Informational Letter No 2354 Mc Ffs Date To

Summary

INFORMATIONAL LETTER NO. 2354-MC-FFS
DATE: July 1, 2022
TO: Home- and Community-based Services (HCBS) Waiver Providers,
HCBS Habilitation Providers, Targeted Case Managers (TCM),
Service Workers, Supervisors, Service Area Administrators, Case
Managers (CM), and Integrated Health Homes (IHH)
APPLIES TO: Managed Care (MC), Fee-for-Service (FFS)
FROM: Iowa Department of Human Services (DHS), Iowa Medicaid
RE: HCBS Waiver and Habilitation Rate Changes
EFFECTIVE: July 1, 2022
As part of the American Rescue Plan Act (ARPA) Section 9817 HCBS implementation
plan, DHS has designated $14.6M 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

For updated Iowa Administrative Code (IAC) rules regarding payment methodologies,
please refer to IAC 441-79.1(2)1

HCBS Waiver Rates
Provider rates in effect June 30, 2022, will increase by 4.25% effective for dates of
service on or after July 1, 2022

HCBS FFS Waiver Monthly Budget Maximums
Each HCBS waiver monthly budget maximum or cap will increase by 4.25% effective for
dates of services on or after July 1, 2022. The new monthly maximums are as follows:
1
441.79.pdf (iowa.gov)
All Informational Letters are sent to the Managed Care Organizations
Iowa Medicaid – 1305 E Walnut St. – Des Moines, IA 50319
Intermediate Care
Skilled Facility for
Nursing Facility
Nursing Persons with
(NF) Level of Hospital
Facility (SNF) Intellectual
Care
Level of Care Disability (ICF/ID)
Level of Care
AIDS/HIV Waiver $2,026.03
Children’s Mental
$2,165.87
Health Waiver
Health and
$3,014.69 $1,035.79 $4,040.52
Disability Waiver
Physical
$761.95
Disability Waiver
HCBS FFS Upper Rate Limits
The HCBS waiver upper rate limits will increase by 4.25% effective for dates of service
on or after July 1, 2022

The HCBS Waiver Annual Caps
The HCBS waiver annual caps for services will increase by 4.25% effective for dates of
service on or after July 1, 2022, as follows:
AIDS/HIV Respite daily limit: $340.15
Waiver
BI Waiver Home and vehicle modifications: $6,872.85 per waiver member year
Specialized medical equipment: $6,872.85 per waiver member year
Supported employment: $3,302.53 per calendar month
Respite daily limit: $340.15
CMH Waiver Environmental modifications/
adaptive devices: $6,872.85 per waiver member year
Respite daily limit: $340.15
EW Home and vehicle modifications: $1,145.48 maximum
Respite daily limit: $340.15
HD Waiver Home and vehicle modifications: $6,872.85 per waiver member year
Respite daily limit: $340.15
ID Waiver Home and vehicle modifications: $5,727.37 maximum
Respite daily limit: $340.15
Respite annual limit: $7,917.79 per waiver member year
Supported employment: $3,302.53 per calendar month
2
PD Waiver Home and vehicle modifications: $6,872.85 per waiver member year
Specialized medical equipment: $6,872.85 per waiver member year
Rates that are Cost Based – HCBS FFS
Cost reported rates in place in members’ service plans on June 30, 2022, will
automatically increase by 4.25% in the Institutional and Waiver Authorization and
Narrative System (IoWANS). This includes:
• Supported community living – 15 minutes (intellectual disability (ID) and brain
injury (BI) waiver) and daily (BI waiver only)
• Family training and counseling
• Interim medical monitoring and treatment
ID Waiver Tiered Rates
The ID waiver tiered rates for adult day care, day habilitation, residential-based
supported community living (RBSCL), and daily supported community living (SCL) will
increase by 4.25% over the rates in effect June 30, 2022, effective for dates of service
on or after July 1, 2022

For the service rate increase effective July 1, 2022, a notice of decision (NOD) issuance
is not necessary; the IHH care coordinator (IHHCC), CM, or community-based case
manager (CBCM), and the service provider, should place a copy of this informational
letter (IL) in the member’s file to support the 4.25% increase over those rates approved
in the service plan on or before June 30, 2022. If a provider wishes to receive a new
NOD from the IHHCC/CM/CBCM, they may request one from the IHHCC/CM/CBCM

These services will be reconciled through the cost report process for the FFS population

Consumer Choice Option (CCO) Rates – HCBS FFS
The CCO rate setting methodology is established in IAC 441- 78.34(13)b2. The CCO
service rates in IoWANS will be increased by 4.25% over the rates in effect June 27,
2022. CCO service plans in IoWANS will automatically update on June 27, 2022. All
service plans that are authorized and valid on June 27, 2022, will automatically update
in IoWANS to the new service rates and monthly budget amount. Updated services
plans will have an effective date of July 1, 2022. Plans that do not receive the automatic
update will need to be manually entered into IoWANS by the case manager. Any
corrections to the updated service plans must be authorized and valid by June 30, 2022,
to be effective July 1, 2022. Members, CMs, MCOs, and independent support brokers
(ISB) will be informed of the new CCO service unit rates

