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Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.10 - Administrator

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Administrator required.
Each subacute care facility shall have
				one person in charge who is duly approved by the department or acting in a
				provisional capacity in accordance with these rules.
(2)
Qualifications of an
				administrator.
The administrator shall be at least 21 years of age and
				shall have a high school diploma or equivalent. In addition, the person shall
				meet at least one of the following conditions:
a. Be a mental health professional, as
				defined in Iowa Code section
				228.1(7),
				with at least one year of experience in an administrative capacity;
				or
b. Have a four-year degree in
				human services, psychology, sociology, nursing, health care administration,
				public administration, or a related field and have a minimum of one year of
				experience in the field; or
c. Have
				a master's degree in human services, psychology, sociology, nursing, health
				care administration, public administration, or a related field; or
d. Be a licensed nursing home
				administrator.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.11 - Administration

Current through Register Vol. 47, No. 3, July 24, 2024
(1) The licensee
				shall:
a. Assume the responsibility for the
				overall operation of the subacute care facility;
b. Be responsible for compliance with all
				applicable laws and with the rules of the department;
c. Establish written policies, which shall be
				available for review, for the operation of the subacute care
				facility.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.12 - Personnel

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Staffing
				requirements. Availability of personnel must be sufficient to meet psychiatric
				and medical treatment needs of the residents served.
(2) Staffing shall include at minimum:
a. Twenty-four-hour-per-day,
				seven-day-per-week availability of on-call psychiatrist or advanced registered
				nurse practitioner with at least one year of experience in psychiatric
				care;
b. Twenty-four-hour-per-day,
				seven-day-per-week availability of on-call registered nurse with at least two
				years of experience in psychiatric care or a registered nurse with a bachelor
				of science in nursing (BSN) and at least one year of experience in psychiatric
				care;
c. A mental health
				professional as defined in Iowa Code section
				228.1(7);
d. Direct care staff with at least one year
				of experience in a mental health care setting; and
e. Social service staff at the bachelor level
				with at least one year of experience in a mental health care setting.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.13 - Admission, Transfer, and Discharge.

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
General admission
				policies.
a. A subacute care
				facility shall not admit or retain a resident who is in need of greater
				services than the facility can provide.
b. Prior to admission of an applicant, the
				facility shall obtain sufficient information to determine if its program is
				appropriate and adequate to meet the individual's needs.
c. A subacute care facility shall admit only
				as many residents as indicated by the number of beds for which the facility is
				licensed.
d. A subacute care
				facility shall adopt policies regarding the admission requirements outlined in
				subrule 71.13(2).
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.14 - Treatment Plan

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A treatment
				plan must be developed with each resident. The plan must be based on initial
				and ongoing assessment of need, be designed to resolve the acute or crisis
				mental health symptoms or the imminent risk of acute or crisis mental health
				symptoms, and be completed within six hours of admission, or no later than 12
				noon following admission if the resident is admitted between 8 p.m. and 6
				a.m.
(2) The treatment plan must be
				documented in the resident's record and must include the following:
a. The resident's name.
b. The date the plan is developed.
c. Standardized diagnostic formulations,
				including but not limited to the current Diagnostic and Statistical Manual
				(DSM) or the current International Statistical Classification of Diseases and
				Related Health Problems (ICD).
d.
				Problems and strengths of the resident that are to be addressed.
e. Observable and measurable individual
				objectives that relate to the specific problems identified.
f. Interventions that address specific
				objectives, identification of staff responsible for interventions, and planned
				frequency of interventions.
g.
				Signatures of mental health professionals responsible for developing the plan,
				including the qualified prescriber.
h. Signatures of the resident and any parent,
				guardian, conservator, or legal custodian. Reasons for refusal to sign or
				inability to participate in treatment plan development must be
				documented.
i. A projected
				discharge date and anticipated postdischarge needs, including documentation of
				resources needed in the community.
j. Review of the treatment plan by the
				appropriate treatment staff at least daily and upon completion of the stated
				goals or objectives and documentation of the following:
(1) Progress toward each treatment objective,
				with revisions as indicated; and
(2) Status of discharge plans, including
				availability of resources needed by the resident in the community, with
				revisions as indicated.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.15 - Crisis Intervention

