Iowa Medicaid and the Iowa Department of Health and Human Services released informational letter 2740 regarding state fiscal year (FY) 2027 Home- and Community-Based Services (HCBS) Waiver rate changes effective Oct. 1, 2026. Provisions of the 2026 House File 2782, Division VI Section 15 appropriated $3 million to implement an increase to specific HCBS Waiver service reimbursement rates for services most used by Elderly Waiver participants.
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Recent feedback from IHCA nursing facility members indicates Molina Healthcare audits are increasingly scrutinizing documentation supporting activities of daily living (ADLs), nutrition-related services and other reimbursement-sensitive resident care activities. If any facility has been the subject of a Molina Healthcare claims audit in recent months, the facility should contact IHCA with any questions.
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Iowa Total Care, in partnership with its parent company Centene, is updating the platform used to deliver provider payments. Providers will have several payment options, including two no-fee options and enhanced electronic options that may have fees.
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CMS has posted updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes subject to the consolidated billing (CB) provision of the SNF Prospective Payment System (PPS). As part of this quarterly update, CMS is also correcting the assignment of certain therapy HCPCS codes that were previously incorrectly included in the Part B SNF CB Files. The updates are effective beginning Oct. 1, 2026.
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Iowa Total Care has announced an update to the prior authorization review process to support timely communication and improve the peer-to-peer experience for requesting providers.
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Questions were raised during a recent monthly Managed Care Organization Call regarding Iowa Total Care, including Carebridge historical data access, nursing facility rate increases, Legacy Portal updates and other topics. Iowa Total Care has provided responses to these member questions.
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Beginning Oct. 1, 2026, Wellpoint will charge contracted Medicare Advantage providers a $5 administrative fee for eligible paper-submitted claims and printed paper checks, where permitted by the provider agreement. Providers can avoid these fees by submitting claims electronically and enrolling in electronic funds transfer (EFT) or another electronic payment option at no cost through Wellpoint’s digital solutions.
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Effective November 2026, provider claim payments and remittance information will transition from Payspan to the Zelis payment platform. This transition changes how payments and remittance information are delivered and accessed; it does not change your contracted reimbursement rates, claims-adjudication process or payment methodology.
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The Iowa Department of Health and Human Services (DHHS) will host a Case Mix Index (CMI) Training for nursing facility providers on Thursday, Sept. 17, from 10:00 a.m. - 11:30 a.m. This training will provide an overview of the CMI Roster, including how to interpret roster details, understand day-weighted CMI, identify payer sources and navigate the roster within the Iowa Medicaid Portal Application.
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Recent feedback from nursing facility members indicates that Molina Healthcare audits are increasingly scrutinizing documentation supporting activities of daily living (ADLs), nutrition-related services and other reimbursement-sensitive resident care activities. For many nursing facilities, ADL performance and nutritional interventions directly influence case mix, reimbursement methodologies, care planning, quality measures and payor verification activities. Additionally, nursing facilities rely on direct care staff, often certified nursing assistants (CNAs), to complete daily documentation of ADL assistance and other cares. Because CNAs and licensed nurses are focused on the delivery of care rather than documentation, it is understandable that documentation is often deprioritized. But a payor like Molina Healthcare has every right to be reasonably sure that health care services for which reimbursement was sought was in fact provided. While providers continue to express concerns regarding certain audit interpretations and technical denials, the strongest defense remains a complete, consistent and truthful interdisciplinary medical record to ensure that truthful statements are not undercut by a lack of documentation.
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Wellpoint will host its next quarterly town hall for network care providers on Wednesday, Sept. 16 from 4:00 p.m. - 5:00 p.m. Agenda items include Wellpoint's upcoming Digital Solutions Learning Hub (on24.com), health outcomes and community-focused care, the upcoming Medicare open enrollment period and more.
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Outsourcing Medicaid enrollment can help your team reclaim valuable time and reduce administrative strain. See why participating facilities are averaging just 36 days from initial family contact to Medicaid approval.
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MDS Support can help nursing facilities address staffing gaps, assessment backlogs, reimbursement concerns and other MDS challenges. Here are five common signs that additional MDS support could help strengthen your facility’s processes and ease the burden on your team.
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Last week, CMS issued the final rule for the skilled nursing facility (SNF) Prospective Payment System (PPS) for fiscal year (FY) 2027. The final rule is virtually the same as the proposed rule issued earlier this year. The rule finalizes a modest 2.4% increase to Medicare Part A rates in FY 2027.
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As of June 1, 2026, home health aide (HHA) services provided while a member is receiving daily supportive community living (SCL) services of eight or more hours per day will be considered non-covered due to duplication of services.
