Text: HF2538
Text: HF2540
Complete Bill History
House File 2539
HOUSE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO HSB 757)
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to health care reform including health care
2 coverage intended for children and adults, health information
3 technology, end=of=life care decision making, preexisting
4 conditions and dependent children coverage, medical homes,
5 prevention and chronic care management, a buy=in provision for
6 certain individuals under the medical assistance program,
7 disease prevention and wellness initiatives, health care
8 transparency, and including an applicability provision.
9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
10 HF 2539
11 jg/25
PAG LIN
1 1 DIVISION I
1 2 HEALTH CARE COVERAGE INTENT
1 3 Section 1. DECLARATION OF INTENT.
1 4 1. It is the intent of the general assembly, as funding
1 5 becomes available, to progress toward achievement of the goal
1 6 that all Iowans have health care coverage which meets certain
1 7 standards of quality and affordability with the initial
1 8 priority being that all children have such health care
1 9 coverage by December 31, 2010.
1 10 2. It is the intent of the general assembly that if
1 11 sufficient funding is available, and if federal
1 12 reauthorization of the state children's health insurance
1 13 program provides sufficient federal allocations to the state
1 14 and authorization to cover such children as an option under
1 15 the state children's health insurance program, the department
1 16 of human services shall expand coverage under the state
1 17 children's health insurance program to cover children with
1 18 family incomes up to three hundred percent of the federal
1 19 poverty level, with appropriate cost sharing established for
1 20 families with incomes above two hundred percent of the federal
1 21 poverty level.
1 22 3. It is the intent of the general assembly that the
1 23 department of human services, in consultation with state and
1 24 national experts, develop an operational plan to provide
1 25 health care coverage for all children in the state by building
1 26 upon the current state children's health insurance program.
1 27 The operational plan shall be completed by January 1, 2010,
1 28 and submitted to the general assembly for review.
1 29 4. It is the intent of the general assembly that the
1 30 department of human services, in consultation with state and
1 31 national experts, develop an operational plan to provide
1 32 health care coverage to all adults. The operational plan
1 33 shall be completed by January 1, 2013, and submitted to the
1 34 general assembly for review.
1 35 5. It is the intent of the general assembly to promote
2 1 continued dialogue between the Iowa comprehensive health
2 2 insurance association and other interested parties to address
2 3 the issues of preexisting conditions and the affordability of
2 4 health care coverage.
2 5 DIVISION II
2 6 IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
2 7 DIVISION XXI
2 8 IOWA HEALTH INFORMATION TECHNOLOGY SYSTEM
2 9 Sec. 2. NEW SECTION. 135.154 DEFINITIONS.
2 10 As used in this division, unless the context otherwise
2 11 requires:
2 12 1. "Board" means the state board of health created
2 13 pursuant to section 136.1.
2 14 2. "Department" means the department of public health.
2 15 3. "Health care professional" means a person who is
2 16 licensed, certified, or otherwise authorized or permitted by
2 17 the law of this state to administer health care in the
2 18 ordinary course of business or in the practice of a
2 19 profession.
2 20 4. "Health information technology" means the application
2 21 of information processing, involving both computer hardware
2 22 and software, that deals with the storage, retrieval, sharing,
2 23 and use of health care information, data, and knowledge for
2 24 communication, decision making, quality, safety, and
2 25 efficiency of clinical practice, and may include but is not
2 26 limited to:
2 27 a. An electronic health record that electronically
2 28 compiles and maintains health information that may be derived
2 29 from multiple sources about the health status of an individual
2 30 and may include a core subset of each care delivery
2 31 organization's electronic medical record such as a continuity
2 32 of care record or a continuity of care document, computerized
2 33 physician order entry, electronic prescribing, or clinical
2 34 decision support.
2 35 b. A personal health record through which an individual
3 1 and any other person authorized by the individual can maintain
3 2 and manage the individual's health information.
3 3 c. An electronic medical record that is used by health
3 4 care professionals to electronically document, monitor, and
3 5 manage health care delivery within a care delivery
3 6 organization, is the legal record of the patient's encounter
3 7 with the care delivery organization, and is owned by the care
3 8 delivery organization.
3 9 d. A computerized provider order entry function that
3 10 permits the electronic ordering of diagnostic and treatment
3 11 services, including prescription drugs.
3 12 e. A decision support function to assist physicians and
3 13 other health care providers in making clinical decisions by
3 14 providing electronic alerts and reminders to improve
3 15 compliance with best practices, promote regular screenings and
3 16 other preventive practices, and facilitate diagnoses and
3 17 treatments.
3 18 f. Tools to allow for the collection, analysis, and
3 19 reporting of information or data on adverse events, the
3 20 quality and efficiency of care, patient satisfaction, and
3 21 other health care=related performance measures.
3 22 5. "Interoperability" means the ability of two or more
3 23 systems or components to exchange information or data in an
3 24 accurate, effective, secure, and consistent manner and to use
3 25 the information or data that has been exchanged and includes
3 26 but is not limited to:
3 27 a. The capacity to connect to a network for the purpose of
3 28 exchanging information or data with other users.
3 29 b. The ability of a connected, authenticated user to
3 30 demonstrate appropriate permissions to participate in the
3 31 instant transaction over the network.
3 32 c. The capacity of a connected, authenticated user to
3 33 access, transmit, receive, and exchange usable information
3 34 with other users.
3 35 6. "Recognized interoperability standard" means
4 1 interoperability standards recognized by the office of the
4 2 national coordinator for health information technology of the
4 3 United States department of health and human services.
4 4 Sec. 3. NEW SECTION. 135.155 IOWA ELECTRONIC HEALTH ==
4 5 PRINCIPLES == GOALS.
4 6 1. Health information technology is rapidly evolving so
4 7 that it can contribute to the goals of improving access to and
4 8 quality of health care, enhancing efficiency, and reducing
4 9 costs.
4 10 2. To be effective, the health information technology
4 11 system shall comply with all of the following principles:
4 12 a. Be patient=centered and market=driven.
4 13 b. Be based on approved standards developed with input
4 14 from all stakeholders.
4 15 c. Protect the privacy of consumers and the security and
4 16 confidentiality of all health information.
4 17 d. Promote interoperability.
4 18 e. Ensure the accuracy, completeness, and uniformity of
4 19 data.
4 20 3. Widespread adoption of health information technology is
4 21 critical to a successful health information technology system
4 22 and is best achieved when all of the following occur:
4 23 a. The market provides a variety of certified products
4 24 from which to choose in order to best fit the needs of the
4 25 user.
4 26 b. The system provides incentives for health care
4 27 professionals to utilize the health information technology and
4 28 provides rewards for any improvement in quality and efficiency
4 29 resulting from such utilization.
4 30 c. The system provides protocols to address critical
4 31 problems.
4 32 d. The system is financed by all who benefit from the
4 33 improved quality, efficiency, savings, and other benefits that
4 34 result from use of health information technology.
4 35 Sec. 4. NEW SECTION. 135.156 ELECTRONIC HEALTH
5 1 INFORMATION == DEPARTMENT DUTIES == ADVISORY COUNCIL.
