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MEDICAID MANAGED CARE UPDATE

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The Department of Human Services has finished its public hearings on managed care. These six hearings have been packed, with lots of questions asked. Since our last report, much has happened.

  • The State has said it will pick up to four managed care organizations. Seventeen (17) managed care organizations have submitted a letter saying the plan to submit a proposal to managed the state's Medicaid system.  They are:
    • Aetna Better Health of Iowa Inc.
    • Amerigroup Corporation
    • AmeriHealth Caritas Iowa
    • CHA HMO, Inc.
    • Cigna HealthSpring
    • Gateway Health Plan, LP on behalf of its managed care affiliates
    • Goold Health Systems, an Emdeon company
    • Health Information Designs
    • Iowa Total Care, Inc. (Centene)
    • Magellan Complete Care of Iowa, Inc
    • Medica Health Plans
    • Meridian Health Plan
    • Molina Healthcare, Inc
    • MultiPlan Shared Health
    • UnitedHealthcare Plan of the River Valley, Inc.
    • UnityPoint Health
    • WellCare Health Plans, Inc.
    • You can read the questions (with answers) asked by these managed care organizations here.

  • The state has issued amendments to the Request for Propsals (RFP) based on the questions from the companies.  Here are the updated documents:
  • The first round of questions/answers has passed, but those with questions about the plan to move Iowa's Medicaid program to managed care have until Thursday, April 2 to ask questions.  These questions are answered in "Frequently Asked Questions" document, which is now being updated weekly to address questions from stakeholders and the general public.

The Department will do another round of public meetings when it puts together its waiver, which will show the Federal government how we plan to roll out managed care.  Those meetings will likely be in June.  Managed care organizations will submit their proposals on May 8, but DHS has until July 31 to make its decision. Here are a few other resources you may find helpful:

Finally, the Iowa Senate has a bill that would create strong legislative oversight of the Medicaid managed care contracts. That bill is Senate File 452, and it was passed unanimously (50-0) by the Iowa Senate two weeks ago.  The bill does two things:

  • Creates a Legislative Medicaid Transformation and Oversight Commission that will monitor the transition to managed care and make recommendations for improvement. The focus of the Commission's work will be defining and monitoring outcomes, reviewing DHS' contract oversight, and ensuring that members are able to access appropriate, high quality healthcare services.

  • Outlines conditions that must be included in any managed care contracts. These conditions focus on consumer protections that ensure access to high quality care that emphasizes consumer choice, self-direction, person- and family-centered care, access to care in close proximity, and necessary appeal processes; transition provisions that ensure people do not "fall through the cracks" as the system changes; healthcare provider protections that ensure adequate reimbursement while promoting care coordination and improved health outcomes; healthcare provider financial incentives that align with outcome metrics and care integration; common metrics and evaluation methodologies across managed care organizations based on socioeconomic determinants of health and improvement in population health outcomes; and appropriate planning, contract monitoring and enhanced legislative oversight.

Obviously the second bullet is causing some heartburn with legislators in the House, who do not want to disrupt the already tight managed care timeline. Some of the things in this bill would require an amendment to the RFP, which would delay the timelines. A subcommittee of the House Human Resources Committee met last week to hear from lobbyists on the bill, most of whom supported the bill (the rest were just "monitoring" it).  Rep. Linda Miller, who chaired the subcommittee, said she needs to think about the bill before deciding to move it forward.  She indicated parts of the bill that woud affect the RFP would need to be amended out.  The subcommittee, which also included Rep. Brian Best and Rep. Ruth Ann Gaines, will discuss the bill's future early in the week.  At this point it appears that the bill will either be heavily amended before passing out of committee, or it will die in the funnel and legislators will work on something smaller to put in a budget bill (where the Governor can veto parts he doesn't like).