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September News 2013 (Issue #10)

Issue 10, August 30, 2013

Articles in This Issue:


Legislative Interim Studies Set

Legislators have decided to study 10 issues more in depth this fall.  Every year, legislators decide which issues they want to talk about over the “interim” (the time between legislative sessions).  An interim study committee of legislators (and sometimes others) is assigned to each issue, and they develop a report for the full Legislature to consider. 

Interim committees are usually assigned to issues that were just too hard to figure out within the time constraints and political pressures of the legislative session.  This year, legislators have a full slate of issues to study, many more than usual.  Below is a list of the interims, their assignments, their members, how many days they will meet, schedules (if they are available), and links to where you can find meeting notices, minutes, and other materials reviewed by the study committee. 

These meetings are always open to the public, and often include time for public comment.  If you can’t attend the meetings but have an interest in the subject being study, you should feel free to contact the legislators on that interim group. They expect to hear from people outside their district, and welcome the “real world “ stories they hear from Iowans impacted by the issue being studied.  So if you care about an issue being studied – let the members of that interim committee know what you think!

  1. Mental Health & Disability Services Redesign – Fiscal Viability Study Committee. This is a continuation of the committee that met last year to address funding for the regional mental health and disability services system.  In addition to monitoring the ongoing MH/DS redesign, this committee is to recommend a sustainable and permanent approach to state, county, and regional funding of the system, and identify any possible cost savings by working with community-based corrections and other programs where there may be cross-over in populations or needs. 

    This committee is also to look at the “Medicaid offset” passed last year, which requires counties to repay the state for any savings they see from the state’s new Iowa Health and Wellness Plan (which provides health insurance for uninsured Iowans earning up to 133% of the federal poverty level).  The study committee is to study the effects of this “offset” and the impact on a region’s ability to adequately fund core services and begin to make headway in core plus services and meet the needs of additional populations.  Finally, as if this wasn’t enough work, the committee is to make recommendations to address any funding insufficiencies that they find.  This committee will meet twice to do all of this work.  No meetings have been scheduled, but you can watch for updates here. Members are:

    Senators:
     Joe Bolkcom (Co-Chair), Rob Hogg, David Johnson, Amanda Ragan & Mark Segebart
    Representatives:
    Dave Heaton (Co-Chair), Joel Fry, Lisa Heddens, Kevin Koester & Cindy Winckler

  2. Elder Abuse Prevention & Intervention Study Committee. Last year, the Task Force on Elder Abuse Prevention and Intervention issued a report that made many recommendations that would help the state protect elder Iowans and prevent abuse.  The committee was specific to the unique needs of elders – not other dependent adults.  This committee is to review these recommendations and work with the Task Force to determine a plan to implement these recommendations.  The committee will meet only once, since most of the real work will continue to be done by the Task Force.  No meetings have been scheduled, but you can watch for updates at here. Members are:

    Senators:  Mary Jo Wilhelm (Co-Chair), Mark Chelgren, Bob Dvorsky, Liz Mathis & Kent Sorenson
    Representatives: Julian Garrett (Co-Chair), Mark Costello, Lisa Heddens, Bruce Hunter & John Landon
     
  3. Integrated Health Care Models & Multi-Payer Delivery Systems Study Committee. The title is a mouthful, and the scope of work lives up to this title.  This group’s focus is health care reform – the new way of delivering and paying for services covered by the Medicaid and Iowa Health and Wellness Plan (with private sector following).  This group’s list of “to dos” is very long and deals with issues such as ways to bring traditional health care providers together into a team with non-clinical community and social supports to create a “patient-centered medical home” and “community care team.”  The group is to look at what other states have tried, and develop recommendations that can work for Iowa. The group is to pay close attention to developing a structure that incorporates public and nonprofit providers that care for vulnerable populations.  The group can choose to add public members, but none have been added yet.  The work group will meet twice to do all of this work.  No meetings have been scheduled, but you can watch for updates at http://bit.ly/17Qs7nc. Members are:

