IAMM2200-R002 (MR-O-12) IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/26/23 T I T L E X I X R E P O R T O F E X P E N D I T U R E S (BY CATEGORY OF SERVICE) (MONTHLY TOTALS AS OF 11/30/23) * * * * * A V E R A G E S * * * * * * * COST PER COST PER UNITS PER COST PER CATEGORY OF SERVICE RECIPIENTS NUMBER OF UNITS OF TOTAL UNIT OF ELIGIBLE RECIPIENT RECIPIENT SERVED CLAIMS SERVICE PAYMENT SERVICE RECIPIENT SERVED SERVED INPATIENT 547 547 2,745 $9,081,502.54 $3,308.38 $13.73 5.0 $16,602.38 OUTPATIENT 4,271 6,598 1,121,389 $1,444,465.88 $1.29 $2.18 262.6 $338.20 CHILD PART HOSP 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 CHILD DAY TREATMENT 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 ADULT PART HOSP 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 ADULT DAY TREATMENT 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 SKILLED NURSING FACILITY 23 26 392 $171,274.98 $436.93 $0.26 17.0 $7,446.74 IHAWP IOWA PLAN LITE 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 IHAWP IOWA PLAN FULL 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 IHAWP HMO 1 0 0 $64.32- $0.00 $0.00 .0 $64.32- IHAWP PCP 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 INTERMEDIATE CARE FACILITY 208 229 6,795 $2,828,234.79 $416.22 $4.28 32.7 $13,597.28 INTER CARE INT DISABLED 22 22 647 $330,711.26 $511.15 $0.50 29.4 $15,032.33 NURSING FAC FOR MENTAL ILL 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 HOME HEALTH 601 830 495,240 $2,182,839.69 $4.41 $3.30 824.0 $3,632.01 LEAD INSPECTION AGENCY 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 PHYSICIAN 5,439 11,288 35,817 $775,532.28 $21.65 $1.17 6.6 $142.59 CLINIC SERVICES 1,142 1,449 1,349 $3,823,656.94 $2,834.44 $5.78 1.2 $3,348.21 MEP CASE MANAGEMENT 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 EHR INCENTIVE PAYMENTS 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 LAB AND RADIOLOGICAL 633 927 2,379 $81,895.73 $34.42 $0.12 3.8 $129.38 HABILITATION SERVICES 35 77 672 $103,728.03 $154.36 $0.16 19.2 $2,963.66 BEHAVIORAL HLTH INTERVENTN SVC 35 118 707 $19,019.69 $26.90 $0.03 20.2 $543.42 REHAB SUPPORT SERVICES 4 3 66 $3,684.78 $55.83 $0.01 16.5 $921.20 AMBULANCE SERVICES 179 207 207 $85,340.87 $412.27 $0.13 1.2 $476.76 LOCAL EDUCATION AGENCY 1,593 23,022 129,104 $3,672,892.48 $28.45 $5.55 81.0 $2,305.64 INFANT TODDLER 266 447 1,201 $16,510.86 $13.75 $0.02 4.5 $62.07 IHAWP WELLNESS EXAM BONUS 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 ACO VIS PAYMENTS 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 PRESCRIBED DRUGS 3,181 12,537 11,775 $1,869,301.00 $158.75 $45.02 3.7 $587.65 IOWA-PLAN-PMIC 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 DRUG CAPITATION 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 NEMT SERVICES 9,725 10,479 9,891 $22,774.90 $2.30 $0.03 1.0 $2.34 INDIAN HEALTH SERVICES 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 FAMILY PLANNING SERVICES 93 98 96 $10,531.06 $109.70 $0.02 1.0 $113.24 IOWA CARE MED HOME CAPITATION 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 IOWA PLAN PROGRAM 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 MANAGED