Subcommittee Advances Bill To Streamline Payment Request To Medicaid Providers

Feb 12, 2020

An Iowa Senate commerce subcommittee has advanced a bill that would require both of the state’s Medicaid managed care organizations to use the same process for approving payments to providers.

Currently, Amerigroup and Iowa Total Care, the state’s two MCOs, each have their own process for prior authorizations, when a doctor obtains advance approval for a procedure or drug.

Abhay Nadipuram, a lobbist with the Iowa Hospital Association, said dealing with two different, complex systems has been burdensome to hospitals.

"That's amounted to more staff time, which has just amounted to maybe slower payments, which are putting hospitals in kind of some dire financial straits," he said.

The bill also requires that the companies provide support around the clock, every day of the year to evaluate requests to "avoid delays in the provision of medically necessary care and services."

Representatives from each company spoke in opposition to the bill, claiming streamlining the process wouldn’t work for the companies’ different patient populations.

"If Iowa Total Care and Amerigroup were both required to do the exact same prior authorization sort of decisions, that would result in more prior authorization, not less," said Kyle Carlson, a lobbyist with Amerigroup, "because we might be viewing things differently in terms of what we're really trying to get more information on versus them based on having different population."

Stacie Maass, a lobbyist with Iowa Total Care, told the subcommittee many providers regularily deal with multiple authorization processes.

"If you're a large health care system, you can easily be, on any given day be dealing, with 50 different insurers." she said.

The state's Medicaid system has been riddled with controversy since former Gov. Terry Branstad privatized it in 2016.

Since its inception, two insurance companies have left the program, citing financial strains.

In January, the Department of Human Services announced it was withholding nearly $44 million from Iowa Total Care, which joined the state last July, after it failed to pay more than 100,000 claims.

Before she signed off to move the bill forward to the full committee, Sen. Janet Petersen, D-Des Moines, said she hears too many excuses from managed care organizations about why they're delaying and denying claims.

"I think we need more oversight and a better system. It's become very clear since managed care took over that it's not managed very well. And it does need more oversight and more streamlining seems like a priority," she said.

Sen. Jake Chapman, R-Adel, said he'd like to further investigate what economic impact the system is currently having on providers.

"I think that's one piece that we need to be considering on as well, you know, because yes, some of these changes would incur cost, but what are the costs being incurred on the backs of providers right now, trying to go through the hoops of getting prior authorization," he said.