Iowa Admin. Code r. 441-75.8

Current through Register Vol. 47, No. 6, October 2, 2024

Rule 441-75.8 - Medical assistance corrective payments

If a decision by the department or the Social Security Administration following an appeal on a denied application for any of the categories of medical assistance eligibility set forth in rule 441-75.1 (249A) is favorable to the claimant, reimbursement will be made to the claimant for any medical bills paid by the claimant during the period between the date of the denial on the initial application and the date regular medical assistance coverage began when the bills were for medical services rendered in the period now determined to be an eligible period based on the following conditions:

(1) These bills must be for services covered by the medical assistance program as set forth in 441-Chapter 78.

(2) Reimbursement will be based on Medicaid rates for services in effect at the time the services were provided.

(3) If a county relief agency has paid medical bills on the recipient's behalf and has not received reimbursement through assignment as set forth in 441-Chapter 80, the department will reimburse the county relief agency directly on the same basis as if the reimbursement was made to the recipient.

(4) Recipients and county relief agencies shall file claims for payment under this subrule by submitting Form 470-2224, Verification of Paid Medical Bills, to the department. A supply of these forms is available from the county office. All requests for reimbursement shall be acted upon within 60 days of receipt of all Forms 470-2224 in the county office.

(5) Any adverse action taken by the department with respect to an application for reimbursement is appealable under 441-Chapter 7.

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

Iowa Admin. Code r. 441-75.8