HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/IA-AC-1.ASC

Text File | 1993-01-14 | 24KB | 572 lines

/* The IOWA ADMINISTRATIVE CODE (IAC) is being updated.  The
protion preently presented addresses insurance and education, and
Medical  issues. */



Insurance



191-15.12(505)  Applications for insurance-testing restrictions.
No person engaged in the business of insurance shall require a
test of an individual in connection with an application for
insurance for the presence of an antibody to the human
immunodeficiency virus unless the individual provides a written
release on a form which contains the following information:

A statement of the purpose, content, use, and meaning of the
test.

A statement regarding disclosure of the test results including
information explaining the effect of releasing the information to
a person engaged in the business of insurance.

A statement of the purpose for which test results may be used.

A preapproved form is provided in the appendix to this rule. A
person wishing to utilize a form which deviates from the language
in the appendix to this rule shall submit the form to the
insurance division for approval. Any form containing, but not
limited to, the language in the appendix shall be deemed
approved.



APPENDIX

HIV Antibody Test

Information Form For Insurance Applicant AIDS

Acquired Immunodeficiency Syndrome (AIDS) is a life-threatening
disorder of the immune system, caused by a virus, HIV. The virus
is transmitted by sexual contact with an infected person, from an
infected mother to her newborn infant, or by exposure to infected
blood (as in needle sharing during IV drug use). Persons at high
risk of contracting AIDS include males who have had sexual
contact with another man, intravenous drug users, hemophiliacs,
and sexual contacts with any of these persons. AIDS does not
typically develop until a person has been infected with HIV for
several years. A person may remain free of symptoms for years
after becoming infected. Infected persons have a 25 percent to 50
percent chance of  developing AIDS over the next 10 years.

The HIV antibody test:

Before consenting to testing, please read the following important
information:

I.   Purpose. This test is being run to determine whether you may
have been infected with HIV. If you are infected, you are
probably not insurable. This test is not a test for AIDS; AIDS
can only be diagnosed by medical evaluation.

2.   Positive test results. If you test positive, you should seek
medical follow-up with your personal physician. If your test is
positive, you may be infected with HIV.

3.   Accuracy. An HIV test will be considered positive only after
confirmation by a laboratory procedure that the state health
officer has determined to be highly accurate. Nonetheless, the
HIV antibody test is not 100 percent accurate. Possible errors
include:

a.   False positives: The test gives a positive result, even
though you are not infected. This happens only rarely and is more
common in persons who have not engaged in high risk behavior.
Retesting should be done to help confirm the validity of a
positive test.

b.   False negatives: The test gives a negative result, even
though you are infected with HIV. This happens most commonly in
recently infected persons; it takes at least 4 to 12 weeks for a
positive test result to develop after a person is infected.

4.   Side effects. A positive test result may cause you
significant anxiety. A positive test may result in uninsurability
for life, health, or disability insurance policies you may apply
for in the future. Although prohibited by law, discrimination in
housing, employment, or public accommodations may result if your
test results were to become known to others. A negative result
may create a false sense of security.

5.   Disclosure of results. A positive test result will be
disclosed to you. You may choose to have information about your
HIV test results communicated to you through your physician or
through the alternative testing site.

6.   Confidentiality. Like all medical information, HIV test
results are confidential. An insurer, insurance agent, or
insurance-support organization is required to maintain the con
fidentiality of HIV test results. However, certain disclosures of
your test results may occur, including those authorized by
consent forms that you may have signed as part of your overall
application. Your test results may be provided to the Medical
Information Bureau, a national insurance data bank. Your
insurance agent will provide you with additional written informa
tion about this subject at your request.

7.   Prevention. Persons who have a history of high risk behavior
should change these behaviors to prevent getting or giving AIDS,
regardless of whether they are tested. Specific important changes
in behavior include safe sex practices (including condom use for
sexual contact with someone other than a long-term monogamous
partner) and not sharing needles.

8.   Information. Further information about HIV testing and AIDS
can be obtained by calling the Iowa AIDS hotline at 1-800-
532.3301.



INFORMED CONSENT

I hereby authorize the company and its designated medical
facilities to draw samples of my blood for the purpose of
laboratory testing to provide applicable medical information con
cerning my insurability. These tests may include but are not
limited to test for: cholesterol and related blood lipids;
diabetes; liver or kidney disorders; infection by the Acquired
Immune Deficiency Syndrome (HIV) virus (if permitted by law);
immune disorders; or the presence of medications, drugs, nicotine
or other metabolites. The tests will be done by a medically
accepted procedure which is extremely reliable.

If an HIV Antibody Screen is performed, it will be performed only
by a certified laboratory and according to the following medical
protocol:

1.   An initial ELISA blood test will be done.

a.   If the initial ELISA blood test is positive, it will be
repeated.

b.   If the initial ELISA blood test is negative, a negative
finding will be reported to the company.

