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The Iowa Senate finally got down to the business of floor debate and voted on over fifty bills this week. This is quite a contrast from last week when we had a heavy load of subcommittee and committee work due to the first funnel deadline. Much of the debate covered non-controversial bills passed out of committee prior to the first funnel. This is very common after the first funnel, and we should continue to debate bills in the weeks to follow.
One of the bills on Tuesday’s debate calendar was Senate File 2198, which also was referred to as the ‘Right to Try’ bill. This legislation would permit Iowans diagnosed with a terminal illness the opportunity to use medicines in the research process that have not been granted final approval from the United States Food and Drug Administration. Forward-thinking legislation such as this can go a long way in providing terminally ill patients the opportunity to receive these breakthrough treatments.
A $115.5 million FY2016 supplemental appropriation to the state budget was up for debate on Wednesday. Senate Republicans understand the importance of meeting our funding obligations. However, the Senate Republicans pointed out the issue of budgeting gimmicks being used to fund the supplemental appropriation. Senate Republicans have stressed that it is essential that the state budgets in the same way as families are expected to and not spend more than we take in. On Wednesday, Senate Republicans maintained that pledge by voting against the supplemental because it is funded by shifting money through different sources.
The Centers for Medicare & Medicaid Services (CMS) have approved the State of Iowa to proceed with Medicaid modernization on April 1, 2016. This results in a second delay in the transition, the first being from January 1 to March 1. The delays were to allow Iowa Medicaid to meet certain metrics before full implementation, like demonstrating the Managed Care Providers (MCO) had enough network adequacies with doctors and hospitals located across the state. In a letter from CMS to Mikki Stier, Iowa’s Medicaid Director, CMS says it has seen significant improvement in Iowa in the past 60 days, and will be ready by April 1.
Most Iowa Medicaid members have already received packets from a randomly assigned MCO and others have changed to a different MCO which better meets the member’s needs. Members also can continue to make changes in their selection for any reason until June 16, 2016, and after for 'good cause,' such as if their provider has not joined that MCO’s network.
Since Governor Branstad’s announcement about moving to managed care there have been more than 350 public meetings, trainings and listening sessions with members, providers and stakeholders. Not all of these were conducted solely by the Iowa Medicaid Enterprise (IME). A whole host of stakeholders were involved, such as the Departments of Human Services, Public Health, Aging, Inspections and Appeals, Insurance Division, and Office of the Long-Term Care Ombudsman.
The reason for this transition is that Medicaid spending in Iowa has grown significantly from $2.6 billion in FY07 to an estimated $5 billion plus in FY17. By contracting with managed care, some of the risk is borne by the MCO and allows Iowa to budget a fixed number without fluctuations that would have large impacts on Iowa’s budget. The other and more important reason is that despite the dramatic growth in spending, Medicaid members’ health outcomes have failed to improve. When the average Medicaid patient has more than four chronic conditions, sees five different physicians, and sees six different prescribers, they have no continuity of care. By going to a managed care model for its Medicaid program, Iowa is utilizing nationally-experienced companies to coordinate care in a way that makes Medicaid members healthier and fits individual needs.
The State has set up a website with all materials that have been distributed to members and providers. It also includes a frequently asked question section. It can be found at: https://dhs.iowa.gov/ime/about/initiatives/MedicaidModernization.
Medicaid members or family members can also call for more information:
Iowa Medicaid Member Services 1 (800) 338-8366
Managed Care Organizations:
Amerigroup Iowa 1 (800) 600-4441
AmeriHealth Caritas 1 (855) 332-2440
United Healthcare Plan of the River Valley 1 (800) 747-1446
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