JANUARY 2016

A Note from the State Long-Term Care Ombudsman:

Greetings and Happy 2016!

As we look ahead to the new year and all of its possibilities, it appears the next 12 months will be an important time for all of us who advocate on behalf of residents and tenants living in Iowa’s long-term care facilities. 

Although only a fraction of Iowans are Medicaid members, the changes coming to Iowa’s Medicaid system have the potential to significantly impact all Iowans, especially those who are dependent on others for care or assistance with daily activities. That’s because Iowa’s ability to transition to managed care is contingent upon ensuring that Medicaid members have an advocate when it comes to protecting their rights, health, safety and quality of care.

As you will read below, the legislature authorized the Office of the State Long-Term Care Ombudsman to create a Managed Care Ombudsman Program to serve as the advocate for members who currently live or receive care in health care facilities, assisted living programs or elder group homes, as well as those who are enrolled in select home and community-based services (HCBS) waiver programs. This equates to approximately 57,000 of Iowa’s 560,000 Medicaid members and is significant in that it recognizes how important it is for this very vulnerable population to have access to someone who can address their complaints and represent their best interests.

However, understanding that all health consumers are, at times, in need of protection and advocacy, the legislature also wrote a requirement into Senate File 505 for the OSLTCO to convene a multi-agency taskforce to develop a proposal as to how the State could establish a coordinated system of independent consumer supports to ensure Iowans are able to obtain health care and “are assisted in resolving issues regarding health care services, coverage, access and rights.”

The taskforce filed its final report in mid-December, which strongly recommends the establishment of a formal Health Consumer Ombudsman Alliance, the development of a Medicaid managed care information program, the implementation of a statewide single point of entry to the Alliance and the expansion of both the current Managed Care Ombudsman Program and Iowa’s legal assistance network to enhance Iowans’ access to protection and advocacy services.

The fact that so many different agencies and organizations who serve different populations worked together to develop a plan to strengthen the advocacy safety-net for all Iowans is worth celebrating. While I cannot predict the future, I will say that I am excited about the prospects that 2016 holds for Iowa, including its long-term care residents/tenants and their caregivers. With legislators so focused on the importance of advocacy, we have an excellent opportunity to work together to shape public policy that benefits everyone who lives in our state.

Deanna Clingan-Fischer, JD

Managed Care Ombudsman Program prepares to advocate for Iowa's Medicaid members

Iowa is preparing to transition Medicaid members to the new managed care program, IA Health Link. Managed care is a health care delivery system that provides Medicaid health benefits and services through a managed care organization (MCO). Health care professionals (doctors, therapists, case managers, etc.) will work together under one program to provide members with health benefits and services in order to improve quality of care.

Legislation passed in July authorized the Office of the State Long-Term Care Ombudsman (OSLTCO) to establish a Managed Care Ombudsman Program (MCOP) to advocate for the rights of Medicaid managed care members who live or receive care in a health care facility, assisted living program or elder group home, as well as members enrolled in one of the following seven home and community-based services (HCBS) waiver programs:

• AIDS/HIV
• Brain Injury
• Children’s Mental Health
• Elderly
• Health and Disability
• Intellectual Disability
• Physical Disability

Through advocacy, self-empowerment and education, the MCOP works to ensure that Iowa Medicaid members' rights are honored and that they are treated with dignity and respect. To do this, the MCOP provides education and information, advocacy and appeals assistance to Medicaid managed care members and individuals who are potentially eligible for Medicaid. All services provided by the MCOP are confidential and free of charge.

For assistance resolving a concern that impacts quality of care, or to learn more about Medicaid managed care members' rights, specific topics related to Medicaid managed care or other available resources, please visit our website or contact the MCOP at (866) 236-1430 or managedcareombudsman@iowa.gov.

Iowa's Office of Substitute Decision Maker provides education, assistance

The Office of Substitute Decision Maker (OSDM) is established in Iowa Code 231E and strives to enhance the quality of life for Iowans who are not capable of making their own decisions about legal, financial or health care matters. The OSDM’s mission is to preserve individual independence through a person-centered process by providing education and assistance to public and private substitute decision makers throughout the state and by providing substitute decision making services in the least restrictive manner as an office of last resort.

Depending on the situation, the OSDM may act as an individual’s guardian; conservator; attorney-in-fact under a health care power of attorney document; agent under a financial power of attorney document; representative payee; or personal representative. The OSDM may also intervene in a case where an appointed guardian or conservator is not fulfilling the prescribed duties, or when the best interests of the ward require intervention.

The OSDM will only accept an application and serve if the office is the substitute decision maker of last resort. To be eligible, an individual must be an Iowa resident who is at least 18 years old who has no appropriate or responsible person available to serve as a substitute decision maker or who is without adequate resources to compensate a substitute decision maker.

When making decisions on behalf of Iowans not capable of making their own decisions, the OSDM takes many factors into consideration, including, but not limited to, the individual’s wishes and directions; the input of caregivers and other persons with knowledge of the individual’s directives; and the individual’s best interests and safety, security, health and welfare.

If you have questions about the Office of Substitute Decision Maker, the services or assistance provided by OSDM or an individual that may be served by OSDM, please contact Susan McCall at susan.mccall@iowa.gov or (515) 725-3039.

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Learn more about anxiety, an underrecognized symptom of Parkinson's Disease, when you join this one-hour online seminar presented by the Parkinson's Disease Foundation. It is free and open to everyone.

> Register

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This webinar sponsored by Home Instead Senior Care will outline the 50/50 Rule, a program designed to help adult siblings improve communication skills and better care for aging parents. It is free and open to everyone and includes complimentary CEUs.

> Register

Elder Law Seminar: Rights of Residents in Long-Term Care
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This online seminar sponsored by the OSLTCO and Iowa Legal Aid will discuss residents' rights, Medicaid eligibility for long-term care services and sexual expression in long-term care environments. It is free and open to everyone.

> Register

Online Survey:
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This online survey is an opportunity for long-term care providers to share information about providing person-centered care. The study by the Rothschild Foundation focuses on the changing culture of care that prioritizes choice and autonomy for consumers and providers of long-term care.

> Take Survey