Iowa Code § 231.44
Utilization of resources — assistance and advocacy related to long-term services and supports under the Medicaid program
Redline — January 1, 2012 → current.View current text →
Current — January 1, 2018
As of January 1, 2012
1. The resident advocate committee volunteer program is administered by the office of the long-term care resident’s advocate. The state and any local long-term care resident’s advocate shall provide information, assistance, and support to resident advocate committee program volunteers to the extent possible. If funding becomes insufficient to process applications and new appointments to resident advocate committees can no longer be made, the director shall notify the director of the department of inspections and appeals. A health care facility shall not be found in violation of section 135C.25 for not having a resident advocate committee if new appointments cannot be made as documented in accordance with this subsection.
2. The responsibilities of the resident advocate committee are in accordance with the rules adopted by the commission pursuant to chapter 17A. When adopting the rules, the commission shall consider the needs of residents of elder group homes as defined in section 231B.1 and each category of licensed health care facility as defined in section 135C.1, subsection 6, and the services each facility may render. The commission shall coordinate the development of appropriate rules with other state agencies.
3. An elder group home or long-term care facility shall disclose the names, addresses, and phone numbers of a resident’s family members, if requested, to a resident advocate committee member, unless permission for this disclosure is refused in writing by a family member.
4. The state, any resident advocate committee member, and any local long-term care resident’s advocate are not liable for an action undertaken by a resident advocate committee member or a local long-term care resident’s advocate in the performance of duty, if the action is undertaken and carried out reasonably and in good faith.
86 Acts, ch 1245, §1018
87 Acts, ch 70, §2; 88 Acts, ch 1068, §3
94 Acts, ch 1170, §46; 99 Acts, ch 129, §14; 2003 Acts, ch 141, §12; 2004 Acts, ch 1090, §13; 2005 Acts, ch 45, §12; 2009 Acts, ch 23, §31; 2010 Acts, ch 1062, §8
Referred to in
1. The office of long-term care ombudsman may utilize its available resources to provide assistance and advocacy services to eligible recipients, or the families or legal representatives of such eligible recipients, of long-term services and supports provided through the Medicaid program. Such assistance and advocacy shall include but is not limited to all of the following:
a. Assisting recipients in understanding the services, coverage, and access provisions and their rights under Medicaid managed care.
b. Developing procedures for the tracking and reporting of the outcomes of individual requests for assistance, the obtaining of necessary services and supports, and other aspects of the services provided to eligible recipients.
c. Providing advice and assistance relating to the preparation and filing of complaints, grievances, and appeals of complaints or grievances, including through processes available under managed care plans and the state appeals process, relating to long-term services and supports under the Medicaid program.
2. A representative of the office of long-term care ombudsman providing assistance and advocacy services authorized under this section for an individual, shall be provided access to the individual, and shall be provided access to the individual’s medical and social records as authorized by the individual or the individual’s legal representative, as necessary to carry out the duties specified in this section.
3. A representative of the office of long-term care ombudsman providing assistance and advocacy services authorized under this section for an individual, shall be provided access to administrative records related to the provision of the long-term services and supports to the individual, as necessary to carry out the duties specified in this section.
4. The office of long-term care ombudsman and representatives of the office, when providing assistance and advocacy services under this section, shall be considered a health oversight agency as defined in 45 C.F.R. §164.501 for the purposes of health oversight activities as described in 45 C.F.R. §164.512(d). Recipient information available to the office of long-term care ombudsman and representatives of the office under this subsection shall be limited to the recipient’s protected health information as defined in 45 C.F.R. §160.103 for the purpose of recipient case resolution. When providing assistance and advocacy services under this section, the office of long-term care ombudsman shall act as an independent agency, and the office of long-term care ombudsman and representatives of the office shall be free of any undue influence that restrains the ability of the office or the office’s representatives from providing such services and assistance. The office of long-term care ombudsman shall adopt rules applicable to long-term care ombudsmen providing assistance and advocacy services under this section to authorize such ombudsmen to function in a manner consistent with long-term care ombudsmen under the federal Act.
5. For the purposes of this section:
a. “Institutional setting” includes a long-term care facility, an elder group home, or an assisted living program.
b. “Long-term services and supports” means the broad range of health, health-related, and personal care assistance services and supports, provided in both institutional settings and home and community-based settings, necessary for older individuals and persons with disabilities who experience limitations in their capacity for self-care due to a physical, cognitive, or mental disability or condition.
Official source: Iowa Legislature. Reproduced from public-domain Iowa statutes; confirm against the official source for the current text. Not legal advice.