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				There shall be written policies and procedures concerning crisis intervention.
				These policies and procedures shall be:
a.
				Directed to maximizing the growth and development of the individual by
				incorporating a hierarchy of available alternative methods that emphasize
				positive approaches;
b. Available
				in each program area and living unit;
c. Available to individuals and their
				families; and
d. Developed with the
				participation, as appropriate, of individuals served.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.16 - Seclusion and Restraint

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Use of a seclusion room.
Pursuant to Iowa Code section
				135G.3(2),
				a seclusion room used by a subacute care facility must meet the conditions of
				42
				CFR §
										483.364(b).
a. A subacute care facility utilizing a
				seclusion room shall have written policies regarding its use. The policy shall:
(1) Specify the types of behavior that may
				result in seclusion room placement.
(2) Delineate the licensed personnel who may
				authorize use of the seclusion room.
(3) Require documentation of the time in the
				seclusion room, the reasons for use of the seclusion room, and the reasons for
				any extension of time beyond one hour. Under no circumstances shall the use of
				the seclusion room exceed four hours.
(4) Require notice to residents of the types
				of behavior that may result in seclusion room placement.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.17 - Medication Management

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Medications must be ordered by qualified prescribers and administered by
				qualified personnel. For purposes of this subrule, "qualified personnel" means,
				at a minimum, a certified medication aide.
(2) Prescription medication must be legally
				dispensed and labeled according to state law.
(3) All medication errors, drug reactions and
				suspected drug overmedication must be documented and reported to the
				practitioner who prescribed the medication.
(4) All medications and other preparations
				intended for internal or external human use must be stored in medicine cabinets
				or drug rooms. When preservation of the medication or other preparation
				requires refrigeration, the facility must provide a means of securely
				refrigerating these items. Such cabinets or drug rooms must be kept securely
				locked when not in use, and the key must be in the possession of the
				supervising nurse or other authorized person.
(5) Schedule II drugs must be stored within
				two separately locked compartments at all times and accessible only to
				qualified personnel in charge of administering medication.
(6) Any unused portions of program-prescribed
				medication(s) must be either turned over to the resident with written
				authorization and directions by the qualified prescriber or returned to a
				pharmacy for proper disposition by the pharmacist.
(7) Whenever a resident brings the resident's
				own prescribed medications into the facility, such medications must not be
				administered unless identified by a qualified prescriber or pharmacist and
				ordered by a qualified prescriber. If such medications cannot be administered,
				they must be packaged, sealed, and returned to an adult member of the
				resident's immediate family or the legal guardian or securely stored and
				returned to the resident upon discharge. However, if previously prescribed
				medication would prove harmful to the resident, the medication may be withheld
				from the resident and disposed of in accordance with subrule 71.17(6). There
				must be documentation by the qualified prescriber in the resident's clinical
				record citing the dangers or contraindications of the medication being
				withheld.
(8) All potent,
				poisonous, or caustic materials shall be stored separately from medications.
				All potent, poisonous, or caustic materials shall be plainly labeled and stored
				in a specific, well-illuminated cabinet, closet or storeroom and made
				accessible only to authorized personnel.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.18 - Dietary

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Nutrition and menu planning.
a. Menus shall be planned and followed to
				meet the nutritional needs of residents.
b. Menus shall be planned and served to
				include foods and amounts necessary to meet federal dietary
				guidelines.
c. At least three meals
				or their equivalent shall be served daily, at regular hours.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.19 - Buildings, Furnishings, and Equipment.

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Buildings
-
general requirements.
a. All
				windows shall be supplied with window treatments that are kept clean and in
				good repair.
b. Whenever glass
				sliding doors or transparent panels are used, they shall be marked
				conspicuously.
c. The facility
				shall meet the equivalent requirements of the appropriate group occupancy of
				the state fire code.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.20 - Records

