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HEALTHY AND WELL KIDS IN IOWA (HAWK-I)
May 16, 2000
Eldon Huston, Chair
Terri Vaughan, Vice-Chair (absent)
Susan Voss (for Terri Vaughan)
Ted Stilwill (absent)
Charlotte Burt (for Ted Stilwill)
Stephen Gleason, D.O. (absent)
Mary Weaver (for Stephen Gleason)
LEGISLATIVE BOARD MEMBERS:
Senator Johnie Hammond (absent)
Senator Kenneth Veenstra
Representative Brad Hansen
Representative Robert Osterhaus
DEPARTMENT OF HUMAN SERVICES:
Deb Van Den Berghe
ATTORNEY GENERAL'S OFFICE:
Thomas Babcock, D.O. McFarland Clinic
Kehla Garrett John Deere Health
Kristine Klauer John Deere Health
Wendy DeWitt Iowa Health Solutions
Jeff Lobas Child Health Specialty Clinics
Leila Carlson National Association of Social Workers
Frann Otte Wellmark
Jennifer Dreibelbis Iowa Community Action Association
Carla Biuche Iowa Department of Public Health
Jerry Bugge Iowa Department of Human Services
Steve Conway Senate Democratic Staff
April Gordon IHA
Barbara Fox-Goldizen Eligibility Services, Inc.
Jan Ruff MAXIMUS
Ed Conlow House Democratic Caucus
Bill BrandIowa Dept. Human Rights - Community Action Agencies
Paul Stanfield Iowa United Professionals
Denise Hill IMS
Mary O'Brien Visiting Nurse Services
Jennifer Davis Iowa Medical Society
WELCOME AND INTRODUCTIONS:
The Healthy and Well Kids in Iowa (HAWK-I) Board met on Tuesday, May 16, 2000, in Salon E of the Des Moines Marriott Hotel, 700 Grand Avenue, Des Moines, Iowa. Eldon Huston, Chair, called the meeting to order at 4:00 p.m.
Anita Smith took the roll call, a quorum was present. Audience members introduced themselves. 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.
INTRODUCTION OF NEW BOARD MEMBERS:
Mr. Huston announced there are three new Board members and asked each of them to introduce themselves.
Barry Cleaveland, Council Bluffs. Mr. Cleaveland has been in the crop insurance business for approximately 25 years and develops policies and procedures for the company he works for in Council Bluffs.
Diane Briest, Storm Lake. Ms. Briest is program director for Family STEPS, an in-home visitation program for families prenatally and children 0-5. Ms. Briest's background is in child welfare.
Senator Ken Veenstra, Orange, City. Senator Veenstra served four years in the Iowa House of Representatives prior to his current first term in the Senate. Senator Veenstra is also an insurance agent with State Farm Insurance and has been with them for 30 years.
APPROVAL OF THE APRIL 17, 2000, MEETING MINUTES
Susie Poulton had a clarification to the April 17th minutes on page 16, 7th paragraph, first sentence. The cost for formula should be stated as 2 to 8 thousand dollars a year, rather than thousands of dollars a month. Mary Weaver made a motion to approve the April 17, 2000, minutes as amended. The motion was seconded by Susan Voss. Unanimous approval was made by Eldon Huston, Susan Voss, Susie Poulton, Charlotte Burt, Mary Weaver, Barry Cleaveland, and Diane Briest.
Mr. Huston stated he had received correspondence from Senator Mary Kramer, resigning from the HAWK-I Board. Mr. Huston said the Board very much appreciated Senator Kramer's service.
Mr. Huston also noted the letter that was sent to John Forsyth, President and CEO of Wellmark Blue Cross and Blue Shield of Iowa. At the April Board meeting it was suggested a letter of appreciation be sent thanking Wellmark for all of their efforts in promoting the HAWK-I program.
