HEALTHY AND WELL KIDS IN IOWA (HAWK-I)
March 20, 2000
Eldon Huston, Chair
Terri Vaughan, Vice-Chair
Ted Stilwill (absent)
Brenda Oas (for Ted Stilwill)
Stephen Gleason, D.O. (absent)
Mary Weaver (for Stephen Gleason)
LEGISLATIVE BOARD MEMBERS:
Senator Johnie Hammond (absent)
Senator Mary Kramer (absent)
Representative Brad Hansen (absent)
Representative Robert Osterhaus (absent)
DEPARTMENT OF HUMAN SERVICES:
Deb Van Den Berghe
ATTORNEY GENERAL'S OFFICE:
Marne Woods (absent)
Jennifer Dreibelbis Iowa Community Action Association
Leila Carlson National Association of Social Workers
Christy Black National Association of Social Workers
Sonni Vierling Iowa Department of Public Health - Covering Kids
Cheryl L. Stewart Iowa Senate Intern
Bill Brand Iowa Dept. Human Rights - Community Action Agencies
Barbara Fox-Goldizen Eligibility Services, Inc.
Mary O'Brien Visiting Nurse Services
Jan Ruff MAXIMUS
Dennis Siebert MAXIMUS
Stacey T. Cyphert University of Iowa Hospitals & Clinics
Frann Otte Wellmark
Jeanie Kerber House of Mercy Clinic
Cindy Groene John Deere Health Plan
WELCOME AND INTRODUCTIONS:
The Healthy and Well Kids in Iowa (HAWK-I) Board met on Monday, March 20, 2000, in the Willow Room at the Botanical Center, 909 East River Drive, Des Moines, Iowa. Eldon Huston, Chair, called the meeting to order at 12:40 p.m.
Mr. Huston noted that a quorum was present as well as staff from the Department of Human Services.
ANNOUNCEMENTS AND ROLL CALL:
Anita Smith took the roll call. Introductions were made. Mr. Huston informed the guests that there would be an opportunity for public comment later in the agenda and if someone would like to address the Board, they should notify him.
APPROVAL OF THE FEBRUARY 21, 2000, MEETING MINUTES
Mr. Huston asked the Board if there were any questions or comments regarding the February 21, 2000, minutes. Nancy Mounts made a motion to accept the minutes as written. The motion was seconded by Brenda Oas. Unanimous approval was made by Eldon Huston, Nancy Mounts, Susie Poulton, Brenda Oas, Mary Weaver, and Terri Vaughan.
Ms. Smith provided a synopsis of the correspondence that was provided to the Board.
The first was a letter from Wellmark Health Plan of Iowa, Inc. dated February 17, 2000, asking four other health plans in Iowa to consider participating in the HAWK-I Program. In response to that letter, Dr. Tom Kline of Secure Care of Iowa contacted the Department of Human Services for additional information regarding the program and a description of the enrollment process.
The second letter, also dated February 17, 2000, was from Wellmark President Peter W. Roberts asking representatives from the health care industry to become more active and supportive of outreach activities for HAWK-I, and asked for their participation in a meeting to discuss roles they might play to enhance outreach activities. Ms. Smith noted that she and Outreach Coordinator Deb Van Den Berghe attended this meeting just before coming to the Board meeting and will provide the Board with an update from that meeting later in the agenda.
A February 28, 2000, letter from Iowa Health Solutions to Anna Ruggle discussed mental health and substance abuse provider networks and what Iowa Health Solutions is doing to increase their provider panel in those areas.
A third letter from Wellmark, dated February 22, 2000, was sent to Ms. Smith to inform her of an administrative change regarding the nonparticipating facility reduction for indemnity coverage and implementing a hospital-specific maximum allowable fee for indemnity and HMO. If anyone has any questions they should speak with Anna Ruggle.
