Home page ||

• Iowa General Assembly called for redesign of Iowa systems serving children and adults with disabilities.
• The MH/MR/DD/BI Commission provided recommendations for adult system redesign to the legislature in 2004, and an initial implementation bill was passed in 2006 (see below).
• Creation of Iowa Medicaid Enterprise brings together Department of Human Services and service contractors to use a performance-based model to improve healthcare services.
• IowaCare Act of 2005 has among its provisions:

  • Development of a plan for case-mix adjusted reimbursement for ICF/MRs and home and community-based services
  • May establish eligibility standards that make it easier to access home and community-based services than nursing home placements
  • Mandates DHS plan to reduce institutional services and expand home and community-based services

• 16,000 older Iowans and Iowans with disabilities will have more service choices as the result of the Consumer Choices Option, Iowa’s self-direction initiative.
• The legislature appropriated $2.4 million for brain injury services in 2005, and established a new brain injury program in the Department of Public Health in 2006.
• Highlights of HF 2780, Mental Health Redesign, passed in 2006:
  • Creates a new DHS Division of Mental Health and Developmental Disabilities
  • Begins transfer of state cases to counties, and begins to remove barriers to the elimination of "legal settlement"
  • Creates committee to review MH/MR/DD/BI service funding and formula used for fund distribution
  • Requires all counties to use same income eligibility guidelines
  • Makes county of residence responsible for managing a person's services; county of legal settlement continues to pay for them
  • Requires Magellan (managed care) to pay Community Mental Health Centers a 100% of cost, and to reimburse psychiatrists and inpatient psychiatric care providers at same rate as Medicaid

• Additional $10.4 million is appropriated for MH/MR/DD/BI Allowed Growth to help address county funding crises.
• Funding of University of Iowa initiative to address shortage of mental health professionals in Iowa.
• Increase in Senior Living Trust Fund authorizes growth from $118 million to $300 million.

Community-based services
2. Service access for children

• Redesign of children’s service system
• Iowa’s new HCBS waiver for children with serious emotional disabilities can serve 300 children with significant mental health needs.
• Medical Home sites are being tested for children with special health care needs.
• Iowa ABCD II Initiative is developing improved screening processes to identify children with developmental needs.
• The Iowa Brain Injury Resource Network is serving families.

• In 2005, HF 420 established health insurance coverage parity for biologically-based mental illness.

Community-based services
4. Assessment

• DHS implementation of a comprehensive and objective assessment process through the Iowa Foundation for Medical Care, begins.
• 2006 legislature appropriated $260,000  to help fund development of assessment tools and processes to guide service choices by people with disabilities and older Iowans.

• 2006 DHS Appropriations Bill increased support for home and community-based waiver services, and substantially reduced waiting lists for a time, although they are increasing again.

• The transformation of Iowa’s Medicaid program into the Iowa Medicaid Enterprise:
  • Strengthened key Medicaid business functions and instilled results-based accountability
  • Improved services to members, providers, and partners
  • Strengthened IME decision-making capabilities through the expanded integrated data warehouse. Steps taken include:

• Iowa Department of Elder Affairs Aging and Disability Resource Center grant is integrating information resources on aging with Iowa COMPASS to create a single gateway for long-term care information. The DHS Family Support 360 grant is collaborating so that the database will eventually have lifespan coverage. Enhanced software will add a resource locator.
• A state mental health Data Infrastructure Grant (DIG) is improving the management of date and data sharing among state providers.
• The Project Seamless grant created a framework for sharing data among local and state agencies in order to streamline eligibility determination for older Iowans.
• The Iowa Medicaid Enterprise is using the ISIS system to provide efficient information management for Medicaid members.
• Networking of existing information and referral systems throughout the state has begun to provide a tool that can be used by consumers, families, and providers.

• HF 825 provided a 3% increase in provider reimbursements beginning 7-1-05. In 2006, the legislature approved another 3% increase.
• Iowa Medicaid Enterprise “right pricing” initiative works to ensure fair reimbursement. This will include development of a plan for person-centered, case-mix adjusted reimbursement for ICF/MR facilities.

Community-based services
9. Institution downsizing

• Under the US Department of Justice settlement with Iowa, DHS plans to a reduction of 15 beds per year at state institutions.
• State Resource Centers have decreased their populations by 8%, or 54 beds, and are making a comprehensive effort to support transitions into the community. By 2007, state Resource Centers project an additional reduction of 52 beds, and an overall reduction of 15% in population since 2001.
• The number of public and private residential care facilities has dropped from 151 to 121 in the past six years; the number of skilled nursing facilities has declined from 471 to 428; and the number of county-owned residential care facilities has dropped from 42 to 35, with more decreases projected.
• Glenwood and Woodward Resource Centers have expanded their transition planning efforts to partnering with Community Service Agencies, including local businesses, to increase employment opportunities. Staff and social workers also work closely with the residents and their families to educate them about their individual choices.

Community-based services
10. Conversion of institutions to community service providers

• New state laws ease restrictions on nursing homes serving as home and community-based services providers.

• Iowa Training Consortium Conner Mini-Grants support transition from state Resource Centers to the community; from July 2000 to December 2005, 26 people made the transition with mini-grant assistance.
• Department of Veterans Affairs is identifying veterans who want to move from facilities to the community.
• The IowaCare Act requires DHS to submit a report to the legislature spelling out the options available under Medicaid to assist individuals in transitioning from institutions to the community.
• Consumers living in institutional settings can now access funding to help meet the costs of transition to community settings.

• Consumer Choices Option in HCBS waivers will make it easier to hire personal assistants.

• The Iowa Caregivers Association has secured funding to establish a mentoring program for care workers in nursing facilities.
• ICA offers professional development opportunities at its annual conference.
• The legislature has established a study group to recommend training and certification requirements for all classifications of direct care workers.

• Person-centered, case-mix adjusted reimbursement may help address wage disparities between community care and institution workers.
• The Iowa Caregivers Association has actively promoted higher wages for workers and, under the "Better Jobs, Better Care" grant, is exploring ways to provide access to health insurance.