ARC 0538D

ARC 0538D

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Proposing rulemaking related to provider enrollment
and providing an opportunity for public comment

    The Department of Health and Human Services hereby proposes to amend Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.

Legal Authority for Rulemaking

    This rulemaking is proposed under the authority provided in Iowa Code chapter 249A.

State or Federal Law Implemented

    This rulemaking implements, in whole or in part, Iowa Code chapter 249A.

Purpose and Summary

    This proposed rulemaking amends subrule 79.15(12) by changing the parameters for Iowa Medicaid provider validation and termination. The current subrule indicates that Iowa Medicaid providers that have not submitted a claim in the past 24 months will be sent a notice asking if the provider wishes to continue participation in the Medicaid program. Providers that fail to respond within 30 calendar days are terminated from participation.

    As proposed to be amended, the subrule states that providers that have not submitted a claim within the previous 12 months will be deactivated from participation in the Iowa Medicaid program. Deactivated providers may request reactivation by contacting the Department and meeting all applicable requirements. Providers that remain deactivated and do not submit any claims for 24 consecutive months following deactivation will be terminated from participation.

Fiscal Impact

     This rulemaking has no fiscal impact to the State of Iowa.

Jobs Impact

    This proposed rulemaking may impact small business health care providers that have not submitted a claim to Iowa Medicaid in the last 12 months. Such providers may be deactivated from participation with Iowa Medicaid. This proposed rulemaking provides an avenue for such providers to reactivate their participation.

Waivers

    Any person who believes that the application of the discretionary provisions of this rulemaking would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to 441—Chapter 2504.

Public Comment

     Any interested person may submit written or oral comments concerning this proposed rulemaking, which must be received by the Department no later than 4:30 p.m. on September 22, 2026. Comments should be directed to:

Public Hearing

     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rulemaking may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members.

Review by Administrative Rules Review Committee

    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rulemaking by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rulemaking at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

Emergency Rulemaking Adopted by Reference

    This proposed rulemaking is also published herein as an Adopted and Filed Emergency rulemaking (see ARC 0539D, IAB 9/2/26). The purpose of this Notice of Intended Action is to solicit public comment on that emergency rulemaking, whose subject matter is hereby adopted by reference.