Bill Text: IA HF447 | 2021-2022 | 89th General Assembly | Introduced
Bill Title: A bill for an act relating to the evaluation of Medicaid-managed care long-term services and supports.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-02-09 - Introduced, referred to Human Resources. H.J. 327. [HF447 Detail]
Download: Iowa-2021-HF447-Introduced.html
House
File
447
-
Introduced
HOUSE
FILE
447
BY
BROWN-POWERS
A
BILL
FOR
An
Act
relating
to
the
evaluation
of
Medicaid-managed
care
1
long-term
services
and
supports.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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H.F.
447
Section
1.
DATA
REPORTING
——
MEDICAID
MANAGED
CARE
1
LONG-TERM
SERVICES
AND
SUPPORTS.
The
department
of
human
2
services
shall
contractually
require
each
Medicaid
managed
care
3
organization
(MCO)
to
report
each
quarter
all
of
the
following
4
information
from
the
previous
quarter
regarding
the
MCO’s
5
long-term
services
and
supports
(LTSS)
population
members:
6
1.
The
total
amount
expended
on
the
LTSS
population
7
categorized
by
institutional
and
noninstitutional
setting
and
8
by
target
population.
9
2.
Any
reductions
or
increases
in
the
total
amount
expended
10
on
the
LTSS
population
categorized
by
setting
and
target
11
population
and
the
reasons
for
the
reduction
or
increase
such
12
as
changes
in
the
service
setting,
changes
attributable
to
13
level
of
care
determinations
or
redeterminations,
decreased
14
or
increased
utilization
of
inpatient
or
outpatient
services,
15
reduced
or
increased
cost
per
unit
or
service,
and
other
16
factors.
17
3.
Trends
identified
in
expenditures
and
the
services
18
provided
to
the
LTSS
population.
19
Sec.
2.
MEDICAID
MANAGED
CARE
LONG-TERM
SERVICES
AND
20
SUPPORTS
POPULATION
——
METRICS
REVIEW
AND
RECOMMENDATIONS.
21
1.
The
department
of
human
services
shall
convene
22
stakeholders
with
expertise
or
interest
in
the
LTSS
population
23
to
review
existing
performance
and
outcome
metrics
for
managed
24
LTSS
to
determine
if
the
current
metrics
provide
constructive
25
information
to
ensure
the
population
is
receiving
access
to
26
necessary
services
and
supports,
that
person-centered
care
27
and
decision
making
are
being
promoted,
and
that
the
delivery
28
system
is
not
resulting
in
adverse
selection
or
creating
29
incentives
to
underserve
or
deny
claims
for
members.
The
30
stakeholder
group
shall
review
national
LTSS
population
31
evaluation
tools
and
metrics
and
shall
make
recommendations
32
to
the
governor
and
the
general
assembly
by
October
1,
2021,
33
for
data
collection
based
on
a
core
set
of
LTSS-specific
34
quality
and
performance
metrics.
The
core
set
of
metrics
35
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447
recommended
shall
address
the
full
spectrum
of
complex
needs
1
for
individuals
accessing
LTSS
and
allow
effective
evaluation
2
beyond
structural
elements
and
service
delivery
processes
by
3
incorporating
measures
of
individual
outcomes
and
personal
4
experiences.
The
core
set
of
metrics
recommended
shall
go
5
beyond
clinical
measures
and
focus
on
quality
of
life
and
6
quality
of
care
outcomes,
and
shall
provide
for
direct
input
7
through
surveys
and
face-to-face
level
encounter
data
solicited
8
from
LTSS
consumers
and
their
support
networks.
9
2.
For
the
purposes
of
this
section,
“managed
LTSS”
means
10
long-term
services
and
supports
delivered
through
Medicaid
11
managed
care.
12
EXPLANATION
13
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
14
the
explanation’s
substance
by
the
members
of
the
general
assembly.
15
This
bill
relates
to
Medicaid
managed
long-term
services
16
and
supports
(LTSS).
The
bill
requires
the
department
of
17
human
services
(DHS)
to
contractually
require
each
Medicaid
18
managed
care
organization
(MCO)
to
report
each
quarter
19
specific
information
from
the
previous
quarter
regarding
the
20
LTSS
population
members
covered
by
the
MCO
including
data
21
related
to
the
total
amount
expended
on
the
LTSS
population
22
categorized
by
institutional
and
noninstitutional
setting
and
23
by
target
population;
reductions
or
increases
in
the
total
24
amount
expended
by
setting
and
target
population
and
the
25
reasons
for
the
reduction
or
increase;
and
trends
identified
in
26
expenditures
and
services
provided.
27
The
bill
also
requires
DHS
to
convene
stakeholders
with
28
expertise
or
interest
in
the
LTSS
population
to
review
existing
29
metrics
for
the
managed
LTSS
population
to
determine
if
the
30
current
metrics
provide
constructive
information
to
ensure
31
the
population
is
receiving
access
to
necessary
services
and
32
supports,
that
person-centered
care
and
decision
making
are
33
being
promoted,
and
that
the
delivery
system
is
not
resulting
34
in
adverse
selection
or
creating
incentives
to
underserve
or
35
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H.F.
447
deny
claims
for
members.
The
stakeholder
group
is
required
to
1
review
national
LTSS
population
evaluation
tools
and
metrics
2
and
make
recommendations
to
the
governor
and
the
general
3
assembly
by
October
1,
2021,
for
data
collection
based
on
a
4
core
set
of
LTSS-specific
metrics.
5
-3-
LSB
2389YH
(2)
89
pf/rh
3/
3
