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.
Read More
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.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) released informational letter (IL) 2634 to provide clarification of the service documentation requirements to support claims for payment submitted to Iowa Medicaid and the managed care organizations (MCOs) specifically related to Home- and Community-Based Services (HCBS).
Read More
Effective Feb. 1, 2025, Iowa Total Care applied changes to prior authorization requirements. These changes are applicable to all Medicaid products. Pay special attention to the procedure codes being listed in the Prior Authorization Code List. Many of the codes commonly billed by long-term care providers are not listed and would experience no change from their current prior authorization process.
Read More
Explore how IHCA Provider Solutions offers expert guidance to improve your facility’s MDS processes, optimize reimbursements and enhance operational efficiency with the help of seasoned professionals.
Read More
CMS recently shared communication that pertains to the Fiscal Year (FY) 2026 and FY 2027 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Total Nursing Staff Turnover measure, which CMS published in the FY 2024 SNF Prospective Payment System (PPS) Final Rule on Aug. 7, 2023, and in the FY 2025 SNF PPS Final Rule on Aug. 6, 2024, respectively.
Read More
Every fall, Medicare beneficiaries are provided an opportunity to review and change their Prescription Drug Plan or Medicare Advantage Plan during the Open Enrollment Period (OEP) from Oct. 15 to Dec. 7. It’s important for Medicare beneficiaries to remember that Prescription Drug Plan and Medicare Advantage Plan costs, benefits and providers can change each year, so evaluating options could help in finding better coverage, and even saving money. Iowa Medicare beneficiaries are encouraged to evaluate and make any necessary changes to their coverage plans, as many new changes take effect in 2025.
Read More
Home health agencies across the state are reporting changes in how they must obtain authorization for services and how authorization requests are reviewed, as well as a marked decrease in the number of services that are being approved. ICHC attended this quarter’s Department of Veterans Affairs (VA) call and asked for clarification on these issues.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services have updated the pharmacy prior authorization (PA) process following a Change Healthcare network outage due to a cybersecurity issue. The PA process will now revert to fax-based submissions, with forms and the Preferred Drug List (PDL) accessible on the Iowa Medicaid website.
Read More
Livanta recently announced several important updates for the provider community and others who rely on Livanta’s services as a Medicare Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO). These updates pertain to changes in Livanta’s contact information, including a new BFCC-QIO mailing address and instructions for helpline callers who use teletype (TTY) machines.
Read More
Join IHCA on Oct. 29 from 12:30 p.m. - 4:30 p.m. for its 2024 Virtual Reimbursement Conference. Key conference topics will include institutional special needs plans (I-SNPs) and accountable care organizations (ACOs), the evolution of value-based purchasing in long-term care, off-cycle revalidation and a Medicaid and case mix update. This virtual course is approved for 4.0 CEUs for nursing facility administrators.
Read More
CMS recently issued an announcement in the MLN Connects newsletter that all skilled nursing facility (SNF) providers will receive off-cycle provider enrollment revalidation notices from their Medicare Administrative Contractor to collect additional data on ownership, managerial and related party information not previously required. This information is to be submitted in a new Appendix on the Form CMS-855A (September 2024) version.
Read More
The Iowa Department of Health and Human Services (DHHS) recently released a crucial notification for providers required to use Electronic Visit Verification (EVV) for home health services billed on institutional (837i) claims. As of yesterday, Oct. 1, 2024, the changes to home health services 837i claim elements must be set up in the CareBridge EVV provider portal. If you have not yet completed your claim setup in the CareBridge provider portal, please take immediate action to avoid billing alerts and potential delays in claims submission.
Read More
In Lieu of Services (ILOS) are now available for Medicaid members who are on a waiting list for one of the 1915(c) Home- and Community-Based Services (HCBS) waivers. These services aim to support members at immediate risk of hospitalization or institutionalization and those needing assistance to return to a community living environment.
Read More
CMS is incorporating the Section GG items into the Home Health Value Based Purchasing (HHVBP) measures in 2025 data collection. CMS has released several resources and tools to provide support to agencies with their GG item accuracy, including updating the GG Web-Based Training series, which can be accessed for free.
Read More
Iowa Total Care has chosen Availity Essentials as its new, secure provider portal. Starting Nov. 18, 2024, you can validate eligibility and benefits, submit claims, check claim status, submit authorizations and access Iowa Total Care payer resources via Availity Essentials.
Read More
To assist in proper payment of claims for long-term care providers, the Iowa Department of Health and Human Services and the managed care organizations are updating revenue code requirements. Claims submitted Oct. 1, 2024, and after will be denied if the revenue codes are not used for the specific service provided.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services recently released informational letter (IL) 2627 regarding an administrative code update to the Vaccine for Children (VFC) Program. Effective Dec. 1, 2012, Iowa Medicaid implemented changes to reduce the maximum reimbursement rates for Current Procedural Terminology (CPT) codes 90460 and 90461 describing vaccine administration and counseling for children ages zero (0) to 18. For reimbursement to process correctly, it is important to list all the vaccine codes on claim lines before the administration codes.
Read More
The U.S. Department of Veterans Affairs (VA) has released a new form/letter for reauthorizations that agencies will soon receive. The form/letter is intended to serve as a reminder that a veteran has a reauthorization coming due.
Read More
CMS has announced that an updated Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) and accompanying instructions have been posted in the downloads section of the fee for service SNF ABN webpage. The revised SNF ABN form is available for immediate use, and it becomes mandatory for Medicare Part A services on Oct. 31, 2024.
Read More
Unlock hidden revenue opportunities with IHCA Provider Solutions’ MDS and EHR Consulting. Through expert guidance from seasoned consultants, your facility can enhance coding accuracy, optimize Assessment Reference Dates (ARD) and identify strategies to maximize both Medicare and Medicaid reimbursements under Iowa’s new case mix formula. From virtual evaluations to on-site support, IHCA’s tailored approach helps facilities streamline processes, improve quality and boost efficiency, ultimately driving better financial outcomes.
Read More
On Sept. 3, 2024, the Iowa Department of Health and Human Services announced the intent to award a managed care organization (MCO) contract to Iowa Total Care. The new Iowa Medicaid contract period begins July 1, 2025, with no change in operations. Iowa Total Care has been serving Iowa Medicaid members as a MCO since July 1, 2019. This request for proposal and resulting contract aligns all three MCO contracts to the same contract cycle. All three MCO contracts will have a final contract end date of June 30, 2031.
Read More
The Iowa Department of Health and Human Services (DHHS) is making an important upcoming change regarding the use of Electronic Visit Verification (EVV) for home health services billed on institutional claims (837i), effective Oct. 1, 2024. DHHS has provided a detailed notification outlining the changes, including updates to specific claim elements and the various communication and training channels available to help you prepare.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have provided notification of an error with the issuance of the supplemental personal needs allowance in June 2024. Approximately 890 individuals residing in a facility were issued a duplicate supplemental personal needs allowance payment in June 2024 in error. The individuals receiving the payment have income below the $50.00 standard and the state supplements those payments to take them to the $50.00 threshold. The one-time extra payment will not be subject to overpayment, nor does it need to be paid back by the member.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2622 regarding the 2024 Civil Money Penalty (CMP) Global Public Health Grant. CMS developed three grant applications using state CMP funds to facilitate family/resident visitation during the COVID-19 public health emergency (PHE). Effective Sept. 25, 2023, CMS has authorized the continued use of CMP funds for the PHE grants, allowing Medicare/Medicaid participating nursing homes to access the products.
Read More
AHCA/NCAL has launched an effort to collect data on Medicare Advantage (MA) provider experiences, particularly related to prior authorizations and MA plan compliance with the CY2024 MA Final Rule. AHCA/NCAL is specifically requesting data on your experiences with MA plans and prior authorization denials during the periods of Aug. 18-31, 2024, and September 2024. A link to a tracking form has been provided, and completed forms should be submitted by Sept. 5, 2024 (for the August reporting period) and Oct. 5, 2024 (for the September reporting period). This data collection will help to better understand the challenges providers face and advocate for necessary reforms.
Read More
Professional Clinical Support Services from IHCA Provider Solutions offers expert facility-level MDS and EHR consultation services from qualified specialists designed to improve quality, increase efficiency and maximize revenue.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2618 to announce upcoming Electronic Visit Verification (EVV) meetings. Some of the previously scheduled meetings have been cancelled. The next scheduled EVV meeting will now take place Tuesday, Sept. 10.
Read More
CMS recently issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2025 update. AHCA has developed a summary of the final rule and CMS has provided a fact sheet.
Read More
The Iowa Department of Health and Human Services (DHHS) has informed providers of an important upcoming change regarding the use of Electronic Visit Verification (EVV) for home health services billed on institutional claims (837i), effective Oct. 1, 2024. In collaboration with Iowa Total Care, Molina Healthcare of Iowa, Wellpoint Iowa and CareBridge, Iowa Medicaid is implementing enhancements to the claiming process to better support all providers.
Read More
Molina Healthcare has issued a provider update that covers an FBI cybersecurity alert and the Molina Healthcare Provider Advisory Council.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services have announced the availability of the Civil Money Penalty Quality Improvement Initiative (CMPQII) grants. Applicants may submit written questions and/or requests for clarifications by Aug. 9, 2024.
Read More
Iowa Medicaid providers must complete enrollment revalidation every five years to remain compliant with Title 42 Code of Federal Regulations (CFR) §455.414. Failure to complete revalidation will result in disenrollment from the Iowa Medicaid program. Iowa Medicaid provides two notices: one at 60 days and the other 30 days prior to your revalidation due date. If you are unsure if you have received this notice or want to confirm your revalidation due date, please contact Provider Services.
Read More
If you are a provider who has been displaced due to flooding and are unable to provide services from the location at which you are currently enrolled with Iowa Medicaid, there is no need to enroll a temporary location. Instead, you may continue to utilize your enrollment information, including location address, that is currently on file with Iowa Medicaid. If services are being rendered at a temporary location due to flooding, please indicate this on your patients’ charts.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have announced upcoming Electronic Visit Verification (EVV) meetings. These meetings will provide stakeholders with the opportunity to engage with Iowa Medicaid, the managed care organizations (MCOs) and the MCOs’ chosen EVV solution for the purpose of supporting the implementation of EVV. The next meeting will be held Tuesday, Aug. 13.
Read More
Form 470-4836 is used to calculate and report the quarterly provider Quality Assurance and Assessment Fee (QAAF). This form has been updated effective July 1, 2024. Providers should begin using the updated form to submit their assessment beginning with July 1, 2024, QAAF payments.
Read More
CMS has posted the 2025 International Classification of Diseases, 10th Revision (ICD-10-CM) files, which contain information on the ICD-10-CM updates for fiscal year (FY) 2025. These 2025 ICD-10-CM codes are to be used for resident stays occurring from Oct. 1, 2024, through Sept. 30, 2025. The update includes 252 new codes, 36 code deletions and 13 code revisions.
Read More
On July 9, Iowa Department of Health and Human Services (DHHS) released informational letter 2607, Home- and Community-Based Services (HCBS) Waiver and Habilitation Rate Changes. This letter describes the provisions of the 2023 Iowa Acts, House File 2698, Section 14, where the Iowa Legislature appropriated $14.6 million to implement an increase in HCBS Waiver and Habilitation reimbursement rates, effective July 1, 2024.
Read More
On July 9, Iowa Department of Health and Human Services (DHHS) released informational letter 2607, Home- and Community-Based Services (HCBS) Waiver and Habilitation Rate Changes. This letter describes the provisions of the 2023 Iowa Acts, House File 2698, Section 14, where the Iowa Legislature appropriated $14.6 million to implement an increase in HCBS Waiver and Habilitation reimbursement rates, effective July 1, 2024.
Read More
Pursuant to the 2024 Iowa Acts House File 2698, Iowa Medicaid gives notice for the fiscal year beginning July 1, 2024, ending on June 30, 2025, per diem rates for nursing facilities will be reimbursed at the amounts in effect on June 30, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2601 regarding revenue code billing for managed care organization (MCO) claims. To assist proper payment of claims for long-term care providers, Iowa DHHS and the MCOs are updating revenue code requirements. This article outlines which revenue codes will be billed for different categories of service.
Read More
Iowa Medicaid has released informational letter (IL) 2608 to announce that assisted living and residential care facilities that utilize shift workers will no longer be required to complete an attestation to opt out of Electronic Visit Verification (EVV), effective April 1, 2024. Iowa Medicaid encourages AL and RCF providers who use shift workers to use EVV, however, they may opt out of this requirement.
Read More
Iowa Total Care recently announced four Provider Summits scheduled for 2024 for Iowa Total Care members. During these in-person sessions, Iowa Total Care will present on clinical practice guidelines, social determinants of health and more. Resource tables will also be available for claims support, Z codes and member-facing program information.
Read More
Professional Clinical Support Services from IHCA Provider Solutions provides IHCA members with expert facility-level MDS and EHR consultation services from qualified specialists designed to improve quality and efficiency. IHCA's expert consultants can assist your team in implementing key strategies to maximize revenue.
Read More
CMS has issued information regarding the two skilled nursing facility (SNF) provider enrollment site visit contractors, in an effort to clear up confusion about this new process. The site visit contractors often utilize subcontractors that visit SNFs to take photos of the building and verify it is operational. The names of these subcontractor companies may be unfamiliar to members. CMS has provided the specific names of these site visit contractors and subcontractors, as well as where providers can go for more information.
Read More
CMS has issued a proposed rule regarding Medicare home health services payment rates for calendar year (CY) 2025. The National Association for Home Care (NAHC) has provided a summary of the proposed rule. Additionally, ICHC will host a one-hour webinar with Annette Lee of Provider Insights to discuss these changes on July 18. ICHC's 2025 Home Health Proposed Rule webinar will cover what the newest proposals may mean for the home health industry and how to best prepare.
Read More
On June 28 the Iowa Department of Health and Human Services (DHHS) released a public notice regarding Medicaid payment rates and legislative rate increases, effective July 1, 2024. Of note, the home health low utilization payment adjustment (LUPA) amounts will be increased by 6.900%, which accounts for $1.5 million state dollars of the appropriation. The remaining $1.5 million state dollars of the appropriation will be reserved to establish an add-on rate for home health agencies serving Medicaid members with higher level acuity at a later effective date.
Read More
The Employee Retention Credit (ERC) has been a hot topic of conversation among providers since the moratorium took place in September 2023, and AHCA/NCAL has heard from members regarding delays in processing ERC applications. On June 20, the Internal Revenue Service (IRS) released an update on the next stages of its work in this area. As noted in the release, the IRS will start a new round of processing what it deems “lower risk claims” to help eligible taxpayers. It is important to note that the IRS made clear that generally the oldest claims will be worked on first, and no claims submitted during the moratorium period will be processed at this time. Considering the large inventory and the results of the ERC review, the IRS will keep the processing moratorium in place on ERC claims submitted after Sept. 14, 2023.
Read More
As part its Hope and Opportunity in Many Environments (HOME) project, the Iowa Department of Health and Human Services (DHHS) is working with Mathematica to develop an appropriate case manager to member ratio for Medicaid members receiving services in a facility. Mathematica is looking to interview Medicaid members receiving care in a nursing facility to provide feedback about the case management services they receive.
Read More
On June 20, Iowa Department of Health and Human Services (DHHS) released a memorandum regarding the nursing facility long-term bed moratorium. On May 28, 2024, after consultation with DHHS, the Iowa Department of Inspections, Appeals and Licensing (DIAL) leadership notified that the moratorium would be extended six months, through Dec. 31, 2024. Prior to that expiration, DIAL and DHHS will consult again to determine if another six-month extension will be issued.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2577. This IL provides additional guidance to IL 2511, dated Oct. 13, 2023, regarding date span billing for durable medical equipment (DME) rental and medical supplies.
Read More
The Iowa Department of Health and Human Services (DHHS) is working on improvements to community-based services in Iowa. To inform this effort, DHHS is conducting a provider survey. This survey will help DHHS learn more about current provider capacity to serve people who need long-term services and supports. The deadline to complete this survey is July 19, 2024.
Read More
The Iowa Department of Health and Human Services (DHHS) will transition the level of care assessment tools for individuals on the Home- and Community-Based Services (HCBS) Intellectual Disability (ID) waiver on Jan. 1, 2025. Iowa DHHS will begin using the interRAI-Intellectual Disability (interRAI-ID) and interRAI Children and Youth Mental Health-Developmental Disabilities (ChYMH-DD) assessment tools for all new and recurring assessments for individuals accessing the ID waiver on that date. To gather essential information to inform the future assessment process, Iowa DHHS will conduct a voluntary “parallel assessment” to facilitate the transition from the SIS instruments to the interRAI assessments. Trained assessors from managed care organizations and Telligen will contact members from June 17 to July 12, 2024, to ask them to participate in this voluntary assessment.
Read More
The Department of Veterans Affairs (VA) Home- and Community-Based Services (HCBS) is informing agencies of upcoming changes with the Standardized Episode of Care (SEOC) for referrals/authorizations. This is a national change determined by the Office of Integrated Veteran Care (IVC).
Read More
Providers billing using a UB-04 claim form are required to report the covered days and non-covered days by using value codes 80 and/or 81. Value codes 80 and/or 81 are required for all inpatient hospital stays, as well as nursing facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-ID) and psychiatric medical institutions for children (PMIC).
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services have provided clarification to Medicaid enrollment options for individual practitioners. Iowa Medicaid is required to comply with federal provider enrollment regulations as outlined in the 21st Century Cures Act, requiring that any provider furnishing/rendering Medicaid covered benefits must be enrolled as an Iowa Medicaid participating provider, including those providers who order services for members, prescribe medications to members and who make referrals for medically necessary services.
Read More
The Iowa Department of Health and Human Services (DHHS) has contracted with the Stephen Group to conduct an assessment of and make improvement recommendations about the current value proposition of the CyncHealth statewide Health Information Exchange (HIE). This survey will provide important information about provider and state use, helping shape the future state of data exchange in Iowa. Please take a few moments to complete the survey by June 30, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently provided notification to eligible providers that Iowa Medicaid intends to distribute American Rescue Plan Act (ARPA) Home- and Community-Based (HCBS) grant funds for the purpose of capacity building and service waitlist reductions. The provider payments are to serve the purpose of providing financial support to providers that have or will be admitting residents from Glenwood Resource Center and providers of high-demand services.
Read More
During the national public health emergency, Iowa Medicaid suspended prescription copayments for all members. Effective July 1, 2024, member copayments of $1.00 for covered prescription and nonprescription drugs will be reinstated. This guidance applies to Fee-for-Service members only. Copayments for outpatient prescription drugs do not apply to members covered under a managed care plan.
Read More
The Final April 2024 Interim Performance Reports (IPRs) are now available on the Internet Quality Improvement and Evaluation System (iQIES). IPRs are only available to home health agencies through iQIES. IPRs are not available to the public.
Read More
Iowa Total Care released a provider news alert regarding an announcement of four Provider Summits scheduled for 2024.
Read More
The June 2024 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2025 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 corrections to their FY 2023 readmission measure rate up to 30 days following this report being made available, until July 3, 2024. Corrections are limited to errors made by CMS or its contractors when calculating a SNF’s readmission measure rate.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently provided information regarding changes to Iowa Medicaid policies impacting the Home- and Community-Based Services (HCBS) waivers.
Read More
After experiencing some significant changes to reimbursement rates for providers in 2023, IHCA is looking ahead to some potential challenges providers may face in upcoming...
Read More
AHCA recently reported that last week, the U.S. Department of Veterans Affairs (VA) announced that its direct Veterans Care Agreements (VCAs) claims processing systems are back online following the Change Healthcare cybersecurity breach. If you submit medical claims directly to VA and were impacted by the recent Change Healthcare incident, you can now submit using the same VA Payer IDs.
Read More
The Iowa Department of Health and Human Services (DHHS) HOME project was created to ensure that everyone has access to high-quality behavioral health, disability and aging services in their communities. Project updates were provided in the May HOME Project Newsletter. To share your thoughts and suggestions on the HCBS changes detailed in the concept paper, please email
[email protected] or fill out a feedback form by Friday, May 17, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2573 to explain how to qualify for Rebuild Iowa Infrastructure Fund (RIIF) funding. RIIF is the primary funding source for public infrastructure related expenditures.
Read More
The Department of Health and Human Services (DHHS) wants to gauge the interest of IHCA nursing facility members on updating the process of submitting provider taxes to Iowa Medicaid. Please provide your feedback by completing a brief two-minute questionnaire by next Tuesday, May 7.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2579 to clarify the process of a Change of Ownership (CHOW) and the responsibilities of the seller and buyer. To minimize any delays, Iowa Medicaid requests that a CHOW notice is submitted at least 60 days prior to the change. The CHOW notice must also be submitted to the managed care organizations (MCOs) and/or the prepaid ambulatory health plan (PAHPs).
Read More
The Iowa Department of Health and Human Services (DHHS) is experiencing an increase of requests to the Iowa Medicaid Portal Application (IMPA) helpdesk when a provider discovers a long-term care resident missing from the rosters they pull from the IMPA. Iowa DHHS would like to remind providers that the correct process to resolve this issue is to contact the Centralized Eligibility Unit (CEU) and not the IMPA helpdesk.
Read More
This article shares the addresses where quarterly Quality Assurance Assessment Fee (QAAF) payments must be sent. The deadline for receipt is next Tuesday, April 30, 2024, to avoid late payment penalties. Please verify you are using these addresses as the Iowa Department of Health and Human Services (DHHS) reports that some providers continue to send to old addresses.
Read More
Last week, CMS released the Contract Year (CY) 2025 Medicare Advantage and Part D Final Rule, which finalized revisions to policies governing Medicare Advantage (MA), Part D, Medicare cost plans and the Program for All-Inclusive Care for the Elderly (PACE).
Read More
On March 28, CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2025. AHCA will host a member webinar this Friday, April 5, on the proposed rule.
Read More
Last week, IHCA received notice from Wellpoint about its recoupment project that it is placing on hold. IHCA had been hearing from members about their concerns with this project and made outreach to the Iowa Department of Health and Human Services (DHHS) and Wellpoint. These recoupments have revolved around the incorrect interpretation that claims for home health need to be billed through Medicare first. Providers are to continue including the diagnosis code Z76.89 as a secondary diagnosis on claims.
Read More
Effective for claims dates of service May 1, 2024, Wellpoint will be aligning its claims edit to NOT deny for other carrier when particular providers bill with these revenue codes/bill types. While not required or enforced at this point across the Iowa Medicaid program, Wellpoint wanted to give an option to begin billing in this fashion to reduce claims adjudication errors, unique to "other carrier" denials.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) informational letter (IL) 2574 is intended to provide notice that Iowa Medicaid is collecting outcome and expenditure data from provider organizations awarded American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Recruitment and Retention (R&R) grant funds during 2022.
Read More
IHCA/ICAL members who are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA's/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
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 Department of Health and Human Services (DHHS) website as of Feb. 13, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services reminds providers that effective March 17, 2023, Home- and Community-Based Services (HCBS) waiver and Habilitation providers must report and receive approval for new residential and non-residential settings prior to using HCBS funding in the setting. March 17, 2023, marked the end of the transition period for states to fully comply with the CMS final rule for HCBS settings. The HCBS settings rule requires states to ensure all settings where HCBS waiver and Habilitation services are provided comply with HCBS settings requirements rule prior to receiving HCBS funding in the setting.
Read More
On March 25, the U.S. Department of Health and Human Services (HHS), CMS and the Administration for Strategic Preparedness and Response (ASPR) provided additional information and resources for providers impacted by the Change Healthcare security incident. Resources include information to help providers connect with payers, links to payer resources, information on advanced payments and more.
Read More
The National Association for Home Care and Hospice (NAHC) is embarking on a landmark survey focused on the operational and financial aspects of the relationship between home health agencies (HHAs) and Medicare Advantage (MA) plans. Home health providers that contract with MA plans are encouraged to complete this survey.
Read More
CMS recently posted a fact sheet with additional guidance for providers and Medicare Administrative Contractors impacted by the Change Healthcare security incident. The fact sheet specifically focuses on frequently asked questions about implementing the Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments program.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application closes this Friday, March 15. After this Friday, these funds will no longer be available. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
As shared previously, UnitedHealth Group Inc.’s technology subsidiary Change Healthcare announced that its systems were adversely affected by a security incident a few weeks ago. AHCA/NCAL has advocated that the U.S. Department of Health and Human Services (HHS) and CMS take specific actions in response to this issue. Over the weekend, CMS took steps to expand financial relief opportunities for impacted providers, consistent with what AHCA/NCAL recommended. AHCA/NCAL has provided a summary of the recent announcements and relief options currently available to providers.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until next Friday, March 15. After March 15, 2024, these funds will no longer be available. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Molina Healthcare recently provided an updated Provider Bulletin regarding the Optum-Change Healthcare outage that has impacted electronic claims submissions, as well as payment and settlement services. Molina Healthcare encourages all providers submitting paper claims to explore its electronic submission options.
Read More
Iowa Total Care members’ Person-Centered Service Plans (PCSPs) are available in Iowa Total Care’s secure provider portal. Iowa Total Care will upload the PCSP into the provider portal instead of sending it directly to you. If you would like the PCSP emailed or mailed, please contact the member’s case manager.
Read More
Providers for both managed care and fee-for-service must begin using the updated universal forms for requesting medical prior authorizations (PAs). The updated universal forms include one PA request form for outpatient services (470-5595), another PA form for inpatient services (470-5594) and a supplemental form (470-5619) for additional provider addresses, member diagnosis and procedure codes. All medical PA requests must be submitted on the new universal forms.
Read More
On Feb. 21, Change Healthcare, a software and data analytics subsidiary of UnitedHealth Group’s Optum unit, experienced a cybersecurity incident that has impacted its network and operations. The cybersecurity incident has created a service disruption impacting Iowa Total Care’s members and provider network in several ways. As of now, Change Healthcare has not provided a timeline for resolution. To protect members and providers, Iowa Total Care fully disconnected system access to and from Change Healthcare on Feb. 21. Iowa Total Care is working on multiple solutions to restore provider functionality and ensure continuity of care for its members and will continue to provide updates as this situation evolves.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
As required by federal regulations at 42 CFR 455.460, Iowa Medicaid began requiring an application fee for certain newly enrolling and re-enrolling providers on Aug. 1, 2016. The application fee is required with initial applications for new enrollment, applications for a new practice location and any re-enrollment. Providers will be required to pay an application fee set by CMS before the application can be processed. Effective Jan. 1, 2024, the fee amount is $709.00. This may be adjusted annually.
Read More
The Iowa Department of Health and Human Services (DHHS) recently released an updated long-term care cost report template and instructions. This updated version of the cost report is required to be used for submissions for FYE Dec. 31, 2023 and beyond, until the next updated version is available. As a reminder, nursing facility cost reports for FYE Dec. 31, 2023 are due by the end of day on Friday, May 31, 2024, with all required documentation, as outlined by the instructions and Iowa Administrative Code rules.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2556 regarding quarter two of the 2023 case mix index calculations. As noted in IL 2442, Iowa Medicaid will replace resource utilization groups (RUG)-III with Patient Driven Payment Model (PDPM) for case mix for rates effective July 1, 2024. Minimum Data Set (MDS) assessments with target dates of July 1, 2023, and after, will use the PDPM nursing component for reimbursement calculations.
Read More
As part of the Iowa Department of Health and Human Services' (DHHS') ongoing Hope and Opportunities in Many Environments (HOME) initiative, Mathematica will soon be leading a Needs on Waitlist (NOW) Survey to better understand the characteristics and needs of individuals awaiting a Home- and Community-Based Services (HCBS) waiver slot. This telephonic survey will run through the end of May 2024 in partnership with teams from Iowa Medicaid’s Targeted Case Management, the Division of Aging and Disability Services and Iowa’s Area Agencies on Aging.
Read More
On Feb. 8, a CMS Medicare Learning Network (MLN) Connects newsletter clarified that hospice and skilled nursing facility medical directors and administrators are always considered managing employees for Medicare provider enrollment purposes and should be reported. The notice provided clarification that providers should not wait for the revalidation period and must submit any missing medical director or administrator via the change of information submission as soon as possible.
Read More
Last month, the U.S. Department of Labor published a final rule, Employee or Independent Contractor Classification Under the Fair Labor Standards Act (FLSA), which goes into effect on March 11, 2024. This rule revises the Department’s guidance on how the agency determines who is an employee or independent contractor under the FLSA. The new standard will, in certain circumstances, make it more difficult for long-term care providers to properly classify a worker as an independent contractor.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
As of Jan. 1, 2024, Medicare Advantage (MA) plans are subject to new regulations governing prior authorizations and utilization management strategies. AHCA/NCAL, in partnership with Hooper, Lundy & Bookman, has developed a checklist to assist association member providers in addressing MA denials to ensure that plans are in compliance with the new requirements. The checklist outlines items such as the appropriateness of the prior authorizations, medical necessity determinations, coverage criteria applied, denial process and provider recourse. In addition, AHCA/NCAL will host a webinar on Tuesday, Feb. 27, at noon on the topic.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15, 2024. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2550 regarding clarification on billing the ventilator rate. This IL updates the diagnosis codes used for ventilator dependent members on IL 1521.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2551 regarding the nursing facility Quality Assurance Assessment Fee (QAAF) mailing address. Issued on April 21, 2022, providers were notified by IL 2333 that the mailing address for the QAAF forms had changed. The forms and instructions to accompany the payments were also updated to reflect the new addresses.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15, 2024. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The calendar year (CY) 2024 Veterans Affairs (VA) fee schedule for Veterans Integrated Services Network (VISN) 23 locations and providers is now available. This is effective Feb. 1, 2024 to Jan. 31, 2025.
Read More
The next Electronic Visit Verification (EVV) Stakeholder Session is Tuesday, Jan. 30, from 3:00 p.m. to 4:00 p.m. on Zoom. Meeting information, such as the agenda and Zoom link, will be posted to the Iowa Department of Health and Human Services (DHHS) Medicaid Meetings webpage by the day of the meeting.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15, 2024. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15, 2024. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open for application until March 15, 2024. The grant operates on a reimbursement model where certified nursing home providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
CMS issued a proposed rule on Dec. 27, 2023, Medicare Program: Appeal Rights for Certain Changes in Patient Status, which establishes appeals processes for Medicare beneficiaries whose inpatient hospital stays were later reclassified to outpatient receiving observation services. Comments on the proposed rule are due Feb. 26, 2024. This proposed rule offers additional beneficiary protections to assure the three-day qualifying hospital stay requirement to access the Medicare Part A skilled nursing facility (SNF) benefit has been met.
Read More
The Provider Relief Fund (PRF) Reporting Period 6 (RP6) opened Jan. 1, 2024, and will remain open through March 31, 2024, at 10:59 p.m. Providers who received one or more PRF (general or targeted) and/or American Rescue Plan Rural payment(s) exceeding $10,000 in the aggregate from July 1, 2022 to Dec. 31, 2022, must report on their use of funds in RP6. The deadline to use funds for RP6 was Dec. 31, 2023.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2519 regarding changes to the Home- and Community-Based Services (HCBS) Elderly Waiver. These changes are effective Oct. 1, 2023.
Read More
Molina Iowa Provider Relations has provided a few reminders for members as they head into the new year, including upcoming Availity trainings, a new Molina Home- and Community-Based Services (HCBS) work group and Iowa Molina Provider Advisory Council, updated provider relations contacts, an Electronic Visit Verification reminder, as well as a reminder on redetermination.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
On Dec. 13, 2023, AHCA announced the Veterans Administration (VA) posted updated Veterans Care Agreements (VCAs) rates for participating skilled nursing facility (SNF) providers. This is great news for the profession because the VCA SNF payment rates for short-stay SNF care have increased by approximately 50%, and long-stay veteran care payments have increased by approximately one-third. These rate increases apply retroactively for dates of service beginning Oct. 1, 2023.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2541 regarding a residential care facility (RCF) maximum per diem rate and personal needs allowance increase. Effective Jan. 1, 2024, the maximum RCF per diem rate will increase from $35.89 to $36.82. 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 will increase from $120.00 to $123.00 per month effective Jan. 1, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2538 about annual submission requirements regarding prevention and detection of Medicaid fraud and abuse. This IL applies to you if you are a provider, or part of a provider entity, that receives payments of $5,000,000 or more from Iowa Medicaid in any federal fiscal year (Oct. 1 to Sept. 30).
Read More
Amerigroup Iowa, a subsidiary of Elevance Health serving Medicaid enrollees, recently released a press release indicating that it will begin rebranding as Wellpoint in January 2024. There will be no impact or changes to current Amerigroup members’ health care benefits or coverage. Members will continue to have access to their established primary care providers, specialists, hospitals and other health care facilities. There will be no changes to Amerigroup Iowa's agreements or levels of support with their health care providers – now or in the future – because of this name change. Providers who serve current Amerigroup members will also have continued access to tools and resources to help streamline day-to-day administrative tasks.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2525 regarding electronic visit verification (EVV) home health care services (HHCS) implementation. Effective for dates of service on or after Jan. 1, 2024, all HHCS subject to EVV requirement not submitted via the CareBridge EVV solution will be denied. While assisted living (AL) facilities and residential care facilities (RCFs) were allowed to opt out for long-term services and support (LTSS) PCSs, the AL facilities and RCFs who provide HHCS may not opt out of this requirement to participate in EVV for HHCS.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2535 regarding upcoming Iowa Medicaid pharmacy program changes effective Jan. 1, 2024. The letter includes information regarding changes to the preferred drug list (PDL), new drug prior authorization (PA) criteria, changes to existing PA criteria, point of sale billing and Drug Utilization Review (DUR) updates.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released an update regarding the timeline for the expenditure of the Home- and Community Based Services (HCBS) American Rescue Plan Act (ARPA) grant funds that have been awarded to eligible HCBS providers. Iowa Medicaid initially informed providers that the grant funds awarded must be fully expended by March 31, 2024. However, CMS clarified that it defines funds as being fully expended once funds are transferred from the state to the entity designated by the state to expend the funds. This means that grant recipients no longer need to fully expend the funds or complete the approved projects by March 31, 2024. Grant award recipients needing additional time should plan to fully expend all grant funds received by March 31, 2025.
