Fee-for-Service (FFS) Informational Letters

Effective on and after August 15, 2016, all Informational Letters published include a modifier that designates which program(s) the Informational Letter applies to. The modifiers are: MC for Managed Care, FFS for Fee-for-Service and D for Dental. All Informational Letters with the ‘FFS’ (for Fee-for-Service) modifier are included here. All Informational Letters that apply to Fee-for-Service which were published prior to August 15, 2016, can be found on the main Informational Letters web page, which are sorted by year and includes Informational Letters for all programs. For more information see IL 1710.

Fee-for-Service Informational Letters

Letter #         Description Issue Date Effective Date
  2017 Fee-for-Service Informational Letters    

Low Utilization Payment Adjustment (LUPA) Reimbursement Rate Rebase

12/12/2017 Immediately
1867-MC-FFS-D Annual Submission Requirements Regarding Prevention and Detection of Medicaid Fraud and Abuse 12/12/2017 Immediately
1866-FFS AmeriHealth Caritas Iowa, Inc. (AmeriHealth) Withdrawal – Mental Health and Substance Abuse Services 12/08/2017 12/01/2017
1865-FFS AmeriHealth Caritas Iowa, Inc. (AmeriHealth) Withdrawal – HH and IHH Services 12/08/2017 12/01/2017
1864-MC-FFS AmeriHealth Caritas Withdrawal Transition - Billing for Medicaid Services 11/30/2017 12/01/2017
1863-MC-FFS-D FQHC/RHC Rate Floor Update 12/01/2017 01/01/2018
1862-MC-FFS-D Suspension of Managed Care Organization (MCO) Choice 11/29/2017 12/01/2017
1861-MC-FFS Non-emergency Medical Transportation (NEMT) IA Health Link Transition Update 11/30/2017 Immediately
1860-MC-FFS Iowa Medicaid Pharmacy Program Changes 11/29/2017 01/01/2018
1859-MC-FFS Multiple Procedure Payment Reduction (MPPR) for Therapy Claims- Increased Payment Reduction and Change in Payment Methodology 11/21/2017 01/01/2018
1858-MC-FFS Outpatient Rehabilitation Services Provided by a Nursing Facility (NF) 11/21/2017 02/01/2018
1855-MC-FFS-D Provider Enrollment with Managed Care Organizations (MCOs) 11/14/2017 Immediately
1854-MC-FFS Nursing Facility FFS Rate Information and Long-Term Care (LTC) Compilation Reports 11/16/2017 Upon Receipt
1852-MC-FFS Preferred Diabetic Syringes 11/07/2017 01/01/2018
1851-MC-FFS Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Procedures – Increased Payment Reduction 11/09/2017 12/01/2017
1850-MC-FFS Service Code Changes to Home- and Community-Based (HCBS) Habilitation Home Based Habilitation Service 11/03/2017 12/01/2017
1849-FFS RCF Maximum Per Diem Rate Increase and Personal Needs Allowance Decrease 11/06/2017 01/01/2018
1848-MC-FFS-D AmeriHealth Caritas Withdraw 11/01/2017 12/01/2017
1847-MC-FFS-D Retroactive Medicaid Coverage 10/30/2017 11/01/2017
1846-MC-FFS Tiered Rates for Home- and Community-Based Services (HCBS) ID Waiver 11/02/2017 12/01/2017
1845-MC-FFS Occupational, Physical, and Speech Therapy (OT/PT/ST) For NF Residents 11/06/2017 Immediately

Accredited Crisis Response Services and Subacute Mental Health Services

11/02/2017 Upon Receipt
1843-MC-FFS-D Same Day Billing for Multiple Encounters with Multiple Diagnoses 11/02/2017 04/01/2017
1842-MC-FFS Home- and Community-Based Services (HCBS) Residential Setting Member Assessment 11/03/2017 Immediately
1841-MC-FFS-D Retroactive Medicaid Coverage 10/26/2017 Upon Receipt
1840-MC-FFS-D Adult Dental Redesign Reminders for Dentists 10/24/2017 07/01/2017
1839-MC-FFS Updated Codes for Long Acting Reversible Contraception (LARC) 10/19/2017 Immediately
1838-MC-FFS-D Care for Kids Periodicity Schedule 10/31/2017 Immediately
1837-MC-FFS Medication Coverage for Medication Assisted Treatment (MAT) 10/19/2017 Immediately

Two-Tiered Hospice Payment and Service Intensity Add-on (SIA)

