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State health care authorities approved a change in how health care providers are reimbursed for long-term Medicaid support and services. But some of those providers say the new system doesn’t pay enough for them to maintain quality care for all enrollees.

The Council on Human Services unanimously voted yes Wednesday to approve a tiered-rate payment system for the home- and community-based services waiver, replacing a fee-for-service system.

That waiver to the Affordable Care Act affects about 5,000 Iowans with traumatic brain injuries or developmental or intellectual disabilities who go to providers for day rehabilitation or adult day care services.

Department of Human Service staffers who spoke during the meeting said the rule change was a move in the right direction, as it pays for care rather than based on the provider setting.

However, the change left some local providers with less funding for the same level of services, including a small Johnson County organization, the Village Community, facing a funding cut of more than 50 percent.

“I guess I’m disappointed,” said Ann Brownsberger, executive director of the Village Community, who listened in on the teleconference. “It just went over with very little fanfare and very little discussion, and I think the concerns that have been expressed by the community as a whole — members, families, providers — I feel were really unheard and dismissed.”

The council, which acts as a policymaking and advisory body on matters within the Department of Human Service jurisdiction, voted after reviewing public comment on the proposed rule change.

Under the previous payment model, the approximately 423 providers who serve that waiver population received funds based on a fee-for-service model.

The payment model approved by the Council on Human Services Wednesday places each member under the home- and community-based services waiver into tiers — one through six — based on the enrollee’s needs. Tier one is the lesser amount of reimbursement, and tier six the greatest.

Many providers say the assessment was not comprehensive and did not accurately measure the level of care the members actually need.

“My only beef with tiered rates is the actual rates. ... It would be nice if there were a system in place where your reimbursement was somehow reflective of the quality of care you are providing.”

Department of Human Services spokesman Matt Highland said in an email to The Gazette tiered rates were put in place as a result of a law — a section of House File 653, passed last year — that went into effect Dec. 1.


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