    Senators:  Amanda Ragan (Co-Chair), Jake Chapman, Jack Hatch, Janet Petersen & Mark Segebart
    Representatives: Linda Miller (Co-Chair), John Forbes, Jo Oldson, Walt Rogers & Rob Taylor

  4. EMS Study Committee. This committee will review Iowa’s Emergency Medical Services (EMS) system, and recommend ways to ensure sustainable statewide funding for EMS.  The group is to consult with stakeholders.
    The committee will meet twice; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Mary Jo Wilhelm (Co-Chair), Michael Breitbach, Jake Chapman, Steve Sodders & Rich Taylor
    Representatives: Ralph Watts (Co-Chair), Bobby Kaufmann, Todd Prichard, Sandy Salmon & Art Staed

  5. Medical Malpractice Study Committee. This was a late issue brought up as health care reform was discussed. Instead of dealing with it then, legislators requested this interim, which will look at ways to address “frivolous” medical malpractice lawsuits (including use of certificate-of-merit affidavits and limitations on the number of health care provider expert witnesses).  The committee will meet once; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Rob Hogg (Co-Chair), Tom Courtney, Pam Jochum, Charles Schneider & Jack Whitver
    Representatives: Chip Baltimore (Co-Chair), Chris Hagenow, Megan Hess, Beth Wessel-Kroeschell & Mary Wolfe

  6. All-Terrain & Off-Road Vehicle Study Committee. This committee will collect information from stakeholders and make recommendations on the use of ATVs and other off-road vehicles. The committee will meet once; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Chris Brase (Co-Chair), Daryl Beall, Tod Bowman, Ken Rozenboom & Dan Zumbach
    Representatives: Brian Moore (Co-Chair), Dwayne Alons, Curt Hanson, Jake Highfill & Sally Stutsman

  7. Iowa Rivers & Waterways Study Committee. This committee will consider options that restore the quality of Iowa’s rivers and waterways, in consultation with engineers, local watershed partnerships, farmers, anglers, boaters and other interested parties. The committee will develop recommendations for an initial plan to prioritize river and waterway projects, and provide defined goals and measurable improvements. The committee will meet once; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Dick Dearden (Co-Chair), Bill Dotzler, Hubert Houser, David Johnson & Brian Schoenjahn
    Representatives: Lee Hein (Co-Chair), Chuck Isenhart, Jarad Klein, Patti Ruff & Jeff Smith
  8. Higher Education Administrative Costs Study Committee. This committee will examine administrative costs at state universities, community colleges, private colleges and for-profit colleges; determine the impact of these costs on Iowa students and families; identify duplication of administrative functions; recommend ways to reduce financial impact on students and families; and review the way fee rates set and charged to students. The committee will meet once; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Rita Hart (Co-Chair), Daryl Beall, Nancy Boettger, Bob Dvorsky & Amy Sinclair
    Representatives: Greg Forristall (Co-Chair), Ron Jorgensen, Patti Ruff, Quentin Stanerson & Beth Wessel-Kroeschell

  9. Iowa Skilled Worker & Job Creation Fund Study Committee. This committee will look at how these funds will be used to attract and retain skilled workers, with emphasis on metrics, reporting, and goals.  The committee will hear testimony from state agencies charged with running each program under this fund and make recommendations to the Economic Development and Education Appropriations Subcommittees. The committee will meet once; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Bill Dotzler (Co-Chair), Rick Bertrand, Mark Chelgren, Brian Schoenjahn & Steve Sodders
    Representatives: Mary Ann Hanusa (Co-Chair), Dennis Cohoon, Dave Deyoe, Cecil Dolecheck & Mary Gaskill

  10. Stray Electric Current & Agriculture Study Committee. This committee will study issues associated with claims that stray electic current or voltage is affecting dairy cattle milk production.  The committee will work with stakeholders in considering options to address the issues and make recommendations to resolve these issues.  The work group will meet once; meetings have not yet been scheduled. You can watch for updates at here. Members are:

