reglab/statecodes huggingface dataset:
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.13 - Initial Enrollment

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Enrollment date.
Applicants who have been determined to be
				eligible shall be enrolled by the department in the Medicaid program.
a.
First day of the month
The effective date of enrollment is the first day of the first month for which
				eligibility has been determined, with the following exceptions:
(1) Presumptive eligibility is effective on
				the date that presumptive eligibility was determined by a qualified entity for
				presumptive Medicaid eligibility determinations.
(2) Eligibility under the qualified Medicare
				beneficiary coverage group begins on the first day of the month after the month
				of decision.
(3) Eligibility for
				individuals approved for supplemental security income, programs related to
				supplemental security income, state supplementary assistance, or medical
				assistance benefits shall be effective on the first day of the month when the
				individual was resource-eligible as of the first moment of the first day of the
				month and met all other eligibility criteria at any time during the
				month.
(4) When a request is made
				to add a new person to the eligible group, medical assistance shall not be
				effective before the first of the month in which the request was
				made.
(5) When a request is made
				prior to January 1, 2014, to add to the eligible group a person who previously
				was excluded, in accordance with the provisions of rule
				441-75.59 (249A), medical
				assistance for the person shall be effective no earlier than the first day of
				the month following the month in which the request was made.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.14 - Reenrollment

Current through Register Vol. 47, No. 3, July 24, 2024
Reviews of all conditions of eligibility will occur for the
				  purposes of determining continued enrollment in Medicaid.
(1)
Reenrollment frequency.
a.
Eligibility reviews for
				eligibility prior to January 1, 2014.
(1) Eligibility reviews shall be made as
				often as circumstances indicate, but in no instance shall the period of time
				between reviews exceed 12 months.
(2) Eligibility reviews will be conducted
				using information contained in and verification supplied with the review form
				specified in 441-subrule 75.52(3).
(3) When the review form is issued in the
				department's regular end-of-month mailing, the member shall return the
				completed form to the department by the fifth calendar day of the following
				month.
(4) When the review form is
				not issued in the department's regular end-of-month mailing, the member shall
				return the completed form to the department by the seventh day after the date
				the form is mailed by the department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.15 - Report of Changes

Current through Register Vol. 47, No. 3, July 24, 2024
As a condition of enrollment and continued enrollment for
				  medical assistance, applicants and members shall report changes in
				  circumstances as required in this rule.
(1)
Report of changes for eligibility
				prior to January 1, 2014.
a. In
				coverage groups for which Medicaid eligibility is determined using the family
				medical assistance program (FMAP) income and resource policies, members shall
				report changes as follows:
(1) At the annual
				review or upon the addition of an individual to the eligible group, members
				shall report any change in the following:
1.
				Income from all sources, including any change in care expenses.
2. Resources.
3. Members of the household.
4. School attendance.
5. A stepparent's recovery from an
				incapacity.
6. Mailing or living
				address.
7. Payment of child
				support.
8. Receipt of a social
				security number.
9. Payment for
				child support, alimony, or dependents as defined in 441-paragraph
				75.57(8)
"b. "
10.
				Health insurance premiums or coverage.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.16 - Action on Information Received

