Iowa Admin. Code r. 441-7.13

Current through Register Vol. 46, No. 24, May 15, 2024

Rule 441-7.13 - Expedited review

(1)Expedited review criteria. Appellants to a medical assistance appeal may, at any time, file with the department a request for expedited review of the appeal. Expedited review shall be granted when the department determines, or a provider acting on behalf or in support of an appellant indicates, that taking the time for a standard resolution could seriously jeopardize the party-in-interest's life, physical or mental health, or ability to attain, maintain, or regain maximum function.

(2)Managed care expedited proceedings.

a. If the appellant is granted an expedited review pursuant to subrule 73.12(2), all subsequent proceedings shall also be expedited without an additional request if the appeal request indicates that the managed care organization appeal was expedited and provides the basis for expedited relief.

b. When review is expedited pursuant to paragraph 7.13(2) "a, " the presiding officer shall issue a proposed decision as expeditiously as the enrollee's health condition requires, but no later than three working days after the department receives from the managed care organization the case file and information for any appeal of a denial of a service that, as indicated by the managed care organization:

(1) Meets the criteria for expedited resolution but was not resolved within the time frame for expedited resolution; or

(2) Was resolved within the time frame for expedited resolution but reached a decision wholly or partially adverse to the enrollee.

(3)Medicaid eligibility, nursing facility transfers or discharges, or preadmission and annual resident review expedited proceedings. For expedited appeals related to Medicaid eligibility, nursing facility transfers or discharges, or preadmission and annual resident review requirements, the presiding officer shall issue a proposed decision as expeditiously as possible, but no later than seven working days after the department receives a request for expedited fair hearing.

(4)Medicaid-covered benefits or services expedited proceedings. For expedited appeals related to Medicaid-covered benefits or services, the presiding officer shall issue a proposed decision as expeditiously as possible, but no later than provided in paragraph 7.13(2)"b. "

(5)Final decision for expedited proceeding. The department shall issue its final decision in accordance with this rule, except as provided by subrule 7.12(2).

(6)Notification if expedited relief is granted or denied. The department shall notify the appellant as expeditiously as possible whether the request for expedited relief is granted or denied. Such notice must be provided orally or through electronic means to the extent consistent with federal and state law. If oral notice is provided, the department shall follow up with written notice, which may be through electronic means to the extent consistent with federal and state law.

Iowa Admin. Code r. 441-7.13

ARC 8003B, lAB 7/29/09, effective 9/2/09; ARC 0304C, lAB 9/5/12, effective 11/1/12; ARC 0487C, lAB 12/12/12, effective 2/1/2013

Amended by IAB June 7, 2017/Volume XXXIX, Number 25, effective 7/12/2017

Amended by IAB March 11, 2020/Volume XLII, Number 19, effective 4/15/2020