
Code
34
2017,
is
amended
to
read
as
follows:
35
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a.
There
is
established
an
advisory
committee
to
the
1
center
for
rural
health
and
primary
care
consisting
of
one
2
representative,
approved
by
the
respective
agency,
of
each
3
of
the
following
agencies:
the
department
of
agriculture
4
and
land
stewardship,
the
Iowa
department
of
public
health,
5
the
department
of
inspections
and
appeals,
the
a
national
or
6
regional
institute
for
rural
health
policy,
the
rural
health
7
resource
center,
the
institute
of
agricultural
medicine
8
and
occupational
health,
and
the
Iowa
state
association
of
9
counties.
The
governor
shall
appoint
two
representatives
10
of
consumer
groups
active
in
rural
health
issues
and
a
11
representative
of
each
of
two
farm
organizations
active
within
12
the
state,
a
representative
of
an
agricultural
business
in
13
the
state,
a
representative
of
a
critical
needs
hospital,
14
a
practicing
rural
family
physician,
a
practicing
rural
15
physician
assistant,
a
practicing
rural
advanced
registered
16
nurse
practitioner,
and
a
rural
health
practitioner
who
is
17
not
a
physician,
physician
assistant,
or
advanced
registered
18
nurse
practitioner,
as
members
of
the
advisory
committee.
The
19
advisory
committee
shall
also
include
as
members
two
state
20
representatives,
one
appointed
by
the
speaker
of
the
house
of
21
representatives
and
one
by
the
minority
leader
of
the
house,
22
and
two
state
senators,
one
appointed
by
the
majority
leader
of
23
the
senate
and
one
by
the
minority
leader
of
the
senate.
24
Sec.
15.
Section
135.163,
Code
2017,
is
amended
to
read
as
25
follows:
26
135.163
Health
and
long-term
care
access.
27
The
department
shall
coordinate
public
and
private
efforts
28
to
develop
and
maintain
an
appropriate
health
care
delivery
29
infrastructure
and
a
stable,
well-qualified,
diverse,
and
30
sustainable
health
care
workforce
in
this
state.
The
health
31
care
delivery
infrastructure
and
the
health
care
workforce
32
shall
address
the
broad
spectrum
of
health
care
needs
of
Iowans
33
throughout
their
lifespan
including
long-term
care
needs
.
The
34
department
shall,
at
a
minimum,
do
all
of
the
following:
35
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1.
Develop
a
strategic
plan
for
health
care
delivery
1
infrastructure
and
health
care
workforce
resources
in
this
2
state.
3
2.
Provide
for
the
continuous
collection
of
data
to
provide
4
a
basis
for
health
care
strategic
planning
and
health
care
5
policymaking.
6
3.
Make
recommendations
regarding
the
health
care
delivery
7
infrastructure
and
the
health
care
workforce
that
assist
8
in
monitoring
current
needs,
predicting
future
trends,
and
9
informing
policymaking.
10
Sec.
16.
Section
135.175,
subsection
1,
paragraph
b,
Code
11
2017,
is
amended
to
read
as
follows:
12
b.
A
health
care
workforce
shortage
fund
is
created
in
13
the
state
treasury
as
a
separate
fund
under
the
control
of
14
the
department,
in
cooperation
with
the
entities
identified
15
in
this
section
as
having
control
over
the
accounts
within
16
the
fund.
The
fund
and
the
accounts
within
the
fund
shall
17
be
controlled
and
managed
in
a
manner
consistent
with
the
18
principles
specified
and
the
strategic
plan
developed
pursuant
19
to
sections
section
135.163
and
135.164
.
20
Sec.
17.
Section
135.175,
subsections
6
and
7,
Code
2017,
21
are
amended
to
read
as
follows:
22
6.
a.
Moneys
in
the
fund
and
the
accounts
in
the
fund
shall
23
only
be
appropriated
in
a
manner
consistent
with
the
principles
24
specified
and
the
strategic
plan
developed
pursuant
to
sections
25
section
135.163
and
135.164
to
support
the
medical
residency
26
training
state
matching
grants
program,
the
fulfilling
Iowa’s
27
need
for
dentists
matching
grant
program,
and
to
provide
28
funding
for
state
health
care
workforce
shortage
programs
as
29
provided
in
this
section
.
30
b.
State
programs
that
may
receive
funding
from
the
fund
31
and
the
accounts
in
the
fund,
if
specifically
designated
for
32
the
purpose
of
drawing
down
federal
funding,
are
the
primary
33
care
recruitment
and
retention
endeavor
(PRIMECARRE),
the
Iowa
34
affiliate
of
the
national
rural
recruitment
and
retention
35
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network,
the
oral
and
health
delivery
systems
bureau
of
the
1
department,
the
primary
care
office
and
shortage
designation
2
program,
and
the
state
office
of
rural
health,
and
the
Iowa
3
health
workforce
center,
administered
through
the
oral
and
4
health
delivery
systems
bureau
of
health
care
access
of
the
5
department
of
public
health;
the
area
health
education
centers
6
programs
at
Des
Moines
university
——
osteopathic
medical
center
7
and
the
university
of
Iowa;
the
Iowa
collaborative
safety
net
8
provider
network
established
pursuant
to
section
135.153
;
any
9
entity
identified
by
the
federal
government
entity
through
10
which
federal
funding
for
a
specified
health
care
workforce
11
shortage
initiative
is
received;
and
a
program
developed
in
12
accordance
with
the
strategic
plan
developed
by
the
department
13
of
public
health
in
accordance
with
sections
section
135.163
14
and
135.164
.
15
c.
State
appropriations
to
the
fund
shall
be
allocated
in
16
equal
amounts
to
each
of
the
accounts
within
the
fund,
unless
17
otherwise
specified
in
the
appropriation
or
allocation.
Any
18
federal
funding
received
for
the
purposes
of
addressing
state
19
health
care
workforce
shortages
shall
be
deposited
in
the
20
health
care
workforce
shortage
national
initiatives
account,
21
unless
otherwise
specified
by
the
source
of
the
funds,
and
22
shall
be
used
as
required
by
the
source
of
the
funds.
If
use
23
of
the
federal
funding
is
not
designated,
the
funds
shall
be
24
used
in
accordance
with
the
strategic
plan
developed
by
the
25
department
of
public
health
in
accordance
with
sections
section
26
135.163
and
135.164
,
or
to
address
workforce
shortages
as
27
otherwise
designated
by
the
department
of
public
health.
Other
28
sources
of
funding
shall
be
deposited
in
the
fund
or
account
29
and
used
as
specified
by
the
source
of
the
funding.
30
7.
No
more
than
five
percent
of
the
moneys
in
any
of
the
31
accounts
within
the
fund
,
not
to
exceed
one
hundred
thousand
32
dollars
in
each
account,
shall
be
used
for
administrative
33
purposes,
unless
otherwise
provided
by
the
appropriation,
34
allocation,
or
source
of
the
funds.
35
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Sec.
18.
REPEAL.
Sections
135.164
and
135.180,
Code
2017,
1
are
repealed.
2
DIVISION
IV
3
UNFUNDED
OR
OUTDATED
PROGRAM
PROVISIONS
4
Sec.
19.
Section
135.11,
subsection
25,
Code
2017,
is
5
amended
by
striking
the
subsection.
6
Sec.
20.
Section
135.141,
subsection
2,
paragraph
c,
Code
7
2017,
is
amended
by
striking
the
paragraph.
8
Sec.
21.
Section
135.141,
subsection
2,
paragraph
e,
Code
9
2017,
is
amended
to
read
as
follows:
10
e.
For
the
purpose
of
paragraphs
“c”
and
paragraph
“d”
,
11
an
employee
or
agent
of
the
department
may
enter
into
and
12
examine
any
premises
containing
potentially
dangerous
agents
13
with
the
consent
of
the
owner
or
person
in
charge
of
the
14
premises
or,
if
the
owner
or
person
in
charge
of
the
premises
15
refuses
admittance,
with
an
administrative
search
warrant
16
obtained
under
section
808.14
.
Based
on
findings
of
the
risk
17
assessment
and
examination
of
the
premises,
the
director
may
18
order
reasonable
safeguards
or
take
any
other
action
reasonably
19
necessary
to
protect
the
public
health
pursuant
to
rules
20
adopted
to
administer
this
subsection
.
21
Sec.
22.
Section
901B.1,
subsection
4,
paragraph
a,
Code
22
2017,
is
amended
to
read
as
follows:
23
a.
The
district
department
of
correctional
services
shall
24
place
an
individual
committed
to
it
under
section
907.3
to
the
25
sanction
and
level
of
supervision
which
is
appropriate
to
the
26
individual
based
upon
a
current
risk
assessment
evaluation.
27
Placements
may
be
to
levels
two
and
three
of
the
corrections
28
continuum.
The
district
department
may,
with
the
approval
of
29
the
Iowa
department
of
public
health
and
the
department
of
30
corrections,
place
an
individual
in
a
level
three
substance
31
abuse
treatment
facility
established
pursuant
to
section
32
135.130
,
to
assist
the
individual
in
complying
with
a
condition
33
of
probation.
The
district
department
may,
with
the
approval
34
of
the
department
of
corrections,
place
an
individual
in
a
35
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level
four
violator
facility
established
pursuant
to
section
1
904.207
only
as
a
penalty
for
a
violation
of
a
condition
2
imposed
under
this
section
.
3
Sec.
23.
REPEAL.
Sections
135.26,
135.29,
135.130,
and
4
135.152,
Code
2017,
are
repealed.
5
DIVISION
V
6
MISCELLANEOUS
PROVISIONS
7
Sec.
24.
Section
135A.2,
subsection
6,
Code
2017,
is
amended
8
to
read
as
follows:
9
6.
“Local
board
of
health”
means
a
county
or
district
board
10
of
health
the
same
as
defined
in
section
137.102
.
11
Sec.
25.
REPEAL.
Section
135.132,
Code
2017,
is
repealed.
12
DIVISION
VI
13
IOWA
HEALTH
INFORMATION
NETWORK
14
Sec.
26.
Section
136.3,
subsection
13,
Code
2017,
is
amended
15
to
read
as
follows:
16
13.
Perform
those
duties
authorized
pursuant
to
sections
17
135.156
and
section
135.159
and
other
provisions
of
law.
18
Sec.
27.
EFFECTIVE
DATE.
This
division
of
this
Act
19
takes
effect
upon
the
assumption
of
the
administration
and
20
governance,
including
but
not
limited
to
the
assumption
of
the
21
assets
and
liabilities,
of
the
Iowa
health
information
network
22
by
the
designated
entity
as
defined
in
2015
Iowa
Acts,
ch.73,
23
section
2.
The
department
of
public
health
shall
notify
the
24
Code
editor
of
the
date
of
such
assumption
by
the
designated
25
entity.
26
DIVISION
VII
27
ORGANIZED
DELIVERY
SYSTEMS
28
Sec.
28.
Section
135H.3,
subsection
2,
Code
2017,
is
amended
29
to
read
as
follows:
30
2.
If
a
child
is
diagnosed
with
a
biologically
based
mental
31
illness
as
defined
in
section
514C.22
and
meets
the
medical
32
assistance
program
criteria
for
admission
to
a
psychiatric
33
medical
institution
for
children,
the
child
shall
be
deemed
34
to
meet
the
acuity
criteria
for
medically
necessary
inpatient
35
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_____
benefits
under
a
group
policy,
contract,
or
plan
providing
1
for
third-party
payment
or
prepayment
of
health,
medical,
and
2
surgical
coverage
benefits
issued
by
a
carrier,
as
defined
in
3
section
513B.2
,
or
by
an
organized
delivery
system
authorized
4
under
1993
Iowa
Acts,
ch.
158,
that
is
subject
to
section
5
514C.22
.
Such
medically
necessary
benefits
shall
not
be
6
excluded
or
denied
as
care
that
is
substantially
custodial
in
7
nature
under
section
514C.22,
subsection
8
,
paragraph
“b”
.
8
Sec.
29.
Section
505.32,
subsection
2,
paragraph
h,
Code
9
2017,
is
amended
by
striking
the
paragraph.
10
Sec.
30.
Section
505.32,
subsection
4,
paragraph
b,
11
subparagraphs
(1)
and
(2),
Code
2017,
are
amended
to
read
as
12
follows:
13
(1)
The
commissioner
may
establish
methodologies
to
provide
14
uniform
and
consistent
side-by-side
comparisons
of
the
health
15
care
coverage
options
that
are
offered
by
carriers
,
organized
16
delivery
systems,
and
public
programs
in
this
state
including
17
but
not
limited
to
benefits
covered
and
not
covered,
the
amount
18
of
coverage
for
each
service,
including
copays
and
deductibles,
19
administrative
costs,
and
any
prior
authorization
requirements
20
for
coverage.
21
(2)
The
commissioner
may
require
each
carrier
,
organized
22
delivery
system,
and
public
program
in
this
state
to
describe
23
each
health
care
coverage
option
offered
by
that
carrier
,
24
organized
delivery
system,
or
public
program
in
a
manner
25
so
that
the
various
options
can
be
compared
as
provided
in
26
subparagraph
(1).
27
Sec.
31.
Section
507B.4,
subsection
1,
Code
2017,
is
amended
28
to
read
as
follows:
29
1.