Nancy Mounts asked about the letter from Iowa Health Solutions; would the expansion be monitored to see if they are really doing what they say they will be doing? Ms. Smith indicated her staff will follow up.
The last item of correspondence is a March 6 letter Central Rehabilitation Ltd. sent to John Deere Health Care. This provider is trying to get on John Deere's panel to provide rehabilitation services for speech, physical, and occupational therapy.
Enrollment and Statistics:
Ms. Smith announced that the HAWK-I Program reported its biggest increase in enrollments ever in February, 2000. There were 1,017 children added to the program in February, the highest since June 1999 when 481 children were added. The record of enrollments has more than doubled. These increases are the result of the 20 percent earned income disregard, and increased community outreach activities. More activity at the local level is being seen.
Mr. Huston asked if it was known whether the trend has continued for March. Ms. Smith indicated it wasn't known at this time.
The February "Applicant Status Summary Report" indicates the denial reasons are still trending the same. There were 502 children classified as "eligible, not enrolled"; which is interpreted to mean waiting for paperwork. This number is significantly higher than in previous months so the March enrollments should increase significantly.
Ms. Mounts asked a question about the status entitled "Not Eligible, Denied / No Premium Received"; does this mean they have been paying their premium and then did not, or that they never started paying? Ms. Smith indicated payments were never started, and that could be for any of a number of reasons; deciding not to participate, moved out of state, already had insurance, et cetera. Ms. Mounts asked if some type of system could be developed to find out why children are not re-enrolled. Ms. Smith indicated HAWK-I staff would be working on some of these processes with the new contractor.
Ms. Weaver asked what could be done in the interim, before MAXIMUS is up and running, to follow up through outreach activities in local communities. Ms. Smith indicated some follow-up is being conducted at the local level for those entities who have confidentiality releases. There was follow-up done for those families who initially did not qualify, but because of the 20 percent exclusion, now do qualify. Because of confidentiality issues, any follow-up would have to be done by the Department of Human Services and not at the local level, so there is a labor issue as well as the information sharing issue.
Mr. Huston asked Ms. Smith to have staff look at options and identify barriers and report back to the Board in April.
Ms. Smith then directed the Board's attention to the "HAWK-I County Call Percentage" report and asked the Board to note increases in some counties. For example, Boone and Bremer Counties more than doubled the number of calls into the 1-800 number. Likewise, there were significant increases in Henry, Howard, Iowa, Jefferson, and Palo Alto counties. This trend is reflective of the additional outreach activities at the local level.
The "HAWK-I Family Size by Poverty Level" report shows no change. The greatest percentage of participation in the program is from the 160 - 170 percent of poverty category. Ms. Smith noted that with the 20 percent income disregard there may be some movement as people qualify.
The February "How You Heard of Us" report shows that 142 applications were a direct result of the letters that were sent to families previously denied but with the 20 percent earned income disregard might now qualify.
Ms. Smith also reported that there were 17 children disenrolled in February for failure to pay the premium. This is higher than in the past, but not significant at this point. Staff will continue to track.
Ms. Smith then discussed the "Medicaid and HAWK-I Progress Monitoring Report". The report shows enrollments with a county-by-county breakdown. The February report indicates 12 counties are at 90 percent or higher of reaching their goal for Medicaid; 17 counties are at 80 percent; 26 at 70 percent or higher; and 54 are at 60 percent or higher. A total of 73 counties are at least half way to their goal for the Medicaid expansion. Dallas County has the lowest percentage of enrollment at 25 percent. Ms. Smith noted that the numbers are still based on the original 15,500 that were estimated to go into Medicaid, and the estimated eligible children are still 100 percent. The take-up rate was not applied to this number.