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Iowa Total Care has cancelled its in-person Provider Summit on Aug. 27. Providers are encouraged to attend one of the virtual Provider Summits on Sept. 10. Each virtual summit will feature key updates, educational sessions and plenty of opportunities to connect directly with subject matter experts from across Iowa Total Care.
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Your MDS program affects everything from reimbursement to quality outcomes. Learn how expanded MDS Support can help your facility improve accuracy, strengthen compliance and reduce the burden on your team.
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Delayed Medicaid approvals can create unnecessary strain on your facility's cash flow while adding to your team's administrative workload. Enrollment Support from IHCA Provider Solutions helps keep applications moving, reducing reimbursement delays and allowing your staff to focus on resident care instead of paperwork. Early results show participating facilities averaging just 36 days from first contact with a resident's family to Medicaid approval.
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IHCA Provider Solutions has expanded MDS Support to offer a broader range of services tailored to the unique needs of nursing facilities. From remote MDS completion and compliance reviews to Case Mix maximization and PDPM reimbursement audits, MDS Support helps facilities improve accuracy, efficiency and financial performance.
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On July 1, CMS issued the calendar year (CY) 2027 Home Health (HH) Prospective Payment System (PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME) and DME, Prosthetics, Orthotics and Supplies Policies proposed rule. CMS has also released a fact sheet accompanying the proposed rule. Comments on the proposed rule are due by Aug. 31, 2026. The overall impact of the rule is an estimated $420 million increase in payments relative to CY 2026.
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CMS is proposing new safeguards, continuing its campaign mission to crush fraud, waste and abuse throughout its programs. The calendar year (CY) 2027 Home Health (HH) Prospective Payment System (PPS) proposed rule would strengthen CMS’ ability to recover improper payments and remove noncompliant providers and suppliers from Medicare, actions estimated to save approximately $82 million in annual savings. This would also expand access for patients receiving care at home and improve the timeliness of publicly reported HH agency quality information. Although included in the CY 2027 HH PPS proposed rule, the provider enrollment provisions would apply across Medicare provider and supplier types. IHCA anticipates these proposed changes would have nominal impact on SNF providers.
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Effective Oct. 1, 2026, Iowa Total Care will reinstate its pre-COVID-19 prior authorization (PA) review process for post-acute placements. As part of Iowa Total Care’s ongoing work to improve the PA process for both providers and members, Iowa Total Care shares some important updates to its PA requirements with a goal to reduce administrative burden, simplify submission and approval processes and facilitate timely access to appropriate, high-quality care.
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The July 2026 Wellpoint Provider Newsletter is now available. Newsletter items include clinical criteria updates, prior authorization (PA) requirement changes, provider data attestation reminder, service line limits for Medicare Advantage (MA) claims and more.
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Iowa Total Care's 2026 Provider Summit Series is an opportunity to receive updates, educational sessions and expert guidance on topics including claims, contracting, authorizations and provider programs. Attend the in-person summit in West Des Moines on Aug. 27 or participate virtually on Sept. 10 to connect directly with Iowa Total Care subject matter experts and get your questions answered.
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IHCA continues to review the Iowa Administrative Bulletin for potential impacts to long-term care providers. The May 27 and June 10 issues include a newly noticed rule regarding quality improvement initiative grants, as well as adopted and filed rules related to the Certificate of Need program, Medicaid waiver services, policies related to providers of medical and remedial care, the Iowa Health and Wellness Plan and more.
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Iowa Medicaid is launching a statewide provider revalidation initiative in response to requirements from CMS. This effort is designed to strengthen program integrity, ensure accurate provider information and reduce fraud, waste and abuse. Revalidation will occur over a two‑year period, from July 1, 2026, through June 30, 2028. Providers will receive revalidation notices in phases. Each provider will have approximately 30 days to complete the revalidation process once notified.
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The Annual Choice Period is the chance to review current health and dental plans and make changes if needed. Tomorrow, June 18, is the deadline to change dental plan enrollment for coverage beginning July 1, 2026. Medicaid members also have an additional 90 days after June 18 to change dental plan enrollment with a future effective date.
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Enrollment Support from IHCA Provider Solutions helps facilities reduce administrative burden by managing the Medicaid enrollment process from start to finish. By handling applications, RFIs, family follow-up, recertifications and status tracking, the service allows staff to focus on admissions, operations and resident care while helping residents achieve Medicaid approval in an average of just 36 days from initial family contact.
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The Iowa Department of Health and Human Services (DHHS) has clarified that billing for 24-hour supported community living (SCL) services and home health aide (HHA) services during the same time period is not permitted under applicable Home- and Community-Based Services waiver requirements. According to guidance provided to IHCA, this change took effect June 1, 2026, for both fee-for-service (FFS) Medicaid and managed care organizations (MCOs).