Current through Register Vol. 47, No. 3, July 24, 2024
When a change in circumstance is reported, or when a change
				  in a member's circumstances otherwise comes to the attention of the department,
				  its effect on eligibility shall be evaluated and eligibility shall be
				  redetermined regardless of whether the report of change was required by rule
				  441-76.15 (249A). When the
				  department has information about an anticipated change in a member's
				  circumstances that may affect eligibility, eligibility will be redetermined at
				  the appropriate time based on such change.
(1) After assistance has been approved,
				except as provided in subrule 76.13(1), action based on a change reported
				during a month shall be effective the first day of the next calendar month
				unless timely notice of adverse action is required as specified in 441-subrule
				16.3(1).
(2) When a request is made
				to add a new person to the eligible group, and that person meets the
				eligibility requirements, assistance shall be effective the first day of the
				month in which the request was made unless otherwise specified at rule
				441-76.12(249A).
(3) When the
				change creates ineligibility, eligibility under the current coverage group
				shall be canceled and an automatic redetermination of eligibility shall be
				completed in accordance with rule
				441-76.17 (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.17 - Automatic Redetermination of Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
Whenever a Medicaid member no longer meets the eligibility
				  requirements of the current coverage group, an automatic redetermination of
				  eligibility for other Medicaid coverage groups shall be made. If the reason for
				  ineligibility under the initial coverage group pertained to a condition of
				  eligibility which applies to all coverage groups, such as failure to cooperate,
				  no further redetermination shall be required. When the redetermination is
				  completed, the member shall be notified of the decision in writing. The
				  redetermination process shall be completed as follows:
(1)
Information received by the tenth
				of the month.
If information that creates ineligibility under the
				current coverage group is received in the department by the tenth of the month,
				the redetermination process shall be completed by the end of that month unless
				the provisions of rule
				441-76.14 (249A)
				apply. The effective date of cancellation for the current coverage group shall
				be the first day of the month following the month in which the information is
				received.
(2)
Information
				received after the tenth of the month.
If information that creates
				ineligibility under the current coverage group is received in the department
				after the tenth of the month, the redetermination process shall be completed by
				the end of the following month unless the provisions of rule
				441-76.14 (249A)
				apply. The effective date of cancellation for the current coverage group shall
				be the first day of the second month following the month in which the
				information is received.
(3)
Change in federal law.
If a change in federal law affects the
				eligibility of large numbers of Medicaid members and the Secretary of Health
				and Human Services has extended the redetermination time limits, in accordance
				with 42 CFR § 435.1003 as amended to January 13,1997, the redetermination
				process shall be completed within the extended time limit and the effective
				date of cancellation for the current coverage group shall be no later than the
				first day of the month following the month in which the extended time limit
				expires.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.1 - Physicians

Current through Register Vol. 47, No. 3, July 24, 2024
All physicians (doctors of medicine and osteopathy) licensed
				  to practice in the state of Iowa are eligible to participate in the program.
				  Physicians in other states are also eligible if duly licensed to practice in
				  that state.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.2 - Retail Pharmacies

Current through Register Vol. 47, No. 3, July 24, 2024
Retail pharmacies are eligible to participate if they meet
				  the requirements of this rule.
(1)
Licensure.
Participating retail pharmacies must be licensed in
				the state of Iowa or duly licensed in another state. Out-of-state retail
				pharmacies delivering, dispensing, or distributing drugs by any method to an
				ultimate user physically located in Iowa must be duly licensed by Iowa as a
				nonresident pharmacy for that purpose.
(2)
Survey participation.
As
				a condition of participation, retail pharmacies are required to make available
				drug acquisition cost invoice information, product availability information if
				known, dispensing cost information, and any other information deemed necessary
				by the department to assist in monitoring and revising reimbursement rates
				pursuant to 441-subrule 79.1(8) or for the efficient operation of the pharmacy
				benefit.
a. A pharmacy shall produce and
				submit all requested information in the manner and format requested by the
				department or its designee at no cost to the department or its
				designee.
b. A pharmacy shall
				submit information to the department or its designee within the time frame
				indicated following receipt of a request for information unless the department
				or its designee grants an extension upon written request of the
				pharmacy.
c. Any dispensing or
				acquisition cost information submitted to the department that specifically
				identifies a pharmacy's individual costs shall be held confidential.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.3 - Hospitals