10/19/2017 10/01/2017
1835-MC-FFS 2017 Provider Quality Management Self-Assessment 10/09/2017 Upon Receipt
1834-MC-FFS Anesthesia Base Unit Updates 09/27/2017 11/01/2017

Annual Hospice Rates

09/19/2017 10/01/2016
1832-MC-FFS Clarification for Referring Providers and Reimbursement on Emergency Room (ER) Visits 09/19/2017 Immediately
1831-MC-FFS Procedure Codes Q9985 and Q9986 Replacing Procedure Code J1725 09/13/2017 07/01/2017
1829-MC-FFS Proper Use of the “SC” Modifier 10/03/2017 Immediately
1828-MC-FFS Third Party Liability for Prenatal Care and Preventive Pediatric Preventive Services 09/18/2017 01/01/2018
1827-MC-FFS Procedure Code 99188 - Topical Fluoride Varnish 09/13/2017 11/01/2017
1826-MC-FFS Further Clarification of Assessment Tools Approved for Home- and Community-Based Services 09/01/2017 09/10/2017
1825-MC-FFS ICD-10 Diagnosis and Procedure Code Updates 09/01/2017 10/01/2017
1824-MC-FFS Iowa Medicaid Pharmacy Program Changes 08/28/2017 10/01/2017
1822-MC-FFS Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Procedures – Increased Payment Reduction 09/05/2017 10/01/2017
1821-MC-FFS 52 Modifier Increased Reduction – Alignment with Industry Standards 08/29/2017 10/01/2017
1820-MC-FFS Cost Reporting Requirements and Medicaid Fee-for-Service (FFS) Cost Settlement 08/23/2017 Immediately
1819-MC-FFS-D Email Address Notification for Informational Letters 08/18/2017 08/21/2017
1818-MC-FFS-D Drugs for Rare Diseases under Outpatient Pharmacy Benefit 08/17/2017 07/01/2017
1817-MC-FFS-D Annual Provider Training 2017 08/17/2017 Upon Receipt
1816-MC-FFS Nursing Facility Rate Rebase 08/15/2017 07/01/2017
1815-MC-FFS Site of Service (SoS) Differential Clarification 08/10/2017 07/01/2017
1814-FFS Critical Incident Reporting (CIR) through IMPA for FFS Members 08/09/2017 01/01/2017
1813-MC-FFS CMS 1500 Billing Clarification for FQHCs and RHCs 08/08/2017 Immediately
1812-FFS Extension of the Hospital Health Care Access Assessment Program 07/28/2017 07/01/2017
1811-FFS Reimbursement Rate and Submission of Cost Reports 08/01/2017 07/01/2017
1810-MC-FFS Reimbursement of Casting and Splint Supplies 07/14/2017 08/01/2017
1809-MC-FFS Provider-Initiated Termination from Participation with Iowa Medicaid 06/30/2017 Immediately
1808-MC-FFS-D Retroactive Medicaid Coverage 06/30/2017 10/01/2017
1807-FFS State Family Planning Program (FPP) Clarification 06/23/2017 Immediately
1806-MC-FFS Reimbursement of Emergency Room (ER) Visits 06/20/2017 Immediately
1805-MC-FFS Electronic Visit Verification (EVV) 06/19/2017 Upon Receipt
1804-MC-FFS-D Adult Dental Redesign 06/14/2017 Immediately
1803-MC-FFS Medicare Part A and Part B Crossover Claims for Dually Eligible Medicare and Medicaid Members 06/01/2017 07/01/2017
1801-MC-FFS 2017 Civil Money Penalty Quality Improvement Initiative Grant (CMPQII) 05/31/2017 Upon Receipt
1800-MC-FFS Site of Service (SoS) Differential 06/01/2017 07/01/2017
1799-MC-FFS Diagnosis-Related Group (DRG) Cost Outlier Threshold 06/01/2017 07/01/2017
1798-MC-FFS Current Procedural Terminology (CPT) Codes for Consultation Services 06/01/2017 07/01/2017
1797-MC-FFS Anesthesia Conversion Factor 06/01/2017 07/01/2017
1796-MC-FFS Increased Payments to Qualifying Primary Care Physicians for Certain Services 06/01/2017 07/01/2017
1795-MC-FFS State Family Planning Program (FPP) 06/06/2017 07/01/2017
1794-FFS Inpatient Psychiatric Hospitalization Prior Authorization Process 05/31/2017 07/01/2017
1793-FFS Referrals from Indain Health Service (IHS) Providers 05/26/2017 Immediately
1792-MC-FFS 2017 Civil Money Penalty Quality Improvement Initiative Grant (CMPQII)
Replaced by IL 1801-MC-FFS
05/26/2017 Immediately
1791-MC-FFS-D IA Health Link - Managed Care Wraparound Payments – Submission of Wraparound Payment Requests 05/23/2017 Immediately
1790-MC-FFS-D IA Health Link - Managed Care Wraparound Payments - Clarification of Data Source for IME Form 470-5419 05/11/2017 Immediately
1789-MC-FFS Updated Emergent Diagnosis Codes 05/19/2017 06/15/2017
1787-MC-FFS-D Final Notice - Provider Enrollment Renewal 05/02/2017 Immediately
1786-MC-FFS Iowa Medicaid Pharmacy Program Changes 04/27/2017 06/01/2017
1785-MC-FFS Billing Usual and Customary Charges 05/03/2017 Immediately
1783-MC-FFS Iowa Medicaid Pharmacy Dispensing Fee Decrease 04/07/2017 Immediately
1782-MC-FFS 2017 Update for Outpatient Prospective Payment System (OPPS) 04/21/2017 01/01/2017
1781-MC-FFS Multiple Procedure Payment Reductions (MPPR) for Therapy Claims 03/21/2017 01/01/2017
1780-MC-FFS-D Amendments to the Iowa Medicaid Provider Agreement General Terms (470-2965) 03/24/2017 04/24/2017

