S.F. 452 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 and family-centered care while moving toward a 15 value and 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- SF 452 (4) 86 pf/nh/jh 1/ 16

S.F. 452 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 co-chairpersons, one 21 representing the senate and one representing the house of 22 representatives, annually, from its membership. A majority of 23 the members of the commission shall constitute a quorum. 24 e. The commission may contract for the services of persons 25 who are qualified by education, expertise, or experience to 26 advise, consult with, or otherwise assist the commission in the 27 performance of its duties. The commission may specifically 28 enlist the assistance of entities such as the university of 29 Iowa public policy center to provide ongoing evaluation of the 30 Medicaid program and to make evidence-based recommendations to 31 improve the program. 32 5. The commission shall do all of the following: 33 a. Provide overall long-term and real-time guidance for the 34 Medicaid program including but not limited to: 35 -2- SF 452 (4) 86 pf/nh/jh 2/ 16

S.F. 452 (1) Developing a strategic plan to provide a predictable 1 guide for transformation prior to any transition. The 2 strategic plan shall address health care delivery and payment 3 reforms that reflect a holistic, integrated, patient-centered 4 and family-centered, primary care-focused, value-based model 5 and extend beyond a medical model to address the social 6 determinants of health. 7 (2) Reviewing, recommending, and approving the design, 8 development, and implementation of all initiatives under the 9 Medicaid program, and making additional recommendations for 10 Medicaid program reform. 11 (3) Monitoring progress in obtaining federal approval of 12 proposals such as those relating to benefit design, service 13 delivery, payment reform, and quality and cost containment 14 measures. 15 (4) Reviewing other states’ models of health care delivery 16 and payment reform and specifically those related to Medicaid 17 managed care to determine best practices and inform future 18 state Medicaid program initiatives. 19 (5) Ensuring that at each stage of transformation, existing 20 models, provider networks, reimbursement methodologies, 21 and performance and quality metrics are integrated into the 22 subsequent stage to provide consistency and reliability. 23 (6) Ensuring that the state has a clearly articulated 24 vision for the Medicaid program, which is reflected in contract 25 expectations, oversight, incentives, and penalties under the 26 program. 27 (7) Assessing state agencies including those involved 28 in the Medicaid program, child welfare, aging and disability 29 services, and public health to articulate clear roles and 30 responsibilities and to promote state program interoperability. 31 (a) The commission shall review and make recommendations 32 regarding potential integration of various service delivery 33 systems including public health, aging and disability services 34 agencies, and mental health and disability services regions to 35 -3- SF 452 (4) 86 pf/nh/jh 3/ 16

S.F. 452 more efficiently and effectively address consumer needs. 1 (b) The commission shall ensure that state agencies provide 2 leadership and have the appropriate organizational structures, 3 adequate resources and funding, and qualified staff with 4 specialized skills, training, and expertise to provide the 5 level of expertise and scrutiny required to administer and 6 oversee the various transformation initiatives, including those 7 related to Medicaid managed care. 8 (8) Ensuring that state Medicaid managed care initiatives 9 comply with the guidance to states using 1115 demonstrations 10 or 1915(b) waivers for managed long-term services and supports 11 programs published by the centers for Medicare and Medicaid 12 services of the United States department of health and human 13 services on May 20, 2013, including those relating to adequate 14 planning, stakeholder engagement, enhanced provision of home 15 and community-based services, alignment of structures and 16 goals, support for beneficiaries, a person-centered process, a 17 comprehensive, integrated service package, qualified providers, 18 consumer protections, and quality. 19 (9) Reviewing the performance under and outcomes of 20 contracts including but not limited to those between the 21 state and the Iowa Medicaid enterprise and managed care 22 organizations, to determine compliance. 23 (10) Ensuring that the various Medicaid populations are 24 managed at all times within funding limitations and contract 25 terms. The commission shall also monitor service delivery 26 and utilization to ensure the responsibility for provision of 27 services to Medicaid consumers is not shifted to non-Medicaid 28 covered services solely to attain savings, and that such 29 responsibility is not shifted to mental health and disability 30 services regions, local public health agencies, aging and 31 disability resource centers, or other entities unless agreement 32 to provide, and provision for adequate compensation for, such 33 services is agreed to in advance. 34 b. Address provider access and workforce adequacy issues. 35 -4- SF 452 (4) 86 pf/nh/jh 4/ 16

