Iowa Administrative Code › Agency 441 - Human Services Department › Title III - Mental Health › Chapter 25 - Disability Services Management › Rule 441-25.21 - Policies and Procedures Manual for the Regional Service System

Current through Register Vol. 47, No. 3, July 24, 2024
The policies and procedures manual shall describe the
				  policies and process developed to direct the management and administration of
				  the regional service system.
(1)
Content.
The manual shall include but not be limited to:
a. Financing and delivery of services and
				supports. A description of the region's process used to develop and ensure the
				ongoing financial accountability and delivery of services outlined in the
				region's annual service and budget plan shall be included.
b. Enrollment. The application and enrollment
				process that is readily accessible to individuals and their families or
				authorized representatives shall be included. This procedure shall identify
				regional access points and where individuals can apply for services and how and
				when the applications will reach the regional administrative entity's
				designated staff for processing.
c.
				Eligibility. The process utilized to determine eligibility shall be included in
				the manual and shall include but not be limited to:
(1) The criteria used to authorize or deny
				funding for services and supports. This shall include guidelines for who is
				eligible to receive services and supports by eligibility group, and type of
				service or support.
(2) Financial
				eligibility and copayment criteria, which shall meet the requirements of rule
				441-25.16(225C).
(3) The time
				frames for conducting eligibility determination that provide for timely access
				to services, including necessary and immediate services not to exceed ten
				days.
(4) The process for
				development of a written notice of decision. The time frame for sending a
				written notice of decision to the individual and guardian (if applicable) and
				the service providers identified in the notice shall be included. The notice of
				decision shall:
1. Explain the action taken on
				the application and the reasons for that action.
2. State what services are approved and name
				the service providers.
3. Outline
				the individual's right to appeal.
4. Describe the appeal process.
d. Utilization of and
				access to services. The process for managing utilization of and access to
				services and other assistance shall be included. The process shall describe how
				coordination between the services included in the annual service and budget
				plan and the disability services administered by the state and others will be
				managed.
e. Quality management and
				improvement process. The quality management and improvement process shall at a
				minimum meet the requirements of the department's outcome and performance
				measures process as outlined in Iowa Code sections
				225C.4(1)
"k"
and 225C.6A.
f. Risk management and fiscal viability. If
				the region contracts with a private entity, the manual must include risk
				management provisions and fiscal viability of the annual services and budget
				plan.
g. Targeted case management.
(1) Designation of targeted case management
				providers. The process used to identify and designate targeted case management
				providers for the region shall be described. This process shall include the
				requirement for the implementation of evidence-based practice models of case
				management within the region. Requirements of this practice include:
1. Providing the individual receiving the
				case management with a choice of providers.
2. Allowing a service provider to be the case
				manager but prohibiting the provider from referring that individual only to
				services administered by the provider.
3. Provisions to ensure compliance with, but
				not exceed, federal requirements for conflict-free case management.
(2) Qualifications of targeted case
				managers. A region's manual shall require that any targeted case managers or
				other persons providing service coordination while working for the designated
				provider meet the qualifications of qualified case managers and supervisors as
				defined in rule 441-24.1 (225C).
(3) Targeted case management and service
				coordination services. Targeted case management and service coordination
				services utilized in a regional service system shall include but are not
				limited to the following as defined in Iowa Code section
				225C.60(4)
"g"
:
1. Performance and
				outcome measures relating to the health, safety, school attendance and
				performance, work performance, and community residency of the individuals
				receiving the services.
2.
				Standards for delivery of the services, including but not limited to the social
				history, assessment, service planning, incident reporting, crisis planning,
				coordination, and monitoring for individuals receiving the services.
3. Methodologies for complying with the
				requirements of paragraph 25.21(1)
"g."
Methodologies may
				include the use of electronic record keeping and remote or Internet-based
				training.
h.
				System of care approach plan.
i.
				Decentralized service provision. Measures to provide services in a dispersed
				manner that meet the minimum access standards of core services and that utilize
				the strengths and assets of the service providers within and available to the
				region shall be included.
j.
				Provider network formation and management. The manual shall require that
				providers that are subject to license, accreditation or approval meet
				established standards. The manual shall detail the approval process, including
				criteria, developed to select providers that are not currently subject to
				license, accreditation or approval standards. The manual shall identify the
				process the regional administrative entity will use to contract with providers
				and manage the provider network to ensure it meets the needs of the individuals
				in the region. The provider network will include but is not limited to the
				following:
(1) A contract with a community
				mental health center that provides services in the individual's region or with
				a federally qualified health center that provides psychiatric and outpatient
				mental health services in the individual's region.
