21
Iowa Wellness Plan Annual Report 1115 Demonstration Waiver Jan 1, 2019 - Dec 31, 2019 March 2019
Iowa Wellness Plan Annual Report
1115 Demonstration Waiver Jan 1, 2019 - Dec 31, 2019
March 2019
March 2020 1
Contents EXECUTIVE SUMMARY .......................................................................................... 2 SIGNIFICANT ACTIVITIES OF THE YEAR .............................................................. 3
Communications and Outreach ............................................................................. 3 Provider Outreach ................................................................................................. 3 Legislative Developments ..................................................................................... 4
ELIGIBILITY/ENROLLMENT .................................................................................... 4 Fourth Quarter Enrollment ..................................................................................... 4 Special Population Groups .................................................................................... 5
ACCESS/DELIVERY ................................................................................................ 6 MEMBER GRIEVANCES AND APPEALS ................................................................ 6
Grievances ............................................................................................................ 6 Appeals and Exceptions ........................................................................................ 7
FINANCIAL REPORT ............................................................................................... 8 OTHER ACTIVITIES ............................................................................................... 17
Dental Wellness Plan (DWP) .............................................................................. 17 Premium Monitoring and the Healthy Behaviors Program ................................... 19 Interim Reports .................................................................................................... 20 1115 Waiver Demonstration Extension ............................................................... 20
March 2020 2
EXECUTIVE SUMMARY
The Iowa Wellness Plan, Iowa’s 1115 Demonstration Waiver continues to cover more Iowa adults during calendar year 2019 than calendar year 2018. There was a 3.7 percent increase in total enrollment. Changes that occurred in 2019, including the addition of a new Managed Care Organization (MCO), Iowa Total Care and the discontinuance of United Healthcare Plan of the River Valley on July 1, 2019. IWP members were given an opportunity to choose either Amerigroup, Inc. or Iowa Total Care until September 1, 2019. Following this letter is a detailed report of key activities and related statistics for the year and the fourth quarter of 2019, consistent with the Special Terms and Conditions (STCs). Additional information about the IWP can be found at https://dhs.iowa.gov/IHAWP. Please contact me at 515-256-4621 or [email protected], or Anna Ruggle at 515-974-3286 or [email protected] should you have any questions about this report. Michael Randol Iowa Medicaid Director Department of Human Services
To
March 2020 3
SIGNIFICANT ACTIVITIES OF THE YEAR
Communications and Outreach
2019 brought changes to the MCOs serving the IWP and Iowa Medicaid. Iowa Total Care (ITC) began providing benefits for IWP and Medicaid members and United Healthcare Plan of the River Valley, Inc. (UHC) left the Iowa Medicaid program. Communication was abundant to IWP members in 2019. In March, members learned that ITC would be a MCO July1, 2019 and then in April learned that UHC that they would not participate with Iowa Medicaid as of June 30, 2019. During these MCO transitions all Medicaid members were given an extension on choosing a MCO for the next enrollment period. In August 2019, passive assignment became effective. Passive assignment assigns IWP and Medicaid members to a MCO at the time eligibility is determined. Previously, members were assigned temporarily to Medicaid Fee-for-Service and then enrolled in a MCO. Passive assignment allows the MCOs to help manage member’s health issues earlier and reduces confusion for both the member and the provider. Throughout the year, members could learn more about IWP and DWP by:
Monthly Member Mailings: • IA Health Link Member Welcome Packet: This packet is
mailed to all new IWP members and includes information about IWP benefits, Healthy Behaviors and the MCO selection process.
• Healthy Behaviors Reminder Letters: These are sent from the member’s MCO and reminds members they need to complete their Healthy Behaviors to keep their free health coverage.
• IWP Contribution Statements: These statements are sent to members who are required to pay monthly contributions. An informational piece on Healthy Behaviors is included with these monthly statements.
Provider Outreach
Outreach to all providers including informational letters informing the providers of the addition of a new MCO, ITC and the departure of
March 2020 4
UHC. The information provided about ITC included how to become a credentialed provider for ITC while the information about UHC focused on billing for outstanding services after the departure. On May 7, 2019, the IME gave updates on IWP to the Medical Assistance Advisory Council (MAAC). Updates included a refresher on IWP, current enrollment, and information about the Dental Wellness Plan.
Legislative Developments
There were no legislative developments for calendar year 2019 for the IWP.