For
purposes
of
subsection
3
,
paragraph
“p”
,
“insurer”
30
means
an
entity
providing
a
plan
of
health
insurance,
health
31
care
benefits,
or
health
care
services,
or
an
entity
subject
32
to
the
jurisdiction
of
the
commissioner
performing
utilization
33
review,
including
an
insurance
company
offering
sickness
and
34
accident
plans,
a
health
maintenance
organization,
an
organized
35
-16-
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1675XC
(7)
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16/
57
S.F.
_____
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158
,
and
1
licensed
by
the
department
of
public
health,
a
nonprofit
health
2
service
corporation,
a
plan
established
pursuant
to
chapter
3
509A
for
public
employees,
or
any
other
entity
providing
a
4
plan
of
health
insurance,
health
care
benefits,
or
health
care
5
services.
However,
“insurer”
does
not
include
an
entity
that
6
sells
disability
income
or
long-term
care
insurance.
7
Sec.
32.
Section
507B.4A,
subsection
2,
paragraph
a,
Code
8
2017,
is
amended
to
read
as
follows:
9
a.
An
insurer
providing
accident
and
sickness
insurance
10
under
chapter
509
,
514
,
or
514A
;
a
health
maintenance
11
organization;
an
organized
delivery
system
authorized
under
12
1993
Iowa
Acts,
ch.
158
,
and
licensed
by
the
department
of
13
public
health;
or
another
entity
providing
health
insurance
or
14
health
benefits
subject
to
state
insurance
regulation
shall
15
either
accept
and
pay
or
deny
a
clean
claim.
16
Sec.
33.
Section
509.3A,
subsection
11,
Code
2017,
is
17
amended
by
striking
the
subsection.
18
Sec.
34.
Section
509.19,
subsection
2,
paragraph
d,
Code
19
2017,
is
amended
by
striking
the
paragraph.
20
Sec.
35.
Section
509A.6,
Code
2017,
is
amended
to
read
as
21
follows:
22
509A.6
Contract
with
insurance
carrier
,
or
health
maintenance
23
organization
,
or
organized
delivery
system
.
24
The
governing
body
may
contract
with
a
nonprofit
corporation
25
operating
under
the
provisions
of
this
chapter
or
chapter
26
514
or
with
any
insurance
company
having
a
certificate
of
27
authority
to
transact
an
insurance
business
in
this
state
with
28
respect
of
a
group
insurance
plan,
which
may
include
life,
29
accident,
health,
hospitalization
and
disability
insurance
30
during
period
of
active
service
of
such
employees,
with
the
31
right
of
any
employee
to
continue
such
life
insurance
in
force
32
after
termination
of
active
service
at
such
employee’s
sole
33
expense;
may
contract
with
a
nonprofit
corporation
operating
34
under
and
governed
by
the
provisions
of
this
chapter
or
chapter
35
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S.F.
_____
514
with
respect
of
any
hospital
or
medical
service
plan;
and
1
may
contract
with
a
health
maintenance
organization
or
an
2
organized
delivery
system
authorized
to
operate
in
this
state
3
with
respect
to
health
maintenance
organization
or
organized
4
delivery
system
activities.
5
Sec.
36.
Section
513B.2,
subsection
8,
paragraph
k,
Code
6
2017,
is
amended
by
striking
the
paragraph.
7
Sec.
37.
Section
513B.5,
Code
2017,
is
amended
to
read
as
8
follows:
9
513B.5
Provisions
on
renewability
of
coverage.
10
1.
Health
insurance
coverage
subject
to
this
chapter
is
11
renewable
with
respect
to
all
eligible
employees
or
their
12
dependents,
at
the
option
of
the
small
employer,
except
for
one
13
or
more
of
the
following
reasons:
14
a.
The
health
insurance
coverage
sponsor
fails
to
pay,
or
to
15
make
timely
payment
of,
premiums
or
contributions
pursuant
to
16
the
terms
of
the
health
insurance
coverage.
17
b.
The
health
insurance
coverage
sponsor
performs
an
18
act
or
practice
constituting
fraud
or
makes
an
intentional
19
misrepresentation
of
a
material
fact
under
the
terms
of
the
20
coverage.
21
c.
Noncompliance
with
the
carrier’s
or
organized
delivery
22
system’s
minimum
participation
requirements.
23
d.
Noncompliance
with
the
carrier’s
or
organized
delivery
24
system’s
employer
contribution
requirements.
25
e.
A
decision
by
the
carrier
or
organized
delivery
system
26
to
discontinue
offering
a
particular
type
of
health
insurance
27
coverage
in
the
state’s
small
employer
market.
Health
28
insurance
coverage
may
be
discontinued
by
the
carrier
or
29
organized
delivery
system
in
that
market
only
if
the
carrier
or
30
organized
delivery
system
does
all
of
the
following:
31
(1)
Provides
advance
notice
of
its
decision
to
discontinue
32
such
plan
to
the
commissioner
or
director
of
public
health
.
33
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
34
no
less
than
three
days
prior
to
the
notice
provided
for
in
35
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_____
subparagraph
(2)
to
affected
small
employers,
participants,
and
1
beneficiaries.
2
(2)
Provides
notice
of
its
decision
not
to
renew
such
3
plan
to
all
affected
small
employers,
participants,
and
4
beneficiaries
no
less
than
ninety
days
prior
to
the
nonrenewal
5
of
the
plan.
6
(3)
Offers
to
each
plan
sponsor
of
the
discontinued
7
coverage,
the
option
to
purchase
any
other
coverage
currently
8
offered
by
the
carrier
or
organized
delivery
system
to
other
9
employers
in
this
state.
10
(4)
Acts
uniformly,
in
opting
to
discontinue
the
coverage
11
and
in
offering
the
option
under
subparagraph
(3),
without
12
regard
to
the
claims
experience
of
the
sponsors
under
the
13
discontinued
coverage
or
to
a
health
status-related
factor
14
relating
to
any
participants
or
beneficiaries
covered
or
new
15
participants
or
beneficiaries
who
may
become
eligible
for
the
16
coverage.
17
f.
A
decision
by
the
carrier
or
organized
delivery
system
to
18
discontinue
offering
and
to
cease
to
renew
all
of
its
health
19
insurance
coverage
delivered
or
issued
for
delivery
to
small
20
employers
in
this
state.
A
carrier
or
organized
delivery
21
system
making
such
decision
shall
do
all
of
the
following:
22
(1)
Provide
advance
notice
of
its
decision
to
discontinue
23
such
coverage
to
the
commissioner
or
director
of
public
health
.
24
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
25
no
less
than
three
days
prior
to
the
notice
provided
for
in
26
subparagraph
(2)
to
affected
small
employers,
participants,
and
27
beneficiaries.
28
(2)
Provide
notice
of
its
decision
not
to
renew
such
29
coverage
to
all
affected
small
employers,
participants,
and
30
beneficiaries
no
less
than
one
hundred
eighty
days
prior
to
the
31
nonrenewal
of
the
coverage.
32
(3)
Discontinue
all
health
insurance
coverage
issued
or
33
delivered
for
issuance
to
small
employers
in
this
state
and
34
cease
renewal
of
such
coverage.
35
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S.F.
_____
g.
The
membership
of
an
employer
in
an
association,
which
1
is
the
basis
for
the
coverage
which
is
provided
through
such
2
association,
ceases,
but
only
if
the
termination
of
coverage
3
under
this
paragraph
occurs
uniformly
without
regard
to
4
any
health
status-related
factor
relating
to
any
covered
5
individual.
6
h.
The
commissioner
or
director
of
public
health
finds
that
7
the
continuation
of
the
coverage
is
not
in
the
best
interests
8
of
the
policyholders
or
certificate
holders,
or
would
impair
9
the
carrier’s
or
organized
delivery
system’s
ability
to
meet
10
its
contractual
obligations.
11
i.
At
the
time
of
coverage
renewal,
a
carrier
or
organized
12
delivery
system
may
modify
the
health
insurance
coverage
for
13
a
product
offered
under
group
health
insurance
coverage
in
14
the
small
group
market,
for
coverage
that
is
available
in
15
such
market
other
than
only
through
one
or
more
bona
fide
16
associations,
if
such
modification
is
consistent
with
the
laws
17
of
this
state,
and
is
effective
on
a
uniform
basis
among
group
18
health
insurance
coverage
with
that
product.
19
2.
A
carrier
or
organized
delivery
system
that
elects
not
to
20
renew
health
insurance
coverage
under
subsection
1
,
paragraph
21
“f”
,
shall
not
write
any
new
business
in
the
small
employer
22
market
in
this
state
for
a
period
of
five
years
after
the
date
23
of
notice
to
the
commissioner
or
director
of
public
health
.
24
3.
This
section
,
with
respect
to
a
carrier
or
organized
25
delivery
system
doing
business
in
one
established
geographic
26
service
area
of
the
state,
applies
only
to
such
carrier’s
or
27
organized
delivery
system’s
operations
in
that
service
area.
28
Sec.
38.
Section
513B.6,
unnumbered
paragraph
1,
Code
2017,
29
is
amended
to
read
as
follows:
30
A
small
employer
carrier
or
organized
delivery
system
shall
31
make
reasonable
disclosure
in
solicitation
and
sales
materials
32
provided
to
small
employers
of
all
of
the
following:
33
Sec.
39.
Section
513B.6,
subsection
2,
Code
2017,
is
amended
34
to
read
as
follows:
35
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S.F.
_____
2.
The
provisions
concerning
the
small
employer
carrier’s
1
or
organized
delivery
system’s
right
to
change
premium
rates
2
and
factors,
including
case
characteristics,
which
affect
3
changes
in
premium
rates.
4
Sec.
40.
Section
513B.7,
Code
2017,
is
amended
to
read
as
5
follows:
6
513B.7
Maintenance
of
records.
7
1.
A
small
employer
carrier
or
organized
delivery
system
8
shall
maintain
at
its
principal
place
of
business
a
complete
9
and
detailed
description
of
its
rating
practices
and
renewal
10
underwriting
practices,
including
information
and
documentation
11
which
demonstrate
that
its
rating
methods
and
practices
are
12
based
upon
commonly
accepted
actuarial
assumptions
and
are
in
13
accordance
with
sound
actuarial
principles.
14
2.
A
small
employer
carrier
or
organized
delivery
system
15
shall
file
each
March
1
with
the
commissioner
or
the
director
16
of
public
health
an
actuarial
certification
that
the
small
17
employer
carrier
or
organized
delivery
system
is
in
compliance
18
with
this
section
and
that
the
rating
methods
of
the
small
19
employer
carrier
or
organized
delivery
system
are
actuarially
20
sound.
A
copy
of
the
certification
shall
be
retained
by
the
21
small
employer
carrier
or
organized
delivery
system
at
its
22
principal
place
of
business.
23
3.
A
small
employer
carrier
or
organized
delivery
system
24
shall
make
the
information
and
documentation
described
in
25
subsection
1
available
to
the
commissioner
or
the
director
of
26
public
health
upon
request.
The
information
is
not
a
public
27
record
or
otherwise
subject
to
disclosure
under
chapter
22
,
28
and
is
considered
proprietary
and
trade
secret
information
29
and
is
not
subject
to
disclosure
by
the
commissioner
or
the
30
director
of
public
health
to
persons
outside
of
the
division
or
31
department
except
as
agreed
to
by
the
small
employer
carrier
or
32
organized
delivery
system
or
as
ordered
by
a
court
of
competent
33
jurisdiction.
34
Sec.
41.
Section
513B.9A,
subsection
1,
unnumbered
35
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87
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57
S.F.
_____
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
1
A
carrier
or
organized
delivery
system
offering
group
health
2
insurance
coverage
shall
not
establish
rules
for
eligibility,
3
including
continued
eligibility,
of
an
individual
to
enroll
4
under
the
terms
of
the
coverage
based
on
any
of
the
following
5
health
status-related
factors
in
relation
to
the
individual
or
6
a
dependent
of
the
individual:
7
Sec.
42.
Section
513B.9A,
subsection
4,
paragraph
a,
Code
8
2017,
is
amended
to
read
as
follows:
9
a.
A
carrier
or
organized
delivery
system
offering
health
10
insurance
coverage
shall
not
require
an
individual,
as
a
11
condition
of
enrollment
or
continued
enrollment
under
the
12
coverage,
to
pay
a
premium
or
contribution
which
is
greater
13
than
a
premium
or
contribution
for
a
similarly
situated
14
individual
enrolled
in
the
coverage
on
the
basis
of
a
health
15
status-related
factor
in
relation
to
the
individual
or
to
a
16
dependent
of
an
individual
enrolled
under
the
coverage.
17
Sec.
43.
Section
513B.9A,
subsection
4,
paragraph
b,
18
subparagraph
(2),
Code
2017,
is
amended
to
read
as
follows:
19
(2)
Prevent
a
carrier
or
organized
delivery
system
20
offering
group
health
insurance
coverage
from
establishing
21
premium
discounts
or
rebates
or
modifying
otherwise
applicable
22
copayments
or
deductibles
in
return
for
adherence
to
programs
23
of
health
promotion
and
disease
prevention.
24
Sec.
44.
