After being in hawk-i for a year: Second Evaluation Report Data Used January 1999 - October 2000 Third Evaluation Report Data Used July 2001 - October 2002 Fourth Evaluation Report Data Used July 2002 – October 2003 Medical Care – Children needed health care at rates similar to when they joined, however: they were less likely to be stopped from getting needed care. 21% before vs. 6% after 19% before vs. 6% after 17% before vs. 4% after they were less likely to be delayed from getting needed care. 34% before vs. 10% after 32% before vs. 10% after 23% before vs. 7% after children were more likely to have ‘always’ received needed care for an illness or injury Data not available. 61% before vs. 80% after 65% before vs. 82% after Specialty Care – Children needed to see a specialist at rates similar to when they joined, however: they were less likely to be stopped from getting specialty care. 38% before vs. 13% after 21% before vs. 15% after 18% before vs. 10% after they were less likely to be delayed from getting specialty care 39% before vs. 23% after 33% before vs. 15% after 27% before vs. 13% after Dental Care – Children needed dental care at the same rate as when they joined, however: they were more likely to have a regular source of dental care. 84% before vs. 88% after 81% before vs. 88% after 82% before vs.86% after they were less likely to be stopped from getting dental care 25% before vs. 8% after 23% before vs. 8% after 22% before vs. 8% after they were less likely to be delayed from getting dental care 27% before vs. 9% after 26% before vs 9% after 23% before vs.9% after they were more likely to have had a dental visit in the past year 55% before vs. 69% after 54% before vs. 71% after 56% before vs.69% after Preventive Care – Children were more likely to Children were more likely to Children were more likely to
have ‘always’ received needed routine preventative care (e.g. physical exams or vaccinations) (percentage not available). have ‘always’ received needed routine preventative care (e.g. physical exams or vaccinations) (60% before vs. 82% after). have “always” received needed routine preventive care (e.g. physical exams or vaccinations) (65% before vs. 82% after) Children were also as likely to receive anticipatory guidance (preventive counseling) as before they joined. Other Care – Children had similar need for vision care, however: they were less likely to have been stopped from receiving vision care. 41% before vs. 15% after 38% before vs. 14% after 32% before vs. 9% after Children had a similar need for behavioral or emotional care, however: they were less likely to have been stopped from receiving behavioral or emotional care. 44% before vs. 15% after 39% before vs. 17% after 39% before vs. 16% after Children had a similar need for prescription medicine, however: Perceived need for prescription medicine increased from 70% to 75%, however, they were less likely to have been stopped from receiving prescription medicines. 20% before vs. 10% after 17% before vs. 8% after 15% before vs. 10% after Health Status – children’s overall 43% were rated 44% were rated 45% were rated
February The Department reported to the Board that a ranking of enrollment among the 50 states shows that Iowa increased enrollment 32.57% in FY 02 over 01. The increase nationally was 13.04%. March The hawk-i Board did not meet in March. April The Board was advised that the first printing of the revised application has been completed. Permission to develop an electronic application that goes with the new application format was given to the Department. The Board approved the Fourth Amendment to the Contract with Iowa Health Solutions for health care services for the hawk-i Program to include expansion into Dallas and Madison Counties effective June 1, 2003. The expansion will provide enrollees a choice between John Deere Health Plan, currently providing health care services in the two counties, and Iowa Health Solutions. The Department reported on the discussion of the Clinical Advisory Committee meeting. The Committee has determined they will look at attention deficit hyperactivity disorder (ADHD) on children with hawk-i. The University of Iowa’s Public Policy Center will complete the special study. The Department updated the Board on the implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA). A notice of privacy practices for hawk-i was developed and distributed to approximately 8,200 households on April 14, 2003. The hawk-i privacy notice is available in English and Spanish and is posted on the hawk-i website. Ongoing, when a child is approved to receive benefits under a notice will be sent to the family. In addition to the privacy notice the Department will implement two electronic transaction sets, payment of premiums and enrollment and disenrollment. Implementation for the transaction sets between the Department and contracted health plans is October 16, 2003. May The Board approved SFY 04 capitation rate increases of 8.8% for Wellmark Indemnity and 10% for Iowa Health Solutions and John Deere managed care plans. The Board was advised that the Governor signed the Department’s technical bill on May 12, 2003. The technical bill requires the number of hawk-i Board meetings from ten to no less than six and no more than twelve per calendar year, eliminates the six month waiting period for children who had employer-sponsored health care coverage allowing children to have health care coverage through the hawk-i Program, changes Healthy and Well Children to Kids to reflect the actual name of the Program and amends the name of the division that currently administers the hawk-i Program from Medical Services to Financial, Health and Work Supports.