2.   If the initial ELISA blood test is positive, it will be
repeated.

a.   if the second ELISA blood test is also positive, a Western
Blot blood test will be performed to confirm the positive results
of the two ELISA blood tests.

b.   If the second ELISA blood test is negative, a third ELISA
blood test will be performed. If the third ELISA blood test is
positive, a Western Blot blood test will be performed to con-firm
the previous positive results. If the third ELISA blood test is
negative, a negative result will be reported to the company.

3.   Only if at least two ELISA blood tests and a Western Blot
blood test are all positive will the result be reported as a
positive. All other results will be reported as negative to the
company.

Without a court order or written authorization from me, these
results will be made known only to the company and its reinsurers
(if involved in the underwriting process). The company will
provide results of all tests to a physician of my choice.
Positive test results to the HIV Antibody Screen will be
disclosed only as I direct below. In addition, the company may
make a brief report to MIB, Inc., in a manner described in the
Pre-notice which I received as a part of the application process.
All the company will report to MIB, Inc. is that positive results
were obtained from a blood test. The company will not report what
tests were performed or that the positive result was for HIV
antibodies.

These organizations will be the only ones maintaining this
information in any type of file except as required by law.
Positive HIV Antibody Screen results are to be reported to:

(elect one) [ ] the Alternative Testing Site

     or     [ ] my physician;

(name and address of attending physician)



This authorization will be valid for 90 days from the date below.



Dated At: _______________ Day ________________ Month
_________________________, 19 _______________



Witness _______________       proposed Insured: ________________

     Agent (Signature)                            (Signature)



This rule is intended to implement 1988 Iowa Acts, House File
2294, section 7.



Education [281]

281-12.5(256)  Education program. The following education program
standards shall be met by schools and school districts for
accreditation with the start of the 1989-1990 school year.

12.5(1)  Prekindergarten program. If a school offers a
prekindergarten program, the program shall be designed to help
children to work and play with others, to express themselves, to
learn to use and manage their bodies, and to extend their
interests and understanding of the world about them. The
prekindergarten program shall relate the role of the family to
the child's developing sense ~f self and perception of others.
Planning and carrying out prekindergarten activities designed to
encourage cooperative efforts between home and school shall focus
on community resources. A prekindergarten teacher shall hold a
certificate certifying that the holder is qualified to teach in
prekindergarten. A nonpublic school which offers only a
prekindergarten may, but is not required to, seek and obtain
accreditation.

12.5(2)  Kindergarten program. The kindergarten program shall
include experiences designed to develop healthy emotional and
social habits and growth in the language arts and communication
skills, as well as a capacity for the completion of individual
tasks, and protect and increase physical well-being with
attention given to experiences relating to the development of
life skills and human growth and development. A kindergarten
teacher shall be certificated to teach In kindergarten. An
accredited nonpublic school must meet the requirements of this
subsection only if the nonpublic school offers a kindergarten
program.

12.5(3)  Elementary program, grades 1-6. The following areas
shall be taught in grades one through six: English-language arts,
social studies, mathematics, science, health, human growth and
development, physical education, traffic safety, music, and
visual art.

In implementing the elementary program standards, the following
general curriculum definitions shall be used.

 * * *

e.   Health. Health instruction shall include personal health;
food and nutrition; environmental health; safety and survival
skills; consumer health; family life; substance abuse and nonuse,
encompassing the effects of alcohol, tobacco, drugs, and poisons
on the human body; human sexuality, self-esteem, stress
management, and interpersonal relationships; emotional and social
health; health resources; and prevention and control of disease,
and the characteristics of communicable diseases, including
acquired immune deficiency syndrome.



* * *



12.5(4)  Junior high program, grades 7 and 8. The following shall
be taught in grades seven and eight: English-language arts,
social studies, mathematics, science, health, human growth  and
development, family and consumer, career, and technology
education, physical education, music, and visual art. Instruction
in the following areas shall include the contributions and
perspectives of persons with disabilities, both men and women,
and persons from diverse racial and ethnic groups and shall be
designed to eliminate career and employment stereotypes.

     In implementing the junior high program standards, the
following general curriculum definitions shall be used.

* * *



e.   Health. Health instruction shall include personal health;
food and nutrition; environmental health; safety and survival
skills; consumer health; family life; substance abuse and nonuse,
encompassing the effects of alcohol, tobacco, drugs, and poisons
on the human body; human sexuality, self-esteem, stress
management, and interpersonal relationships; emotional and social
health; health resources; and prevention and control of disease
and the characteristics of communicable diseases, including
sexually transmitted diseases and acquired immune deficiency
syndrome.