S.F. 452 (1) As the state moves toward integration of long-term 1 services and supports into Medicaid managed care, the 2 commission shall provide for a comprehensive review of 3 long-term services and supports and make recommendations to 4 create a sustainable, person-centered approach that increases 5 health and life outcomes, supports maximum independence, 6 addresses medical and social needs in a coordinated, integrated 7 manner, and provides for sufficient resources including a 8 stable, well-qualified workforce. 9 (a) The commission shall provide a forum for open and 10 constructive dialogue among stakeholders representing 11 individuals involved in the delivery and financing of long-term 12 services and supports, address the cost and financing of 13 long-term services and supports, the coordination of services 14 among providers, and the availability of and access to a 15 well-qualified workforce, and consider methods to educate 16 consumers and enhance engagement of consumers in the broader 17 conversation regarding long-term services and supports. 18 (b) The commission shall recommend ways to eliminate Iowa’s 19 institutional bias and come into full compliance with the 20 Olmstead decision. 21 (2) The commission shall review current and projected 22 overall health care workforce availability to determine 23 the most efficient utilization of the roles, functions, 24 responsibilities, activities, and decision-making capacity 25 of health care professionals and make recommendations for 26 improvement. The commission shall encourage the use of 27 alternative modes of health care delivery, as appropriate. 28 (3) The commission shall ensure the linguistic and cultural 29 competency of providers and other program facilitators. 30 c. Provide for consumer engagement, address consumer 31 choice and satisfaction, and provide for consumer appeal and 32 grievance procedures. The commission shall provide for input 33 from the medical assistance advisory council created in section 34 249A.4B, the mental health and disabilities services commission 35 -5- SF 452 (4) 86 pf/nh/jh 5/ 16

S.F. 452 created in section 225C.5, the commission on aging created 1 in section 231.11, the medical home system advisory council 2 created in section 135.159, the bureau of substance abuse of 3 the department of public health, and other appropriate entities 4 to provide advice to the commission. 5 d. Review and make recommendations regarding reimbursement 6 and rate setting to ensure adequate compensation for all 7 providers of services and supports to the Medicaid population, 8 an adequate provider network, and timely access to services for 9 consumers. 10 e. Define the desired outcomes and the metrics by which 11 improvement is determined. The commission shall provide for 12 consistency and uniformity of metrics and required outcomes 13 across payors and providers to the greatest extent possible. 14 f. Ensure that care coordination and case management are 15 provided in a patient-centered and family-centered manner that 16 requires a knowledge of community supports, a reasonable ratio 17 of care coordinators to consumers, standards for frequency 18 of contact with the consumer, and specific and adequate 19 reimbursement. 20 g. Address health information technology and data collection 21 and sharing. 22 6. The commission shall submit a report of its findings and 23 recommendations to the governor and the general assembly by 24 December 15, annually. 25 Sec. 2. TRANSITION TO MEDICAID MANAGED CARE —— 26 DIRECTIVES. In order to ensure a seamless transition of 27 Medicaid consumers to Medicaid managed care, all of the 28 following circumstances shall be considered and all of the 29 following conditions shall be met in any design, development, 30 or implementation of Medicaid managed care on or after March 31 1, 2015: 32 1. The state shall engage in a thoughtful and deliberative 33 planning process that permits sufficient time to outline a 34 clear vision for the program, solicit and consider stakeholder 35 -6- SF 452 (4) 86 pf/nh/jh 6/ 16