Section
513B.10,
Code
2017,
is
amended
to
read
as
25
follows:
26
513B.10
Availability
of
coverage.
27
1.
a.
A
carrier
or
an
organized
delivery
system
that
offers
28
health
insurance
coverage
in
the
small
group
market
shall
29
accept
every
small
employer
that
applies
for
health
insurance
30
coverage
and
shall
accept
for
enrollment
under
such
coverage
31
every
eligible
individual
who
applies
for
enrollment
during
the
32
period
in
which
the
individual
first
becomes
eligible
to
enroll
33
under
the
terms
of
the
health
insurance
coverage
and
shall
not
34
place
any
restriction
which
is
inconsistent
with
eligibility
35
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rules
established
under
this
chapter
.
1
b.
A
carrier
or
organized
delivery
system
that
offers
health
2
insurance
coverage
in
the
small
group
market
through
a
network
3
plan
may
do
either
of
the
following:
4
(1)
Limit
employers
that
may
apply
for
such
coverage
to
5
those
with
eligible
individuals
who
live,
work,
or
reside
in
6
the
service
area
for
such
network
plan.
7
(2)
Deny
such
coverage
to
such
employers
within
the
service
8
area
of
such
plan
if
the
carrier
or
organized
delivery
system
9
has
demonstrated
to
the
applicable
state
authority
both
of
the
10
following:
11
(a)
The
carrier
or
organized
delivery
system
will
not
have
12
the
capacity
to
deliver
services
adequately
to
enrollees
of
any
13
additional
groups
because
of
its
obligations
to
existing
group
14
contract
holders
and
enrollees.
15
(b)
The
carrier
or
organized
delivery
system
is
applying
16
this
subparagraph
uniformly
to
all
employers
without
regard
to
17
the
claims
experience
of
those
employers
and
their
employees
18
and
their
dependents,
or
any
health
status-related
factor
19
relating
to
such
employees
or
dependents.
20
c.
A
carrier
or
organized
delivery
system
,
upon
denying
21
health
insurance
coverage
in
any
service
area
pursuant
to
22
paragraph
“b”
,
subparagraph
(2),
shall
not
offer
coverage
in
the
23
small
group
market
within
such
service
area
for
a
period
of
one
24
hundred
eighty
days
after
the
date
such
coverage
is
denied.
25
d.
A
carrier
or
organized
delivery
system
may
deny
health
26
insurance
coverage
in
the
small
group
market
if
the
issuer
has
27
demonstrated
to
the
commissioner
or
director
of
public
health
28
both
of
the
following:
29
(1)
The
carrier
or
organized
delivery
system
does
not
have
30
the
financial
reserves
necessary
to
underwrite
additional
31
coverage.
32
(2)
The
carrier
or
organized
delivery
system
is
applying
the
33
provisions
of
this
paragraph
uniformly
to
all
employers
in
the
34
small
group
market
in
this
state
consistent
with
state
law
and
35
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without
regard
to
the
claims
experience
of
those
employers
and
1
the
employees
and
dependents
of
such
employers,
or
any
health
2
status-related
factor
relating
to
such
employees
and
their
3
dependents.
4
e.
A
carrier
or
organized
delivery
system
,
upon
denying
5
health
insurance
coverage
pursuant
to
paragraph
“d”
,
shall
not
6
offer
coverage
in
connection
with
health
insurance
coverages
7
in
the
small
group
market
in
this
state
for
a
period
of
one
8
hundred
eighty
days
after
the
date
such
coverage
is
denied
or
9
until
the
carrier
or
organized
delivery
system
has
demonstrated
10
to
the
commissioner
or
director
of
public
health
that
the
11
carrier
or
organized
delivery
system
has
sufficient
financial
12
reserves
to
underwrite
additional
coverage,
whichever
is
later.
13
The
commissioner
or
director
may
provide
for
the
application
of
14
this
paragraph
on
a
service
area-specific
basis.
15
f.
Paragraph
“a”
shall
not
be
construed
to
preclude
16
a
carrier
or
organized
delivery
system
from
establishing
17
employer
contribution
rules
or
group
participation
rules
for
18
the
offering
of
health
insurance
coverage
in
the
small
group
19
market.
20
2.
A
carrier
or
organized
delivery
system
,
subject
to
21
subsection
1
,
shall
issue
health
insurance
coverage
to
an
22
eligible
small
employer
that
applies
for
the
coverage
and
23
agrees
to
make
the
required
premium
payments
and
satisfy
the
24
other
reasonable
provisions
of
the
health
insurance
coverage
25
not
inconsistent
with
this
chapter
.
A
carrier
or
organized
26
delivery
system
is
not
required
to
issue
health
insurance
27
coverage
to
a
self-employed
individual
who
is
covered
by,
or
is
28
eligible
for
coverage
under,
health
insurance
coverage
offered
29
by
an
employer.
30
3.
Health
insurance
coverage
for
small
employers
shall
31
satisfy
all
of
the
following:
32
a.
A
carrier
or
organized
delivery
system
offering
group
33
health
insurance
coverage,
with
respect
to
a
participant
or
34
beneficiary,
may
impose
a
preexisting
condition
exclusion
only
35
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as
follows:
1
(1)
The
exclusion
relates
to
a
condition,
whether
physical
2
or
mental,
regardless
of
the
cause
of
the
condition,
for
3
which
medical
advice,
diagnosis,
care,
or
treatment
was
4
recommended
or
received
within
the
six-month
period
ending
on
5
the
enrollment
date.
However,
genetic
information
shall
not
be
6
treated
as
a
condition
under
this
subparagraph
in
the
absence
7
of
a
diagnosis
of
the
condition
related
to
such
information.
8
(2)
The
exclusion
extends
for
a
period
of
not
more
than
9
twelve
months,
or
eighteen
months
in
the
case
of
a
late
10
enrollee,
after
the
enrollment
date.
11
(3)
The
period
of
any
such
preexisting
condition
exclusion
12
is
reduced
by
the
aggregate
of
the
periods
of
creditable
13
coverage
applicable
to
the
participant
or
beneficiary
as
of
the
14
enrollment
date.
15
b.
A
carrier
or
organized
delivery
system
offering
group
16
health
insurance
coverage
shall
not
impose
any
preexisting
17
condition
exclusion
as
follows:
18
(1)
In
the
case
of
a
child
who
is
adopted
or
placed
for
19
adoption
before
attaining
eighteen
years
of
age
and
who,
as
of
20
the
last
day
of
the
thirty-day
period
beginning
on
the
date
21
of
the
adoption
or
placement
for
adoption,
is
covered
under
22
creditable
coverage.
This
subparagraph
shall
not
apply
to
23
coverage
before
the
date
of
such
adoption
or
placement
for
24
adoption.
25
(2)
In
the
case
of
an
individual
who,
as
of
the
last
day
26
of
the
thirty-day
period
beginning
with
the
date
of
birth,
is
27
covered
under
creditable
coverage.
28
(3)
Relating
to
pregnancy
as
a
preexisting
condition.
29
c.
A
carrier
or
organized
delivery
system
shall
waive
30
any
waiting
period
applicable
to
a
preexisting
condition
31
exclusion
or
limitation
period
with
respect
to
particular
32
services
under
health
insurance
coverage
for
the
period
33
of
time
an
individual
was
covered
by
creditable
coverage,
34
provided
that
the
creditable
coverage
was
continuous
to
a
35
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_____
date
not
more
than
sixty-three
days
prior
to
the
effective
1
date
of
the
new
coverage.
Any
period
that
an
individual
2
is
in
a
waiting
period
for
any
coverage
under
group
health
3
insurance
coverage,
or
is
in
an
affiliation
period,
shall
not
4
be
taken
into
account
in
determining
the
period
of
continuous
5
coverage.
A
health
maintenance
organization
that
does
not
6
use
preexisting
condition
limitations
in
any
of
its
health
7
insurance
coverage
may
impose
an
affiliation
period.
For
8
purposes
of
this
section
,
“affiliation
period”
means
a
period
9
of
time
not
to
exceed
sixty
days
for
new
entrants
and
not
to
10
exceed
ninety
days
for
late
enrollees
during
which
no
premium
11
shall
be
collected
and
coverage
issued
is
not
effective,
so
12
long
as
the
affiliation
period
is
applied
uniformly,
without
13
regard
to
any
health
status-related
factors.
This
paragraph
14
does
not
preclude
application
of
a
waiting
period
applicable
15
to
all
new
enrollees
under
the
health
insurance
coverage,
16
provided
that
any
carrier
or
organized
delivery
system-imposed
17
carrier-imposed
waiting
period
is
no
longer
than
sixty
days
and
18
is
used
in
lieu
of
a
preexisting
condition
exclusion.
19
d.
Health
insurance
coverage
may
exclude
coverage
for
late
20
enrollees
for
preexisting
conditions
for
a
period
not
to
exceed
21
eighteen
months.
22
e.
(1)
Requirements
used
by
a
carrier
or
organized
delivery
23
system
in
determining
whether
to
provide
coverage
to
a
small
24
employer
shall
be
applied
uniformly
among
all
small
employers
25
applying
for
coverage
or
receiving
coverage
from
the
carrier
26
or
organized
delivery
system
.
27
(2)
In
applying
minimum
participation
requirements
with
28
respect
to
a
small
employer,
a
carrier
or
organized
delivery
29
system
shall
not
consider
employees
or
dependents
who
have
30
other
creditable
coverage
in
determining
whether
the
applicable
31
percentage
of
participation
is
met.
32
(3)
A
carrier
or
organized
delivery
system
shall
not
33
increase
any
requirement
for
minimum
employee
participation
34
or
modify
any
requirement
for
minimum
employer
contribution
35
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applicable
to
a
small
employer
at
any
time
after
the
small
1
employer
has
been
accepted
for
coverage.
2
f.
(1)
If
a
carrier
or
organized
delivery
system
offers
3
coverage
to
a
small
employer,
the
carrier
or
organized
delivery
4
system
shall
offer
coverage
to
all
eligible
employees
of
the
5
small
employer
and
the
employees’
dependents.
A
carrier
or
6
organized
delivery
system
shall
not
offer
coverage
to
only
7
certain
individuals
or
dependents
in
a
small
employer
group
or
8
to
only
part
of
the
group.
9
(2)
Except
as
provided
under
paragraphs
“a”
and
“d”
,
a
10
carrier
or
organized
delivery
system
shall
not
modify
health
11
insurance
coverage
with
respect
to
a
small
employer
or
any
12
eligible
employee
or
dependent
through
riders,
endorsements,
or
13
other
means,
to
restrict
or
exclude
coverage
or
benefits
for
14
certain
diseases,
medical
conditions,
or
services
otherwise
15
covered
by
the
health
insurance
coverage.
16
g.
A
carrier
or
organized
delivery
system
offering
coverage
17
through
a
network
plan
shall
not
be
required
to
offer
coverage
18
or
accept
applications
pursuant
to
subsection
1
with
respect
to
19
a
small
employer
where
any
of
the
following
apply
applies
:
20
(1)
The
small
employer
does
not
have
eligible
individuals
21
who
live,
work,
or
reside
in
the
service
area
for
the
network
22
plan.
23
(2)
The
small
employer
does
have
eligible
individuals
who
24
live,
work,
or
reside
in
the
service
area
for
the
network
plan,
25
but
the
carrier
or
organized
delivery
system
,
if
required,
has
26
demonstrated
to
the
commissioner
or
the
director
of
public
27
health
that
it
will
not
have
the
capacity
to
deliver
services
28
adequately
to
enrollees
of
any
additional
groups
because
of
its
29
obligations
to
existing
group
contract
holders
and
enrollees
30
and
that
it
is
applying
the
requirements
of
this
lettered
31
paragraph
uniformly
to
all
employers
without
regard
to
the
32
claims
experience
of
those
employers
and
their
employees
and
33
the
employees’
dependents,
or
any
health
status-related
factor
34
relating
to
such
employees
and
dependents.
35
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(3)
A
carrier
or
organized
delivery
system
,
upon
denying
1
health
insurance
coverage
in
a
service
area
pursuant
to
2
subparagraph
(2),
shall
not
offer
coverage
in
the
small
3
employer
market
within
such
service
area
for
a
period
of
one
4
hundred
eighty
days
after
the
coverage
is
denied.
5
4.
A
carrier
or
organized
delivery
system
shall
not
be
6
required
to
offer
coverage
to
small
employers
pursuant
to
7
subsection
1
for
any
period
of
time
where
the
commissioner
or
8
director
of
public
health
determines
that
the
acceptance
of
the
9
offers
by
small
employers
in
accordance
with
subsection
1
would
10
place
the
carrier
or
organized
delivery
system
in
a
financially
11
impaired
condition.
12
5.
A
carrier
or
organized
delivery
system
shall
not
be
13
required
to
provide
coverage
to
small
employers
pursuant
to
14
subsection
1
if
the
carrier
or
organized
delivery
system
elects
15
not
to
offer
new
coverage
to
small
employers
in
this
state.
16
However,
a
carrier
or
organized
delivery
system
that
elects
not
17
to
offer
new
coverage
to
small
employers
under
this
subsection
18
shall
be
allowed
to
maintain
its
existing
policies
in
the
19
state,
subject
to
the
requirements
of
section
513B.5
.
20
6.