    Senators:  Tom Courtney (Co-Chair), Bill Anderson, Wally Horn, Charles Schneider & Rich Taylor
    Representatives:
    Peter Cownie (Co-Chair), Nancy Dunkel, Pat Grassley, Bob Kressig & Steve Olson

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Iowa Health & Wellness Plan Waivers Requested

After five public hearings and a two-month period for written testimony, the Department of Human Services (Iowa Medicaid Enterprise) and Governor Terry Branstad submitted their Iowa Health and Wellness Plan to the Federal government.  The Federal government must now decide whether Iowa will be allowed to use federal Medicaid funds to pay for the plan, which also asks for permission to waive (that is, not pay for) some Medicaid required services.

BACKGROUND
The federal Affordable Care Act (aka "ObamaCare") allowed states to expand their Medicaid programs to include any low-income individuals or families earning up to 138% of the federal poverty level.  That’s $15,414 for an individual or $31,809 for a family of four.  But Iowa took a different approach - the Iowa Health and Wellness Plan.

The Governor and most Republicans in the Iowa Legislature didn’t want to expand Medicaid to cover additional people; Democrats did.  Instead, they passed a compromise (the Iowa Health and Wellness Plan) that expanded Medicaid to people earning up to 100% of the federal poverty level, and paid for private health insurance for people earning between 101-138% of the federal poverty level. 

While both plans will cover “essential health benefits” outlined by the federal Affordable Care Act, they do not pay for the same services that our traditional Medicaid program does. Because Iowa didn't do a straight Medicaid expansion to cover low-income Iowans (and because our Legislature didn’t allow the same package of benefits currently offered by Medicaid), the state must ask the federal government for permission. 

ABOUT THE IOWA HEALTH & WELLNESS PLAN
The Iowa Health & Wellness Plan is divided into two separate components:

  • The Iowa Wellness Plan, which expands Medicaid to provide benefits like those state employees get for Iowans earning up to 100% of the Federal poverty level (FPL), and those considered Medically Frail and earning up to 138% FPL.

  • The Marketplace Choice Plan, which allows a person or family earning between 101-138% FPL to choose a private health insurance plan offered by one of the insurers that has agreed to participate in the federal health care reform “exchange,” or for people earning up to 133% FPL with employer-sponsored health insurance (to help pay for premiums).

As mentioned before, the state has decided to provide a package of benefits that is different than that currently offered through Medicaid.  It is important to remember that current Medicaid programs are not changed – benefits remain the same and do not affect current recipients, new applicants or those on waiting lists.  The changes to the benefits offered only apply to the newly eligible population – people who are eligible just because of their income and do not meet any other requirements of Medicaid (disabled, elderly, or have child living with them).

The state is asking for waivers for these new plans so that it will not have to pay for two required Medicaid services - non-emergency transportation and EPSDT (Early, Periodic, Screening, Diagnostic Treatment, which is the child health component of Medicaid and is designed to improve the health of low-income children). 

Waivers are also requested so premiums can be charged to people in the Marketplace Choice Plan who fail to comply with certain "healthy behaviors” (like getting an annual physical). Medicaid does not usually allow premiums. There are other waiver requests included, but health care groups cite these three as potentially creating access barriers. 

We will continue to follow this issue, including how to sign up, who will be available to help you sign up, and where you can submit public comment on the waiver application.   Watch www.infonetiowa.org for updates, and go to our policy tools to read the Governor's letter to US Health & Human Services Secretary Kathleen Sebelius, review the waiver requests pending federal approval, find out more about the Affordable Care Act, and more.

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Are YOU Eligible for the Iowa Health & Wellness Plan?

Check all that apply.  Are you:

___ Not currently eligible for Medicaid?
___ Age 19-64?
___ Earn less than $15,414/year, or $31,809/year for family of four?

