Informational Letter No 2384 Mc Ffs Date September

Summary

INFORMATIONAL LETTER NO. 2384-MC-FFS
DATE: September 30, 2022
TO: Home- and Community-Based Services (HCBS) Waiver and State Plan
HCBS Habilitation, Home Health Agencies, Targeted Case Management
(TCM), Behavioral Health Intervention Services (BHIS), Applied Behavioral
Analysis (ABA) Providers, Community-Based Neurobehavioral
Rehabilitation Services (CNRS), Behavioral Health Service Providers
APPLIES TO: Managed Care (MC), Fee-for-Service (FFS)
FROM: Iowa Department of Health and Human Services (HHS), Iowa Medicaid
RE: American Rescue Plan Act (ARPA) HCBS Health Information Technology
(IT) and Infrastructure Grant
EFFECTIVE: Upon Receipt
Beginning October 1, 2022, Iowa Medicaid will accept applications from eligible providers to
receive funds from the ARPA HCBS Health IT and Infrastructure Grant

Grants will serve the purpose of assisting qualified HCBS providers with funding projects that
improve, enhance, and/or expand HCBS, including but not limited to those that allow providers
to implement meaningful use of certified electronic health records (EHR) systems; to fully
comply with the HCBS settings rule1 or electronic visit verification (EVV) requirements2; or to
otherwise expand their capacity to serve HCBS waiver or HCBS habilitation participants

Eligible providers for the HCBS Health IT and Infrastructure Grant include:
• 1915(c) HCBS waiver providers, including case management and consumer choices option
(CCO) employees

• 1915(i) state plan HCBS habilitation providers, including case management

• Home health agencies delivering HCBS waiver services, personal care and private duty nursing

• Rehabilitative service providers including:
o Assertive community treatment (ACT) providers

1
https://dhs.iowa.gov/ime/about/initiatives/HCBS
2
https://dhs.iowa.gov/ime/providers/EVV
All Informational Letters are sent to the Managed Care Organizations
Iowa Medicaid – 1305 E Walnut St. – Des Moines, IA 50319
o ABA

o BHIS

o CNRS

o Behavioral health service providers delivering mental health services or substance use
disorder services

To be eligible for grant funds, providers must meet these requirements:
• They billed a managed care organization (MCO) or FFS Medicaid for eligible services
provided between July 1, 2020, and June 30, 2021

• They continued to provide patient care after April 1, 2021

• They have not permanently ceased providing patient care directly or indirectly

• With respect to Medicare, any state Medicaid program, and any federal health care
program, the recipient is not:
o suspended or excluded from participation

o suspended from receiving payments

o under any other sanction or penalty

Eligible Projects
Projects may include but are not limited to those listed below

• Projects that expand providers’ capacity to serve HCBS participants. Examples of projects
include but are not limited to:
o Vehicles – purchasing new or modifying existing vehicles to transport HCBS participants in
more individualized ways
o Vehicles – purchasing new or modifying existing vehicles for use by staff to conduct HCBS
(on-call response, medication administration, planning meetings, etc.)
o Purchase of single-family homes in neighborhoods in the community to expand access to
HCBS residential services to individuals with multi-occurring diagnoses and complex needs;
and those transitioning from hospitals, nursing facilities, skilled nursing facilities,
rehabilitation facilities, and other congregate care settings
o Renovations to existing homes and buildings where direct services are provided
• Accessibility
• Safety
• Service expansion (adding space to accommodate additional service recipients)
o Purchase of critical building systems
o Upgrading or purchasing electrical, heating, ventilation, air conditioning, security, life safety,
lighting, utilities, telecommunications, and energy management
• Projects that improve access to care and monitoring of the quality of care for HCBS Medicaid
members
o Purchasing of certified EHR technology to improve the quality of member care
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• New or upgraded technology
• Purchasing or updating internal IT systems
• Modifying current software or hardware
• Training costs related to implementing technology
o Projects to fully comply with federal EVV requirements. Examples of projects include, but
are not limited to:
• New or upgraded technology to allow for compliance with EVV
• Purchasing or updating internal IT systems
• Modifying current software or hardware
• Training costs related to implementing technology
o Purchasing of electronic service record technology
• New or upgraded technology to allow for compliance with service documentation
requirements
• Purchasing or updating internal IT systems
• Modifying current software or hardware
• Training costs related to implementing technology
o Purchasing of telehealth equipment and software
• The technology and equipment must comply with all relevant safety laws, rules,
regulations, and codes for technology and technical safety for devices that interact with
patients or are integral to diagnostic capabilities

