Read the full stored bill text
Senate
File
558
-
Introduced
SENATE
FILE
558
BY
TRONE
GARRIOTT
,
DONAHUE
,
PETERSEN
,
ZIMMER
,
and
WAHLS
A
BILL
FOR
An
Act
relating
to
Medicaid
program
improvements,
making
an
1
appropriation,
and
providing
penalties.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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DIVISION
I
1
MEDICAID
LONG-TERM
SERVICES
AND
SUPPORTS
POPULATION
MEMBERS
——
2
PROVISION
OF
CONFLICT-FREE
SERVICES
3
Section
1.
MEDICAID
LONG-TERM
SERVICES
AND
SUPPORTS
4
POPULATION
MEMBERS
——
PROVISION
OF
CONFLICT-FREE
SERVICES.
The
5
department
of
health
and
human
services
shall
adopt
rules
6
pursuant
to
chapter
17A
to
ensure
that
services
are
provided
7
under
the
Medicaid
program
to
members
of
the
long-term
8
services
and
supports
population
in
a
conflict-free
manner.
9
Specifically,
case
management
services
shall
be
provided
by
10
independent
providers
and
supports
intensity
scale
assessments
11
shall
be
performed
by
independent
assessors.
12
DIVISION
II
13
LONG-TERM
SERVICES
AND
SUPPORTS
POPULATION
MEMBERS
——
OPTION
14
FOR
FEE-FOR-SERVICE
PROGRAM
ADMINISTRATION
15
Sec.
2.
LONG-TERM
SERVICES
AND
SUPPORTS
POPULATION
MEMBERS
16
——
OPTION
FOR
FEE-FOR-SERVICE
PROGRAM
ADMINISTRATION.
The
17
department
of
health
and
human
services
shall
require
each
18
Medicaid
managed
care
organization
with
whom
the
department
19
executes
a
contract
to
administer
the
Iowa
high-quality
20
health
care
initiative
as
established
by
the
department,
21
to
provide
the
option
to
Medicaid
long-term
services
and
22
supports
population
members
to
enroll
in
or
transition
to
23
fee-for-service
Medicaid
program
administration
rather
than
24
managed
care
administration.
The
department
shall
amend
any
25
contract,
request
any
Medicaid
state
plan
amendment,
and
adopt
26
rules
pursuant
to
chapter
17A,
as
necessary,
to
administer
this
27
section.
The
rules
shall
include
the
process
for
transitioning
28
a
current
Medicaid
long-term
services
and
supports
population
29
member
to
fee-for-service
program
administration.
30
DIVISION
III
31
LONG-TERM
SERVICES
AND
SUPPORTS
POPULATION
MEMBERS
——
POLICY
32
FOR
DENIAL
OF
CARE
33
Sec.
3.
LONG-TERM
SERVICES
AND
SUPPORTS
POPULATION
MEMBERS
34
——
POLICY
FOR
DENIAL
OF
CARE.
The
department
of
health
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and
human
services
shall
require
each
Medicaid
managed
care
1
organization
with
whom
the
department
executes
a
contract
2
under
the
Medicaid
program
to
maintain
an
authorized
member’s
3
Medicaid
long-term
services
and
supports
unless
the
member’s
4
health
care
provider
determines
a
change
in
the
long-term
5
services
and
supports
is
medically
necessary.
The
inability
of
6
a
member
who
is
authorized
for
long-term
services
and
supports
7
to
utilize
all
approved
service
hours,
including
respite
care,
8
shall
not
result
in
a
reduction
in
authorized
services
unless
9
there
is
medical
evidence
that
the
services
are
medically
10
unnecessary
for
the
member.
11
DIVISION
IV
12
MEDICAID
WORKFORCE
PROGRAM
13
Sec.
4.
WORKFORCE
RECRUITMENT,
RETENTION,
AND
TRAINING
14
PROGRAMS.
