Excerpt from Democrat Sen. Janet Petersen’s newsletter:
Because Governor Reynolds and legislative Republicans are determined to stick with Iowa’s troubled privatized Medicaid, Democrats have proposed a Medicaid Improvement Bill (SF 156)
The bill focuses on helping Iowans and Iowa health care providers, instead of allowing out-of-state MCOs to continue hurting Iowa’s health care system. The bill would:
- Return the most complex cases to a state-run system – The out-of-state corporations managing Medicaid make money by helping sick people get better, thereby lowering costs. Iowans with severe, complex, permanent disabilities and conditions won’t get better, so denying care and cutting services is a bad way to save money.
- Require independent, conflict-free case management and assessments – Case management and patient assessments are both performed by the Managed Care Organization (MCO) that pays for the care. Assessments are more accurate when made by an independent entity and coordinated by case managers who put the patient’s best interest first.
- End prior authorization for substance abuse treatment – An immediate response is essential when someone requests substance abuse treatment. Waiting for prior authorization results in missed opportunities or even overdose deaths that could have been prevented.
- Require MCOs to join in worker recruitment and training – Iowa has a severe shortage of health care workers. All major health care providers and insurers in Iowa contribute to expanding and improving our health care workforce. This legislation ensures the MCOs participate in that effort.
- Implement an external review process for providers – When an MCO denies a claim, Iowa health care providers must negotiate with the MCO itself. When commercial health insurers deny claims, providers can appeal to an external reviewer. This legislation establishes a similar process for MCOs.
- Make it easier to switch MCOs – If a local doctor decides to switch MCOs, their patients should be able switch as well. Currently, patients must wait up to 45 days before they can request a change for good cause. This legislation would allow patients to request an MCO switch after 10 days.
- Move oversight to the State Ombudsman’s Office – Iowa’s Long Term Care Ombudsman has only one full-time managed care ombudsman. There could be three to four more if we took full advantage of federal matching funds. To do that, the MCO ombudsman services should be moved to the State Ombudsman Office.