Ms. Smith noted there were approximately 11 different newspaper articles from all over the state about the HAWK-I program, many due from the legislative session. However, Ms. Smith stated she felt many were generated as a result of increased outreach activities at the grassroots level all over the state.
MEETING WITH HEALTH PLANS AND ADVISORY COMMITTEES REGARDING BENEFIT RECOMMENDATIONS:
Mr. Huston stated that recently a meeting was held between the providers, representatives of the Clinical Advisory Committee and the HAWK-I Board, and Department of Human Services staff to go over some recommendations that came from the Clinical Advisory Committee and the response of the consulting actuary. Mr. Huston asked Anna Ruggle, DHS, to brief the Board.
Ms. Ruggle told the Board that the meeting was held to talk about care coordination and what that means, case management for children with special health care needs, mental health and substance abuse issues, and necessary nutritional services. No decisions were made at this meeting, it was merely for the purpose of information sharing.
Mr. Huston stated that a lot of the discussion at this meeting centered around definitions. For instance, the health plans say they do a certain degree and amount of care coordination as a standard part of their plan, while others interpret care coordination to be broader.
Ms. Ruggle provided the Board with a handout that described care coordination. Care coordination can be broken down into two functions. The first function is informing the families of what services are available to them. The second function is making appointments for the family and coordinating referrals to specialists. Under Medicaid, every family with a child under 21 is contacted and informed about care coordination services. This is billed at a rate of $7.71 per 15 minute segment, or $30.84 per hour. The cost for care coordination under Medicaid for the period 1/1/99 through 3/31/00 was $1.5 million. Making appointments, follow up visits, and so forth are billed through the EPSDT coordinator, or Medipass physician. Those services vary on how much they cost because of what is actually being provided. Cost of service for Medicaid for the same period was $286,413.19 (32,847 claims) with 112 unique providers billing for this service.
Mr. Huston stated that the Clinical Advisory Committee wanted to discuss this again and the Board members are trying to differentiate between what the health plans provide as a normal part of their plan and what is provided by public health and others through Medicaid. These are the items that the Clinical Advisory Committee would like added to the contract. If the Board concur, a budget request for these items would need to be submitted to the Legislature in order to be added to the existing coverage. Mr. Huston stated he would like for the Board to discuss these issues at this meeting so a final decision can be made at the Board's June 19th meeting.
Susan Voss stated she felt the May 8th meeting provided a good discussion, particularly in the area of costs and what was expected. Some of the health plans are already doing some care coordination, especially with special needs kids.
Susie Poulton noted that the one thing that continued to come up through the Clinical Advisory Committee was that these are families who have not used the health care system and by providing some sort of care coordination it will help them utilize health care in a positive, preventive way. Ms. Poulton stated that she agreed with Ms. Voss, that it was interesting to find out what benefits the plans are already providing.
Representative Hansen inquired about the statistics in the memorandum from Deloitte and Touche and noted that there was not a cost for mental health. Ms. Ruggle stated that the Clinical Advisory Committee is not talking about increasing the benefits for mental health and substance abuse, but ensuring there is a continuum of care for mental health, outpatient hospitalization, medication, and so forth. The health plans did indicate they do cover all levels, inpatient and outpatient. Mr. Huston said there was a difference between one of the contractors where they provide 20 outpatient visits and the others provide 30, but all of the plans do meet the benchmark required.
Anita Smith stated that an informal telephone survey had been conducted to find out what the enrollees are saying about the program, the experience they have had, and if enrollees need additional services. A list of all enrolled children was furnished by ESI and every tenth family on the list was called. Some have only been on the program for a short time, while others have been on it quite a while. A summary of the survey results and a summary of the results by health plan were provided to the Board members.
Ms. Smith noted that in response to the question, "On a scale of 1 to 10 (with 10 being the best) how do you like the HAWK-I program?", 90 percent of the respondents rated it an 8 or higher. Other results included: 95 percent indicated their child has a primary care doctor they see for exams, shots, or if they are sick; 69 percent have not been referred to a specialist since being on HAWK-I; 62 percent have had a dental appointment since being on HAWK-I; and 96 percent indicated their child had not missed a doctor or dentist appointment because they did not have transportation.
