ARC 8959C

ARC 8959C

Rulemaking related to psychiatric medical institution for children plan of care team

Notice of Intended Action for this rulemaking was published in the Iowa Administrative Bulletin on December 25, 2024, as ARC 8570C. A public hearing was held on the following date(s):

●January 15, 2025

●January 21, 2025

No one attended the public hearings. No public comments were received. No changes from the Notice have been made.

ITEM 1.Amend subparagraph 78.12(2)“a”(3) as follows:

(3)Behavioral health intervention is not covered for members who are in an acute care or psychiatric hospital,or a long-term care facility, or a psychiatric medical institution for children.

ITEM 2.Amend subrule 78.29(2) as follows:

78.29(2) Exclusions. Payment will not be approved for the following services:

a. Services provided in a medical institution.

b. a.Services performed without relationship to a specific condition, risk factor, symptom, or complaint.

c. b.Services provided for nonspecific conditions of distress such as job dissatisfaction or general unhappiness.

d. c.Sensitivity training, marriage enrichment, assertiveness training, and growth groups or marathons.

ITEM 3.Amend paragraph 85.3(3)“a” as follows:

a.For persons eligible for Medicaid prior to admission, this preadmission certification shall be performed within 45 days prior to the proposed date for admission to the facility by an independent team that includes a physician who has competence in diagnosis and treatment of mental illness, preferably in child psychiatry, and who has knowledge of the person’s situation. If a social worker is a part of the team, the social worker may be from the county office of the department of human services.A physician’s assistant or advanced registered nurse practitioner may also serve as a member of the plan of care team.

The evaluation shall be submitted to the facility on or prior to the date of the patient’s admission.

ITEM 4.Adopt the following new subparagraph 85.6(3)“c”(4):

(4)The team may also include a physician’s assistant or an advanced registered nurse practitioner.

ITEM 5.Amend paragraph 85.22(3)“a” as follows:

a.For persons determined eligible for Medicaid prior to admission, this preadmission certification shall be performed within 45 days prior to the proposed date for admission to the facility by an independent team that includes a physician who has competence in diagnosis and treatment of mental illness, preferably in child psychiatry, and who has knowledge of the person’s situation. If a social worker is a part of the team, the social worker may be from the county office of the department of human services.A physician’s assistant or advanced registered nurse practitioner may also serve as a member of the plan of care team.

The evaluation shall be submitted to the facility on or prior to the date of the patient’s admission.

ITEM 6.Adopt the following new subparagraph 85.24(3)“c”(4):

(4)The team may also include a physician’s assistant or an advanced registered nurse practitioner.

[Filed 1/31/25, effective 4/1/25]

[Published 2/19/25]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 2/19/25.