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MEDICAID MANAGED CARE OVERSIGHT COMES BACK TO LIFE

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The Iowa Senate passed a bill two weeks ago that would set up a structure to make sure Medicaid managed care organizations (MCOs) are held accountable for the delivery of health care services and long-term services and supports to the 560,000 low-income Iowans, older Iowans, and Iowans with disabilities.  Nearly two-thirds of Iowa's 50 Senators voted to develop a system of oversight to make sure MCOs were doing what was expected, and that care to vulnerable Iowans was monitored and problems were addressed. 

However, bipartisan support in the Senate for Senate File 2213 did not translate to support in the House, and the bill failed to make it out of committee before the March 11th funnel deadline.   But we have always said, in the Legislature nothing is ever really dead, and where there is a will, there is a way. As you might recall, bills coming out of the Government Oversight Committee are not subject to deadlines, so they can be debated at any time.

Sen. Rob Hogg of Cedar Rapids, who chairs the Government Oversight Committee, decided the issue was too important to let it die for the year, so he redrafted the bill and voted it out of committee on March 17.  Sen. Hogg told the committee the  bill (Senate File 2305) gives House members "one more shot" at addressing the oversight of managed care.  Senators Hogg, Schoenjahn, and Kinney voted for the bill; Senators Garrett and Whitver voted against it.

Legislators say the intent of the bill is the same   - Medicaid managed care should be implemented and administered in a manner that safeguards the interests of Medicaid members, encourages the participation of Medicaid providers and protects the interests of Iowa taxpayers.  The new bill (Senate File 2305) has not changed much and includes:

  • Vigorous government oversight of the privatized Medicaid system
  • Significant stakeholder involvement
  • Investments in system improvements and not just private company profits
  • Requirements that DHS and the managed care companies comply with provisions to protect consumers, preserve provider networks, address the unique needs of children and assure accountability.
  • Requirements that the Legislative Health Policy Oversight Committee created as part of the Legislature last session to meet at least quarterly to provide continuing oversight for the publicly funded hawk-i and Medicaid programs to:
    • Ensure effective and efficient administration of hawk-i and Medicaid
    • Address stakeholder concerns
    • Monitor program costs and expenditures
    • Ensure the needs of eligible members are being met and health outcomes are improving
  • Comprehensive review of program integrity activities
  • Creation of a Medicaid Reinvestment Fund
  • Strengthening of Duties and Authority of the Managed Care Ombudsman Program
  • Expansion and Enhancement of the Medical Assistance Advisory Council
  • Direction to the Patient-Centered Health Advisory Council to recommend appropriate alignment with holistic, population-health based approaches
  • Direction to DHS to undertake specific tasks to improve policies in the areas of: consumer protections, children, provider participation enhancement, rates and payments, data collection, and evaluation and oversight.

Click here for a full review of the bill.