Capitol Update: Week 15

House Majority Continues to Address Managed Care Solutions

Last week the House majority passed a bill out of House Appropriations Committee to address the Medicaid managed care program. Since the implementation of managed care, there have been challenges, and the House majority has listened to Medicaid members and providers about the difficulties they have had.  These issues include communication from the managed care organizations (MCOs), timeliness of payment, prior authorizations, appeals, level of care determinations, health homes, and credentialing.

This bill (HF 2483) addresses all of these concerns and brings even stronger oversight and accountability to managed care.

Holding MCOs Accountable to Providers:

  • Require MCOs to pay providers in a timely manner and provide justification for denying a claim
  • Require evaluation of all prior authorization requirements by MCOs
  • Require a uniform credentialing process between all MCOs
  • Require mental health and substance abuse services to be paid for court committed individuals

Holding MCOs Accountable to Members:

  • Require the state to review any decrease in level of care for a LTSS member by an MCO
  • Extend services for a member that has won on appeal against an MCO
  • Require an evaluation of health home services with providers and the MCOs

Stronger Oversight of the Medicaid System:

  • Require the state to update Medicaid eligibility files promptly to provide notice to providers
  • Require an audit of small LTSS claims paid or denied by MCOs

This is the House majority’s second attempt to have this legislation passed by the Senate on managed care. The House majority remains committed to passing meaningful managed care legislation and to have it signed by the Governor this year.

The House majority is dedicated to assisting any Medicaid member or provider that is having issues navigating the managed care program. The MCOs are contractors for the state, and they should be held accountable if they are not fulfilling the obligations to the state and those it serves. Please contact me if I can assist in any way.

House Sends Campground Rental Bill to Governor

Last week, the Iowa House passed Senate File 2389 with a vote of 89-8. This bill will now be sent to the Governor for signature.

This bill allows the Iowa Department of Natural Resources to shift the way it establishes camping and special privileges (rental) fees at state parks and recreational areas. Previously, for any slight change in pricing for any state park or rental facility, the change had to go through the long administrative rules process with the Natural Resources Commission. With this bill, the DNR will have flexibility to increase, decrease, or allow for promotional packages during certain seasons or holidays.

The bill does include oversight over the DNR by requiring them to make the fees reasonably competitive with fees established in other public parks or recreation areas within 60 miles of each park, as well as explain their methodology for the fee policy. The legislature will also receive an annual report from the DNR with information about fees and occupancy rates at each camp/rental facility and special promotional events or holiday rates during the year.

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