249J.7 - EXPANSION POPULATION PROVIDER NETWORK.
249J.7 EXPANSION POPULATION PROVIDER NETWORK.
1. Expansion population members shall only be eligible to receive
expansion population services through a provider included in the
expansion population provider network. Except as otherwise provided
in this chapter, the expansion population provider network shall be
limited to a publicly owned acute care teaching hospital located in a
county with a population over three hundred fifty thousand, the
university of Iowa hospitals and clinics, and the state hospitals for
persons with mental illness designated pursuant to section 226.1 with
the exception of the programs at such state hospitals for persons
with mental illness that provide substance abuse treatment, serve
gero-psychiatric patients, or treat sexually violent predators.
2. Expansion population services provided to expansion population
members by providers included in the expansion population provider
network shall be payable at the full benefit recipient rates.
3. Providers included in the expansion population provider
network shall submit clean claims within twenty days of the date of
provision of an expansion population service to an expansion
population member.
4. Unless otherwise prohibited by law, a provider under the
expansion population provider network may deny care to an individual
who refuses to apply for coverage under the expansion population.
5. Notwithstanding the provision of section 347.16, subsection 2,
requiring the provision of free care and treatment to the persons
described in that subsection, the publicly owned acute care teaching
hospital described in subsection 1 may require any sick or injured
person seeking care or treatment at that hospital to be subject to
financial participation, including but not limited to copayments or
premiums, and may deny nonemergent care or treatment to any person
who refuses to be subject to such financial participation. Section History: Recent Form
2005 Acts, ch 167, §7, 66
Referred to in § 249J.24, 249J.24A