ARC 2899C

ARC 2899C

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Twenty-five interested persons, a governmental subdivision, an agency or association of 25 or more persons may demand an oral presentation hereon as provided in Iowa Code section 17A.4(1)"b."

Notice is also given to the public that the Administrative Rules Review Committee may, on its own motion or on written request by any individual or group, review this proposed action under section 17A.8(6) at a regular or special meeting where the public or interested persons may be heard.

Pursuant to the authority of Iowa Code sections 249A.4 and 249A.4B, the Department of Human Services hereby gives Notice of Intended Action to amend Chapter 79, "Other Policies Relating to Providers of Medical and Remedial Care," Iowa Administrative Code.

The proposed amendment clarifies the roles, responsibilities and membership of the Medical Assistance Advisory Council (MAAC) in accordance with Iowa Code section 249A.4B, which was amended by 2016 Iowa Acts, chapter 1139, section 99, by rescinding the existing rule pertaining to the MAAC and adopting a new rule that:

● Replaces the chairperson and vice-chairperson positions with co-chairperson positions.

● Adds criteria for the co-chairperson who is a public member of the MAAC, including criteria relating to:

oElection of the "public" co-chairperson.

oThe public co-chairperson's term of office.

oThe voting rights of the public co-chairperson.

● Clarifies that the responsibilities of the co-chairpersons are to:

oCreate the council meeting agenda in consultation with Department staff.

oAppoint members to committees approved by the council.

● Clarifies the membership of the council and the members' terms of service.

● Designates public members and professional and business members as voting members.

● Designates partner agency and medical school representatives as nonvoting members.

● Clarifies the process for electing council members to fill executive committee vacancies.

● Clarifies the membership and terms of service of the executive committee.

● Clarifies that the responsibilities of the Department are to:

oProvide clerical support to arrange for MAAC meetings.

oProvide reports, data, and proposed rule amendments for comment.

oPresent the annual budget.

oGrant access to internal policy subject matter experts.

oMaintain the current list of council members and executive committee members.

oOrganize committee meetings.

oMaintain meeting minutes.

● Provides clarification that written notice of council meetings shall be electronically mailed at least five business days in advance of the meeting. Each notice shall include an agenda for the meeting. The final agenda will be distributed no later than 24 hours prior to the meeting.

● Provides council procedures regarding topics for review and consideration.

● Clarifies the executive committee's responsibility to make recommendations to the Director regarding the budget, policy, and administration of the medical assistance program.

● Clarifies that council procedures apply to both the executive committee and the council.

● Adds a requirement that the council regularly review Medicaid managed care.

● Adds a requirement that the council submit an executive summary of pertinent information regarding deliberations during the prior year relating to Medicaid managed care to the Department no later than November 15 annually.

● Adds a requirement that the council submit to the chairpersons and ranking members of the human resources committees of the Senate and House of Representatives and to the chairpersons and ranking members of the Joint Appropriations Subcommittee on Health and Human Services, on a quarterly basis, minutes of the council meetings during which the council addressed Medicaid managed care.

● Adds a requirement that the council review the recommendations submitted by the executive committee regarding feedback received at the IA Health Link statewide public comment meetings outlined in 2016 Iowa Acts, chapter 1139, section 102.

Any interested person may make written comments on the proposed amendment on or before February 7, 2017. Comments should be directed to Harry Rossander, Bureau of Policy Coordination, Department of Human Services, Hoover State Office Building, Fifth Floor, 1305 East Walnut Street, Des Moines, Iowa 50319-0114. Comments may be sent by fax to (515)281-4980 or by e-mail to policyanalysis@dhs.state.ia.us.

This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department's general rule on exceptions at 441—1.8(17A,217).

After analysis and review of this rule making, no impact on jobs has been found.

This amendment is intended to implement Iowa Code sections 249A.4 and 249A.4B.

The following amendment is proposed.

Rescind rule 441—79.7(249A) and adopt the following new rule in lieu thereof:

441—79.7(249A) Medical assistance advisory council.

79.7(1) Officers.

a. Definitions.

"Co-chairpersons" means the public health director co-chairperson and the public co-chairperson.

"Public co-chairperson" means the individual selected by the other publicly appointed members of the council to serve as a co-chairperson of the council.

"Public health director co-chairperson" means the director of the department of public health, who serves as a co-chairperson of the council.

b. The public co-chairperson's term of office shall be two years. A public co-chairperson shall serve no more than two consecutive terms.

c. The public co-chairperson shall have the right to vote on any issue before the council. The public health director co-chairperson serves as a nonvoting member of the council.

d. The position of public co-chairperson shall be held by one of the ten publicly appointed council members. Ballots will be distributed to the public council members at the quarterly meeting closest to the beginning of the next state fiscal year and will be collected in paper and electronic format and administered by department of human services staff.

e. The co-chairpersons shall appoint members to other committees approved by the council.

f. The co-chairpersons shall also serve on the executive committee and will serve as the co-chairpersons of that committee.

g. Responsibilities.

