HEALTHY AND WELL KIDS IN IOWA (HAWK-I)

BOARD MEETING

MINUTES

February 21, 2000

BOARD MEMBERS Eldon Huston, Chair (absent) Terri Vaughan, Vice Chair Dave Krutzfeldt Nancy Mounts Ted Stilwill (absent) Brenda Oas (for Ted Stilwill) Stephen Gleason, D.O. (absent) Susie Poulton LEGISLATIVE BOARD MEMBERS Senator Johnie Hammond (absent) Senator Mary Kramer (absent) Representative Brad Hansen (absent) Representative Robert Osterhaus (absent) DEPARTMENT OF HUMAN SERVICES Anita Smith Anna Ruggle Shellie Goldman ATTORNEY GENERAL'S OFFICE Marne Woods

GUESTS Barbara Fox-Goldizen Sonni Vierling Bill Brand Jennifer Dreibelbis Jack Hatch Fran Otte Bob Harpster Stacy T. Cyphert Edward Schor Kermit Dahlen Chris McCaten Carla Beneke Brett Norell Jeanie Kerber Jim Donoghue Marie Glancy Cindy Groene Leila Carlson Christy Black Regan Roberts David Alexander Pete Damiano

AFFILIATION Eligibility Services, Inc. Iowa Department of Public Health Div. of Community Action Agencies Iowa Community Action Assoc. Jack Hatch and Associates Wellmark Blue Cross Blue Shield Iowa Dental Association University of Iowa Hospitals & Clinics Iowa Department of Public Health Gordon Recovery Centers Iowa Health Systems Iowa Department of Public Health University of Iowa , College of Public Health House of Mercy Broadlawns Medical Center John Deere Health John Deere Health National Association of Social Workers National Association of Social Workers Hatch & Associates Blank Children's Hospital University of Iowa Public Policy Center & College of Dentistry

WELCOME AND INTRODUCTIONS

Terri Vaughan, Vice Chair, called the meeting to order on February 21, 2000, in the Oak Room of the Botanical Center at 12:45 p.m. with 32 people present.

Introductions were made.

ANNOUNCEMENTS AND ROLL CALL

Terri Vaughan announced that Eldon Huston was absent, therefore, she would be presiding over the meeting. Roll call was taken with four voting Board members present not constituting a quorum.

APPROVAL OF THE DECEMBER 30, 1999, MEETING MINUTES

Ms. Vaughan announced the minutes could not be approved without a quorum present.

APPROVAL OF THE JANUARY 28, 2000, MEETING MINUTES

Ms. Vaughan announced the minutes could not be approved without a quorum present.

CORRESPONDENCE

Ms. Smith reported on the correspondence from Anderson-Erickson Dairy declining HAWK-I Outreach Coordinator Willie Mosley's offer to participate as a corporate sponsor of the HAWK-I program.

CLINICAL ADVISORY COMMITTEE UPDATE

Dr. David Alexander stated that the committee felt there were ways to improve the benefits of the health plans participating in HAWK-I (Iowa Health Solutions and Wellmark Blue Cross Blue Shield) to better serve the needs of kids. Dr. Alexander mentioned that timeliness was important as the current fiscal year review of the HAWK-I program's health contractors is due soon.

Dr. Alexander reported the recommendations fall into five categories:

1) Care Coordination

2) Dental Benefits

3) Mental Health & Substance Abuse

4) Nutrition

5) Therapies

1) Care Coordination - Dr. Edward Schor spoke on care coordination and whether that ought to be a mandated benefit. Dr. Schor distinguished between care coordination and case management. Dr. Schor stated that care coordination is an important part of Medicaid and that Medicaid has certain responsibilities to the federal government to achieve certain levels of participation in preventive care.

Ms. Mounts clarified if Dr. Schor was stating that in Medicaid, care coordination is an important part of their benefit package, and it could also be a part of Iowa Health Solutions' and Wellmark Blue Cross Blue Shield's benefit package. Dr. Schor replied, yes.

Ms. Mounts asked who does the care coordination for Medicaid.