5 2 1. a. The department shall direct a public and private
5 3 collaborative effort to promote the adoption and use of health
5 4 information technology in this state in order to improve
5 5 health care quality, increase patient safety, reduce health
5 6 care costs, enhance public health, and empower individuals and
5 7 health care professionals with comprehensive, real=time
5 8 medical information to provide continuity of care and make the
5 9 best health care decisions. The department shall provide
5 10 oversight for the development, implementation, and
5 11 coordination of an interoperable electronic health records
5 12 system, telehealth expansion efforts, the health information
5 13 technology infrastructure, and other health information
5 14 technology initiatives in this state. The department shall be
5 15 guided by the principles and goals specified in section
5 16 135.155.
5 17 b. All health information technology efforts shall
5 18 endeavor to represent the interests and meet the needs of
5 19 consumers and the health care sector, protect the privacy of
5 20 individuals and the confidentiality of individuals'
5 21 information, promote physician best practices, and make
5 22 information easily accessible to the appropriate parties. The
5 23 system developed shall be consumer=driven, flexible, and
5 24 expandable.
5 25 2. The department shall do all of the following:
5 26 a. Establish a technical advisory group which shall
5 27 consist of the representatives of entities involved in the
5 28 electronic health records system task force established
5 29 pursuant to section 217.41A, Code 2007, a licensed practicing
5 30 physician, a consumer, and any other members the department
5 31 determines necessary to assist in the department's duties at
5 32 various stages of development of the electronic health
5 33 information system. Executive branch agencies shall also be
5 34 included as necessary to assist in the duties of the
5 35 department. Public members of the technical advisory group
6 1 shall receive reimbursement for actual expenses incurred while
6 2 serving in their official capacity only if they are not
6 3 eligible for reimbursement by the organization that they
6 4 represent. Any legislative members shall be paid the per diem
6 5 and expenses specified in section 2.10.
6 6 b. Adopt a statewide health information technology plan by
6 7 January 1, 2009. In developing the plan, the department shall
6 8 seek the input of providers, payers, and consumers. Standards
6 9 and policies developed for the plan shall promote and be
6 10 consistent with national standards developed by the office of
6 11 the national coordinator for health information technology of
6 12 the United States department of health and human services and
6 13 shall address or provide for all of the following:
6 14 (1) The effective, efficient, statewide use of electronic
6 15 health information in patient care, health care policymaking,
6 16 clinical research, health care financing, and continuous
6 17 quality improvement. The department shall adopt requirements
6 18 for interoperable electronic health records in this state
6 19 including a recognized interoperability standard.
6 20 (2) Education of the public and health care sector about
6 21 the value of health information technology in improving
6 22 patient care, and methods to promote increased support and
6 23 collaboration of state and local public health agencies,
6 24 health care professionals, and consumers in health information
6 25 technology initiatives.
6 26 (3) Standards for the exchange of health care information.
6 27 (4) Policies relating to the protection of privacy of
6 28 patients and the security and confidentiality of patient
6 29 information.
6 30 (5) Policies relating to information ownership.
6 31 (6) Policies relating to governance of the various facets
6 32 of the health information technology system.
6 33 (7) A single patient identifier or alternative mechanism
6 34 to share secure patient information. If no alternative
6 35 mechanism is acceptable to the department, all health care
7 1 professionals shall utilize the mechanism selected by the
7 2 department by January 1, 2010.
7 3 (8) A standard continuity of care record and other issues
7 4 related to the content of electronic transmissions. All
7 5 health care professionals shall utilize the standard
7 6 continuity of care record by January 1, 2010.
7 7 (9) Requirements for electronic prescribing.
7 8 (10) Economic incentives and support to facilitate
7 9 participation in an interoperable system by health care
7 10 professionals.
7 11 c. Identify existing and potential health information
7 12 technology efforts in this state, regionally, and nationally,
7 13 and integrate existing efforts to avoid incompatibility
7 14 between efforts and avoid duplication.
7 15 d. Coordinate public and private efforts to provide the
7 16 network backbone infrastructure for the health information
7 17 technology system. In coordinating these efforts, the
7 18 department shall do all of the following:
7 19 (1) Adopt policies to effectuate the logical cost
7 20 effective usage of and access to the state=owned network, and
7 21 support of telecommunication carrier products, where
7 22 applicable.
7 23 (2) Consult with the Iowa communications network, private
7 24 fiberoptic networks, and any other communications entity to
7 25 seek collaboration, avoid duplication, and leverage
7 26 opportunities in developing a backbone network.
7 27 (3) Establish protocols to ensure compliance with any
7 28 applicable federal standards.
7 29 (4) Determine costs for accessing the network at a level
7 30 that provides sufficient funding for the network.
7 31 e. Promote the use of telemedicine.
7 32 (1) Examine existing barriers to the use of telemedicine
7 33 and make recommendations for eliminating these barriers.
7 34 (2) Examine the most efficient and effective systems of
7 35 technology for use and make recommendations based on the
8 1 findings.
8 2 f. Address the workforce needs generated by increased use
8 3 of health information technology.
8 4 g. Adopt rules in accordance with chapter 17A to implement
8 5 all aspects of the statewide plan and the network.
8 6 h. Coordinate, monitor, and evaluate the adoption, use,
8 7 interoperability, and efficiencies of the various facets of
8 8 health information technology in this state.
8 9 i. Seek and apply for any federal or private funding to
8 10 assist in the implementation and support of the health
8 11 information technology system and make recommendations for
8 12 funding mechanisms for the ongoing development and maintenance
8 13 costs of the health information technology system.
8 14 j. Identify state laws and rules that present barriers to
8 15 the development of the health information technology system
8 16 and recommend any changes to the governor and the general
8 17 assembly.
8 18 3. Recommendations and other activities resulting from the
8 19 duties authorized for the department under this section shall
8 20 require approval by the board prior to any subsequent action
8 21 or implementation.
8 22 Sec. 5. Section 8D.13, Code 2007, is amended by adding the
8 23 following new subsection:
8 24 NEW SUBSECTION. 20. Access shall be offered to the Iowa
8 25 hospital association for the collection, maintenance, and
8 26 dissemination of health and financial data for hospitals and
8 27 for hospital educational services. The Iowa hospital
8 28 association shall be responsible for all costs associated with
8 29 becoming part of the network, as determined by the commission.
8 30 Sec. 6. Section 136.3, Code 2007, is amended by adding the
8 31 following new subsection:
8 32 NEW SUBSECTION. 11. Perform those duties authorized
8 33 pursuant to section 135.156.
8 34 Sec. 7. Section 217.41A, Code 2007, is repealed.
8 35 DIVISION III
9 1 END=OF=LIFE CARE DECISION MAKING
9 2 Sec. 8. NEW SECTION. 231.62 END=OF=LIFE CARE DECISION
9 3 MAKING.
9 4 1. The department shall consult with the Iowa medical
9 5 society, the Iowa end=of=life coalition, the Iowa hospice
9 6 organization, the university of Iowa palliative care program,
9 7 and other health care professionals whose scope of practice
9 8 includes end=of=life care to develop educational and
9 9 patient=centered information on end=of=life care for
9 10 terminally ill patients and health care professionals.
9 11 2. For the purposes of this section, "end=of=life care"
9 12 means care provided to meet the physical, psychological,
9 13 social, spiritual, and practical needs of terminally ill
9 14 patients and their caregivers.
