Initiatives

The Iowa Medicaid Enterprise continuously makes progress on a wide variety of initiatives and projects. To access more details about a specific IME initiative, you may also click on the active headings below.

American Rescue Plan Act (ARPA) 2021

On March 11, 2021, President Joe Biden signed the American Rescue Plan Act (ARPA). Section 9817 of the ARPA provides qualifying states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS programs from April 1, 2021, through March 31, 2022. States must use these federal funds to supplement existing state funds for Medicaid HCBS in effect as of April 1, 2021.

Medicaid Modernization

The Iowa Department of Human Services (DHS) released a Request for Proposal (RFP) for Governor Branstad's Medicaid Modernization on February 16, 2015. This initiative aims to improve the coordination and quality of care while providing predictability and sustainability for taxpayers in Medicaid spending. The RFP, titled the Iowa High Quality Health Care Initiative, asks for bids from potential vendors as the state moves toward a risk-based managed care approach for Iowa’s Medicaid program.

State Innovation Model (SIM)

Awarded a $43.1 million federal grant over a four year period to support state wide health system transformation, Iowa is one of only 11 states to receive this State Innovation Model (SIM) testing grant. Iowa will use the SIM grant to implement and evaluate a sustainable health care delivery and payment system that will improve population health, improve patient care, and bend health care cost trends. Read more about the new SIM program by following the link above.

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 (STAKEHOLDER WEBPAGES)

The Iowa Health and Wellness Plan began on January 1, 2014. The plan provides coverage for individuals age 19-64 with income up to and including 133 percent of the Federal Poverty Level. If you are looking for enrollment information on the Iowa Health and Wellness Plan, please visit the member webpages of the Iowa Health and Wellness Plan.

Health Home

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 Homes

An Integrated Health Home (IHH) is a team of professionals working together to provide whole-person, patient-centered, coordinated care for adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED). The Integrated Health Home will be administered by the Medicaid Behavioral Health Care Managed care Organization (Magellan Behavioral Care of Iowa) and provided by community-based Integrated Health Homes.

Health Information Technology (HIT)

Iowa's Medicaid Promoting Interoperability Program (formerly known as Electronic Health Record (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 incentive program via the Provider Incentive Payment Program (PIPP) system at http://www.imeincentives.com/

International Classification of Diseases, 10th Edition (ICD-10)

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. As announced in Informational Letter 1440, the Iowa Medicaid Enterprise (IME) can no longer accept claims with ICD-9 codes for services delivered on or after October 1, 2015, and inpatient discharges occurring October 1, 2015 or after.  The registration for Iowa Medicaid Enterprise (IME) ICD-10 Volunteer Testing is now open. To register for testing, please contact the IME Provider Services Unit at 1-800-338-7909, or locally in Des Moines at 515-256-4609 or by email at ICD-10project@dhs.state.ia.us.

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. Read more at Medicaid Value Management: Realizing the fiscal value of quality care