2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM
514I.7 - ADMINISTRATIVE CONTRACTOR.

        514I.7  ADMINISTRATIVE CONTRACTOR.
         1.  An administrative contractor shall be selected by the hawk-i
      board through a request for proposals process.
         2.  The administrative contractor shall do all of the following:
         a.  Determine individual eligibility for program enrollment
      based upon review of completed applications and supporting
      documentation.  The administrative contractor shall not enroll a
      child who has group health coverage.
         b.  Enroll qualifying children in the program with maintenance
      of a supporting eligibility file or database.
         c.  Forward names of children who appear to be eligible for
      medical assistance to the department of human services for follow-up
      and retain identifying data on children who are referred.
         d.  Monitor and assess the medical and dental care provided
      through or by participating insurers as well as complaints and
      grievances.
         e.  Verify and forward to the department participating
      insurers' payment requests.
         f.  Develop and issue appropriate approval, denial, and
      cancellation notifications to inform applicants and enrollees of the
      status of the applicant's or enrollee's eligibility to participate in
      the program.  Additionally, the administrative contractor shall
      process applications, including verifications and mailing of
      approvals and denials, within ten working days of receipt of the
      application, unless the application cannot be processed within this
      period for a reason that is beyond the control of the administrative
      contractor.
         g.  Create and maintain eligibility files that are compatible
      with the data system of the department including, but not limited to,
      data regarding beneficiaries, enrollment dates, disenrollments, and
      annual financial redeterminations.
         h.  Provide electronic access to the administrative
      contractor's database to the department.
         i.  Provide periodic reports to the department for
      administrative oversight and monitoring of federal requirements.
         j.  Perform annual financial reviews of eligibility for each
      beneficiary.
         k.  Receive completed applications and verifications at a
      central location.
         l.  Collect and track monthly family premiums to assure that
      payments are current.
         m.  Notify each participating insurer of new program enrollees
      who are enrolled by the administrative contractor in that
      participating insurer's plan.
         n.  Verify the number of program enrollees with each
      participating insurer for determination of the amount of premiums to
      be paid to each participating insurer.
         o.  Maintain data for the purpose of quality assurance reports
      as required by rule of the board.  

         98 Acts, ch 1196, §8, 16; 99 Acts, ch 208, §39; 2003 Acts, ch 108,
      §131; 2003 Acts, ch 124, §9, 10; 2008 Acts, ch 1188, §10; 2009 Acts,
      ch 118, §34