House File 653 S-3384 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. In addition to being consistent with options under 7 federal law and regulations, and contingent upon receipt of 8 approval from the office of the governor of reimbursement 9 for each abortion performed under the Medicaid program, the 10 medical assistance appropriation for the fiscal year beginning 11 July 1, 2017, in this 2017 Act, shall also be contingent upon 12 completion of the Medicaid managed care program evaluation as 13 specified in this section. 14 2. a. The department of human services shall utilize the 15 medical assistance advisory council to receive input from the 16 membership of the council, the university of Iowa public policy 17 center, and representatives of other entities and consumers 18 with interest or expertise relevant to the Medicaid program, to 19 review Medicaid managed care and, at a minimum, accomplish all 20 of the following: 21 (1) Evaluate the effects on the Medicaid long-term services 22 and supports population in receiving Medicaid services through 23 capitated Medicaid managed care and determine the feasibility 24 of transitioning the long-term services and supports population 25 to a fee-for-service or other payment model that best meets 26 the needs of the population. The objectives of the evaluation 27 shall include a determination of the best service delivery 28 system and reimbursement methodology to ensure sufficient 29 access by members to providers and services, to provide 30 adequate reimbursement to providers of services and supports, 31 to improve the health of the population, to improve member 32 experience of care and ensure positive outcomes, and to reduce 33 costs through these improvements. 34 (2) In addition to the evaluation of the effects on the 35 -1- HF653.2647 (2) 87 pf/rn 1/ 3 #1.

Medicaid long-term services and supports population, evaluate 1 the effects of capitated Medicaid managed care on the remaining 2 Medicaid populations and determine the best service delivery 3 system and reimbursement methodology to ensure sufficient 4 access of members to providers and services, provide adequate 5 reimbursement to providers of services and supports, to 6 encourage the delivery of high quality services, and to ensure 7 positive outcomes for each population. 8 (3) Review the impact of capitated Medicaid managed care 9 provider reimbursement methodologies and rates on provider 10 sustainability and member access, and make recommendations 11 regarding rate and payment methodologies to ensure provider 12 sustainability and adequate access to providers. 13 (4) Review and determine measures to institute consistency 14 and uniformity across processes and procedures utilized by 15 Medicaid managed care organizations to increase efficiencies 16 and reduce duplication and delay. 17 (5) Review data needs to determine additional Medicaid 18 managed care contractor data reporting requirements to ensure 19 member access to medically necessary services and achievement 20 of overall positive health outcomes. 21 b. The department shall submit a report, summarizing the 22 evaluation and including findings and recommendations, to the 23 governor and the general assembly by December 15, 2017. 24 3. The department of human services shall require the 25 completion of an initial external quality review of the 26 Medicaid managed care program by January 1, 2018, and, as 27 part of the ongoing quality assurance activities of the 28 Iowa Medicaid program, shall continue to contract with 29 the university of Iowa public policy center to perform an 30 evaluation of Medicaid managed care by January 1, 2018. > 31 2. By renumbering as necessary. 32 -2- HF653.2647 (2) 87 pf/rn 2/ 3