Week 9 Legislative Update

Next week marks the second legislative funnel – the date by which most policy bills must have passed a full chamber and a committee in the other chamber in order to remain eligible for consideration this session. The legislature is preparing to turn its attention toward crafting the budget for the upcoming 2019 Fiscal Year. Today’s meeting of the Revenue Estimating Conference (REC) will have a significant impact both on this work and on whether or not the legislature will need to craft a deappropriation bill for the current 2018 Fiscal Year due to declining state tax revenue. Among the issues of interest to the medical community this week, were the following:

Medicaid Managed Care Oversight

This week, the House took up floor debate of HF 2462, the Department of Human Services omnibus bill. In passing the bill, the House voted to attach an amendment to establish new Medicaid managed care oversight measures. Among the provisions of interest to the medical community, are the following:

  • Loose standards to ensure MCO compliance with their contractual timely claims processing standards, consistent with national industry standards.
  • Establish a 90 day limit for MCOs to correct systemic claims processing issues and a 30 day limit after the corrections have been made for the MCOs to reprocess affected claims.
  • DHS is directed to develop standardized Medicaid provider enrollment forms. (Since 2016, DHS has had in place a uniform credentialing application, however, the MCOs are currently allowed to imposed additional credentialing requirements beyond the initial form.)
  • Extend the duration of a member’s services if the member prevails in disputing an MCO denial of services, for a period of time equivalent to the period of the dispute.
  • DHS is directed to convene a workgroup to review the health home program and issue recommendations to the General Assembly by December 15th.
  • DHS is directed to review the effectiveness of prior authorization standards, with the goal of making adjustments.
  • DHS is directed to contract for an independent audit of small dollar claims to determine the accuracy of MCO determinations and payment. (Small dollar claims are defined as less than $2,500.)


Opioid Abuse

Last week, we told you about HF 2377, the opioid omnibus bill, which was amended in the House to include a broad continuing medical education (CME) mandate for all licensed providers to receive training on the CDC opioid prescribing guidelines. On Monday, a Senate subcommittee took up HF 2377. IMS brought an amendment to narrow this CME mandate to apply to only prescribers who have prescribed opioids during the previous licensure cycle and to repeal the existing Iowa Board of Medicine administrative rule mandating two hours of continuing medical education (CME) on chronic pain management every five years. Despite support from all members of the prescribing community, the Senate floor manager for HF 2377 has expressed reservations about this proposal. IMS and the other members of Team Doctor continue to work behind the scenes to push for this common-sense refinement to the bill.


Behavioral Health

HF 2456, the legislation to implement the Complex Service Needs Workgroup recommendations to strengthen Iowa’s behavioral health system, continues to move through the legislative process. This week, the Senate held a lengthy subcommittee to review the legislation. Proponents for the bill explained logistical components of this extensive policy package and urged swift adoption of the legislation. Some members of the subcommittee expressed concern that the legislation seeks to expand behavioral health services, yet it does not include additional funding to do so. This is a common concern that has been voiced throughout the meetings of the Complex Service Needs Workgroup and the crafting of the legislation.

Later today, the Revenue Estimating Conference (REC) will meet to develop revised tax receipt projections for the current 2018 Fiscal Year and the upcoming 2019 Fiscal Year. It is anticipated that these projections will show a need for spending reductions in both budget years. In light of these budgetary constraints, it is high unlikely that the legislature will be able to support increased state spending to support implementation of the policy measures created by HF 2456. The legislation does include provisions to allow for the blending of existing funding streams, including the mental health regions’ reserve funds, Medicaid, and commercial insurance, to help support efforts to expand services. Ultimately, additional funding will likely be necessary to fully support implementation of all of the measures called for by the Complex Service Needs Workgroup. In the meantime, HF 2456 develops a framework to start expanding services and increasing access for Iowans with mental health and substance abuse needs.

Recent News

IMS Board Holds Summer Retreat

This past weekend, the IMS Board of Directors held its July board meeting on the campus of Des Moines University (DMU) and its annual board retreat.

Medicaid MCO Transition Assistance

July 1 marked the scheduled transition of Medicaid administrators within the managed care system with UnitedHealthcare (UHC) ending active benefit administration and Iowa Total Care (ITC) beginning active patient operations.

New Laws Take Effect Monday

Several bills and Iowa statutes of interest to the medical community will go into effect July 1

MIPS Data Validation and Audit

Merit-based Incentive Payment System (MIPS) Data Validation and Audit to begin June 2019 for Performance Years 2017 and 2018

GPCI Fix Legislation Introduced

IMS President-Elect Brian Privett joined Congresswoman Abby Finkenauer for Cedar Rapids press conference to introduce new bill.

CMS RFI on Reducing Administrative Burden

CMS seeks input on are reporting and documentation requirements, prior authorization requirements, and policies for dually enrolled beneficiaries.

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