reglab/statecodes huggingface dataset:
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.15 - Licensed psychologists eligible for payment — provisional licensees.

249A.15 Licensed psychologists eligible for payment — provisional licensees.
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 clinical experience in a recognized health setting, or have met the standards of a national register of health service providers in psychology, to payment for services provided to recipients of medical assistance, subject to limitations and exclusions the department finds necessary on the basis of federal laws and regulations and of funds available for the medical assistance program. The rules shall also provide that an individual, who holds a provisional license to practice psychology pursuant to section 154B.6, is entitled to payment under this section for services provided to recipients of medical assistance, when such services are provided under the supervision of a supervisor who meets the qualifications determined by the board of psychology by rule, and claims for payment for such services are submitted by the supervisor.
2. Entitlement to payment under this section is applicable to services provided to recipients of medical assistance under both the fee-for-service and managed care payment and delivery systems. Neither the fee-for-service nor the managed care payment and delivery system shall impose a practice or supervision restriction which is inconsistent with or more restrictive than the authority already granted by law, including the authority to provide supervision in person or remotely through electronic means as specified by rule of the board of psychology.
[81 Acts, ch 7, §16]
2015 Acts, ch 137, §107, 162, 163; 2018 Acts, ch 1165, §135, 139
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.15B - Speech pathologists eligible for payment.

249A.15B Speech pathologists eligible for payment.
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 limitations and exclusions the department finds necessary on the basis of federal laws and regulations.
2012 Acts, ch 1092, §1
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.16 - New rates for services — effective date.

249A.16 New rates for services — effective date.
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 first day of the month in which the report is postmarked, or if the report is personally delivered, in which the report is received by the department.
[81 Acts, ch 83, §1]
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.18 - Cost-based reimbursement — rural health clinics and federally qualified health centers.

249A.18 Cost-based reimbursement — rural health clinics and federally qualified health centers.
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
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.18A - Resident assessment.

249A.18A Resident assessment.
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 regardless of payor source. The nursing facility may utilize the same resident assessment tool required for certification of the facility under the medical assistance and federal Medicare programs to comply with this section.
2000 Acts, ch 1004, §12, 22
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.20 - Noninstitutional health providers — reimbursement.

249A.20 Noninstitutional health providers — reimbursement.
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-service basis for provision of services under the medical assistance program. The department shall apply the federal Medicare resource-based relative value scale methodology to such health providers in the same manner as the methodology is applied under the federal Medicare program and shall not utilize the resource-based relative value scale methodology in a manner that discriminates between such health providers. The reimbursement schedule shall be adjusted annually on July 1, and shall provide for reimbursement that is not less than the reimbursement provided under the fee schedule established for Iowa under the federal Medicare program in effect on January 1 of that calendar year.
2. A provider reimbursed under section 249A.31 is not a noninstitutional health provider.
2000 Acts, ch 1221, §7; 2002 Acts, ch 1120, §2, 9; 2018 Acts, ch 1041, §127
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.27 - Indemnity for case management and disallowed costs.

249A.27 Indemnity for case management and disallowed costs.
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 state shall indemnify the employees and agents for acts within the scope of their employment. The state’s duties to defend and indemnify shall not apply if the conduct upon which any claim is based constitutes a willful and wanton act or omission or malfeasance in office.
2. If the department is the case management contractor, the state shall be responsible for any costs included within the unit rate for case management services which are disallowed for medical assistance reimbursement by the federal centers for Medicare and Medicaid services. The contracting county shall be credited for the county’s share of any amounts overpaid due to the disallowed costs. However, if certain costs are disallowed due to requirements or preferences of a particular county in the provision of case management services, the county shall not receive credit for the amount of the costs.
91 Acts, ch 158, §8; 2002 Acts, ch 1050, §25
Referred to in §249A.26
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.29 - Home and community-based services waiver providers — records checks.