9 15 DIVISION IV
9 16 HEALTH CARE COVERAGE
9 17 Sec. 9. NEW SECTION. 505.31 REIMBURSEMENT ACCOUNTS.
9 18 The commissioner of insurance shall assist employers with
9 19 twenty=five or fewer employees with implementing and
9 20 administering plans under section 125 of the Internal Revenue
9 21 Code, including medical expense reimbursement accounts and
9 22 dependent care accounts. The commissioner shall provide
9 23 information about the assistance available to small employers
9 24 on the insurance division's internet site.
9 25 Sec. 10. Section 509.3, Code 2007, is amended by adding
9 26 the following new subsection:
9 27 NEW SUBSECTION. 8. A provision that the insurer will
9 28 permit continuation of existing coverage for an unmarried
9 29 dependent child of an insured or enrollee who so elects, at
9 30 least through the age of twenty=five years old or so long as
9 31 the dependent child maintains full=time status as a student in
9 32 an accredited institution of postsecondary education,
9 33 whichever occurs last, at a premium established in accordance
9 34 with the insurer's rating practices.
9 35 Sec. 11. Section 513C.7, subsection 2, paragraph a, Code
10 1 2007, is amended to read as follows:
10 2 a. The individual basic or standard health benefit plan
10 3 shall not deny, exclude, or limit benefits for a covered
10 4 individual for losses incurred more than twelve months
10 5 following the effective date of the individual's coverage due
10 6 to a preexisting condition. A preexisting condition shall not
10 7 be defined more restrictively than any of the following:
10 8 (1) a. A condition that would cause an ordinarily prudent
10 9 person to seek medical advice, diagnosis, care, or treatment
10 10 during the twelve months immediately preceding the effective
10 11 date of coverage.
10 12 (2) b. A condition for which medical advice, diagnosis,
10 13 care, or treatment was recommended or received during the
10 14 twelve months immediately preceding the effective date of
10 15 coverage.
10 16 (3) c. A pregnancy existing on the effective date of
10 17 coverage.
10 18 Sec. 12. Section 513C.7, subsection 2, paragraph b, Code
10 19 2007, is amended by striking the paragraph.
10 20 Sec. 13. NEW SECTION. 514A.3B ADDITIONAL REQUIREMENTS.
10 21 1. An insurer which accepts an individual for coverage
10 22 under an individual policy or contract of accident and health
10 23 insurance shall waive any time period applicable to a
10 24 preexisting condition exclusion or limitation period
10 25 requirement of the policy or contract with respect to
10 26 particular services in an individual health benefit plan for
10 27 the period of time the individual was previously covered by
10 28 qualifying previous coverage as defined in section 513C.3 that
10 29 provided benefits with respect to such services, provided that
10 30 the qualifying previous coverage was continuous to a date not
10 31 more than sixty=three days prior to the effective date of the
10 32 new policy or contract. For purposes of this section, periods
10 33 of coverage under medical assistance provided pursuant to
10 34 chapter 249A or 514I, or Medicare coverage provided pursuant
10 35 to Title XVIII of the federal Social Security Act shall not be
11 1 counted with respect to the sixty=three=day requirement.
11 2 2. An insurer issuing an individual policy or contract of
11 3 accident and health insurance which provides coverage for
11 4 dependent children of the insured shall permit continuation of
11 5 coverage for an unmarried dependent child of an insured or
11 6 enrollee who so elects, at least through the age of
11 7 twenty=five years old or so long as the dependent child
11 8 maintains full=time status as a student in an accredited
11 9 institution of postsecondary education, whichever occurs last,
11 10 at a premium established in accordance with the insurer's
11 11 rating practices.
11 12 Sec. 14. APPLICABILITY. This division of this Act applies
11 13 to policies or contracts of accident and health insurance
11 14 delivered or issued for delivery or continued or renewed in
11 15 this state on or after July 1, 2008.
11 16 DIVISION V
11 17 MEDICAL HOME
11 18 DIVISION XXII
11 19 MEDICAL HOME
11 20 Sec. 15. NEW SECTION. 135.157 DEFINITIONS.
11 21 As used in this chapter, unless the context otherwise
11 22 requires:
11 23 1. "Board" means the state board of health created
11 24 pursuant to section 136.1.
11 25 2. "Department" means the department of public health.
11 26 3. "Health care professional" means a person who is
11 27 licensed, certified, or otherwise authorized or permitted by
11 28 the law of this state to administer health care in the
11 29 ordinary course of business or in the practice of a
11 30 profession.
11 31 4. "Medical home" means a team approach to providing
11 32 health care that originates in a primary care setting; fosters
11 33 a partnership among the patient, the personal provider, and
11 34 other health care professionals, and where appropriate, the
11 35 patient's family; utilizes the partnership to access all
12 1 medical and nonmedical health=related services needed by the
12 2 patient and the patient's family to achieve maximum health
12 3 potential; maintains a centralized, comprehensive record of
12 4 all health=related services to promote continuity of care; and
12 5 has all of the characteristics specified in section 135.158.
12 6 5. "National committee for quality assurance" means the
12 7 nationally recognized, independent nonprofit organization that
12 8 measures the quality and performance of health care and health
12 9 care plans in the United States; provides accreditation,
12 10 certification, and recognition programs for health care plans
12 11 and programs; and is recognized in Iowa as an accrediting
12 12 organization for commercial and Medicaid=managed care
12 13 organizations.
12 14 6. "Personal provider" means the patient's first point of
12 15 contact in the health care system with a primary care provider
12 16 who identifies the patient's health needs, and, working with a
12 17 team of health care professionals, provides for and
12 18 coordinates appropriate care to address the health needs
12 19 identified.
12 20 7. "Primary care" means health care which emphasizes
12 21 providing for a patient's general health needs and utilizes
12 22 collaboration with other health care professionals and
12 23 consultation or referral as appropriate to meet the needs
12 24 identified.
12 25 8. "Primary care provider" means any of the following who
12 26 provide primary care:
12 27 a. A physician who is a family or general practitioner, a
12 28 pediatrician, an internist, an obstetrician, or a
12 29 gynecologist.
12 30 b. An advanced registered nurse practitioner.
12 31 c. A physician assistant.
12 32 Sec. 16. NEW SECTION. 135.158 MEDICAL HOME PURPOSES ==
12 33 CHARACTERISTICS.
12 34 1. The purposes of a medical home are the following:
12 35 a. To reduce disparities in health care access, delivery,
13 1 and health care outcomes.
13 2 b. To improve quality of health care and lower health care
13 3 costs, thereby creating savings to allow more Iowans to have
13 4 health care coverage and to provide for the sustainability of
13 5 the health care system.
13 6 c. To provide a tangible method to document if each Iowan
13 7 has access to health care.
13 8 2. A medical home has all of the following
13 9 characteristics:
13 10 a. A personal provider. Each patient has an ongoing
13 11 relationship with a personal provider trained to provide first
13 12 contact and continuous and comprehensive care.
13 13 b. A provider=directed medical practice. The personal
13 14 provider leads a team of individuals at the practice level who
13 15 collectively take responsibility for the ongoing health care
13 16 of patients.
13 17 c. Whole person orientation. The personal provider is
13 18 responsible for providing for all of a patient's health care
13 19 needs or taking responsibility for appropriately arranging
13 20 health care by other qualified health care professionals.