If you answered YES to all of these questions, you may be eligible for the new Iowa Health and Wellness Plan, which provides no cost health insurance for people earning less than 138% of the federal poverty level.  Read three articles for more information!

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About the Iowa Wellness Plan

WHO IS ELIGIBLE?
Iowans age 19-64 earning between 0-100% of the federal poverty level (FPL), who are not otherwise eligible for Medicaid.  If a person has access to insurance through an employer, the program will pay the premiums on their employer-sponsored plans. People who are considered “medically frail” and earn up to 138% of the federal poverty level are also eligible. 

WHAT DOES THE PLAN COVER?
The plan will include benefits similar to those in the state employees health plan, and all federally required “essential health benefits.”  These include primary care physician services, specialty care visits, home health services, chiropractic care, outpatient surgery as needed, allergy testing, chemotherapy, IV infusion services, radiation therapy, dialysis, dental services, emergency room services (non-emergency visits to the ER will require $10 copay after first year), emergency transportation, urgent care clinics, hospitalization, transplants, congenital abnormality corrections, hospice care & respite, skilled nursing (up to 120 days), prescription drugs, physical therapy (60 visit annual cap), durable medical equipment, prosthetics, lab tests, x-rays, medical imaging, sleep studies, diagnostic genetic tests, preventive care services, nutritional counseling (for patients with diabetes only), family planning, and vision care exams.  Mental health and substance use disorder inpatient and outpatient treatment is a covered service, but will be managed by the state’s mental health contractor (Magellan).  Dental services are covered, but will also be provided by contract.

WHAT ISN’T COVERED?
The plan does not cover infertility treatment or diagnosis, acupuncture, bariatric surgery, hearing aides, eye glasses, nursing facility services (except up to 120 days for rehabilitation), non-emergency transportation services, EPSDT (Early Periodic Screening, Diagnosis & Treatment), and Long Term Services and Supports (LTSS).  Individuals who need LTSS (including habilitation services) will be considered medically frail and will automatically be eligible for regular Medicaid services, which cover LTSS.  If a person chooses the Wellness Plan over regular Medicaid, they will not receive LTSS as a wrap-around service.  So if you want LTSS covered, you need to be enrolled in the state’s regular Medicaid plan.

HOW MANY PEOPLE WILL BE COVERED?
An estimated 116,000 people will qualify for this part of the plan, with an additional 19,000 qualifying for premium assistance for their employer-sponsored plans.

DO I GET TO PICK MY DOCTOR?
Yes, people will be given the chance to choose their primary care provider from a list of current Medicaid providers. However, if they do not choose, Medicaid will assign them one. The primary care provider will coordinate all care, and make referrals as needed.  Eventually the provider will be rewarded with better payments if they help a person become or stay healthy.

WILL I HAVE TO PAY FOR ANY SERVICES?
There is no cost to a person in the first year – no premiums and no copayments.  In the second year:

  • Copayments: There is a $10 fee for non-emergency use of the ER. There are no other copayments – not for prescriptions, office visits, hospitalizations, etc. 

  • Premiums: People earning 50% FPL or less are not charged a monthly premium.  People earning 51-100% FPL will be charged a monthly premium based on income ($10-16/month). However, premiums are waived annually if a person engages in certain “healthy behaviors.” Hardship waivers can be requested if they cannot do these healthy behaviors.

Again, there is no cost to anyone in the first year, and no cost in future years if a person engages in “healthy behaviors” annually and doesn’t misuse the ER.

WHAT ARE THESE “HEALTHY BEHAVIORS”?
In the first year, a person must visit their primary care provider for a wellness exam and health risk assessment.  If a person does this in 2014, the monthly premiums are waived in the second year.  Beginning in the second year (and annually after), a person will have to do two of the following annually: health risk assessment, wellness exam, dental exam, smoking cessation program or be a non-smoker, lower BMI, or participate in health education programs or preventive screenings (like a mammogram).

