249K.5 - PARTICIPATION CRITERIA.
249K.5 PARTICIPATION CRITERIA.
1. The Iowa Medicaid enterprise shall administer this chapter.
The department of human services shall adopt rules, pursuant to
chapter 17A, to administer this chapter.
2. A provider requesting instant relief or a nondirect care limit
exception under this chapter shall meet one of the following
criteria:
a. The nursing facility for which relief or an exception is
requested is in violation of life safety code requirements and
changes are necessary to meet regulatory compliance.
b. The nursing facility for which relief or an exception is
requested is proposing development of a home and community-based
services waiver program service that meets the following
requirements:
(1) The service is provided on the direct site and is a
nonnursing service.
(2) The service is provided in an underserved area, which may
include a rural area, and the nursing facility provides documentation
of this.
(3) The service meets all federal and state requirements.
(4) The service is adult day care, consumer directed attendant
care, assisted living, day habilitation, home delivered meals,
personal emergency response, or respite.
3. In addition to any other factors to be considered in
determining if a provider is eligible to participate under this
chapter, the Iowa Medicaid enterprise shall consider all of the
following:
a. The history of the provider's regulatory compliance.
b. The historical access to nursing facility services for
medical assistance program beneficiaries.
c. The provider's dedication to and participation in quality
of care, considering all quality programs in which the provider has
participated.
d. The provider's plans to facilitate person-directed care.
e. The provider's plans to facilitate dementia units and
specialty post-acute services.
4. a. Any relief or exception granted under this chapter is
temporary and shall be immediately terminated if all of the
participation requirements under this chapter are not met.
b. If a provider's medical assistance program or Medicare
certification is revoked, any existing exception or relief shall be
terminated and the provider shall not be eligible to request
subsequent relief or an exception under this chapter.
5. Following a change in ownership, relief or an exception
previously granted shall continue and future rate calculations shall
be determined under the provisions of 441 IAC 81.6(12) relating to
termination or change of ownership of a nursing facility. Section History: Recent Form
2007 Acts, ch 219, §39, 41, 43 Footnotes
Approval received April 17, 2008, from centers for Medicare and
Medicaid services of the United States department of health and human
services for medical assistance state plan amendment effective
October 1, 2007; approval of instant relief or nondirect care limit
exception dependent on extent of available funding; 2007 Acts, ch
219, §41