Iowa Code r. 441-22.6 - Provider network
The administrator shall establish and maintain a network of department-approved autism service providers so that applied behavioral analysis services are available to eligible individuals statewide to the maximum extent possible.
(1) A provider
shall be approved to participate in the autism support program provider network
if the provider meets one of the following standards in paragraph
22.6(1)"a," "b" or "c":
a. The autism service provider is certified
as a behavior analyst by the Behavior Analyst Certification Board; or
b. The autism service provider is a
psychologist licensed under Iowa Code chapter 154B; or
c. The autism service provider is a
psychiatrist licensed under Iowa Code chapter 148; and
d. A provider shall be deemed eligible to
participate in the autism support program provider network if the autism
service provider meets the standards in paragraph
22.6(1)"a,""b" or "c" and the provider is
approved to provide applied behavioral analysis services through
Medicaid.
(2) The
administrator's provider network shall accept the rate established by the
department through the department's contract with the administrator as payment
in full for the services rendered and will not charge eligible individuals any
additional fees for services rendered, except for those eligible individuals
who are required to pay a portion of the cost of services due to cost-sharing
requirements.
(3) The department is
responsible for calculating the cost-sharing amount according to standards
established in this chapter.
(4)
The autism service provider is responsible for collecting the cost-sharing
amount from the eligible individual and will only be reimbursed by the
administrator for the balance of the service fee minus the amount of cost
sharing.
Notes
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