April 3, 2017

A note from the State Long-Term Care Ombudsman:

It’s officially spring in Iowa, which makes it an ideal time to reflect on new programs and policies serving those in long-term care. 

On Friday, the Governor signed a bill put forward by the Iowa Department of Inspections and Appeals that would further protect dependent adults living in long-term care facilities. You can find more information on the bill below.

Within the Office of the State Long-Term Care Ombudsman (OSLTCO), April also marks the first anniversary of the launch of managed care in Iowa. As with any anniversary, it’s important to reflect on the year’s activities,successes, and challenges to chart a path for the next year.

The history of the OSLTCO’s Managed Care Ombudsman Program is important to understanding what this new direct service means for Iowa. The Program was created to carry out the legislature’s intent to establish an advocate for Medicaid managed care members receiving long-term services and supports (LTSS). It’s located within the Office of the State Long-Term Care Ombudsman and was structured to harmonize with the existing local long-term care ombudsman program. This placement and leveraging of existing expertise means Iowa now has an ombudsman program that reflects the full-array of modern care settings. Below, we’ve highlighted just a few of the ways that the new program is improving care for countless Iowans.

Deanna Clingan-Fischer, JD

Managed Care Ombudsman Program celebrates first anniversary

Since the launch of the Managed Care Ombudsman Program on April 1, 2016, the Program’s primary charge and ultimate goal is to ensure members receive the care they need, when they need it, and to support members wherever they are in the process of obtaining resolution to their issue, concern or question.To date, the Program has received 1,880 contacts. The issues addressed varied throughout the year, but themes did emerge. This information is documented in the Managed Care Ombudsman Program’s monthly reports, which are sent to the Department of Human Services (DHS), the Centers for Medicare and Medicaid Services (CMS) and state legislators.

The Program also guides individual members who request assistance with their Managed Care Organization (MCO) during their decision-making process. This benefits the member, MCO and the State, because members receive necessary services in a timely fashion, which leads to better health outcomes and often eliminates the need for more costly formal dispute resolution avenues.

In addition to working directly with members, representatives of the Office meet regularly with health policy stakeholders to inform discussion and address systemic issues that are impeding better and more efficient outcomes. The Office has a seat on the Medicaid Assistance Advisory Council (MAAC), regularly updates state and federal policymakers, and helps coordinate less formal discussions across the state, as needed.  Serving members throughout the state in a non-partisan, unbiased fashion leaves the Office in a unique position  to be able to identify and suggest solutions for issues that impact multiple members, populations, locales and specific Medicaid programs. The positive relationships we have built over the course of the year with other state and county agencies, policymakers, workgroups, advocacy organizations, providers and managed care organizations are among the most valuable outcomes for the State this year. Some of our systems advocacy efforts are also discussed in the Managed Care Ombudsman Program’s quarterly reports and will continue to be an important part of our service to Iowans.

To promote and share the value of our expertise, the Office has been diligent in developing tools and resources, many of which are also on our website. With success, comes the responsibility to evaluate areas for growth and improvement.  As we begin a second year in managed care, we will continue to measure and evaluate our methods and outcomes, explore ideas for improvement and refine our services and resources to better meet the needs of the Iowans we serve.

We look forward to continuing our work with each of you, as we all play an important role in making Medicaid managed care a success. If you would like to receive program updates and reports from the Managed Care Ombudsman Program, email managedcareombudsman@iowa.gov to be added to our distribution list.

New requirements for notifying the OSLTCO about discharges

New regulations went into effect in 2016 requiring notices for all discharges/transfers from a facility to be provided to the Office of the State Long-Term Care Ombudsman (OSLTCO). As a reminder:

• All involuntary discharge notices must comply with state regulations still in effect.
• Non-involuntary discharge notices must be transmitted to the Office of the State Long-Term Care Ombudsman per the new regulations. Notices may be transmitted via mail to 510 E. 12th Street, Suite 2, Des Moines, IA 50319, via fax to (515) 725-3313 or via email to cynthia.pederson@iowa.gov.
• Please be sure that the notice includes a reason for the discharge. 
• Do not include protected personal information, such as a social security number or date of birth, in the notice.  
• If using face sheets as notices, please include a reason for the discharge and redact all protected personal information.
• If the notice you are providing includes appeal rights, please include the correct appeal rights for the type of discharge you are issuing.

Please consult your facility counsel, corporate counsel or industry trade association for additional guidance regarding these notices.

Brochures available to Iowa nursing facilities through OSLTCO

The Office of the State Long-Term Care Ombudsman (OSLTCO) has used Civil Money Penalty Quality Improvement Initiative funds to design and publish a series of educational and informational brochures for residents, staff and caregivers in Iowa's nursing facilities. 

To order additional brochures for your nursing facility, please complete and submit the Kiosk Brochure Order Form. Individual brochures will be sent in sets of 20; you may also order a complete set of all the brochures (20 copies of each). At this time, funding is only available to send printed brochures to nursing facilities; if you have questions, please call (866) 236-1430.