S.F. 452 input, educate program consumers, assess readiness, and 1 develop safeguards and oversight mechanisms to ensure a 2 smooth transition to and effective ongoing implementation of 3 Medicaid managed care. The movement to Medicaid managed care 4 shall retain an emphasis on choice, consumer-driven care and 5 services, a community-based infrastructure, and promotion of 6 community-based alternatives. The state shall demonstrate 7 that systems and processes are in place between state agencies 8 to support the populations enrolled in Medicaid managed care 9 such as elders, persons with physical, intellectual, and 10 developmental disabilities, persons with chronic diseases, and 11 persons with mental health or substance abuse issues. 12 2. a. Prior to the transition to Medicaid managed care 13 of any population, and especially to ensure that high-risk 14 populations are provided continuity of care and do not 15 experience gaps in coverage or access to care issues, the state 16 shall perform a readiness assessment to ensure that managed 17 care organizations are in compliance with network adequacy 18 requirements, that necessary consumer and provider outreach and 19 education have been conducted, and that programmatic gaps have 20 been identified prior to the system becoming operational. 21 b. A managed care contract shall include a provision 22 for continuity and coordination of care for a consumer 23 transitioning to managed care, including maintaining existing 24 provider-consumer relationships and honoring the amount and 25 duration of an individual’s authorized services under an 26 existing service plan, based on individual assessment and 27 needs. In the initial transition of a consumer to Medicaid 28 managed care, to ensure the least amount of disruption, managed 29 care organizations shall provide, at a minimum, a one-year 30 transition of care period for all provider types, regardless of 31 network status with an individual managed care organization. 32 c. The state shall ensure that if an individual is 33 auto-enrolled in a Medicaid managed care plan, there are 34 sufficient staff and safeguards available to ensure continuity 35 -7- SF 452 (4) 86 pf/nh/jh 7/ 16

S.F. 452 of care for the consumer through the consumer’s existing 1 provider. 2 d. The state shall administratively credential existing 3 Medicaid providers, rather than requiring such providers to 4 complete a new credentialing process, to ensure a seamless 5 transition to the new managed care system and to ensure rapid 6 development of managed care provider networks. 7 e. The state shall retain external managed care experts to 8 guide patient transition, system implementation, and oversight 9 until the department of human services is able to develop the 10 internal staff capacity to confidently operate independently. 11 Such external experts shall be selected through a request for 12 proposals process and the state shall ensure that such experts 13 are not affiliated with any of the managed care organizations 14 selected in order to provide unbiased and appropriate guidance. 15 3. a. The state shall establish a specific, enforceable 16 process to ensure managed care organizations grievance and 17 appeals procedures are fully accessible to patients regardless 18 of physical, intellectual, behavioral, or sensory barriers. 19 b. Managed care contracts shall include consumer 20 protections including a statement of consumer rights and 21 responsibilities, a critical incident management system with 22 safeguards to prevent abuse, neglect, and exploitation, and 23 fair hearing protections including the continuation of services 24 during an appeal. 25 c. Managed care organization contracts shall include 26 provider appeals and grievance procedures that in part allow a 27 provider to file a grievance independently but on behalf of a 28 member and to appeal claims denials which, if determined to be 29 based on claims for medically necessary services whether or not 30 denied on an administrative basis, shall receive appropriate 31 payment. 32 4. a. The state shall utilize public forums, public input 33 surveys, stakeholder workgroup sessions, and other effective 34 formal channels for stakeholder engagement in the design, 35 -8- SF 452 (4) 86 pf/nh/jh 8/ 16

S.F. 452 development, and implementation of Medicaid managed care. The 1 state shall utilize the medical assistance advisory council 2 established pursuant to section 249A.4B to provide a forum 3 for oversight of managed care organizations and to advise the 4 department regarding systemic issues identified by the council. 5 b. Managed care organizations shall maintain stakeholder 6 panels comprised of an equal number of consumers and providers 7 in place at least thirty days prior to the transition to 8 managed care. Managed care organizations shall provide for 9 separate provider-specific panels to address detailed payment 10 and claims issues and grievance and appeals processes. 11 5. a. The state shall ensure that a managed care 12 organization develops and maintains a network of qualified 13 providers who meet state licensing, credentialing, and 14 certification requirements, as applicable, which network shall 15 be sufficient to provide adequate access to all services 16 covered and for all populations served under the managed 17 care contract. The state shall ensure that managed care 18 organizations incorporate existing and traditional providers, 19 including but not limited to those that comprise the Iowa 20 collaborative safety net provider network created in section 21 135.153. 22 b. Managed care contracts shall specify provider network 23 composition and access requirements including continuity of 24 care provisions and rules for when and how consumers may 25 access out-of-network providers. Managed care plans shall 26 provide reports of compliance with state network composition 27 and access standards and the state shall include financial 28 incentives and disincentives as management tools to support 29 state expectations. 30 c. The state shall review managed care organization 31 credentialing processes to provide consistency across such 32 organizations and to simplify and streamline the credentialing 33 process. 34 d. The state shall ensure that management of care for the 35 -9- SF 452 (4) 86 pf/nh/jh 9/ 16