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Qualifications.
All hospitals licensed in the state of Iowa or
				in another state and certified as eligible to participate in Part A of the
				Medicare program (Title XVIII of the Social Security Act) are eligible to
				participate in the medical assistance program, subject to the additional
				requirements of this rule.
(2)
Referral to health home services provider.
As a condition of
				participation in the medical assistance program, hospitals must establish
				procedures for referring to health home services providers any members who seek
				or need treatment in the hospital emergency department and who are eligible for
				health home services pursuant to 441-subrule 78.53(2).
(3)
Psychiatric bed tracking
				system.
As a condition of participation in the medical assistance
				program, hospitals must establish procedures for participating in and updating
				the statewide psychiatric bed tracking system.
a. Definitions.
"Adult beds"
means the number of staffed and
				  available psychiatric beds ready for admission to individuals 18 years of age
				  to 60 years of age.
"Child beds"
means the number of staffed and
				  available psychiatric beds ready for admission to individuals up to the age of
				  18.
"Gender"
means female or male.
"Geriatric beds"
means the number of staffed
				  and available psychiatric beds ready for admission to individuals 60 years of
				  age and older.
"Hospital,"
for purposes of this subrule,
				  means any licensed hospital providing inpatient psychiatric services and the
				  state mental health institutes.
"Psychiatric bed tracking system"
means a
				  web-based electronic system managed by the department that can be searched to
				  locate inpatient psychiatric services at an Iowa hospital.
b. Hospitals are required to participate in
				the psychiatric bed tracking system.
c. Hospitals shall update the psychiatric bed
				tracking system, at a minimum, two times per day. The first update shall be
				entered between 12:00:01 a.m. and 9:59:59 a.m. each day; the second update
				shall be entered between 8:00:00 p.m. and 11:59:59 p.m. each day.
d. Each update must include the number of
				child beds by gender, the number of adult beds by gender, and the number of
				geriatric beds by gender.
e.
				Failure to comply with the psychiatric bed tracking reporting may result in
				sanctions in accordance with rule
				441-79.2 (249A).
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.4 - Dentists

Current through Register Vol. 47, No. 3, July 24, 2024
All dentists licensed to practice in the state of Iowa are
				  eligible to participate in the program. Dentists in other states are also
				  eligible if duly licensed to practice in that state.
NOTE: DENTAL LABORATORIES -Payment will not be made to a
				  dental laboratory.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.5 - Podiatrists

Current through Register Vol. 47, No. 3, July 24, 2024
All podiatrists licensed to practice in the state of Iowa are
				  eligible to participate in the program. Podiatrists in other states are also
				  eligible if duly licensed to practice in that state.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.6 - Optometrists

Current through Register Vol. 47, No. 3, July 24, 2024
All optometrists licensed to practice in the state of Iowa
				  are eligible to participate in the program. Optometrists in other states are
				  also eligible if duly licensed to practice in that state.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.7 - Opticians

Current through Register Vol. 47, No. 3, July 24, 2024
All opticians in the state of Iowa are eligible to
				  participate in the program.
Opticians in other states are also eligible to
				  participate.
NOTE: Opticians in states having licensing requirements for
				  this professional group must be duly licensed in that state.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.8 - Chiropractors

Current through Register Vol. 47, No. 3, July 24, 2024
All chiropractors licensed to practice in the state of Iowa
				  are eligible to participate providing they have been determined eligible to
				  participate in Title XVIII of the Social Security Act (Medicare) by the Social
				  Security Administration. Chiropractors in other states are also eligible if
				  duly licensed to practice in that state and determined eligible to participate
				  in Title XVIII of the Social Security Act.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.10 - Medical Equipment and Appliances, Prosthetic Devices and Medical Supplies

Current through Register Vol. 47, No. 3, July 24, 2024
All dealers in medical equipment and appliances, prosthetic
				  devices and medical supplies in Iowa or in other states are eligible to
				  participate in the program.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.11 - Ambulance Service

Current through Register Vol. 47, No. 3, July 24, 2024
Providers of ambulance service are eligible to participate
				  providing they meet the eligibility requirements for participation in the
				  Medicare program (Title XVIII of the Social Security Act).
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.12 - Behavioral Health Intervention