The
department
of
health
and
human
services
shall
15
contractually
require
any
managed
care
organization
with
whom
16
the
department
executes
a
contract
under
the
Medicaid
program
17
to
collaborate
with
the
department
and
stakeholders
to
develop
18
and
administer
a
workforce
recruitment,
retention,
and
training
19
program
to
provide
adequate
access
to
appropriate
services,
20
including
but
not
limited
to
services
to
older
Iowans.
21
The
department
shall
ensure
that
any
program
developed
is
22
administered
in
a
coordinated
and
collaborative
manner
across
23
all
contracting
managed
care
organizations
and
shall
require
24
the
managed
care
organizations
to
submit
quarterly
progress
and
25
outcomes
reports
to
the
department.
26
DIVISION
V
27
PROVIDER
APPEALS
PROCESS
——
EXTERNAL
REVIEW
28
Sec.
5.
MEDICAID
MANAGED
CARE
ORGANIZATION
APPEALS
PROCESS
29
——
EXTERNAL
REVIEW
——
PENALTY.
30
1.
a.
A
Medicaid
managed
care
organization
under
contract
31
with
the
department
of
health
and
human
services
shall
include
32
in
any
written
response
to
a
Medicaid
provider
under
contract
33
with
the
managed
care
organization
that
reflects
a
final
34
adverse
determination
of
the
managed
care
organization’s
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internal
appeal
process
relative
to
an
appeal
filed
by
the
1
Medicaid
provider,
all
of
the
following:
2
(1)
A
statement
that
the
Medicaid
provider’s
internal
3
appeal
rights
within
the
managed
care
organization
have
been
4
exhausted.
5
(2)
A
statement
that
the
Medicaid
provider
is
entitled
to
6
an
external
independent
third-party
review
pursuant
to
this
7
section.
8
(3)
The
requirements
for
requesting
an
external
independent
9
third-party
review.
10
b.
If
a
managed
care
organization’s
written
response
does
11
not
comply
with
the
requirements
of
paragraph
“a”,
the
managed
12
care
organization
shall
pay
to
the
affected
Medicaid
provider
a
13
penalty
not
to
exceed
one
thousand
dollars.
14
2.
a.
A
Medicaid
provider
who
has
been
denied
the
provision
15
of
a
service
to
a
Medicaid
member
or
a
claim
for
reimbursement
16
for
a
service
rendered
to
a
Medicaid
member,
and
who
has
17
exhausted
the
internal
appeal
process
of
a
managed
care
18
organization,
shall
be
entitled
to
an
external
independent
19
third-party
review
of
the
managed
care
organization’s
final
20
adverse
determination.
21
b.
To
request
an
external
independent
third-party
review
of
22
a
final
adverse
determination
by
a
managed
care
organization,
23
an
aggrieved
Medicaid
provider
shall
submit
a
written
request
24
for
such
review
to
the
managed
care
organization
within
sixty
25
calendar
days
of
receiving
the
final
adverse
determination.
26
c.
A
Medicaid
provider’s
request
for
an
external
27
independent
third-party
review
shall
include
all
of
the
28
following:
29
(1)
Identification
of
each
specific
issue
and
dispute
30
directly
related
to
the
final
adverse
determination
issued
by
31
the
managed
care
organization.
32
(2)
A
statement
of
the
basis
upon
which
the
Medicaid
33
provider
believes
the
managed
care
organization’s
determination
34
to
be
erroneous.
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(3)
The
Medicaid
provider’s
designated
contact
information,
1
including
name,
mailing
address,
phone
number,
fax
number,
and
2
email
address.
3
3.
a.
Within
five
business
days
of
receiving
a
Medicaid
4
provider’s
request
for
an
external
independent
third-party
5
review
pursuant
to
this
subsection,
the
managed
care
6
organization
shall
do
all
of
the
following:
7
(1)
Confirm
to
the
Medicaid
provider’s
designated
contact,
8
in
writing,
that
the
managed
care
organization
has
received
the
9
request
for
review.
10
(2)
Notify
the
department
of
health
and
human
services
of
11
the
Medicaid
provider’s
request
for
review.