13 21 This responsibility includes health care at all stages of life
13 22 including provision of acute care, chronic care, preventive
13 23 services, and end=of=life care.
13 24 d. Coordination and integration of care. Care is
13 25 coordinated and integrated across all elements of the complex
13 26 health care system and the patient's community. Care is
13 27 facilitated by registries, information technology, health
13 28 information exchanges, and other means to assure that patients
13 29 receive the indicated care when and where they need and want
13 30 the care in a culturally and linguistically appropriate
13 31 manner.
13 32 e. Quality and safety. The following are quality and
13 33 safety components of the medical home:
13 34 (1) Provider=directed medical practices advocate for their
13 35 patients to support the attainment of optimal,
14 1 patient=centered outcomes that are defined by a care planning
14 2 process driven by a compassionate, robust partnership between
14 3 providers, the patient, and the patient's family.
14 4 (2) Evidence=based medicine and clinical decision=support
14 5 tools guide decision making.
14 6 (3) Providers in the medical practice accept
14 7 accountability for continuous quality improvement through
14 8 voluntary engagement in performance measurement and
14 9 improvement.
14 10 (4) Patients actively participate in decision making and
14 11 feedback is sought to ensure that the patients' expectations
14 12 are being met.
14 13 (5) Information technology is utilized appropriately to
14 14 support optimal patient care, performance measurement, patient
14 15 education, and enhanced communication.
14 16 (6) Practices participate in a voluntary recognition
14 17 process conducted by an appropriate nongovernmental entity to
14 18 demonstrate that the practice has the capabilities to provide
14 19 patient=centered services consistent with the medical home
14 20 model.
14 21 (7) Patients and families participate in quality
14 22 improvement activities at the practice level.
14 23 f. Enhanced access to health care. Enhanced access to
14 24 health care is available through systems such as open
14 25 scheduling, expanded hours, and new options for communication
14 26 between the patient, the patient's personal provider, and
14 27 practice staff.
14 28 g. Payment. The payment system appropriately recognizes
14 29 the added value provided to patients who have a
14 30 patient=centered medical home. The payment structure
14 31 framework of the medical home provides all of the following:
14 32 (1) Reflects the value of provider and nonprovider staff
14 33 and patient=centered care management work that is in addition
14 34 to the face=to=face visit.
14 35 (2) Pays for services associated with coordination of
15 1 health care both within a given practice and between
15 2 consultants, ancillary providers, and community resources.
15 3 (3) Supports adoption and use of health information
15 4 technology for quality improvement.
15 5 (4) Supports provision of enhanced communication access
15 6 such as secure electronic mail and telephone consultation.
15 7 (5) Recognizes the value of physician work associated with
15 8 remote monitoring of clinical data using technology.
15 9 (6) Allows for separate fee=for=service payments for
15 10 face=to=face visits. Payments for health care management
15 11 services that are in addition to the face=to=face visit do not
15 12 result in a reduction in the payments for face=to=face visits.
15 13 (7) Recognizes case mix differences in the patient
15 14 population being treated within the practice.
15 15 (8) Allows providers to share in savings from reduced
15 16 hospitalizations associated with provider=guided health care
15 17 management in the office setting.
15 18 (9) Allows for additional payments for achieving
15 19 measurable and continuous quality improvements.
15 20 Sec. 17. NEW SECTION. 135.159 MEDICAL HOME SYSTEM ==
15 21 ADVISORY COUNCIL == DEVELOPMENT AND IMPLEMENTATION.
15 22 1. The department shall administer the medical home
15 23 system. The department shall adopt rules pursuant to chapter
15 24 17A necessary to administer the medical home system.
15 25 2. a. The department shall establish an advisory council
15 26 which shall include but is not limited to all of the following
15 27 members, selected by their respective organizations, and any
15 28 other members the department determines necessary to assist in
15 29 the department's duties at various stages of development of
15 30 the medical home system:
15 31 (1) The director of human services, or the director's
15 32 designee.
15 33 (2) The commissioner of insurance, or the commissioner's
15 34 designee.
15 35 (3) A representative of health insurers.
16 1 (4) A representative of the Iowa dental association.
16 2 (5) A representative of the Iowa nurses association.
16 3 (6) A physician licensed pursuant to chapter 148 and a
16 4 physician licensed pursuant to chapter 150 who are family
16 5 physicians and members of the Iowa academy of family
16 6 physicians.
16 7 (7) A health care consumer.
16 8 (8) A representative of the Iowa collaborative safety net
16 9 provider network established pursuant to section 135.153.
16 10 (9) A representative of the governor's developmental
16 11 disabilities council.
16 12 (10) A representative of the Iowa chapter of the American
16 13 academy of pediatrics.
16 14 (11) A representative of the child and family policy
16 15 center.
16 16 (12) A representative of the Iowa pharmacy association.
16 17 (13) A representative of the Iowa chiropractic society.
16 18 b. Public members of the advisory council shall receive
16 19 reimbursement for actual expenses incurred while serving in
16 20 their official capacity only if they are not eligible for
16 21 reimbursement by the organization that they represent.
16 22 3. The department shall develop a plan for implementation
16 23 of a statewide medical home system. The initial phase shall
16 24 focus on providing a medical home for children, beginning with
16 25 those children who are recipients of the medical assistance
16 26 program. The second phase shall focus on providing a medical
16 27 home to the expansion population under the IowaCare program
16 28 and to adult recipients of medical assistance. The third
16 29 phase shall focus on providing a medical home to other adults.
16 30 The department, in collaboration with parents, schools,
16 31 communities, health plans, and providers, shall endeavor to
16 32 increase healthy outcomes for children and adults by linking
16 33 the children and adults with a medical home, identifying
16 34 health improvement goals for children and adults, and linking
16 35 reimbursement strategies to increasing healthy outcomes for
17 1 children and adults. The plan shall provide that the medical
17 2 home system shall do all of the following:
17 3 a. Coordinate and provide access to evidence=based health
17 4 care services, emphasizing convenient, comprehensive primary
17 5 care and including preventive, screening, and well=child
17 6 health services.
17 7 b. Provide access to appropriate specialty care and
17 8 inpatient services.
17 9 c. Provide quality=driven and cost=effective health care.
17 10 d. Provide access to pharmacist=delivered medication
17 11 reconciliation and medication therapy management services,
17 12 where appropriate.
17 13 e. Promote strong and effective medical management
17 14 including but not limited to planning treatment strategies,
17 15 monitoring health outcomes and resource use, sharing
17 16 information, and organizing care to avoid duplication of
17 17 service.
17 18 f. Emphasize patient and provider accountability.
17 19 g. Prioritize local access to the continuum of health care
17 20 services in the most appropriate setting.
17 21 h. Establish a baseline for medical home goals and
17 22 establish performance measures that indicate a child or adult
17 23 has an established and effective medical home. For children,
17 24 these goals and performance measures may include but are not
17 25 limited to childhood immunizations rates, well=child care
17 26 utilization rates, care management for children with chronic
17 27 illnesses, emergency room utilization, and oral health service
17 28 utilization.
