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