12
(3)
Notify
the
affected
Medicaid
member
of
the
Medicaid
13
provider’s
request
for
review,
if
the
review
is
related
to
the
14
denial
of
a
service.
15
b.
If
the
managed
care
organization
fails
to
satisfy
the
16
requirements
of
this
subsection,
the
Medicaid
provider
shall
17
automatically
prevail
in
the
review.
18
4.
a.
Within
fifteen
calendar
days
of
receiving
a
Medicaid
19
provider’s
request
for
an
external
independent
third-party
20
review,
the
managed
care
organization
shall
do
all
of
the
21
following:
22
(1)
Submit
to
the
department
of
health
and
human
services
23
all
documentation
submitted
by
the
Medicaid
provider
in
the
24
course
of
the
managed
care
organization’s
internal
appeal
25
process.
26
(2)
Provide
the
managed
care
organization’s
designated
27
contact
information,
including
name,
mailing
address,
phone
28
number,
fax
number,
and
email
address.
29
b.
If
a
managed
care
organization
fails
to
satisfy
the
30
requirements
of
this
subsection,
the
Medicaid
provider
shall
31
automatically
prevail
in
the
review.
32
5.
A
request
for
an
external
independent
third-party
review
33
shall
automatically
extend
the
deadline
to
file
an
appeal
for
a
34
contested
case
hearing
under
chapter
17A,
pending
the
outcome
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of
the
external
independent
third-party
review,
until
thirty
1
calendar
days
following
receipt
of
the
review
decision
by
the
2
Medicaid
provider.
3
6.
Upon
receiving
notification
of
a
request
for
an
external
4
independent
third-party
review,
the
department
of
health
and
5
human
services
shall
do
all
of
the
following:
6
a.
Assign
the
review
to
an
external
independent
third-party
7
reviewer.
8
b.
Notify
the
managed
care
organization
of
the
identity
of
9
the
external
independent
third-party
reviewer.
10
c.
Notify
the
Medicaid
provider’s
designated
contact
of
the
11
identity
of
the
external
independent
third-party
reviewer.
12
7.
The
department
of
health
and
human
services
shall
deny
a
13
request
for
an
external
independent
third-party
review
if
the
14
requesting
Medicaid
provider
fails
to
exhaust
the
managed
care
15
organization’s
internal
appeal
process
or
fails
to
submit
a
16
timely
request
for
an
external
independent
third-party
review
17
pursuant
to
this
section.
18
8.
a.
Multiple
appeals
through
the
external
independent
19
third-party
review
process
regarding
the
same
Medicaid
member,
20
a
common
question
of
fact,
or
the
interpretation
of
common
21
applicable
regulations
or
reimbursement
requirements
may
22
be
combined
and
determined
in
one
action
upon
request
of
a
23
party
in
accordance
with
rules
and
regulations
adopted
by
the
24
department
of
health
and
human
services.
25
b.
The
Medicaid
provider
that
initiated
a
request
for
26
an
external
independent
third-party
review,
or
one
or
more
27
other
Medicaid
providers,
may
add
claims
to
such
an
existing
28
external
independent
third-party
review
request
following
the
29
exhaustion
of
any
applicable
managed
care
organization
internal
30
appeal
process,
if
the
claims
involve
a
common
question
of
31
fact
or
interpretation
of
common
applicable
regulations
or
32
reimbursement
requirements.
33
9.
Documentation
reviewed
by
the
external
independent
34
third-party
reviewer
shall
be
limited
to
documentation
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submitted
pursuant
to
subsection
4.
1
10.
An
external
independent
third-party
reviewer
shall
do
2
all
of
the
following:
3
a.
Conduct
an
external
independent
third-party
review
4
of
any
claim
submitted
to
the
reviewer
pursuant
to
this
5
subsection.
6
b.