S.F. 452 population served is consumer-driven, patient-focused and 1 family-focused, and provider-led. 2 e. The state shall monitor and enforce access standards 3 to ensure that consumers are able to access appropriate care 4 as close to their own homes as possible. The state shall 5 review, at least quarterly, network adequacy compliance and 6 require the dissemination of easily accessible and updated 7 provider directories to ensure consumers have the most accurate 8 information possible regarding the number, location, type, and 9 current capacity of providers contracted with the individual 10 managed care organization. The state shall ensure that 11 noncompliance results in swift corrective action. 12 f. The state shall require managed care plans to remove 13 administrative barriers to, provide reimbursement for, 14 and utilize emerging technologies such as e-health, mobile 15 technologies, and telehealth in health care delivery in a 16 medically appropriate manner in order to expand access to 17 services and extend the reach of approved provider networks 18 into rural and underserved areas of the state. Reimbursement 19 for telehealth shall be at the same rate as in-person services. 20 Reimbursable activities shall include store and forward 21 consultation, direct-to-consumer virtual care, telehealth 22 visits, home-based monitoring, and telehealth monitoring in 23 long-term care facilities. 24 g. The state shall require managed care organizations to 25 implement tools and strategies that support community-level 26 system integration between acute care, long-term services and 27 supports, and community-level agencies and organizations to 28 further population health goals. 29 6. a. (1) The state shall require managed care 30 organizations to align economic incentives, delivery system 31 reform, and performance and outcome metrics with those of the 32 state innovation models initiative and Medicaid accountable 33 care organizations. 34 (2) The state shall develop a common, uniform set of 35 -10- SF 452 (4) 86 pf/nh/jh 10/ 16

S.F. 452 process, quality, and consumer satisfaction measures across 1 all Medicaid payors and providers that align with those 2 developed through the state innovation models initiative and 3 shall ensure that such measures are expanded and adjusted to 4 address additional populations and to meet population health 5 objectives. Measures considered may include but are not 6 limited to those related to consumer education, transition 7 to and ongoing implementation of managed care, monitoring 8 and oversight, consumer input and rights, network adequacy 9 and access to care including services that address social 10 determinants of health, the provision of preventive services 11 and supports as well as those that address chronic conditions, 12 continuity of care, long-term services and supports, provider 13 standards, and evaluation and quality measures. 14 (3) Any quality data collected regarding provider 15 performance shall be shared with providers for review and input 16 prior to dissemination to consumers. 17 b. Managed care contracts shall include long-term 18 performance goals that reward success in achieving population 19 health goals such as improved community health metrics. 20 c. The state shall require consistency and uniformity 21 of processes and forms across all managed care organizations 22 including but not limited to the use of uniform cost and 23 quality reporting and uniform prior authorization procedures. 24 7. The state shall require the provision of independent 25 choice counseling, education, functional assessment, and 26 enrollment and disenrollment from a managed care plan by 27 an entity free of conflicts. The state shall ensure an 28 independent advocate is available to assist consumers in 29 navigating the Medicaid managed care landscape, understanding 30 their rights, responsibilities, choices, and opportunities, 31 and helping to resolve any problems that arise between the 32 consumer and the managed care organization. Unless such an 33 entity declines, as applicable to the population of consumers, 34 the aging and disability resource centers and the long-term 35 -11- SF 452 (4) 86 pf/nh/jh 11/ 16

