IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services

What this rule requires your agency to do

• 1Covered services must be consistent with the diagnosis and treatment of the patient's condition and in accordance with standards of good medical practice (79.9(2)"a" and "b").(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 2Services must be provided with the full knowledge and consent of the recipient or someone acting on the recipient's behalf, unless otherwise required by law, court order, or in emergencies (79.9(2)"g").(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 3Medical assistance funds are incorrectly paid whenever the individual who provided the service was, at the time, the parent of a minor child, spouse, or legal representative of the member, except that a legal representative (not a spouse, or parent/stepparent of a member aged 17 or younger) may provide consumer-directed attendant care or consumer choices option services under an agreement in effect on or after December 31, 2013 (79.9(7)"a" and "b").(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 4Services must be required to meet the medical need of the patient and not furnished for the convenience of the patient, practitioner, or caregiver, and must be the least costly type of service reasonably meeting the medical need (79.9(2)"c" and "d").(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 5Providers must supply all the same services to Medicaid eligibles served by the provider as are offered to other clients of the provider (79.9(3)).(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 6Services must be within the scope of the licensure of the provider (79.9(2)"f").(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 7Providers must use the billing procedures and documentation requirements described in 441-Chapters 78 and 80 (79.9(2)"h").(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)
• 8Recipients must be informed before a noncovered service is provided that the recipient will be responsible for the bill (79.9(4)).(IAC 441—79.9(249A) — General provisions for Medicaid coverage applicable to all Medicaid providers and services)