State of Iowa

							                                       A State of Iowa
                               Department of Human Services
                       MEDICAL ASSISTANCE ADVISORY COUNCIL
                                    Summary of Meeting
                                     November 3, 2004



MEMBERS PRESENT
Jerry Karbeling        (Chair)      Iowa Pharmacy Association
Anne Kinzel                         Department of Public Health
Barbara Nebel                       Iowa Speech & Hearing Association
Brian Sheesley                      Public Representative
Cindy Haverkamp                     Iowa Health Care Association
 for Steve Ackerson
Dana Petrowsky                      Iowa Assn of Homes & Services for the Aging
Don St. John                        Iowa Physician Assistant Society
Erika Anderson                      Iowa Physical Therapy Association
 for Lorelei Heisinger
George Appleby                      Iowa Council of Health Care Centers
Jennifer Harbison                   Iowa Academy of Family Physicians
  for Dr. Dave Carlyle
Jodi Tomlonovic                     Public Representative
Karla Fultz McHenry                 Iowa Medical Society
Kevin Kruse                         Iowa Podiatric Medical Society
  for Dr. Richard Spencer
Larry Breeding                      Iowa Association for Home Care
Larry Carl                          Iowa Dental Association
Leila Carlson                       Iowa Chapter - National Assoc. of Social Workers
 for Jay Cayner
Linda Goeldner                      Iowa Nurses Association
Mark Peltan            (Co-Chair)   Iowa Psychological Association
Peg Shelton                         Alliance for the Mentally Ill of Iowa
 for Margaret Stout
Rik Shannon                         Governor’s DD Council
Tracy Warner                        Iowa Hospital Association
Ed Friedman                         Iowa Association of Rural Health Clinics
Chris Halston                       Iowa Optometric Association
 for Gary Ellis
Karen Loihl                         Iowa Psychiatric Society

MEMBERS ABSENT
Joe Hutter                          Iowa State Representative
Leah McWilliams                     Iowa Osteopathic Medical Association


                                               1
Dr. Gene Handley      Iowa Chiropractic Society
Angela Hansen-Abbas   Iowa Occupational Therapy Association
Bev Thomas            Iowa Association of Hearing Health Professionals
Deborah Berry         Iowa State Representative
Jill Davisson         Iowa State Association of Counties
Kathleen Gradoville   Iowa Association of Nurse Practitioners
Maggie Tinsman        Iowa State Senator
Michele Wray          Iowa Association of Community Providers
Orvil Nelson          Public Representative
Rizwan Z. Shah MD     Iowa Chapter of the American Academy of Pediatrics
Ron Bolar             Opticians Association of Iowa
Sen. Jack Hatch       Iowa State Senator
Stacey Cyphert        University of Iowa College of Medicine
Vacant                The ARC of Iowa
Vacant                Des Moines University
Vacant                Public Representative

OTHERS PRESENT
CeCe Zenti            ACS
Tom Kline             IME
Ned Chiodo            Aventis
Frank Severino        Iowa Dental Association
Mike Heller           GSK
Kelly Boryca          Pfizer
Bryan Reichmuth       Lilly
Joel Wulf             DEA
Anne Chu              Bradshaw, Fowler, Proctor & Fairgrave
Mary Tavegia          DHS
Lisa Roberts          DHS
Susan Trotter         DHS
Dan Hart              DHS-AG
Patti Becker          DHS
Carolyn Pritchard     DHS




