Iowa Senate takes up Medicaid oversight

By Rod Boshart, Gazette Des Moines Bureau

DES MOINES — Iowa senators launched an effort Tuesday to require more government oversight of private companies the state has contracted effective April 1 to manage care provided to 560,000 Iowans who rely on Medicaid for their health services.

'The intent of this legislation is to safeguard the interests of Medicaid members, encourage the participation of Medicaid providers and protect Iowa taxpayers,' Sen. Amanda Ragan, D-Mason City, said at the start of floor debate in the Iowa Senate on Senate File 2213.

The measure, which cleared committee with bipartisan support, seeks 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, Ragan said in her opening remarks.

Other provisions of the bill would assign duties and authority to the managed-care ombudsman program, expand and enhance the Medical Assistance Advisory Council, and direct state officials to improve consumer protections, monitor rates and payments and collect data as part of the evaluation and oversight process, she added.

Floor debate was deferred after Ragan's opening remarks to give minority Republicans time to review changes made to the original legislation and allow time to have amendments drafted for consideration when senators return to the topic today.

'There are too many unanswered questions about who will provide oversight and how and where individuals will get services,' said Ragan, who noted that federal regulators twice delayed Gov. Terry Branstad's implementation of Medicaid privatization that initially was to begin Jan. 1.

'It is undeniable that Gov. Branstad took a 'too much, too fast' approach to Medicaid privatization,' Ragan added. 'This Medicaid privatization program is destined to harm the very people it was supposed to help.'

Branstad reaction

Branstad has questioned the need for oversight that he sees onerous and duplicative beyond new duties of the three private managed-care organizations and the authority that his administration and the Legislature already have to monitor Medicaid as it moves from a fee-for-service model to a system that encourages health outcomes and rewards providers for improvements.

'The whole idea of managed-care companies is indeed to provide oversight over the providers to see that we're moving in that direction,' the governor told reporters earlier this week.

'So we're looking at more people that oversee the overseers basically to manage the managers,' Branstad said of the Senate's proposed oversight expansion. 'How much of that duplication do we want and how much will it cost? 'Those are the kinds of things you have to balance in determining whether this is good public policy.'

The six-term GOP governor said the state insurance commissioner already is in place to oversee the MCOs and the state has ombudsmen to advocate for Medicaid participants who have questions or problems. He said he was open to adding more ombudsmen if needed but was reserving judgment on legislation calling for more oversight.

Lower voting age

In other action, senators voted 49-0 to lower the age to 17 that Iowans can register to vote in primary and general elections.

Sen. Jeff Danielson, D-Waterloo, said Senate File 2142 was another step in an effort to make Iowa's election process more secure, efficient, accurate and citizen-friendly.

'With this bill, we will expand the enterprise of democracy, hopefully deepening the meaning of freedom by broadening our definition of universal suffrage,' he said. 'We're not moving heaven and earth, but we do believe that allowing Iowans who are 17 to begin that process so that when they are 18 on Election Day that they have had the full benefit of participating in who those candidates would be in particular primaries and other research that they would want to do.'

Outpatient options

Senators also voted 49-0 to expand options for outpatient treatment of a person with a serious mental impairment who fails to comply with a court order — including the ability to provide the choice of an injectable medication to address bipolar of schizophrenic conditions.

Prescription authority

Also Tuesday, senators voted 24-25 to defeat a bill designed to give prescription-writing authority to certain psychologists.

Sen. Joe Bolkcom, D-Iowa City, switched his vote to make it possible for him to file a motion to reconsider Senate File 2188 to keep the measure eligible for possible changes or further work this session. Three GOP senators voted with 21 Democrats to support the measure, while four majority Democrats opposed the bill in its current form.