reglab/statecodes huggingface dataset:
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.22 - Rates for Medicaid Eligibles

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Maximum client
				participation.
A nursing facility may not charge more client
				participation for Medicaid-eligible clients as determined in rule
				441-75.16
				(249A) than the maximum monthly allowable payment for their facility as
				determined according to 441-subrule 79.1(9) or rule
				441-81.6
				(249A). When the department makes a retroactive increase in the maximum daily
				rate, the nursing facility can charge the client the increased amount for the
				retroactive period.
(2)
Beginning date of payment.
When a resident becomes eligible
				for Medicaid payments for facility care, the facility shall accept Medicaid
				rates effective when the resident's Medicaid eligibility begins. A nursing
				facility is required to refund any payment received from a resident or family
				member for any period of time during which the resident is determined to be
				eligible for Medicaid.
Any refund owing shall be made no later than 15 days after
				  the nursing facility first receives Medicaid payment for the resident for any
				  period of time. Facilities may deduct the resident's client participation for
				  the month from a refund of the amount paid for a month of Medicaid
				  eligibility.
The beginning and renewal date of eligibility and resident
				  client participation amounts may be obtained through the Iowa Medicaid portal
				  access (IMPA) system. When the beginning Medicaid eligibility date is a future
				  month, the facility shall accept the Medicaid rate effective the first of that
				  future month.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.23 - State-funded Personal Needs Supplement

Current through Register Vol. 47, No. 3, July 24, 2024
A Medicaid member living in a nursing facility who has
				  countable income for purposes of rule
				  441-75.16 (249A) of less than
				  $50 per month shall receive a state-funded payment from the department for the
				  difference between that countable income and $50 if the legislature has
				  appropriated funding specifically for this purpose. This payment shall not be
				  considered a benefit under Title XIX of the Social Security Act.
This rule is intended to implement Iowa Code section
				  249A.30A.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.31 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"CMS"
means the Centers for Medicare and
				  Medicaid Services of the federal Department of health and Human
				  Services.
"Deficiency"
means a nursing facility's
				  failure to meet a participation requirement.
"Department"
means the Iowa department of
				  human services.
"Immediate jeopardy "
means a situation in
				  which immediate corrective action is necessary because the provider's
				  noncompliance with one or more requirements of participation has caused, or is
				  likely to cause, serious injury, harm, impairment, or death to a
				  resident.
"New admission "
means a resident who is
				  admitted to the facility on or after the effective date of a denial of payment
				  remedy and, if previously admitted, has been discharged before that effective
				  date. Residents admitted before the effective date of the denial of payment,
				  and taking temporary leave, are not considered new admissions, nor are they
				  subject to the denial of payment.
"Noncompliance "
means any deficiency that
				  causes a facility to not be in substantial compliance.
"Plan of correction"
means a plan developed
				  by the facility and approved by the department of inspections and appeals which
				  describes the actions the facility shall take to correct deficiencies and
				  specifies the date by which those deficiencies shall be corrected.
"Standard survey"
means a periodic,
				  resident-centered inspection which gathers information about the quality of
				  service furnished in a facility to determine compliance with the requirements
				  for participation.
"Substandard quality of care"
means one or
				  more deficiencies related to the participation requirements for resident
				  behavior and facility practices, quality of life, or quality of care which
				  constitute either immediate jeopardy to resident health or safety; a pattern of
				  or widespread actual harm that is not immediate jeopardy; or a widespread
				  potential for more than minimal harm, but less than immediate jeopardy, with no
				  actual harm.
"Substantial compliance "
means a level of
				  compliance with the requirements of participation such that any identified
				  deficiencies pose no greater risk to resident health or safety than the
				  potential for causing minimal harm.
"Temporary management"
means the temporary
				  appointment by the department of inspections and appeals of a substitute
				  facility manager or administrator with authority to hire, terminate or reassign
				  staff, obligate facility funds, alter facility procedures, and manage the
				  facility to correct deficiencies identified in the facility's
				  operation.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.32 - General Provisions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Purpose of remedies.
The purpose of remedies is to ensure
				prompt compliance with program requirements.
(2)
Basis for imposition and duration
				of remedies.
The department of inspections and appeals, as the state
				survey agency under contract with the department, determines the remedy to be
				applied for noncompliance with program requirements. When the department of
				inspections and appeals chooses to apply one or more remedies specified in rule
				441-81.34
				(249A), the remedies are applied on the basis of noncompliance found during
				surveys conducted by the department of inspections and appeals.
(3)
Number of remedies.
The
				department of inspections and appeals may apply one or more remedies for each
				deficiency constituting noncompliance or for all deficiencies constituting
				noncompliance.
(4)
Plan of
				correction requirement.
a. Except as
				specified in paragraph
"b, "
regardless of which remedy is
				applied, each facility that has deficiencies with respect to program
				requirements shall submit a plan of correction for approval by the department
				of inspections and appeals.
b. A
				facility is not required to submit a plan of correction when the department of
				inspections and appeals determines the facility has deficiencies that are
				isolated and have a potential for minimal harm, but no actual harm has
				occurred.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.33 - Factors to Be Considered in Selecting Remedies

