Relating to Medicaid program improvements, and including effective date provisions

DHS is required to seek any Medicaid state plan or waiver amendments as necessary to complete the transition. The division takes effect upon enactment. Division II of the bill requires DHS to adopt administrative rules to ensure that services are provided to the Medicaid long-term services and supports population in a conflict-free manner. Specifically, the bill requires that case management services shall be provided by independent providers and that the supports intensity scale assessments are performed by independent assessors. Division III of the bill relates to medication-assisted treatment. The bill requires DHS to adopt administrative rules to prohibit prior authorization for the provision of medication-assisted treatment under both the Medicaid fee-for-service and managed care payment and delivery systems. The division also requires DHS to include this prohibition in any contract entered into with a Medicaid MCO. Under the division, “medication-assisted treatment” means the medically monitored use of certain substance use disorder medications in combination with other treatment services. Division IV of the bill requires DHS to contractually require any Medicaid MCO to collaborate with the department and stakeholders to develop and administer a workforce recruitment, retention, and training program to provide adequate access to appropriate services, including but not limited to services to older Iowans. The department shall ensure that any such program developed is administered in a coordinated and collaborative manner across all contracting MCOs and shall require the MCOs to submit quarterly progress and outcomes reports to the department. Division V of the bill establishes an external review process for Medicaid providers for the review of final adverse determinations of the MCOs’ internal appeal processes. The division provides that a final decision of an external reviewer may be reviewed in a contested case proceeding pursuant to Code chapter 17A, and ultimately is subject to judicial review. Division VI of the bill relates to member disenrollment for good cause during the 12 months of closed enrollment between open enrollment periods. Currently, a member may request disenrollment for good cause initially through their MCO’s grievance process, which may take up to 30 to 45 days to process. The bill requires DHS to adopt administrative rules and contractually require all Medicaid MCOs to issue a decision in response to a member’s request for disenrollment for good cause within 10 days of the date the member submits the request to the MCO utilizing the MCO’s grievance process. Division VII of the bill directs the ombudsman to appoint an assistant who shall be primarily responsible for investigating complaints relating to the Medicaid program, including both the Medicaid managed care and fee-for-service payment and delivery systems, and all Medicaid populations including the long-term services and supports population. The division specifies the minimum areas of assistance and advocacy to be provided, directs the ombudsman to adopt administrative rules for administration of this division of the bill, and directs the ombudsman to publish special reports and investigative reports as deemed necessary, and to include findings and recommendations related to the Medicaid program assistance and advocacy provided under the bill in the ombudsman’s annual report. The division also repeals the section of the Code that directs the office of long-term care ombudsman to provide assistance and advocacy services to members of the Medicaid long-term services and supports population since under the bill, the ombudsman will provide assistance and advocacy for both Medicaid managed care and fee-for-service payment and delivery systems and for all populations including the long-term services and supports population.