Within
thirty
calendar
days
from
receiving
the
request
7
for
an
external
independent
third-party
review
from
the
8
department
of
health
and
human
services
and
the
documentation
9
submitted
pursuant
to
subsection
4,
issue
the
reviewer’s
final
10
decision
to
the
Medicaid
provider’s
designated
contact,
the
11
managed
care
organization’s
designated
contact,
the
department
12
of
health
and
human
services,
and
the
affected
Medicaid
member
13
if
the
decision
involves
a
denial
of
service.
The
reviewer
may
14
extend
the
time
to
issue
a
final
decision
by
up
to
fourteen
15
calendar
days
upon
agreement
of
all
parties
to
the
review.
16
11.
The
department
of
health
and
human
services
shall
17
enter
into
a
contract
with
an
external
independent
review
18
organization
that
does
not
have
a
conflict
of
interest
with
the
19
department
of
health
and
human
services
or
any
managed
care
20
organization
to
conduct
the
external
independent
third-party
21
reviews
under
this
section.
22
a.
A
party,
including
the
affected
Medicaid
member
or
23
Medicaid
provider,
may
appeal
a
final
decision
of
the
external
24
independent
third-party
reviewer
in
a
contested
case
proceeding
25
in
accordance
with
chapter
17A
within
thirty
calendar
days
from
26
receiving
the
final
decision.
A
final
decision
in
a
contested
27
case
proceeding
is
subject
to
judicial
review.
28
b.
The
final
decision
of
an
external
independent
29
third-party
reviewer
conducted
pursuant
to
this
section
shall
30
also
direct
the
nonprevailing
party
to
pay
an
amount
equal
to
31
the
costs
of
the
review
to
the
external
independent
third-party
32
reviewer.
Any
payment
ordered
pursuant
to
this
subsection
33
shall
be
stayed
pending
any
appeal
of
the
review.
If
the
34
final
outcome
of
any
appeal
is
to
reverse
the
decision
of
the
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external
independent
third-party
reviewer,
the
nonprevailing
1
party
on
appeal
shall
pay
the
costs
of
the
review
to
the
2
external
independent
third-party
reviewer
within
forty-five
3
calendar
days
of
entry
of
the
final
order.
4
DIVISION
VI
5
MEMBER
DISENROLLMENT
FOR
GOOD
CAUSE
6
Sec.
6.
MEMBER
DISENROLLMENT
FOR
GOOD
CAUSE.
The
department
7
of
health
and
human
services
shall
contractually
require
all
8
Medicaid
managed
care
organizations
to
issue
a
decision
in
9
response
to
a
member’s
request
for
disenrollment
for
good
cause
10
within
ten
days
of
the
date
the
member
submits
the
request
to
11
the
Medicaid
managed
care
organization
utilizing
the
Medicaid
12
managed
care
organization’s
grievance
process.
The
department
13
shall
adopt
rules
pursuant
to
chapter
17A
to
administer
this
14
division.
15
DIVISION
VII
16
UNIFORM,
SINGLE
CREDENTIALING
17
Sec.
7.
MEDICAID
PROGRAM
——
USE
OF
UNIFORM
AUTHORIZATION
18
CRITERIA
AND
SINGLE
CREDENTIALING
VERIFICATION
19
ORGANIZATION.
The
department
of
health
and
human
services
20
shall
develop
uniform
authorization
criteria
for,
and
21
shall
utilize
a
request
for
proposals
process
to
procure,
22
a
single
credentialing
verification
organization
to
be
23
utilized
in
credentialing
and
recredentialing
providers
for
24
both
the
Medicaid
managed
care
and
fee-for-service
payment
25
and
delivery
systems.
The
department
or
health
and
human
26
services
shall
contractually
require
all
Medicaid
managed
care
27
organizations
to
apply
the
uniform
authorization
criteria
and
28
to
accept
verified
information
from
the
single
credentialing
29
verification
organization
procured
by
the
department,
and
shall
30
contractually
prohibit
Medicaid
managed
care
organizations
31
from
requiring
additional
credentialing
information
from
a
32
provider
in
order
to
participate
in
the
Medicaid
managed
care
33
organization’s
provider
network.
