Medicaid Amends Emergency Coverage Rule

Iowa Medicaid provides emergency medical coverage for undocumented immigrants, so long as the patient meets the other eligibility requirements for Medicaid, such as Iowa residency. Applicable law defines an “emergency medical condition” as a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the patient’s health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. Labor and delivery is also considered an emergency medical condition.

In the July 5 Iowa Administrative Bulletin, the Department of Human Services published a final rule (ARC 5215B) changing the verification process for emergency Medicaid. Previously, the Iowa Medicaid Manual and corresponding administrative rules provided a list of diagnosis codes that qualified as emergency services, but the list of codes was often out of date, resulting in erroneous denials. The new rule eliminates the list of covered codes and allows the medical provider to verify that the condition was an emergency.

Effective July 1, to verify the presence of an emergency medical condition, the medical provider who treated the emergency medical condition or the provider’s designee must submit verification of the existence of the emergency medical condition on either Form 470-4299, Verification of Emergency Health Care Services, or a signed statement that contains the same information as requested by the form. IHA supports this change because it will substantially reduce the amount of denials and appeals for emergency Medicaid reimbursement.

The Iowa Medicaid program limits payment for emergency Medicaid services to the day treatment is initiated for the emergency medical condition and the following two days. The date the patient first sought treatment is considered as the first day of the emergency, regardless of length of treatment or the condition. Emergency Medicaid will be allowed more than once in a calendar month, but only for an emergency that is unrelated to the previous emergency