 IA Health Link-Managed Care Wraparound Payments-Clarifications

03/15/2017 Immediately
1778-MC-FFS-D Electronic Health Record (EHR) Incentive Program 03/10/2017 Immediately
1776-MC-FFS Update Patient Tier Assignment Tool (PTAT) with Expanded Diagnosis Clusters (EDCs) Version 10 03/29/2017 Immediately
1777-MC-FFS New Billing Requirement - Clinical Laboratory Improvement Amendments (CLIA) Certification Number on Claims 03/03/2017 04/01/2017

IA Health Link-Managed Care Wraparound Payments-Clarifications
Replaced by IL 1779-MC-FFS-D

03/03/2017 Immediately
1774-MC-FFS-D Iowa’s Participation in the Federal Fiscal Year 2017 PERM Program 03/16/2017 Upon Receipt
1773-MC-FFS Billing Medicaid for Services Provided in a Certified Level 2 or 3 Neonatal Intensive Care Unit (NICU) 03/01/2017 04/01/2017
1772-MC-FFS Type of Bill for Hospice 03/02/2017 04/01/2017
1771-MC-FFS-D How to Report and Access Third Party Liability (TPL)  03/14/2017 Immediately
1770-FFS Iowa Medicaid Pharmacy Reimbursement Rules 02/24/2017 04/01/2017
1769-MC-FFS-D Iowa Medicaid Pharmacy Program Changes 02/20/2017 04/01/2017
1768-MC-FFS Low Utilization Payment Adjustment (LUPA) Reimbursement Methodology Update 02/17/2017 Immediately
1767-MC-FFS Pediatric Flu Vaccine Provided by the Vaccine for Children (VFC) Program 02/17/2017 Immediately
1766-MC-FFS Two-Tiered Hospice Payment and Service Intensity Add-on (SIA)
02/17/2017 Immediately
1765-MC-FFS Billing Nursing and Home Health Aide (HHA) Services by Medicare Certified Home Health Agencies 02/14/2017 Immediately
1764-FFS Face-to-Face Encounter on Initiation of Home Health Services 02/13/2017 Immediately
1763-MC-FFS Billing Home Health Agency Nursing and Home Health Aide (HHA) Services
Replaced by Info Letter 1765-MC-FFS
02/07/2017 Immediately
1761-MC-FFS Clarification of Assessment Tools Approved for Home- and Community- Based Services (HCBS) 02/01/2017 Immediately
1760-MC-FFS Care Planning For Preadmission Screening and Resident Review (PASRR) Level II Identified Services 01/31/2017 Immediately
1759-MC-FFS Occupational, Physical, and Speech Therapy (OT/PT/ST) For NF Residents
Replaced by Info Letter 1845-MC-FFS
02/01/2017 Immediately
1758-MC-FFS Reimbursement of Emergency Room (ER) Visits – CLARIFICATION 02/01/2017 04/01/2016
1757-MC-FFS Iowa Medicaid Pharmacy Program Changes Prospective Drug Utilization Review (ProDUR) Antipsychotic Edits 01/18/2017 03/01/2017
1756-FFS Home- and Community Based-Services (HCBS) Habilitation-Update 01/11/2017 04/01/2016
Home- and Community Based-Services (HCBS) Habilitation
Replaced by Info Letter 1756-FFS
01/10/2017 04/01/2016
  2016 Fee-for-Service Informational Letters    
1753-MC-FFS Reimbursement of Emergency Room (ER) Visits 12/23/2016 04/01/2016
1752-MC-FFS Multiple Procedure Payment Reductions (MPPR) for Therapy Claims 12/19/2016 01/01/2017
1751-MC-FFS-D Important Mailing Dates to all Medicaid Members 12/15/2016 Upon Receipt
1750-MC-FFS Preferred Diabetic Syringes 12/15/2016 01/01/2017
1749-MC-FFS Reminder of Upcoming Webinar on the Revised Critical Incident Report (CIR) Form 470-4698 12/09/2016 01/01/2017
1748-FFS Use of Modifier “82” for Surgical Assistance 12/13/2016 01/01/2017

