As a condition of doing business in Iowa, health insurers
shall provide, upon the request of the state, information with respect to
individuals who are eligible for or are provided medical assistance under the
state's medical assistance state plan to determine (1) during what period the
member or the member's spouse or dependents may be or may have been covered by
a health insurer and (2) the nature of the coverage that is or was provided by
the health insurer. This requirement applies to self-insured plans, group
health plans as defined in the federal Employee Retirement Income Security Act
of 1974 (Public Law 93-406), service benefit plans, managed care organizations,
pharmacy benefits managers, and other parties that are, by statute, contract,
or agreement, legally responsible for payment of a claim for a health care item
or service.
(1)
Agreement
required. The parties shall sign a data use agreement for the purposes
of this rule. A data use agreement shall prescribe the specific detail elements
required, in addition to any privacy protections, in the manner in which
information shall be provided to the department of human services, or its
designee, and the acceptable uses of the information provided.
a. The initial provision of data shall
include the data necessary to enable the department or its designee to match
covered persons and identify third-party payers for the two-year period before
the initial provision of the data. The data shall include the name, address,
and identifying number of the plan.
b. Ongoing monthly matches may be limited to
changes in the data previously provided, including additional covered persons,
with the effective dates of the changes.
(2)
Confidentiality of data.
The exchange of information carried out under this rule shall be consistent
with all laws, regulations, and rules relating to the confidentiality or
privacy of personal information or medical records, including but not limited
to:
a. The federal Health Insurance
Portability and Accountability Act of 1996,
Public Law
104-191; and
b. Regulations promulgated in accordance with
that Act and published in 45 CFR Parts
160 through
164 as amended to April 11,
2022.
Notes
Iowa Admin. Code
r. 441-80.7
ARC 1070C, IAB
10/2/2013, effective 10/1/2013
Amended by
IAB
February 8, 2023/Volume XLV, Number 16, effective
4/1/2023
