Senate File 460 - Reprinted SENATE FILE BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SSB 1071) Passed Senate, Date Passed House, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act relating to providing an appeal process for certain 2 medical assistance providers and child care providers. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 SF 460 5 pf/cc/26 PAG LIN 1 1 Section 1. NEW SECTION. 217.41B PROVIDER APPEALS == 1 2 FINAL DECISION. 1 3 1. a. Notwithstanding any conflicting provision of 1 4 chapter 17A, when an administrative law judge, assigned by the 1 5 division of administrative hearings in accordance with the 1 6 provisions of section 10A.801, is the presiding officer at a 1 7 provider appeal hearing as described in subsection 2, the 1 8 administrative law judge shall make a proposed decision that 1 9 shall include findings of fact and conclusions of law, 1 10 separately stated. 1 11 b. When the presiding officer makes a proposed decision, 1 12 that decision then becomes the final decision of the 1 13 department, and shall meet the requirements of a final 1 14 decision pursuant to section 17A.16, without further 1 15 proceedings, unless there is an appeal to, or review on motion 1 16 of, the department within the time provided by rule. 1 17 c. On appeal or review of the proposed decision, the 1 18 department may only reject or modify the presiding officer's 1 19 findings of fact and conclusions of law if the department 1 20 states, with particularity, the department's reasons for 1 21 rejecting or modifying each finding of fact and conclusion of 1 22 law. 1 23 (1) The department may only reject or modify findings of 1 24 fact if the department first determines from a review of the 1 25 entire record, and states with particularity in the order, 1 26 that the findings of fact were clearly erroneous in view of 1 27 the reliable, probative, and substantial evidence on the 1 28 record as a whole, or that the proceedings on which the 1 29 findings were based did not comply with the essential 1 30 requirements of law. 1 31 (2) The department may only reject or modify the 1 32 conclusions of law if the department first determines from a 1 33 review of the entire record, and states with particularity in 1 34 the order, that the conclusions of law were clearly erroneous 1 35 in view of the reliable, probative, and substantial evidence 2 1 on the record as a whole. 2 2 (3) Rejection or modification of conclusions of law shall 2 3 not form the basis for rejection or modification of findings 2 4 of fact. 2 5 d. A party to a provider appeal hearing as described in 2 6 subsection 2 may file a request for rehearing pursuant to 2 7 section 17A.16. 2 8 e. A party who is aggrieved or adversely affected by a 2 9 final decision under this section is entitled to judicial 2 10 review as provided in section 17A.19. 2 11 2. A provider appeal hearing shall be available to a 2 12 provider, if any of the following conditions, which 2 13 constitutes a contested case, is met: 2 14 a. The provider's license, certification, registration, 2 15 approval, or accreditation has been denied or revoked or has 2 16 not been acted upon in a timely manner. 2 17 b. The provider's claim for payment or request for prior 2 18 authorization for payment has been denied. 2 19 c. The provider's contract as a medical assistance patient 2 20 manager has been terminated. 2 21 d. The provider has been notified that an overpayment has 2 22 been established and repayment is requested. 2 23 e. The provider has been notified that the reconsideration 2 24 process has been exhausted and the provider is not satisfied 2 25 with the result. 2 26 f. The provider's claim for payment was not made according 2 27 to department policy. 2 28 g. The provider's application for a child care quality 2 29 rating has not been acted upon in a timely manner, the 2 30 provider disagrees with the department's quality rating 2 31 decision, or the provider's certificate of quality rating has 2 32 been revoked. 2 33 3. For purposes of this subsection, "provider" means 2 34 provider as defined in section 249A.2 or a provider of child 2 35 care as defined in section 237A.1. 3 1 SF 460 3 2 pf/cc/26