In response to the question, "Have you and your child been treated with courtesy, respect, sensitivity, and friendliness by your health care provider and health care plan?", 98 percent said yes. In response to the question, "If your child had special health care needs (such as diabetes or child obesity that required nutritional services), have you ever had difficulty finding a provider to provide those services or getting those services paid by your health plan?", 87 percent said it was not applicable, 24 said they did not have problems, and 1 person indicated they had some problems. Additionally, 82 percent indicated there was not a time when they were unable to get a prescription filled and if so, it was usually because it was an over-the-counter drug or they did not want to use a generic brand.
96 percent said that since their enrollment there had not been a time when they were unable to contact the health plan to get benefit information; and 97 percent indicated that since being enrolled in the HAWK-I program they had not needed assistance in setting up appointments, or being reminded that their child is due for a physical, dental exam, or immunization.
In response to the question, "Are there any services your child needed but could not get under HAWK-I either because it was not a covered service or because there were limits on service?" 81 percent said no. Ms. Smith stated that when you look at the comments to that question, the number one service that people want added to the benefit plan is orthodontia. In response to the question, "On a number between 0 and 10 (zero being the worst possible and 10 the best) how would you rate your child's health care under HAWK-I?"; 96 percent rated it 8 or higher and 4 percent rated 7 or less. Ms. Smith then highlighted some of the other comments received: "It's a blessing for our family"; "Very pleased with the program"; "Have been through Title XIX and it's so degrading this program is better"; "Fabulous program"; "Everyone has been very nice, better than the one in Arkansas". Ms. Smith also noted that some issues had been identified and staff will contact some of those people to find out exactly what their issues are.
Mr. Huston said that case management for children with special health care needs had been discussed at the May 8th meeting and it is still difficult to identify who these children are and whether they are getting help through another source. Mr. Huston said he found the dental discussion interesting because it was felt that the reimbursement rate was very favorable so the lack of participation may be for reasons other than lack of payment. There was also a lack of consistency with limits; one plan at $1,000 and another at $1,500.
Representative Hansen asked if there are really access problems with dental care. Mr. Huston stated that they had discussed working with the Dental Society and at least one of the health plans indicated they were having a very difficult time getting to talk to dentists to tell them about the program and getting them enrolled in the program.
Ms. Smith added that Outreach Coordinator Deb Van Den Berghe had a HAWK-I exhibit table at the Dental Society's conference recently held in Des Moines. A lot of the dentists assumed the reimbursement rates were the same as Medicaid and when they found out that wasn't the case, it generated a lot of interest.
Representative Hansen asked if access standards are in place that are quantifiable, like the dentist per enrollee ratio or geo access; is that part of their bid? Mr. Huston said that the Iowa Foundation for Medical Care is to analyze and determine whether or not there are an adequate number. Representative Hansen asked if that was specific to the HAWK-I program. Ms. Smith said that they review it for the HAWK-I program. For example, when Iowa Health Solutions wanted to expand into 9 additional counties, the Iowa Foundation for Medical Care called providers and made sure they were accepting new patients, that there was not an excessive wait for initial appointments, et cetera.
Representative Hansen then asked what the program's access standard is. Ms. Smith said they just have to have an adequate network, there is not a ratio standard. Representative Hansen stated that is one piece of information he would like to find out, what standard is the Iowa Foundation for Medical Care using and whether that standard is different for HAWK-I than it is for the commercial population and if there is a different one for Medicaid. Representative Hansen said the policy issue to him is whether that standard needs to be adjusted because it is important to have the right access standards.
Ms. Smith stated that her staff is currently working on quality issues with the new contractor, MAXIMUS, and they are considering software to do geo mapping. With the information provided by the health plans, geo mapping will provide information on exactly where the various providers are located for the health plans.
