reglab/housing_qa huggingface dataset:
IA Code § 514I.10 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.10 - Cost sharing.

514I.10 Cost sharing.   1. Cost sharing for eligible children whose family income is below one hundred fifty percent of the federal poverty level shall not exceed the standards permitted under 42 U.S.C. §1396o(a)(3) or §1396o(b)(1).   2. Cost sharing for eligible children whose family income equals one hundred fifty percent but does not exceed two hundred percent of the federal poverty level may include a premium or copayment amount which does not exceed five percent of the annual family income. The amount of any premium or the copayment amount shall be based on family income and size.   3. Cost sharing for an eligible child whose family income exceeds two hundred percent but does not exceed three hundred percent of the federal poverty level may include copayments and graduated premium amounts which do not exceed the limitations of federal law.   4. The payment to and acceptance by an automated case management system or the department of the premium required under this section shall not automatically confer initial or continuing program eligibility on an individual. A premium paid to and accepted through the department’s premium payment process that is subsequently determined to be untimely or to have been paid on behalf of an individual ineligible for the program shall be refunded to the remitter in accordance with rules adopted by the department.  98 Acts, ch 1196, §11, 16; 2000 Acts, ch 1221, §10; 2003 Acts, ch 124, §12; 2008 Acts, ch 1014, §4; 2008 Acts, ch 1188, §12; 2009 Acts, ch 118, §36; 2014 Acts, ch 1026, §115  Referred to in §514I.2
IA Code § 514I.11 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.11 - Hawk-i trust fund.

514I.11 Hawk-i trust fund.   1. A hawk-i trust fund is created in the state treasury under the authority of the department of human services, in which all appropriations and other revenues of the program such as grants, contributions, and participant payments shall be deposited and used for the purposes of the program. The moneys in the fund shall not be considered revenue of the state, but rather shall be funds of the program.   2. The trust fund shall be separate from the general fund of the state and shall not be considered part of the general fund of the state. The moneys in the trust fund are not subject to section 8.33 and shall not be transferred, used, obligated, appropriated, or otherwise encumbered, except to provide for the purposes of this chapter and except as provided in subsection 4. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the trust fund shall be credited to the trust fund.   3. Moneys in the fund are appropriated to the department and shall be used to offset any program costs.   4. The department may transfer moneys appropriated from the fund to be used for the purpose of expanding health care coverage to children under the medical assistance program.   5. The department shall provide periodic updates to the general assembly regarding expenditures from the fund.  99 Acts, ch 203, §52; 2003 Acts, ch 108, §131; 2005 Acts, ch 175, §124, 125; 2008 Acts, ch 1188, §13; 2009 Acts, ch 118, §37
IA Code § 514I.12 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.12 - Hawk-i expansion program.

514I.12 Hawk-i expansion program. Repealed by  2009 Acts, ch 118, §41  .
IA Code § 514J.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.1 - Legislative intent.

514J.1 Legislative intent. Repealed by  2011 Acts, ch 101, §21  .
IA Code § 514J.2 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.2 - Definitions.

514J.2 Definitions. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.3 - Exclusions.

514J.3 Exclusions. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.3A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.3A - Notice.

514J.3A Notice. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.4 - External review request — fee.

514J.4 External review request — fee. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.5 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.5 - Certification of request — eligibility.

514J.5 Certification of request — eligibility. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.6 - Independent review entities.

514J.6 Independent review entities. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.7 - External review.

514J.7 External review. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.8 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.8 - Expedited review.

514J.8 Expedited review. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.9 - Funding.

514J.9 Funding. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.10 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.10 - Reporting.

514J.10 Reporting. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.11 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.11 - Immunity.

514J.11 Immunity. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.12 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.12 - Standard of review.

514J.12 Standard of review. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.13 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.13 - Effect of external review decision.

514J.13 Effect of external review decision. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.14 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.14 - Rules.

514J.14 Rules. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.15 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.15 - Penalties.

514J.15 Penalties. Repealed by 2011 Acts, ch 101, §21.
IA Code § 514J.101 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.101 - Purpose — applicability.

514J.101 Purpose — applicability.   The purpose of this chapter is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determination made by a health carrier as required by the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, which amends the Public Health Service Act and adopts, in part, new 42 U.S.C. §300gg-19, and to address issues which are unique to the external review process in this state.  2011 Acts, ch 101, §1
IA Code § 514J.103 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.103 - Applicability and scope.

