CMS will begin validating Minimum Data Set (MDS) data for the Skilled Nursing Facility (SNF) Value-Based Purchasing and Quality Reporting Programs on Jan. 1, 2026, with provider notifications starting mid-January 2026. SNF providers will be randomly selected, and selection notices will be posted in the MDS 3.0 Provider Preview Reports folders within iQIES. This data validation process is intended to ensure the accuracy of MDS-based quality measures, as required by federal law, and will apply beginning with the FY 2027 program year/FY 2025 performance period. Providers should monitor their iQIES folders for notifications and review available CMS training resources for additional guidance.
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MDS Support helps IHCA nursing facility members improve MDS accuracy, timeliness and efficiency while supporting compliance and protecting reimbursement. Facilities can choose Remote MDS for short-term staffing support with assessments completed by clinical experts, or MDS + EHR Consulting to strengthen their current workflow through process evaluation and customized improvement recommendations.
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Effective Jan. 1, 2026, all Wellcare (Medicare) prior authorization requests for certain services will transition from Evolent to Wellcare, with no changes to Iowa Total Care (Medicaid) processes. Affected services include advanced and cardiac imaging, therapies, select surgeries, oncology services and interventional pain management, with all requests required to be submitted through Wellcare’s secure provider portal.
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As part of Iowa Total Care's ongoing work to improve the prior authorization (PA) process for both providers and members, Iowa Total Care is sharing some important updates to their PA requirements. Their goal is to reduce administrative burden, simplify submission and approval processes and facilitate timely access to appropriate, high-quality care. Code changes will become effective on April 1, 2026.
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Iowa Medicaid and Iowa Department of Health and Human Services (DHHS) have announced upcoming updates to Home- and Community-Based Services (HCBS) waiver service names, procedure codes and Attendant Care forms, effective Jan. 1, 2026. The changes affect multiple waivers, including AIDS/HIV, Brain Injury, Elderly, Intellectual Disabilities and Physical Disability, and will align service names and codes with updated Medicaid fee schedules. Providers are encouraged to review the implementation guidance and prepare their systems in advance, as a revised Attendant Care form will also be released to support Electronic Visit Verification (EVV) and documentation requirements.
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IHCA Provider Solutions offers flexible MDS Support services to help long-term care facilities maintain accurate, timely submissions and protect compliance and reimbursement. Providers can choose between Remote MDS services or MDS and EHR Consulting, both delivered by experienced clinical experts with deep knowledge of MDS, PDPM and care planning. These services are designed to fill staffing gaps, strengthen workflows and support measurable operational improvements with minimal disruption.
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CMS has formally suspended the mandatory off-cycle skilled nursing facility (SNF) provider enrollment revalidation deadline that had been set for Jan. 1, 2026, with no new deadline announced at this time. The suspension was confirmed in CMS’s Dec. 11, 2025, MLN Connects Newsletter, with CMS indicating that additional guidance will be provided in future updates.
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As 2026 approaches, Home Health Value-Based Purchasing (HHVBP) measures continue to evolve, with performance from multiple years influencing future payment adjustments. Provider Insights’ 2026 HHVBP comparison sheet helps agencies understand how 2024 and 2025 performance data connect to updated measures taking effect in 2026, providing a clear, at-a-glance view to support planning and compliance.
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Since launching earlier this year, IHCA Provider Solutions’ Enrollment Support service has helped participating facilities achieve Medicaid approvals in an average of 36 days from initial family contact. By managing the full Medicaid application process, Enrollment Support reduces administrative burden, accelerates admissions and eligibility decisions and supports stronger cash flow while improving the experience for residents and their families.
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On Thursday, Dec. 4, CMS informed AHCA that the mandatory off-cycle SNF provider enrollment revalidation deadline of Jan. 1, 2026, has been suspended indefinitely. Official guidance has now been released from CMS on the off-cycle 855 revalidations.
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The Iowa Medicaid Long-Term Services and Supports (LTSS) team, in partnership with the managed care organizations, invite you to join for a special Home- and Community-Based Services (HCBS) Enabling Technology Town Hall held tomorrow, Dec. 11, at 2:30 p.m.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2720 regarding the increase of personal needs allowance and maximum per diem rate for residential care facilities (RCFs). Effective Jan. 1, 2026, the maximum RCF per diem rate will increase from $37.60 to $38.47. There will be no increase in the flat per diem rate at this time. The flat per diem rate remains at $17.86.
