Home Care In Colwell, IA

The Supreme Court of Iowa ruled in favor of appellee Robert F. Colwell, DDS, over the Iowa Department of Human Services in the Supreme Court of Iowa, No. 18-0464, on February 8, 2019, in a case that addressed the way denied claims may be appealed.

Colwell is a general dentist and credentialed dentist Medicaid provider in Iowa, practicing in Council Bluffs. When Iowa opted to expand dental Medicaid coverage to adult beneficiaries in 2014, Colwell elected to add this population and program to his practice.

Yet when Colwell filed his claims with the state’s Medicaid managed care organization (MCO), Delta Dental of Iowa, he says that the MCO unfairly withheld tens of thousands of dollars of his billed fees for dental services. He then filed internal appeals with Delta Dental of Iowa, to no avail, so he went to court.

The Victory

One major thrust of Colwell’s court victory was the right to an impartial appeals process for Delta Dental of Iowa’s denials of claims. Previously, Colwell’s challenges with denied billing claims for services to Medicaid patients were only reviewed internally by Delta Dental of Iowa, which was the initial claims processor.

The lack of an impartial appeals process, Colwell argued, challenged the fiscal solvency of Iowa’s dental Medicaid providers. The Iowa Department of Human Services, as well as its retained agent, Delta Dental of Iowa, allegedly exacerbated the “access to care” problem.

The court ruled that claims for dental services that were previously denied may now be subject to an external, independent, and impartial appeals and review process by state administrative law courts.

The second element of Colwell’s litigation was the right to bill Iowa dental Medicaid patients for services not covered under an MCO’s plan. The court’s ruling emphasized that patients must be fully informed of their personal out-of-pocket costs and the specific services to be rendered (complete informed consent).

The court stressed that Colwell, as all other Iowa dental Medicaid providers, cannot bill the patient for the difference between steeply discounted Medicaid fees and usual and customary rates. The court’s opinion clearly targeted dental treatments, be they be medically necessary or elective, that were not listed as covered services under Delta Dental of Iowa’s Medicaid plan.

The MCO also may not deny a dental provider the right to offer patients dental treatments that aren’t covered by the MCO’s plan. This is consistent with standard of care within the doctor/patient relationship. State dental Medicaid plans may only offer very limited services and not always comport with federal statutes that obligate plans to cover all “medically necessary” care.

Post-Case Comments

“The underlying claims at issue arose from services provided under the Iowa Dental Wellness Plan, which was part of Iowa’s Medicaid expansion that was implemented in 2014. The Dental Wellness Plan provides certain benefits for individuals between the ages of 19 and 64 that do not qualify for traditional Medicaid. Delta Dental contracted with Iowa to serve as the managed care organization for the Dental Wellness Plan,” said Colwell’s attorney, Rebecca A. Brommel.

“We believe this was a win for accountability in that it is forcing the state to allow for hearings before state administrative law judges to review claim denials by Delta Dental. It means the state will review claims and decide whether Delta Dental’s denials can be supported and/or whether Dr. Colwell is entitled to payment for the services performed,” Brommel said.

“We believe it was also a win in clarifying that dentists can charge patients for services that are not covered by Medicaid or a Medicaid-type plan like the Dental Wellness Plan, so long as the patient is given an appropriate disclosure in advance of the treatment.” expanded Brommel.

Delta Dental of Iowa did not respond to a request for comments.

“I am not sure that there are any implications nationally from this matter due to the Iowa-specific nature of the statute, rules, and program at issue.” Brommel concluded.

In the Washington State Dental Association’s pending litigation against Delta Dental of Washington, the WSDA is seeking the right of an impartial review process by a state agency, in the event of claim denials. Obviously, the issue of allegedly unfair dental claims denial by dental MCOs and insurance companies, without a fair and impartial appeals process, is a trending national issue.

Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at [email protected] or smilesofsantafe.com.

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Iowa must consider the appeals of a Council Bluffs dentist who says a Medicaid company is improperly denying payment for the services he provides to poor and elderly residents, the Iowa Supreme Court ruled Friday.

The government program is managed by private corporations and provides dental services to more than 155,000 Iowans.

If dentists can't appeal payment denials, fewer dentists will offer care under the Medicaid program, and more low-income Iowans won't get the care they need, the dentist's attorney argued.

Dentist Robert Colwell contends Delta Dental has for years denied him payment for tens of thousands of dollars in services he provided under the program.

