DES MOINES — Two health care leaders in the Iowa Senate have introduced legislation to make significant reforms to Iowa’s privatized Medicaid system.
Senate File 156, the Senate Democratic Medicaid Improvement Bill, has been introduced by Senators Amanda Ragan of Mason City and Liz Mathis of Hiawatha. They are, respectively, the ranking members of the Senate Health & Human Services Budget Committee and the Senate Human Resources Committee.
“Governor Reynolds and legislative Republicans are sticking with privatized Medicaid,” Ragan said. “Given that, our focus is making urgently needed improvements. We are proposing large and small improvements to how privatized Medicaid serves Iowa families and healthcare providers.”
“Iowans need privatized Medicaid to do three things and do them well,” Mathis said. “One, make sure Iowans get the healthcare services they need when they need them. Two, make sure Iowa healthcare providers are correctly paid for the work they do and paid on time. Three, key Medicaid decisions should be made by Iowans rather than by employees of out-of-state, for-profit companies.”
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Senate File 156 Highlights
Senate File 156 would make these changes to Iowa’s privatized Medicaid on behalf of Iowa patients and providers:
Return the Long Term Services and Supports (LTSS) population to publicly managed Medicaid
The MCOs are supposed to make money by helping sick people get better and thereby lowering costs. Many Iowans suffering the most from privatized Medicaid system are Iowans living with severe, complex, permanent disabilities and conditions. Because these Iowans aren’t going to “get better,” denying care and cutting needed services is largely the only way to “save money.” This is unacceptable.
Require independent conflict-free case management and assessments
There is an inherent conflict of interest in privatized managed care. Case management and patient assessments are both performed by employees of the MCO that pays for the care of those patients. Assessments are more accurate when made by an independent entity and coordinated by case managers who put the patient’s best interest first.
End the practice of requiring prior authorization for substance abuse treatment
Every substance abuse counselor knows that an immediate response is essential when someone requests treatment. “Medication assisted treatment” can quickly take away the cravings once it begins. However, waiting for prior authorizations results in missed opportunities or even overdose deaths that could have been prevented.
Require MCOs to develop and implement workforce recruitment, retention and training programs
Iowa has a severe health care workforce shortage. The MCOs now manage the care of some 600,000 Iowans. Every other major health care provider and insurer in the state of Iowa contributes time, talent, and money to efforts to expand and improve Iowa’s health care workforce. This legislation will require the MCOs to join that effort.
Implement an external review process for providers
Today, when the MCOs deny a claim, an Iowa health care provider can only attempt to negotiate with MCO that denied the claim. When commercial health insurers deny claims, providers can appeal to an external reviewer. This legislation establishes a similar appeal system when the MCOs refuse to pay for care.
Make it easier and quicker for members to switch MCOs
If a local doctor decides to switch the MCO he or she contracts with, that doctor’s patients must be able switch COs if they want to continue seeing that doctor. Currently, patients must wait up to 45 days before they can ask DHS to approve a change for good cause. This is an unusually long and burdensome process for Iowans. This legislation would allow patients to request that DHS approve an MCO switch after 10 days.
Move the Managed Care Ombudsman Program to the State Ombudsman’s Office
Independent advocates for Iowans are an absolute necessary if Iowa managed care is going to work. Iowa’s Long Term Care Ombudsman has only one full-time managed care ombudsman. There could be three to four more working for Iowa families and health care providers if we took full advantage of federal matching funds. The MCO ombudsman services should be moved to the State Ombudsman Office.