Read More
The December 2023 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2025 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). These reports contain facility and stay-level data and results for the SNF 30-Day All-Cause Readmission Measure (SNFRM) for FY 2019, the FY 2025 SNF VBP Program baseline period.
Read More
A letter from the CMS dated Sept. 13, 2023, updated the rates for the two-tiered system and Service Intensity Add-On (SIA) effective October 1, 2023. The State of Iowa will be using tables for providers who have submitted the required quality data.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
IHCA/ICAL members who are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA's/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
On Nov. 16, 2023, the Iowa Department of Health and Human Services (DHHS) launched a brand-new website. The new site does include the same content as legacy website, but the page URLs and links have changed, so you will need to update any bookmarked links you have saved. Iowa Medicaid and Iowa DHHS have provided a list of most frequently used Medicaid links. These new links should replace the links you have saved and can be used going forward.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
On Nov. 15, CMS issued a display copy of a final rule, titled, "Medicare and Medicaid Programs: Disclosures of Ownership and Additional Disclosable Parties Information for Skilled Nursing Facilities and Nursing Facilities; Medicare Providers' and Suppliers' Disclosure of Private Equity Companies and Real Estate Investment Trusts." The final rule requires nursing homes to disclose additional ownership and management information to CMS and the states, much of which will be made available to the public by CMS within one year.
Read More
Iowa Department of Health and Human Services’ (DHHS’) new initiative, Hope and Opportunity in Many Environments (HOME), is aimed at redesigning community-based services (CBS) to help Iowans stay independent in their communities. Three virtual HOMEtown Conversations are scheduled for Nov. 28, Nov. 30 (Spanish language event) and Dec. 7 (Medicaid town hall event). These forums provide an opportunity for invested Iowans to directly connect with Iowa DHHS leadership to learn more about HOME, ask questions and share their ideas to improve the CBS system.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
On April 6, 2023, CMS released a bulletin regarding the Minimum Data Set (MDS) Quality Improvement and Evaluation System (QIES) to Internet Quality Improvement and Evaluation System (iQIES) migration regarding state extract files, stating that CMS will change the creation and delivery process for the extract files that states receive and use to maintain their state-level MDS data repository. Iowa Medicaid now has access to the MDS state extract files and can resume the production of quarterly case mix rosters. However, Quarter 1 through Quarter 4 of 2023 will all be delayed. The calendar in Iowa Medicaid Portal Application (IMPA) will be updated with new dates for Quarter 1 and Quarter 2 of 2023.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
CMS issued the final rule regarding Medicare home health services payment rates for CY 2024. As usual, the rule also includes a mix of non-rate related proposals as well. This article from National Association for Home Care and Hospice (NAHC) provides a summary of the final rule. NAHC will provide more detail over the next week as the rule is further analyzed.
Read More
Iowa Medicaid and Iowa Department of Health and Human Services (DHHS) have released informational letter 2521 regarding respiratory syncytial virus (RSV) vaccine codes.
Read More
CMS is providing notifications to home health agencies that were determined to be out of compliance with the Home Health Quality Reporting Program (HHQRP) requirements for CY 2022, which will affect their CY 2024 Annual Payment Update (APU). Home health agencies that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than Nov. 13, 2023, at 11:59 p.m.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2520 regarding the public health emergency (PHE) Home- and Community-Based Services (HCBS) flexibilities unwind. The HCBS Habilitation flexibilities, which were extended after May 11, 2023, and the HCBS waiver flexibilities granted during the PHE that the Department has chosen not to continue will end Nov. 11, 2023.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Effective back to July 1, 2023, all Iowa nursing facilities will experience changes to their daily per diem, reflective of cost changes from their 2022 fiscal year end and the $15 million appropriation from the Iowa Legislature this past session.
Read More
Providers were notified by Iowa Medicaid in June that telehealth services that were granted use during the PHE would be facing a discontinuation date of Dec. 31, 2023, unless they were added to the Telehealth Approved List. ICHC has made it a priority throughout 2023 to make permanent some of the services that were being used by home health agencies throughout the state. Having services permanently approved by Iowa Medicaid can open the door for agencies to invest in technology to provide these services through this avenue, creating greater access to the tremendous work you provide. ICHC has provided a list of services relevant to home health members that have been added to the permanent list.
Read More
Provider Magazine recently shared new tools available to help providers prepare for Skilled Nursing Facility Value-Based Purchasing (SNF VBP) changes.
Read More
Molina Iowa has reported that the enhancement of modifiers and units are now live on the Availity portal. Additionally, Molina’s Continuity of Care period will end Nov. 1, 2023. Molina members should submit prior authorizations (PAs) as required. If you have questions regarding whether a PA is required, please use Molina's PA look up tool.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program remains open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
As the complexity of care requirements increase for many individuals seeking care placement in Iowa’s nursing facilities, assisted living programs, residential care facilities and home health agencies, oftentimes the way providers are reimbursed for the care they provide is not sufficient. At times, a tool that has proven to be helpful for providers is the use of single case agreements (SCAs). These are oftentimes used on individuals that the managed care organization (MCO) or Iowa Medicaid have extreme difficulties in placing. The use of SCAs would likely be characterized as the exception, rather than the rule. IHCA has provided descriptions from each of Iowa’s MCOs and for individuals discharging from hospitals with no payer source on when/how they use SCAs.
Read More
IHCA encourages its members to prepare for the return of the 85% occupancy rule, which was temporarily reduced to 70% for the current rebase cycle. Effective July 1, 2025, providers rates will be calculated using a minimum occupancy of 85%, which is determined by the cost reports submitted by providers for their 2024 fiscal year end. All providers should consider the return of the 85% occupancy limitation and determine if a reduction in licensed beds is necessary. This will not impact any current rate calculations. These steps are to protect and possibly enhance rates in the next rebasing cycle, which will establish rates for July 1, 2025.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently provided clarification to all providers submitting claims for COVID-19 vaccines and administration.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2505 regarding Electronic Data Interchange Support Services (EDISS) registration. All providers must ensure their registration with EDISS, which is located within EDISS Connect, is accurate and up to date to avoid issues with their electronic transactions.
Read More
As part of its redesign of community-based services (CBS) through the Hope and Opportunity in Many Environments (HOME) initiative, Iowa DHHS is seeking to ensure access to high-quality behavioral health, disability and aging services in local communities. This October, November and December, Iowa providers are invited to attend HOMEtown Conversations, a series of local events held both in-person and virtually across the state. These events provide an opportunity for invested Iowans to connect directly with DHHS leadership to learn more about HOME, ask questions and share their ideas to improve the CBS system. Providers are encouraged to attend, participate and distribute HOMEtown Conversations promotional materials within their networks and to the communities they serve.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Utilize IHCA Provider Solutions endorsed product partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
IHCA encourages its members to prepare for the return of the 85% occupancy rule, which was temporarily reduced to 70% for the current rebase cycle. Effective July 1, 2025, providers rates will be calculated using a minimum occupancy of 85%, which is determined by the cost reports submitted by providers for their 2024 fiscal year end. All providers should consider the return of the 85% occupancy limitation and determine if a reduction in licensed beds is necessary. This will not impact any current rate calculations. These steps are to protect and possibly enhance rates in the next rebasing cycle, which will establish rates for July 1, 2025.
Read More
Iowa Total Care members may be receiving lettters regarding possible sanctions on their Medicaid eligibility. Sanctions will sometimes occur if a member has a slip/fall or injury that could possibly be related to a third party. If an Iowa Total Care member gets a letter from The Rawlings Company in regard to possible sanctions from Iowa Total Care, they need to follow the directions in the letter as soon as possible.
Read More
On Sept. 25, 2023, CMS released QSO-23-23-NHs, which outlines revisions to the Civil Money Penalty Reinvestment Program (CMPRP). In the memo, CMS requests more information about resident access to broadband, wireless internet, citing that residents should have access to the same comforts or conveniences that exist in typical households. CMS asks that any provider without facility-wide, wireless, broadband access complete a survey and submit their responses no later than Dec. 22, 2023. CMS will then assess the number of facilities without this capability and determine if CMP funds can be used for a project to help address this issue.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently announced that effective Oct. 12, 2023, over the counter COVID-19 testing code T5999 - Supply not otherwise specified code, will no longer be available for claim submission.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Hospital and Healthcare Compensation Service (HCS) is conducting its annual Assisted Living (AL) Salary and Benefits Study and requests your participation. AL providers are asked to complete the study’s questionnaire by Nov. 6. There is no cost to participate, and participants may purchase the results at the reduced price of $185, versus the $375 nonparticipant rate.
Read More
In October 2023, the second quarterly Interim Performance Report (IPR) will be available to home health agencies (HHAs) via the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide HHAs with the cohort assignment, performance year measure data for the 12 most recent months and interim Total Performance Score (TPS). To receive an IPR during the Calendar Year (CY) 2023 performance year, HHAs must be active, Medicare-certified prior to Jan. 1, 2022, and meet the minimum threshold of data for at least one quality measure in the quarterly reporting period for the performance year.
Read More
Hope and Opportunity in Many Environments (HOME) is an Iowa Department of Health and Human Services (DHHS) initiative aimed at redesigning community-based services (CBS) to help Iowans stay independent in their communities. As part of this effort, DHHS leadership will visit communities in October and November. HOMEtown Conversations will be held both in-person and virtually across the state. These forums provide an opportunity for invested Iowans to directly connect with Iowa DHHS leadership to learn more about HOME, ask questions and share their ideas to improve the CBS system. The first forum will take place on Oct. 23 in Des Moines at the Polk County River Place from 9:00 a.m. to 10:30 a.m.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
IHCA's variety of member benefits includes access to a collection of 200+ regulatory resource documents, saving you time and money. Due to IHCA’s relationships with state agencies, consultants and experts, members are able to receive prompt and accurate answers to their regulatory issues.
Read More
Join Mathematica and the Iowa Department of Health and Human Services (DHHS) for an upcoming series of in-person events this October and November to discuss Home- and Community-Based Services (HCBS). These public forums are an important opportunity for HCBS waiver providers to hear from Iowans about their needs and experiences with HCBS.
Read More
Iowa Department of Health and Human Services (DHHS) and the three managed care organizations (MCOs), Amerigroup, Iowa Total Care and Molina Healthcare, will host the 2023 Annual Provider Training through a series of in-person and virtual presentations throughout the month of October. All sessions will cover the same presentation topics. The deadline to register is Thursday, Oct. 5, 2023.
Read More
Molina Healthcare has provided updates on continuity of care, the Iowa Medicaid Roadshow, rejection issues, its payment cycle timeline, the Availity portal, out of network rates and more.
Read More
On Sept. 26, the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) shared how Civil Monetary Penalty (CMP) funds remain available to improve communicative technology, air quality and visitation. During the global public health emergency (PHE), CMS developed three applications to facilitate visitation and prevent the spread of COVID-19. According to CMS's Sept. 25 Quality, Safety and Oversight (QSO) memo, these applications will continue beyond the PHE to allow all Medicare and Medicaid participating nursing homes access to the products.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have announced that Medicaid clients may receive a visit from their managed care organization (MCO). To ensure as many people as possible retain their Medicaid coverage after the end of the continuous coverage requirement, Medicaid’s three MCOs, Amerigroup, Iowa Total Care and Molina Healthcare, are attempting to reach members by phone call, text and email. If these efforts are not successful, the respective MCO may send a representative to follow up in person at the address on file. These representatives will help members complete their renewal paperwork or schedule an appointment to fill it out over the phone. Providers are asked to inform their Medicaid clients about the renewal paperwork and direct them to send it to Iowa DHHS promptly.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2472 to provide additional guidance for billing appropriate Place of Service (POS) codes for covered services delivered via telehealth.
Read More
CMS recently released the Guiding an Improved Dementia Experience (GUIDE) Model aimed at improving the way dementia care is delivered and supporting unpaid caregivers. The goal is to help those living with Alzheimer’s disease and dementia remain in their homes and communities, thereby minimizing hospitalizations, post-acute and long-term care through improved care coordination and management, caregiver education and support and respite services. Through GUIDE, CMS will test an alternative payment for participants that delivers key supportive services to people with dementia. CMS is accepting letters of interest for the GUIDE Model through Sept. 15, 2023.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
Amerigroup Iowa, Iowa Total Care and Molina Healthcare of Iowa are working with CareBridge to leverage their software platform for the Electronic Visit Verification (EVV) solution for providers in Iowa. Over the next several months, CareBridge will be leading the efforts to prepare provider agencies to successfully use EVV beginning Oct. 1, 2023. To help ensure a smooth implementation, each agency needs to complete the CareBridge Provider Set Up and Access Request Form by Nov. 1, 2023.
Read More
The October 2023 release of the Home Health Prospective Payment System Grouper Software (HHGS) (v04.2.23) is now available on the CMS website. Included in the v04.2.23 HHGS update are the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes, effective beginning Oct. 1, 2023.
Read More
CMS recently released the Guiding an Improved Dementia Experience (GUIDE) Model aimed at improving the way dementia care is delivered and supporting unpaid caregivers. The goal is to help those living with Alzheimer’s disease and dementia remain in their homes and communities, thereby minimizing hospitalizations, post-acute and long-term care through improved care coordination and management, caregiver education and support and respite services. Through GUIDE, CMS will test an alternative payment for participants that delivers key supportive services to people with dementia. CMS is accepting letters of interest for the GUIDE Model through Sept. 15, 2023.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
CMS will host an Open Door Forum tomorrow, Thursday, Aug. 31 at 1:00 p.m. Advance registration for this webinar is required. CMS will provide updates regarding the fiscal year (FY) 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule, Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual, MDS Crossover Rule, August 2023 performance score reports and more.
Read More
As of July 1, 2023, all claims for services provided on or after July 1, 2023, for managed care organization (MCO) enrolled members must be submitted directly to the appropriate MCO, adhering to each MCO’s claims submission and timeliness guidelines. There are limited exceptions to this rule outlined in Iowa Medicaid informational letter 2489. Any services provided prior to July 1, 2023, should be billed to the MCO that the member was enrolled with for the month of services.
Read More
UnitedHealthcare/Optum has reported that agencies may be overlooking recredentialing emails/messages from UnitedHealthcare/Optum. Please remember to recredential with UnitedHealthcare/Optum when requested.
Read More
Iowa Medicaid and the Managed Care Organizations (MCOs) - Amerigroup, Iowa Total Care and Molina Healthcare - are working to ensure as many members as possible keep their Medicaid health coverage after the end of the public health emergency (PHE) continuous coverage requirement. According to Iowa Medicaid and Iowa Department of Health and Human Services (DHHS), the MCOs may reach out to members via phone call, text or email to make sure their information is up to date. If they are not able to reach a member, an MCO representative may come to the member’s home to offer assistance with renewal paperwork or to schedule an appointment to fill it out over the phone.
Read More
Molina Healthcare's provider services team will host weekly office hours in September for providers that have a question about claims, the provider portal, authorizations or simply want to meet their provider representative. Additionally, Molina has provided updates on rejection issues, its payment cycle timeline, the Availity portal, out of network rates and more.
Read More
Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid have launched a brand-new Iowa Medicaid dashboard. The dashboard brings several new benefits and clarity to the Iowa Medicaid program, including improved accessibility, enhanced data analysis capabilities and oversight of the managed care plans (MCPs). The dashboard streamlines the reporting process, provides timely updates and ensures information is available to Medicaid stakeholders.
Read More
Iowa Medicaid fee-for-service (FFS) is updating how it communicates with providers about coverage and billing guidelines regarding code updates. Iowa Medicaid has created a new communication bulletin containing the code updates that is posted on the Iowa Department of Health and Human Services (DHHS) website.
Read More
In an effort to ensure that Iowa Medicaid members have access to high-quality behavioral health, disability and aging services in their communities, Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) are implementing a new program called Hope and Opportunity in Many Environments (HOME), which is highlighted in informational letter (IL) 2489. HOME will be implemented in phases through the end of 2024. Community members, caregivers and providers are encouraged to share their thoughts during virtual and in-person feedback sessions, which will be announced in the coming months.
Read More
AHCA's Skilled Nursing Facility (SNF) Value Based Purchasing (VBP) Essentials is a one-hour course that details the new CMS measures and discusses how CMS calculates VBP measures, risk adjustment, facility score and payment adjustments. The course provides instructions on using a SNF VBP prediction calculator tool that helps estimate the financial impact the measures will have on a nursing facility’s Medicare Part A revenue. The training delves into the existing all-cause hospital readmission measure and the three new measures to be counted Oct. 1, 2023. Also covered are the four additional measures CMS will incorporate into SNF VBP calculations effective Oct. 1, 2024. The course is approved for 1.25 National Association of Long-Term Care Administrator Boards (NAB) CEUs and 1.00 CEU through the Iowa Board of Nursing upon course completion.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2495 regarding competency-based training reporting changes for critical (major) incident reporting. The recent IL 2480, released on June 27, 2023, announced reporting changes for critical (major) incident reporting for all Home- and Community-Based Services (HCBS) waiver, habilitation and Money Follows the Person (MFP) members. The “Incident Report User Guide” in the Iowa Medicaid Portal Access (IMPA) was updated in June to prepare for these changes. The new direct entry reporting form was effective July 1, 2023.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2498 regarding upcoming Iowa Medicaid pharmacy program changes effective Oct. 1, 2023. The letter includes information regarding new drug prior authorization (PA) criteria, changes to and removal of certain existing PA criteria and point-of-sale billing updates.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
IHCA's variety of member benefits includes the opportunity to join Iowa Health Care Quality Partners (IHCQP), a network of 200 independent long-term care and post-acute care providers joined together for the purpose of improving the quality and efficiency of patient care and financially rewarding providers for doing so through value-based contracts with MCOs. Network partners have the opportunity to pursue better contract terms due to IHCQP’s connections with national insurance plans, national experts and legal counsel.
Read More
Your urgent attention and action are needed to safeguard the future of home health care. CMS has proposed a rule that would include a staggering 9.36% rate cut, posing severe, long-term consequences to Iowa's home health care agencies. ICHC urges home health members to submit comment letters to CMS. Letter templates have been provided to assist in preparing comments, which are due online via the Federal Register by Aug. 29.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
IHCA/ICAL members who are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA's/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
On July 31, CMS issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2024 update. The final rule provides for a net market basket increase for SNFs of 4.0% (approximately $1.4 billion) beginning Oct. 1, 2023. This is 0.3% more than was originally proposed in April. The new rule also included updates to consolidated billing, the Quality Reporting Program (QRP), Value-Based Purchasing (VBP) measures and the Civil Monetary Penalty (CMP) program.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. Eligible claims submitted by the 15th of each month will be paid within the following 75 days.
Read More
All assisted living facility and residential care facility providers must complete a new Electronic Visit Verification (EVV) provider attestation identifying their exemption status with Iowa Medicaid by July 31, 2023, and annually thereafter by June 30 of each year.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
IHCA members can stay up to date on the latest reimbursement news through a variety of services and resources, including reimbursement interpretations and guidance from expert staff, access to key personnel with Iowa’s managed care organizations (MCOs) through IHCA’s monthly member calls, a collection of reimbursement resource documents and wage information to assist in competing for and retaining qualified staff. Additionally, IHCA offers reimbursement education, including the upcoming Nursing Facility Reimbursement Conference on Aug. 23.
Read More
The National Association for Home Care and Hospice (NAHC) filed a lawsuit against CMS and the U.S. Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additional cuts expected over the next several years. CMS has proposed an additional 5.653% permanent rate cut to begin in 2024 based on the same challenged payment methodology.
Read More
With the recent changes to the Quality Assurance Assessment Fee (QAAF) program that went into effect on April 1, 2023, the Iowa Department of Health and Human Services (DHHS) has recently issued updated forms for providers to complete when calculating and making their updated payments. As a reminder, payments and forms are due to Iowa Medicaid from providers no later than 30 days after quarter end.
Read More
All assisted living facility and residential care facility providers must complete a new Electronic Visit Verification (EVV) provider attestation identifying their exemption status with Iowa Medicaid by July 31, 2023, and annually thereafter by June 30 of each year.
Read More
The Iowa Department of Health and Human Services (DHHS) and Mathematica have developed a survey to learn about people’s experiences with community-based Medicaid services. These are services and supports that Medicaid pays for to help people live, work and participate in their community. The survey takes approximately 15-25 minutes to complete, and survey responses are due July 24.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
CMS issued the proposed rule regarding Medicare home health services payment rates for calendar year (CY) 2024. The rule also includes non-rate-related proposals as well. This article from the National Association for Home Care and Hospice (NAHC) provides a summary of the proposed rule.
Read More
CMS will host a Home Health Value Based Purchasing (HHVBP) model webinar on July 27, 2023 at 1:00 - 2:00 p.m. During this live event, members of the HHVBP Model Technical Assistance Team will provide an overview of the data and information available in the Interim Performance Report (IPR), which will help home health agencies monitor their performance during the 2023 performance year.
Read More
Molina Healthcare of Iowa, Iowa's newest managed care organization (MCO), has officially launched in Iowa and has provided tips to providers. Additionally, Molina Healthcare of Iowa is hosting Lunch and Learn town hall meetings three times per week, starting this week through Aug. 11.
Read More
All assisted living facility and residential care facility providers must complete a new Electronic Visit Verification (EVV) provider attestation identifying their exemption status with Iowa Medicaid by July 31, 2023, and annually thereafter by June 30 of each year.
Read More
Iowa Medicaid has released informational letter 2481 regarding the billing and coding of Spravato®. Spravato® (esketamine nasal spray) is U.S. Food and Drug Administration (FDA)-approved, in combination with an oral antidepressant, for treatment-resistant depression in adults, and for the treatment of depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.
Read More
Iowa Medicaid released informational letter (IL) 2485 regarding a clarification to 340B Drug Pricing Program and replacing IL 2243. The new IL covers background, definitions, enrollment and responsibility, Medicaid requirements, billing and more.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
Utilize IHCA Provider Solutions endorsed product partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2471 regarding the Electronic Visit Verification (EVV) attestation requirement. All assisted living facility and residential care facility providers must complete a new EVV provider attestation identifying their exemption status with Iowa Medicaid by July 31, 2023, and annually thereafter by June 30 of each year.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2480 regarding critical incident reporting changes. As a condition of participation in the medical assistance program, HCBS waiver and habilitation providers must comply with the requirements of Iowa Administrative Code (IAC) 441 – Chapter 77.25(3) – incident management and reporting. Additionally, case managers, targeted case managers, integrated health home (IHH) care coordinators and community-based case managers are required to submit an incident report when an incident has been witnessed or discovered.
Read More
Effective July 1, 2023, case mix calculations will transition from Resource Utilization Group (RUG)-III to using the Patient Driven Patient Model (PDPM) Nursing Component. The Omnibus Budget Reconciliation Act of 1987 (OBRA) and prospective payment system (PPS) schedules set forth in the Resident Assessment Instrument (RAI) manual will remain the same. Providers will no longer need to complete the Optional State Assessment (OSA) as of July 1, 2023.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2481 regarding Spravato® billing and coding. Spravato® (esketamine nasal spray) is U.S. Food and Drug Administration (FDA)-approved, in combination with an oral antidepressant, for treatment-resistant depression in adults, and for the treatment of depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.
Read More
CMS and PASRR Technical Assistance Center (PTAC) will host a Preadmission Screening and Resident Review (PASRR) 101 webinar on July 26 from noon to 1:30 p.m. This webinar, held on a quarterly basis, is intended for people who are just beginning a role covered by the PASRR process.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2471 regarding the Electronic Visit Verification (EVV) attestation requirement. All assisted living facility and residential care facility providers must complete a new EVV provider attestation identifying their exemption status with Iowa Medicaid by July 31, 2023, and annually thereafter by June 30 of each year.
Read More
ICHC has provided its members with information from the Home Health Value Based Purchasing (HHVBP) Newsletter, which provides home health agencies (HHAs) with the latest information about the expanded HHVBP Model, as well as important tools, news and timely insights from CMS and the HHVBP Model Technical Assistance (TA) team.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, and then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2477 regarding the American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) Housing Infrastructure Grant.
Read More
Iowa Medicaid recently released informational letter (IL) 2478 regarding a change of review contractor for the federal fiscal year (FY) 2024 Payment Error Rate Measurement (PERM) Program. As noted in IL 2429, Iowa is participating in the federal FY 2024 PERM program. The original IL stated that providers may be contacted by CMS review contractor, NCI Information Systems, Inc. (NCI), who will collect medical records either in hard copy or electronic format. The CMS review contractor has changed names and is now known as Empower AI.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2479 regarding upcoming competency-based training opportunities for all Iowa Medicaid long-term services and supports (LTSS) providers. Competency-based training allows providers and direct support professionals to acquire skills that can be applied to member care. Trainings are provided at no cost to agencies or direct support professionals. The next training is July 10 and will cover providing support through behavioral challenges.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, and then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
Be prepared for the changes ahead for Medicaid funding and processing. The 2023 Medicaid Funding Update Webinar is now available on-demand. This webinar addresses recent developments in Medicaid funding, policies and claims processing, which go into effect on July 1, 2023. Discussion focuses on several key elements from the 2023 legislative session and some of the impacts for providers. This course is for individuals at your facility involved with reimbursement.
Read More
Iowa Total Care has provided additional clarity related to a provider alert that was posted on March 28, 2023, related to pre-pay review of claims.
Read More
Molina Healthcare, Iowa's newest managed care organization, recently provided an update regarding its contact information and trainings, including Molina Iowa Townhall Lunch and Learn series beginning July 10.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, and then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
CMS has reissued transmittal instructions for Medicare Administrative Contractors (MACs) to perform a five-claim probe and educate medical review on every skilled nursing facility (SNF) in their jurisdiction. The purpose of this widespread review, which will be implemented in waves over the next year and began June 5, 2023, is to lower the SNF improper payment rate. Providers should be on the lookout starting in early June for medical records requests related to this program.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2457 regarding telehealth flexibilities following the public health emergency (PHE).
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2466 regarding the Iowa Medicaid Specialty Drug Administration - Alternative Site of Care (SOC). The goal of this program is to provide members with alternative SOC options for select chronic, provider-administered specialty drugs when appropriate (i.e., improve access and accessibility).
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) has announced upcoming competency-based training opportunities for all Iowa long-term services and supports (LTSS) providers. Competency-based training allows providers and direct support professionals to acquire skills that can be applied to member care. Trainings are provided at no cost to agencies or direct support professionals. The next training will be June 19.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2462 regarding the unwinding of COVID-19 public health emergency (PHE) provider enrollment renewal flexibilities.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2468 regarding Home- and Community-Based Services (HCBS) waiver expanded services, including medical day care for children and adult day care.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
IHCA/ICAL members who are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA's/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
CMS has reissued transmittal instructions for Medicare Administrative Contractors (MACs) to perform a five-claim probe and educate medical review on every skilled nursing facility (SNF) in their jurisdiction. The purpose of this widespread review, which will be implemented in waves over the next year beginning June 5, 2023, is to lower the SNF improper payment rate. Providers should be on the lookout starting in early June for medical records requests related to this program.
Read More
IHCA was recently notified of a letter sent to all Iowa nursing facilities regarding “Record Retention Requirements for all Facility Audits.” This letter is a general reminder of the expectations surrounding records retention for routine Medicaid audits conducted by the Department of Inspections and Appeals (DIA). If your nursing facility currently following Iowa’s records retention laws, no further action is needed.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2450 regarding a virtual training session on June 6 that will address revalidation requirements as a part of the Public Health Emergency (PHE) unwind. This training is intended for all provider types.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have announced upcoming competency-based training opportunities for all Iowa long-term services and supports (LTSS) providers. Competency-based training allows providers and direct support professionals to acquire skills that can be applied to member care. Trainings are provided at no cost to agencies or direct support professionals.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Iowa’s newest managed care organization (MCO), Molina Healthcare of Iowa, will join Amerigroup and Iowa Total Care in providing medical benefits for IA Health Link and Healthy and Well Kids in Iowa (Hawki) members on July 1, 2023. DHHS will reallocate up to one-third of Medicaid members to Molina effective July 1, 2023. This IL provides guidance for providers regarding contracting with Molina, Molina provider training dates and locations, information about member choice and assignment and how to assist members should they have questions.
Read More
Iowa Medicaid providers and members are invited to a virtual listening session to discuss challenges to the current home health (HH) system and propose solutions to improve the program in Iowa. The listening session will be held on Monday, May 22, 2023, from 4:00 p.m. to 5:30 p.m.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open, with a deadline of next Monday, May 15, for the seventh round of grant distributions. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2453 regarding Home- and Community-Based Services (HCBS) waiver eligibility. This (IL) clarifies the HCBS waiver eligibility policy pertaining to the need for services.
Read More
On April 27, 2023, CMS released a proposed rule that will significantly impact the Medicaid program, if finalized. The notice of proposed rulemaking (NPRM) addresses a wide range of issues regarding access to and payment for Medicaid services. While there are positive components to the regulation, there are also several areas of potential concern for providers.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2455 regarding premiums and co-payments for Medicaid, Healthy and Well Kids in Iowa (Hawki), Iowa Health and Wellness Plan (IHAWP) and Medicaid for Employed People with Disabilities (MEPD). During the national public health emergency (PHE), Iowa Medicaid suspended co-payments and premiums for all members. The PHE is scheduled to end May 11, 2023. Iowa Medicaid will complete eligibility redeterminations for most members. To ensure accurate premiums and co-payments are billed to members, premiums will remain suspended until June 2024 for all members that have coverage under Hawki, IHAWP and MEPD.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is open, with a deadline of May 15 for the seventh round of grant distributions. The funds may be used for a variety of costs, including continuing education costs for long-term care staff, certified nursing assistant (CNA) training, technology improvements to assist with rapid identification and monitoring of infectious diseases, personal protective equipment (PPE) and more. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
Beginning Oct. 1, 2022, Iowa Medicaid began accepting applications from eligible providers for the American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) Employee Training and Scholarship Grant. Because of the limited time remaining to expend ARPA funds, the deadline to apply for the ARPA HCBS Employee Training and Scholarship Grant is April 30, 2023. Applications received after this date will not be considered.
Read More
Molina Healthcare will be hosting provider educations from May 2 to June 22, 2023. These 'General Sessions' are all identical, live presentations. Molina Healthcare will have an open Q&A after the presentation is complete, which will occur mid-way through this time slot to allow for a substantial amount of time for questions and answers.
Read More
In March 2020, the federal public health emergency (PHE) established flexibilities to the Medicaid program in accordance with PHE policies and benefits. With the announcement that the PHE will end on May 11, 2023, Iowa Medicaid has provided an update on the status of Home- and Community-Based Services (HCBS) flexibilities for the state plan 1915(i) HCBS Habilitation program and the 1915(c) HCBS waivers.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is now open, with a deadline of May 15 for the seventh round of grant distributions. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2448 regarding the end of COVID-19 coverage for uninsured individuals. The Families First Coronavirus Response Act (FFCRA) created a new Medicaid eligibility group for uninsured individuals. The new eligibility group was provided a limited benefit package of services related to testing and diagnosis of COVID-19 during the public health emergency (PHE). Under federal law, Medicaid coverage of COVID-19 vaccinations and testing for this group will end when the PHE ends on May 11, 2023.
Read More
On April 4, 2023, CMS released the following notice. The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of Jan. 31, 2026 will be mandatory on June 30, 2023. You may continue to use the ABN form with the expiration date of June 30, 2023 until the renewed form (expiration date Jan. 31, 2026) becomes mandatory on June 30, 2023. The ABN form CMS-R-131 is the notice you would provide a beneficiary who wishes to receive Part B services (therapy) which the provider believes Medicare won’t pay. This form would be required to provide to the beneficiary prior to services you intend to bill the beneficiary due to Medicare B non-coverage.
Read More
Amerigroup recently released an updated provider experience representative map for Iowa providers. The provider contact information provides Amerigroup Iowa, Inc., Iowa Health Link and Health and Well Kids in Iowa (Hawki) account management representatives.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is accepting a sixth round of applications. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Please take a moment to view a video update from IHCA President and CEO Brent Willett on IHCA's strategy to improve operating conditions for skilled nursing facility providers across Iowa in 2023, including the latest news on Medicaid rebasing efforts, private pay rates, the proposed Skilled Nursing Facility (SNF) Prospective Payment System rule and the Iowa Health PAC.
Read More
IHCA members can now access the recording of last week's AHCA webinar with President and CEO Mark Parkinson reviewing key details of the fiscal year (FY) 2024 skilled nursing facility (SNF) proposed payment rule. AHCA has reviewed the proposed rule and developed a summary outlining key provisions and impacts on members.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2446 regarding provider messaging and the continuous coverage requirements unwind. Members will not automatically lose coverage after March 31, 2023. Because of the COVID-19 public health emergency (PHE) unwind, most members will need to renew their coverage this year, but member renewal dates are different.
Read More
On April 11, the Iowa Department of Health and Human Services (DHHS) announced that some Medicaid members’ personal information was compromised in a national data breach affecting a contractor’s computer system last year. The Iowa Medicaid system was not breached.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open, with an April 15 deadline for the sixth round of distributions. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Yesterday, CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2024 update. Highlights of the proposed rule include a net market basket increase for skilled nursing facilities (SNFs) of 3.7% beginning Oct. 1, 2023. Members are encouraged to attend a webinar hosted by AHCA, Friday, April 7, to learn more.
