Section 441.153.55. Eligible services.

Services eligible for reimbursement under the state payment program are the services defined in the approved county management plan of the applicant’s county of residence.

       153.55(1) Purchased services.

        a.           Service management may be provided through a county CPC process during the period for which services are paid.

        b.           The county may pay for services as long as the member is eligible and the following criteria are met:

       (1)             The member is receiving a service that requires funding from the state payment program.

       (2)             The service is provided under the approved county management plan of the member’s county of residence.

       (3)             The member’s county of residence provides or pays for the service from the county mental health, mental retardation, and developmental disabilities services fund for persons who have legal settlement in the county.

       (4)             Service providers bill the other payment systems for which the member is eligible before billing the county of residence.

       153.55(2) Excluded costs. The following costs are excluded from payment by the state payment program:

        a.           Services received before the effective date of eligibility.

        b.           The cost of local services that the member is eligible to have funded by private sources or by other state or federal programs or funds, such as medical assistance program services or services provided in a state institution.

        c.           Scheduled appointments or consultations for which the member did not appear.

        d.           Service management (county chart of accounts numbers beginning with 22-000) for members eligible for Medicaid targeted case management, unless the Iowa plan contractor decertifies the member for case management services.

        e.           Services described by the following county chart of accounts codes:

       (1)             4x03, information and referral.

       (2)             4x04, consultation.

       (3)             4x11, direct administrative.

       (4)             4x12, purchased administrative.

       (5)             4x21-374, case management Medicaid match.

       (6)             4x32-328, home/vehicle modification.

[ARC 8486B, IAB 1/13/10, effective 1/1/10; ARC 8612B, IAB 3/10/10, effective 4/14/10]