A Quick recap of the IME Townhall meeting for providers on 6-22-23

Medicaid reimbursement rates for individual mental health providers increases

Approximately 30 individual mental health provider (clinical social workers, psychologists and behavioral health providers) billing codes will be increased by 56.57%.

Iowa Medicaid Enterprise (IME) is working on a letter that will include all of the specific billing codes that they will send out to providers.

The rate increase will be effective starting 7-1-23 – with 2 caveats:

• IME does have to file an amendment to the State Medicaid Plan, which has to be approved by the Centers for Medicare and Medicaid (CMS).  IME Director Liz Matney anticipates that the rate increases will be approved.  
• The new rates won’t be uploaded into the billing systems for several weeks, so there will be some delay in the actual rate increase that providers see.  However, the new rates will be retroactive to 7-1-23.

The rates were brought up to at least 85% of benchmark rates.  Community Mental Health Center rates were already above 85%, so those billing codes will not be increased this year.

Rates at hospitals:  Iowa Hospital Association is working on new rates for both inpatient and outpatient services at hospitals.

Substance Use Disorder Rate Increases

Substance Use Disorder rates will be increased by 96.47%.  There are about 5 billing codes that will be impacted.

Durable Medical Equipment (DME)

There was not an appropriation for DME, but IME has reviewed those rates is aware of the need for additional investment for DME.

MEDICAID UNWIND

If clients have not provided the information requested by IME for redetermination and are disenrolled, they do have a 90 day grace period to provide that information (either with a new application or with the  redetermination form) and then if they qualify, have their coverage be reinstated retroactively.