Section 441.86.10. Reporting changes.

Changes that may affect eligibility shall be reported timely to the department or the third-party administrator. “Timely” shall mean no later than ten working days after the change occurred. The ten working-day period begins the first working day following the date of the change. The parent, guardian, or other adult responsible for the child shall report the change unless the child is emancipated, married, or otherwise in an independent living situation, in which case the child shall be responsible for reporting the change.

       86.10(1) Entry to a nonmedical public institution. The entry of a child into a nonmedical public institution, such as a penal institution, shall be reported following entry to the institution.

       86.10(2) Iowa residence is abandoned. The abandonment of Iowa residence shall be reported following the move from the state.

       86.10(3) Other insurance coverage. Enrollment of the child in other health insurance coverage shall be reported.

      86.10(4) Employment with the state of Iowa. The employment of the child’s parent with the state of Iowa shall be reported.

       86.10(5) Decrease in income. If the family reports a decrease in income, the third-party administrator shall ascertain whether the change affects the premium obligation of the family. If the change is such that the family is no longer required to pay a premium in accordance with the provisions of rule 441—86.8(514I), premiums will no longer be charged beginning with the month following the month of the report of the change.

       86.10(6) Information reported by a third party. Information reported by a third party shall not be acted upon until the information is verified in accordance with subrule 86.3(7).

       86.10(7) Cooperation. The provisions of subrule 86.3(7) shall apply when a request for information or verification is made due to a change. In addition, failure of the enrollee or of the person acting on behalf of the enrollee to provide requested information or verification that may affect eligibility for the program shall result in cancellation and recoupment of all payments made by the department on behalf of the enrollee during the period in question.

       86.10(8) Effective date of change in eligibility.

        a.           When a change in circumstances has a positive effect on eligibility, the change in eligibility shall be effective no earlier than the month following the month in which the change in circumstances was reported, regardless of when the change was reported.

        b.           When a change in circumstances has an adverse effect on eligibility, the change in eligibility shall be effective no earlier than the month following the issuance of a timely notification, in accordance with the provisions of rule 441—86.11(514I). When the change in circumstances was not reported timely, as defined in this rule, benefits shall be recouped beginning with the month following the month in which the change occurred.

        c.           When an anticipated change in circumstances is reported before the change occurs, no action shall be taken until the change actually occurs and is verified in accordance with the provisions of subrule 86.3(7).

[ARC 0837C, IAB 7/24/13, effective 10/1/13]