17 29 i. For children, coordinate with and integrate guidelines,
17 30 data, and information from existing newborn and child health
17 31 programs and entities, including but not limited to the
17 32 healthy opportunities to experience, success=healthy families
17 33 Iowa program, the community empowerment program, the center
17 34 for congenital and inherited disorders screening and health
17 35 care programs, standards of care for pediatric health
18 1 guidelines, the office of multicultural health established in
18 2 section 135.12, the oral health bureau established in section
18 3 135.15, and other similar programs and services.
18 4 4. The department shall develop an organizational
18 5 structure for the medical home system in this state. The
18 6 organizational structure plan shall integrate existing
18 7 resources, provide a strategy to coordinate health care
18 8 services, provide for monitoring and data collection on
18 9 medical homes, provide for training and education to health
18 10 care professionals and families, and provide for transition of
18 11 children to the adult medical care system. The organizational
18 12 structure may be based on collaborative teams of stakeholders
18 13 throughout the state such as local public health agencies, the
18 14 collaborative safety net provider network established in
18 15 section 135.153, or a combination of statewide organizations.
18 16 Care coordination may be provided through regional offices or
18 17 through individual provider practices. The organizational
18 18 structure may also include the use of telemedicine resources,
18 19 and may provide for partnering with pediatric and family
18 20 practice residency programs to improve access to preventive
18 21 care for children. The organizational structure shall also
18 22 address the need to organize and provide health care to
18 23 increase accessibility for patients including using venues
18 24 more accessible to patients and having hours of operation that
18 25 are conducive to the population served.
18 26 5. The department shall adopt standards and a process to
18 27 certify medical homes based on the national committee for
18 28 quality assurance standards. The certification process and
18 29 standards shall provide mechanisms to monitor performance and
18 30 to evaluate, promote, and improve the quality of health of and
18 31 health care delivered to patients through a medical home. The
18 32 mechanism shall require participating providers to monitor
18 33 clinical progress and performance in meeting applicable
18 34 standards and to provide information in a form and manner
18 35 specified by the department. The evaluation mechanism shall
19 1 be developed with input from consumers, providers, and payers.
19 2 At a minimum the evaluation shall determine any increased
19 3 quality in health care provided and any decrease in cost
19 4 resulting from the medical home system compared with other
19 5 health care delivery systems. The standards and process shall
19 6 also include a mechanism for other ancillary service providers
19 7 to become affiliated with a certified medical home.
19 8 6. The department shall adopt education and training
19 9 standards for health care professionals participating in the
19 10 medical home system.
19 11 7. The department shall provide for system simplification
19 12 through the use of universal referral forms, internet=based
19 13 tools for providers, and a central medical home internet site
19 14 for providers.
19 15 8. The department shall recommend a reimbursement
19 16 methodology and incentives for participation in the medical
19 17 home system to ensure that providers enter and remain
19 18 participating in the system. In developing the
19 19 recommendations for incentives, the department shall consider,
19 20 at a minimum, providing incentives to promote wellness,
19 21 prevention, chronic care management, immunizations, health
19 22 care management, and the use of electronic health records. In
19 23 developing the recommendations for the reimbursement system,
19 24 the department shall analyze, at a minimum, the feasibility of
19 25 all of the following:
19 26 a. Reimbursement under the medical assistance program to
19 27 promote wellness and prevention, provide care coordination,
19 28 and provide chronic care management.
19 29 b. Increasing reimbursement to Medicare levels for certain
19 30 wellness and prevention services, chronic care management, and
19 31 immunizations.
19 32 c. Providing reimbursement for primary care services by
19 33 addressing the disparities between reimbursement for specialty
19 34 services and primary care services.
19 35 d. Increased funding for efforts to transform medical
20 1 practices into certified medical homes, including emphasizing
20 2 the implementation of the use of electronic health records.
20 3 e. Targeted reimbursement to providers linked to health
20 4 care quality improvement measures established by the
20 5 department.
20 6 f. Reimbursement for specified ancillary support services
20 7 such as transportation for medical appointments and other such
20 8 services.
20 9 g. Providing reimbursement for medication reconciliation
20 10 and medication therapy management service, where appropriate.
20 11 9. The department shall coordinate the requirements and
20 12 activities of the medical home system with the requirements
20 13 and activities of the dental home for children as described in
20 14 section 249J.14, subsection 7, and shall recommend financial
20 15 incentives for dentists and nondental providers to promote
20 16 oral health care coordination through preventive dental
20 17 intervention, early identification of oral disease risk,
20 18 health care coordination and data tracking, treatment, chronic
20 19 care management, education and training, parental guidance,
20 20 and oral health promotions for children.
20 21 10. The department shall integrate the recommendations and
20 22 policies developed by the prevention and chronic care
20 23 management advisory council into the medical home system.
20 24 11. Implementation phases.
20 25 a. Initial implementation shall require participation in
20 26 the medical home system of children who are recipients of the
20 27 medical assistance program. The department shall work with
20 28 the department of human services and shall recommend to the
20 29 general assembly a reimbursement methodology to compensate
20 30 providers participating under the medical assistance program
20 31 for participation in the medical home system.
20 32 b. The department shall work with the department of human
20 33 services to expand the medical home system to adult recipients
20 34 of medical assistance and the expansion population under the
20 35 IowaCare program. The department shall work with the centers
21 1 for Medicare and Medicaid services of the United States
21 2 department of health and human services to allow Medicare
21 3 recipients to utilize the medical home system.
21 4 c. The department shall work with the department of
21 5 administrative services to allow state employees to utilize
21 6 the medical home system.
21 7 d. The department shall work with insurers and
21 8 self=insured companies, if requested, to make the medical home
21 9 system available to individuals with private health care
21 10 coverage.
21 11 12. The department shall provide oversight for all
21 12 certified medical homes. The department shall review the
21 13 progress of the medical home system and recommend improvements
21 14 to the system, as necessary.
21 15 13. The department shall annually evaluate the medical
21 16 home system and make recommendations to the governor and the
21 17 general assembly regarding improvements to and continuation of
21 18 the system.
21 19 14. Recommendations and other activities resulting from
21 20 the duties authorized for the department under this section
21 21 shall require approval by the board prior to any subsequent
21 22 action or implementation.
21 23 Sec. 18. Section 136.3, Code 2007, is amended by adding
21 24 the following new subsection:
21 25 NEW SUBSECTION. 12. Perform those duties authorized
21 26 pursuant to section 135.159.
21 27 Sec. 19. Section 249J.14, subsection 7, Code 2007, is
21 28 amended to read as follows:
21 29 7. DENTAL HOME FOR CHILDREN. By July 1, 2008 December 31,
21 30 2010, every recipient of medical assistance who is a child
21 31 twelve years of age or younger shall have a designated dental
21 32 home and shall be provided with the dental screenings, and
21 33 preventive care identified in the oral health standards
21 34 services, diagnostic services, treatment services, and
21 35 emergency services as defined under the early and periodic
22 1 screening, diagnostic, and treatment program.
22 2 DIVISION VI
22 3 PREVENTION AND CHRONIC CARE MANAGEMENT
22 4 DIVISION XXIII
22 5 PREVENTION AND CHRONIC CARE MANAGEMENT
22 6 Sec. 20. NEW SECTION. 135.160 DEFINITIONS.
22 7 For the purpose of this division, unless the context
22 8 otherwise requires:
22 9 1. "Board" means the state board of health created
22 10 pursuant to section 136.1.
