Dems: Mathis: Medicaid Oversight Law takes effect July 1 in midst of continued problems

June 30, 2016
After the news conference, Senator Liz Mathis (left) speaks with Pat Giorgio (right), president of Evergreen Estates in Cedar Rapids and the former Board Chair of the National Center for Assisted Living.

After the news conference, Senator Liz Mathis (left) speaks with Pat Giorgio (right), president of Evergreen Estates in Cedar Rapids and the former Board Chair of the National Center for Assisted Living.


Senate Committee will meet this month to seek answers and solutions

June 30, 2016

Statement by Sen. Liz Mathis

Thank you for coming today. I’m State Senator Liz Mathis, the chair of the Iowa Senate Human Resources Committee. 

Today I want to highlight the Medicaid oversight reforms which go into effect tomorrow, July 1. 

I also want to draw attention on the continuing problems the Medicaid mess is creating for Iowa families and Iowa health care providers.  Medicaid beneficiaries and providers will take questions about problems created by the mismanaged transition from publicly-managed Medicaid to for-profit private managed care. 

To review –Governor Branstad made a unilateral decision last year to change the way Medicaid is administered.  The Governor switched from a non-profit government-run system (Iowa Medicaid Enterprise) to privatized managed care involving three for-profit corporations.

In 2016 Senate Democrats wrote two bills; one to sever the managed care contracts and another comprehensive Medicaid oversight bill. 

Both passed the Senate with bipartisan support, but neither were taken up by the House GOP. 

The Iowa Senate and House did agree on compromise oversight language which was approved as part of the human services appropriations bill, House File 2460. 

Your handout summarizes that compromise.  It is intended to make sure vulnerable Iowans get the services they need and that taxpayer dollars are well-spent.  Its measures include:

  • Expanded authority and staffing for the Long-Term Care Ombudsman.
  • Expanded authority and a larger consumer role in the Medical Assistance Advisory Council (MAAC).
  • Additional accountability and transparency through expanded reporting and public posting of data on consumer protections, outcome achievement and program integrity
  • External quality review reports and independent NCQA (National Committee for Quality Assurance) reports on the three MCOs that will be submitted directly to the legislature
  • Specific program policy improvements include:

At a recipient’s request, an MCO will continue services during an appeal and provide adequate prior notice of potential recovery of costs.

Providers shall be allowed to file appeals on a recipient’s behalf.

MCOs shall not impose a more restrictive scope of practice requirements or standards of practice on a primary care provider than those in current state law.

MCO shall attempt to set up single case arrangements with out of network providers. 

Occupational therapy is added as a covered service in hawk-i insurance program for children.

I want to make it clear today that the transition from Medicaid to managed care continues to be a major burden on Iowa families and Iowa health care providers.

I know because legislators continue to receive an unprecedented number of emails, phone calls and face-to-face questions from Iowa families and health care providers desperate for help.  Their concerns include complicated, frustrating problems involving with billing, pre-authorization, transportation, and rates.

It is not getting any better; in fact, it is getting worse.

I’m concerned that Iowa’s persistent Medicaid mess will make Iowa physicians more hesitant to take new Medicaid/managed care patients.  That would reduce access to care, and result in poorer health outcomes and increased overcall costs. 

Many clinics report that their nurses are force to spend spending more time correcting MCO mistakes and less time helping patients.

Many providers report that while they contracted for payments at one rate, they are now being paid at a lower rate.

Here are some details on two specific cases. 

The Senior Vice President and COO of Iowa Health Care has told me that 150 Iowa Nursing Facility providers have called in the last two days because a managed care organization is rejecting 60 percent of their claims for May. 

In short, the MCO is refusing to pay for millions of dollars of health care services that have already been provided.

Those sorts of refusals to pay make it very difficult for these nursing facilities to pay bills they owe to Iowa companies and pay the salaries they owe to Iowa workers.

One nursing home administrator told Iowa Health Care that he—again—been forced to borrowed money to pay bills – this time in the amount of a $150,000 loan from the bank.

These are not success stories.

Health care providers are businesses – businesses that help drive the economic engine in this state. They pay taxes, employ people, contribute to the community, and care for our sick and disabled.    

That’s why, as the Chair of the Senate Human Resources Committee, I’ve called a committee meeting on July 26 at the State Capitol.  We have asked DHS and IME to give us updates and will hear from providers and beneficiaries as well.  The public is encouraged to attend.  It will begin at 10 a.m. and end around 2:30 in the afternoon.



Medicaid Oversight Summary

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