(1)The co-chairpersons shall be responsible for development of the agendas for meetings of the full council. Agendas will be developed and distributed in compliance with the advance notice requirements of Iowa Code section 21.4. Agendas will be developed in consultation with the staff and director of human services, taking into consideration the following:

1.Workplans. Items will be added to the council's agenda as various tasks for the council are due to be discussed based on calendar requirements. Council deliberations are to be conducted within a time frame to allow the executive committee to receive the council's feedback and make recommendations to the director and for the director to consider those recommendations as budgets and policy for the medical assistance program are developed for the review of the council on human services and the governor, as well as for the upcoming legislative session.

2.Requests from the director of human services.

3.Discussion and action items from council members. The co-chairpersons will review any additional suggestions from council members at any time, including after the draft agenda has been distributed. The agenda will be distributed in draft form five business days prior to the council meeting, and the final agenda will be distributed no later than 24 hours prior to the council meeting.

(2)The co-chairpersons shall preside over all council and executive committee meetings, calling roll, determining a quorum, counting votes, and following the agenda for the meeting.

(3)The co-chairpersons shall consult with the department of human services on other administrative tasks to oversee the council and shall participate in workgroups and subcommittees as appropriate.

79.7(2) Membership. The membership of the council and its executive committee shall be as prescribed at Iowa Code sections 249A.4B(2), 249A.4B(3), and 249A.4B(4a).

a. Council membership.

(1)Council membership of professional and business entities shall consist of those entities outlined in Iowa Code section 249A.4B(2). Professional and business entities shall identify their representatives and report information to the department of human services.

1.If an entity's representative does not attend more than three consecutive meetings, the department of human services will notify the entity and representative and verify whether an alternate contact is needed.

2.Professional and business entities shall determine the length of appointment of their representatives. The department of human services will confirm each representative's participation every two years, regardless of the representative's meeting attendance.

3.All professional and business entities will be voting members of the council.

(2)Council membership of public representatives shall consist of ten representatives which may include members of consumer groups, including recipients of medical assistance or their families, consumer organizations, and others, appointed by the governor for staggered terms of two years each, none of whom shall be members of, or practitioners of, or have a pecuniary interest in any of the professional or business entities specifically represented in Iowa Code sections 249A.4B(2) and 249A.4B(3) and a majority of whom shall be current or former recipients of medical assistance or members of the families of current or former recipients. All public representatives will be voting members of the council.

(3)A member of the HAWK-I board, created in Iowa Code section 514I.5, selected by the members of the HAWK-I board, shall be a member of the council. The HAWK-I board member representative will be a voting member of the council.

(4)Council membership shall also consist of state agency and medical school partners, including representatives from the department of public health, the department on aging, the office of the long-term care ombudsman, Des Moines University and the University of Iowa College of Medicine.

1.Partner agency and medical school representatives will be nonvoting members of the council.

2.If an agency's or school's representative does not attend more than three consecutive meetings, the department of human services will notify the agency or school.

3.Partner agencies and medical schools shall determine the length of appointment of their representatives. The department of human services will confirm each representative's participation every two years, regardless of the representative's meeting attendance.

(5)The following members of the general assembly shall be members of the council, each for a term of two years as provided in Iowa Code section 69.16B. Members appointed from the general assembly will serve as nonvoting members of the council.

1.Two members of the house of representatives, one appointed by the speaker of the house of representatives and one appointed by the minority leader of the house of representatives from their respective parties.

2.Two members of the senate, one appointed by the president of the senate after consultation with the majority leader of the senate and one appointed by the minority leader of the senate.

b. Executive committee membership. Executive committee membership shall consist of the following:

(1)Five professional and business entities identified in Iowa Code section 249A.4B(2). The entity, not the individual representative, is selected for membership on the executive committee. Each selected entity shall appoint its individual representative. Professional and business entities of the council vote to select the business and professional entities of the executive committee.

(2)Five individuals appointed to the council as public members, pursuant to Iowa Code section 249A.4B(2).

1.One of the five public member positions on the executive committee will be held by the co-chairperson identified in subrule 79.7(1).

2.At least one public member shall be a recipient of medical assistance.

3.Public members of the council vote to select the public members of the executive committee.

(3)The co-chairpersons identified in subrule 79.7(1), who shall serve as the co-chairpersons of the executive committee.

(4)The executive committee will be elected for two-year terms, beginning at the start of a state fiscal year.

1.All voting members of the council will be eligible for election to the executive committee, based on the criteria outlined in this paragraph.

2.Ballots will be distributed at the quarterly meeting closest to the beginning of the next state fiscal year and will be collected in paper and electronic format and administered by department of human services staff.

3.Should any vacancy occur on the executive committee, a special election will be held following the standards outlined in this paragraph.