249A.29 Home and community-based services waiver providers — records checks.
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.
c. “Waiver” means a home and community-based services waiver approved by the federal government and implemented under the medical assistance program.
2. If a person is being considered by a provider for employment involving direct responsibility for a consumer or with access to a consumer when the consumer is alone, and if the person has been convicted of a crime or has a record of founded child or dependent adult abuse, the department shall perform an evaluation to determine whether the crime or founded abuse warrants prohibition of employment by the provider. The department shall conduct criminal and child and dependent adult abuse records checks of the person in this state and may conduct these checks in other states. The records checks and evaluations required by this section shall be performed in accordance with procedures adopted for this purpose by the department.
3. If the department determines that a person employed by a provider has committed a crime or has a record of founded abuse, the department shall perform an evaluation to determine whether prohibition of the person’s employment is warranted.
4. In an evaluation, the department shall consider the nature and seriousness of the crime or founded abuse in relation to the position sought or held, the time elapsed since the commission of the crime or founded abuse, the circumstances under which the crime or founded abuse was committed, the degree of rehabilitation, the likelihood that the person will commit the crime or founded abuse again, and the number of crimes or founded abuses committed by the person involved. The department may permit a person who is evaluated to be employed or to continue to be employed by the provider if the person complies with the department’s conditions relating to the employment, which may include completion of additional training.
5. If the department determines that the person has committed a crime or has a record of founded abuse which warrants prohibition of employment, the person shall not be employed by a provider.
95 Acts, ch 93, §5; 2002 Acts, ch 1120, §4
Referred to in §249A.32, 335.34, 414.32
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.30 - Home and community-based services waiver — service provider reimbursement rate adjustments.

249A.30 Home and community-based services waiver — service provider reimbursement rate adjustments.
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 immediately preceding three-year period.
2. The annual inflation factor used to adjust such a provider’s reimbursement rate for a fiscal year shall not exceed the percentage increase in the employment cost index for private industry compensation issued by the federal department of labor, bureau of labor statistics, for the most recently completed calendar year.
2002 Acts, ch 1120, §5; 2004 Acts, ch 1086, §48; 2010 Acts, ch 1031, §390; 2013 Acts, ch 30, §52
Referred to in §249A.29
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.30A - Medical assistance — personal needs allowance.

249A.30A Medical assistance — personal needs allowance.
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 illness, as defined in section 135C.1, or a person who is a resident of a psychiatric medical institution for children as defined in section 135H.1, shall be fifty dollars per month. A resident who has income of less than fifty dollars per month shall receive a supplement from the state in the amount necessary to receive a personal needs allowance of fifty dollars per month, if funding is specifically appropriated for this purpose.
2006 Acts, ch 1113, §1; 2007 Acts, ch 218, §44; 2008 Acts, ch 1032, §41; 2012 Acts, ch 1019, §107
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.31 - Reimbursement — targeted case management services — inpatient psychiatric services.

249A.31 Reimbursement — targeted case management services — inpatient psychiatric services.
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 twenty-one years of age shall be reimbursed as follows:
a. For non-state-owned providers, services shall be reimbursed according to a fee schedule without reconciliation.
b. For state-owned providers, services shall be reimbursed at one hundred percent of the actual and allowable cost of providing the service.
2002 Acts, ch 1120, §6, 9; 2004 Acts, ch 1090, §17; 2007 Acts, ch 218, §120; 2009 Acts, ch 121, §2, 3; 2010 Acts, ch 1031, §389; 2012 Acts, ch 1019, §108; 2018 Acts, ch 1165, §132
Referred to in §249A.20
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.32 - Medical assistance home and community-based services waivers — consumer-directed attendant care — termination of contract.

249A.32 Medical assistance home and community-based services waivers — consumer-directed attendant care — termination of contract.
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 determines that the person has breached the contract by not providing the services agreed to under the contract.
2. For the purposes of this section, “consumer” and “waiver” mean consumer and waiver as defined in section 249A.29.
2003 Acts, ch 118, §2
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.32A - Home and community-based services waivers — limitations.

249A.32A Home and community-based services waivers — limitations.
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 first-come, first-served basis.
2005 Acts, ch 175, §115
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.32B - Early and periodic screening, diagnosis, and treatment funding.

249A.32B Early and periodic screening, diagnosis, and treatment funding.
The department of human services, in consultation with the Iowa department of public health and 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 the early and periodic screening, diagnosis, and treatment program through the schools. The department may enter into contracts to utilize maternal and child health centers, the public health nursing program, or school nurses in implementing this section.
2005 Acts, ch 175, §116
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.33 - Pharmaceutical settlement account — medical assistance program.

