Iowa Admin. Code r. 441-79.10 - Requests for preadmission review
The inpatient hospitalization of Medicaid recipients is subject to preadmission review by the Iowa Medicaid enterprise (IME) medical services unit as required in rule 441-78.3 (249A).
(1) The patient's admitting
physician, the physician's designee, or the hospital will contact the IME
medical services unit to request approval of Medicaid coverage for the
hospitalization, according to instructions issued to providers by the IME
medical services unit and instructions in the Medicaid provider
manual.
(2) Medicaid payment will
not be made to the hospital if the IME medical services unit denies the
procedure requested in the preadmission review.
(3) The IME medical services unit shall issue
a letter of denial to the patient, the physician, and the hospital when a
request is denied. The patient, the physician, or the hospital may request a
reconsideration of the decision by filing a written request with the IME
medical services unit within 60 days of the date of the denial
letter.
(4) The aggrieved party may
appeal a denial of a request for reconsideration by the IME medical services
unit according to 441-Chapter 7.
(5) The requirement to obtain preadmission
review is waived when the patient is enrolled in the managed health care option
known as patient management and proper authorization for the admission has been
obtained from the patient manager as described in 441-Chapter 73.
This rule is intended to implement Iowa Code section 249A.4.
Notes
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