WHEN DOES THIS START?
Enrollment for the program begins October 1, 2013, and coverage begins January 1, 2014. 

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About the Marketplace Choice Plan

WHO IS ELIGIBLE?
Iowans age 19-64 earning between 101-138% of the federal poverty level (FPL), who are not otherwise eligible for Medicaid and do not have access to insurance through an employer.  Those with employer-sponsored plans will receive premium assistance through another state program (Medicaid HIPP Program).

HOW IS THIS DIFFERENT THAN THE WELLNESS PLAN?
The Iowa Wellness Plan is a new limited benefit Medicaid program, run by the state.  The Marketplace Choice Plan will use state and federal Medicaid dollars to pay for a person’s private insurance plan (purchased on the “marketplace”).  So a person will have a private insurance plan, not a state-run Medicaid plan.

DO I GET TO CHOOSE MY PLAN?
Yes, people will choose from two available “qualified health plans” being offered at this time. If a person does not choose a plan, they will be assigned one. Lawmakers hope more plans will become available after the first year, thus giving this group more choices (for instance, the state’s largest insurer Wellmark decided not to offer a plan in 2014, but said they will consider doing so in 2015).

WHAT DOES THE PLAN COVER?
The plan will include all federally required “essential health benefits,” including primary care physician services, specialty care visits, home health services, chiropractic care, infertility diagnoses and treatment (excluding artificial insemination and in vitro fertilization), outpatient surgery, allergy testing, chemotherapy, IV infusion services, radiation therapy, dialysis, dental services (accident only), emergency room services (non-emergency visits to the ER will require $10 copay after first year), emergency transportation, urgent care clinics, hospitalization, transplants, bariatric surgery, congenital abnormality corrections, hospice care, hospice respite (lifetime limit 15 days), skilled nursing (up to 90 days), mental health inpatient and outpatient treatment (parity is required), substance use disorder inpatient and outpatient treatment (parity required), prescription drugs, physical therapy, occupational and speech therapy, durable medical equipment, prosthetics, lab tests, x-rays, medical imaging, sleep studies, diagnostic genetic tests, preventive care services, and nutritional counseling (for patients with diabetes only). Dental services are covered, but will also be provided by a separate plan.

WHAT ISN’T COVERED?
Acupuncture, vision exams, eyeglasses, hearing aides, nursing facility services (except up to 90 days for rehabilitation), non-emergency transportation services, and EPSDT are not covered. HOW MANY PEOPLE WILL BE COVERED?
An estimated 36,000 people will qualify for this part of the plan, with an additional 17,800 qualifying for premium assistance for their employer-sponsored plans.

DO I GET TO PICK MY DOCTOR?
Yes, people will be able to choose their providers from their plan’s provider network.

WILL I HAVE TO PAY FOR ANY SERVICES?
There is no cost to a person in the first year – no premiums and no copayments.  In the second year:

  • Copayments: There is a $10 fee for non-emergency use of the ER. There are no other copayments – not for prescriptions, office visits, hospitalizations, etc. 

  • Premiums: Participants will pay a $20 monthly premium. However, premiums are waived annually if a person engages in certain “healthy behaviors.” Hardship waivers can be requested if they cannot do these healthy behaviors.

Again, there is no cost to anyone in the first year, and no cost in future years if a person engages in “healthy behaviors” annually and doesn’t misuse the ER.

WHAT ARE THESE “HEALTHY BEHAVIORS”?
In the first year, a person must visit their primary care provider for a wellness exam and health risk assessment.  If a person does this in 2014, the monthly premiums are waived in the second year.  Beginning in the second year (and annually after), a person will have to do two of the following annually: health risk assessment, wellness exam, dental exam, smoking cessation program or be a non-smoker, lower BMI, or participate in health education programs or preventive screenings (like a mammogram).