And he says the Iowa Department of Human Services has failed in its responsibility to provide oversight of the for-profit company by refusing him a chance to appeal Delta Dental’s denials.

With no possibility of appeal to DHS, it's more difficult for doctors to challenge wrongful denials and maintain the financial solvency that allows them to provide services to the state’s poor, said Rebecca Brommel, Colwell’s attorney.

Friday’s ruling is a win for accountability, Brommel said.

“Doctors start to say, ‘I don’t want to deal with Medicaid or Delta Dental, so I’m not going to provide services to those patients at all,’” Brommel said. “That then creates an access-to-care problem.”

Segments of Iowa’s $60 million annual dental care program have been managed by two private companies — MCNA Insurance Co. and Delta Dental of Iowa — since 2014. Private management in the dental program expanded in 2017 and now covers almost all adult participants.

The expansion followed a larger shift by Iowa Gov. Terry Branstad in 2015 to privatize the overarching statewide $5 billion Medicaid program, which provides services to 600,000 people.

Hundreds of Iowans in the larger Medicaid program have been denied services since the privatization in situations that were not routinely denied when the state managed the program, doctors and patient advocates say. But in hundreds of those cases, patients were allowed to pursue an appeal through the DHS, and their cases were heard before an administrative law judge.

In Colwell’s case, DHS contended the issue was a contractual dispute between the dentist and the private company. DHS determined Colwell was not entitled to an administrative review, as is the case with individual patients.

Friday’s Supreme Court ruling affirms a Polk County District Court ruling that said Colwell is entitled to a hearing, as outlined in the state’s administrative rules. The ruling, however, reversed the district court’s judgment that awarded Colwell attorney fees.

Spokespeople for Delta Dental and DHS did not immediately respond Friday to requests for comment.

Three Council Bluffs dentists allege a private nonprofit tapped to run a state dental insurance program for low-income Iowans is rejecting more claims than other insurers typically would, forcing them to provide substandard care.

Robert Colwell, Kate May and Richard Duvall have also filed a complaint with the Federal Trade Commission and the U.S. Justice Department, alleging they were illegally penalized as whistle-blowers for reporting problems with the program run by Delta Dental of Iowa.

The three, who also practice in nearby Bellevue, Neb., petitioned the Iowa Department of Human Services to have an administrative law judge interpret Delta Dental’s contract. That judgment, expected in about a month, will help decide whether Delta Dental acted within the law when it terminated the contract with the dentists in January with no cause.

Colwell says he and his associates withdrew a lawsuit this year in Polk County because it would have proven too expensive. Instead, he says, they are pursuing their case administratively through DHS to better protect the almost 136,000 members who have enrolled in the Dental Wellness Plan.

“The state should be stepping in on this, and it is not,” he said. “Enrollees are not getting the care they need.”

Jill Hamilton, a spokeswoman for Delta Dental, said the Johnston-based company denies all the dentists’ allegations.

She claimed neither Colwell nor any of his patients have appealed claims through Delta Dental’s or the state’s appeal process.

But Colwell says he and his colleagues have filed hundreds of online appeals over rejected claims. The problem, he says, is that unlike other insurers, Delta Dental requires that patients participate in appeals to proceed and many won't.

“We can’t even get some of our patients to show up for appointments,” he said.

Colwell says the company also requires many more narratives of cases for claims to be paid, placing a huge burden on dentists.

"They are trying to dictate to doctors how to practice dentistry, or they won't be paid," he said.

Iowa Medicaid contracted with Delta Dental of Iowa in May 2014 to provide comprehensive dental benefits for low-income, uninsured adults. The benefits are supposed to be equivalent to Medicaid’s current dental program, but members become eligible for enhanced benefits with regular follow-up exams.

Colwell contends that since Delta Dental began managing the program it has routinely rejected cases needing immediate attention.

“We have patients who have infections, deep decay or need a root canal. But under the contract with Iowa Medicaid, Delta Dental isn’t allowing these procedures,” Colwell said by way of an example.

Colwell alleged that in some cases decisions to deny claims are being made by dental hygienists, which is illegal.

But Hamilton said such decisions are made by licensed dentists with years of experience and the claims are denied because they do not meet clinical criteria.

I filed an open records request with DHS to see if any other dentists in Iowa have voiced similar complaints with Delta Dental.

Amy Lorentzen McCoy, a spokesperson for DHS in Iowa, said none have. “We are hearing the program is going really well,” she said.

