WASHINGTON, D.C. – Tuesday, Gov. Terry Branstad met with the Department of Health and Human Services (HHS) Secretary Sylvia Burwell in Washington, DC. In the encouraging meeting they discussed Iowa’s Medicaid modernization plan aimed at improving quality, access, and health care outcomes and creating a more predictable and sustainable Medicaid program that begins January 1, 2016. Specifically, Gov. Branstad outlined how Iowa has learned from the more than two dozen other states using this approach and how Iowa will begin a two-year phase-in starting January 1, 2016.
“We began Iowa’s Medicaid modernization plans in January 2015 and will be phasing in services over a two-year time period. I appreciate the mutual interest in improving patient outcomes that HHS and the State of Iowa share,” said Branstad. “I also appreciate the collaboration we have had in the past with federal officials including the Iowa Health and Wellness Plan, which has increased the healthcare coverage in our state, and look forward to implementing our patient-centered Medicaid plan beginning on January 1, 2016.”
Iowa has learned best practices from 30 other states who have taken steps to modernize Medicaid. Iowa’s phased-in approach ensures a smooth transition starting on day one for all Medicaid patients. For the first two years, Medicaid patients who receive long-term care services and supports (LTSS) can keep those same services without any change. Those services include HCBS (Home Community Based Services) waiver services, nursing facilities, and Intermediate Care Facilities for the Intellectually Disabled.
The measures outlined ensure patients have the option to keep the same services they receive today through the Medicaid modernization transition. To protect doctors and Medicaid providers, they can sign up with as many Managed Care Organizations (MCOs) as they wish and MCOs cannot restrict enrollment for doctors and providers. Additionally, doctors and providers who sign up with a plan are protected from reimbursement cuts and cannot be paid less than current Medicaid rates.
Phase-in measures protecting patients include:
· For the first 3 months, all existing Medicaid authorizations will be honored by the MCOs.
· For the first 6 months, Medicaid patients can keep their current physical & behavioral health providers (primary care, hospitals, specialists etc.) and case managers even if they’re out-of-network.
· For the first 2 years, the most vulnerable Medicaid population patients can keep their current long-term services including nursing facilities, HCBS waivers, ICF/ID’s (Intermediate Care Facilities for the Intellectually Disabled) services, home health services, community mental health center services, and substance use disorder treatment services even if they’re out-of-network.
On Monday, Branstad appointed Janet Phipps to act as the final decision-maker for the Iowa Quality Care Initiative RFP No. MED-16-009, more commonly known as Medicaid modernization.
Under administrative rules that govern appeals, Director of Human Services Charles Palmer was to act as the final decision-maker for any request for review of the proposed decision of the presiding officer in the contested case. However, Director Palmer testified in the contested case hearing on matters material to the ultimate merits of the appeals.
Under Iowa code, Gov. Branstad has appointed Janet Phipps, who is an attorney and has experience and familiarity with the state procurement rules and regulations, as the substitute final decision-maker.