Current through Register Vol. 47, No. 3, July 24, 2024
A provider of behavioral health intervention is eligible to
				  participate in the medical assistance program when the provider is accredited
				  by one of the following bodies:
1. The
				Joint Commission accreditation (TJC), or
2. The Healthcare Facilities Accreditation
				Program (HFAP), or
3. The
				Commission on Accreditation of Rehabilitation Facilities (CARF), or
4. The Council on Accreditation (COA),
				or
5. The Accreditation Association
				for Ambulatory Health Care (AAAHC), or
6. Iowa Administrative Code 441-Chapter 24,
				"Accreditation of Providers of Services to Persons with Mental Illness,
				Intellectual Disabilities, or Developmental Disabilities."
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.13 - Hearing Aid Dispensers

Current through Register Vol. 47, No. 3, July 24, 2024
Hearing aid dispensers are eligible to participate if they
				  are duly licensed by the state of Iowa. Hearing aid dispensers in other states
				  will be eligible to participate if they are duly licensed in that state.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.14 - Audiologists

Current through Register Vol. 47, No. 3, July 24, 2024
Audiologists are eligible to participate in the program when
				  they are duly licensed by the state of Iowa. Audiologists in other states will
				  be eligible to participate when they are duly licensed in that state. In states
				  having no licensure requirement for audiologists, an audiologist shall obtain a
				  license from the state of Iowa.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.15 - Community Mental Health Centers

Current through Register Vol. 47, No. 3, July 24, 2024
Community mental health centers are eligible to participate
				  in the medical assistance program when they comply with the standards for
				  mental health centers in the state of Iowa established by the Iowa mental
				  health authority.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.16 - Screening Centers

Current through Register Vol. 47, No. 3, July 24, 2024
Public or private health agencies are eligible to participate
				  as screening centers when they have the staff and facilities needed to perform
				  all of the elements of screening specified in
				  441-78.18
				  (249A) and meet the department of public health's standards for a child health
				  screening center The staff members must be employed by or under contract with
				  the screening center Screening centers shall direct applications to participate
				  to the Iowa Medicaid enterprise provider services unit.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.17 - Physical Therapists

Current through Register Vol. 47, No. 3, July 24, 2024
Physical therapists are eligible to participate when they are
				  licensed, in independent practice; and are eligible to participate in the
				  Medicare program. This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.18 - Orthopedic Shoe Dealers and Repair Shops

Current through Register Vol. 47, No. 3, July 24, 2024
Establishments eligible to participate in the medical
				  assistance program are retail dealers in orthopedic shoes prescribed by
				  physicians or podiatrists and shoe repair shops specializing in orthopedic work
				  as prescribed by physicians or podiatrists.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.19 - Rehabilitation Agencies

Current through Register Vol. 47, No. 3, July 24, 2024
Rehabilitation agencies are eligible to participate providing
				  they are certified to participate in the Medicare program (Title XVIII of the
				  Social Security Act).
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.20 - Independent Laboratories

Current through Register Vol. 47, No. 3, July 24, 2024
Independent laboratories are eligible to participate
				  providing they are certified to participate as a laboratory in the Medicare
				  program (Title XVIII of the Social Security Act). An independent laboratory is
				  a laboratory that is independent of attending and consulting physicians'
				  offices, hospitals, and critical access hospitals.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.21 - Rural Health Clinics

Current through Register Vol. 47, No. 3, July 24, 2024
Rural health clinics are eligible to participate providing
				  they are certified to participate in the Medicare program (Title XVIII of the
				  Social Security Act).
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.22 - Psychologists

Current through Register Vol. 47, No. 3, July 24, 2024
(1) All
				psychologists licensed to practice in the state of Iowa and meeting the current
				credentialing requirements of the National Register of Health Service
				Psychologists are eligible to participate in the medical assistance program.
				Psychologists in other states are eligible to participate when they are duly
				licensed to practice in that state and meet the current credentialing
				requirements of the National Register of Health Service
				Psychologists.
(2) A psychologist
				provisionally licensed to practice in the state of Iowa pursuant to Iowa Code
				section
				154B.6
				is eligible to participate in the medical assistance program when the person:
a. Possesses a doctoral degree in psychology
				from an institution approved by the board of psychology; and
b. Provides treatment under the supervision
				of a licensed psychologist pursuant to Iowa Code section
				154B.6.
				Claims for payment for such services must be submitted by the licensed
				psychologist.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.23 - Maternal Health Centers

