Iowa Admin. Code r. 441-73.5 - MCP covered services
(1)
Required services-MCOs. A managed care organization shall
provide:
a. For enrollees other than Iowa
health and wellness plan enrollees and hawki program enrollees, services as set
forth in 441-Chapters 78, 81, 82, 83, 84, 85, and 87, with the exception of the
following:
(1) Area education agency
services.
(2) Dental services not
provided in an outpatient hospital setting.
(3) Infant and toddler program
services.
(4) Local education
agency services.
(5) State of Iowa
Veterans Home services.
(6) Money
Follows the Person (MFP) Rebalancing Demonstration Grant-funded
services.
b. Services as
set forth in 441-Chapter 74 for Iowa health and wellness plan
enrollees.
c. Services as set forth
in 441-Chapter 86 for hawki program enrollees.
(2)
Community-based case management
service. The managed care organization is required to provide services
that meet requirements specified in the contract and in 441-Chapter
90.
(3)
Health home
services. The managed care organization is required to provide
services that meet the requirements specified in 441-Chapter 78 and as
specified in the contract .
(4)
Value-added services. A managed care organization may develop
optional services and supports to address the needs of enrollees. These
services and supports shall be implemented only after approval by the
department .
(5)
Required
services-PAHPs. A PAHP shall provide services to enrollees under the
contract with the state agency and on the bases of prepaid capitation payments
or other payment arrangements that do not use state plan payment rates. PAHPs
shall provide:
a. For enrollees other than
Iowa health and wellness plan enrollees and hawki program enrollees, services
as set forth in 441-Chapter 73, 74, 78, and 88 with the exception of the
following:
(1) Area education agency
services.
(2) Inpatient hospital or
institutional services.
(3) Advance
directive requirements in dental nonclinical services such as
transportation.
(4) Long-term care
(skilled nursing facilities, intermediate care facilities, residential care
facilities, state resource centers, or intermediate care facilities for persons
with an intellectual disability).
(5) Inpatient psychiatric care provided at
the state-administered mental health institutes.
(6) Services provided at specialized
adolescent psychiatric facilities.
(7) Day treatment and partial hospitalization
services for persons aged 20 or under.
(8) Enhanced services provided to certain
eligible recipients.
b.
Services as set forth in 441-Chapter 74 for Iowa health and wellness plan
enrollees.
c. Services as set forth
in 441-Chapter 86 for hawki program enrollees.
Notes
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