Ask for a Waiver of Administrative Rules
A waiver request must be in writing. You can write a letter or complete a Waiver of Administrative Rules Petition form.
Please answer all questions on this form and be specific. Complete the Waiver of Administrative Rules Petition form online.
Once the form is completely filled out, click the submit button at the bottom of the form. Your request will be sent directly to the Appeals Section.
If you have additional documentation that will help support your request, please mail, fax or email the information to the Appeals Section so it can be used when making a decision on your request.
If the request is medical in nature, please provide documentation to prove that the item or service is medically necessary. You will need to include the costs or proposed savings of the request.
Mail, fax or email the additional documentation to:
Department of Health and Human Services
Appeals Bureau
321 E. 12th Street, 4th Floor
Des Moines, IA 50319
FAX: 515-564-4118
Email: [email protected]
If you choose not to use the Waiver of Administrative Rules Petition form and you want to request a waiver, write a letter with the following:
List the name, address, and Medicaid number (state ID number) of the person who needs the waiver.
- Describe what the person needs.
- Explain why it is needed. If it is medical in nature, include the medical necessity of the item or service.
- Include the costs and/or proposed savings of the request.
- Tell what has been tried in the past with the person.
If a home health agency is requesting a waiver on behalf of a consumer, the following should be included, as well as the information listed above:
- Explain the services needed, including the hours requested and the level of care involved.
- Identify what other programs are involved with the consumer, such as waiver, in-home health-related care, etc.
- Describe the cost breakdown, salary, fringe benefits, and mileage of the person who is doing the care.
- Incorporate the plan of care or the plan of treatment.
- Include the past 30 days of care notes.
Waiver of Administrative Rule Review
A waiver of administrative rule is granted when the item or service being requested would improve the quality of life of a consumer at no additional cost to the state, or when it would result in savings to the state.
HHS may approve a waiver of administrative rule if all of the following are true:
- The rule causes a hardship for the person or group asking for the waiver.
- Granting the waiver won’t affect someone else’s rights;
- The rule isn’t required by state or federal law; and
- The requestor’s health, safety and welfare will still be protected even if the rule is waived.
A waiver of administrative rule is granted at the discretion of the Director of the Department of Health and Human Services.
If your disagree with a waiver of administrative rule recommendation, you can ask to have your request reconsidered. You may write a letter or complete the Waiver of Administrative Rules Petition form.
Please answer all questions on this form and be sure to be specific. Complete the Waiver of Administration Rules Petition online.
Once the form is completely filled out, click the submit button at the bottom of the form. Your request will be sent directly to the Appeals Bureau.
If you have additional information that will help support your request, please mail, fax, or e-mail the information to the Appeals Bureau so it can be used when making a decision on your request.
If the request is medical in nature, please provide documentation to prove that the item or service is medically necessary. You will need to include the costs or proposed savings of the request.
Mail, fax or email the additional documentation to:
Department of Health and Human Services
Appeals Bureau
321 E 12th Street, 4th Floor
Des Moines, IA 50319
FAX: 515-564-4118
Email: [email protected]
There are no appeal rights on a waiver of administrative rule request.
Time Limits at https://hhs.iowa.gov/appeals/how-appeal