Pursuant to the authority of Iowa Code Section 249A.4, the Iowa Department of Health and Human Services (HHS) has proposed changes to the state plan under Medicaid State Plan Amendment (SPA) Attachment 3.1-C and Attachment 4.19-B 1915(i) State Plan HCBS Habilitation (IA-23-0023) and serves to open the 30-day public comment period which closes on August 31, 2023. 


The State of Iowa’s Medicaid program currently operates the 1915(i) State Plan HCBS Habilitation program. The changes to the 1915(i) SPA listed below were developed in partnership and collaboration with the Managed Care Organizations (MCOs), provider association and Habilitation providers.  The proposed changes in each SPA are summarized below:

This SPA is intended to:

  • Make technical corrections to include:
  • Changing Iowa Medicaid Enterprise and IME to Iowa Medicaid
  • Changing Department of Human Services (DHS) to Department of Health and Human Services (HHS)
  • Changing Individualized Services Information System (ISIS) to Institutional and Waiver Authorization and Narrative System (IoWANS)
  • Permanently adopt COIVD-19 PHE flexibilities including
  • Allow some services to be delivered via telehealth.
  • Electronic signatures will continue to be appropriate when a pen and ink signature is not possible.
  • Add Remote Supports and Host Home service delivery model guidelines to the Home-Based Habilitation service description.
  • Add Enabling Technology to support the implementation of Remote Support 
  • Remove the limitation that prevents the immediate family member from being a direct support professional (DSP).
  • Added Exception to Policy (ETP) language under services that allow for ETPs to be requested.
  • Added Telehealth as a service delivery option for services where it is allowed.
  • Update the definition of major and minor incidents.
  • Performance Measures and Quality Improvement Section (QIS)
  • All QIS Sections updated PMs to remove introductory language and only start with “Number and Percent”
  • All QIS Sections with less than 100% sampling: updated the confidence interval text box to read as: “95% confidence level with +/- 5% margin of error”.
  • All QIS Sections reviewed and updated as needed to ensure they meet the standard and that the PM, Numerator, and Denominator all align.
  • Added new health and welfare performance measures related to emergency room visits and primary care physician visits and updated existing measures to match the 1915(c) waiver performance measures where applicable and appropriate.
  • Updated the Financial Integrity performance measures.

The tentative effective date for SPA 23-0023 is November 1, 2023

Fiscal Impact

The fiscal impact is related to implementation of the Enabling Technology service and is minimal during SFY2024 and SFY2025. It is anticipated that a cost savings will be realized in SFY2025 as members begin to utilize enabling technology with remote support.

Total Annual Projected Cost SFY 24

State Share SFY 24

Fed Share SFY 24




Total Annual Projected Cost SFY 25

State Share SFY 25

Fed Share SFY 25




Public Review and Comments

A copy of SPA IA 23-0023 and this public notice are available at the following link: https://hhs.iowa.gov/public-notices.

To reach all stakeholders, non-electronic copies will be made available for review at the HHS Field Offices.

Prior to finalizing, HHS will consider all written comments received.  The comments will be summarized and addressed in the final SPA submitted to CMS.

Written comments concerning this notice, or the SPA, may be addressed to: LeAnn Moskowitz, LTSS Policy Specialist, Iowa Department of Health and Human Services, Iowa Medicaid, 1305 East Walnut Street, Des Moines, Iowa 50319-0114 or via email at lmoskow@dhs.state.ia.us.

Please indicate the SPA Number IA 23-0023 in the subject line of the email.  All comments must be received by: August 31, 2023, at 4:30 PM.


Submitted by:

Elizabeth Matney, Medicaid Director

Iowa Department of Health and Human Services

Iowa Medicaid