Iowa Code 514I.4 – Director and department — duties — powers
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Terms Used In Iowa Code 514I.4
- Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Child: includes child by adoption. See Iowa Code 4.1
- Contract: A legal written agreement that becomes binding when signed.
- 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
- Oversight: Committee review of the activities of a Federal agency or program.
- 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
- Rule: includes "regulation". See Iowa Code 4.1
- 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
514I.4 Director and department — duties — powers.
1. The director, with the approval of the Hawki board, shall implement this chapter. The
director shall do all of the following:
a. At least every six months, evaluate the scope of the program currently being provided under this chapter, project the probable cost of continuing the program, and compare the probable cost with the remaining balance of the state appropriation made for payment of assistance under this chapter during the current appropriation period. The director shall report the findings of the evaluation to the board and shall annually report findings to the governor and the general assembly by January 1.
b. Establish premiums to be paid to participating insurers for provision of health insurance coverage.
c. Contract with participating insurers to provide health insurance coverage under this chapter.
d. Recommend to the board proposed rules necessary to implement the program.
e. Recommend to the board individuals to serve as members of the clinical advisory committee.
2. a. The director, with the approval of the board, may contract with participating insurers to provide dental-only services.
b. The director, with the approval of the board, may contract with participating insurers to provide the supplemental dental-only coverage to otherwise eligible children who have private health care coverage as specified in the federal Children’s Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111-3.
3. The department may enter into contracts with other persons whereby the other person provides some or all of the functions, pursuant to rules adopted by the board, which are required of the director or the department under this section. All contracts entered into pursuant to this section shall be made available to the public.
4. The department shall do or shall provide for all of the following:
a. Determine eligibility for program enrollment as prescribed by federal law and regulation, using policies and procedures adopted by rule of the department pursuant to chapter 17A. The department shall not enroll a child who has group health coverage unless expressly authorized by such rules.
b. Enroll qualifying children in the program with maintenance of a supporting eligibility file or database.
c. Utilize the department’s eligibility system to maintain eligibility files with pertinent eligibility determination and ongoing enrollment information including but not limited to data regarding beneficiaries, enrollment dates, disenrollments, and annual financial redeterminations.
d. Provide for administrative oversight and monitoring of federal requirements.
e. Perform annual financial reviews of eligibility for each beneficiary.
f. Collect and track monthly family premiums to assure that payments are current.
g. Notify each participating insurer of new program enrollees who are enrolled by the department in that participating insurer’s plan.
h. Verify the number of program enrollees with each participating insurer for determination of the amount of premiums to be paid to each participating insurer.
i. Maintain data for the purpose of quality assurance reports as required by rule of the board.
j. (1) Establish the family cost sharing amounts for children of families with incomes of one hundred fifty percent or more but not exceeding two hundred percent of the federal poverty level, of not less than ten dollars per individual and twenty dollars per family, if not otherwise prohibited by federal law, with the approval of the board.
(2) Establish for children of families with incomes exceeding two hundred percent but not exceeding three hundred percent of the federal poverty level, family cost sharing amounts, and graduated premiums based on a rationally developed sliding fee schedule, in accordance with federal law, with the approval of the board.
k. Perform annual, random reviews of enrollee applications to ensure compliance with
§514I.4, HEALTHY AND WELL KIDS IN IOWA PROGRAM 2
1. The director, with the approval of the Hawki board, shall implement this chapter. The
director shall do all of the following:
a. At least every six months, evaluate the scope of the program currently being provided under this chapter, project the probable cost of continuing the program, and compare the probable cost with the remaining balance of the state appropriation made for payment of assistance under this chapter during the current appropriation period. The director shall report the findings of the evaluation to the board and shall annually report findings to the governor and the general assembly by January 1.
b. Establish premiums to be paid to participating insurers for provision of health insurance coverage.
c. Contract with participating insurers to provide health insurance coverage under this chapter.
d. Recommend to the board proposed rules necessary to implement the program.
e. Recommend to the board individuals to serve as members of the clinical advisory committee.
2. a. The director, with the approval of the board, may contract with participating insurers to provide dental-only services.
b. The director, with the approval of the board, may contract with participating insurers to provide the supplemental dental-only coverage to otherwise eligible children who have private health care coverage as specified in the federal Children’s Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111-3.
3. The department may enter into contracts with other persons whereby the other person provides some or all of the functions, pursuant to rules adopted by the board, which are required of the director or the department under this section. All contracts entered into pursuant to this section shall be made available to the public.
4. The department shall do or shall provide for all of the following:
a. Determine eligibility for program enrollment as prescribed by federal law and regulation, using policies and procedures adopted by rule of the department pursuant to chapter 17A. The department shall not enroll a child who has group health coverage unless expressly authorized by such rules.
b. Enroll qualifying children in the program with maintenance of a supporting eligibility file or database.
c. Utilize the department’s eligibility system to maintain eligibility files with pertinent eligibility determination and ongoing enrollment information including but not limited to data regarding beneficiaries, enrollment dates, disenrollments, and annual financial redeterminations.
d. Provide for administrative oversight and monitoring of federal requirements.
e. Perform annual financial reviews of eligibility for each beneficiary.
f. Collect and track monthly family premiums to assure that payments are current.
g. Notify each participating insurer of new program enrollees who are enrolled by the department in that participating insurer’s plan.
h. Verify the number of program enrollees with each participating insurer for determination of the amount of premiums to be paid to each participating insurer.
i. Maintain data for the purpose of quality assurance reports as required by rule of the board.
j. (1) Establish the family cost sharing amounts for children of families with incomes of one hundred fifty percent or more but not exceeding two hundred percent of the federal poverty level, of not less than ten dollars per individual and twenty dollars per family, if not otherwise prohibited by federal law, with the approval of the board.
(2) Establish for children of families with incomes exceeding two hundred percent but not exceeding three hundred percent of the federal poverty level, family cost sharing amounts, and graduated premiums based on a rationally developed sliding fee schedule, in accordance with federal law, with the approval of the board.
k. Perform annual, random reviews of enrollee applications to ensure compliance with
§514I.4, HEALTHY AND WELL KIDS IN IOWA PROGRAM 2
program eligibility and enrollment policies. Quality assurance reports shall be made to the board based upon the data maintained by the department.
l. Perform other duties as determined by the board.
98 Acts, ch 1196, §5, 16; 2003 Acts, ch 108, §131; 2003 Acts, ch 124, §1; 2003 Acts, ch 175,
§38; 2009 Acts, ch 118, §26, 27; 2013 Acts, ch 138, §95; 2019 Acts, ch 124, §2, 3; 2023 Acts, ch
19, §1213
Subsection 1, unnumbered paragraph 1 amended