Complaints to the Iowa Office of the Ombudsman increased in the past year, in part due to a 157 percent increase in cases connected to Medicaid managed-care organizations, according to its annual report released Monday — the day after the second anniversary of the program’s rollout in Iowa.
The Office of Ombudsman, an independent agency that investigates complaints against agencies or state and local governments, released its annual report detailing the complaints it received in 2017 from Iowa citizens.
Overall, 4,855 complaints and information requests were filed to the office in 2017, representing a 6.7 increase from the previous year, according to the report.
Jurisdiction complaints alone — which take the most time and effort to investigate, the report stated — were up 14 percent.
Ombudsman Kristie Hirschman said in the report that she has “assigned one full-time staff member to respond to all of our managed-care complaints.”
Managed care was implemented for Iowa’s Medicaid system in April 2016, with three managed-care organizations initially administering coverage for Iowa members.
Complaints from health care providers and members have persisted since that handover, and Monday’s report highlighted the level of frustration Iowans have faced for the past two years.
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Specific cases laid out in the report — including a reduction of services for an elderly member and a quadriplegic as well as a provider’s payments disputes that were ongoing for more than a year — provide a small sampling of the complaints filed, “but they do not begin to describe the systemic frustration voiced by our complainants,” Hirschman stated in the report.
“We share in their frustration,” Hirschman’s comments in the report continued. “In one case, it took us 18 months to get a provider’s payment problems resolved.”
In this instance, an unnamed company that provides care for Medicaid members contacted the Ombudsman office in September 2016 for unpaid reimbursements.
The issue persisted and, in January 2017, the provider claimed a managed-care organization owned the company $289,000 in unpaid reimbursements. A resolution was reached in February 2018.
Hirschman stated in the report she has yet to be convinced that the Department of Human Services, which oversees Iowa’s Medicaid system, “is providing adequate oversight” of the managed-care organizations.
Department of Human Service spokesman Matt Highland wrote in an email that “the department is committed to providing strong oversight from our managed-care partners.”
Sen. David Johnson, I-Ocheyedan, agreed issues have arisen due to the lack of oversight, in particular on the part of the state Legislature.
“It was a unilateral move by the administration (to switch from a state-run program to managed care) and it remains pretty much under their purview,” Johnson said.
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“ ... The (managed-care organizations) are not accountable to the Legislature. The (managed-care organizations) are accountable to their shareholders. That’s what it really comes down to. It isn’t about people, it’s about profits.”
State Rep. David Heaton, R-Mount Pleasant, said he was disappointed in the report’s findings.
“It’s against what we’re trying to do for managed care,” he said. “We want to make sure we’re getting the right services at the right time in the right way.”
The Ombudsman report shared the case of an 80-year-old Medicaid member being denied services by a managed-care organization even after the patient won an appeal to retain those services.
Heaton pointed out legislation that has passed through the House would address that issue head on. An amendment onto House File 2462 would require that if a Medicaid member prevails in an appeal against a managed-care organization, the services must be extended “for a time period determined by the DHS director, unless the member’s condition warrants a change in services as determined by the provider, there is a change in the member’s eligibility status, or the member withdraws from services.”
Therefore, more oversight would be placed on the insurers, Heaton said.
There has been no movement on the Senate side on legislation.
Iowa Corrections, Other Complaints
The Office of Ombudsman’s 2017 annual report also noted that complaints about the state’s corrections facilities have increased 24 percent from 2016. Complaints filed against the Iowa Department of Corrections were up 25 percent, while those against county jails increased 34 percent.
The report stated that inadequate funding and resources as well as dismissive responses to inmate appeals and requests have led to an increase of prison-related complaints. This all points to a trend that “could be a horror story in the making” for Iowa’s correctional system.
State licensing boards also were found to be operating “in almost total secrecy,” Hirschman said in a news release accompanying the report.
Monday’s report pointed to a 17-page special report issued in February 2017 that found a culture of secrecy among state regulators who license doctors, real estate agents and other professionals. It called for 36 licensing boards to “commit to greater transparency in order to improve public confidence of their work.”
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