Mr. Huston said he felt the May 8th discussion on mental health was more informative than anything else. There was a great deal of confusion as to what is covered and what is not covered among the various plans. Ms. Poulton stated that there were differences in the plans in covering 20 versus 30 days, and that needs to be clarified. Ms. Voss stated that there may be certain types of services that some mental health providers feel should be covered but may not actually be in the mental health coverage. A lot of the confusion is how stays are coded.
Mr. Huston stated it was his impression that the plans are providing medically necessary nutrition services when requested. The subject of PKU was brought up and all of the plans said they cover that service. Ms. Poulton noted that the plans said that if there are special needs situations, the plans would provide case management to a certain degree. Ms. Poulton said she would like to see what their criteria is because it could be helpful to the Board in their decision making.
Mr. Huston said he would like to have another meeting to clarify some of these points before the Board meets again in June. Ms. Ruggle will schedule.
Representative Hansen said he wanted to make sure that there is some justification or an explanation of where the issues are coming from, whether families are requesting, families are having problems receiving, or providers are confused.
Enrollment and Statistics:
Ms. Smith stated that the HAWK-I program had another significant increase for the month of April with enrollments at 6,491, which is an increase of 557 over March. Medicaid continues to grow as well. As discussed at the last Board meeting, the number of HAWK-I applications referred to Medicaid continues to grow. An average of 69 percent of the people applying for HAWK-I are being referred to Medicaid, which is significantly higher than when this program initially started out. Ms. Smith reminded the Board that the April report from ESI showed there were over 2,000 pending applications that had been referred to Medicaid and had not been processed. A meeting was held with ESI and the income maintenance staff and a system error was discovered with ESI. Once a case was referred to Medicaid it was put into a pending status. When the case was disposed of, it was never taken out of pending status. That system error has been corrected and the current, correct numbers are reflected in this month's reports. Ms. Smith said the number one reason for denial of HAWK-I applications is still because they have become eligible for Medicaid and 50 percent of the people referred to Medicaid don't follow through. Ms. Smith said that federal legislation has a Medicaid screen and enroll requirement that all HAWK-I applications must be reviewed for Medicaid eligibility and if it appears the family would be eligible for Medicaid, they have to be referred to Medicaid. If the family fails to cooperate with that process and establish that they either are or are not eligible for Medicaid, then their HAWK-I application is also denied. There have been 7,288 children denied for failure to cooperate with Medicaid.
Ms. Weaver asked if anything was being done to follow up with those families. Ms. Smith said that some states contact the family and ask them why they didn't follow through; why they don't want Medicaid. Even though there has been a high success rate, it becomes a resource and staffing issue.
Ms. Smith said that the "How You Heard of Us" report is showing a variety of ways applicants learned about HAWK-I, which is a reflection of the grassroots efforts. Applications are still being submitted as a result of the letters which were sent out in February informing applicants who had been turned down in the past about the earned income disregard. Ms. Smith noted that during April there were 74 children disenrolled; 30 because they went to the Medicaid program and 20 were cancelled because they had other insurance. No one was cancelled for failure to pay premiums.
Expenditures for HAWK-I administration have totaled $167,298 out of $377,486 budgeted. There will be some significant expenditures applied for start-up costs for the MAXIMUS contract beginning June 1. Interest earned to date from the trust fund is $116,321 and that is being used to offset administrative expenditures. Ms. Smith informed the Board that she found out this week that delinking money can still be used for outreach. Iowa has $900,000 left of that money and will use $300,000 of it to fund the community outreach efforts again this year. Ms. Smith stated that is at a 90 percent match and will help on the10 percent administrative cap.
