Iowa

SUMMARY

In the 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.

 

LEGISLATION/REGULATION

Legislative Calendar

Iowa’s current regular legislative session runs from 1/8/2018 – 4/18/2018.

 

Recent Legislative Developments

Healthcare Transparency

2018 SF 2026  DISCLOSING PRICES CHARGED FOR HEALTH SERVICES: The bill requires 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.  

Active –Introduced to Human Resources Committee on 1/10/18.

 

Healthcare Cost

2018 SB 3161 INCENTIVE PROGRAMS AND HEALTHCARE COSTS: Provides transparency tools offered by health carriers and health care providers to enable insured individuals to seek lower cost health services, and including applicability. Active – Subcommittee approves and recommends passage on 2/12/18.
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.

 

Healthcare Markets

2018 SB 1168/HF 2305 HEALTH INSURANCE COVERAGE FOR TELEHEALTH: reintroduced version of HF 348. Passed – Reported correctly enrolled, signed by Speaker and President on 3/27/18.
SF 2298 PHARMACY REGULATION: Entities engaged in the wholesale distribution of prescription drugs will be held to a higher minimum standard, equivalent to the standards required by the federal Drug Supply Chain Security Act, than entities engaged in other drug distribution activities. Creates specific license categories for third party logistics providers, limited distributors, and wholesale distributors to shield entities exempt from DSCA from the standards required of wholesale distributions under federal law. Active – Placed on House Calendar on 3/22/18.
SSB 3004 PRESCRIPTION DRUG BENEFITS – NO-DEDUCTIBLE COPAYMENT STRUCTURE: Would require that 25 percent of health carrier policies or plans in individual, group, or small group markets not include deductibles for prescription drug coverage. If a health carrier offers only one contract, policy, or plan in the individual market, all policies must provide first dollar coverage in the prescription drug benefit. Active -Senate Subcommittee recommends amendment and passage 2/14/18.
2017 HF 348 HEALTH INSURANCE COVERAGE FOR TELEHEALTH: The bill provides definitions relative to telehealth and requires that a contract, policy, or plan providing for third party payment or repayment for health, medical, or surgical coverage benefits cover telehealth. On or after January 1, 2018, the contract, policy or plan shall not deny coverage of telehealth services on the basis that the basis that the services are provided via telehealth if the services would be covered if provided in person. Inactive –Referred to Commerce Committee on 2/16/2017.

 

Key Statutes

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.

 

Healthcare Costs

  • Iowa Code § 155A.3 If an authorized prescriber prescribes a biological product, the pharmacist may exercise professional judgment in the economic interest of the patient by selecting a biological product that is an interchangeable biological product for the biological product prescribed for dispensing and sale to the patient. If the cost of the prescription or any part of it will be paid by expenditure of public funds authorized under chapter 249A, the pharmacist shall exercise professional judgment by selecting a biological product that is an interchangeable biological product for the biological product prescribed for dispensing and sale.

 

Healthcare Contracting

  • 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 § 514F.7 health carrier, health benefit plan, or utilization review organization shall consider available recognized evidence-based and peer-reviewed clinical practice guidelines when establishing a step therapy protocol. Upon written request of a covered person, a health carrier, health benefit plan, or utilization review organization shall provide any clinical review criteria applicable to a specific prescription drug covered by the health carrier, health benefit plan, or utilization review organization.

 

Healthcare Markets

  • 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.

 

LITIGATION/ENFORCEMNT

  • 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.

 

KEY RESOURCES 

Iowa State Legislature

Iowa Office of the Attorney General