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Initial assessment.
In
				order to select the appropriate remedy, if any, to apply to a facility with
				deficiencies, the department of inspections and appeals shall determine the
				seriousness of the deficiencies.
(2)
Determining seriousness of
				deficiencies.
To determine the seriousness of the deficiency, the
				department of inspections and appeals shall consider at least the following
				factors:
a. Whether a facility's deficiencies
				constitute:
(1) No actual harm with a
				potential for minimal harm.
(2) No
				actual harm with a potential for more than minimal harm, but not immediate
				jeopardy.
(3) Actual harm that is
				not immediate jeopardy.
(4)
				Immediate jeopardy to resident health or safety.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.34 - Available Remedies

Current through Register Vol. 47, No. 3, July 24, 2024
In addition to the remedy of termination of the provider
				  agreement, the following remedies are available:
1. Temporary management.
2. Denial of payment for all new
				admissions.
3. Civil money
				penalties.
4. State
				monitoring.
5. Closure of the
				facility in emergency situations or transfer of residents, or both.
6. Directed plan of correction.
7. Directed in-service training.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.35 - Selection of Remedies

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Categories of remedies.
Remedies specified in rule
				441-81.34
				(249A) are grouped into categories and applied to deficiencies according to the
				severity of noncompliance.
(2)
Application of remedies.
After considering the factors
				specified in rule
				441-81.33
				(249A), if the department of inspections and appeals applies remedies, as
				provided in paragraphs 81.35(3) "a, " 81.35(4) "a, " and 81.35(5) "a, " for
				facility noncompliance, instead of, or in addition to, termination of the
				provider agreement, the department of inspections and appeals shall follow the
				criteria set forth in 81.35(3)
"h,
"81.35(4)
"h,
				"
and 81.35(5)
"h, "
as applicable.
(3)
Category 1.
a. Category 1 remedies include the following:
(1) Directed plan of correction.
(2) State monitoring.
(3) Directed in-services training.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.36 - Action When There Is Immediate Jeopardy

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Terminate agreement or appoint
				temporary manager
If there is immediate jeopardy to resident health or
				safety, the department of inspections and appeals shall appoint a temporary
				manager to remove the immediate jeopardy or the provider agreement shall be
				terminated within 23 calendar days of the last date of the survey.
The rules for appointment of a temporary manager in an
				  immediate jeopardy situation are as follows:
a. The department of inspections and appeals
				shall notify the facility that a temporary manager is being
				appointed.
b. If the facility fails
				to relinquish control to the temporary manager, the provider agreement shall be
				terminated within 23 calendar days of the last day of the survey if the
				immediate jeopardy is not removed. In these cases, state monitoring may be
				imposed pending termination.
c. If
				the facility relinquishes control to the temporary manager, the department of
				inspections and appeals shall notify the facility that, unless it removes the
				immediate jeopardy, its provider agreement shall be terminated within 23
				calendar days of the last day of the survey.
d. The provider agreement shall be terminated
				within 23 calendar days of the last day of survey if the immediate jeopardy has
				not been removed.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.37 - Action When There Is No Immediate Jeopardy

