Title VI, HUMAN SERVICES (Ch. 216 - 255A)

1. Moneys appropriated from the general fund of the state to the department for the medical assistance program shall not be used for reimbursement for sex reassignment surgery or associated procedures, including hormone therapy or other medical interventions intended to alter pri…

1. The department shall adopt rules pursuant to chapter 17A entitling psychologists who are licensed pursuant to chapter 154B and psychologists who are licensed in the state where the services are provided and have a doctorate degree in psychology, have had at least two years of …

1. The department shall adopt rules pursuant to chapter 17A entitling marital and family therapists who are licensed pursuant to chapter 154D to payment for behavioral health services provided to recipients of medical assistance, subject to limitations and exclusions the departme…

The department shall adopt rules pursuant to chapter 17A entitling speech pathologists who are licensed pursuant to chapter 154F , including those certified in independent practice, to payment for speech pathology services provided to recipients of medical assistance, subject to …

Health care facilities licensed under chapter 135C receiving assistance payments for persons provided services by the health care facility shall submit the financial report to the department as provided by rule. Payment at a new rate is effective for services rendered as of the f…

Rural health clinics and federally qualified health centers shall receive cost-based reimbursement for one hundred percent of the reasonable costs for the provision of services to recipients of medical assistance. 98 Acts, ch 1069, §1 ; 99 Acts, ch 203, §51

A nursing facility as defined in section 135C.1 shall complete a resident assessment prior to initial admission of a resident and periodically during the resident’s stay in the facility. The assessment shall be completed for each prospective resident and current resident regardle…

As used in this chapter : 1. “Department” means the department of health and human services. 2. “Director” means the director of health and human services. 3. “Discretionary medical assistance” means mandatory medical assistance or optional medical assistance provided to medicall…

1. Beginning November 1, 2000, the department shall use the federal Medicare resource-based relative value scale methodology to reimburse all applicable noninstitutional health providers, excluding anesthesia and dental services, that on June 30, 2000, are reimbursed on a fee-for…

1. The department shall establish and implement a preferred drug list program under the medical assistance program. The department shall submit a medical assistance state plan amendment to the centers for Medicare and Medicaid services of the United States department of health an…

1. An intermediate care facility for persons with an intellectual disability, as defined in section 135C.1 , shall be assessed an amount for the preceding calendar quarter, not to exceed six percent of the actual paid claims for the previous quarter. 2. The assessment shall be pa…

1. An Iowa medical assistance drug utilization review commission is created within the department. The commission membership, duties, and related provisions shall comply with 42 C.F.R. pt. 456, subpt. K . 2. In addition to any other duties prescribed, the commission shall make re…

1. The state shall pay for one hundred percent of the nonfederal share of the services paid for under any prepaid mental health services plan for medical assistance implemented by the department as authorized by law. 2. a. Except as provided for disallowed costs in section 249A.2…

1. If the department contracts with a county or consortium of counties to provide case management services funded under medical assistance, the state shall appear and defend the department’s employees and agents acting in an official capacity on the department’s behalf and the st…

A hospital participating in the hospital directed payment program pursuant to 42 C.F.R. §438.6 shall not knowingly pass on the directed payment increase for health care services provided to non-Medicaid payors, including as a fee or rate increase. If a hospital violates this sect…

1. For purposes of this section and section 249A.30 unless the context otherwise requires: a. “Consumer” means an individual approved by the department to receive services under a waiver. b. “Provider” means an agency certified by the department to provide services under a waiver…

The extent of and the limitations upon eligibility for assistance under this chapter is prescribed by this section , subject to federal requirements, and by laws appropriating funds for assistance provided pursuant to this chapter . 1. Mandatory medical assistance shall be provid…

1. The base reimbursement rate for a provider of services under a medical assistance program home and community-based services waiver for persons with an intellectual disability shall be recalculated at least every three years to adjust for the changes in costs during the immedia…

1. The personal needs allowance under the medical assistance program, which may be retained by a person who is a resident of a nursing facility, an intermediate care facility for persons with an intellectual disability, or an intermediate care facility for persons with mental ill…

1. Effective July 1, 2018, targeted case management services shall be reimbursed based on a statewide fee schedule amount developed by rule of the department pursuant to chapter 17A . 2. Effective July 1, 2014, providers of inpatient psychiatric services for individuals under twe…

1. A case manager for a medical assistance home and community-based services waiver may terminate the contract of a person providing consumer-directed attendant care services to whom payment is being made for provision of such services under the waiver if the case manager determi…

In administering a home and community-based services waiver, the total number of openings at any one time shall be limited to the number approved for the waiver by the secretary of the United States department of health and human services. The openings shall be available on a fir…

The department, in consultation with the department of education, shall continue the program to utilize the early and periodic screening, diagnosis, and treatment program funding under the medical assistance program, to the extent possible, to implement the screening component of…