A
carrier
or
organized
delivery
system
that
elects
not
to
21
offer
new
coverage
to
small
employers
pursuant
to
subsection
5
22
shall
provide
notice
to
the
commissioner
or
director
of
public
23
health
and
is
prohibited
from
writing
new
business
in
the
small
24
employer
market
in
this
state
for
a
period
of
five
years
from
25
the
date
of
notice
to
the
commissioner
or
director
.
26
Sec.
45.
Section
513C.3,
subsection
5,
Code
2017,
is
amended
27
to
read
as
follows:
28
5.
“Carrier”
means
any
entity
that
provides
individual
29
health
benefit
plans
in
this
state.
For
purposes
of
this
30
chapter
,
carrier
includes
an
insurance
company,
a
group
31
hospital
or
medical
service
corporation,
a
fraternal
benefit
32
society,
a
health
maintenance
organization,
and
any
other
33
entity
providing
an
individual
plan
of
health
insurance
34
or
health
benefits
subject
to
state
insurance
regulation.
35
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“Carrier”
does
not
include
an
organized
delivery
system.
1
Sec.
46.
Section
513C.3,
subsection
7,
Code
2017,
is
amended
2
by
striking
the
subsection.
3
Sec.
47.
Section
513C.3,
subsection
9,
Code
2017,
is
amended
4
to
read
as
follows:
5
9.
“Established
service
area”
means
a
geographic
area,
6
as
approved
by
the
commissioner
and
based
upon
the
carrier’s
7
certificate
of
authority
to
transact
business
in
this
state,
8
within
which
the
carrier
is
authorized
to
provide
coverage
or
9
a
geographic
area,
as
approved
by
the
director
and
based
upon
10
the
organized
delivery
system’s
license
to
transact
business
11
in
this
state,
within
which
the
organized
delivery
system
is
12
authorized
to
provide
coverage
.
13
Sec.
48.
Section
513C.3,
subsection
12,
Code
2017,
is
14
amended
by
striking
the
subsection.
15
Sec.
49.
Section
513C.3,
subsection
15,
paragraph
a,
16
subparagraph
(3),
Code
2017,
is
amended
by
striking
the
17
subparagraph.
18
Sec.
50.
Section
513C.3,
subsection
18,
Code
2017,
is
19
amended
to
read
as
follows:
20
18.
“Restricted
network
provision”
means
a
provision
of
an
21
individual
health
benefit
plan
that
conditions
the
payment
22
of
benefits,
in
whole
or
in
part,
on
the
use
of
health
care
23
providers
that
have
entered
into
a
contractual
arrangement
with
24
the
carrier
or
the
organized
delivery
system
to
provide
health
25
care
services
to
covered
individuals.
26
Sec.
51.
Section
513C.5,
subsection
1,
unnumbered
paragraph
27
1,
Code
2017,
is
amended
to
read
as
follows:
28
Premium
rates
for
any
block
of
individual
health
benefit
29
plan
business
issued
on
or
after
January
1,
1996,
or
the
date
30
rules
are
adopted
by
the
commissioner
of
insurance
and
the
31
director
of
public
health
and
become
effective,
whichever
32
date
is
later,
by
a
carrier
subject
to
this
chapter
shall
be
33
limited
to
the
composite
effect
of
allocating
costs
among
the
34
following:
35
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Sec.
52.
Section
513C.6,
Code
2017,
is
amended
to
read
as
1
follows:
2
513C.6
Provisions
on
renewability
of
coverage.
3
1.
An
individual
health
benefit
plan
subject
to
this
4
chapter
is
renewable
with
respect
to
an
eligible
individual
or
5
dependents,
at
the
option
of
the
individual,
except
for
one
or
6
more
of
the
following
reasons:
7
a.
The
individual
fails
to
pay,
or
to
make
timely
payment
8
of,
premiums
or
contributions
pursuant
to
the
terms
of
the
9
individual
health
benefit
plan.
10
b.
The
individual
performs
an
act
or
practice
constituting
11
fraud
or
makes
an
intentional
misrepresentation
of
a
material
12
fact
under
the
terms
of
the
individual
health
benefit
plan.
13
c.
A
decision
by
the
individual
carrier
or
organized
14
delivery
system
to
discontinue
offering
a
particular
type
15
of
individual
health
benefit
plan
in
the
state’s
individual
16
insurance
market.
An
individual
health
benefit
plan
may
be
17
discontinued
by
the
carrier
or
organized
delivery
system
in
18
that
market
with
the
approval
of
the
commissioner
or
the
19
director
and
only
if
the
carrier
or
organized
delivery
system
20
does
all
of
the
following:
21
(1)
Provides
advance
notice
of
its
decision
to
discontinue
22
such
plan
to
the
commissioner
or
director
.
Notice
to
the
23
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
24
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
25
to
affected
individuals.
26
(2)
Provides
notice
of
its
decision
not
to
renew
such
plan
27
to
all
affected
individuals
no
less
than
ninety
days
prior
28
to
the
nonrenewal
date
of
any
discontinued
individual
health
29
benefit
plans.
30
(3)
Offers
to
each
individual
of
the
discontinued
plan
the
31
option
to
purchase
any
other
health
plan
currently
offered
by
32
the
carrier
or
organized
delivery
system
to
individuals
in
this
33
state.
34
(4)
Acts
uniformly
in
opting
to
discontinue
the
plan
and
35
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in
offering
the
option
under
subparagraph
(3),
without
regard
1
to
the
claims
experience
of
any
affected
eligible
individual
2
or
beneficiary
under
the
discontinued
plan
or
to
a
health
3
status-related
factor
relating
to
any
covered
individuals
or
4
beneficiaries
who
may
become
eligible
for
the
coverage.
5
d.
A
decision
by
the
carrier
or
organized
delivery
system
6
to
discontinue
offering
and
to
cease
to
renew
all
of
its
7
individual
health
benefit
plans
delivered
or
issued
for
8
delivery
to
individuals
in
this
state.
A
carrier
or
organized
9
delivery
system
making
such
decision
shall
do
all
of
the
10
following:
11
(1)
Provide
advance
notice
of
its
decision
to
discontinue
12
such
plan
to
the
commissioner
or
director
.
Notice
to
the
13
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
14
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
15
to
affected
individuals.
16
(2)
Provide
notice
of
its
decision
not
to
renew
such
plan
17
to
all
individuals
and
to
the
commissioner
or
director
in
each
18
state
in
which
an
individual
under
the
discontinued
plan
is
19
known
to
reside,
no
less
than
one
hundred
eighty
days
prior
to
20
the
nonrenewal
of
the
plan.
21
e.
The
commissioner
or
director
finds
that
the
continuation
22
of
the
coverage
is
not
in
the
best
interests
of
the
23
individuals,
or
would
impair
the
carrier’s
or
organized
24
delivery
system’s
ability
to
meet
its
contractual
obligations.
25
2.
At
the
time
of
coverage
renewal,
a
carrier
or
organized
26
delivery
system
may
modify
the
health
insurance
coverage
for
27
a
policy
form
offered
to
individuals
in
the
individual
market
28
so
long
as
such
modification
is
consistent
with
state
law
and
29
effective
on
a
uniform
basis
among
all
individuals
with
that
30
policy
form.
31
3.
An
individual
carrier
or
organized
delivery
system
that
32
elects
not
to
renew
an
individual
health
benefit
plan
under
33
subsection
1
,
paragraph
“d”
,
shall
not
write
any
new
business
in
34
the
individual
market
in
this
state
for
a
period
of
five
years
35
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_____
after
the
date
of
notice
to
the
commissioner
or
director
.
1
4.
This
section
,
with
respect
to
a
carrier
or
organized
2
delivery
system
doing
business
in
one
established
geographic
3
service
area
of
the
state,
applies
only
to
such
carrier’s
or
4
organized
delivery
system’s
operations
in
that
service
area.
5
5.
A
carrier
or
organized
delivery
system
offering
coverage
6
through
a
network
plan
is
not
required
to
renew
or
continue
in
7
force
coverage
or
to
accept
applications
from
an
individual
who
8
no
longer
resides
or
lives
in,
or
is
no
longer
employed
in,
9
the
service
area
of
such
carrier
or
organized
delivery
system
,
10
or
no
longer
resides
or
lives
in,
or
is
no
longer
employed
11
in,
a
service
area
for
which
the
carrier
is
authorized
to
do
12
business,
but
only
if
coverage
is
not
offered
or
terminated
13
uniformly
without
regard
to
health
status-related
factors
of
a
14
covered
individual.
15
6.
A
carrier
or
organized
delivery
system
offering
coverage
16
through
a
bona
fide
association
is
not
required
to
renew
or
17
continue
in
force
coverage
or
to
accept
applications
from
an
18
individual
through
an
association
if
the
membership
of
the
19
individual
in
the
association
on
which
the
basis
of
coverage
20
is
provided
ceases,
but
only
if
the
coverage
is
not
offered
or
21
terminated
under
this
paragraph
uniformly
without
regard
to
22
health
status-related
factors
of
a
covered
individual.
23
7.
An
individual
who
has
coverage
as
a
dependent
under
a
24
basic
or
standard
health
benefit
plan
may,
when
that
individual
25
is
no
longer
a
dependent
under
such
coverage,
elect
to
continue
26
coverage
under
the
basic
or
standard
health
benefit
plan
if
27
the
individual
so
elects
immediately
upon
termination
of
the
28
coverage
under
which
the
individual
was
covered
as
a
dependent.
29
Sec.
53.
Section
513C.7,
subsection
1,
Code
2017,
is
amended
30
to
read
as
follows:
31
1.
a.
(1)
A
carrier
shall
file
with
the
commissioner,
in
32
a
form
and
manner
prescribed
by
the
commissioner,
the
basic
33
or
standard
health
benefit
plan.
A
basic
or
standard
health
34
benefit
plan
filed
pursuant
to
this
paragraph
may
be
used
by
35
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_____
a
carrier
beginning
thirty
days
after
it
is
filed
unless
the
1
commissioner
disapproves
of
its
use.
2
(2)
b.
The
commissioner
may
at
any
time,
after
providing
3
notice
and
an
opportunity
for
a
hearing
to
the
carrier,
4
disapprove
the
continued
use
by
a
carrier
of
a
basic
or
5
standard
health
benefit
plan
on
the
grounds
that
the
plan
does
6
not
meet
the
requirements
of
this
chapter
.
7
b.
(1)
An
organized
delivery
system
shall
file
with
the
8
director,
in
a
form
and
manner
prescribed
by
the
director,
9
the
basic
or
standard
health
benefit
plan
to
be
used
by
the
10
organized
delivery
system.
A
basic
or
standard
health
benefit
11
plan
filed
pursuant
to
this
paragraph
may
be
used
by
the
12
organized
delivery
system
beginning
thirty
days
after
it
is
13
filed
unless
the
director
disapproves
of
its
use.
14
(2)
The
director
may
at
any
time,
after
providing
notice
and
15
an
opportunity
for
a
hearing
to
the
organized
delivery
system,
16
disapprove
the
continued
use
by
an
organized
delivery
system
of
17
a
basic
or
standard
health
benefit
plan
on
the
grounds
that
the
18
plan
does
not
meet
the
requirements
of
this
chapter
.
19
Sec.
54.
Section
513C.7,
subsection
3,
Code
2017,
is
amended
20
to
read
as
follows:
21
3.
A
carrier
or
an
organized
delivery
system
shall
not
22
modify
a
basic
or
standard
health
benefit
plan
with
respect
23
to
an
individual
or
dependent
through
riders,
endorsements,
24
or
other
means
to
restrict
or
exclude
coverage
for
certain
25
diseases
or
medical
conditions
otherwise
covered
by
the
health
26
benefit
plan.
27
Sec.
55.
Section
513C.9,
subsections
1,
2,
3,
6,
and
8,
Code
28
2017,
are
amended
to
read
as
follows:
29
1.
A
carrier
,
an
organized
delivery
system,
or
an
agent
30
shall
not
do
either
of
the
following:
31
a.
Encourage
or
direct
individuals
to
refrain
from
32
filing
an
application
for
coverage
with
the
carrier
or
the
33
organized
delivery
system
because
of
the
health
status,
claims
34
experience,
industry,
occupation,
or
geographic
location
of
the
35
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_____
individuals.
1
b.
Encourage
or
direct
individuals
to
seek
coverage
from
2
another
carrier
or
another
organized
delivery
system
because
of
3
the
health
status,
claims
experience,
industry,
occupation,
or
4
geographic
location
of
the
individuals.
5
2.
Subsection
1
,
paragraph
“a”
,
shall
not
apply
with
respect
6
to
information
provided
by
a
carrier
or
an
organized
delivery
7
system
or
an
agent
to
an
individual
regarding
the
established
8
geographic
service
area
of
the
carrier
or
the
organized
9
delivery
system,
or
the
restricted
network
provision
of
the
10
carrier
or
the
organized
delivery
system
.
11
3.
A
carrier
or
an
organized
delivery
system
shall
not,
12
directly
or
indirectly,
enter
into
any
contract,
agreement,
or
13
arrangement
with
an
agent
that
provides
for,
or
results
in,
the
14
compensation
paid
to
an
agent
for
a
sale
of
a
basic
or
standard
15
health
benefit
plan
to
vary
because
of
the
health
status
or
16
permitted
rating
characteristics
of
the
individual
or
the
17
individual’s
dependents.
