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Rule change for calculating county savings on Medicaid mental health and disabilities services

Hawk Eye, The (Burlington, IA) - 7/25/2014

July 25--The repercussions of the state's mental health and disabilities services redesign legislation, or at least the latest bit passed in May 2014, is rippling through the Iowa Administrative Code, and public comment is part of the process.

The administrative code gives definitions and details on how state law is to be carried out.

Local residents affected by MHDS laws and rules have back-door access to an official advising state leaders.

Des Moines County Supervisor Tom Broeker recently was appointed by Iowa Gov. Terry Branstad to serve on the Mental Health and Disabilities Services Commission.

He announced to those attending the board of supervisors' meeting Tuesday an administrative code amendment has been proposed.

The state Department of Human Services is responsible for administering MHDS laws and therefore is responsible for drafting related administrative code.

The issue covered in the rule change is how Medicaid-offset payments are to be calculated.

It has been one year since the state took over Medicaid services from the county for those who qualify with mental illness or disabilities. Since the counties now are delivering fewer services, they should experience some savings, the state reasoned.

The state promised to pay the counties "equalization payments" for freezing the MHDS property tax rate and making counties lower that rate to $47.28.

But then the state said it would "claw back" money from the equalization payments equal to the supposed savings from Medicaid services no longer delivered by the county.

How to calculate those savings has been a point of contention for about a year, but the rule change is meant to resolve the matter.

The state, at one point, was planning to estimate the savings, but now actual costs per county, and therefore, actual savings per county will be calculated.

The rule change says the costs will be determined by referring to the "Uniform Chart of Accounts for Iowa County Governments," which is a database already in use by counties before the redesign.

Des Moines County Community Services Director Ken Hyndman said the Iowa State Association of Counties has been chosen by the counties, regional MHDS service providers and DHS to be the neutral body that will do the computer query that will come up with actual costs and savings.

Once the savings are calculated, the state law, not the administrative code, says 80 percent will go to the state, which will be put toward mental health and disabilities services. The remaining 20 percent will remain with the new regional MHDS service provider.

Regionalizing services was part of the redesign, which had to be accomplished by July 1. This region's MHDS provider is Southeast Iowa Link, or SEIL.

The public may make comments on the amendment to the Iowa Administrative Code until Aug. 25. Written comments should reference "amendment to Chapter 25, Disability Services Management."

Direct written comments to Harry Rossander, Bureau of Policy Coordination, Department of Human Services, Hoover State Office Building, Fifth Floor, 1305 East Walnut St., Des Moines, Iowa 50319-0114.

Comments also may be sent by fax to (515) 281-4980 or by email to policyanalysis@dhs.state.ia.us.

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(c)2014 The Hawk Eye (Burlington, Iowa)

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