Current through Register Vol. 47, No. 3, July 24, 2024
A maternal health center is eligible to participate in the
				  Medicaid program if the center provides a team of professionals to render
				  prenatal and postpartum care and enhanced perinatal services (see rule
				  441-78.25
				  (249A)). The prenatal and postpartum care shall be in accordance with the
				  latest edition of the American College of Obstetricians and Gynecologists,
				  Standards for Obstetric Gynecologic Services. The team must have at least a
				  physician, a registered nurse, a licensed dietitian and a person with at least
				  a bachelor's degree in social work, counseling, sociology or psychology. Team
				  members must be employed by or under contract with the center This rule is
				  intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.24 - Ambulatory Surgical Centers

Current through Register Vol. 47, No. 3, July 24, 2024
Ambulatory surgical centers that are not part of hospitals
				  are eligible to participate in the medical assistance program if they are
				  certified to participate in the Medicare program (Title XVIII of the Social
				  Security Act). Freestanding ambulatory surgical centers providing only dental
				  services are also eligible to participate in the medical assistance program if
				  the board of dental examiners has issued a current permit pursuant to
				  650-Chapter 29 for any dentist to administer deep sedation or general
				  anesthesia at the facility.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.26 - Behavioral Health Services

Current through Register Vol. 47, No. 3, July 24, 2024
The following persons are eligible to participate in the
				  Medicaid program as providers of behavioral health services.
(1)
Licensed marital and family
				therapists (LMFT).
Any person licensed by the board of behavioral
				science as a marital and family therapist pursuant to 645-Chapter 31 is
				eligible to participate. A marital and family therapist in another state is
				eligible to participate when duly licensed to practice in that state.
(2)
Temporarily licensed marital and
				family therapists.
Any person who holds a temporary license to
				practice marital and family therapy pursuant to Iowa Code section
				154D.7
				is eligible to participate when the temporarily licensed marital and family
				therapist provides treatment under the supervision of a qualified marital and
				family therapist as determined by the board of behavioral science by rule.
				Claims for payment for such services must be submitted by the supervising
				licensed marital and family therapist.
(3)
Licensed independent social
				workers (LISW).
Any person licensed by the board of social work as an
				independent social worker pursuant to 645-Chapter 280 is eligible to
				participate. An independent social worker in another state is eligible to
				participate when duly licensed to practice in that state.
(4)
Licensed master social workers
				(LMSW).
a. A person licensed by the
				board of social work as a master social worker pursuant to 645-Chapter 280 is
				eligible to participate when the person:
(1)
				Holds a master's or doctoral degree as approved by the board of social work;
				and
(2) Provides treatment under
				the supervision of an independent social worker licensed pursuant to
				645-Chapter 280.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.27 - Birth Centers

Current through Register Vol. 47, No. 3, July 24, 2024
Birth centers are eligible to participate in the Medicaid
				  program if they are licensed or receive reimbursement from at least two
				  third-party payors.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.28 - Area Education Agencies

