Terms Used In Iowa Code > Chapter 249N - Iowa Health and Wellness Plan

• Accountable care organization: means a risk-bearing, integrated health care organization characterized by a payment and care delivery model that ties provider reimbursement to quality metrics and reductions in the total cost of care for an attributed population of patients. See Iowa Code 249N.2
• Contract: A legal written agreement that becomes binding when signed.
• Covered benefits: means covered benefits as specified in section 249N. See Iowa Code 249N.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 249N.2
• Director: means the director of health and human services. See Iowa Code 249N.2
• Eligible individual: means an individual eligible for medical assistance pursuant to section 249A. See Iowa Code 249N.2
• Essential health benefits: means essential health benefits as defined in section 1302 of the Affordable Care Act, that include at least the general categories and the items and services covered within the categories of ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. See Iowa Code 249N.2
• Federal poverty level: means the most recently revised poverty income guidelines published by the United States department of health and human services. See Iowa Code 249N.2
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• 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
• Household income: means household income as determined using the modified adjusted gross income methodology pursuant to section 2002 of the Affordable Care Act. See Iowa Code 249N.2
• Iowa health and wellness plan provider: means any provider enrolled in the medical assistance program or any participating accountable care organization. See Iowa Code 249N.2
• Iowa health and wellness plan provider network: means the health care delivery network approved by the department for Iowa health and wellness plan members. See Iowa Code 249N.2
• Medicaid: means the program paying all or part of the costs of care and services provided to an individual pursuant to chapter 249A and Tit. See Iowa Code 249N.2
• Medical home: means a team approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient's family; utilizes the partnership to access and integrate all medical and nonmedical health-related services across all elements of the health care system and the patient's community as needed by the patient and the patient's family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care; and has all of the following characteristics:
   a. See Iowa Code 249N.2
• Member: means an eligible individual who is enrolled in the Iowa health and wellness plan. See Iowa Code 249N.2
• month: means a calendar month, and the word "year" and the abbreviation "A. See Iowa Code 4.1
• Participating accountable care organization: means an accountable care organization approved by the department to participate in the Iowa health and wellness plan provider network. See Iowa Code 249N.2
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Personal provider: means the patient's first point of contact in the health care system with a primary care provider who identifies the patient's health-related needs and, working with a team of health care professionals and providers of medical and nonmedical health-related services, provides for and coordinates appropriate care to address the health-related needs identified. See Iowa Code 249N.2
• plan: means the Iowa health and wellness plan established under this chapter. See Iowa Code 249N.2
• Preventive care services: means care that is provided to an individual to promote health, prevent disease, or diagnose disease. See Iowa Code 249N.2
• Primary care provider: includes but is not limited to any of the following licensed or certified health care professionals who provide primary care:
   a. See Iowa Code 249N.2
• Primary medical provider: means the personal provider trained to provide first contact and continuous and comprehensive care to a member, chosen by a member or to whom a member is assigned under the Iowa health and wellness plan. See Iowa Code 249N.2
• 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
• United States: includes all the states. See Iowa Code 4.1
• Value-based reimbursement: means a payment methodology that links provider reimbursement to improved performance by health care providers by holding health care providers accountable for both the cost and quality of care provided. See Iowa Code 249N.2
• year: means twelve consecutive months. See Iowa Code 4.1