Notice of Intended Action

Providers of medical and remedial care—service documentation, 79.3(2)“c”(3)

Untitled document

ARC 6419C

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Proposing rule making related to service documentation

and providing an opportunity for public comment

The Human Services Department hereby proposes to amend Chapter 79, "Other Policies Relating to Providers of Medical and Remedial Care," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is proposed under the authority provided in Iowa Code section 249A.4.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code section 249A.4.

Purpose and Summary

The Department is proposing to amend the documentation requirements for narrative service documentation for each service encounter and each shift for 24-hour services. This proposed rule making removes this administrative burden related to delivering services.

These amendments will clarify that Medicaid providers must include all records and documentation to substantiate the services provided to the member and all information necessary to allow accurate adjudication of the claim. In addition, documentation requirements must meet the professional standards pertaining to the service provided.

This rule making will positively impact direct service providers by removing the requirement for narrative service documentation for each service encounter or shift and replacing it with the requirement to provide a narrative only when any incident or illness or unusual or atypical event occurs during the service encounter.

This rule making will provide immediate relief to providers struggling to recruit and retain direct care staff. Providers have requested the amendments in response to the direct care workforce crisis.

Fiscal Impact

This rule making has no fiscal impact to the State of Iowa.

Jobs Impact

After analysis and review of this rule making, no impact on jobs has been found.

Waivers

Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).

Public Comment

Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m.on August 16, 2022. Comments should be directed to:

Nancy Freudenberg

Department of Human Services

Hoover State Office Building, Fifth Floor

1305 East Walnut Street

Des Moines, Iowa 50319-0114

Email: appeals@dhs.state.ia.us

Public Hearing

No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)"b," an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members.

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee's meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

The following rule-making actions are proposed:

Item 1. Amend subparagraph 79.3(2)"c"(3) as follows:

(3)Service documentation. The record for each service provided shall include information necessary to substantiate that the service was provided. Service documentation shall include narrative documentation and may also include documentation in checkbox format. Unless otherwise indicated below, the provider may document the services in any format so long as the documentation adequately substantiates the medical necessity and that the services were rendered. The service record shall include the following:

1. to 3. No change.

4.The location where the service was provided if otherwise required on the billing form or in 441—paragraph 77.30(5)"c" or "d,"441—paragraph 77.33(6)"d,"441—paragraph 77.34(5)"d,"441—paragraph 77.37(15)"d,"441—paragraph 77.39(13)"e,"441—paragraph 77.39(14)"d," or 441—paragraph 77.46(5)"i," or 441—subparagraph 78.9(10)"a"(1).

5.Medication administration record (MAR). The name, dosage, and route of administration of any medication dispensed or administered as part of the service.

6.Mileage log. The name, date, purpose of the trip, and total miles for transportation provided as part of the service.

7.Narrative description of any incidents or illnesses or unusual or atypical occurrences that occur during service provision.

6. 8.Any supplies dispensed as part of the service.

7. 9.The first and last name and professional credentials, if any, of the person providing the service.

8. 10.The signature of the person providing the service, or the initials of the person providing the service if a signature log indicates the person's identity.

9. 11.For 24-hour care, documentation for every shift of the services provided, the member's response to the services provided, and the person who provided the services.

Item 2. Amend paragraph 79.3(2)"d," introductory paragraph, as follows:

d. Basis for service requirements for specific services. The health care provider should include all records and documentation that substantiate the services provided to the member and all information necessary to allow accurate adjudication of the claim. Additionally, documentation requirements must meet the professional standards pertaining to the service provided. The medical record for the following services must include, but is not limited to, the items specified below (unless the listed item is not routinely received or created in connection with the particular service or activity and is not required to document the reason for performing the service or activity, its medical necessity, or the level of care associated with it). These items will be specified on Form 470-4479, Documentation Checklist, when the Iowa Medicaid enterprise program integrity unit requests providers to submit records for review. (See paragraph 79.4(2)"b.")

Human Services Department

Closed For Comments

This notice is now closed for comments. Collection of comments closed on 8/16/2022.

Official Document

  • Providers of medical and remedial care—service documentation, 79.3(2)“c”(3)
  • Published on 7/27/2022
  • 228 Views , 1 Comments
  • Notice of Intended Action

The official published PDF of this document is available from the Iowa General Assembly’s Administrative Rules page.

View Official PDF

View the Iowa Administrative Bulletin for 7/27/2022.

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