Relating to Medicaid program improvements

This bill relates to Medicaid program improvements. Division I of the bill requires the department of human services (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 II of the bill requires DHS to contractually require any Medicaid managed care organization (MCO) to collaborate with DHS 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. DHS 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 DHS. Division III of the bill establishes an external independent third-party review process for Medicaid providers for the review of final adverse determinations of the MCOs’ internal appeal processes. The bill provides that a final decision of an external independent third-party reviewer may be reviewed in a contested case proceeding pursuant to Code chapter 17A, and ultimately is subject to judicial review. Division IV of the bill requires DHS to develop uniform authorization criteria for, and to utilize a request for proposals process to procure, a single credentialing verification organization to be utilized in credentialing and recredentialing providers for the Medicaid managed care and fee-for-service payment and delivery systems. The bill requires DHS to contractually require all MCOs to apply the uniform authorization criteria and to accept verified information from the single credentialing verification organization procured by the state, and to contractually prohibit MCOs from requiring additional credentialing information from a provider in order to participate in the Medicaid managed care organization’s provider network.