The Iowa Medicaid Enterprise is entering one of the busiest six months in its history with projects ranging from normal business processes to complex system transformations. We have created a summary document in PDF format that you can download or print entitled Iowa Medicaid Enterprise Initiatives Snapshot which outlines all the current major IME initiatives and provides a snapshot summary of what they are. To access more details about a specific IME initiative, you may also click on the active headings below.
State Innovation Models (SIM)
On September 24, 2012, Iowa applied for a State Innovation Models (SIM) Cooperative Agreement with the Centers for Medicare and Medicaid Services (CMS). On February 21, 2013 Iowa received notice that our application was selected for a Model Design Award to commence April 1, 2013. The goal of this CMS Innovation Center initiative is to test whether new payment and service delivery models will produce superior results when implemented in the context of a state-sponsored State Health Care Innovation Plan. These Plans must improve health, improve health care, and lower costs for citizens through a sustainable model of multi-payer payment and delivery reform, and must be dedicated to delivering the right care at the right time in the right setting. The Innovation Center has created the SIM initiative for states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation.
Home and Community-Based Services (HCBS) Settings Transition
The Centers for Medicare & Medicaid Services (CMS) have issued regulations that define the settings in which it is permissible for states to pay for Medicaid Home and Community-Based Services (HCBS). The purpose of these regulations is to ensure that individuals receive Medicaid HCBS in settings that are integrated in and support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree as individuals who do not receive HCBS.
Iowa Health and Wellness Plan
The Iowa Medicaid Enterprise is working to implement the Iowa Health and Wellness Plan. The Iowa Health and Wellness Plan will begin on January 1, 2014. The plan will provide coverage for individuals age 19-64 with income up to and including 133 percent of the Federal Poverty Level.
Balancing Incentive Program (BIP)
Iowa is pleased to announce that, the Centers for Medicare and Medicaid Services (CMS) approved Iowa's application for State Balancing Incentive Program (BIP) grant. BIP is designed to "balance" states' spending on long term supports and services. The goal of BIP is to provide persons with greater access to home and community-based services and to reduce unnecessary reliance on institutional services. Iowa currently spends approximately 46.5% of its Medicaid long term supports and services funds on the Home and Community-Based Services program. Under this successful grant Iowa will received an enhanced match rate of 2% for non-institutional long term services and supports, for a total of $61.8 million. The grant award period is July 1, 2012 through September 30, 2015. The department plans to work with key stakeholders to plan implementation steps.
A Health Home is a patient-centered, whole person approach to coordinated care for all stages of life and transitions of care; a model of care where Medicaid members with multiple or chronic conditions can receive help that integrates all their needs into a single plan of care. A Health Home is a Medicaid program that enables providers to offer additional services for members with specific chronic conditions. Providers must meet standards outlined by the State and seek patient centered medical home (PCMH) recognition within 12 months of enrolling in the program. To facilitate a team-based, community focused approach, providers participating as a Health Home must connect to the Iowa Health Information Network (IHIN).
Integrated Health Home Informational Flyer (Revised April 18, 2013)
Integrated Health Home FAQs (Revised April 30, 2013)
Integrated Health Homes for Medicaid Members with a Serious & Persistent Mental Illness (Marni Bussell April 9, 2013)
Health Information Technology (HIT)
Iowa's Medicaid Electronics Health Records (EHR) Incentive Program is playing an important role in establishing critical health information technology designed to reduce costs, improve care, and advance coordination across the healthcare platform. This focused effort is leading to better coordination, quality of care, and fostering healthier lives in Iowa. Eligible professionals and hospitals can apply for the EHR via the Provider Incentive Payment Program (PIPP) system at http://www.imeincentives.com/
ICD-10-CM and PCS (International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System) is an update to the ICD-9 and provides an expanded set of diagnosis and procedure codes to keep pace with advances in medicine over the last three decades. Another primary reason driving the migration from ICD-9 to ICD-10 is that the ICD-9 code set is running out of codes and its limited structural design is preventing the addition of new codes.
As announced in Informational Letter 1115, the Iowa Medicaid Enterprise (IME) continues to move forward in preparing for the use of the new ICD-10 code set for services provided on and after October 1, 2013. On February 16, 2012, the United States Department of Health & Human Services (HHS) announced that it intends to delay the ICD-10 compliance date. The message indicated the delay would be for certain health care entities but did not offer any specifics. Until more information is made public by the HHS, the IME will re-evaluate its ICD-10 efforts and make its best effort to offer clear direction. The Centers for Medicare and Medicaid Services (CMS) offers valuable training materials and information to review on the ICD 10 transition. These can be found by following this link: http://www.cms.gov/Medicare/Coding/ICD10
Affordable Care Act Educational Materials
The Affordable Care Act was signed on March 23, 2010. The law is complex and requires many changes. The Iowa Department of Human Services is committed to working collaboratively to implement these complex changes and to being a leader in the delivery of health care to vulnerable Iowans. This web page will maintain educational materials to help promote understanding about the impact of the Affordable Care Act on Iowa Medicaid.
Medicaid Value Management Data
The Iowa Medicaid Value Management program utilizes quality measures developed by the Agency for Healthcare Research and Quality (AHRQ) to evaluate the alignment of care received by Iowas adult Medicaid members with best practice standards. First quarter, SFY 13, data is now available. Points of interest include interventions taken by the IME, the Iowa Department of Public Health and March of Dimes appear to be having positive impacts on low birth weight babies in the Medicaid population. Read more at Medicaid Value Management: Realizing the fiscal value of quality care.
The Iowa Medicaid Value Management program analyzed demographic and claim data for members who are dually eligible for both Medicare and Medicaid benefits. The report completed in the third quarter, SFY 12, is now available. Points of interest include analysis of changing demographics for this population, hospital readmission rates compared to the general Medicaid population, quality measure outcomes and initiatives in management of this population as a partner with CMS. Read more at Medicaid Value Management: Realizing the fiscal value of quality care.
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