• The technology and equipment must be of sufficient quality, size, resolution, and clarity
such that the licensee can safely and effectively provide the telemedicine services

• The technology and equipment utilized in the provision of telemedicine services must be
compliant with HIPAA

• Training costs related to implementing technology
o Purchasing of services that improve overall organizational infrastructure. Eligible activities
under this category include:
• hiring staff or consultants to assist with:
o developing database management systems
o developing financial systems
o developing meaningful use EHR systems
o developing technology enabled services
o developing internal quality monitoring and improvement systems
o Building other administrative systems needed to increase the organization’s ability to access
and sustain new funding sources and deliver on the organization’s mission
o Purchasing of technology or other equipment for HCBS staff to support community-based
services and programs
• One-time purchases of equipment to increase HCBS participant independence and community
access (when purchases are not otherwise available by other dedicated funding sources, or
otherwise covered services). Examples of projects may include, but are not limited to:
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o Adaptive equipment to assist with community access, activities of daily living, and
independence
• Wheelchair ramp
• Vehicle platform lift (VPL)
• Ceiling lift
o Assistive technology – equipment, software program, or products/systems used to increase,
maintain, or improve the functional capabilities for HCBS participants not otherwise
available through the HCBS waiver or state plan Medicaid
• Other projects which meet the intent of improving, enhancing, or expanding Iowa’s HCBS
infrastructure
• Projects aligning with those described above and that have been implemented since April 1,
2021, are eligible for grant funds. Providers must include a detailed description of the project,
its intended outcomes, and a detailed budget to support the request for funds

Funding
The department will assess the amount of proposed funding along with the number of
participants the project(s) would affect. Entities may submit proposals for more than $100,000,
with the knowledge they may not be funded for the entire amount. Entities should entertain
fundraising or identify other sources of funding to supplement any funding gaps

Funding Restrictions
All awarded funds have the following restrictions:
• Funds shall not be used for the purchase or development of multi-family units serving more
than five (5) individuals, including apartments and duplexes

• Funds shall not be used for anything other than the projects specified in the project proposal

• Funds shall not be used to pay for administrative costs or clinical care

• Funds shall not be used to pay for indirect costs. All costs must be related to the project
proposal and be outlined and justified in the budget

• Funds shall not be used for wages, retention, or other bonuses for staff

• Funds shall not be used for disposable or single-use items for a single person. Projects must
be for the benefit of individuals served overall (as applicable). Evaluation of the project will
reflect this restriction and proposals are subject to disqualification if for a single person only
unless the project or item can be transferred or used multiple times

• If awarded only a portion of the requested funding, and the submitted proposal application
indicates the project can be completed with other funding sources, the project must be fully
completed by March 31, 2024. Any unspent funds shall be remitted to the department

• Entities must maintain complete records of fund expenditures and understand that project
budgets are subject to potential post-payment review or audit

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Applying for Grant Funds
Agency providers enrolled under multiple national provider identifiers (NPIs) for eligible HCBS
should list those NPIs and their corresponding tax ID number and pay-to-legacy numbers on
the application. Providers should submit only one application per organization. Duplicate
applications will be rejected

Agency providers may apply for the Health IT and Infrastructure Grant funds beginning
October 1, 2022. The application period will remain open until the funds allocated for this
project have been expended. Providers may request grant funds by completing the online
application3 and attestation and uploading the required documents and minority impact
statement. The department will only accept complete applications which include the submission
of the required documents listed below