18
6.
Denial
by
a
carrier
or
an
organized
delivery
system
of
an
19
application
for
coverage
from
an
individual
shall
be
in
writing
20
and
shall
state
the
reason
or
reasons
for
the
denial.
21
8.
If
a
carrier
or
an
organized
delivery
system
enters
into
22
a
contract,
agreement,
or
other
arrangement
with
a
third-party
23
administrator
to
provide
administrative,
marketing,
or
other
24
services
related
to
the
offering
of
individual
health
benefit
25
plans
in
this
state,
the
third-party
administrator
is
subject
26
to
this
section
as
if
it
were
a
carrier
or
an
organized
27
delivery
system
.
28
Sec.
56.
Section
513C.10,
subsection
1,
paragraph
a,
Code
29
2017,
is
amended
to
read
as
follows:
30
a.
All
persons
that
provide
health
benefit
plans
in
this
31
state
including
insurers
providing
accident
and
sickness
32
insurance
under
chapter
509
,
514
,
or
514A
,
whether
on
an
33
individual
or
group
basis;
fraternal
benefit
societies
34
providing
hospital,
medical,
or
nursing
benefits
under
chapter
35
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57
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_____
512B
;
and
health
maintenance
organizations,
organized
delivery
1
systems,
other
entities
providing
health
insurance
or
health
2
benefits
subject
to
state
insurance
regulation,
and
all
other
3
insurers
as
designated
by
the
board
of
directors
of
the
Iowa
4
comprehensive
health
insurance
association
with
the
approval
of
5
the
commissioner
shall
be
members
of
the
association.
6
Sec.
57.
Section
513C.10,
subsection
2,
paragraph
a,
Code
7
2017,
is
amended
to
read
as
follows:
8
a.
Rates
for
basic
and
standard
coverages
as
provided
in
9
this
chapter
shall
be
determined
by
each
carrier
or
organized
10
delivery
system
as
the
product
of
a
basic
and
standard
factor
11
and
the
lowest
rate
available
for
issuance
by
that
carrier
or
12
organized
delivery
system
adjusted
for
rating
characteristics
13
and
benefits.
Basic
and
standard
factors
shall
be
established
14
annually
by
the
Iowa
comprehensive
health
insurance
association
15
board
with
the
approval
of
the
commissioner.
Multiple
basic
16
and
standard
factors
for
a
distinct
grouping
of
basic
and
17
standard
policies
may
be
established.
A
basic
and
standard
18
factor
is
limited
to
a
minimum
value
defined
as
the
ratio
19
of
the
average
of
the
lowest
rate
available
for
issuance
and
20
the
maximum
rate
allowable
by
law
divided
by
the
lowest
rate
21
available
for
issuance.
A
basic
and
standard
factor
is
limited
22
to
a
maximum
value
defined
as
the
ratio
of
the
maximum
rate
23
allowable
by
law
divided
by
the
lowest
rate
available
for
24
issuance.
The
maximum
rate
allowable
by
law
and
the
lowest
25
rate
available
for
issuance
is
determined
based
on
the
rate
26
restrictions
under
this
chapter
.
For
policies
written
after
27
January
1,
2002,
rates
for
the
basic
and
standard
coverages
28
as
provided
in
this
chapter
shall
be
calculated
using
the
29
basic
and
standard
factors
and
shall
be
no
lower
than
the
30
maximum
rate
allowable
by
law.
However,
to
maintain
assessable
31
loss
assessments
at
or
below
one
percent
of
total
health
32
insurance
premiums
or
payments
as
determined
in
accordance
33
with
subsection
6
,
the
Iowa
comprehensive
health
insurance
34
association
board
with
the
approval
of
the
commissioner
may
35
-35-
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1675XC
(7)
87
pf/nh
35/
57
S.F.
_____
increase
the
value
for
any
basic
and
standard
factor
greater
1
than
the
maximum
value.
2
Sec.
58.
Section
513C.10,
subsections
3,
4,
7,
8,
9,
and
10,
3
Code
2017,
are
amended
to
read
as
follows:
4
3.
Following
the
close
of
each
calendar
year,
the
5
association,
in
conjunction
with
the
commissioner,
shall
6
require
each
carrier
or
organized
delivery
system
to
report
7
the
amount
of
earned
premiums
and
the
associated
paid
losses
8
for
all
basic
and
standard
plans
issued
by
the
carrier
or
9
organized
delivery
system
.
The
reporting
of
these
amounts
must
10
be
certified
by
an
officer
of
the
carrier
or
organized
delivery
11
system
.
12
4.
The
board
shall
develop
procedures
and
assessment
13
mechanisms
and
make
assessments
and
distributions
as
required
14
to
equalize
the
individual
carrier
and
organized
delivery
15
system
gains
or
losses
so
that
each
carrier
or
organized
16
delivery
system
receives
the
same
ratio
of
paid
claims
to
17
ninety
percent
of
earned
premiums
as
the
aggregate
of
all
18
basic
and
standard
plans
insured
by
all
carriers
and
organized
19
delivery
systems
in
the
state.
20
7.
The
board
shall
develop
procedures
for
distributing
21
the
assessable
loss
assessments
to
each
carrier
and
organized
22
delivery
system
in
proportion
to
the
carrier’s
and
organized
23
delivery
system’s
respective
share
of
premium
for
basic
and
24
standard
plans
to
the
statewide
total
premium
for
all
basic
and
25
standard
plans.
26
8.
The
board
shall
ensure
that
procedures
for
collecting
27
and
distributing
assessments
are
as
efficient
as
possible
28
for
carriers
and
organized
delivery
systems
.
The
board
may
29
establish
procedures
which
combine,
or
offset,
the
assessment
30
from,
and
the
distribution
due
to,
a
carrier
or
organized
31
delivery
system
.
32
9.
A
carrier
or
an
organized
delivery
system
may
33
petition
the
association
board
to
seek
remedy
from
writing
a
34
significantly
disproportionate
share
of
basic
and
standard
35
-36-
LSB
1675XC
(7)
87
pf/nh
36/
57
S.F.
_____
policies
in
relation
to
total
premiums
written
in
this
state
1
for
health
benefit
plans.
Upon
a
finding
that
a
carrier
or
2
organized
delivery
system
has
written
a
disproportionate
share,
3
the
board
may
agree
to
compensate
the
carrier
or
organized
4
delivery
system
either
by
paying
to
the
carrier
or
organized
5
delivery
system
an
additional
fee
not
to
exceed
two
percent
6
of
earned
premiums
from
basic
and
standard
policies
for
that
7
carrier
or
organized
delivery
system
or
by
petitioning
the
8
commissioner
or
director,
as
appropriate,
for
remedy.
9
10.
a.
The
commissioner,
upon
a
finding
that
the
acceptance
10
of
the
offer
of
basic
and
standard
coverage
by
individuals
11
pursuant
to
this
chapter
would
place
the
carrier
in
a
12
financially
impaired
condition,
shall
not
require
the
carrier
13
to
offer
coverage
or
accept
applications
for
any
period
of
time
14
the
financial
impairment
is
deemed
to
exist.
15
b.
The
director,
upon
a
finding
that
the
acceptance
of
the
16
offer
of
basic
and
standard
coverage
by
individuals
pursuant
17
to
this
chapter
would
place
the
organized
delivery
system
in
a
18
financially
impaired
condition,
shall
not
require
the
organized
19
delivery
system
to
offer
coverage
or
accept
applications
for
20
any
period
of
time
the
financial
impairment
is
deemed
to
exist.
21
Sec.
59.
Section
514A.3B,
subsection
3,
paragraph
k,
Code
22
2017,
is
amended
by
striking
the
paragraph.
23
Sec.
60.
Section
514B.25A,
Code
2017,
is
amended
to
read
as
24
follows:
25
514B.25A
Insolvency
protection
——
assessment.
26
1.
Upon
a
health
maintenance
organization
or
organized
27
delivery
system
authorized
to
do
business
in
this
state
and
28
licensed
by
the
director
of
public
health
being
declared
29
insolvent
by
the
district
court,
the
commissioner
may
levy
an
30
assessment
on
each
health
maintenance
organization
or
organized
31
delivery
system
doing
business
in
this
state
and
licensed
by
32
the
director
of
public
health,
as
applicable
,
to
pay
claims
33
for
uncovered
expenditures
for
enrollees.
The
commissioner
34
shall
not
assess
an
amount
in
any
one
calendar
year
which
is
35
-37-
LSB
1675XC
(7)
87
pf/nh
37/
57
S.F.
_____
more
than
two
percent
of
the
aggregate
premium
written
by
each
1
health
maintenance
organization
or
organized
delivery
system
.
2
2.
The
commissioner
may
use
funds
obtained
through
an
3
assessment
under
subsection
1
to
pay
claims
for
uncovered
4
expenditures
for
enrollees
of
an
insolvent
health
maintenance
5
organization
or
organized
delivery
system
and
administrative
6
costs.
The
commissioner,
by
rule,
may
prescribe
the
time,
7
manner,
and
form
for
filing
claims
under
this
section
.
The
8
commissioner
may
require
claims
to
be
allowed
by
an
ancillary
9
receiver
or
the
domestic
receiver
or
liquidator.
10
3.
a.
A
receiver
or
liquidator
of
an
insolvent
health
11
maintenance
organization
or
organized
delivery
system
shall
12
allow
a
claim
in
the
proceeding
in
an
amount
equal
to
uncovered
13
expenditures
and
administrative
costs
paid
under
this
section
.
14
b.
A
person
receiving
benefits
under
this
section
for
15
uncovered
expenditures
is
deemed
to
have
assigned
the
rights
16
under
the
covered
health
care
plan
certificates
to
the
17
commissioner
to
the
extent
of
the
benefits
received.
The
18
commissioner
may
require
an
assignment
of
such
rights
by
a
19
payee,
enrollee,
or
beneficiary,
to
the
commissioner
as
a
20
condition
precedent
to
the
receipt
of
such
benefits.
The
21
commissioner
is
subrogated
to
these
rights
against
the
assets
22
of
the
insolvent
health
maintenance
organization
or
organized
23
delivery
system
that
are
held
by
a
receiver
or
liquidator
of
24
a
foreign
jurisdiction.
25
c.
The
assigned
subrogation
rights
of
the
commissioner
and
26
allowed
claims
under
this
subsection
have
the
same
priority
27
against
the
assets
of
the
insolvent
health
maintenance
28
organization
or
organized
delivery
system
as
those
claims
of
29
persons
entitled
to
receive
benefits
under
this
section
or
for
30
similar
expenses
in
the
receivership
or
liquidation.
31
4.
If
funds
assessed
under
subsection
1
are
unused
32
following
the
completion
of
the
liquidation
of
an
insolvent
33
health
maintenance
organization
or
organized
delivery
system
,
34
the
commissioner
shall
distribute
the
remaining
amounts,
if
35
-38-
LSB
1675XC
(7)
87
pf/nh
38/
57
S.F.
_____
such
amounts
are
not
de
minimis,
to
the
health
maintenance
1
organizations
or
organized
delivery
systems
that
were
assessed.
2
5.
The
aggregate
coverage
of
uncovered
expenditures
under
3
this
section
shall
not
exceed
three
hundred
thousand
dollars
4
with
respect
to
one
individual.
Continuation
of
coverage
5
shall
cease
after
the
lesser
of
one
year
after
the
health
6
maintenance
organization
or
organized
delivery
system
is
7
terminated
by
insolvency
or
the
remaining
term
of
the
contract.
8
The
commissioner
may
provide
continuation
of
coverage
on
a
9
reasonable
basis,
including,
but
not
limited
to,
continuation
10
of
the
health
maintenance
organization
or
organized
delivery
11
system
contract
or
substitution
of
indemnity
coverage
in
a
form
12
as
determined
by
the
commissioner.
13
6.
The
commissioner
may
waive
an
assessment
of
a
health
14
maintenance
organization
or
organized
delivery
system
if
such
15
organization
or
system
is
impaired
financially
or
would
be
16
impaired
financially
as
a
result
of
such
assessment.
A
health
17
maintenance
organization
or
organized
delivery
system
that
18
fails
to
pay
an
assessment
within
thirty
days
after
notice
of
19
the
assessment
is
subject
to
a
civil
forfeiture
of
not
more
20
than
one
thousand
dollars
for
each
day
the
failure
continues,
21
and
suspension
or
revocation
of
its
certificate
of
authority.
22
An
action
taken
by
the
commissioner
to
enforce
an
assessment
23
under
this
section
may
be
appealed
by
the
health
maintenance
24
organization
or
organized
delivery
system
pursuant
to
chapter
25
17A
.
26
Sec.
61.
Section
514C.10,
subsection
2,
paragraph
e,
Code
27
2017,
is
amended
by
striking
the
paragraph.
28
Sec.
62.
Section
514C.11,
Code
2017,
is
amended
to
read
as
29
follows:
30
514C.11
Services
provided
by
licensed
physician
assistants
31
and
licensed
advanced
registered
nurse
practitioners.
32
1.