1. A pharmaceutical settlement account is created in the state treasury under the authority of the department. Moneys received from settlements relating to provision of pharmaceuticals under the medical assistance program shall be deposited in the account. 2. Moneys in the accoun…

A computation for the purposes of determining eligibility under this chapter concerning an individual who is the beneficiary of a qualified long-term care insurance policy under chapter 514H shall include consideration of the asset disregard provided in section 514H.5 . 2005 Acts…

1. For the purposes of this section , “Medicaid payor” , “recipient” , “third party” , and “third-party benefits” mean the same as defined in section 249A.54 . 2. The third-party obligations specified under this section are a condition of doing business in the state. A third part…

1. Following the first thirty days of commitment, the department shall suspend, but not terminate, the eligibility of an individual who is an inmate of a public institution as defined in 42 C.F.R. §435.1010 , who is enrolled in the medical assistance program at the time of commit…

Notwithstanding any provision of law to the contrary, a Medicaid recipient residing at the state mental health institute at Cherokee or the state mental health institute at Independence shall retain Medicaid eligibility during the period of the Medicaid recipient’s stay for which…

1. As used in this section , “supported community living service” means a service provided in a noninstitutional setting to persons sixteen years of age and older with mental illness, an intellectual disability, brain injury, or developmental disabilities to meet the persons’ dai…

1. A provider who has received an overpayment shall notify in writing, and return the overpayment to, the department, the department’s agent, or the department’s contractor, as appropriate. The notification shall include the reason for the return of the overpayment. 2. Notificati…

The department shall provide medical assistance to individuals under nineteen years of age who meet the income eligibility requirements for the state medical assistance program and for whom federal financial participation is or becomes available for the cost of such assistance. 2…

The director shall be responsible for the effective and impartial administration of this chapter and shall, in accordance with the standards and priorities established by this chapter , by applicable federal law, by the regulations and directives issued pursuant to federal law, b…

Medical assistance paid to a provider following administrative dissolution of the provider pursuant to chapter 490, subchapter XIV, part 2 , shall be considered incorrectly paid for the purposes of section 249A.53 and the provider shall be considered to have received an overpayme…

1. Interest may be collected upon any overpayment determined to have been made and shall accrue at the rate and in the manner specified in this section . 2. Prior to the provision of a notice of overpayment to the provider, interest shall accrue at the statutory rate for prejudgm…

1. An administrative action to recover an overpayment to a provider shall be commenced within five years of the date the overpayment was incurred. For the purposes of this subsection , “incurred” means the date the medical assistance claim was paid, or the date any applicable rec…

Notwithstanding any provision to the contrary, if a recipient is deemed ineligible for medical assistance following delivery of care or service by a provider, in an administrative action to recover an overpayment to the provider based solely on the grounds of such recipient’s ine…

1. Any overpayment to a provider under this chapter shall become a judgment against the provider, by operation of law, ninety days after a notice of overpayment is personally served upon the enrolled provider as required in the Iowa rules of civil procedure or by certified mail, …

1. Concurrently with a withholding of payment, the imposition of a sanction, or the institution of a criminal, civil, or administrative proceeding against a provider or other person for overpayment, the director or the attorney general may bring an action for a temporary restrain…

1. The department may refuse to accept a financial and statistical report, cost report, or any other submission from any third party acting under a provider’s authority or direction to prepare or submit such documents or information, for good cause shown. For the purposes of this…

1. The department may require repayment of medical assistance paid from the person submitting an incorrect or improper claim, the person causing the claim to be submitted, or the person receiving payment for the claim. 2. Nothing in this section shall be construed to impede or re…

1. In addition to any other remedies or penalties prescribed by law, including but not limited to those specified pursuant to section 249A.51 or chapter 685 , all of the following shall be applicable to violations under the medical assistance program: a. A person who intentionall…

1. The Medicaid program shall impose a temporary moratorium on the enrollment of new providers or provider types identified by the centers for Medicare and Medicaid services of the United States department of health and human services as posing an increased risk to the Medicaid p…

1. The director shall maintain on the department’s internet site, in a manner readily accessible by the public, all of the following: a. A list of all providers that the department has terminated, suspended, or placed on probation. b. A list of all providers that have failed to r…

1. For purposes of this section , “health care provider” means a health care provider as defined in section 135.24 , a mental health professional, or a substance use professional. 2. The director may establish health care coordination and intervention teams as part of the state m…

1. A medical assistance advisory council is created to comply with 42 C.F.R. §431.12 based on section 1902(a)(4) of the federal Social Security Act and to advise the director about health and medical care services under the medical assistance program. The council shall meet as ne…

1. A person who obtains assistance or payments for medical assistance under this chapter by knowingly making or causing to be made, a false statement or a misrepresentation of a material fact or by knowingly failing to disclose a material fact required of an applicant for aid und…