Proposals from entities that have multiple locations may be awarded for only one location or all
locations at the department’s discretion. Entities should indicate the location(s) in their
proposal application. Entities can submit proposals for multiple projects (if applicable, submit
one proposal application with all projects listed)

The Health IT and Infrastructure Grant application must include:
• A Brief Project Description and Point of Contact (POC)
o Identify or name the entity submitting the application

o Provide a brief description and purpose of the project, in no more than five sentences

o Include total amount of funds requested

o Identify a POC for the application, including name, position/title, address, phone
number, and email address

• Entity Information
o List the entity’s current programs and activities

o Provide the entity’s national provider identification (NPI) Number
o Provide the entity’s tax identification number (TIN)
• Project Description
o Describe the project in detail explaining how it will enhance improve or expand HCBS
o Provide a timeline of the project, purchases or expenditures using grant funds that
shows major milestones for the project
o If the applicant will be collaborating with any other entities (e.g., individuals,
organizations, associations, facilities, etc.) on the initiative, the other entities should be
identified. Include any entity and whether the entity will be applying for ARPA grant
funds. Explain what specific deliverables the other entity is responsible for

3
https://www.tfaforms.com/5016328
5
• Budget
o Describe the budget for the project, including other funding sources and allocations

Include the source of the pricing as applicable

o Provide a detailed line-item budget proposal using a table format outlining the specific
cost requirements within each of the following budget categories:
• Personnel/consultants
• Travel
• Equipment purchases and rentals
• Training
• Cost of project activities to be undertaken by a sub-contractor. Each subcontractor
is budgeted separately

• Other direct costs (expenses not covered in any of the previous costs)
• Total indirect costs
o If the entity is purchasing goods and services that are available from multiple
sources, the entity must include three competitive quotes for the cost of any
equipment, construction, and labor. The quotes shall be from businesses that
comply with federal, state, and local laws as required

o Please note budget amounts for anything prohibited by the ARPA section 9817
guidelines or federal and state rules will be disallowed

• Sustainability Plan
o Describe the sustainability plan for the project after grant funds awarded have been
exhausted

Application Processing
• Iowa Medicaid Provider Services will record receipt of the applications, project descriptions,
budgets, and MIS as they are received and notify the HCBS Quality Improvement
Organization (QIO) project team

• The ARPA HCBS QIO project team will verify that the provider submitting the application
had claims paid during SFY21 and are in good standing with the department by sharing the
provider listings with program integrity to ensure that the providers are not:
• suspended or excluded from participation

• suspended from receiving payments

• under any other sanction or penalty

• The ARPA HCBS project team will review a project and the associated budget and make a
recommendation on the eligibility of the project and the amount of funds to distribute

• During the bi-monthly award meeting, the ARPA HCBS team will review the
recommendation for the award for each project and make a final determination on the
eligibility and amount of the award. Providers or projects identified as not eligible will be
notified by Provider Services

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• The process above will be repeated monthly until all project funds have been expended

Distribution of Funds to Providers
• Each month the ARPA HCBS project team will approve the amount of ARPA project funds
to be awarded to the providers applying during the prior month

• The ARPA HCBS project lead will identify the amount to be distributed to each provider
based on the approved project and budget and send the final agency provider listing to
CORE services to enable the one-time payment to the provider

• The provider will receive the gross payment on the regularly scheduled payment date the
month following the month of application and award determination

An FAQ will be posted to the department’s ARPA webpage4

If you have questions, please contact Iowa Medicaid Provider Services at 1-800-338-7909 or by
email at [email protected]

4
https://dhs.iowa.gov/ime/about/initiatives/ARPA
7

All Informational Letters are sent to the Managed Care Organizations Iowa Medicaid – 1305 E Walnut St. – Des Moines, IA 50319 INFORMATIONAL LETTER NO. 2384-MC-FFS DATE: …

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Informational Letters. The Iowa Medicaid Enterprise publishes provider bulletins called Informational Letters that are necessary to clarify and explain new and existing program and policy. All Informational Letters published after Aug. 15, 2016, include a modifier after the Informational Letter number that designates which program(s)...

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