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Iowa Medicaid contracts similar to other states, auditor's report shows

Iowa Auditor Rob Sand explains results of an audit his agency conducted of the Iowa Medicaid Home Health Services progra
Iowa Auditor Rob Sand explains results of an audit his agency conducted of the Iowa Medicaid Home Health Services program during a Jan. 9 news conference at the Iowa Capitol in Des Moines. Standing behind him are Deputy Auditor Annette Campbell (left) and Senior Auditor Melissa Finestead. Sand criticized the Iowa Department of Human Services for providing data he claimed was so flawed he couldn’t test it. (AP Photo/David Pitt)

State Auditor Rob Sand, months after he decried “bad data” stifling the ability to track services under Iowa’s privatized Medicaid system, found agreements with the companies that oversee the state’s program “do not significantly vary from the contracts established by other states.”

However, Sand’s office did find that these agreements have certain criteria that were not typical elsewhere, according to a report released Monday.

“Each of these criteria appear to incentivize managed care organizations for efficient administration of the Medicaid program and/or facilitate Department of Human Services’ monitoring and oversight of the managed care organization operations,” according to the 40-page report.

The managed care organizations, or private companies that administer benefits to Medicaid enrollees for the Iowa Medicaid Enterprise are Amerigroup Iowa and Iowa Total Care. As of June, nearly 654,000 Iowans received Medicaid benefits from a managed care organization.

The state transitioned to the IA Health Link program for Medicaid in April 2016, and has since been plagued with member complaints about denial of services and provider complaints about the lack of adequate reimbursement.

The review by Sand — who has been a critic of the program in the past — was conducted to determine whether criteria included in other states’ contracts would be beneficial to Iowa’s contracts.

When compared with states such as Colorado, Hawaii and Kansas, Iowa is the only state that prohibits “arbitrary reduction” without a clinical reason of managed care organization staff who serve members that require individualized care, according to the report.

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In addition, the report stated that of the other states with comparable programs selected for the review, Iowa was the only state that required managed care organizations to collect data on incurred, but not yet reimbursed, claims for services.

In January, Sand criticized the Iowa Department of Human Services for slowing down another audit of the Medicaid program with “bad data,” inefficiencies and a slow response time. In a 13-page report, Sand detailed the resistance his office encountered from the Iowa Medicaid program.

“Long story short, the finding in this audit is we do not have reliable data. Data are missing. Data are incomplete and incorrect,” he said during a Jan. 9. news conference.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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