Iowa Medicaid and Managed Care Updates for American Indian and Alaska Natives

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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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

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