Iowa Nursing Facility Reimbursement Rates

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Iowa Department of Human Services (DHS) and Iowa Medicaid Enterprise (IME) issued INFORMATIONAL LETTER NO. 2258-MC-FFS on August 6, 2021.

Provisions of the 2021 Iowa Acts, House File (HF) 891, Section 31, required the IME to implement an increase to nursing facility rates effective July 1, 2021. The increase will continue to use cost information based on calendar year 2018 cost reports in accordance with Iowa Administrative Code (IAC) reports. The increase includes an updated inflation factor calculated to ensure estimated spending does not exceed the amount appropriated in HF 891.

Due to the provider challenges related to the COVID-19 Public Health Emergency, the Department has made an exception to our normal process in allowing provider rate increases prior to approval from the Centers for Medicare and Medicaid Services (CMS) and State Plan Amendment (SPA) submission. Rate notifications effective July 1, 2021, and October 1, 2021, will be mailed to providers beginning August 6, 2021. The rates will be submitted to the Managed Care Organizations (MCOs) on August 6, 2021. The IME appreciates your partnership as we work together to serve the needs of Iowa Medicaid members. If you have any questions, please contact the IME Provider Cost Audit and Rate Setting Unit at 1-866-863-8610, locally at 515-256-4610, or by email at costaudit@dhs.state.ia.us.