249A.33 Pharmaceutical settlement account — medical assistance program.
1. A pharmaceutical settlement account is created in the state treasury under the authority of the department of human services. Moneys received from settlements relating to provision of pharmaceuticals under the medical assistance program shall be deposited in the account.
2. Moneys in the account shall be used only as provided in appropriations from the account to the department for the purpose of technology upgrades under the medical assistance program.
3. The account 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 account shall not be considered revenue of the state, but rather shall be funds of the account. The moneys in the account are not subject to reversion to the general fund of the state under section 8.33 and shall not be transferred, used, obligated, appropriated, or otherwise encumbered, except to provide for the purposes of this section. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the account shall be credited to the account.
4. The treasurer of state shall provide a quarterly report of account activities and balances to the director.
2003 Acts, ch 178, §55
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.35 - Purchase of qualified long-term care insurance policy — computation under medical assistance program.

249A.35 Purchase of qualified long-term care insurance policy — computation under medical assistance program.
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, ch 166, §1, 13; 2009 Acts, ch 145, §1
Referred to in §514H.5
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.37 - Health care information sharing.

249A.37 Health care information sharing.
1. As a condition of doing business in the state, health insurers including self-insured plans, group health plans as defined in the federal Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, service benefit plans, managed care organizations, pharmacy benefits managers, and other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service, shall do all of the following:
a. Provide, with respect to individuals who are eligible for or are provided medical assistance under the state’s medical assistance state plan, upon the request of the state, information to determine during what period the individual or the individual’s spouse or dependents may be or may have been covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan, in accordance with section 505.25, in a manner prescribed by the department of human services or as agreed upon by the department and the entity specified in this section.
b. Accept the state’s right of recovery and the assignment to the state of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the medical assistance state plan.
c. Respond to any inquiry by the state regarding a claim for payment for any health care item or service that is submitted no later than three years after the date of the provision of such health care item or service.
d. Agree not to deny any claim submitted by the state solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if all of the following conditions are met:
(1) The claim is submitted to the entity by the state within the three-year period beginning on the date on which the item or service was furnished.
(2) Any action by the state to enforce its rights with respect to such claim is commenced within six years of the date that the claim was submitted by the state.
2. The department of human services may adopt rules pursuant to chapter 17A as necessary to implement this section. Rules governing the exchange of information under this section shall be consistent with all laws, regulations, and rules relating to the confidentiality or privacy of personal information or medical records, including but not limited to the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, and regulations promulgated in accordance with that Act and published in
45 C.F.R. pts. 160 – 164
.
2008 Acts, ch 1187, §124
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.38 - Inmates of public institutions — suspension of medical assistance.

249A.38 Inmates of public institutions — suspension of medical assistance.
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 commitment to the public institution, and who remains eligible for medical assistance as an individual except for the individual’s institutional status, during the entire period of the individual’s commitment to the public institution.
2. a. A public institution shall provide the department and the social security administration with a monthly report of the individuals who are committed to the public institution and of the individuals who are discharged from the public institution. The monthly report to the department shall include the date of commitment or the date of discharge, as applicable, of each individual committed to or discharged from the public institution during the reporting period. The monthly report shall be made through the reporting system created by the department for public, nonmedical institutions to report inmate populations. Any medical assistance expenditures, including but not limited to monthly managed care capitation payments, provided on behalf of an individual who is an inmate of a public institution but is not reported to the department in accordance with this subsection, shall be the financial responsibility of the respective public institution.
b. The department shall provide a public institution with the forms necessary to be used by the individual in expediting restoration of the individual’s medical assistance benefits upon discharge from the public institution.
3. The department may adopt rules pursuant to chapter 17A to implement this section.
2011 Acts, ch 98, §13, 15; 2012 Acts, ch 1038, §1; 2018 Acts, ch 1165, §127; 2019 Acts, ch 81, §1
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.39 - Reporting of overpayment.