34
DIVISION
VIII
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MEDICAID
MANAGED
CARE
OMBUDSMAN
PROGRAM
——
APPROPRIATION
1
Sec.
8.
OFFICE
OF
LONG-TERM
CARE
OMBUDSMAN
——
MEDICAID
2
MANAGED
CARE
OMBUDSMAN.
3
1.
There
is
appropriated
from
the
general
fund
of
the
4
state
to
the
department
of
health
and
human
services
office
of
5
long-term
care
ombudsman
for
the
fiscal
year
beginning
July
6
1,
2025,
and
ending
June
30,
2026,
in
addition
to
any
other
7
funds
appropriated
from
the
general
fund
of
the
state
to,
8
and
in
addition
to
any
other
full-time
equivalent
positions
9
authorized
for,
the
office
of
long-term
care
ombudsman
for
the
10
same
purpose,
the
following
amount,
or
so
much
thereof
as
is
11
necessary,
to
be
used
for
the
purposes
designated:
12
For
the
purposes
of
the
Medicaid
managed
care
ombudsman
13
program
including
for
salaries,
support,
administration,
14
maintenance,
and
miscellaneous
purposes,
and
for
not
more
than
15
the
following
full-time
equivalent
positions:
16
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
300,000
17
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
FTEs
2.50
18
2.
The
funding
appropriated
and
the
full-time
equivalent
19
positions
authorized
under
this
section
are
in
addition
to
any
20
other
funds
appropriated
from
the
general
fund
of
the
state
and
21
actually
expended,
and
any
other
full-time
equivalent
positions
22
authorized
and
actually
filled
as
of
July
1,
2025,
for
the
23
Medicaid
managed
care
ombudsman
program.
24
3.
Any
funds
appropriated
to
and
any
full-time
equivalent
25
positions
authorized
for
the
office
of
long-term
care
ombudsman
26
for
the
Medicaid
managed
care
ombudsman
program
for
the
fiscal
27
year
beginning
July
1,
2025,
and
ending
June
30,
2026,
shall
28
be
used
exclusively
for
the
Medicaid
managed
care
ombudsman
29
program.
30
4.
The
additional
full-time
equivalent
positions
authorized
31
in
this
section
for
the
Medicaid
managed
care
ombudsman
program
32
shall
be
filled
no
later
than
September
1,
2025.
33
5.
The
office
of
long-term
care
ombudsman
shall
include
34
in
the
Medicaid
managed
care
ombudsman
program
report,
on
a
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quarterly
basis,
the
disposition
of
resources
for
the
Medicaid
1
managed
care
ombudsman
program
including
actual
expenditures
2
and
a
full-time
equivalent
positions
summary
for
the
prior
3
quarter.
4
DIVISION
IX
5
HEALTH
POLICY
OVERSIGHT
COMMITTEE
MEETINGS
6
Sec.
9.
Section
2.45,
subsection
5,
Code
2025,
is
amended
7
to
read
as
follows:
8
5.
The
legislative
health
policy
oversight
committee,
9
which
shall
be
composed
of
ten
members
of
the
general
10
assembly,
consisting
of
five
members
from
each
house,
to
11
be
appointed
by
the
legislative
council.
The
legislative
12
health
policy
oversight
committee
may
shall
meet
at
least
two
13
times,
annually
,
during
the
legislative
interim
to
provide
14
continuing
oversight
for
Medicaid
managed
care,
and
to
ensure
15
effective
and
efficient
administration
of
the
program,
address
16
stakeholder
concerns,
monitor
program
costs
and
expenditures,
17
and
make
recommendations.
18
DIVISION
X
19
MANAGED
CARE
ORGANIZATIONS
——
ANNUAL
REPORT
ON
PROFIT
20
Sec.
10.
MANAGED
CARE
ORGANIZATIONS
——
REPORT
ON
21
PROFIT.
