MAAC MEETING MATERIALS EXECUTIVE COMMITTEE MEETING ... · PDF fileMAAC MEETING MATERIALS...

MAAC MEETING MATERIALS EXECUTIVE COMMITTEE MEETING SEPTEMBER 12, 2017

1. Agenda of Meeting for September 12, 2017 2. Meeting Minutes of the August 24, 2017- MAAC Executive Committee Meeting 3. MAAC Recommendations Quarterly Public Comment Listening Sessions SFY2018 4. MAAC IAHL Recommendations SFY18 Timeline 5. Meeting Minutes of the MAAC Recommendations Subcommittee 6. IA Health Link Public Comment Meeting – MASON CITY 7. IA Health Link Public Comment Meeting – SIOUX CITY 8. IA Health Link Public Comment Meeting – BETTENDORF 9. Action Items

August 31, 2017

Executive Committee Meeting

Tuesday, September 12, 2017 Time: 3:00 p.m. – 4:30 p.m.

Hoover State Office Building, A-Level

Conference Room 7, 1305 E. Walnut Street

Des Moines, IA

Dial: 1-866-685-1580 Code: 515-725-1031#

AGENDA

3:00 Introduction and roll call – Gerd Clabaugh

3:05 Approval of minutes from previous Executive Committee meeting – Gerd Clabaugh

Executive Committee: August 24, 2017

3:10 Discussions on Recommendations – Gerd Clabaugh

SFY17 Q4 (due date was July 15, 2017) o Subcommittee Update o Final draft of SFY17 Q4 recommendations due as soon as possible

SFY18 Q1 (due date is October 10, 2017) o Subcommittee Update o Public Comment Listening Sessions Summary – Davenport (Aug. 29, 2017) o Initial draft of SFY18 Q1 recommendations

3:50 Medicaid Director’s Update – Mikki Stier (including review of Action Items document)

Discussion on MCO to MCO transfer of information – Liz Matney

4:20 Open Discussion – Gerd Clabaugh

4:30 Adjourn

Medical Assistance Advisory Council

MAAC

Iowa Department of Human Services

Mikki Stier, Medicaid Director

August 28, 2017



Mikki Stier, Iowa Medicaid Director MAAC

EXECUTIVE COMMITTEE MEMBERS DEPARTMENT OF HUMAN SERVICES

Gerd Clabaugh – present Jerry Foxhoven -

David Hudson – present Mikki Stier - present

Dennis Tibben – present Deb Johnson -

Natalie Ginty – present Liz Matney - present

Shelly Chandler – present Matt Highland - present

Cindy Baddeloo (Brandon) – present Lindsay Paulson - present

Kate Gainer – Sean Bagniewski - present

Lori Allen – Amy McCoy -

Richard Crouch – present Luisito Cabrera - present

Julie Fugenschuh – present Alisha Timmerman - present

Jodi Tomlonovic – present

Introduction David called the meeting to order and performed the roll call. Executive Committee attendance is as reflected above and quorum met.

Approval of the Executive Committee Meeting Minutes of July 11, 2017 Minutes of the Executive Committee meeting on July 11, 2017 was approved.

Discussions on Recommendations Dave suggested that there be fewer recommendations with a more clearly articulated rationale compared to the last set of recommendations. The Executive Committee agreed that previous recommendations that had been declined by Director Foxhoven were to be further reviewed by the recommendations subcommittee for future recommendation consideration. The Full Council minutes from the August 8, 2017, meeting was reviewed and the nine Council recommendations discussed. The MAAC would review the LTSS Ombudsman’s reports and work with the Long Term Care Ombudsman’s Office for potential recommendations. The subcommittee will consist of Dennis Tibben, Natalie Ginty, Julie Fugenschuh, Jodi Tomlonovic, Gerd Clabaugh, and David Hudson.

