Section 641.80.4. Utilization of LPHS contract funding.

The contractor may bill public health activities to the LPHS contract based on the identified needs of the community.

         80.4(1) Planning process. Annually, the contractor shall initiate a planning process with input from authorized agencies in order for the contractor to identify the utilization of LPHS contract funding.

         80.4(2) Funder of last resort. The LPHS contract shall be billed as the funder of last resort.

            a.               The LPHS contract shall be billed at the authorized agency’s cost or charge, whichever is less.

            b.               The LPHS contract shall not be billed for services eligible for third-party reimbursement (e.g., Medicare, Medicaid, private insurance, approved Iowa waivers, or other federal or state funds).

            c.               The LPHS contract shall not be billed for the balance between the authorized agency cost or charge, whichever is less, and the allowed reimbursement from a third-party payer.

            d.               The LPHS contract shall not be billed for fees waived by the authorized agency.

            e.               The LPHS contract shall not be billed for services provided in a previous fiscal year.

         80.4(3) Cost analysis. The authorized agency shall complete, at a minimum, an annual cost report for each approved LPHS contract activity using a method approved by the department. The authorized agency shall maintain documentation to support each cost report. Expenses to be included in an annual cost report must be documented by the agency as received before the expenses can be included in the cost report.

         80.4(4) Fees and donations.

            a.               Authorized agencies shall use fees billed and donations received from consumers to support the activities billed to the LPHS contract.

            b.               Fees for services provided shall be based on a financial assessment which determines the consumer’s financial responsibility.

            c.               Fees for services may be established by the authorized agency except for services described in subparagraph 80.4(4)“f”(6).

            d.               Donations shall be accepted.

            e.               A financial assessment that considers financial resources and income and determines the consumer’s financial responsibility shall be completed for nursing (skilled and health maintenance) activities and all home care aide activities.

             (1)             The financial assessment shall be updated annually by the authorized agency.

             (2)             An authorized agency may consider additional health care-related expenses or financial resources above $10,000 when determining the consumer’s fee according to an agency’s policy.

             (3)             Restricted assets shall not be considered as a resource in the determination of a consumer’s financial responsibility for services.

             (4)             Unrestricted assets shall be considered in the determination of a consumer’s financial responsibility for services in the sliding fee calculation.

            f.                Sliding fee scale. The following instructions apply to the use of the sliding fee scale.

             (1)             The authorized agency shall establish a sliding fee scale for all home care aide activities and nursing (skilled and health maintenance) activities.

             (2)             The sliding fee scale shall be based on the authorized agency’s charge for services.

             (3)             The authorized agency shall determine the amount the consumer will pay according to the sliding fee scale prior to providing the service.

             (4)             A fee shall be charged to consumers who have an income at or above 200 percent of the most recent federal poverty guidelines.

             (5)             No fee shall be charged to consumers who have an income at or below 75 percent of the most recent federal poverty guidelines and have financial resources of $10,000 or less.

             (6)             No fee shall be charged for protective services or communicable disease follow-up services.

             (7)             An authorized agency may charge a fee according to the authorized agency’s policy for services other than those described in subparagraphs 80.4(4)“f”(1) to (6).

         80.4(5) Alternative plan. A request and written plan is required for the use of the LPHS contract funds for any activity that is not one of the current activities identified in the contract documents. The request and plan shall be based on an assessment of the needs of the community and shall be submitted by the contractor to the department for approval. The plan shall:

            a.               Identify essential public health services to be delivered;

            b.               Describe the activity to be delivered;

            c.               Identify target populations to be served; and

            d.               Describe the anticipated impact due to the use of an alternative plan.

         80.4(6) Reallocation. The department will annually determine the potential for unused funds from contracts. If funds are available, reallocation of the funds shall be at the discretion of the department.

[ARC 1925C, IAB 4/1/15, effective 7/1/15]