Senate Study Bill 1253 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON MATHIS) A BILL FOR An Act relating to Medicaid program transformation and 1 oversight. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2591XC (9) 86 pf/nh
S.F. _____ Section 1. NEW SECTION . 249A.9 Medicaid transformation and 1 oversight commission —— findings, goals, and intent. 2 1. The general assembly finds that state Medicaid program 3 initiatives have consistently advanced the goals of a health 4 care delivery system that improves population health, enhances 5 the experiences and outcomes of patients, reduces the costs of 6 care, and integrates and coordinates services and supports to 7 address social determinants of health. Existing initiatives, 8 including the healthiest state initiative, the balancing 9 incentive program, the Iowa health and wellness plan created 10 pursuant to chapter 249N, and the state innovation models 11 initiative, all reflect these consistent goals. Each of 12 these programs and initiatives has been formulated to realign 13 the health care delivery system to provide whole-person, 14 patient-centered care while moving toward a value and 15 risk-based model of reimbursement. 16 2. Legislative involvement and oversight is essential to 17 ensure stakeholder input, consumer protection, and quality 18 assurance in the transformation of the Medicaid program. A 19 transition to a managed care system, especially one that 20 affects vulnerable populations so diverse in medical and 21 functional needs and that involves such a wide spectrum of 22 providers and state agencies, requires intentional planning 23 and attention. The state must also provide for appropriate 24 and adequate infrastructure, resources, and funding to ensure 25 accountability to and compliance with state policy, rules, and 26 contract requirements. 27 3. Given the challenges presented, a Medicaid 28 transformation and oversight commission is created to provide 29 a formal venue for guidance and oversight of and stakeholder 30 engagement in, the design, development, and implementation of 31 Medicaid program transformation. 32 4. a. The commission shall include all of the following 33 members: 34 (1) The co-chairpersons and ranking members of the 35 -1- LSB 2591XC (9) 86 pf/nh 1/ 16
S.F. _____ legislative joint appropriations subcommittee on health 1 and human services, or members of the joint appropriations 2 subcommittee designated by the respective co-chairpersons or 3 ranking members. 4 (2) The chairpersons and ranking members of the 5 human resources committees of the senate and house of 6 representatives, or members of the respective committees 7 designated by the respective chairpersons or ranking members. 8 (3) The chairpersons and ranking members of the 9 appropriations committees of the senate and house of 10 representatives, or members of the respective committees 11 designated by the respective chairpersons or ranking members. 12 b. The members of the commission shall receive a per diem as 13 provided in section 2.10. 14 c. The commission shall meet at least quarterly, but may 15 meet as often as necessary. The commission may use sources of 16 information deemed appropriate, and the department of human 17 services and other agencies of state government shall provide 18 information to the commission as requested. The legislative 19 services agency shall provide staff support to the commission. 20 d. The commission shall select a chairperson, annually, from 21 its membership. A majority of the members of the commission 22 shall constitute a quorum. 23 e. The commission may contract for the services of persons 24 who are qualified by education, expertise, or experience to 25 advise, consult with, or otherwise assist the commission in the 26 performance of its duties. The commission may specifically 27 enlist the assistance of entities such as the university of 28 Iowa public policy center to provide ongoing evaluation of the 29 Medicaid program and to make evidence-based recommendations to 30 improve the program. 31 5. The commission shall do all of the following: 32 a. Provide overall long-term and real-time guidance for the 33 Medicaid program including but not limited to: 34 (1) Developing a strategic plan to provide a predictable 35 -2- LSB 2591XC (9) 86 pf/nh 2/ 16