Subcommittee Topics for Recommendations 1. Review declined recommendations from Quarter 2 SFY2017 and Quarter 3 SFY2017 2. Review Durable Medical Equipment issues 3. Review input from the LTC Ombudsman’s Office reports to identify persistent issues

LTC Ombudsman “How to be Your Own Best Advocate” Kelli reviewed the “How to Be Your Own Best Advocate” guidebook. She stated that the goal of the Document is to inform managed care members how to file appeals and grievance forms and better understand CDAC and Case Management processes. She stated that the document is available

Executive Committee Summary of Meeting Minutes

August 24, 2017

August 28, 2017

electronically through the State LTCO Office website. Provider Re-Enrollment Update Sean confirmed that of the 38,029 provider tax IDs, 9,868 have not yet re-enrolled. Of the 9,868 providers that have not re-enrolled, 5,600 have not billed the IME or the MCOs this year. He stated that of the 9,868 providers, there are 4,266 who have billed the IME or MCOs this year. Those who have not billed the IME or MCOs this year will be sent a letter informing them that they must re-enroll with the IME by September 30, 2017, or will be disenrolled with the IME and MCOs. In addition to the written document, they will receive a phone call from either the IME or MCOs. Providers who have billed the IME or MCOs this year will receive notice via email that they must re-enroll with the IME by October 31, 2017. Medicaid Director’s Update (Including review of Action Items document) Mikki reviewed the outstanding items in the Action Items document. Liz Matney addressed the Action Items below. Further information and data will be provided at the September 12, 2017, Executive Committee meeting. Top Five Reasons for Grievances and Appeals to Identify Systemic Trends:

Grievances Liz stated the top three grievances are concerning transportation, provider issues, and eligibility. There was less than 1/10 of 1% of members filing grievances given each member contacted their MCO once. All calls to the IME regarding concerns that could be classified as grievances continue to be tracked and addressed by the IME and the MCOs.

Appeals Liz stated that the top reasons for appeals are issues with prescriptions and service authorizations. There had been 13 member appeals regarding prescriptions and approximately 79 appeals regarding service authorizations that were escalated to the state fair hearing level since implementation of the program. The most common reason for appeal denials at the state fair hearing level was that the member had not gone through their MCO’s appeals process prior to filing an appeal with Iowa Medicaid.

Identifying Trends Involving Payment Issues: Liz confirmed the number of reported provider payment issues had decreased following implementation. The most prevalent payment issues are due to the process of how the rate files are loaded into the system, discrepancies in rate files due to incorrect provider type classification, changes in member eligibility, and delays in MCO credentialing. The top reason for provider calls to MCO call centers was verification of claim status. Average Aggregate Cost Per Member Per Day for Special Needs Members in ICF/ID: Liz confirmed that the average cost per member per day for members residing in community-based ICF/IDs in the state is approximately $325. The average daily cost for members in out-of-state ICF/IDs is approximately $336 per member. The average daily cost is approximately $869 per member for those residing in state resource centers. Out-of-State Placement for Members in Facilities: Liz stated the Department attempts to place members in the state, close to their supports and family members, and require exhaustion of in-state facility placement options prior to considering out-of-state placement. Liz confirmed there are currently 11 members residing in bordering states. There are currently 18 members placed out-of-state due to their medical conditions; with a large portion being children residing in Psychiatric Medical Institutes for Children (PMIC) facilities. Liz stated that there were currently 112 members placed in an out-of-state facility due to reasons such as the member having severe aggression or failure at other in-state facilities. Open Discussion David solicited comments. No comments were made. Adjourn 4:33 P.M.

