HF 2483 — A bill for an act relating to programs and activities under the purview of the department of human services. (Formerly HSB 680.)

The department of human services, in collaboration with Medicaid providers and managed care organizations, shall initiate a review process to determine the effectiveness of prior authorizations used by the managed care organizations with the goal of making adjustments based on relevant service costs and member outcomes data utilizing existing industry-acceptedHF standards.2483 (4) 87 -5- pf/rh/md 5/8 H.F.

2483 industry-accepted standards.

The department may take any action specified in the managed care contract relative to any claim the auditor determines to LSBbe 6226HVincorrectly (3)paid 87or -5-denied, pf/rhsubject 5/10to H.F.appeal by the managed care organization to the director of human services.

2483 be incorrectly paid or denied, subject to appeal by the managed care organization to the director of human services.

DIVISION IVIII MEDICAID PROGRAM PHARMACY COPAYMENT Sec.

5.3.

A copayment of $2 for each covered nonpreferred brand–nameHF prescription2483 drug(4) for87 which-6- thepf/rh/md cost6/8 toH.F. the state is more than $25 and up to and including $50.

2483 brand–name prescription drug for which the cost to the state is more than $25 and up to and including $50.

DIVISION VIV MEDICAL ASSISTANCE ADVISORY COUNCIL Sec.

6.4.

7.5.

The executive committee of the medical assistance advisory council shall review LSBthe 6226HVdata (3)collected 87and -6-analyzed pf/rhfor 6/10inclusion H.F.in periodic reports to the general assembly, including but not limited to the information and data specified in 2016 Iowa Acts, chapter 1139, section 93, to determine which data points and information should be included and analyzed to more accurately identify trends and issues with, and promote the effective and efficient administration of, Medicaid managed care for all stakeholders.

2483 the data collected and analyzed for inclusion in periodic reports to the general assembly, including but not limited to the information and data specified in 2016 Iowa Acts, chapter 1139, section 93, to determine which data points and information should be included and analyzed to more accurately identify trends and issues with, and promote the effective and efficient administration of, Medicaid managed care for all stakeholders.

DIVISION VIV TARGETED CASE MANAGEMENT AND INPATIENT PSYCHIATRIC SERVICES REIMBURSEMENT Sec.

8.6.

Providers of individual case management services for personsHF with2483 an(4) intellectual87 disability,-7- apf/rh/md developmental7/8 disability,H.F. or chronic mental illness shall receive cost-based reimbursement for one hundred percent of the reasonable costs for the provision of the services in accordance with standards adopted by the mental health and disability services commission pursuant to section 225C.6.

2483 persons with an intellectual disability, a developmental disability, or chronic mental illness shall receive cost-based reimbursement for one hundred percent of the reasonable costs for the provision of the services in accordance with standards adopted by the mental health and disability services commission pursuant to section 225C.6.

Effective July 1, 2010 2014, the department shall apply a cost-based reimbursement methodology for reimbursement of psychiatric medical institution for children providers of inpatient psychiatric services for individuals under twenty-one LSByears 6226HVof (3)age 87shall -7-be pf/rhreimbursed 7/10as H.F.follows:

2483 years of age shall be reimbursed as follows:

EXPLANATIONHF The2483 inclusion(4) of87 this-8- explanationpf/rh/md does8/8 not constitute agreement with the explanation’s substance by the members of the general assembly.

This bill relates to programs and activities under the purview of the department of human services (DHS).

The bill is organized into divisions.

Division I of the bill relates to the healthy and well kids in Iowa (hawk-i) program by transferring two duties of the administrative contractor, the capitation process and member premium collection, to DHS through the Iowa Medicaid enterprise.

Division II of the bill relates to suspension of Medicaid relating to inmates of public institutions.

The bill requires DHS to suspend eligibility of an individual following the first 30 days of the individual’s commitment to the institution.

The bill also requires public institutions to provide a monthly report of the individuals who are committed to the public institution and of the individuals who are discharged from the public institution to DHS and to the social security administration.

The report to DHS is required to include the date of commitment or discharge, as applicable, of each individual committed to or discharged from the public institution during the reporting period, and the report is to be made through the reporting system created by DHS for public, nonmedical institutions to report inmate populations.

Any medical assistance expenditures, including but not limited to monthly managed care capitation payments, provided on behalf of an individual who is an inmate of a public institution but is not reported as required, shall be the financial responsibility LSB 6226HV (3) 87 -8- pf/rh 8/10 H.F.

2483 of the respective public institution.

Division III of the bill relates to Medicaid provider processes and procedures, Medicaid member services and processes, and Medicaid program review and oversight.

Division IV of the bill eliminates the various copayments for a covered prescription drug under the Medicaid program based upon the prescription drug’s status, and instead provides that a recipient of Medicaid is required to pay a copayment of $1 on each prescription filled for a covered prescription drug, including each refill of such prescription.

Division V of the bill relates to the medical assistance advisory council (MAAC).

The bill directs the executive committee of MAAC to review data collected and analyzed in periodic reports to the general assembly to determine which data points should be included and analyzed to more accurately identify trends and issues with, and promote the effective and efficient administration of, Medicaid managed care for all stakeholders.

The executive committee is required to report its findings and recommendations to the MAAC for review and comment by October 1, 2018, and to submit a final report to the governor and the general assembly by December 31, 2018.

Division VI of the bill amends the reimbursement provision for targeted case management services under the Medicaid program which is currently established as cost-based reimbursement for 100 percent of the reasonable costs for provision of the services.

Under the bill, effective July 1, 2018, targeted case management services will instead be reimbursed based on a statewide fee schedule amount developed by rule of the department in accordance with Code chapter 17A.

This division of the bill also amends the reimbursement provision for psychiatric medical institutions for children to provide that inpatient psychiatric services for individuals under 21 years of age that are provided by non-state-owned providers shall be reimbursed according to a fee schedule without reconciliation and for state-owned providers shall be LSB 6226HV (3) 87 -9- pf/rh 9/10 H.F.

2483 reimbursed at 100 percent of the actual and allowable cost of providing the service.

LSB 6226HV (3) 87 -10- pf/rh 10/10