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CMS has released an updated Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Coverage Guide to help states deliver the full scope of care for children covered by Medicaid or the Children's Health Insurance Program. This guide compiles decades of guidance in one place and serves as a technical assistance tool for state EPSDT staff.
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Iowa Medicaid is notifying managed care organizations and key stakeholders of an upcoming transition involving the Iowa Medicaid Core Standardized Assessment (CSA) contract. Effective July 1, 2026, CareStar, Inc. will assume operational responsibility for the Iowa Medicaid CSA contract, succeeding Telligen, Inc., whose current contract expires June 30, 2026.
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Following IHCA's April Managed Care Organization Call, Iowa Total Care has provided responses and additional clarification on authorization issues related to CareBridge, electronic visit verification (EVV)-related issues, dual-eligible claims and more, which are shared for reference and continued guidance.
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Delayed Medicaid approvals, incomplete applications and missed follow-ups can quickly lead to write-offs and bad debt. Enrollment Support from IHCA Provider Solutions manages the Medicaid process from start to finish, helping facilities protect cash flow while reducing administrative burden. Early results show participating facilities averaging just 36 days from first contact with a resident’s family to Medicaid approval.
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Whether you need immediate help completing MDS assessments or want to strengthen your team’s processes and performance, IHCA Provider Solutions offers two flexible MDS Support options tailored to your facility’s needs. From remote MDS completion during staffing shortages to in-depth consulting that improves accuracy, compliance and reimbursement, both services are designed to help nursing facilities operate more efficiently and protect revenue.
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Effective May 12, 2026, home health agencies (HHAs) must begin using the updated Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 with the new expiration date of March 31, 2029. The previous ABN form version (expiration date Jan. 31, 2026) is no longer valid for notices issued on or after May 12, 2026. Although the updated form includes readability and formatting enhancements, the purpose, content and instructions for use remain largely unchanged.
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Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) have outlined updates to the personal needs allowance and supplemental personal needs payments, which increased from $50 to $55 per month for Medicaid members living in facilities, retroactive to Aug. 1, 2025. Iowa Medicaid and DHHS have completed the necessary system updates, and affected fee-for-service claims will be automatically reprocessed while managed care organizations will reprocess applicable managed care claims. Providers should review updated client participation amounts now available in the system and resubmit any claims that were previously denied due to incorrect member information.
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IHCA has been actively engaged with the Iowa Department of Health and Human Services (DHHS) to advocate on behalf of members regarding the interpretation of supported community living and home health aide services in group home settings. Iowa DHHS has issued guidance outlining its interpretation and expectations moving forward.
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On April 30, the Iowa Total Care provider relations team released a provider alert regarding person-centered service plans (PCSPs) and level of care assessments. While Iowa Total Care continues to enhance the functionality of the Availity Portal, PCSPs and level of care assessments can be found on its Legacy Portal.
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Electronic visit verification (EVV) continues to be an important requirement for providers delivering Medicaid-funded services — but we know implementation hasn’t been without challenges. The Iowa Department of Health and Human Services (DHHS) is actively seeking provider feedback on issues related to EVV. Please share your feedback with the Iowa Medicaid EVV team by this Friday, April 24.
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IHCA Provider Solutions’ Enrollment Support service is helping facilities streamline the Medicaid application process, with early results showing approvals in an average of just 36 days from first contact. By managing the full application process, the service reduces administrative burden, speeds admissions and eligibility decisions, and improves financial stability. Participating providers report a smoother admissions workflow and less strain on staff, allowing teams to focus more on resident care.
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Electronic visit verification (EVV) continues to be an important requirement for providers delivering Medicaid-funded services — but we know implementation hasn’t been without challenges. The Iowa Department of Health and Human Services (DHHS) is actively seeking provider feedback on issues related to EVV. Please share your feedback with the Iowa Medicaid EVV team by Friday, April 24.
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IHCA Provider Solutions’ Remote MDS Service offers expert support to complete MDS assessments and develop aligned care plans without the need to hire permanent staff. Designed as a temporary solution, it helps facilities maintain timely, accurate submissions while navigating staffing shortages. Providers also benefit from expert guidance on PDPM scoring and quality measures to support optimal reimbursement outcomes.
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CMS recently issued a number of rules, including the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2027. The rule proposes a 2.4% increase to Medicare Part A rates in FY 2027. Additionally, the rule provides updates on the SNF Quality Reporting Program, Value-Based Purchasing and more.
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For a state to have its Medicaid plan approved by CMS, it must maintain a Preadmission Screening and Resident Review (PASRR) program that complies with the relevant federal laws and regulations. Iowa Department of Health and Human Services (DHHS) will host PASRR trainings next week in Council Bluffs, Fort Dodge, Cedar Rapids and Des Moines.
