514I.7 Administrative contractor.

1. An administrative contractor shall be selected by the hawk-i board through a request for proposals process.

2. The administrative contractor shall do all of the following:

a. Determine eligibility for program enrollment as prescribed by federal law and regulation, using policies and procedures adopted by rule of the department pursuant to chapter 17A. The administrative contractor shall not enroll a child who has group health coverage, unless expressly authorized by such rules.

b. Enroll qualifying children in the program with maintenance of a supporting eligibility file or database.

c. Utilize the department’s eligibility system to maintain eligibility files with pertinent eligibility determination and ongoing enrollment information including but not limited to data regarding beneficiaries, enrollment dates, disenrollments, and annual financial redeterminations.

d. Provide electronic access to the administrative contractor’s database to the department.

e. Provide periodic reports to the department for administrative oversight and monitoring of federal requirements.

f. Perform annual financial reviews of eligibility for each beneficiary.

g. Collect and track monthly family premiums to assure that payments are current.

h. Notify each participating insurer of new program enrollees who are enrolled by the administrative contractor in that participating insurer’s plan.

i. Verify the number of program enrollees with each participating insurer for determination of the amount of premiums to be paid to each participating insurer.

j. Maintain data for the purpose of quality assurance reports as required by rule of the board.

98 Acts, ch 1196, §8, 16; 99 Acts, ch 208, §39; 2003 Acts, ch 108, §131; 2003 Acts, ch 124, §9, 10; 2008 Acts, ch 1188, §10; 2009 Acts, ch 118, §34; 2013 Acts, ch 138, §98, 99