Coverage for full continuum of treatment services Adequate provider panels Admission, discharge, continued stay, and placement criteria are specific to children and adolescents and that the Iowa Juvenile Placement Criteria for substance abuse be used. organic disorders, nicotine and caffeine use problems, pervasive developmental, TIC and neurological disorders, conduct and impulse control disorders, antisocial personality disorder, paraphilias, insomnia and other sleep related disorders (some of these may be covered under the medical part of the plan) Wellmark excludes bereavement counseling or services, family counseling, impulse control disorders, certain developmental and learning disorders, certain disorders of early childhood, communication disorders, nicotine dependence, sensitivity, shyness and social withdrawal disorder, sexual identification or gender disorders. All of the health plans provide inpatient and outpatient services subject to above limits. John Deere covers partial hospital/day treatment programs that may be independent or Wellmark reimburses for mental health day programs based out of the hospital setting billing using a UB92. For community mental health centers to be able to provide day programming, they can only bill services using an HCFA-1500; therefore, level of reimbursement for CMHC’s would be different. Each plan has its own criteria to determine medical necessity for mental health and substance abuse. The benefits and pricing make provision for inpatient days and outpatient visits. Intent was not to exclude service locations. Cost is dependent on what method the quality assurance committee would recommend to determine adequate access. A cost estimate is not necessary for this. 5. Nutrition Services. Medically necessary nutrition services should be covered by a license dietitian with a physician’s referral. Provide for nutrition services beyond basic Iowa Health Solutions covers medically necessary nutritional services. In certain cases allow coverage for medically necessary formulas. Each case is reviewed individually by the Cost estimate for nutrition services: $16- $17 per half hour, with an estimated frequency of 200/1000/year = .27 per member per month to .28 per member per month
IOWA’S SCHIP ALLOTMENTS FFY 1998 (began October 1, 1997) FFY 1999 (began October 1, 1998) FFY 2000 (began October 1, 1999) FFY 2001 (began October 1, 2000) FFY 2002 (began October 1, 2001) FFY03 (began October 1, 2002) FFY 04 (began Oct. 1, 20003) Allotment* $32,460,463 $32,307,161 +$3,957,863 carryover from FFY 1998 Total $36,265,024 $32,382,884 +$4,787,171 carryover from FFY 1999 Total $37,170,055 $32,940,215 +$4,222,574 carryover from FFY 2000 Total $37,162,789 $22,411,236 $21,368,268 $19,703,000 Expenditures * $26.3 $24,846,556 $28,724,249 $32,885,307 $43,968,839 (estimated) $ Unspent Funds* $ 6.1 ($2.2) reverted $3.96** carried over to FFY 1999 $0 $11,387,171 ($6.6) reverted $4.8** carried over to FFY 2000 $0 $8.4 reverted ($4.2) reverted $4.2 *** carried over to FFY 2001 $0 $3.2 estimated) $ $ Months of Federal Fiscal Year 10-11-12-1-2-3-4-5-6-7-8-9 10-11-12-1-2-3-4-5-6-7-8-9 10-11-12-1-2-3-4-5-6-7-8-9 10-11-12-1-2-3-4-5-6-7-8-9 10-11-12-1-2-3-4-5-6-7-8-9 * In Millions