S.F. 452 care ombudsman shall provide such independent, conflict-free 1 services in an accessible, ongoing, and consumer-friendly 2 manner, and shall be provided adequate resources and 3 reimbursement for provision of such services. 4 7A. a. Managed care organization contracts shall 5 specifically and appropriately address the unique needs of 6 children and children’s health care delivery. 7 b. Managed care organizations shall maintain child health 8 panels that include representatives of child health, welfare, 9 policy, and advocacy organizations in the state that address 10 child health and child well-being. 11 c. Managed care organization contracts that apply 12 to children’s health care delivery shall address early 13 intervention and prevention strategies, the provision of a 14 child health delivery infrastructure for children with special 15 health care needs, utilization of current standards and 16 guidelines for children’s health care and pediatric-specific 17 screening and assessment tools, the inclusion of pediatric 18 specialty providers in the provider network, and the 19 utilization of health homes for children and youth with special 20 health care needs including intensive care coordination and 21 family support and access to a professional family-to-family 22 support system. 23 d. Managed care organization contracts that apply 24 to children’s health care delivery shall utilize 25 pediatric-specific quality measures, which shall align 26 with existing pediatric-specific measures as determined in 27 consultation with the child health panel. 28 e. Managed care contracts shall provide special incentives 29 for innovative and evidence-based preventive, behavioral, and 30 developmental health care and mental health care for children’s 31 programs that improve the life course trajectory of those 32 children. 33 8. The state shall require the use of uniform, standardized, 34 person-centered, and state-approved instruments to assess 35 -12- SF 452 (4) 86 pf/nh/jh 12/ 16

S.F. 452 a consumer’s physical, psychosocial, and functional needs, 1 including current health status and treatment needs; social, 2 employment, and transportation needs and preferences; 3 personal goals; consumer and caregiver preferences for 4 care; back-up plans for situations in which caregivers are 5 unavailable; and informal networks. The state shall approve a 6 pediatric-specific assessment tool and quality measures. The 7 information collected from these assessments shall be used to 8 identify health risks and social determinants of health that 9 impact health outcomes. Plans and providers shall use this 10 data in care coordination and interventions to improve patient 11 outcomes and to drive program designs that improve the health 12 of the population. Managed care organizations shall share 13 aggregate assessment data for consumers with providers on a 14 routine basis. 15 9. The state shall establish guidelines for care 16 coordination across managed care organizations to ease 17 administrative burdens on providers and help streamline 18 access to care. Coordinated care shall utilize the team-based 19 care model by connecting a Medicaid consumer to a single 20 primary care provider. The state shall require managed care 21 organizations to coordinate data sharing and analytics across 22 providers to facilitate care coordination. A managed care plan 23 shall provide for identification of the care coordination needs 24 of a consumer including those related to social determinants of 25 health, ensure that appropriate care coordination services are 26 provided, and provide evidence on an ongoing basis to the state 27 that both have occurred. 28 10. The state shall review and integrate the activities of 29 state agencies, including those agencies with public health, 30 child welfare, aging and disabilities, and ombudsman functions 31 to ensure there is no wrong door for consumers to access the 32 medical and social services and supports necessary for improved 33 outcomes. Managed care organizations shall provide or ensure 34 that consumers are connected with or referred to providers 35 -13- SF 452 (4) 86 pf/nh/jh 13/ 16

S.F. 452 and services to meet social determinants of health, even if 1 provision of services is outside their provider network. 2 Managed care contracts shall encourage partnerships between 3 managed care organizations and local public health agencies, 4 aging and disability resource centers, child welfare agencies, 5 mental health and disability services regions, and others to 6 address the holistic needs of the consumer and shall provide 7 for adequate reimbursement for such services. 8 11. a. Managed care plans shall include policies, plans, 9 and procedures to prepare consumers for transitions between 10 care settings to improve the quality of care for all consumers, 11 reduce avoidable rehospitalizations, and allow individuals to 12 live and receive services in the setting of their choice. 13 b. The state shall require managed care organizations 14 to have in place nursing facility diversion programs. The 15 state shall provide for the use of incentives in managed care 16 contracts for transition of consumers from a nursing facility 17 to home and community-based services. 18 12. The state shall ensure a sufficient and sustainable 19 state infrastructure for monitoring managed care organizations. 20 There shall be sufficient resources for the state to evaluate 21 contractually required quality reports and financial reports, 22 evaluate the impact or effectiveness of incentive programs, 23 conduct quality-focused audits, provide quality-related 24 technical assistance, validate that managed care organization 25 corrective actions have been implemented, analyze quality 26 findings and develop reports to assess quality trends and 27 to identify areas for improvement, develop, implement, and 28 evaluate performance improvement projects, solicit and analyze 29 consumer feedback, and investigate and follow up on critical 30 incident events. 31 13. a. Managed care contracts shall require that a portion 32 of the savings achieved by a managed care organization be 33 reinvested in innovations and longer-term community investments 34 to address population health, infrastructure, the healthcare 35 -14- SF 452 (4) 86 pf/nh/jh 14/ 16

