What is an Exception to Policy?
An Exception to Policy (ETP) is special permission from the Iowa Department of Health and Human Services (HHS) to do something that is normally not allowed under the Iowa Administrative Code.
What is a Waiver of Administrative Rules?
This is the legal term for an ETP. Both terms mean the same thing.
Why might I need an ETP?
You might ask for an ETP if you need something that does not fit within standard Medicaid rules. Examples include:
- Requesting to have certain rules waived for your specific situation
- Requesting more services than normally allowed
- Requesting to pay a provider a different rate than Medicaid typically pays
- Requesting medical equipment that Medicaid does not usually cover
Who can request an ETP?
You can request an ETP on your own using the form liked here, to the HHS website. More information can be found by following this link. If you have a case manager, it can be helpful to work with them. They can ensure your request is complete and provide supporting information.
What type of information should I include in my ETP request?
Your request should clearly explain:
- Why you need the ETP
- What may happen if it is not approved
- What other services or equipment you have tried and why they did not meet your needs
- The cost of what you are requesting and, if relevant, why it is the most cost‑effective option
- If a doctor or medical provider is recommending what you are asking for, include letters of support, medical records, or other documentation from them.
What if my ETP is denied?
ETP decisions are granted at the discretion of the Director of the Department of Health and Human Services. A denied ETP cannot be appealed. However, you may ask the Director to reconsider by:
- Submitting a new ETP request, or
- Writing a letter to the Director asking for a different decision