Ms. Smith explained that for a county that shows it has reached 100 percent, it means it is believed that they really do have 100 percent of the children rather than 100 percent of their goal. At 60 percent, Ringgold has the highest HAWK-I enrollment as far as reaching their goal. When this chart is revised for the upcoming fiscal year the numbers will be changed to reflect 40 percent of the children going into Medicaid and also will incorporate the 75 percent take-up rate. These numbers for estimated Medicaid kids are based on original assumptions before it was known that 40 percent of the applicants were going into Medicaid. As these numbers are adjusted to reflect the 40 percent referral to Medicaid, estimates will go up for Medicaid and down for HAWK-I.
The "Statewide Weekly HAWK-I Application Count shows the program receiving well over 200 applications a week, in most weeks over 300. This is three times what was being received one year ago. The same percentage is still being referred to Medicaid.
Nancy Mounts asked about the "HAWK-I Demographics Summary" report which is a breakdown by county of gender, language preference, ethnicity, and how they heard of us. Ms. Mounts wanted to know how ethnicity enrollment compared to the actual demographics of the state. Is it proportionate? Ms. Smith indicated staff could work on getting that information.
Mr. Dave Krutzfeldt joined the meeting at this time.
Ms. Smith indicated that the year-to-date expenditures are at $2.5 million and the interest earned from the HAWK-I trust fund is $71,218. The interest from the trust fund is used to offset administrative costs. Ms. Smith noted that some expenditures were inadvertently charged to Medicaid rather than HAWK-I, but this is being rectified. The March report may reflect a large increase in administrative costs, but this will be due to the correction.
Mr. Huston asked if anything affecting the budget has come out of the legislature. Ms. Smith indicated there has been nothing at this time. Ms. Weaver indicated that the tobacco settlement negotiations were nearly completed, but there was disagreement between the parties concerning continuous care for children under Medicaid.
Proposed Application Revisions:
Ms. Smith shared a photocopy of the revised HAWK-I application with the Board. The application will not be reprinted until it is known whether the Legislature is going to increase the income limit to 200 percent of FPL. Because the poverty levels are increasing April 1 there will be new income guidelines, so the new insert is being revised with the new guidelines.
Ms. Smith outlined the revisions for the Board. Section 2 previously asked the names of the mother and father and the purpose was to help figure out household composition. This is not really needed since Section 3 asks who the other adults in the household are and how they are related. Added in Section 2 are the words "for whom you are applying". Previously Section 2 asked about all children under 19 living in the home. The word "optional" was added under social security number.
Section 6 previously asked if this child was on Medicaid or does this child currently have insurance. This has been added to Section 2 for only the children for whom application is being made. In Section 4 emphasis was placed on the question, "I expect this amount to be the same for the next 12 months" (referring to gross income).
In Section 5, insurance history, the words "remember your children must be uninsured to be eligible for HAWK-I" have been added. There has been an increase in the number who have applied and their children were already insured and should not have been in the program.
Section 7 is new, "Referrals to Medicaid". Currently, the back of the application states if it looks like your child may be eligible for Medicaid, this application will be sent to DHS. A supplemental form is sent asking two questions, one concerning retroactive Medicaid eligibility; do they have unpaid medical bills from the past 3 months, and the other is if there is an absent parent, it seeks information for child support purposes. It was suggested to have the retroactive Medicaid question on the application, then the supplemental only needs to be sent in those situations that have absent parents.
The 1-800 number has been added on every page, and the charts have been stacked for easier reading. Also in Section 2 a statement has been added that the "information on the application is not shared with INS".
Ms. Smith clarified for the Board that social security numbers are not a requirement for HAWK-I, but they are for Medicaid. It the applicant does not provide a social security number it will not be requested nor the application denied, only if it gets referred to Medicaid would the social security number be a requirement.
Health Plan Update:
Anna Ruggle provided a brief update for the Board. At the February 21, 2000, Board meeting there was discussion about the benefit structure from the Clinical Advisory Committee. The Board requested more specifics and asked for a report. Ms. Ruggle indicated there had not been an opportunity to meet with the advisory committee yet this month. Mr. Huston asked if they would be meeting with the health plans. Ms. Ruggle indicated yes they hoped to get that accomplished.
