Iowa Code 249A.42A – Overpayment — subsequent ineligibility of recipient — recovery — recoupment — reimbursement
Current as of: 2023 | Check for updates
|
Other versions
Notwithstanding any provision to the contrary, if a recipient is deemed ineligible for medical assistance following delivery of care or service by a provider, in an administrative action to recover an overpayment to the provider based solely on the grounds of such recipient’s ineligibility, the department acting as the state Medicaid agency shall reimburse the provider for any recoupment of an overpayment using state-only funds for care or services delivered if all of the following conditions are met:
1. The provider verified eligibility through the eligibility and verification system or the secure web portal of, and obtained any necessary prior authorization for, the recipient on whose behalf payment was made to the provider prior to the delivery of care or service to the recipient.
Terms Used In Iowa Code 249A.42A
- Department: means the department of human services. See Iowa Code 249A.2
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- Medicaid: means payment of all or part of the costs of the care and services made in accordance with Tit. See Iowa Code 249A.2
- overpayment: includes such funds for which the provider's administrative and judicial review remedies under Iowa Code 249A.2
- Provider: means an individual, firm, corporation, association, or institution which is providing or has been approved to provide medical assistance to recipients under this chapter. See Iowa Code 249A.2
- Recipient: means a person who receives medical assistance under this chapter. See Iowa Code 249A.2
- Rule: includes "regulation". See Iowa Code 4.1
- state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
2. The provider documented the eligibility verification performed and any necessary prior authorization obtained pursuant to subsection 1 in a manner and format established by the department by rule, and retained the required documentation in the recipient’s file.