249A.39 Reporting of overpayment.
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. Notification and return of an overpayment under this section shall be provided by no later than the later of either of the following, as applicable:
a. The date which is sixty days after the date on which the overpayment was identified by the provider.
b. The date any corresponding cost report is due.
3. A violation of this section is a violation of chapter 685.
2013 Acts, ch 24, §3
Referred to in §249A.47, 249A.49
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.40 - Involuntarily dissolved providers — overpayments or incorrect payments.

249A.40 Involuntarily dissolved providers — overpayments or incorrect payments.
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 overpayment for the purposes of this subchapter. For the purposes of this section, the overpayment shall not accrue until after a grace period of ninety days following receipt of notice by the provider of the dissolution from the department. Notwithstanding section 490.1422, or any other similar retroactive provision for reinstatement, the director shall recoup any medical assistance paid to a provider while the provider was dissolved if the provider is not retroactively reinstated within the ninety-day grace period. The principals of the provider shall be personally liable for the incorrect payment or overpayment.
2013 Acts, ch 24, §4; 2019 Acts, ch 24, §104; 2021 Acts, ch 165, §219, 230
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.41 - Overpayment — interest.

249A.41 Overpayment — interest.
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 prejudgment interest applicable in civil actions.
3. After the provision of a notice of overpayment to the provider and after all of the provider’s administrative and judicial review remedies under
441 IAC ch. 7
and chapter 17A have been exhausted, interest shall accrue at the statutory rate for prejudgment interest applicable in civil actions plus five percent per annum, or the maximum legal rate, whichever is lower.
4. At the discretion of the director, interest on an overpayment may be waived in whole or in part when the department determines the imposition of interest would produce an unjust result, would unduly burden the provider, or would substantially delay the prompt and efficient resolution of an outstanding audit or investigation.
2013 Acts, ch 24, §5
Referred to in §249A.2
Interest on judgments, see §535.3 and 668.13
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.42 - Overpayment — limitations periods.

249A.42 Overpayment — limitations periods.
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 reconciliation was completed, whichever is later.
2. An administrative action to impose a sanction related to an overpayment to a provider shall be commenced within five years of the date the conduct underlying the sanction concluded, or the director discovered such conduct, whichever is later.
2013 Acts, ch 24, §6
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.42A - Overpayment — subsequent ineligibility of recipient — recovery — recoupment — reimbursement.

249A.42A Overpayment — subsequent ineligibility of recipient — recovery — recoupment — reimbursement.
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 ineligibility, the department acting as the state Medicaid agency shall reimburse the provider for any recoupment of an overpayment using state-only funds for care or services delivered if all of the following conditions are met:
1. The provider verified eligibility through the eligibility and verification system or the secure web portal of, and obtained any necessary prior authorization for, the recipient on whose behalf payment was made to the provider prior to the delivery of care or service to the recipient.
2. The provider documented the eligibility verification performed and any necessary prior authorization obtained pursuant to subsection 1 in a manner and format established by the department by rule, and retained the required documentation in the recipient’s file.
2022 Acts, ch 1065, §1; 2022 Acts, ch 1153, §10
NEW section
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.43 - Provider overpayment — notice — judgment.

249A.43 Provider overpayment — notice — judgment.
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, return receipt requested, by the director or the attorney general or, if applicable, upon exhaustion of the provider’s administrative and judicial review remedies under
441 IAC ch. 7
or chapter 17A, whichever is later. The judgment is entitled to full faith and credit in all states.
2. The notice of overpayment shall include the amount and cause of the overpayment, the provider’s appeal rights, and a disclaimer that a judgment may be established if an appeal is not timely filed or if an appeal is filed and at the conclusion of the administrative process under chapter 17A a determination is made that there is an overpayment.
3. An affidavit of service of a notice of entry of judgment shall be made by first class mail at the address where the debtor was served with the notice of overpayment. Service is completed upon mailing as specified in this subsection.
4. On or after the date an unpaid overpayment becomes a judgment by operation of law, the director or the attorney general may file all of the following with the district court:
a. A statement identifying, or a copy of, the notice of overpayment.
b. Proof of service of the notice of overpayment.
c. An affidavit of default, stating the full name, occupation, place of residence, and last known post office address of the debtor; the name and post office address of the department; the date or dates the overpayment was incurred; the program under which the debtor was overpaid; and the total amount of the judgment.
5. Nothing in this section shall be construed to impede or restrict alternative methods of recovery of the overpayments specified in this section or of overpayments which do not meet the requirements of this section.
2013 Acts, ch 24, §7; 2013 Acts, ch 140, §59
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.44 - Overpayment — emergency relief.