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Iowa Medicaid recently released its quarterly newsletter. Key areas of focus include upcoming monthly town hall dates, Iowa Wellness Plan Demonstration Annual Forum details, new Medicaid events, Hope and Opportunity in Many Environments (HOME) project updates, managed care plan updates, a new 'Flourish' magazine from the Iowa Department of Health and Human Services (DHHS) and more.
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Enrollment Support from IHCA Provider Solutions handles Medicaid applications for your facility from start to finish. They can also help with insurance verification, admissions and financial-related issues. It’s a simple way to save staff time and stay on top of the process.
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On Thursday, March 12, IHCA held its monthly Home Care Provider Update Call to discuss important developments in home health and home care. Conversation covered the OASIS E-2 system, changes to patient care measures and surveys, key bills moving through state legislature, Spring Conference announcements and medication error reporting and denials.
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CMS has officially published the final versions of the OASIS E-2 data set, OASIS E-2 manual and OASIS E-2 Q&A documents. OASIS-E2 is scheduled for implementation on April 1, 2026. Minor differences between the drafted and the finalized data set include typo corrections, a revised definition and a citation addition.
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IHCA Provider Solutions’ MDS and EHR Consulting Service helps providers strengthen documentation practices, improve accuracy and identify opportunities to enhance reimbursement. Through a comprehensive review of MDS processes and clinical documentation — along with personalized guidance from reimbursement experts — facilities receive practical recommendations to improve efficiency and maximize revenue under PDPM and Iowa’s case mix system.
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CMS updated its skilled nursing facility (SNF) Provider Enrollment Guidance and FAQ to clarify that while submission deadlines for certain SNF revalidation applications are suspended, facilities that have not yet applied or had applications rejected must still submit them once a new deadline is announced. Medicare Administrative Contractors will continue processing pending applications, and SNFs must still respond within 30 days to any requests for additional information. CMS also emphasized that SNFs must provide all required enrollment data — not just section 1124(c) disclosures — or risk rejection or denial of their applications.
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As a reminder, the Skilled Nursing Facility (SNF) Data Validation Process for the SNF Value-Based Purchasing (VBP) and Quality Reporting (QRP) programs is now in effect. Selected SNFs will be notified through their iQIES MDS 3.0 Provider Preview Report folder and must submit medical chart documentation for 10 MDS assessments within 45 days to avoid a 2% Medicare reimbursement penalty. Facilities are encouraged to begin checking their iQIES folders weekly and seek additional guidance from CMS, if needed.
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The Iowa Department of Health and Human Services (DHHS) has announced free competency-based training (CBT) opportunities for Iowa long-term services and supports providers. Upcoming sessions will address service documentation and monitoring best practices as well as early and periodic screening, diagnostic and treatment (EPSDT) requirements, with content tailored to providers, direct support professionals and case managers. All trainings will be recorded and made available through the agencies’ online training archive and Learning Management System.
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CMS has updated the MLN Booklet titled, "Medicare Billing: CMS 1450 & 837I." The updated guidance has added COVID-19 vaccinations to its roster billing options. More information about roster billing can be found on the CMS website.
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Livanta’s BFCC-QIO program rebranded to Commence Health in August 2025, and providers are encouraged to update internal materials and beneficiary notices to reflect the new name where possible. While branding, emails and communications have changed, contracts, review processes, contact numbers and existing forms remain valid, and operations continue as before under the same Medicare agreement.
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Enrollment Support from IHCA Provider Solutions helps facilities manage Medicaid applications from start to finish while strengthening the broader admissions and revenue-cycle process. In addition to Medicaid enrollment support, members can access tools and optional services for payor verification, admissions, compliance and legal assistance to address resident financial matters and recover outstanding balances.
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Iowa Department of Health and Human Services (DHHS) is seeking public comments through this Friday, Feb. 13, on a proposal to redesign its Medicaid HCBS waiver system under the HOME project, replacing six disability-based waivers with two new waivers (Children and Youth, and Adults with Disabilities) while keeping the Elderly Waiver. The redesign aims to simplify the system, better match services to individual needs and support people with disabilities in living at home rather than in institutions. The transition would occur in phases starting in late 2026, with all changes subject to CMS approval after the public comment process.
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Iowa Medicaid and Iowa Department of Health and Human Services (DHHS) have announced the FFY 2025 SUPPORT Act reporting survey, which collects data on providers’ compliance with required Prescription Drug Monitoring Program (PDMP) checks before prescribing controlled substances to most Medicaid members. The survey supports Iowa’s annual Medicaid Drug Utilization Review reporting to CMS and applies to prescribing practices from October 2024 through September 2025. Providers must complete the survey by March 31, 2026.
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