22 11 2. "Chronic care" means health care services provided by a
22 12 health care professional for an established clinical condition
22 13 that is expected to last a year or more and that requires
22 14 ongoing clinical management attempting to restore the
22 15 individual to highest function, minimize the negative effects
22 16 of the chronic condition, and prevent complications related to
22 17 the chronic condition.
22 18 3. "Chronic care information system" means approved
22 19 information technology to enhance the development and
22 20 communication of information to be used in providing chronic
22 21 care, including clinical, social, and economic outcomes of
22 22 chronic care.
22 23 4. "Chronic care management" means a system of coordinated
22 24 health care interventions and communications for individuals
22 25 with chronic conditions, including significant patient
22 26 self=care efforts, systemic supports for the health care
22 27 professional and patient relationship, and a chronic care plan
22 28 emphasizing prevention of complications utilizing
22 29 evidence=based practice guidelines, patient empowerment
22 30 strategies, and evaluation of clinical, humanistic, and
22 31 economic outcomes on an ongoing basis with the goal of
22 32 improving overall health.
22 33 5. "Chronic care plan" means a plan of care between an
22 34 individual and the individual's principal health care
22 35 professional that emphasizes prevention of complications
23 1 through patient empowerment including but not limited to
23 2 providing incentives to engage the patient in the patient's
23 3 own care and in clinical, social, or other interventions
23 4 designed to minimize the negative effects of the chronic
23 5 condition.
23 6 6. "Chronic care resources" means health care
23 7 professionals, advocacy groups, health departments, schools of
23 8 public health and medicine, health plans, and others with
23 9 expertise in public health, health care delivery, health care
23 10 financing, and health care research.
23 11 7. "Chronic condition" means an established clinical
23 12 condition that is expected to last a year or more and that
23 13 requires ongoing clinical management.
23 14 8. "Department" means the department of public health.
23 15 9. "Director" means the director of public health.
23 16 10. "Eligible individual" means a resident of this state
23 17 who has been diagnosed with a chronic condition or is at an
23 18 elevated risk for a chronic condition and who is a recipient
23 19 of medical assistance, is a member of the expansion population
23 20 pursuant to chapter 249J, or is an inmate of a correctional
23 21 institution in this state.
23 22 11. "Health care professional" means health care
23 23 professional as defined in section 135.157.
23 24 12. "Health risk assessment" means screening by a health
23 25 care professional for the purpose of assessing an individual's
23 26 health, including tests or physical examinations and a survey
23 27 or other tool used to gather information about an individual's
23 28 health, medical history, and health risk factors during a
23 29 health screening.
23 30 13. "State initiative for prevention and chronic care
23 31 management" or "state initiative" means the state's plan for
23 32 developing a chronic care organizational structure for
23 33 prevention and chronic care management, including coordinating
23 34 the efforts of health care professionals and chronic care
23 35 resources to promote the health of residents and the
24 1 prevention and management of chronic conditions, developing
24 2 and implementing arrangements for delivering prevention
24 3 services and chronic care management, developing significant
24 4 patient self=care efforts, providing systemic support for the
24 5 health care professional=patient relationship and options for
24 6 channeling chronic care resources and support to health care
24 7 professionals, providing for community development and
24 8 outreach and education efforts, and coordinating information
24 9 technology initiatives with the chronic care information
24 10 system.
24 11 Sec. 21. NEW SECTION. 135.161 PREVENTION AND CHRONIC
24 12 CARE MANAGEMENT INITIATIVE == ADVISORY COUNCIL.
24 13 1. The director, in collaboration with the prevention and
24 14 chronic care management advisory council, shall develop a
24 15 state initiative for prevention and chronic care management.
24 16 2. The director may accept grants and donations and shall
24 17 apply for any federal, state, or private grants available to
24 18 fund the initiative. Any grants or donations received shall
24 19 be placed in a separate fund in the state treasury and used
24 20 exclusively for the initiative or as federal law directs.
24 21 3. a. The director shall establish and convene an
24 22 advisory council to provide technical assistance to the
24 23 director in developing a state initiative that integrates
24 24 evidence=based prevention and chronic care management
24 25 strategies into the public and private health care systems,
24 26 including the medical home system. Public members of the
24 27 advisory council shall receive their actual and necessary
24 28 expenses incurred in the performance of their duties and may
24 29 be eligible to receive compensation as provided in section
24 30 7E.6.
24 31 b. The advisory council shall elicit input from a variety
24 32 of health care professionals, health care professional
24 33 organizations, community and nonprofit groups, insurers,
24 34 consumers, businesses, school districts, and state and local
24 35 governments in developing the advisory council's
25 1 recommendations.
25 2 c. The advisory council shall submit initial
25 3 recommendations to the director for the state initiative for
25 4 prevention and chronic care management no later than July 1,
25 5 2009. The recommendations shall address all of the following:
25 6 (1) The recommended organizational structure for
25 7 integrating prevention and chronic care management into the
25 8 private and public health care systems. The organizational
25 9 structure recommended shall align with the organizational
25 10 structure established for the medical home system developed
25 11 pursuant to division XXII. The advisory council shall also
25 12 review existing prevention and chronic care management
25 13 strategies used in the health insurance market and in private
25 14 and public programs and recommend ways to expand the use of
25 15 such strategies throughout the health insurance market and in
25 16 the private and public health care systems.
25 17 (2) A process for identifying leading health care
25 18 professionals and existing prevention and chronic care
25 19 management programs in the state, and coordinating care among
25 20 these health care professionals and programs.
25 21 (3) A prioritization of the chronic conditions for which
25 22 prevention and chronic care management services should be
25 23 provided, taking into consideration the prevalence of specific
25 24 chronic conditions and the factors that may lead to the
25 25 development of chronic conditions; the fiscal impact to state
25 26 health care programs of providing care for the chronic
25 27 conditions of eligible individuals; the availability of
25 28 workable, evidence=based approaches to chronic care for the
25 29 chronic condition; and public input into the selection
25 30 process. The advisory council shall initially develop
25 31 consensus guidelines to address the two chronic conditions
25 32 identified as having the highest priority and shall also
25 33 specify a timeline for inclusion of additional specific
25 34 chronic conditions in the initiative.
25 35 (4) A method to involve health care professionals in
26 1 identifying eligible patients for prevention and chronic care
26 2 management services, which includes but is not limited to the
26 3 use of a health risk assessment.
26 4 (5) The methods for increasing communication between
26 5 health care professionals and patients, including patient
26 6 education, patient self=management, and patient follow=up
26 7 plans.
26 8 (6) The educational, wellness, and clinical management
26 9 protocols and tools to be used by health care professionals,
26 10 including management guideline materials for health care
26 11 delivery.
26 12 (7) The use and development of process and outcome
26 13 measures and benchmarks, aligned to the greatest extent
26 14 possible with existing measures and benchmarks such as the
26 15 best in class estimates utilized in the national healthcare
26 16 quality report of the agency for health care research and
26 17 quality of the United States department of health and human
26 18 services, to provide performance feedback for health care
26 19 professionals and information on the quality of health care,
26 20 including patient satisfaction and health status outcomes.
