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

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…

A person who knowingly makes or causes to be made false statements or misrepresentations of material facts or knowingly fails to disclose material facts in application for payment of services or merchandise rendered or purportedly rendered by a provider participating in the medic…

When payment is made by the department for medical care or expenses through the medical assistance program on behalf of a recipient, the department may garnish the wages, salary, or other compensation of the person obligated to pay child support or may withhold amounts pursuant t…

1. Medical assistance paid to, or on behalf of, a recipient or paid to a provider of services is not recoverable, except as provided in subsection 2 , unless the assistance was incorrectly paid. Assistance incorrectly paid is recoverable from the provider, or from the recipient, …

1. It is the intent of the general assembly that a Medicaid payor be the payor of last resort for medical services furnished to recipients. All other sources of payment for medical services are primary relative to medical assistance provided by the Medicaid payor. If benefits of …

If restitution is ordered by the court pursuant to section 910.2 , and the victim is a recipient of medical assistance for whom expenditures were made as a result of the offender’s criminal activities, restitution may be made to the medical assistance program in accordance with s…

It is the intent of the general assembly that violations of law relating to the family investment program, medical assistance, and supplemental assistance shall be prosecuted by county attorneys. Area prosecutors of the office of the attorney general shall provide assistance in p…

The department shall adopt rules pursuant to chapter 17A to assess and collect, with interest, a civil penalty for each day a health care facility which receives medical assistance reimbursements does not comply with the requirements of the federal Social Security Act, section 19…

1. Unless exempt pursuant to state or federal law or regulation, an applicant for or recipient of medical assistance shall be required to cooperate with child support services as a condition of eligibility. 2. The department shall adopt rules pursuant to chapter 17A to administer…

As used in this chapter , unless the context otherwise requires: 1. “Community spouse” means an individual who has not resided or is not likely to reside in a hospital or a health care facility for more than twenty-nine consecutive days and is married to an institutionalized spou…

1. Medical assistance provided to an institutionalized spouse due to the institutionalized spouse’s assignment of support rights, an inability to execute an assignment of support rights, or hardship, creates a spousal support debt due and owing to the department from the communit…

1. The department shall issue a notice establishing and demanding payment of an accrued or accruing spousal support debt due and owing to the department. The notice shall be served upon the community spouse in accordance with the rules of civil procedure. The notice shall include…

1. If a timely written request for a hearing is received, the department shall certify the matter to the district court in the county where the institutionalized spouse resides. 2. The certification shall include true copies of the notice and finding of financial responsibility o…

A true copy of an order entered by the department pursuant to this chapter , along with a true copy of the return of service if applicable, may be filed in the office of the clerk of the district court in the county in which the institutionalized spouse resides. Upon filing, the …

Interest accrues on a spousal support debt at the rate provided in section 535.3 for court judgments. The department may collect the accrued interest, but is not required to maintain interest balance accounts. The department may waive payment of the interest if the waiver will fa…

Upon entry of a court order or upon the failure of a community spouse to make payments pursuant to a court order, the court may require the community spouse to provide security, a bond, or other guarantee which the court determines is satisfactory to secure the payment of the spo…

As used in this chapter , unless the context otherwise requires: 1. “Department” means the department of health and human services. 2. “Medical assistance” means “mandatory medical assistance” , “optional medical assistance” , “discretionary medical assistance” , or “Medicare cos…

A transfer of assets creates a debt due and owing to the department from the transferee in an amount equal to medical assistance provided to or on behalf of the transferor, on or after the date of the transfer of assets, but not exceeding the fair market value of the assets at th…

1. The department may issue a notice establishing and demanding payment of an accrued or accruing debt due and owing to the department as provided in section 249F.2 . The notice shall be sent by restricted certified mail as defined in section 618.15 , to the transferee at the tra…

1. If a timely written request for a hearing is received, the department shall certify the matter to the district court in the county where the transferee resides. 2. The certification shall include true copies of the original notice, the return of service, if applicable, any req…

1. A true copy of an order entered by the department pursuant to this chapter , along with a true copy of the return of service, if applicable, may be filed in the office of the clerk of the district court in the county in which the transferee resides or, if the transferee reside…

Upon entry of a court order or upon the failure of a transferee to make payments pursuant to a court order, the court may require the transferee to provide security, a bond, or other guarantee which the court determines is satisfactory to secure the payment of the debt under the …

Exemption from chapter 17A . Actions initiated under this chapter are not subject to chapter 17A . Review by the district court shall be an original hearing before the district court. 2000 Acts, ch 1060, §6

As provided in this chapter , the establishment of a debt for medical assistance due to transfer of assets shall be administered by the department. All administrative discretion in the administration of this chapter shall be exercised by the department, and any state administrati…

If it is determined by the attorney general that any provision of this chapter would cause denial of funds from the United States government under Tit. XIX of the federal Social Security Act, or would otherwise be inconsistent or conflict with the requirements of federal law for …

The purpose of this chapter is to provide a mechanism to support the appropriate number of nursing facility beds for the state’s citizens and to financially assist nursing facilities in remaining compliant with applicable regulations. It is the intent of this chapter that the adm…

As used in this chapter , unless the context otherwise requires: 1. “Complete replacement” means completed construction on a new nursing facility to replace an existing licensed and certified facility. The replacement facility shall be located in the same geographical service are…

1. A provider that constructs a complete replacement, makes major renovations to, or newly constructs a nursing facility may be entitled to the rate relief and exceptions provided under this chapter . The total period during which a provider may participate in any relief shall no…

1. A provider preparing cost or other feasibility projections for a request for relief or an exception pursuant to section 249K.3 may submit a request for preliminary evaluation. 2. The request shall contain all of the information required for the type of assistance sought pursua…

1. The Medicaid program shall administer this chapter . The department shall adopt rules, pursuant to chapter 17A , to administer this chapter . 2. A provider requesting instant relief or a nondirect care limit exception under this chapter shall meet one of the following criteria…

This chapter shall be known and may be cited as the “Quality Assurance Assessment Program” . 2009 Acts, ch 160, §1, 5

As used in this chapter , unless the context otherwise requires: 1. “Department” means the department of health and human services. 2. “Direct care worker” means an employee of a nursing facility who holds a nursing assistant certification, is employed for the purpose of nursing …

1. a. A nursing facility in this state shall be assessed a quality assurance assessment for each patient day for the preceding quarter. b. The quality assurance assessment shall be implemented as a broad-based health care-related tax as defined in 42 U.S.C. §1396b(w)(3)(B) . c. T…