For planning purposes, members and ISBs may use the current approved June 1, 2022,
monthly CCO budget amount plus 4.25% for use in creating the CCO budget beginning
July 1, 2022. If the current budget amount is unknown, or if CCO budget changes are
going into effect on July 1, 2022, the member or ISB should contact the member’s case
manager to confirm the July 1, 2022, monthly CCO budget amount. To implement the
2
441.78.pdf (iowa.gov)
3
rate increase, the CCO financial management service (FMS) service provider, Veridian
Fiscal Solutions (VFS), will automatically apply the 4.25% increase to all applicable
services and pay rates on approved monthly budgets on file as of June 30, 2022. The
increase will take effect on July 1, 2022. No action is required by the member to access
the increase in funding. Rather than the automatic budget change, a member may opt
to make changes to their July 2022 monthly budget by submitting a revised CCO
budget. VFS will communicate options available to all members and their ISBs to apply
the 4.25% rate increase effective July 1, 2022

HCBS Habilitation FFS Upper Rate Limits
The HCBS habilitation upper rate limits for case management, day habilitation, home-
based habilitation, and prevocational, and supported employment services will be
increased by 4.25% effective for dates of service on or after July 1, 2022.

The HCBS habilitation cap on services for supported employment is $3,302.53 per
calendar month

Rates that are Fee Schedule – FFS HCBS Waiver and Habilitation
• Provider rates will not be automatically increased for FFS members in IoWANS
by Iowa Medicaid

• Providers must contact the IHHCC/CM to request a rate increase for FFS members

• The FFS member’s IHHCC/CM may be asked by the provider to increase the fee
in the member’s service plan. The rate increase will be effective the month of the
provider’s request. Upon a request from the provider, the FFS member’s
IHHCC/CM should update the FFS member’s service span effective the month of
the provider’s request with the increased rate and complete the service plan
workflow to authorize the rate increase

• For the service rate increase effective July 1, 2022, a NOD issuance is not
necessary; the member’s IHHCC/CM should place a copy of this IL in the
member’s file to support the 4.25% increase over those rates approved in the
service plan on or before June 30, 2022. If a provider wishes to receive a new
NOD from the IHHCC/CM they may request one from the IHHCC/CM

• Providers must ensure that the requested rate is no more than 4.25% over the
rate in effect on June 30, 2022

• IHHCC/CMs are responsible to ensure that the rate increase requested by the
provider is no more than 4.25% over the rate in effect June 30, 2022

Exception to Policy (ETP) Approved Rates
• ETPs that are currently approved to exceed the upper rate limit cannot be
increased by 4.25%. The provider is already being reimbursed at a rate that
exceeds the upper rate limit and will not receive an additional 4.25% over the
rate granted through an ETP

• Members with ETPs to exceed the monthly cap on the total cost of services,
which include services that are fee based, such as transportation or meals, may
have the fee schedule rates increased by 4.25%. This applies only to those rates
in place on or before June 30, 2022. The IHHCC/CM/MCO do not need to
4
request a reconsideration of a previously approved ETP to increase the fee
schedule by 4.25% but should follow the directions for fee schedule rates above

The fee schedules for HCBS waiver and habilitation prevocational and supported
employment services, HCBS waiver transportation, ID waiver tiers, and home-based
habilitation will be updated and posted to the Iowa Medicaid fee schedule website3

Iowa Medicaid is aware that there are individual situations that do not fall into one of the
categories mentioned above. Providers, IHHCCs, CMs, CBCMs, and Iowa Medicaid
staff will coordinate efforts to address these situations as they arise

Iowa Medicaid appreciates your partnership as we work together to serve the needs of
Iowa Medicaid members. If you have any questions, please contact Iowa Medicaid
Provider Services Unit at 1-800-338-7909, locally in Des Moines at 515-256-4609, or by
email at [email protected]

3
Fee Schedules | Iowa Department of Human Services
5

Manager (CBCM), and the service provider, should place a copy of this informational letter (IL) in the member’s file to support the 4.25% increase over those rates approved in the service plan …

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What do the modifiers mc and ffs stand for?

The modifiers are: MC for Managed Care, FFS for Fee-for-Service and D for Dental. To see all Informational Letters access the links below which are sorted by year of publication. For more information see IL 1710. Effective January 1, 2021, Informational Letters will no longer be posted on this webpage.

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All Informational Letters published after Aug. 15, 2016, include a modifier after the Informational Letter number that designates which program (s) the Informational Letter applies to. The modifiers are: MC for Managed Care, FFS for Fee-for-Service and D for Dental.

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