249A.4 - DUTIES OF DIRECTOR.
249A.4 DUTIES OF DIRECTOR.
The director shall be responsible for the effective and impartial
administration of this chapter and shall, in accordance with the
standards and priorities established by this chapter, by applicable
federal law, by the regulations and directives issued pursuant to
federal law, by applicable court orders, and by the state plan
approved in accordance with federal law, make rules, establish
policies, and prescribe procedures to implement this chapter.
Without limiting the generality of the foregoing delegation of
authority, the director is hereby specifically empowered and directed
to:
1. Determine the greatest amount, duration, and scope of
assistance which may be provided, and the broadest range of eligible
individuals to whom assistance may effectively be provided, under
this chapter within the limitations of available funds. In so doing,
the director shall at least every six months evaluate the scope of
the program currently being provided under this chapter, project the
probable cost of continuing a like program, and compare the probable
cost with the remaining balance of the state appropriation made for
payment of assistance under this chapter during the current
appropriation period. After each evaluation of the scope of the
program, the director shall report to the general assembly through
the legislative council or in another manner as the general assembly
may by resolution direct.
2. Reserved.
3. Have authority to provide for payment under this chapter of
assistance rendered to any applicant prior to the date the
application is filed.
4. Have authority to contract with any corporation authorized to
engage in this state in insuring groups or individuals for all or
part of the cost of medical, hospital, or other health care or with
any corporation maintaining and operating a medical, hospital, or
health service prepayment plan under the provisions of chapter 514 or
with any health maintenance organization authorized to operate in
this state, for any or all of the benefits to which any recipients
are entitled under this chapter to be provided by such corporation or
health maintenance organization on a prepaid individual or group
basis.
5. May, to the extent possible, contract with a private
organization or organizations whereby such organization will handle
the processing of and the payment of claims for services rendered
under the provisions of this chapter and under such rules and
regulations as shall be promulgated by such department. The state
department may give due consideration to the advantages of
contracting with any organization which may be serving in Iowa as
"intermediary" or "carrier" under Tit. XVIII of the federal Social
Security Act, as amended.
6. Shall cooperate with any agency of the state or federal
government in any manner as may be necessary to qualify for federal
aid and assistance for medical assistance in conformity with the
provisions of chapter 249, this chapter, and Tit. XVI and XIX of the
federal Social Security Act, as amended.
7. Shall provide for the professional freedom of those licensed
practitioners who determine the need for or provide medical care and
services, and shall provide freedom of choice to recipients to select
the provider of care and services, except when the recipient is
eligible for participation in a health maintenance organization or
prepaid health plan which limits provider selection and which is
approved by the department.
a. However, this shall not limit the freedom of choice to
recipients to select providers in instances where such provider
services are eligible for reimbursement under the medical assistance
program but are not provided under the health maintenance
organization or under the prepaid health plan, or where the recipient
has an already established program of specialized medical care with a
particular provider. The department may also restrict the
recipient's selection of providers to control the individual
recipient's overuse of care and services, provided the department can
document this overuse. The department shall promulgate rules for
determining the overuse of services, including rights of appeal by
the recipient.
b. Advanced registered nurse practitioners licensed pursuant
to chapter 152 shall be regarded as approved providers of health care
services, including primary care, for purposes of managed care or
prepaid services contracts under the medical assistance program.
This paragraph shall not be construed to expand the scope of practice
of an advanced registered nurse practitioner pursuant to chapter 152.
8. Implement the premium assistance program options described
under the federal Children's Health Insurance Program Reauthorization
Act of 2009, Pub. L. No. 111-3, for the medical assistance program.
The department may adopt rules as necessary to administer these
options.
9. Adopt rules pursuant to chapter 17A in determining the method
and level of reimbursement for all medical and health services
referred to in section 249A.2, subsection 1 or 7, after considering
all of the following:
a. The promotion of efficient and cost-effective delivery of
medical and health services.
b. Compliance with federal law and regulations.
c. The level of state and federal appropriations for medical
assistance.
d. Reimbursement at a level as near as possible to actual
costs and charges after priority is given to the considerations in
paragraphs "a", "b", and "c".
10. Shall provide an opportunity for a fair hearing before the
department of inspections and appeals to an individual whose claim
for medical assistance under this chapter is denied or is not acted
upon with reasonable promptness. Upon completion of a hearing, the
department of inspections and appeals shall issue a decision which is
subject to review by the department of human services.
11. In determining the medical assistance eligibility of a
pregnant woman, infant, or child under the federal Social Security
Act, § 1902(l), resources which are used as tools of the trade shall
not be considered.
12. Reserved.
13. In implementing subsection 9, relating to reimbursement for
medical and health services under this chapter, when a selected
out-of-state acute care hospital facility is involved, a contractual
arrangement may be developed with the out-of-state facility that is
in accordance with the requirements of Tit. XVIII and XIX of the
federal Social Security Act. The contractual arrangement is not
subject to other reimbursement standards, policies, and rate setting
procedures required under this chapter.
14. A medical assistance copayment shall only be applied to those
services and products specified in administrative rules of the
department in effect on February 1, 1991, which under federal medical
assistance requirements, are provided at the option of the state.
15. Establish appropriate reimbursement rates for community
mental health centers that are accredited by the mental health,
mental retardation, developmental disabilities, and brain injury
commission.
Judicial review of the decisions of the department of human
services may be sought in accordance with chapter 17A. If a petition
for judicial review is filed, the department of human services shall
furnish the petitioner with a copy of the application and all
supporting papers, a transcript of the testimony taken at the
hearing, if any, and a copy of its decision. Section History: Early Form
[C62, 66, § 249A.5, 249A.10; C71, 73, 75, 77, 79, 81, § 249A.4; 82
Acts, ch 1260, § 121, 122] Section History: Recent Form
83 Acts, ch 96, § 157, 159; 83 Acts, ch 153, § 12, 13; 83 Acts, ch
201, § 13; 86 Acts, ch 1245, § 2031; 89 Acts, ch 37, § 1; 89 Acts, ch
104, § 5; 89 Acts, ch 304, § 203; 90 Acts, ch 1204, § 61, 62; 90
Acts, ch 1223, § 21; 90 Acts, ch 1256, § 41; 90 Acts, ch 1264, § 34;
91 Acts, ch 97, § 32; 91 Acts, ch 158, § 5; 92 Acts, ch 1229, § 29,
30; 94 Acts, ch 1150, §1, 2; 97 Acts, ch 165, § 1; 98 Acts, ch 1181,
§4; 99 Acts, ch 96, §27; 2000 Acts, ch 1029, §1, 2; 2001 Acts, ch 24,
§65, 74; 2001 Acts, ch 74, §17; 2003 Acts, ch 21, §1; 2004 Acts, ch
1090, §14; 2005 Acts, ch 120, §2; 2005 Acts, ch 167, §46, 66; 2009
Acts, ch 41, §243; 2009 Acts, ch 118, §18
Referred to in §249A.3