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Title 8: Medicaid Page 20 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Department Responsibilities Revised January 13, 2023 Notification When a member resolves the original reason for a cancelation but should be canceled for a new reason, timely and adequate notice of the new action must be sent unless the new reason does not require timely notice. Timely Notice When Probable Fraud Exists Legal reference: 42 CFR 431.214, 441 IAC 7.7(3) When the Department receives information that indicates Medicaid should be discontinued, suspended, terminated, or reduced because of probable fraud, timely notice is required. Verify any information received about probable fraud. Obtain your supervisor’s approval before taking any action. Document the basis for your action in the case record. Timely notice in cases involving probable fraud must be issued at least five calendar days before an action becomes effective. Specify that an appeal must be filed within five days rather than ten days, as stated on the back of the Notice of Decision or Notice of Action. Count the day after the notice is mailed as day one. Send this notice by certified mail, return receipt requested. When Timely Notice Is Not Required Legal reference: 42 CFR 431.213 and 431.231(d), 441 IAC 7.7(2) Notice must be adequate but does not need to be timely when: ▪ The member dies, and the death is verified by a relative, newspaper obituary, nursing home, or hospital. ▪ The member gives you a clear, written, signed statement that the member no longer wants Medicaid. ▪ The member gives you a signed statement containing information that results in the end or reduction Medicaid benefits. The statement must indicate the member understands the consequences of supplying the information. ▪ The member is admitted or committed to an institution where the member does not qualify for Medicaid payments. ▪ You do not know the location of the member, and the post office has returned the member’s Medicaid card with no known forwarding address. ▪ The member has been approved for Medicaid in another state. ▪ The member’s physician prescribes a change in the level of medical care. ▪ The member was previously notified that Medicaid benefits would be granted for a specified period, and the period has ended. ▪ Assistance is simultaneously approved and terminated for a past period, such as the retroactive period.