MANAGED CARE AND CLINICAL SERVICES
Managed Care and Clinical Services is responsible for oversight and administration of managed care programs and policy review of clinical services (i.e. dental, chiropractic). The following is a partial listing of the functions of the Unit:
- Administrative oversight of the Iowa Plan (mental health and substance abuse care for Medicaid recipients).
- Administrative oversight of the contracting with HMOs serving Medicaid recipients.
- Administrative oversight of the MediPASS option, operated through the fiscal agent.
- Administrative oversight and monitoring of Quality of Care initiatives for all managed care programs.
- Review of Medicaid Policy in relation to various clinical services.
- Review and respond to Exception to Policy requests in relation to clinical services or managed care.
- Review and respond to Appeals submitted in relation to clinical services or managed care.
- Proposal and implementation of Administrative Rules in relation to clinical services or managed care programs.
Who is eligible to receive managed care services?
- The Iowa Plan (mental health and substance abuse) is available to nearly all Medicaid recipients.
- Medical managed care is available to Medicaid recipients within a specified group of assistance types. In general, these are the FMAP and FMAP related assistance types. This will vary from county to county, depending upon provider panels available.
How do I apply for services?
These services are only available to persons already receiving Medical Assistance (Medicaid). The application process for general medical assistance is started with the Income Maintenance Worker (IMW) at the respective county office of the Department of Human Services (DHS).
Services we provide:
- Oversight of the contract for the Iowa Plan
- Oversight of the contract for the MHC enrollment broker
- Oversight of the contracts with each of the HMOs
- Oversight of the contract with the External Quality Review Organization (EQRO)
- Review of changes to the appropriate Iowa Administrative Code (IAC) Rules
- Implementation of appropriate changes in the IAC Rules
- Recommendation of proposed changes effecting various services
People we serve:
Most Medicaid recipients will automatically be enrolled in the Iowa Plan for mental health and substance abuse related services.
Medicaid recipients in the FMAP and FMAP related aid types will be enrolled in the MHC program.
The review of clinical services is for the benefit of all Medicaid recipients.
Other information, innovations, awards:
Policy Analysts are regular speakers to various professional organizations and other states.
Where do I go to get more information?
Telephone: (515) 256-4600