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Iowa Medicaid has released the Home Health Low Utilization Payment Adjustment (LUPA) rates effective July 1, 2025. These updated rates apply to home health services delivered under the state Medicaid program for the current fiscal year.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released an amended informational letter (IL) 2711 on Dec. 9, 2025. This serves as an amendment to the original IL 2711, published on Nov. 14, 2025. The updates include correcting the citation for Iowa Administrative Code and adding a link to the Telecommunication Technology Guide. The effective date of the IL remains the same.
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On Nov. 28, CMS issued the calendar year (CY) 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Updates Final Rule. CMS has also released a fact sheet accompanying the final rule, along with a fact sheet addressing durable medical equipment competitive bidding provisions. The overall impact of the rule is an estimated -1.3% ($220 million) decrease in payments relative to CY 2025. This is in comparison to a proposed -6.4% ($1.135 billion) decrease in payments relative to CY 2025.
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CMS has issued notices to home health agencies that did not meet Home Health Quality Reporting Program requirements for the CY 2026 annual payment update, with notifications posted in iQIES on Nov. 26, 2025. Medicare administrative contractors will also send follow-up letters, and non-compliant agencies may request reconsideration by Jan. 6, 2026. CMS reminds providers that reconsideration requests must be under 20 MB and cannot contain any protected health information.
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On Thursday, Dec. 4, CMS informed AHCA that the mandatory off-cycle SNF provider enrollment revalidation deadline of Jan. 1, 2026, has been suspended indefinitely. CMS is not announcing a new compliance date at this time and will post a formal notice in the coming days.
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Skilled nursing facility (SNF) providers enrolled in Medicare or Medicare/Medicaid must submit a mandatory off-cycle provider enrollment revalidation by Jan. 1, 2026, or risk having enrollment suspended or revoked. CMS extended the deadline from Aug. 1, 2025, following AHCA/NCAL advocacy efforts for relief on the extensive new reporting requirements. AHCA/NCAL continues to advocate for additional relief. However, as this deadline still stands, it is important for SNF providers notified by their Medicare administrative contractor to ensure completion of the revalidation submission process by Jan. 1.
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Iowa Medicaid and Iowa Department of Health and Human Services (DHHS) have issued IL 2717 outlining annual fraud- and abuse-prevention submission requirements for providers or entities receiving $5 million or more in Medicaid payments during a federal fiscal year. Eligible providers must maintain specific written policies and submit the required Attestation of Compliance form (470-5506) by Jan. 31, 2026. Failure to comply may result in sanctions, including suspension or termination from the Iowa Medicaid program.
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CMS has approved a one-year temporary extension and amendment of the "Iowa Wellness Plan" section 1115 demonstration. This approval allows the state to continue operating the demonstration through 2026 and sunsets the waiver of non-emergency medical transportation on Dec. 31, 2026.
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Iowa Medicaid has announced the release of the 2025 Home- and Community-Based Services (HCBS) Provider Quality Self-Assessment questionnaire, which is due Jan. 31, 2026. All HCBS waiver and habilitation providers enrolled for the services listed in this article are required to complete this annual HCBS Provider Quality Self-Assessment. Failure to submit by Jan. 31, 2026, will jeopardize an organization’s Medicaid enrollment, including managed care contracts, and may result in a sanction of payment suspension.
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Iowa Medicaid is aligning with the requirements for the coordination of benefits to ensure when a member has both Medicaid and commercial insurance (primary payer), Medicaid is the payor of last resort. Payments cannot exceed the Medicaid allowable amount or the amount paid by commercial insurance. This is known as the Lesser of Logic. This policy is effective for claims received by managed care organizations (MCOs) and dental plans on or after Dec. 1, 2025. Implementation for Fee-For-Service claims will occur at a later date and additional guidance will be provided. This logic has been applied to Medicare claims since July 1, 2017, and will be extended to commercial claims received on or after Dec. 1, 2025, for claims received by MCOs and dental plans.
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A recently passed continuing resolution restores Medicare telehealth flexibilities for home health and hospice face-to-face (FTF) encounters through Jan. 30, 2026, retroactive to Oct. 1, 2025, preventing denials during the shutdown period. The law also renews funding for Medicare hospice surveys, halts an additional 4% sequestration cut by waiving Statutory PAYGO through 2026, and stabilizes VA and TriCare funding so claims from the shutdown period can be paid.
