Iowa's plan phases in Medicaid efforts over two years for the most vulnerable Medicaid patients

(WASHINGTON, D.C.)  - Today Gov. Terry Branstad met with the Department of Health and Human Services (HHS) Secretary Sylvia Burwell in Washington, DC.  In the encouraging meeting they discussed Iowa's Medicaid modernization plan aimed at improving quality, access, and health care outcomes and creating a more predictable and sustainable Medicaid program that begins January 1, 2016.  Specifically, Gov. Branstad outlined how Iowa has learned from the more than two dozen other states using this approach and how Iowa will begin a two-year phase-in starting January 1, 2016.

"We began Iowa's Medicaid modernization plans in January 2015 and will be phasing in services over a two-year time period.  I appreciate the mutual interest in improving patient outcomes that HHS and the State of Iowa share," said Branstad.  "I also appreciate the collaboration we have had in the past with federal officials including the Iowa Health and Wellness Plan, which has increased the healthcare coverage in our state, and look forward to implementing our patient-centered Medicaid plan beginning on January 1, 2016."

Iowa has learned best practices from 30 other states who have taken steps to modernize Medicaid.  Iowa's phased-in approach ensures a smooth transition starting on day one for all Medicaid patients.  For the first two years, Medicaid patients who receive long-term care services and supports (LTSS) can keep those same services without any change.  Those services include HCBS (Home Community Based Services) waiver services, nursing facilities, and Intermediate Care Facilities for the Intellectually Disabled.

The measures outlined ensure patients have the option to keep the same services they receive today through the Medicaid modernization transition.  To protect doctors and Medicaid providers, they can sign up with as many Managed Care Organizations (MCOs) as they wish and MCOs cannot restrict enrollment for doctors and providers.  Additionally, doctors and providers who sign up with a plan are protected from reimbursement cuts and cannot be paid less than current Medicaid rates.

Phase-in measures protecting patients include :

• For the first 3 months, all existing Medicaid authorizations will be honored by the MCOs.

• For the first 6 months, Medicaid patients can keep their current physical & behavioral health providers (primary care, hospitals, specialists etc.) and case managers even if they're out-of-network.

• For the first 2 years, the most vulnerable Medicaid population patients can keep their current long-term services including nursing facilities, HCBS waivers, ICF/ID's (Intermediate Care Facilities for the Intellectually Disabled) services, home health services, community mental health center services, and substance use disorder treatment services even if they're out-of-network.

(DES MOINES)  - Gov. Terry Branstad today appointed Janet Phipps to act as the final decision-maker for the Iowa Quality Care Initiative RFP No. MED-16-009, more commonly known as Medicaid modernization.

Under administrative rules that govern appeals, Director of Human Services Charles Palmer was to act as the final decision-maker for any request for review of the proposed decision of the presiding officer in the contested case.  However, Director Palmer testified in the contested case hearing on matters material to the ultimate merits of the appeals.

Under Iowa code, Gov. Branstad has appointed Janet Phipps, who is an attorney and has experience and familiarity with the state procurement rules and regulations, as the substitute final decision-maker.

To read the letter sent by the governor, click here.

·         Novel Research Model to Tap Best and Brightest Minds from Various Disciplines

ORLANDO, Florida, November 8, 2015 – The American Heart Association (AHA) and Google Life Sciences have announced a joint commitment to form a research collaboration that will bring new, unconventional thinking to one of the longstanding challenges of cardiovascular disease. Each organization will invest $25 million for a total of $50 million over roughly five years to support novel strategies to understand, prevent, and reverse coronary heart disease and its consequences, such as heart failure and sudden cardiac death.

Cardiovascular diseases are the number one cause of death globally, accounting annually for approximately 17 million deaths, or about one of every three deaths.  Coronary heart disease itself is responsible for more than 7 million deaths annually. But the root causes of this disease continue to be explored and a concerted effort, combining technology and medicine, could help. Because traditional research funding models, which are often incremental and piecemeal, make it difficult to study a multifaceted subject that plays out over many years, AHA and Google Life Sciences have committed to a bold new approach: a $50 million investment in one research team, which will be tasked with developing a richer, deeper understanding of cardiovascular disease.

This marks the largest one-time research investment in AHA's history. In early 2016, a Joint Leadership Group made up of individuals from AHA and Google Life Sciences will select a team leader to run this effort. This team leader, who may be a cardiologist but could come from any background or area of expertise, will receive the full $50 million in funding over roughly five years to design a program, assemble a cross-functional group of investigators, and lead all efforts towards further finding new causes and drivers of coronary heart disease. The team will have support across many important areas, including clinical research, engineering, and data analysis, as well as ongoing strategic counsel, oversight and access to resources from the Joint Leadership Group.