Ms. Ruggle reported that Deloitte Touche is currently looking at the benefit payments and she should be hearing this week whether the premiums will be increased or not.
Ms. Ruggle informed the Board of John Deere's request to expand to a number of counties; Black Hawk, Bremer, Butler, Cedar, Grundy, Jones, Dallas, Madison, Polk Warren, Benton, and Linn. Mr. Huston said he would entertain a motion to approve the expansion of John Deere and asked if this includes all the counties in which John Deere writes coverage. Cindy Groene, John Deere Representative, indicated they have other commercial memberships in the state, but do not expand until they have an adequate network for HAWK-I. Nancy Mounts moved to approve the amendment to the contract. Motion seconded by Dave Krutzfeldt. Unanimous approval was made by Eldon Huston, Nancy Mounts, Susie Poulton, Brenda Oas, Mary Weaver, Terri Vaughan, and Dave Krutzfeldt.
Ms. Smith noted that with the addition of John Deere in these 12 counties, there will be five counties in which children will have a choice of three health plans.
Ms. Smith introduced the new Outreach Coordinator, Deb Van Den Berghe. Ms. Van Den Berghe most recently had been doing local outreach in Muscatine, Iowa. Ms. Van Den Berghe stressed to the Board her commitment to outreach and stated in the past two weeks she has been involved with Child Watch at the State Capitol in conjunction with the Children's Defense Fund; met with the Decat Board in Fairfield; participated in Boost for Kids, sponsored by RWJ; and Kids Fest. In the near future she will be working with Iowa-Nebraska Primary Care, Iowa chiropractors, and school nurses. The largest activity in the state currently is working kindergarten roundups. Other outreach involvement includes making presentations with DHS workers in Cedar Rapids, school nurses and nursing associations in April, Minority Health Task Force, St Ambrose students, and a reasonable efforts course in the 7th Judicial District.
Ms. Van Den Berghe announced that on May 17 there will be a conference at the Des Moines Marriott entitled "Still Searching for Austin". Bill Smith, a nationally known social marketing expert, will be the keynote speaker. Mr. Smith will also facilitate a session on "working with the private sector". Other sessions planned will be facilitated by representatives from the Health Care Financing Administration (HCFA) office and the Justice Department's Immigration and Naturalization Service. A panel discussion is planned on successful outreach programs and barriers which have been identified
Ms. Van Den Berghe stated there are approximately 20 people on the planning committee and they have applied for CEUs for social workers, dieticians, and nurses. The seminar is currently scheduled for 8:30 to 5:00, and registration will be approximately $20. Three providers, John Deere, Iowa Health Solutions, and Wellmark, have agreed to sponsor the conference.
The Committee is attempting to get Governor Vilsack to open the conference, and a representative from HCFA to talk about possible changes at the federal level. Tomas Zuninga, INS, will discuss myths about immigration and the INS and will also facilitate a breakout session targeting immigrant populations. Breakout sessions planned include: Eligibility for HAWK-I and Medicaid and how they relate; provider panels for what health plans cover; Nancy Shafer will facilitate a session on volunteerism; and representatives from Refugee Services and the INS will facilitate a session on reaching minority populations (Hispanic, Bosnian, Sudanese, and Southeast Asian).
Mr. Huston encouraged the board to put this date on the calendar.
Mr. Huston indicated that no one had requested an opportunity to address the Board.
DISCUSSION AND APPROVAL OF MAXIMUS CONTRACT:
The Board had previously been given a copy of the MAXIMUS contract for their review. Mr. Huston asked how this contract differs from the previous contract. Ms. Smith indicated this contract provides that a pre-printed review form will be sent out rather than a blank form. The family will correct the information, update the pay information, and return. Also, more reports have been requested, including more detailed demographic information, which will help those involved with outreach activities. The services are the same as the previous contract, but the website will contain more demographic information. MAXIMUS will maintain a Des Moines office, which will include room for ten income maintenance staff.
