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