NEWS

The Iowa Department of Health and Human Services (HHS), pursuant to the requirements outlined in 42 CFR 441.304(f), hereby gives notice of the following intention to amend the Home and Community Based Services (HCBS) AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly, Health and Disability (HD), Intellectual Disabilities (ID), and Physical Disability (PD) Waivers. 

Summary of Submission:

The following changes are being proposed to the 1915(c) waivers:

• Services will now be paid using a straight fee schedule for all providers instead of having variability. This will allow for consistency across waivers. Waivers with the edits: AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly (EW), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD).
• Added the ability to use an “off year” assessment tool every other year when redetermining the level of care for members ages 7 and over. Waivers with the edits: AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD).
• Added new target groups of Autism and Developmental Disability to the Health and Disability (HD) waiver.
• Added new services for members to access on specific waivers.
• Community Transition Services – Community Transitions Services are non-recurring set-up expenses for members who are transitioning from a Medicaid-funded institution or another provider-operated/controlled living arrangement in a private residence where the person is directly responsible for his or her own living expenses, and youth transitioning from Medicaid or HHS funded institutions (PMIC/PRTF/MHI) or settings (foster care or group care/QRTP) to adult residential services. Waivers with the edits: AIDS/HIV, Brain Injury (BI), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD). 
• Peer Mentoring – Peer Mentoring is provided by a peer who draws from common experience as a waiver participant, family member or caregiver to a participant, to support a person with acclimation to independent community living and maintaining community tenure. The peer supports the person by offering advice, guidance, and encouragement on matters of community living. Waivers with the edits: AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD).
• Prevocational Services - Services that provide learning and work experiences, including volunteer work, where the individual can develop general, non-job-task-specific strengths and skills that contribute to employability in paid employment in integrated community settings. Waivers with the edits: AIDS/HIV and Health and Disability (HD). Also updated verbiage in the service definition on the Brain Injury (BI), Intellectual Disability (ID) to ensure consistency.
• Supported Employment- Services are provided to, or on behalf of, the person to enable the person to obtain and maintain an individualized job in competitive employment, customized employment, or self-employment in an integrated work setting in the general workforce. Waivers with the edits: AIDS/HIV and Health and Disability (HD). Also updated verbiage in the service definition on the Brain Injury (BI), Intellectual Disability (ID) to ensure consistency.
• Updated the sampling methodology to be 100% for two of the current performance measures, FA-a1 and HW-d1, within the waivers. This is a technical clean up as these measures were recently revised and were found to have incorrect sampling methods check marked on them during the last reporting to CMS. Waivers with the edits: AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly (EW), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD).
• Technical correction of language from DHS to HHS and from CDAC to Attendant Care. Waivers with the edits: AIDS/HIV and Elderly (EW).

Fiscal Impact:

The fiscal impact for the addition of Peer Mentoring, Community Transition Services, Prevocational Services and Supported Employment for the respective waivers these services are being incorporated into is estimated to be $4,995,884.

Public Review and Comments

A copy of the Waiver amendments and this public notice are posted on the HHS website at the following link: PUBLIC NOTICE: 1915(c) Home and Community Based Services (HCBS) AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly, Health and Disability (HD), Intellectual Disabilities (ID), and Physical Disability (PD) Waivers | Health & Human Services

To reach all stakeholders, non-electronic copies will be made available for review at each local HHS office. 

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

Submission of Comments

Written comments concerning this notice may be addressed to the Long Term Services and Supports (LTSS) Policy Team, Department of Health and Human Services, Iowa Medicaid, 321 East 12th Street, Des Moines, IA 50319 or may be emailed to HCBS_Public_Comment@hhs.iowa.gov. 

All written and emailed comments must be received within 30 days from the issuance of this notice and no later than October 23, 2026 by 4:30 p.m.