Another change is for managed care plans which require primary care physicians be identified. In the past, problematic delays occurred because the notice of approval indicated the participant needed to contact the health plan to designate the primary care physician, then the health plan would issue the card. MAXIMUS will ask for the primary care physician at the point the child is enrolled, or assist them in getting a primary care physician if they do not have one, thus speeding up the enrollment process.
Shellie Goldman, Department of Human Services, indicated that the MAXIMUS contract gives the opportunity through the different edits and standardization of formats to be able to produce a lot more information regarding quality of care and claims data. An array of different procedure and diagnosis codes will be loaded into the system enabling the department to get a feel for who the kids are that are being served and the types of services they are receiving.
Mr. Huston stated he would entertain a motion to approve the contract with MAXIMUS. Motion to approve the contract was made by Dave Krutzfeldt. Motion was seconded by Nancy Mounts. Unanimous approval was made by Eldon Huston, Nancy Mounts, Susie Poulton, Brenda Oas, Mary Weaver, Terri Vaughan, and Dave Krutzfeldt.
Dennis Siebert and Jan Ruff of MAXIMUS were introduced. Mr. Siebert indicated MAXIMUS was very pleased to be selected as the administrative contractor for the HAWK-I program. Mr. Siebert works out of the MAXIMUS corporate headquarters in Virginia, just outside of Washington, D.C. and will be in Des Moines as the implementation manager until full implementation on June 1. Ms. Ruff is from the MAXIMUS office in Lansing, Michigan, and will be the project director for this contract. The project manager, who will be on site in Des Moines, will report directly to Ms. Ruff.
Mr. Siebert provided the Board with a handout which gives a brief overview of MAXIMUS and explains their experience relative to the HAWK-I program. Mr. Siebert stated that MAXIMUS was founded in 1975 and is probably the largest company in the country which focuses almost entirely on public programs, primarily in the area of health and human services. Mr. Siebert said that MAXIMUS has 25 customer service centers across the country to meet the needs of their customers.
Ms. Ruff outlined MAXIMUS' experience in other states with relevant projects. They currently manage the CHIP programs in Kansas and Michigan and perform encounter data processing in Connecticut, Kansas, and Texas, and will be providing this in Iowa.
Ms. Ruff indicated that a six-person team came to Iowa in February and the systems staff will be coming on-site soon. Mr. Siebert and Ms. Ruff have been looking at office space in Des Moines and will complete this process soon. A documentation process of the HAWK-I procedures from beginning to end will take place, and from that a service policies and procedures manual will be written, training completed, and performance standards and goals will be set. There will be 13 full-time employees located in Iowa. Ms. Ruff and Mr. Siebert will be meeting with the various health plan representatives on March 21 to discuss what processes currently exist and need to stay in place and what needs to be changed.
Ms. Smith indicated that the 1-800 number, the website, and the post office box number will all remain the same.
Mr. Huston reminded the Board members that additional discussion on the Clinical Advisory Committee recommendations would be the main agenda item for next month's meeting. Dave Krutzfeldt indicated that it would be difficult to do anything with the recommendations at that time since the legislature will be out of session. Mr. Huston also reminded the Board that during these discussions they need to keep in mind what the Board's charge from the legislature and the governor is.
Mr. Huston inquired as to whether the May Board meeting should be held in conjunction with the conference. The decision will be made at the April meeting.
Mary Weaver asked if it is possible to have a transitional meeting where the new Board members and the outgoing Board members can all be in attendance. Ms. Weaver stated this would be a nice orientation for the new Board members. Ms. Smith indicated that she has been in contact with the Governor's Office on a related issue and will see if this is something that can be arranged.
The next meeting is scheduled for Monday, April 17, 2000, at 12:30 in the Oak Room at the Des Moines Botanical Center.