Dr. Schor replied the Department of Public Health, who sub-contracts with agencies around the State. Dr. Schor stated that the Department of Public Health receives a monthly printout of children newly eligible for Medicaid and is responsible for contacting those families making sure they understand the program. Dr. Schor stated the same system that Medicaid uses is in place if HAWK-I or the health plans wanted to use it.

2) Dental Benefit Programs - Dr. Alexander reported that the committee had spent a lot of time reviewing various dental plans that have been offered. Dr. Alexander stated that a background for all of the issues the committee is bringing forward is that neither of the health plans has past experience in the dental insurance business. Dr. Alexander stated that the committee recommends that dental benefits afforded by all plans should have the same annual limit of $1,500. Dr. Alexander stated that the committee also recommends that partials and dentures be covered and that the prior authorization policy be made consistent with other commercially available plans.

Ms. Mounts inquired if care coordination would include dental? Dr. Alexander replied, yes.

Ms. Poulton asked what was included in the typical prior authorization?

Dr. Alexander replied that there are certain costly procedures that require prior authorization. For example, a crown would need prior approval but a filling would not.

3) Mental Health & Substance Abuse - Mr. Dahlen stated that in reviewing the plans, it was concluded by the committee that the mental health and substance abuse plans need to reflect the needs of children. Mr. Dahlen added that they have strong inpatient hospitalization benefits as opposed to the standard of care in both psychiatry and substance abuse currently being used for outpatient care. Mr. Dahlen stated that with both the Iowa Department of Public Health and the Department of Human Services, clinical necessity criteria are utilized rather than medical necessity criteria. Mr. Dahlen clarified that within clinical judgement, things like home environment, supportive environment, skill development, and social issues are considered in the length of stay, and placement would be in different levels of care.

Mr. Dahlen stated that another issue of concern to the committee is that the standard practice in a community requires that a continuum of care be available to patients starting with hospitalizations and moving toward a less intense after care. Mr. Dahlen stated that neither health plan provides for an inpatient acute care, which moves toward a less restrictive outpatient for a continuum of care.

Mr. Dahlen reported that the committee recommends that the health plan's benefits be standard. Mr. Dahlen reported that the committee recommends that the plans cover all AXIS I diagnosis. AXIS I diagnosis are those primary diagnosis, for example, behavioral disorders. Mr. Dahlen stated that the committee recommends that a full continuum of services be reimbursed, not only inpatient and outpatient services.

Mr. Dahlen stated that the provider panel should include community mental health centers or licensed substance abuse centers. Mr. Dahlen commented that community mental health centers are primary providers of mental health services especially in rural areas, and that licensed substance abuse centers are normally the only providers of substance abuse in the State. Mr. Dahlen added that the provider panel should also include child and adolescence specialty practitioners.

Mr. Dahlen stated that in conclusion, the Clinical Advisory Committee recommends the same admission and discharge continued stay criteria, specific to adolescents. For substance abuse the committee recommends that plans be required to use the Iowa Juvenile Treatment Placement criteria which utilizes the American Society of Addiction to Medicine (ASAM) which is a standard profession criteria designed specifically for kids with substance abuse.

Ms. Mounts asked Dr. Alexander if the plans limited the number of treatments that a child was able to incur if that child had cancer? Dr. Alexander replied, no. Ms. Mounts gave the scenario of a child having cancer or asthma, which are chronic conditions, and inquired if the health plans gave that child a limited number of physician visits for that specific condition? Ms. Mounts added that substance abuse treatment works most of the time just like treatment for cancer or asthma and other chronic conditions.

Ms. Vaughan reported that the parity bill that is being proposed would raise the number of outpatient visits to 52 per year. Ms. Vaughan inquired of Mr. Dahlen if the committee had a discussion about what is an adequate number of outpatient visits. Mr. Dahlen replied that they did not have that discussion. Ms. Vaughan asked for clarification on the term "axis one diagnosis." Mr. Dahlen replied that it was the "primary" diagnosis of the mental health disorder that is being treated and is inclusive of all disorders.