Read More
Iowa Medicaid has updated the Financial and Statistical Report, Form 470-0030 (cost report). The cost report should be used by all nursing facilities (NFs), intermediate care facilities for individuals with intellectual disability (ICF/IDs) and intermediate care facilities for persons with medical complexity (ICF/MCs), with the exception of hospital-based NFs that are Medicare-certified and provide only skilled level of care. The updated cost report and instructions are posted on the forms page of the DHHS website.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2442 regarding an Optional State Assessment (OSA) and Patient-Driven Payment Model (PDPM) for case mix.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open, with an April 15 deadline for the sixth round of distributions. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Utilize IHCA Provider Solutions endorsed product partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Please take a moment to view a video update from IHCA President and CEO Brent Willett on IHCA's strategy to improve operating conditions for skilled nursing facility providers across Iowa in 2023, including the latest news on Medicaid rebasing efforts.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2434. In response to the COVID-19 public health emergency (PHE), Iowa Medicaid directed the managed care organizations (MCOs) to provide 100% reimbursement to out-of-network providers. This flexibility will end on April 30, 2023.
Read More
Iowa Medicaid and Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2438 regarding details about the Medicaid continuous coverage requirement ending on March 31, 2023. Because of this, renewal dates for most Medicaid members have been changed in the Iowa DHHS Medicaid eligibility systems.
Read More
In a Provider News Alert released on March 28, Iowa Total Care stated it is committed to continuously improving its overall payment integrity solutions to prevent overpayments due to waste or abuse. Iowa Total Care will begin performing additional prepayment claim reviews starting April 4, 2023, using Optum’s Comprehensive Payment Integrity (CPI) tool.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently updated informational letter (IL) 2082 with IL 2435 regarding Home- and Community-Based Services (HCBS) waiver billing code updates. Effective Jan. 1, 2020, procedure codes 96152 and 96153 are no longer valid for health behavior and intervention services under the Iowa Medicaid HCBS waivers. These HCBS waiver codes were overlooked when the prior code update was announced. Iowa Medicaid is replacing the invalid codes effective April 1, 2023.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2441 regarding the Rebuild Iowa Infrastructure Fund (RIIF). RIIF is the primary funding source for public infrastructure-related expenditures. The 2022 Iowa Acts, House File 2578, reduced the major renovation threshold from $1.5 million to $750,000 as of July 1, 2022.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently announced upcoming competency-based training opportunities for Iowa long-term services and supports (LTSS) providers and case managers. The in-person and virtual trainings will cover quality improvement and Home- and Community-Based Services (HCBS) landlord/tenant rules and will occur on April 11 and April 13.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
IHCA/ICAL members that are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
Veterans Integrated Services Network 23 (VISN23), also known as the Veterans Affairs (VA) Midwest Health Care Network, hosted live webinars on March 14 and 16 regarding a new standardized form to request new services or reauthorizations. For those who could not attend the webinar, resources offered last week are now available for the VISN23 Request for Services (RFS) and Reauthorization form.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
As of March 13, 2023, the Iowa Total Care Provider Portal claims dashboard and claim details page has a new look. This redesign changes the look and feel of the claims portion of the portal.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2432 regarding the end of the federal public health emergency (PHE) flexibilities. In March 2020, the federal PHE established flexibilities to the Medicaid program in accordance with PHE policies and benefits. With the announcement that the PHE will end on May 11, 2023, Iowa Medicaid will begin releasing a series of ILs concerning the end of these PHE flexibilities. As each flexibility ends, Iowa Medicaid will publish an IL explaining the piece that is “unwinding” or returning to normal operating procedures.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) released informational letter (IL) 2423 regarding stand-alone COVID-19 vaccine counseling. CMS requires states to cover stand-alone COVID-19 vaccine counseling. Stand-alone vaccine counseling occurs when a member and/or caregiver receives counseling from a health care practitioner regarding the vaccine, but the member does not receive the vaccination at the same time as the counseling because the member and/or caregiver is not ready to consent.
Read More
Veterans Integrated Services Network 23 (VISN23), also known as the Veterans Affairs (VA) Midwest Health Care Network, has been working on a process improvement project to help streamline care coordination and communication between their community partners and the VA. VISN23 will be offering a series of webinars next Tuesday, March 14 and Thursday, March 15 to update individuals on the upcoming changes.
Read More
CMS will host an expert-led overview of the calendar year (CY) 2023 Home Health (HH) Prospective Payment System (PPS) final rule. The webinar will take place on Wednesday, March 29, from 12:30 p.m. to 2:00 p.m. During this webinar, CMS will provide an overview of several provisions from the CY 2023 HH PPS final rule on behavior changes, the construction of 60-day episodes, payment rate development and more.
Read More
CMS's February 2023 Home Infusion Therapy (HIT) Monitoring Report is now available. This report summarizes utilization for the HIT service visits, characteristics of HIT recipients and characteristics of durable medical equipment (DME)/HIT supplier organizations. Data points are presented from the first quarter of 2020 through the end of the second quarter of 2022.
Read More
The Home Health Value-Based Purchasing (HHVBP) Model Technical Assistance (TA) team invites you to participate in a brief survey. CMS hopes to learn more about your home health agency’s (HHA) experience with the resources provided for the expanded HHVBP Model and identify areas for future outreach and education. Your input in this survey is vital and appreciated. The last day to complete the survey is Friday, March 31.
Read More
The March 2023 Interim Quarterly Confidential Feedback Reports for the fiscal year (FY) 2024 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports (CASPER) reporting system.
Read More
CMS has released the schedule for state Medicaid unwinding start dates and the effective date of the anticipated terminations for procedural reasons. This is generally the first month that members who have not had their eligibility successfully renewed in the past 12 months may be disenrolled for procedural reasons, such as non-response to a renewal form, per CMS guidelines. Terminations for individuals the state has re-determined as ineligible for Medicaid and Children's Health Insurance Program (CHIP) may occur on or after April 1, 2023.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
IHCA continues to track issues of importance to members, including the subjects mentioned in the Iowa Administrative Bulletin that is released every two weeks. The bi-weekly areas of note found in the Feb. 22 issue include newly noticed rules related to health care facilities administration, nursing facilities and minimum physical standards for residential care facilities (RCFs).
Read More
IHCA has developed new resources for nursing facility (NF) member providers to help clarify upcoming changes to the Quality Assurance Assessment Fee (QAAF) program and to calculate the estimated impact to their facility’s cash flows to help plan accordingly.
Read More
A recording of yesterday’s Skilled Nursing Facility (SNF) Provider Update Call, sponsored by Right Dose, A Guardian Pharmacy, is now available on the IHCA website. ICHC’s Home Health (HH) Provider Update Call will be next Thursday, March 9. Due to scheduling conflicts with IHCA’s Day on the Hill and MCO training, there will be no IHCA MCO Calls in March.
Read More
IHCA received informational letter (IL) 2428 from Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) announcing Iowa Medicaid Pharmacy Program changes, effective April 1, 2023. The letter includes information regarding new drug prior authorization (PA) criteria, changes to and removal of certain existing PA criteria and point-of-sale billing updates.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
The Iowa Department of Health and Human Services (DHHS) will host a Virtual Town Hall call on Feb. 28 at 10:00 a.m. to discuss changes to the Quality Assurance Assessment Fee (QAAF) and the inflation factor currently used to calculate nursing facility (NF) rates. These changes will be implemented with the April 1, 2023, rates and are expected to generate additional funding for the NF rates. For an estimate on how these changes will impact your specific facility, contact Brandon at IHCA.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have announced upcoming competency-based training opportunities. Competency-based training ensures providers and direct support professionals acquire skills that can be applied in the home- and community-based services (HCBS) setting. Trainings are provided at no cost to agencies or direct support professionals. The next training webinar, “Accessibility Gone Viral,” will take place tomorrow, Feb. 23.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is open. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. This grant will remain open for application until March 15, 2024.
Read More
Today is the deadline to apply for the fourth round of grant fund distributions for the Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. If you are unable to make the Feb. 15 deadline for the next round, there will still be time to apply. This grant will remain open for application until March 15, 2024.
Read More
As an assisted living (AL) employer affected by the pandemic, you may be eligible to receive a tax credit of up to $26,000 per employee. Join AHCA/NCAL for a free webinar about the Employee Retention Credit (ERC) tomorrow, Thursday, Feb. 16 from 1:00 p.m. – 2:00 p.m.
Read More
The Iowa Department of Health and Human Services (DHHS) recently released details regarding the managed care organization (MCO) onboarding and open enrollment period beginning on March 1, 2023. Member reassignment happens when a new MCO joins the Iowa Health Link program. Members will be distributed between the three MCOs to ensure equal membership and will have a chance to choose their MCO during the open choice period (March 1 through May 18).
Read More
AHCA/NCAL recently released a memorandum regarding how to prepare for the COVID-19 public health emergency (PHE) unwinding and returning to Medicaid eligibility redetermination. The Consolidated Appropriations Act of 2023 laid out timelines for states to return to regular Medicaid redeterminations, which were paused during the COVID-19 PHE. For providers, this means your state will begin re-determining all residents covered by Medicaid in February, March or April of 2023, and your buildings will begin receiving Redetermination Notices all together depending upon your state’s start date.
Read More
The Iowa State Treasurer's Office provides a free service known as The Great Iowa Treasure Hunt. Each year, funds are turned over to the State Treasurer's Office as unclaimed property. Examples of unclaimed property include utility refunds, uncashed checks, dormant bank accounts and more. The goal of the Great Iowa Treasure Hunt is to help Iowans locate and reunite with their lost or abandoned funds. IHCA encourages providers to check for any potential property owed to them.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is now open, with a deadline of Feb. 15 for the fourth round of grant fund distributions. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. If you are unable to make the Feb. 15 deadline for the next round, there will still be time to apply. This grant will remain open for application until March 15, 2024.
Read More
Iowa Department of Health and Human Services (DHHS), with Mathematica and The Harkin Institute, recently conducted an evaluation of the state’s community-based behavioral, disability and aging services to understand how Iowans access and use services through Medicaid and other programs and how the state can improve on the current structure. On Jan. 31, 2023, DHHS shared recommendations for strengthening Iowa's community-based services system, which describes findings and recommendations to improve service delivery throughout the state.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is now open, with a deadline of Feb. 15 for the fourth round of grant fund distributions. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) will host a stakeholder session covering the end of the continuous coverage requirement today, Wednesday, Jan. 25, from 3:00 to 4:00 p.m.
Read More
In accordance with Section 441 of the Iowa Administrative Code (IAC), Chapter 79.1(27), Medicaid fee-for-service (FFS) reimbursement rates for early periodic screening, diagnosis and treatment (EPSDT), private duty nursing and personal care services provided by home health agencies are limited to 133 percent of the statewide average. Payment rates are established at the lesser of actual unit cost or the rate maximum. Interim payment rates will be updated for the new rate maximum as cost reports are finalized.
Read More
On Jan. 18, Iowa Total Care released a provider alert regarding oxygen concentrators. Effective Nov. 1, 2022, pre-authorization is not required for procedure code E1390, Oxygen Concentrator, for participating (PAR) providers with home location (12). Participating (PAR) providers will need an authorization in any location other than home (location 12). Non-participating (Non-PAR) providers will need an authorization in all instances.
Read More
On Thursday, Jan. 12, 2023, Iowa Department of Health and Human Services (DHHS) launched a new website. The Iowa Medicaid portion of the new website mirrors the structure and content of the previous website. Iowa DHHS will temporarily maintain a redirect service for the legacy site. At this time, there are no changes to sites that do not have a DHHS domain, such as the Iowa Medicaid Preferred Drug List and the Iowa Medicaid Portal Access (IMPA).
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program is accepting a fourth round of applications, due Feb. 15. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
On Jan. 17, Iowa Total Care (ITC) released a Provider Alert regarding assisted living (AL) billing for Consumer Directed Attendant Care (CDAC) and homemaker services. The alert stated that ITC recognizes that AL facilities are exempt from submitting CDAC (S5125) and homemaker (S5130) claims through its electronic visit verification (EVV) vendor CareBridge. In order to ensure that these services are paid appropriately, ITC asks that CDAC and homemaker services (provided in an AL facility) be billed with the place of service (POS) code 13.
Read More
Molina Healthcare recently released an updated 2023 Provider Manual. The Provider Manual includes information regarding provider responsibilities, member rights and responsibilities, benefits and covered services, cultural competency and linguistic services, managed long-term services and support (MLTSS), health care services, behavioral health services, eligibility, enrollment, credentialing, claims and more.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is underway. The funds may be used for continuing education costs for long-term care staff, certified nursing assistant (CNA) training, technology improvements to assist with rapid identification and monitoring of infectious diseases and more.
Read More
On Dec. 29, 2022, the Consolidated Appropriations Act of 2023 was signed and ends the Medicaid program’s continuous coverage requirement as of April 1, 2023. This means that beginning April 1, Iowa Medicaid will no longer be required to maintain a member’s health coverage if they are found to be ineligible after an evaluation of their eligibility status. Iowa Medicaid will host a one-hour webinar on Jan. 25 at 3:00 p.m. where Medicaid team members will share details about the state's plan and what members can expect in the coming weeks and months.
Read More
Molina Healthcare is convening a listening session on Jan. 17, 2023, at 5:00 p.m. for providers. The purpose of this engagement is to listen, hear and discuss critical issues and priorities for providers. As Molina Healthcare prepares to launch, their team values hearing from providers about what is important to them in delivering health care services to their patients and the most vulnerable populations.
Read More
The Health Resources and Services Administration (HRSA) recently released two important updates related to the Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments that HRSA began distributing in November 2021 and continued throughout 2022.
Read More
Providers who applied by Nov. 15 for the first round of the Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program will be notified of the results of their application by the end of January, with funds issued for approved applications anticipated by the end of February. The deadline for the third round of distributions is Jan. 15. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2399 to provide guidance regarding appropriate billing of Type of Bill (TOB) frequency codes in conjunction with patient discharge status codes. The information in this IL went into effect on Jan. 1, 2023.
Read More
The Department of Veterans Affairs (VA) recently published the 2023 VA Fee Schedule (VAFS) with a new yearly cycle adjustment. Beginning in 2023, the VAFS cycle will run Feb. 1 to Jan. 31. The VA adjusted the yearly fee schedule cycle to ensure rate settings take into account comprehensive data from other industry sources.
Read More
IHCA continues to track issues of importance to members, including the subjects mentioned in the Iowa Administrative Bulletin that is released every two weeks. An area of note that was found in the Dec. 13 issue includes an adopted and filed rule regarding the College Student Aid Commission.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2411 to provide guidance regarding Home- and Community-Based Services (HCBS) cost report submission requirements.
Read More
The Iowa Long-Term Care (LTC) Workforce and Infection Control Grant Program application process is underway. The funds may be used for a variety of costs, including continuing education costs for LTC staff, certified nursing assistant (CNA) training, technology improvements to assist with rapid identification and monitoring of infectious diseases and much more.
Read More
AHCA/NCAL recently shared how the Health Resources and Services Administration (HRSA) began transmitting emails to providers who, based on the Provider Relief Fund (PRF) reporting period one submissions, will receive a Repayment Request Notice via the U.S. Postal Service (USPS).
Read More
The Iowa Long-Term Care (LTC) Workforce and Infection Control Grant Program application process is underway. The funds may be used for a variety of costs, including continuing education costs for LTC staff, certified nursing assistant (CNA) training, technology improvements to assist with rapid identification and monitoring of infectious diseases and much more.
Read More
Effective Jan. 1, 2023, the maximum residential care facility (RCF) per diem rate will increase from $33.53 to $35.89. 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 will increase from $111.00 to $120.00 per month, effective Jan. 1, 2023.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is now open, with a Dec. 15 deadline for the second round of distributions. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses. IHCA has provided tips on submitting an application.
Read More
Iowa Total Care recently released a provider alert indicating that, in mid-December, the Provider Portal claims dashboard and claims details page will have a new look. This redesign will change the look and feel of the claims portal as it exists today.
Read More
Join ICHC tomorrow, Dec. 8, for its December Home Health (HH) Provider Update Call at 2:00 p.m. The call will cover the status of the federal public health emergency (PHE), Home Health Value-Based Purchasing (HHVBP) pre-implementation reports, the ICHC Home Care Accreditation Program, details on the Provider Annual Self-Assessment, the vaccination status in health care settings, upcoming education events and more. IHCA has provided the call-in details for all remaining member calls in December.
Read More
CMS is hosting a Virtual Skilled Nursing Facility (SNF) / Long-Term Care (LTC) Open Door Forum tomorrow, Dec. 8, at noon. The tentative call agenda includes a Nursing Home Care Compare update, the Minimum Data Set (MDS) transition to Internet Quality Improvement and Evaluation System (iQIES) and an open discussion forum.
Read More
CMS recently released its Home Health Value-Based Purchasing (HHVBP) November 2022 Newsletter. This newsletter provides home health agencies (HHAs) with the latest information about the expanded HHVBP Model, as well as important tools, news and timely insights from the CMS and HHVBP Model Technical Assistance (TA) team. Please consider sharing this newsletter within your organization.
Read More
IHCA/ICAL members that are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently announced the release of the 2022 Home- and Community-Based (HCBS) Provider Quality Management Self-Assessment, which consists of the self-assessment form found on the Iowa DHHS website and address collection tool which is emailed out to contacts listed on last year’s self-assessment or is available upon request. Both documents have been updated for 2022. The completed self-assessment form must be received no later than Dec. 31, 2022.
Read More
The Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid recently released informational letter (IL) 2399 to provide guidance regarding appropriate billing of Type of Bill (TOB) frequency codes in conjunction with patient discharge status codes.
Read More
The Iowa Long-term Care (LTC) Workforce and Infection Control Grant Program application process is now open, with a deadline of Dec. 15 for the second round of grant fund distributions. Eligible applications received by Dec. 15 can receive grant distributions within the following 75 days. The grant operates on a reimbursement model where eligible providers submit receipts for qualifying expenses, then the grant funds are dispersed. To apply online, applicants must enter the application ID number from their eligibility notification letter and upload receipts for proof of purchase of eligible grant expenses.
Read More
IHCA received informational letter (IL) 2405 from the Iowa Department of Health and Human Services (DHHS) and Iowa Medicaid announcing Iowa Medicaid Pharmacy Program changes, effective Jan. 1, 2023. The letter includes changes to the preferred drug list (PDL), new drug prior authorization (PA) criteria, changes to existing PA criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
Iowa Total Care has identified an internal project review that was incorrectly triggered and executed letters notifying providers of a recoupment. These letters should not have been sent, as internal reviews were not complete relative to the data in the internal project. Providers should ignore this letter; there are no funds being recouped at this time.
Read More
The annual provider self-assessment will be released soon and is due to be submitted with all supporting documents by Dec. 31, 2022. The self-assessment is required for any provider that is reviewed by the Home- and Community-Based Services (HCBS) quality improvement organization (QIO). To assist with this process, Iowa Medicaid is hosting a Self-Assessments for HCBS Providers Virtual Training on Nov. 30 at 10:00 – 11:00 a.m.
Read More
The Iowa Long-Term Care (LTC) Workforce and Infection Control Grant Program began accepting a second round of applications on Nov. 16. The LTC Grant is designed to provide Iowa’s nursing facility providers with the resources their health care workers need to identify, report, prevent and respond to infectious diseases and outbreaks. Eligible expenses include technology improvements, respiratory fit testing and personal protective equipment (PPE).
Read More
On Oct. 1, 2022, Iowa Medicaid began accepting applications from eligible providers for the American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) Health Information Technology and Infrastructure (HIT&I) and Remote Monitoring (RM) grants. Because of the number of responses that included multiple requests for exceptionally high-dollar amounts, the deadline to apply for HIT&I and RM grants is Nov. 30, 2022. Review and approval of HIT&I and RM grant projects and funding amounts will occur during the month of December 2022. Funding decisions for grant applications received between Oct. 1, 2022, and Nov. 30, 2022, will be announced in January 2023.
Read More
CMS has issued Change Request 12805 that creates new G-codes for reporting home health (HH) services furnished by telehealth and to revise original Medicare systems to process them without affecting payment to the home health agencies (HHAs).
Read More
Iowa Medicaid recently released informational letter (IL) 2402 announcing the dates and times for the Iowa Medicaid member and provider town halls for the month of November. Because of the Thanksgiving holiday, this month’s town hall series will be held on Thursday, Dec. 1, 2022.
Read More
The National Center for Assisted Living (NCAL) has partnered with Hospital and Healthcare Compensation Service (HCS) to complete a wage and benefit survey for assisted living (AL) providers across the nation. The deadline for participation in the AL Salary & Benefits study has been extended to Monday, Nov. 21. Anyone needing an extension may email Rich Cioffe, or call 201-405-0075, ext. 13 to let HCS know they need additional time to complete the survey. There is no cost to participate in the study.
Read More
Iowa Medicaid will be hosting a listening session regarding Home- and Community-Based Services (HCBS) flexibilities today, Nov. 9, from 2:00 p.m. to 3:30 p.m. The purpose of the session is to gather feedback from providers that the department can incorporate into its plans for the unwinding of the COVID-19 PHE. Iowa Medicaid holds monthly virtual town hall meetings with providers and members to gather feedback on the current state of the program and how to improve. They also plan to use these town hall meetings to share information on current and future program projects and improvements.
Read More
In preparation for upcoming holidays, bank and office closures, Iowa Total Care would like to notify providers of changes to the normal Tuesday/Thursday processing and Wednesday/Friday payment transmission for the remainder of 2022.
Read More
Iowa Medicaid recently released informational letter (IL) 2350, which replaces IL 2088. Effective July 1, 2022, for the 1915(i) Home- and Community-Based Services (HCBS) habilitation program, the interRAI assessment tools will be replaced by the Level of Care Utilization System (LOCUS) for adults ages 19 and older and the Child and Adolescent Level of Care Utilization System (CALOCUS) for youth ages 18 and under for the purposes of the needs-based eligibility (NBE) determination, person-centered service planning and home-based habilitation tier authorization. The LOCUS/CALOCUS will be based on the member’s Comprehensive Assessment and Social History (CASH).
Read More
On Nov. 8, Iowa Medicaid released informational letter (IL) 2398 regarding an electronic visit verification (EVV) implementation update. On Oct. 5, 2022, Iowa Medicaid filed a good faith effort (GFE) exemption with CMS to delay implementation of home health care services (HHCS) EVV in Iowa. CMS has approved this exemption. Therefore, while Iowa works through implementation of the home health codes, there will not be federal match penalties in calendar year (CY) 2023 for the delay in implementation. The Department of Health and Human Services (DHHS) and the managed care organizations (MCOs) are working on a phased approach to implement HHCS codes in Iowa. Phase 1 includes waiver HHCS codes. This phase is live now, and claims are required to flow through CareBridge by Jan. 1, 2023.
Read More
CMS issued the Final Rule regarding Medicare home health (HH) services payment rates for calendar year (CY) 2023. ICHC has provided details on the Final Rule, as well as the Home Health Quality Reporting Program and the expanded Home Health Value-Based Purchasing Model.
Read More
Iowa Medicaid recently released informational letter (IL) 2394. The IL addresses the annual submission requirements regarding prevention and detection of Medicaid fraud and abuse. This IL applies to any provider entity or provider that receives payments of $5 million or more from Iowa Medicaid in any federal fiscal year (FY) (Oct. 1 - Sept. 30).
Read More
Iowa Medicaid recently released informational letter (IL) 2392-MC-FFS regarding an upcoming telehealth virtual listening session. This virtual session will focus on telehealth flexibilities implemented during the COVID-19 public health emergency (PHE). This session is open to Iowa Medicaid providers and members and will be held virtually on Monday, Nov. 7, 2022 from 1:30 p.m. to 3:00 p.m. The purpose of this session is to share proposals for which telehealth flexibilities to continue and which to sunset with the end of the COVID-19 PHE and to gather input from stakeholders.
Read More
Iowa Medicaid will host a Home-and Community-Based Services (HCBS) unwind process virtual listening session on Nov. 9. This virtual session is open to all Iowa Medicaid providers and will focus on HCBS flexibilities implemented during the COVID-19 public health emergency (PHE).
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Iowa Medicaid recently released Informational Letter (IL) 2387 providing guidance on provider enrollment COVID-19 flexibilities. Iowa Medicaid will begin unwinding some of the flexibilities given by the federal public health emergency (PHE) that relates to provider enrollment. These flexibilities include enrollment revalidation requirements and the suspension of site visits for newly enrolled providers.
Read More
Iowa Medicaid recently released Informational Letter (IL) 2389 announcing additional upcoming competency-based training opportunities for case managers and long-term services and supports (LTSS) providers. Competency-based training ensures providers and direct support professionals acquire skills that can be applied in the Home- and Community-Based Services (HCBS) setting. Trainings are provided at no cost to agencies or direct support professionals. The next training will be on Oct. 25 and will cover person-centered planning and supports.
Read More
Iowa Medicaid recently released Informational Letter 2372 regarding guidance on eligibility recovery claim submissions. This letter provides instructions on how providers may submit their claims to Medicaid following a payment recovery from a managed care plan. This includes managed care organizations (MCO) and dental plans.
Read More
Join IHCA for its monthly Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy, next Wednesday, Oct. 12. Additionally, ICHC will host its Home Health (HH) Provider Update Call next Friday, Oct. 14.
Read More
On Sept. 21, CMS released a state Medicaid director letter that provides states with guidance on nursing facility state plan payment and upper payment limit (UPL) approaches in Medicaid that rely on the Medicare Patient-Driven Payment Model (PDPM). This guidance is especially important since CMS will no longer support the Medicare Resource Utilization Groups (RUGs) systems after Oct. 1, 2023.
Read More
Beginning Oct. 1, 2022, Iowa Medicaid will accept applications from eligible providers to receive funds from the American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) Employee Training and Scholarship Grant. Grants will serve the purpose of assisting qualified HCBS providers with funding employee training and scholarships for education and training in nursing, behavioral health and other health care fields.
Read More
Beginning Oct. 1, 2022, Iowa Medicaid will accept applications from eligible providers to receive funds from the American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) Health Information Technology (IT) and Infrastructure Grant. Grants will serve the purpose of assisting qualified HCBS providers with funding projects that improve, enhance and/or expand HCBS.
Read More
Policy clarifications (PCs) are correspondence issued by Iowa Medicaid to clarify policy that affects managed care organization (MCO) operations. PCs have been provided to the MCOs, and the MCOs have attested to each PC based on Iowa Medicaid business practices at the time of issuance. Iowa Medicaid has created a policy clarification webpage that allows stakeholders to see PCs provided to MCOs. Providers are encouraged to sign up to receive PCs. To sign up online, please visit the policy clarification webpage.
Read More
Iowa Medicaid has announced changes to the Medicaid service documentation requirements, effective Sept. 16, 2022. The changes are being implemented to clarify documentation requirements and remove administrative burden related to delivering services. Providers have requested the amendments in response to the direct care workforce crisis. This will provide immediate relief to providers struggling to recruit and retain direct care staff. These amendments were published in the July 27, 2022, Iowa Administrative Bulletin.
Read More
The Department of Veterans Affairs (VA) shared a document to assist providers when a service is considered bundled or non-bundled. The document also tells providers when bundled or non-bundled services are used, what the reimbursement model is and whether an Outcome and Assessment Information Set (OASIS) is required.
Read More
On July 8, 2022, Iowa Medicaid submitted a final draft of the statewide transition plan (STP) to CMS. The Home- and Community-Based Services (HCBS) rules require that all residential and non-residential settings be in compliance by March 17, 2023. Beginning in September 2022, the Iowa Medicaid Quality Improvement Organization (QIO) HCBS unit will send letters to providers with outstanding remediation related to settings, notifying them of actions needed and associated timelines to come into compliance with the settings rule.
Read More
CMS has released guidance outlining requirements and expectations for the resumption of normal eligibility business processes when the federal COVID-19 public health emergency (PHE) expires. Iowa Medicaid has utilized this guidance to establish a phased approach to resuming normal eligibility business processes. Phases 1 through 3 of Iowa Medicaid’s plan have been implemented, and the associated processes contained in each phase continue to be executed during the PHE.
Read More
CMS recently issued a letter to all nursing homes and debt collectors regarding debt collection practices. The focus behind the letter is to draw attention to the prohibited practice outlined in the Nursing Home Reform Act (NHRA) of nursing facilities requesting or requiring that a third party personally guarantee payment to the facility as a condition of a resident’s admission or continued stay in the facility. CMS reminds nursing facilities that violations of such requirements may be subject to enforcement action by state agencies and CMS.
Read More
CMS recently released a draft version outlining anticipated changes to the comprehensive Minimum Data Set (MDS), which will go into effect Oct. 1, 2023. This item set is to be used for both skilled nursing facility (SNF) prospective payment system (PPS) and Omnibus Budget Reconciliation Act (OBRA) assessments. These items were intended to be implemented in October 2020, but that implementation was delayed due to COVID-19 and other technical issues.
Read More
Join ICHC tomorrow, Sept. 8, for its Home Health (HH) Provider Update Call. IHCA's Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy, are cancelled this month since they occur at the same time as Iowa Medicaid's Annual Provider Trainings. The MCOs are participating in Iowa Medicaid's trainings, and IHCA, ICAL and ICHC members are encouraged to attend as well.
Read More
Iowa Medicaid will host virtual town hall events for providers, members and stakeholders on Thursday, Sept. 8 at 4:00 p.m. and 6:00 p.m. to discuss recent developments in the managed care request for proposal (RFP) process. The event for providers will be at 4:00 p.m., and the event for members will be at 5:00 p.m.
Read More
The Iowa Department of Health and Human Services (DHSS) announced that it has issued a Notice of Intent to award to two managed care organization (MCO) bidders for Request for Proposal (RFP) MED-23-005, IA Health Link. The bidders announced on Aug. 31, 2022, include Amerigroup Iowa, Inc. and Molina Healthcare of Iowa, Inc. Molina Healthcare of Iowa, Inc. will join Amerigroup Iowa, Inc. and Iowa Total Care, Inc. as MCOs in the Iowa Medicaid program.
Read More
Iowa Medicaid released informational letter (IL) 2371 to provide guidance for the treatment of American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) funds when completing the annual financial and statistical report. Iowa Medicaid providers that are eligible for HCBS ARPA grant funds and provide applicable services are required to submit reports in accordance with Iowa Administrative Code (IAC).
Read More
Iowa Medicaid is participating in the federal FY 2024 Payment Error Rate Measurement (PERM) program. This means that providers may be contacted by the CMS review contractor who will collect medical records either in hard copy or in electronic format. Upon receipt of the request for medical records, providers must submit the records within 75 days.
Read More
The August 2022 Home Health Value-Based Purchasing (HHVBP) Newsletter, containing the latest information about the expanded HHVBP model, as well other as important tools, news and insights, is now available on the CMS website. A recording of the Aug. 25 CMS webinar on the expanded HHVBP model is now available online as well.
Read More
Iowa Medicaid has announced new competency-based training for Iowa long-term services and supports (LTSS) providers and case managers. Competency-based training ensures providers and direct support professionals acquire skills that can be applied in the Home- and Community-Based Services (HCBS) setting. Trainings are provided at no cost to agencies or direct support professionals. The next trainings will be held on Sept. 20 and 21 and will cover service documentation with Iowa Medicaid.
Read More
Recently, the Iowa Health Care Quality Partners (IHCQP) Board of Managers and Quality Committee took the next step in the maturity of the provider network by moving to clinical integration. This move to clinical integration, known as Tier 2, makes Iowa the first AHCA/NCAL affiliated, provider-owned network to make this advancement. This advancement allows IHCQP to begin negotiating rates with insurance payors and leveraging the high quality care that is being provided by those members electing to move to Tier 2, all while maintaining the current opportunities and benefits that are in place for members in Tier 1.
Read More
Beginning Sept. 1, 2022, Iowa Medicaid will accept applications from eligible providers to receive funds from the Home- and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Recruitment and Retention Grant. Grant funds must be used to cover costs related to recruitment and retention incentive payments to direct care employees and other essential staff supporting the delivery of HCBS directly or indirectly including, but not limited to, program coordinators, managers, nurses, counselors, accounting, human resources, informational technology, transportation and maintenance.
Read More
Iowa Medicaid has implemented a medically exempt (ME) status look-up function within Iowa Medicaid Portal Access (IMPA). The look-up function will allow skilled nursing facility and nursing facility providers the ability to look up an Iowa Health and Wellness Program (IHAWP) member’s ME status when the individual is admitted to their facility. Ongoing changes to an IHAWP member’s ME status will be displayed for providers to monitor. The Medicaid member must be a resident of a provider’s facility for that provider to access this information in IMPA.
Read More
2022 Iowa Medicaid Annual Provider Training sessions will be held in-person and via Zoom live broadcast. There will be six four-hour sessions. Each session will cover the same material; providers only need to sign up for one session. Iowa Medicaid will record the sessions and post the recordings to the Iowa Department of Health and Human Services (DHHS) website for providers who are unable to attend.
Read More
IHCA received informational letter (IL) 2370 from Iowa Medicaid announcing Iowa Medicaid Pharmacy Program changes, effective Oct. 1, 2022. The letter includes changes to the preferred drug list (PDL), new drug prior authorization (PA) criteria, changes to existing PA criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
IHCA/ICAL members that are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
Iowa nursing facilities have two opportunities to submit proposals for Civil Money Penalty Quality Improvement Initiative (CMPQII) grants for 2022. For consideration, proposals must be received by Sept. 23, 2022, or Jan. 3, 2023. Grants will be awarded beginning on or after Jan. 3, 2023, or April 1, 2023.
Read More
Join IHCA on Aug. 17 for its Reimbursement Market Strategies Conference. This new in-person conference, sponsored by BCG Research, Trio Pharmacy Services and Williams & Company P.C., will provide attendees with timely and applicable reimbursement market strategies. This conference is approved for 5.0 CEUs for nurses, administrators and social services staff in the nursing facility setting.
Read More
Join IHCA for its monthly Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy, next Wednesday, Aug. 10. Additionally, ICHC is hosting its Home Health (HH) Provider Update Call next Thursday, Aug. 11.
Read More
Last Friday, CMS issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2023 update. In April 2022, CMS proposed a negative 0.7% cut. The final rule instead provides a net market basket increase for SNFs of 2.7% beginning Oct. 1, 2023. While IHCA and AHCA advocated strongly for this change, this positive outcome is ultimately the result of the hard work of IHCA and AHCA members who together submitted thousands comments to CMS on the proposed rule and made their voices heard.