Current through Register Vol. 47, No. 3, July 24, 2024
An area education agency is eligible to participate in the
				  Medicaid program when it has a plan for providing comprehensive special
				  education programs and services approved by the Iowa department of education.
				  Covered services shall be provided by personnel who are licensed, endorsed, or
				  registered as provided in this rule and shall be within the scope of the
				  applicable license, endorsement, or registration.
(1) Personnel providing audiological or
				speech-language services shall be licensed by the Iowa board of speech
				pathology and audiology as a speech pathologist or audiologist pursuant to
				645-Chapters 299, 300 and 303 through 305.
(2) Personnel providing physical therapy
				shall be licensed by the Iowa board of physical and occupational therapy as a
				physical therapist pursuant to 645-Chapters 199 through 204.
(3) Personnel providing occupational therapy
				shall be licensed by the Iowa board of physical and occupational therapy as an
				occupational therapist pursuant to 645-Chapters 205 through 210.
(4) Personnel providing psychological
				evaluations and counseling or psychotherapy services shall be:
a. Endorsed by the Iowa board of educational
				examiners as a school psychologist pursuant to 282-subrule 27.3(3);
b. Licensed by the Iowa board of psychology
				as a psychologist pursuant to 645-Chapters 239 through 243;
c. Licensed by the Iowa board of social work
				as a social worker pursuant to 645-Chapters 279 through 284;
d. Licensed by the Iowa board of medicine as
				a physician pursuant to 653-Chapters 9 through 11; or
e. Registered by the Iowa nursing board as an
				advanced registered nurse practitioner pursuant to 655-Chapter 7.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.29 - Case Management Provider Organizations

Current through Register Vol. 47, No. 3, July 24, 2024
Case management provider organizations are eligible to
				  participate in the Medicaid program provided that they meet the standards for
				  the populations being served. Providers shall meet the following
				  standards:
(1)
Standards in
				441-Chapter 24.
Providers shall be accredited as case management
				providers pursuant to 441-Chapter 24 as a condition of providing case
				management services to persons with an intellectual disability, developmental
				disabilities or chronic mental illness.
(2)
Standards in 441-Chapter
				186.
Rescinded IAB 10/12/05, effective 10/1/05.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.30 - Hcbs Health and Disability Waiver Service Providers

Current through Register Vol. 47, No. 3, July 24, 2024
HCBS health and disability waiver services shall be rendered
				  by a person who is at least 16 years old (except as otherwise provided in this
				  rule) and is not the spouse of the member served or the parent or stepparent of
				  a member aged 17 or under. People who are 16 or 17 years old must be employed
				  and supervised by an enrolled HCBS provider unless they are employed to provide
				  self-directed personal care services through the consumer choices option. A
				  person hired for self-directed personal care services need not be supervised by
				  an enrolled HCBS provider. A provider hired through the consumer choices option
				  for independent support brokerage, self-directed personal care,
				  individual-directed goods and services, or self-directed community support and
				  employment is not required to enroll as a Medicaid provider. The following
				  providers shall be eligible to participate in the Medicaid HCBS health and
				  disability waiver program if they meet the standards in subrule 77.30(18) and
				  the integrated, community-based settings standards in subrule 77.25(5) and also
				  meet the standards set forth below for the service to be provided:
(1)
Homemaker providers.
Homemaker providers shall be agencies that are:
a. Certified as a home health agency under
				Medicare, or
b. Authorized to
				provide similar services through a contract with the department of public
				health (IDPH) for local public health services. The agency must provide a
				current IDPH local public health services contract number.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.31 - Occupational Therapists

Current through Register Vol. 47, No. 3, July 24, 2024
Occupational therapists are eligible to participate if they
				  are licensed and in private practice independent of the administrative and
				  professional control of an employer such as a physician, institution, or
				  rehabilitation agency. Licensed occupational therapists in an independent group
				  practice are eligible to enroll.
(1)
				Occupational therapists in other states are eligible to participate if they are
				licensed in that state and meet the Medicare criteria for enrollment.
(2) Occupational therapists who provide
				services to Medicaid members who are also Medicare beneficiaries must be
				enrolled in the Medicare program.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.32 - Hospice Providers

Current through Register Vol. 47, No. 3, July 24, 2024
Hospice providers are eligible to participate in the Medicaid
				  program providing they are certified to participate in the Medicare program.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.33 - Hcbs Elderly Waiver Service Providers

