Second Amendment to the Iowa Department of Human Services 
Iowa Dental Wellness Plan and Hawki Dental Pre-Paid Ambulatory Health Plan (PAHP)
 Request for Proposal

This Amendment to RFP Number MED-24-004 is effective as of July 7, 2023.  The RFP is amended as follows:

Revision 1.  The following language from Attachment F, Section 2, Subsection D.4.27 is hereby amended to read as follows:
D.4.27.  Coverage Year.  Each Coverage Year will be considered a twelve (12) month period.  The Medical Loss Ratio Calculation shall be prepared using all data available from the Coverage Year, including IBNP and six (6) months of run-out for Benefit Expense.

Revision 2.  The following language from Attachment F, Section 2, Subsection F.4.04 is hereby amended to read as follows. The previous final sentence in this section ("All non-enrolled Medicaid provider payments must be reviewed and approved by Iowa Medicaid prior to payment to assure program quality and integrity") has been removed:
F.4.04.  Out of Network Providers.  The Contractor shall negotiate and execute written Single Case Agreements or arrangements with non-Network Providers, when necessary, to ensure Access to covered services.  

Only under very limited circumstances may a provider or organization bill and receive payment for services without being enrolled as an Iowa Medicaid provider. A Single Case Agreement may be used to provide Enrolled Members’ medically necessary services when the Contractor's provider network is unable to provide access to necessary services to maintain a member’s health and/or the member’s health would be endangered if required to travel or wait for care from an in-network provider.

All health care providers are encouraged to enroll in Iowa Medicaid to receive payment and may be denied payment if the required above criteria are not met.