26 21 (8) Payment methodologies to align reimbursements and
26 22 create financial incentives and rewards for health care
26 23 professionals to utilize prevention services, establish
26 24 management systems for chronic conditions, improve health
26 25 outcomes, and improve the quality of health care, including
26 26 case management fees, payment for technical support and data
26 27 entry associated with patient registries, and the cost of
26 28 staff coordination within a medical practice.
26 29 (9) Methods to involve public and private groups, health
26 30 care professionals, insurers, third=party administrators,
26 31 associations, community and consumer groups, and other
26 32 entities to facilitate and sustain the initiative.
26 33 (10) Alignment of any chronic care information system or
26 34 other information technology needs with other health care
26 35 information technology initiatives.
27 1 (11) Involvement of appropriate health resources and
27 2 public health and outcomes researchers to develop and
27 3 implement a sound basis for collecting data and evaluating the
27 4 clinical, social, and economic impact of the initiative,
27 5 including a determination of the impact on expenditures and
27 6 prevalence and control of chronic conditions.
27 7 (12) Elements of a marketing campaign that provides for
27 8 public outreach and consumer education in promoting prevention
27 9 and chronic care management strategies among health care
27 10 professionals, health insurers, and the public.
27 11 (13) A method to periodically determine the percentage of
27 12 health care professionals who are participating, the success
27 13 of the empowerment=of=patients approach, and any results of
27 14 health outcomes of the patients participating.
27 15 (14) A means of collaborating with the health professional
27 16 licensing boards pursuant to chapter 147 to review prevention
27 17 and chronic care management education provided to licensees,
27 18 as appropriate, and recommendations regarding education
27 19 resources and curricula for integration into existing and new
27 20 education and training programs.
27 21 4. Following submission of initial recommendations to the
27 22 director for the state initiative for prevention and chronic
27 23 care management by the advisory council, the director shall
27 24 submit the state initiative to the board for approval.
27 25 Subject to approval of the state initiative by the board, the
27 26 department shall initially implement the state initiative
27 27 among the population of eligible individuals. Following
27 28 initial implementation, the director shall work with the
27 29 department of human services, insurers, health care
27 30 professional organizations, and consumers in implementing the
27 31 initiative beyond the population of eligible individuals as an
27 32 integral part of the health care delivery system in the state.
27 33 The advisory council shall continue to review and make
27 34 recommendations to the director regarding improvements to the
27 35 initiative. Any recommendations are subject to approval by
28 1 the board.
28 2 5. The director of the department of human services shall
28 3 obtain any federal waivers or state plan amendments necessary
28 4 to implement the prevention and chronic care management
28 5 initiative within the medical assistance and IowaCare
28 6 populations.
28 7 Sec. 22. NEW SECTION. 135.162 CLINICIANS ADVISORY PANEL.
28 8 1. The director shall convene a clinicians advisory panel
28 9 to advise and recommend to the department clinically
28 10 appropriate, evidence=based best practices regarding the
28 11 implementation of the medical home as defined in section
28 12 135.157 and the prevention and chronic care management
28 13 initiative pursuant to section 135.161. The director shall
28 14 act as chairperson of the advisory panel.
28 15 2. The clinicians advisory panel shall consist of nine
28 16 members representing licensed medical health care providers
28 17 selected by their respective professional organizations.
28 18 Terms of members shall begin and end as provided in section
28 19 69.19. Any vacancy shall be filled in the same manner as
28 20 regular appointments are made for the unexpired portion of the
28 21 regular term. Members shall serve terms of three years. A
28 22 member is eligible for reappointment for three successive
28 23 terms.
28 24 3. The clinicians advisory panel shall meet on a quarterly
28 25 basis to receive updates from the director regarding strategic
28 26 planning and implementation progress on the medical home and
28 27 the prevention and chronic care management initiative and
28 28 shall provide clinical consultation to the department
28 29 regarding the medical home and the initiative.
28 30 DIVISION VII
28 31 FAMILY OPPORTUNITY ACT
28 32 Sec. 23. 2007 Iowa Acts, chapter 218, section 126,
28 33 subsection 1, is amended to read as follows:
28 34 1. a. The provision in this division of this Act relating
28 35 to eligibility for certain persons with disabilities under the
29 1 medical assistance program shall only be implemented if when
29 2 the department of human services determines that sufficient
29 3 funding is available in appropriations made in this Act, in
29 4 combination with federal allocations to the state, for the
29 5 state children's health insurance program, in excess of the
29 6 amount needed to cover the current and projected enrollment
29 7 under the state children's health insurance program. If such
29 8 a determination is made, the department of human services
29 9 shall transfer funding from the appropriations made in this
29 10 Act for the state children's health insurance program, not
29 11 otherwise required for that program, to the appropriations
29 12 made in this Act for medical assistance, as necessary, to
29 13 implement such provision of this division of this Act.
29 14 b. The department shall notify the general assembly and
29 15 the Code editor when the contingency in paragraph "a" occurs.
29 16 DIVISION VIII
29 17 MEDICAL ASSISTANCE QUALITY IMPROVEMENT
29 18 Sec. 24. NEW SECTION. 249A.36 MEDICAL ASSISTANCE QUALITY
29 19 IMPROVEMENT COUNCIL.
29 20 1. A medical assistance quality improvement council is
29 21 established. The council shall evaluate the clinical outcomes
29 22 and satisfaction of consumers and providers with the medical
29 23 assistance program. The council shall coordinate efforts with
29 24 the costs and quality performance evaluation completed
29 25 pursuant to section 249J.16.
29 26 2. a. The council shall consist of seven voting members
29 27 appointed by the majority leader of the senate, the minority
29 28 leader of the senate, the speaker of the house, and the
29 29 minority leader of the house of representatives. At least one
29 30 member of the council shall be a consumer and at least one
29 31 member shall be a medical assistance program provider. An
29 32 individual who is employed by a private or nonprofit
29 33 organization that receives one million dollars or more in
29 34 compensation or reimbursement from the department, annually,
29 35 is not eligible for appointment to the council. The members
30 1 shall serve terms of three years beginning and ending as
30 2 provided in section 69.19, and appointments shall comply with
30 3 sections 69.16 and 69.16A. Members shall receive
30 4 reimbursement for actual expenses incurred while serving in
30 5 their official capacity and may also be eligible to receive
30 6 compensation as provided in section 7E.6. Vacancies shall be
30 7 filled by the original appointing authority and in the manner
30 8 of the original appointment. A person appointed to fill a
30 9 vacancy shall serve only for the unexpired portion of the
30 10 term.
30 11 b. The members shall select a chairperson, annually, from
30 12 among the membership. The council shall meet at least
30 13 quarterly and at the call of the chairperson. A majority of
30 14 the members of the council constitutes a quorum. Any action
30 15 taken by the council must be adopted by the affirmative vote
30 16 of a majority of its voting membership.
30 17 c. The department shall provide administrative support and
30 18 necessary supplies and equipment for the council.
30 19 3. The council shall consult with and advise the Iowa
30 20 Medicaid enterprise in establishing a quality assessment and
30 21 improvement process.
30 22 a. The process shall be consistent with the health plan
30 23 employer data and information set developed by the national
30 24 committee for quality assurance and with the consumer
30 25 assessment of health care providers and systems developed by
30 26 the agency for health care research and quality of the United
30 27 States department of health and human services. The council
30 28 shall also coordinate efforts with the Iowa healthcare
30 29 collaborative to create consistent quality measures.