Lorentzen McCoy declined to comment on the dentists’ allegations because of the pending petition with DHS.

According to Delta Dental’s last publicly filed tax return in 2013, the company had year-end assets of almost $60 million. At that time, the company’s president and CEO Jeff Russell made $256,633. That was before the company won the contract to administer the statewide program.

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Now that the driverless car has gone mainstream at least in the conscious of many Americans, it’s time to think about the driverless tractor and other autonomous farm equipment.

John Deere, which provides a broad variety of products for working the land, is now working on applying software to its array of tractors and other offerings to help farmers do more with less effort.

With the world population growing and resources shrinking in some areas, there is a need to produce food faster and easier. John Deere is looking to new technology areas such as artificial intelligence (AI), the internet of things (IoT) and open APIs to help farmers produce more and better crops.

Earlier this year, John Deere sponsored the 2016 agBOT Challenge in Rockville, Indiana, where about a dozen teams of students representing some of the top research universities from across North America competed in a challenge to create the next generation of innovation in the precision agriculture industry. Specifically, students worked to develop a fully-autonomous machine that could load seed, then plant and fertilize a two-acre parcel. The winning team received $50,000, with $100,000 in combined total prize winnings doled out to the top three projects.

Each team devised an unmanned, “robotic” planter, able to follow programmed coordinates through a field while planting seeds and sending real-time information back to the computer. The 2016 agBOT Challenge was a competition for the development of an unmanned crop seeder. The 2017 agBOT Challenge will consist of two competitions: a competition for development of an unmanned crop seeder and a competition for pest and weed identification and eradication. And the 2018 agBOT Challenge will be a competition for harvest method robotics.

Indeed, over the last 15 years, John Deere has worked to help farmers increase production sustainability by developing driverless tractors and sensors that interact with real-time data. At the agBOT event, John Deere also showed off several different precision technology innovations, including an autonomous lawn mower and various applications of the John Deere Operations Center, which acts as a central location to connect a farmer’s machines, operators and fields.

Last week, John Deere opened its data platform to other software suppliers. The company announced that the John Deere Operations Center, which delivers value to farmers with tools and features that enable them to easily access farm information to better manage their operations, has a new page called More Tools. The “More Tools” page provides information and links to solutions from other companies that are using the John Deere open data platform. This enables farmers to access the tools they need from agricultural software providers and keep their data housed in a single location.

“This new page represents a significant step forward for our John Deere precision Ag data solutions,” said Kevin Krieg, software segment manager at John Deere Intelligent Solutions Group, in a statement. “Farmers will now have the ability to not only use our premium Ag data management solution with the John Deere Operations Center, but they will be able to customize their own ‘data toolbox.'”

Moreover, John Deere offers its JDLink Connect solution, which connects the company’s machines to the framer’s Operations Center and handles data collection and transmission for the farmer. It also connects the machines to a John Deere dealer so they can know when to offer support to the farmer.

“The option to pick and choose the solutions that make sense for an operation with practically no extra effort needed to transfer data between them is key for simplicity and usability,” said Krieg. “This setup keeps the farmers in control of their data when they collaborate with trusted partners to put that data to work enhancing their performance and profitability.”

Lane Arthur, director of the Information Solutions Group at John Deere, said the company is working on making its machines smarter and more precise. In that regard, John Deere has embedded a number of IoT technologies into its machines. The company is able to provide “sub-inch” accuracy in harvesting based on the planters it provides. The 24-row planters have three sensors or controllers on each row.

John Deere Adds AI, IoT to Farm Equipment

“A 24 row planter would have 72 basically ‘IoT’ devices on that row, and then the planter itself has another five in the centralized hub,” Arthur said in a statement. “So that planter has 77 IoT devices that are capturing data, and the data they’re capturing is how the machine interacts with the soil, as well as where the seeds are being placed, so we can see what’s called ‘singulation’ of the seed. All of this is happening at six to 10 miles an hour on a tractor.”

However, despite the advances in agriculture technology, Arthur said he is more intrigued by what’s going on in the automotive industry.

“The autonomous automobile area is one of great interest to me,” he said. “Because we solved a certain problem around how to use satellites and drive around machines, and the automotive industry is solving a similar problem in a very different way, using a variety of sensors and fusing those sensors together – using a lot more AI.”

