Medical Assistance Act
Iowa · Medical Assistance · §§ 249A.1 to 249A.58 · 62 sections
Overview
The Medical Assistance Act governs the state's Medicaid program, setting out who is eligible for coverage, which categories of licensed health and behavioral health practitioners may be paid, and how providers are reimbursed for institutional, outpatient, and long-term care services. It establishes the program's payment machinery — rate-setting and rate adjustments, cost-based reimbursement for rural and federally qualified clinics, provider assessments and dedicated funds that help finance the program, managed care organization premiums, and drug-cost controls such as a preferred drug list and utilization review — along with home and community-based services waivers, case management, and shared state and county funding for services to people with disabilities or chronic mental illness. It also addresses program integrity and eligibility administration, including background checks on waiver providers, recovery from liable third parties, reporting of overpayments, treatment of people residing in public or mental health institutions, and the administrative duties of the agency director.
Editorial summary generated from the text of this act. It is not part of the statute — read the sections below for the operative language.
In the courts
Sections of this act have been cited in 12 court decisions.
Most-cited authority: 841 N.W.2d 867 - In the Matter of the Estate of Arnold Melby, Iowa
Sections covered
- Iowa Code § 249A.1Title
- Iowa Code § 249A.11Payment for patient care segregated
- Iowa Code § 249A.12Assistance to persons with an intellectual disability
- Iowa Code § 249A.13Medicaid managed care organization premiums fund
- Iowa Code § 249A.14Sex reassignment surgeries or associated procedures — reimbursement prohibited
- Iowa Code § 249A.15Licensed psychologists eligible for payment — provisional licensees
- Iowa Code § 249A.15ALicensed marital and family therapists, licensed master social workers, licensed mental health counselors, certified alcohol and drug counselors, licensed behavior analysts, and licensed assistant behavior analysts — temporary licensees
- Iowa Code § 249A.15BSpeech pathologists eligible for payment
- Iowa Code § 249A.16New rates for services — effective date
- Iowa Code § 249A.17Transitional medical assistance. Repealed by
- Iowa Code § 249A.18Cost-based reimbursement — rural health clinics and federally qualified health centers
- Iowa Code § 249A.18AResident assessment
- Iowa Code § 249A.2Definitions3 cites
- Iowa Code § 249A.20Noninstitutional health providers — reimbursement
- Iowa Code § 249A.20APreferred drug list program
- Iowa Code § 249A.20BNursing facility quality assurance assessment. Repealed by
- Iowa Code § 249A.21Intermediate care facilities for persons with an intellectual disability — assessment
- Iowa Code § 249A.24Iowa medical assistance drug utilization review commission — created
- Iowa Code § 249A.26State and county participation in funding for services to persons with disabilities — case management
- Iowa Code § 249A.26AState and county participation in funding for rehabilitation services for persons with chronic mental illness. Repealed by
- Iowa Code § 249A.27Indemnity for case management and disallowed costs
- Iowa Code § 249A.28Hospital directed payment — prohibition of pass-through on non-Medicaid payors
- Iowa Code § 249A.29Home and community-based services waiver providers — records checks
- Iowa Code § 249A.3Eligibility3 cites
- Iowa Code § 249A.30Home and community-based services waiver — service provider reimbursement rate adjustments
- Iowa Code § 249A.30AMedical assistance — personal needs allowance
- Iowa Code § 249A.31Reimbursement — targeted case management services — inpatient psychiatric services
- Iowa Code § 249A.32Medical assistance home and community-based services waivers — consumer-directed attendant care — termination of contract
- Iowa Code § 249A.32AHome and community-based services waivers — limitations
- Iowa Code § 249A.32BEarly and periodic screening, diagnosis, and treatment funding
- Iowa Code § 249A.33Pharmaceutical settlement account — medical assistance program
- Iowa Code § 249A.34Medical assistance crisis intervention team. Repealed by
- Iowa Code § 249A.35Purchase of qualified long-term care insurance policy — computation under medical assistance program
- Iowa Code § 249A.37Duties of third parties
- Iowa Code § 249A.38Inmates of public institutions — suspension of medical assistance
- Iowa Code § 249A.38AResidents of mental health institutes — retaining of Medicaid eligibility
- Iowa Code § 249A.38BSupported community living services
- Iowa Code § 249A.39Reporting of overpayment
- Iowa Code § 249A.3AMedical assistance — all income-eligible children
- Iowa Code § 249A.4Duties of director3 cites
- Iowa Code § 249A.40Involuntarily dissolved providers — overpayments or incorrect payments
- Iowa Code § 249A.41Overpayment — interest
- Iowa Code § 249A.42Overpayment — limitations periods
- Iowa Code § 249A.42AOverpayment — subsequent ineligibility of recipient — recovery — recoupment — reimbursement
- Iowa Code § 249A.43Provider overpayment — notice — judgment
- Iowa Code § 249A.44Overpayment — emergency relief2 cites
- Iowa Code § 249A.45Provider’s third-party submissions
- Iowa Code § 249A.46Liability of other persons — repayment of claims
- Iowa Code § 249A.47Improperly filed claims — other violations — imposition of monetary recovery and sanctions
- Iowa Code § 249A.48Temporary moratoria
- Iowa Code § 249A.49Internet site — providers found in violation of medical assistance program
- Iowa Code § 249A.4AHealth care coordination and intervention teams
- Iowa Code § 249A.4BMedical assistance advisory council
- Iowa Code § 249A.50Fraudulent practices — investigations and audits — Medicaid fraud fund
- Iowa Code § 249A.51Fraudulent practice
- Iowa Code § 249A.52Garnishment
- Iowa Code § 249A.53Recovery of payment1 cite
- Iowa Code § 249A.54Responsibility for payment on behalf of Medicaid-eligible persons — liability of other parties
- Iowa Code § 249A.55Restitution
- Iowa Code § 249A.56County attorney to enforce
- Iowa Code § 249A.57Health care facilities — penalty
- Iowa Code § 249A.58Cooperation with child support services
Enacted in other states
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