Bills › 89th General Assembly
Relating to a pilot program to allow Medicaid members to participate in direct primary care agreements
Where it is now
- Done: IntroducedJanuary 14, 2021
- Done: SubcommitteeJanuary 20, 2021
- Done: Senate committeeFebruary 9, 2021
- Done: Passes the SenateMarch 29, 202128–17
- Stopped: House committeeDied when the General Assembly ended
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2022 session adjourned on May 24, 2022, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary The Iowa Department of Human Services will start a two-year test program to change how some people get medical care. Under this plan, pregnant women and adults without children can use direct primary care services paid for by the state. Medicaid will act as the payer for these specific health services during the pilot program.1
Read the official explanation
This bill requires the department of human services to develop and oversee a pilot program beginning January 1, 2022, and ending December 31, 2023, to allow Medicaid members in specified categories to receive primary care health services through a direct primary care arrangement, with the Iowa Medicaid enterprise acting as the third-party payor for such services utilizing state-only funds. The eligible Medicaid member categories shall include childless adults and pregnant women.
Senate subcommittee
Named January 20, 2021. On January 21, 2021 it recommended passage.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
Fiscal note
Can’t be estimated Compare with other bills
AI summary Senate File 81 creates a pilot program that allows pregnant women and childless adults to receive primary care services through monthly fee arrangements paid for by the state. The fiscal impact cannot be determined until the program's scope is defined, though costs are assumed to range between $50 and $150 per member per month. A small portion of these increased costs to the state may be offset by lower payments to managed care organizations.3
Read the fiscal note
Description
Senate File 81 requires the Department of Human Services (DHS) to develop and oversee a pilot program beginning January 1, 2022, and ending December 31, 2023, to allow childless adults and pregnant women to receive primary care health services through a direct primary care arrangement (DPCA), with the Iowa Medicaid Enterprise (IME) acting as the third-party payor for services utilizing State-only funds.
Background
A DPCA is a contract between a primary care provider and a patient, under which the provider agrees to deliver primary care services in exchange for a monthly fee. Under the traditional DPCA model, the provider does not accept insurance reimbursement, and patients’ fees cover outpatient, nonspecialty services such as preventive services, basic lab services, and chronic disease management. The DPCA typically does not include coverage of prescription drugs, specialty care services, hospitalization, or most other benefits provided by a medical insurance policy.
Assumptions
- There are approximately 199,000 Iowa Health and Wellness Plan members and 30,000 pregnant women enrolled in Iowa Medicaid who would be eligible for a pilot program.
- A DPCA would cost between $50 and $150 per member per month (PMPM) for each member who elects to participate in the pilot program.
- The new pilot program will be funded with 100.0% State funds.
- There may be a small decrease in the PMPM capitation payment paid to the managed care organizations (MCOs) for each individual enrolled in the pilot program. The amount of change would depend on benefit design for the new program, including which primary care services are included or excluded.
Fiscal Impact
The fiscal impact for SF 81 cannot be determined until the scope of the pilot program is defined, although the cost is assumed to range between $50 and $150 PMPM depending on the benefits provided. A small portion of the increased cost may be offset by lower PMPM capitation payments to the MCOs due to reduced cost of primary care services.
Sources
- Department of Human Services
- Commonwealth Fund
- Medicaid, Direct Primary Care · February 10, 2021
Lobbying
0 for · 5 against · 16 undecided · Who →
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Tried before
89th General Assembly
Earlier and later bills are matched by wording or an identical title.
Tried before
This idea has been filed in an earlier General Assembly. None became law, though one got through a chamber.
- SF 2346 Relating to a pilot program to allow Medicaid members to participate in direct primary car…88th General Assembly · Passed Senate · same titlePassed a chamber
Matched by wording or an identical title.