ELIGIBILITY/ENROLLMENT
Iowa continues to see an increase in the number of people eligible for IWP. Calendar year 2019 ended with total membership at 177,041, which is 3.7 percent increase over 2018. The group with the largest increase in population from 2018 to 2019 was 45 percent for American Indian/Alaska Native. This population self-reports their status as American Indian/Alaska Native.
Fourth Quarter Enrollment
The IWP population totaled 177,041 at the end of the fourth quarter of calendar year 2019. Month-end totals by population group are shown below.
March 2020 5
Population Group Oct 2019 Nov 2019 Dec 2019
0 to 100% FPL 144,493 145,714 145,958 101 to 133% FPL 30,668 30,970 31,083 Total 175,161 176,684 177,041
Special Population Groups
The state monitors specific population groups enrolled in the IWP to ensure their health care needs are met in accordance with the STCs. These groups are comprised of: (1) Nineteen and twenty year-olds, (2) American Indian/Alaskan Natives, and (3) the medically exempt (frail). Below are month-end enrollment totals during the fourth quarter of calendar year 2019.
Population Group Oct 2019 Nov 2019 Dec 2019
19 & 20 Year Olds 15,723 15,799 15,750 0 to 100% FPL 13,571 13,652 13,610 101 to 133% FPL 2,152 2,147 2,140
American Indian/Alaskan Native
2,715 2,756 2,745
0 to 100% FPL 2,302 2,340 2,335 101 to 133% FPL 413 416 410
Medically Exempt 5,587 5,668 5,808 0 to 100% FPL 3,434 3,491 3,583 101 to 133% FPL 2,153 2,177 2,225
Total 24,025 24,223 24,303
March 2020 6
ACCESS/DELIVERY
Effective April 1, 2016, the majority of Medicaid members began accessing services through the IA Health Link managed care program. Information on access and delivery is available in the Network Adequacy and Historical Utilization section of the reports available at https://dhs.iowa.gov/ime/about/performance-data/MC-quarterly-reports.
MEMBER GRIEVANCES AND APPEALS
Grievances
Beginning April 1, 2016, all Medicaid members enrolled in MCOs have access to their respective member hotlines to report complaints about the IA Health Link program. A summary of MCO grievances and appeals can be found in the MCO quarterly reports, Consumer Protections and Supports section of the reports available at https://dhs.iowa.gov/ime/about/performance-data/MC-quarterly-reports. IWP members are able to report their complaints to the Iowa Medicaid Member Services Call Center. A summary of these complaints is provided below.
Complaint Type Oct 2019 Nov 2019 Dec 2019
Benefits and Services 9 3 10 Access 3 1 1 Substance Abuse/Mental Health Access
1 0 0
Quality of Care 0 0 0 Medical Provider Network 0 1 2 Premiums/Cost Sharing 0 1 0 Healthy Behaviors 0 0 1 Non-Emergency Medical Transportation
1 0 1
Early Periodic Screening, Diagnosis and Treatment (EPSDT)
0 0 0
Total 14 6 15
March 2020 7
Appeals and Exceptions
During the fourth quarter of calendar year 2019 the state received 0 requests for exceptions to Medicaid policy and 34 requests for appeal hearings for IWP members in FFS. There are three tables below. The first is for members who appealed their medical contributions. The second is for members who appealed their dental contributions and the third is those who appeal both the medical and dental contributions. More information about the dental appeals can be found under section, Dental Wellness Plan.
MEMBER APPEALS - Medical Contributions Month Category Outcome* Count Oct 2019 Medical Contributions Affirmed 1
Dismissed 10
Denied 1
Withdrawn 1
Nov 2019 Medical Contributions Dismissed 4
Withdrawn 2
Dec 2019 Medical Contributions Affirmed 5
Dismissed 2
Withdrawn 2
Total Appeals 28
MEMBER APPEALS – Dental Contributions Month Category Outcome* Count Oct 2019 Dental Contributions Dismissed 1
Nov 2019 Dental Contributions Denied 1
Withdrawn 1
Dec 2019 Dental Contributions 0 Total Appeals 3
MEMBER APPEALS – Medical and Dental Contributions Month Category Outcome* Count Oct 2019 Contributions Denied 1
Nov 2019 Contributions Withdrawn 2
March 2020 8
Dec 2019 Contributions 0
Total Appeals 3 * Affirmed - DHS' action is correct. * Dismissed - Appeal is unnecessary for approval of coverage/payment; dismissed by DHS or appellant
abandoned the hearing. * Reversed - Appellant's request is approved; DHS is ordered to reverse its action. * Withdrawn - Appeal request withdrawn by appellant prior to hearing date.
