Iowa Administrative Bulletin Review for March 8
IHCA continues to track issues of importance to members, including the subjects mentioned in the Iowa Administrative Bulletin that is released every two weeks. Here are the bi-weekly areas of note that were found in the March 8 issue of the Iowa Administrative Bulletin. If and when issues arise, IHCA will take appropriate steps in an effort to remediate problems for members.
Adopted and Filed Rules
ARC 6937C — Human Services Department | HCBS provider reimbursement rates
During the 2022 Legislative Session, 2022 Iowa Acts, House File 2578, appropriated funds to increase specific home- and community-based services (HCBS) waiver and HCBS habilitation provider reimbursement rates over the rates in effect June 30, 2022, as follows:
- Increase rates for home health agency providers located in rural areas. These are the providers covered under the low utilization payment adjustment (LUPA) methodology, whose rates may vary depending on type of provider. LUPA is a standard per-visit payment for episodes of care with a low number of visits. Currently, LUPA occurs when there are four or fewer visits during a 60-day episode of care.
As part of the American Rescue Plan Act (ARPA), Section 9817, HCBS implementation plan, the Department has designated $14.6 million in state funds to increase HCBS waiver and habilitation reimbursement rates by 4.25%. This rule-making makes the following changes as a result of the rate changes:
- Increase the reimbursement rates and upper rate limits for providers of HCBS waiver and habilitation services beginning July 1, 2022, by 4.25% over the rates that are in effect on June 30, 2022.
ARC 6935C —Human Service Department | Nursing Facility – Major Renovations and Medicaid Utilization
2022 Iowa Acts, House File 2578, reduced to $750,000 the cost that an improvement project to an existing licensed and certified nursing facility must exceed for the project to meet the definition of “major renovations.” The previous amount was $1.5 million. This rule-making lowers the threshold to the $750,000 amount. These amendments also include heating, ventilation and air conditioning (HVAC) projects as qualifying projects. Calculation of Medicaid utilization rates is also established as part of this rule-making.
ARC 6934C — Human Services Department | NF Quality Incentive Payment Program
This rule-making provides for a quality incentive payment program (QIPP) for non-state government owned (NSGO) nursing facilities to promote, maintain and improve quality of care and health outcomes. These amendments identify the criteria the NSGO facility must meet to qualify for participation in the program. The goal is to issue additional payments for quality of care above what is required by CMS. There is no fiscal impact anticipated because the provider/nursing facility will be paying the state share of the add-on rate, similar to other intergovernmental transfer programs.
ARC 6933C — Human Services Department | Iowa Health and Wellness Plan
Chapter 74 was reviewed as part of the Department’s five-year rules review. Chapter 74 defines and structures the Iowa health and wellness plan. The chapter is rescinded and replaced to eliminate rules that are outdated, redundant and inconsistent. Terminology is updated in the new chapter. The references to marketplace choice are removed since it no longer exists. Retroactive enrollment has been updated to include residential nursing facilities. The website has been added as a payment method for contributions. Members are no longer required to pay premiums when no services were provided.
New informational letters (ILs) from the Iowa Department of Health and Human Services (DHHS)
IL 2432 — End of Federal Public Health Emergency (PHE) Flexibilities