Iowa Admin. Code r. 441-81.22

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 441-81.22 - Rates for Medicaid eligibles

(1)Maximum client participation. A nursing facility may not charge more client participation for Medicaid-eligible clients as determined in rule 441-75.16 (249A) than the maximum monthly allowable payment for their facility as determined according to 441-subrule 79.1(9) or rule 441-81.6 (249A). When the department makes a retroactive increase in the maximum daily rate, the nursing facility can charge the client the increased amount for the retroactive period.

(2)Beginning date of payment. When a resident becomes eligible for Medicaid payments for facility care, the facility shall accept Medicaid rates effective when the resident's Medicaid eligibility begins. A nursing facility is required to refund any payment received from a resident or family member for any period of time during which the resident is determined to be eligible for Medicaid.

Any refund owing shall be made no later than 15 days after the nursing facility first receives Medicaid payment for the resident for any period of time. Facilities may deduct the resident's client participation for the month from a refund of the amount paid for a month of Medicaid eligibility.

The beginning and renewal date of eligibility and resident client participation amounts may be obtained through the Iowa Medicaid portal access (IMPA) system. When the beginning Medicaid eligibility date is a future month, the facility shall accept the Medicaid rate effective the first of that future month.

This rule is intended to implement Iowa Code section 249A.4.

Iowa Admin. Code r. 441-81.22

Amended by IAB January 7, 2015/Volume XXXVII, Number 14, effective 3/1/2015