S.F. _____ guide for transformation prior to any transition. The 1 strategic plan shall address health care delivery and payment 2 reforms that reflect a holistic, integrated, patient-centered, 3 primary care-focused, value-based model and extend beyond a 4 medical model to address the social determinants of health. 5 (2) Reviewing, recommending, and approving the design, 6 development, and implementation of all initiatives under the 7 Medicaid program, and making additional recommendations for 8 Medicaid program reform. 9 (3) Monitoring progress in obtaining federal approval of 10 proposals such as those relating to benefit design, service 11 delivery, payment reform, and quality and cost containment 12 measures. 13 (4) Reviewing other states’ models of health care delivery 14 and payment reform and specifically those related to Medicaid 15 managed care to determine best practices and inform future 16 state Medicaid program initiatives. 17 (5) Ensuring that at each stage of transformation, existing 18 models, provider networks, reimbursement methodologies, and 19 performance and quality metrics are honored, retained, and 20 incorporated into the subsequent stage to provide consistency 21 and reliability. 22 (6) Ensuring that the state has a clearly articulated 23 vision for the Medicaid program, which is reflected in contract 24 expectations, oversight, incentives, and penalties under the 25 program. 26 (7) Assessing state agencies including those involved 27 in the Medicaid program, child welfare, aging and disability 28 services, and public health to articulate clear roles and 29 responsibilities and to promote state program interoperability. 30 (a) The commission shall review and make recommendations 31 regarding potential integration of various service delivery 32 systems including public health, aging and disability services 33 agencies, and mental health and disability services regions to 34 more efficiently and effectively address consumer needs. 35 -3- LSB 2591XC (9) 86 pf/nh 3/ 16
S.F. _____ (b) The commission shall ensure that state agencies provide 1 leadership and have the appropriate organizational structures, 2 adequate resources and funding, and qualified staff with 3 specialized skills, training, and expertise to provide the 4 level of expertise and scrutiny required to administer and 5 oversee the various transformation initiatives, including those 6 related to Medicaid managed care. 7 (8) Ensuring that state Medicaid managed care initiatives 8 comply with the guidance to states using 1115 demonstrations 9 or 1915(b) waivers for managed long-term services and supports 10 programs published by the centers for Medicare and Medicaid 11 services of the United States department of health and human 12 services on May 20, 2013, including those relating to adequate 13 planning, stakeholder engagement, enhanced provision of home 14 and community-based services, alignment of structures and 15 goals, support for beneficiaries, a person-centered process, a 16 comprehensive, integrated service package, qualified providers, 17 consumer protections, and quality. 18 (9) Reviewing the performance under and outcomes of 19 contracts including but not limited to those between the 20 state and the Iowa Medicaid enterprise and managed care 21 organizations, to determine compliance. 22 (10) Ensuring that the various Medicaid populations are 23 managed at all times within funding limitations and contract 24 terms. The commission shall also monitor service delivery 25 and utilization to ensure the responsibility for provision of 26 services to Medicaid consumers is not shifted to non-Medicaid 27 covered services solely to attain savings, and that such 28 responsibility is not shifted to mental health and disability 29 services regions, local public health agencies, aging and 30 disability resource centers, or other entities unless agreement 31 to provide, and provision for adequate compensation for, such 32 services is agreed to in advance. 33 b. Address provider access and workforce adequacy issues. 34 (1) As the state moves toward integration of long-term 35 -4- LSB 2591XC (9) 86 pf/nh 4/ 16
S.F. _____ services and supports into Medicaid managed care, the 1 commission shall provide for a comprehensive review of 2 long-term services and supports and make recommendations to 3 create a sustainable, person-centered approach that increases 4 health and life outcomes, supports maximum independence, 5 addresses medical and social needs in a coordinated, integrated 6 manner, and provides for sufficient resources including a 7 stable, well-qualified workforce. 8 (a) The commission shall provide a forum for open and 9 constructive dialogue among stakeholders representing 10 individuals involved in the delivery and financing of long-term 11 services and supports, address the cost and financing of 12 long-term services and supports, the coordination of services 13 among providers, and the availability of and access to a 14 well-qualified workforce, and consider methods to educate 15 consumers and enhance engagement of consumers in the broader 16 conversation regarding long-term services and supports. 