Iowa Total Care has announced new enhancements to Availity Essentials, effective April 21, 2025. Key updates include the ability to submit claim corrections directly from the claim status page, an improved Remittance Viewer with advanced search and filter options, and integrated InterQual review functionality within authorization requests. Live training sessions will be held today and tomorrow regarding these features.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have issued guidance (IL 2638) clarifying that home health care providers may complete up to five initial visits without prior authorization, regardless of discipline. These visits are intended to address immediate needs and develop the member’s plan of care. A prior authorization must be submitted before billing for any visits beyond the fifth, or claims will be denied. This policy applies to all Iowa Medicaid MCOs: Iowa Total Care, Molina Healthcare of Iowa, and Wellpoint Iowa, Inc.
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CMS has notified AHCA/NCAL that the mandatory off-cycle SNF provider enrollment revalidation deadline has been pushed back to Aug. 1, 2025. CMS states it will issue an MLN article soon with the formal announcement. Additionally, CMS recently updated its sub-regulatory guidance on this issue. This most recent update, the first since December 2024, adds information related to Section (IV)(B)(2) concerning therapy and other types of services.
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On Friday, April 11, CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2026. AHCA has reviewed the proposed rule and developed a summary outlining key provisions and impacts on members.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have released updated intermediate care facilities for individuals with intellectual disabilities (ICF/ID) rates for July 1, 2025, through June 30, 2026, as outlined in Informational Letter 2674. The new eightieth percentile maximum rate is set at $487.81, with a 2.9% inflation factor applied based on the CPI-U.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have recently provided guidance and clarification on the requirements and configuration for home health care services (HHCS), billed to the managed care organizations (MCOs) on an 837 Institutional (837i) claim requiring Electronic Visit Verification (EVV).
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Nursing facilities certified by Medicare or Medicaid must complete Section Q of the MDS to inform eligible residents about Home- and Community-Based Services and support care in the least restrictive setting. The Iowa Department of Health and Human Services (DHHS) has noted a lack of recent Section Q referrals and reminds providers that referrals are only required for residents who may return home within three months. Additional guidance is available in Informational Letter 1939 and the MDS Section Q Fact Sheet.
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Looking to strengthen your MDS systems or train new staff? IHCA Provider Solutions’ MDS and EHR Consulting Service delivers expert-level support to help your team improve accuracy, uncover missed revenue opportunities and increase efficiency. IHCA members can receive a full evaluation of their current MDS and EHR processes, personalized recommendations for improvement and hands-on guidance from long-term care expert Daleen Seibold, a trusted clinical reimbursement nurse with nearly 30 years of experience.
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As a reminder, skilled nursing facility (SNF) providers enrolled in Medicare or Medicare/Medicaid must submit a mandatory off-cycle provider enrollment revalidation by May 1, 2025. It is important for SNF providers to ensure completion of the revalidation process by May 1 or risk having their Medicare enrollment suspended or revoked. As of mid-March, less than 20% of SNF providers have submitted revalidation applications. IHCA's webinar, "CMS Mid-Cycle Revalidations – Are You Ready?" from last week is now available on-demand to assist providers with this process. This webinar provides SNF owners, senior leadership and key vendors with practical guidance related to their revalidation obligations.
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The Spring 2025 PASRR Roadshow, hosted by Maximus and the Iowa Department of Health and Human Services, will take place April 22–25 in Des Moines, Fort Dodge, Waterloo and Ottumwa. This free, in-person training will provide attendees with in-depth instruction on Iowa’s PASRR provider website, PathTracker+, service delivery and collaboration with community partners. Participants will gain valuable insights into PASRR-identified services, care planning and compliance, with up to 4.25 IBON contact hours available.
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Skilled nursing facility (SNF) providers enrolled in Medicare or Medicare/Medicaid must complete a mandatory provider enrollment revalidation by May 1, 2025, or risk suspension or revocation of enrollment. To assist providers, AHCA is hosting a webinar on March 28 and provides various resources online, while CMS offers detailed guidance and application instructions via PECOS. Additionally, AHCA will hold a webinar on April 1 to educate members on significant changes to the SNF Medicare Cost Report, which includes separate reporting of Medicare Advantage and Medicaid HMO data, enhanced contract labor reporting and more precise revenue categorization.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) released clarification on reporting requirements for recipients of Home- and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Recruitment and Retention (R&R) grant funds. Recipients must submit quarterly expenditure reports and are encouraged to fully expend their grant funds by March 31, 2025, though an extension until March 31, 2026, is available if needed. Final expenditure reports are due by April 30, 2026.