WHEN DOES THIS START & HOW DO I SIGN UP?
Enrollment for the program begins October 1, 2013, and coverage begins January 1, 2014.  There will be a simple streamlined process to select a marketplace plan, and enrollment assistance will be available. 

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More on Iowa Health & Wellness Plan Waivers

WHAT WAIVERS DID THE STATE ASK THE FEDERAL GOVERNMENT TO APPROVE?
Not surprisingly, the federal government puts strings on the money it gives to states for Medicaid.  For instance, Medicaid requires:

  • Payment for EPSDT (Early Periodic Screening Diagnosis and Testing) services, which are a child health benefit.  Iowa is requesting a waiver from this requirement, so it will not have to cover this service. Iowa’s waiver application says that because the population served is adult (age 19-64), these services are not needed.
  • Payment for Non-Emergency Transportation, because low-income populations often have difficulty getting to medical visits.  Iowa is requesting a waiver from this requirement, because the Iowa Legislature didn’t include this in the legislation passed.
  • Choice of Provider, so that people have the choice of where to get their services.  Iowa wants people to choose a primary care provider that will be their health care gatekeeper, or be assigned to one if they do not choose.  Medicaid rules do not allow for the “assigning” of a provider, so Iowa has requested a waiver to allow this.
  • Retroactive Eligibility, so that people can sign up and receive coverage immediately.  Iowa asked for a waiver for this, because the legislation that created the plan makes a person eligible for services on the first day of the month following the application.
  • Cost Sharing Caps, so that people pay no more than 5% of their income on copayments. Iowa is asking to waive all copayments except for the ER visit charge, and is instead asking permission to do monthly premiums that can be waived (but still adding up to no more than 5% of a person’s income).

There are other waiver requests addressing administration of the program and provider payment and rate setting, but the ones listed above were the ones noted as concerning to some advocates in the public hearings.

WHAT WILL THE FEDERAL GOVERNMENT DO?
The US Department of Health and Human Services (Centers for Medicare & Medicaid Services, or CMS) will make a decision on the Iowa Health and Wellness Plan. They will give Iowans another chance to submit comments, and will consider those comments before deciding whether Iowa can implement the program as outlined in the waiver applications. They can decide to approve it as is, deny it, or approve it with certain modifications. Their options are:

  1. Approve the plans.
  2. Approve the plans, but deny some of the waiver requests.
  3. Reject the plans.

We’ll let you know more about the public comment period when information becomes available. Watch www.infonetiowa.org or follow us on Facebook for breaking news.

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MHDS Redesign Update

We will provide more coverage on MHDS Redesign as the interim committees begin to explore ongoing issues. Right now, DHS has written rules that regions will need to follow, including rules about “core services” and “case management.”  These rules are controversial.

What you may not know is that a year-round legislative committee meets monthly to review rules, and hears testimony from people concerned about the rules.  This group is called the “Administrative Rules Review Committee.” 

You can read the proposed rules, find who serves on the Administrative Rules Review Committee, committee schedules and meetings, and more here.  You can also go to the DHS rules website here.

Other News – About half of the 54 counties eligible for equalization payments either got their payments from DHS late or are still waiting for their funds, causing some concern about their ability to maintain services.  This is being resolved on a county-by-county basis, but you may hear about this happening in your area. It has to do with state bills owed, and some misinformation between state and county bookkeeping. Hopefully this will be resolved soon; updates will be posted online at www.infonetiowa.org.

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REMINDER! 2013 Reader Survey

Don’t forget to take our 2013 Reader Survey!

You should have received a copy of the survey in the mail within the last two weeks.  We know you are busy, but your comments help us continuously improve infoNET, our website, and our advocate resources. 

So please take 2-3 minutes and fill out our survey and mail it back (we gave you a postage-paid return envelope too!). You can also fill out the survey online at https://www.surveymonkey.com/s/2013INFONET.

The first 300 people to fill out the survey will be entered into a drawing – with a chance to win one of three $25 gift cards!  So help us out – it’s a win for us, and potentially a win for you!

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