Read More
CMS has released Change Request (CR) 12790, modifying the Medicare systems to ensure prior periods are updated correctly when a notice of admission (NOA) is canceled. The CR also ensures medical review information is not removed when claims are subsequently adjusted due to period sequence edits.
Read More
Iowa Department of Human Services (DHS) announced new competency-based training for Iowa Medicaid enrolled long-term services and supports (LTSS) providers and case managers. Competency-based training ensures providers and direct support professionals acquire skills that can be applied in the Home- and Community-Based Services (HCBS) setting. Training sessions are provided at no cost to agencies or direct support professionals.
Read More
As directed in information letter (IL) 2239, Electronic Visit Verification (EVV) was declared optional for all personal care services provided by assisted living (AL) and residential care facility (RCF) shift workers. AL and RCF providers must complete an EVV Provider Attestation identifying their exemption status with Iowa Medicaid by Sept. 1, 2022, and annually thereafter.
Read More
Iowa Department of Human Services (DHS) has reopened the third application period from eligible Home- and Community-Based Services (HCBS) direct service providers to receive funds from the HCBS American Rescue Plan Act (ARPA) Recruitment and Retention Grant. Eligible agency providers identified below who did not apply for funds during the first application period prior to the application closing will now have until close of business Friday, Aug. 19, 2022, to apply for a portion of the grant funds.
Read More
On July 7, 2022, CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after Jan. 1, 2023. One of the key proposals addresses how new owners of skilled nursing facilities (SNFs) have more requirements, which is highlighted by the fingerprinting and FBI background checks.
Read More
The U.S. Department of Justice (DOJ) recently secured an agreement with a nursing facility company in New York that has resulted in a $7.85 million dollar settlement. The DOJ case notes examples of facility staff disenrolling residents from Medicare Advantage (MA) plans back to original Medicare without the resident’s consent. IHCA urges nursing facilities to develop internal Medicare Advantage plan policies and procedures and has provided guidelines that should be incorporated.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Join IHCA next Wednesday, July 13, for its Managed Care Organization (MCO) Calls sponsored by Right Dose, A Guardian Pharmacy. ICHC's Home Health (HH) Provider Update Call will be next Thursday, July 14.
Read More
Iowa is currently exploring the possibility of starting a Quality Incentive Payment Program (QIPP) for Iowa’s non-state government owned (NSGO) facilities. Eligible entities would need to be owned by either a city or the county to qualify for participation in the program. The state is currently drafting a state plan amendment to send to CMS for approval of this program.
Read More
The COVID-19 Unwind Plan is the process of returning to normal operations after the federal COVID-19 public health emergency (PHE) ends. Once the U.S. Department of Health and Human Services (HHS) ends the federal PHE, states must put plans in place to implement normal eligibility processes and roll-back flexibilities, as well as redetermine eligibility for all Medicaid members. The redeterminations of eligibility will be completed over a 12-month unwinding period.
Read More
As part of the American Rescue Plan Act (ARPA) Section 9817 Home- and Community-Based Services (HCBS) implementation plan, Iowa Department of Human Services (DHS) has designated $14.6 million in state funds to increase HCBS waiver and habilitation reimbursement rates by 4.25%, effective for dates of service on or after July 1, 2022. Medicaid HCBS providers are reimbursed based on retrospectively limited prospective rate services or fee schedules.
Read More
Iowa Health Care Quality Partners (IHCQP) is a business entity organized and owned by a network of independent long-term care providers for the purpose of reducing overhead and pursuing business ventures, including reimbursement and value-based contracts with managed care organizations (MCOs). Since the launch of IHCQP in early 2020, network participants have received increased contracted rates from Medicare Advantage plans and a payout of quality bonus of over 1.1 million dollars from a payer.
Read More
Iowa Department of Human Services (DHS) is currently refining the provider manual review process and would like to incorporate stakeholder input. To this end, DHS has developed a feedback survey for providers. The survey can be completed multiple times should providers wish to submit multiple recommendations on content. This survey is not intended for recommending policy or coverage changes.
Read More
IHCA received informational letter (IL) 2352 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective Aug. 1, 2022. The letter includes new drug prior authorization (PA) criteria, changes to existing PA criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
Iowa Medicaid is accepting applications from eligible Home- and Community-Based Services (HCBS) direct service providers to receive funds from the HCBS American Rescue Plan Act (ARPA) Recruitment and Retention Grant. Providers that were not included in the first and second application periods and are identified in informational letter (IL) 2351 may apply for a share of the funds. Agency providers will have until close of business on Friday, June 24, 2022, to request grant funds by completing the online application and attestation and submitting the minority impact statement.
Read More
Iowa Department of Human Services (DHS) is instructing all Home- and Community-Based Services (HCBS) waiver and habilitation service providers who received COVID-19 retainer payments for the month of April 2020 to conduct a self-audit of their retainer claims submitted and retainer payments received. Providers are obligated to notify the managed care organizations (MCOs) when funds are incorrectly paid or when an overpayment has been detected. Any overpayments or improper payments for the month of April 2020 must be returned to the MCO no later than July 31, 2022.
Read More
Effective July 1, 2022, for the 1915(i) Home- and Community-Based Services (HCBS) habilitation program, the interRAI assessment tools will be replaced by the Level of Care Utilization System (LOCUS) for adults ages 19 and older and the Child and Adolescent Level of Care Utilization System (CALOCUS) for youth ages 18 and under for the purposes of the needs-based eligibility (NBE) determination, person-centered service planning and home-based habilitation tier authorization.
Read More
AHCA/NCAL is offering a pre-recorded webinar titled, "Employee Retention Tax Credit (ERTC) – An Overview and Insights on Updated Program Eligibility." The ERTC is intended to offer employers with a tax credit which can be used for wages when employees are furloughed during a government-ordered shutdown. The webinar provides an overview of the ERTC and offers concrete action steps to explore your eligibility and how to leverage the ERTC.
Read More
Effective July 1, 2022, nursing facility COVID-19 Relief Rate (CRR) payments will be discontinued. Payments may be made on claims with dates of service through June 30, 2022. Claims must be filed within given time requirements. Please review the CRR matrix for questions regarding claims that qualify for the additional $300 per day per member.
Read More
CMS ended the alternative settings waiver for skilled nursing facilities (SNFs), nursing facilities (NFs), inpatient hospices, intermediate care facilities for intellectually disabled individuals (ICF/IDs), psychiatric medical institutions for children (PMICs) and end-stage renal disease (ESRD) facilities, effective June 6, 2022. Prior to this, the Medicaid waiver allowed all facilities to be fully reimbursed for services rendered at unlicensed facilities.
Read More
To support home health agencies (HHAs) participating in the expanded Home Health Value Based Purchasing (HHVBP) Model, the HHVBP Technical Assistance Team has produced two new learning materials.
Read More
On April 11, CMS released the proposed rule, FY 2023 Skilled Nursing Facility Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765). Due to the proposed parity adjustment, CMS estimates the net market basket update would decrease Medicare skilled nursing facility (SNF) payments by approximately $320 million. AHCA and IHCA encourage SNF providers to submit a comment letter to CMS by the June 10 deadline and have provided guidelines to assist members in composing their letters.
Read More
Effective Oct. 22, 2021, Iowa Medicaid began using Iowa Medicaid Portal Access (IMPA) to distribute information regarding member Home- and Community-Based Services (HCBS) habilitation and waiver eligibility. Iowa Department of Human Services (DHS) has worked to improve the portal and providers are now able to access HCBS habilitation and waiver eligibility information for members they serve based on members’ current Medicaid eligibility and providers’ authorization to offer services based on the most recent HCBS service plans submitted to Iowa Medicaid by the managed care organizations (MCOs).
Read More
Iowa Medicaid offers provider training sessions on a quarterly basis. Second quarter training this year will focus on vision care, and there will be two one-hour sessions held via Zoom on June 21. Each session will cover the same material, and providers only need to attend one session. Iowa Department of Human Services (DHS) will record the sessions and post the recordings to the DHS website for providers who are unable to attend a live session.
Read More
Join IHCA for its monthly Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy, next Wednesday, June 8. ICHC's Home Health (HH) Provider Update Call is next Thursday, June 9. Additionally, a recording of yesterday's Skilled Nursing Facility (SNF) Provider Update Call, sponsored by Lee Agency and CliftonLarsonAllen, is now available on the IHCA website.
Read More
On April 11, CMS released the proposed rule, FY 2023 Skilled Nursing Facility Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765). Due to the proposed parity adjustment, CMS estimates the net market basket update would decrease Medicare skilled nursing facility (SNF) payments by approximately $320 million. AHCA encourages SNF providers to submit a comment letter to CMS by the June 10 deadline and has provided guidelines to assist members in composing their letters.
Read More
IHCA/ICAL members that are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
On April 11, CMS released the proposed rule, FY 2023 Skilled Nursing Facility Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765). Due to the proposed parity adjustment, CMS estimates the net market basket update would decrease Medicare skilled nursing facility (SNF) payments by approximately $320 million. AHCA and IHCA encourage SNF providers to submit a comment letter to CMS by the June 10 deadline and has provided guidelines to assist members in composing their letters.
Read More
Iowa Medicaid has amended the terms and conditions of the Home- and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Recruitment and Retention Grant after receiving feedback from providers that there is a need for greater flexibility in how the funds are distributed to direct care workers.
Read More
On April 11, CMS released the proposed rule, FY 2023 Skilled Nursing Facility Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765). Due to the proposed parity adjustment, CMS estimates the net market basket update would decrease Medicare skilled nursing facility (SNF) payments by approximately $320 million. AHCA encourages SNF providers to submit a comment letter to CMS by the June 10 deadline and has provided guidelines to assist members in composing their letters.
Read More
As of March 1, 2021, providers could submit the National Provider Identifier (NPI) of the residing nursing facility in Box 77 (operating provider) on their UB-04 claims form when billing revenue code 658. This allowed for a more expedient processing of their submitted claims. Since March 1, 2021, Iowa Total Care has continued to allow providers to bill the nursing facility NPI in Box 80. However, effective June 1, 2022, Iowa Total Care will require providers to bill with the NPI in Box 77 and will no longer process claims with the NPI in Box 80.
Read More
The achievement thresholds and benchmarks for each quality measure in the expanded Home Health Value Based Purchasing (HHVBP) Model are now available on the Internet Quality Improvement and Evaluation System (iQIES) portal.
Read More
On April 11, CMS released the proposed rule, FY 2023 Skilled Nursing Facility Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765). Due to the proposed parity adjustment, CMS estimates the net market basket update would decrease Medicare skilled nursing facility (SNF) payments by approximately $320 million. AHCA encourages SNF providers to submit a comment letter to CMS by the June 10 deadline and has provided guidelines to assist members in composing their letters.
Read More
The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. Due to the public health emergency (PHE), the sequestration was suspended through March 31, 2022. Effective April 1, 2022, the 1% sequestration payment adjustment will be applied for claims with dates of services from April 1, 2022 to June 30, 2022. Of note, the sequestration payment adjustment will revert to the 2% rate for claims with dates of services as of July 1, 2022. This will bring the total sequestration rate to 2%, which was the rate in effect prior to the PHE.
Read More
The April 2022 Expanded Home Health Value Based Purchasing (HHVBP) Model newsletter is now available. Education materials will be located on the expanded model webpage and some items will be located in iQIES. Benchmark and achievement thresholds are expected to be posted in iQIES in mid-May. ICHC has provided information on how baseline years will be used in the expanded HHVBP Model.
Read More
AHCA's two-part webinar series, Population Health Management (PHM): The Path to Independent Owner (IO) Participation, focuses on PHM and how providers with ten or fewer skilled nursing facilities can engage. The webinars will be held on May 19 and June 24.
Read More
IHCA's monthly Managed Care Organization (MCO) Calls for May have been cancelled. If you have any questions you would like submitted to the MCOs, please send them to
[email protected]. Next month's MCO Calls will be on Wednesday, June 8. ICHC's Home Health (HH) Provider Update Call will be next Thursday, May 12.
Read More
Electronic visit verification (EVV) is a federal requirement for home health services beginning Jan. 1, 2023. Iowa Medicaid will implement EVV in phases and use lessons learned from the current implementation to improve implementation in later phases. Iowa Department of Human Services (DHS) informational letter (IL) 2338 addresses the first home health implementation phase.
Read More
Iowa Medicaid has updated the Financial and Statistical Report, Form 470-0030 (Cost Report). The Provider Cost Audit (PCA) recommends using the updated form for the fiscal year ending Dec. 31, 2021. The updated form is required beginning with the fiscal year ending Jan. 31, 2022.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2313 to clarify the department’s policy regarding the Home- and Community-Based Services (HCBS) procedure codes and level II modifiers required for service authorization and reimbursement. This policy is applicable to fee-for-service (FFS) and managed care.
Read More
In informational letter (IL) 2333, Iowa Department of Human Services (DHS) notified providers of an address change for submitting nursing facility Quality Assurance Assessment Fee (QAAF) forms and payments. As a reminder, this quarter's payments should be received by Iowa Medicaid Enterprise by April 30. This means they should be mailed out with enough lead time for them to get there on or before April 30.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2334 to remind providers of the critical nature of using current Medicaid application and review forms. If your office retains unused applications or review forms, please ensure they are current and destroy all previous versions. DHS has provided links to the current forms and information about estate recovery requirements.
Read More
IHCA has heard from members regarding some challenges surrounding naviHealth, the care coordinator for UnitedHealthcare and Humana plans. IHCA has provided links to provider resource webpages for UnitedHealthcare and Humana. Within these webpages are webinar videos related to UnitedHealthcare/Humana partnerships, the naviHealth clinical model/processes, presentation slide decks, FAQ sheets, as well as contact sheets to help providers find additional information about naviHealth.
Read More
The Iowa Department of Human Services (DHS) has announced Iowa Medicaid Pharmacy Program changes, effective June 1, 2022. Changes have been made to the Preferred Drug List (PDL), prior authorization criteria and point of sale billing.
Read More
Join ICHC for its monthly Home Health (HH) Provider Update Call tomorrow, April 14, at 2:00 p.m. Additionally, ICAL is hosting its monthly Assisted Living (AL) Provider Update Call this Friday, April 15, at 11:00 a.m.
Read More
On April 11, CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2023 update. AHCA has provided highlights and a summary of the proposed rule. Additionally, AHCA is hosting a webinar tomorrow, April 14, at 3:00 p.m. CST that will provide an overview of the proposed rule and brief members on submitting comments to CMS.
Read More
On April 6, the Health Resources and Services Administration (HRSA), announced a limited opportunity for recipients of Provider Relief Fund (PRF) payments who are out of compliance with their reporting requirements. Non-compliant providers that are in specific, extenuating circumstances will be able to submit a “Request to Report Late Due to Extenuating Circumstances” for Reporting Period 1 from April 11 to April 22, 2022.
Read More
NaviHealth will conduct outcome report education sessions on Tuesday, April 26, and Thursday, April 28. The 30-minute sessions will provide insight into Navihealth's Predict Outcome tool, highlighting details and components of the report that aid care planning and add value to skilled nursing facility providers to enhance multidisciplinary team collaboration to track and promote quality patient outcomes and safe discharge planning.
Read More
Join IHCA next Wednesday, April 13, for its monthly Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy. Additionally, ICHC's monthly Home Health (HH) Provider Update Call is next Thursday, April 14, and ICAL's monthly Assisted Living (AL) Provider Update Call is next Friday, April 15.
Read More
Iowa Total Care's new provider relations map is now available. There are now five regions instead of 12, and the regions are organized by subject matter experts. Additionally, claims staff are also organized by subject matter expert specialty to ensure a more comprehensive and collaborative working environment to address claim opportunities.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Iowa Department of Human Services is hosting free online competency-based training and technical assistance (TA) for Iowa Medicaid-enrolled long-term services and supports providers and case managers. Competency-based training ensures providers and direct support professionals acquire skills that can be applied in the Home- and Community-Based Services (HCBS) setting. The first training will take place tomorrow, March 31, at 11:00 a.m., and will cover incident reporting.
Read More
Join IHCA next Wednesday, April 6, for its Skilled Nursing Facility Medicare Review. This in-person class, sponsored by BCG Research, will focus on skilled nursing facility level of care requirements, pre-admission screening, facility expense, billing requirements and Medicare reimbursement, including deductible, co-insurance, RUG-IV and the appeal process. This class is approved for 5.0 CEUs for nurses, social services staff and nursing facility administrators.
Read More
As previously announced, Iowa Medicaid is accepting applications from eligible Home- and Community-Based Services (HCBS) Waiver and Habilitation direct service providers to receive funds from the HCBS American Rescue Plan Action (ARPA) Recruitment and Retention Grant. The previously announced deadline for the first round of grant applications was Feb. 18, 2022. Iowa Medicaid is opening a second application period. Individual Consumer-Directed Attendant Care (ICDAC) and agency providers who did not apply for funds during the first application period will now have until April 22, 2022 to apply for a portion of the grant funds.
Read More
Iowa Department of Human Services (DHS) has worked with CMS to arrive at an agreed upon methodology for distribution of the American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) Recruitment and Retention Grant funds to Individual Consumer Directed Attendant Care (ICDAC) and HCBS agency providers. DHS will distribute the funds for eligible providers to the managed care organizations (MCOs) during the month of March. The MCOs will distribute the funds to the eligible providers who applied for the funds during the Jan. 26 to Feb. 18, 2022 application period in the amount determined by DHS based on the number of full-time equivalents (FTEs) identified on the application. Distribution of the funds to ICDAC and agency providers is estimated to occur the week of March 28, 2022. Providers receiving payment via paper check can expect to receive the funds the week of April 4, 2022.
Read More
Iowa Department of Human Services (DHS) released informational letter 2326 regarding changes to nursing facility day-weighted Case Mix Index (CMI) methodology. The budget-neutral changes will help to modernize the case mix system and increase efficiencies in the rebasing processes. The updates will assist in stabilizing swings in nursing facility rates and significantly reduce impacts of retrospective rates. Iowa Medicaid will conduct virtual provider training sessions regarding the nursing facility day-weighted CMI methodology via Zoom, and the next session will be held on April 27.
Read More
IHCA/ICAL members that are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
The Health Resources and Services Administration (HRSA) Provider Relief Fund (PRF) reporting portal is open for providers who need to report the use of PRF funds in Reporting Period 2. The deadline for Reporting Period 2 is March 31, 2022. Additionally, there have been challenges with Reporting Period 1. HRSA has shared suggested action steps for members if they receive a failure to report notification.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2323 to provide additional guidance on billing place of service (POS) for telehealth for covered services on an interim period for the COVID-19 public health emergency (PHE). Billing requirements for some services provided via telehealth may change when the PHE is lifted. An IL will be issued in the coming months addressing telehealth changes after the end of the PHE.
Read More
Iowa Department of Human Services (DHS) has announced the availability of additional Civil Money Penalty (CMP) grant funds for in-person visitation aids during the federal COVID-19 public health emergency (PHE). Nursing facilities may request the use of CMP reinvestment funds to purchase portable fans and portable room air cleaners with high-efficiency particulate air filters to increase or improve air quality.
Read More
Iowa Medicaid has scheduled three quarterly training sessions on program integrity and payment error rate measurement to be held virtually via Zoom on March 29-31. Providers only need to attend one training session as each will cover the same material. Iowa Department of Human Services (DHS) will record the sessions and post the recordings to the DHS website for providers who are unable to attend a live session.
Read More
The Iowa Medicaid provider refund address has changed. If your organization identifies a fee-for-service overpayment and has previously sent voluntary refunds to box 310202, please update the address to the following: Iowa Medicaid Enterprise,
PO Box 850202, Minneapolis, MN 55485-0202. Payments received at this address will be processed in the normal manner. This address change does not impact other PO boxes or Iowa Medicaid programs.
Read More
Join IHCA for its Special Skilled Nursing Facility (SNF) Survey Call next Wednesday, March 9, where the latest SNF survey outcomes will be discussed. The monthly Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy, will also take place next Wednesday. Additionally, ICHC is hosting its monthly Home Health (HH) Provider Update Call next Thursday, March 10.
Read More
The Health Resources and Services Administration (HRSA) is making more than $560 million in Provider Relief Fund (PRF) Phase 4 General Distribution payments this week. Providers should have received an email notification on Feb. 24 if their application was among those processed in this latest batch.
Read More
The Iowa Department of Human Services (DHS) previously announced that the distribution of the Home- and Community-Based Services (HCBS) recruitment and retention grant funds, scheduled for the week of Feb. 28, 2022, was contingent upon CMS approval of Iowa’s supplement grant request to spend more than $50 million. DHS has not yet received CMS approval, and the distribution of grant funds to Individual Consumer Directed Attendant Care (ICDAC) and HCBS agency provider applicants has been delayed.
Read More
Nursing facility services are a Medicaid state plan benefit and available as a covered service for all qualifying members who have full Medicaid benefits. This includes Iowa Health and Wellness Plan (IHAWP) members who have a medically exempt (ME) status and members on Modified Adjusted Gross Income (MAGI) Medicaid coverage groups. To qualify for nursing facility (NF) services, the member must reside in a skilled nursing facility (SNF), NF, hospital providing swing bed care, or must be receiving hospice benefits while residing in a SNF or NF. They must also meet the required level of care (LOC) and are subject to transfer of assets (TOA) policies.
Read More
The Des Moines Veterans Affairs (VA) office has a new form for reauthorization requests for home-based community care. Members should use this form for all future reauthorization requests.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Iowa's Public Health Disaster Emergency expired on Feb. 15, 2022. Iowa Department of Human Services has released informational letter 2315 stating that the end of the state-declared Public Health Disaster Emergency does NOT impact Medicaid flexibilities currently in place.
Read More
Iowa Department of Human Services (DHS) released informational letter 2313 to clarify its policy regarding the Home- and Community-Based Services (HCBS) procedure codes and level II modifiers required for service authorization and reimbursement. This policy is applicable to fee-for-service (FFS) and managed care.
Read More
The Office of Management and Budget (OMB) has issued the information collection packet for the Outcome and Assessment Information Set (OASIS)-E, which includes three attachments and the supporting statement document, outlining the burden estimate for both home health agencies (HHAs) and the federal government.
Read More
The Provider Relief Fund (PRF) Reporting Portal opened on Jan. 1, 2022, for Reporting Period 2 (RP2), which is the first time providers will be reporting on Nursing Home Infection Control (NHIC) Distribution payments. Providers required to report in RP2 must do so by March 31, 2022. The Health Resources and Services Administration (HRSA) will host a technical assistance session on Thursday, Feb. 17, at 2:00 p.m. CST for reporting on NHIC payments. Additionally, the PRF Phase 4 and American Rescue Plan (ARP) Rural Reconsideration process is now open. The submission deadline is May 2, 2022.
Read More
AHCA has released its Revenue Cycle Management (RCM) Academy, a five-module online program that offers training about a holistic interdisciplinary approach toward revenue management. RCM can be implemented in a building or as an organization-wide approach to enhance revenue by minimizing losses from payments that too often are unnecessarily lost or overlooked.
Read More
Join IHCA next Wednesday, Feb. 9, for its monthly Managed Care Organization (MCO) Calls, sponsored by Right Dose, A Guardian Pharmacy. Additionally, ICHC's monthly Home Health (HH) Provider Update Call is next Thursday, Feb. 10.
Read More
The Health Resources and Services Administration (HRSA) released an additional $2 billion in Provider Relief Fund (PRF) Phase 4 general distribution payments to more than 7,600 providers across the country last week. The reconsideration period for Phase 4 and American Rescue Plan (ARP) rural distribution began on Feb. 1, Reporting Period 2 submissions are due by March 31 and Phase 4 awards are still being made.
Read More
The Veterans Administration (VA) has a new feature called the Clinical Viewer Portal that is now available in the HealthShare Referral Manager (HSRM). The Clinical Viewer Portal offers users a comprehensive view of a veteran’s medical documentation history in the HSRM. Categories of information available include a clinical summary of the patient’s history, allergies, immunizations, medications, lab results, procedures and more.
Read More
Home health providers are invited to participate in a series of home health Electronic Visit Verification (EVV) stakeholder informational meetings held virtually on April 7 and May 5. The sessions will be led by Iowa Medicaid and the managed care organizations, and will include representatives from CareBridge. Registration is required and providers are encouraged to submit EVV questions with their registration. To accompany these stakeholder informational meetings, Iowa Medicaid is also conducting a survey to augment its understanding of providers’ perspectives.
Read More
The Central Iowa Veterans Affairs (VA) Regional Office has notified ICHC of staffing changes within the organization. The home care referral team now falls under the Care in the Community (CITC) department, supervised by Tonya Crees. The reauthorization request form has been updated to reflect staff changes.
Read More
Recordings of ICAL's Assisted Living Provider Update Call, IHCA's Skilled Nursing Facility Provider Update Call and ICHC's Veterans Administration/Optum Call are now available on the IHCA website.
Read More
ICHC became aware of home health claims processing problems in the last several weeks, caused by a CMS systems issue and some Medicare Administrative Contractor (MAC)-specific issues. At this time, it appears that Notices of Admission (NOAs) are processing as they should, and the MACs have provided a job aid for NOAs being submitted electronically and a job aid for NOAs being submitted via direct data entry. This should help clarify for providers exactly what is needed for each.
Read More
ICAL's monthly Assisted Living Provider Update Call is this Friday at 11:00 a.m. Join IHCA next Tuesday for its monthly Skilled Nursing Facility (SNF) Provider Update Call, sponsored by Lee Agency. ICHC is also hosting its quarterly Veterans Administration (VA)/Optum call next Tuesday. A recording of last week's Home Health (HH) Provider Update Call, sponsored by CliftonLarsonAllen, is now available on the IHCA website.
Read More
The Rebuild Iowa Infrastructure Fund (RIIF) is the primary funding source for public infrastructure-related expenditures. Iowa nursing facilities can request reimbursement for qualifying projects. To qualify for RIIF funding, a facility must have undertaken a complete replacement of a facility, started a new construction or undertaken a major renovation to comply with the Life Safety Code requirements or the development of Home- and Community-Based Services (HCBS) waiver services.
Read More
Join ICHC for its monthly Home Health (HH) Provider Update Call, sponsored by CliftonLarsonAllen, tomorrow, Jan. 13, at 2:00 p.m. A recording of yesterday's All Member Provider Update Call is now available on the IHCA website.
Read More
The State of Iowa has recently started a request for proposal (RFP) process to procure new Medicaid managed care organizations (MCOs) into the Iowa Health Link program. IHCA is aware of at least three companies that plan to make a bid for these services, and has recently heard from providers who are receiving requests to contract with at least one plan. You are not required to sign these contracts at this time. Once the State selects the health plan that will become the next MCO, there will be a time period for contracting with them at that time.
Read More
ICHC has been made aware of claims processing issues with the new Notice of Admission (NOA) process that took effect on Jan. 1, 2022. ICHC encourages agencies to document the issues they are encountering. This may include written documentation and/or screenshots of attempted submissions. Members should follow any guidance from their Medicare Administrative Contractor (MAC) related to resubmission of the NOA.
Read More
Join IHCA next Tuesday, Jan. 11, for a special call for skilled nursing facility (SNF) members that will cover updates on vaccine mandates and COVID-19 return-to-work guidelines for health care personnel. Additionally, IHCA's monthly Managed Care Organization (MCO) Calls are next Wednesday and ICHC's monthly Home Health (HH) Provider Update Call is next Thursday.
Read More
Due to recurrent themes and the proposals received from providers to develop breakout groups to focus on more specialized topics, Iowa Medicaid has reserved times to hold listening sessions with providers on several areas of focus. The goal of these listening sessions is to hear from providers who have experience in these topic areas and have ideas for ways in which to improve processes and policies.
Read More
The Health Resources and Services Administration (HRSA) has provided updated information on the status of Provider Relief Funds (PRF) Phase 4 and American Rescue Plan (ARP) Rural Payments. Topics include size of Phase 4 awards, additional detail on Phase 4 methodology, an update on hospital funds transfers to skilled nursing facilities (SNFs) and updated timelines regarding receipt of funds and provider requests for individualized support.
Read More
Due to recurrent themes and the proposals received from providers to develop breakout groups to focus on more specialized topics, Iowa Medicaid has reserved times to hold listening sessions with providers on several areas of focus. The goal of these listening sessions is to hear from providers who have experience in these topic areas and have ideas for ways in which to improve processes and policies.
Read More
Iowa Department of Human Services informational letter 2296 announced that effective Jan. 1, 2022, the maximum residential care facility (RCF) per diem rate will increase from $32.01 to $33.53. 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 will increase from $106.00 to $111.00 per month, effective Jan. 1, 2022.
Read More
The Health Resources and Services Administration (HRSA) has shared an updated status of delayed American Rescue Plan (ARP) rural payments, as well as suggestions for provider action steps, an overview of Phase 4 and action steps for Period 1 reporting if providers missed the Nov. 30 deadline.
Read More
On Nov. 23, 2021, the Office of Management and Budget (OMB) approved the extension for the continued use of the Outcome and Assessment Information Set (OASIS)-D instrument with a new expiration date of Nov. 23, 2024. Providers collecting OASIS on paper may use up any current inventory prior to using the instruments with the updated expiration date.
Read More
AHCA/NCAL has released new online education opportunities for IHCA/ICAL members. The three new courses cover inventory supply management for personal protective equipment and point of care testing, creating inclusive communities for LGBTQI and HIV+ older adults and population health management.
Read More
A recording of yesterday's Skilled Nursing Facility (SNF) Provider Update Call, sponsored by Lee Agency, is now available on the IHCA website. Additionally, IHCA's monthly Managed Care Organization (MCO) calls are next Wednesday, and ICHC's monthly Home Health Provider Update Call is next Thursday.
Read More
IHCA received informational letter 2291 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective Jan. 1, 2022. The letter includes changes to the Preferred Drug List (PDL), pharmacy benefit policy changes, new drug prior authorization criteria, changes to existing prior authorization criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
During the 2021 legislative session, IHCA successfully lobbied for three specific asks surrounding the nursing facility reimbursement structure. Those items included a significant request for a state appropriation for Medicaid rates, a delay in rebase for one cycle and a reduction of the 85% occupancy rule. All three items were accomplished and have been or are in the process of being implemented right now. IHCA has provided details about each of those specific items and how providers will experience the impacts in the near term.
Read More
On Nov. 15, IHCA received notice that the Health Resources and Services Administration (HRSA) began notifying providers who submitted applications for Provider Relief Fund (PRF) Phase 4 General Distribution payments that they would not be receiving their allocation until HRSA has received the provider’s Period 1 reporting information.
Read More
Optum has provided information that members may find helpful when receiving referrals from the Department of Veterans Affairs (VA) and best practices in billing to optimize being paid promptly. Optum has provided information on its weekly training sessions, 2022 CMS changes, multiple visits per day and claim billing reminders.
Read More
A recording of yesterday's Provider Update Call for IHCA, ICAL and ICHC members is now available on the IHCA website. The call covered the CMS and OSHA rules on vaccination mandates that were released last week. Additionally, ICHC's monthly Home Health (HH) Provider Update Call is tomorrow, Nov. 11, at 2:00 p.m.
Read More
CMS finalized its home health payment rate update last week. Key highlights include the 2.6% increase in home health payment rates, a recalibration of 432 case mix weights using 2020 data, the discontinuation of the 5% cap on negative wage index changes and the one-year delay of the Home Health Value Based Purchasing (HHVBP) demonstration nationwide expansion.
Read More
There was much discussion regarding the HealthShare Referral Manager (HSRM) system during ICHC's quarterly Veterans Administration (VA)/Optum Call on Oct. 26. After further discussion with the Des Moines and Iowa City VA centers, ICHC received instructions on how providers can enroll if they are not currently in the system and how the Iowa VA centers are and are not using the system.
Read More
Iowa Medicaid is distributing a new round of grants to certain Home- and Community-Based Services (HCBS) waiver and habilitation direct service providers to help mitigate the cost of overtime payments and other workforce concessions that providers have made to continue serving members during the COVID-19 pandemic. Grant applications are due Nov. 19. Per terms of the CARES Act, funds must be used by Dec. 31, 2021.
Read More
Last week, CMS issued a display copy of the agency’s final rule on payment policies for the calendar year (CY) 2022 under the Medicare Physician Fee Schedule. Several policy changes impact IHCA, ICAL and ICHC members and their residents, tenants and patients for services from physicians, nurse practitioners, rehabilitation therapists, portable x-ray providers and clinical laboratories, among other providers paid under the Medicare Part B fee schedule.
Read More
Iowa Medicaid Enterprise (IME) has scheduled its 2021 Annual Provider Training sessions via Zoom. These trainings will consist of three morning sessions and three afternoon sessions broadcasted live. Providers only need to sign up for one session. Providers unable to attend one of the six sessions can view the recording on the Iowa Department of Human Services (DHS) website. Iowa Total Care and Amerigroup Iowa, Inc. will participate in the training as well.
Read More
Registration is now open for the November 2021, December 2021 and January 2022 Iowa Medicaid virtual monthly town hall meetings. Beginning in January 2022, the monthly virtual town halls will be held on the fourth Thursday of each month.
Read More
Join IHCA next Wednesday, Nov. 10, for its monthly Managed Care Organization (MCO) Calls. Additionally, ICHC is hosting its monthly Home Health (HH) Provider Update Call on Thursday, Nov. 11, sponsored by CliftonLarsonAllen.
Read More
CMS is offering an updated web-based training series on the assessment and coding of Section GG. This training is intended for skilled nursing facilities, home health agencies, in-patient rehabilitation facilities and long-term care hospitals. The on-demand online training series consists of three courses, and each course includes interactive exercises to test knowledge related to the assessment and coding of Section GG items.