"With its devastating human impact on countless generations of families, cardiovascular disease, and in particular coronary heart disease remains the greatest and deadliest global health challenge we face today," said American Heart Association CEO Nancy Brown. "By working together, AHA and Google Life Sciences will be able to serve as the catalyst for change and transformation in reducing the impact of coronary heart disease on people's lives and alleviating this global burden.  Just imagine if we could reverse coronary artery disease and restore the healthy heart muscle it destroys or, even better, prevent the whole process from beginning in the first place!"

Technology has a critical role to play. The collaboration will provide the scientific community with channels to technical capabilities and insights offered by Google Life Sciences. With the unique opportunity to access such resources, the collaboration will expand research pathways and empower researchers to conceptualize and test new approaches. AHA, the nation's authority on cardiovascular disease will contribute its vast scientific and medical resources, resulting in the application of a unique blend of technical and scientific knowledge to the search for new cardiovascular solutions.

"This is a fundamentally different kind of model for funding innovation," said Andy Conrad, CEO of Google Life Sciences. "The team leader will be able to bring together clinicians, engineers, designers, basic researchers and other experts to think in new ways about the causes of coronary heart disease. We're already imagining the possibilities when a team like that has access to the full resources of both Google Life Sciences and the AHA -- and we can't wait to see what they discover."

More information about the structure of the collaborative will be released as it's developed in coming months.

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About the American Heart Association
The American Heart Association is devoted to saving people from heart disease and stroke - America's No. 1 and No. 5 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.

About the life sciences team at Google

The life sciences team at Google is focused on helping to move health care from reactive to proactive.  Combining expertise from the fields of biology, chemistry, physics, medicine, electrical engineering and computer science, we're developing new technology tools for physicians that can integrate easily into daily life and help transform the detection, prevention, and management of disease. Current projects in development include a smart contact lens with miniaturized glucose sensor; a collaboration to develop new kinds of continuous glucose monitors, a nanodiagnostics platform to help with early detection of disease; cardiac and activity sensors, and Liftware utensils for people with tremor. The life sciences team graduated from Google[x] and is now in the process of becoming a standalone Alphabet company.

Earlier this year, Sen. Chuck Grassley of Iowa asked key government agencies what they're doing to prevent and punish Medicaid dental fraud, including billing for unnecessary and painful treatments for children, in light of inspector general audits and related media reports documenting worrisome practices.  This week, the Department of Health and Human Services Office of Inspector General notified Grassley that it has excluded two pediatric dentists from federal health programs.  One dentist is in Florida.  The other dentist is in Colorado.  Grassley made the following comment on the exclusions.

"The taxpayers pay for quality health care services.  If doctors and dentists are bilking the taxpayers and mistreating patients, they need to be shut out of Medicare and Medicaid, period. The inspector general is right to use this tool whenever it's appropriate."

The Department of Health and Human Services Office of Inspector General provided the following details of the two newly excluded dentists:

On September 30, 2015, OIG excluded Howard Sheldon Schneider, DDS, from participation in all Federal health care programs because his license to practice in the State of Florida was revoked, suspended, or otherwise lost for reasons bearing on his professional competence, professional performance, or financial integrity.  OIG conducted an investigation of Dr. Schneider which revealed that the State of Florida Board of Dentistry issued a Final Order for a Disciplinary Voluntary Relinquishment of his dental license after the Florida Department of Health opened an investigation into allegations of Dr. Schneider's abuse of his pediatric dental patients.  Dr. Schneider cannot apply for reinstatement until his dental license is reissued by the State of Florida.

On August 12, 2015, Dr. Robert E. Hackley, Jr., DDS, agreed to be excluded from participation in all Federal health care programs for a period of three years. OIG conducted an investigation of Dr. Hackley for dental care he provided to patients at Small Smiles Dentistry for Children in Colorado Springs, Colorado. OIG's investigation revealed that Dr. Hackley furnished dental services to patients of a quality which failed to meet professionally recognized standards of care, including: performing medically unnecessary dental procedures, failing to treat existing dental conditions, and performing dental procedures that were below professionally recognized standards of care.

Grassley's letters to the Justice Department and the Department of Health and Human Services Office of Inspector General from June are available here and here.

In 2013, following a year-long investigation, Grassley and then-Finance Committee Chairman Max Baucus of Montana issued a report and recommendations urging the administration to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices to prevent substandard care.  In 2014, the inspector general moved to disqualify a firm from Medicaid.