2017 Informational Letters

Effective on and after August 15, 2016, all Informational Letters published include a modifier after the Informational Letter number 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. For example, Informational letters that pertain to managed care are designated with the letters "MC" at the end of the Informational Letter number. All Informational Letters for 2016, regardless of modifier, are included here. For more information see IL 1710.

Published Informational Letters

Letter #         Description Issue Date Effective Date
1873-FFS Rate Maximum for Private Duty Nursing and Personal Care Services 12/27/2017 01/01/2018
Clarification - Billing for Acute Diagnosis Related Group (DRG) Hospital Services
12/21/2017 04/01/2016
Physician-Administered Drugs and National Drug Code (NDC) Billing Requirements
12/21/2017 Immediately
1869-MC Provider Enrollment with Managed Care Organizations (MCOs) 12/19/2017 12/01/2017

 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 Floors 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
1857-MC CDAC Provider Enrollment with Managed Care Organizations (MCOs) 11/15/2017 Immediately
1856-MC-FFS-D CDAC Provider Enrollment with Managed Care Organizations (MCOs)
Replaced by IL 1857-MC
11/14/2017 Immediately
1855-MC-FFS-D Provider Enrollment with Managed Care Organizations (MCOs)
Replaced by IL 1869-MC
11/14/2017 Immediately
1854-MC-FFS Nursing Facility FFS Rate Information and Long-Term Care (LTC) Compilation Reports 11/16/2017 Upon Receipt
1853-MC-FFS Procedure Codes J1726 and J1729 Replacing Procedure Codes Q9985 and Q9986 12/21/2017 01/01/2018
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
1830-D Dental Care for Healthy and Well Kids in Iowa (hawk-i) Members 09/11/2017 Immediately
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

Out-of-Network Reimbursement for Managed Care Claims

Replaced by IL 1883-MC

08/28/2017 Immediately
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
1802-MC-FFS Clarification on Billing for Oxygen Concentrators 06/05/2017 Immediately
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 Indian Health Services (IHS) Providers 05/26/2017 Immediately
2017 Civil Money Penalty Quality Improvement Initiative Grant (CMPQII)
Replaced by IL 1801-MC-FFS
1791-MC-FFS-D IA Health Link - Managed Care Wraparound Payments – Submission of Wraparound Payment Requests
Replaced by IL 1905-MC-FFS-D
05/23/2017 Immediately
1790-MC-FFS-D IA Health Link - Managed Care Wraparound Payments - Clarification of Data Source for IME Form 470-5419
Replaced by IL 1905-MC-FFS-D
05/11/2017 Immediately
1789-MC-FFS Updated Emergent Diagnosis Codes 05/19/2017 06/15/2017
1788-D Medicaid Adult Dental Program Redesign 05/02/2017 07/01/2017
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
1779-MC-FFS-D  IA Health Link-Managed Care Wraparound Payments-Clarifications
Replaced by IL 1905-MC-FFS-D
  • Iowa Medicaid Federally Qualified Health Centers (FQHC) and  Rural Health Clinics (RHC) Wraparound Payment Example Scenarios
03/15/2017 Immediately
1778-MC-FFS-D Electronic Health Record (EHR) Incentive Program 03/10/2017 Immediately
1777-MC-FFS New Billing Requirement - Clinical Laboratory Improvement Amendments (CLIA) Certification Number on Claims 03/03/2017 04/01/2017
1776-MC-FFS Update Patient Tier Assignment Tool (PTAT) with Expanded Diagnosis Clusters (EDCs) Version 10 03/29/2017 Immediately

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
1762-MC-D Extension of Due Dates for Managed Care and Dental Wellness Wraparound Requests
Replaced by Info Letter 1905-MC-FFS-D
01/31/2017 01/01/2017
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

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 0301/2017
1756-FFS Home- and Community Based-Services (HCBS) Habilitation-Update 01/11/2017 04/01/2016
1755-D Ordering Referring Prescribing (ORP) 01/05/2017 Immediately
Home- and Community Based-Services (HCBS) Habilitation
Replaced by Info Letter 1756-FFS
01/10/2017 04/01/2016