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UnitedHealthcare Leaving Iowa’s Medicaid Managed Care Program

In the afternoon of Friday, March 29, Governor Reynold’s office announced that UnitedHealthcare (UHC) will be departing from Iowa’s Medicaid managed care program. The departure of UHC means that Amerigroup and the newly contracted MCO, Iowa Total Care/Centene, will take over as the two remaining MCOs in Iowa later this year. 

Governor Reynolds stated, “Today I ended negotiations between the State of Iowa and UnitedHealthcare because of terms that I believed to be unreasonable and unsustainable… Unfortunately, UnitedHealthcare continued to make additional demands that I found to be unacceptable, including a provision that would remove pay for performance measures that would hold them accountable.” 

Director of DHS Jerry Foxhoven stated the primary issue for the breakdown of the negotiations was that UHC wanted to be released from contract terms that would have denied them part of their state payments if they didn’t meet quality goals, such as paying bills to providers on time and inappropriate use of emergency room services. 

The Governor’s office and DHS has indicated that UHC will continue to provide services through their contract period which ends in June. On July 1, Centene will take over. It is not clear how Amerigroup and Centene will split the 425,000 Medicaid recipients that UHC currently serves. LAI will keep members informed with new information as it is provided.  

For additional information:  
Governor Reynold’s Statement
DHS Statement
Des Moines Register Article

 

Advocacy Needed on Nursing Facility Rebase

In late February, Iowa House Republicans released details on their plans for key FY2020 budget increases.  House Republicans plan to appropriate $19 million dollars of general funds in the FY2020 budget for the nursing facility rebase. The $19 million, in addition to the $8.5 million from the QAAF rate increases, bring the total nursing facility rebase funding to $27.5 million, half of the overall $54.9 million shortfall!  This would be the largest general fund appropriation made to nursing facilities in decades (if not ever).   

LAI is excited the Iowa House recognizes the need for nursing facility rebase funding and commends them for making it a priority of their caucus. In their announcement of the planned key budget increases, they cite the number of concerns that they have heard in their districts about the fiscal condition of those providers and how that relates private pay residents and the increasing number of Medicaid residents. 

While the House announcement is an exciting first step there is still much work to be done.  The Iowa Senate has announced budget targets $48 million lower than the Iowa House. The Senate has not yet released exact plans and numbers for their key budget increases, but LAI believes the Senate’s planned rebase appropriation is lower than the $19 million proposal in the House.

All members are encouraged to contact their Legislators to urge support of the nursing facility rebase in an amount at least as high as the House proposal. 

 

DIA Clarifies Interim Revisit Expectations for LTC

On February 7, the OIG released a report  outlining insufficient confirmation of corrective actions by state survey agencies in a sample of states.  As a result, the OIG recommended that CMS improve guidance to state survey agencies regarding verification expectations for correction of deficiencies, improve its forms for the survey process, and work with state agencies to address any technical issues related to the survey system for maintaining documentation. 

One week later on February 15, DIA issued a notice clarifying expectations for interim revisits.  For interim revisits performed in lieu of an onsite visit, DIA must have evidence and documentation from the LTC provider that the Plan of Correction has been implemented.  This evidence and documentation could include staff training records, invoices for maintenance work performed, or other documentary evidence. 

CMS is requiring this type of evidence to certify compliance via an interim revisit.  Without this type of documentary evidence certifying implementation of the Plan of Correction, DIA would need to conduct an onsite revisit to certify compliance which could unnecessarily delay the determination of the compliance date and, in certain cases, result in an increased per-diem fine amount assessed by CMS.  

Please contact Liz Davidson ([email protected]), LAI’s Director of Clinical Services, with any questions.

 

 

Industrial Hemp Legalized with Passage of 2018 Farm Bill

The Agricultural Improvement Act of 2018 (Farm Bill) was signed into law on December 20, 2018. The bill revises the Controlled Substances Act to define two types of cannabis – marijuana and hemp.  Marijuana remains a controlled substance, but hemp (and its derivatives, including cannabidiol "CBD"), is now legal. 

The regulation of hemp and its derivative products will remain under the jurisdiction of the Federal Food and Drug Administration (FDA). The FDA commissioner released a statement clarifying its regulatory authority over hemp derivative products. The FDA plans to hold public meetings and gather input as it determines its future regulatory approach to hemp and hemp derivative products. 

See the FDA memo here: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm628988.htm 

There will be more information and analysis as to the impact of this on  providers. With CBD oil now legal in Iowa, how the legalization will impact state law still needs to be determined. LAI has already reached out to DIA to clarify the law. LAI will keep members informed on any new information on this developing change in federal law and policy.

 

Welcome New Associate Member 

LeadingAge Iowa would like to welcome the following new associate member:

SeniorDent – Richard Sawicz – [email protected] – 888.970.3400

“SeniorDent” is the largest and oldest Mobile On-Site Dental Care plan in the country. Nursing Home Residents enrolled in SeniorDent receive quality dental care, in the comfort of their familiar surroundings on a regular schedule, regardless of the number of residents enrolled in your facility. 

View all our associate members in our online virtual tradeshow.

 
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