FINANCIAL REPORT
See the following pages for the actual number of member months for the Iowa Health and Wellness Plan as of 12/31/2019. This report is required under the STCs for the purpose of tracking program costs, which includes calculating the budget neutrality expenditure cap.
March 2020 9
Inco
me
0-10
0% F
PL
FFS:
Med
ical
ly E
xem
pt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
1,78
1 22
1 28
9 33
6 31
0 29
3 19
0 18
5 19
8 18
4 17
9 15
4 4,
320
12/2
019
555
36
47
61
60
62
92
99
101
115
134
154
1,51
6
11/2
019
40
1 2 3 8 7 5 4 16
26
45
157
10/2
019
42
2 6 5 8 6 9 17
26
43
164
09/2
019
51
1 3 8 12
5 11
25
55
171
08/2
019
58
5 6 14
12
24
19
40
178
07/2
019
57
6 10
6 9 26
54
168
06/2
019
176
19
21
51
146
163
576
05/2
019
87
6 12
115
55
275
04/2
019
94
15
109
73
291
03/2
019
135
97
73
305
02/2
019
233
33
266
01/2
019
253
253
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 11
,833
89
4 1,
054
1,20
6 1,
066
813
738
652
559
440
313
154
19,7
22
12/2
019
6,66
0 39
6 47
0 54
9 48
0 43
4 55
2 49
5 40
4 34
5 26
8 15
4 11
,207
11/2
019
440
10
18
24
56
42
25
16
48
52
45
776
10/2
019
420
18
48
35
48
30
36
51
52
43
781
09/2
019
459 8 21
48
60
20
33
50
55
754
08/2
019
464
35
36
70
48
72
38
40
803
07/2
019
399
36
50
24
27
52
54
642
06/2
019
1,05
6 95
84
15
3 29
2 16
3
1,84
3
05/2
019
435
24
36
230
55
780
04/2
019
376
45
218
73
712
03/2
019
405
194
73
672
02/2
019
466
33
499
01/2
019
253
253
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 10
Inco
me
0-10
0% F
PL
FFS:
Non
-Med
ical
ly E
xem
pt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
12,6
65
3,01
7 3,
188
3,31
1 3,
142
3,09
6 62
4 66
5 65
1 67
8 58
7 55
8 32
,182
12/2
019
2,40
0 17
0 16
8 18
8 22
6 22
7 22
8 26
8 31
8 38
7 41
2 55
8 5,
550
11/2
019
134
12
8 21
16
15
19
18
47
92
175
557
10/2
019
133
14
16
11
11
21
30
57
104
199
596
09/2
019
135
18
22
23
29
27
41
103
182
580
08/2
019
229
19
20
33
30
31
93
219
674
07/2
019
195
11
20
25
57
92
213
613
06/2
019
474
61
69
297
2,27
8 2,
683
5,86
2
05/2
019
287
26
188
2,05
4 49
5
3,05
0
04/2
019
348
217
2,14
0 65
9
3,36
4
03/2
019
1,67
4 2,
124
537
4,33
5
02/2
019
3,30
8 34
5
3,65
3
01/2
019
3,34
8
3,34
8
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 56
,673
8,
112
7,91
1 7,
998
7,47
3 4,
852
2,10
5 2,
008
1,80
3 1,
544
999
558
102,
036
12/2
019
28,8
00
1,87
0 1,
680
1,69
2 1,
808
1,58
9 1,
368
1,34
0 1,
272
1,16
1 82
4 55
8 43
,962
11/2
019
1,47
4 12
0 72
16
8 11
2 90
95
72
14
1 18
4 17
5
2,70
3
10/2
019
1,33
0 12
6 12
8 77
66
10
5 12
0 17
1 20
8 19
9
2,53
0
09/2
019
1,21
5 14
4 15
4 13
8 14
5 10
8 12
3 20
6 18
2
2,41
5
08/2
019
1,83
2 13
3 12
0 16
5 12
0 93
18
6 21
9
2,86
8
07/2
019
1,36
5 66
10
0 10
0 17
1 18
4 21
3
2,19
9
06/2
019
2,84
4 30
5 27
6 89
1 4,
556
2,68
3
11,5
55
05/2
019
1,43
5 10
4 56
4 4,
108
495
6,70
6
04/2
019
1,39
2 65
1 4,
280
659
6,98
2
03/2