Ms. Smith asked Mr. Dahlen to clarify if his recommendation was to use the Iowa Plan for kids on HAWK-I? Mr. Dahlen replied that they mentioned specific inclusions of the plan and would leave it up to the Board to determine the best way to make it happen. Mr. Dahlen added that in the committee, there were specific discussions about carve-out programs or other different ways of implementing the plan inclusions.

Ms. Smith stated that currently the DHS has a mental health and substance abuse carve-out program for kids on Medicaid. Ms. Smith added that depending on the category of eligibility, the DHS pays a per member per month (PM/PM) premium for the coverage of $11 to $16 and would have to be added to the HAWK-I premium if adopted.

Dr. Pete Damiano entered the meeting at this time.

Ms. Smith directed a concern to Dr. Damiano regarding the timing of the recommendations. Ms. Smith's concern was that the functional health assessment process is in place, and for Year #1 a baseline to determine what the enrollees' experience was prior to the HAWK-I program is being established. Ms. Smith added that we are just starting Year #2 and will determine what the enrollees' experience has been after being enrolled in the HAWK-I program for one year. Ms. Smith questioned if benefits should be changed before the Department could establish a need based on the data from the functional health assessment survey.

Questions to take into consideration are:

a) Does the current plan meet their needs?

b) If not, where is it falling down?

c) If the plan is falling down, what needs changed to meet the needs?

Ms. Smith questioned whether changing benefits at this point will affect the findings in regard to whether the current benefit package is meeting the need.

Dr. Damiano replied that from the beginning there were discussions about the health plans relative to the mental and dental health. Dr. Damiano stated that a child enrolled in the HAWK-I program should have similar dental health benefits regardless of which carrier they are with.

Dr. Alexander asked Ms. Smith if these recommendations could be included during the Department's yearly review of the health plans.

Ms. Smith replied that the Department begins developing the budget in July and August and did not previously budget any additional costs associated with these recommendations. Although, the contract can be amended at any time, a change in the budget requires legislative action to appropriate additional funds.

Dr. Damiano suggested that the committee's main goal is to make benefits between the health plans comparable, and that it would not require significant changes in the budget in order to raise the yearly maximum dental limit for kids. Dr. Damiano stated that this is something that the Board needs to discuss and there may not be cost implications per say for some of the recommendations.

Mr. Dahlen stated that the mental health recommendations would have cost implications. Mr. Dahlen suggested a functional health assessment instrument to adequately assess gaps in mental health and substance abuse coverage. Mr. Dahlen stated that mental health and substance abuse providers are needed on the Department's health plan panel of providers in order to receive coverage from these types of services.

Ms. Mounts inquired of Ms. Smith if the Department still had funds available for the HAWK-I program?

Ms. Smith explained that the Department has federal funds available, but not the matching state funds to draw them down, therefore, it would take an additional state appropriation to draw down the federal funds.

Dr. Schor stated that the committee has been working on these recommendations for one and one half years and that the Department should have included funding in the budget in anticipation of the recommendations. Ms. Smith replied that the Department cannot budget in anticipation that recommendations would be made when it wasn't clear what the recommendations would be or that the recommendations would be supported by the Board. Additionally, the Board had not directed the Department to include funding in the budget for anticipated recommendations.

4) Nutrition - Dr. Alexander reported that there was no coverage in the health plans for nutritional services, even if the patient was diagnosed with diabetes or some other illness that requires the patient being seen by a nutritionist.

5) Therapies - Dr. Alexander stated that there is no insurance coverage, when medically necessary, of a patient being referred for physical therapy.

Ms. Ruggle reviewed the actuarial analysis completed by Deloitte and Touche on the cost of the additional benefits being recommended. The additional cost for care coordination was estimated to be $.70 to $1.30 per member per month.

Dr. Schor questioned why it was so high when the cost for the same service in Medicaid was lower.

Ms. Smith stated that the cost disparity was probably due to the difference in provider reimbursement rates between Medicaid and HAWK-I.

Ms. Ruggle proceeded to report on Deloitte & Touche's draft report regarding case management, dental maximum, comparability across plans, and continuum of treatment services, etc.

