§ 249A.42A — Overpayment — subsequent ineligibility of recipient — recovery — recoupment — reimbursement

Iowa § 249A.42A

• Jurisdiction: Iowa
• Title VI: HUMAN SERVICES
• Ch. 249A: MEDICAL ASSISTANCE

Text

recoupment — reimbursement.
Notwithstandinganyprovisiontothecontrary,ifarecipientisdeemedineligibleformedical
assistance following delivery of care or service by a provider, in an administrative action
to recover an overpayment to the provider based solely on the grounds of such recipient’s
ineligibility, the department acting as the state Medicaid agency shall reimburse the provider
for any recoupment of an overpayment using state-only funds for care or services delivered
if all of the following conditions are met:
1. The provider verified eligibility through the eligibility and verification system or the
secure web portal of, and obtained any necessary prior authorization for, the recipient on
whose behalf payment was made to the provider prior to the delivery of care or service to the
recipient.
2. The provider documented the eligibility verification performed and any necessary prior
authorization obtained pursuant to subsection 1 in a manner and format established by the
department by rule, and retained the required documentation in the recipient’s file.