Iowa Department of Human Services

Medicaid State Plan Documents

A State Plan is a contract between a state and the Federal Government describing how that state administers its Medicaid program. It gives an assurance that a state abides by Federal rules and may claim Federal matching funds for its Medicaid program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative requirements that States must meet to participate. States frequently send a state plan amendment, otherwise referred to as a SPA, to the Centers for Medicare and Medicaid Services (CMS) for review and approval. There are many reasons why a state might want to amend their state plan. For example, the state may wish to implement changes required by Federal or state law, Federal or state regulations, or court orders. States also have the flexibility to request permissible program changes, make corrections, or update their plan with new information.

Send your questions or comments to:
Alisa Horn - AHorn@dhs.state.ia.us

Cover

Table of Contents

List of Attachments

1.0 Single State Agency Organization Unit
	1.1 Designation and Authority
	Attachment A: Attorney General's Certification
	1.2 Organization for Administration
	Attachment A: Organization and Function of State Agency Attachment B: Organization and Function of Medical Assistance Unit Attachment C: Professional Medical and Supporting Staff Attachment D: Description of Staff Making Eligibility Determination
	1.3 Statewide Operation
	1.4 State Medical Care Advisory Committee
	1.5 Pediatric Immunization Program

2.0 Coverage and Eligibility
	2.1 Application, Determination of Eligibility and Furnishing Medicaid
	Attachment A: Definition of an HMO that is Not Federally Qualified
	2.2 Coverage and Conditions of Eligibility
	Attachment A- Groups Covered and Agencies Responsible for Eligibility S1 - Supplement 1 to Attachment A S3 - Supplement 3 to Attachment A
	2.3 Residence
	2.4 Blindness
	2.5 Disability
	2.6 Financial Eligibility
	Attachment A- Eligibility Conditions and Requirements S1 - Income Eligibility Levels- Categorically Needy, Medically Needy and Qualified Medicare Beneficiaries S2- Resource Levels- Categorically Needy, Including Groups with Income up to a Percentage of the Federal Poverty Level, Med S3- Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid S4- Section 1902(f) Methodologies for Treatment of Income that Differ from those of the SSI Program S5- Section 1902(f) Methodologies for Treatment of Resources that Differ from those of the SSI Program S5a- Methodologies for Treatment of Resources for Individuals with Income up to a Percentage of Federal Poverty Level S6- Standards for Optional State Supplementary Payments S7- Income Levels for 1902(f) States- Categorically Needy Who Are Covered Under Requirements More Restrictive than SSI S8- Resource Standards for 1902(f) States- Categorically Needy S8a - More Liberal Methods of Treating Income Under Section 1902 r (2) S8b- Supplement 8b to Attachment A S9- Transfer of Resources S9a- Supplement 9a to Attachment A S9b- Supplement 9b to Attachment A S10- Consideration of Medicaid Qualifying Trusts- Undue Hardship S11- Cost-Effective Methods for COBRA Groups (States and Territories) S12- Supplement 12 to Attachment A S13- Supplement 13 to Attachment A S14- Supplement 14 to Attachment A S17- Supplement 17 to Attachment A
	2.7 Medicaid Furnished Out of State

3.0 Services: General Provisions
	3.1 Amount, Duration, and Scope of Services
	Attachment A - Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy S1- Supplement 1 to Attachment A S2- Supplement 2 to Attachment A S3- Supplement 3 to Attachment A Attachment B Attachment C Attachment D Attachment E Attachment F Attachment H
	3.2 Coordination of Medicaid with Medicare Part B
	Attachment A Attachment B
	3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
	3.4 Special Requirements Applicable to Sterilization Procedures
	3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries
	3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period

4.0 General Program Administration
	4.1 Methods of Administration
	4.2 Hearings for Applicants and Recipients
	4.3 Safeguarding Information on Applicants and Recipients
	4.4 Medicaid Quality Control
	4.5 Medicaid Agency Fraud Detection and Investigation Program
	4.6 Reports
	4.7 Maintenance of Records
	4.8 Availability of Agency Program Manuals
	4.9 Reporting Provider Payments to the Internal Revenue Service
	4.10 Free Choice of Providers
	4.11 Relations with Standard-Setting and Survey Agencies
	Attachment A
	4.12 Consultation to Medical Facilities
	4.13 Required Provider Agreement
	4.14 Utilization Control
	4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases
	4.17 Liens and Recoveries
	Attachment A
	4.18 Cost Sharing and Similar Charges
	Attachment A - Charges Imposed on Categorically Needy AttachmentC - Charges Imposed on Categorically Needy and Other Optional Groups AttachmentD - Premiums Imposed on Low-Income Pregnant Women and Infants Attachment E - Premiums Imposed on Qualified Disabled and Working Individuals
	4.19 Payment for Services
	Attachment A - Methods and Standards for Establishing Payment Rates- Inpatient Hospital Care Attachment B - Methods and Standards for Establishing Payment Rates- Other Types of Care S1- Supplement1 to Attachment B S2- Supplement2 to Attachment B Attachment C - Payments of Reserved Beds Attachment D - Methods and Standards for Establishing Payment Rates- Skilled Nursing and Intermediate Care Facility Services S1- Supplement 1 to Attachment D S2- Supplement 2 to Attachment D S3- Supplement3 to Attachment D S3- Supplement 4 to Attachment D Attachment E - Timely-Claims Payment- Definition of Claim
	4.20 Direct Payments to certain Recipients for Physicians' or Dentists' Services
	4.21 Prohibition Against Reassignment of Provider Claims
	4.22 Third Party Liability
	Attachment A - Requirements for Third Party Liability- Identifying Liable Resources Attachment B - Requirements for Third Party Liability- Payment of Claims Attachment C - Cost-Effective Methods for Employer-Based Group Health Plans
	4.23 Use of Contracts
	4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
	4.25 Program for Licensing Administrators of Nursing Homes
	4.27 Disclosure of Survey information and Provider or Contractor Evaluation
	4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities
	4.29 Conflict of Interest Provisions
	4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals
	Attachment OT - Attachment to 4.30
	4.31 Disclosure of Information by Providers and Fiscal Agents
	4.32 Income and Eligibility Verification System
	Attachment A - Income and Eligibility Verification System Procedures: Requests to Other State Agencies
	4.33 Medicaid Eligibility Cards for Homeless Individuals
	Attachment A - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
	4.34 Systematic Alien Verification for Entitlements
	Attachment A
	4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation
	Attachment A Attachment B Attachment C Attachment D Attachment E Attachment F Attachment G Attachment H
	4.36 Required Coordination Between the Medicaid and WIC Programs
	4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
	4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
	Attachment A
	4.40 Survey and Certification Process
	Attachment A Attachment B Attachment C Attachment D Attachment E
	4.41 Resident Assessment for Nursing Facilities
	4.43 Frequency and Description of Method of Compliance Oversight
	Attachment A

5.0Personnel Administration
	5.1Standards of Personnel Administration
	5.3Training Programs; Subprofessional and Volunteer Programs

6.0Financial Administration
	6.1 Fiscal Policies and Accountability
	Attachment to 6.1
	6.2 Cost Allocation
	6.3 State Financial Participation

7.0General Provisions
	7.1Plan Amendments
	7.2Nondiscrimination
	Attachment A - Methods of Administration- Civil Rights Act (Title VI)
	7.3Maintenance of AFDS Effort
	7.4State Governor's Review

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