Notwithstanding
section
514C.6
,
a
policy
or
contract
33
providing
for
third-party
payment
or
prepayment
of
health
or
34
medical
expenses
shall
include
a
provision
for
the
payment
of
35
-39-
LSB
1675XC
(7)
87
pf/nh
39/
57
S.F.
_____
necessary
medical
or
surgical
care
and
treatment
provided
by
1
a
physician
assistant
licensed
pursuant
to
chapter
148C
,
or
2
provided
by
an
advanced
registered
nurse
practitioner
licensed
3
pursuant
to
chapter
152
and
performed
within
the
scope
of
the
4
license
of
the
licensed
physician
assistant
or
the
licensed
5
advanced
registered
nurse
practitioner
if
the
policy
or
6
contract
would
pay
for
the
care
and
treatment
if
the
care
and
7
treatment
were
provided
by
a
person
engaged
in
the
practice
8
of
medicine
and
surgery
or
osteopathic
medicine
and
surgery
9
under
chapter
148
.
The
policy
or
contract
shall
provide
that
10
policyholders
and
subscribers
under
the
policy
or
contract
may
11
reject
the
coverage
for
services
which
may
be
provided
by
a
12
licensed
physician
assistant
or
licensed
advanced
registered
13
nurse
practitioner
if
the
coverage
is
rejected
for
all
14
providers
of
similar
services.
A
policy
or
contract
subject
15
to
this
section
shall
not
impose
a
practice
or
supervision
16
restriction
which
is
inconsistent
with
or
more
restrictive
than
17
the
restriction
already
imposed
by
law.
18
2.
This
section
applies
to
services
provided
under
a
policy
19
or
contract
delivered,
issued
for
delivery,
continued,
or
20
renewed
in
this
state
on
or
after
July
1,
1996,
and
to
an
21
existing
policy
or
contract,
on
the
policy’s
or
contract’s
22
anniversary
or
renewal
date,
or
upon
the
expiration
of
the
23
applicable
collective
bargaining
contract,
if
any,
whichever
24
is
later.
This
section
does
not
apply
to
policyholders
or
25
subscribers
eligible
for
coverage
under
Tit.
XVIII
of
the
26
federal
Social
Security
Act
or
any
similar
coverage
under
a
27
state
or
federal
government
plan.
28
3.
For
the
purposes
of
this
section
,
third-party
payment
or
29
prepayment
includes
an
individual
or
group
policy
of
accident
30
or
health
insurance
or
individual
or
group
hospital
or
health
31
care
service
contract
issued
pursuant
to
chapter
509
,
514
,
or
32
514A
,
an
individual
or
group
health
maintenance
organization
33
contract
issued
and
regulated
under
chapter
514B
,
an
organized
34
delivery
system
contract
regulated
under
rules
adopted
by
the
35
-40-
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1675XC
(7)
87
pf/nh
40/
57
S.F.
_____
director
of
public
health,
or
a
preferred
provider
organization
1
contract
regulated
pursuant
to
chapter
514F
.
2
4.
Nothing
in
this
section
shall
be
interpreted
to
require
3
an
individual
or
group
health
maintenance
organization
,
an
4
organized
delivery
system,
or
a
preferred
provider
organization
5
or
arrangement
to
provide
payment
or
prepayment
for
services
6
provided
by
a
licensed
physician
assistant
or
licensed
advanced
7
registered
nurse
practitioner
unless
the
physician
assistant’s
8
supervising
physician,
the
physician-physician
assistant
team,
9
the
advanced
registered
nurse
practitioner,
or
the
advanced
10
registered
nurse
practitioner’s
collaborating
physician
has
11
entered
into
a
contract
or
other
agreement
to
provide
services
12
with
the
individual
or
group
health
maintenance
organization
,
13
the
organized
delivery
system,
or
the
preferred
provider
14
organization
or
arrangement.
15
Sec.
63.
Section
514C.13,
subsection
1,
paragraph
h,
Code
16
2017,
is
amended
by
striking
the
paragraph.
17
Sec.
64.
Section
514C.13,
subsection
2,
Code
2017,
is
18
amended
to
read
as
follows:
19
2.
A
carrier
or
organized
delivery
system
which
offers
to
20
a
small
employer
a
limited
provider
network
plan
to
provide
21
health
care
services
or
benefits
to
the
small
employer’s
22
employees
shall
also
offer
to
the
small
employer
a
point
of
23
service
option
to
the
limited
provider
network
plan.
24
Sec.
65.
Section
514C.13,
subsection
3,
unnumbered
25
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
26
A
carrier
or
organized
delivery
system
which
offers
to
a
27
large
employer
a
limited
provider
network
plan
to
provide
28
health
care
services
or
benefits
to
the
large
employer’s
29
employees
shall
also
offer
to
the
large
employer
one
or
more
30
of
the
following:
31
Sec.
66.
Section
514C.14,
subsections
1
and
3,
Code
2017,
32
are
amended
to
read
as
follows:
33
1.
Except
as
provided
under
subsection
2
or
3
,
a
carrier,
34
as
defined
in
section
513B.2
,
an
organized
delivery
system
35
-41-
LSB
1675XC
(7)
87
pf/nh
41/
57
S.F.
_____
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
1
pursuant
to
chapter
509A
for
public
employees,
which
terminates
2
its
contract
with
a
participating
health
care
provider,
3
shall
continue
to
provide
coverage
under
the
contract
to
a
4
covered
person
in
the
second
or
third
trimester
of
pregnancy
5
for
continued
care
from
such
health
care
provider.
Such
6
persons
may
continue
to
receive
such
treatment
or
care
through
7
postpartum
care
related
to
the
child
birth
and
delivery.
8
Payment
for
covered
benefits
and
benefit
levels
shall
be
9
according
to
the
terms
and
conditions
of
the
contract.
10
3.
A
carrier
,
organized
delivery
system,
or
a
plan
11
established
under
chapter
509A
,
which
terminates
the
contract
12
of
a
participating
health
care
provider
for
cause
shall
not
13
be
liable
to
pay
for
health
care
services
provided
by
the
14
health
care
provider
to
a
covered
person
following
the
date
of
15
termination.
16
Sec.
67.
Section
514C.15,
Code
2017,
is
amended
to
read
as
17
follows:
18
514C.15
Treatment
options.
19
A
carrier,
as
defined
in
section
513B.2
,
;
an
organized
20
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
21
and
licensed
by
the
director
of
public
health;
or
a
plan
22
established
pursuant
to
chapter
509A
for
public
employees,
23
shall
not
prohibit
a
participating
provider
from,
or
penalize
a
24
participating
provider
for,
doing
either
of
the
following:
25
1.
Discussing
treatment
options
with
a
covered
individual,
26
notwithstanding
the
carrier’s,
organized
delivery
system’s,
or
27
plan’s
position
on
such
treatment
option.
28
2.
Advocating
on
behalf
of
a
covered
individual
within
29
a
review
or
grievance
process
established
by
the
carrier
,
30
organized
delivery
system,
or
chapter
509A
plan,
or
established
31
by
a
person
contracting
with
the
carrier
,
organized
delivery
32
system,
or
chapter
509A
plan.
33
Sec.
68.
Section
514C.16,
subsection
1,
Code
2017,
is
34
amended
to
read
as
follows:
35
-42-
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_____
1.
A
carrier,
as
defined
in
section
513B.2
,
;
an
organized
1
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
2
and
licensed
by
the
director
of
public
health;
or
a
plan
3
established
pursuant
to
chapter
509A
for
public
employees,
4
which
provides
coverage
for
emergency
services,
is
responsible
5
for
charges
for
emergency
services
provided
to
a
covered
6
individual,
including
services
furnished
outside
any
7
contractual
provider
network
or
preferred
provider
network.
8
Coverage
for
emergency
services
is
subject
to
the
terms
and
9
conditions
of
the
health
benefit
plan
or
contract.
10
Sec.
69.
Section
514C.17,
subsections
1
and
3,
Code
2017,
11
are
amended
to
read
as
follows:
12
1.
Except
as
provided
under
subsection
2
or
3
,
if
a
carrier,
13
as
defined
in
section
513B.2
,
an
organized
delivery
system
14
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
15
pursuant
to
chapter
509A
for
public
employees,
terminates
its
16
contract
with
a
participating
health
care
provider,
a
covered
17
individual
who
is
undergoing
a
specified
course
of
treatment
18
for
a
terminal
illness
or
a
related
condition,
with
the
19
recommendation
of
the
covered
individual’s
treating
physician
20
licensed
under
chapter
148
may
continue
to
receive
coverage
for
21
treatment
received
from
the
covered
individual’s
physician
for
22
the
terminal
illness
or
a
related
condition,
for
a
period
of
23
up
to
ninety
days.
Payment
for
covered
benefits
and
benefit
24
levels
shall
be
according
to
the
terms
and
conditions
of
the
25
contract.
26
3.
Notwithstanding
subsections
1
and
2
,
a
carrier
,
27
organized
delivery
system,
or
a
plan
established
under
chapter
28
509A
which
terminates
the
contract
of
a
participating
health
29
care
provider
for
cause
shall
not
be
required
to
cover
health
30
care
services
provided
by
the
health
care
provider
to
a
covered
31
person
following
the
date
of
termination.
32
Sec.
70.
Section
514C.18,
subsection
2,
paragraph
a,
33
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
34
subparagraph.
35
-43-
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57
S.F.
_____
Sec.
71.
Section
514C.19,
subsection
7,
paragraph
a,
1
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
2
subparagraph.
3
Sec.
72.
Section
514C.20,
subsection
3,
paragraph
f,
Code
4
2017,
is
amended
by
striking
the
paragraph.
5
Sec.
73.
Section
514C.21,
subsection
2,
paragraph
d,
Code
6
2017,
is
amended
by
striking
the
paragraph.
7
Sec.
74.
Section
514C.22,
subsection
1,
unnumbered
8
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
9
Notwithstanding
the
uniformity
of
treatment
requirements
of
10
section
514C.6
,
a
group
policy,
contract,
or
plan
providing
11
for
third-party
payment
or
prepayment
of
health,
medical,
and
12
surgical
coverage
benefits
issued
by
a
carrier,
as
defined
in
13
section
513B.2
,
or
by
an
organized
delivery
system
authorized
14
under
1993
Iowa
Acts,
ch.
158,
shall
provide
coverage
benefits
15
for
treatment
of
a
biologically
based
mental
illness
if
either
16
of
the
following
is
satisfied:
17
Sec.
75.
Section
514C.22,
subsection
6,
Code
2017,
is
18
amended
to
read
as
follows:
19
6.
A
carrier
,
organized
delivery
system,
or
plan
20
established
pursuant
to
chapter
509A
may
manage
the
benefits
21
provided
through
common
methods
including,
but
not
limited
to,
22
providing
payment
of
benefits
or
providing
care
and
treatment
23
under
a
capitated
payment
system,
prospective
reimbursement
24
rate
system,
utilization
control
system,
incentive
system
for
25
the
use
of
least
restrictive
and
least
costly
levels
of
care,
26
a
preferred
provider
contract
limiting
choice
of
specific
27
providers,
or
any
other
system,
method,
or
organization
28
designed
to
assure
services
are
medically
necessary
and
29
clinically
appropriate.
30
Sec.
76.
Section
514C.25,
subsection
2,
paragraph
a,
31
subparagraph
(5),
Code
2017,
is
amended
by
striking
the
32
subparagraph.
33
Sec.
77.
Section
514C.26,
subsection
5,
paragraph
a,
34
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
35
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S.F.
_____
subparagraph.
1
Sec.
78.
Section
514C.27,
subsection
1,
unnumbered
2
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
3
Notwithstanding
the
uniformity
of
treatment
requirements
4
of
section
514C.6
,
a
group
policy
or
contract
providing
for
5
third-party
payment
or
prepayment
of
health
or
medical
expenses
6
issued
by
a
carrier,
as
defined
in
section
513B.2
,
or
by
an
7
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
8
158
,
shall
provide
coverage
benefits
to
an
insured
who
is
a
9
veteran
for
treatment
of
mental
illness
and
substance
abuse
if
10
either
of
the
following
is
satisfied:
11
Sec.
79.
Section
514C.27,
subsection
6,
Code
2017,
is
12
amended
to
read
as
follows:
13
6.
A
carrier
,
organized
delivery
system,
or
plan
14
established
pursuant
to
chapter
509A
may
manage
the
benefits
15
provided
through
common
methods
including
but
not
limited
to
16
providing
payment
of
benefits
or
providing
care
and
treatment
17
under
a
capitated
payment
system,
prospective
reimbursement
18
rate
system,
utilization
control
system,
incentive
system
for
19
the
use
of
least
restrictive
and
least
costly
levels
of
care,
20
a
preferred
provider
contract
limiting
choice
of
specific
21
providers,
or
any
other
system,
method,
or
organization
22
designed
to
assure
services
are
medically
necessary
and
23
clinically
appropriate.
24
Sec.
80.
Section
514C.29,
subsection
2,
paragraph
e,
Code
25
2017,
is
amended
by
striking
the
paragraph.
26
Sec.
81.
Section
514C.30,
subsection
2,
paragraph
e,
Code
27
2017,
is
amended
by
striking
the
paragraph.
28
Sec.
82.