514J.103 Applicability and scope.   1. Except as provided in subsection 2, this chapter shall apply to all health carriers.   2. This chapter shall not apply to any of the following:   a. A policy or certificate that provides coverage only for a specified disease, specified accident or accident-only, credit, disability income, hospital indemnity, long-term care, vision care, or any other limited supplemental benefit.   b. A Medicare supplement policy of insurance, as defined by the commissioner by rule.   c. Coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, any coverage issued under 10 U.S.C. ch. 55, and any coverage issued as supplemental to that coverage.   d. Any coverage issued as supplemental to liability insurance.   e. Workers’ compensation or similar insurance.   f. Automobile medical-payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.  2011 Acts, ch 101, §3; 2014 Acts, ch 1140, §111
IA Code § 514J.105 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.105 - Request for external review.

514J.105 Request for external review.   A covered person or the covered person’s authorized representative may make a request for an external review of a final adverse determination. Except for a request for an expedited external review, all requests for external review shall be made in writing to the commissioner. The commissioner may prescribe by rule the form and content of external review requests.  2011 Acts, ch 101, §5
IA Code § 514J.106 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.106 - Exhaustion of internal grievance process — exceptions — expedited external review request.

514J.106 Exhaustion of internal grievance process — exceptions — expedited external review request.   1. Except as otherwise provided in this section, a request for an external review shall not be made until the covered person or the covered person’s authorized representative has exhausted the health carrier’s internal grievance process and received a final adverse determination.   2. A covered person or the covered person’s authorized representative shall be considered to have exhausted the health carrier’s internal grievance process if the covered person or the covered person’s authorized representative has filed a grievance involving an adverse determination and, except to the extent the covered person or the covered person’s authorized representative requested or agreed to a delay, has not received a written decision on the grievance from the health carrier within thirty days following the date the covered person or the covered person’s authorized representative filed the grievance with the health carrier.   3. A covered person or the covered person’s authorized representative may file a request for an expedited external review of an adverse determination without exhausting the health carrier’s internal grievance process under either of the following circumstances:   a. The covered person has a medical condition pursuant to which the time frame for completion of an internal review of the grievance involving an adverse determination would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function as provided in section 514J.108.   b. The adverse determination involves a denial of coverage based on a determination that the recommended or requested health care service or treatment is experimental or investigational and the covered person’s treating physician certifies in writing that the recommended or requested health care service or treatment that is the subject of the adverse determination would be significantly less effective if not promptly initiated as provided in section 514J.109.   4. A request for an external review of an adverse determination may be made before the covered person or the covered person’s authorized representative has exhausted the health carrier’s internal grievance procedures whenever the health carrier agrees to waive the exhaustion requirement. If the requirement to exhaust the health carrier’s internal grievance procedures is waived, the covered person or the covered person’s authorized representative may file a request with the commissioner in writing for a standard external review.  2011 Acts, ch 101, §6  Referred to in §514J.107, 514J.109
IA Code § 514J.111 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.111 - Approval of independent review organizations.

514J.111 Approval of independent review organizations.   1. The commissioner shall approve applications submitted by independent review organizations to conduct external reviews under this chapter. The commissioner may retain an outside expert to perform reviews of such applications.   2. In order to be eligible for approval by the commissioner to conduct external reviews, an independent review organization shall meet all of the following requirements:   a. Be accredited by a nationally recognized private accrediting entity that the commissioner determines has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established in this chapter.   b. Submit an application in a form and format as directed by the commissioner.   c. Meet the minimum qualifications contained in section 514J.112.   3. The commissioner may approve independent review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.   4. The commissioner shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.   5. The commissioner may charge an initial application fee and a renewal fee as specified by rule.   6. The approval of an independent review organization to conduct external reviews by the commissioner pursuant to this chapter is effective for two years, unless the commissioner determines that the independent review organization is not satisfying the minimum qualifications of this chapter. If the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under this chapter, the commissioner shall terminate approval of the independent review organization to conduct external reviews and remove the independent review organization from the list of independent review organizations approved to conduct external reviews that is maintained by the commissioner.   7. The commissioner shall maintain a list of currently approved independent review organizations.  2011 Acts, ch 101, §11
IA Code § 514J.113 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.113 - Immunity for independent review organizations.

514J.113 Immunity for independent review organizations.   An independent review organization, a clinical reviewer working on behalf of an independent review organization, or an employee, agent, or contractor of an independent review organization shall not be liable in damages to any person for any opinions rendered or acts or omissions performed within the scope of the duties of the organization, the clinical reviewer, or an employee, agent, or contractor of the organization under this chapter during, or upon completion of, an external review conducted pursuant to this chapter, unless the opinion was rendered or the act or omission was performed in bad faith or involved gross negligence.  2011 Acts, ch 101, §13
IA Code § 514J.114 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.114 - External review reporting requirements.

