DES MOINES — An update Wednesday on Iowa’s controversial Medicaid managed care program from the Department of Human Services was encouraging for leaders of the Iowa House Government Oversight Committee, which held a similar hearing a year ago.
“It left me feeling positive,” said Rep. Ruth Ann Gaines of Des Moines, the committee’s ranking Democrat. “I feel better than I did last year and in 2018.”
Human Services Director Kelly Garcia and Medicaid Enterprises Director Michael Randol briefed the oversight committee on work they’ve done to address concerns over prior authorization and timely payment issues. They told lawmakers they developed new processes and are meeting regularly with the private managed care organizations to ensure they are living up to the contracts.
The department is monitoring claims payments and denials and member grievances and appeals, Randol said.
Prior authorizations required for services and procedures, which have been the source of complaints, were reduced. More than a half million Iowans rely on Medicaid for health care. In the year’s first quarter, 5.46 million claims were processed. About 210,000 required prior authorization, he said, and there were 441 grievances and 333 appeals filed.
That sounded like progress to Chairwoman Mary Ann Hanusa, R-Council Bluffs.
“We’ve heard a number of concerns from service providers and constituents about prior authorizations,” Hanusa said. “Prior authorizations comes up most frequently and I’m pleased to hear the department and the (private managers) are working to streamline that process.”
For example, Randol said that in some cases the managers were approving more than 90 percent of the requests for prior authorization.
“So we asked why have them? Are they necessary?” he asked.
Randol doubts the prior authorization requirement will decrease sharply because Amerigroup already has removed more than 600 authorization codes.
He also addressed Gov. Kim Reynolds’ decision in January to withhold $44 million from Iowa Total Care due to issues related to incorrect payments to medical providers and the insurance company’s record keeping. Iowa Total Care is one of the companies paid by the state to administer health coverage to thousands of Iowans under the Medicaid managed-care program.
The company was required to reprocess at least 75 percent of 900,000 claims and make system changes in order to be paid, Randol said.
Human Services met with the company three times a week until last week when the meetings were scaled back to twice weekly. In addition, the department met with Iowa Total Care after each check run to look at the number of claims received, rejected, denied and paid.
Human Services also looked at the top 10 denial reasons, the top 10 procedures most denied and the top three providers affected by the denials.
Randol said care providers will be surveyed before the state decides whether to release payment to the company.
Garcia spoke of her vision for community integration of people with intellectual disabilities. “Very soon,” she said her department will unveil a plan for serving that population. It will be done with providers, families and other stakeholders.
“At the heart of this effort is a reinvigorated approach, from our perspective at DHS, to really have a vision around how we provide services to individuals with intellectual disabilities,” Garcia said.
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She anticipates a series of town hall meetings across the state to get input from providers and others about the challenges and barriers to that transition to community integration.
The oversight committee has another hearing with Garcia at 2 p.m. Monday to talk about Glenwood Resource Center. The U.S. Department of Justice is conducting an investigation of allegations that Jerry Rea, the former Glenwood superintendent, was planning to conduct human sexual arousal experiments and had begun questionable hydration therapy on patients at the state facility.
Committee members will be the only ones allowed to ask questions, Hanusa said.
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