17 (b) The commission shall recommend ways to eliminate Iowa’s 18 institutional bias and come into full compliance with the 19 Olmstead decision. 20 (2) The commission shall review current and projected 21 overall health care workforce availability to determine 22 the most efficient utilization of the roles, functions, 23 responsibilities, activities, and decision-making capacity 24 of health care professionals and make recommendations for 25 improvement. The commission shall encourage the use of 26 alternative modes of health care delivery, as appropriate. 27 (3) The commission shall ensure the linguistic and cultural 28 competency of providers and other program facilitators. 29 c. Provide for consumer engagement, address consumer 30 choice and satisfaction, and provide for consumer appeal and 31 grievance procedures. The commission shall provide for input 32 from the medical assistance advisory council created in section 33 249A.4B, the mental health and disabilities services commission 34 created in section 225C.5, the commission on aging created 35 -5- LSB 2591XC (9) 86 pf/nh 5/ 16
S.F. _____ in section 231.11, the medical home system advisory council 1 created in section 135.159, the bureau of substance abuse of 2 the department of public health, and other appropriate entities 3 to provide advice to the commission. 4 d. Review and make recommendations regarding reimbursement 5 and rate setting to ensure adequate compensation for all 6 providers of services and supports to the Medicaid population, 7 an adequate provider network, and timely access to services for 8 consumers. 9 e. Define the desired outcomes and the metrics by which 10 improvement is determined. The commission shall provide for 11 consistency and uniformity of metrics and required outcomes 12 across payors and providers to the greatest extent possible. 13 f. Ensure that care coordination and case management are 14 provided in a patient-centered manner that requires a knowledge 15 of community supports, a reasonable ratio of care coordinators 16 to consumers, standards for frequency of contact with the 17 consumer, and specific and adequate reimbursement. 18 g. Address health information technology and data collection 19 and sharing. 20 6. The commission shall submit a report of its findings 21 and recommendations to the governor and the general assembly 22 by January 15, annually. 23 Sec. 2. TRANSITION TO MEDICAID MANAGED CARE —— 24 DIRECTIVES. In order to ensure a seamless transition of 25 Medicaid consumers to Medicaid managed care, all of the 26 following circumstances shall be considered and all of the 27 following conditions shall be met in any design, development, 28 or implementation of Medicaid managed care on or after March 29 1, 2015: 30 1. The state shall engage in a thoughtful and deliberative 31 planning process that permits sufficient time to outline a 32 clear vision for the program, solicit and consider stakeholder 33 input, educate program consumers, assess readiness, and 34 develop safeguards and oversight mechanisms to ensure a 35 -6- LSB 2591XC (9) 86 pf/nh 6/ 16
S.F. _____ smooth transition to and effective ongoing implementation of 1 Medicaid managed care. The movement to Medicaid managed care 2 shall retain an emphasis on choice, consumer-driven care and 3 services, a community-based infrastructure, and promotion of 4 community-based alternatives. The state shall demonstrate 5 that systems and processes are in place between state agencies 6 to support the populations enrolled in Medicaid managed care 7 such as elders, persons with physical, intellectual, and 8 developmental disabilities, persons with chronic diseases, and 9 persons with mental health or substance abuse issues. 10 2. a. Prior to the transition to Medicaid managed care 11 of any population, and especially to ensure that high-risk 12 populations are provided continuity of care and do not 13 experience gaps in coverage or access to care issues, the state 14 shall perform a readiness assessment to ensure that managed 15 care organizations are in compliance with network adequacy 16 requirements, that necessary consumer and provider outreach and 17 education has been conducted, and that programmatic gaps have 18 been identified prior to the system becoming operational. 19 b. A managed care contract shall include a provision 20 for continuity and coordination of care for a consumer 21 transitioning to managed care, including maintaining existing 22 provider-consumer relationships and honoring the amount and 23 duration of an individual’s authorized services under an 24 existing service plan, based on individual assessment and 25 needs. In the initial transition of a consumer to Medicaid 26 managed care, to ensure the least amount of disruption, managed 27 care organizations shall provide, at a minimum, a one-year 28 transition of care period for all provider types, regardless of 29 network status with an individual managed care organization. 30 c. The state shall ensure that if an individual is 31 auto-enrolled in a Medicaid managed care plan, there are 32 sufficient staff and safeguards available to ensure continuity 33 of care for the consumer through the consumer’s existing 34 provider. 35 -7- LSB 2591XC (9) 86 pf/nh 7/ 16