4.Ballots should include the professional and business entity name but omit the name of the representative of the entity.

79.7(3) Responsibilities, duties and meetings. The responsibility of the medical assistance advisory council is to provide recommendations on the medical assistance program to the department of human services through the executive committee of the council.

a. Recommendations. Recommendations made by the executive committee from the council shall be advisory and not binding upon the department of human services or the professional and business entities represented. The director of the department of human services shall consider the recommendations in the director's preparation of medical assistance budget recommendations to the council on human services, pursuant to Iowa Code section 217.3 and implementation of medical assistance program policies.

b. Council. The council shall be provided with information to deliberate and provide input on the medical assistance program. The executive committee will use that input in making final recommendations to the department of human services.

(1)Council meetings.

1.The council will meet no more than quarterly.

2.Meetings may be called by the co-chairpersons; upon written request of at least 50 percent of members; or by the director of the department of human services.

3.Meetings shall be held in the Des Moines, Iowa, area unless other notification is given. Meetings will also be made available via teleconference, when available.

4.Written notice of council meetings shall be electronically mailed at least five business days in advance of the meeting. Each notice shall include an agenda for the meeting. The final agenda will be distributed no later than 24 hours prior to the meeting.

(2)The council shall advise the professional and business entities represented and act as liaison between them and the department.

(3)The council shall perform other functions as may be provided by state or federal law or regulation.

(4)Pursuant to 2016 Iowa Acts, chapter 1139, section 93, the council shall regularly review Medicaid managed care. The council shall submit an executive summary of pertinent information regarding deliberations during the prior year relating to Medicaid managed care to the department of human services no later than November 15 annually.

(5)Pursuant to 2016 Iowa Acts, chapter 1139, section 94, the council shall submit to the chairpersons and ranking members of the human resources committees of the senate and house of representatives and to the chairpersons and ranking members of the joint appropriations subcommittee on health and human services, on a quarterly basis, minutes of the council meetings during which the council addressed Medicaid managed care.

(6)The council shall review the recommendations submitted by the executive committee regarding feedback received at the IA Health Link statewide public comment meetings outlined in 2016 Iowa Acts, chapter 1139, section 102.

c. Executive committee.

(1)Executive committee meetings.

1.The executive committee shall meet on a monthly basis.

2.Meetings may be called by the co-chairpersons; upon written request of at least 50 percent of executive committee members; or by the director of the department of human services.

3.Meetings shall be held in the Des Moines, Iowa, area unless other notification is given. Meetings will also be made available via teleconference, when available.

4.In a month when a council meeting is held, the executive committee shall meet after the council meeting, allowing committee members to discuss and make recommendations based on the topics discussed by council members.

(2)Based on the deliberations of the full council, the executive committee shall make recommendations to the director of human services regarding the budget, policy, and administration of the medical assistance program. Such recommendations may include:

1.Recommendations on the reimbursement for medical services rendered by providers of services.

2.Identification of unmet medical needs and maintenance needs which affect health.

3.Recommendations for objectives of the program and for methods of program analysis and evaluation, including utilization review.

4.Recommendations for ways in which needed medical supplies and services can be made available most effectively and economically to program recipients.

5.Advice on such administrative and fiscal matters as the director of human services may request.

(3)Pursuant to 2016 Iowa Acts, chapter 1139, section 102, the executive committee shall review the compilation of the input and recommendations from the public meetings convened statewide and shall submit recommendations based upon the compilation to the director of human services on a quarterly basis through December 31, 2017.

79.7(4) Procedures.

a. Procedures shall apply to both the council and the executive committee.

b. A quorum shall consist of 50 percent of the current voting members.

c. Where a quorum is present, a position is carried by two-thirds of the council members present.

d. Minutes of council meetings and other written materials developed by the council shall be distributed by the department to each member of the full council.

e. In cases not covered by these rules, Robert's Rules of Order shall govern.

79.7(5) Expenses, staff support, and technical assistance. Expenses of the council and executive committee, such as those for clerical services, mailing, telephone, and meeting place, shall be the responsibility of the department of human services. The department shall arrange for a meeting place, related services, and accommodations. The department shall provide staff support and independent technical assistance to the council and the executive committee.

a. The department shall provide reports, data, and proposed and final amendments to rules, laws, and guidelines to the council for its information, review, and comment.

b. The department shall present the annual budget for the medical assistance program for review and comment.

c. The department shall permit staff members to appear before the council to review and discuss specific information and problems.

d. The department shall maintain a current list of members on the council and executive committee.

e. The department shall be responsible for the organization of all council and executive committee meetings and notice of meetings.

f. As required in Iowa Code section 21.3, minutes of the meetings of the council and of the executive committee will be kept by the department. The co-chairpersons will review minutes before distribution.

g. The department shall compile input and recommendations received at the public meetings established in 2016 Iowa Acts, chapter 1139, section 102, and submit the information to the executive committee for review.