Iowa Administrative Bulletin


State Policies & Initiatives: 
Medicaid & Employment

~~The Centers for Medicare and Medicaid services (CMS) has issued regulations that
define the residential and nonresidential
settings in which it is permissible for states to
provide and pay for Medicaid home-and-
community-based services (HCBS). The
purpose of the CMS regulations is to ensure
that individuals receive Medicaid HCBS in
settings that are integrated in and support full
access to the greater community. These
regulations also aim to ensure that individuals
have a free choice of where they live and who
provides services to them, as well as to ensure
that individual rights are not restricted. While
providing Medicaid HCBS in institutional
settings has never been allowed, these new
regulations clarify that HCBS may not be
provided in settings that have the qualities
of an institution. The federal regulations were
effective March 17, 2014, with an initial five-year transition time period for all HCBS
providers to be in full compliance with the
regulations or lose federal HCBS funding for services provided in the setting. Due to the
complexity of the changes required for full
compliance, CMS extended the implementation time period by three years on May 9, 2017. The State has until March 17, 2022, to demonstrate full compliance with the HCBS settings regulations.
As part of a statewide transition plan developed to transition HCBS services to meet the federal regulations, CMS required the State of Iowa to complete a full assessment of the administrative rules in the Iowa Administrative Code for compliance with the federal regulations. These amendments make changes to the Department’s administrative rules necessary for full compliance with federal regulations as cited above.

  • Medicaid Agencies
  • Home and Community Based Services (HCBS)
Date Enacted: