Medicaid Modernization

RHC Medicaid Rates

We have learned more details from the Medical Assistance Advisory Committee meeting that was held recently.

MCO “floor” rate for FQHCs and RHCs = BIPA PPS rate in effect on 1/1/16, adjusted annually
The MCOs will pay FQHCs the PPS rate in effect January 1, 2016, not the greater of cost or PPS. .

Wrap payment - Upon provider request, the Department will make quarterly MCO wraparound supplemental payments equal to the fee for-service methodology
If your clinic’s cost-based encounter rate (per your most recent annual cost report) is higher than your PPS rate paid by the MCOs, you can submit Form 470-3495 to request a wrap payment directly from IME. This request can be made on a quarterly basis. This is the same process the IME currently uses for other HMO payers, such as Meridian and Marketplace Choice plans.

We assume that the State will continue its current cost reporting process in order to calculate encounter rates.

Next Steps
We need to confirm the cost reporting process with the IME.


Medicaid & Insurance Marketplace Updates

DHS to Begin Member Introductory Mailing: The Iowa Department of Human Services will begin member mailings announcing the managed care transition and IA Health Link program. This mailing will include general information on managed care, what members can expect in the coming months, a timeline and frequently asked questions. The mailings will be divided into four different versions, based on a member’s current program eligibility. A mailing schedule is listed below, along with samples of the letters. Additionally, samples of the letters are now included in the Stakeholder Toolkit and Provider Toolkit. If members have questions about the mailing and the transition, they are encouraged to contact Iowa Medicaid Member Services at 1-800-338-8366, 8:00 a.m. – 5:00 p.m., Monday- Friday, or by email at .

DHS Announces Medicaid Modernization Contracts: The Iowa Department of Human Services (DHS) announced Friday that contracts have been signed with the winning bidders for Governor Branstad’s Medicaid Modernization initiative. “Together with these four partners, we are modernizing the Medicaid program in a way that focuses on patients’ individuals needs and on providing a higher quality of care,” said Iowa Medicaid Director Mikki Stier. She noted that this new approach is aimed at improving quality and access, promoting outcomes and accountability and creating a more predictable and sustainable Medicaid budget. “With the help of these experienced partners, Medicaid members will receive better coordinated care so that they get the services they need to become healthier. An overall healthier Medicaid population will drive down program costs,” Stier said. “This is good for Medicaid members and for Iowa’s taxpayers who support this critical program.”

Contracts for the new, patient-centered care coordination effort have been signed with the following managed care organizations (MCOs):

  • Amerigroup Iowa, Inc.
  • AmeriHealth Caritas Iowa, Inc.
  • UnitedHealthcare Plan of the River Valley, Inc.
  • WellCare of Iowa, Inc.

Under the new IA Health Link program, savings come from improving Medicaid members’ health so there are fewer emergency room visits, hospitalizations and surgeries, and from eliminating unnecessary or duplicative services. And, the MCOs will be able to offer preventive services above and beyond what the traditional Medicaid program has been able to offer. The Department is working with the MCOs as they establish provider networks to serve nearly 600,000 Iowans through the IA Health Link program. DHS has held nearly 90 public and stakeholder meetings since announcing the modernization initiative, with dozens of additional ones scheduled and more being added. Find schedules here: