‘Intensive, ongoing’ oversight essential: Ragan Managed-care oversight’s future look in question

Jan. 03--One big Medicaid question has been hanging in the air since Republicans took control of the Iowa Statehouse this past November -- what will oversight look like?

The state handed over management of its $5 billion Medicaid program with more than 600,000 enrollees to three private insurers -- AmeriHealth Caritas Iowa, Amerigroup and UnitedHealthcare of the River Valley -- in April. Since then, providers have complained of late and inaccurate payments and the managed-care organizations have reported more than $100,000 in losses.

The Senate Democrats regularly used their authority as the majority party last session to question Department of Human Services officials and leaders of the MCOs.

They also worked with Republicans to create oversight, which provides funding for a managed-care ombudsman, requires external quality reports and offers expanded duties for the Medical Assistance Advisory Council.

Legislators from both parties in the House and Senate also met twice outside the legislative session to review quarterly data put out by the DHS and speak with the heads of the MCOs.

Sen. Amanda Ragan, D-Mason City, said during the final December meeting that "intensive, ongoing oversight of privatized Medicaid is absolutely essential."

That's something both parties appear to agree on.

"We'll continue oversight, but there is some tweaking that needs to be done," said Sen. Mark Costello, R-Imogene, vice chairman of the human resources committee and chairman of health and human services subcommittee.

"We want to solve problems and help improve people's lives while also making sure we be efficient in how we use state funds," he said.

Costello said some of the data the MCOs report could be made more useful and compared more easily. It's also important to ensure providers continue to be paid properly, he said.

The first several months of the managed-care transition were plagued by reports of providers receiving inaccurate and late payments. The MCOs and the state have worked to get those issues resolved, fixing incorrect fee schedules and meeting one on one with the state's providers.

Even still, some issues remain.

"We want to make sure those who depend on Medicaid get the care they need and the folks who provide that care get paid for services," said Scott McIntyre, spokesman for the Iowa Hospital Association, which represents the state's 118 hospitals. "It's the job of oversight to ensure those two things happen and that the MCOs are held accountable.

"How (oversight) is going to play out in this new environment, how it will function and (Republicans') priorities is not clear yet," McIntyre said. "We probably won't get clarity until we're underway."

The IHA was an outspoken critic of the move to managed care when plans were first announced, going as far as to ask a district judge to delay implementation in late 2015. It now has strengthening Medicaid oversight as one of its legislative priorities, saying 2016 laid out a good first step but "doesn't go far enough."

It adds that more "evaluative measures are needed to determine if the program's objectives are being met."

"There are still things we need to pay attention to," said Sen. Liz Mathis, D-Robins. "We'll have to iron out the difficulties."

Mathis, one of the transition's more vocal opponents in the Senate, said it's important for there to be a smooth handoff between Republicans and Democrats in the Senate, so that Republicans have a clear understanding of the health care climate.

"This also gives us the opportunity to share information and to work together instead of being conflicted," she added.

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