Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 78 - Amount, Duration and Scope of Medical and Remedial Services › Rule 441-78.56 - Community-based Neurobehavioral Rehabilitation Services

Current through Register Vol. 47, No. 3, July 24, 2024
Payment will be made for community-based neurobehavioral
				  rehabilitation services that do not duplicate other services covered in this
				  chapter.
(1)
Definitions.
"Assessment"
means the review of the current
				  functioning of the member using the service in regard to the member's
				  situation, needs, strengths, abilities, desires, and goals.
"Brain injury"
means a diagnosis in
				  accordance with rule 441-83.81(249A).
"Health care"
means the services provided by
				  trained and licensed health care professionals to restore or maintain the
				  member's health.
"Intermittent community-based neurobehavioral
				  rehabilitation services"
are provided to a Medicaid member on an
				  as-needed basis to support the member and the member's family or caregivers to
				  assist the member to increase adaptive behaviors, decrease maladaptive
				  behaviors, and adapt and accommodate to challenging behaviors to support the
				  member to remain in the member's own home and community.
"Member"
means a person who has been
				  determined to be eligible for Medicaid under 441-Chapter 75.
"Neurobehavioral rehabilitation"
refers to a
				  specialized category of neurorehabilitation provided by a multidisciplinary
				  team that has been trained in, and delivers, services individually designed to
				  address cognitive, medical, behavioral and psychosocial challenges, as well as
				  the physical manifestations of acquired brain injury. Services concurrently
				  work to optimize functioning at personal, family and community levels, by
				  supporting the increase of adaptive behaviors, decrease of maladaptive
				  behaviors and adaptation and accommodation to challenging behaviors to support
				  a member to maximize the member's independence in activities of daily living
				  and ability to live in the member's home and community.
"Program"
means a set of related resources
				  and services directed to the accomplishment of a fixed set of goals for
				  eligible members.
"Standardized assessment"
means a valid,
				  reliable, and comprehensive functional assessment tool(s) or process, or both,
				  approved by the department for use in the assessment of a member's individual
				  needs.
(2)
Member
				eligibility.
To be eligible to receive community-based neurobehavioral
				rehabilitation services, a member shall meet the following criteria:
a.
Brain injury diagnosis.
To be eligible for community-based neurobehavioral rehabilitation services, the
				member must have a brain injury diagnosis as set forth in rule
				441-83.81(249A).
b.
Risk factors.
The member
				has the following post-brain injury risk factors:
(1) The member is exhibiting neurobehavioral
				symptoms in such frequency or severity that the member has undergone or is
				currently undergoing treatment more intensive than outpatient care and is
				currently hospitalized, institutionalized, incarcerated or homeless or is at
				risk of hospitalization, institutionalization, incarceration or homelessness;
				or
(2) The member has a history of
				presenting with neurobehavioral or psychiatric symptoms resulting in at least
				one episode that required professional supportive care more intensive than
				outpatient care more than once in a lifetime (e.g., emergency services,
				alternative home care, partial hospitalization, or inpatient
				hospitalization).
c.
Need for assistance.
The member exhibits neurobehavioral
				symptoms in such frequency, severity or intensity that community-based
				neurobehavioral rehabilitation is required.
d.
Needs assessment.
The
				member shall have an assessment of need completed prior to admission. The
				member shall have the Mayo-Portland Adaptability Inventory (MPAI) assessment
				completed by a qualified trained assessor. The assessment of need shall
				document the member's need for community-based neurobehavioral rehabilitation,
				and the medical services unit of the Iowa Medicaid enterprise or the member's
				managed care organization has determined that the member is in need of
				specialty neurobehavioral rehabilitation services.
e.
Standards for assessment.
Each member will have had the MPAI assessment completed within the 90 days
				prior to admission. In addition to the functional assessment, the needs
				assessment will have been completed and will include the assessment of a
				member's individual physical, emotional, cognitive, medical and psychosocial
				residuals related to the member's brain injury and must include the following:
(1) Identification of the neurobehavioral
				needs that put the member at risk, including but not limited to verbal
				aggression, physical aggression, self-harm, unwanted sexual behavior, cognitive
				and or behavioral perseveration, wandering or elopement, lack of motivation,
				lack of initiation or other unwanted social behaviors not otherwise
				specified.
(2) Identification of
				triggers of unwanted behaviors and the member's ability to self-manage the
				member's symptoms.
(3) The member's
				rehabilitation and medical care history to include medication history and
				status.
(4) The member's employment
				history and the member's barriers to employment.
(5) The member's dietary and nutritional
				needs.
(6) The member's community
				accessibility and safety.
(7) The
				member's access to transportation.
(8) The member's history of substance
				abuse.
(9) The member's
				vulnerability to exploitation and history of risk of exploitation.
(10) The member's history and status of
				relationships, natural supports and socialization.
f.
Emergency admission.
In
				the event that emergency admission is required, the assessment shall be
				completed within ten calendar days of admission.