House File 653 S-3371 Amend House File 653, as amended, passed, and reprinted by 1 the House, as follows: 2 1. Page 151, after line 20 by inserting: 3 < DIVISION ___ 4 MEDICAID MANAGED CARE —— PROGRAM EVALUATION 5 Sec. ___. MEDICAID MANAGED CARE —— PROGRAM EVALUATION. 6 1. a. The department of human services shall utilize the 7 medical assistance advisory council to receive input from the 8 membership of the council, the university of Iowa public policy 9 center, and representatives of other entities and consumers 10 with interest or expertise relevant to the Medicaid program, to 11 review Medicaid managed care and, at a minimum, accomplish all 12 of the following: 13 (1) Evaluate the effects on the Medicaid long-term services 14 and supports population in receiving Medicaid services through 15 capitated Medicaid managed care and determine the feasibility 16 of transitioning the long-term services and supports population 17 to a fee-for-service or other payment model that best meets 18 the needs of the population. The objectives of the evaluation 19 shall include a determination of the best service delivery 20 system and reimbursement methodology to ensure sufficient 21 access by members to providers and services, to provide 22 adequate reimbursement to providers of services and supports, 23 to improve the health of the population, to improve member 24 experience of care and ensure positive outcomes, and to reduce 25 costs through these improvements. 26 (2) In addition to the evaluation of the effects on the 27 Medicaid long-term services and supports population, evaluate 28 the effects of capitated Medicaid managed care on the remaining 29 Medicaid populations and determine the best service delivery 30 system and reimbursement methodology to ensure sufficient 31 access of members to providers and services, provide adequate 32 reimbursement to providers of services and supports, to 33 encourage the delivery of high quality services, and to ensure 34 positive outcomes for each population. 35 -1- HF653.2581 (3) 87 pf/rn 1/ 2 #1.

(3) Review the impact of capitated Medicaid managed care 1 provider reimbursement methodologies and rates on provider 2 sustainability and member access, and make recommendations 3 regarding rate and payment methodologies to ensure provider 4 sustainability and adequate access to providers. 5 (4) Review and determine measures to institute consistency 6 and uniformity across processes and procedures utilized by 7 Medicaid managed care organizations to increase efficiencies 8 and reduce duplication and delay. 9 (5) Review data needs to determine additional Medicaid 10 managed care contractor data reporting requirements to ensure 11 member access to medically necessary services and achievement 12 of overall positive health outcomes. 13 b. The department shall submit a report, summarizing the 14 evaluation and including findings and recommendations, to the 15 governor and the general assembly by December 15, 2017. 16 2. The department of human services shall require the 17 completion of an initial external quality review of the 18 Medicaid managed care program by January 1, 2018, and, as 19 part of the ongoing quality assurance activities of the 20 Iowa Medicaid program, shall continue to contract with 21 the university of Iowa public policy center to perform an 22 evaluation of Medicaid managed care by January 1, 2018. > 23 2. By renumbering as necessary. 24 ______________________________ AMANDA RAGAN ______________________________ LIZ MATHIS -2- HF653.2581 (3) 87 pf/rn 2/ 2 #2.