Iowa Admin. Code r. 191-72.13 - Plan of action
(1) Each issuer
shall, prior to qualification by the division of insurance, submit to the
department of human services a plan for complying with the information
maintenance and documentation requirements set forth in rules
191-72.9 (514H) and
191-72.10 (514H). No policy or
certificate shall be qualified until the department of human services has
approved the issuer's documentation plan for the policy or certificate . The
documentation plan will include the following:
a. The location where records will be kept.
Records required for purposes of the Iowa long-term care asset preservation
program must be available at no more than three locations, each of which shall
be easily accessible to the division of insurance.
b. The issuer shall agree to give the
commissioner access to all information described in rule
191-72.10 (514H) on an aggregate
basis for all policyholders or certificate holders and on an individual basis
for all policyholders or certificate holders who have ever received any
benefits. Access to information on persons who have not applied for Medicaid is
required in order for the commissioner to determine if an issuer's system for
documenting asset protection is functioning correctly. The commissioner shall
have the final decision concerning the frequency of access to the data and the
size of samples for auditing or other purposes.
c. The name, job title, address, and
telephone number of the person primarily responsible for the maintenance of the
information required and for acting as liaison with the department of human
services and the division of insurance concerning the information.
d. Methods for determining when insurance
benefits or prepaid benefits qualify for asset protection , including the
following:
(1) Documentation of the insured
event .
(2) Description of
services.
(3) Documentation of
charges and benefits paid.
(4)
Documentation of plans of care, when required.
e. Description of electronic and manual
systems which will be used in maintaining the required information.
f. Information that will be retained which is
needed to comply with this rule.
g.
Copies of forms and descriptions of standard procedures for maintaining and
reporting the information required, including the specific electronic medium
which will be used to report required information and a description of the
relevant files.
(2)
After the department of human services reviews a plan of action, that
department shall advise the division of insurance and the issuer in writing
whether the department of human services approves the plan of action. If the
department of human services disapproves a plan of action, that department
shall advise the division of insurance and the issuer of the shortcomings in
the plan of action and shall instruct the issuer of the methods necessary to
resolve them.
Notes
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