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Resident record.
The licensee shall keep a permanent record
				about each resident with all entries current, dated, and signed. The record
				shall include:
a. Name and previous address
				of resident;
b. Birth date, sex,
				and marital status of resident;
c.
				Provisional or admitting diagnosis;
d. A biopsychosocial history sufficient to
				provide data on the resident's relevant past history, present situation, social
				support system, community resource contacts, and other information relevant to
				appropriate treatment and discharge planning;
e. The name, telephone number and address of
				the licensed mental health professional completing the biopsychosocial history;
f. Name, address and telephone
				number of next of kin or legal representative;
g. Name, address and telephone number of the
				person to be notified in case of emergency;
h. Pharmacy name, telephone number, and
				address;
i. Written orders for
				treatment and medications, signed by a physician, physician assistant or
				advanced registered nurse practitioner;
j. Any change in the resident's
				condition;
k. Notations describing
				the resident's condition on admission, transfer, and discharge;
l. A copy of instructions given to the
				resident, legal representative, or facility in the event of discharge or
				transfer;
m. Individualized
				treatment and discharge or transfer plan pursuant to rule
				481-71.14 (135G);
n. Progress notes, including any use of
				seclusion or restraint pursuant to rule
				481-71.16 (135G), recorded by
				the physician, physician assistant, advanced registered nurse practitioner or
				mental health professional and, when appropriate, others significantly involved
				in active treatment modalities. Progress notes must contain a concise
				assessment of the resident's progress and recommendations for revising the
				treatment plan as indicated by the resident's condition;
o. The discharge summary, including a
				recapitulation of the resident's hospitalization, recommendations for
				appropriate services concerning follow-up, and a brief summary of the
				resident's condition on discharge.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.21 - Residents Rights in General

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Policies and procedures.
Each facility shall ensure that policies and procedures are written and
				implemented, include all of the following subrules, and govern all areas of
				service provided to staff and residents, their families or legal
				representatives. The policies and procedures shall be available to the public
				and shall be reviewed annually by the facility.
(2)
Grievances.
Written
				policies and procedures shall include a method for submission of grievances and
				recommendations by residents or their responsible parties and a method to
				ensure a response and disposition by the facility. The written grievance
				procedure shall ensure protection of the resident from any form of reprisal or
				intimidation and shall include:
a. The name
				of an employee or an alternate staff person designated to be responsible for
				handling grievances and recommendations; and
b. Methods to investigate and assess the
				validity of a grievance or recommendation, resolve grievances, and take
				action.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 71 - Subacute Mental Health Care Facilities › Rule 481-71.22 - Health and Safety

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Emergency care.
Each facility shall have written policies and
				procedures for emergency medical and psychiatric treatment, which shall include
				immediate notification by the person in charge to the physician, physician
				assistant, advanced registered nurse practitioner or mental health professional
				of any accident, injury or adverse change in the resident's condition.
				"Immediate" for purposes of this subrule means within 24 hours.
(2)
First-aid kit.
A
				first-aid emergency kit shall be available on each floor.
(3)
Infection control.
Each
				facility shall have a written and implemented infection control
				program.
(4)
Safe
				environment.
The licensee of a subacute care facility is responsible
				for the provision and maintenance of a safe environment for residents and
				personnel. The subacute care facility shall meet the fire and safety rules as
				promulgated by the state fire marshal or the state fire marshal's
				designee.
(5)
Disaster.
The licensee shall have a written emergency plan to
				be followed in the event of fire, tornado, explosion, or other emergency.
a. The plan shall be posted.
b. Training shall be provided to ensure that
				all employees are knowledgeable of the emergency plan. The training shall be
				documented.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Client"
means any person who has made an
				  application for or is receiving state or federal public assistance from DHS or
				  any other state or federal agency.
"Collateral contact"
means a reliable source
				  other than the client who is knowledgeable about information relative to
				  pertinent public assistance case factors.
"Department"
means the department of
				  inspections and appeals.
"DHS"
means the department of human
				  services.
"Division"
means the investigations division
				  of the department.
"EBT"
or
"electronic benefit
				  transfer"
means the electronic process that allows a client to
				  authorize transfer of the client's benefits from a financial account to a
				  retailer to pay for eligible items received. Clients are issued an EBT card
				  similar to a bank ATM or debit card to receive and use their supplemental
				  nutrition assistance program (SNAP) benefits.
"EBT trafficking or misuse"
means the use of
				  SNAP benefits for something other than their intended use.
"EFCB"
or
"bureau"
means
				  the economic fraud control bureau.
"Intentional program violation"
or
"IPV"
means having intentionally made a false or misleading
				  statement; or misrepresented, concealed, or withheld facts; or committed an act
				  that is a violation of the Food Stamp Act, Supplemental Nutrition Assistance
				  Program regulations, or any state rule relating to the use, presentation,
				  transfer, acquisition, receipt or possession of a benefit transfer
				  instrument.
"Pertinent public assistance case factors"
means information considered necessary to verify household composition, income,
				  resources or any other potential program violation.
"Program violation"
means action that is
				  contrary to the rules of eligibility for any state or federal public assistance
				  program.
"Public assistance"
means child care
				  assistance, family investment program, SNAP, medical assistance, state
				  supplementary assistance, refugee cash assistance, or any other state or
				  federal assistance program.
"Referral"
means a request to investigate
				  pertinent public assistance case factors for potential program violations and
				  eligibility issues.
"Referring agency"
means DHS or any other
				  state or federal agency.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.2 - Economic Fraud Control Bureau (EFCB)