514J.114 External review reporting requirements.   1. a. An independent review organization assigned to conduct an external review shall maintain written records in the aggregate by state and by health carrier of all requests for external review for which it conducted an external review during a calendar year.   b. Each independent review organization required to maintain written records pursuant to this section shall submit to the commissioner, upon request, a report in the format specified by the commissioner. The report shall include in the aggregate by state and by health carrier all of the following:   (1) The total number of requests for external review assigned to the independent review organization.   (2) The average length of time for resolution of each request for external review assigned to the independent review organization.   (3) A summary of the types of coverages or cases for which an external review was requested, in the format required by the commissioner by rule.   (4) Any other information required by the commissioner.   c. The independent review organization shall retain the written records for at least three years.   2. a. Each health carrier shall maintain written records in the aggregate by state and by type of health benefit plan offered by the health carrier of all requests for external review that the health carrier receives notice of from the commissioner pursuant to this chapter.   b. Each health carrier required to maintain written records of requests for external review pursuant to this subsection shall submit to the commissioner, upon request, a report in the format specified by the commissioner. The report shall include in the aggregate by state and by type of health benefit plan offered all of the following:   (1) The total number of requests for external review of the health carrier’s adverse determinations and final adverse determinations.   (2) Of the total number of requests for external review, the number of requests determined eligible for external review.   (3) The number of requests for external review resolved and, of those resolved, the number resolved upholding the adverse determination or final adverse determination of the health carrier and the number resolved reversing the adverse determination or final adverse determination of the health carrier.   (4) The number of external reviews that were terminated as the result of a reconsideration by the health carrier of its adverse determination or final adverse determination after the receipt of additional information from the covered person or the covered person’s authorized representative.   (5) Any other information the commissioner may request or require.   c. The health carrier shall retain the written records for at least three years.  2011 Acts, ch 101, §14
IA Code § 514J.115 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.115 - Expenses of external review.

514J.115 Expenses of external review.   The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the costs of retaining an independent review organization to conduct the external review.  2011 Acts, ch 101, §15
IA Code § 514J.116 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.116 - Disclosure requirements.

514J.116 Disclosure requirements.   1. Each health carrier shall include a description of the external review procedures contained in this chapter in or attached to any policy, certificate, membership booklet, outline of coverage, or other evidence of coverage that is provided to a covered person. The description shall be in a format prescribed by the commissioner by rule.   2. The description required by subsection 1 shall include a statement that informs the covered person of the right of the covered person to file a request for an external review of an adverse determination or final adverse determination of the health carrier with the commissioner. The statement shall explain that external review is available when the adverse determination or final adverse determination involves an issue of medical necessity, appropriateness, health care setting, level of care, or effectiveness. The statement shall include the telephone number and address of the commissioner. The statement shall also inform the covered person that when filing a request for external review, the covered person will be required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the request for external review.  2011 Acts, ch 101, §16  Referred to in §514J.104, 514J.120
IA Code § 514J.117 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.117 - Rulemaking authority.

514J.117 Rulemaking authority.   The commissioner may adopt rules pursuant to chapter 17A to carry out the provisions of this chapter.  2011 Acts, ch 101, §17
IA Code § 514J.118 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.118 - Severability.

514J.118 Severability.   If any provision of this chapter, or the application of the provision to any person or circumstance is held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.  2011 Acts, ch 101, §18
IA Code § 514J.119 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.119 - Penalties.

514J.119 Penalties.   A person who fails to comply with the provisions of this chapter or the rules adopted pursuant to this chapter is subject to the penalties provided under chapter 507B.  2011 Acts, ch 101, §19
IA Code § 514J.120 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS|Section 514J.120 - Applicability.

514J.120 Applicability.   1. This chapter applies to all requests for external review filed on or after July 1, 2011.   2. Section 514J.116 applies to all health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2011.  2011 Acts, ch 101, §20
IA Code § 514K.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514K - HEALTH CARE PLAN INFORMATION|Section 514K.1 - Health care plan disclosures — information to enrollees.

514K.1 Health care plan disclosures — information to enrollees.   1. A health maintenance organization or an insurer using a preferred provider arrangement shall provide to each of its enrollees at the time of enrollment, and shall make available to each prospective enrollee upon request, written information as required by rules adopted by the commissioner. The information required by rule shall include but not be limited to all of the following:   a. A description of the plan’s benefits and exclusions.   b. Enrollee cost-sharing requirements.   c. A list of participating providers.   d. Disclosure of the existence of any drug formularies used and, upon request, information about the specific drugs included in the formulary.   e. An explanation for accessing emergency care services.   f. Any policies addressing investigational or experimental treatments.   g. The methodologies used to compensate providers.   h. Performance measures as determined by the commissioner and the director.   i. Information on how to access internal and external grievance procedures.   2. The commissioner shall annually publish a consumer guide providing a comparison by plan on performance measures, network composition, and other key information to enable consumers to better understand plan differences.  99 Acts, ch 41, §21; 2017 Acts, ch 148, §95, 96