September 5, 2017

MAAC Recommendations Quarterly Public Comment Listening Sessions

SFY2018

In accordance with HF2460, Division XXII, Section 94, Subsection 5, the MAAC public comment quarterly recommendations are to be made based on the meetings held in the corresponding quarter. Please see below for Quarterly recommendation submission dates and the public comment meeting months for review in each set of quarterly recommendations: Quarter 4 SFY2017 Recommendations

Months for review: April 1, 2017 – June 30, 2017 Public comment meetings to review:

Mason City – April 12, 2017

Sioux City – June 13, 2017 Submission date: July 15, 2017

Quarter 1 SFY2018 Recommendations Months for review: July 1, 2017 – September 30, 2017 Public comment meetings to review:

Bettendorf – August 29, 2017 Submission date: October 15, 2017

Quarter 2 SFY2018 Recommendations Months for review: October 1, 2017 – December 31, 2017 Public comment meetings for review:

Dubuque – October 11, 2017

Des Moines – December 14, 2017 Submission date: January 15, 2017

Quarter 3 SFY2018 Recommendations Months for review: January 1, 2018 – March 31, 2018 Public comment meetings to review: TBD Submission date: April 15, 2018 Quarter 4 SFY2018 Recommendations Months for review: April 1, 2018 – June 30, 2018 Public comment meetings to review: TBD Submission date: July 15, 2018


MAAC



September2017

Executive Committee

Meeting

9/12/2017

October2017

November2017

December2017

January2018

Subcommittee Meeting

Initial Discussion on Input

9/12/2017

Subcommittee Final draft of

recommendations completed

10/6/2017

Submission of recommendations

10/13/2017(10/15/2017)

Executive Committee

Meeting Final vote on

recommendations

10/10/2017

Full Council Meeting

11/7/2017

Submission of recommendations

1/15/2018

Executive Committee

Meeting

11/16/2017

Executive Committee

Meeting

12/19/2017

Executive Committee

Meeting Final vote on

recommendations

TBD

Subcommittee Final draft of

recommendations completed

1/8/2017

Subcommittee Meeting

Initial Discussion on Input

12/19/2017

Iowa Department of Human ServicesMedical Assistance Advisory Council

IA Health Link Quarterly RecommendationsSFY18

Quarter 1 SFY18(July 1, 2017 – Sept. 30, 2017)

Quarter 2 SFY18(Oct. 1, 2017 – Dec. 31, 2017)

· Bettendorf – August 29, 2017 · Dubuque – October 11, 2017· Des Moines – December 14, 2017

September 8, 2017

MAAC Recommendations Subcommittee Summary of Meeting Minutes

September 5, 2017

EXECUTIVE COMMITTEE MEMBERS DEPARTMENT OF HUMAN SERVICES

Gerd Clabaugh – present Mikki Stier -

David Hudson – present Lindsay Paulson - present

Dennis Tibben – present Luisito Cabrera - present

Natalie Ginty – present Alisha Timmerman - present

Jodi Tomlonovic - present

Julie Fugenschuh - present

Topics for Recommendations

1. Review declined recommendations from Quarter 4 SFY2017 and Quarter 3 SFY2017

The subcommittee agreed that the next set of recommendations would not contain extensive dialogue about previously declined recommendations. It was agreed that a future discussion/meeting should take place between the Executive Committee, Mikki Stier, and Liz Matney regarding declined recommendations for additional insight in their denial for the determination of future recommendations. It was decided that the previous letter would not be reviewed in its entirety and the subcommittee identified the areas of the previous recommendations letter that were to be discussed.

Future Actions 1) Hold future discussion in Executive Committee meeting with Mikki Stier and Liz

Matney regarding previously declined recommendations that the subcommittee deemed as ongoing concerns.

Previous recommendations for discussion: The Department is to develop a new methodology to track consistency of

prior authorization determinations within each MCO. Include the accuracy and consistency of information provided by the MCO

Customer Service Representatives to both providers and members in the Managed Care Quarterly Report.

Include secret shopper results to the Managed Care Quarterly Report. 2) Request that Mikki and Liz ask the MCOs for the agendas, minutes, etc. from

the MCO advisory councils to determine the discussions and actions taken in their advisory meetings.


MAAC



September 8, 2017

2. Review Durable Medical Equipment Issues

The subcommittee agreed that additional information would be needed from a Durable Medical Equipment (DME) provider or organization regarding specific issues and concerns.

Future Actions 1) The Department is to contact Full Council member Matt Flatt, designee of

Midwest Association for Medical Equipment Services, to ask that he attend a future subcommittee meeting for discussion of DME issues and concerns.

