Life and Everyday

Iowa Medicaid moves forward with cost containment strategies

This is where I obtained this information. The IMS Advocate use the above link to see the entirety of document.

Iowa Medicaid moves forward with cost containment strategies The Iowa Medicaid program is moving forward with various cost containment strategies as directed in HF 649, passed by the Iowa legislature this year. All of these will be detailed in Informational Letters sent out to Medicaid providers and most are effective August 1 of this year. Some of the strategies relevant to Iowa physicians treating Medicaid members:

1. There will be a 15-day supply limit on initial fill of select prescriptions that have high side effect profiles, high discontinuation rates, or frequent dose adjustments.

2. Medicaid will no longer cover drugs used to promote weight loss or prescription drugs used for symptomatic relief of cough and cold.

3. Medicaid will eliminate coverage for bariatric surgery for the treatment of morbid obesity.

4. Medicaid will eliminate payment for hospital-acquired conditions (“never events”).

5. Medicaid payment for some physician services will be reduced based on the place of service. A new procedure pricing factor code derived from Medicare will apply. Medicaid’s rationale is that it will be consistent with Medicare in paying less for physician services rendered in certain facility and related settings that they do not believe include the same sort of cost factors that are present in a physician’s office.

6. All Iowa Medicaid providers will be required to use Iowa Medicaid’s Medicare Crossover Claim Form when submitting them in paper.

7. Iowa Medicaid will eliminate direct and indirect graduate medical education payments to out-of-state hospitals.

**The Iowa Department of Human Services has yet to post the bulletin regarding Letter #1030 which was mentioned in an earlier blog from me. I don’t know why it hasn’t been posted yet. But I will keep checking back. I will keep looking and searching and asking questions. I will find an answer.


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