SF 2346 — A bill for an act relating to a pilot program to allow Medicaid members to participate in direct primary care agreements. (Formerly SF 2256.)

Senate File 2346 - IntroducedReprinted SENATE FILE 2346 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 2256) (As Amended and Passed by the Senate February 27, 2020) A BILL FOR An Act relating to a pilot program to allow the Medicaid programmembers to actparticipate asin a third-party payor under direct primary care agreements.

TLSBSF 5783SV2346 (1)(2) 88 pf/rhpf/rh/mb S.F.

DIRECT PRIMARY CARE AGREEMENTS —— MEDICAID MEMBERS —— PILOT PROGRAM.

The department of human services shall submitdevelop anyand Medicaidoversee statea planpilot amendmentprogram orbeginning waiverJanuary request1, necessary2021, toand theending centersDecember for31, Medicare2022, andto allow Medicaid servicesmembers ofin thespecified Unitedcategories Statesto departmentreceive ofprimary care health andservices, humanas servicesdefined forin approvalsection to135N.1, implementthrough a pilot program relating to direct primary care agreementsarrangement, inwith accordancethe withIowa chapterMedicaid 135Nenterprise andacting as specifiedthe inthird-party thispayor section.for such services utilizing state-only funds.

The requesteligible shall authorize the department to develop and oversee a pilot program beginning January 1, 2021, and ending December 31, 2026, to allow Medicaid membersmember in specified categories toshall receiveinclude primarychildless careadults healthand services,pregnant aswomen. defined in section 135N.1, through a direct primary care arrangement, with Medicaid acting as the third-party payor for such services.

TheSF eligible2346 Medicaid(2) member88 categories-1- shallpf/rh/mb include1/1 childless adults, children under seven years of age, children seven years of age through eighteen years of age, parents, pregnant women, the elderly, and individuals with disabilities.

EXPLANATION The inclusion of this explanation does not constitute agreement with the explanation’s substance by the members of the general assembly.

This bill requires the department of human services (DHS) to submit any Medicaid state plan amendment or waiver request necessary to the centers for Medicare and Medicaid services of the United States department of health and human services for approval to implement a pilot program relating to direct primary care agreements as specified in the bill.

The request shall authorize DHS to develop and oversee a pilot program beginning January 1, 2021, and ending December 31, 2026, to allow Medicaid members in specified categories to receive primary care health services through a direct primary care arrangement with Medicaid acting as the third-party payor for such services.

The eligible Medicaid member categories shall include childless adults, children under seven years of age, children seven years of age through 18 years of age, parents, LSB 5783SV (1) 88 -1- pf/rh 1/2 S.F.

2346 pregnant women, the elderly, and individuals with disabilities.

Direct primary care agreements are authorized under Code chapter 135N.

Such agreements are agreements between a direct provider and a direct patient, or the direct patient’s representative, in which the direct provider agrees to provide primary care health services for a specified period of time to the direct patient for a direct service charge.

Code chapter 135N authorizes a direct provider to accept payment of a direct service charge for a direct patient either directly or indirectly from a third party.

Under the bill, the Medicaid program would act as the third-party payor.

LSB 5783SV (1) 88 -2- pf/rh 2/2