135.152 - STATEWIDE OBSTETRICAL AND NEWBORN INDIGENT PATIENT CARE PROGRAM.

        135.152  STATEWIDE OBSTETRICAL AND NEWBORN INDIGENT
      PATIENT CARE PROGRAM.
         1.  The department shall establish a statewide obstetrical and
      newborn indigent patient care program to provide obstetrical and
      newborn care to medically indigent residents of this state at the
      appropriate and necessary level, at a licensed hospital or health
      care facility closest and most available to the residence of the
      indigent individual.
         2.  The department shall administer the program, and
      appropriations by the general assembly for the program shall be
      allocated to the obstetrical and newborn patient care fund within the
      department to be utilized for the obstetrical and newborn indigent
      patient care program.
         3.  The department shall adopt administrative rules pursuant to
      chapter 17A to administer the program.
         4.  The department shall establish a patient quota formula for
      determining the maximum number of obstetrical and newborn patients
      eligible for the program, annually, from each county.  The formula
      used shall be based upon the annual appropriation for the program,
      the average number of live births in each county for the most recent
      three-year period, and the per capita income for each county for the
      most recent year.  The formula shall also provide for reassignment of
      an unused county quota allotment on April 1 of each year.
         5. a.  The department, in collaboration with the department of
      human services and the Iowa state association of counties, shall
      adopt rules pursuant to chapter 17A to establish minimum standards
      for eligibility for obstetrical and newborn care, including physician
      examinations, medical testing, ambulance services, and inpatient
      transportation services under the program.  The minimum standards
      shall provide that the individual is not otherwise eligible for
      assistance under the medical assistance program or for assistance
      under the medically needy program without a spend-down requirement
      pursuant to chapter 249A, or for expansion population benefits
      pursuant to chapter 249J.  If the individual is eligible for
      assistance pursuant to chapter 249A or 249J, or if the individual is
      eligible for maternal and child health care services covered by a
      maternal and child health program, the obstetrical and newborn
      indigent patient care program shall not provide the assistance, care,
      or covered services provided under the other program.
         b.  The minimum standards for eligibility shall provide
      eligibility for persons with family incomes at or below one hundred
      eighty-five percent of the federal poverty level as defined by the
      most recently revised poverty income guidelines published by the
      United States department of health and human services, and shall
      provide, but shall not be limited to providing, eligibility for
      uninsured and underinsured persons financially unable to pay for
      necessary obstetrical and newborn care.  The minimum standards may
      include a spend-down provision.  The resource standards shall be set
      at or above the resource standards under the federal supplemental
      security income program.  The resource exclusions allowed under the
      federal supplemental security income program shall be allowed and
      shall include resources necessary for self-employment.
         c.  The department in cooperation with the department of human
      services, shall develop a standardized application form for the
      program and shall coordinate the determination of eligibility for the
      medical assistance and medically needy programs under chapter 249A,
      the medical assistance expansion under chapter 249J, and the
      obstetrical and newborn indigent patient care program.
         6.  The department shall establish application procedures and
      procedures for certification of an individual for obstetrical and
      newborn care under this section.
         7.  An individual certified for obstetrical and newborn care under
      this division may choose to receive the appropriate level of care at
      any licensed hospital or health care facility.
         8.  The obstetrical and newborn care costs of an individual
      certified for such care under this division at a licensed hospital or
      health care facility or from licensed physicians shall be paid by the
      department from the obstetrical and newborn patient care fund.
         9.  All providers of services to obstetrical and newborn patients
      under this division shall agree to accept as full payment the
      reimbursements allowable under the medical assistance program
      established pursuant to chapter 249A, adjusted for intensity of care.

         10.  The department shall establish procedures for payment for
      providers of services to obstetrical and newborn patients under this
      division from the obstetrical and newborn patient care fund.  All
      billings from such providers shall be submitted directly to the
      department.  However, payment shall not be made unless the
      requirements for application and certification for care pursuant to
      this division and rules adopted by the department are met.
         11.  Moneys encumbered prior to June 30 of a fiscal year for a
      certified eligible pregnant woman scheduled to deliver in the next
      fiscal year shall not revert from the obstetrical and newborn patient
      care fund to the general fund of the state.  Moneys allocated to the
      obstetrical and newborn patient care fund shall not be transferred
      nor voluntarily reverted from the fund within a given fiscal year.
      
         Section History: Recent Form
         2005 Acts, ch 167, §43, 66
         Referred to in § 249J.5