249A.44 Overpayment — emergency relief.
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 restraining order or injunctive relief to prevent a provider or other person from whom recovery may be sought, from transferring property or otherwise taking action to protect the provider’s or other person’s business inconsistent with the recovery sought.
2. To obtain such relief, the director or the attorney general shall demonstrate all necessary requirements for the relief to be granted.
3. If an injunction is granted, the court may appoint a receiver to protect the property and business of the provider or other person from whom recovery may be sought. The court shall assess the costs of the receiver to the provider or other person.
4. The director or the attorney general may file a lis pendens on the property of the provider or other person during the pendency of a criminal, civil, or administrative proceeding.
5. When requested by the court, the director, or the attorney general, a provider or other person from whom recovery may be sought shall have an affirmative duty to fully disclose all property and liabilities to the requester.
6. An action brought under this section may be brought in the district court for Polk county or any other county in which a provider or other person from whom recovery may be sought has its principal place of business or is domiciled.
2013 Acts, ch 24, §8
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.45 - Provider’s third-party submissions.

249A.45 Provider’s third-party submissions.
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 section, “good cause” includes but is not limited to a pattern or practice of submitting unallowable costs on cost reports; making a false statement or certification to the director or any representative of the department; professional negligence or other demonstrated lack of knowledge of the cost reporting process; conviction under a federal or state law relating to the operation of a publicly funded program; or submission of a false claim under chapter 685.
2. If the department refuses to accept a cost report from a third party for good cause under this section, the third party shall be strictly liable to the provider for all fees incurred in preparation of the cost report, as well as reasonable attorney fees and costs. The department shall not take any adverse action against a provider that results from the unintentional delay in the submission of a new cost report or other submission necessitated by the department’s refusal to accept a cost report or other submission under this section. The department shall notify an affected provider within seven business days of any refusal to accept a cost report.
2013 Acts, ch 24, §9
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.46 - Liability of other persons — repayment of claims.

249A.46 Liability of other persons — repayment of claims.
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 restrict alternative recovery methods for claims specified in this section or claims which do not meet the requirements of this section.
2013 Acts, ch 24, §10
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.48 - Temporary moratoria.

249A.48 Temporary moratoria.
1. The Iowa Medicaid enterprise 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 medical assistance program.
a. This section shall not be interpreted to require the Iowa Medicaid enterprise to impose a moratorium if the Iowa Medicaid enterprise determines that imposition of a temporary moratorium would adversely affect access of recipients to medical assistance services.
b. If the Iowa Medicaid enterprise makes a determination as specified in paragraph “a”, the Iowa Medicaid enterprise shall notify the centers for Medicare and Medicaid services of the United States department of health and human services in writing.
2. The Iowa Medicaid enterprise may impose a temporary moratorium on the enrollment of new providers, or impose numerical caps or other limits that the Iowa Medicaid enterprise and the centers for Medicare and Medicaid services identify as having a significant potential for fraud, waste, or abuse.
a. Before implementing the moratorium, caps, or other limits, the Iowa Medicaid enterprise shall determine that its action would not adversely impact access by recipients to medical assistance services.
b. The Iowa Medicaid enterprise shall notify, in writing, the centers for Medicare and Medicaid services, if the Iowa Medicaid enterprise seeks to impose a moratorium under this subsection, including all of the details of the moratorium. The Iowa Medicaid enterprise shall receive approval from the centers for Medicare and Medicaid services prior to imposing a moratorium under this subsection.
3. a. The Iowa Medicaid enterprise shall impose any moratorium for an initial period of six months.
b. If the Iowa Medicaid enterprise determines that it is necessary, the Iowa Medicaid enterprise may extend the moratorium in six-month increments. Each time a moratorium is extended, the Iowa Medicaid enterprise shall document, in writing, the necessity for extending the moratorium.
2013 Acts, ch 24, §12
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.49 - Internet site — providers found in violation of medical assistance program.

