In the Iowa’s 2017 legislative term, Iowa has been relatively inactive in regard to healthcare price transparency, cost, and competition legislation. Iowa approved a bill that corrects an apparent oversight that has allowed lawmakers to avoid paying hundreds of thousands of dollars each year in health insurance premiums. However, Iowa did not pass legislation concerning constituent healthcare price transparency, cost, and competition.
Recent Legislative Developments
|2018||SF 2026||DISCLOSING PRICES CHARGED FOR HEALTH SERVICES: The bill requires a healthcare providers to disclose the prices charged, prior to the negotiation of any discounts and assuming no medical complications, for the 25 most common health services the health care provider renders.
Requires hospitals to disclose and make available to the public in a single document the prices charged, prior to the negotiation of any discounts and assuming no medical complications, for the 75 most common inpatient and the 75 most common outpatient health services, as grouped by a Medicare diagnosis – related group, rendered by the hospital.
|Introduced to Human Resources Committee on 1/10/18.|
|2017||SF 230||CONCERNING PAYMENT OF INSURANCE PREMIUM COSTS BY MEMBERS AND FULL TIME EMPLOYEES OF THE GENERAL ASSEMBLY AND INCLUDING EFFECTIVE DATE AND APPLICABILITY PROVISIONS: Corrects an apparent oversight that has allowed lawmakers to avoid paying hundreds of thousands of dollars each year in health insurance premiums. Premiums for most lawmakers will increase monthly premiums from $20 to, in some cases, as much as $446. The Bill requires lawmakers to adopt only nonunion insurance plans offered to executive branch employees and will apply not only to Iowa’s 150 lawmakers, but also to most other full-time employees of the legislative branch.||Passed – Signed by Governor on 4/12/17.|
- None identified.
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Iowa Code § 135.166 directs the Department of Public Health to enter into a memorandum of understanding with the Iowa Hospital Association (IHA) to act as the state’s agent for the purposes of collecting, maintaining, and disseminating hospital and ambulatory information. The IHA operates the Iowa Hospital Charges Compare website containing actual charge data for inpatient and outpatient hospital and ambulatory services, stating that “Iowa Hospital Charges Compare should be considered a starting point for comparing costs of care between Iowa hospitals.”
- Iowa Code § 135.78 directs the Department of Public Health to compile “all relevant financial and utilization data in order to have available the statistical information necessary to properly monitor hospital and health care facility charges and costs.” The Department is also mandated to collect a current rate schedule and any subsequent modifications from all hospitals and healthcare facilities.
- Iowa Admin. Code § 191-27.3 (514F) authorizes preferred provider arrangements between a health insurance carrier and a provider, stating the manner of payment may include capitation payments as a system of remuneration.
- Iowa Code § 249N.1 through 249N.6, the “Iowa Health and Wellness Plan,” a medical assistance program and provider network, is established for the purposes of achieving healthcare cost containment and quality healthcare outcomes through a patient-centered, integrated healthcare system. Eligible members receive defined coverage and benefits under the plan, which is operated under Iowa Medicaid for individuals with an income at or below one hundred percent of the federal poverty level, and operated by qualified health plans on the federal exchange for individuals above the one hundred percent mark but below 133% of the federal poverty level. The provider network shall include all providers enrolled in the medical assistance program and all participating accountable care organizations, who shall receive payment based on a value-based system (risk-based, and tied to quality of care and cost avoided). A member in the plan must choose a primary medical provider to coordinate member care.
- Iowa Code §§ 135.61 through 135.83 prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Public Health through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.
- Iowa Code § 515.102 requires that the form of all insurance policies to be issued in state must be filed with and approved by the Commissioner of Insurance.
- Iowa Code § 514A.13 requires that the classification of risks and premium rates for an insurance policy must be filed with and approved by the Commissioner of Insurance. Subsequent rate changes are also subject to approval by the Commissioner.
FY 2018 BUDGET
Iowa’s fiscal year begins July 1st and ends June 30th of the following year. Iowa enacted its FY 2018 Budget in the 2017 regular legislative session. To view Iowa’s Council on Human Services Budget submission for FY 2018, click here.
- Iowa because was one of 16 states to file an amicus brief in the Ninth Circuit appeal of Luke’s Health Care Sys. v. FTC.