Current through Register Vol. 47, No. 3, July 24, 2024
Generally, the EFCB conducts investigations of public
				  assistance fraud in order to maintain integrity and accountability in the
				  administration of public assistance benefits.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.3 - Types of Investigations

Current through Register Vol. 47, No. 3, July 24, 2024
The EFCB conducts three types of investigations.
(1)
Front-end
				investigations.
The EFCB conducts front-end investigations to
				determine whether a client has accurately reported the information necessary to
				become eligible for or to retain public assistance benefits.
(2)
Fraud investigations.
The EFCB conducts a fraud investigation when the referring agency suspects that
				a client received public assistance benefits the client was not entitled to
				receive.
(3)
EBT
				trafficking or misuse.
The EFCB conducts an investigation to determine
				whether a client is responsible for EBT trafficking or misuse.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.4 - Referrals

Current through Register Vol. 47, No. 3, July 24, 2024
DHS shall initiate public assistance eligibility referrals
				  and EBT trafficking or misuse referrals to the division. EBT trafficking or
				  misuse investigations also may be initiated by the division without a referral.
				  Referrals from other referring agencies may be made directly to the
				  division.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.5 - Investigation Procedures

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Client contact.
The bureau may, but is not required to,
				contact the client during the course of an investigation. If the bureau
				contacts the client and the client does not respond, the client's nonresponse
				will be included in the bureau's investigation findings.
(2)
Evidence gathered.
The
				bureau may conduct record reviews and gather evidence to verify a client's
				employment, wages, residence, household composition, income versus expenses, or
				property ownership or other relevant facts.
(3)
Subpoenas.
The director
				of the department or the director's designee may issue subpoenas pursuant to
				Iowa Code section
				10A.104
				and 481-subrules 1.1(6) to 1.1(9) to obtain information necessary to an
				investigation. Subpoenas may be personally served by division personnel upon
				the respondent of the subpoena or the respondent's registered agent, mailed
				directly to the respondent or the respondent's registered agent via USPS mail,
				or electronically transmitted directly to the respondent or the respondent's
				registered agent via facsimile or email. Division personnel shall have the
				authority to determine the appropriate method by which the respondent is
				requested to deliver information in response to a subpoena duces
				tecum.
(4)
Collateral
				contacts.
The division may use collateral contacts to collect
				information pertinent to an investigation or verify information provided by the
				client.
(5)
Cooperation.
The division
				may cooperate with local, state or federal law enforcement agencies in
				conducting an investigation.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.6 - Ebt Trafficking or Misuse Investigations

Current through Register Vol. 47, No. 3, July 24, 2024
In addition to the procedures outlined in rule 481-72.5
				  (10A), the following apply to EBT trafficking or misuse investigations.
(1)
Probable cause.
Probable
				cause must be established before an EBT trafficking or misuse investigation may
				be conducted.
(2)
Referrals.
Referrals to the division may come from DHS,
				retailers, law enforcement agencies or the general public. A referral may be
				initiated following the identification of questionable EBT card transactions
				through federal or state databases. The bureau may open an investigation
				without an outside referral.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.7 - Findings

Current through Register Vol. 47, No. 3, July 24, 2024
At the completion of an investigation, the bureau will
				  transmit its findings in writing to the appropriate state or federal agency and
				  make recommendations based on the evidence obtained or provided during the
				  investigation.
(1)
Decisions
				about public assistance eligibility.
The appropriate state or federal
				agency makes all decisions about public assistance eligibility. DHS will report
				the case action taken and any determination of overpayment, cost avoidance, or
				intentional program violation to the division.
(2)
Testimony and hearings.
Staff of the division may be called to testify in administrative and legal
				proceedings related to an investigation, in addition to conducting EBT
				intentional program violation hearings.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 72 - Economic Fraud Control Bureau › Rule 481-72.8 - Confidentiality