                               2
Introductions
The Medical Assistance Advisory Council (MAAC) convened in the Board Room of the Iowa
Hospital Association on December 1, 2004 at 1:00 p.m.
Mr. Jerry Karbeling opened the meeting. Everyone introduced himself and/or herself.
Approval of November Minutes
Mr. George Appleby, Ms. Barb Nebel, and Ms. Karen Loihl said they were listed as not present but
they were present at the November meeting. Ms. Jodi Tomlonovic motioned and Mr. Appleby
seconded to accept the minutes with the attendance corrections. All agreed and the motion
carried.
Events/Trends
   Eligibles/Expenditures
Ms. Patti Becker provided the information for October - the number of individuals enrolled in
Medicaid was 295,907 and the total expenditures were $182,176,404. The number of eligibles for
November was 295,729 and November expenditures were $184,949,886.
Ms. Anne Kinzel asked if the statistics could be shown based on different enrollment groups. Ms.
Becker said there are 150 groups of eligibles, and if specific groupings are requested she will
provide that information.
Rules
   Medicaid Application Signature Requirements
There were no comments or questions.
   Cost of Living Adjustment, Spousal
There were no comments or questions.
Process for Organizations to be added to MAAC
Mr. Karbeling explained that in September he received expressed interest from the Department of
Elder Affairs and other organizations requesting information on the process of being included in
the MAAC membership.
Mr. Dan Hart, Assistant Attorney General, said the composition of the MAAC is in the Iowa Code
249A.4 under Duties of the Director. The MAAC is changed by changing the Iowa Code enacted
by the Iowa Legislature. When asked how it can be introduced, Mr. Hart said any legislator, the
Elder Affairs and the DHS can. Mr. Larry Breeding commented that the MAAC is based on the
federal law. Ms. Becker said although that is true the federal law is silent as to the composition of
the MAAC. Mr. Breeding asked about the criteria for the composition and if a member has to be a
provider group or something similar.
(Mr. Hart followed up this conversation after the meeting and provided a copy of The federal
requirements for the MAAC in federal regulations at 42 C.F.R. § 431.12. This copy was emailed
to the MAAC on the afternoon of December 1, 2004.)
Ms. Kinzel said that the over 65 population consumes the bulk of expenditures and it would seem
logical that the State's Elder Affairs Department, assigned to look to the interests of the elderly
population would be represented.
There was some discussion on whether the MAAC is required to take any action if someone
introduces a bill to become a member. Although, It was agreed not necessary, there may be a


                                                  3
need to address the issue if there were any objections regarding the contributions that specific
organization could make to the MAAC.
Iowa Medicaid Enterprise (IME) Update
Ms. Mary Tavegia provided the update on IME. She said the ACS contract is expiring and by
federal regulations the Department must re-procure and the Department did that this past year a
little differently than before. Previously, there was one fiscal agent doing multiple services. The
strategy employed this time was a best of breed concept of hiring vendors whose expertise were
in specific areas.
Ms. Tavegia reported that there are eight contractors on board, a Pharmacy Point of Sale (POS)
RFP is being evaluated and all units have been meeting since July 1, 2004. The IME is on
schedule. All contractors will be co-located with the State Policy staff, and the staff from the
Division of Data Management that run the State Medicaid system. They are scheduled to move
into a facility at 100 Army Post Road on February 1, 2005.
The key strategies to be used in the IME are that all vendors will be co-located and will use the
same sets of tools, the MMIS data warehouse. There will be a workflow management process put
in place for the state to assume a greater responsibility for the operation, direction and delivery of
health care. During the transition period for providers, there will be provider informational
releases, the first overview for all providers is slated to be released in December, and then more
specific and targeted releases in the first of the year and spring.
Ms. Tracy Warner asked if there will be provider training sessions and if they will be targeted to
the provider type. Ms. Tavegia said they will be mainly in the spring, April through June, and they
will have both general and provider specific sessions.
The proprietary product software (WinASAP) that providers have used will be replaced by
software called PCAcePro that is used in the Medicare world. Mr. Larry Carl asked about
specialized training for different practitioner groups. Ms. Tavegia said she would have to review
the schedule for provider services, but that it is in planning, may be consistent with what was done
in the past and she expects it to be very similar. She said there will probably be many ICN
training sessions and that much of the staff for this section will be coming on in the spring. They
will be doing the planning for training. Mr. Mark Peltan asked if the managed care plan providers
will notice much change.
Ms. Tavegia explained the nine units.
   Medicaid Management Information System (MMIS): Currently, the Core computer system is in
    Pittsburgh PA. The State will transition that system to the State facilities. That has been
    transferred to State Information Technology Enterprise (ITE) which currently resides in the
    Hoover building. As part of the procurement, there will be enhancements to that system. The
    Core MMIS unit is responsible to run that piece of the system and to bring the workflow
    process management system with them.
   Pharmacy POS RFP: Is in the process of being evaluated and to be awarded in mid-
    December.
   Data Warehouse: the Department's Division of Data Management is developing the central
    support system on State equipment.
   Medical Services unit and the Pharmacy Medical Services unit: The Medical Service unit
    houses the medical review staff and they have a number of components. The Pharmacy
    Medical Services has the pharmacy prior authorization (PA), drug utilization review (DUR), and
    the preferred drug list (PDL).