S.F. 452 workforce, and improved service delivery and capacity. 1 b. A managed care contract shall impose a medical loss ratio 2 of at least eighty-five percent and shall include well-defined 3 criteria of what qualifies as a medical expense, and reporting 4 requirements and recoupment provisions to ensure compliance. 5 14. a. The state shall ensure that savings achieved 6 through Medicaid managed care do not come at the expense 7 of further reduction in already inadequate provider rates. 8 The state shall ensure that managed care organizations use 9 reasonable reimbursement standards for all provider types and 10 compensate providers for covered services at not less than 11 current Medicaid fee-for-service levels, as determined in 12 conjunction with actuarially sound rate setting procedures. 13 Such reimbursement shall extend for the entire duration of a 14 managed care organization’s contract. 15 b. The state shall address rate setting and reimbursement 16 of the entire scope of services provided under the Medicaid 17 program to ensure the adequacy of the provider network and to 18 ensure that providers that contribute to the holistic health 19 of the consumer, whether inside or outside of the provider 20 network, are compensated for their services. 21 c. The state shall ensure that managed care organizations do 22 not arbitrarily deny coverage for medically necessary services 23 solely based on financial reasons. 24 15. a. In order to provide adequate access to care for 25 vulnerable Iowans, managed care organizations shall extend 26 nonemergency transportation services to all consumers. 27 b. The state shall ensure that dental coverage, if not 28 integrated into an overall managed care contract, is provided 29 and is part of the overall integrated coverage for physical, 30 behavioral, and long-term services and supports provided to a 31 Medicaid consumer. 32 c. The state shall ensure that the existing formulary for 33 pharmacy benefits under the Medicaid state plan is honored and 34 continued. 35 -15- SF 452 (4) 86 pf/nh/jh 15/ 16

S.F. 452 d. Managed care plans shall ensure consumers receive 1 services and supports in the amount, duration, scope, and 2 manner as identified through the applicable person-centered 3 assessment and service planning process. 4 e. The state shall ensure that for those populations 5 for whom Medicaid home and community-based services waiver 6 services have been historically provided, managed care 7 organizations address with specific plans the expansion, 8 support, reinvestment of savings in, and adequate reimbursement 9 of community-based services and supports. 10 16. a. The state shall utilize the application of 11 liquidated damages in contracts to be paid from moneys other 12 than those paid by the state to hold managed care organizations 13 accountable regarding such provisions as timely claims 14 processing and claims payment accuracy, compliance with 15 licensure and background check requirements, timely provision 16 of an approved service, continuation of benefits pending 17 appeal, timely development of a plan of care, initiation 18 of long-term services and supports, and completion of care 19 coordination contacts. 20 b. The state shall review and approve or deny approval 21 for contract amendments on an ongoing basis to provide for 22 continuous improvement in Medicaid managed care. 23 c. Medicaid managed care organization contracts shall 24 include sanctions for failure to comply with the terms of 25 a contract, including failure relating to performance or 26 deliverables including meeting of performance and outcomes 27 measures. Such sanctions may include but are not limited to 28 assessment of a penalty or assessment of liquidated damages or 29 other monetary remedies. 30 Sec. 3. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 31 immediate importance, takes effect upon enactment. 32 -16- SF 452 (4) 86 pf/nh/jh 16/ 16