30 30 b. The process may utilize as a basis the medical
30 31 assistance and state children's health insurance quality
30 32 improvement efforts of the centers for Medicare and Medicaid
30 33 services of the United States department of health and human
30 34 services.
30 35 c. The process shall include assessment and evaluation of
31 1 both managed care and fee=for=service programs, and shall be
31 2 applicable to services provided to adults and children.
31 3 d. The initial process shall be developed and implemented
31 4 by December 31, 2008, with the initial report of results to be
31 5 made available to the public by June 30, 2009. Following the
31 6 initial report, the council shall submit a report of results
31 7 to the governor and the general assembly, annually, in
31 8 January.
31 9 DIVISION IX
31 10 PREVENTION AND WELLNESS
31 11 INITIATIVES
31 12 Sec. 25. Section 135.27, Code 2007, is amended by striking
31 13 the section and inserting in lieu thereof the following:
31 14 135.27 IOWA HEALTHY COMMUNITIES INITIATIVE == GRANT
31 15 PROGRAM.
31 16 1. PROGRAM GOALS. The department shall establish a grant
31 17 program to energize local communities to transform the
31 18 existing culture into a culture that promotes healthy
31 19 lifestyles and leads collectively, community by community, to
31 20 a healthier state. The grant program shall expand an existing
31 21 healthy communities initiative to assist local boards of
31 22 health, in collaboration with existing community resources, to
31 23 build community capacity in addressing the prevention of
31 24 chronic disease that results from risk factors including being
31 25 overweight and obesity.
31 26 2. DISTRIBUTION OF GRANTS. The department shall
31 27 distribute the grants on a competitive basis and shall support
31 28 the grantee communities in planning and developing wellness
31 29 strategies and establishing methodologies to sustain the
31 30 strategies. Grant criteria shall be consistent with the
31 31 existing statewide initiative between the department and the
31 32 department's partners that promotes increased opportunities
31 33 for physical activity and healthy eating for Iowans of all
31 34 ages, or its successor, and the statewide comprehensive plan
31 35 developed by the existing statewide initiative to increase
32 1 physical activity, improve nutrition, and promote healthy
32 2 behaviors. Grantees shall demonstrate an ability to maximize
32 3 local, state, and federal resources effectively and
32 4 efficiently.
32 5 3. DEPARTMENTAL SUPPORT. The department shall provide
32 6 support to grantees including capacity=building strategies,
32 7 technical assistance, consultation, and ongoing evaluation.
32 8 4. ELIGIBILITY. Local boards of health representing a
32 9 coalition of health care providers and community and private
32 10 organizations are eligible to submit applications.
32 11 Sec. 26. NEW SECTION. 135.27A GOVERNOR'S COUNCIL ON
32 12 PHYSICAL FITNESS AND NUTRITION.
32 13 1. A governor's council on physical fitness and nutrition
32 14 is established consisting of twelve members appointed by the
32 15 governor who have expertise in physical activity, physical
32 16 fitness, nutrition, and promoting healthy behaviors. At least
32 17 one member shall be a representative of elementary and
32 18 secondary physical education professionals, at least one
32 19 member shall be a health care professional, at least one
32 20 member shall be a registered dietician, at least one member
32 21 shall be recommended by the department of elder affairs, and
32 22 at least one member shall be an active nutrition or fitness
32 23 professional. In addition, at least one member shall be a
32 24 member of a racial or ethnic minority. The governor shall
32 25 select a chairperson for the council. Members shall serve
32 26 terms of three years beginning and ending as provided in
32 27 section 69.19. Appointments are subject to sections 69.16 and
32 28 69.16A. Members are entitled to receive reimbursement for
32 29 actual expenses incurred while engaged in the performance of
32 30 official duties. A member of the council may also be eligible
32 31 to receive compensation as provided in section 7E.6.
32 32 2. The council shall assist in developing a strategy for
32 33 implementation of the statewide comprehensive plan developed
32 34 by the existing statewide initiative to increase physical
32 35 activity, improve physical fitness, improve nutrition, and
33 1 promote healthy behaviors. The strategy shall include
33 2 specific components relating to specific populations and
33 3 settings including early childhood, educational, local
33 4 community, worksite wellness, health care, and older Iowans.
33 5 The initial draft of the implementation plan shall be
33 6 submitted to the governor and the general assembly by December
33 7 1, 2008.
33 8 3. The council shall assist the department in establishing
33 9 and promoting a best practices internet site. The internet
33 10 site shall provide examples of wellness best practices for
33 11 individuals, communities, workplaces, and schools and shall
33 12 include successful examples of both evidence=based and
33 13 nonscientific programs as a resource.
33 14 4. The council shall provide oversight for the governor's
33 15 physical fitness challenge. The governor's physical fitness
33 16 challenge shall be administered by the department and shall
33 17 provide for the establishment of partnerships with communities
33 18 or school districts to offer the physical fitness challenge
33 19 curriculum to elementary and secondary school students. The
33 20 council shall develop the curriculum, including benchmarks and
33 21 rewards, for advancing the school wellness policy through the
33 22 challenge.
33 23 Sec. 27. SMALL BUSINESS QUALIFIED WELLNESS PROGRAM TAX
33 24 CREDIT == PLAN. The department of public health, in
33 25 consultation with the division of insurance of the department
33 26 of commerce and the department of revenue, shall develop a
33 27 plan to provide a tax credit to small businesses that provide
33 28 qualified wellness programs to improve the health of their
33 29 employees. The plan shall include specification of what
33 30 constitutes a small business for the purposes of the qualified
33 31 wellness program, the minimum standards for use by a small
33 32 business in establishing a qualified wellness program, the
33 33 criteria and a process for certification of a small business
33 34 qualified wellness program, and the process for claiming a
33 35 small business qualified wellness program tax credit. The
34 1 department of public health shall submit the plan including
34 2 any recommendations for changes in law to implement a small
34 3 business qualified wellness program tax credit to the governor
34 4 and the general assembly by December 15, 2008.
34 5 DIVISION X
34 6 HEALTH CARE TRANSPARENCY
34 7 DIVISION V
34 8 HEALTH CARE TRANSPARENCY
34 9 Sec. 28. NEW SECTION. 135.45 HEALTH CARE TRANSPARENCY ==
34 10 REPORTING REQUIREMENTS.
34 11 1. A hospital licensed pursuant to chapter 135B and a
34 12 physician licensed pursuant to chapter 148, 150, or 150A shall
34 13 report quality indicators, annually, to the Iowa healthcare
34 14 collaborative as defined in section 135.40. The indicators
34 15 shall be developed by the Iowa healthcare collaborative in
34 16 accordance with evidence=based practice parameters and
34 17 appropriate sample size for statistical validation.
34 18 2. A manufacturer or supplier of durable medical equipment
34 19 or medical supplies doing business in the state shall submit a
34 20 price list to the department of human services, annually, for
34 21 use in comparing prices for such equipment and supplies with
34 22 rates paid under the medical assistance program. The price
34 23 lists submitted shall be made available to the public.
34 24 HF 2539
34 25 av:pf/jg/25
Text: HF2538
Text: HF2540
Complete Bill History