019
5,02
2 4,
248
537
9,80
7
02/2
019
6,61
6 34
5
6,96
1
01/2
019
3,34
8
3,34
8
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 11
Inco
me
0-10
0% F
PL
MC
O: M
edic
ally
Exe
mpt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
16,2
30
588
686
752
722
661
1,01
4 76
8 80
7 72
7 89
9 90
4 24
,758
12/2
019
10,9
13
357
459
537
538
498
776
655
708
672
862
904
17,8
79
11/2
019
367
18
19
23
17
26
40
28
32
31
37
638
10/2
019
399
14
13
21
29
28
50
21
28
24
627
09/2
019
382
20
23
18
21
18
51
30
39
602
08/2
019
449
23
19
20
29
31
44
34
649
07/2
019
435
18
27
33
22
27
53
615
06/2
019
495
18
31
35
32
33
644
05/2
019
512
22
26
29
34
623
04/2
019
570
19
33
36
658
03/2
019
617
33
36
686
02/2
019
588
46
634
01/2
019
503
503
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 16
0,39
8 5,
009
5,57
9 5,
703
4,98
2 4,
034
5,35
0 3,
544
3,02
3 2,
102
1,76
1 90
4 20
2,38
9
12/2
019
130,
956
3,92
7 4,
590
4,83
3 4,
304
3,48
6 4,
656
3,27
5 2,
832
2,01
6 1,
724
904
167,
503
11/2
019
4,03
7 18
0 17
1 18
4 11
9 15
6 20
0 11
2 96
62
37
5,35
4
10/2
019
3,99
0 12
6 10
4 14
7 17
4 14
0 20
0 63
56
24
5,02
4
09/2
019
3,43
8 16
0 16
1 10
8 10
5 72
15
3 60
39
4,29
6
08/2
019
3,59
2 16
1 11
4 10
0 11
6 93
88
34
4,29
8
07/2
019
3,04
5 10
8 13
5 13
2 66
54
53
3,59
3
06/2
019
2,97
0 90
12
4 10
5 64
33
3,38
6
05/2
019
2,56
0 88
78
58
34
2,81
8
04/2
019
2,28
0 57
66
36
2,43
9
03/2
019
1,85
1 66
36
1,95
3
02/2
019
1,17
6 46
1,22
2
01/2
019
503
503
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 12
Inco
me
0-10
0% F
PL
MC
O: N
on-M
edic
ally
Exe
mpt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
109,
044
4,75
4 5,
154
6,12
8 5,
013
4,54
2 10
,144
5,
276
4,93
5 5,
160
5,49
7 5,
566
171,
213
12/2
019
72,0
54
3,08
3 3,
666
4,53
2 3,
710
3,55
7 8,
249
4,44
0 4,
315
4,76
9 5,
268
5,56
6 12
3,20
9
11/2
019
2,98
2 24
5 14
7 14
4 14
7 13
7 31
8 15
4 17
7 16
3 22
9
4,84
3
10/2
019
2,81
4 12
3 13
1 16
7 12
5 14
6 31
6 22
3 21
0 22
8
4,48
3
09/2
019
2,80
0 14
4 13
8 16
9 14
0 16
0 37
6 22
5 23
3
4,38
5
08/2
019
3,18
3 10
9 13
4 17
9 20
4 17
9 43
7 23
4
4,65
9
07/2
019
3,05
2 11
6 12
7 17
9 19
5 18
3 44
8
4,30
0
06/2
019
3,13
4 12
5 15
6 23
2 21
5 18
0
4,04
2
05/2
019
3,20
8 13
8 15
6 22
7 27
7
4,00
6
04/2
019
3,47
3 19
4 21
5 29
9
4,18
1
03/2
019
4,00
7 21
2 28
4
4,50
3
02/2
019
4,47
6 26
5
4,74
1
01/2
019
3,86
1
3,86
1
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 1,
071,
188
42,5
29
43,2
42
47,1
83
34,2
67
28,1
74
54,7
98
24,1
69
18,4
44
14,8
61
10,7
65
5,56
6 1,
395,
186
12/2
019
864,
648
33,9
13
36,6
60
40,7
88
29,6
80
24,8
99
49,4
94
22,2
00
17,2
60
14,3
07
10,5
36
5,56
6 1,
149,
951
11/2
019
32,8
02
2,45
0 1,
323
1,15
2 1,
029
822
1,59
0 61
6 53
1 32
6 22
9
42,8
70
10/2
019
28,1
40
1,10
7 1,
048
1,16
9 75
0 73
0 1,
264
669
420
228
35,5
25
09/2
019
25,2
00
1,15
2 96
6 1,
014
700
640
1,12
8 45
0 23