Meanwhile, John Deere is one of four investors supporting a new startup business accelerator in central Iowa that will further establish the region as a destination for agriculture technology. The Greater Des Moines Partnership and the Cultivation Corridor announced the formation of an Ag Tech Accelerator (The Accelerator) with the support of investors DuPont Pioneer, Farmers Mutual Hail Insurance Company, John Deere and Peoples Company. Each investor company committed $100,000 to support the Accelerator for the first year.

“John Deere has long been dedicated to those who are linked to the land, and is always ready to embrace change that leads to new opportunities,” said Cory Reed, senior vice president of John Deere’s Intelligent Solutions Group, in a statement. “Being able to support the continuing progress in the field of precision ag is important both here in Iowa, as well as around the world.”

Mike Colwell, executive director of Entrepreneurial Initiatives at the Greater Des Moines Partnership, told eWEEK: “We expect Artificial Intelligence to have a profound impact on the ag business and to be a part of startups we consider for the Ag Tech Accelerator.”

He noted that the Ag Tech Accelerator will further expand Greater Des Moines’ technology strengths. “Greater Des Moines is already known as a global leader in technology in several areas including agricultural technology, fintech, insurtech, autonomous vehicles and more,” Colwell said.

Moreover, Colwell noted that Greater Des Moines has been named the number four “Tech City to Start a Career” by Computer Training Schools, the number two top Under the Radar Tech Hub by Square Foot, the number eight top city for tech workers by Smart Asset and one of the “5 Tech Hubs With Low Cost of Living “by US News and World Report.

Microsoft also recently announced that it will build its third data center in West Des Moines, which will be the company’s largest data center deployment in the country. Facebook is building a third data center building in Altoona, Iowa.

And the Des Moines-based Global Insurance Accelerator has graduated two classes of six startups that are working closely with established companies in the insurance and financial services industry to spur innovation.

In addition, John Deere APIs enable customers to access a wide range of business and machine data from the Operations Center such as agronomic data such as production data summaries and client, farm, field, and boundary details through the MyJohnDeere API.

Developers also can integrate telematics machine data into their applications through the Machine Monitoring resources in the MyJohnDeere API. And the John Deere Field Connect API enables developers to build apps that provide machine locations, use, alerts, fuel level, and other data points such as soil moisture and weather.

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Columbia Threadneedle’s head of UK equities, Richard Colwell (pictured), will retire in November after over 30 years in industry.

He will be succeeded by Catherine Stanley, managing director of a specialist equities team, and head of equity research Jeremy Smith, who become co-heads of UK equities.

William Davies, global CIO, said: “Richard has had a long and successful career and leaves a strong franchise and track record of delivering for our clients. He has taken a long-term approach to investing, demonstrating clear stewardship over many years.

“As a major shareholder, he has helped guide a number of notable UK companies to deliver good outcomes for all stakeholders. We thank him for his contribution to our clients and our business and wish him well for his retirement.”

Colwell has led the CT UK Equity Income Fund since 2010, which has been continually featured on Bestinvest’s buy list.

Jason Hollands, managing director of Bestinvest, said: “Richard is without doubt one of the biggest beasts in the UK equity income space and his flagship CT UK Equity Income, which he has managed consistently since inception […], is one of the longest standing funds to have held a coveted place on Bestinvest’s Best Funds List. At £3.78bn, it is by some distance the largest fund in the IA UK equity income sector.”

Prior to joining Columbia Threadneedle, Colwell had stints at Schroders, Credit Suisse and Aviva Investors.

Richard Watts, Columbia Threadneedle CIO, EMEA, said: “We place significant emphasis on succession planning and I’m pleased that Catherine and Jeremy will be leading this expanded team, which brings together the existing UK equities and specialist equities teams.

“Together these two teams create one of the largest UK equities desks comprising 21 experienced investment professionals responsible for more than £20bn.

“We believe strongly in the sharing of research, debate and challenge, and the expanded team will bring broader perspectives for the benefit of investment decision making.”

Colwell is lead manager on four funds: CT UK Equity Income, CT UK Equity Alpha Income; CT UK Equity Growth and Income and Threadneedle (Lux) UK Equity Income and co-manager on CT Monthly Extra Income Fund alongside Alasdair Ross.

Jonathan Barber is deputy manager across all five strategies.

From the end of November, Smith will assume lead manager responsibility on the four funds solo-managed by Colwell, while Barber will step up to co-manage the CT Monthly Extra Income Fund alongside Ross, with Smith assuming the deputy role.