Section
514E.1,
subsection
6,
paragraph
k,
Code
29
2017,
is
amended
by
striking
the
paragraph.
30
Sec.
83.
Section
514E.1,
subsection
17,
Code
2017,
is
31
amended
by
striking
the
subsection.
32
Sec.
84.
Section
514E.2,
subsection
1,
paragraph
a,
Code
33
2017,
is
amended
to
read
as
follows:
34
a.
All
carriers
and
all
organized
delivery
systems
licensed
35
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57
S.F.
_____
by
the
director
of
public
health
providing
health
insurance
or
1
health
care
services
in
Iowa,
whether
on
an
individual
or
group
2
basis,
and
all
other
insurers
designated
by
the
association’s
3
board
of
directors
and
approved
by
the
commissioner
shall
be
4
members
of
the
association.
5
Sec.
85.
Section
514E.2,
subsection
2,
paragraph
a,
6
subparagraph
(3),
Code
2017,
is
amended
to
read
as
follows:
7
(3)
Two
members
selected
by
the
members
of
the
association,
8
one
of
whom
shall
be
a
representative
from
a
corporation
9
operating
pursuant
to
chapter
514
on
July
1,
1989,
or
10
any
successor
in
interest,
and
one
of
whom
shall
be
a
11
representative
of
an
organized
delivery
system
or
an
insurer
12
providing
coverage
pursuant
to
chapter
509
or
514A
.
13
Sec.
86.
Section
514E.7,
subsection
1,
paragraph
a,
14
subparagraphs
(1)
and
(2),
Code
2017,
are
amended
to
read
as
15
follows:
16
(1)
A
notice
of
rejection
or
refusal
to
issue
substantially
17
similar
insurance
for
health
reasons
by
one
carrier
or
18
organized
delivery
system
.
19
(2)
A
refusal
by
a
carrier
or
organized
delivery
system
to
20
issue
insurance
except
at
a
rate
exceeding
the
plan
rate.
21
Sec.
87.
Section
514E.7,
subsection
1,
paragraph
b,
Code
22
2017,
is
amended
to
read
as
follows:
23
b.
A
rejection
or
refusal
by
a
carrier
or
organized
delivery
24
system
offering
only
stoploss,
excess
of
loss,
or
reinsurance
25
coverage
with
respect
to
an
applicant
under
paragraph
“a”
,
26
subparagraphs
(1)
and
(2)
,
is
not
sufficient
evidence
for
27
purposes
of
this
subsection
.
28
Sec.
88.
Section
514E.9,
Code
2017,
is
amended
to
read
as
29
follows:
30
514E.9
Rules.
31
Pursuant
to
chapter
17A
,
the
commissioner
and
the
director
32
of
public
health
shall
adopt
rules
to
provide
for
disclosure
33
by
carriers
and
organized
delivery
systems
of
the
availability
34
of
insurance
coverage
from
the
association,
and
to
otherwise
35
-46-
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(7)
87
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46/
57
S.F.
_____
implement
this
chapter
.
1
Sec.
89.
Section
514E.11,
Code
2017,
is
amended
to
read
as
2
follows:
3
514E.11
Notice
of
association
policy.
4
Every
carrier,
including
a
health
maintenance
organization
5
subject
to
chapter
514B
and
an
organized
delivery
system
,
6
authorized
to
provide
health
care
insurance
or
coverage
for
7
health
care
services
in
Iowa,
shall
provide
a
notice
of
the
8
availability
of
coverage
by
the
association
to
any
person
9
who
receives
a
rejection
of
coverage
for
health
insurance
10
or
health
care
services,
or
a
rate
for
health
insurance
or
11
coverage
for
health
care
services
that
will
exceed
the
rate
of
12
an
association
policy,
and
that
person
is
eligible
to
apply
13
for
health
insurance
provided
by
the
association.
Application
14
for
the
health
insurance
shall
be
on
forms
prescribed
by
the
15
association’s
board
of
directors
and
made
available
to
the
16
carriers
and
organized
delivery
systems
and
other
entities
17
providing
health
care
insurance
or
coverage
for
health
care
18
services
regulated
by
the
commissioner.
19
Sec.
90.
Section
514F.5,
Code
2017,
is
amended
to
read
as
20
follows:
21
514F.5
Experimental
treatment
review.
22
1.
A
carrier,
as
defined
in
section
513B.2
,
an
organized
23
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
24
plan
established
pursuant
to
chapter
509A
for
public
employees,
25
that
limits
coverage
for
experimental
medical
treatment,
drugs,
26
or
devices,
shall
develop
and
implement
a
procedure
to
evaluate
27
experimental
medical
treatments
and
shall
submit
a
description
28
of
the
procedure
to
the
division
of
insurance.
The
procedure
29
shall
be
in
writing
and
must
describe
the
process
used
to
30
determine
whether
the
carrier
,
organized
delivery
system,
31
or
chapter
509A
plan
will
provide
coverage
for
new
medical
32
technologies
and
new
uses
of
existing
technologies.
The
33
procedure,
at
a
minimum,
shall
require
a
review
of
information
34
from
appropriate
government
regulatory
agencies
and
published
35
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pf/nh
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57
S.F.
_____
scientific
literature
concerning
new
medical
technologies,
new
1
uses
of
existing
technologies,
and
the
use
of
external
experts
2
in
making
decisions.
A
carrier
,
organized
delivery
system,
3
or
chapter
509A
plan
shall
include
appropriately
licensed
4
or
qualified
professionals
in
the
evaluation
process.
The
5
procedure
shall
provide
a
process
for
a
person
covered
under
6
a
plan
or
contract
to
request
a
review
of
a
denial
of
coverage
7
because
the
proposed
treatment
is
experimental.
A
review
of
8
a
particular
treatment
need
not
be
reviewed
more
than
once
a
9
year.
10
2.
A
carrier
,
organized
delivery
system,
or
chapter
509A
11
plan
that
limits
coverage
for
experimental
treatment,
drugs,
or
12
devices
shall
clearly
disclose
such
limitations
in
a
contract,
13
policy,
or
certificate
of
coverage.
14
Sec.
91.
Section
514I.2,
subsection
10,
Code
2017,
is
15
amended
to
read
as
follows:
16
10.
“Participating
insurer”
means
any
entity
licensed
by
the
17
division
of
insurance
of
the
department
of
commerce
to
provide
18
health
insurance
in
Iowa
or
an
organized
delivery
system
19
licensed
by
the
director
of
public
health
that
has
contracted
20
with
the
department
to
provide
health
insurance
coverage
to
21
eligible
children
under
this
chapter
.
22
Sec.
92.
Section
514J.102,
subsection
24,
Code
2017,
is
23
amended
to
read
as
follows:
24
24.
“Health
carrier”
means
an
entity
subject
to
the
25
insurance
laws
and
regulations
of
this
state,
or
subject
26
to
the
jurisdiction
of
the
commissioner,
including
an
27
insurance
company
offering
sickness
and
accident
plans,
a
28
health
maintenance
organization,
a
nonprofit
health
service
29
corporation,
a
plan
established
pursuant
to
chapter
509A
30
for
public
employees,
or
any
other
entity
providing
a
plan
31
of
health
insurance,
health
care
benefits,
or
health
care
32
services.
“Health
carrier”
includes,
for
purposes
of
this
33
chapter
,
an
organized
delivery
system.
34
Sec.
93.
Section
514J.102,
subsection
29,
Code
2017,
is
35
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87
pf/nh
48/
57
S.F.
_____
amended
by
striking
the
subsection.
1
Sec.
94.
Section
514K.1,
subsection
1,
unnumbered
paragraph
2
1,
Code
2017,
is
amended
to
read
as
follows:
3
A
health
maintenance
organization
,
an
organized
delivery
4
system,
or
an
insurer
using
a
preferred
provider
arrangement
5
shall
provide
to
each
of
its
enrollees
at
the
time
of
6
enrollment,
and
shall
make
available
to
each
prospective
7
enrollee
upon
request,
written
information
as
required
by
rules
8
adopted
by
the
commissioner
and
the
director
of
public
health
.
9
The
information
required
by
rule
shall
include,
but
not
be
10
limited
to,
all
of
the
following:
11
Sec.
95.
Section
514K.1,
subsection
2,
Code
2017,
is
amended
12
to
read
as
follows:
13
2.
The
commissioner
and
the
director
shall
annually
publish
14
a
consumer
guide
providing
a
comparison
by
plan
on
performance
15
measures,
network
composition,
and
other
key
information
to
16
enable
consumers
to
better
understand
plan
differences.
17
Sec.
96.
Section
514L.1,
subsection
3,
Code
2017,
is
amended
18
to
read
as
follows:
19
3.
“Provider
of
third-party
payment
or
prepayment
of
20
prescription
drug
expenses”
or
“provider”
means
a
provider
of
an
21
individual
or
group
policy
of
accident
or
health
insurance
or
22
an
individual
or
group
hospital
or
health
care
service
contract
23
issued
pursuant
to
chapter
509
,
514
,
or
514A
,
a
provider
of
a
24
plan
established
pursuant
to
chapter
509A
for
public
employees,
25
a
provider
of
an
individual
or
group
health
maintenance
26
organization
contract
issued
and
regulated
under
chapter
514B
,
27
a
provider
of
an
organized
delivery
system
contract
regulated
28
under
rules
adopted
by
the
director
of
public
health,
a
29
provider
of
a
preferred
provider
contract
issued
pursuant
to
30
chapter
514F
,
a
provider
of
a
self-insured
multiple
employer
31
welfare
arrangement,
and
any
other
entity
providing
health
32
insurance
or
health
benefits
which
provide
for
payment
or
33
prepayment
of
prescription
drug
expenses
coverage
subject
to
34
state
insurance
regulation.
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Sec.
97.
Section
514L.2,
subsection
1,
paragraph
a,
1
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
2
follows:
3
A
provider
of
third-party
payment
or
prepayment
of
4
prescription
drug
expenses,
including
the
provider’s
agents
or
5
contractors
and
pharmacy
benefits
managers,
that
issues
a
card
6
or
other
technology
for
claims
processing
and
an
administrator
7
of
the
payor,
excluding
administrators
of
self-funded
employer
8
sponsored
health
benefit
plans
qualified
under
the
federal
9
Employee
Retirement
Income
Security
Act
of
1974,
shall
issue
10
to
its
insureds
a
card
or
other
technology
containing
uniform
11
prescription
drug
information.
The
commissioner
of
insurance
12
shall
adopt
rules
for
the
uniform
prescription
drug
information
13
card
or
technology
applicable
to
those
entities
subject
to
14
regulation
by
the
commissioner
of
insurance.
The
director
of
15
public
health
shall
adopt
rules
for
the
uniform
prescription
16
drug
information
card
or
technology
applicable
to
organized
17
delivery
systems.
The
rules
shall
require
at
least
both
of
the
18
following
regarding
the
card
or
technology:
19
Sec.
98.
Section
521F.2,
subsection
7,
Code
2017,
is
amended
20
to
read
as
follows:
21
7.
“Health
organization”
means
a
health
maintenance
22
organization,
limited
service
organization,
dental
or
vision
23
plan,
hospital,
medical
and
dental
indemnity
or
service
24
corporation
or
other
managed
care
organization
licensed
under
25
chapter
514
,
or
514B
,
or
1993
Iowa
Acts,
ch.
158
,
or
any
other
26
entity
engaged
in
the
business
of
insurance,
risk
transfer,
27
or
risk
retention,
that
is
subject
to
the
jurisdiction
of
the
28
commissioner
of
insurance
or
the
director
of
public
health
.
29
“Health
organization”
does
not
include
an
insurance
company
30
licensed
to
transact
the
business
of
insurance
under
chapter
31
508
,
515
,
or
520
,
and
which
is
otherwise
subject
to
chapter
32
521E
.
33
Sec.
99.
1993
Iowa
Acts,
chapter
158,
section
4,
is
amended
34
to
read
as
follows:
35
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SEC.
4.
EMERGENCY
RULES.
Pursuant
to
sections
1
,
and
2
,
and
1
3
of
this
Act,
the
commissioner
of
insurance
or
the
director
of
2
public
health
shall
adopt
administrative
rules
under
section
3
17A.4,
subsection
2,
and
section
17A.5,
subsection
2,
paragraph
4
“b”,
to
implement
the
provisions
of
this
Act
and
the
rules
5
shall
become
effective
immediately
upon
filing,
unless
a
later
6
effective
date
is
specified
in
the
rules.
Any
rules
adopted
in
7
accordance
with
the
provisions
of
this
section
shall
also
be
8
published
as
notice
of
intended
action
as
provided
in
section
9
17A.4.
10
Sec.
100.
REPEAL.
Section
135.120,
Code
2017,
is
repealed.
11
Sec.
101.
REPEAL.
1993
Iowa
Acts,
chapter
158,
section
3,
12
is
repealed.
13
Sec.
102.
CODE
EDITOR’S
DIRECTIVE.
The
Code
editor
shall
14
correct
and
eliminate
any
references
to
the
term
“organized
15
delivery
system”
or
other
forms
of
the
term
anywhere
else
in
16
the
Iowa
Code
or
Iowa
Code
Supplement,
in
any
bills
awaiting
17
codification,
in
this
Act,
and
in
any
bills
enacted
by
the
18
Eighty-seventh
General
Assembly,
2017
Regular
Session,
or
any
19
extraordinary
session.
