Page 25

Title 8: Medicaid Page 23 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Appeals Revised January 13, 2023 Reimbursement After Appeal Decisions ▪ The medical bills were for services incurred in the period now determined to have been denied in error. The period of eligibility can be as early as the first of the third month before the month of application. The ending date is the date on the Notice of Decision or Notice of Action that approves Medicaid eligibility. This policy does not apply to appeals resulting from cancellation of ongoing cases. It applies only to denied applications.

1-6-09 SSI application is filed. 6-16-09 SSI application is denied. 7-5-09 Request for reconsideration is filed (part of Social Security appeal process). 8-15-09 SSI is denied after reconsideration. 9-10-09 Request for hearing is filed. 12-4-09 SSI is approved due to hearing. Eligibility is granted back to date of SSI approval, 2-1-09. 3-4-10 Department Notice of Decision or Notice of Action approving Medicaid is issued. Medicaid is approved back to 10-1-08, as there are unpaid medical bills for services received in each of the three retroactive months, and all Medicaid eligibility criteria were met in those months including all retroactive period criteria as defined in 8-A, Definitions. (If there were no unpaid bills in those months or retroactive period criteria was not met, eligibility would begin 1-1-09.) The appeal period is the time between June 16, 2009 (date of denial of initial application) and March 4, 2010 (date Medicaid was approved). PERIOD OF ELIGIBILITY Retro- active Period Application Period Appeal Period Approval Date

10-1-08 12-31-08 Application date: 1-6-09 Denial date: 6-16-09

6-17-09

3-3-10

3-4-10 Any Medicaid-covered services received in and paid for in this period cannot be reimbursed. Any Medicaid-covered services received in and paid for in this period can be reimbursed. The medical provider must submit bills for unpaid medical services received on or after this date to the IME for payment. Any Medicaid-covered services received in this period but… paid in the appeal period can be reimbursed. There is no retroactive time limit on bills that can be reimbursed, as long as these requirements are met.