S.F. _____ d. The state shall administratively credential existing 1 Medicaid providers, rather than requiring such providers to 2 complete a new credentialing process, to ensure a seamless 3 transition to the new managed care system and to ensure rapid 4 development of managed care provider networks. 5 e. The state shall retain external managed care experts to 6 guide patient transition, system implementation, and oversight 7 until the department of human services is able to develop the 8 internal staff capacity to confidently operate independently. 9 Such external experts shall be selected through a request for 10 proposals process and the state shall ensure that such experts 11 are not affiliated with any of the managed care organizations 12 selected in order to provide unbiased and appropriate guidance. 13 3. a. The state shall establish a specific, enforceable 14 process to ensure managed care organizations grievance and 15 appeals procedures are fully accessible to patients regardless 16 of physical, intellectual, behavioral, or sensory barriers. 17 b. Managed care contracts shall include consumer 18 protections including a statement of consumer rights and 19 responsibilities, a critical incident management system with 20 safeguards to prevent abuse, neglect, and exploitation, and 21 fair hearing protections including the continuation of services 22 during an appeal. 23 4. The state shall utilize public forums, public input 24 surveys, stakeholder workgroup sessions, and other effective 25 formal channels for stakeholder engagement in the design, 26 development, and implementation of Medicaid managed care. The 27 state shall utilize the medical assistance advisory council 28 established pursuant to section 249A.4B to provide a forum 29 for oversight of managed care organizations and to advise the 30 department regarding systemic issues identified by the council. 31 5. a. The state shall ensure that a managed care 32 organization develops and maintains a network of qualified 33 providers who meet state licensing, credentialing, and 34 certification requirements, as applicable, which network shall 35 -8- LSB 2591XC (9) 86 pf/nh 8/ 16
S.F. _____ be sufficient to provide adequate access to all services 1 covered under the managed care contract. The state shall 2 ensure that managed care organizations incorporate existing and 3 traditional providers, including but not limited to those that 4 comprise the Iowa collaborative safety net provider network 5 created in section 135.153. 6 b. Managed care contracts shall specify provider network 7 composition and access requirements including continuity of 8 care provisions and rules for when and how consumers may 9 access out-of-network providers. Managed care plans shall 10 provide reports of compliance with state network composition 11 and access standards and the state shall include financial 12 incentives and disincentives as management tools to support 13 state expectations. 14 c. The state shall review managed care organization 15 credentialing processes to provide consistency across such 16 organizations and to simplify and streamline the credentialing 17 process. 18 d. The state shall ensure that management of care for the 19 population served is provider-led. 20 e. The state shall monitor and enforce access standards 21 to ensure that consumers are able to access appropriate care 22 as close to their own homes as possible. The state shall 23 review, at least quarterly, network adequacy compliance and 24 require the dissemination of easily accessible and updated 25 provider directories to ensure consumers have the most accurate 26 information possible regarding the number, location, type, and 27 current capacity of providers contracted with the individual 28 managed care organization. The state shall ensure that 29 noncompliance results in swift corrective action. 30 f. The state shall require managed care plans to remove 31 administrative barriers to, provide reimbursement for, 32 and utilize emerging technologies such as e-health, mobile 33 technologies, and telehealth in health care delivery in a 34 medically appropriate manner in order to expand access to 35 -9- LSB 2591XC (9) 86 pf/nh 9/ 16
