Bill
Bill > HF2053
IA HF2053
IA HF2053A bill for an act relating to the standardization of claim submission and reimbursement processes of managed care organizations.
summary
Introduced
01/14/2026
01/14/2026
In Committee
01/14/2026
01/14/2026
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
This bill relates to claim submission and reimbursement processes followed by managed care organizations (MCOs) administering the medical assistance program (program). The bill defines “managed care contract” and “managed care organization”. Under current law, the department of health and human services (HHS) is directed to adopt rules determining the method and level of reimbursement for all medical and health services provided under the program. The bill directs the director of HHS to also adopt rules establishing a standardized submission and reimbursement process (process) for claims for all benefits received by or services rendered to a recipient by a provider on or after July 1, 2027. The bill requires HHS to amend all managed care contracts, pursuant to the terms of each contract, to provide that MCOs adhere to the process. The bill further requires that all managed care contracts entered into, extended, or renewed by HHS on or after July 1, 2027, provide that MCOs adhere to the process.
AI Summary
This bill aims to standardize how healthcare providers submit claims and get reimbursed by managed care organizations (MCOs) that administer the state's medical assistance program. It defines "managed care contract" as an agreement between the state's Department of Health and Human Services (HHS) and an MCO to manage the program, and "managed care organization" as a specific type of health plan operating under such a contract. Currently, HHS sets reimbursement rates, but this bill mandates that by July 1, 2027, HHS must also establish a standardized process for providers to submit claims for services rendered to program recipients. Furthermore, HHS is required to update all existing managed care contracts to ensure MCOs follow this new standardized process, and any new, extended, or renewed contracts after that date must also include this requirement.
Committee Categories
Health and Social Services
Sponsors (1)
Last Action
Introduced, referred to Health and Human Services. H.J. 77. (on 01/14/2026)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF2053 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/HF2053.html |
Loading...