20
EXPLANATION
21
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
22
the
explanation’s
substance
by
the
members
of
the
general
assembly.
23
This
bill
relates
to
programs
and
activities
under
the
24
purview
of
the
department
of
public
health
(DPH).
25
Division
I
of
the
bill
relates
to
program
funding
26
flexibility
and
reporting.
27
The
bill
provides
that
if
the
amount
of
estimated
moneys
to
28
be
received
from
certain
liquor
fees
and
retail
beer
permit
29
fees
that
is
transferred
to
DPH
annually
for
grants
to
counties
30
operating
a
substance
abuse
program
exceeds
grant
requests,
31
in
addition
to
using
the
remainder
for
grants
to
entities
to
32
operate
a
substance
abuse
prevention
program,
DPH
may
also
use
33
the
remainder
for
activities
and
public
information
resources
34
that
align
with
best
practices
for
substance-related
disorder
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prevention.
1
The
bill
eliminates
the
requirement
under
Code
section
2
135.11,
subsection
31,
that
DPH
report
to
the
chairpersons
and
3
ranking
members
of
the
joint
appropriations
subcommittee
on
4
health
and
human
services,
the
legislative
services
agency,
the
5
legislative
caucus
staffs,
and
the
department
of
management
6
within
60
calendar
days
of
applying
for
or
renewing
a
federal
7
grant
which
requires
a
state
match
or
maintenance
of
effort
8
and
has
a
value
of
over
$100,000,
including
a
listing
of
9
the
federal
funding
source
and
the
potential
need
for
the
10
commitment
of
state
funding
in
the
present
or
future.
11
The
bill
amends
Code
section
135.150
to
require
DPH
to
report
12
annually
rather
than
semiannually
to
the
general
assembly’s
13
standing
committees
on
government
oversight
regarding
14
the
operation
of
the
gambling
treatment
program
including
15
information
on
the
moneys
expended
and
grants
awarded
for
16
operation
of
the
program.
17
Division
II
of
the
bill
relates
to
medical
home
and
the
18
patient-centered
health
advisory
council.
19
The
bill
amends
provisions
relating
to
medical
homes.
20
Code
sections
135.157
and
135.158,
providing
definitions
and
21
describing
the
purposes
and
characteristics
of
medical
homes,
22
are
repealed
by
the
bill.
Code
section
135.159
provides
23
parameters
for
the
development
and
implementation
of
a
medical
24
home
system
in
the
state,
as
well
as
the
establishment
of
the
25
patient-centered
health
advisory
council.
The
bill
amends
26
Code
section
135.159
to
provide
for
the
continuation
of
the
27
patient-centered
health
advisory
council
and
to
revise
the
28
purposes
of
the
council.
29
The
bill
also
makes
conforming
changes
throughout
the
Code,
30
including
those
relative
to
the
definitions
of
“medical
home”,
31
“personal
provider”,
and
“primary
medical
provider”,
due
to
32
elimination
of
certain
definitions
and
concepts
based
upon
the
33
repeal
of
Code
sections
135.157
and
135.158.
34
Division
III
of
the
bill
includes
provisions
relating
to
35
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workforce
programming.
1
The
bill
amends
Code
section
135.107
relating
to
the
center
2
for
rural
health
and
primary
care.
Of
the
programs
that
3
constitute
the
primary
care
provider
recruitment
and
retention
4
endeavor
or
PRIMECARRE,
the
bill
eliminates
the
primary
care
5
provider
community
scholarship
program,
but
retains
the
primary
6
care
loan
repayment
program
and
the
community
grant
program
7
that
is
renamed
the
health
care
workforce
and
community
support
8
grant
program.
The
bill
amends
the
application
and
matching
9
funds
requirements
for
a
grant
under
the
health
care
workforce
10
and
community
support
grant
program
and
specifies
that
the
11
target
areas
for
awarding
of
such
grants
are
rural,
underserved
12
areas
or
special
populations
identified
by
the
department’s
13
strategic
plan
or
evidence-based
documentation.
14
The
bill
provides
that
the
primary
care
provider
loan
15
repayment
program
may
cancel
a
loan
repayment
program
contract
16
for
reasonable
cause
unless
federal
requirements
otherwise
17
require
and
provides
that
the
center
for
rural
health
and
18
primary
care
may
enter
into
an
agreement
under
Code
chapter
28E
19
with
the
college
student
aid
commission
for
administration
of
20
the
center’s
grant
and
loan
repayment
programs.
21
The
bill
eliminates
the
requirement
that
a
community
or
22
region
applying
for
assistance
under
any
of
the
programs
23
established
under
PRIMECARRE
submit
a
letter
of
intent
to
24
conduct
a
community
health
services
assessment
and
instead
25
requires
that
the
community
or
region
shall
document
26
participation
in
the
community
health
services
assessment.
In
27
addition
to
any
other
requirements,
an
applicant’s
plan
is
28
also
to
include,
to
the
extent
possible,
a
clear
commitment
to
29
informing
high
school
students
of
the
health
care
opportunities
30
which
may
be
available
to
such
students.
31
The
bill
removes
the
representation
by
the
obsolete
rural
32
health
resource
center
on
the
advisory
committee
to
the
center
33
for
rural
health
and
primary
care
and
corrects
the
reference
to
34
a
national
or
regional
institute
for
rural
health
policy.
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The
bill
eliminates
the
reference
to
“long-term
care”
in
1
Code
section
135.163
which
directs
DPH
to
coordinate
public
and
2
private
efforts
to
develop
and
maintain
an
appropriate
health
3
care
delivery
infrastructure
and
a
stable,
well-qualified,
4
diverse,
and
sustainable
health
care
workforce
in
this
state.
5
Under
this
section,
DPH
is
required,
at
a
minimum,
to
develop
6
a
strategic
plan
for
health
care
delivery
infrastructure
and
7
health
care
workforce
resources
in
this
state;
provide
for
8
the
continuous
collection
of
data
to
provide
a
basis
for
9
health
care
strategic
planning
and
health
care
policymaking;
10
and
make
recommendations
regarding
the
health
care
delivery
11
infrastructure
and
the
health
care
workforce
that
assist
12
in
monitoring
current
needs,
predicting
future
trends,
and
13
informing
policymaking.
14
The
bill
amends
Code
section
135.175
relating
to
the
health
15
care
workforce
support
initiative,
the
workforce
shortage
fund,
16
and
the
accounts
within
the
fund.
The
bill
provides
that
17
state
programs
that
may
receive
moneys
from
the
fund
or
the
18
accounts
in
the
fund,
if
specifically
designated
for
drawing
19
down
federal
funding,
include
PRIMECARRE,
the
Iowa
affiliate
20
of
the
national
rural
recruitment
and
retention
network,
the
21
oral
and
health
delivery
systems
bureau
of
the
department,
22
the
primary
care
office
and
shortage
designation
program,
and
23
the
state
office
of
rural
health,
but
eliminates
inclusion
of
24
the
Iowa
health
workforce
center,
the
area
health
education
25
centers
programs
at
Des
Moines
university
osteopathic
medical
26
center
and
the
university
of
Iowa,
and
the
Iowa
collaborative
27
safety
net
provider
network
as
potential
recipients.
The
bill
28
also
eliminates
the
requirement
that
state
appropriations
to
29
the
fund
shall
be
allocated
in
equal
amounts
to
each
of
the
30
accounts
within
the
fund,
unless
otherwise
specified
in
the
31
appropriation
or
allocation,
and
eliminates
the
restriction
32
that
moneys
in
each
of
the
accounts
in
the
fund
used
for
33
administrative
purposes
are
not
to
exceed
$100,000
in
each
34
account,
but
retains
the
limitation
that
no
more
than
5
percent
35
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of
the
moneys
in
any
of
the
accounts
within
the
fund
shall
be
1
used
for
administrative
purposes
unless
otherwise
provided
in
2
the
appropriation,
allocation,
or
source
of
the
funds.
3
The
bill
repeals
Code
section
135.164
which
relates
to
the
4
health
care
delivery
infrastructure
and
health
care
workforce
5
resources
strategic
plan
to
be
developed
by
DPH
including
the
6
specific
elements
of
the
strategic
plan
and
the
requirements
7
for
developing
the
strategic
plan.
8
The
bill
repeals
Code
section
135.180,
the
mental
health
9
professional
shortage
area
program,
which
provides
stipends
to
10
support
psychiatrist
positions
with
an
emphasis
on
securing
and
11
retaining
medical
directors
at
community
mental
health
centers
12
designated
under
Code
chapter
230A
and
hospital
psychiatric
13
units
that
are
located
in
mental
health
professional
shortage
14
areas.
15
Division
IV
of
the
bill
relates
to
unfunded
or
outdated
16
program
provisions.
17
The
bill
eliminates
the
provision
under
Code
section
135.11
18
requiring
DPH
to
establish
and
administer
a
substance
abuse
19
treatment
facility
for
persons
on
probation,
repeals
Code
20
section
135.130,
and
strikes
the
conforming
provision
in
Code
21
section
901B.1.
The
substance
abuse
treatment
facility
for
22
persons
on
probation
was
authorized
in
2001
but
was
never
23
established.
24
The
bill
strikes
the
directive
in
Code
section
135.141
for
25
the
division
of
acute
disease
prevention
and
emergency
response
26
of
DPH
to
conduct
and
maintain
a
statewide
risk
assessment
27
of
any
present
or
potential
danger
to
the
public
health
from
28
biological
agents.
29
The
bill
repeals
Code
section
135.26
establishing
the
30
automated
external
defibrillator
(AED)
grant
program
to
provide
31
matching
fund
grants
to
local
boards
of
health,
community
32
organizations,
or
cities
to
implement
AED
programs.
33
The
bill
repeals
Code
section
135.29,
relating
to
local
34
substitute
medical
decision-making
boards,
which
authorized
35
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_____
each
county
to
establish
and
fund
a
local
substituted
medical
1
decision-making
board
to
act
as
a
substitute
decision
maker
for
2
patients
incapable
of
making
their
own
medical
care
decisions
3
if
no
other
substitute
decision
maker
is
available
to
act.
4
The
bill
repeals
Code
section
135.120,
relating
to
the
5
taxation
of
organized
delivery
systems
(ODSs).
1993
Iowa
6
Acts,
chapter
158,
section
3,
directs
DPH
to
adopt
rules
and
a
7
licensing
procedure
for
the
establishment
of
ODSs.
The
bill
8
only
eliminates
the
provision
for
taxation
of
ODSs,
not
all
9
other
provisions
relating
to
ODSs.
10
The
bill
repeals
Code
section
135.152,
the
statewide
11
obstetrical
and
newborn
indigent
patient
care
program.
The
12
program
acts
as
a
payer
of
last
resort
for
eligible
individuals
13
but
has
not
been
utilized
since
2009
due
to
other
options
14
for
coverage
including
through
the
Medicaid
program
and
the
15
Affordable
Care
Act
for
otherwise
eligible
individuals.
16
Division
V
includes
miscellaneous
provisions.
17
The
bill
amends
the
definition
of
“local
board
of
health”
in
18
Code
section
135A.2
under
the
public
health
modernization
Act
19
to
be
consistent
with
the
definition
under
Code
chapter
137,
20
relating
to
local
boards
of
health.
21
The
bill
repeals
Code
section
135.132,
the
interagency
22
pharmaceuticals
bulk
purchasing
council.
The
provision
was
23
enacted
in
2003,
but
the
council
was
never
established.
24
Division
VI
relates
to
the
Iowa
health
information
25
network.
Legislation
was
enacted
in
2015
Iowa
Acts,
chapter
26
73,
to
provide
for
the
future
assumption
of
the
Iowa
health
27
information
network
by
a
designated
entity.
The
bill
28
includes
a
conforming
change
that
would
take
effect
upon
29
future
assumption
of
the
Iowa
health
information
network
by
a
30
designated
entity.
31
Division
VII
relates
to
organized
delivery
systems
that
are
32
regulated
by
DPH.
Organized
delivery
systems
were
created
33
pursuant
to
1993
Iowa
Acts,
chapter
158.
Rules
adopted
34
under
the
provision
define
an
organized
delivery
system
as
35
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S.F.
_____
“an
organization
with
defined
governance
that
is
responsible
1
for
delivering
or
arranging
to
deliver
the
full
range
of
2
health
care
services
covered
under
a
standard
benefit
plan
3
and
is
accountable
to
the
public
for
the
cost,
quality
and
4
access
of
its
services
and
for
the
effect
of
its
services
5
on
their
health.”
(641
IAC
201.2)
An
organization
operating
6
as
an
organized
delivery
system
is
required
to
assume
risk
7
and
be
subject
to
solvency
standards.
The
bill
eliminates
8
all
references
to
organized
delivery
systems
in
the
Code
and
9
repeals
the
provision
in
the
Acts
authorizing
the
establishment
10
of
organized
delivery
systems.
The
most
recent
application
for
11
licensure
was
received
by
DPH
in
1998.
Since
being
authorized
12
in
1993,
only
two
entities
applied
for
licensure
as
organized
13
delivery
systems
and
both
of
these
entities
have
since
ceased
14
operations.
15
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