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The One Big Beautiful Bill Act introduces major Medicaid changes that will significantly affect Iowa’s long-term care providers, including reduced retroactive coverage beginning in 2027, more frequent eligibility redeterminations and new asset and home equity limits in 2028. While the law delays the federal staffing mandate, it also adjusts how states can finance Medicaid, creating additional operational and administrative considerations for providers. Facilities will need to prepare for shorter coverage windows, increased renewal activity and upcoming eligibility rule changes.
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Iowa Medicaid’s new guidance establishes that, beginning Dec. 1, 2025, telehealth services billed with POS codes 02 or 10 will receive reduced reimbursement to account for the lower cost of virtual care compared to in-person visits. Providers must ensure services are on the approved telehealth list and billed with the correct POS code, with fee-for-service implementation details to be issued later. The Iowa Department of Health and Human Services (DHHS) and the MCOs have provided contact information for questions and additional support.
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Iowa Medicaid’s new policy requires certain medications to be dispensed in 90-day supplies beginning Dec. 1, 2025, with a single dispensing fee and one copay per 90-day fill. Beneficiaries in long-term care facilities, residential programs and medically needy populations are excluded, and pharmacists may use an override code when medically appropriate. A full list of affected medications is available on the Preferred Drug List website.
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The Iowa Department of Health and Human Services (DHHS) has released an updated version of form 470-2115 – Authorization to Disclose Personal Health Information (PHI) Form for Eligibility Verification Purposes. This form replaces the previous version of form 470-2115 – Authorization for the Department to Release Information. Effective immediately, any prior versions of form 470-2115 on file that have not yet expired cannot be honored for the release of information. Facilities and individuals must use the new form to authorize the release of information to Iowa DHHS. Providers should ensure they are using the updated form moving forward to avoid delays in eligibility verification or information requests.
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On Nov. 10, Iowa Total Care released an updated Provider News Alert regarding prior authorization (PA) requirements, originally published on Nov. 3. The revised alert includes key updates regarding additional details on behavioral health PA requirements, inclusion of a new maternal health item and code changes effective Feb. 1, 2026. Aside from these updates, the information remains consistent with the version previously issued. Providers are encouraged to review the full alert carefully to ensure compliance with the updated effective date and new requirements.
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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.
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Last Friday, Oct. 31, CMS issued a final rule establishing final payment rate under the Medicare Part B Physician Fee Schedule and other policy updates for calendar year 2026. The rule will become effective for items and services beginning on Jan. 1, 2026. Also on Oct. 31, CMS issued an additional revision to a previously released memo on its contingency plans during the federal government shutdown. Per the updated memo, CMS is now allowing survey revisits for discretionary denial of payments that are in effect.
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Iowa Total Care announced updates to its prior authorization (PA) requirements effective Nov. 3, 2025, aimed at reducing administrative burden and improving access to care. The revisions include removing certain PA requirements, standardizing rules across service categories and markets and refining criteria for services. Providers are encouraged to review the updated code list and contact their provider relations specialist with any questions.
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Enrollment Support from IHCA Provider Solutions helps facilities simplify admissions and protect revenue by managing the entire Medicaid application process at no cost to the facility. Diana Roberts of Healthcare of Iowa says the service has been “night and day” for her team — reducing administrative burden, improving cash flow and enhancing the experience for residents and families. Learn more about how Enrollment Support can strengthen your facility’s financial stability and streamline your workflow.
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Medicare's open enrollment period is here! Visit Medicare.gov/plan-compare now through Dec. 7 to compare all your coverage options.
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For nursing facilities operating on a calendar year fiscal year, this is the ideal time to evaluate and, if needed, make adjustments to your licensed bed capacity before the new year begins. Changes to certified beds must take effect on the first day of the cost reporting year or the first day of a cost reporting quarter — meaning providers who wish to update their bed capacity for the 2026 fiscal year should complete the process in time for changes to take effect by Jan. 1, 2026. Having adjustments in place by the start of the year ensures that the entire fiscal year reflects the updated capacity.