Ms. Vaughan suggested that because of the lack of time and also the lack of a quorum, that the Clinical Advisory Committee should meet to review the Deloitte & Touche draft report and report back to the Board in March.

Ms. Smith suggested that the health plans be included in the discussion because of the impact that the recommended benefit changes might have on them.

Dr. Alexander stated that the Clinical Advisory Committee would be keeping with their clinical recommendations for the gaps in coverage of the health plans and would expect the Board to be responsible for figuring out whether the state can afford them or whether the plans can implement the changes.

Mr. David Krutzfeldt entered the meeting at this time, and the Board now has a quorum present.

Ms. Vaughan inquired as to when the Board should come to a decision on the recommendations.

Ms. Smith stated that the Department is in the process of reviewing the health plan contracts, which expire on June 30, 2000. Although benefit renegotiations can take place at a later date and do not have to take place at the time of the renewal. Ms. Smith stated that her concern is not the timeliness of the contract's renegotiation, but that the Department does not have additional dollars appropriated for increased HAWK-I premiums. Ms. Smith stated that another concern is with changing benefits mid-stream before the collection of data can be completed using the follow-up functional health assessment form.

Ms. Vaughan stated that Dr. Alexander put it appropriately when he stated that the committee should be concerned with the clinical issues and the Board should be concerned with the dollar issues. Ms. Vaughan referred to Ms. Ruggle's draft report of Deloitte & Touche where it was stated that some things could not be costed out until more information was obtained. Ms. Vaughan suggested that before the Board could make any decisions, it would require additional information from the committee and also comments from the health plans. Ms. Vaughan asked the Board if March provided adequate time to deal with the contract issue.

Ms. Smith stated that she could look into budget alternatives. However, when the Department's budget recommendations were established back in July and August, it was built on "knowns," and the knowns at that time were that the premiums were set at a certain amount and that a certain number of children would be enrolled. Ms. Smith stated that when the budget was built, there were no known recommendations to be submitted. Ms. Smith offered two potential solutions: a) the Department could look at the current budget for possibilities, or b) the Department could wait until the next budget cycle and include the recommendations at that time.

Ms. Mounts inquired if Title XIX expansion is paid from the Title XXI money?

Ms. Smith replied yes. Ms. Smith clarified that the federal law was designed for the State to pay for expansions out of Title XXI money.

Mr. Dahlen stated that the bottom line is that Iowa Health Solutions does not include licensed mental health centers and substance abuse centers. He expressed that this is a critical issue in their provider panel, and in so doing, does not meet the needs of the kids in Eastern Iowa.

Ms. Vaughan commented that if there is a plan that does not have an adequate network of services and has a contract to deliver, it becomes a regulatory issue, and the Insurance Division should look into it. Ms. Vaughan stated that a regulatory issue is also a concern of the Board who should be placing pressure on the plan through the contract.

Ms. Mounts inquired if the Department could put together a list of the recommendations and how much that would add to the budget.

Ms. Vaughan suggested that the Board continue this discussion at the next meeting and include in the Board packet, that goes out in advance, what the budget is for the next fiscal year along with the impact of each of these recommendations.

Ms. Oas suggested that enough time be set aside on the agenda for next month's Board meeting to adequately explore the issues at hand.

Dr. Damiano reported that at the last meeting, the request was made to the Board for input on developing the follow-up functional assessment survey, however, no input was received. Dr. Damiano stated that a follow-up instrument was developed and proceeded to list the items. Several questions were added to the baseline survey along with two new sections (Substance Abuse care and Chiropractic care). Dr. Damiano stated that three questions were eliminated in the child section, which related to the uninsured period prior to when the child was enrolled and no longer applied. As a result, some questions were moved up and some modified. Dr. Damiano stated that Question #63 which came up at the Board meeting last month was: Has your insurance coverage reduced the amount of stress within the family? Also discussed at the Board meeting was the addition of a "Comments" section, which was in fact included in the back of the survey booklet.

