Current through Register Vol. 47, No. 6, September 18, 2024
An applicant for the IGS program must satisfy the criteria
outlined in this rule. If an applicant does not meet these criteria, the
applicant shall be provided information by contracted local program staff
regarding the health insurance marketplace, Medicaid or sliding-fee clinics
available in the area in which the applicant lives.
(1)
Age. Individuals 45
through 75 years of age shall be the target population to receive colorectal
cancer screening.
(2)
Income.
a. The IGS program
income guidelines are based upon 300 percent of the federal poverty level
(FPL), which is set annually by the Centers for Medicare and Medicaid Services
(CMS). New IGS program income guidelines will be adjusted following any change
in CMS guidelines.
b.
Self-declaration of income may be accepted.
c. Eligibility shall be based on net income
for the household.
d. Assets shall
not affect income status and shall not be counted when eligibility under the
IGS program is determined.
(3)
Insurance.
a. The IGS program shall determine
individuals to be uninsured if they do not have health insurance
coverage.
b. The IGS program shall
determine individuals to be underinsured if they have health insurance with
unreasonably high copayments, deductibles or coinsurance or the insurance does
not cover the IGS program's covered services.
c. Individuals who have Medicaid or Medicare
Part B are not eligible.
(4)
Residency.
a. Individuals must reside in the state of
Iowa.
b. Individuals shall have an
established address and contact information as needed for program staff to
provide screening results, rescreens, and follow-up services.
(5)
Risk level.
Individuals with an average or increased risk for developing colorectal cancer
as defined by the recommendations of the USPSTF may qualify for IGS program
services.
(6)
Ineligible. The IGS program does not provide coverage for:
a. Individuals with Medicare Part B
coverage.
b. Individuals 44 years
of age and younger.
c. Individuals
76 years of age and older.
d.
Individuals who do not have a primary care provider.
e. Individuals at high risk for developing
colorectal cancer. Individuals at high risk include:
(1) A genetic diagnosis of familial
adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer
(HNPCC),
(2) A clinical diagnosis
or suspicion of FAP or HNPCC, or
(3) A history of inflammatory bowel disease
(ulcerative colitis or Crohn's disease).
