Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.82 - Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
To be eligible for brain injury waiver services a consumer
				  must meet eligibility criteria and be determined to need a service allowable
				  under the program.
(1)
Eligibility criteria.
All of the following criteria must be
				met. The person must:
a. Have a diagnosis of
				brain injury.
b. Be eligible for
				Medicaid under SSI, SSI-related, FMAP, or FMAP-related coverage groups or be
				eligible under the special income level (300 percent) coverage group consistent
				with a level of care in a medical institution.
c. Be at least one month of age.
d. Be a U.S. citizen and Iowa
				resident.
e. Rescinded IAB 7/11/01,
				effective 7/1/01.
f. Be determined
				by the IME medical services unit as in need of intermediate care facility for
				persons with an intellectual disability (ICF/ID), skilled nursing, or ICF level
				of care based on information submitted on a completed Form 470-4694 for
				children aged 3 and under, the interRAI - Pediatric Home Care (PEDS-HC) for
				those aged 4 to 20, or the interRAI - Home Care (HC) for those aged 21 and
				over, the most recent version of the Mayo-Portland Adaptability Inventory
				(MPAI), and other supporting documentation as relevant. Form 470-4694, the
				interRAI - Pediatric Home Care (PEDS-HC), and the interRAI - Home Care (HC),
				Form 470-4694, and Form 470-5572, the Mayo-Portland Adaptability Inventory
				(MPAI), are available on request from the member's managed care organization or
				the IME medical services unit. Copies of the completed information submission
				tool for an individual are available to that individual from the individual's
				case manager or managed care organization.
g. Be assessed by the IME medical services
				unit as able to live in a home- or community-based setting where all medically
				necessary service needs can be met within the scope of this waiver.
h. At a minimum, receive a waiver service
				each quarter in addition to case management.
i. Choose HCBS.
j. To be eligible for interim medical
				monitoring and treatment services the consumer must be:
(1) Under the age of 21;
(2) Currently receiving home health agency
				services under rule 441-78.9 (249A) and require
				medical assessment, medical monitoring, and regular medical intervention or
				intervention in a medical emergency during those services. (The home health
				aide services for which the consumer is eligible must be maximized before the
				consumer accesses interim medical monitoring and treatment.);
(3) Residing in the consumer's family home or
				foster family home; and
(4) In need
				of interim medical monitoring and treatment as ordered by a physician, nurse
				practitioner, clinical nurse specialist, or physician assistant.
k. Receive services in a
				community, not an institutional, setting.
l. Be assigned a state payment slot within
				the yearly total approved by the Centers for Medicare and Medicaid
				Services.
m. For the consumer
				choices option as set forth in rule 441-subrule 78.43(15), not be living in a
				residential care facility.
n. For
				individual supported employment and long-term job coaching services:
(1) Be at least 16 years of age.
(2) The services must not be available to the
				member through one of the following:
1.
				Special education and related services as defined in the Individuals with
				Disabilities Education Act (
				20
				U.S.C. 1401 et seq.); or
2. A program funded under Section 110 of the
				Rehabilitation Act of 1973 (
				29 U.S.C. 730
				).
(3) Not reside in a
				medical institution.
(4) Have
				documented in the waiver service plan a goal to achieve or to sustain
				individual employment and an expectation that this service will result in this
				outcome.
o. For
				small-group supported employment services:
(1)
				Be at least 16 years of age.
(2)
				The services must not be available to the member through one of the following:
1. Special education and related services as
				defined in the Individuals with Disabilities Education Act (
				20
				U.S.C. 1401 et seq.); or
2. A program funded under Section 110 of the
				Rehabilitation Act of 1973 (
				29 U.S.C. 730
				).
(3) Have documented
				in the waiver service plan a goal to achieve or to sustain individual
				employment.
(4) Have documented in
				the waiver service plan that the choice to receive individual supported
				employment services was offered and explained in a manner sufficient to ensure
				informed choice, after which the choice to receive small-group supported
				employment services was made.
(5)
				Not reside in a medical institution.
p. For prevocational services:
(1) Be at least 16 years of age.
(2) The services must not be available to the
				member through one of the following:
1.
				Special education and related services as defined in the Individuals with
				Disabilities Education Act (
				20
				U.S.C. 1401 et seq.); or
2. A program funded under Section 110 of the
				Rehabilitation Act of 1973 (
				29 U.S.C. 730
				).
(3) Have documented
				in the waiver service plan a goal to achieve or to sustain individual
				employment and an expectation that this service will result in community
				employment.
(4) Have documented in
				the waiver service plan that the choice to receive individual supported
				employment services was offered and explained in a manner sufficient to ensure
				informed choice, after which the choice to receive prevocational services was
				made.