3
31,4
83
08/2
019
25,4
64
763
804
895
816
537
874
234
30,3
87
07/2
019
21,3
64
696
635
716
585
366
448
24,8
10
06/2
019
18,8
04
625
624
696
430
180
21,3
59
05/2
019
16,0
40
552
468
454
277
17,7
91
04/2
019
13,8
92
582
430
299
15,2
03
03/2
019
12,0
21
424
284
12,7
29
02/2
019
8,95
2 26
5
9,21
7
01/2
019
3,86
1
3,86
1
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 13
Inco
me
Ove
r 100
% F
PL
FFS:
Med
ical
ly E
xem
pt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
135
50
28
47
40
37
15
13
13
11
5 4 398
12/2
019
17
3 3 3 4 4 6 3 4 4 4 4 59
11/2
019
2 0 0 1 2 0 1 3 2 3 1
15
10/2
019
1 0 0 1 0 0 0 0 3 4
9
09/2
019
2 0 0 1 0 1 1 3 4
12
08/2
019
7 2 0 2 2 0 0 4
17
07/2
019
3 1 0 0 0 0 7
11
06/2
019
11
1 2 5 21
32
72
05/2
019
4 0 1 17
11
33
04/2
019
7 5 11
17
40
03/2
019
14
31
11
56
02/2
019
33
7
40
01/2
019
34
34
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 58
7 14
2 74
12
4 10
7 64
51
37
32
22
9 4
1,25
3
12/2
019
204
33
30
27
32
28
36
15
16
12
8 4 445
11/2
019
22
0 0 8 14
0 5 12
6 6 1
74
10/2
019
10
0 0 7 0 0 0 0 6 4
27
09/2
019
18
0 0 6 0 4 3 6 4
41
08/2
019
56
14
0 10
8 0 0 4
92
07/2
019
21
6 0 0 0 0 7
34
06/2
019
66
5 8 15
42
32
168
05/2
019
20
0 3 34
11
68
04/2
019
28
15
22
17
82
03/2
019
42
62
11
115
02/2
019
66
7
73
01/2
019
34
34
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 14
Inco
me
Ove
r 100
% F
PL
FFS:
Non
-Med
ical
ly E
xem
pt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
2,95
2 85
5 85
3 92
8 92
1 83
2 72
83
84
90
62
82
7,
814
12/2
019
222
10
15
20
21
15
27
28
27
36
36
82
539
11/2
019
26
3 1 1 2 0 1 4 3 14
26
81
10/2
019
25
1 3 1 2 1 3 4 17
40
97
09/2
019
12
2 2 2 4 1 1 8 37
69
08/2
019
25
0 4 2 3 2 11
39
86
07/2
019
22
4 0 3 1 12
29
71
06/2
019
53
10
6 78
667
801
1,61
5
05/2
019
38
5 87
564
221
915
04/2
019
41
67
530
257
895
03/2
019
472
589
205
1,26
6
02/2
019
914
164
1,07
8
01/2
019
1,10
2
1,10
2
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 8,
680
1,80
2 1,
771
1,84
8 1,
784
945
233
223
188
176
98
82
17,8
30
12/2
019
2,66
4 11
0 15
0 18
0 16
8 10
5 16
2 14
0 10
8 10
8 72
82
4,
049
11/2
019
286
30
9 8 14
0 5 16
9 28
26
431
10/2
019
250 9 24
7 12
5 12
12
34
40
405
09/2
019
108
16
14
12
20
4 3 16
37
230
08/2
019
200 0 24
10
12
6 22
39
313
07/2
019
154
24
0 12
3 24
29
246
06/2
019
318
50
24
234
1,33
4 80
1
2,76
1
05/2
019
190
20
261
1,12
8 22
1
1,82
0
04/2
019
164
201
1,06
0 25
7
1,68
2
03/2
019
1,41
6 1,
178
205
2,79
9
02/2
019
1,82
8 16
4
1,99
2
01/2
019
1,10
2
1,10
2
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 15
Inco
me
Ove
r 100
% F
PL
MC
O: M
edic
ally
Exe
mpt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
2,88
6 12
7 17
7 18
2 17
0 16
0 21
2 17
6 15
3 13
5 19
8 22
8 4,
804
12/2
019
1,45
7 69
11
0 10
7 10
7 10
5 16
5 14
8 12
1 12
2 18
3 22
8 2,
922
11/2
019
95
9 6 12
5 7 6 3 7 8 15
173
10/2
019
89
4 6 5 3 8 6 7 10
