Section 441.73.5. Covered services.

         73.5(1) Required services. A managed care organization shall provide:

            a.               For enrollees other than Iowa Health and Wellness Plan enrollees and HAWK-I program enrollees, services as set forth in 441—Chapters 78, 81, 82, 83, 84, 85, and 87, with the exception of the following:

             (1)             Area education agency services.

             (2)             Dental services not provided in an outpatient hospital setting.

             (3)             Infant and toddler program services.

             (4)             Local education agency services.

             (5)             State of Iowa Veterans Home services.

             (6)             Money Follows the Person Grant-funded services.

            b.               Services as set forth in 441—Chapter 74 for Iowa Health and Wellness Plan enrollees.

            c.               Services as set forth in 441—Chapter 86 for HAWK-I program enrollees.

         73.5(2) Community-based case management service. The managed care organization is required to provide services that meet requirements specified in the contract and in 441—subrule 90.5(1).

         73.5(3) Health home services. The managed care organization is required to provide services that meet the requirements specified in 441—subrule 78.53(1) and as specified in the contract.

         73.5(4) Value-added services. A managed care organization may develop optional services and supports to address the needs of enrollees. These services and supports shall be implemented only after approval by the department.

[ARC 2358C, IAB 1/6/16, effective 1/1/16]