Adopted and Filed Emergency

Provider reimbursement rates; fee schedules, 78.27(10)“f,” 78.34(9)“g,” 78.41(2)“i,” 78.43, 78.46, 79.1, 83.2(2)“b,” 83.42(2)“b,” 83.102(2)“b,” 83.122(6)“b”

Untitled document

ARC 5896C

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Rule making related to provider rates and fee schedules

The Human Services Department hereby amends Chapter 78, "Amount, Duration and Scope of Medical and Remedial Services," Chapter 79, "Other Policies Relating to Providers of Medical and Remedial Care," and Chapter 83, "Medicaid Waiver Services," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is adopted under the authority provided in Iowa Code section 249A.4 and 2021 Iowa Acts, House File 891, section 32.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code section 249A.4 and 2021 Iowa Acts, House File 891.

Purpose and Summary

As part of the 2021 Legislative Session, 2021 Iowa Acts, House File 891, appropriates funds to increase specific provider reimbursement rates. The amendments to Chapters 78, 79 and 83 do the following:

Increase the reimbursement rates and upper rate limits for providers of Home- and Community-Based Services (HCBS) Waiver and HCBS Habilitation services beginning July 1, 2021, by 3.55 percent over the rates in effect on June 30, 2021.

Increase the monthly caps on the total monthly cost of HCBS Waiver and Habilitation services.

Increase the monthly cap on HCBS Supported Employment and the annual cap on Intellectual Disability Waiver Respite services.

Increase annual or lifetime limitations for home and vehicle modifications and specialized medical equipment.

Increase air ambulance rates to $550 beginning July 1, 2021.

In addition, the amendments to Chapter 79:

Add the inflation factor limitation.

Implement the fee schedule rate in effect July 1, 2021, for air ambulance providers. 2021 Iowa Acts, House File 891, appropriates funds to increase air ambulance rates to $550 per one-way trip.

Implement the home health agency low utilization payment adjustment (LUPA) rate increase. This rate is applied when there are three or fewer visits provided in a 30-day period.

Increase psychiatric medical institutions for children (PMIC) provider-specific fee schedule rate percentages over the rates in effect June 30, 2021. House File 891 appropriates $3.9 million to increase non-State-owned PMIC provider rates over the rates in effect June 30, 2021.

Reason for Adoption of Rule Making Without

Prior Notice and Opportunity for Public Participation

Pursuant to Iowa Code section 17A.4(3), the Department finds that notice and public participation are unnecessary or impractical because statute so provides and because the emergency adoption was reviewed by the Administrative Rules Review Committee. 2021 Iowa Acts, House File 891, allows for emergency adoption due to a July 1, 2021, effective date provided in the legislation. This also provides a benefit of increased provider rates. In compliance with 2021 Iowa Acts, House File 891, section 32, the Administrative Rules Review Committee at its August 17, 2021, meeting reviewed the Department's determination and this rule filing.

Reason for Waiver of Normal Effective Date

Pursuant to Iowa Code section 17A.5(2)"b"(1)(a) and (b), the Department also finds that the normal effective date of this rule making, 35 days after publication, should be waived and the rule making made effective on August 17, 2021, because 2021 Iowa Acts, House File 891, section 32, so provides and because increased provider rates provide a benefit.

Adoption of Rule Making

This rule making was adopted by the Council on Human Services on August 12, 2021.

Concurrent Publication of Notice of Intended Action

In addition to its adoption on an emergency basis, this rule making has been initiated through the normal rule-making process and is published herein under Notice of Intended Action as ARC 5903C to allow for public comment.

Fiscal Impact

The targeted HCBS and Habilitation increases were calculated assuming both the regular federal medical assistance percentages (FMAP) and COVID-increased FMAP. The Legislature opted for the COVID-increased FMAP scenario for both sets of services. These are the only adjustments for which the Legislature agreed to base the increase on the COVID-increased FMAP. All other adjustments are based on the regular FMAP. The FMAP is estimated at 65.14 percent in SFY22 and 62.01 percent in SFY23. As part of the 2021 Legislative Session, 2021 Iowa Acts, House File 891, appropriates funds to increase specific provider reimbursement rates.

Jobs Impact

These amendments may have a positive influence on private-sector jobs and employment opportunities in Iowa.

Waivers

Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making 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).

Effective Date

This rule making became effective on August 17, 2021.

The following rule-making actions are adopted:

Item 1. Amend subparagraph 78.27(10)"f"(2) as follows:

(2)In absence of a monthly cap on the cost of waiver services, the total monthly cost of all supported employment services may not exceed $3,059.29 $3,167.89 per month.

