441—78.21 (249A) Rural health clinics. Payment will be made to rural health clinics for the same services payable under the Medicare program (Title XVIII of the Social Security Act). Payment will be made for sterilization in accordance with 78.1(16).
	 78.21(1) Utilization review. Utilization review shall be conducted of Medicaid recipients who access more than 24 outpatient visits in any 12-month period from physicians, advanced registered nurse practitioners, federally qualified health centers, other clinics, and emergency rooms. Refer to rule 441—76.9(249A) for further information concerning the recipient lock-in program.
	 78.21(2) Risk assessments. Risk assessments, using Form 470-2942, Medicaid Prenatal Risk Assessment, shall be completed twice during a Medicaid recipient’s pregnancy. If the risk assessment reflects a high-risk pregnancy, referral shall be made for enhanced services. See description of enhanced services at subrule 78.25(3).
Rural health clinics which wish to administer vaccines which are available through the vaccines for children program to Medicaid recipients shall enroll in the vaccines for children program. In lieu of payment, vaccines available through the vaccines for children program shall be accessed from the department of public health for Medicaid recipients.
	 78.21(3) EPSDT care coordination. Payment for EPSDT care coordination services outlined in 78.18(6)“b”(2)“1” to “7” is available to MediPASS eligible providers as defined in rule 441—88.41(249A) who accept responsibility for providing EPSDT care coordination services to the MediPASS recipients under the age of 21 assigned to them on a monthly basis. All MediPASS providers shall be required to complete Form 470-3183, Care Coordination Agreement, to reflect acceptance or denial of EPSDT care coordination responsibility. When the MediPASS provider does not accept the responsibility, the MediPASS patients assigned to the MediPASS provider are automatically referred to the designated department of public health EPSDT care coordination agency in the recipient’s geographical area. Acknowledgment of acceptance of the EPSDT care coordination responsibility shall be for a specified period of time of no less than six months. MediPASS providers who identify MediPASS EPSDT recipients in need of transportation assistance beyond that available according to rule 441—78.13(249A) shall be referred to the designated department of public health agency assigned to the geographical area of the recipient’s residence.
This rule is intended to implement Iowa Code section 249A.4.