Iowa Admin. Code r. 441-22.6

Current through Regsiter Vol. 46, No. 26, June 12, 2024

Rule 441-22.6 - Provider network

The administrator shall establish and maintain a network of department-approved autism service providers so that applied behavioral analysis services are available to eligible individuals statewide to the maximum extent possible.

(1) A provider shall be approved to participate in the autism support program provider network if the provider meets one of the following standards in paragraph 22.6(1)"a, " "b " or"c":

a. The autism service provider is certified as a behavior analyst by the Behavior Analyst Certification Board; or

b. The autism service provider is a psychologist licensed under Iowa Code chapter 154B; or

c. The autism service provider is a psychiatrist licensed under Iowa Code chapter 148; and

d. A provider shall be deemed eligible to participate in the autism support program provider network if the autism service provider meets the standards in paragraph 22.6(1) "a, ""b" or"c" and the provider is approved to provide applied behavioral analysis services through Medicaid.

(2) The administrator's provider network shall accept the rate established by the department through the department's contract with the administrator as payment in full for the services rendered and will not charge eligible individuals any additional fees for services rendered, except for those eligible individuals who are required to pay a portion of the cost of services due to cost-sharing requirements.

(3) The department is responsible for calculating the cost-sharing amount according to standards established in this chapter.

(4) The autism service provider is responsible for collecting the cost-sharing amount from the eligible individual and will only be reimbursed by the administrator for the balance of the service fee minus the amount of cost sharing.

Iowa Admin. Code r. 441-22.6

ARC 1329C, IAB 2/19/2014, effective 4/1/2014

Amended by IAB November 23, 2016/Volume XXXIX, Number 11, effective 1/1/2017