House File 447 - Introduced
HOUSE FILE 447
BY BROWN-POWERS
A BILL FOR
1 An Act relating to the evaluation of Medicaid-managed care
2 long-term services and supports.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 Section 1. DATA REPORTING —— MEDICAID MANAGED CARE
2 LONG-TERM SERVICES AND SUPPORTS. The department of human
3 services shall contractually require each Medicaid managed care
4 organization (MCO) to report each quarter all of the following
5 information from the previous quarter regarding the MCO’s
6 long-term services and supports (LTSS) population members:
7 1. The total amount expended on the LTSS population
8 categorized by institutional and noninstitutional setting and
9 by target population.
10 2. Any reductions or increases in the total amount expended
11 on the LTSS population categorized by setting and target
12 population and the reasons for the reduction or increase such
13 as changes in the service setting, changes attributable to
14 level of care determinations or redeterminations, decreased
15 or increased utilization of inpatient or outpatient services,
16 reduced or increased cost per unit or service, and other
17 factors.
18 3. Trends identified in expenditures and the services
19 provided to the LTSS population.
20 Sec. 2. MEDICAID MANAGED CARE LONG-TERM SERVICES AND
21 SUPPORTS POPULATION —— METRICS REVIEW AND RECOMMENDATIONS.
22 1. The department of human services shall convene
23 stakeholders with expertise or interest in the LTSS population
24 to review existing performance and outcome metrics for managed
25 LTSS to determine if the current metrics provide constructive
26 information to ensure the population is receiving access to
27 necessary services and supports, that person-centered care
28 and decision making are being promoted, and that the delivery
29 system is not resulting in adverse selection or creating
30 incentives to underserve or deny claims for members. The
31 stakeholder group shall review national LTSS population
32 evaluation tools and metrics and shall make recommendations
33 to the governor and the general assembly by October 1, 2021,
34 for data collection based on a core set of LTSS-specific
35 quality and performance metrics. The core set of metrics
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 H.F. 447
1 recommended shall address the full spectrum of complex needs
2 for individuals accessing LTSS and allow effective evaluation
3 beyond structural elements and service delivery processes by
4 incorporating measures of individual outcomes and personal
5 experiences. The core set of metrics recommended shall go
6 beyond clinical measures and focus on quality of life and
7 quality of care outcomes, and shall provide for direct input
8 through surveys and face-to-face level encounter data solicited
9 from LTSS consumers and their support networks.
10 2. For the purposes of this section, “managed LTSS” means
11 long-term services and supports delivered through Medicaid
12 managed care.
13 EXPLANATION
14 The inclusion of this explanation does not constitute agreement with
15 the explanation’s substance by the members of the general assembly.
16 This bill relates to Medicaid managed long-term services
17 and supports (LTSS). The bill requires the department of
18 human services (DHS) to contractually require each Medicaid
19 managed care organization (MCO) to report each quarter
20 specific information from the previous quarter regarding the
21 LTSS population members covered by the MCO including data
22 related to the total amount expended on the LTSS population
23 categorized by institutional and noninstitutional setting and
24 by target population; reductions or increases in the total
25 amount expended by setting and target population and the
26 reasons for the reduction or increase; and trends identified in
27 expenditures and services provided.
28 The bill also requires DHS to convene stakeholders with
29 expertise or interest in the LTSS population to review existing
30 metrics for the managed LTSS population to determine if the
31 current metrics provide constructive information to ensure
32 the population is receiving access to necessary services and
33 supports, that person-centered care and decision making are
34 being promoted, and that the delivery system is not resulting
35 in adverse selection or creating incentives to underserve or
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 H.F. 447
1 deny claims for members. The stakeholder group is required to
2 review national LTSS population evaluation tools and metrics
3 and make recommendations to the governor and the general
4 assembly by October 1, 2021, for data collection based on a
5 core set of LTSS-specific metrics.
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