PUBLIC NOTICE: State Plan Amendment (SPA) IA 23-005 Non-State Government-Owned or Operated Nursing Facility Quality of Care Incentive Payment Program

The Department of Health and Human Services (HHS), pursuant to the requirements outlined in 42 CFR 447.205 and 1902(a)(13)(A) of the Social Security Act, hereby gives notice of the following proposed action regarding its methods and standards for paying providers under the State Plan Amendment under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Summary

Effective for nursing facility services provided on or after approval of State Plan Amendment (SPA) IA-23-0005), but no earlier than July 1, 2023, Iowa Medicaid proposes to implement a quality-of-care incentive payment program (QIPP) for participating non-state government owned or operated nursing facilities (NSGO).  Under this program:

  • NSGO nursing facility (NF) providers meeting quality measures would receive Medicaid supplemental calculated in accordance with the upper payment limit (UPL) requirements pursuant to 42 CFR 447.272.
  • HHS would use matching federal funds to increase payment to eligible NSGO NF providers.
  • NSGO NF providers would provide the state share of total payments through an intergovernmental transfer (IGT).

The QIPP supplemental reimbursement is in addition to the reimbursement that NSGO NF providers currently receive from Iowa Medicaid. The QIPP program would allow NSGO NF providers supplemental payments when they are meeting quality measures described here.

This proposed SPA IA-23-0005 will allow HHS to establish a supplemental payment for NSGO NF providers and will allow these providers to receive the funds. To follow legislative requirements when it implements the QIPP program, HHS will also need to:

  • Create a system to collect funds from eligible providers and set up appropriate federal matching and enhanced payments.
  • Create an IGT agreement with eligible providers for participation.
  • Oversee the ongoing collection of funds and business processes to ensure proper federal matching and enhanced payment to participating providers

Estimated Fiscal Impact

Iowa Medicaid estimates the changes described will not increase total Medicaid expenditures as there were no fee-for-service claims for NSGO providers in the state fiscal year ending June 30, 2022. The proposed NSGO supplemental payment program is subject to approval by the Centers for Medicare and Medicaid Services (CMS).

Public Review and Comments

A copy of this SPA 23-0005 and public notice is posted on the HHS website at the following link: https://hhs.iowa.gov/sites/default/files/Public-Notice_2.9.23.pdf.  To reach all stakeholders, non-electronic copies will be made available for review at each local HHS office.

Submission of Comments

Written comments may be sent to Jessica McBride, Policy Program Manager, Department of Health and Human Services, Iowa Medicaid, 1305 E. Walnut Street, Des Moines, IA 50319 or may be emailed to jmcbrid@dhs.state.ia.us. Please indicate SPA IA-23-0005 in the subject line of the email.

All written and emailed comments must be received no later than March 13, 2023, by 4:30 p.m.

Attachments

Submitted by:

Elizabeth Matney

Medicaid Director

Iowa Medicaid

Iowa Department of Health and Human Services