3. Review input from the LTC Ombudsman’s office to identify persistent issues

A smaller workgroup is to be developed that consists of approximately 2 subcommittee members, Kelli Todd, and Cindy Baddeloo or Shelly Chandler for discussion of ongoing LTC issues.

Future Actions 1) Gerd is to contact Kelli Todd and workgroup members for future meeting to

discuss ongoing LTC issues.

Iowa Department of Human Services: April 2017 1

Mason City IA Health Link Public Comment Meeting

Wednesday, April 12, 2017 Time: 5 p.m. – 7 p.m.

North Iowa Community College Room AC 101

500 College Drive Mason City, IA 50401

Meeting Comments and Questions IME/DHS Staff MCO Representatives MAAC Representatives

Lindsay Paulson - present Amerigroup Iowa, Inc. - present Tom Ryan - present

Sean Bagniewski - AmeriHealth Caritas Iowa, Inc. - present

Bob Schlueter - present UnitedHealthcare Plan of the River Valley, Inc. - present

Sarah Belmer - present

Peter Crane - present

Comments Assistance An advocate and mother to a son in the managed care program commended her son’s MCO for the assistance and attention that her family had received. Prior Authorizations Tom Ryan, MAAC representative and advocate for the area, stated that multiple providers had contacted him inquiring if the MCOs were able to implement a universal prior authorization form. The providers had stated that a universal form would make the authorization process more streamlined. Reimbursement Tom stated that providers had expressed concerns regarding the amount of time it had taken to be reimbursed by the MCOs. The providers identified that claims were frequently denied and returned to the provider due to incorrect or missing information. The issue with denied claims had been time consuming and bothersome for staff which resulted in some health providers quitting.

Questions

1. Is Amerigroup Iowa, Inc. now requiring annual recertification that needs to be completed by the individual/facility?

2. What is the MAAC Council, how many people make up the MAAC, and how can I become a member?

Iowa Department of Human Services: June 2017 1

Sioux City IA Health Link Public Comment Meeting

Tuesday, June 13, 2017 Time: 5 p.m. – 7 p.m.

Sioux City Public Library 529 Pierce St Sioux City, IA


Lindsay Paulson - present Amerigroup Iowa, Inc. - present Gerd Clabaugh - present

Sean Bagniewski - present AmeriHealth Caritas Iowa, Inc. - present

Matt Highland - present UnitedHealthcare Plan of the River Valley, Inc. - present

Peter Crane – present

Adrian Olivares – present

Comments Reimbursement, Billing and Claims A provider stated that his office had purchased medically necessary medications for patients and had not yet been reimbursed by two of the MCOs. In regards to denials, a different provider stated that medications were being denied and how hard it had been for patients to obtain needed medications. Multiple providers stated that they had been experiencing claims issues such as unpaid claims, claims denials or claims that had been paid incorrectly. Providers identified issues with the timeliness and accuracy of reimbursements. Some providers also stated that their employees have to work extra hours to correct denied claims. A different provider mentioned their facility will not be accepting any new patients until the claim issues are resolved. A Consumer Directed Attendant Care (CDAC) provider mentioned that some CDAC providers were being paid for their services every other month and not monthly as they should be. A substance abuse treatment center representative stated that they were owed 1.5 million by the MCOs. Durable Medical Equipment (DME) Providers have not yet been reimbursed for DME provided to the patients. A DME provider commented on the ongoing claims issues with one of the MCOs, and stated that they have 101 unpaid and incorrectly paid claims as of April 2016. Providers have contacted the IME in regards to unpaid claims although issues have not yet been resolved and providers continue to encounter unpaid claims. A DME provider stated that one of the MCOs took over 4 months to pay for oxygen services for a patient in a nursing home.