SUBSTANCE ABUSE 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 MENTAL HEALTH ACCESS PLAN 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 EPSDT SCREENING 57 54 52 $102,333.03 $1,967.94 $10.43 .9 $1,795.32 HMO SERVICES 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 PACE SERVICES 663 663 663 $2,768,557.23 $4,175.80 $4.19 1.0 $4,175.80 PATIENT MANAGEMENT 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 HEALTH INS PREMIUM PAYMENT 1,725 3,676 3,676 $472,391.78 $128.51 $0.71 2.1 $273.85 MEDICAL SUPPLIES 1,354 2,066 89,763 $134,741.20 $1.50 $3.25 66.3 $99.51 HEALTH HOME PROVIDER 134 151 71 $14,830.25 $208.88 $0.02 .5 $110.67 TCM PAYMENTS TO IOWAPLAN 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 IHAWP QHP 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 MCO 616,707 650,227 648,651 $616,675,579.09 $950.70 $932.18 1.1 $999.95 IAMM2200-R002 (MR-O-12) IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/26/23 T I T L E X I X R E P O R T O F E X P E N D I T U R E S (BY CATEGORY OF SERVICE) (MONTHLY TOTALS AS OF 11/30/23) * * * * * A V E R A G E S * * * * * * * COST PER COST PER UNITS PER COST PER CATEGORY OF SERVICE RECIPIENTS NUMBER OF UNITS OF TOTAL UNIT OF ELIGIBLE RECIPIENT RECIPIENT SERVED CLAIMS SERVICE PAYMENT SERVICE RECIPIENT SERVED SERVED OTHER PRACTITIONER 4,214 18,995 52,117 $2,666,893.33 $51.17 $4.03 12.4 $632.87 FAMILY CENTERED PROGRAM 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 FAMILY PRESERVATION 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 TREATMENT FOSTER FAMILY CARE 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 GROUP TREATMENT THERAPY 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 DENTAL 54 54 54 $3,415.38 $63.25 $0.08 1.0 $63.25 ACCOUNTABLE CARE ORGANIZATIONS 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 OPTOMETRIST 203 238 286 $11,557.68 $40.41 $0.02 1.4 $56.93 CHIROPRACTIC 239 432 468 $4,586.84 $9.80 $0.11 2.0 $19.19 IOWA-PLAN-HAB 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 PODIATRIC 150 189 465 $7,089.93 $15.25 $0.01 3.1 $47.27 PREPAID AMBULATORY HEALTH PLAN 617,133 655,443 655,289 $8,841,764.69 $13.49 $13.37 1.1 $14.33 PHYSICAL DISABILITIES SVCS 4 7 855 $3,728.04 $4.36 $0.01 213.8 $932.01 BRAIN INJ WAIVER SERVICES 139 290 9,550 $591,918.87 $61.98 $0.89 68.7 $4,258.41 PSYCHIATRIC 455 738 914 $61,133.99 $66.89 $0.09 2.0 $134.36 RESIDENTIAL CARE FACILITY 303 414 12,078 $108,373.76 $8.97 $0.16 39.9 $357.67 ID WAIVER SERVICE 555 930 42,972 $2,615,173.36 $60.86 $286.12 77.4 $4,712.02 CHILDRENS MENTAL HEALTH SVC 22 28 4,420 $21,280.07 $4.81 $33.83 200.9 $967.28 AIDS WAIVER SERVICES 1 1 1 $1,237.04 $1,237.04 $56.23 1.0 $1,237.04 ELDERLY WAIVER SERVICES 26 85 2,519 $33,185.83 $13.17 $6.87 96.9 $1,276.38 ILL & HANDICAPPED WAIVER SVCS 266 341 15,636 $570,828.15 $36.51 $353.89 58.8 $2,145.97 COUNTY OFFICE REIMBURSEMENT 0 0 0 $0.00 $0.00 $0.00 .0 $0.00 MEP SERVICES 597 623 5,046 $325,971.60 $64.60 $0.49 8.5 $546.02 UNASSIGNED 1 0 0 $595,978.61- $0.00 $0.90- .0 $595,978.61- * A L L C A T E G O R I E S * 635,817 1,404,549 3,366,018 $661,964,425.97 $196.66 $1,000.64 5.3 $1,041.12 *** END OF REPORT ***