Read More
Section 6032 of the Deficit Reduction Act of 2005 (Pub L. 109-171) mandates that any provider or provider entity that receives payments, in any federal fiscal year, of $5 million 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, that provide detailed information about Medicaid fraud and abuse. Previously, providers were required to submit copies of these policies annually. Effective immediately, 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 annually.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2281 to provide further guidance related to IL 2267 regarding the Home- and Community-Based Services (HCBS) waiver rates that were increased by 3.55%, effective July 1, 2021.
Read More
The Health Resources and Services Administration (HRSA) announced this week that providers have additional time to complete their Provider Relief Fund Phase 4 and Rural Application. Additionally, last week, HRSA provided AHCA/NCAL with guidance on changes of ownership.
Read More
The Home- and Community-Based Services (HCBS) 2021 Provider Quality Management Self-Assessment form and corresponding address collection tool can now be completed and submitted. The 2021 self-assessment form has been updated and a new 2021 form must be obtained from the self-assessment webpage. Resubmissions from previous years will not be accepted because of the changes in the form. Self-assessments and address collection tool forms must be received in the designated format via email no later than Dec. 31, 2021.
Read More
Last week, AHCA/NCAL updated the guidance document titled, "3-Day Stay and Benefit Period Waivers for Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS)." Members are encouraged to review the guidance document and share the information with their medical providers and referral sources.
Read More
In an effort to improve its provider processes and systems, Iowa Medicaid has identified eight areas to continually improve provider outcomes. Iowa Medicaid is gathering feedback from providers on the proposed outcomes through an anonymous survey. Iowa Medicaid encourages all providers to review the survey and submit feedback by Nov. 15.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
On Oct. 13, the Health Resources and Services Administration (HRSA) held its third Phase 4 and rural distribution webinar focusing on documentation needed for the single application. HRSA also released detailed guidance on submitting Phase 3 reconsideration applications. AHCA/NCAL has provided a summary of last week's webinar for members to easily reference.
Read More
Join IHCA for its monthly Managed Care Organization (MCO) Calls next Wednesday. Additionally, ICHC is hosting its Home Health (HH) Provider Update Call, sponsored by CliftonLarsonAllen, next Thursday, and ICAL is holding its Assisted Living (AL) Provider Update Call next Friday.
Read More
The Provider Relief Fund (PRF) Phase 4 and rural distributions application webpage is now live. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. The application will close on Oct. 26, 2021, at 10:59 p.m. CST. Applications must undergo a number of validation checks before financial information is submitted. Providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline.
Read More
On Sept. 29, the Iowa Department of Human Services (DHS) issued informational letter (IL) 2266 to inform and update providers regarding the authorization of an additional dose of COVID-19 vaccine following an initial two-dose primary series of mRNA COVID-19 vaccine for certain immunocompromised individuals. The IL contains information regarding billing and coding for administration fees.
Read More
The Iowa Medicaid Enterprise (IME) is implementing changes to its Preferred Drug List (PDL) due to availability issues for albuterol inhalers, effective Nov. 5, 2021. IHCA has provided lists of what products will be considered preferred and non-preferred after these changes become effective.
Read More
Iowa Medicaid Enterprise (IME) is planning to hold its annual provider training sessions in late October or early November of this year. IME is looking for input from providers to ensure the sessions are convenient to attend and that topics of interest to providers are discussed. To assist IME in improving the quality and content of its annual training, providers are encouraged to complete a brief survey by Friday, Oct. 8.
Read More
On Sept. 15, the Health Resources and Services Administration (HRSA) released additional details on the $25 billion in funding, composed of the $17 billion Phase 4 distribution and the $8.5 billion rural distribution, that was announced on Sept. 10.
Read More
CMS has issued Change Request 12424 that provides additional instructions related to claims processing for the notice of admission (NOA) for claims that span calendar years 2021 and 2022, as well as special circumstances for discharges when no visits are made in a subsequent 30-day period.
Read More
ICAL is hosting its monthly Assisted Living (AL) Provider Update Call this Friday, Sept. 17, at 11:00 a.m. Recordings of yesterday's Skilled Nursing Facility (SNF) Provider Update Call and last Thursday's Home Health (HH) Provider Update Call are now available on the IHCA website.
Read More
Last week, the U.S. Department of Health and Human Services (HHS) announced it will be releasing Phase 4 of the Provider Relief Fund (PRF). Phase 4 consists of $17 billion for providers who can document revenue loss and expenses associated with the pandemic. HHS has also created an option for reconsideration of Phase 3 awards and extended the due date for the first PRF Reports, formerly due on Sept. 30, 2021, by 60 days.
Read More
On Sept. 8, 2021, CMS updated Medicare Learning Network Matters article SE20011, titled, "Medicare Fee-for-Service Response to the Public Health Emergency." The guidance contains details about several important blanket CMS billing waivers. In the billing guidance, CMS did not change the longstanding blanket three-day qualifying stay or spell-of-illness waivers for beneficiary eligibility for skilled nursing facility Part A coverage.
Read More
ICHC is hosting its monthly Home Health (HH) Provider Update Call, sponsored by CliftonLarsonAllen, tomorrow at 2:00 p.m. Additionally, IHCA's monthly Skilled Nursing Facility (SNF) Provider Update Call, sponsored by Lee Agency, will be next Tuesday at 10:00 a.m.
Read More
ICHC is hosting its monthly Home Health Provider Update Call next Thursday, Sept. 9. There will be no Managed Care Organization (MCO) Calls this month. However, members may submit questions to
[email protected] by end of day on Monday, Sept. 6, and IHCA will collect answers from the MCOs. Additionally, a recording of yesterday's Skilled Nursing Facility (SNF) Provider Update Call is now available on the IHCA website.
Read More
CMS has announced the resumption of home health and hospice Targeted Probe and Educate (TPE) reviews. While there is not much additional information available at this time, ICHC expects Medicare Administrative Contractors (MACs) to release more details later this week, as many of the MAC websites still indicate a paused status for TPE. Checking claim status codes may help providers identify any claims that might be part of TPE reviews. A reminder has been issued by Palmetto, but applies to all MACs.
Read More
IHCA received informational letter 2263 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective Oct. 1, 2021. The letter includes changes to the Preferred Drug List (PDL), new drug prior authorization criteria, removal and changes to existing prior authorization criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
Iowa Medicaid is hosting virtual town hall meetings for Medicaid providers and members this Thursday, Aug. 26. A town hall for providers will be held from 4:00 - 5:00 p.m., followed by a separate town hall for members from 5:00 - 6:00 p.m. Advance registration is encouraged to help ensure that there are enough virtual slots available for the meeting. These virtual meetings will occur monthly through October on the fourth Thursday of the month.
Read More
IHCA/ICAL members that are considering implementing a Population Health Management (PHM) model in the future are encouraged to learn the fundamentals now through AHCA/NCAL's PHM Innovation Lab. Phase I of the lab contains free member-only foundational resources designed to introduce nursing facility, assisted living and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Read More
Get the latest reimbursement updates at IHCA’s in-person Nursing Facility Reimbursement Conference, sponsored by Brighton Consulting Group and Williams & Company P.C., on Aug. 24. This conference is approved for 5.25 CEUs for social services staff, nurses and administrators.
Read More
ICAL is hosting its monthly Assisted Living (AL) Provider Update Call this Friday. IHCA has added an additional Skilled Nursing Facility (SNF) Provider Update Call on Aug. 24 to cover pressing issues related to COVID-19. Additionally, ICAP will host its Quarterly Activity Professionals Call on Aug. 24. A recording of last Thursday's Home Health Provider Update Call is now available on the IHCA website.
Read More
IHCA received informational letter (IL) 2256, replacing IL 2245, from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective Sept. 1, 2021. The letter includes information regarding the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, as well as updates to prior authorization and point of sale billing.
Read More
Join ICHC tomorrow, Aug. 12, for its monthly Home Health Provider Update Call, sponsored by CliftonLarsonAllen. The call will cover COVID-19 uptick and the delta variant, LUPA rates, Home- and Community-Based Services (HCBS) waiver rate changes, system changes for Home Health Notice of Admission (NOA) and more. IHCA has also compiled the call-in details for other member-only calls occurring in August.
Read More
Informational letter 2258 from Iowa Department of Human Services (DHS) states that rate sheets for July 1, 2021 and Oct. 1, 2021 would be mailed to providers and submitted to the managed care organizations (MCOs) for upload to their systems starting on Aug. 6, 2021. The release of the rates at this time is being done without receiving approval from CMS and the State Plan Amendment (SPA). DHS is making an exception to its normal process in response to challenges faced by providers related to the Public Health Emergency.
Read More
Last week the Iowa Department of Human Services (DHS) released informational letter 2252 regarding Home- and Community-Based Services (HCBS) waiver rate changes. This update is a result of the $11 million appropriation that was secured during the 2021 legislative session for all Iowa HCBS waiver providers. This increase results in a 3.55% increase to HCBS waiver rates for dates of services on or after July 1, 2021.
Read More
Iowa Department of Human Services (DHS) released informational letter 2260 announcing that Iowa Medicaid Enterprise (IME) is extending the due date of cost reports for Home- and Community-Based Services and intermediate care facilities for individuals with intellectual disability (ICF/ID) providers with a fiscal year end of June 30, 2021.
Read More
Join IHCA next Wednesday for its monthly Managed Care Organization (MCO) calls with Iowa Total Care and Amerigroup. ICHC is hosting its monthly Home Health Provider Update Call next Thursday, sponsored by CliftonLarsonAllen.
Read More
Last week, the president and a bipartisan group of senators reached an agreement on an infrastructure deal, including offsets to pay for the spending included in the bill. At this time, it appears the U.S. Department of Health and Services (HHS) Provider Relief Fund (PRF) is not included as a pay-for in the agreement.
Read More
Yesterday, Aug. 3, Iowa Department of Human Services (DHS) issued informational letter (IL) 2250 on home health agency Low Utilization Payment Adjustment (LUPA) reimbursement rates. During the 2021 legislative session, IHCA was able to secure an additional $2 million in state funds to increase LUPA rates for providers, effective July 1, 2021.
Read More
On July 29, 2021, CMS issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2022 update. IHCA and AHCA have provided highlights of the final rule.
Read More
Yesterday, IHCA held its monthly Skilled Nursing Facility (SNF) Provider Update Call and ICHC held its quarterly VA/Optum Call. Recordings of these calls are now available on the IHCA website.
Read More
CMS Change Request (CR) 12227 outlines the business requirements describing the changes to the Medicare systems to implement processing of the notice of admission (NOA) and claims. NOAs will be submitted using type of bill (TOB) 32A and may be cancelled using TOB 032D. All claims for periods of care following the admission will be submitted using TOB 329.
Read More
The Iowa Department of Human Services (DHS) issued informational letter (IL) 2242 as a reminder to providers of the current process for the extraction of Minimum Data Set (MDS) assessment data for case mix and to provide important dates for case mix 2021.
Read More
Updates have been made to the case mix payer change form, 470-5667. The case mix payer change form can only update the pay source and should not be used for resource utilization group (RUG) RUG discrepancies or changes to Medicaid numbers.
Read More
Iowa Department of Human Services (DHS) began using a phased approach to return to normal medical assistance eligibility processes in order to comply with the continued enrollment requirement under the Maintenance of Effort (MOE) provision of the federal Families First Coronavirus Response Act (FFCRA). The unwinding of Medicaid COVID-19 flexibilities will occur in five phases over several months. DHS has released IL 2246, detailing the first three phases.
Read More
Several new staff members have been added to the Iowa Health Care Quality Partners (IHCQP) team to assist the provider network and its members. IHCQP is a business entity organized and owned by a network of IHCA, ICAL and ICHC members for the purpose of improving quality, reducing overhead and pursuing business ventures, including reimbursement and value-based contracts with managed care organizations (MCOs).
Read More
IHCA's monthly Skilled Nursing Facility (SNF) Provider Update Call and ICHC's quarterly VA/Optum Call will be held next Tuesday, July 27. A recording of ICAL's monthly Assisted Living (AL) Provider Update Call from last Friday is now available on the IHCA website.
Read More
As a result of collaboration between ICAL and Iowa Department of Human Services (DHS), informational letter (IL) 2239-MC was issued on June 18 to provide clarification on electronic visit verification (EVV) for providers. EVV will be optional for all personal care services provided by assisted living (AL) and residential care facility (RCF) shift workers. Providers must complete an attestation by identifying their exemption status with the Iowa Medicaid Enterprise (IME) by July 31, 2021, and annually via the provider self-assessment thereafter.
Read More
Last week, CMS issued a proposed rule on payment policies for the calendar year (CY) 2022 under the Medicare Physician Fee Schedule (PFS) Quality Payment Program and other revisions to Part B. The public comment period will close on Sept. 13, 2021.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Join ICAL this Friday, July 16, for its monthly Assisted Living (AL) Provider Update Call. A recording of last Thursday's Home Health Provider Update Call is now available on the IHCA website, and IHCA has provided the call-in details for the remaining member-only calls for the month of July.
Read More
Iowa Department of Human Services (DHS) is starting to unwind COVID-19 restrictions and resume normal operations. Informational letter (IL) 2244 outlines DHS’s requirements for returning to face-to-face encounters for Home- and Community-Based Services (HCBS) providers, case managers and integrated health homes.
Read More
ICHC's monthly Home Health (HH) Provider Update Call is this Thursday, July 8. IHCA's monthly Managed Care Organization (MCO) Calls are next Wednesday, July 14. IHCA has provided the schedule and call-in details for all member-only calls for the month of July.
Read More
The Provider Relief Fund (PRF) reporting portal is now open for providers to report fund use for April 10, 2020 through June 30, 2020. Providers who received one or more PRF payments exceeding $10,000, in the aggregate, during this time have until Sept. 30, 2021 to submit the initial report.
Read More
Mary Jane Carothers, retiring IHCA vice president of quality improvement and clinical affairs, has accepted a part time consultant position with AHCA to provide clinical and quality improvement guidance for the Iowa Health Care Quality Partners provider network.
Read More
CMS has proposed a payment rate update to home health in 2022, including a nationwide expansion of the Home Health Value Based Purchasing (HHVBP) model. In addition to the payment rate updates, CMS proposed some changes to the home health quality reporting program.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2238 to clarify its policy regarding Home- and Community-Based Services (HCBS) Waiver nursing services durations for a per visit unit of service.
Read More
As a result of collaboration between ICAL and Iowa Department of Human Services (DHS), informational letter (IL) 2239-MC was issued on June 18 to provide clarification on electronic visit verification (EVV) for providers. EVV will be optional for all personal care services provided by assisted living (AL) and residential care facility (RCF) shift workers. Providers must complete an attestation by identifying their exemption status with the Iowa Medicaid Enterprise (IME) by July 31, 2021, and annually via the provider self-assessment thereafter.
Read More
Join ICAL on Friday for its monthly Assisted Living (AL) Provider Update Call. Call recordings from last week's Managed Care Organization (MCO) Calls, Home Health Provider Update Call and IHCA's special Office Hour Q&A Call on National Healthcare Safety Network (NHSN) vaccination reporting are now available on the IHCA website.
Read More
The U.S. Department of Health and Human Services (HHS) released updated reporting requirements for recipients of Provider Relief Fund (PRF) payments. With this announcement, HHS expands the amount of time providers will have to report information, aims to reduce burdens on smaller providers and extends key deadlines for expending PRF payments for recipients who received payments after June 30, 2020.
Read More
Join ICHC for its monthly Home Health Provider Update Call tomorrow, June 10, at 2:00 p.m. Additionally, IHCA is offering an Office Hour Q&A Call tomorrow at 3:00 p.m. This special one-hour call for skilled nursing facility (SNF) providers will cover the National Healthcare Safety Network (NHSN) vaccination reporting guidelines and will provide an opportunity for members to ask questions.
Read More
IHCA's monthly Managed Care Organization (MCO) Calls will be next Wednesday, June 9. ICHC's monthly Home Health (HH) Provider Update Call will be next Thursday, June 10. IHCA has provided the schedule and call-in details for all member-only calls for the month of June.
Read More
On May 14, the Iowa Department of Human Services (DHS) notified the public of its intentions to release a request for proposal (RFP) on or around Dec. 22, 2021, to procure managed care organizations (MCOs) to provide care through the Iowa Health Link Medicaid program. DHS intends to procure up to four contracts with MCOs to provide high quality health services to Iowans.
Read More
CMS has issued Change Request (CR) 12256, replacing home health requests for anticipated payment (RAPs) with the notice of admission (NOA). Home health agencies must submit the NOA to the Medicare Administrative Contractor (MAC) by mail, electronic data interchange (EDI) or direct data entry (DDE).
Read More
Join ICAL this Friday at 11:00 a.m. for its Monthly Assisted Living (AL) Provider Update Call. IHCA’s Monthly Skilled Nursing Facility (SNF) Provider Update Call and the Quarterly Activity Professionals Call will be next Tuesday, May 25. Recordings of last week’s Managed Care Organization (MCO) and Home Health (HH) Provider Update Calls are now available on the IHCA website.
Read More
Last week, CMS issued a State Medicaid Directors’ letter on how states may draw down and use additional federal Medicaid funds aimed at expanding access to Home- and Community-Based Services (HCBS). AHCA/NCAL is still analyzing the guidance, but upon initial review, CMS indicates states must comply with two program requirements to receive the increased federal medical assistance percentage (FMAP) for HCBS expenditures.
Read More
ICHC's monthly Home Health (HH) Provider Update Call is tomorrow, May 13, at 2:00 p.m. The call will cover revised Centers for Disease Control and Prevention (CDC) guidance, the Employee Retention Credit, waivers and license renewals, Electronic Visit Verification (EVV), sequester delay, updates to the Home Health Quality Reporting Program, claims processing issues and more. IHCA has also provided call-in details for the remaining member-only calls for the month of May.
Read More
While Electronic Visit Verification (EVV) implementation was effective on Jan. 1, 2021, claims not submitted via the CareBridge EVV solution will be accepted for services provided through Jan. 31, 2021. Effective for dates of service on or after Feb. 1, 2021, all claims for personal care and homemaker services not submitted via the CareBridge EVV solution will be denied. For assisted living facilities and residential care facilities (RCFs), claims not submitted via the CareBridge EVV solution will be accepted for services provided through June 30, 2021. If you have not already started the registration process, CareBridge has provided resources to get started.
Read More
Iowa Total Care (ITC) has identified an issue with recoupment projects related to coordination of benefits (COB) on commercial insurance and Medicare insurance coverage. These projects are currently on hold. Please disregard any previous ITC notification sent related to these projects. Additional notification will be sent in the future and through the weekly website updates. No action is needed by providers, and no dispute should be filed.
Read More
Join IHCA next Wednesday, May 12, for its monthly Managed Care Organization (MCO) Calls. Additionally, IHCA has provided the schedule and call details for all upcoming member-only calls occurring in May.
Read More
CMS issued guidance for nursing facilities regarding resident disenrollment from Medicare Advantage plans in 2015 and will soon be re-releasing this guidance. In anticipation of CMS’ release, AHCA/NCAL has provided a summary of this guidance for members.
Read More
In a provider alert, Iowa Total Care (ITC) announced it has identified an issue with recoupment projects related to coordination of benefits (COB) on commercial insurance. ITC identified member third party liability (TPL) discrepancies and is currently working with a vendor for reconciliation. These projects are currently on hold, and members should disregard any previous notification sent from ITC related to these projects. Additional notification will be sent in the future. No action is needed by providers and no dispute should be filed.
Read More
In 2019, CMS put claim review services on temporary hold as the agency began to modify the program for coordination by a single national contractor. Livanta will soon begin conducting these claim reviews for CMS, which include short stay reviews, higher-weighted diagnosis related group (HWDRG) reviews and other reviews, as directed by CMS.
Read More
Join ICAL next Tuesday, May 4, for its Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review, sponsored by Assisted Living Partners. This live virtual training program will be recorded, and registered participants will receive a link to the recording that can be accessed until June 30, 2021. This digital course is approved for 4.5 CEUs for nurses, social services, administrators and assisted living managers.
Read More
In an April 23 provider alert, Iowa Total Care (ITC) announced it has identified an issue where Client Participation (CP) was not correctly applied to 3,470 members. As of April 19, 2021, ITC has implemented a system correction for new day claims. Any claims submitted on or after April 19, 2021, will have the correct CP applied. Claims related to the identified members will be reprocessed after system configuration is complete on May 28, 2021.
Read More
IHCA received informational letter 2230 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective June 1, 2021. The letter includes changes to the Preferred Drug List (PDL), new drug prior authorization criteria, changes to existing prior authorization criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
Last week, HR 1868 was signed into law. A key provision of this was the extension of the suspension of the Medicare sequestration through Dec. 31, 2021. The sequester would otherwise have resulted in a 2% reduction in payments to most health care providers and plans.
Read More
On April 13, CMS held its Home Health, Hospice and Durable Medical Equipment Open Door Forum. Several issues impacting home health agencies were discussed, including the Home Health Quality Reporting Program (HHQRP), claims processing issues and the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS).
Read More
Join IHCA for its Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Program virtual training on May 4 and the Assisted Living Nurses Digital Conference on May 13. IHCA’s Leadership Academy kicks off in-person on June 8-9 and applications are due May 21. Additionally, IHCA has several digital trainings available on-demand now, covering topics such as dementia, infection prevention and control and nurse leadership.
Read More
CMS issued the yearly proposed skilled nursing facility (SNF) payment rule on April 8. The proposed rule provides for a net market basket increase for SNFs of 1.3% beginning Oct. 1, 2021. This 1.3% increase is reflective of a forecast error adjustment and the multifactor productivity adjustment required by the Affordable Care Act. CMS estimates that the net market basket update will increase Medicare SNF payments by approximately $444 million nationally in fiscal year 2022.
Read More
There's still time to earn 10.0 CEUs to renew your license at IHCA's Digital Spring Quarterly Conference, available now on-demand through April 30. IHCA also has additional education opportunities available, including its Dementia Care Digital Training Series that's available now on-demand, as well as the Medicaid HCBS Elderly Waiver Review on May 4, Assisted Living Nurses Digital Conference on May 13 and in-person District Education and Meetings in four locations on May 11-12 and 18-19.
Read More
Join ICHC for its ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World live virtual training next Wednesday and Thursday, April 14-15. This interactive two-day intermediate coding course will increase knowledge and understanding of ICD-10 coding, and participants will gain the expertise home health agencies need to thrive in the PDGM. The class will not be recorded and is approved for 14.0 CEUs for nurses and administrators.
Read More
Iowa Total Care (ITC) has identified an issue with several recoupment projects related to coordination of benefits (COB) for members who are receiving home health services but are not homebound. The claims relating to home health have been removed from the project and will not be recovered.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
It's not too late to register for IHCA's Spring Quarterly Conference that is available on-demand until April 30. Additionally, IHCA is offering an on-demand Infection Prevention and Control course that's available now, Medicaid HCBS Elderly Waiver Review on May 4, Assisted Living Nurses Digital Conference on May 13, as well as in-person District Education and Meetings in four locations on May 11-12 and 18-19. Also, save the date for IHCA's 2021 Annual Convention and Trade Show on Sept. 27-29.
Read More
In anticipation of possible congressional action to extend the 2% sequester reduction suspension, CMS has instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow.
Read More
With the recent federal approval of the American Rescue Plan Act (ARPA), the Iowa Medicaid Enterprise (IME) has released informational letter (IL) 2225, and is updating its COVID-19 vaccine administration rate for both managed care and fee-for-service to match the new Medicare rate of $40 per dose.
Read More
The Veterans Affairs (VA) Central Iowa Healthcare system has announced new contact information and a change in alphabet assignments for home health providers that care for veterans through the Des Moines VA office, as well as an updated reauthorization request form reflecting these changes and the 2021 fee schedule.
Read More
It's not too late to register for IHCA's Spring Quarterly Conference that is available on-demand until April 30. Additionally, IHCA is offering an on-demand Infection Prevention and Control course that's available now, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15, Recruiting and Retention During and After the Pandemic on April 21, Minimum Data Set (MDS) 101 and 201 on April 27-28, Medicaid HCBS Elderly Waiver Review on May 4, Assisted Living Nurses Digital Conference on May 13, as well as in-person District Education and Meetings in four locations on May 11-12 and 18-19.
Read More
IHCA's ICD-10 Coding Essentials for Post-Acute Care starts next Tuesday, March 30, and ends Thursday, April 1. This virtual three-day class will offer training on coding terms, official coding guidelines and basic coding knowledge. The course is approved for 12.0 CEUs for nurses, social services staff and administrators.
Read More
On March 19, Iowa Total Care released a provider news alert on an update to hospice billing. Effective March 1, 2021, providers can submit the National Provider Identifier (NPI) of the residing nursing facility in box 77 (operating provider) on the UB-04 claims form when billing revenue code 658. This will allow for more expedient processing of submitted claims.
Read More
IHCA is offering several new education events, including its on-demand Infection Prevention and Control course, the Assisted Living Regulatory Class on April 7, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15, Recruiting and Retention During and After the Pandemic on April 21, Minimum Data Set (MDS) 101 and 201 on April 27-28, and Medicaid HCBS Elderly Waiver Review on May 4.
Read More
In 2020, CMS authorized the use of Civil Money Penalty (CMP) grant funds for communicative technology devices and in-person visitation aids for Medicaid-certified nursing facilities. Funds are still available through the end of the Public Health Emergency (PHE). If a facility has already applied and was approved for a grant, the Iowa Medicaid Enterprise (IME) needs a copy of the invoice and receipts in order to reimburse a facility for the expenses of the technology grant or in-person visitation aids.
Read More
IHCA is offering several new education events, including ICD-10 Coding Essentials for Post-Acute Care on March 30-April 1, the Assisted Living Regulatory Class on April 7, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15, Recruiting and Retention During and After the Pandemic on April 21, Minimum Data Set (MDS) 101 and 201 on April 27-28, and Medicaid HCBS Elderly Waiver Review on May 4.
Read More
The National Association for Home Care and Hospice (NAHC) has learned of a claims processing issue that is impacting many home health agencies. Claims are not processing when the date for revenue code line 0023 on the Requests for Anticipated Payments (RAP) does not match the date on line 0023 on the final claim. Agencies will need to correct line 0023 on the claim to match the RAP in order for claims with reason codes 38107 and U5391 to process.
Read More
IHCA is offering several new education events, including its Digital Spring Quarterly Conference that launches on March 22, ICD-10 Coding Essentials for Post-Acute Care on March 30-April 1, the Assisted Living Regulatory Class on April 7, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15, Recruiting and Retention During and After the Pandemic on April 21, Minimum Data Set (MDS) 101 and 201 on April 27-28, and Medicaid HCBS Elderly Waiver Review on May 4.
Read More
Home health providers can now have a physician, nurse practitioner or physician assistant order and sign the home health care treatment plan. All documentation previously required for the physician applies to the nurse practitioner and the physician assistant. This provision is ongoing and applies after the end of the Public Health Emergency (PHE).
Read More
The National Association for Home Care and Hospice (NAHC) has received additional clarification on Medicare coverage policies for home health agencies (HHAs), including the inconsistency in the regulations and the statute for the face-to-face requirements for home health certifications, private duty nursing and an apparent conflict in the Medicare manual related to who may sign the home health plan of care (POC)
Read More
IHCA is offering several new education events, including its Digital Spring Quarterly Conference that launches on March 22, ICD-10 Coding Essentials for Post-Acute Care on March 30-April 1, the Assisted Living Regulatory Class on April 7, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15, Recruiting and Retention During and After the Pandemic on April 21, as well as Minimum Data Set (MDS) 101 and 201 on April 27-28.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
AHCA recently updated the COVID-19-related Three-Day Stay and Benefit-Period Waivers for Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) fact sheet and FAQ resource. This is an important resource as this issue could financially expose providers that do not understand the nuance of the waivers. Members are encouraged to review these updates and share with applicable clinical and billing staff.
Read More
Medicare Accelerated and Advance Payment (AAP) repayments will begin for all Medicare providers, including skilled nursing facilities (SNFs) and home health agencies, that received AAP payments one year from the date of receipt. Providers do not need to take any action to repay. Medicare Administrative Contractors (MACs) will automatically begin to recover payment amounts, reducing paid claims, until the AAP is repaid.
Read More
IHCA is offering several new education events, including ICD-10 Coding Essentials for Post-Acute Care on March 30-April 1, the Assisted Living Regulatory Class on April 7, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15, Recruiting and Retention During and After the Pandemic on April 21, as well as Minimum Data Set (MDS) 101 and 201 on April 27-28.
Read More
IHCA is offering several new online education opportunities, including the Infection Prevention and Control in LTC webinar on March 3, the 2021 Digital Spring Quarterly Conference that launches on March 22, ICD-10 Coding Essentials for Post-Acute Care on March 30-April 1, the Assisted Living Regulatory Class on April 7, ICD-10 Coding in a Patient-Driven Groupings Model (PDGM) World on April 14-15 and the Long-Term Care Nurse Leadership Training Series that is available now on-demand.
Read More
IHCA is offering new upcoming virtual education opportunities, including the Life Safety-Fire Safety Virtual Conference on Feb. 23-24, the Infection Prevention and Control in LTC Webinar on March 3, the 2021 Digital Spring Quarterly Education Conference that launches on March 22, as well as ICD-10 Coding Essentials for Post-Acute Care on March 30 - April 1 and ICD-10 Coding in a PDGM World on April 14-15.
Read More
Iowa Medicaid Enterprise (IME) has created a dedicated email address,
[email protected], to answer questions from providers regarding billing for COVID-19 vaccines and monoclonal antibodies. Providers are encouraged to view IME’s COVID-19 vaccine billing FAQ webpage, as well as the Iowa Department of Public Health (IDPH) website for guidance before submitting a question.
Read More
Iowa Medicaid Enterprise (IME) Provider Cost Audit (PCA) Unit is extending the due date of cost reports following revised guidance issued by CMS. This is a blanket extension and providers do not need to submit a written request. If cost reports are completed sooner, they can be submitted any time prior to the extended due dates.
Read More
Amerigroup has created a question and answer (Q&A) document that should answer questions providers may have regarding the universal prior authorization form for medical requests.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2210, updating providers on the process for registering to receive distribution of quarterly case mix rosters. Effective Dec. 29, 2020, Iowa Medicaid Enterprise (IME) is using the Iowa Medicaid Portal Access (IMPA) for distribution of quarterly case mix rosters for nursing facilities. Each nursing facility will need to ensure that a user is registered in IMPA to have access to the preliminary and final quarterly case mix rosters.
Read More
IHCA is offering new upcoming virtual education opportunities, including the Infection Prevention and Control in LTC Webinar on March 3, the 2021 Digital Spring Quarterly Education Conference that launches on March 22, as well as ICD-10 Coding Essentials for Post-Acute Care on March 30 - April 1.
Read More
AHCA/NCAL has released a new four-module webinar series that trains staff on how to deliver person-centered care under the Patient-Driven Payment Model (PDPM). Person-Centered Care in a PDPM World is built to train senior staff on delivering short-stay post-acute person-centered care and position them to then train facility staff.
Read More
Yesterday, Jan. 26, IHCA held its COVID-19 Provider Update Call for skilled nursing facilities (SNFs), sponsored by NuCara Long-Term Care Pharmacy, as well as its quarterly VA/Optum Update Call for home health members. Recordings of both calls are now available on the IHCA website. IHCA's next SNF Provider COVID-19 Update Call, sponsored by Lee Agency, is next Tuesday, Feb. 2.
Read More
Providers now have until June 30, 2021, to use CARES Act funding on eligible expenses. The previous deadline was Dec. 30, 2020. The June 30, 2021, deadline is a state requirement to allow time for the state to recoup any unused funds and complete all necessary reporting requirements.
Read More
U.S. Department of Health and Human Services (HHS) recently launched the Provider Relief Fund (PRF) Reporting Portal, which is only open for providers to set up user accounts and register to submit reports. Currently, HHS has not established a registration deadline or set a due date for first reports. The original due date was Feb. 15, but that has been pushed back to a date still to be determined.
Read More
ICHC held its quarterly VA/Optum Call yesterday, Jan. 26. The VA and Optum have supplied reference guides and resources in response to questions asked during the call, including a home health billing FAQ, Patient-Driven Groupings Model (PDGM) billing requirements, the 2021 fee schedule, the claims service model and a provider reference guide.
Read More
Effective Feb. 1, 2021, providers do not have to authorize or notify Iowa Total Care (ITC) of members receiving room and board services defined by Revenue Code 658. The requirement for all prior authorizations, subsequent authorizations and notifications has been lifted. For those members who only have ITC coverage, providers must authorize Revenue Code 651 by the 90th day and then every 60 days thereafter.
Read More
While electronic visit verification (EVV) implementation was effective Jan. 1, 2021, claims not submitted via the CareBridge EVV solution will be accepted for services provided through Jan. 31, 2021. Effective for dates of service on or after Feb. 1, 2021, all claims for personal care and homemaker services not submitted via the CareBridge EVV solution will be denied.
Read More
IHCA is offering new virtual education events, including the Life Safety-Fire Safety 2021 Virtual Conference on Feb. 23 - 24, sponsored by Midwest Alarm Services, and a webinar titled, Infection Prevention and Control in LTC: Lessons Learned from the Pandemic, sponsored by Medline, on March 3. Additionally, IHCA's Leadership Academy, sponsored by Healthcare of Iowa, will begin on June 8.
Read More
Join IHCA on Jan. 26-28 and Feb. 2-4 for parts one and two of the live-streamed AANAC RAC-CT Virtual Training Program. Individuals who become RAC-CT® certified show their expertise in the skilled nursing facility prospective payment system and Minimum Data Set (MDS 3.0) assessment. This virtual course is approved for 24.0 CEUs for nurses, social services staff and administrators.
Read More
The U.S. Department of Health and Human Services (HHS) has launched the Provider Relief Fund (PRF) Reporting Portal. The portal is only open for providers to set up user accounts and register to submit reports. In the updated PRF reporting requirements, HHS indicates reporting is delayed until further notice. No date is provided in the PRF reporting FAQs.
