1. 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

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 Pharmacy Program Changes (effective April 1, 2018)
Informational Letter 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:
Hours: 24 hours a day, 7 days a week
Member Transportation
Broker: Logisticare
Phone:

6. UnitedHealthcare Resources
Provider Services
Phone:
Hours: 7:30 AM – 6 PM
Pharmacy Prior Authorizations
Phone:
Hours: 24 hours a day, 7 days a week
Transportation
Broker: MTM
Phone:

7. Iowa Medicaid Enterprise Resources
Provider Services
Phone:
Hours: 7:30 AM – 4:30 PM
Pharmacy Prior Authorization
Phone:
Hours: 24 hours a day, 7 days a week
Transportation
Broker: Access2Care
Phone:

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
B-3 Services
Online Resources  

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