* * *

12.5(5)  High school program, grades 9-12. In grades nine through
twelve a unit is a course or equivalent related components or
partial units taught throughout the academic year as defined in
subrule 12.5(18). The following shall be offered and taught as
the minimum program: English-language arts, six units; social
studies, five units; mathematics, six units as specified in
subrule 12.5(5)"e", science, five units; health, one unit;
physical education, one unit; fine arts, three units; foreign
language, four units; and vocational education, five units as
specified in subrule 12.5(5)"i."

In implementing the high school program standards, the following
curriculum standards shall be used.

* * *

e.   Health (one unit). Health instruction shall include personal
health; food and nutrition; environmental health, safety and
survival skills; consumer health; family life; human growth and
development; substance abuse and nonuse; emotional and social
health; health resources; and prevention and control of disease,
including sexually transmitted diseases and acquired immune
deficiency syndrome, current crucial health issues, human
sexuality, self-esteem, stress management, and interpersonal
relationships.

* * *



HUMAN SERVICES

44l-75.22(249A)  AIDS/HIV health insurance premium payment pilot
project. For the purposes of this rule, 'AIDS" and "HIV" are
defined in accordance with Iowa Code section 141.21.

75.22(l)  Conditions of eligibility. The department shall pay for
the cost of continuing health insurance coverage to persons with
AIDS or HIV-related illnesses when the following criteria are
met:

a.   The person with AIDS or HIV-related illness shall be the
policyholder of an individual or group health plan.

b.   The person shall be a resident of Iowa in accordance with
the provisions of rule 44l-75.10(249A).

c.   The person shall not be eligible for Medicaid. The person
shall be required to apply for Medicaid benefits when it appears
Medicaid eligibility may exist. Persons who are required to meet
a spenddown obligation under the medically needy program, as
provided in 441 -Chapter 56, are not considered Medicaid-eligible
for the purpose of establishing eligibility under these
provisions.

When Medicaid eligibility is attained, premium payments shall be
made under the provisions of rule 441  75.2l(249A) if all
criteria of that rule are met.

d.   A physician's statement shall be provided verifying the
policyholder suffers from AIDS or an HIV-related illness. The
physician's statement shall also verify that the policyholder is
or will be unable to continue employment in the person's current
position or that hours of employment will be significantly
reduced due to AIDS or HIV-related illness. The Physician's
Verification of Diagnosis, Form 470-2958, shall be used to obtain
this information from the physician.

e.   Gross income shall not exceed 300 percent of the federal
poverty level for a family of the same size. The gross income of
all family members shall be counted using the definition of gross
income under the Supplemental Security Income (SSI) program.

f.   Liquid resources shall not exceed $l0,000 per household. The
following are examples of countable resources:

(1)  Unobligated cash.

(2)  Bank accounts.

(3)  Stocks, bonds, certificates of deposit, excluding Internal
Revenue Service defined retirement plans.

g.   The health insurance plan must be cost-effective based on
the amount of the premium and the services covered.



75.22(2)  Application process.

a.   Application. Persons applying for participation in this
program shall complete the AIDS/HIV Health Insurance Premium
Payment Application, Form 470-2953. The applicant shall be
required to provide documentation of income and assets. The
application shall be available from and may be filed at any
county departmental office or at the Bureau of Operations,
Department of Human Services, Hoover State Office Building, Des
Moines, Iowa 50319-0114.

An application shall be considered as filed on the date an
AIDS/HIV Health Insurance Premium Payment Application, Form 470-
2953, containing the applicant's name, address and signature is
received and date-stamped in any county departmental office or
the bureau of operations.

b.   Time limit for decision. Every reasonable effort will be
made to render a decision within 30 days. Additional time for
rendering a decision may be taken when, due to circumstances
beyond the control of the applicant or the department, a decision
regarding the applicant's eligibility cannot be reached within 30
days (e.g., verification from a third party has not been
received).

e.   Waiting list. After funds appropriated for this purpose are
obligated, pending applications shall be denied by the bureau of
operations. A denial shall require a notice of decision to be
mailed within ten calendar days following the determination that
funds have been obligated. The notice shall state that the
applicant meets eligibility requirements but no funds are
available and that the applicant will be placed on the waiting
list, or that the applicant does not meet eligibility
requirements. Applicants not awarded funding who meet the
eligibility requirements will be placed on a statewide waiting
list according to the order in which the completed applications
were filed. In the event that more than one application is
received at one time, applicants shall be entered on the waiting
list on the basis of the day of the month of the applicant's
birthday, lowest number being first on the waiting list. Any
subsequent tie shall be decided by the month of birth, January
being month one and the lowest number.