Current through Register Vol. 47, No. 3, July 24, 2024
The EFCB shall maintain confidentiality of investigative case
				  information in accordance with Iowa Code sections
				  10A.105 and
				  22.7(5)
				   and any other applicable state or federal
				  law.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.2 - Investigative Authority

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Pursuant to Iowa Code section
				10A.402(5),
				the unit is responsible for conducting investigations involving the state
				medical assistance program. These investigations include, but are not limited
				to, allegations involving:
a. Fraud within
				the administration of the Iowa Medicaid program.
b. Fraud in the provision of medical
				assistance or activities of Medicaid providers.
c. Incidents of abuse or neglect.
d. Any aspect of the provision of health care
				services and activities of Medicaid providers upon the approval of the U.S.
				Department of Health and Human Services, Office of the Inspector
				General.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.3 - Referrals

Current through Register Vol. 47, No. 3, July 24, 2024
(1) The MFCU
				director reviews referrals in order to confirm that the unit has jurisdiction
				to investigate the allegation(s).
(2) Upon confirming MFCU jurisdiction and
				taking into consideration numerous factors and referral-specific information,
				the MFCU director shall determine the disposition of the referral, which may
				include, but is not limited to, the following:
a. Opening a case and assigning the case to
				unit personnel.
b. Referring the
				allegations to appropriate outside agencies for further review.
c. Declining the referral and taking no
				further action in the matter.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.4 - Investigations

Current through Register Vol. 47, No. 3, July 24, 2024
Unit personnel investigate referrals opened and assigned as
				  MFCU cases by utilizing all legally authorized means to identify any of the
				  following:
1. Criminal activity
				resulting in violations of state or federal criminal code.
2. Fraudulent activity resulting in
				violations of state or federal civil statutes.
3. Financial damages sustained by the Iowa
				Medicaid program.
4. Victims
				involved in incidents of abuse or neglect.
5. Perpetrators involved in Medicaid provider
				fraud schemes or incidents of abuse or neglect.
6. Overpayments received by Medicaid
				providers as a result of fraudulent or criminal activity.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.5 - Access to Records

Current through Register Vol. 47, No. 3, July 24, 2024
In addition to the authority maintained by investigators with
				  the unit pursuant to Iowa Code section
				  10A.403,
				  the unit is established as a health oversight agency, as defined by
				  45
				  CFR 164.501, exempt from the privacy
				  regulations of the federal Health Insurance Portability and Accountability Act
				  (HIPAA) and authorized to engage in health oversight activities in accordance
				  with
				  45
				  CFR 164.512.
(1) Unit personnel shall have the authority
				to request, review, and retain any medical, clinical, financial, or personnel
				records maintained by a Medicaid provider in order for unit personnel to
				investigate allegations of incidents that fall within MFCU's investigative
				authority as established in rule
				481-73.2
				(10A).
(2) For Medicaid provider
				fraud investigations, unit personnel shall have access to any records
				pertaining to Medicaid and non-Medicaid recipients of health care goods and
				services to verify that:
a. Medicaid claims
				for goods and services have been accurately paid.
b. Medicaid recipients actually received the
				goods and services claimed by the Medicaid provider.
c. Medicaid providers have retained
				supporting documentation to substantiate claims.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.6 - Subpoenas

Current through Register Vol. 47, No. 3, July 24, 2024
The director or the director's designee may issue subpoenas
				  in connection with MFCU investigations. In addition to the provisions of
				  481-subrules 1.1(6) to 1.1(9), the following apply.
(1) Unit personnel may serve subpoenas during
				the course of an open MFCU case investigation. The subpoena must be approved
				and signed by the director or the director's designee.
(2) Subpoenas may be personally served by
				unit personnel upon the respondent of the subpoena or the respondent's
				registered agent, mailed directly to the respondent or the respondent's
				registered agent via USPS mail, or electronically transmitted directly to the
				respondent or the respondent's registered agent via facsimile or
				email.
(3) Unit personnel shall
				have the authority to determine the appropriate method by which the respondent
				is requested to deliver information in response to a subpoena duces
				tecum.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.7 - Investigation Results