Ms. Smith referred the Board to an article which appeared in "Medicine and Health". The article indicates that states have up to three years to spend each year's funding allotment and any unspent funds revert and are redistributed among the states that have exceeded their allotments for that year. A total of 38 states have not spent their first year allotments, including Iowa, and there are 13 states that have. Approximately $1.9 billion will revert to the redistribution pool. Legislation has been introduced in Congress to allow states a longer period of time to spend that first year's allotment, and the extension is expected to pass. Ms. Smith said that Iowa is close to using their full first year's allotment and has between 1 and 3 million dollars which would have to revert if the extension is not passed.
Ms. Smith informed the Board that the U. S. Senate appropriations committee approved FY 2001 appropriations for the Department of Health and Human Services, reducing funding for the Social Services Block Grant by $1.1 billion. Apparently the committee felt states can make up lost revenues with tobacco settlement money. The impact on individual states is unknown at this time, but more information should be coming out in the next few weeks. Also included were measures to rescind nearly $2 billion in state CHIP allotments, so those states that already planned to spend their tobacco money on other things may have to shore up their CHIP programs if this happens.
Ms. Smith stated that the Department of Human Services has a quality control unit that reviews the work of Medicaid. Case files are reviewed to see that eligibility was determined correctly, people received the appropriate benefits, they reported all their income, et cetera. Recently the unit has started doing that for HAWK-I. Staff has pulled files from ESI to make sure that eligibility was determined correctly and that families have been reporting income correctly. Ms. Smith said that before continuing with the process, she would like the Board's feelings on this review. While federal law requires this kind of review for Medicaid, HAWK-I only requires that quality measures are in place.
Jerry Bugge from the Department of Human Services was introduced and outlined the process to the Board. Mr. Bugge said staff contacts the family and asks for help verifying the eligibility factors, particularly verification of income. Documentation is asked for only when the information the Department has is insufficient. Sometimes the employer is contacted, but only after obtaining the client's permission to do so. Mr. Bugge stated they had experienced resistance from one person so far who was hesitant to provide the information that was requested. Mr. Bugge stated the unit has just started to review HAWK-I and about 10 cases are reviewed a month.
Ms. Smith stated that when eligibility is determined for HAWK-I the information provided on the application is verified. However, it isn't known whether everything is being reported, for example, all income in the household. That is what the quality control unit is doing when contacting the family. Also, Department employees do have access to Job Service and Department of Revenue and Finance records which can be used to verify income information. Outside contractors, such as ESI, are not granted access to those resources.
After a brief discussion, the Board determined that a desk review be done and only in those instances where something really seems amiss should quality control follow-up with the client.
Transition to MAXIMUS:
Jan Ruff from MAXIMUS was introduced. Ms. Ruff will be overseeing the HAWK-I program and currently oversees Michigan's "MI Child" program as well.
Ms. Ruff reported that the new office in West Des Moines is coming together. All but two staff have been hired and final interviews for those positions are being held. Barbara Fox-Goldizen has been named project manager and several other staff were brought over from ESI as well. This is a very systems intensive program and over the course of the next few weeks testing will occur. The physical move is scheduled for May 25th and the income maintenance staff will move from ESI to the new location. Anita Smith has reviewed the MAXIMUS employee manual and is currently reviewing all the notices and other correspondence to ensure they are customer-friendly. Another change is the website's redesign. One of the new components is people can submit questions electronically.
Ms. Smith noted that all of the statistical reports that are furnished to the Board will be available from the website. These reports will not be available to the general public, but can be accessed by password. The reports are currently being redesigned so they are more meaningful and easier to understand.
The Department of Human Services' appropriation bill directs the Department to seek a demonstration waiver from HCFA to give families the choice between Medicaid and HAWK-I. Early indications are that HCFA will not approve the waiver as they don't have the authority to waive statutory provisions. It would take federal legislation to give the states the ability to do this.
Mr. Huston said it was his understanding that the Legislature had not appropriated any funds for the development of the waiver and the trust fund is to be used. Representative Hansen asked if there was interest in the Board sending a letter to the Iowa delegation asking them to look at this possibility. The Board concurred and asked the Department to prepare a letter to send to the Iowa delegation.
