SF 168 (LSB 1969XS (3) 88)

SENATE FILE 168

BY  RAGAN and MATHIS

A BILL FOR

An Act relating to an ombudsman to provide Medicaid program assistance and advocacy.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  2C.6A  Assistant for Medicaid program.
   1.  The ombudsman shall appoint an assistant who shall be primarily responsible for investigating complaints relating to the Medicaid program, including both Medicaid fee-for-service and managed care payment and delivery systems, and all Medicaid populations including the long-term services and supports population.
   2.  The ombudsman shall provide assistance and advocacy services to Medicaid recipients and the families or legal representatives of Medicaid recipients. Such assistance and advocacy shall include but is not limited to all of the following: 
   a.  Assisting recipients in understanding the services, coverage, and access provisions and their rights under the Medicaid program.
   b.  Developing procedures for the tracking and reporting of the outcomes of individual requests for assistance, the procedures available for obtaining services, and other aspects of the services provided to Medicaid recipients.
   c.  Providing advice and assistance relating to the preparation and filing of complaints, grievances, and appeals of complaints or grievances, including through processes available under managed care plans and the state appeals process under the Medicaid program.
   3.  The ombudsman shall adopt rules to administer this section.
   4.  The ombudsman shall publish special reports and investigative reports as deemed necessary and shall include findings and recommendations related to the assistance and advocacy provided under this section in the ombudsman’s annual report. 
   5.  The ombudsman and the department of human services shall collaborate to develop a cost allocation plan requesting Medicaid administrative funding to provide for the claiming of federal financial participation for ombudsman activities that are performed to assist with the administration of the Medicaid program. The cost allocation plan shall document the costs that directly benefit the Medicaid program and are consistent with federal requirements. The cost allocation plan shall be developed in a timely manner to allow for such claiming to begin by January 1, 2020.
    Sec. 2.  REPEAL.  Section 231.44, Code 2019, is repealed.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill directs the ombudsman to appoint an assistant who shall be primarily responsible for investigating complaints relating to the Medicaid program, including both the Medicaid managed care and fee-for-service payment and delivery systems, and all Medicaid populations including the long-term services and supports population. The bill specifies the minimum areas of assistance and advocacy to be provided, directs the ombudsman to adopt administrative rules for administration of the bill, and directs the ombudsman to publish special reports and investigative reports as deemed necessary, and to include findings and recommendations related to the Medicaid program assistance and advocacy provided under the bill in the ombudsman’s annual report. 
   The bill also repeals the section of the Code that directs the office of long-term care ombudsman to provide assistance and advocacy services to members of the Medicaid long-term services and supports population since under the bill, the ombudsman will provide assistance and advocacy for both Medicaid managed care and fee-for-service payment and delivery systems and for all populations including the long-term services and supports population. 
   The bill also requires the ombudsman and the department of human services to collaborate to develop a cost allocation plan, consistent with federal requirements, requesting Medicaid administrative funding to provide for the claiming of federal financial participation, by January 1, 2020, for ombudsman activities that are performed to assist with administration of the Medicaid program.