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Investigations resulting in sufficient evidence to support criminal or civil
				prosecution will be referred to the appropriate prosecutorial agency to be
				reviewed for a charging decision by the prosecutorial agency.
(2) For investigations that result in
				identification of potential overpayment made to a Medicaid provider, unit
				personnel will either attempt to collect such overpayment or refer the matter
				to an appropriate state agency for collection.
(3) Investigations that result in the
				identification of potential regulatory violations committed by a Medicaid
				provider may be referred to the appropriate regulatory agency for
				administrative review.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.8 - Confidentiality

Current through Register Vol. 47, No. 3, July 24, 2024
The unit shall maintain confidentiality of all investigative
				  case information in accordance with Iowa Code sections
				  22.7(5)
				   and
				  685.6,
				  42 CFR
				  1007.11(f), and any other
				  applicable state or federal law.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 73 - Medicaid Fraud Control Unit › Rule 481-73.9 - Appeal by Provider of Care

Current through Register Vol. 47, No. 3, July 24, 2024
Collection decisions are made by DHS. Providers may appeal
				  decisions of the department according to rules in human services 441-Chapter
				  7.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 90 - Public Assistance Debt Recovery Unit › Rule 481-90.2 - Recovery Process

Current through Register Vol. 47, No. 3, July 24, 2024
The recovery process begins when data is successfully entered
				  on the designated overpayment recovery system and a notice of debt is issued to
				  the debtor. The data specifies which public assistance program(s) is owed a
				  debt.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 90 - Public Assistance Debt Recovery Unit › Rule 481-90.3 - Records

Current through Register Vol. 47, No. 3, July 24, 2024
The recovery unit maintains an account for each debt that has
				  occurred for a debtor. The account is filed under the debtor's name and
				  includes information maintained pursuant to rule
				  441-11.2
				  (217).
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 90 - Public Assistance Debt Recovery Unit › Rule 481-90.5 - Debt Repayment

Current through Register Vol. 47, No. 3, July 24, 2024
A notice of debt or Form 470-0495, Agreement to Pay a Debt,
				  is used to initiate payments of a debt. The minimum rate of payment is
				  determined by each program unless set by a court order or otherwise negotiated
				  by DHS. All recoveries are transmitted to the DHS cashier. Payments are made
				  directly by cash, check, or money order or through an online payment portal by
				  the debtor except as otherwise provided in this rule. The amount of allotment
				  reduction for a FIP overpayment caused by an agency error shall be different
				  from the amount of allotment reduction for a client error, as determined by
				  DHS.
(1)
Active cases-PROMISE
				JOBS program.
For payment reduction for the PROMISE JOBS program, the
				debtor must provide written permission to effectuate a FIP reduction.
(2)
Active cases-FIP, RCA,
				SNAP.
Allotment reduction shall be used, except that cash payment
				pursuant to a repayment agreement may be used when the repayment amount exceeds
				the amount that may be collected by allotment reduction. For SNAP, debt
				repayment may also be made in accordance with subrule 90.5(3).
(3)
SNAP with electronic benefit
				balances.
SNAP payments may be made by returning electronic benefits
				to pay the debt.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 90 - Public Assistance Debt Recovery Unit › Rule 481-90.6 - Further Collection Action

Current through Register Vol. 47, No. 3, July 24, 2024
If complete repayment has not been received by the methods
				  described in rule 481-90.5(10A), further
				  collection action may be taken. This action includes, but is not limited to,
				  the following:
(1)
For all
				debts.
a. Debts of $5,000 or less,
				small claims court action.
b. Debts
				of more than $5,000, referral to the attorney general for district court
				action.
c. State income tax refund
				offset in accordance with 441-Chapter 11 and Iowa Code section
				8A.504.
d. The filing of a claim in a debtor's estate
				or bankruptcy proceedings.
e.
				Garnishment of wages or assets.
f.
				Setoff of a state warrant.
g.
				Distress warrants.
h.
				Liens.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 90 - Public Assistance Debt Recovery Unit › Rule 481-90.7 - Appeal Rights

