2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM
514I.5 - HAWK-I BOARD.

        514I.5  HAWK-I BOARD.
         1.  A hawk-i board for the hawk-i program is established.  The
      board shall meet not less than six and not more than twelve times
      annually, for the purposes of establishing policy for, directing the
      department on, and adopting rules for the program.  The board shall
      consist of seven members, including all of the following:
         a.  The commissioner of insurance, or the commissioner's
      designee.
         b.  The director of the department of education, or the
      director's designee.
         c.  The director of public health, or the director's designee.

         d.  Four public members appointed by the governor and subject
      to confirmation by the senate.  The public members shall be members
      of the general public who have experience, knowledge, or expertise in
      the subject matter embraced within this chapter.
         e.  Two members of the senate and two members of the house of
      representatives, serving as ex officio, nonvoting members.  The
      legislative members of the board shall be appointed one each by the
      majority leader of the senate, after consultation with the president
      of the senate, and by the minority leader of the senate, and by the
      speaker of the house of representatives, after consultation with the
      majority leader of the house of representatives, and by the minority
      leader of the house of representatives.  Legislative members shall
      receive compensation pursuant to section 2.12.
         2.  A public member shall not have a conflict of interest with the
      administrative contractor.
         3.  Members appointed by the governor shall serve two-year
      staggered terms as designated by the governor, and legislative
      members of the board shall serve two-year terms.  The filling of
      positions reserved for the public representatives, vacancies,
      membership terms, payment of compensation and expenses, and removal
      of the members are governed by chapter 69.  Members of the board are
      entitled to receive reimbursement of actual expenses incurred in the
      discharge of their duties.  Public members of the board are also
      eligible to receive compensation as provided in section 7E.6.  The
      members shall select a chairperson on an annual basis from among the
      membership of the board.
         4.  The board shall approve any contract entered into pursuant to
      this chapter.  All contracts entered into pursuant to this chapter
      shall be made available to the public.
         5.  The department of human services shall act as support staff to
      the board.
         6.  The board may receive and accept grants, loans, or advances of
      funds from any person and may receive and accept from any source
      contributions of money, property, labor, or any other thing of value,
      to be held, used, and applied for the purposes of the program.
         7.  The hawk-i board shall do all of the following:
         a.  Develop the criteria to be included in a request for
      proposals for the selection of any administrative contractor for the
      program.
         b.  Define, in consultation with the department, the regions
      of the state for which plans are offered in a manner as to ensure
      access to services for all children participating in the program.
         c.  Approve the benefit package design, review the benefit
      package design on a periodic basis, and make necessary changes in the
      benefit design to reflect the results of the periodic reviews.
         d.  Develop, with the assistance of the department, an
      outreach plan, and provide for periodic assessment of the
      effectiveness of the outreach plan.  The plan shall provide outreach
      to families of children likely to be eligible for assistance under
      the program, to inform them of the availability of and to assist the
      families in enrolling children in the program.  The outreach efforts
      may include, but are not limited to, solicitation of cooperation from
      programs, agencies, and other persons who are likely to have contact
      with eligible children, including but not limited to those associated
      with the educational system, and the development of community plans
      for outreach and marketing.  Other state agencies shall assist the
      department in data collection related to outreach efforts to
      potentially eligible children and their families.
         e.  In consultation with the clinical advisory committee,
      assess the initial health status of children participating in the
      program, establish a baseline for comparison purposes, and develop
      appropriate indicators to measure the subsequent health status of
      children participating in the program.
         f.  Review, in consultation with the department, and take
      necessary steps to improve interaction between the program and other
      public and private programs which provide services to the population
      of eligible children.  The board, in consultation with the
      department, shall also develop and implement a plan to improve the
      medical assistance program in coordination with the hawk-i program,
      including but not limited to a provision to coordinate eligibility
      between the medical assistance program and the hawk-i program, and to
      provide for common processes and procedures under both programs to
      reduce duplication and bureaucracy.
         g.  By January 1, annually, prepare, with the assistance of
      the department, and submit a report to the governor, the general
      assembly, and the council on human services, concerning the board's
      activities, findings, and recommendations.
         h.  Solicit input from the public regarding the program and
      related issues and services.
         i.  Establish and consult with a clinical advisory committee
      to make recommendations to the board regarding the clinical aspects
      of the hawk-i program.
         j.  Prescribe the elements to be included in a health
      improvement program plan required to be developed by a participating
      insurer.  The elements shall include but are not limited to health
      maintenance and prevention and health risk assessment.
         k.  Establish an advisory committee to make recommendations to
      the board and to the general assembly by January 1 annually
      concerning the provision of health insurance coverage to children
      with special health care needs.  The committee shall include
      individuals with experience in, knowledge of, or expertise in this
      area.  The recommendations shall address, but are not limited to, all
      of the following:
         (1)  The definition of the target population of children with
      special health care needs for the purposes of determining eligibility
      under the program.
         (2)  Eligibility options for and assessment of children with
      special health care needs for eligibility.
         (3)  Benefit options for children with special health care needs.