Ms. Smith said that the Governor has signed the tobacco bill. The Bill directs the Department to expand HAWK-I to 200 percent of the poverty level. As a result, administrative rules have been drafted in order to implement this legislation effective July 1, 2000. Susan Voss made a motion to approve the Adopted and Filed Emergency rules and the Notice of Intended Action which amend Chapter 86. The motion was seconded by Mary Weaver. Unanimous approval was made by Eldon Huston, Susan Voss, Susie Poulton, Charlotte Burt, Mary Weaver, Barry Cleaveland, and Diane Briest.
Ms. Smith said staff will again be sending out letters to families who have been denied due to excess income advising them of the income change and giving them the opportunity to re-apply. The HAWK-I brochure has been revised with the new income limits and a few changes were made to the application upon the recommendation of the Children's Defense Fund. The brochure has been sent out to be printed and supplies should be available by July 1st.
Anita Smith announced that a little over 400 are enrolled for the "Still Searching for Austin" conference, but quite a few walk-ins are expected.
Ms. Smith stated that a year ago the HAWK-I Board directed the Department to develop a grassroots outreach campaign to conduct outreach activities for HAWK-I. DHS Director Rasmussen asked the Department's regional administrators to ensure grassroots activities were occurring at each of the local levels. Within the Department there are 5 regions and 38 clusters below those regions. At the cluster level, they were asked to bring their community partners together to develop an outreach plan and to designate a lead agency. Once the plans were approved then money was allocated directly to those entities to conduct outreach activities. Work has begun on community plans and contracts for FY 2001. It was requested that plans and contracts be submitted by June 15th so that the funds can be distributed as soon after July 1 as possible. The delinking money will be used for the $300,000 that is targeted towards those community outreach efforts. Mr. Huston noted that once the outreach efforts began, immediate results were seen in the number of applications received.
Ms. Smith then introduced Denise Hill, Public Relations Manager at the Iowa Medical Society. Ms. Hill is a member of the Iowa Covering Kids Now Task Force.
Ms. Hill stated that Covering Kids Now is a national initiative started in the 1980's by the Southern Institute. This is the group that started the momentum to pass the CHIP program at the Congressional level. As part of their efforts they came in contact with the Robert Wood Johnson Foundation, which then gave grants to the states who are involved with the CHIP program. In Iowa, the grantee is the Iowa Department of Public Health and the grant is close to one million dollars. The Department of Public Health contracted with the Iowa Medical Society to facilitate the Covering Kids Now Task Force. The task force will meet over the course of the next three years and is responsible for identifying and making recommendations related to barriers to children's health care, with a primary focus on enrollment and retention of children in the Medicaid and HAWK-I public health insurance programs. The task force will address barriers at the federal, state, local, and individual levels within and outside government administration.
To date, the task force has met four times and in December they distributed a report focused on continuous eligibility for Medicaid, presumptive eligibility, depreciation, capital assets, and recommended that HAWK-I be increased to 200 percent of poverty guidelines. Ms. Hill said that the members of the task force are very committed and plan to meet up to 6 times a year. Ms. Hill noted that the task force will work closely with the Department of Human Services, and that Anita Smith and Deb Van Den Berghe sit in on the task force, as do several members of the Department of Public Health.
Ms. Hill said that the task force meetings are open to the public and invited anyone interested to attend. As they look at different barriers, they will be inviting guest speakers and welcome any suggestions that anyone might have. Ms. Hill also said that if the HAWK-I Board has any issues they would like the task force to take a more in depth look at, to let her or someone on the task force know.
Outreach Coordinator Deb Van Den Berghe then addressed the Board. Ms. Van Den Berghe told the Board that most of her time in the next 5 weeks will be spent visiting the different areas and providing assistance as they develop their plans for the next fiscal year. Assistance will be provided in setting and measuring goals. Also, areas are being asked to track how many applications were completed and denied in their area.