Current through Register Vol. 47, No. 3, July 24, 2024
If a notice of debt or other notice of adverse action is
				  received by the debtor and the debtor wishes to contest the debt, an appeal is
				  submitted to the recovery unit or to DHS. If an appeal is submitted, the
				  recovery process is suspended until conclusion of the appeal process outlined
				  in 481-Chapter 9 and 441-Chapter 7.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 90 - Public Assistance Debt Recovery Unit › Rule 481-90.8 - Data Processing Systems Matches

Current through Register Vol. 47, No. 3, July 24, 2024
The recovery unit compares information with other data
				  processing systems to identify the location, resources, or income of a debtor
				  Part or all of a data processing system is used. The recovery unit uses, but is
				  not limited to using, the data processing systems of the following
				  entities:
1. Social Security
				Administration,
2. Department of
				workforce development,
3.
				Department of revenue,
4.
				Department of administrative services,
5. Department of transportation (driver's
				license and motor vehicle registration), and
6. Department of human services.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
In addition to the definitions found in Iowa Code chapter
				  99B, and unless specifically defined in 481-Chapters 101 to 106, the following
				  definitions apply to all social and charitable gambling rules.
"Bingo supplies and equipment"
means a
				  machine, display board, monitor, card, bingo paper, or any other implement or
				  provision used in the conduct of the game of bingo licensed pursuant to Iowa
				  Code chapter 99B.
"Director"
means the director of the
				  department of inspections and appeals.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.2 - Licensure

Current through Register Vol. 47, No. 3, July 24, 2024
Gambling shall only occur upon receipt of a license issued by
				  the department. The license shall be prominently displayed at the gambling
				  location.
(1)
Types of
				gambling licenses-qualified organizations.
A qualified organization
				(QO), as defined in Iowa Code section
				99B.1(26),
				may apply for the six following license types, each of which permits the
				activities listed. A QO with a two-year QO license may also apply for a seventh
				license type, a very large raffle license.
License type/Activity
								type
Two-year QO
One-year QO
180-day QO
90-day QO
14-day QO
Bingo at a fair or
								festival
Bingo
Three occasions per week; 15 occasions per
								month
No
No
No
Two occasions
One occasion per day for length of fair or
								festival
Games of skill and chance
Unlimited carnival-style games
No
No
No
Unlimited carnival-style games
No
Game night
One per calendar month
One per calendar month
One per calendar month
One per calendar month
One per calendar month
No
Very small and small raffles
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
No
Large raffles
One per calendar year
Eight per license period, each conducted in a
								different county
One per calendar year
One per calendar year
One per calendar year
No
Very large raffles
One per calendar year, requires additional very
								large raffle license
One per calendar year, requires additional very
								large raffle license
No
No
No
No
Electronic raffles
One small raffle per day; one large raffle per
								calendar year
No
No
No
No
No
(2)
Other types of gambling licenses.
There are four other types
				of gambling licenses:
a. One-year license for
				an amusement concession.
b.
				Two-year license for social gambling in beer and liquor
				establishments.
c. Two-year license
				for social gambling in public places.
d. Annual license for manufacturers and
				distributors of bingo equipment and supplies or electronic raffle systems.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.3 - License Application

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Applications.
Applications may be completed online or
				downloaded by visiting dia.iowa.govand clicking on the link for "Social and
				Charitable Gambling." A paper application may be requested from the Social and
				Charitable Gambling Unit, Iowa Department of Inspections and Appeals, Lucas
				State Office Building, Des Moines, Iowa 50319-0083; or by calling
				(515)281-6848.
(2)
Receipt
				of application.
An application shall be submitted at least 30 days
				before the beginning date requested.
(3)
Fees.
License fees are
				not refundable.
(4)
Documentation.
Qualified organizations applying for a
				charitable gambling license must submit with the application documentation, as
				described in the application, to prove tax-exempt status.
(5)
Application for incorrect
				license.
If the applicant does not apply for the appropriate license,
				the license fee may be applied to the appropriate license within 30 days of
				notification to the applicant by the department. For example, the applicant
				applies for a 90-day qualified organization license but wishes to conduct
				bingo. The fee for the 90-day qualified organization license may be applied to
				a two-year or 14-day qualified organization license, if the applicant responds
				within 30 days of notification by the department.
(6)
Incomplete application
				submitted.
If the applicant submits an incomplete application, the
				application may be completed and submitted within 30 days of notification to
				the applicant by the department without forfeiting the fee submitted with the
				incomplete application.
(7)
Responsible party.
The responsible party identified on the
				application shall sign the application or submit the online application. The
				responsible party shall be a person who is authorized to make decisions on
				behalf of the qualified organization.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.4 - Additional Requirements for Licensure

