Medicaid Initiatives

Managed Health Care
The Iowa Department of Human Services (DHS), with support from the Iowa Medical Society and the Iowa Osteopathic Medical Association, developed and Implemented the Managed Health Care program in Iowa as mandated by the Iowa Legislature via House File 2447 in 1988 and Senate File 541 in 1989. Learn more about the various managed health care options available.

International Classification of Diseases, 10th Edition (ICD-10):
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) must implement ICD-10 code sets for medical coding on October 1, 2013. On August 24, 2012, the HHS announced that it will delay the ICD-10 compliance date by one year to October 1, 2014. The change in the compliance date for ICD-10 gives providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

The Iowa Medicaid Enterprise's (IME) progress toward implementation of the ICD-10 code sets is continuing. The IME continues to prepare for the implementation of ICD-10 by reviewing policy and preparing for updates to medical coverage, rules, operational procedures, and technical systems and intends to conduct external end-to-end testing with providers between October 2013 and October 2014. The IME urges providers to continue forward with their ICD-10 projects. It remains the IMEs goal to work with any impacted organizations doing business with the IME. 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:

Heath Information Technology:
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

Iowa Medicaid Care Management Programs:
The Iowa Medicaid Care Management consists of Care Management, Disease Management, Maternity, and Lock-In. The common themes across these programs are to provider a high level of care coordination to high utilization high risk Medicaid members. The goals of the programs are to support the provider's plan of care and to coordinate services deemed necessary. Medicaid members receiving the best possible health outcomes from high quality health care.

Iowa Medicaid Pharmaceutical Care Management:
Iowa Medicaid Pharmaceutical Care Management (PCM) is an Iowa Medicaid service provided by physicians and pharmacists working together to closely manage the total medication regimens of their most complex patients. The services are provided to Medicaid members who are identified as being at high risk for medication-related problems. The innovative care delivered through this program is based on a model of care known to improve medication safety in hospital and clinic settings where pharmacists and physicians practice under the same roof and have access to patient care records.