Medicaid Oversight

After working with families and their providers through Iowa's Medicaid program, I am pleased that we have passed legislation that will Hold MCOs Accountable to Providers: Require MCOs to pay providers in a timely manner and provide justification for denying a claim Require evaluation of all prior authorization requirements by MCOs Require a uniform credentialing process between all MCOs Require mental health and substance abuse services to be
paid for court committed individuals
Holding MCOs Accountable to Members: Require the state to review any decrease in level of care for a LTSS member by an MCO Extend services for a member that has won on appeal against an MCO Require an evaluation of health home services with providers and the MCOs
Stronger Oversight of the Medicaid System: Require the state to update Medicaid eligibility files promptly to provide notice to providers Require an audit of small LTSS claims paid or denied by MCOs.
This is our second attempt to have this legislation passed by the Senate on managed care. I remain committed to passing meaningful managed care legislation and to have it signed by the Governor this year.
I am dedicated to assisting any Medicaid member or provider that is having issues navigating the managed care program. The MCOs are contractors for the state, and they should be held accountable if they are not fulfilling the obligations to the state and those it serves.