Iowa agrees to $103 million payment to Medicaid insurance companies
That is a 7.5 percent increase in the state payments from the previous year, state officials announced Friday.
Amerigroup of
The contract states the insurance companies will receive a 8.4 percent overall increase in payments -- which includes state and federal funding -- from the past fiscal year, totaling up to
"We're able now to move forward with this program and we can ensure sustainability and continue to provide those services to our members," said Medicaid Director
The state had previously agreed to a 3.3 percent increase for state fiscal year 2018.
Gov.
"The increased funding for Medicaid fits within the state's expected revenue," Reynolds said. "
However, despite new provisions that department officials say will provide stronger oversight of the managed-care organizations and better protection of health care services, some lawmakers are doubtful it will address issues they see within the program.
"Taxpayers are being hurt because they must now pay an additional
" ... We all know for-profit Medicaid has been a disaster for
NEW COST, NEW PROVISIONS
The rate increases partially are based on additional data from the past two years on the "actual experience" of members in the program, including costs such as hospitalizations, medications, physician visits and more, Randol said.
Given the program has been in place since 2016, Medicaid officials have a better measure of member costs than they did when it was first privatized.
Provisions within the new contracts -- which were created based on feedback from members, providers and other program stakeholders -- are meant to address a number of concerns over the program, department officials said.
"Last session, the House passed Medicaid oversight legislation three times, so I am pleased to see that these measures have been included in the new contracts," said Rep.
"These additional requirements on
The privatized Medicaid program, which offers care for poor and disabled Iowans, has received vocal criticism from members who claim their services were unfairly cut and from providers that say their insurance claims are not paid in a timely manner.
This year's rate increase is "a reflection of looking at what wasn't getting paid and should have been, and making sure that it's built into the rates so it'll get paid in the future," DHS Director
In the new contract, insurers are required to decide on at least 95 percent of all "clean" provider claims within 30 days of receiving them.
Randol said providers had raised concerns relative to errors by the insurers, and officials wanted to ensure the language was "strong enough to hold the (managed-care organization) accountable" for the payments.
However, some believe this provision will not address the root problem. Sen.
"They still have outstanding debt and bills from
New provisions also centered on the longer-term services and supports population -- the Medicaid members who are the most costly when it comes to health care expenses. Insurers are required to help members feel more a part of their service planning, and prohibits "arbitrary reductions in staffing for those who require individualized, enhanced staffing," according to the contract summary.
"We want to make sure that every plan of care and every service provided within those plans of care are appropriate," Randol said. "We did not want the (managed-care) organizations to be able to just arbitrarily (cut staffing) without going through a process of evaluating the individual and going through the assessment and developing a plan of care with an interdisciplinary team."
Foxhoven also attributed the payment increase to the expansion of mental health care services for adults across the state.
"Everyone recognizes this is going to cost more money," Foxhoven said. "We designed that system to be sustained by Medicaid, so this is the first year that comprehensive mental health system comes into play as it starts getting built, so we had to build in money to pay for those services -- services that didn't exist in the past."
"By every measure,
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