Medicaid Managed Care scheduled to begin April 1

February 25, 2016

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Medicaid Managed Care scheduled to begin April 1 Iowa Medicaid Enterprise (IME) is transitioning its service to a new managed care program called Iowa Health Link. Four Oaks is ready to help current clients with this transition, and we would be happy to serve new clients who are enrolled with any of the Managed Care Organizations (MCOs). Please call us at 1-844-364-0259 for information. We are happy to help.  

Here is information to help you navigate the system and make good choices
Four Oaks has signed agreements to work with all three Managed Care Organizations. The three are: 
  • Amerigroup Iowa, Inc.
  • AmeriHealth Caritas Iowa, Inc.
  • UnitedHealthcare Plan of the River Valley, Inc. 
These links will give you important phone numbers and contacts
Here are some Frequently Asked Questions (FAQs) about this transition: 
What is new? 
The Centers for Medicare and Medicaid Services (CMS) have reached a decision on the IA Health Link managed care program. The program will begin March 1, 2016, instead of January 1, 2016, pending final federal approval. 

Will my benefits change? 
Your benefits will remain the same and you will receive coverage through Iowa Medicaid during this transition period. Managed care coverage through a managed care organization (MCO) will begin March 1, 2016, with final federal approval. 

How can I learn more? 
For questions about your benefits, please contact Iowa Medicaid Member Services at 
1-800-338-8366, or locally in the Des Moines Area at 515-256-4606, Monday through Friday, 8:00 a.m. – 5:00 p.m. You may also email Member Services at IMEMemberServices@dhs.state.ia.us

What is Medicaid Managed Care? 
Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments. Medicaid in Iowa currently provides health care assistance to about 560,000 people. 

Medicaid costs in Iowa continue to grow and the state wants to save money by better “managing” these growing heath care costs. To manage Medicaid health care costs, the state of Iowa is contracting with three Managed Care Organizations (MCOs) to provide and pay for health care services. The management of these services is called Iowa Health Link. 

MCOs will be responsible for managing, paying for, and delivering services that balance cost, quality, and access. The objectives are to provide efficient, coordinated, and high quality health care – which is integrated with behavioral health (that’s Four Oaks) – while promoting member choice and accountability. 

In short, this means Managed Care will pay attention to 1) medical necessity of services, 2) coordination of services (to avoid duplication), and 3) lengths of stay and/or duration of services. 

The MCOs are currently in the process of developing a network of providers (hospitals, clinics, long term care facilities, and agencies like Four Oaks and Family Resources, for example) and MCOs will establish guidelines for providers to assure appropriate services are provided at the right time, in the right way, and in the right setting. Holding providers accountable to these guidelines is how the MCOs intend to better manage and reduce health care costs in Iowa. 

Who are the Managed Care Organizations? 
DHS has selected the following MCOs to provide Medicaid services in Iowa: 
  • Amerigroup Iowa, Inc.
  • AmeriHealth Caritas Iowa, Inc.
  • UnitedHealthcare Plan of the River Valley, Inc.
Which MCOs will Four Oaks and Family Resources, Inc. contract with? 
Four Oaks and Family Resources Inc. have completed application and credentialing packets for all three MCOs and contracts for all three MCOs will be signed. 

What Four Oaks and Family Resources Inc. services does Medicaid Managed Care impact? 
PMIC, Foster Group Care, BHIS (both RT BHIS and community based BHIS), Integrated Health Homes, Therapy, and Counseling 

How are other (non-Medicaid) Four Oaks and Family Resources programs impacted? 
Referrals, intake, and services provided by Four Oaks and Family Resources non-Medicaid programs will not change on March 1. 

Are Four Oaks and Family Resources ready for Medicaid Managed Care? 
Four Oaks and Family Resources have been jointly planning for Medicaid Managed Care for several months. We have moved from a multi-disciplinary Design and Implementation Team to a “Go Live” Team. 

To talk to us directly about your needs for Medicaid Managed Care services call:
1-844-364-0259 

What changes are Four Oaks and Family Resources making for Medicaid Managed Care? 
  • We will have a new centralized Customer Service Center for Four Oaks and Family Resources
  • The Customer Service Center will manage all the authorizations for PMIC, Group Care, IHH, Group Care, and BHIS (both community based and RT BHIS)
  • The Customer Service Center will also directly manage relations with the MCOs
  • The new Utilization Management Team will manage all reauthorizations for PMIC, Group Care, IHH, Group Care, and BHIS (both community based and RT BHIS)
  • The Go Live Team is developing a process for timely documentation and clean billing claims.