5
143
09/2
019
84
4 5 7 8 10
13
7 15
153
08/2
019
109 6 4 8 12
6 10
11
166
07/2
019
100 3 7 9 7 10
12
148
06/2
019
101 5 10
10
9 14
149
05/2
019
119 6 6 11
19
161
04/2
019
162 7 9 13
191
03/2
019
199 5 14
218
02/2
019
186 9
195
01/2
019
185
185
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 24
,750
1,
066
1,38
6 1,
277
1,05
5 90
9 1,
115
798
540
387
381
228
33,8
92
12/2
019
17,4
84
759
1,10
0 96
3 85
6 73
5 99
0 74
0 48
4 36
6 36
6 22
8 25
,071
11/2
019
1,04
5 90
54
96
35
42
30
12
21
16
15
1,45
6
10/2
019
890
36
48
35
18
40
24
21
20
5
1,13
7
09/2
019
756
32
35
42
40
40
39
14
15
1,01
3
08/2
019
872
42
24
40
48
18
20
11
1,07
5
07/2
019
700
18
35
36
21
20
12
842
06/2
019
606
25
40
30
18
14
733
05/2
019
595
24
18
22
19
678
04/2
019
648
21
18
13
700
03/2
019
597
10
14
621
02/2
019
372 9
381
01/2
019
185
185
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 16
Inco
me
Ove
r 100
% F
PL
MC
O: N
on-M
edic
ally
Exe
mpt
Mem
ber C
ount
s
Elig
ibili
ty E
nd M
onth
To
tal
27,4
99
1,89
6 2,
132
2,23
0 1,
808
1,75
0 3,
441
1,97
9 1,
918
1,95
1 2,
455
2,44
1 51
,500
12/2
019
9,95
7 95
3 1,
221
1,41
2 1,
173
1,24
7 2,
675
1,61
6 1,
637
1,72
6 2,
317
2,44
1 28
,375
11/2
019
1,06
4 13
5 10
2 93
79
77
17
7 66
83
11
3 13
8
2,12
7
10/2
019
1,21
7 86
56
81
86
10
2 13
7 97
82
11
2
2,05
6
09/2
019
1,19
7 60
85
11
3 12
8 72
12
6 82
11
6
1,97
9
08/2
019
1,29
7 60
11
2 16
5 65
71
14
3 11
8
2,03
1
07/2
019
1,42
2 74
15
0 82
84
89
18
3
2,08
4
06/2
019
1,47
8 13
5 68
69
81
92
1,92
3
05/2
019
1,71
4 71
83
98
11
2
2,07
8
04/2
019
1,86
2 85
98
11
7
2,16
2
03/2
019
2,20
0 10
8 15
7
2,46
5
02/2
019
2,06
7 12
9
2,19
6
01/2
019
2,02
4
2,02
4
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
Mem
ber M
onth
s
Tota
l 21
2,10
5 15
,510
16
,467
16
,370
11
,879
10
,472
18
,330
8,
917
7,07
7 5,
516
4,77
2 2,
441
329,
856
12/2
019
119,
484
10,4
83
12,2
10
12,7
08
9,38
4 8,
729
16,0
50
8,08
0 6,
548
5,17
8 4,
634
2,44
1 21
5,92
9
11/2
019
11,7
04
1,35
0 91
8 74
4 55
3 46
2 88
5 26
4 24
9 22
6 13
8
17,4
93
10/2
019
12,1
70
774
448
567
516
510
548
291
164
112
16,1
00
09/2
019
10,7
73
480
595
678
640
288
378
164
116
14,1
12
08/2
019
10,3
76
420
672
825
260
213
286
118
13,1
70
07/2
019
9,95
4 44
4 75
0 32
8 25
2 17
8 18
3
12,0
89
06/2
019
8,86
8 67
5 27
2 20
7 16
2 92
10,2
76
05/2
019
8,57
0 28
4 24
9 19
6 11
2
9,41
1
04/2
019
7,44
8 25
5 19
6 11
7
8,01
6
03/2
019
6,60
0 21
6 15
7
6,97
3
02/2
019
4,13
4 12
9
4,26
3
01/2
019
2,02
4
2,02
4
01/2
019
02/2
019
03/2
019
04/2
019
05/2
019
06/2
019
07/2
019
08/2
019
09/2
019
10/2
019
11/2
019
12/2
019
Tota
ls
Eligibility Begin Month
March 2020 17
. OTHER ACTIVITIES
Dental Wellness Plan (DWP)
DWP saw some plan design changes in 2019. • Dental procedures needing a prior authorization were adjusted
based on feedback from providers and the Pre-Ambulatory Health Plans (PAHP).
