441—81.3 (249A) Initial approval for nursing facility care.
	 81.3(1) Need for nursing facility care. Residents of nursing facilities must be in need of either nursing facility care or skilled nursing care. Payment will be made for nursing facility care residents only upon certification of the need for the level of care by a licensed physician of medicine or osteopathy and approval of the level of care by the department.
	  a.   	 Decisions on level of care shall be made for the department by the Iowa Medicaid enterprise (IME) medical services unit within two working days of receipt of medical information. The IME medical services unit determines whether the level of care provided or to be provided should be approved based on medical necessity and the appropriateness of the level of care under 441—subrules 79.9(1) and 79.9(2).
	  b.   	 Adverse decisions by the IME medical services unit may be appealed to the department pursuant to 441—Chapter 7.
	 81.3(2) Skilled nursing care level of need. Rescinded IAB 7/11/01, effective 7/1/01.
	 81.3(3) Screening. All persons, regardless of the source of payment, seeking admission to a nursing facility shall also be screened by the IME medical services unit to determine if mental illness, mental retardation, or a related condition is present. The Iowa Medicaid program will cover the cost of this screening through the managed mental health contractor.
	  a.   	 Final approval for initial admissions and continued stay of persons with mental illness, mental retardation, or a related condition is determined by the department of human services, division of mental health and disability services.
	  b.   	 Nursing facility payment under the Iowa Medicaid program will be made for persons with mental illness, mental retardation, or a related condition only if it is determined by the division of mental health and disability services that the person’s treatment needs will be or are being met.
	 81.3(4) Special care level of need. Rescinded IAB 3/20/91, effective 3/1/91.
This rule is intended to implement Iowa Code sections 249A.2(6), 249A.3(2)“a” and 249A.4.
[ARC 8445B, IAB 1/13/10, effective 12/11/09]