Iowa Admin. Code r. 441-151.21 - Certification process
The chief
(1)Any party intending to request
court-ordered services funds shall complete an application and receive approval
for the funding request from the chief juvenile court officer or approved
administrator.
a. The application form with
instructions shall be available upon request from the office of each chief
juvenile court officer .
b. The
applicant shall have verified that there are no other alternative funding
sources for the service.
c. The
chief juvenile court officer or approved administrator may establish procedures
for handling emergency or after-hours situations and for the handling of
transports.
(2)
Determination. The chief juvenile court officer or approved
administrator shall determine whether the requested service is eligible for
reimbursement and shall certify that there are sufficient funds available to
pay for the service. The chief juvenile court officer or approved administrator
shall determine whether:
a. The requested
service falls within the court-ordered services expenses defined in Iowa Code
section
232.141, subsections (4)
and (5), and subrule 151.22(1); and
b. There are sufficient funds in the
district's fiscal year fund allocation to pay for the requested service.
(3)
Use of
other funding sources. The department , in cooperation with the chief
juvenile court officers, shall ensure that the funds allocated for
court-ordered services are spent only after all other reasonable actions have
been taken to use other funding sources. Services are not eligible for
reimbursement when another payment source is available.
a. Medicaid. The department shall maximize
the use of funds that may be available from the Medicaid program, including
coverage for early and periodic screening, diagnosis, and treatment and for
psychiatric medical institutions for children (PMIC), before requesting
assistance through the court-ordered services fund. However, medical cost
sharing for the one-time payment per court order of a deductible amount or a
coinsurance amount for treatment specified in a court order is an allowable
expense that may be paid through the court-ordered services fund when insurance
or Medicaid is then available to pay the remainder of the cost.
b. Other third-party payments. The department
shall recover payments from any third-party insurance carrier that is liable
for coverage of the services, including health insurance coverage. The
department shall submit claims to third-party insurance carriers liable for
coverage of the services before the claims are submitted for payment through
the court-ordered services fund.
c.
The date of a medical claim's accrual for reimbursement through court-ordered
services is the date the claim becomes a state liability. For example, a claim
becomes a state liability on:
(1) The date of
a court order for a contested claim; or
(2) The date of a determination by Medicaid
or private insurance that Medicaid or private insurance denies partial or full
payment for care and treatment for which an application has been
made.
d. If eligible for
reimbursement through the court-ordered services fund, medical claims that are
submitted to, but are denied by, Medicaid or private insurance shall be paid at
a rate not to exceed the rate set by Medicaid.
(4)
Certification.The chief
juvenile court officer or approved administrator shall approve or disapprove
the request for funds and shall sign and return the application to the
applicant.
a. If the request is disapproved,
the applicant must approach another service.
b. If the request is approved, the service
plan may be presented to the court for a court order to be issued for the
services.
(5)
Allowable rates not available. When the department has been
unable to establish an allowable rate of reimbursement for a service or a
provider , the chief juvenile court officer or approved administrator shall
negotiate a reimbursement rate with the provider to obtain the service at a
reasonable cost based on available community or statewide
rates.
Notes
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