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INTEGRATED HEALTH HOME DIRECTIVE SURVIVES

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There were at least six bills introduced this year dealing with integrated health homes, the intensive care coordination program for Iowans with serious and persistent mental illness or complex mental health and disability services needs.

Integrated health homes (IHHs) were first developed by Iowa's former managed care company, Magellan.  Magellan spent months (years even) working with providers to develop the program and give technical assistance to local providers.  In December, the United MCO made the sudden decision to pull these programs in-house, with no notice and no explanation. 

Since that time the IHH community has been in an uproar, demanding legislators take action. Legislators from both partiies, and in both chambers, have put pressure on DHS and the MCOs to figure out a course of action.  Here's where we are at post-funnel with this issue:

  • Iowa's Medicaid Director (Mike Randol) has "paused" all action on health homes and will bring MCOs and providers together to discuss the futre of the program, look at data collected, discuss improvements, identify corrective courses of action if needed, and outline alternative paths if needed.  He has said this review should take about six months, but added MCOs have the right and ability in their contracts to change the health home program. 
  • Not all legislators were satisfied with this "pause" and fear changes will occur when the session is adjourned, and they will have not ability to stop any further action.  Sen. Mark Chelgren of Ottumwa is leading debate on a bill (SF 2284) that requires DHS submit a report on the health home review to legislators by October 1, 2018, and allows changes only through rule (which takes an average of 6-9 months and must go through the Legislature's Administrative Rules Review Committee before being enacted).  The bill also prohibits MCOs from doing the care coordination in-house, and requires they run the program as required in the state plan amendment in place as of July 1, 2017.  
     
  • Providers say this may all be a little too late - they are losing IHH staff and at least one integrated health home in NW Iowa has closed their doors rather than wait out the program's slow demise. 

We will continue to watch the progress of this issue, but if this is something important to you, contact your legislators while there is still an opportunity to keep this issue alive!