This bill seeks to enhance the Medicaid program in Iowa by implementing several provisions aimed at improving long-term services and supports (LTSS) for members. It requires the Department of Health and Human Services (HHS) to adopt rules that ensure services are provided in a conflict-free manner, which includes the use of independent providers for case management and independent assessors for supports intensity scale assessments. The bill also allows LTSS members to transition from managed care to fee-for-service Medicaid administration, with HHS responsible for amending contracts and establishing rules for this process. Additionally, it mandates that Medicaid managed care organizations (MCOs) maintain authorized LTSS unless a healthcare provider determines a medically necessary change, and it requires MCOs to work with HHS on workforce recruitment and training programs.

Moreover, the bill introduces significant changes to improve oversight and accountability within the Medicaid managed care system. It requires MCOs to submit quarterly progress and outcomes reports to HHS and establishes an external independent review process for final adverse determinations made by MCOs, allowing for contested case proceedings and judicial review. Civil penalties are imposed on MCOs that do not comply with response requirements related to adverse determinations. The bill also mandates HHS to develop uniform authorization criteria for credentialing providers and appropriates $300,000 for the Office of Long-Term Care Ombudsman for the Medicaid managed care ombudsman program for fiscal year 2025-2026. Additionally, it amends the Health Policy Oversight Committee's meeting requirements and mandates MCOs to report their profits from Medicaid administration to HHS for public disclosure.

Statutes affected:
Introduced: 2.45