Iowa Department of Human Services: June 2017 2

Prior Authorizations Providers raised concerns about the MCOs not following the IME guidelines for prior authorizations. Comments A provider commented that the MCOs were making treatment decisions for the patients rather than the providers and medical staff. Providers were also having difficulty with following three different sets of rules and procedures for the MCOs. A remark was made that the MCOs were progressively improving. It was stated that the data and information within the MCO quarterly reports was not accurate. A provider mentioned an MCO’s members were forced to switch their MCO in order for their services to be approved. Providers were being referred to their account representatives when calling the MCO’s customer service call centers. Providers said issues were being passed to different departments throughout the organizations and while they had received callbacks and emails in regards to their issues, the issues were not being resolved. NEMT A member raised a concern about the lack of transportation services in their area. A transportation broker had asked a member unnecessary information for services such as what provider they would be seeing and their diagnosis. The member believed she should not be asked those types of questions when scheduling transportation to appointments. Case Management A member also raised concerns about their case manager assigned by their MCO. The member stated the case manager sent rude emails saying “I’m busy what do you need” and “effective immediately I’m no longer your case manager. Your new one will contact you.” The member stated they were now afraid to contact their new case manager as they had never experienced such treatment from previous case managers. In regards to case managers, a member stated that they believed the case managers were under a lot of stress due to the amount of cases they were dealing handling. A member gave accolades to their son’s case manager.

Questions

1. What is being done to update the websites in order to obtain information on how to bill properly?

2. Are the MCOs willing to have face-to-face meetings to go over the billing issues? 3. We get denials for medical equipment and have to appeal, get a hearing and then the

items will be approved. What will happen when the MCOs can no longer provide equipment?

4. What are the guidelines or requirements the medical directors are going by? How do we explain it to parents with children approved for one item but not the other?

Iowa Department of Human Services: August 2017 1

Bettendorf IA Health Link Public Comment Meeting

Tuesday, Tuesday 29, 2017 Time: 5 p.m. – 7 p.m.

Scott Community College Student Life Center 500 Belmont Road

Bettendorf, IA 52722


Lindsay Paulson - present Amerigroup Iowa, Inc. - present Dennis Tibben - present

Sean Bagniewski - present AmeriHealth Caritas Iowa, Inc. - present

Natalie Ginty - present

Matt Highland - present UnitedHealthcare Plan of the River Valley, Inc. - present

Sarah Belmer - present

Peter Crane - present

Comments Services Parents, advocates, and providers have expressed their concerns regarding how a member is able to obtain services they need. One provider stated that the Managed Care Organizations (MCOs) are prescribing medications rather than approving services. It was stated that members were being required to try medications before services would be approved. A parent conveyed his frustration about how his 38 year old mentally disabled and deaf son was denied an interpreter by the MCO. Durable Medical Equipment For the past four months a pediatric physical therapist has had a difficulty with obtaining approval for a wheelchair for a severely disabled 18 month old child. The MCO for that child has only worked with the member’s primary care provider for additional information rather than the pediatric physical therapist who was working directly with the child and submitting the paperwork.

Prior Authorizations A provider is requesting to have a set format for how and what information needs to be submitted in order for services and DME to be approved without having to go back and forth with the MCOs.

Case Management There is an issue with the MCOs using in-house case management because the person/entity determining the members hours and services are also making a profit when


services are reduced. A parent stated they are also no longer able to sit down with the member’s team to discuss options and make a decision for the member like they were able to prior to the privatization; case managers were making decisions on behalf of the member. MCO Oversight State Representative Cindy Winckler informed the Public Comment Meeting recipients that the MCOs have taken the legislature oversight out of the system. Prior to implementation, legislators had the opportunity to provide input at meetings but now the meetings are not happening and despite trying to place more oversight in legislation, they do not have enough votes to do so. Representative Winckler stated the legislature was frustrated that they have been taken out of the process and that the Executive branch was the one who chose to privatize Medicaid. A parent also agreed that the lack in MCO oversite was unsettling. Home- and Community-Based Services (HCBS) Waiver A mother expressed concerns regarding low capitation rates and that her son was not receiving the HCBS Waiver services that he needed due to limited funding. The mother stated that the MCOs were receiving a maximum of $4,488 per HCBS Waiver member residing in a facility. Independent Support Brokers (ISB) and parents caring for members who are on a waiver are experiencing difficulties with effective communication. Prior to the privatization, any changes to the member’s Consumer Choice Options (CCO) budgets were electronically updated in the system for the ISB to view. Now the ISBs are no longer being informed when there has been a change to a member’s budget and case workers were not informing the ISBs. It was affirmed that facilities were being shut down due to the floor rates and that the people who needed HCBS services were not able to obtain the services that they needed. Consumer Directed Attendant Care (CDAC) CDAC providers are paid at a very low rate and members are requesting a higher rate to retain their CDAC providers although the MCOs are rejecting their requests. Questions

