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Medicaid/CHIP Data Requirements in Iowa

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Medicaid/CHIP Data Requirements in Iowa

Subtopic Statute/Regulation Description
Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) Community mental health centers, I.A.C. r. 441-78.16 Community mental health centers   States that Iowa’s Medicaid program will approve payments for reasonable and necessary services provided...
Discharge and Transfer, I.A.C. r. 441-81.5 Discharge and Transfer   Requires nursing facility administrators to notify the Department of Human Services when a Medicaid member requests a...
Maintenance of records, I.A.C. r. 441-79.3 Maintenance of records by providers of service   Requires Medicaid providers to maintain financial and medical records and to make these records...
Participating Health and Dental Plans, I.A.C. r. 441-86.15 Participating Health and Dental Plans   Establishes requirements for health and dental plans that wish to participate in Iowa’s CHIP...
Pharmaceutical Case Management Services, I.A.C. r. 441-78.47 Pharmaceutical Case Management Services   Permits physicians and pharmacists to provide pharmaceutical case management services to Medicaid...
Records and Reports, I.A.C. r. 441-73.18 Records and reports   Requires managed care organizations that provide Medicaid services to maintain clinical records in compliance with state...
Records and Reports, I.A.C. r. 441-88.9 Records and Reports,    Requires Prepaid Health Organizations (PHPs) to comply with the Medicaid records standards codified in Iowa Admin....
Records I.A.C. r. 441-81.9 Records.    Establishes record keeping requirements for nursing facilities that provide Medicaid services. These requirements address the...
Responsibilities of Hospitals, I.A.C. r. 441-85.6 Responsibilities of Hospitals   Requires psychiatric hospitals that provide Medicaid services to maintain medical and fiscal records. Specifies...
Screening Centers, I.A.C. r. 441-78.18 Screening Centers   States the circumstances in which Iowa’s Medicaid program will approve payments to screening centers. Requires...
Access to Medicaid data (by patients, providers, and government agencies) Confidentiality of records, Iowa Code ยง 217.30 Confidentiality of records -- report of recipients.    Specifies the information regarding Department of Human Services program...
Mandatory reporting by Medicaid providers (cost/utilization information) Determination of Payment Rate, I.A.C. r. 441-86.6 Financial and Statistical report and Determination of Payment Rate    Requires nursing facilities to submit a Financial and Statistical...
Health Home Services Providers, I.A.C. r. 441-77.47 Health Home Services Providers   Establishes qualifications for health home services providers’ participation in Iowa’s Medicaid...
Quality reporting by Medicaid providers (cross post to care coordination/care management (chronic disease management; sharing information across providers; enrollee participation) Grievance Procedures, I.A.C. r. 441-88.8 Grievance Procedures   Requires prepaid health plans (PHPs) to establish grievance procedures and to obtain the Department of Human Services...
Grievances, I.A.C. r. 441-73.15 Grievances   Requires managed care organizations that provide Medicaid services to establish procedures for handling nonclinical grievances....
Quality assurance, I.A.C. r. 441-73.24 Quality Assurance   Requires managed care organizations that provide Medicaid services to implement a systems for quality assurance and...
Written Record, I.A.C. r. 441-73.16 Written record   Requires managed care organizations to maintain records of received grievances and their disposition and report these records...
Click on the individual state law in the table above to see our summary of the individual law.


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