The
department
of
health
and
human
services
shall
22
require
each
Medicaid
managed
care
organization
with
whom
the
23
department
executes
a
contract
under
the
Medicaid
program
24
to
annually
submit
a
report
by
March
1
to
the
department
25
detailing
the
profit
the
managed
care
organization
received
26
from
administering
Medicaid
care
during
the
immediately
27
preceding
calendar
year,
and
the
methodology
used
to
calculate
28
the
profit.
The
department
may
select
an
independent
auditor
29
to
verify
each
managed
care
organization’s
profit
report.
The
30
department
shall
make
each
managed
care
organization’s
report
31
publicly
available
on
the
department’s
internet
site.
32
EXPLANATION
33
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
34
the
explanation’s
substance
by
the
members
of
the
general
assembly.
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This
bill
relates
to
the
Medicaid
program.
1
Division
I
of
the
bill
requires
the
department
of
health
2
and
human
services
(HHS)
to
adopt
administrative
rules
to
3
ensure
that
services
are
provided
to
the
Medicaid
long-term
4
services
and
supports
(LTSS)
population
in
a
conflict-free
5
manner.
Specifically,
the
bill
requires
that
case
management
6
services
shall
be
provided
by
independent
providers
and
that
7
the
supports
intensity
scale
assessments
are
performed
by
8
independent
assessors.
9
Division
II
of
the
bill
directs
HHS
to
require
each
Medicaid
10
managed
care
organization
(MCO)
with
whom
HHS
executes
a
11
contract,
to
provide
the
option
to
LTSS
population
members
to
12
enroll
in
or
transition
to
fee-for-service
Medicaid
program
13
administration
rather
than
managed
care
administration.
The
14
department
shall
amend
any
contract,
request
any
Medicaid
state
15
plan
amendment,
and
adopt
administrative
rules,
as
necessary,
16
to
administer
this
provision.
The
rules
shall
include
the
17
process
for
transitioning
a
current
LTSS
population
member
to
18
fee-for-service
program
administration.
19
Division
III
of
the
bill
directs
HHS
to
require
each
MCO
with
20
whom
HHS
executes
a
contract
to
maintain
an
authorized
member’s
21
LTSS
unless
the
member’s
health
care
provider
determines
a
22
change
in
the
LTSS
is
medically
necessary
for
the
member.
The
23
inability
of
a
member
who
is
authorized
for
LTSS
to
utilize
24
all
approved
service
hours,
including
respite
care,
shall
not
25
result
in
a
reduction
in
authorized
services
unless
there
is
26
medical
evidence
that
the
services
are
medically
unnecessary
27
for
the
member.
28
Division
IV
of
the
bill
requires
HHS
to
contractually
29
require
any
Medicaid
MCO
to
collaborate
with
HHS
and
30
stakeholders
to
develop
and
administer
a
workforce
recruitment,
31
retention,
and
training
program
to
provide
adequate
access
to
32
appropriate
services,
including
but
not
limited
to
services
33
to
older
Iowans.
The
department
shall
ensure
that
any
such
34
program
developed
is
administered
in
a
coordinated
and
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collaborative
manner
across
all
contracting
MCOs
and
shall
1
require
the
MCOs
to
submit
quarterly
progress
and
outcomes
2
reports
to
HHS.
3
Division
V
of
the
bill
establishes
an
external
independent
4
third-party
review
process
for
Medicaid
providers
for
the
5
review
of
final
adverse
determinations
of
the
MCOs’
internal
6
appeals
processes.
The
division
provides
that
a
final
7
decision
of
an
external
independent
third-party
reviewer
may
8
be
reviewed
in
a
contested
case
proceeding
pursuant
to
Code
9
chapter
17A,
and
ultimately
is
subject
to
judicial
review.
The
10
bill
provides
a
civil
penalty
for
an
MCO
that
does
not
comply
11
with
the
written
response
requirements
relating
to
an
adverse
12
determination.
13
Division
VI
of
the
bill
relates
to
member
disenrollment
14
for
good
cause
during
the
12
months
of
closed
enrollment
15
between
open
enrollment
periods.
