Iowa Code r. 441-151.21 - Certification process
The chief juvenile court officer or approved administrator shall determine the certification of the court for each ordered service.
(1)
Application for court-ordered
services. 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
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.