(2) Contracts with licensed and accredited
				providers to provide each service in the required core service
				domains.
(3) Adequate numbers of
				licensed and accredited providers to ensure availability of core services so
				that there is no waiting list for services due to lack of available
				providers.
(4) A contract with an
				inpatient psychiatric hospital unit or state mental health institute within
				reasonably close proximity.
k. Service provider payment provisions. A
				policy for payment of service providers which describes the method and process
				of paying for services and supports delivered to the region shall be
				included.
l. Grievance processes.
				The manual shall develop and implement processes for appealing the decisions of
				the regional administrative entity in the following circumstances:
(1) Nonexpedited appeal process. The appeal
				process shall be based on objective criteria, specify time frames, provide for
				notification in accessible formats of the decisions to all parties, and provide
				some assistance to individuals with disabilities using the process.
				Responsibility for the final step in the appeal process shall be a state
				administrative law judge in nonexpedited appeals.
(2) Expedited appeal process. This appeal
				process is to be used when the decision of the regional administrative entity
				concerning an individual varies from the type and amount of service identified
				to be necessary for the individual in a clinical determination made by a mental
				health professional and the mental health professional believes that the
				failure to provide the type and amount of service identified could cause an
				immediate danger to an individual's health or safety. This appeal process shall
				be performed by a mental health professional who is either the administrator of
				the division of mental health and disability services of the department of
				human services or the administrator's designee.
1. The appeal shall be filed within five days
				of receipt of the notice of decision by the regional administrative
				entity.
2. The expedited review by
				the division administrator or designee shall take place within two days of
				receipt of the request, unless more information is needed. There is an
				extension of two days from the time the new information is received.
3. The administrator shall issue an order,
				including a brief statement of findings of fact, conclusions of law, and policy
				reasons for the order, to justify the decision made concerning the expedited
				review. If the decision concurs with the contention that there is an immediate
				danger to the individual's health or safety, the order shall identify the type
				and amount of service which shall be provided for the individual. The
				administrator or designee shall give such notice as is practicable to
				individuals who are required to comply with the order. The order is effective
				when issued.
4. The decision of the
				administrator or designee shall be considered a final agency action and is
				subject to judicial review in accordance with Iowa Code section
				17A.19.
m.
				Implementation of interagency and multisystem collaboration and care
				coordination. The policies and procedures manual shall describe how the region
				will collaborate with other funders, other regional service systems, service
				providers, case management, individuals and their families or authorized
				representatives, and advocates to ensure that authorized services and supports
				are responsive to individuals' needs, consistent with system principles, and
				cost-efficient. The manual shall describe the process for collaboration with
				the court to ensure alternatives to commitment and to coordinate funding for
				services to individuals who are under court-ordered commitment services
				pursuant to Iowa Code chapter 229.
n. Addressing multioccurring needs. The
				policies and procedures manual shall include criteria and measures to be used
				to address the needs of individuals who have two or more co-occurring mental
				health, intellectual or other developmental disability, brain injury, or
				substance-related disorders. The manual shall also include criteria and
				measures to be used to address the needs of individuals with specialized
				needs.
o. Service management and
				functional assessment. The policies and procedures manual shall describe how
				functional assessments and service management will be incorporated in
				accordance with applicable requirements.
p. Service system management. The policies
				and procedures manual shall identify whether the region will be directly
				implementing a system of service management or will contract with a private
				entity to manage the regional service system. If the region contracts with a
				private entity, the region will ensure that all requirements of Iowa Code
				section 225C.60 and these administrative
				rules are fulfilled.
q. Assistance
				to other than core service populations. The policies and procedures manual
				shall specify the services populations, other than core service populations, to
				whom the region will provide assistance if funding is available.
r. Waiting list criteria. The policies and
				procedures manual shall specify whether the region will use waiting lists. If
				the policy and procedures manual specifies the use of waiting lists for funding
				services and supports, it shall specify criteria for the use and review of each
				waiting list, including the criteria to be used to determine how and when an
				individual will be placed on a waiting list. The criteria will include how core
				services and additional core services will be impacted the least by budgetary
				limitations. The manual shall specify how waiting list data will be used in
				future planning.