HOUSE REPUBLICAN STAFF ANALYSIS ________________________________________________________________________ Bill: Committee: Date: Staff:
House File 580 Human Resources March 16, 2009 Brad Trow (1-3471)
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Reimbursement for IowaCare Services Provided by Non-Participating Facilities In 2005, the Iowa Legislature created the IowaCare program which provides health care coverage to adults with incomes below 200 percent of poverty. Services are limited to Broadlawns Medical Center in Des Moines for Polk County Residents, and the University of Iowa Hospitals and Clinics for the rest of the state. While this program has worked well for some, the ability to get IowaCare services for many around the state is complicated by their inability to get to Iowa City. Instead they go to their local hospital which provides the care, but is not reimbursed for it. Since the program was created via federal Medicaid waiver, changing the rules would be difficult at this point. But, the waiver is up for renewal in 2010. House File 580 is the first attempt by the Legislature to direct the Department of Human Services on what changes are to be proposed for the IowaCare program under a revised waiver. The bill directs that non-participating providers be reimbursed by the IowaCare program for service provided to IowaCare enrollees in emergency situations. ________________________________________________________________________
Summary of Action ________________________________________________________________________
Section by Section Analysis Section 1 –NonParticipating Provider – IowaCare – Reimbursement For Eligible Services Provided to a Member - Section 1 states that beginning on July 1, 2010, the Department of Human Services will include in any federal Medicaid waiver language providing reimbursement for services provided to an IowaCare enrollee at a health care facility that is not part of the IowaCare program.
Payment for these services are conditional. The non-participating provider must contact the appropriate IowaCare provider (either Broadlawns or UIHC) and come to a consensus on one of two options: The non-participating facility and the IowaCare provider agree that the medical status of the IowaCare enrollee seeking care is such that the service could be postponed until they get to the IowaCare provider; or The non-participating facility and the IowaCare provider agree that the medical status of the IowaCare enrollee seeking care is such that it is medically necessary for the nonparticipating facility must provide care. If condition of the IowaCare enrollee is such that it is a medical emergency and the nonparticipating facility cannot contact the IowaCare provider, then the non-participating facility will stabilize the enrollee and document the situation. Once the enrollee is stabilized, the nonparticipating facility will get in contact with IowaCare provider.