1. Are the MCOs required to be accredited?

2. When members and providers call the Iowa Medicaid Enterprise and the Managed

Care Organizations call centers, they are receiving different answers. What is being

done to train staff appropriately?

3. With demands of the Americans with Disabilities Act, why would a member be denied

an interpreter?

4. Is there a process that providers must follow to receive approval for prior

authorizations for DME/Services?


5. Are they going to level out the reimbursement rates for the MCOs to be more

standardized (capitation rates)?

6. What happens to those of us who have kids with an exception to policy who go over

the daily rate? How are the MCOs going to address situations where the funding is

dropped to the floor rates set by the state?

7. How cost efficient is this to have SIS assessments done every 3-5 years?

8. What are the benefits from doing SIS assessments?

9. Why are SIS assessments required?

10. Is the shift to managed care because the state could not handle the costs?

Iowa Department of Human ServicesMedical Assistance Advisory Council (MAAC)

Outstanding Items from the Executive Committee Meeting of September 12, 2017

Date Added Action Item Who is Responsible for Follow-Up

Status (Outstanding / Complete / In Process / To Be Scheduled)

11/4/2016 Update on the new CMS managed care rules and whether changes are necessary to be in compliance.

Medicaid Director Ongoing

2/23/2017 To have presentations regarding Integrated Health Homes and the Health Homes project. UPDATE on March 14, 2017: Deb Johnson and Joyce Vance are to be invited to a future Executive Committee meeting to continue the discussion on Chronic and Integrated Health Homes

Medicaid Director A follow-up presentation will take place at future Executive Committee meeting.

2/23/2017 Secondary Payer: * Clarify MCOs as a secondary payer. * To have presentation on the coordination between Medicaid and Medicare for dual eligible members in the waiver programs.

Medicaid Director To be discussed at future Executive Committee meeting.

3/14/2017 Matt Highland and representatives from the three MCOs are to present information regarding mobile applications at a future Executive Committee meeting; after July 2017

Medicaid Director In Process

7/11/2017 Research national benchmark on Program Integrity fraud rate data with home health providers.

Medicaid Director Outstanding

7/11/2017 Updates on the EVV stakeholder workgroup meetings. Medicaid Director Monthly EVV Workgroup Schedule: * Wednesday, September 13, 2017 * Wednesday, October 11, 2017 * Wednesday, November 8, 2017 * Wednesday, December 6, 2017

8/8/2017 Managed Care Division to provide a review of managed care quality performance measures - HEDIS and HSAG

Medicaid Director - Managed Care Division

Outstanding

8/8/2017 Review the process involving transfer of member information from one MCO to another MCO when a member chooses to change their MCO

EC Members and Medicaid Director

Outstanding

8/8/2017 Have future discussion on the role of care coordinators and case managers responsible for waivers. Which set of activities is making the greatest impact on improving outcomes?


A follow-up presentation will take place at future Executive Committee meeting.

8/8/2017 Consider a discussion relating to the federal discussions on block granting Medicaid dollars, and how the state is positioned relative to this possible outcome.