Current through Register Vol. 47, No. 3, July 24, 2024
HCBS elderly waiver services shall be rendered by a person
				  who is at least 16 years old (except as otherwise provided in this rule) and is
				  not the spouse of the consumer served or the parent or stepparent of a consumer
				  aged 17 or under. People who are 16 or 17 years old must be employed and
				  supervised by an enrolled HCBS provider unless they are employed to provide
				  self-directed personal care services through the consumer choices option. A
				  person hired for self-directed personal care services need not be supervised by
				  an enrolled HCBS provider. A person hired through the consumer choices option
				  for independent support brokerage, self-directed personal care,
				  individual-directed goods and services, or self-directed community support and
				  employment is not required to enroll as a Medicaid provider. The following
				  providers shall be eligible to participate in the Medicaid HCBS elderly waiver
				  program if they meet the standards in subrule 77.33(22) and the integrated,
				  community-based settings standards in subrule 77.25(5) and also meet the
				  standards set forth below for the service to be provided:
(1)
Adult day care
				providers.
Adult day care providers shall be agencies that are
				certified by the department of inspections and appeals as being in compliance
				with the standards for adult day services programs at 481-Chapter 70.
(2)
Emergency response system
				providers.
Emergency response system providers must meet the following
				standards:
a. The agency shall provide an
				electronic component to transmit a coded signal via digital equipment over
				telephone lines to a central monitoring station. The central monitoring station
				must operate receiving equipment and be fully staffed by trained attendants, 24
				hours a day, seven days per week. The attendants must process emergency calls
				and ensure the timely notification of appropriate emergency resources to be
				dispatched to the person in need.
b. The agency, parent agency, institution or
				corporation shall have the necessary legal authority to operate in conformity
				with federal, state and local laws and regulations.
c. There shall be a governing authority which
				is responsible for establishing policy and ensuring effective control of
				services and finances. The governing authority shall employ or contract for an
				agency administrator to whom authority and responsibility for overall agency
				administration are delegated.
d.
				The agency or institution shall be in compliance with all legislation relating
				to prohibition of discriminatory practices.
e. There shall be written policies and
				procedures established to explain how the service operates, agency
				responsibilities, client responsibilities and cost information.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.34 - Hcbs Aids/hiv Waiver Service Providers

Current through Register Vol. 47, No. 3, July 24, 2024
HCBS AIDS/HIV waiver services shall be rendered by a person
				  who is at least 16 years old (except as otherwise provided in this rule) and is
				  not the spouse of the consumer served or the parent or stepparent of a consumer
				  aged 17 or under. People who are 16 or 17 years old must be employed and
				  supervised by an enrolled HCBS provider unless they are employed to provide
				  self-directed personal care services through the consumer choices option. A
				  person hired for self-directed personal care services need not be supervised by
				  an enrolled HCBS provider. A person hired through the consumer choices option
				  for independent support brokerage, self-directed personal care,
				  individual-directed goods and services, or self-directed community support and
				  employment is not required to enroll as a Medicaid provider. The following
				  providers shall be eligible to participate in the Medicaid HCBS AIDS/HIV waiver
				  program if they meet the standards in subrule 77.34(14) and the integrated,
				  community-based settings standards in subrule 77.25(5) and also meet the
				  standards set forth below for the service to be provided:
(1)
Counseling providers.
Counseling providers shall be:
a. Agencies
				which are certified under the community mental health center standards
				established by the mental health and developmental disabilities commission, set
				forth in 441-Chapter 24, Divisions I and III.
b. Agencies which are licensed as meeting the
				hospice standards and requirements set forth in department of inspections and
				appeals rules 481-Chapter 53 or which are certified to meet the standards under
				the Medicare program for hospice programs.
c. Agencies which are accredited under the
				mental health service provider standards established by the mental health and
				developmental disabilities commission, set forth in 441-Chapter 24, Divisions I
				and IV.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.35 - Federally Qualified Health Centers

Current through Register Vol. 47, No. 3, July 24, 2024
Federally qualified health centers are eligible to
				  participate in the Medicaid program when the Centers for Medicare and Medicaid
				  Services has notified the Medicaid program of their eligibility as allowed by
				  Section
				  6404(b) of
				  Public Law
				  101-239.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.36 - Advanced Registered Nurse Practitioners