S.F. _____ services and extend the reach of approved provider networks 1 into rural and underserved areas of the state. Reimbursement 2 for telehealth shall be at the same rate as in-person services. 3 g. The state shall require managed care organizations to 4 implement tools and strategies that support community-level 5 system integration between acute care, long-term services and 6 supports, and community-level agencies and organizations to 7 further population health goals. 8 6. a. (1) The state shall require managed care 9 organizations to align economic incentives, delivery system 10 reform, and performance and outcome metrics with those of the 11 state innovation models initiative and Medicaid accountable 12 care organizations. 13 (2) The state shall develop a common, uniform set of 14 process, quality, and consumer satisfaction measures across 15 all Medicaid payors and providers that align with those 16 developed through the state innovation models initiative and 17 shall ensure that such measures are expanded and adjusted to 18 address additional populations and to meet population health 19 objectives. Measures considered may include but are not 20 limited to those related to consumer education, transition 21 to and ongoing implementation of managed care, monitoring 22 and oversight, consumer input and rights, network adequacy 23 and access to care including services that address social 24 determinants of health, the provision of preventive services 25 and supports as well as those that address chronic conditions, 26 continuity of care, long-term services and supports, provider 27 standards, and evaluation and quality measures. 28 b. Managed care contracts shall include long-term 29 performance goals that reward success in achieving population 30 health goals such as improved community health metrics. 31 c. The state shall require consistency and uniformity 32 of processes and forms across all managed care organizations 33 including but not limited to the use of uniform cost and 34 quality reporting and uniform prior authorization procedures. 35 -10- LSB 2591XC (9) 86 pf/nh 10/ 16
S.F. _____ 7. The state shall require the provision of independent 1 choice counseling, education, functional assessment, and 2 enrollment and disenrollment from a managed care plan by 3 an entity free of conflicts. The state shall ensure an 4 independent advocate is available to assist consumers in 5 navigating the Medicaid managed care landscape, understanding 6 their rights, responsibilities, choices, and opportunities, 7 and helping to resolve any problems that arise between 8 the consumer and the managed care organization. Unless 9 such an entity declines, the aging and disability resource 10 centers and the long-term care ombudsman shall provide such 11 independent, conflict-free services in an accessible, ongoing, 12 and consumer-friendly manner, and shall be provided adequate 13 resources and reimbursement for provision of such services. 14 8. The state shall require the use of a uniform, 15 standardized, person-centered, and state-approved instrument 16 to assess a consumer’s physical, psychosocial, and functional 17 needs, including current health status and treatment needs; 18 social, employment, and transportation needs and preferences; 19 personal goals; consumer and caregiver preferences for 20 care; back-up plans for situations in which caregivers are 21 unavailable; and informal networks. The information collected 22 from these assessments shall be used to identify health risks 23 and social determinants of health that impact health outcomes. 24 Plans and providers shall use this data in care coordination 25 and interventions to improve patient outcomes and to drive 26 program designs that improve the health of the population. 27 Managed care organizations shall share aggregate assessment 28 data for consumers with providers on a routine basis. 29 9. The state shall establish guidelines for care 30 coordination across managed care organizations to ease 31 administrative burdens on providers and help streamline 32 access to care. Coordinated care shall utilize the team-based 33 care model by connecting a Medicaid consumer to a single 34 primary care provider. The state shall require managed care 35 -11- LSB 2591XC (9) 86 pf/nh 11/ 16
