Iowa Administrative Code › Agency 441 - Human Services Department › Title I - General Departmental Procedures › Chapter 7 - Appeals and Hearings › Rule 441-7.13 - Expedited Review

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Expedited review criteria.
Appellants to a medical assistance
				appeal may, at any time, file with the department a request for expedited
				review of the appeal. Expedited review shall be granted when the department
				determines, or a provider acting on behalf or in support of an appellant
				indicates, that taking the time for a standard resolution could seriously
				jeopardize the party-in-interest's life, physical or mental health, or ability
				to attain, maintain, or regain maximum function.
(2)
Managed care expedited
				proceedings.
a. If the appellant is
				granted an expedited review pursuant to subrule 73.12(2), all subsequent
				proceedings shall also be expedited without an additional request if the appeal
				request indicates that the managed care organization appeal was expedited and
				provides the basis for expedited relief.
b. When review is expedited pursuant to
				paragraph 7.13(2)
"a,"
the presiding officer shall issue a
				proposed decision as expeditiously as the enrollee's health condition requires,
				but no later than three working days after the department receives from the
				managed care organization the case file and information for any appeal of a
				denial of a service that, as indicated by the managed care organization:
(1) Meets the criteria for expedited
				resolution but was not resolved within the time frame for expedited resolution;
				or
(2) Was resolved within the time
				frame for expedited resolution but reached a decision wholly or partially
				adverse to the enrollee.
(3)
Medicaid eligibility, nursing facility transfers or discharges, or
				preadmission and annual resident review expedited proceedings.
For
				expedited appeals related to Medicaid eligibility, nursing facility transfers
				or discharges, or preadmission and annual resident review requirements, the
				presiding officer shall issue a proposed decision as expeditiously as possible,
				but no later than seven working days after the department receives a request
				for expedited fair hearing.
(4)
Medicaid-covered benefits or services expedited proceedings.
For expedited appeals related to Medicaid-covered benefits or services, the
				presiding officer shall issue a proposed decision as expeditiously as possible,
				but no later than provided in paragraph 7.13(2)
"b."
(5)
Final decision for expedited
				proceeding.
The department shall issue its final decision in
				accordance with this rule, except as provided by subrule 7.12(2).
(6)
Notification if expedited relief
				is granted or denied.
The department shall notify the appellant as
				expeditiously as possible whether the request for expedited relief is granted
				or denied. Such notice must be provided orally or through electronic means to
				the extent consistent with federal and state law. If oral notice is provided,
				the department shall follow up with written notice, which may be through
				electronic means to the extent consistent with federal and state law.