75.22(3)  Presumed eligibility. The applicant may be presumed
eligible to participate in the program for a period of two
calendar months or until a decision regarding eligibility can be
made, whichever is earlier. Presumed eligibility shall be granted
when:

a.   The application is accompanied by a completed Physician's
Verification of Diagnosis, Form 470-2958.

b.   The application is accompanied by a premium statement from
the insurance carrier indicating the policy will lapse before an
eligibility determination can be made.

c.   It can be reasonably anticipated that the applicant will be
determined eligible from income and resource statements on the
application.

75.22(4)  Family coverage. When the person is enrolled in a
policy that provides health insurance coverage to other members
of the family, only that portion of the premium required to
maintain coverage for the policyholder with AIDS or an HIV-
related illness shall be paid under this rule unless modification
of the policy would result in a loss of coverage for the person
with AIDS or an HIV-related illness.

75.22(5)  Method of premium payment. Premiums shall be paid in
accordance with the provisions of subrule 75.21(9).

75.22(6)  Effective date of premium payment. Premium payments
shall be effective with the month of application or the effective
date of eligibility, whichever is later.

75.22(7)  Reviews. The circumstances of persons participating in
the program shall be reviewed quarterly' to ensure eligibility
criteria continues to be met. The AIDS/HIV Health Insurance
Premium Payment Program Review, Form 470-2877, shall be completed
by the recipient or someone acting on the recipient's behalf for
this purpose.

75.22(8)  Termination of assistance. Premium payments for
otherwise eligible persons shall be paid under this rule until
one of the following conditions is met:

a.   The person becomes eligible for Medicaid. In which case,
premium payments shall be paid in accordance with the provisions
of rule 44I-75.2I(249A).

b.   The insurance coverage is no longer available.

c.   Maintaining the insurance plan is no longer considered the
most cost-effective way to pay for medical services.

d.   Funding appropriated for the program is exhausted.



75.22(9)  Notices.

a.   An adequate notice as defined in 441-subrule 7.7(l) shall be
provided under the following circumstances:

(1)  To inform the applicant of the initial decision regarding
eligibility to participate in the program.

(2)  To inform the recipient that premium payments are being
discontinued under these provisions because Medicaid eligibility
has been attained and premium payments will be made under the
provisions of rule 44l-75.2l(249A).

(3)  To inform the recipient that premium payments are being
discontinued because the policy is no longer available.

(4)  To inform the recipient that premium payments are being
discontinued because funding for the program is exhausted.

b.   A timely and adequate notice as defined in 441-subrule
7.7(1) shall be provided to the recipient informing the recipient
of a decision to discontinue payment of the health insurance
premium when the recipient no longer meets the eligibility
requirements of the program or fails to cooperate in providing
information to establish eligibility.

75.22(10)  Confidentiality. The department shall protect the
confidentiality of persons participating in the program in
accordance with Iowa Code chapter 141. When it is necessary for
the department to contact a third party to obtain information in
order to determine initial or ongoing eligibility, a Consent to
Release or Obtain Information, Form 470-0429, shall be signed by
the recipient authorizing the department to make the contact.

This rule is intended to implement Iowa Code section 249A.4 and
1992 Iowa Acts, Second Extraordinary Session, chapter 1001,
section 409, subsection 6.



441-77.34(249A)  AIDS/HIV waiver service providers. The following
AIDS/HIV waiver service providers shall be eligible to
participate in the Medicaid program provided that they' meet the
standards set forth below:

77.34(1)  Counseling providers. Counseling providers shall be:

a.   Agencies which are certified under the standards established
by the Iowa mental health authority, set forth in 441-Chapter 33.

b.   Agencies which are licensed as meeting the standards and
requirements set forth in department of inspections and appeals
rules 481-Chapter 53 or which are certified to meet the standards
under the Medicare program for hospice programs.

c.   Agencies which are accredited under the standards
established by the Iowa mental health authority, set forth in 441-
Chapter 35.

77.34(2)  Home health aide providers. Home health aide providers
shall be agencies which meet the standards and requirements set
forth in department of public health rules, 0 641-80.3(135), 641-
80.4(135) and 641-80.5(135), or which are certified to meet the
standards under the Medicare program for home health agencies.

77.34(3)  Homemaker providers. Homemaker providers shall be
agencies which meet the standards and requirements set forth in
department of public health rules, 641-80.3(135), 641-80.4(135)
and 641-80.5(135), or which are certified to meet the standards
under the Medicare program for home health agencies.

77.34(4)  Nursing care providers. Nursing care providers shall be
agencies which are certified to meet the standards under the
Medicare program for home health agencies.

77.34(5)  Respite care providers. In-home respite care providers
shall be agencies which meet the conditions of participation set
forth in subrule 77.34(2). Out-of-home respite care providers
shall be nursing facilities which are certified to meet the
standards set forth in 441-Chapter 81 or hospitals certified to
participate in the Medicaid program.

This rule is intended to implement Iowa Code section 249A.4.