HOME HEALTH SERVICES PROVIDER IN IOWA

DELIVERING SKILLED CARE IN THE COMFORT OF HOME TO SUPPORT HEALTH, INDEPENDENCE, AND RECOVERY

Home Health Services in Iowa provide intermittent skilled nursing, therapy, and home health aide services to individuals who require medical care in a home setting. These services are authorized under Iowa Medicaid’s State Plan and support individuals recovering from illness, managing chronic conditions, or preventing institutionalization.

1. GOVERNING AGENCIES

Agency: Iowa Department of Inspections, Appeals, and Licensing (DIAL)

Role: Licenses home health agencies, conducts surveys, and enforces federal and state regulatory compliance

Agency: Iowa Department of Health and Human Services (HHS) — Iowa Medicaid Enterprise (IME)

Role: Administers Medicaid provider enrollment, reimbursement, and oversight for home health services

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal certification for Medicare participation and oversight to ensure Conditions of Participation (CoPs) are met for Medicaid-funded home health care

2. HOME HEALTH SERVICE OVERVIEW

Home Health Services include intermittent, medically necessary care provided by licensed professionals under physician orders in the participant’s place of residence.

Approved providers may deliver:

• Skilled nursing care (e.g., wound care, IV administration, medication management)

• Physical, occupational, and speech-language therapy

• Home health aide services (assisting with personal hygiene, mobility, ADLs)

• Medical social work and care coordination

• Monitoring of chronic conditions and post-acute recovery

• Patient and caregiver education for disease management and safety

All services must be part of an individualized Plan of Care (POC) developed in collaboration with a physician and updated every 60 days.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Iowa Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Apply for a Home Health Agency License through DIAL

• Meet CMS certification requirements (if serving Medicare clients)

• Enroll as a provider through the Iowa Medicaid Enterprise (IME)

• Maintain general liability, professional liability, and workers’ compensation insurance

• Develop policies addressing patient rights, clinical documentation, infection control, and emergency response

• Ensure all clinical staff meet licensure and competency standards

4. IOWA PROVIDER ENROLLMENT PROCESS

Initial Licensing:

• Submit application to DIAL for Home Health Agency License

• Prepare required documentation, including service descriptions, staff qualifications, policies, and facility plans

• Undergo pre-licensure survey and Life Safety Code review

Medicaid and Medicare Enrollment:

• Apply for Medicaid through the Iowa Medicaid Provider Portal

• Submit CMS 855A application via PECOS for Medicare certification (if applicable)

Billing Readiness:

• Implement billing systems that accommodate unit-based and episodic payment structures

• Ensure clinical documentation aligns with Medicaid audit requirements

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License

• IRS EIN confirmation

• NPI confirmation

• Iowa Home Health Agency License (from DIAL)

• CMS Medicare Provider Number (if billing Medicare)

• Proof of general, professional, and malpractice insurance

• Home Health Services Policy & Procedure Manual, including:

  • Intake, assessment, and Plan of Care development procedures

  • Clinical service delivery and documentation protocols

  • Medication administration and chronic condition monitoring

  • Infection control and emergency preparedness procedures

  • HIPAA compliance and patient rights protection policies

  • Staff hiring, licensure verification, and ongoing competency assessments

  • Medicaid billing, care coordination, and audit-ready documentation

6. STAFFING REQUIREMENTS

Role: Administrator / Clinical Supervisor

Requirements: Experience in healthcare administration or home health leadership; background clearance

Role: Registered Nurses (RNs)

Requirements: Active Iowa license; experience in skilled home care; CPR certification

Role: Licensed Practical Nurses (LPNs)Requirements: Active Iowa license; clinical oversight by RN required

Role: Home Health Aides (HHAs)

Requirements: Completion of a 75-hour state-approved training program; background check and competency evaluation

Role: Therapists (PT, OT, SLP)

Requirements: Active Iowa license in respective discipline; background clearance

All staff must complete:

• HIPAA training and patient confidentiality protocols

• Infection control and emergency procedures training

• Abuse prevention, incident reporting, and participant safety training

• Annual performance evaluations and continuing education

7. MEDICAID STATE PLAN COVERAGE

Home Health Services are covered under Iowa’s Medicaid State Plan for individuals who:

• Have a physician-ordered Plan of Care

• Require intermittent skilled nursing or therapy

• Are they homebound or receive care in their place of residence

• Meet medical necessity criteria and have prior authorization (if required)

Covered services include:

• Skilled nursing (visits or hourly)

• Home health aide assistance

• Physical, occupational, and speech therapy

• Social work and case management (as applicable)

8. TIMELINE TO LAUNCH

Phase: Business Formation, Licensing, and Policy Development

Timeline: 2–4 months

Phase: Staff Hiring, Credentialing, and Survey Preparation

Timeline: 2–3 months

Phase: DIAL Survey, CMS Certification (if applicable), and Medicaid Enrollment

Timeline: 90–120 days

Phase: Billing System Setup and Home Health Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Iowa Department of Inspections, Appeals, and Licensing (DIAL)

Website: https://dial.iowa.gov

Iowa Medicaid Enterprise (IME)

Website: https://ime.iowa.gov/providers

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — IOWA HOME HEALTH SERVICES PROVIDER

WCG supports home health agencies, skilled nursing providers, and interdisciplinary teams in launching Medicaid- and Medicare-compliant Home Health Services across Iowa.

Scope of Work:

• Business registration, licensing, and CMS/Medicaid enrollment

• Policy & Procedure Manual development for home health operations

• Staff credentialing templates, clinical documentation systems, and Plan of Care templates

• Medicaid billing system setup and claims management

• Website, domain, and branding development

• MDS and survey preparation tools for compliance audits

• Referral network development with hospitals, discharge planners, and primary care teams

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