Current through Register Vol. 47, No. 3, July 24, 2024
Advanced registered nurse practitioners are eligible to
				  participate in the Medicaid program if they are duly licensed and registered by
				  the state of Iowa as advanced registered nurse practitioners certified pursuant
				  to board of nursing rules 655-Chapter 7.
(1) Advanced registered nurse practitioners
				in another state shall be eligible to participate if they are duly licensed and
				registered in that state as advanced registered nurse practitioners with
				certification in a practice area consistent with board of nursing rules
				655-Chapter 7.
(2) Advanced
				registered nurse practitioners who have been certified eligible to participate
				in Medicare shall be considered as having met these guidelines.
(3) Licensed nurse anesthetists who have
				graduated from a nurse anesthesia program meeting the standards set forth by a
				national association of nurse anesthetists within the past 18 months and who
				are awaiting initial certification by a national association of nurse
				anesthetists approved by the board of nursing shall be considered as having met
				these guidelines.
This rule is intended to implement Iowa Code section 249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.38 - Assertive Community Treatment

Current through Register Vol. 47, No. 3, July 24, 2024
Services in the assertive community treatment (ACT) program
				  shall be rendered by a multidisciplinary team composed of practitioners from
				  the disciplines described in this rule. The team shall be under the clinical
				  supervision of a psychiatrist. The program shall designate an individual team
				  member who shall be responsible for administration of the program, including
				  authority to sign documents and receive payment on behalf of the
				  program.
(1)
Minimum
				composition.
At a minimum, the team shall consist of a nurse, a mental
				health service provider, and a substance abuse treatment
				professional.
(2)
Psychiatrists.
A psychiatrist on the team shall be a physician
				(MD or DO) who:
a. Is licensed under
				653-Chapter 9,
b. Is certified as a
				psychiatrist by the American Board of Medical Specialties' Board of Psychiatry
				and Neurology or by the American Osteopathic Board of Neurology and Psychiatry,
				and
c. Has experience treating
				serious and persistent mental illness.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.40 - Lead Inspection Agencies

Current through Register Vol. 47, No. 3, July 24, 2024
The Iowa department of public health and agencies certified
				  by the Iowa department of public health pursuant to 641-subrule 70.5(5) are
				  eligible to participate in the Medicaid program as providers of lead inspection
				  services. This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.41 - Hcbs Physical Disability Waiver Service Providers

Current through Register Vol. 47, No. 3, July 24, 2024
Providers shall be eligible to participate in the Medicaid
				  physical disability waiver program if they meet the requirements in this rule
				  and the subrules applicable to the individual service. Enrolled providers shall
				  maintain the certification listed in the applicable subrules in order to remain
				  eligible providers. The integrated, community-based settings standards in
				  subrule 77.25(5) apply to all HCBS physical disability waiver service
				  providers.
Services shall be rendered by a person who is at least 16
				  years old (except as otherwise provided in this rule) and is not the spouse of
				  the consumer served or the parent or stepparent of a consumer aged 17 or under.
				  People who are 16 or 17 years old must be employed and supervised by an
				  enrolled HCBS provider unless they are employed to provide self-directed
				  personal care services through the consumer choices option. A person hired for
				  self-directed personal care services need not be supervised by an enrolled HCBS
				  provider. A person hired through the consumer choices option for independent
				  support brokerage, self-directed personal care, individual-directed goods and
				  services, or self-directed community support and employment is not required to
				  enroll as a Medicaid provider and is not subject to the requirements of subrule
				  77.41(1).
(1)
Enrollment
				process.
Reviews of compliance with standards for initial enrollment
				shall be conducted by the department's quality assurance staff. Enrollment
				carries no assurance that the approved provider will receive funding.
Review of a provider may occur at any time.
The department may request any information from the
				  prospective service provider that is pertinent to arriving at an enrollment
				  decision. This may include, but is not limited to:
a. Current accreditations, evaluations,
				inspection reports, and reviews by regulatory and licensing agencies and
				associations.
b. Fiscal capacity of
				the prospective provider to initiate and operate the specified programs on an
				ongoing basis.