By OPEN MINDS Circle
On August 31, 2022, the Iowa Department of Health and Human Services (HHS) issued a notice of intent to award Medicaid managed care organization (MCO) contracts to Molina Healthcare of Iowa, Inc. and Amerigroup Iowa Inc. (an Elevance Health subsidiary) for managed care services for Medicaid members in Iowa. The total annual aggregate value for each contract is not yet available. The contracts are slated to begin on July 1, 2023. The contracts will have an initial term of four years, with the option to extend for one additional two-year term.
These awards are the result of a new procurement. HHS rebid the contracts on February 17, 2022. The procurement included the state’s Medicaid managed care program, Health Link, the Iowa Health and Wellness Plan (IHAWP), and the Healthy and Well Kids in Iowa (Hawki) programs. The MCOs are responsible for delivering all covered benefits including physical health, behavioral health, and long-term services and supports (LTSS) for the Medicaid and Children’s Health Insurance Program (CHIP) populations. By the May 11, 2022, response deadline, HHS received proposals from Aetna Better Health of Iowa; Amerigroup Iowa, Inc.; CareSource Iowa Co.; Molina Healthcare of Iowa, Inc.; and UCare Iowa. HHS had intended to contract on a statewide basis with up to four bidders.
The state has current Medicaid health plan contracts with Amerigroup and Iowa Total Care. Amerigroup’s contract expires in 2023. It currently serves more than 400,000 members. These new contracts will go into effect while the state finishes out its current contract with Iowa Total Care, which is set to expire in 2025
These new contracts will have pay-for-performance initiatives focused on MCO performance on administrative process measures and quality of care measures. During each measurement year, HHS will withhold 2% of the approved capitation payment from the contractor. The contractor may be eligible to receive some or all the withheld funds based on its performance on the pay-for-performance measures, depending on how well it meets the measure targets. The measures will differ for the new MCO Molina and the incumbent MCO Amerigroup.
For Molina, the pay-for-performance measures focus on six MCO administrative processes. The measures are timely claims processing, prior authorization decisions, and appeals adjudication; accuracy of encounter data reconciliation; and establishing accurate data stream reporting for member waiver service data and social determinants of health data.
For the incumbent Amerigroup, the pay-for-performance measures focus one administrative process and five quality of care measures. The administrative measure is timely claims processing. The quality-of-care measures are: follow-up care after a child’s or an adult’s hospitalization for mental illness, the timeliness of prenatal care, the service level of the non-emergency medical transportation (NEMT) helpline, and the wait time for members using NEMT services.
By the end of the first contract year, the MCOs must have at least 40% their members in a value-based purchasing (VBP) arrangement with the health care delivery system. The RFP noted that HHS anticipates that in subsequent years the MCOs will exceed 50% VBP enrollment. The VBP arrangements are anticipated to result in population health outcome improvement and lower total cost of care for the population in the VBP arrangement. MCO members served by a provider organization in a VBP arrangement must be assigned by the MCO to a primary care professional. All contracted hospitals will be required to report admission and discharge information for enrolled members to the MCO and the care teams participating in VBP agreements. The information will include reports about inpatient and emergency department events.
For general information about the Iowa Medicaid program, contact: Alex Carfrae, Public Information Officer, Iowa Department of Health and Human Services, 1305 East Walnut Street, Hoover Building, 1st Floor, Des Moines, Iowa 50319-0114; 515-281-4848; Email: acarfra@dhs.state.ia.us; Website: https://dhs.iowa.gov/iahealthlink
For more information about the RFP, contact: Shannon Mueller, RFP contact point, Iowa Department of Human Services, Hoover State Office Building, 1st Floor, 1305 East Walnut Street, Des Moines, Iowa 50319-0114; 515-393=8408; Email: RFPMED-23-005@dhs.state.ia.us; Website: https://dhs.iowa.gov/iahealthlink
For more information about Molina, contact: Caroline Zubieta, Director of Public Relations, Molina Healthcare, Inc., 200 Oceangate, Suite 100, Long Beach, California 90802; 562-951-1588; Email: Caroline.Zubieta@molinahealthcare.com; Website: https://www.molinahealthcare.com/
For more information about Amerigroup, contact: Amerigroup Iowa, a subsidiary of Elevance Health, Post Office Box 71099, Clive, Iowa 50325; Website: https://www.myamerigroup.com/ia/iowa-home.html