                                                  4
   Provider Services: Is responsible for provider training, provider enrollment, and the provider
    call center.
   Member Services: Is a call center for members with specific questions.
   Surveillance and Utilization Review (SURS)
   Provider Audit and Rates Setting.
   Revenue Collection.
Mr. Karbeling asked if the transition will be transparent to the members and if there will be
education for the members/recipients. She said it will be transparent, although she has not seen
the member's budget and training plan at this point, there will be releases to them.
Ms. Tavegia stated that Policy Studies Inc. (PSI) out of Colorado will be managing the provider
services unit. There is core staff in each of the units currently conducting the implementation
activities. Many meetings and transitions are taking place with the current contractor, ACS, the
Department and the new units. Most units will staff up for operation in the spring. Currently, Core
has approximately twenty or thirty people on site. While ACS still has the contract, any issues still
go through ACS.
Ms. Tomlonovic asked how these notices are being sent to providers because her agencies say
they do not get the letters. Ms. Tavegia said ACS has a list of 30,000-40,000 providers in the
MMIS system and the releases are sent to those addresses. Ms. Tavegia affirmed there will be
an IME website where notices will be maintained. In the past the notices were not on the website
but in the future Provider Services has the responsibility to maintain provider and member
websites. Ms. Tomlonovic wanted to know how to check next month what the system is using for
mailings. Ms. Tavegia said she could call provider relations at ACS.
Ms. Warner requested that when the contractors are staffed next spring, their key people come to
a MAAC meeting. The members agreed they would appreciate a time for introductions, more
detail on their contracts, and a question and answer time. Ms. Tavegia concurred that the MAAC
would be a good forum to meet with the new contractors.
Medical Assistance Crisis Intervention Team (MACIT)
Mr. Karbeling reported from the final MACIT meeting held in November in Des Moines. He
distributed a two-page document that highlighted key issues in the 56-page draft report.
He explained that it covered the major points of the final MACIT document and all members and
alternates received a copy of the report at the final meeting. A number of details have been
addressed in the editing including discussion about the economic impact of healthcare services
on communities large and small across the state. The report mainly recommended no direct cuts
to eligibility covered services or provider reimbursement. Those components would have direct
impact on access to care and related issues. The report is now posted on the website
(http://www.uiowa.edu/~govrel/macit/) and Mr. Stacey Cyphert is actually taking the report to
legislature at the same time as the MAAC meeting. Along with the 56-page report, MACIT
addenda includes about sixty pages of minutes, written testimony provided by many including the
MAAC groups, and other input that was provided.
Mr. Peltan said attendance had increased so that the November meeting had to be moved from
the State Historical Building to an auditorium in the Iowa Methodist Medical Center. He
commented that a larger portion of those who testified at the Des Moines meeting were Medicaid
recipients.



