House File 447 - Introduced HOUSE FILE 447 BY BROWN-POWERS A BILL FOR An Act relating to the evaluation of Medicaid-managed care 1 long-term services and supports. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2389YH (2) 89 pf/rh

H.F. 447 Section 1. DATA REPORTING —— MEDICAID MANAGED CARE 1 LONG-TERM SERVICES AND SUPPORTS. The department of human 2 services shall contractually require each Medicaid managed care 3 organization (MCO) to report each quarter all of the following 4 information from the previous quarter regarding the MCO’s 5 long-term services and supports (LTSS) population members: 6 1. The total amount expended on the LTSS population 7 categorized by institutional and noninstitutional setting and 8 by target population. 9 2. Any reductions or increases in the total amount expended 10 on the LTSS population categorized by setting and target 11 population and the reasons for the reduction or increase such 12 as changes in the service setting, changes attributable to 13 level of care determinations or redeterminations, decreased 14 or increased utilization of inpatient or outpatient services, 15 reduced or increased cost per unit or service, and other 16 factors. 17 3. Trends identified in expenditures and the services 18 provided to the LTSS population. 19 Sec. 2. MEDICAID MANAGED CARE LONG-TERM SERVICES AND 20 SUPPORTS POPULATION —— METRICS REVIEW AND RECOMMENDATIONS. 21 1. The department of human services shall convene 22 stakeholders with expertise or interest in the LTSS population 23 to review existing performance and outcome metrics for managed 24 LTSS to determine if the current metrics provide constructive 25 information to ensure the population is receiving access to 26 necessary services and supports, that person-centered care 27 and decision making are being promoted, and that the delivery 28 system is not resulting in adverse selection or creating 29 incentives to underserve or deny claims for members. The 30 stakeholder group shall review national LTSS population 31 evaluation tools and metrics and shall make recommendations 32 to the governor and the general assembly by October 1, 2021, 33 for data collection based on a core set of LTSS-specific 34 quality and performance metrics. The core set of metrics 35 -1- LSB 2389YH (2) 89 pf/rh 1/ 3

H.F. 447 recommended shall address the full spectrum of complex needs 1 for individuals accessing LTSS and allow effective evaluation 2 beyond structural elements and service delivery processes by 3 incorporating measures of individual outcomes and personal 4 experiences. The core set of metrics recommended shall go 5 beyond clinical measures and focus on quality of life and 6 quality of care outcomes, and shall provide for direct input 7 through surveys and face-to-face level encounter data solicited 8 from LTSS consumers and their support networks. 9 2. For the purposes of this section, “managed LTSS” means 10 long-term services and supports delivered through Medicaid 11 managed care. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 This bill relates to Medicaid managed long-term services 16 and supports (LTSS). The bill requires the department of 17 human services (DHS) to contractually require each Medicaid 18 managed care organization (MCO) to report each quarter 19 specific information from the previous quarter regarding the 20 LTSS population members covered by the MCO including data 21 related to the total amount expended on the LTSS population 22 categorized by institutional and noninstitutional setting and 23 by target population; reductions or increases in the total 24 amount expended by setting and target population and the 25 reasons for the reduction or increase; and trends identified in 26 expenditures and services provided. 27 The bill also requires DHS to convene stakeholders with 28 expertise or interest in the LTSS population to review existing 29 metrics for the managed LTSS population to determine if the 30 current metrics provide constructive information to ensure 31 the population is receiving access to necessary services and 32 supports, that person-centered care and decision making are 33 being promoted, and that the delivery system is not resulting 34 in adverse selection or creating incentives to underserve or 35 -2- LSB 2389YH (2) 89 pf/rh 2/ 3

H.F. 447 deny claims for members. The stakeholder group is required to 1 review national LTSS population evaluation tools and metrics 2 and make recommendations to the governor and the general 3 assembly by October 1, 2021, for data collection based on a 4 core set of LTSS-specific metrics. 5 -3- LSB 2389YH (2) 89 pf/rh 3/ 3