Outstanding

Action Page 1


Outstanding Recommendations from the Executive Committee Meeting ‐ September 12, 2017

Date Added Action Item Iowa Department of Human Services

Status (Outstanding / Complete / In Process / To Be Scheduled)

Recommendations Page 2


Completed Items from the Executive Committee Meeting ‐ September 12, 2017

Date Added Item Responsible Party Status (Outstanding / Complete / In Process / To Be Scheduled)

1/19/2017 Public Comment Recommendation: The Department Develop a new methodology to track consistency or prior authorization determinations within each MCO.

Medical Assistance Advisory Council (MAAC)

Completed - Director Response Letter dated June 27, 2017, reviewed by MAAC Full Council on August 8, 2017.

1/19/2017 Public Comment Recommendation: The Department to enforce and communicate to the MCOs the cap after which a PA request is deemed approved (seven days) if a determination has not been made. The MCOs are then to communicate the determination to providers.

Outstanding Items from the Executive Committee Meeting of

July 11, 2017


1/19/2017 Public Comment Recommendation: Encourage the MCOs to develop consistent service groups or crosswalk standards for PAs to allow for instances where approval is obtained for a specific service or products. Recommend that each of the MCOs develop an exemption process based on medical necessity.

Medicaid Director


1/19/2017 Public Comment Recommendation: Require MCOs to provide a plain language explanation to Iowa Medicaid members and providers for PA denials.

Medicaid DirectorCompleted - Director Response Letter dated June 27, 2017, reviewed by MAAC Full Council on August 8, 2017.

1/19/2017 Public Comment Recommendation: The Department to determine the differences in credentialing requirements between the MCOs and develop a comparison grid of what additional measures beyond the IME's universal credentialing is required by each MCO.

Medicaid Director


1/19/2017 Public Comment Recommendation: Require the MCOs explain the rationale for additional credentialing requirements beyond what is contractually required by the IME.


1/19/2017 Public Comment Recommendation: Determine the percentage of clean claims payments that are paid on time and accurately based upon the established rate floors to track the accuracy of provider payments.

Medicaid Director


1/19/2017 Public Comment Recommendation: Regarding clearinghouse to clearinghouse issues: Request that the MCOs provide data related to the initial denail rates from their clearinghousees and include this data in the Managed Care Quarterly Report.

Medicaid Director


1/19/2017 Public Comment Recommendation: Include the accuracy and consistency of information provided by the MCO Customer Service Representatives to both providers and members in the Managed Care Quarterly Report.

Medicaid Director


1/19/2017 Public Comment Recommendation: Include secret shopper results to the Managed Care Quarterly Report.

Medicaid Director Completed - Director Response Letter dated June 27, 2017, reviewed by MAAC Full Council on August 8, 2017.

1/19/2017 Public Comment Recommendation: Request that the MCOs report information regarding outreach efforts to increase access to care in areas identified in the MCOs' GeoAccess Reports as limited access areas.

Medicaid Director


1/19/2017 Public Comment Recommendation: Request that MCOs present on results of outreach efforts in order to determine outstanding issues that the MAAC may be able to address.


Completed Page 3




1/19/2017 Public Comment Recommendation: Request summaries of the MCOs' Consumer Advisory Panels and Clinical Advisory Panels. Request that MCOs make a periodic formal presentation to the MAAC regarding the timely data and feedback obtained from their required advisory panels.

Medicaid Director


1/19/2017 Public Comment Recommendation: Encourage the development of a standardized process across the MCOs to create consistent member material to inform members on what services are provided by each MCO, the process for denying services, and what resources will be given to review available services

Medicaid Director


1/19/2017 Public Comment Recommendation: Require MCOs to provide a plain language explanation to Iowa Medicaid members on all MCO denials.


1/19/2017 Public Comment Recommendation: Require that all MCO provider manuals be clearly posted in an easily accessible format and location on the MCOs' websites and available in hardcopy.


1/19/2017 Explanation and definition of plain language standards Medicaid Director Completed - Discussed in March 14, 2017 Executive Committee meeting.

2/14/2017 Executive Committee to meet with Iowa Medicaid Communications Specialist to discuss reconfiguration of the Iowa Medicaid website for ease of navigation for members/consumers.

