1. For the purposes of this section, unless the context otherwise requires:

 a. “County of residence” means the county in this state in which, at the time a person applies for or receives services, the person is living and has established an ongoing presence with the declared, good faith intention of living in the county for a permanent or indefinite period of time. The county of residence of a person who is a homeless person is the county where the homeless person usually sleeps. A person maintains residency in the county or state in which the person last resided while the person is present in another county or this state receiving services in a hospital, a correctional facility, a halfway house for community-based corrections or substance use disorder treatment, a nursing facility, an intermediate care facility for persons with an intellectual disability, or a residential care facility, or for the purpose of attending a college or university.
 b. “Homeless person” means the same as defined in section 48A.2.
 c. “Mental health professional” means the same as defined in section 228.1.
 d. “Person” means a person who is a United States citizen or a qualified alien as defined in 8 U.S.C. § 1641.
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Terms Used In Iowa Code 225C.61

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Court: shall mean and include any court upon which jurisdiction has been conferred to determine the liability of persons for the support of dependents. See Iowa Code 252A.2
  • Department: means the department of health and human services. See Iowa Code 249L.2
  • Department: means the department of health and human services. See Iowa Code 225C.2
  • Director: means the director of health and human services. See Iowa Code 225C.2
  • Disability services: means services and other support available to a person with mental illness, an intellectual disability or other developmental disability, or brain injury. See Iowa Code 225C.2
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
  • Intellectual disability: means a diagnosis of intellectual disability or intellectual developmental disorder, global developmental delay, or unspecified intellectual disability or intellectual developmental disorder which diagnosis shall be made only when the onset of the person's condition was during the developmental period and based on an assessment of the person's intellectual functioning and level of adaptive skills. See Iowa Code 4.1
  • Mental health and disability services region: means a mental health and disability services region formed in accordance with section 225C. See Iowa Code 225C.2
  • mental health professional: means the same as defined in section 228. See Iowa Code 225C.6
  • month: means a calendar month, and the word "year" and the abbreviation "A. See Iowa Code 4.1
  • Nursing facility: means a licensed nursing facility as defined in section 135C. See Iowa Code 249L.2
  • Party: means a petitioner, a respondent, or a person who intervenes in a proceeding instituted under this chapter. See Iowa Code 252A.2
  • person: means individual, corporation, limited liability company, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity. See Iowa Code 4.1
  • Regional administrator: means the same as defined in section 225C. See Iowa Code 225C.2
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
  • United States: includes all the states. See Iowa Code 4.1
 2. If a person appeals a decision regarding a service authorization or other services-related decision made by a regional administrator that cannot be resolved informally, the appeal shall be heard in a contested case proceeding by a state administrative law judge. The administrative law judge’s decision shall be considered final agency action under chapter 17A.
 3. If a service authorization or other services-related decision made by a regional administrator concerning a person varies from the type and amount of service identified to be necessary for the person in a clinical determination made by a mental health professional and the mental health professional believes that failure to provide the type and amount of service identified could cause an immediate danger to the person’s health or safety, the person may request an expedited review of the regional administrator’s decision to be made by the department. An expedited review held in accordance with this subsection is subject to the following procedures:

 a. The request for the expedited review shall be filed within five business days of receiving the notice of decision by the regional administrator. The request must be in writing, plainly state the request for an expedited review in the caption and body of the request, and be supported by written documentation from the mental health professional who made the clinical determination stating how the notice of decision on services could cause an immediate danger to the person’s health or safety.
 b. The expedited review shall be performed by a designee of the director who is a mental health professional and is free of any conflict of interest to perform the expedited review. The expedited review shall be performed within two business days of the time the request is filed. If the reviewer determines the information submitted in connection with the request is inadequate to perform the review, the reviewer shall request the submission of additional information and the review shall be performed within two business days of the time that adequate information is submitted. The regional administrator and the person, with the assistance of the mental health professional who made the clinical determination, shall each provide a brief statement of facts, conclusions, and reasons for the decision made. Supporting clinical information shall also be attached. All information related to the proceedings and any related filings shall be considered to be mental health information subject to chapter 228.
 c. The director’s designee shall issue an order, including a brief statement of findings of fact, conclusions of law, and policy reasons for the order, to justify the decision made concerning the expedited review. If the decision concurs with the contention that there is an immediate danger to the person’s health or safety, the order shall identify the type and amount of service which shall be provided for the person. The director’s designee shall give such notice as is practicable to persons who are required to comply with the order. The order is effective when issued.
 d. The decision of the director’s designee shall be considered a final agency action and is subject to judicial review in accordance with section 17A.19. The record for judicial review consists of any documents regarding the matter that were considered or prepared by the director’s designee. The director’s designee shall maintain these documents as the official record of the decision. If the matter is appealed to the district court, the record shall be filed as confidential.
 4. The responsibilities of the county under law regarding mental health and disability services shall be performed on behalf of the county by the regional administrator. The mental health and disability services region is responsible for paying the public costs of the mental health and disability services that are not covered by the medical assistance program under chapter 249A and are provided in accordance with the region’s approved service management plan to persons who are residents of the region.
 5. a. The dispute resolution process implemented in accordance with this subsection applies to residency disputes. The dispute resolution process is not applicable to disputes involving persons committed to a state facility pursuant to chapter 812 or rule of criminal procedure 2.22, Iowa court rules, or to disputes involving service authorization decisions made by a region.

