NURSING FACILITY SERVICES PROVIDER IN IOWA

DELIVERING 24-HOUR SKILLED CARE IN LICENSED FACILITIES FOR INDIVIDUALS WITH MEDICAL AND PERSONAL SUPPORT NEEDS

Nursing Facility Services in Iowa provide medically necessary, around-the-clock care in a licensed residential setting for individuals who require skilled nursing or rehabilitative services. These services are funded under Iowa’s Medicaid State Plan and are intended for individuals whose clinical needs exceed the level of care available through home and community-based services (HCBS).

1. GOVERNING AGENCIES

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

Role: Licenses and inspects nursing facilities, enforces compliance with federal and state regulations, and conducts surveys and investigations

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

Role: Administers Medicaid funding for nursing facility services, processes claims, manages eligibility, and oversees reimbursement

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring nursing facilities comply with Medicare and Medicaid Conditions of Participation (CoPs), quality of care standards, and resident protections

2. NURSING FACILITY SERVICE OVERVIEW

Nursing Facility Services include long-term or short-term residential care with access to 24-hour medical supervision, rehabilitation, and daily living assistance.

Approved facilities may deliver:

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

• Personal care assistance with ADLs (bathing, dressing, eating, toileting, mobility)

• 24-hour monitoring and supervision

• Rehabilitative therapies (physical, occupational, and speech therapy)

• Social services, mental health support, and recreational programming

• Nutrition and dietary services, including special diet preparation

• End-of-life and palliative care when appropriate

Services must be based on an individualized care plan developed by an interdisciplinary team and regularly reviewed.

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 Nursing Facility License through the Iowa Department of Inspections, Appeals, and Licensing (DIAL)

• Pass pre-licensure survey and life safety code inspection

• Enroll as a Medicaid and/or Medicare provider via Iowa Medicaid Enterprise (IME) and CMS PECOS

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

• Develop policies addressing resident care, quality assurance, infection control, and resident rights

• Ensure all staff meet licensing, credentialing, and training requirements

4. IOWA PROVIDER ENROLLMENT PROCESS

Initial Application:

• Submit the Nursing Facility license application to DIAL with floor plans, operational policies, and staffing model

Survey and Licensing:

• Complete pre-licensure inspections and health/safety code reviews

Medicaid and Medicare Enrollment:

• Apply to Iowa Medicaid (IME) and CMS for reimbursement authorization

• Provide CMS 855A application and supporting documentation through PECOS (if billing Medicare)

Billing Readiness:

• Set up RUGs-based billing system (Resource Utilization Groups), configure MDS (Minimum Data Set) assessments, and ensure compliance with federal claims processes

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business Registration (Iowa Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• DIAL-issued Nursing Facility License

• CMS Medicare Certification (if applicable)

• Proof of insurance (general, malpractice, and liability)

• Nursing Facility Policy & Procedure Manual including:

  • Resident admission, care planning, discharge, and transition protocols

  • Infection control and emergency preparedness plans

  • Nursing service delivery and documentation protocols

  • HIPAA compliance, resident rights, and grievance procedures

  • Staff hiring, credentialing, licensure tracking, and supervision policies

  • Medicaid/Medicare billing procedures and audit-ready documentation

6. STAFFING REQUIREMENTS

Role: Nursing Home Administrator

Requirements: Licensed by the Iowa Board of Nursing Home Administrators; experience in long-term care administration; background check

Role: Director of Nursing (DON)

Requirements: Active Iowa RN license; leadership experience in skilled nursing settings

Role: Licensed Nursing Staff (RNs, LPNs)

Requirements: Valid Iowa nursing license; CPR certification; clinical competency evaluations

Role: Certified Nurse Aides (CNAs)

Requirements: Completion of approved CNA training; inclusion in Iowa Direct Care Worker Registry; background check

All staff must complete:

• Abuse, neglect, and exploitation prevention training

• HIPAA confidentiality and resident rights training

• Infection control and emergency response training

• Annual in-service education and competency validation

7. MEDICAID STATE PLAN COVERAGE

Nursing Facility Services are covered under Iowa’s Medicaid State Plan for individuals who:

• Meet Level of Care criteria (Nursing Facility Level of Care)

• Have an approved PASRR Level I and Level II screening (for behavioral health/intellectual disability)

• Require skilled care as determined by medical necessity

• Have exhausted or are ineligible for HCBS waiver alternatives

Covered services include:

• 24/7 skilled nursing care and personal assistance

• Access to therapy and rehabilitative services

• Medication administration and monitoring

• Routine supplies and medical equipment are provided on-site

8. TIMELINE TO LAUNCH

Phase: Business Formation, Licensing, and Survey Preparation

Timeline: 3–6 months

Phase: Facility Setup, Staff Hiring, and Policy Development

Timeline: 2–4 months

Phase: DIAL Licensing, CMS Certification, and Medicaid Enrollment

Timeline: 90–120 days

Phase: Billing Configuration and Facility Opening

Timeline: 30–60 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 NURSING FACILITY PROVIDER

WCG supports long-term care operators, skilled nursing companies, and transitional care organizations in launching licensed, Medicaid-certified Nursing Facilities in Iowa.

Scope of Work:

• Business registration, facility setup, and Medicaid/Medicare enrollment

• Development of Nursing Facility Policy & Procedure Manual

• MDS assessment readiness, RUGs billing configuration, and staff credentialing support

• Survey preparation and compliance walkthroughs

• Website, branding, and marketing materials for admissions and referral growth

• Quality assurance program templates for audits, grievances, and resident satisfaction

• Partnership development with hospitals, discharge planners, and managed care entities

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