Read More
Iowa Department of Human Services (DHS) released informational letter (IL) 2210, updating providers on the process for registering to receive distribution of quarterly case mix rosters. Effective Dec. 29, 2020, Iowa Medicaid Enterprise (IME) is using the Iowa Medicaid Portal Access (IMPA) for distribution of quarterly case mix rosters for nursing facilities. Each nursing facility will need to ensure that a user is registered in IMPA to have access to the preliminary and final quarterly case mix rosters.
Read More
Sleeping rooms at the Des Moines Marriott Downtown are now available to reserve for IHCA's 2021 Annual Convention and Trade Show on Sept. 26-29. The room rate at the Des Moines Marriott Downtown is $130 per night. Additionally, IHCA has several upcoming education offerings available, including a Life Safety-Fire Safety Virtual Conference, On-Demand Assisted Living Management Certification Course, IHCA Leadership Academy and more.
Read More
A recording and links referenced during yesterday's Skilled Nursing Facility Provider COVID-19 Update Call are now available on the IHCA website. ICHC's monthly Home Health Provider COVID-19 Update Call is tomorrow, Jan. 14, at 2:00 p.m. IHCA has also provided the call-in details for all of its member-only calls for the month of January.
Read More
Join IHCA next Wednesday, Jan. 20, for the start of its three-part Provider Relief Fund Reporting Requirements Webinar Series. These webinars are intended for nursing facility administrators, business office staff and management, financial reporting specialists, accounting firms and cost report preparers. This virtual course will be recorded and is approved for 3.0 CEUs for administrators and department heads.
Read More
Iowa Department of Human Services (DHS) has released informational letter (IL) 2207 to inform and update providers regarding the release of COVID-19 vaccines and monoclonal antibodies to treat COVID-19. The IL contains information on COVID-19 vaccine orders, priority groups, Medicaid billing and rates, pharmacy partners, documentation requirements for pharmacies, prior authorization and more.
Read More
To assist senior housing and long-term care facilities across the country, AHCA/NCAL has asked Congress and the U.S. Department of Housing and Urban Development (HUD) to support a provision in the stimulus package that the President recently signed into law. The provision permits HUD to finance up to one year of operating losses for certain hospitals and residential care facilities insured by the Federal Housing Administration (FHA) under Sections 232 and 242 of the National Housing Act.
Read More
Amerigroup has released a message updating providers on home health recoveries and home health system enhancements that were put in place in November.
Read More
IHCA is offering several new digital education opportunities, including the RAC-CT Virtual Training Program, Activity Professionals Qualification Course, a Life Safety-Fire Safety Virtual Conference and more.
Read More
Nearly 5,000 providers that applied for Phase 2 or 3 stimulus relief from the U.S. Department of Health and Human Services (HHS) Provider Relief Fund were initially informed that their application could not proceed due to an ineligible taxpayer identification number (TIN). HHS has indicated that this determination was done in error and will provide an opportunity to apply for Phase 3 funding under a new Jan. 6 application deadline.
Read More
A recording and links referenced during IHCA's COVID-19 Skilled Nursing Facility (SNF) Provider Update Call yesterday are now available. Additionally, IHCA has compiled the call-in details for member-only calls happening this month, including next Tuesday's COVID-19 SNF Provider Update Call and next Wednesday's Managed Care Organization (MCO) Calls.
Read More
IHCA was notified by Iowa Medicaid Enterprise (IME) that it will no longer mail case mix rosters to nursing facilities. Those rosters will now be available on the Iowa Medicaid Portal Access (IMPA) system. Providers will need to request access to the case mix rosters via an email to
[email protected].
Read More
In an off-cycle update to the 2021 ICD-10-CM coding guidelines posted in December in response to the COVID-19 pandemic, the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS) implemented six new diagnosis codes into the ICD-10-CM, effective Jan. 1, 2021. Members should share this information with their minimum data set (MDS) and billing staff.
Read More
CMS has updated the outpatient therapy code list and per-beneficiary edit/audit threshold amounts for 2021. Members should ensure their billing staff is aware of these updates.
Read More
On Jan. 1, 2021, the U.S. Department of Veterans Affairs (VA) began phasing in a new approach for its community care fee schedule payment rate calculations that better aligns the VA to industry best practices. Instead of rates being calculated based on the location of the referring VA medical center, rates will now be calculated based on the location of where the care is provided.
Read More
IHCA is offering new virtual education events, including the Provider Relief Fund Reporting Requirements Webinar Series starting Jan. 20, Prepping for Life After COVID-19 Webinar Series starting Jan. 21, RAC-CT Virtual Training Program on Jan. 26 and the Life Safety-Fire Safety 2021 Virtual Conference on Feb. 23 - 24. Additionally, IHCA's Leadership Academy will begin on June 8.
Read More
In informational letter (IL) 2200, Iowa Department of Human Services (DHS) announced the delay of the use of the managed care organization (MCO) Electronic Visit Verification (EVV) solution for assisted living programs until July 1, 2021. DHS is working with the MCOs to ensure this change is in place and claims from assisted living providers will not be denied on Jan. 1, 2021.
Read More
IHCA's new Prepping for Life After COVID-19 three-part webinar series, sponsored by Lee Agency, begins on Jan. 21 and the RAC-CT Virtual Training Program starts on Jan. 26. Additionally, ICAL's Assisted Living Management Certification Course, sponsored by Assisted Living Partners, is available on-demand.
Read More
IHCA's new Prepping for Life After COVID-19 three-part webinar series, sponsored by Lee Agency, begins on Jan. 21 and the RAC-CT Virtual Training Program starts on Jan. 26. Additionally, ICAL's Assisted Living Management Certification Course, sponsored by Assisted Living Partners, is available on-demand.
Read More
Today the U.S. Department of Human Services (HHS) announced funding has been approved and the first half of Phase 3 payments from the Provider Relief Fund (PRF) should start going out today. If an organization doesn’t receive a payment, there isn’t necessarily an issue with the application, it may simply be a timing consideration for applications they have processed to date and that they are working through the remaining applications.
Read More
Iowa Department of Human Services released informational letter (IL) 2195, replacing IL 2112 and updating the application fee amount and effective date. Effective Jan. 1, 2021, the fee amount is $599.00. This may be adjusted annually.
Read More
Iowa Department of Human Services (DHS) informational letter 2197 announced the maximum residential care facility (RCF) per diem rate will increase from $31.66 to $32.01, effective Jan. 1, 2021. There will be no increase in the flat per diem rate at this time. The flat per diem rate remains at $17.86.
Read More
Join IHCA on Jan. 26-28 and Feb. 2-4 for parts one and two of the live-streamed AANAC RAC-CT Virtual Training Program. This virtual course is approved for 24.0 CEUs for nurses, social services staff and administrators.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for rest of December, including tomorrow's COVID-19 Provider Update Call for home health members and next Tuesday's COVID-19 Provider Update Call for skilled nursing facilities and assisted living programs.
Read More
On Dec. 4, Iowa Total Care (ITC) released a provider news alert that answered frequently asked questions (FAQ) regarding COVID-19 relief rate payments. The FAQ covers when a member's claim is eligible, how to bill for COVID-19 relief payments and whether providers need to increase their billed charges to include the COVID-19 relief payment.
Read More
ICAL met with Iowa Department of Human Services (DHS) early last week about the implementation of Electronic Visit Verification (EVV) in assisted living programs, effective Jan. 1, 2021. On Dec. 8, ICAL was notified by DHS that the implementation of EVV requirements will be delayed for all assisted living providers until July 1, 2021.
Read More
Iowa Department of Human Services has released informational letter (IL) 2196 regarding Minimum Data Set (MDS) assessments and the Case Mix Index (CMI). In an effort to set rates in a timely manner, Iowa Medicaid Enterprise (IME) will extract MDS assessment data from the Quality Improvement Evaluation System (QIES) database on the specified dates listed in Table 1 in DHS IL 2196.
Read More
Approximately $14 million of CARES Act funds will be given to Iowa nursing facility providers for staffing and testing due to COVID-19. Iowa Medicaid Enterprise (IME) plans to distribute grants starting Dec. 7, 2020. Facilities should expect to receive the payment within one week. In order to keep the grant, the facility will need to complete an electronic attestation online form immediately upon receipt of funds. Funds must be used by Dec. 30, 2020. Any grant payment not attested for or not returned to IME by Jan. 4, 2021, will be recouped.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the month of December, including tomorrow's quarterly Home Health Regulatory Update Call, where the latest survey trends will be discussed, and next Tuesday's COVID-19 Provider Update Call for skilled nursing facilities and assisted living programs.
Read More
From September 2020 through December 2020, nursing facilities can qualify for Quality Incentive Payments (QIPs) based on their performance of managing the spread of COVID-19 in their facilities and mortality rates, both compared to county positivity averages. One area that can automatically prevent a provider from receiving QIPs is if they do not complete the National Healthcare Safety Network (NHSN) reports in their entirety.
Read More
Iowa Department of Human Services (DHS) has released informational letter 2191 announcing an updated version of the Department’s incident reporting training for all Home- and Community-Based Services (HCBS) providers. Iowa Administrative Code Chapter 77 requires that HCBS providers must report any major incidents that involve Medicaid waiver recipients in their respective organizations.
Read More
IHCA received informational letter 2192 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective Jan. 1, 2021. The letter includes changes to the Preferred Drug List (PDL), new drug prior authorization criteria, changes to existing prior authorization criteria, point of sale billing updates and a Drug Utilization Review (DUR) update.
Read More
The Restorative Nursing Virtual Training Program on Dec. 2, sponsored by Millennium Therapy, will teach participants how to organize and set up a restorative nursing program to capture all the restorative nursing care that is being provided. There will also be a discussion on how to offer restorative services during COVID-19 isolation or quarantine.
Read More
As the Jan. 1, 2021 Electronic Visit Verification (EVV) deadline approaches, IHCA is hosting a webinar with CareBridge on Nov. 30 for members to ask questions. The state of Iowa has contracted with CareBridge as its EVV partner to ensure success under the 21st Century Cures Act. CareBridge is an established EVV and EVV data aggregation vendor.
Read More
Due to the public health emergency and current strain on hospitals due to COVID-19, Iowa Total Care (ITC) and UnitedHealthcare have loosened prior authorization requirements for skilled nursing facilities.
Read More
Iowa Department of Human Services (DHS) released informational letter 2185 about the annual submission requirements regarding prevention and detection of Medicaid fraud and abuse for any provider, or part of a provider entity, that receives payments of $5 million or more from Iowa Medicaid in any federal fiscal year (Oct. 1 to Sept. 30).
Read More
As the Jan. 1, 2021 Electronic Visit Verification (EVV) deadline approaches, IHCA is hosting a webinar with CareBridge on Nov. 30 for members to ask questions. If you would like to submit questions, email them to Brandon Hagen prior to Nov. 23.
Read More
The first round of Quality Incentive Payments for the testing of staff and residents was received on Nov. 1, 2020. The total received for Iowa skilled nursing facilities was approximately $10.65 million and included a wide range of payments, with the average payment being around $35,000. There were 128 Iowa facilities that did not receive a payment.
Read More
Due to the public health emergency and because the fiscal year 2019 financial and statistical reports will not be used to rebase provider payment rates, Iowa Medicaid Enterprise (IME) policy is delaying implementation of its updated rule for determining reimbursable lease expense for non-related party leasing arrangements for fiscal years ending in 2019 only.
Read More
Iowa Department of Human Services (DHS) has issued informational letter (IL) 2186, replacing IL 2178 that contained incorrect criteria regarding service intensity add-on (SIA) payments for hospice claims.
Read More
Join IHCA for its Minimum Data Set (MDS) 101 Virtual Training on Nov. 18 and MDS 201 Virtual Training on Nov. 19. Each digital training event is approved for 5.0 CEUs for nurses, social services staff and administrators. MDS 101 is a prerequisite for MDS 201. There is a separate registration and fee for MDS 201.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the month of November, including tomorrow's Home Health COVID-19 Provider Update Call and next Tuesday's COVID-19 All Member Provider Update Call.
Read More
Iowa Medicaid Enterprise (IME) is hosting provider training opportunities on Electronic Visit Verification (EVV). Training is currently happening and will continue through December. The most recent meeting was yesterday, Nov. 10, and the next meeting is Wednesday, Dec. 2. The agenda and materials will be posted on IME's dedicated EVV webpage. Questions answered during the meeting will be recorded and posted IME's website at a later date.
Read More
The Restorative Nursing Virtual Training Program on Dec. 2, sponsored by Millennium Therapy, will teach participants how to organize and set up a restorative nursing program. This digital training event is approved for 4.0 CEUs for nurses, physical therapists and administrators.
Read More
Applications for Provider Relief Fund (PRF) payments from the U.S. Department of Health and Human Services (HHS) are due this Friday, Nov. 6. Late last week, HHS made a significant number of updates to its PRF frequently asked questions (FAQ) document. AHCA compiled all of the new PRF FAQs that were released on Oct. 28 into a single document that is available to members. IHCA members involved in the reporting of PRF dollars are encouraged to review these updated FAQs.
Read More
IHCA held its COVID-19 All Member Provider Update Call yesterday, Nov. 3, sponsored by Encounter Telehealth. A recording of the call and links referenced during the call are now available on the IHCA website. IHCA has compiled the call-in details for its upcoming member-only calls for the month of November, including Friday's Iowa Council of Nurse Leaders Call and next Wednesday's Managed Care Organization (MCO) Call with Iowa Total Care and Amerigroup.
Read More
CMS has published the 2021 final rule, Home Health Prospective Payment System Rate Update, which includes payment rates and the wage index for calendar year 2021
Read More
Iowa is participating in the Federal Fiscal Year 2021 Payment Error Rate Measurement (PERM) program. Due to Iowa's participation in this program, providers may be contacted by the CMS review contractor, NCI Information Systems, Inc. (NCI), who will collect medical records from you either in hard copy or in electronic format. Upon receipt of the request for medical records, you must submit the records within 75 days.
Read More
Amerigroup Iowa has updated the hospice room and board billing procedure. Effective Nov. 1, 2020, hospice providers that have been reporting the National Provider Identifier (NPI) of the residing nursing facility in box 80 must now report the facility NPI in box 77 of the UB-04 claim form.
Read More
The Iowa Medicaid Enterprise (IME) will host its 2020 Annual Provider Training sessions on Nov. 17-18 via Zoom. You only need to sign up for one session. If you are unable to attend one of the four sessions, you will be able to watch a recording on the IME website. Iowa Total Care and Amerigroup will participate in the training as well.
To suggest a topic for these sessions, email
[email protected] before Nov. 6, 2020.
Read More
CMS has released video tutorials to assist skilled nursing facilities with standardized data assessment guidance and strategies for cognitive assessments. Additionally, an updated version of CMS' Skilled Nursing Facility (SNF) COVID-19 Quality Reporting Program (QRP) Tip Sheet that was originally posted on Sept. 8, 2020, is now available.
Read More
Join IHCA for its Minimum Data Set (MDS) 101 Virtual Training on Nov. 18 and MDS 201 Virtual Training on Nov. 19. Each digital training event is approved for 5.0 CEUs for nurses, social services staff and administrators. MDS 101 is a prerequisite for MDS 201. There is a separate registration and fee for MDS 201.
Read More
IHCA is hosting three online education events regarding the Minimum Data Set (MDS) 3.0 and the changes that went into effect on Oct. 1, 2020. Join us for the MDS 3.0 Update Webinar next Tuesday, Nov. 3. Additionally, IHCA is hosting MDS 101 Virtual Training on Nov. 18 and MDS 201 Virtual Training on Nov. 19.
Read More
The National Nursing Home COVID-19 Action Network, a partnership between the Agency for Health Research and Quality (AHRQ), the University of New Mexico’s ECHO Institute and the Institute for Healthcare Improvement (IHI), is offering a series of pre-launch webinars. The next webinar is tomorrow, Oct. 29, at 11:30 a.m. and will cover cohorting, cleaning and disinfection.
Read More
In light of recent developments regarding outbreaks, vaccines and a new reporting mandate, IHCA held a special COVID-19 All Member Provider Update Call yesterday, Oct. 27. A recording is available on the IHCA website. Additionally, a recording of the Oct. 19 Iowa Department of Public Health (IDPH) Long-Term Care (LTC) webinar is now available on YouTube.
Read More
Civil Money Penalty (CMP) grant funds for in-person visitation aids during the COVID-19 public health emergency (PHE) are now available. CMP grant funds are also still available for communicative technology during COVID-19.
Read More
The U.S. Department of Health and Human Services (HHS) has announced changes to the reporting requirements and expanded the types of providers that can apply for Provider Relief Funds. HHS is returning to its previous definition of lost revenue, a decrease from 2019 revenue, and is now allowing private pay assisted living programs to apply for Phase 3 awards.
Read More
The Home Health Emergency Access to Telehealth (HEAT) Act (S.4854/H.R. 8677) was introduced to Congress on Friday, Oct. 23. The bipartisan bill would provide Medicare reimbursement for audio and video telehealth services furnished by home health agencies during the COVID-19 emergency and future public health emergencies.
Read More
ICHC partnered with Optum and local Veterans Affairs (VA) offices to host its quarterly VA/Optum call yesterday, Oct. 27. During the call, VA and Optum representatives pointed ICHC members to a variety of resources to help answer claim, billing and Customer Engagement Portal questions.
Read More
Iowa Department of Human Services (DHS) released informational letter 2183 regarding clarification on its policy on Home- and Community- Based Services (HCBS) waiver transportation and members receiving daily Supported Community Living (SCL) services.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls, including tomorrow's Skilled Nursing Facility Regulatory Call at 11:30 a.m., where the latest survey issues will be discussed. Home health members should join the VA/Optum call next Tuesday at 10:00 a.m. and activity professionals are invited to the Iowa Council of Activity Professionals (ICAP) call on Tuesday at noon.
Read More
The National Nursing Home COVID-19 Action Network is offering a series of pre-launch webinars to explore some of the key themes that will later be featured more deeply over the 16-week sessions. The pre-launch webinars will take place this Friday, Oct. 23 and next Thursday, Oct. 29.
Read More
IHCA held its bi-weekly COVID-19 All Member Provider Update Call yesterday, Oct. 20. The call was sponsored by Encounter Telehealth and topics covered include ICAL's new visitation guidance, IHCA's new clinical guidance, an update on resident voting for the upcoming general election, COVID-positive transfer issues, updates on the COVID-19 vaccine, upcoming Project ECHO webinars and the Phase 3 General Distribution.
Read More
The 21st Century Cures Act mandates all providers that deliver personal care, respite care and companion care to start using Electronic Visit Verification (EVV) no later than Jan. 1, 2021. IHCA recommends all members who provide the relevant services begin using CareBridge as soon as possible to prevent a disruption in claims reimbursement and to ensure home health providers are fully operational by Jan. 1, 2021. It has been confirmed recently that this also applies to assisted living providers that bill the codes listed in this article.
Read More
IHCA has compiled the latest informational letters (ILs) that pertain to IHCA members from the Iowa Department of Human Services (DHS) and the Iowa Medicaid Enterprise (IME). This week's letters include details on the COVID-19 Relief Rate add-on payments for hospice providers and the two-tiered hospice payment and service intensity add-on.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
A 30-minute introductory Project ECHO webinar will take place tomorrow, Oct. 15 at 11:00 a.m. to provide more information on the 16-week training program on infection prevention practices that is free for Medicare or Medicaid-certified nursing facilities. Facilities eligible to receive funding from the Provider Relief Fund can receive $6,000 in compensation for participating in the 16-week program.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the next month, including this Friday's Assisted Living Regulatory Call, where the latest survey issues will be discussed.
Read More
On Oct. 8, CMS released updated Medicare accelerated and advance payment guidance based upon the recently enacted Continuing Appropriations Act, 2021 and Other Extensions Act.
Read More
Effective Oct. 1, 2020, the Iowa Medicaid Enterprise (IME) began collecting the Patient Driven Payment Model (PDPM) payment codes on all Omnibus Budget Reconciliation Act (OBRA) assessments by requiring the addition of Section GG on all Iowa assessments. Learn more about these changes to the Minimum Data Set (MDS) on Nov. 3 at IHCA's MDS 3.0 Update webinar.
Read More
The 2020 Home- and Community-Based Services (HCBS) Provider Quality Management Self-Assessment process is underway. Both the completed Self-Assessment and Address Collection Tool forms must be received by the Iowa Medicaid Enterprise (IME) no later than Dec. 1, 2020. Failure to submit both of the required documents by the deadline will jeopardize your agency’s Medicaid enrollment.
Read More
After a recent outage, the U.S. Department of Veterans Affairs' (VA's) Customer Engagement Portal (CEP) has relaunched, and several enhancements have been made to improve the security of CEP.
Read More
Registration is now open for the last stakeholder informational meetings on EVV implementation on Nov. 10 and Dec. 2. Additionally, The EDI Support Services (EDISS) Gateway transition that was scheduled to take place on Oct. 11 has been pushed back to Oct. 18.
Read More
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a Microsoft Excel workbook that summarizes provider-specific Medicare claims data statistics for areas that CMS has identified as prone to improper Medicare payments due to billing, coding and/or admission necessity issues.
Read More
IHCA has compiled a list of upcoming webinars and recordings relating to COVID-19, including tomorrow's Project ECHO introductory webinar on infection control, and recordings of AHCA's Office Hours on the provider relief fund and the Families First Coronavirus Response Act (FFCRA).
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the next month, including next Wednesday's calls with Iowa's managed care organizations (MCOs). These calls are an exclusive member benefit for IHCA, ICAL and ICHC members.
Read More
IHCA has compiled the most important long-term care news from this week relating to COVID-19, including testing updates and outbreak definitions, reporting, compassionate care visits, new visitation guidance, Provider Relief Fund Phase 3 General Distribution, OSHA reminders, vaccination preparations, the nursing facility ECHO Project, an Abbott BinaxNow training webinar and more.
Read More
On Oct. 1, President Trump signed into law H.R.8337: Continuing Appropriations Act, 2021 and Other Extensions Act. This continuing resolution and short-term funding measure is helpful to the long-term care sector, as it provides continued FY 2021 appropriations to federal agencies through Dec. 11, 2020 and extends several programs.
Read More
IHCA has compiled the latest informational letters (ILs) that pertain to IHCA members from the Iowa Department of Human Services (DHS) and the Iowa Medicaid Enterprise (IME). This week's letters include an application deadline extension for a grant for Home- and Community-Based Service (HCBS) providers and a reminder about the EDI Support Services (EDISS) Gateway transition that will take place on Oct. 11.
Read More
IHCA members should take advantage of two AHCA webinars tomorrow, one covering influenza vaccination and one on COVID-19 testing. ICHC members should also take advantage of the Home Health Member COVID-19 Update Call tomorrow. IHCA's next bi-weekly COVID-19 Member Provider Update Call will be Tuesday, Oct. 6, sponsored by Exceltox Laboratories.
Read More
Starting July 1, 2020, providers for both managed care and Fee-For-Service (FFS) can use the new universal prior authorization (PA) forms for requesting medical PAs. The managed care organizations (MCOs) and Iowa Medicaid Enterprise (IME) will accept either the new universal PA request forms or the current MCO or FFS specific forms for any PA request through Sept. 30, 2020. Effective tomorrow, Oct. 1, 2020, all medical PA requests must be submitted on the new universal forms.
Read More
Federal regulations under FY 2021 Final Rule: CMS-1735-F now require ALL providers to transmit medical records and other documentation, such as notices of non-coverage, to the Beneficiary and Family Centered Care - Quality Improvement Organizations (BFCC-QIOs) electronically using an electronic submission method determined by the QIO. Beginning Oct. 1, 2020, Livanta will accept medical records electronically in two ways – direct secure messaging or via Livanta’s file transfer portal.
Read More
IHCA has compiled the most important long-term care news from this week relating to COVID-19, including revised nursing facility visitation and testing guidance from Iowa Department of Public Health (IDPH) and Iowa Department of Inspections and Appeals (DIA), IDPH reporting of antigen testing, clarification on the need for assisted living Clinical Laboratory Improvement Amendment (CLIA) waivers, additional Provider Relief Fund reporting guidance, an upcoming COVID-19 vaccine needs assessment survey, considerations when testing residents and employees for COVID-19, as well as upcoming COVID-19 webinars and calls.
Read More
CMS has revised Change Request (CR) 11855 to update service date reporting on the claim and to update remarks. NAHC asked CMS how a home health agency (HHA) should document on the claim in situations where a date could not be entered on line 0023 because the first visit did not occur within the first five days of the period. CMS responded that the HHA may enter the first day of the period of care as the service date on this line when submitting a request for anticipated payment (RAP) for a subsequent period of care.
Read More
IHCA received informational letter 2170 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, effective Nov. 1, 2020, including new drug prior authorization criteria, changes to existing prior authorization criteria, removal of prior authorization criteria and a Drug Utilization Review (DUR) update.
Read More
IHCA has compiled the most important long-term care news from this week relating to COVID-19, including testing updates for nursing facilities, assisted living communities and home health agencies, as well as an IHCA summary of CMS's new visitation guidance, an updated to the nursing facility Provider Relief Fund, resident and tenant voting guidance, call-in details for IDPH's LTC webinar this Friday and more.
Read More
Starting July 1, 2020, providers for both managed care and Fee-For-Service (FFS) can use the new universal prior authorization (PA) forms for requesting medical PAs. The managed care organizations (MCOs) and Iowa Medicaid Enterprise (IME) will accept either the new universal PA request forms or the current MCO or FFS specific forms for any PA request through Sept. 30, 2020. Effective Oct. 1, 2020, all medical PA requests must be submitted on the new universal forms.
Read More
The Department of Veteran Affairs (VA) released a memo regarding the ability of physician assistants (PAs), nurse practitioners (NPs) and clinical nurse specialists (CNSs) to certify and sign orders within the VA system.
Read More
On July 14, 2020, CMS extended the date for full compliance with the Home- and Community-Based Services (HCBS) settings rules to March 17, 2023. Iowa completed the assessment of all existing non-residential settings on March 31, 2018. Providers have either come into compliance with the settings rules or have developed a corrective action plan (CAP) that fully addresses the needed changes and establishes reasonable timelines for compliance. The HCBS Quality Oversight Unit will monitor the provider CAPs to ensure progress is being made toward full compliance prior to March 17, 2023.
Read More
Electronic Visit Verification (EVV) will not be implemented for Fee-For-Service (FFS) beginning Jan. 1, 2021. Providers will continue to submit FFS claims as usual for FFS members. Claims and billing information is available on the Iowa Department of Human Resources (DHS) website. Further updates related to this project will be provided as they become available on the dedicated DHS EVV webpage.
Read More
The Iowa Department of Human Services and Iowa Medicaid Enterprise issued a number of Informational Letters (ILs) this past week, including ILs on Medicare Part A and Part B Crossover Claims for Dually Eligible Medicare and Medicaid Members, MDS Version 1.17.2, Person-Centered Planning Considerations during COVID-19 and more.
Read More
On Monday, Centers for Medicare and Medicaid Administrator (CMS) Administrator Seema Verma announced via Twitter that CMS was pulling the Medicaid Fiscal Accountability Rule (MFAR). This is extremely positive news for Iowa care providers. This proposed rule was intended to overhaul Medicaid supplemental payments - and could have put as much as $50 billion nationally, and approximately $100 million of federal dollars for Iowa nursing facility providers in jeopardy.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the month of September, including tomorrow's Home Health Regulatory Call and next Tuesday's COVID-19 Provider Update Call.
Read More
IHCA is offering new exciting online education opportunities, including tomorrow's webinar on Bronze Award applications. Also, don't forget to register for IHCA's on-demand 2020 Digital Convention, launching on Sept. 28.
Read More
Join IHCA tomorrow, Sept. 17, for a free Bronze Award Application Webinar that will help members compose their first AHCA/NCAL 2021 Quality Award application. After participating in the webinar, attendees should have an understanding on how to access AHCA/NCAL’s video series and successfully write their Quality Award application using the step-by-step method provided by the video instructions.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the month of September, including next Wednesday's member-only Skilled Nursing Facility Regulatory Call, which covers the latest survey, reimbursement and regulatory issues.
Read More
IHCA has compiled the latest COVID-19 news for long-term care providers, including Provider Relief Fund updates for nursing facilities and assisted living programs, new county COVID-19 positivity test rates posted by CMS, testing and reporting updates, IHCA COVID-19 Provider Update Call recordings and more.
Read More
IHCA received informational letter 2165 from Iowa Department of Human Services regarding a cost report deadline extension for certain providers with a fiscal year end of June 30, 2020.
Read More
IHCA is offering new exciting online education opportunities, including the new ICAL Assisted Living Medication Manager Curriculum that launched yesterday and next Thursday's webinar on Bronze Award applications. Also, don't forget to register for IHCA's on-demand 2020 Digital Convention, launching on Sept. 28.
Read More
Yesterday, Sept. 1, the U.S. Department of Health and Human Services (HHS) announced that private-pay assisted living/memory care providers will be eligible to apply for CARES Act Provider Relief Funds under the current Phase 2 General Distribution round of funding. It was also announced by an HHS official yesterday that the federal government plans to ship rapid COVID-19 tests to assisted living communities across the country.
Read More
IHCA has compiled the latest COVID-19 news for long-term care providers, including the CARES Act Provider Relief Fund Nursing Home – Infection Control Distribution, new data elements added to National Healthcare Safety Network (NHSN) reporting, a new eviction moratorium that goes into effect on Sept. 4, as well as upcoming member-only COVID-19 calls.
Read More
IHCA has compiled the latest COVID-19 news for long-term care providers, including the CARES Act Provider Relief Fund Nursing Home – Infection Control Distribution, new data elements added to National Healthcare Safety Network (NHSN) reporting, a new eviction moratorium that goes into effect on Sept. 4, as well as upcoming member-only COVID-19 calls.
Read More
IHCA's digital 2020 Skilled Nursing Facility (SNF) Reimbursement Update is tomorrow, Sept. 3, and will cover the new guidance on the reporting of funds received through the CARES Act and the Paycheck Protection Program that was recently announced by the Health Resources and Services Administration (HRSA). A recording of this education will be available for purchase after the online event.
Read More
IHCA has compiled the call-in details for its upcoming member-only calls for the month of September, including tomorrow's Home Health COVID-19 Provider Update, next Tuesday's all-member COVID-19 Provider Update and next Wednesday's calls with Iowa's managed care organizations (MCOs).
Read More
In informational letter (IL) 2159, Iowa Department of Human Services (DHS) stated that the Medicaid flexibilities that DHS currently has in place due to the COVID-19 public health emergency also apply to providers and members affected by the Aug. 10, 2020 derecho that moved across the state and caused widespread damage.
Read More
The 21st Century Cures Act mandates all providers that deliver personal care, respite care and companion care to start using Electronic Visit Verification (EVV) no later than Jan. 1, 2021. The state of Iowa has contracted with CareBridge as its EVV partner to ensure success under the 21st Century Cures Act. Each provider contracted with Amerigroup or Iowa Total Care must complete a provider survey for CareBridge. ICHC encourages providers to complete the provider survey, begin training and start using EVV as soon as possible to work out any error messages encountered to ensure there is not a disruption in claim reimbursement.
Read More
The Iowa Department of Human Services (DHS) and Preadmission Screening and Resident Review (PASRR) program partner, Ascend/Maximus, will migrate the program from its existing system to the Maximus-developed AssessmentPro application for the state’s PASRR process. The transition to the AssessmentPro system is scheduled to take place on Thursday, Oct. 1. Training webinars regarding this new system are happening this week, where providers can get answers to any lingering questions they may have about AssessmentPro or PASRR processes.
Read More
IHCA is offering a wealth of online education opportunities through a wide range of courses, including the new ICAL Assisted Living Medication Manager Curriculum that launches next Tuesday, Sept. 8. Also, don't forget to register for IHCA's on-demand 2020 Digital Convention, launching on Sept. 28.
Read More
IHCA's digital 2020 Skilled Nursing Facility (SNF) Reimbursement Update next Thursday, Sept. 3, will cover the new guidance on the reporting of funds received through the CARES Act and the Paycheck Protection Program that was recently announced by the Health Resources and Services Administration (HRSA).
Read More
IHCA has compiled a list of recent updates that impact long-term care providers, including a new testing rule from CMS, antigen testing guidance, news on survey prioritization and enforcement cases, Iowa Department of Inspection and Appeals' (DIA's) personal protective equipment (PPE) policy, an update on hospital discharges, vaccination planning guidance, National Healthcare Safety Network (NHSN) data insight, a reminder of the Provider Relief Fund Phase 2 deadline this Friday, a reimbursement opportunity through ECHO and IHCA COVID-19 Update Call details.
Read More
IHCA has compiled a list of recent updates that impact long-term care providers, including a new testing rule from CMS, antigen testing guidance, news on survey prioritization and enforcement cases, Iowa Department of Inspection and Appeals' (DIA's) personal protective equipment (PPE) policy, an update on hospital discharges, vaccination planning guidance, National Healthcare Safety Network (NHSN) data insight, a reminder of the Provider Relief Fund Phase 2 deadline this Friday, a reimbursement opportunity through ECHO and IHCA COVID-19 Update Call details.
Read More
Iowa Department of Human Services' (DHS') first stakeholder informational meeting on Electronic Visit Verification (EVV) implementation will take place virtually next Monday, Aug. 31. The deadline to register is Aug. 28 at 5:00 p.m. The sessions will be led by Iowa Medicaid Enterprise (IME) and the managed care organizations (MCOs), and will include representatives from CareBridge, the MCO EVV solution.
Read More
Starting July 1, 2020, providers for both managed care and Fee-For-Service (FFS) can use the new universal prior authorization (PA) forms for requesting medical PAs. The managed care organizations (MCOs) and Iowa Medicaid Enterprise (IME) will accept either the new universal PA request forms or the current MCO or FFS specific forms for any PA request through Sept. 30, 2020. Effective Oct. 1, 2020, all medical PA requests must be submitted on the new universal forms.
Read More
IHCA is offering a wealth of online education opportunities through a wide range of courses covering reimbursement, Bronze Quality Awards, assisted living medication management and more. Also, don't forget that IHCA's on-demand 2020 Digital Convention and Trade Show launches on Sept. 28.
