Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 78 - Amount, Duration and Scope of Medical and Remedial Services › Rule 441-78.49 - Infant and Toddler Program Services

Current through Register Vol. 47, No. 3, July 24, 2024
Subject to the following subrules, payment shall be made for
				  medical services provided to Medicaid eligible children by infant and toddler
				  program providers under the infants and toddlers with disabilities program
				  administered by the Iowa Child Health Specialty Clinics and the departments of
				  education, public health, and human services.
(1)
Covered services.
Covered services include, but are not limited to, audiology, psychological
				evaluation and counseling, health and nursing services, nutrition services,
				occupational therapy services, physical therapy services, developmental
				services, speech-language services, vision services, case management, and
				medical transportation.
(2)
Case management services.
Payment shall also be approved for
				infant and toddler case management services subject to the following
				requirements:
a.
Definition.
"Case management" means services that will assist eligible children in gaining
				access to needed medical, social, educational, and other services. Case
				management is intended to address the complexities of coordinated service
				delivery for children with medical needs. The case manager should be the focus
				for coordinating and overseeing the effectiveness of all providers and programs
				in responding to the assessed need. Case management does not include the direct
				delivery of an underlying medical, educational, social, or other service to
				which an eligible child has been referred or any activities that are an
				integral part or an extension of the direct services.
b.
Choice of provider
Children who also are eligible to receive targeted case management services
				under 441-Chapter 90 must choose whether to receive case management through the
				infant and toddler program or through 441-Chapter 90. The chosen provider must
				meet the requirements of this subrule.
(1)
				When a child resides in a medical institution, the institution is responsible
				for case management. The child is not eligible for any other case management
				services. However, noninstitutional case management services may be provided
				during the last 14 days before the child's planned discharge if the child's
				stay in the institution has been less than 180 consecutive days. If the child
				has been in the institution 180 consecutive days or longer, the child may
				receive noninstitutional case management services during the last 60 days
				before the child's planned discharge.
(2) If the case management agency also
				provides direct services, the case management unit must be designed so that
				conflict of interest is addressed and does not result in
				self-referrals.
(3) If the costs of
				any part of case management services are reimbursable under another program,
				the costs must be allocated between those programs and Medicaid in accordance
				with 0MB Circular No. A-87 or any related or successor guidance or regulations
				regarding allocation of costs.
(4)
				The case manager must complete a competency-based training program with content
				related to knowledge and understanding of eligible children. Early ACCESS
				rules, the nature and scope of services in Early ACCESS, and the system of
				payments for services, as well as case management responsibilities and
				strategies. The department of education or its designee shall determine whether
				a person has successfully completed the training.
c.
Assessment.
The case
				manager shall conduct a comprehensive assessment and periodic reassessment of
				an eligible child to identify all of the child's service needs, including the
				need for any medical, educational, social, or other services. Assessment
				activities are defined to include the following:
(1) Taking the child's history;
(2) Identifying the needs of the
				child;
(3) Gathering information
				from other sources, such as family members, medical providers, social workers,
				and educators, if necessary, to form a complete assessment of the
				child;
(4) Completing documentation
				of the information gathered and the assessment results; and
(5) Repeating the assessment every six months
				to determine whether the child's needs or preferences have changed.
d.
Plan of care.
The case manager shall develop a plan of care based on the information
				collected through the assessment or reassessment. The plan of care shall:
(1) Include the child's strengths and
				preferences;
(2) Consider the
				child's physical and social environment;
(3) Specify goals of providing services to
				the child; and
(4) Specify actions
				to address the child's medical, social, educational, and other service needs.
				These actions may include activities such as ensuring the active participation
				of the child and working with the child or the child's authorized health care
				decision maker and others to develop goals and identify a course of action to
				respond to the assessed needs of the child.
e.
Other service components.
Case management must include the following components:
(1) Contacts with the child and family. The
				case manager shall have face-to-face contact with the child and family within
				the first 30 days of service and every three months thereafter In months in
				which there is no face-to-face contact, a telephone contact between the service
				coordinator and the family is required.
(2) Referral and related activities to help a
				child obtain needed services. The case manager shall help to link the child
				with medical, social, or educational providers or other programs and services
				that are capable of providing needed services. Referral activities do not
				include provision of the direct services, program, or activity to which the
				child has been linked. Referral activities include:
1. Assisting the family in gaining access to
				the infant and toddler program services and other services identified in the
				child's plan of care.
2. Assisting
				the family in identifying available service providers and funding resources and
				documenting unmet needs and gaps in services.
3. Making referrals to providers for needed
				services.
4. Scheduling
				appointments for the child.
5.
				Facilitating the timely delivery of services.
6. Arranging payment for medical
				transportation.
(3)
				Monitoring and follow-up activities. Monitoring activities shall take place at
				least once annually for the duration of the child's eligibility, but may be
				conducted as frequently as necessary to ensure that the plan of care is
				effectively implemented and adequately addresses the needs of the child.
				Monitoring and follow-up activities may be with the child, family members,
				providers, or other entities. The purpose of these activities is to help
				determine:
1. Whether services are being
				furnished in accordance with the child's plan of care.
2. Whether the services in the plan of care
				are adequate to meet the needs of the child.
3. Whether there are changes in the needs or
				status of the child. If there are changes in the child's needs or status,
				follow-up activities shall include making necessary adjustments to the plan of
				care and to service arrangements with providers.
(4) Keeping records, including preparing
				reports, updating the plan of care, making notes about plan activities in the
				child's record, and preparing and responding to correspondence with the family
				and others.
f.
Documentation of case management.
For each child receiving
				case management, case records must document:
(1) The name of the child;
(2) The dates of case management
				services;
(3) The agency chosen by
				the family to provide the case management services;
(4) The nature, content, and units of case
				management services received;
(5)
				Whether the goals specified in the care plan have been achieved;
(6) Whether the family has declined services
				in the care plan;
(7) Time lines
				for providing services and reassessment; and
(8) The need for and occurrences of
				coordination with case managers of other programs.