249A.49 Internet site — providers found in violation of medical assistance program.
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 return an identified overpayment of medical assistance within the time frame specified in section 249A.39.
c. A list of all providers found liable for a false claims law violation related to the medical assistance program under chapter 685.
2. The director shall take all appropriate measures to safeguard the protected health information, social security numbers, and other information of the individuals involved, which may be redacted or omitted as provided in
rule of civil procedure 1.422
. A provider shall not be included on the internet site until all administrative and judicial remedies relating to the violation have been exhausted.
2013 Acts, ch 24, §13; 2014 Acts, ch 1092, §153, 197, 199
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.50 - Fraudulent practices — investigations and audits — Medicaid fraud fund.

249A.50 Fraudulent practices — investigations and audits — Medicaid fraud fund.
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 under the provisions of this chapter and a person who knowingly makes or causes to be made, a false statement or a misrepresentation of a material fact or knowingly fails to disclose a material fact concerning the applicant’s eligibility for aid under this chapter commits a fraudulent practice.
2. The department of inspections and appeals shall conduct investigations and audits as deemed necessary to ensure compliance with the medical assistance program administered under this chapter. The department of inspections and appeals shall cooperate with the department of human services on the development of procedures relating to such investigations and audits to ensure compliance with federal and state single state agency requirements.
3. a. A Medicaid fraud fund is created in the state treasury under the authority of the department of inspections and appeals. Moneys from penalties, investigative costs recouped by the Medicaid fraud control unit, and other amounts received as a result of prosecutions involving the department of inspections and appeals investigations and audits to ensure compliance with the medical assistance program that are not credited to the program shall be credited to the fund.
b. Notwithstanding section 8.33, moneys credited to the fund from any other account or fund shall not revert to the other account or fund. Moneys in the fund shall only be used as provided in appropriations from the fund and shall be used in accordance with applicable laws, regulations, and the policies of the office of inspector general of the United States department of health and human services.
c. For the purposes of this subsection, “investigative costs” means the reasonable value of a Medicaid fraud control unit investigator’s, auditor’s or employee’s time, any moneys expended by the Medicaid fraud control unit, and the reasonable fair market value of resources used or expended by the Medicaid fraud control unit in a case resulting in a criminal conviction of a provider under this chapter or chapter 714 or 715A.
[C62, 66, §249A.15; C71, 73, 75, 77, 79, 81, §249A.7]
90 Acts, ch 1204, §63; 97 Acts, ch 56, §3; 2009 Acts, ch 136, §10; 2011 Acts, ch 52, §1; 2011 Acts, ch 127, §49, 89; 2013 Acts, ch 24, §14
C2014, §249A.50
Referred to in §910.1
Fraudulent practices, see §714.8 – 714.14
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.51 - Fraudulent practice.

249A.51 Fraudulent practice.
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 medical assistance program under this chapter commits a fraudulent practice.
91 Acts, ch 107, §12
CS91, §249A.8
97 Acts, ch 56, §4; 2013 Acts, ch 24, §14
C2014, §249A.51
Referred to in §249A.47
Fraudulent practices, see §714.8 – 714.14
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.52 - Garnishment.

249A.52 Garnishment.
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 to chapter 252D from the income of the person obligated to pay support, and shall withhold amounts from state income tax refunds of a person obligated to pay support, to the extent necessary to reimburse the department for expenditures for medical care or expenses on behalf of a recipient if all of the following conditions apply:
1. The person is required by court or administrative order to provide medical support to a recipient.
2. The person has received payment from a third party for the costs of medical assistance to the recipient and has not used the payments to reimburse the costs of medical care or expenses.
94 Acts, ch 1171, §9
C95, §249A.4A
2013 Acts, ch 24, §14
C2014, §249A.52
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.55 - Restitution.

249A.55 Restitution.
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 section 910.2.
2010 Acts, ch 1093, §1
C2011, §249A.6A
2013 Acts, ch 24, §14
C2014, §249A.55
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.56 - County attorney to enforce.