Read More
IHCA has compiled a list of recent updates that impact long-term care providers, including updated ICAL reopening guidance, state survey news, updates to National Healthcare Safety Network (NHSN) instructions, changes to return to work criteria, COVID-19 grants for Home- and Community-Based Service (HCBS) providers, a Crisis Relief Fund reminder from the IHCA Foundation, a hand sanitizer alert and more.
Read More
As power outages, building repairs and cleanup from the Aug. 10 derecho continues, IHCA has developed additional guidance to assist members in their storm recovery efforts. Additionally, Governor Reynolds has formally requested an expedited Presidential Major Disaster Declaration, and Iowa Medicaid Enterprise (IME) has provided information on how the storm has impacted nursing facility transfers and case activity reports.
Read More
IHCA has compiled the latest informational letters (ILs) that pertain to IHCA members from the Iowa Department of Human Services (DHS) and the Iowa Medicaid Enterprise (IME). This week's letters include information on grants for Home- and Community-Based Service (HCBS) providers, Iowa Medicaid Pharmacy Program changes and a revised extended due date of cost reports.
Read More
IHCA has compiled the latest informational letters (ILs) that pertain to IHCA members from the Iowa Department of Human Services (DHS) and the Iowa Medicaid Enterprise (IME). This week's letters include information on grants for Home- and Community-Based Service (HCBS) providers, Iowa Medicaid Pharmacy Program changes and a revised extended due date of cost reports.
Read More
IHCA is offering a wealth of online education opportunities through a wide range of courses covering the Five-Star rating system, reimbursement, Bronze Quality Awards, assisted living medication management and more. Also, don't forget that IHCA's on-demand 2020 Digital Convention and Trade Show launches on Sept. 28.
Read More
Please join AHCA/NCAL for a member-only call with AHCA President and CEO Mark Parkinson and his team tomorrow, Aug. 13 at 2:00 p.m. CST, regarding details on the upcoming COVID-19 relief distributions to skilled nursing facilities (SNFs) from the Provider Relief Fund. This call is for SNF members only, and attendees are required to register prior to the call.
Read More
IHCA has compiled a list of recent updates that impact long-term care providers, including a $5 billion distribution for nursing facilities, updates on Point-of-Care testing equipment, screening, surveys, reopening guidance and more.
Read More
Last Friday CMS issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2021 update. CMS projects aggregate payments to SNFs will increase by $750 million, or 2.2%, for FY 2021 compared to FY 2020.
Read More
Registration is now open for the first in a series of stakeholder informational meetings on Electronic Visit Verification (EVV) implementation. The sessions will be led by Iowa Medicaid Enterprise (IME) and the managed care organizations (MCOs), and will include representatives from CareBridge, the MCO EVV solution. The first session will be held virtually on Aug. 31 and will focus on provider agencies. Registration for the first session closes on Aug 28.
Read More
IHCA is offering a wealth of online education opportunities through a wide range of courses covering reimbursement, assisted living regulations, social services, the Five-Star rating system and more.
Read More
Join ICHC for tomorrow's Home Health COVID-19 Provider Update Call. Topics covered will include an update on the emergency declaration and waiver extensions, home health survey updates, Medicaid nurse practitioner and physician assistant signature authorizations and more. IHCA has also compiled the call-in details for all of the member-only calls this month, including next Tuesday's All Member COVID-19 Provider Update Call.
Read More
ICHC has compiled the latest COVID-19 updates for home health members, including CMS's July 2020 question and answer (Q&A) document that includes the handling of OASIS completion during this public health emergency, as well as a list of the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA (Clinical Laboratory Improvement Amendments of 1988).
Read More
ICHC has compiled the latest COVID-19 updates for home health members, including CMS's July 2020 question and answer (Q&A) document that includes the handling of OASIS completion during this public health emergency, as well as a list of the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA (Clinical Laboratory Improvement Amendments of 1988).
Read More
IHCA has compiled a list of recent updates that impact all long-term care providers, including the Phase 2 General Distribution deadline extension, updates on payments for providers that had a change in ownership, CPR certification extension, best practices for personal protective equipment (PPE) vendor vetting, the IHCA Foundation COVID-19 Crisis Relief Fund, upcoming COVID-19 calls and more.
Read More
IHCA is offering a wealth of online education opportunities in August through a wide range of courses covering reimbursement, fall investigations and interventions, assisted living regulations, social services, the Five-Star rating system and more.
Read More
The Iowa Medicaid Enterprise (IME) Provider Cost Audit (PCA) Unit is extending the due date of cost reports following the revised guidance issued by CMS. This is a blanket extension and providers do not need to submit a written request. If cost reports are completed sooner, they can be submitted any time prior to the extended due dates.
Read More
The National Association for Home Care & Hospice (NAHC) is inquiring how home health agencies (HHAs) are preparing for the new home infusion therapy supplier benefit. To inform its comments to CMS on the Home Health Prospective Payment System (HHPPS) proposed rule for the home infusion therapy supplier benefit, NAHC is asking HHAs to complete a brief survey by Aug. 21, 2020.
Read More
IHCA's digital 2020 Skilled Nursing Facility (SNF) Reimbursement Update that was originally scheduled for Aug. 5 has been rescheduled for Sept. 3. The Health Resources and Services Administration (HRSA) recently announced new guidance on the reporting of funds received through the CARES Act and the Paycheck Protection Program, with detailed reporting instructions being released on Aug. 17. IHCA has rescheduled this virtual conference to allow time for the speaker to review these instructions and provide direction on the material.
Read More
Relief funds for private-pay assisted living providers are under consideration from the Department of Health and Human Services (HHS). To help facilitate this, HHS has requested specific information on assisted living programs and other licensed senior living providers. ICAL members should begin collecting the information requested and will receive a link to a secure portal to upload this information once the portal becomes available. The deadline to submit the data is this Friday, July 31 at 4:00 p.m. CST.
Read More
IHCA's digital 2020 Skilled Nursing Facility (SNF) Reimbursement Update that was originally scheduled for Aug. 5 has been rescheduled for Sept. 3. The Health Resources and Services Administration (HRSA) recently announced new guidance on the reporting of funds received through the CARES Act and the Paycheck Protection Program, with detailed reporting instructions being released on Aug. 17. IHCA has rescheduled this virtual conference to allow time for the speaker to review these instructions and provide direction on the material.
Read More
IHCA has compiled a list of recent updates that impact all long-term care providers, including the renewal of the national Public Health Emergency (PHE) through Oct. 23, the updated U.S. Department of Health and Human Services (HHS) FAQ on auditing and funds transfers, price increase guidance and recent and upcoming COVID-19 calls.
Read More
IHCA has compiled a list of recent updates that impact all long-term care providers, including the renewal of the national Public Health Emergency (PHE) through Oct. 23, the updated U.S. Department of Health and Human Services (HHS) FAQ on auditing and funds transfers, price increase guidance and recent and upcoming COVID-19 calls.
Read More
On July 15, Iowa Medicaid Enterprise (IME) posted all finalized Home- and Community-Based Services (HCBS) Waiver provider quality self-assessments (form 470- 4547) received by IME in 2019 to its website. By posting the provider self-assessments, IME is making provider information available to all interested parties about an individual provider’s compliance with the HCBS rules, regulations and quality related information in HCBS waiver and habilitation programs in the state.
Read More
During the 2020 legislative session, the monthly budget maximum, or cap, was eliminated for individuals eligible for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver. This change is effective for dates of service beginning July 1, 2020. Elderly Waiver recipients no longer need to request an exception to policy (ETP) to exceed the monthly cap allowed under the Elderly Waiver.
Read More
IHCA is offering a wealth of online education opportunities in August through a wide range of courses covering dementia care, reimbursement, fall investigations and interventions, assisted living regulations, social services, the Five-Star rating system and more.
Read More
Join ICHC tomorrow, July 23, for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
Join IHCA for its All-Member COVID-19 Provider Update Call and its quarterly Veteran's Administration (VA)/Optum Call next Tuesday. These calls are member benefits and allow IHCA members to receive the most up-to-date information.
Read More
Late last week, the U.S. Department of Health and Human Services (HHS) extended the application deadline for the Medicaid tranche of the COVID-19 Provider Relief Fund to Monday, Aug. 3, 2020. The payment to each provider will be approximately 2% of reported gross revenue from patient care, and the final amount each provider receives will be determined after the data is submitted.
Read More
On July 21, the U.S. Department of Health and Human Services (HHS) released a framework for more detailed Provider Relief Fund (PRF) reporting guidance and materials to be released on Aug. 17, 2020. Additionally, the reporting system will become available to recipients on Oct. 1, 2020.
Read More
CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2019, which will affect their FY 2021 Annual Payment Update (APU). Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 p.m., Aug. 18, 2020.
Read More
IHCA is offering a wealth of online education opportunities in August through a wide range of courses covering dementia care, reimbursement, fall investigations and interventions, assisted living regulations, social services, the Five-Star rating system and more.
Read More
During this time of social distancing and lack of in-person education events, IHCA members still have access to a variety of online education through AHCA/NCAL, including the new Infection Preventionist Specialized Training Version 2.
Read More
Join IHCA tomorrow for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol.
Read More
Join ICHC next Thursday, July 23, for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
The Health Resources and Services Administration (HRSA) has expanded its resources regarding the CARES Act Provider Relief Fund Medicaid and Children’s Health Insurance Program (CHIP) Distribution. Resources include a recording of its June 25 webcast, a fact sheet, frequently asked questions and instruction and application forms.
Read More
IHCA has received numerous questions from members about Iowa Department of Human Services (DHS) informational letter 2146 regarding COVID-19 Relief Rate add-on payments. IHCA has been in contact with DHS and has submitted questions to the department for comment. The department intends to have a frequently asked questions (FAQ) page completed and posted to its website by the end of the week. IHCA will let members know when the page is posted.
Read More
IHCA has received Iowa Department of Human Services (DHS) informational letter (IL) 2147 regarding universal prior authorization (PA) forms for medical requests. Starting July 1, 2020, providers for both managed care and Fee-For-Service (FFS) can use the new universal forms for requesting medical PAs. The managed care organizations (MCOs) and Iowa Medicaid Enterprise (IME) will accept either the new universal PA request forms or the current MCO or FFS specific forms for any PA request through Sept. 30, 2020. Effective Oct. 1, 2020, all medical PA requests must be submitted on the new universal forms.
Read More
The AHCA/NCAL Data Solutions team has created a new tool for AHCA skilled nursing facility (SNF) members to generate an extremely useful report using hospital and SNF claims to track patient flow and availability in your market area. This information is of real value for SNF providers as it helps facilities improve in the clinical areas where they see the most volume and adapt skills to deliver high-value care. To learn more, check out a recently-recorded informational webinar on this new product.
Read More
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in June 2020. The updated files are posted on OIG's website, and health care providers have an "affirmative duty" to check to ensure that excluded individuals are not working in their facilities or can face significant fines. As a best practice, IHCA members should check the LEIE on a regular basis.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Join IHCA on Aug. 5 for its its digital Skilled Nursing Facility (SNF) Reimbursement Update that will cover population health management (PHM) updates, the effects of the Patient-Driven Payment Model (PDPM), as well as Medicaid and CARES Act reporting. This education will offer three CEUs for nurses, social services staff and administrators.
Read More
Join IHCA on Aug. 18 for its live stream version of the annual long-term care (LTC) social services training. The day-long course will be broken into two sessions covering the importance of ethics and communication.
Read More
Have you checked your Five-Star rating recently? How does your facility rate? If your rating isn’t where you want it, IHCA's Managing Your Stars webinar on Aug. 20 will help you improve your rating by providing you with a better understanding of the Five-Star rating system. The webinar will help participants implement key strategies that result in better outcomes and help you maintain a competitive edge as a preferred provider.
Read More
Join ICHC for its monthly member-only Home Health COVID-19 Provider Update Call tomorrow, July 9 at 2:00 p.m. The call will cover staff screening recommendations, on-site infection control survey updates, news on the regulatory relief waiver extension and more. Call-in details for the Home Health COVID-19 Provider Update Call, as well as other July IHCA member-only conference calls are included as well.
Read More
Join IHCA next Thursday, July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. This education will offer 4.5 CEUs for nurses, social services staff, administrators and assisted living managers.
Read More
Yesterday the Health Resources and Services Administration (HRSA) released a new fact sheet for Medicaid and Children's Health Insurance Program (CHIP) providers regarding the Provider Relief Fund. The fact sheet covers eligibility requirements, repayment, uses of funds, attestation requirements and more.
Read More
On June 25, CMS posted a preview of the CY 2021 home health proposed rule. The proposal is light compared to recent years’ proposed rules, but does contain meaningful updates and changes. The National Association for Home Care and Hospice (NAHC) has provided summaries of each of the areas addressed by CMS – payment rates, telehealth, quality program and home infusion therapy.
Read More
The Advance Beneficiary Notice of Non–Coverage (ABN), Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The ABN form is renewed every three years in accord with Paperwork Reduction Act. The use of the renewed form with the expiration date of June 30, 2023 will be mandatory on Aug. 31, 2020.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
Join IHCA on Aug. 18 for its live stream version of the annual long-term care (LTC) social services training. The day-long course will be broken into two sessions covering the importance of ethics and communication. This education will offer four CEUs for social services staff and administrators.
Read More
IHCA's Medicare Review virtual live stream education event next Wednesday, July 8, sponsored by Brighton Consulting Group, will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services staff and administrators.
Read More
Get the latest reimbursement news and have your claims processing questions answered by Iowa's managed care organizations (MCOs) during IHCA's member-only MCO calls next Wednesday, July 8. Submit your questions for next week's calls by tomorrow to
[email protected].
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including reopening, personal protective equipment (PPE) and testing updates, the regulatory relief waiver extension, a documentation tip on staff screening and more.
Read More
The AHCA/NCAL Data Solutions team has created a new tool for AHCA skilled nursing facility (SNF) members to generate an extremely useful report using hospital and SNF claims to track patient flow and availability in your market area. This information is of real value for SNF providers as it helps facilities improve in the clinical areas where they see the most volume and adapt skills to deliver high-value care.
Read More
EDI Support Services (EDISS) is working to transition all Iowa Medicaid managed care organization (MCO) encounter transactions, Fee-for-Service (FFS) web portal users and all existing Iowa Medicaid web portal functionality out of the legacy EDI Gateway. This Gateway transition is scheduled to take place between August and October of 2020. To ensure a smooth transition, EDISS will require Iowa submitters who utilize the legacy web portal to verify their EDISS Connect account profile fax number and email address.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. This education will offer 4.5 CEUs for nurses, social services staff, administrators and assisted living managers.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
Join IHCA on Aug. 18 for its live stream version of the annual long-term care (LTC) social services training. The day-long course will be broken into two sessions covering the importance of ethics and communication. This education will offer four CEUs for social services staff and administrators.
Read More
ICHC is hosting its biweekly Home Health Member COVID-19 Update Call tomorrow at 2:00 p.m. Topics covered will include a legislative wrap-up, COVID-19 legal liability immunity, a survey update, CARES Act Medicaid provider relief and portal, economic incentive payment guidance and more. Call-in details for all IHCA COVID-19 member calls are included as well.
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including legal liability immunity guidance, personal protective equipment (PPE) and reopening update, U.S. Department of Health and Human Services (HHS) Medication Allocation application tutorials and more.
Read More
Join IHCA on Aug. 18 for its live stream version of the annual long-term care (LTC) social services training. The day-long course will be broken into two sessions covering the importance of ethics and communication. This education will offer four CEUs for social services staff and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
It's not too late to register for tomorrow's webinar, Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational event for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
Join IHCA next Tuesday and Wednesday for live stream versions of the Minimum Data Set (MDS) 101 and 201 courses. Participants can register for one or both trainings, but must register for MDS 101 and MDS 201 separately as there is a separate registration fee for each training. Each training offers five CEUs for nurses, social services staff and administrators.
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including IHCA and ICAL reopening toolkits, personal protective equipment (PPE) standards expectations, National Healthcare Safety Network (NHSN) reporting citations, CARES Act Medicaid provider relief and portal and more.
Read More
The Veterans Administration (VA) has provided resources for ICHC home health providers to use when receiving referrals from the Iowa City VA, including an overview presentation, case mix tool, VA authorization request form and examples of referrals.
Read More
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in May 2020. The updated files are posted on OIG's website, and health care providers have an "affirmative duty" to check to ensure that excluded individuals are not working in their facilities or can face significant fines. As a best practice, IHCA members should check the LEIE on a regular basis.
Read More
CMS continues to drive the health care system to one of value by shifting financial risk to providers through a range of fee-for-service (FFS) and managed care models. Population Health Management (PHM) is the application of interventions and strategies to improve the health outcomes and manage the costs of a targeted group. AHCA/NCAL has launched the first phase of its PHM Innovation Lab. Phase 1 contains free members-only foundational resources designed to introduce members to the wide array of PHM models available today and in the future.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
IHCA and ICAL members have access to a wealth of online education through AHCA/NCAL. A new webinar is now available that offers insight from four AHCA members who share their experiences with COVID-19 telehealth waivers. This webinar is free to members and is viewable on-demand. Other online education include courses on functional outcomes and improvement, infection prevention, ICD-10 and more.
Read More
IHCA is also hosting a call on reopening guidance for skilled nursing facility and assisted living members tomorrow, at 10:00 a.m. Also tomorrow, ICHC is hosting its biweekly Home Health COVID-19 Update call at 2:00 p.m. Topics covered will include the governor’s proclamation on waiver extensions, CMS’s enhanced enforcement announcement, the passing of IHCA’s background check bill and more.
Read More
Join ICHC next Thursday, June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including the IHCA Foundation COVID-19 Fund Crisis Relief Fund, reopening guidance, the Paycheck Protection Program (PPP), CMS scam calls and more.
Read More
To ensure compliance with the waiver assurances for the Home- and Community-Based Services (HCBS) waiver application, Iowa Department of Human Services (DHS) has added an additional reporting metric related to the prevention of abuse, neglect and exploitation designed to support the health and welfare of Medicaid members. This change includes a measurement of how members have been informed on how to report abuse, neglect, exploitation and unexplained death during their service plan reviews.
Read More
The Iowa City Veterans Administration Medical Center (VAMC) has developed training on what providers will see moving forward regarding skilled nursing, home maker and home health aide services. Additionally, VAMC will host a question and answer (Q&A) call this Friday, June 12, at 1:00 p.m. for providers who have questions after billing.
Read More
Effective July 1, 2020, health home providers will submit claims using code S0280 for Chronic Condition Health Home (CCHH) providers or code 99490 for Integrated Health Home (IHH) providers. These codes must be entered on the first line of the claim along with the appropriate modifier in order to receive a per member per month (PMPM) payment for providing health home services. Providers will document the appropriate procedure informational code(s) on subsequent lines of the claim. This change is being made in an effort to track usage of health home services.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
Join IHCA for its monthly member calls with Iowa's managed care organizations (MCOs) next Wednesday, where Iowa Total Care and Amerigroup will share recent news and answer providers' questions about claims processing and reimbursement. Submit questions or issues to discuss by tomorrow to Brandon Hagen, VP, Managed Care and Reimbursement, at
[email protected]. Call-in details for other June member-only calls are also provided.
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including enhanced CMS enforcement actions, Department of Inspections and Appeals (DIA) surveys, testing guidance, reopening plan update, outdoor visitation and more.
Read More
Join ICHC on June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
EDI Support Services (EDISS) is working to transition all Iowa Medicaid managed care organization (MCO) encounter transactions, Fee-for-Service (FFS) web portal users and all existing Iowa Medicaid web portal functionality out of the legacy EDI Gateway. This Gateway transition is scheduled to take place between August and October of 2020.
Read More
IHCA received informational letter 2140 from Iowa Department of Human Services (DHS) announcing Iowa Medicaid Pharmacy Program changes, including updates to existing prior authorization criteria for hepatitis C treatments and the Preferred Drug List (PDL) effective July 1, 2020.
Read More
ICHC is offering a call tomorrow, May 28 from 2:00 p.m. to 3:00 p.m. for home health care providers related to COVID-19. This call is a critical opportunity to get the latest updates, important information on what home care providers should do to ensure patient and staff safety.
Read More
CMS issued a national regulatory 1135 waiver effective retroactive to March 1 due to COVID-19, leaving providers with many questions. Join IHCA next Wednesday, June 3 at 1:00 p.m. for a webinar titled, "Providing Medicare Part A Services Under the Current Three-Day Stay Waiver."
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including the joint testing proposal presented to state officials, reporting baseline testing data, the extension of the CARES Act Provider Relief Fund attestation window and more.
Read More
CMS published updated targeted probe and educate (TPE) information contained in Chapter 3 of the CMS Program Integrity Manual. The updates incorporate information about TPE practices providers have experienced, but were not clearly outlined in the manual.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter 2131 stating that the Eligibility Verification System (ELVS) no longer provides third-party liability (TPL) verification for members assigned to a managed care organization (MCO) or dental pre-paid ambulatory health plan (PAHP). MCOs and dental PAHPs will provide verified TPL information for their members. Providers should report TPL leads or changes for member’s health insurance or dental coverage to the member’s assigned MCO or dental PAHP.
Read More
Join ICHC on June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
Join ICHC on July 23 for a webinar that will provide home health care directors, nurses and billing staff with the latest updates on the status of Medicare to ensure compliance with regulations and guidelines. Learn from CGS provider outreach and education staff from both clinical and billing areas as they review the post COVID-19 Medicare world, the Patient-Driven Groupings Model (PDGM), top denials, tools and resources, while providing answers to questions from providers.
Read More
IHCA activity professionals are invited to join the Iowa Council of Activity Professionals (ICAP) call next Tuesday at noon to discuss summer activities and outing safety. Call-in details for other provider and member conference calls taking place in May are also available.
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including CMS preliminary facility reopening guidance, new testing information, National Healthcare Safety Network (NHSN) registration issues, Home- and Community-Based Services (HCBS) retainer payments, Federal Emergency Management Agency (FEMA) personal protective equipment (PPE) deliveries and more.
Read More
Earlier this year, Iowa Total Care (ITC) extended the deadlines for claims submissions and disputes. Effective immediately, the initial claims dispute filing extension deadline is now Aug. 1, 2020 instead of May 31, 2020. A summary of the Feb. 25, 2020 and April 8, 2020 ITC Provider Alerts has been provided, noting the exceptions and should help clarify provider questions.
Read More
IHCA received informational letter (IL) 2134 from Iowa Department of Human Services (DHS) regarding an Electronic Visit Verification (EVV) stakeholder meeting on June 4 from 1:30 p.m. to 2:30 p.m. The virtual stakeholder meeting will provide information on the managed care organization (MCO) EVV solution, Carebridge.
Read More
Join ICHC on June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
ICHC is offering a call tomorrow, May 14 at 2:00 p.m. for home health care providers related to COVID-19. Call-in details are also available for other provider and member conference calls taking place in May.
Read More
Here is the most important information long-term care providers need to know this week related to COVID-19, including Strike Team testing, case reporting, the home health blanket waiver, extension of attestation window, Civil Money Penalties (CMP) communication technology funds and more.
Read More
The Veterans Administration (VA) Central Iowa Healthcare System has notified Iowa home health providers that beginning Tuesday, May 26, all new referrals will be with Optum and not a Veterans Care Agreement (VCA.) As current authorizations expire, the VA will make Optum the payer source for reauthorizations, effective May 26. Any authorization that providers currently have through a VCA will continue until the expiration date.
Read More
ICHC has received updated information from Optum regarding whether a veteran requires an Outcome and Assessment Information Set (OASIS) assessment. An OASIS is required for the skilled home health bundled Standardized Episodes of Care (SEOC), and is not required for the un-skilled non-bundled SEOC.
Read More
CMS has announced that the Advance Beneficiary Notice of Noncoverage (ABN), form CMS-R-131, is currently awaiting Office of Management and Budget (OMB) approval for renewal. CMS will provide instructions when it is approved. In the meantime, members should continue to use the current form and disregard the expiration date of March 2020 until further instruction is provided.
Read More
Join ICHC on June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
As the number of COVID-19 cases in Iowa continues to grow, so does the amount of information long-term care providers need to know in order to prepare and respond. Below is a summary of new information and resources from the past week to help you keep up to date.
Read More
IHCA has recently communicated with Iowa Department of Human Services (DHS), Iowa's managed care organizations (MCOs) and the Governor’s Office regarding the payment of rebase claims. Last week, a majority of providers began seeing large amounts of claims begin to be paid by Amerigroup. To date, IHCA is not aware of providers having accurately been paid for retroactive rebase claims from Iowa Total Care (ITC). IHCA has been notified of a claims investigation to be completed by Iowa Medicaid Enterprise (IME) contractor Myers and Stauffer LC (MSLC) on outstanding provider claims with ITC for July 1, 2019 through March 31, 2020. If you receive a request from MSLC in the coming weeks, it is likely that it is in relation to this investigation.
Read More
CMS has delayed the release of the updated version of the Outcome and Assessment Information Set (OASIS-E) Instrument to reduce the burden that home health providers would otherwise incur as a result of being required to incorporate OASIS-E into their operations by January 1, 2021. CMS indicates this delay will enable providers to continue using the current version of the OASIS instrument. Home health agencies will be required to use OASIS-E on January 1 of the year that is at least one full calendar year after the end of the COVID-19 public health emergency.
Read More
Join ICHC on June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Join IHCA on July 16 for the Medicaid Home- and Community-Based Services (HCBS) Elderly Waiver Review virtual live stream education event, sponsored by Assisted Living Partners. Participants will gain knowledge on what HCBS policies and procedures facilities are required to have in place, the requirements for staff training, how to properly complete the service documentation and an understanding of the billing protocol. There will also be a review of the programs and services generally received under the elderly waiver program.
Read More
IHCA members have access to a wealth of online education through AHCA/NCAL. Online courses feature live and pre-recorded events, toolkits and resources, covering a wide range of timely topics. CEUs are also available, depending on the course.
Read More
Due to COVID-19, the Department of Veterans Affairs (VA) requests that all paper claims and supporting documentation for services rendered in the community be mailed to a new address in order to maintain the efficient processing of Community Care claims. This request becomes effective May 1. However, the VA strongly encourages community providers to submit claims and required supporting documentation electronically through the VA’s clearinghouse.
Read More
ICHC members had questions regarding claims and billing during Tuesday's quarterly member call with the Department of Veterans Affairs (VA) and Optum. The VA and Optum have provided information on the revised fee schedule, Health Share Referral Manager (HSRM) and Customer Engagement Portal in response to questions frequently asked by members.
Read More
Join ICHC on June 18 for Providing Home Health in a Whole New World - PDGM and COVID-19 - What We Know Now, an educational webinar for home health providers. This in-depth webinar will include current information and data regarding the Patient-Driven Groupings Model (PDGM) and will focus on both the financial and operational impacts since the implementation of PDGM, as well as the impacts of COVID-19.
Read More
IHCA is offering live stream versions of the Minimum Data Set (MDS) 101 and 201 trainings on June 23-24, allowing participants to attend online from their computer as if they were in the room with the instructor. Each training offers five CEUs for nurses, social services and administrators.
Read More
IHCA's Medicare Review virtual live stream education event on July 8 will help participants understand the ever-changing rules and regulations, documentation and training involved with Medicare. This education will offer five CEUs for nurses, social services and administrators.
Read More
Well-trained CNAs are needed now more than ever. IHCA offers the Online CNA Program in partnership with Academic Platforms, AHCA’s preferred provider. This blended online CNA training program features online classes coupled with in-person, clinical labs. Students can continue working while taking the class, as they have the ability to access the class online and do the clinical lab portion while in the facility.
Read More
IHCA added several brand new online learning opportunities to its education calendar. Register for next Thursday's webinar and hear how three of the first organizations in Iowa handled COVID-19 and what your facility can do to prepare. Check out IHCA's LTC Health Care Professionals Webinar Series, which includes a webinar on infection prevention and control on May 13 and avoiding unplanned re-hospitalizations on June 10. Additionally, MDS 101 and 201 virtual trainings will be held June 23-24.
Read More
Join ICHC for a call next Tuesday, April 28 at 10:00 - 11:00 a.m. where home health members can get answers to their questions from the Veterans Administration (VA) and Optum. ICHC has partnered with Optum and the local VA office to offer a quarterly conference call exclusively for home health members.
Read More
NAHC's PDGM 2020 Virtual Summit on April 28 will help home health agencies successfully manage the transition to the Patient-Driven Groupings Model (PDGM). The event for the central time zone will begin at 8:30 a.m. Registrants are welcome to attend the live event or purchase the recording.
Read More
During this time of social distancing and lack of in-person education events, IHCA members have access to a wealth of online education through AHCA/NCAL. Online courses feature live and pre-recorded events, toolkits and resources, covering a wide range of timely topics. CEUs are also available, depending on the course.
Read More
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in March 2020. The updated files are posted on OIG’s website, and health care providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or can face significant fines. As a best practice, IHCA members should check the LEIE on a regular basis.
Read More
During this essential time, IHCA is pleased to offer upcoming online education courses. Join Jo Ellen Whitney of Davis Brown Law on April 21 for a webinar covering HR issues and employment law regarding the COVID-19 pandemic. Additionally, Minimum Data Set (MDS) 101 and 201 trainings will be offered via live stream on June 23-24. IHCA will continue to schedule virtual online courses that offer CEUs, as well as timely webinars. View the events calendar on IHCA's website to view the latest education and training information.
Read More
As the number of COVID-19 cases in Iowa continues to grow, so does the amount of information long-term care providers need to know in order to prepare and respond. Below is a summary of new information and resources from the past week to help you keep up to date.
Read More
As the United States Department of Veterans Affairs (VA) and Optum continue to improve claims processing timeliness, they are taking the opportunity to ensure claims received are billed accurately with appropriate codes and units. Proper billing will result in claims being processed more quickly. Optum has provided answers to commonly asked questions, which should assist ICHC members.
Read More
As the United States Department of Veterans Affairs (VA) and Optum continue to improve claims processing timeliness, they are taking the opportunity to ensure claims received are billed accurately with appropriate codes and units. Proper billing will result in claims being processed more quickly. Optum has provided answers to commonly asked questions, which should assist ICHC members.
Read More
AHCA has partnered again with the American Health Information Management Association (AHIMA) to offer four new in-depth online ICD-10 trainings. Members can now register for any of the trainings through ahcancalED.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on the AHCA PDPM Academy 2020.
Read More
As the number of COVID-19 cases in Iowa continues to grow, so does the amount of information long-term care providers need to know in order to prepare and respond. Below is a summary of new information and resources from the past week to help you keep up to date, including call recordings, information on tomorrow's home health call and Small Business Assistance (SBA) loan call, Personal Protective Equipment (PPE) news and more.
Read More
During this time of social distancing and lack of in-person education events, IHCA members still have access to a wealth of online education through AHCA/NCAL. Online courses feature live and pre-recorded events, toolkits and resources, covering a wide range of timely topics. CEUs are also available, depending on the course.
Read More
A federal appeals court has granted certain hospital patients the right to appeal observation stay designations in a ruling that may lead to greater access to Medicare-covered long-term care services. By giving hospital patients the right to appeal their observation stay if the appeal is won, it would allow for coverage of their skilled stay in a skilled nursing facility by Medicare.
Read More
When filing a claim for an Iowa Total Care (ITC) member receiving hospice services while residing in a nursing facility, the hospice provider must use Box 80 on their UB-04 claim form or in the 2300 loop for electronic claim submission to enter the residing nursing facility National Provider Identifier (NPI). The residing nursing facility NPI entered into Box 80 is used to ensure that the correct payment is made to the hospice provider.
Read More
AHCA has partnered again with the American Health Information Management Association (AHIMA) to offer four new in-depth online ICD-10 trainings. Members can now register for any of the trainings through ahcancalED.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including news on how COVID-19 is impacting AHCA'S PDPM 2020 Academy and where to find updates related to PDPM during this pandemic.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
IHCA received informational letter (IL) 2119 from Iowa Department of Human Services (DHS) that provides additional guidance on billing for covered services on an interim period for COVID-19. After the interim period ends, Medicaid will return to normal billing guidelines.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter (IL) 2112 regarding a change in the provider enrollment application fee. Please refer to the provider application fee chart on the DHS provider enrollment webpage for the specific requirements for each Iowa Medicaid provider type.
Read More
IHCA received Iowa Department of Human Services informational letter (IL) 2039 regarding a good faith effort exemption filed by Iowa Medicaid Enterprise (IME) with CMS to delay implementation of electronic visit verification (EVV) in Iowa. CMS has approved this exemption. As a result, federal match penalties will not be applied in calendar year 2020. Service codes that IME determined will require EVV beginning Jan. 1, 2021 were published in IL 2117.
Read More
CMS released three short video tutorials to assist providers with coding Section GG. IHCA members should view these videos, which range from five to 10 minutes and are designed to provide targeted guidance using simulated patient scenarios.
Read More
The ICD-10 Coding for Home Health workshop on April 1-2 will take place online via live stream, allowing participants to attend online from their computer as if they were in the room with the instructor. The live stream will be interactive, allowing participants to ask questions via the chat box at any time. The class will not be recorded.
Read More
AHCA has partnered again with the American Health Information Management Association (AHIMA) to offer four new in-depth online ICD-10 trainings. Members can now register for any of the trainings through ahcancalED.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including a live PDPM Academy open discussion forum and the first on-demand PDPM Academy continuing education (CE) course that covers restorative nursing and skilled maintenance nursing and therapy, both occurring on March 31.
Read More
The Veteran’s Affair’s Central Iowa Healthcare System (VA) has experienced staffing changes within the last month and has provided updated contact information. Additionally, it has released an updated reauthorization/recertification request form and provided updates on authorizations and new reimbursement rates.
Read More
A recent Medicare Learning Network (MLN) article reminds home health agency (HHA) providers what steps need to be taken to ensure claims match the corresponding OASIS assessment, so the claims may be processed and paid.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter (IL) 2107 regarding an update for House File (HF) 766, the requirement for a uniform prior authorization (PA) process.