 b. If a county or region, as applicable, receives a billing for services provided to a resident in another county or region, or objects to a residency determination certified by another county’s or region’s regional administrator and asserts either that the person has residency in another county or region or the person is not a resident of this state, the person’s residency status shall be determined as provided in this subsection. If the county or region asserts that the person has residency in another county or region, the county or region shall notify the other county or region within one hundred twenty days of receiving the billing for services.
 c. The county or region that received the notification, as applicable, shall respond to the party that provided the notification within forty-five days of receiving the notification. If the parties cannot agree to a settlement as to the person’s residency status within ninety days of the date of notification, on motion of any of the parties, the matter shall be referred to the department of inspections, appeals, and licensing for a contested case hearing under chapter 17A before an administrative law judge assigned in accordance with section 10A.801 to determine the person’s residency status.
 d. (1) The administrative law judge’s determination of the person’s residency status shall be considered final agency action, notwithstanding contrary provisions of section 17A.15. The party that does not prevail in the determination or subsequent judicial review is liable for costs associated with the proceeding, including reimbursement of the department of inspections, appeals, and licensing’s actual costs associated with the administrative proceeding. Judicial review of the determination may be sought in accordance with section 17A.19.

 (2) If following the determination of a person’s residency status in accordance with this subsection, additional evidence becomes available that merits a change in that determination, the parties affected may change the determination by mutual agreement. Otherwise, a party may move that the matter be reconsidered by the county or region, or by the administrative law judge.
 e. (1) Unless a petition is filed for judicial review, the administrative law judge’s determination of the person’s residency status shall result in one of the following:

 (a) If a county or region is determined to be the person’s residence, the county or region shall pay the amounts due and shall reimburse any other amounts paid for services provided by the other county or region on the person’s behalf prior to the determination.
 (b) If it is determined that the person is not a resident of this state neither the region in which the services were provided nor the state shall be liable for payment of amounts due for services provided to the person prior to the determination.
 (2) The payment or reimbursement shall be remitted within forty-five days of the date the determination was issued. After the forty-five-day period, a penalty of not greater than one percent per month may be added to the amount due.
 6. a. The dispute resolution process implemented in accordance with this subsection applies beginning July 1, 2012, to billing disputes between the state and a county or region, other than residency disputes or other dispute processes under this section, involving the responsibility for service costs for services provided on or after July 1, 2011, under any of the following:

 (1) chapter 221.
 (2) chapter 222.
 (3) chapter 229.
 (4) chapter 230.
 (5) chapter 249A.
 (6) chapter 812.
 b. If a county, region, or the department, as applicable, disputes a billing for service costs listed in paragraph “a”, the dispute shall be resolved as provided in this subsection. The county or region shall notify the department of the county’s or region’s assertion within ninety days of receiving the billing. However, for services provided on or after July 1, 2011, for which a county has received the billing as of July 1, 2012, the county shall notify the department of the county’s assertion on or before October 1, 2012. If the department disputes such a billing of a regional administrator, the department shall notify the affected counties or regions of the department’s assertion.
 c. The department, county, or region that received the notification, as applicable, shall respond to the party that provided the notification within forty-five days of receiving the notification. If the parties cannot agree to a settlement as to the dispute within ninety days of the date of notification, on motion of any of the parties, the matter shall be referred to the department of inspections, appeals, and licensing for a contested case hearing under chapter 17A before an administrative law judge assigned in accordance with section 10A.801 to determine facts and issue a decision to resolve the dispute.
 d. (1) The administrative law judge’s decision is a final agency action, notwithstanding contrary provisions of section 17A.15. The party that does not prevail in the decision or subsequent judicial review is liable for costs associated with the proceeding, including reimbursement of the department of inspections, appeals, and licensing’s actual costs associated with the administrative proceeding. Judicial review of the decision may be sought in accordance with section 17A.19.

 (2) If following the decision regarding a dispute in accordance with this subsection, additional evidence becomes available that merits a change in that decision, the parties affected may change the decision by mutual agreement. Otherwise, a party may move that the matter be reconsidered by the department, county, or region, or by the administrative law judge.
 e. (1) Unless a petition is filed for judicial review, the administrative law judge’s decision regarding a disputed billing shall result in one of the following:

 (a) If a county or region is determined to be responsible for the disputed amounts, the county or region shall pay the amounts due and shall reimburse any other amounts paid for services provided by the other county or region or the department on the person’s behalf prior to the decision.
 (b) If it is determined that the state is responsible for the disputed amounts, the state shall pay the amounts due and shall reimburse the county or region, as applicable, for any payment made on behalf of the person prior to the decision.
 (2) The payment or reimbursement shall be remitted within forty-five days of the date the decision was issued. After the forty-five-day period, a penalty of not greater than one percent per month may be added to the amount due.
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