249A.56 County attorney to enforce.
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 prosecution as required.
[C79, 81, §249A.14]
85 Acts, ch 195, §27; 93 Acts, ch 97, §38; 2013 Acts, ch 24, §14
C2014, §249A.56
Referred to in §331.756(43)
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249A - MEDICAL ASSISTANCE › Section 249A.57 - Health care facilities — penalty.

249A.57 Health care facilities — penalty.
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 1919, as codified in 42 U.S.C. §1396r. A civil penalty shall not exceed the amount authorized under
42 C.F.R. §488.438
for health care facility violations. Any moneys collected by the department pursuant to this section shall be applied to the protection of the health or property of the residents of the health care facilities which are determined by the state or by the federal centers for Medicare and Medicaid services to be out of compliance. The purposes for which the collected moneys shall be applied may include payment for the costs of relocation of residents to other facilities, maintenance or operation of a health care facility pending correction of deficiencies or closure of the facility, and reimbursing residents for personal funds lost. If a health care facility is assessed a civil penalty under this section, the health care facility shall not be assessed a penalty under section 135C.36 for the same violation.
90 Acts, ch 1031, §1
C91, §249A.19
96 Acts, ch 1107, §2; 2002 Acts, ch 1050, §24; 2013 Acts, ch 24, §14
C2014, §249A.57
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249B - MEDICAL ASSISTANCE TO INSTITUTIONALIZED SPOUSES › Section 249B.1 - Definitions.

249B.1 Definitions.
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 spouse.
2. “Community spouse resource allowance” means a resource amount established for a community spouse pursuant to state policy adopted in accordance with the federal Social Security Act, section 1924(f)(2), as codified in 42 U.S.C. §1396r-5(f)(2).
3. “Court order” means a judgment or order of a court of this state or another state requiring the payment of a set or determinable amount of monetary support.
4. “Department” means the department of human services.
5. “Institutionalized spouse” means a married individual who has resided or is likely to reside in a hospital or a health care facility for more than twenty-nine consecutive days.
6. “Medical assistance” means “mandatory medical assistance”, “optional medical assistance”, “discretionary medical assistance” or “Medicare cost sharing” as defined in section 249A.2 which is provided to an individual pursuant to chapter 249A and Tit. XIX of the federal Social Security Act.
7. “Minimum monthly maintenance needs allowance” or “minimum allowance” means the minimum monthly maintenance needs allowance established for the community spouse in accordance with Tit. XIX of the federal Social Security Act, section 1924(d)(3), as codified in 42 U.S.C. §1396r-5(d)(3).
90 Acts, ch 1098, §1; 91 Acts, ch 158, §9; 2010 Acts, ch 1061, §180; 2013 Acts, ch 138, §73
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249B - MEDICAL ASSISTANCE TO INSTITUTIONALIZED SPOUSES › Section 249B.2 - Creation of spousal support debt.

249B.2 Creation of spousal support debt.
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 community spouse in an amount equal to the medical assistance provided on behalf of the institutionalized spouse.
2. The department may recover the spousal support debt from any income or resources of the community spouse that are not exempt for medical assistance eligibility purposes and that are in excess of the minimum monthly maintenance needs allowance and the community spouse resource allowance.
3. When an institutionalized spouse is determined to be eligible for medical assistance pursuant to subsection 1, prior to issuing a formal notice of a spousal support debt pursuant to section 249B.3, the department shall offer to meet with the community spouse concerning creation of the spousal support debt.
90 Acts, ch 1098, §2
2023 Iowa Code › Title VI - HUMAN SERVICES › Chapter 249B - MEDICAL ASSISTANCE TO INSTITUTIONALIZED SPOUSES › Section 249B.4 - Certification to court — hearing — default.

249B.4 Certification to court — hearing — default.
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 or notice of the spousal support debt accrued and accruing, the return of service, the written objections and request for hearing, and true copies of any administrative orders previously entered.
3. The district court shall set the matter for hearing and notify the parties of the time and place of hearing.
4. If a party fails to appear at the hearing, upon a showing of proper notice to the party, the district court may find the party in default and enter an appropriate order.
90 Acts, ch 1098, §4