         (4)  Options for enrollment of children with special health care
      needs in and disenrollment of children with special health care needs
      from qualified child health plans utilizing a capitated fee form of
      payment.
         (5)  The appropriateness and quality of care for children with
      special health care needs.
         (6)  The coordination of health services provided for children
      with special health care needs under the program with services
      provided by other publicly funded programs.
         l.  Develop options and recommendations to allow children
      eligible for the hawk-i program to participate in qualified
      employer-sponsored health plans through a premium assistance program.
      The options and recommendations shall ensure reasonable alignment
      between the benefits and costs of the hawk-i program and the
      employer-sponsored health plans consistent with federal law.  In
      addition, the board shall implement the premium assistance program
      options described under the federal Children's Health Insurance
      Program Reauthorization Act of 2009, Pub. L. No. 111-3, for the
      hawk-i program.
         8.  The hawk-i board, in consultation with the department of human
      services, shall adopt rules which address, but are not limited to
      addressing, all of the following:
         a.  Implementation and administration of the program.
         b.  The program application form.  The form shall include a
      request for information regarding other health insurance coverage for
      each child.
         c.  Criteria for the selection of an administrative contractor
      for the program.
         d.  Qualifying standards for selecting participating insurers
      for the program.
         e.  The benefits to be included in a qualified child health
      plan which are those included in a benchmark or benchmark equivalent
      plan and which comply with Tit. XXI of the federal Social Security
      Act.  Benefits covered shall include but are not limited to all of
      the following:
         (1)  Inpatient hospital services including medical, surgical,
      intensive care unit, mental health, and substance abuse services.
         (2)  Nursing care services including skilled nursing facility
      services.
         (3)  Outpatient hospital services including emergency room,
      surgery, lab, and x-ray services and other services.
         (4)  Physician services, including surgical and medical, and
      including office visits, newborn care, well-baby and well-child care,
      immunizations, urgent care, specialist care, allergy testing and
      treatment, mental health visits, and substance abuse visits.
         (5)  Ambulance services.
         (6)  Physical therapy.
         (7)  Speech therapy.
         (8)  Durable medical equipment.
         (9)  Home health care.
         (10)  Hospice services.
         (11)  Prescription drugs.
         (12)  Dental services including preventive services.
         (13)  Medically necessary hearing services.
         (14)  Vision services including corrective lenses.
         (15)  Translation and interpreter services as specified pursuant
      to the federal Children's Health Insurance Program Reauthorization
      Act of 2009, Pub. L. No. 111-3.
         f.  Standards for program eligibility.  The standards shall
      not discriminate on the basis of diagnosis.  Within a defined group
      of covered eligible children, the standards shall not cover children
      of higher income families without covering children of families with
      lower incomes.  The standards shall not deny eligibility based on a
      child having a preexisting medical condition.
         g.  Presumptive eligibility criteria for the program.
      Beginning January 1, 2010, presumptive eligibility shall be provided
      for eligible children.
         h.  The amount of any cost sharing under the program which
      shall be assessed based on family income and which complies with
      federal law.
         i.  The reasons for disenrollment including, but not limited
      to, nonpayment of premiums, eligibility for medical assistance or
      other insurance coverage, admission to a public institution,
      relocation from the area, and change in income.
         j.  Conflict of interest provisions applicable to the
      administrative contractor and participating insurers, and between
      public members of the board and the administrative contractor and
      participating insurers.
         k.  Penalties for breach of contract or other violations of
      requirements or provisions under the program.
         l.  A mechanism for participating insurers to report any
      rebates received to the department.
         m.  The data to be maintained by the administrative contractor
      including data to be collected for the purposes of quality assurance
      reports.
         n.  The use of provider guidelines in assessing the well-being
      of children, which may include the use of the bright futures for
      infants, children, and adolescents program as developed by the
      federal maternal and child health bureau and the American academy of
      pediatrics guidelines for well-child care.
         9. a.  The hawk-i board may provide approval to the director
      to contract with participating insurers to provide dental-only
      services.  In determining whether to provide such approval to the
      director, the board shall take into consideration the impact on the
      overall program of single source contracting for dental services.
         b.  The hawk-i board may provide approval to the director to
      contract with participating insurers to provide the supplemental
      dental-only coverage to otherwise eligible children who have private
      health care coverage as specified in the federal Children's Health
      Insurance Program Reauthorization Act of 2009, Pub. L. No. 111-3.  

         98 Acts, ch 1196, §6, 16; 99 Acts, ch 208, §38; 2002 Acts, ch
      1175, §37; 2003 Acts, ch 108, §131; 2003 Acts, ch 124, §2--7; 2003
      Acts, ch 175, §39; 2007 Acts, ch 218, §106; 2008 Acts, ch 1156, §51,
      58; 2008 Acts, ch 1188, §8, 9; 2009 Acts, ch 118, §28--31
         Confirmation, see §2.32