Iowa House Republicans unveil Medicaid oversight plan

DES MOINES — House Republicans unveiled a Medicaid oversight plan Thursday that requires 'unprecedented' data and reporting by private managed care organizations to protect consumers, focus on patient health outcomes and guard against waste, fraud and abuse of taxpayer dollars.

Rep. Linda Miller, R-Bettendorf, said the GOP health care initiative is intended to add protections and accountability measures to ensure patients continue to receive high-quality care by providing an information 'conduit' to legislators, policymakers and the public without expanding government bureaucracy.

Confused by how the new Medicaid system works?

We're here to help. Click the image above to check out an interactive explanation of Iowa's new Medicaid managed care system.

'Iowans expect us to have oversight of the Medicaid system. It's our job,' Miller told reporters at a Statehouse news conference. She said the House GOP approach will provide details lawmakers need to make good decisions within an existing framework to oversee a Medicaid program that now is being managed by three private companies.

'We want it to be efficient and we want to make sure that the data that we're getting back as legislators and policy makers actually makes sense,' added Miller in discussing a plan also calls for letting the public see much of the performance data from managed care organizations in charge of services for Iowa's 580,000 Medicaid patients.

Senators who supported a more-expansive oversight structure called the GOP bill a good start for negotiations they hope will net a bipartisan compromise.

'We believe the bill that we passed provides the kind of oversight we need in Iowa to ensure that that health care safety net is truly in place and, if it's not, what we can do to try and make sure that we close any gaps,' said Senate President Pam Jochum, D-Dubuque. 'Does that mean that we shut the door on any negotiations — of course not.'

Earlier this session, senators voted 32-18 in support of a government oversight plan to closely monitor private companies managing Iowa's $5 billion Medicaid system to ensure the needs of Iowans and their health care providers do not take a back seat to corporate profits.

Included in the 48-page bill were provisions to enhance the role and responsibilities of the Health Policy Oversight Committee, execute a comprehensive review of program integrity, and create a special fund to finance system improvements and support for recipients among other things.

Sen. Liz Mathis, D-Cedar Rapids, chair of the Senate Human Resources Committee, said much of the data covered in the GOP plan is information that the private companies and state agencies already are going to produce under the Medicaid managed care contract. She wanted to see 'a little bit more robust consumer protection' and independent assessments from providers, enrollees and experts outside the Medicaid system.

Sen. David Johnson, R-Ocheyedan, said at first blush the House GOP approach 'appears quite passive,' calling for a lot of reports with no explanation of what happens next or who determines when protections and advocates are needed — MCOs or the Medicaid clients' doctors.

'This is a work in progress. I believe we need to leave the session with some form of legislative oversight but we actually need to give the Legislature more authority to hold meetings with administrative staff and MCO representatives,' said Johnson, who called for quarterly Medicaid oversight meetings. 'I'm still optimistic we can leave here with some agreement on oversight.'

House Speaker Linda Upmeyer, R-Clear Lake, said she expected some form of Medicaid oversight would be included in the Legislature's fiscal 2017 health & human services budget bill that gets passed before the session ends later this month.

'At the end of the day what is important to know is that we have never, ever held this state's health plan to higher standards than we are today,' Upmeyer told reporters. 'We have never had higher standards of integrity, transparency and accountability.'

Including the Medicaid oversight language in a budget bill would make it subject to an item veto by Gov. Terry Branstad, which was a concern from some legislators on Thursday.

Branstad spokesman Ben Hammes said the governor has been supportive of efforts to protect patients and taxpayers from the beginning of this process. 'Gov. Branstad is pleased that the House Republicans have come up with their own proposal and looks forward to working with the Legislature to build consensus on the appropriate level of oversight,' he said in an email.