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 found in the Dec. 24 and Jan. 7 issues of the Iowa Administrative Bulletin. If and when issues arise, IHCA will take appropriate steps in an effort to remediate problems for members.
Newly noticed rules
ARC 9856C | Human Services Department — Medicaid Waiver Services
The purpose of this proposed chapter is to describe and outline the provision of services under the Medicaid waiver program. Medicaid waiver services are services provided to maintain persons in their own homes or communities who would otherwise require care in a medical institution, including support for persons to seek and maintain employment in the community. Provision of these services must be cost-effective. Services are limited to certain targeted client groups for whom a federal waiver has been requested and approved. Services provided through the waivers are not available to other Medicaid recipients since the services are beyond the scope of the Medicaid State plan.
This proposed chapter underwent a Red Tape Review pursuant to Executive Order 10. As a result of its review, the Department deleted redundant, restrictive and outdated language and added dates certain.
ARC 9851C | Human Services Department — Procedure and Method of Payment
This proposed rulemaking underwent a Red Tape Review in response to Executive Order 10. As a result of the review, the Department:
- Eliminated restrictive terms
- Standardized use of acronyms
- Added and updated dates certain
- Referred items back to the applicable CFR or Iowa Code section
- Removed references to the integrated health home program, which is sunsetting
- Reordered rules
- Referred items back to the appropriate provider manual
- Removed references to specific form numbers
- Eliminated references to specific areas of the Department and replaced with “Iowa Medicaid” or “the department.”
- Eliminated outdated references
This proposed rulemaking provides guidance on claim format and submission for providers of medical and remedial care that participate in Iowa’s medical assistance program.
ARC 9852C | Human Services Department — Other Policies Relating to Providers of Medical and Remedial Care
This proposed chapter provides information for providers about Iowa’s Medicaid program, including the following:
- Provider reimbursement methodology
- Provider sanctions
- Medical record maintenance
- Reviews and audits
- Provider agreements
- The Medical Assistance Advisory Council
- Requirements for prior-authorization, preadmission review and preprocedure surgical review
- Provider enrollment
- Requirements for participating laboratories
- Requirements for providers prescribing controlled substances
This proposed chapter underwent a Red Tape Review pursuant to Executive Order 10. As a result of its review, the Department:
- Eliminated restrictive terms and outdated terminology, information, dates and system references
- Added dates certain
- Standardized references to the Department pursuant to government realignment
- Updated provisions to match current Department practice and policy.
The Department also deleted references to Iowa Code sections repealed by 2024 Iowa Acts, House File 2673.
ARC 9865C | Human Services Department — Amount, Duration and Scope of Medical and Remedial Services
This proposed chapter outlines parameters for provision and payment for services under Iowa Medicaid. The proposed chapter provides guidance to participating providers and members about which services are covered, are not covered and require prior authorization.
This proposed rulemaking is being undertaken as a result of Executive Order 10. As a result of its review, the Department eliminated some restrictive and outdated terms, referred items back to the Iowa Code or to program manuals, made technical corrections, deleted references to programs that are sunsetting and updated terminology.
In addition, the Department updated the home-based habilitation benefit in certain Medicaid waivers to reflect changes made by 2025 Iowa Acts, Senate File 474, section 40, which lowers the age at which individuals may receive home-based habilitation services under those waivers from 17 years of age to 16 years of age.
ARC 9855C | Human Services Department — Conditions of Participation for Providers of Medical and Remedial Care
This proposed chapter outlines the qualifications needed for providers to participate in Iowa’s Medical Assistance Program.
This proposed chapter underwent a Red Tape Review pursuant to Executive Order 10. As a result of the Department’s review, the Department added or updated dates certain, replaced restrictive terms with less restrictive alternatives, referred language duplicative of federal regulations back to the Code of Federal Regulations, replaced outdated terminology with current terminology, referred items to the appropriate provider manuals, consolidated references to like services, renumbered and standardized the use of acronyms.
ARC 9848C | Human Services Department — Iowa Health and Wellness Plan
This proposed chapter defines and structures the Iowa Health and Wellness Plan, a medical assistance program for individuals with countable income that does not exceed 133 percent of the federal poverty level. This proposed chapter underwent a Red Tape Review pursuant to Executive Order 10. As a result, the Department removed duplicative, redundant and outdated language and information. In addition, the Department is changing the due date for financial participation payments from the last day of the month to the fifteenth day of the month.
ARC 9853C | Human Services Department — Managed Care
This proposed chapter is the subject of a Red Tape Review pursuant to Executive Order 10. The proposed chapter provides that most Iowa medical assistance program benefits will be provided through managed care.
Adopted and filed rules
ARC 9859C | Human Services Department — State Supplementary Assistance — Increase in Personal Needs Allowance
This rulemaking implements 2025 Iowa Acts, House File 1049, section 19, which increases the personal needs allowance described in Iowa Code chapters 81, 82 and 85 from $50 to $55.
In addition, this rulemaking updates incorrect cross-references in subrule 81.13(2). All references to Iowa Code section 249A.30A herein are to that section as amended by 2025 Iowa Acts, House File 1049.