S.F. _____ organizations to coordinate data sharing and analytics across 1 providers to facilitate care coordination. A managed care plan 2 shall provide for identification of the care coordination needs 3 of a consumer including those related to social determinants of 4 health, ensure that appropriate care coordination services are 5 provided, and provide evidence on an ongoing basis to the state 6 that both have occurred. 7 10. The state shall review and integrate the activities of 8 state agencies, including those agencies with public health, 9 child welfare, aging and disabilities, and ombudsman functions 10 to ensure there is no wrong door for consumers to access the 11 medical and social services and supports necessary for improved 12 outcomes. Managed care organizations shall provide or ensure 13 that consumers are connected with or referred to providers 14 and services to meet social determinants of health, even if 15 provision of services is outside their provider network. 16 Managed care contracts shall encourage partnerships between 17 managed care organizations and local public health agencies, 18 aging and disability resource centers, child welfare agencies, 19 mental health and disability services regions, and others to 20 address the holistic needs of the consumer and shall provide 21 for adequate reimbursement for such services. 22 11. a. Managed care plans shall include policies, plans, 23 and procedures to prepare consumers for transitions between 24 care settings to improve the quality of care for all consumers, 25 reduce avoidable rehospitalizations, and allow individuals to 26 live and receive services in the setting of their choice. 27 b. The state shall require managed care organizations 28 to have in place nursing facility diversion programs. The 29 state shall provide for the use of incentives in managed care 30 contracts for transition of consumers from a nursing facility 31 to home and community-based services. 32 12. The state shall ensure a sufficient and sustainable 33 state infrastructure for monitoring managed care organizations. 34 There shall be sufficient resources for the state to evaluate 35 -12- LSB 2591XC (9) 86 pf/nh 12/ 16
S.F. _____ contractually required quality reports and financial reports, 1 evaluate the impact or effectiveness of incentive programs, 2 conduct quality-focused audits, provide quality-related 3 technical assistance, validate that managed care organization 4 corrective actions have been implemented, analyze quality 5 findings and develop reports to assess quality trends and 6 to identify areas for improvement, develop, implement, and 7 evaluate performance improvement projects, solicit and analyze 8 consumer feedback, and investigate and follow up on critical 9 incident events. 10 13. Managed care contracts shall require that a portion 11 of the savings achieved by a managed care organization be 12 reinvested in innovations and longer-term community investments 13 to address population health, infrastructure, the healthcare 14 workforce, and improved service delivery and capacity. 15 14. a. The state shall ensure that savings achieved 16 through Medicaid managed care does not come at the expense 17 of further reduction in already inadequate provider rates. 18 The state shall ensure that managed care organizations use 19 reasonable reimbursement standards for all provider types and 20 compensate providers for covered services at not less than 21 current Medicaid fee-for-service levels, as determined in 22 conjunction with actuarially sound rate setting procedures. 23 Such reimbursement shall extend for the entire duration of a 24 managed care organization’s contract. 25 b. The state shall address rate setting and reimbursement 26 of the entire scope of services provided under the Medicaid 27 program to ensure the adequacy of the provider network and to 28 ensure that providers that contribute to the holistic health 29 of the consumer, whether inside or outside of the provider 30 network, are compensated for their services. 31 c. The state shall ensure that managed care organizations do 32 not arbitrarily deny coverage for medically necessary services 33 solely based on financial reasons. 34 15. a. In order to provide adequate access to care for 35 -13- LSB 2591XC (9) 86 pf/nh 13/ 16
S.F. _____ vulnerable Iowans, managed care organizations shall extend 1 nonemergency transportation services to all consumers. 2 b. The state shall ensure that dental coverage, if not 3 integrated into an overall managed care contract, is provided 4 and is part of the overall integrated coverage for physical, 5 behavioral, and long-term services and supports provided to a 6 Medicaid consumer. 7 c. The state shall ensure that the existing formulary for 8 pharmacy benefits under the Medicaid state plan is honored and 9 continued. 10 d. Managed care plans shall ensure consumers receive 11 services and supports in the amount, duration, scope, and 12 manner as identified through the person-centered assessment and 13 service planning process. 