Participating Health and Dental Plans, I.A.C. r. 441-86.15

Participating Health and Dental Plans
 
Establishes requirements for health and dental plans that wish to participate in Iowa’s CHIP program that address items such as licensure, marketing, and appeals processes. Requires health and dental plans to maintain clinical and fiscal records. Classifies these records as confidential and prohibits release without the enrollee’s written authorization. Provides exceptions for the disclosure of information to participating providers, Department of Human Services staff that need the information for administrative purposes, CMS monitoring authorities, or other subcontractors that need the information. Clarifies that any information regarding HIV, substance abuse, or mental health treatment may only be released with written authorization in accordance with other state and federal law. Requires health and dental plans to establish internal quality assurance systems.