Read More
The Iowa Medicaid Pharmacy Program changes relayed in Iowa Department of Human Services (DHS) informational letter (IL) 2086, scheduled to be effective March 18, 2020, are being suspended pending approval of Iowa Administrative Code changes. Providers should view the Iowa Medicaid Preferred Drug List (PDL) website to view all recent changes to the PDL.
Read More
Effective April 2, 2020, the webpage where the Iowa Medicaid Enterprise (IME) informational letters (ILs) are posted is changing and will have a new look and new search options. Because of this, any internet favorites or bookmarks you had for ILs will need to be updated.
Read More
AHCA has partnered again with the American Health Information Management Association (AHIMA) to offer four new in-depth online ICD-10 trainings. Members can now register for any of the trainings through ahcancalED.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA'S PDPM Academy 2020. This new training takes the place of the 2019 PDPM Academy, which ceased to be updated as of January 2020.
Read More
The in-person ICD-10 Coding for Home Health education course on April 1-2 will now take place online via live stream on those dates. Attendees will need a computer or tablet with an internet connection in order to participate. The live stream will be interactive, allowing for questions via the chat box at any time. The class will not be recorded.
Read More
On Feb. 24, Amerigroup faxed home health agencies guidance regarding how providers should handle instances where a patient’s services are not covered by Medicare and the primary payer should be Medicaid. This typically occurs for home health providers when a patient is not homebound. Effective for claims received beginning April 1, 2020, Amerigroup is updating its guidance, asking that providers begin including the ICD-10-CM diagnosis code Z76.89 (persons encountering health services in other specified circumstances) as a secondary diagnosis code on claims submissions.
Read More
Iowa Total Care (ITC) has issued a provider alert regarding its recoupment request and remittance/explanation of payment (EOP) guides. These support guides will assist members in reading and interpreting incoming remittance advice and EOP.
Read More
AHCA has partnered again with the American Health Information Management Association (AHIMA) to offer four new in-depth online ICD-10 trainings. Members can now register for any of the trainings through ahcancalED.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA'S PDPM Academy 2020. This new training takes the place of the 2019 PDPM Academy, which ceased to be updated as of January 2020.
Read More
Home health nurses and administrators should attend IHCA's ICD-10 Coding for Home Health in a Patient-Driven Groupings Model (PDGM) World. This comprehensive two-day intermediate coding course on April 1-2 was created specifically for home care coders to help them thrive in today's world of new codes, guidelines, interpretations and payment changes.
Read More
Nurses, administrators and social services employees are invited to attend IHCA's three-day AANAC Resident Assessment Coordinator—Certified (RAC-CT) Workshop next week. RAC-CT certification is the nationally recognized gold standard in resident assessment in the long-term care nursing profession. By earning it, individuals have shown their expertise in skilled nursing facility prospective payment system and minimum data set (MDS 3.0) assessment.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including instruction from CMS regarding PDPM claims processed out of sequence not paying the correct Variable Per Diem (VPD)-adjusted rate. This issue will not be fixed until October. However, CMS is offering workarounds providers can follow to avoid receiving incorrect payment rates on initial claim submissions or receiving unexpected and incorrect payment adjustments when claim corrections are submitted later.
Read More
In its February 2020 Network Bulletin, UnitedHealthcare announced changes being made to post-acute prior authorizations for UnitedHealthcare Medicare Advantage members. The changes will go into effect on March 11. Members should share this information with facility staff members who handle individual prior authorizations.
Read More
Iowa Total Care (ITC) has confirmed system configuration issues that may impact claims processing and payment. To ensure providers have adequate time, ITC has extended the claims dispute timely filing parameters to allow enough time for the projects to be completed and for providers to review and work remittance advices.
Read More
Home health nurses and administrators should attend IHCA's ICD-10 Coding for Home Health in a Patient-Driven Groupings Model (PDGM) World. This comprehensive two-day intermediate coding course on April 1-2 was created specifically for home care coders to help them thrive in today's world of new codes, guidelines, interpretations and payment changes.
Read More
AHCA has partnered again with the American Health Information Management Association (AHIMA) to offer four new in-depth online ICD-10 trainings. Members can now register for any of the trainings through ahcancalED.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
Iowa Department of Human Services (DHS) has released informational letter 2104 regarding the Money Follows the Person (MFP) extension. The federally funded MFP grant assists members residing in qualifying facilities with moving to an integrated community setting of their choice. Due to program funding ending on Dec. 31, 2021, Iowa will accept new referrals for the MFP immediately.
Read More
It has come to the attention of ICHC that Amerigroup faxed a provider update to all their home health care agency providers regarding a change to how providers are to bill if Medicare is not the appropriate payor. ICHC is seeking clarification from Amerigroup regarding their update guidance. As soon as ICHC is provided with these clarifications, a communication will be sent to home health members.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter (IL) 2106 regarding the Rebuild Iowa Infrastructure Fund (RIIF), the primary funding source for public infrastructure-related expenditures. Iowa nursing facilities can request reimbursement for qualifying projects. The IL contains information on request for RIIF deadlines.
Read More
ICAL recently spoke with Shannon Mueller of Iowa Medicaid Enterprise (IME) regarding questions arising from Home- and Community-Based Services (HCBS) compliance audits being conducted across the state. Mueller provided guidance regarding the documentation needed to support assisted living (AL) on-call services and service plan requirements for tenant rights restrictions, when appropriate.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter 2108, announcing that the Iowa Medicaid Enterprise (IME) second quarter provider training session will take place in Mason City on March 30. The training will cover Community-Based Services (HCBS) and Consumer Directed Attendant Care (CDAC) services.
Read More
ICHC has received the finalized reimbursement rates for home care from the Veterans Administration (VA). This good news comes after six months of collaboration between ICHC, NAHC and local VA offices, as well as ICHC and NAHC members diligently writing to and calling their elected officials, in hopes of increasing rates.
Read More
ICHC members have access to multiple upcoming Patient-Driven Groupings Model (PDGM) education opportunities to become proficient in this new payment model. Upcoming PDGM events include a free webinar series offered by NAHC, National Summits at a discounted rate and a session at the IHCA Spring Quarterly Education Conference.
Read More
Registration is open for the AANAC Resident Assessment Coordinator—Certified (RAC-CT) workshop on March 10-12. RAC-CT certification is the nationally recognized gold standard in resident assessment in the long-term care nursing profession. By earning it, individuals have shown their expertise in skilled nursing facility prospective payment system and minimum data set (MDS 3.0) assessment.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA's newly released 2020 PDPM Academy, which provides post-implementation technical assistance, six program interpretation webinars, six additional topical continuing education (CE) webinars and more.
Read More
The Patient-Driven Payment Model (PDPM) has dramatically increased the importance of accurate ICD-10-CM diagnoses by shifting Medicare payments from therapy volume to resident characteristics. Join us next Tuesday, Feb. 25 and Wednesday, Feb. 26 for two days of training on the basic coding knowledge, terms, official guidelines and case studies for each chapter in ICD-10-CM, and education on diagnosis management.
Read More
There are several significant developments impacting the current calendar year (CY) 2020 Medicare physician fee schedule (PFS) policies and rates for Part B physical therapy (PT), occupational therapy (OT) as well as speech-language pathology (SLP) services. Additionally, there is the potential of an 8% rate cut in CY 2021 for these Part B therapy services. AHCA has provided a summary of these developments. Providers are encouraged to share this information, particularly the CY 2020 updates, with therapy and billing staff.
Read More
ICHC members have access to multiple upcoming Patient-Driven Groupings Model (PDGM) education opportunities to become proficient in this new payment model. Upcoming events include PDGM National Summits at a discounted rate, a PDGM session at the IHCA Spring Quarterly Conference and a free six-part PDGM webinar series.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA's newly released 2020 PDPM Academy, which provides post-implementation technical assistance, six program interpretation webinars, six additional topical continuing education (CE) webinars and more.
Read More
This week, IHCA launched Iowa Health Care Quality Partners (IHCQP), a business entity organized and owned by a network of independent long-term care and post-acute care providers for the purpose of improving health outcomes for Iowans. This network will also assist in reducing the costs of services and pursuing business ventures including traditional and value-based contracts with managed care organizations (MCOs).
Read More
Livanta, a Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that handles Medicare beneficiary appeals, was recently required to transition to a new CMS case review system known as QMARS. Livanta has provided appeals case processing guidance for members, as this implementation has substantially increased the time required to complete case reviews and thus notify beneficiaries and providers of appeal decisions.
Read More
Iowa Total Care (ITC) has confirmed system configuration issues that may impact claims processing and payment. In an effort to reduce the administrative burden to providers, providers should not submit formal claims disputes as outlined in the ITC provider billing manual until the expected reprocessing of claims completion date of Feb. 29, 2020. To ensure providers have adequate time, ITC has extended the claims dispute timely filing parameters to allow enough time for the projects to be completed and for providers to review and work remittance advices.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, detailed below, including information on AHCA's newly released 2020 PDPM Academy, which can save facilities up to $600.
Read More
Last week CMS released state guidance on an option for states that cap Medicaid funding for specific populations, much like a block grant. Governor Kim Reynolds has announced her support of this program. IHCA and AHCA have reviewed the guidance and determined it would have a very limited impact to the long-term care profession because it excluded anyone over 65 or disabled.
Read More
On Oct. 1, 2019, CMS replaced its skilled nursing facility (SNF) Resource Utilization Groups (RUG)-IV classification system with the Patient-Driven Payment Model (PDPM). IHCA has received a letter from TRICARE explaining changes to its payment and authorization requirements due to PDPM.
Read More
IHCA received informational letter 2096 from Iowa Department of Human Services (DHS) regarding a new vendor that is printing and mailing Medical Assistance Eligibility Cards (Form 470-19111) on behalf of DHS to all newly eligible Medicaid members as well as existing members who request a replacement card, effective Jan. 1, 2020.
Read More
ICHC members are invited to attend NAHC’s PDGM 2020 National Summits in Minneapolis, MN and Kansas City, MO at discounted rates this spring. These one-day intensive Patient-Driven Groupings Model (PDGM) events will focus on content related to ongoing performance improvement in financial, clinical, operations and data analytics.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA's newly released 2020 PDPM Academy.
Read More
This week ICHC was notified by the Des Moines Veterans Administration (VA) office that the VA has decreased its home care reimbursement rates for all of Iowa. Due to this rate change, agencies may be getting paid different rates for the same codes depending on the timing and which system the claim was processed through.
Read More
ICHC has been working with the Veterans Administration (VA) and members during the recent transition to Optum. Multiple resources are available to assist members during this change, including a quarterly VA/Optum call hosted by ICHC, as well as information on how to become a Veteran’s Affairs Community Care Network (VACCN) provider and details on HealthShare Referral Manager.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA's newly released 2020 PDPM Academy. For $299, IHCA members can register for the academy and receive access to PDPM policy update webinars, six additional educational webinars worth continuing education credits, all new PDPM Academy materials and all 2019 PDPM Academy resources.
Read More
The Patient-Driven Payment Model (PDPM) has dramatically increased the importance of accurate ICD-10-CM diagnoses by shifting Medicare payments from therapy volume to resident characteristics. Join us Feb. 25 – Feb. 26 for two days of training on the basic coding knowledge, terms, official guidelines and case studies for each chapter in ICD-10-CM and education on diagnosis management.
Read More
Mark your calendar for the AANAC Resident Assessment Coordinator—Certified (RAC-CT) workshop March 10-12. RAC-CT Certification is the nationally recognized gold standard in resident assessment in the long-term care nursing profession. By earning it, individuals have shown their expertise in skilled nursing facility prospective payment system and minimum data set (MDS 3.0) assessment.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter 2094 regarding the provider enrollment renewal process. Providers must renew their enrollment every five years, otherwise their Medicaid provider number could be terminated. Providers must complete an enrollment renewal form for each tax ID number they operate under.
Read More
In response to recent changes in the Veterans Administration’s (VA’s) system and feedback from members, ICHC has partnered with Optum and the local VA offices to offer a quarterly conference call exclusively for members as a member benefit. These calls will serve as a forum for members to get questions answered from the VA and Optum. The first call will take place next Tuesday, Jan. 28 from 10:00 a.m. to 11:00 a.m.
Read More
Iowa Department of Human Services (DHS) has mailed and posted the updated nursing facility (NF) rates for July 1, 2019, Oct. 1, 2019, Jan. 1, 2020 and April 1, 2020. The rate updates are inclusive of the rebase appropriation received during the 2019 legislative session and the changes made to the Quality Assurance Assessment Fee (QAAF) program.
Read More
Hospitals are required to provide a Medicare Outpatient Observation Notice (MOON) to Medicare beneficiaries, including Medicare Advantage health plan enrollees, informing them that they are outpatients receiving observation services and are not inpatients of a hospital. IHCA skilled nursing facility (SNF) members should ask potential admissions if they have received a MOON. This will help inform the SNF on whether the beneficiary was admitted and determine whether the SNF has the ability to skill them.
Read More
IHCA has received information from the Senior Health Insurance Information Program - Senior Medicare Patrol (SHIIP – SMP) regarding adding an authorized representative to a Medicare record.
Read More
IHCA received Iowa Department of Human Services (DHS) informational letter 2093 regarding the final statewide transition plan (STP) for Home- and Community-Based Services (HCBS) settings. The final draft of the STP covers all seven HCBS waivers and was submitted to CMS in December 2019. The final draft is available on the DHS website, and the final STP will be posted on the DHS website when approved by CMS.
Read More
CMS has provided ICHC with clarification on discharges by significantly modifying the OASIS Frequently Asked Questions (FAQ) document that was previously causing confusion. The clarification has been published in the quarterly CMS Question and Answer (Q&A) document that was posted this week.
Read More
The Patient-Driven Payment Model (PDPM) has dramatically increased the importance of accurate ICD-10-CM diagnoses by shifting Medicare payments from therapy volume to resident characteristics. Join us Feb. 25 – Feb. 26 for two days of training on the basic coding knowledge, terms, official guidelines and case studies for each chapter in ICD-10-CM, and education on diagnosis management.
Read More
Mark your calendar for the AANAC Resident Assessment Coordinator—Certified (RAC-CT) workshop March 10 - March 12. RAC-CT Certification is the nationally recognized gold standard in resident assessment in the long-term care nursing profession. By earning it, individuals have shown their expertise in skilled nursing facility prospective payment system and minimum data set (MDS 3.0) assessment.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA's newly-released 2020 PDPM Academy, as well as a policy update webinar next Tuesday, Jan. 28.
Read More
If you are negotiating rates with the new Optum plan and are finding that the reimbursed rates are lower than the cost to provide the services to veterans, ICHC encourages you to contact your local Veterans Administration (VA) office.
Read More
Last week, IHCA received a provider news alert from Iowa Total Care (ITC) regarding changes to its claims filing deadlines.
Read More
Due to a question regarding the Minimum Data Set (MDS) posed during the Patient-Driven Payment Model (PDPM) session at IHCA's Winter Quarterly Conference, IHCA reached out to Telligen and Mary Pickle of LTC Resources, who have provided guidance on the Omnibus Budget Reconciliation Act (OBRA), MDS and a Significant Change in Status Assessment (SCSA).
Read More
Join us Feb. 25 – Feb. 26 for two days of training on the basic coding knowledge, terms, official guidelines and case studies for each chapter in ICD-10-CM, and education on diagnosis management.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on a policy update webinar on Jan. 28 through AHCA's 2020 PDPM Academy.
Read More
The state of Iowa says it will withhold nearly $44 million in funding from Iowa Total Care (ITC) due to issues related to incorrect payments to providers and the insurance company’s record keeping. IHCA hosted their monthly member conference call with ITC today where the penalty and resolution plan were discussed. IHCA members should contact Brandon Hagen at IHCA if they are experiencing delayed claims processing for ITC claims as a result of the $44 million withhold.
Read More
IHCA has received informational letter (IL) 2084 from Iowa Department of Human Services (DHS) regarding the requirement that Iowa nursing facilities (NFs) submit supplementation information annually to DHS by Jan. 15. This is to be submitted even if supplementation was not utilized during the preceding calendar year.
Read More
Due to a question regarding the Minimum Data Set (MDS) posed during the Patient-Driven Payment Model (PDPM) session at IHCA's Winter Quarterly Conference, IHCA reached out to Telligen and Mary Pickle of LTC Resources, who have provided guidance on the Omnibus Budget Reconciliation Act (OBRA), MDS and a Significant Change in Status Assessment (SCSA).
Read More
In response to recent changes in the Veterans Administration’s (VA’s) system and feedback from members, ICHC has partnered with Optum and the local VA offices to offer a quarterly conference call exclusively for members as a member benefit.
Read More
ICHC has received informational letter 2079 from Iowa Department of Human Services (DHS) regarding health home (HH) chart reviews. Iowa Medicaid Enterprise (IME) conducts reviews with certain HH providers to assist providers in being compliant with laws, rules, requirements and best practices. When members are selected for a HH chart review, the provider will be notified via letter. The HH provider receiving notice of the chart review will be required to provide member documentation via upload through the Iowa Medicaid Providers Access (IMPA) portal.
Read More
IHCA members should ensure they are using Medicare Beneficiary Identifiers (MBIs). As of Jan. 1, Medicare will reject claims submitted without MBIs, with a few exceptions.
Read More
IHCA has received information regarding Iowa Medicaid Enterprise (IME) quarterly and annual provider trainings. The first quarterly training of this year will be held on Jan. 13 in Dubuque and is geared toward case managers.
Read More
Late last year, CMS published the Calendar Year 2020 Physician Fee Schedule Payment Final Rule. This rule implements several changes that became effective Jan. 1, 2020.
Read More
ICAL and ICHC received informational letter (IL) 2088 from Iowa Department of Human Services (DHS) clarifying IL 1806 regarding the administrative rule for each of the Home- and Community-Based Services (HCBS) Waiver programs and assessment tools.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on AHCA's 2020 PDPM Academy.
Read More
A new draft version of the 2020 Minimum Data Set (MDS) item sets (v1.18.0) is posted. This version is scheduled to become effective Oct. 1, 2020. IHCA members should note that Section G has been removed from all federal item sets.
Read More
Due to a question regarding the Minimum Data Set (MDS) posed during the Patient-Driven Payment Model (PDPM) session at IHCA's Winter Quarterly Conference, IHCA reached out to Telligen and Mary Pickle of LTC Resources, who have provided guidance on the Omnibus Budget Reconciliation Act (OBRA), MDS and a Significant Change in Status Assessment (SCSA).
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, detailed below, including information on AHCA's 2020 PDPM Academy.
Read More
Due to a question regarding the Minimum Data Set (MDS) posed during the Patient-Driven Payment Model (PDPM) session at IHCA’s Winter Quarterly Conference, IHCA reached out to Telligen and Mary Pickle of LTC Resources, who have provided guidance on the Omnibus Budget Reconciliation Act (OBRA), MDS and a Significant Change in Status Assessment (SCSA).
Read More
Last Wednesday, Dec. 18, ICHC received a Provider News Alert from Iowa Total Care (ITC) regarding non-covered Medicare home health (HH) services and how they should be billed to Medicaid.
Read More
With the new Patient-Driven Groupings Model (PDGM) going into effect next week on Jan. 1, 2020, ICHC has created a PDGM resource page for home health agency (HHA) members to utilize during implementation.
Read More
Utilize ECSI’s group purchasing partner, Touché, to assist with your admission process and help secure revenue, regardless of payor source. Touché is a digital platform developed by long-term care providers for long-term care providers.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including information on the new AHCA PDPM Grouper Tool.
Read More
In this edition of LTC 360, IHCA President and CEO Brent Willett discusses Iowa Health Care Quality Partners, IHCA's newest member service offering. Iowa Health Care Quality Partners is a contract network that brings together IHCA member providers to jointly negotiate better contract terms with Medicare Advantage and other insurance companies that providers work with on a reimbursement basis.
Read More
A proposed federal rule, Medicaid Fiscal Accountability Regulation (MFAR), if finalized in its current form, would materially impact the Quality Assurance Assessment Fee (QAAF) system, one of the areas providers may factor in when considering whether to become a Continuing Care Retirement Community (CCRC). IHCA will be very involved in this proposed rule change in 2020.
Read More
IHCA has worked with Iowa Total Care (ITC) to provide a question and answer (Q&A) document that includes member questions and ITC responses from previous ITC managed care organization (MCO) monthly member calls.
Read More
IHCA has worked with Iowa Total Care (ITC) to provide a question and answer (Q&A) document that includes member questions and ITC responses from previous ITC managed care organization (MCO) monthly member calls.
Read More
To be more transparent with providers, Iowa Medicaid Enterprise (IME) is requiring Amerigroup Iowa and Iowa Total Care (ITC) to post on their respective websites any systemic claims-related configuration issues that are affecting providers. IHCA members should view these resources when experiencing claims issues.
Read More
CMS has released an article regarding the new home infusion therapy (HIT) benefit under Medicare Part B that was recently released. This is an important article for ICHC member organizations that are seeking accreditation to become qualified suppliers that furnish HIT services in coordination with the furnishing of home infusion drugs administered through an item of durable medical equipment (DME) beginning in calendar year 2021 and in subsequent years.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including details on a webinar this Thursday, Dec. 19.
Read More
Stay up to date on important claims processing deadlines, reimbursement timelines and current news from Iowa's managed care organizations (MCOs) during this Wednesday's MCO calls, exclusively for IHCA, ICAL and ICHC members. These calls at 10:30 a.m. and 11:30 a.m. also provide an opportunity for members to speak directly with representatives from the MCOs and get their questions answered.
Read More
The Iowa Finance Authority (IFA) has two program funds available for assistance with Home- and Community-Based Services (HCBS).
Read More
On Nov. 27, IHCA received Informational Letter (IL) 2070 from Iowa Department of Human Services (DHS) stating that the maximum residential care facility (RCF) per diem rate will increase from $31.27 to $31.66, effective Jan. 1, 2020.
Read More
IHCA has obtained a guide on Medicare Advantage and other health plans in Iowa for 2020 that was created by Senior Health Insurance Information Program (SHIIP). IHCA members should reference this guide throughout the coming year regarding deductibles, co-pays and service areas.
Read More
ICHC members should participate in a free webinar hosted by NAHC this Wednesday, Dec. 11 from 2:30 p.m. to 3:00 p.m. to learn more about NAHC’s Patient-Driven Groupings Model (PDGM) Physician Toolkit.
Read More
IHCA received Informational Letter (IL) 2075 from Iowa Department of Human Services (DHS) announcing that Iowa Medicaid Enterprise (IME) will hold quarterly provider training sessions in addition to the annual provider training that takes place each year. The quarterly training sessions will be held in one region and focus on a specific topic. The annual training sessions will continue to be held throughout the state and will target all provider types. All sessions, quarterly and annual, will include representatives from IME and the managed care organizations (MCOs.)
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, detailed below, including details on a webinar next Thursday, Dec. 19.
Read More
Materials from recent Iowa Health Care Quality Partners (IHCQP) presentations are now available on the IHCQP webpage, including the non-binding letter of intent to participate. The deadline to submit the letter of intent is this Friday, Dec. 6. Due to antitrust implications related to market share penetration, there will be a cap on the size of the network. As a result, network participation is on a first-come, first-served basis. With demand being stronger than anticipated, we expect it to become fully subscribed. The only way to reserve your place in this network is to submit a letter of intent as soon as possible, and by this Friday at the latest.
Read More
ICHC members should utilize two new articles pertaining to the Patient-Driven Groupings Model (PDGM), released by the Medicare Learning Network.
Read More
ICHC members now have access to a document that provides Patient-Driven Groupings Model (PDGM) transition guidance. The guidance includes Outcome and Assessment Information Set (OASIS) time points, a data set version and M0090 date assessment completed considerations for patients where resulting assessments must provide the Health Insurance Prospective Payment System (HIPPS) code for a PDGM payment period that begins Jan. 1, 2020 or later.
Read More
To provide ongoing communication with providers, Iowa Total Care (ITC) has added a Provider Alerts page to its website. This page will feature updates on ongoing projects, as well as a link that includes information on known system configuration issues and the expected date of claims reprocessing. IHCA members are encouraged to view this resource when experiencing claims issues with ITC.
Read More
Last week, Iowa Department of Human Services (DHS) released Informational Letter (IL) 2068, replacing IL 2056, as an annual reminder to all Iowa Medicaid providers of the federal rules associated with being or employing individuals excluded from participation in the Medicaid program. An incorrect web link was listed in the previous IL, and this IL also includes additional information about the Iowa Medicaid Provider Sanctions list.
Read More
Last Tuesday, Nov. 26, IHCA received Informational Letter (IL) 2069 from Iowa Department of Human Services (DHS), reminding Iowa Medicaid providers of the mandatory electronic billing requirements that went into effect on Aug. 1, 2019.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including details on a webinar this Thursday, Dec. 5.
Read More
IHCA and AHCA are looking to 2020 and what can help members thrive during the first full year the Patient-Driven Payment Model (PDPM) is in effect. AHCA soon will launch its new 2020 PDPM Academy and the existing PDPM Academy resources will be archived and no longer updated at the end of 2019.
Read More
IHCA and AHCA need your feedback on Patient-Driven Payment Model (PDPM) transition and implementation experiences. IHCA members are encouraged to complete a member experience form every other week, or as issues arise.
Read More
On Nov. 18, Iowa Department of Human Services (DHS) released Informational Letter (IL) 2065, announcing the updated home health Low Utilization Payment Adjustment (LUPA) rates. In July, ICHC submitted a public comment letter to DHS and calculated estimates of the anticipated rates for provider planning purposes. The estimates have been confirmed as accurate, and the released rates can be used as they are now confirmed by DHS and CMS.
Read More
CMS has issued Change Request (CR) 11527, which includes further updates to the Claims Processing Manual related to the Patient-Driven Grouper Model (PDGM).
Read More
On Dec. 11, 2019, Iowa Department of Human Services (DHS) will submit the Home- and Community-Based Services (HCBS) Final Settings Statewide Transition Plan (STP) to CMS. ICAL assisted living (AL) and residential care facility (RCF) members should complete the Provider Self-Assessment (PSA) annually, utilize the DHS webinar training and review the DHS review process and assessment tool outlined in the report.
Read More
CMS released a brief update on the new Medicare cards that were shipped out to all beneficiaries from April 2018 to April 2019. This includes information for IHCA members on what to do if a Medicare Beneficiary Identifier (MBI) is changed.
Read More
Last Friday, Nov. 22, IHCA received Informational Letter (IL) 2067 from Iowa Department of Human Services (DHS) regarding two-tiered hospice payment and service intensity add-on (SIA) that may affect members who offer hospice services.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) updates, including news that all PDPM claims, including multiple Health Insurance Prospective Payment System (HIPPS) code claims, will now process. Members should submit all claims as quickly as possible to start the 14-day floor claims process.
Read More
AHCA soon will launch its new 2020 PDPM Academy and the existing PDPM Academy resources will be archived and no longer updated at the end of 2019.
Read More
IHCA and AHCA need your feedback on Patient-Driven Payment Model (PDPM) transition and implementation experiences. IHCA members are encouraged to complete a member experience form every other week, or as issues arise.
Read More
Skilled nursing facility (SNF) and nursing facility (NF) personnel who are actively involved with the completion of the Minimum Data Set (MDS) process should attend MDS 101 – Introduction to MDS 3.0 and MDS 201 – Additional MDS 3.0 Training this Wednesday and Thursday in West Des Moines.
Read More
On Nov. 14, 2019, IHCA received Iowa Department of Human Services information letter (IL) 2063, replacing IL 1993, regarding intermediate care facilities for individuals with intellectual disabilities (ICF/ID) rates.
Read More
Multiple IHCA members received letters from the Office of Auditor of State requesting that they complete a survey on providing services to Medicaid participants. IHCA reached out to the auditor’s office and confirmed that the letter and survey were sent to approximately 10% of Medicaid providers, and providers are not required to complete the survey.
Read More
View a recording of last week's webinar featuring IHCA General Counsel Ken Watkins and Jeff Steggerda of Brighton Consulting Group as they discuss what it takes to become a continuing care retirement community (CCRC), giving providers the insight to make an informed decision on if changing to a CCRC would be beneficial.
Read More
Due to SVP and COO Cindy Baddeloo’s upcoming retirement, VP of Managed Care and Reimbursement Brandon Hagen has been named to the Medical Assistance Advisory Council (MAAC) through 2022.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) news, including a webinar this Thursday, Nov. 21, a reminder to report any Medicare Administrative Contractors (MACs) miscommunication, as well as other resources.
Read More
AHCA and IHCA are looking to 2020 and what can help members thrive during the first full year the Patient-Driven Payment Model (PDPM) is in effect. AHCA soon will launch its new 2020 PDPM Academy and the existing PDPM Academy resources will be archived and no longer updated at the end of 2019.
Read More
IHCA and AHCA need your feedback on the Patient-Driven Payment Model (PDPM) transition and implementation experiences. IHCA members are encouraged to complete a member experience form every other week, or as issues arise. The information collected will be used to develop future PDPM resources and tools, target advocacy with CMS and with Medicare Administrative Contractors (MACs) and inform dialogue with skilled nursing facility partners such as information technology vendors, hospital associations, physician associations, states and managed care plans.
Read More
Stay up to date on important claims processing deadlines, reimbursement timelines and current news from Iowa’s MCOs during this Wednesday's MCO calls, exclusively for IHCA, ICAL and ICHC members. These calls at 10:30 a.m. and 11:30 a.m. also provide an opportunity for members to speak directly with representatives from the MCOs and get their questions answered.
Read More
Join us for webinar this Thursday, Nov. 14, 2019 at 10:00 a.m. with IHCA General Counsel Ken Watkins and Jeff Steggerda of Brighton Consulting Group as they discuss what it takes to become a continuing care retirement community (CCRC).
Read More
IHCA continues to push for action to fully rectify the Amerigroup claims delay situation that occurred for September claims for August services, including addressing interest and late fees incurred by IHCA members as a result of this delay. Last week, Amerigroup shared with IHCA the details of a new process and an invoice form for IHCA members to submit for reimbursement of interest and late fees incurred as part of the September claims delay.
Read More
Health care providers in Iowa were required to sign a new Memorandum of Agreement (MOA) with Livanta by June 8, 2019. Unless you received an email confirmation from Livanta on Oct. 1, 2019, your organization’s MOA has not been received. IHCA members should complete their MOAs as soon as possible. After Dec. 31, Livanta will report instances of non-compliance to CMS.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) news from over the last week, including news that claims with single Health Insurance Prospective Payment System (HIPPS) codes are now being released for processing, a PDPM status update webinar this Thursday, Nov. 14, as well as other resources.
Read More
Now that the Patient-Driven Payment Model (PDPM) system is in effect for skilled nursing facilities (SNFs), AHCA and IHCA are looking to 2020 and what can help members thrive during the first full year PDPM is in effect. AHCA soon will launch its new 2020 PDPM Academy and the existing PDPM Academy resources will be archived and no longer updated at the end of 2019.
Read More
IHCA and AHCA need your feedback on Patient-Driven Payment Model (PDPM) transition and implementation experiences. IHCA members are encouraged to complete a member experience form every other week, or as issues arise. The information collected will be used to develop future PDPM resources and tools, target advocacy with CMS and with Medicare Administrative Contractors (MACs) and inform dialogue with skilled nursing facility partners such as information technology vendors, hospital associations, physician associations, states and managed care plans.
Read More
Last Thursday, Oct. 31, CMS issued the final rule for the 2020 payment model, Patient-Driven Groupings Model (PDGM), including rates of payment that would start Jan. 1, 2020. The new payment model had been finalized in its design in the 2019 rulemaking cycle, but the final rule offers some minor tweaks in the payment model and sets out 2020 payment rates. ICHC and NAHC have provided an explanation and resources to assist with this change.
Read More
Iowa Department of Human Services (DHS) and Iowa Medicaid Enterprise (IME) have notified IHCA that nursing facilities (NFs) are having difficulties submitting Case Activity Reports (CARs) upon admission of residents to a facility. Information has been provided in an effort to clear up confusion.
Read More
IHCA and AHCA have compiled the latest Patient-Driven Payment Model (PDPM) news from over the last week, including a claims processing update, a PDPM status update webinar this Thursday, Nov. 7, as well as other resources.
Read More
IHCA and AHCA need your feedback on Patient-Driven Payment Model (PDPM) transition and implementation experiences. IHCA members are encouraged to complete a member experience form every other week, or as issues arise. The information collected will be used to develop future PDPM resources and tools, target advocacy with CMS and with Medicare Administrative Contractors (MACs) and inform dialogue with skilled nursing facility partners such as information technology vendors, hospital associations, physician associations, states and managed care plans.
Read More
IHCA has been in contact with Iowa Total Care (ITC), Iowa’s newest managed care organization (MCO), regarding claims denial. ITC stated it is aware that some providers may have received claims that were incorrectly denied, and that it is working to identify the root cause.
Read More
As of Oct. 15, 2019, items requiring a signature (i.e., certified mail or overnighted packages) when mailing payments for the nursing facility Quality Assurance Assessment Fee (QAAF) should be shipped to a new address.
Read More
ICHC has been in contact with the Veterans Affairs (VA) Central Iowa Health Care System to provide more information to members regarding the recent transition to Optum.
Read More
An updated quarterly Outcome and Assessment Information Set (OASIS) question and answer (Q&A) document is now available for ICHC members to view.
Read More
An updated quarterly Outcome and Assessment Information Set (OASIS) question and answer (Q&A) document is now available for ICHC members to view.
Read More
Last week IHCA received Informational Letter 2059 from Iowa Department of Human Services (DHS) regarding the annual submission requirements to prevent and detect Medicaid fraud and abuse. These requirements apply to any provider, or part of a provider entity, that receives payments of $5 million or more from Iowa Medicaid in any federal fiscal year (Oct. 1 to Sept. 30).
Read More