                                                  5
Mr. Peltan stated the last meeting had an agitated presentation from Iowa Health Solutions (IHS).
Mr. Peltan was asked to elaborate on the IHS presentation which was followed with much
discussion. He said IHS had also presented in Red Oak and Mason City.
Mr. Peltan described how an IHS representative gave the presentation that had a rather hostile
and paranoid feeling to it. IHS expressed they felt the MACIT did not consider their
recommendations very seriously, and didn’t include recommendations for more of managed care
kinds of activities. Mr. Karbeling thought their presenter was grossly inappropriate and very
accusatory to the Department and she made the people in the room very sympathetic toward the
Department because of the degree of accusation. He said she had been given by Dr. Skorton
specific presentation guidelines for time and then disregarded that there were thirteen or fourteen
people in line behind the IHS speaker who traveled long distances to make their presentations.
The substance of their presentation was that by the Department not accepting that Medicaid
managed care is the only way to go, the Department has made a significant mistake. Mr. Peltan
explained the Milliman study revealed that managed care didn't necessarily save money and in
some cases made provisional care more expensive. He said that she attacked the methodology
of the study and some of the language where Milliman didn’t claim to have done an exhaustive
study, but he felt that from a psychologist's study it was well done. .
Ms. Linda Goeldner said that the Milliman report said that maybe MediPASS did a better job than
the managed care plans.
Ms. Karla Fultz McHenry has not seen anything IHS do that proved they made significant changes
in other states other than what Iowa has done. IHS is talking about a very different structure than
Iowa has or will have because of the way the Department has set up the Medicaid program
through the State Plan. She implied it is laughable that the Medicaid managed HMO in Iowa that
has the worst payment rate and owes money to everybody in the state, is the one who comes
forward and wants to do this.
Mr. Karbeling found it refreshing and appropriate that no one went after her or her comments, and
it was the low point of the meeting. Mr. Peltan agreed that it was the most negative presentation
he had heard.
Ms. Tracey Warner stated their lack of experience with Iowa was evident at the Red Oak meeting
when IHS brought in individuals from St. Louis and Phoenix about their experience. The St. Louis
plan has as many enrolled in the greater St. Louis area as what Iowa has in the entire state. She
said they were unfamiliar with Iowa Medicaid, the Department's lack of managed care to date and
the way that care is delivered in the state. They have shown their lack of understanding, and Iowa
has had an Insurance Division review of IHS' claims practices, repeated complaints to the
heartland for the last year about their handling of claims situation, lack of adherence to the
contract, etc. Ms. Warner stated that these were some reasons why Iowa Hospital Association
was adamant that it could not support expansion of the Medicaid managed care program and its
current work with that particular contract unless things were dramatically improved.
Mr. Larry Carl referenced one of the comments on the summary that stated strong support of the
National Counsel on State Legislatures suggestions and proposals. Mr. Peltan said the
information was in a handout they received at one of the earlier meetings, so it may be included in
the packet. Mr. Karbeling said there was a booklet of the NCSL recommendations to the state
legislatures of strategies that could be employed. Ms. McHenry said it is on the NCSL webpage
(http://www.ncsl.org/). The NCSL draft recommendations for Medicaid represent a national
perspective. Mr. Karbeling said that Mr. Gessow had pointed out that some of these things are
written so broadly they are not relevant to Iowa or that they may already be in place.



                                                 6
Ms. Jodi Tomlonovic referenced page two where expansion of the rolling community health
centers was encouraged and asked if the recommendation of the MACIT is to have more
community health centers. Mr. Peltan said the MACIT was supportive of most of the bill that
Senator Jack Hatch is going to introduce in January and that includes seeking funding for more
community health centers. Mr. Peltan said the idea is to expand to 25 within the first couple of
years. Mr. Karbeling explained the early draft reads that there are eight CHC's in Iowa serving
tens of thousands of Iowa Medicaid patients located in high need areas and open to all residents
regardless of insurance status, comprehensive, primary, and preventative, and care is provided at
free or reduced cost based on ability to pay. In addition, insulated services such as case
management and transportation are offered to help patients access care. He said the Team
encourages support for these important resources. He clarified that this was two drafts ago and
may have been edited since then.
Ms. Goeldner requested information about the revenue enhancements regarding the
supplemental tax and advertising, marketing and services. Mr. Karbeling clarified that much like
tobacco and alcohol, both create additional burdens for Medicaid. The potential marketing or
promotional tax would be for either products or services that are being marketed that create
additional burdens for Medicaid or other programs. He gave examples of affected areas that
could include motorized scooters, lift chairs, consumer advertising of prescription drug products
that may not be therapeutically enhanced patient outcomes.
Mr. Karbeling said the MACIT report includes a recommended $1 tax for tobacco. Mr. Peltan said
that is what the American Cancer Society has lobbied for and achieved in other states.
New Business
   Next Meeting Date for MAAC
Mr. Breeding moved and Mr. Carl seconded that the next MAAC meeting be scheduled for
Wednesday, January 1, 2005.
Adjourn
The meeting adjourned at 2:00.
Respectfully Submitted by:
Carolyn Pritchard




                                                7