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Since launching earlier this year, IHCA Provider Solutions’ Enrollment Support service has already made a measurable impact for participating facilities — with early results showing an average of just 36 days from first contact with a resident’s family to Medicaid approval. Early users report faster admissions, reduced administrative burden and stronger financial stability.
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Accurate, timely MDS submissions are critical to your facility’s compliance and reimbursement — and IHCA Provider Solutions is here to help. Whether you’re facing temporary staffing gaps or looking to improve your current MDS workflow, our MDS Support services are designed with your needs in mind.
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The Iowa Department of Health and Human Services (DHHS) submitted the nursing facility rebasing state plan amendment (SPA) to CMS on Sept. 25, securing a retroactive effective date of July 1, 2025. Key figures include a $90.31 direct care median, $139.15 non-direct care median, and a -8.269% inflation factor, with rate sheets expected in mid-October. All QAAF payments must now be mailed to the Iowa Medicaid Minnesota lockbox.
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The flexibility allowing telehealth for face-to-face (FTF) encounters in home health and hospice expired yesterday, Sept. 30, 2025. As of now, CMS has not indicated any plans to extend this waiver. All FTF encounters for home health and hospice were to be completed by Sept. 30, 2025, to be eligible for telehealth. Going forward, FTF encounters must return to in-person visits, regardless of the start of care or recertification timing.
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The Preliminary CY 2025 Annual Performance Reports (CY 2025 APRs) for the expanded Home Health Value-Based Purchasing (HHVBP) Model have been published in the Internet Quality Improvement and Evaluation System (iQIES).
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Effective Oct. 1, 2025, Iowa Total Care has provided a list of manufacturers that will be terminated from the Medicaid Drug Rebate Program (MDRP) and will no longer be covered. For additional information regarding the MDRP changes please email the Iowa Total Care pharmacy team at
[email protected].
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On Jan. 1, 2026, CMS will implement new prior authorization (PA) response time requirements for all providers. With shorter response times for supporting clinical information requests, all necessary clinical information should be submitted at the time of the authorization request. Centene clinical policies and criteria can be found at Availity or on Iowa Total Care’s clinical, payment and pharmacy policies webpage.
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IHCA Provider Solutions’ Enrollment Support helps member facilities simplify the Medicaid application process by managing submissions, recertifications, RFI responses and real-time resident tracking. The service also provides a powerful admissions platform for verifying eligibility, generating agreements and ensuring compliance — all at no out-of-pocket cost to IHCA members. It is part of a broader suite of Provider Solutions designed to optimize operations and reduce burdens for long-term care providers.
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Iowa Medicaid and the Iowa Department of Health and Human Services have launched a new Provider Self-Assessment (PSA) application within the Iowa Medicaid Portal Application (IMPA) to streamline the annual self-assessment and Home- and Community-Based Services (HCBS) provider tracking process. The 2025 provider self-assessment has not been issued yet, and there is no due date at this time. Right now, the expectation is that providers ensure they can access the application. From there, verify your organization’s contact details, program/service enrollment and qualification information, ensuring that HCBS settings are correct.
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CMS is overhauling its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit program, expanding reviews to all 500+ MA plans, increasing record samples to 200 per plan and adding 2,000 coders by September 2025 with artificial intelligence support. Audits for payment years 2018–2024 are slated for completion by early 2026. Long-term and post-acute providers may face increased record requests, tighter turnaround times and potential clawbacks through MA contracts, as AHCA continues urging CMS to address system-wide impacts.
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Iowa Medicaid will host its 2025 Annual Medicaid Provider Training this fall, with sessions offered in person on Sept. 30 in Des Moines and virtually on Oct. 14. Providers must register by Sept. 19 to participate, choosing either the in-person or virtual option. The training offers an opportunity to connect with Iowa Medicaid, ask questions and learn about program updates impacting providers. Additionally, Iowa Medicaid now offers competency-based training and technical assistance for long-term care providers and case managers, with resources available for a wide range of services.
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Enrollment Support from IHCA Provider Solutions manages the entire Medicaid enrollment process from start to finish. That includes application submission, recertifications, real-time tracking and more. It also features an all-in-one platform for verifying eligibility, payor sources and generating electronic admission agreements.
