Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 72 - Long-term Care Asset Preservation Program › Rule 191-72.10 - Maintaining Auditing Information

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Each issuer shall maintain information as stipulated in 72.10(6) on all
				policyholders or certificate holders who have ever received any benefit under
				the policy or certificate. Such information shall be updated at least
				quarterly. This requirement for updating shall not require the conduct of any
				assessment, reassessment, or other evaluation of the policyholder's or
				certificate holder's condition which is not otherwise required by federal or
				state statute or regulation.
(2)
				When a policyholder or certificate holder who has received any benefit dies or
				lapses the policy or certificate for any reason, the issuer must retain the
				stipulated information for a period of at least five years after the time when
				the policy was in force. Unless notified by the division of insurance to the
				contrary during this period, after the five years, the service summary provided
				by the issuer will be deemed to comply with all asset protection reporting,
				record keeping, and auditing requirements of this rule. The issuer may use
				microfiche, microfilm, optical storage media, or any other cost-effective
				method of record storage as alternatives to storage of paper copies of
				stipulated information.
(3) At the
				time the policy or certificate ceases to be in force, the issuer shall notify
				the policyholder or certificate holder of the right to request service records
				as stipulated in 72.10(6).
(4) The
				issuer shall also, upon request in writing, provide such policyholder or
				certificate holder or the policyholder's or certificate holder's authorized
				designee, if any, with a copy of the issuer's service records as required in
				72.10(6) which are necessary to establish the asset disregard. These records
				shall be provided to the policyholder or certificate holder or the
				policyholder's or certificate holder's authorized designee, if requested,
				within 60 days of the request. The issuer may charge a reasonable fee to cover
				the costs of providing each set of requested service record copies.
(5) The issuer shall enclose with the records
				a statement advising the former policyholder or certificate holder that it is
				in the best interest of the former policyholder or certificate holder to retain
				the records to establish eligibility for Medicaid.
(6) The information to be maintained includes
				the following:
a. Evidence that the insured
				event has taken place. The occurrence of the insured event may be documented in
				any of the following ways:
(1) By case
				management agency staff, as part of the initial assessment of the client or as
				part of a subsequent reassessment.
(2) By an assessment conducted as part of the
				preadmission screening program of the Iowa Foundation of Medical
				Care.
(3) By an assessment of a
				resident of a nursing facility as required by Section 1919(b)(3) of the Social
				Security Act.
(4) For persons for
				whom subparagraphs (1) through (3) are not available or do not provide the
				required information, by an assessment, carried out by or under the supervision
				of a physician or a registered nurse, which is substantially comparable to any
				of the methods in subparagraphs (1) through (3). These assessments must be
				based on direct observations and interviews in conjunction with a medical
				record review. The physician or registered nurse carrying out or supervising
				the assessment must sign and certify the completion of the assessment. Each
				individual who completes a portion of such assessment shall sign and certify as
				to the accuracy of that portion of the assessment.