The
bill
requires
HHS
to
16
contractually
require
all
Medicaid
MCOs
to
issue
a
decision
17
in
response
to
a
member’s
request
for
disenrollment
for
good
18
cause
within
10
days
of
the
date
the
member
submits
the
request
19
to
the
MCO
utilizing
the
MCO’s
grievance
process
and
to
adopt
20
administrative
rules
to
administer
the
division.
21
Division
VII
of
the
bill
requires
the
HHS
to
develop
22
uniform
authorization
criteria
for,
and
to
utilize
a
request
23
for
proposals
process
to
procure,
a
single
credentialing
24
verification
organization
to
be
utilized
in
credentialing
25
and
recredentialing
providers
for
the
Medicaid
managed
care
26
and
fee-for-service
payment
and
delivery
systems.
The
bill
27
requires
HHS
to
contractually
require
all
Medicaid
MCOs
to
28
apply
the
uniform
authorization
criteria,
to
accept
verified
29
information
from
the
single
credentialing
verification
30
organization
procured
by
HHS,
and
to
contractually
prohibit
the
31
MCOs
from
requiring
additional
credentialing
information
from
a
32
provider
in
order
to
participate
in
the
Medicaid
MCO’s
provider
33
network.
34
Division
VIII
of
the
bill
relates
to
the
office
of
long-term
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care
ombudsman
(OLTCO)
and
the
Medicaid
managed
care
ombudsman
1
program
(MCOP).
2
For
fiscal
year
2025-2026,
the
bill
appropriates
$300,000
3
from
the
general
fund
of
the
state,
in
addition
to
any
other
4
funds
appropriated
from
the
general
fund
of
the
state
to,
5
and
authorizes
2.50
FTEs
in
addition
to
any
other
full-time
6
equivalent
(FTE)
positions
authorized
for,
HHS
for
the
OLTCO
7
for
the
purposes
of
the
MCOP.
The
funding
appropriated
and
the
8
FTE
positions
authorized
under
the
bill
are
in
addition
to
any
9
other
funds
appropriated
from
the
general
fund
of
the
state
and
10
actually
expended,
and
any
other
FTE
positions
authorized
and
11
actually
filled
as
of
July
1,
2025,
for
the
MCOP.
12
The
bill
requires
that
any
funds
appropriated
to
and
any
13
full-time
equivalent
positions
authorized
for
the
OLTCO
for
the
14
MCOP
for
fiscal
year
2025-2026
shall
be
used
exclusively
for
15
the
MCOP.
The
additional
FTE
positions
authorized
in
the
bill
16
for
the
MCOP
shall
be
filled
no
later
than
September
1,
2025.
17
The
bill
requires
the
OLTCO
to
include
in
the
MCOP
report,
on
18
a
quarterly
basis,
the
disposition
of
resources
for
the
MCOP
19
including
expenditures
and
an
FTE
positions
summary
for
the
20
prior
quarter.
21
Division
IX
amends
the
provision
regarding
the
meetings
of
22
the
health
policy
oversight
committee
(HPOC)
of
the
legislative
23
council.
Current
law
provides
that
HPOC
may
meet
annually.
24
The
bill
provides
that
HPOC
shall
meet,
and
further
requires
25
that
HPOC
meet
at
least
two
times,
annually,
during
the
26
legislative
interim.
27
Division
X
of
the
bill
directs
HHS
to
require
each
MCO
with
28
whom
HHS
executes
a
contract
to
annually
submit
a
report
by
29
March
1
to
HHS
detailing
the
profit
the
MCO
received
from
30
administering
Medicaid
care
during
the
immediately
preceding
31
calendar
year,
and
the
methodology
the
MCO
used
to
calculate
32
the
profit.
HHS
may
select
an
independent
auditor
to
verify
33
each
MCO’s
report.
HHS
shall
make
each
MCO’s
report
publicly
34
available
on
HHS’s
internet
site.
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