Item 2. Amend paragraph 78.34(9)"g" as follows:

g. Service payment shall be made to the enrolled home or vehicle modification provider. If applicable, payment will be forwarded to the subcontracting agency by the enrolled home or vehicle modification provider following completion of the approved modifications. Payment of up to $6,366.64 $6,592.66 per year may be made to certified providers upon satisfactory completion of the service.

Item 3. Amend paragraph 78.41(2)"i" as follows:

i. Payment for respite services shall not exceed $7,334.62 $7,595 per the member's waiver year.

Item 4. Amend paragraph 78.43(5)"g" as follows:

g. Service payment shall be made to the enrolled home or vehicle modification provider. If applicable, payment will be forwarded to the subcontracting agency by the enrolled home or vehicle modification provider following completion of the approved modifications. Payment of up to $6,366.64 $6,592.66 per year may be made to certified providers upon satisfactory completion of the service.

Item 5. Amend paragraph 78.43(8)"c" as follows:

c. Payment of up to $6,366.64 $6,592.66 per year may be made to enrolled specialized medical equipment providers upon satisfactory receipt of the service. Each month within the 12-month period, the service worker shall encumber an amount within the monthly dollar cap allowed for the member until the amount of the equipment cost is reached.

Item 6. Amend paragraph 78.46(2)"g" as follows:

g. Service payment shall be made to the enrolled home or vehicle modification provider. If applicable, payment will be forwarded to the subcontracting agency by the enrolled home or vehicle modification provider following completion of the approved modifications. Payment of up to $6,366.64 $6,592.66 per year may be made to certified providers upon satisfactory completion of the service.

Item 7. Amend paragraph 78.46(4)"c" as follows:

c. Payment of up to $6,366.64 $6,592.66 per year may be made to enrolled specialized medical equipment providers upon satisfactory receipt of the service.

Item 8. Adopt the following new paragraph 79.1(1)"i":

i. Inflation factor. When the department's reimbursement methodology for any provider includes an inflation factor, this inflation factor shall not exceed the amount by which the consumer price index for all urban consumers increased during the calendar year ending December 31, 2002.

Item 9. Amend subrule 79.1(2), provider categories of "Ambulance," "HCBS waiver service providers," "Home- and community-based habilitation services," "Home health agencies" and "Psychiatric medical institutions for children," as follows:

Ambulance

Fee schedule

Ground ambulance: Fee schedule in effect 6/30/14 plus 10%.

Air ambulance: Fee schedule in effect 6/30/14 plus 10% 7/1/21.

HCBS waiver service providers,

including:

Except as noted, limits apply to all waivers that cover the named provider.

1. Adult day care

For AIDS/HIV, brain injury, elderly, and health and disability waivers:

Fee schedule

Effective 7/1/16 7/1/21, for AIDS/HIV, brain injury, elderly, and health and disability waivers: Provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute, half-day, full-day, or extended-day rate. If no 6/30/16 6/30/21 rate: Veterans Administration contract rate or $1.47 $1.52 per 15-minute unit, $23.47 $24.30 per half day, $46.72 $48.38 per full day, or $70.06 $72.55 per extended day if no Veterans Administration contract.

For intellectual disability waiver:

Fee schedule for the member's acuity tier, determined pursuant to 79.1(30)

Effective 7/1/17 7/1/21, for intellectual disability waiver: The provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute or half-day rate. If no 6/30/16 6/30/21 rate, $1.96 $2.03 per 15-minute unit or $31.27 $32.38 per half day.

For daily services, the fee schedule rate published on the department's website, pursuant to 79.1(1)"c," for the member's acuity tier, determined pursuant to 79.1(30).

2. Emergency response system:

Personal response system

Fee schedule

Effective 7/1/13 7/1/21, provider's rate in effect 6/30/13 6/30/21 plus 3% 3.55%. If no 6/30/13 6/30/21 rate: Initial one-time fee: $52.04 $53.89. Ongoing monthly fee: $40.47 $41.91.

Portable locator system

Fee schedule

Effective 7/1/13 7/1/21, provider's rate in effect 6/30/13 6/30/21 plus 3% 3.55%. If no 6/30/13 6/30/21 rate: One equipment purchase: $323.26 $334.74. Initial one-time fee: $52.04 $53.89. Ongoing monthly fee: $40.47 $41.91.