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The Hospital & Healthcare Compensation Service (HCS) invites nursing home providers to participate in its annual Nursing Home Salary and Benefits Study. Please complete the brief questionnaire by May 12. The final report, published by HCS and supported by AHCA, will be available in July. There is no cost to participate. Participants may purchase the results at the reduced participant price of $200, versus the $400 non-participant rate.
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CMS has eliminated the requirement for skilled nursing facilities to submit Medicare credit balance reports (CMS-838) quarterly. However, facilities must still file the form if they have credit balances to report for a given quarter. This rule applies only for Medicare Part A providers. However, the credit balances to report would be for either Part A or Part B overpayments for a Medicare Part A provider.
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IHCA is hosting a live webinar, "CMS Mid-Cycle Revalidations - Are You Ready?", on April 3 to help skilled nursing facility owners, senior leadership and key vendors navigate new heightened disclosure requirements and mid-cycle revalidation obligations before the May 1, 2025, deadline. The session will cover enhanced financial, operational and managerial disclosure requirements and provide practical guidance based on completed revalidations. Registrants will have access to both the live and on-demand versions, with CEU credit available for nursing facility administrators.
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An updated version of the Iowa Medicaid Long-Term Care Financial and Statistical Report (Cost Report) and Cost Report instructions have been posted to the provider forms webpage on the Iowa DHHS website as of Feb. 12, 2025. Please note, this updated version of the Cost Report is required to be used beginning with the fiscal year ends (FYE) Dec. 31, 2024, until a new version of the Cost Report is uploaded to the DHHS website.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have issued Informational Letter (IL) 2654, updating hospice payment policies and replacing previous guidance. A letter from CMS dated Sept. 13, 2024, updated the rates for the two-tiered system and Service Intensity Add-On (SIA), effective Oct. 1, 2024.
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Accurate MDS coding and efficient EHR management are critical for maximizing reimbursement and improving quality outcomes in skilled nursing facilities. IHCA Provider Solutions offers expert MDS and EHR consulting to help your facility optimize revenue, streamline processes and ensure compliance with evolving regulations.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) are requesting Medicaid providers to complete a survey on Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act Section 5042(e)(1)(A) reporting requirements for FFY 2024. The survey gathers data on providers’ compliance with prescription drug monitoring requirements when prescribing controlled substances. The survey will close on March 21, 2025.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have identified an error in 1099-MISC tax forms sent to providers who received fee-for-service (FFS) payments in calendar year 2024. Forms postmarked Jan. 27, 2025, were issued with incorrect payer information and should be disregarded. Providers who received a form listing TIN XXXXX4568, payer name: Iowa Department of Human Services, and address: 1305 East Walnut will receive a corrected version.
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As an IHCA member, you have access to IHCA’s provider network – Iowa Health Care Quality Partners (IHCQP) – a collaboration of over 200 long-term and post-acute care providers. This network has been helping members for years by streamlining administrative processes, improving contract terms and providing valuable resources to support quality care.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently announced the release of the 2024 Home and Community-Based Services (HCBS) Provider Quality Self-Assessment. The HCBS Provider Quality Self-Assessment (form 470-4547) can be found on the Iowa DHHS website and is due this Friday, Jan. 31. The form has been updated and prior years’ versions will not be accepted. A complete and accurate self-assessment must be received no later than Jan. 31, 2025. Failure to submit by Jan. 31, 2025, will jeopardize an organization’s Medicaid enrollment, including managed care contracts, and may result in a sanction of payment suspension.
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Effective Jan. 1, 2025, Iowa Medicaid began using a new assessment tool for members enrolled in the Home and Community-Based Services (HCBS) Intellectual Disability (ID) Waiver. Iowa Medicaid has replaced the Supports Intensity Scale (SIS) with interRAI tools. Also, effective Jan. 1, 2025, managed care organizations (MCOs) no longer conduct assessments for members enrolled in the HCBS ID Waiver. ID Waiver members enrolled with an MCO will now have their assessments completed by Telligen, Iowa Medicaid’s core standardized assessment vendor.
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This week IHCA received notification from the National Veterans Affairs (VA) Office that modifications will be made to the 2025 VA Fee Schedule (VAFS) for home health providers in Iowa. Overall, most of the home health aide rates will experience a slight decrease (5.3%), rather than the 35% decrease in the initial 2025 rate file. Homemaker rates will experience a slight increase of 4.7%, rather than the 28% decrease in the initial 2025 rate file.
