On December 1, 2017, the Iowa Medicaid IA Health Link managed care organizations (MCOs) began using a tiered rate payment methodology to reimburse organizations providing full-day services to people enrolled in the state’s home- and community-based services (HCBS) waiver. Previously the MCOs reimbursed using a fee-for-service model. The new reimbursement methodology affects approximately 423 provider organizations that serve about 5,000 waiver participants with traumatic brain injury or intellectual/developmental disability (I/DD). DHS explained the tiered rate methodology in a notice to provider organizations on November 2, 2017. The new methodology affects daily rates . . .