Centers for Medicare and Medicaid Services (CMS) Managed Care Update Centers for Medicare and Medicaid Services (CMS) I/T/U Conference Alisa Horn May 2018

Important facts about Medicaid for American Indian and Alaska Natives Very important to identify as AI/AN on the Medicaid application. Continue receiving services from local Indian Health Services provider. Option to choose a Managed Care Organization (MCO) or stay with Fee-for-Service (FFS). Organization can bill your insurance program. Benefits to the tribal community. Certain mental health and substance abuse services are referred to as B-3 services which are not covered by FFS. Members who want access to these services will need to choose an MCO.

Managed Care Updates Two Managed Care Organizations Amerigroup Iowa, Inc. UnitedHealthcare Plan of the River Valley, Inc. AmeriHealth Caritas Iowa, Inc. left the IA Health Link program effective December 1, 2017. RFP open now for new Managed Care Organization(s) to begin July 2019.

Iowa Medicaid Updates Elimination of retroactive coverage for new applicants Verify eligibility to check MCO assignment and benefits through ELVS web portal or by calling the IME Provider Services call center Informational Letter 1891 - Pharmacy Program Changes (effective April 1, 2018) Informational Letter 1843 - Same day billing for multiple encounters with multiple diagnoses (effective April 1, 2017) Draft for Medicaid Administrative Match is under review

Amerigroup Resources Provider Services Phone: 1-800-454-3730 Hours: M-F, 7:30 AM – 6 PM Pharmacy Prior Authorization Phone:1-855-712-0104 Hours: 24 hours a day, 7 days a week Member Transportation Broker: Logisticare Phone: 1-844-544-1389

UnitedHealthcare Resources Provider Services Phone: 888-650-3462 Hours: 7:30 AM – 6 PM Pharmacy Prior Authorizations Phone: 800-310-6826 Hours: 24 hours a day, 7 days a week Transportation Broker: MTM Phone: 1-888-513-1613

Iowa Medicaid Enterprise Resources Provider Services Phone: 1-800-338-7909 Hours: 7:30 AM – 4:30 PM Pharmacy Prior Authorization Phone: 1-877-776-1567 Hours: 24 hours a day, 7 days a week Transportation Broker: Access2Care Phone: 1-866-572-7662

AI/AN: Online Resource Includes Information On: Historical background on government-to-government relationship. Different health program options available to AI/Ans. Special protections for AI/ANs, including cost-sharing exemptions, estate recovery protections and managed care protections. Important facts about Medicaid for AI/ANs.

AI/AN: Useful Websites Important Facts https://dhs.iowa.gov/ime/members/FFS/AINA/important-facts B-3 Services https://dhs.iowa.gov/sites/default/files/B-3_Mental_Health_and_SubstanceAbuse_Services.pdf Online Resources https://dhs.iowa.gov/ime/members/FFS/AINA  

Alisa Horn – 515-256-4647 ahorn@dhs.state.ia.us www.dhs.state.ia.us Questions? Alisa Horn – 515-256-4647 ahorn@dhs.state.ia.us www.dhs.state.ia.us