The State Ombudsman just released a scathing report on the privately-run program. The bill directs state officials to review any case where services are cut by one of the private companies. Legislators call them managed care organizations or MCOs.
Republican Representative Dave Heaton of Mount Pleasant says the bill also requires state officials to step in if a patient wins an appeal.
“The decisions on the services continued will lie with the department and not the MCO,” Heaton says. “I think we need to make sure we have covered that.”
Representative Lisa Heddens, a Democrat from Ames, had been hoping for something tougher.
“I know this is a starting spot,” Heddens said, “and I hope we can be able to continue to work on addressing all the problems that still are a part of the managed care companies.”
The bill would require the private companies to pay doctors, hospitals and other health care providers by the contract deadlines — and explain any delays. An independent auditor would randomly check payments, too, if the bill becomes law.
Senate Republicans balked at the nearly $5 million price tag for a previous version of this bill, so it was scaled back.
(Reporting by Iowa Public Radio’s Joyce Russell)