Ms. Poulton referred to Question #63 and suggested adding these words, "helped to," in front of "reduce the amount of stress within the family." Dr. Damiano was in agreement to her suggestion.

Ms. Smith referred to Question #58: In the last 12 months did you child need any of the following services but could not get them for any reason? Ms. Smith stated that three of the items that followed in that particular section were recommended benefit changes. Ms. Smith inquired of Dr. Damiano if he thought that today's recommendations to the Board would or would not affect these baseline questions?

Dr. Damiano replied that he agreed the questions would be affected, although it would depend on how the data received in the survey is utilized. Dr. Damiano stated that the information would still be comparable depending on how the new questions are worded. Dr. Damiano stated that the recommendations were primarily functional health status, and that most of the survey is geared toward access to services.

A quorum was now present. Dave Krutzfeldt moved that the Board approve the follow-up functional health assessment survey. The motion was seconded by Nancy Mounts. The motion was carried unanimously by Dave Krutzfeldt, Susie Poulton, Brenda Oas, Terri Vaughan, and Nancy Mounts.

APPROVAL OF THE DECEMBER 30, 1999, MEETING MINUTES

Ms. Vaughan announced that a quorum was now present and the Board could proceed with approval of the December 30, 1999, minutes. A motion was made by Nancy Mounts to accept the minutes as written. The motion was seconded by Dave Krutzfeldt. Unanimous approval was made by Terri Vaughan, Dave Krutzfeldt, Nancy Mounts, Brenda Oas, and Susie Poulton.

APPROVAL OF THE JANUARY 28, 2000, MEETING MINUTES

Ms. Vaughan asked for approval of the minutes from the January 28, 2000, meeting. A motion was made by Susie Poulton to accept the minutes as written. The motion was seconded by Dave Krutzfeldt. Unanimous approval was made by Terri Vaughan, Dave Krutzfeldt, Nancy Mounts, Brenda Oas, and Susie Poulton.

ADMINISTRATOR'S REPORT

Ms. Smith directed the Board's attention to the color-coded charts. Ms. Smith indicated enrollment into the HAWK-I program is continuing to increase; there were approximately 400 additions in the month of January. The handout entitled "HAWK-I Disenroll Reason by County for the Month of January 2000, identifies why people are disenrolling from the program. For the month of January, 2000, 44 children were disenrolled; 18 because they were eligible for Medicaid. 15 because they are over the age of 19; and 4 were disenrolled because the premium was not paid. The Board was then referred to the "Applicant Status Summary Report", page 7. Ms. Smith indicated the denial reasons are still trending the same. The number 1 reason for denial for HAWK-I is that the applicant is either on Medicaid or was referred to Medicaid and became eligible; number 2 is that they are referred to Medicaid and, for whatever reason, they do not follow through with the process; number 3 is over income; number 4 is failed to provide information; and the number 5 reason is the applicant was currently insured. There are some administrative issues in that people have indicated they do not have coverage, but the health plans are identifying that the enrollees do have coverage. These participants have to be canceled retroactively and premiums refunded. The new poverty level was received last week and more emphasis is being put on the application that if the child has insurance they are not eligible for HAWK-I. A question was asked concerning notice to pay the premium. Ms. Smith explained that the notices go out the 5^th working day before the end of the month and the premium is due by the 10^th of the following month. For instance, on January 25th a notice would go out that the premium must be paid by February 10th for March coverage. If it is not paid, on February 11th a reminder notice would go out indicating the premium needs to be paid. After that, a cancellation notice is sent.

Ms. Smith then explained the handout "Medicaid and HAWK-I Progress Monitoring Report". Between Medicaid and HAWK-I, there are currently 12,447 children enrolled; 23 percent of the total goal.

Ms. Smith then discussed the CHIP budget. The interest from the HAWK-I trust fund is used to offset the administrative expenditures. So far, $62,347 in interest has been earned from the HAWK-I trust fund. Of the $5.9 million budget, $2.2 million has been spent. Start-up costs of $900,000 were carried over into this fiscal year that is being applied to administration costs this year. $300,000 in outreach money is coming out of the delinking dollars rather than from the HAWK-I administration budget.

