Iowa must maintain focus on brain health after midterm elections
Republican Gov. Kim Reynolds and Democratic challenger Fred Hubbell took part in their first face-to-face debate Wednesday night.
Zachary Boyden-Holmes, DesMoines
The midterm election focus on mental health, or more positively termed ‘brain health’ is wonderful and attention to changing the stigma remains important. On behalf of Hillcrest Family Services, I hope support will continue mounting after Tuesday’s elections.
Switching a process midstream may not be the most cost-effective strategy; like trading cars because the washer fluid is low. Suggestions are plentiful, but as anyone with experience managing a highly layered organization knows, systems are complicated. Top-level and front-line folks may be more in harmony with wanting to do the right thing than that carried out by those in the middle.
In April, Hillcrest opened the first Subacute in Iowa. This level in the continuum of care is not just for Medicaid clients. Conceptually like medical skilled nursing, subacute became part of legislative code in July 2015; and in July 2018 it became a core requirement that regions must provide.
Socioeconomic boundaries do not define the need for services. This is not just a Medicaid or managed care issue. Middle-income consumers with commercial insurance are frustrated, too. Hillcrest operates one of the few dual diagnosis residential treatment programs in Iowa. Many families must declare their “child in need of assistance” with the Department of Human Services for admission consideration. Paying out of pocket may not be an option. If authorized, benefits from private insurance might pay part of 30 days’ treatment.
The impetus for “access centers” was a topic in Gov. Kim Reynolds’ Condition of the State Address in January 2018, including substance abuse assessment. Centers will alleviate burden on law enforcement, decrease congestion in emergency rooms and provide less restrictive intervention for the safety of the individual and the community. Funding allocated by legislation remains an issue in many programs, driving the likelihood of sustainable reimbursement.
Dubuque is exploring an access center and assertive community care team (ACT) services, through agency partnership, drawing upon models set up in other states. The goals: maximize existing resources and provide cost-effective, accessible programming.
It is encouraging that the new interim United Healthcare (UHC) CEO facilitated “removing the stops” in processing so Hillcrest received subacute payments, along with a verbal promise to be considered in-network for crisis and subacute services retroactively. Future meetings will cover $766,000 in claims, not including disputed cost settlement, owed Hillcrest for 120-plus days.
We FINALLY have a signed contract addendum for Amerigroup, which promises processing subacute claims in the near future — although not in the next week. Amerigroup, historically prompt with claims, owes us six figures over four months old.
Amerihealth Caritas (ACIA) dropped out of the managed care arena Dec. 1, 2018, and still owes Hillcrest $800,000 in claims alone. State officials indicate final payments owed to ACIA are being withheld pending settlement debts with providers.
Expansion of services is hard to fathom given continued difficulties receiving funds for long-established services. The ongoing battle with the managed care companies for payment prompted consideration of the Hillcrest Board of Trustees ceasing operation of our Subacute Program in August and ongoing monitoring of all programs continue. Appealing to Mike Randol, Iowa Medicaid director, didn’t resolve things; the governor intervened to facilitate progress.
Barriers remain in receiving services when needed. Let’s not lose momentum achieved to date. Many issues relating to basic human needs are important, but brain health is a matter of life or death.
Improvement does not fall on any one person’s shoulder. Expecting one elected official to “fix” a problem is a hands-off approach. It takes investment on everyone’s part and the saying “it takes a village” should apply.
About Hillcrest Family Services: Established in 1896, Hillcrest Family Services is an Iowa-based, 501(c) 3 organization providing more than 30 programs. In our fiscal year 2018, we touched the lives of over 34,000 individuals. The agency’s mission: “As a leading human services provider for children, adults and families in need, we deliver innovative, collaborative, and resourceful care.”
Julie Heiderscheit is president/CEO of Hillcrest Family Services, Dubuque. She holds an MBA from the University of Iowa and has more than 20 years in various health and human service organizational experience.
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