Home Health LUPA reimbursement rate rebase announced

Informational Letter No. 1868-MC-FFS, Low Utilization Payment Adjustment (LUPA) Reimbursement Rate Rebase, announces the rebased LUPA rates effective July 1, 2017.

Pursuant to the authority of Iowa House File (HF) 653 and State Plan Amendment (SPA) approval received from the Centers for Medicare and Medicaid Services (CMS), the Medicaid LUPA reimbursement rates shall continue to be updated every two years. The following Home Health program services are impacted by this update:

Revenue Code

 Service Description


Physical Therapy


Occupational Therapy


Speech Language Pathology


Skilled Nursing


Medical Social Service


Home Health Aide

The attached table identifies the rebased LUPA rates effective July 1, 2017. The rates are also posted on the DHS Fee Schedules webpage. The IME is currently in the process of updating the LUPA rates in the Medicaid Management Information System (MMIS). Subsequently, a mass adjustment will be transacted for Iowa Medicaid FFS claims submitted with dates of service on or after July 1, 2017. The remittance advice will include the adjusted claims detail over the next few weeks.

In addition, the IME will provide the updated managed care rate floors for services reimbursed under the LUPA methodology to the managed care plans for the IA Health Link Program.

If you have questions, please contact the IME Provider Services Unit at 800.338.7909.