Ms. Smith indicated that staff had recently met with Wellmark, Iowa Health Solutions and John Deere in regard to how they could participate in HAWK-I outreach. Mr. Peter Roberts, President of Wellmark Health Plan in Iowa has offered to host an outreach conference in May, hopefully the week of May 15. The exact location and date are being worked out at this time. It was noted by Nancy Mounts that Wellmark is doing this "pro bono" and Wellmark should be commended for that.

Ms. Smith referred the Board to the handout "Follow Up on Renewal Applications". After a year on HAWK-I, eligibility is reviewed. Approximately 50 percent of the participants are not going back on HAWK-I at renewal time. During the month of February, 2000, 67 renewals were sent and only 44 were returned. Of those 44, 26 were approved, 10 referred to Medicaid, and 6 are pending. There is no way to tell of the 23 that did not come back, why the participants did not re-enroll. The RFP for the TPA requires that when the review form is sent out, all the information about the household that is currently in the system will be pre-printed. All the applicant needs to do is correct any information and sign the form.

Ms. Smith then reviewed the President's FY 2001 Budget Proposal. The proposal would allow parents to enroll in the same public health program that their children are in, whether it is Medicaid or CHIP, but before state's can offer parental coverage they would have to be at 200 percent of the federal poverty level. Iowa, for example, at 185 percent, could not provide the parental option. Additionally, there could be no children on waiting lists if the state wants to cover parents. Under the proposal, it would become mandatory by 2006 that all parents be covered up to 100 percent of poverty and family care would encourage the use of employer-sponsored health care coverage.

CREDITABLE COVERAGE UNDER HIPAA

Ms. Vaughan discussed the Health Insurance Portability and Accountability Act (HIPAA) that provides reforms so that people who had qualifying coverage for a period of time are guaranteed the right to get coverage, if they should lose coverage, without having to satisfy pre-existing conditions. This provision goes beyond COBRA. Most states, including Iowa, set up the high-risk pool as the mechanism for this coverage. People who are covered by their employer and lose that insurance coverage can go to the high-risk pool in Iowa and get health insurance coverage without satisfying pre-existing conditions. Medicaid and HAWK-I are considered previous qualifying coverage under HIPAA. Upon reaching age 19 they can go to the high-risk pool as not having to satisfy pre-existing conditions. In Iowa, we also have individual health insurance reform. If you have been covered under a private health insurance policy you can go into the private health insurance market and get a guaranteed issue policy and not have to satisfy pre-existing conditions. The statute is not specific as to whether HAWK-I is or is not considered private coverage.

PUBLIC COMMENT

Bill Brand from the Department of Human Rights stated he thought it was a good idea to come back to the Board this month to give a further explanation of why they had included a line item of $100,000 in their budget request to do HAWK-I outreach.

Mr. Brand provided the Board with a handout which summarized the network of community action agencies around the state. Mr. Brand explained they have a statewide network of 18 agencies with outreach offices in every county. Their primary mission is to alleviate the effects of poverty on Iowans and they serve over 100,000 low-income Iowans every year. Their job is to coordinate and integrate efforts at the local level between a variety of different community participants and the coordination of state, federal, local, and private dollars. Mr. Brand explained community action in Iowa is a key delivery of a wide variety of programs including Head Start, energy assistance, child care resource and referral, and WIC nutrition services. These services are designed to reach low-income children and he feels their role is to see that these same families get access to HAWK-I. They have been working very hard over the last year to make HAWK-I available to the families they are serving now. Additionally, the handout shows a map which reflects the counties in the state where community action agencies have been designated as the outreach contact person or have some kind of contract with the Department of Human Services to serve as outreach coordinator in those counties; presently about half the counties in the state.

Mr. Brand indicated his handout also includes a two-page summary of their proposed plan if they receive requested funding from the legislature. He feels that the funding would supplement the efforts of the HAWK-I Board and the Department of Human Services to bring more resources and commitment to serving low-income Iowans in the state. If the legislature should fund their request, Mr. Brand would like to work with the Board in helping this program succeed.