3. Home health aides

Retrospective cost-related Fee schedule

For AIDS/HIV, elderly, and health and disability waivers effective 7/1/16 7/1/21: Lesser of maximum Medicare rate in effect 6/30/16 6/30/21 plus 1% 3.55% or maximum Medicaid rate in effect 6/30/16 6/30/21 plus 1% 3.55%.

For intellectual disability waiver effective 7/1/16 7/1/21: Lesser of maximum Medicare rate in effect 6/30/16 6/30/21 plus 1% 3.55% or maximum Medicaid rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to an hourly rate.

4. Homemakers

Fee schedule

Effective 7/1/13 7/1/21, provider's rate in effect 6/30/13 6/30/21 plus 3% 3.55%, converted to a 15-minute rate. If no 6/30/13 6/30/21 rate: $5.20 $5.38 per 15-minute unit.

5. Nursing care

Fee schedule

For AIDS/HIV, health and disability, elderly and intellectual disability waiver effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%. If no 6/30/16 6/30/21 rate: $87.99 $91.11 per visit.

6. Respite care when provided by:

Home health agency:

Specialized respite

Cost-based rate for nursing services provided by a home health agency Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: Lesser of maximum Medicare rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate, or maximum Medicaid rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate, not to exceed $315.09 $326.28 per day.

Basic individual respite

Cost-based rate for home health aide services provided by a home health agency Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: Lesser of maximum Medicare rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate, or maximum Medicaid rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate, not to exceed $315.09 $326.28 per day.

Group respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Home care agency:

Specialized respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $8.96 $9.28 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Basic individual respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $4.78 $4.95 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Group respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Nonfacility care:

Specialized respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $8.96 $9.28 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Basic individual respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $4.78 $4.95 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Group respite

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Facility care:

Hospital or nursing facility

providing skilled care

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed the facility's daily Medicaid rate for skilled nursing level of care.

Nursing facility

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed the facility's daily Medicaid rate.

Camps

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed $315.09 $326.28 per day.

Adult day care

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed rate for regular adult day care services.

Intermediate care facility

for persons with an intellectual disability

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed the facility's daily Medicaid rate.

Residential care facilities

for persons with an intellectual

disability

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed contractual daily rate.

Foster group care

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed daily rate for child welfare services.

Child care facilities

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit, not to exceed contractual daily rate.

7. Chore service

Fee schedule

Effective 7/1/13 7/1/21, provider's rate in effect 6/30/13 6/30/21 plus 3% 3.55%, converted to a 15-minute rate. If no 6/30/13 6/30/21 rate: $4.05 $4.19 per 15-minute unit.

8. Home-delivered meals

Fee schedule

Effective 7/1/13 7/1/21, provider's rate in effect 6/30/13 6/30/21 plus 3% 3.55%. If no 6/30/13 6/30/21 rate: $8.10 $8.39 per meal. Maximum of 14 meals per week.

9. Home and vehicle

modification

Fee schedule. See 79.1(17)

For elderly waiver effective 7/1/13 7/1/21: $1,061.11 $1,098.78 lifetime maximum.

For intellectual disability waiver effective 7/1/13 7/1/21: $5,305.53 $5,493.88 lifetime maximum.

For brain injury, health and disability, and physical disability waivers effective 7/1/13 7/1/21: $6,366.64 $6,592.66 per year.

10. Mental health outreach

providers

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%. If no 6/30/16 6/30/21 rate: On-site Medicaid reimbursement rate for center or provider. Maximum of 1,440 units per year.

11. Transportation

Fee schedule

Effective 10/1/13: The provider's nonemergency medical transportation contract rate or, in the absence of a nonemergency medical transportation contract rate, the median nonemergency medical transportation contract rate paid per mile or per trip within the member's DHS region. Fee schedule in effect 7/1/21.

12. Nutritional counseling

Fee schedule

Effective 7/1/16 7/1/21 for non-county contract: Provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $8.76 $9.07 per 15-minute unit.

13. Assistive devices

Fee schedule. See 79.1(17)

Effective 7/1/13 7/1/21: $115.62 $119.72 per unit.

14. Senior companion

Fee schedule

Effective 7/1/16 7/1/21 for non-county contract: Provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $1.89 $1.96 per 15-minute unit.

15. Consumer-directed attendant

care provided by:

Agency (other than an elderly waiver assisted living program)

Fee agreed upon by

member and provider

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $5.35 $5.54 per 15-minute unit, not to exceed $123.85 $128.25 per day.

Assisted living program (for elderly waiver only)

Fee agreed upon by

member and provider

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $5.35 $5.54 per 15-minute unit, not to exceed $123.85 $128.25 per day.