Ms. Weaver asked if copies of the plans would be made available to the Board. Ms. Weaver stated that she was concerned that the $100,000 appropriation that the cap agencies will be receiving does not result in a duplication of effort. Ms. Van Den Berghe stated that she has been working as a liaison with Bill Brand and others to ensure that there is not a duplication of effort, but the plans compliment one another. Mr. Huston noted that any plans involving the $100,000 appropriation would have to come to the Board for approval before any funds are expended.
Ms. Smith stated that one of the things they can do when looking at the community plans is to ask what the role of the cap agency is within that plan. Then if anything that is being proposed with the new outreach money is duplicative, that information can be provided to the Board.
Ms. Poulton asked for an update on the Dental Association Conference. Ms. Van Den Berghe stated that HAWK-I was very well received and there are a lot of myths. Dentists still connotate the HAWK-I program directly with Medicaid, so a lot of those myths were dispelled. Ms. Van Den Berghe stated that she also had met with a group of medical office managers, and again found a lot of myths and misunderstandings about the program.
HEALTH PLAN UPDATE:
Anna Ruggle reminded the Board that several months ago Secure Care had expressed an interest in HAWK-I. In a follow-up conversation, Ms. Ruggle was told Secure Care is still interested, but it will be a slow process for them.
Ms. Ruggle stated she had received a report from Deloitte & Touche regarding a rate increase for the HAWK-I plan and provided the Board with a summary of the report. Originally the premium rates were based on assumptions of what the HAWK-I population would be, utilization environment, and level of provider reimbursement. The actuary figured there are three trend factor models that can be approached for FY 2001. One is "construct a trend" and that is based on utilization increases and provider fee increases. The percent of premium increase range is from 4.5 to 8.9 percent. The per member per month (PMPM) would increase for indemnity from $110.63 to between $115.61 and $120.48. HMO is currently $84.97 PMPM and it would increase to $88.79 up to $92.53. The impact on state funding is $225,548 to $446,084 per year.
Another method is commercial models and the premium increase for commercial model insurance goes up to 12 percent. That increases indemnity to $123.91 and HMO to $95.17, which would have an impact on state funding of $601,461 per year.
The third method is comparative to Medicaid. The fee for service would increase to 3.5 to 7 percent and managed care 3 to 10 percent. Impact on state funding for indemnity would be $175,426 to $350,852; or for HMO $150,365 to $501,218. Deloitte & Touche's recommendation is somewhere between a 5 and 9 percent increase to the rate. If the rate is too low there may be criticism about provider access and reimbursement. If the rate is too high there may be criticism that it's not prudent enough. Prescription drugs have the highest increase, about 18 to 20 percent. The lower range of this increase assumes a 14 percent increase.
Ms. Smith said that the Board would probably want to take this information into consideration and take action at their June Board meeting. This is a budget issue, so it needs to be a part of the budget request that will be prepared in July.
Representative Hansen asked if this information is based on the utilization with the current enrollees for HAWK-I. Ms. Smith said no it was not. The HAWK-I program just reached a year of statewide activity with Wellmark on March 1, a year with Iowa Health Solutions as of January 1, and Unity Choice will be a year in October, so Deloitte and Touche did not feel there was sufficient data available at this point. Ms. Smith said that each of the plans have agreed to resubmit all their encounter data from day one so MAXIMUS can create the encounter reports, but again, even with that data, Deloitte & Touche questions whether the data is sufficient at this point.
Mr. Huston asked that Board members and DHS staff work with Susan Voss and see if these recommendations are in line with what is happening in other places. The Board can then take up the matter at the June Board meeting.
Ms. Voss asked if it was known what other states are doing, what rate increases they are predicting. Ms. Smith stated they can contact other states for that information.
