Branstad's ideologically driven mess continues:
With the switch to Medicaid managed care a little more than two weeks away, there’s still one key piece of the transition that needs to fall into place — approval from the Centers for Medicare and Medicaid Services.
And one state official believes that answer might come sometime this week or next.
Gov. Terry Branstad announced plans to transition Iowa’s $5 billion Medicaid system to four out-of-state, private care companies earlier this year. In August, the state awarded contracts to Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley and WellCare of Iowa.
Iowa Department of Human Services Director Charles Palmer said on Wednesday during an Iowa Council on Human Services meeting — during which the council adopted the emergency rules that establish the structure for implementing the Jan. 1 changeover — that he expects to hear results from CMS this week or sometime next week.
The federal officials in charge of approving the transition have a range of options, he said, which include granting Iowa’s waiver outright to declaring that the state isn’t ready and putting a hold on the proceedings. Within those parameters, he said CMS could approve parts of Iowa’s criteria while delaying others.
Mikki Stier, Iowa’s Medicaid director, said DHS staff is in daily — and sometimes hourly — contact with CMS officials, who conducted intensive on-site inspections in Iowa last week to assess the state’s readiness and whether to grant waivers allowing the transition to proceed.
The managed-care organizations have been working to secure contracts with the state’s nearly 30,000 Medicaid providers, and data released by the state on Tuesday shows three of the four organizations have contracts with only about 50 percent of providers.
According to the Iowa Department of Human Services, Amerigroup have contracts with 50.8 percent of providers; Amerihealth with 51.7 percent; UnitedHealthcare with 63.1 percent; and WellCare with 48.8 percent.
In addition:
l UnityPoint Health, which includes St. Luke’s Hospital in Cedar Rapids, signed contracts with UnitedHealthcare.
l University of Iowa Hospitals and Clinics signed contracts with AmeriHealth, UnitedHealthcare and WellCare.
l Mercy Medical Center in Cedar Rapids has yet to sign any contracts.
Starting Thursday, the 560,000 Medicaid recipients can select a different managed-care organization from the one assigned to them by the state. Medicaid enrollees have until March 17 to select a different organization for any reason, DHS spokeswoman Amy McCoy said.
Enrollees can change for “good cause” reasons throughout the year, which DHS said could include a provider not contracting with a managed-care organization, change in eligibility or if related services that must be performed at the same time are not available in the manage-care organization’s network.
Lisa Salter of Hiawatha said she is holding off on making a decision until she has a better picture of with whom her son’s providers will sign contracts. Her 16-year-old son, Noah, is on an intellectual disability waiver, and several of his providers — including Mercy and his primary care doctor — have not signed contracts yet, she said.
Five of the past seven surgeries Noah has had have taken place at Mercy, she said, and he also receives physical therapy services from that hospital. So rather than choose a managed-care organization Thursday and then possibly have to switch a few months down the road, Salter is sticking with Noah’s pre-assigned selection, UnitedHealthcare, she said.
Salter believes there’s been a good deal of confusion surrounding the Dec. 17 date, adding she’s been contacted by several friends who have children with disabilities who believed that date to be a hard deadline.
“It’s pushed people into a fearful panic,” she said.
The state also is awaiting the answers on two decisions — a Polk County district judge heard the argument last week from the Iowa Hospital Association and 11 hospitals to delay the implementation of managed care until a legal conflict is addressed, while Janet Phipps, director of the Department of Administrative Services, will determine whether to keep or toss out WellCare’s contract.
http://www.thegazette.com/subject/l...nsition-still-needs-federal-approval-20151216
With the switch to Medicaid managed care a little more than two weeks away, there’s still one key piece of the transition that needs to fall into place — approval from the Centers for Medicare and Medicaid Services.
And one state official believes that answer might come sometime this week or next.
Gov. Terry Branstad announced plans to transition Iowa’s $5 billion Medicaid system to four out-of-state, private care companies earlier this year. In August, the state awarded contracts to Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley and WellCare of Iowa.
Iowa Department of Human Services Director Charles Palmer said on Wednesday during an Iowa Council on Human Services meeting — during which the council adopted the emergency rules that establish the structure for implementing the Jan. 1 changeover — that he expects to hear results from CMS this week or sometime next week.
The federal officials in charge of approving the transition have a range of options, he said, which include granting Iowa’s waiver outright to declaring that the state isn’t ready and putting a hold on the proceedings. Within those parameters, he said CMS could approve parts of Iowa’s criteria while delaying others.
Mikki Stier, Iowa’s Medicaid director, said DHS staff is in daily — and sometimes hourly — contact with CMS officials, who conducted intensive on-site inspections in Iowa last week to assess the state’s readiness and whether to grant waivers allowing the transition to proceed.
The managed-care organizations have been working to secure contracts with the state’s nearly 30,000 Medicaid providers, and data released by the state on Tuesday shows three of the four organizations have contracts with only about 50 percent of providers.
According to the Iowa Department of Human Services, Amerigroup have contracts with 50.8 percent of providers; Amerihealth with 51.7 percent; UnitedHealthcare with 63.1 percent; and WellCare with 48.8 percent.
In addition:
l UnityPoint Health, which includes St. Luke’s Hospital in Cedar Rapids, signed contracts with UnitedHealthcare.
l University of Iowa Hospitals and Clinics signed contracts with AmeriHealth, UnitedHealthcare and WellCare.
l Mercy Medical Center in Cedar Rapids has yet to sign any contracts.
Starting Thursday, the 560,000 Medicaid recipients can select a different managed-care organization from the one assigned to them by the state. Medicaid enrollees have until March 17 to select a different organization for any reason, DHS spokeswoman Amy McCoy said.
Enrollees can change for “good cause” reasons throughout the year, which DHS said could include a provider not contracting with a managed-care organization, change in eligibility or if related services that must be performed at the same time are not available in the manage-care organization’s network.
Lisa Salter of Hiawatha said she is holding off on making a decision until she has a better picture of with whom her son’s providers will sign contracts. Her 16-year-old son, Noah, is on an intellectual disability waiver, and several of his providers — including Mercy and his primary care doctor — have not signed contracts yet, she said.
Five of the past seven surgeries Noah has had have taken place at Mercy, she said, and he also receives physical therapy services from that hospital. So rather than choose a managed-care organization Thursday and then possibly have to switch a few months down the road, Salter is sticking with Noah’s pre-assigned selection, UnitedHealthcare, she said.
Salter believes there’s been a good deal of confusion surrounding the Dec. 17 date, adding she’s been contacted by several friends who have children with disabilities who believed that date to be a hard deadline.
“It’s pushed people into a fearful panic,” she said.
The state also is awaiting the answers on two decisions — a Polk County district judge heard the argument last week from the Iowa Hospital Association and 11 hospitals to delay the implementation of managed care until a legal conflict is addressed, while Janet Phipps, director of the Department of Administrative Services, will determine whether to keep or toss out WellCare’s contract.
http://www.thegazette.com/subject/l...nsition-still-needs-federal-approval-20151216
