Medicaid Modernization

Unprecedented Oversight

This week, the House released our oversight plan for Medicaid Modernization. Our approach will require an unprecedented amount of data and reporting, from the Center for Medicare and Medicaid Services (CMS), the Iowa Department of Human Services (DHS), and the three managed care organizations (MCOs), to be submitted to the legislature for review.  This will provide legislators with a wide assortment of figures and information on the Medicaid program that has never been available in the past.  This plan ensures that consumers are protected, patient health and financial outcomes are monitored and transparent, and the integrity of our health care system remains.

Consumer Protections

Medicaid patients must be able to have access to protections and advocates when needed to ensure that they are receiving the high-quality healthcare that they expect. Our plan requires that the legislature receive reports on consumer protections like:

• Customer service satisfaction including call center performance, grievances and appeals filed, and how timely issues are resolved with DHS and the MCOs
• The number of doctors and providers that are available to patients to ensure adequate access
• The total number of Medicaid patients and how that changes over time.

Healthy Outcomes

One of the main goals of Medicaid Modernization is to promote wellness and healthy living. However, we need a way to track whether or not people are becoming healthier, which was never part of the old Medicaid system.  As part of our plan, the legislature will receive detailed reports on outcomes like:

• Annual health care effectiveness data to ensure that patients are becoming healthier
• Specific reporting on vulnerable Medicaid patients like those with special needs, behavioral issues, and the elderly
• The percentage of claims paid and denied to confirm that patients are receiving the care they need
• Cost savings to the Medicaid program including the amount spent on medical care versus administrative cost.

Program Integrity

Finally, federal, state, and contractual safeguards are in place for Medicaid Modernization to prevent, detect, and eliminate fraud, waste, and abuse. Even with all of these protections, the legislature will be monitoring to ensure efficient and effective use of tax dollars and will be able to act on any cases of fraud or abuse.

Equally important is that all of this information will be made public online for Iowans to view. This provides a level of transparency that the Medicaid program has never before seen.  While patient-specific information will not be made public, aggregate data and summaries will be available in an easy to read format so that Iowans can also review the information themselves.

This plan offers Iowans the assurance that the health care of Iowa’s most vulnerable are not being put in jeopardy. As the new system continues to roll out, the House Majority will keep a watchful eye on the transition to ensure that Iowans continue to receive the care that they count on.

News from District 96

The end of the legislative session is fast approaching. We reached budget targets last week and now we are getting into the details.  I currently believe that we will be done with this session sometimes late next week.

This Tuesday I had the chance to visit with the Grow Iowa Ag who promotes the advancement of Iowa Agriculture. We had the chance to discuss issues that were important to Iowa’s Ag Community. Wednesday morning I had the chance to welcome John Harms and Joe Yedlik to the Capitol.  They were here with the Association of County Fairs.  They shared with me some of the newer projects that are taking place at county fairs across Iowa.

On Thursday we passed the Agriculture and Natural Resources Appropriations Budget out of the House. It is the first budget to be completed this session.  This is a status quo budget that remains largely unchanged from last year and is now on its’ way to the Senate.

As always if you have any comments, questions, or concerns please feel free to get in touch. My phone number is (319) 480-1997 and my email is lee.hein@legis.iowa.gov.