Medicaid Director Completed - Discussed in March 14, 2017 Executive Committee meeting.

2/14/2017 Request that the MCOs assist in advertisement of the IA Health Link Public Comment meetings

Medicaid Director Completed - Confirmed by the State at March 14, 2017 Executive Committee meeting that MCOs were assisting by way of newsletters, the clinical advisory and the community advisory committees.

2/23/2017 Update on the new CMS managed care rules and whether changes are necessary to be in compliance. UPDATE on February 23, 2017: Matt Highland to present information and progress on new standardization of member content and format in publications at the March 14, 2017, Executive Committee meeting. Within presentation, Matt will also discuss how standardization will impact the grievance and appeals process.

Medicaid Director Completed - Matt Highland presented on the communications standardization of managed care regulations in March 14, 2017 Executive Committee meeting.

2/23/2017 General Recommendation: Enforce regulation that Managed Care Organizations (MCOs) follow established state Preferred Drug List (PDL), as required within their contracts.


2/23/2017 General Recommendation: Encourage the MCOs provide data regarding medication denial rates for MAAC Executive Committee to monitor for future recommendations.


2/23/2017 General Recommendation: Extend the allotted 30 day nursing facility stay for HCBS waiver recipients to 120 days.

Medicaid Director In rules process for change.

3/14/2017 Matt Highland to give an update regarding Communications Standardization for Managed Care Regulations at a future Executive Committee meeting.

Medicaid Director Completed

Completed Page 4




4/11/2017 Gather previous quarterly report data regarding the top five reasons for grievances and appeals for comparison to assist in determination if there are systemic trends in the information. The Department is to determine if a quarter by quarter comparison chart regarding this topic should be included in future quarterly reports.

Medicaid Director Completed - Discussed at August 24, 2017, Executive Committee meeting.

6/15/2017 Identify trends involving payment issues: * The largest issues * Where issues are most prevalent and if this trend changes over time * Where issues continue to reside * If the same issues affect different provider types * The proportion of issues that occur with the MCOs versus with provider organizations * The top reasons why payment issues persist * Identify if the top reasons for payment issues change over time


Completed - Discussed at August 24, 2017, Executive Committee meeting.

7/11/20147 Provide data on grievance and appeals - at the State Fair Hearing: * How many cases are ruled in favor of an MCO * How many never go through the entire appeals process * How many issues are resolved at the MCO level and never go to the level of the State Fair Hearing.


4/11/2017 Examine out-of-state placement for members in facilities to determine the impact on members as well as program. * Border Issues * Medical Conditions * Ages * Other factors leading to out-of-state placement


Completed - Discussed at August 24, 2017, Executive Committee meeting.

4/11/2017 Determine average aggregate cost per member per day for special needs members in ICF/ID. UPDATE July 11, 2017: Additionally, break down by: * Community-based ICF/ID providers * State resource centers * Out-of-state placement


11/4/2016 Provide information on status of individuals who are institutionalized in a hospital or facility for beyond 30 days and had been on waiver services although when transitioning out of institution to lose their waiver services.

Medicaid Director Completed - 1/19/2017:HCBS Recommendations Workgroup created for members who transition out of an instituion beyond the alloted 30 days.

11/4/2016 One-pager as preamble to Administrative Rules outlining changes that have been made to the document and submitted to the DHS Council

Medicaid Director Completed - In rules process.

11/4/2016 Calendar to be developed regarding when reports are to be due and process timeline for when data is to be reviewed and recommendations made. Information to be added to the workplan.

Medicaid Director Completed - To be handed out at 1/19/17 EC meeting.

5/19/2016 One pager regarding the role of MAAC that members can use with the organizations in which they are representing and stakeholders

Medicaid Director Completed - Sent via email to EC members on 1/23/17.

11/4/2016 Request that the Attorney General's office attend a future meeting for orientation and the expectations for the EC members in addition to governance training and new sunshine advisory.

Medicaid Director Completed - Attended February 14, 2017, Full Council meeting.

Completed Page 5

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