Proyectos de ley › 89.ª Asamblea General
Relating to a pilot program to allow Medicaid members to participate in direct primary care agreements
Dónde está ahora
- Hecho: Presentado14 de enero de 2021
- Hecho: Subcomité20 de enero de 2021
- Hecho: Comité del Senado9 de febrero de 2021
- Hecho: Lo aprueba el Senado29 de marzo de 202128–17
- Se detuvo: Comité de la CámaraMurió al terminar la Asamblea General
- Sigue: Lo aprueba la Cámara
- Sigue: A gobernador(a)
- Sigue: Firmado como ley
Murió al terminar la sesión La sesión de 2022 terminó el 24 de mayo de 2022, la última sesión ordinaria de la Asamblea General. Los proyectos que no pasaron por ambas cámaras murieron. ¿Qué es el embudo (funnel)?
Qué contiene
Resumen con IA 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. (Todavía no está traducido al español.)1
Lea la explicación oficial (en inglés)
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
Nota fiscal
Can’t be estimated Compare con otros proyectos
Resumen con IA 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. (en inglés)3
Lea la nota fiscal (en inglés)
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 · 10 de febrero de 2021
Cabildeo
0 a favor · 5 en contra · 16 indecisos · Quiénes →
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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.