Representative Osterhaus said it was his recollection that Iowa started out with higher rates than some of the other states so he is curious as to what the other states are doing in the next year. Ms. Smith stated that part of that higher rate had to do with cost sharing. There had been discussion with the plans that other than the $25 ER co-payment, there is not any cost sharing. Other states may not have as a high a premium but were imposing more cost sharing on the part of the enrollees. Ms. Smith said that staff will contact other states to see what they are projecting as far as premiums.
Senator Veenstra asked if Iowa still has a sliding scale for co-pay. Ms. Smith stated that for families over 150 percent of poverty it is $10 per month per child with a maximum of $20. Senator Veenstra said that before a decision is made on selecting a methodology for rate increase, the co-pay should be examined and incorporate some of that adjustment as well.
IFMC PROPOSED CONTRACT WORDING:
Ms. Ruggle referred the Board to the draft contract language between the Iowa Department of Human Services and the Iowa Foundation for Medical Care. The Department has a contract with IFMC to review Medicaid. Rather than the HAWK-I program having a separate contract, the proposed contract language adds HAWK-I to that review.
Ms. Ruggle stated that there will be an on-site evaluation focusing on services unique to HAWK-I such as mental health, substance abuse, dental, pharmaceutical and vision services. The medical record review is going to focus on well child, well adolescent visits, and immunizations. The review team will pull 50 charts from the HAWK-I members and look at those. The contract starts July 1. IFMC will conduct a HAWK-I external evaluation during the same visit as the commercial evaluation for two MCO's during this contract term. Reviews shall be conducted for Wellmark's Unity Choice in September 2000 and Iowa Health Solutions in October 2000. IFMC will work with the Department to define the timeframe for the onsite evaluation of Wellmark's indemnity plan. A review of John Deere will be conducted in April 2001. The costs will be $15,000 for managed care reviews, 3 plans at $5,000 each; and one indemnity plan at $5,000 for a total cost to the program of $20,000. There are federal matching funds.
Ms. Smith stated that since the existing IFMC contract covers Medicaid, the Board wouldn't approve the contract, but would approve just the HAWK-I component being inserted into the contract renewal.
Mary Weaver made a motion to approve the HAWK-I component and have it added to the Medicaid contract. Motion was seconded by Susan Voss. Unanimous approval was made by Eldon Huston, Susan Voss, Susie Poulton, Charlotte Burt, Mary Weaver, Barry Cleaveland, Diane Briest, Bob Osterhaus, Ken Veenstra, and Brad Hansen.
Dr. Thomas Babcock, of the McFarland Clinic in Jefferson, Iowa, addressed the Board. Dr. Babcock stated his concern is that Wellmark only offers one option for any one county. Dr. Babcock practices in Greene County, but many of his patients live in Dallas, Carroll, Guthrie, and Boone Counties. Dr. Babcock stated that only Unity Choice is available to his patients from Dallas County, a Wellmark program he does not participate in. Dr. Babcock stated that he believes the HAWK-I program should offer the option of an alternative Wellmark product in addition to Unity Choice in each county.
Mr. Huston stated that the Board is attempting under the HAWK-I program to emulate the private market and the private market does have limitation and choice. Mr. Huston said the Board has discussed this issue a number of times and at this point there has been no effort to change the present policy.
Ms. Weaver asked Dr. Babcock to clarify his statement. Dr. Babcock stated McFarland Clinic has contracts with Wellmark, but only those who sign Wellmark's universal contract are allowed to participate in Unity Choice. His clinic did not sign the universal contract.
Mr. Huston thanked Dr. Babcock for sharing his concerns with the Board. There was no other public comment.
MENTAL HEALTH PARITY LEGISLATION:
The Iowa Legislature did not pass the mental health parity legislation under consideration this year.
There was no new business to present before the Board.
The next HAWK-I Board meeting is scheduled for Monday, June 19, 2000, at 12:30 in the Oak Room at the Des Moines Botanical Center.
The meeting was adjourned at 6:10 p.m.