Change in Provider Enrollment Application Fee

12/01/2016 01/01/2017
1746-MC-FFS-D Iowa Medicaid Pharmacy Program Changes 11/28/2016 01/01/2017
1745-MC-FFS Iowa Medicaid Critical Incident Reporting (CIR) Revision and Training for HCBS and Habilitation Providers 11/22/2016 01/01/2017
1743-MC-FFS Limitations of HCBS Home Delivered Meals 11/10/2016 Immedialtey
1742-MC-FFS-D Electronic Health Record (EHR) Incentive Program 11/07/2016 Immediately
1741-MC-FFS Supplementation Submission 11/22/2016 Upon Receipt
1740-FFS Residential Care Facility (RCF) Maximum Per Diem Rate Increase and Personal Needs Allowance Decrease 11/03/2016 01/01/2017
1738-FFS Monthly Provider Assessment Update 11/04/2016 07/01/2016
1737-MC-FFS-D New Centers for Medicare and Medicaid Services (CMS) Guidance on Access and Cultural Considerations 11/01/2016 Immediately
1736-MC-FFS-D Statewide Alert Notification (SWAN) Process Change 10/27/2016 Immediately
1735-MC-FFS Hospice Provided in an Intermediate Care Facility for the Intellectually  Disabled (ICF/ID) 11/01/2016 Immediately
1734-MC-FFS-D Documentation Submission Process 11/01/2016 12/01/2016
1732-MC-FFS Reminder – Iowa Wellness Plan (IWP) Copayment Requirement Non-emergent Use of the Emergency Department (ED) 10/28/2016 12/01/2016
1729-MC-FFS 2016 Provider Quality Management Self-Assessment 10/19/2016 Upon Receipt
1727-MC-FFS-D Annual Submission Requirements - Employee Policies Regarding Prevention and Detection of Medicaid Fraud and Abuse 10/06/2016 Immediately
1726-MC-FFS Managed Care Information available through the Individualized Services Information System (ISIS) 10/05/2016 Immediately
1725-MC-FFS-D 1915(b)(3) Mental Health and Substance Abuse Services 09/29/2016 04/01/2016
1724-MC-FFS IA Health Link Newborn Eligibility 10/24/2016 04/01/2016
1723-MC-FFS-D Reminder - Provider Enrollment Renewal 09/19/2016 Immedialtey
1722-MC-FFS Iowa Medicaid Pharmacy Program Changes 09/14/2016 10/01/2016
1721-FFS Implementation and Reprocessing of Inpatient Hospital Rebase and Recalibration and Outpatient Hospital Rebase 09/14/2016 Immediately
1720-MC-FFS Approval of the HCBS Waiver Settings Statewide Transition Plan (STP) 09/14/2016 Immediately
1719-MC-FFS Same Day Billing for Mental Health and Primary Care Services 09/19/2016 10/01/2016
1717-MC-FFS In-Home Health Related Care (IHHRC) and Iowa Medicaid 09/07/2016 Immediately
1716-MC-FFS Iowa Medicaid Pharmacy Program Changes
Replaced by Info Letter 1722-MC-FFS
08/30/2016 10/01/2016
1714-MC-FFS-D IA Health Link-Managed Care Wraparound Payments-Updated Forms and Clarifications 08/22/2016 Immediately
1713-MC-FFS Crossover Claims for Ambulance Services for Dually Eligible Medicare and Medicaid Members 08/22/2016 Immediately
1711-MC-FFS HH Agency Condition Codes-Clarification 08/15/2016 08/01/2016
1709-MC-FFS-D Annual Provider Training 2016 08/15/2016 Upon Receipt