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As of Jan. 1, 2025, Iowa Medicaid will no longer cover over the counter (OTC) COVID-19 test kits. CMS ended coverage for OTC COVID-19 test kits on May 11, 2023.
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Effective Jan. 1, 2025, the maximum residential care facility (RCF) per diem rate increased from $36.82 to $37.60. There will be no increase in the flat per diem rate at this time. The flat per diem rate remains at $17.86. Additionally, the personal needs allowance for RCF assistance recipients increased from $123.00 to $126.00 per month, effective Jan. 1, 2025.
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The 2025 Veterans Affairs (VA) Fee Schedule is now available. Rates went into effect on Jan. 1, 2025.
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On Dec. 18, the Iowa Department of Health and Human Services (DHHS) issued Policy Clarification #PC00028, which reduces the allowable managed care organization (MCO) payment recoupment period to two years. The new policies, which apply to all MCO claims, took effect Jan. 1, 2025. IHCA is happy to have worked with the department on this needed change to the managed care system, providing needed relief on the administrative side of many provider’s operations.
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Recently, the Iowa Department of Health and Human Services (DHHS) issued Policy Clarification #PC00028, which reduces the allowable managed care organization (MCO) payment recoupment period to two years. The new policies, which apply to all MCO claims, take effect Jan. 1, 2025. IHCA is happy to have worked with the department on this needed change to the managed care system, providing needed relief on the administrative side of many provider’s operations.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently announced the release of the 2024 Home and Community-Based Services (HCBS) Provider Quality Self-Assessment. The HCBS Provider Quality Self-Assessment (form 470-4547) can be found on the Iowa DHHS website and is due Jan. 31, 2025. The form has been updated and prior years’ versions will not be accepted. A complete and accurate self-assessment must be received no later than Jan. 31, 2025. Failure to submit by Jan. 31, 2025, will jeopardize an organization’s Medicaid enrollment, including managed care contracts, and may result in a sanction of payment suspension.
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CMS recently posted the ninth update to sub-regulatory guidance for the Skilled Nursing Facility (SNF) Mandatory Off-Cycle SNF Provider Enrollment Revalidation process. This update includes three significant changes and updates of which providers need to be aware.
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On Dec. 16, CMS posted the final Office of Management and Budget-approved Outcome and Assessment Information Set (OASIS)-E1 time points instruments, effective Jan. 1, 2025. Additionally, CMS provided updated forms for the Notice of Medicare Non-Coverage, its corresponding Detailed Explanation of Non-Coverage, and the Home Health Change of Care Notice.
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Iowa Total Care has announced several updates regarding home health services and prior authorizations (PAs). Effective Oct. 1, 2024, enhancements have been made to PAs for home health services billed on institutional (837i) claims, and PAs are now required after the care plan creation period (up to the first three visits). Additionally, starting Jan. 3, 2025, home health authorizations will be sent to CareBridge to align with state and managed care organization processes. Providers are encouraged to review training resources, update claim elements in the CareBridge Electronic Visit Verification (EVV) portal and ensure third-party EVV vendors are properly configured.
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Iowa has been selected as one of 20 states where the Unified Program Integrity Contractor (UPIC), CoventBridge, will conduct an audit of the Iowa Medicaid managed care programs (MCPs). The audit will include the managed care organizations (MCOs) and the prepaid ambulatory health plans (PAHPs). CoventBridge may request documentation from providers during the audit. The lifecycle of this audit is expected to be 13 months. Providers are required to comply with the requests for the documentation and the timeframes established by CoventBridge.
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Iowa Medicaid will distribute $1.7 million in funding to eligible providers through the American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Disaster Relief and Recovery Grant. This grant aims to support HCBS providers in counties impacted by disasters with their relief and recovery efforts. Eligible providers can apply for up to $200,000 in grant funds by completing the online application, open now through Dec. 29, 2024. Note: Since the article's original publication on Dec. 11, additional counties have been added to the list of eligible areas.
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Iowa Medicaid intends to distribute $1.7 million to eligible providers from the American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Disaster Relief and Recovery Grant. This grant is intended to provide funding to disaster affected HCBS providers operating in disaster affected counties to assist with relief and recovery efforts. Eligible providers may request up to $200,000 in grant funds by completing the online grant application now through Dec. 29, 2024.