14 16. a. The state shall utilize the application of 15 liquidated damages in contracts to be paid from moneys other 16 than those paid by the state to hold managed care organizations 17 accountable regarding such provisions as timely claims 18 processing and claims payment accuracy, compliance with 19 licensure and background check requirements, timely provision 20 of an approved service, continuation of benefits pending 21 appeal, timely development of a plan of care, initiation 22 of long-term services and supports, and completion of care 23 coordination contacts. 24 b. The state shall review and approve or deny approval 25 for contract amendments on an ongoing basis to provide for 26 continuous improvement in Medicaid managed care. 27 Sec. 3. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 28 immediate importance, takes effect upon enactment. 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill relates to Medicaid program transformation. 33 The bill establishes the Medicaid transformation and 34 oversight commission, to provide for legislative involvement 35 -14- LSB 2591XC (9) 86 pf/nh 14/ 16
S.F. _____ and oversight and ensure stakeholder input, consumer 1 protection, and quality assurance in the transformation of the 2 Medicaid program. The membership of the commission consists 3 of the co-chairpersons and ranking members of the legislative 4 joint appropriations subcommittee on health and human services, 5 or a member of the joint appropriations subcommittee designated 6 by the respective co-chairperson or ranking member; the 7 chairpersons and ranking members of the human resources 8 committees of the senate and house of representatives, or a 9 member of the respective committee designated by the respective 10 chairperson or ranking member; and the chairpersons and 11 ranking members of the appropriations committees of the senate 12 and house of representatives, or a member of the respective 13 committee designated by the respective chairperson or ranking 14 member. The bill provides that the members are to receive 15 a per diem, and that the commission shall meet at least 16 quarterly, but may meet as necessary. The commission may use 17 sources of information deemed appropriate, and the department 18 of human services and other agencies of state government are 19 required to provide information to the commission as requested. 20 The legislative services agency will provide staff support to 21 the commission. The commission is to select a chairperson, 22 annually, from its membership and a majority of the members 23 of the commission constitute a quorum. The bill authorizes 24 the commission to contract for the services of persons who are 25 qualified by education, expertise, or experience to advise, 26 consult with, or otherwise assist the commission in the 27 performance of its duties, and provides that the commission 28 may specifically enlist the assistance of entities such as the 29 university of Iowa public policy center to provide ongoing 30 evaluation of the Medicaid program and to make evidence-based 31 recommendations to improve the program. 32 The bill specifies the duties of the commission including: 33 to provide overall long-term and real-time guidance for the 34 Medicaid program, addressing provider access and workforce 35 -15- LSB 2591XC (9) 86 pf/nh 15/ 16
S.F. _____ adequacy, providing for consumer engagement, addressing 1 consumer choice and satisfaction, and providing for consumer 2 appeal and grievance procedures; reviewing and making 3 recommendations regarding reimbursement and rate setting to 4 ensure adequate compensation for all providers of services 5 and supports to the Medicaid population, an adequate provider 6 network, and timely access to services for consumers; defining 7 the desired outcomes and the metrics by which improvement is 8 determined; ensuring that care coordination and case management 9 are provided in a patient-centered manner; and addressing 10 health information technology and data collection and sharing. 11 The commission is required to submit a report of findings and 12 recommendations to the governor and the general assembly by 13 January 15, annually. 14 The bill also specifies directives for the transition to 15 Medicaid managed care. The directives relate to overall 16 policy and planning, transition of Medicaid members to 17 managed care, appeals and grievance procedures, consumer 18 protections, stakeholder input, provider networks and access, 19 uniform processes, conflict-free consumer choice, education, 20 enrollment and disenrollment, care coordination, state agency 21 readiness and infrastructure, the use of savings by managed 22 care organizations, health care delivery alternatives, 23 required benefits, metrics and outcomes, and penalties for 24 noncompliance. 25 -16- LSB 2591XC (9) 86 pf/nh 16/ 16