Ms. Smith indicated the Department was not aware of this budget request until receiving an inquiry from the Legislative Fiscal Bureau wanting to know if money was available in the HAWK-I trust fund to fund Mr. Brand's request. Ms. Smith indicated the trust fund does not have the money to support the $100,000 request and the administration budget is very tight. Legislation requires that any funds appropriated for the HAWK-I program must be deposited into the HAWK-I trust fund, so if money is appropriated elsewhere to do HAWK-I outreach, those funds would most likely also have to be deposited into the trust fund.

APPROVAL OF JOHN DEERE CONTRACT

Anna Ruggle presented the contact with John Deere Health Plan for the Board's consideration. Ms. Ruggle indicated to the Board that John Deere would like to begin April 1st in Clayton, Delaware, Dubuque, Jackson and Scott counties.

Nancy Mounts moved to approve the John Deere contract for the five counties beginning April 1. Motion was seconded by Dave Krutzfeldt and unanimously approved by Terri Vaughan, Dave Krutzfeldt, Nancy Mounts, Brenda Oas, and Susie Poulton.

APPROVAL OF RULES FOR NOTICE

Shellie Goldman indicated that they are withdrawing the proposed rule at this time.

RECOMMENDATION AND DISCUSSION OF THIRD PARTY ADMINISTRATOR (TPA) BIDS

Ms. Vaughan entertained a motion to go into closed session pursuant to Iowa Code Section 21.5(1)"c" to discuss the third party administrator proposals. These proposals are required to be kept confidential until they are formally released.

Nancy Mounts motioned to go into closed session pursuant to Iowa Code Section 421.5(1 )"c" for this purpose. Dave Krutzfeldt seconded the motion. Ms. Vaughan called roll on the vote. Terri Vaughan - yes, Dave Krutzfeldt - yes; Nancy Mounts - yes; Brenda Oas - yes; Susie Poulton - yes.

Ms. Vaughan announced that the Board was now in closed session and requested that those persons who are not on the Board or on staff leave the meeting.

MEETING CALLED TO ORDER AFTER CLOSED SESSION

Ms. Vaughan called the meeting to order after coming out of closed session. Ms. Vaughan indicated the Board had a closed session to discuss the third party administrator proposals and the Board did not take any votes in closed session. Ms. Vaughan noted one correction in the record. Statutory authority to go into closed session is pursuant to Iowa Administration Code chapter 441, paragraph 21.5(1)"a". Paragraph "c" was mistakenly quoted earlier.

Roll call was taken. Brenda Oas, present; Susie Poulton, present; David Krutzfeldt, present; Nancy Mounts, present; and Terri Vaughan, present. Eldon Huston, absent; Ted Stilwill, absent; Stephen Gleason, absent; Senator Johnie Hammond, absent; Senator Mary Kramer, absent; Representative Brad Hansen, absent; and Representative Robert Osterhaus, absent.

Ms. Vaughan entertained a motion to award the third party administrator contract. A motion was made by Dave Krutzfeldt that the Board approve the contract with MAXIMUS. Mr. Krutzfeldt explained that the business evaluation by the Board was unanimous as far as recommending MAXIMUS. From a cost standpoint they seem to be the most cost-effective given all the advantages they bring to the table. The lowest-cost contractor was found to be unacceptable in the fact that they would not have a center in Iowa and the customer service hours did not line up with what was specified in the RFP.

Motion was seconded by Susie Poulton. There was no further discussion. The motion was unanimously carried by Terri Vaughan, Dave Krutzfeldt, Nancy Mounts, Brenda Oas, and Susie Poulton.

Ms. Vaughan thanked the evaluation team for a great job.

NEW BUSINESS

Ms. Smith notified the Board that the new poverty limits have been released and that the new brochure is being redesigned to reflect the new guidelines as well as to make several other changes that need to be made since the last reprinting. If the legislature votes for 200 percent of the poverty level, then the brochure would need to be reprinted again.

MEETING ADJOURNED