Iowa Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Iowa's plan contracts, statutes and notices. For 19 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 19of 21
- Plans on record
- 15
- Directed payments
- 0
- Capitation cells
- 1,737$3.88–$11,545.91 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans must pay at least thisPlans must pay at least the published rate | 56,988 | Paid by the state, outside plansState sets the plan rate |
| Hospital outpatient | Plans must pay at least thisPlans must pay at least the published rate | 11,108 | |
| Radiology | Plans must pay at least thisPlans must pay at least the published rate | 9,548 | |
| Lab & pathology | Plans must pay at least thisPlans must pay at least the published rate | 9,454 | Paid by the state, outside plansState sets the plan rate |
| Equipment & supplies | Plans must pay at least thisPlans must pay at least the published rate | 5,597 | State sets the plan rate |
| Pharmacy | Plans must pay at least thisPlans must pay at least the published rate | 4,987 | State sets the plan rate |
| Behavioral health | Plans must pay at least thisPlans must pay at least the published rate | 2,195 | Paid by the state, outside plans |
| Nursing facility | Plans must pay at least thisPlans must pay at least the published rate | 1,159 | |
| Dental | Plans must pay at least thisPlans must pay at least the published rate | 1,033 | |
| Hospital inpatient | Plans must pay at least thisPlans must pay at least the published rate | 771 | |
| Vision & hearing | Plans must pay at least thisPlans must pay at least the published rate | 659 | Paid by the state, outside plansState sets the plan rate |
| Other home & community services | Plans must pay at least thisPlans must pay at least the published rate | 573 | Paid by the state, outside plansState sets the plan rate |
| Therapy (PT/OT/speech) | Plans must pay at least thisPlans must pay at least the published rate | 293 | Paid by the state, outside plans |
| Home health | Plans must pay at least thisPlans must pay at least the published rate | 247 | |
| Other | Paid by the state, outside plansPaid directly by the state, outside managed care | 136 | |
| Hospice | Plans must pay at least thisPlans must pay at least the published rate | 113 | |
| IDD services | Plans must pay at least thisPlans must pay at least the published rate | 89 | |
| Transportation | Plans must pay at least thisPlans must pay at least the published rate | 88 | Paid by the state, outside plans |
| Private duty nursing | Plans must pay at least thisPlans must pay at least the published rate | 50 | Paid by the state, outside plans |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 27 | |
| ABA / autism services | Plans must pay at least thisPlans must pay at least the published rate | 23 | Paid by the state, outside plans |
Frequently asked questions
Do Iowa Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital outpatient, Radiology, Lab & pathology, Equipment & supplies, Pharmacy, Behavioral health, Nursing facility, Dental, Hospital inpatient, Vision & hearing, Other home & community services, Therapy (PT/OT/speech), Home health, Hospice, IDD services, Transportation, Private duty nursing, ABA / autism services. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Iowa's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.