Iowa speech therapy providers, advocates worry over impact of pending state rule change

DES MOINES — Providers of and advocates for services like speech therapy are expressing concern that a pending state rule change for Medicaid billing could weaken those services.

The rule change would bring the state into compliance with the federal health care law known as the Affordable Care Act — and save the state roughly $400,000 — according to the Iowa Department of Health and Human Services, which is implementing the change.

The pending change received its first hearing Monday at the Iowa Capitol during a regular meeting of the Administrative Rules Review Committee, a bipartisan panel of state lawmakers that reviews and signs off on the implementation of and changes to the state rules that enforce Iowa laws.

Currently, Iowa providers are billing Medicaid for certain medical remedial services in 15-minute increments.

But the federal health care law requires the services to be billed daily.

Iowa HHS is implementing a new state rule to match the federal law’s requirements roughly 15 years after its original implementation. The agency on Nov. 14 sent a letter to notify providers of the change, which the agency has made effective Dec. 1, 2025.

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Iowa Medicaid Director Lee Grossman, who was named to the post in July, told the state panel during Monday’s meeting that the change is being made simply to bring the state into compliance with federal law.

“I think this comes down to how we administer this important public program,” Grossman said. “Approximately $10 million, over 600,000 Iowans rely on Medicaid at any point in time, upwards of 800,000 per year. And how we safeguard those dollars, I think, is that we have to be vigilant in terms of opportunities to align with any federal standards, laws, practices. And so if we identify those, I think we have an obligation to act upon this.”

The state agency’s move has concerned providers and advocates who fear that limiting the way Medicaid can be billed for the services will result in fewer services available to Iowans who need them.

Iowa Rep. Chad Ingels, a Republican from Randalia who co-chairs the legislative rules review committee, said after Monday’s meeting that he understands that concern.

“It’s a (Medicaid) cost-saving measure, but if you’re reducing costs, you have providers providing a service, being paid that amount, so they’re losing revenue — potential loss of services,” Ingels said. “That’s where our concerns are.”

The rule change will result in $1.2 million less spent by the federal and state governments reimbursing providers through Medicaid, Grossman said during Monday’s meeting when asked by panel member and Sen. Sarah Trone Garriott, a Democrat from West Des Moines. Iowa’s share of that savings would be roughly $400,000, Grossman said.

“When I see cost savings, especially under managed care and health care, to me, that means that services will not be provided,” Sen. Cindy Winckler, a Democrat from Davenport and panel member, said during the meeting. “My concern is the number of individuals that are currently receiving services that will no longer receive those services or will receive diminished services.”

Grossman insisted the expected cost savings were not the motivating factor for the change, but rather the need for Iowa to comply with federal law.

“That’s what’s driving the change. It’s not because we think reimbursement is too high or low in this particular area, but to bring Iowa Medicaid into alignment with that federal law,” Grossman said.

Some legislators also questioned why Iowa HHS is moving so fast to implement the rule after 15 years of the current practice without a request from the federal government for corrective action.

“The reason we’re trying to fix this on a very short timeline is anytime we have a federal compliance issue, I think it’s best that we fix that expeditiously and that we try to do that looking prospectively and not retrospectively,” Grossman said. “So from my perspective, trying to minimize the potential for any federal claw back, things like that, is a big, big point of emphasis.”

Iowa HHS did not respond to questions from The Gazette.

The rule change must still complete a process to be formally adopted, which likely will take multiple months, Ingels said. But Ingels said Iowa HHS appears to be effectively implementing the rule already by virtue of its Dec. 1 letter to providers.

“My understanding is, yes, (providers) should be following the guidance of the (Iowa HHS) letter, and (HHS) have support from federal law. That’s how (providers) should be operating,” Ingels said. “Hopefully through all this clarification happens. But I understand the providers’ concern that it changes how they bill. They have to refigure all that out.”

The Administrative Rules Review Committee’s next scheduled meeting is Jan. 12.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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