Individual

Fee agreed upon by

member and provider

Effective 7/1/16 7/1/21, $3.58 $3.71 per 15-minute unit, not to exceed $83.36 $86.32 per day. When an individual who serves as a member's legal representative provides services to the member as allowed by 79.9(7)"b," the payment rate must be based on the skill level of the legal representative and may not exceed the median statewide reimbursement rate for the service unless the higher rate receives prior approval from the department.

16. Counseling:

Individual

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $11.45 $11.86 per 15-minute unit.

Group

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $11.44 $11.85 per 15-minute unit. Rate is divided by six, or, if the number of persons who comprise the group exceeds six, the actual number of persons who comprise the group.

17. Case management

Fee schedule

For brain injury and elderly waivers : Fee schedule effective 7/1/21, provider's rate in effect 7/1/18 6/30/21 plus 3.55%.

18. Supported community living

For brain injury waiver:

Retrospectively limited prospective rates. See 79.1(15)

For brain injury waiver effective 7/1/16 7/1/21: $9.28 $9.61 per 15-minute unit, not to exceed the maximum daily ICF/ID rate per day plus 3.927% 7.477%.

For intellectual disability waiver:

Fee schedule for the member's acuity tier, determined pursuant to 79.1(30). Retrospectively limited prospective rate for SCL 15-minute unit. See 79.1(15)

For intellectual disability waiver effective 7/1/17 7/1/21: $9.28 $9.61 per 15-minute unit. For daily service, the fee schedule rate published on the department's website, pursuant to 79.1(1)"c," for the member's acuity tier, determined pursuant to 79.1(30).

19. Supported employment:

Individual placement and support

Fee schedule

Fee schedule in effect 7/1/21.

Individual supported employment

Fee schedule

Fee schedule in effect 7/1/16 7/1/21. Total monthly cost for all supported employment services not to exceed $3,059.29 $3,167.89 per month.

Long-term job coaching

Fee schedule

Fee schedule in effect 7/1/16 7/1/21. Total monthly cost for all supported employment services not to exceed $3,059.29 $3,167.89 per month.

Small-group supported

employment (2 to 8

individuals)

Fee schedule

Fee schedule in effect 7/1/16 7/1/21. Maximum 160 units per week. Total monthly cost for all supported employment services not to exceed $3,059.29 $3,167.89 per month.

20. Specialized medical equipment

Fee schedule. See 79.1(17)

Effective 7/1/13 7/1/21, $6,366.64 $6,592.66 per year.

21. Behavioral programming

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%. If no 6/30/16 6/30/21 rate: $11.45 $11.86 per 15 minutes.

22. Family counseling and training

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $11.44 $11.85 per 15-minute unit.

23. Prevocational services, including

career exploration

Fee schedule

Fee schedule in effect 7/1/16 7/1/21.

24. Interim medical monitoring

and treatment:

Home health agency

(provided by home health

aide)

Cost-based rate for home health aide services provided by a home health agency Fee schedule

Effective 7/1/16 7/1/21: Lesser of maximum Medicare rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate, or maximum Medicaid rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate.

Home health agency

(provided by nurse)

Cost-based rate for nursing services provided by a home health agency Fee schedule

Effective 7/1/16 7/1/21: Lesser of maximum Medicare rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate, or maximum Medicaid rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate.

Child development home

or center

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.49 $3.61 per 15-minute unit.

Supported community living

provider

Retrospectively limited prospective rate. See 79.1(15)

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $9.28 $9.61 per 15-minute unit, not to exceed the maximum ICF/ID rate per day plus 3.927% 7.477%.

25. Residential-based supported

community living

Fee schedule for the member's acuity tier, determined pursuant to 79.1(30)

Effective 7/1/17 7/1/21: The fee schedule rate published on the department's website, pursuant to 79.1(1)"c," for the member's acuity tier, determined pursuant to 79.1(30).

26. Day habilitation

Fee schedule for the member's acuity tier, determined pursuant to 79.1(30)

Effective 7/1/17 7/1/21: Provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $3.51 $3.63 per 15-minute unit. For daily service, the fee schedule rate published on the department's website, pursuant to 79.1(1)"c," for the member's acuity tier, determined pursuant to 79.1(30).

27. Environmental modifications

and adaptive devices

Fee schedule. See 79.1(17)

Effective 7/1/13 7/1/21, $6,366.64 $6,592.66 per year.

28. Family and community support

services

Retrospectively limited prospective rates. See 79.1(15)

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $9.28 $9.61 per 15-minute unit.

