The Centers for Medicare & Medicaid Services (CMS) has issued regulations that define the settings in which it is permissible for states to pay for Medicaid Home-and Community-Based Services (HCBS).

Iowa Department of Human Services (DHS) intends to submit a final Statewide Transition Plan (STP), in accordance with 42 CFR §441.304 for CMS approval. This notice provides details about the STP for HCBS Settings and serves to open the 30-day public comment period which closes on July 5, 2022. 


On March 17, 2014, CMS issued a final rule for HCBS that requires the State of Iowa to identify all residential and nonresidential settings where HCBS services are provided for the purpose compliance with the final rule. Once identified, Iowa is required to establish a systematic process to review and assess the settings where members receive HCBS services to determine if each setting complies with the final rule.  CMS required that Iowa’s systematic approach would be assessed through the development and submission of an initial and final STP.

Iowa Medicaid submitted an initial STP to CMS in March 2016.  CMS provided feedback and identified required changes prior to initial approval. Iowa addressed the technical corrections identified by CMS and was given approval of the initial STP on August 9, 2016. A final version of the STP was submitted to CMS on December 19, 2019.  After review, CMS requested additional information that would be required before final approval of the plan could be accepted.  The final STP open for public comment includes the requested information needed for final approval of Iowa’s STP.

Fiscal Impact

There is no fiscal impact related to the changes proposed in the Final STP for HCBS Settings.

Public Review and Comments

A final draft version of the STP has been developed to address the actions needed by Iowa Medicaid for final plan approval. Information about previous STP submissions and the final Statewide HCBS STP can be found on the DHS website: A copy of the STP can be found along with the public notice on the DHS website:

To reach all stakeholders, non-electronic copies will be made available for review at each local DHS office.

Prior to submitting the final STP to CMS, DHS will consider all written comments received. The comments will be summarized and included in the final STP submitted to CMS.

Written comments concerning this notice or the State Transition Plan, may be addressed to: Iowa Department of Human Services, Iowa Medicaid, 1305 East Walnut Des Moines, Iowa 50309 or via email at Please indicate “Final STP for HCBS Settings” in the subject line of the email. Written and e-mailed comments must be received within 30 days from the issuance of this notice. All comments must be received by: July 5, 2022 at 4:30 PM.

Additional Attachments

Submitted by:

Elizabeth Matney,

Medicaid Director

Iowa Department of Human Services