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AHCA has released a new toolkit to support skilled nursing facilities (SNFs) and post-acute care (PAC) providers preparing for the Transforming Episode Accountability Model (TEAM). Additional data on hospital discharge patterns and episodic trends will be available in mid-September on LTC Trend Tracker. Additionally, AHCA will host a webinar on TEAM for providers on Thursday, Sept. 25 from 1:00-2:00 p.m. CDT.
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AHCA has released a recording of its webinar with President and CEO Clif Porter and AHCA staff on the Medicare Skilled Nursing Facility (SNF) Fiscal Year (FY) 2026 Final Payment Rule, available to members with a log-in. A detailed summary of key provisions and member impacts is also available online.
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CMS recently issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2026. AHCA has reviewed the final rule and developed a summary outlining key provisions and impacts on members. Additionally, AHCA will host a webinar tomorrow, Aug. 7, at 2:30 p.m. where AHCA President and CEO Clif Porter and AHCA team members will provide details on what you need to know about the payment rule.
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The August 2025 Performance Score Reports (PSRs) for the fiscal year (FY) 2026 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). SNFs may submit requests for corrections to their performance score and ranking up to 30 days following this report being made available, until Aug. 31, 2025.
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Providers must submit Payroll Based Journal (PBJ) data for April 1 – June 30, 2025, by Aug. 14, 2025. Providers are encouraged to submit data early so that they have sufficient time to review the PBJ CASPER Reports and make any necessary corrections prior to the deadline. As a reminder, CMS does not accept late PBJ submissions. IHCA and CMS both have resources available to support providers with PBJ.
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Providers must submit Payroll Based Journal (PBJ) data for April 1 – June 30, 2025 by Aug. 14, 2025.
Providers are encouraged to submit data early so that they have sufficient time to review the PBJ CASPER Reports and make any necessary corrections prior to the deadline. As a reminder, CMS does not accept late PBJ submissions. IHCA and CMS both have resources available to support providers with PBJ.
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In response to the CMS proposed rule for calendar year (CY) 2026, which includes a significant 9% cut to the Medicare home health 30-day payment rate, The Alliance for Care at Home has finalized and submitted a pre-comment letter voicing strong opposition to the proposed reductions. The pre-comment letter was circulated to state associations and other partners with an invitation to sign on in support. IHCA was joined by 57 other state associations in support of the letter. A more detailed and comprehensive comment letter is currently in development and will be submitted later in the official comment period. In the meantime, the pre-comment letter serves as both an early response and a helpful resource for organizations preparing their own submissions to CMS.
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Iowa Medicaid and the Iowa Department of Health and Human Services have launched a new Provider Self-Assessment (PSA) application within the Iowa Medicaid Portal Application (IMPA) to streamline the annual self-assessment and Home- and Community-Based Services (HCBS) provider tracking process. The application includes four sections and is required for HCBS providers delivering specific services under Iowa’s waivers and habilitation programs. A user guide, training video and FAQ are available to support consistent use. Access is limited to authorized IMPA users with signatory responsibilities.
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AHCA has received notice from CMS that the agency is extending the deadline for the mandatory skilled nursing facility (SNF) provider enrollment off-cycle revalidation from Aug. 1, 2025, to Jan. 1, 2026. This extension does not eliminate the reporting requirement, but does allow more time for providers to work through the various data collection and data submission processes.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have issued guidance outlining face-to-face contact requirements for case managers working with individuals enrolled in Home- and Community Based Services (HCBS) Waivers and Habilitation Services. During the first three months of enrollment, case managers must conduct monthly in-person visits; ongoing contact must occur monthly, with some flexibility for virtual methods. Individuals with intellectual or developmental disabilities must receive in-home, face-to-face visits every other month, while others must receive them quarterly. Exceptions for virtual visits due to medical conditions require annual physician documentation.
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Iowa Medicaid's Annual Provider Training will take place in person on Tuesday, Sept. 30, from 8:00 a.m. to 5:00 p.m. at the Iowa State Historical Museum in Des Moines. The event is open to all provider types and will include sessions on fee-for-service billing, provider enrollment and updates from MCOs. A virtual session will be available later this fall for those unable to attend in person. Registration opens next month, and providers are encouraged to submit topic suggestions or questions in advance.
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Medicaid enrollment doesn’t have to be a bottleneck. IHCA Provider Solutions now offers Enrollment Support – a service designed to streamline the Medicaid application process, simplify admissions and reduce reimbursement delays, all at no out-of-pocket cost to your facility.
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