29. In-home family therapy

Fee schedule

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%, converted to a 15-minute rate. If no 6/30/16 6/30/21 rate: $24.85 $25.73 per 15-minute unit.

30. Financial management services

Fee schedule

Effective 7/1/13 7/1/21, provider's rate in effect 6/30/13 6/30/21 plus 3% 3.55%. If no 6/30/13 6/30/21 rate: $68.97 $71.42 per enrolled member per month.

31. Independent support broker

Rate negotiated by member

Effective 7/1/16 7/1/21, provider's rate in effect 6/30/16 6/30/21 plus 1% 3.55%. If no 6/30/16 6/30/21 rate: $16.07 $16.64 per hour.

32. to 34. No change.

35. Assisted living on-call

service providers (elderly

waiver only)

Fee agreed upon by member

and provider

$26.08 $27.01 per day.

Home- and community-based

habilitation services:

1. Case management

Fee schedule. See 79.1(24)"d"

Fee Effective 7/1/21: Fee schedule in effect 7/1/18 6/30/21 plus 3.55%.

2. Home-based habilitation

See 79.1(24)"d"

Effective 7/1/13: $11.68 per 15-minute unit, not to exceed $6,083 per month, or $200 per day. Fee schedule in effect 7/1/21.

3. Day habilitation

See 79.1(24)"d"

Effective 7/1/13 7/1/21: $3.30 $3.42 per 15-minute unit or $64.29 $66.57 per day.

4. Prevocational habilitation

Career exploration

Fee schedule

Fee schedule in effect May 4, 2016 7/1/21.

5. Supported employment:

Individual supported employment

Fee schedule

Fee schedule in effect May 4, 2016 7/1/21. Total monthly cost for all supported employment services not to exceed $3,029.00 $3,136.53 per month.

Long-term job coaching

Fee schedule

Fee schedule in effect May 4, 2016 7/1/21. Total monthly cost for all supported employment services not to exceed $3,029.00 $3,136.53 per month.

Small-group supported employment

(2 to 8 individuals)

Fee schedule

Fee schedule in effect May 4, 2016 7/1/21. Maximum 160 units per week. Total monthly cost for all supported employment services not to exceed $3,029.00 $3,136.53 per month.

Home health agencies

1. Skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social services; home health care for maternity patients and children

Fee schedule. See 79.1(26). For members living in a nursing facility, see 441—paragraph 81.6(11)"r."

Effective 7/1/18: Medicare LUPA rates in effect on 6/30/18 plus a 3% increase. 7/1/21: The Medicaid LUPA fee schedule rate published on the department's website.

2. and 3. No change.

Psychiatric medical institutions

for children:

1. Inpatient in non-state-owned facilities

Fee schedule

Effective 7/1/14 7/1/21: non-state-owned facilities provider-specific fee schedule in effect.

2. and 3. No change.

Item 10. Amend paragraph 83.2(2)"b," table, as follows:

Skilled level of care

Nursing level of care

ICF/ID

$2,792.65 $2,891.79

$959.50 $993.56

$3,742.93 $3,875.80

Item 11. Amend paragraph 83.42(2)"b" as follows:

b. The total monthly cost of the AIDS/HIV waiver services shall not exceed the established aggregate monthly cost for level of care. The monthly cost of AIDS/HIV waiver services cannot exceed the established limit of $1,876.80 $1,943.43.

Item 12. Amend paragraph 83.102(2)"b" as follows:

b. The total cost of physical disability waiver services, excluding the cost of home and vehicle modifications, shall not exceed $705.84 $730.90 per month.

Item 13. Amend paragraph 83.122(6)"b" as follows:

b. The total cost of children's mental health waiver services needed to meet the member's needs, excluding the cost of environmental modifications, adaptive devices and therapeutic resources, may not exceed $2,006.34 $2,077.57 per month.

[Filed Emergency 8/17/21, effective 8/17/21]

[Published 9/8/21]

Editor's Note: For replacement pages for IAC, see IAC Supplement 9/8/21.

Human Services Department

Official Document

  • Provider reimbursement rates; fee schedules, 78.27(10)“f,” 78.34(9)“g,” 78.41(2)“i,” 78.43, 78.46, 79.1, 83.2(2)“b,” 83.42(2)“b,” 83.102(2)“b,” 83.122(6)“b”
  • Published on 9/8/2021
  • 9 Views
  • Adopted and Filed Emergency

The official published PDF of this document is available from the Iowa General Assembly’s Administrative Rules page.

View Official PDF

View the Iowa Administrative Bulletin for 9/8/2021.

View Bulletin

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