Current through Register Vol. 47, No. 3, July 24, 2024
In addition to requirements for licensure found in Iowa Code
				  chapter 99B, the department may use the following standards to determine
				  whether to issue a gambling license. These standards do not apply to licensure
				  of manufacturers or distributors of bingo equipment and supplies or electronic
				  raffle equipment.
(1)
Sales tax
				permit-exemptions.
Qualified organizations shall either possess or
				have made application for a sales tax permit at the time the license
				application is submitted. The following gambling activities are exempt from
				sales and local option taxes:
a. Gambling
				activities conducted by county and city governments.
b. Gambling activities held by the Iowa state
				fair, Iowa state fair authority, or Iowa state fair foundation (organized under
				Iowa Code chapter 173), including gambling activities that occur outside of the
				annual scheduled fair event.
c.
				Gambling activities held by a fair (as defined in Iowa Code section
				174.1(2)),
				including gambling activities that occur outside of scheduled fair
				events.
d. Raffles held by a
				licensed qualified organization at a fair as defined in Iowa Code section
				99B.1 and pursuant to the
				requirements specified in Iowa Code section 99B.24.
e. Raffles, whether or not they are conducted
				at a fair event, where the proceeds are used to provide educational
				scholarships by a qualifying organization representing veterans as defined in
				Iowa Code section 99B.27(1)
"b."
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.5 - Returned Checks

Current through Register Vol. 47, No. 3, July 24, 2024
If a check intended to pay for any license provided for under
				  Iowa Code chapter 99B is not honored for payment by the bank on which the check
				  is drafted, the department will attempt to redeem the check. The department
				  will notify the applicant of the need to provide sufficient payment. An
				  additional fee of $25 shall be assessed for each dishonored check. If the
				  department does not receive cash to replace the check, no license will be
				  issued.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.6 - Payment Systems

Current through Register Vol. 47, No. 3, July 24, 2024
Licensees allowing participants to make payment by debit
				  card, as authorized by Iowa Code section
				  99B.5, shall ensure that payment
				  systems comply with all applicable federal and state laws regarding payment
				  card processing and the protection of personal information. Licensees
				  conducting amusement concessions at a fair and allowing participants to make
				  payment by credit card, as authorized by Iowa Code section
				  99B.5(2), shall
				  ensure that payment systems comply with all applicable federal and state laws
				  regarding payment card processing and the protection of personal
				  information.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.7 - Participation-game of Skill, Game of Chance or Raffle

Current through Register Vol. 47, No. 3, July 24, 2024
No one who conducts a game of skill, game of chance or raffle
				  may participate in the game or raffle. For purposes of this rule, an individual
				  "conducts" a raffle if the individual directly participates in the mechanism of
				  selection of the prize, such as drawing the winning entry. For purposes of this
				  rule, an individual "conducts" a game of skill or game of chance if, for
				  example, the person is a dealer or a croupier or otherwise operates the
				  game.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.8 - Posted Rules-games Other Than Bingo and Raffles

Current through Register Vol. 47, No. 3, July 24, 2024
Rules established by the licensee shall be posted on a sign
				  near the front of the playing area or made available electronically at each
				  player's location. Rules for each game shall be accessible to a player before
				  the player forfeits money to play the game. Rules shall be in large, easily
				  readable print and shall include:
1.
				The name and mailing address of the licensee;
2. Prices to play;
3. How winners will be determined;
4. Prize(s) or categories of prizes for each
				game; and
5. Rules established by
				the licensee for the game. Rules shall define a game and indicate the cost per
				game. For example, a game might be one opportunity to shoot and make one
				basket, or three opportunities to shoot and make one basket.
Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Games of Skill, Chance, Bingo and Raffles › Chapter 100 - General Provisions for Social and Charitable Gambling › Rule 481-100.9 - Posted Rules-bingo

Current through Register Vol. 47, No. 3, July 24, 2024
Requirements for posted bingo rules are found in rule
				  481-103.5(99B).