The Iowa Department of Health and Human Services (HHS), pursuant to the requirements outlined in 42 C.F.R. §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 changes to the nursing facility (NF) per diem rates utilizing 2022 cost report data under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Summary
Nursing facilities are reimbursed based on a modified price-based system with quarterly adjustments to reflect changes in case-mix (acuity) of Medicaid members residing in the nursing facility. Nursing facility rates are rebased every second year beginning July 1, 2001, to reflect more current cost information on a biannual basis with an effective date of July 1 of each odd numbered year.
Iowa Medicaid calculates prospective per diem rates for nursing facilities and applies an inflation factor to allowable costs. Per diem rates for nursing facilities effective July 1, 2024, shall be at the amounts in effect on June 30, 2024.
The proposed State Plan Amendment (SPA) IA- 24-0004 will also change the method for calculating the case-mix weights. Case-mix weights shall be determined using patient driven payment model (PDPM).
Iowa Medicaid is making this proposed change as required by the 2024 Iowa Acts House File (HF) 2698.
Estimated Fiscal Impact
The changes to reimbursing rates at the amounts in effect on June 30, 2024 is not expected to have a fiscal impact to the facilities or state for rates effective July 1, 2024.
The change to using PDPM weights is not expected to have a fiscal impact to the facilities or state for rates effective July 1, 2024.
Public Review and Comments
A copy of this SPA 24-0004 and public notice is posted on the HHS website at the following link. 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 Robert Payne, Policy Program Manager, Department of Health and Human Services, Iowa Medicaid, 1305 E. Walnut Street, Des Moines, IA 50319 or may be emailed to rpayne@dhs.state.ia.us. Please indicate “SPA IA-24-0004” in the subject line of the email.
All written and emailed comments must be received no later than Thursday, July 18, 2024, by 4:30 p.m.
Submitted by
Elizabeth Matney, Medicaid Director