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CMS will host training sessions on several key provisions of the Ensuring Access to Medicaid Services Final Rule (Access Rule) to ensure that all partners fully understand the various home-and community-based services (HCBS) provisions within the rule and have an opportunity ask questions and provide feedback. The first webinar, "Grievance Systems," will take place today, Dec. 11, at 2:00 p.m.
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Iowa Total Care now has Availity Essentials as its secure provider portal. On Nov. 18, 2024, providers became able to submit authorizations and access other payer resources via Availity Essentials.
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In need of an MDS coordinator or additional MDS support? IHCA's experts can help. Through IHCA Provider Solutions’ Remote MDS Service, a team of expert consultants complete your facility’s MDS assessments remotely and develop care plans that align with the MDS.
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Iowa Medicaid and the Iowa Department of Health and Human Services recently announced upcoming Iowa Medicaid pharmacy program changes effective Jan. 1, 2025. The letter includes information regarding changes to the preferred drug list, new drug prior authorization (PA) criteria, changes to existing PA criteria and point of sale billing updates.
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The U.S. Department of Health and Human Services (HHS) recently published the Fiscal Year (FY) 2024 HHS Agency Financial Report, which highlights the Medicare Fee-for-Service (FFS) paid claims error rates for Part A and Part B services for October 2023 through September 2024.
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On Tuesday, Nov. 26, CMS released the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D proposed rule, which aims to hold MA plans more accountable. The release of this rule comes during the Lame Duck period, and it is unclear whether or how the incoming Trump Administration will proceed with these proposed policies.
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Iowa Medicaid and the Iowa Department of Health and Human Services has released a formal policy clarification regarding home health care services electronic visit verification (EVV) claims as a result of the CareBridge system submitting claims with issues or errors.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released a reminder to providers that per their provider agreement, their ownership and control disclosure (OCD) is to be updated within 35 business days after any change in ownership or control.
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In need of an MDS coordinator or additional MDS support? IHCA's experts can help. Through IHCA Provider Solutions’ Remote MDS Service, a team of expert consultants complete your facility’s MDS assessments remotely and develop care plans that align with the MDS.
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On Friday, Nov. 1, CMS issued the Final Rule regarding Medicare home health services payment rates for calendar year (CY) 2025. The rule contains final policies related to the Medicare home health benefit for CY 2025 on payment and quality related programs. The Final Rule will become effective on Jan. 1, 2025. This article provides a summary of the Final Rule.
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Yesterday, CMS extended the due date to May 1, 2025, to submit the new Form CMS-855A SNF Disclosures Attachment 1 nationwide for all SNF revalidations and for all “pending as of Oct. 1” applications. This replaces the original 90-day period that was required to submit information (with exception of states impacted by the recent hurricanes) within receiving notice from a respective Medicare Administrative Contractor between October and December 2024.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released annual submission requirements for prevention and detection of Medicaid fraud and abuse for federal fiscal year (FFY) 2025. Any provider or provider entity that receives payments, in any FFY, of $5,000,000 or more from any state Medicaid program must have written policies for all employees, including management, and for all employees of any contractor or agent. Providers are not required to send copies of their policies but must complete and return the Attestation of Compliance with Section 6032 of The Federal Deficit Reduction Act Form (470-5506) annually. The form can be found on the Iowa DHHS provider forms webpage. For the FFY ending Sept. 30, 2024, the attestation form must be received by Iowa Medicaid by Jan. 31, 2025.
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In an effort to strengthen incident management and reporting, Iowa Medicaid has introduced updated protocols for Home- and Community-Based Services (HCBS) waiver, Habilitation and Money Follows the Person (MFP) providers. These changes emphasize clearer definitions, expanded incident types and enhanced reporting guidelines to support the safety and well-being of members. The effective date of these changes is Nov. 1, 2024, so providers are to begin implementing these changes right away.
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CMS released an update to the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN)—Form CMS-10055 in August. The revised form and updated instructions were made available for immediate use but implementation of the revised document will become mandatory on Oct. 31, 2024. Therefore, IHCA reminds members to review their current SNF ABN to ensure the correct form is being used.
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On Oct. 15, CMS released the annual update for two post-acute care Health Equity Confidential Feedback Reports for Skilled Nursing Facilities (SNFs) in iQIES: Discharge to Community (DTC) Health Equity Confidential Feedback Report and the Medicare Spending Per Beneficiary (MSPB) Health Equity Confidential Feedback Report.
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