• Current Dental Terminology (CDT) codes were updated to reflect the 2019 changes.
• Denture services were added to the basic dental benefit. • Added two dental services to qualify as a Healthy Behavior service:
D0190 Screening of a patient (allowed only for non-dentist providers) and D1206 Topical application of fluoride varnish
Below is the fourth quarter report by the dental plans, Delta Dental of Iowa (DDIA) and Managed Care of North America, Inc. (MCNA).
March 2020 18
March 2020 19
Premium Monitoring and the Healthy Behaviors Program
In accordance with the STCs, the state is required to collect premium related data to monitor the effects of premiums on IWP members with incomes between 50 and 133 percent of the FPL.
October 2019 November 2019 December 2019 50-100%
FPL Over 100%
FPL 50-100%
FPL Over
100% FPL 50-100%
FPL Over
100% FPL Members subject to premiums (non-exempt and past initial 13 month grace period)
35,219 13,506 35,461 13,564 35,426 13,709
Members who owe premiums (did not complete Healthy Behaviors)
30,173 9,784 30,497 9,922 30,459 10,170
Members who completed Healthy Behaviors (premiums waived)
5,046 3,722 4,964 3,642 4,967 3,539
American Indian/Alaskan Natives (exempt)
1,421 254 1,446 255 1,445 256
Medically Frail (exempt) 3,441 2,156 3,501 2,183 3,584 2,223
Members in the Health Insurance Premium Payment Program (exempt)
63 63 62 65 63 66
Members ineligible for IWP - churn (exempt)
1,805 726 1,847 857 1,864 779
Members with incomes below 50% FPL (exempt)
55,796 14 56,599 16 57,228 11
Members with debt sent to collections for failure to pay premiums within 90-day grace period
0 2,450 0 0 0 0
Members within initial 13 month grace period
49,763 15,234 49,819 15,564 50,115 15,807
March 2020 20
Interim Reports The following are interim reports completed in 2019. Dental Wellness Interim Report The Dental Wellness Interim Report shares DWP members experience in the DWP. Areas of focus for the member survey were, access to care, provider attitude towards DWP, effects of the benefit structure and the effect of outreach and referral services. Findings of the survey can be found at: https://dhs.iowa.gov/sites/default/files/Dental%20Wellness%20Plan%20Interim%20Evaluation.pdf?062620192053. Healthy Behaviors Interim Evaluation This report focused on the IWP Healthy Behaviors and the quality measures associated with healthy behaviors. IWP members were asked about their knowledge of the Healthy Behaviors program. The survey showed increases in completion of a wellness exam and the Health Risk Assessment from 2014 to 2017 for the income group of 101 to 133 percent FPL. While for the same period and same measures, there was a decrease for the lower income group. This could be due to the fact that the higher income group is charged a $10 contribution and may be disenrolled from IWP if contributions aren’t paid. The lower income group is charged a $5 contribution and is not disenrolled from IWP. Claims data was analyzed to determine if IWP members had ambulatory visits, diabetic screening, use of the emergency department and other similar measures. This report can be found at: https://dhs.iowa.gov/sites/default/files/Healthy%20Behaviors%20Interim%20Evaluation.pdf?062620192054.
1115 Waiver Demonstration Extension Iowa submitted a five-year extension request of the 1115 Demonstration Waiver on June 20, 2019. The Centers for Medicare and Medicaid Services approved the extension request for five years. The new Demonstration period is January 1, 2020 to December 31, 2024.
