House File 2518 - Reprinted HOUSE FILE 2518 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 621) (As Amended and Passed by the House February 25, 2026 ) A BILL FOR An Act relating to the department of health and human services 1 and reporting requirements for shelter care, residential 2 treatment, and Medicaid provider reimbursement rates, and 3 establishing provider reimbursement rates for Medicaid home 4 and community-based waiver services. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 HF 2518 (2) 91 ak/ko/md

H.F. 2518 Section 1. Section 235.2, Code 2026, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 9. Upon implementation by the department 3 of a uniform cost report for shelter care and qualified 4 residential treatment providers, the department shall 5 biennially conduct a review of shelter care and qualified 6 residential treatment provider costs compared to current 7 shelter care and qualified residential treatment provider 8 rates. On or before October 1 of the calendar year immediately 9 succeeding the calendar year in which the review is conducted, 10 the department shall submit a report to the governor and the 11 general assembly detailing the results of the department’s 12 review and recommendations for rate adjustments. 13 Sec. 2. Section 249A.4, Code 2026, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 15. a. Conduct an annual review of 16 provider reimbursement rates for medical and health services 17 provided under this chapter that are reimbursed by a statewide 18 fee schedule and that are not periodically updated or rebased 19 pursuant to federal or state law or rule. The department shall 20 compare each provider reimbursement rate in the following 21 manner: 22 (1) For all medical and health services other than dental 23 services, to reimbursement rates under the federal Medicare 24 program. 25 (2) For dental services, to reimbursement rates for 26 Medicaid programs in states contiguous to Iowa. 27 b. On or before January 15 of each calendar year, the 28 department shall submit to the general assembly a report 29 summarizing the department’s review under paragraph “a” . 30 Sec. 3. NEW SECTION . 249A.32C Home and community-based 31 service waivers —— provider rate limits. 32 1. For purposes of this section: 33 a. “Consumer” means the same as defined in section 249A.29. 34 b. “Provider” means the same as defined in section 249A.29. 35 -1- HF 2518 (2) 91 ak/ko/md 1/ 2

H.F. 2518 c. “Waiver” means the same as defined in section 249A.29. 1 2. On or before July 1 of each fiscal year, providers 2 shall submit actual cost of service and supply data to the 3 department. Upon request by the department, a provider shall 4 submit to reasonable review of the actual cost of service and 5 supply data submitted. 6 3. a. Upon the required submission of annual cost reports 7 by providers and implementation by the department of a waiver 8 fee schedule, the department, with input from the public, 9 consumers, providers, and other stakeholders, shall develop a 10 proposed cost-based reimbursement system and related changes to 11 department policies and procedures for all services rendered 12 under a waiver during the period of review specified by 13 the department. The cost-based reimbursement system shall 14 be developed using information provided to the department 15 including but not limited to all of the following: 16 (1) Provider cost data. 17 (2) Provider claims data. 18 (3) Consumer needs assessment data. 19 (4) Other relevant regional and national data. 20 b. The department shall, with input from providers and 21 other relevant stakeholders, develop a uniform and streamlined 22 provider cost reporting mechanism for home and community-based 23 services. 24 4. At least once every four years, the department shall 25 establish a new base period to be used in calculating proposed 26 rate models and related changes to department policies and 27 procedures. On or before October 1 of each year that a new base 28 period is established, the department shall submit a report 29 to the general assembly that includes proposed rate models, 30 the projected fiscal impact of implementing the proposed rate 31 models, including documentation supporting the actuarial 32 soundness of the proposed rate models, and the proposed changes 33 to department policies and procedures. 34 -2- HF 2518 (2) 91 ak/ko/md 2/ 2