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Termination of agreement or
				limitation of participation.
If a facility's deficiencies do not pose
				immediate jeopardy to residents' health or safety, and the facility is not in
				substantial compliance, the facility's provider agreement may be terminated or
				the facility may be allowed to continue to participate for no longer than six
				months from the last day of the survey if:
a.
				The department of inspections and appeals finds that it is more appropriate to
				impose alternative remedies than to terminate the facility's provider
				agreement;
b. The department of
				inspections and appeals has submitted a plan of correction approved by CMS;
				and
c. The facility agrees to repay
				payments received after the last day of the survey that first identified the
				deficiencies if corrective action is not taken in accordance with the approved
				plan of correction and posts bond acceptable to the department to guarantee the
				repayment.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.38 - Action When There Is Repeated Substandard Quality of Care

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
General.
If a facility
				has been found to have provided substandard quality of care on the last three
				consecutive standard surveys, regardless of other remedies provided:
a. Payment for all new admissions shall be
				denied, as specified in rule
				441-81.40
				(249A).
b. The department of
				inspections and appeals shall impose state monitoring, as specified in rule
				441-81.42 (249A)
				until the facility has demonstrated to the satisfaction of the department of
				inspections and appeals that it is in substantial compliance with all
				requirements and will remain in substantial compliance with all
				requirements.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.39 - Temporary Management

Current through Register Vol. 47, No. 3, July 24, 2024
The department of inspections and appeals may appoint a
				  temporary manager from qualified applicants.
(1)
Qualifications.
The
				temporary manager must:
a. Be qualified to
				oversee correction of deficiencies on the basis of experience and education, as
				determined by the department of inspections and appeals.
b. Not have been found guilty of misconduct
				by any licensing board or professional society in any state.
c. Have, or a member of the manager's
				immediate family have, no financial ownership interest in the
				facility.
d. Not currently serve
				or, within the past two years, have served as a member of the staff of the
				facility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.40 - Denial of Payment for All New Admissions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Optional denial of
				payment.
Except as specified in subrule 81.40(2), the denial of
				payment for all new admissions may be imposed when a facility is not in
				substantial compliance with the requirements.
(2)
Required denial of
				payment.
Payment for all new admissions shall be denied when:
a. The facility is not in substantial
				compliance three months after the last day of the survey identifying the
				noncompliance; or
b. The department
				of inspections and appeals has cited a facility with substandard quality of
				care on the last three consecutive standard surveys.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.41 - Secretarial Authority to Deny All Payments

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
CMS option to deny all
				payment.
If a facility has not met a requirement, in addition to the
				authority to deny payment for all new admissions as specified in rule
				441-81.40
				(249A), CMS may deny any further payment to the state for all Medicaid
				residents in the facility. When CMS denies payment to the state, the department
				shall deny payment to the facility.
(2)
Resumption of payment.
When CMS resumes payment to the state, the department shall also resume payment
				to the facility. The department shall make payments to the facility for the
				same periods for which payment is made to the state.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.42 - State Monitoring

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
State monitor.
A state monitor:
a. Oversees the correction of deficiencies
				specified by the department of inspections and appeals at the facility site and
				protects the facility's residents from harm.
b. Is an employee or a contractor of the
				department of inspections and appeals.
c. Is identified by the department of
				inspections and appeals as an appropriate professional to monitor cited
				deficiencies.
d. Is not an employee
				of the facility.
e. Does not
				function as a consultant to the facility.
f. Does not have an immediate family member
				who is a resident of the facility to be monitored.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.43 - Directed Plan of Correction

Current through Register Vol. 47, No. 3, July 24, 2024
The department of inspections and appeals or the temporary
				  manager (with department of inspections and appeals' approval) may develop a
				  plan of correction and require a facility to take action within specified time
				  frames.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.44 - Directed In-service Training

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Required training.
The
				department of inspections and appeals may require the staff of a facility to
				attend an in-service training program if:
a.
				The facility has a pattern of deficiencies that indicate noncompliance;
				and
b. Education is likely to
				correct the deficiencies.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.45 - Closure of a Facility or Transfer of Residents, or Both

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Closure during an
				emergency.
In an emergency, the department and the department of
				inspections and appeals have the authority to:
a. Transfer Medicaid and Medicare residents
				to another facility; or
b. Close
				the facility and transfer the Medicaid and Medicare residents to another
				facility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.46 - Civil Money Penalties-basis for Imposing Penalty

Current through Register Vol. 47, No. 3, July 24, 2024
The department of inspections and appeals may impose a civil
				  money penalty for the number of days a facility is not in substantial
				  compliance with one or more participation requirements, regardless of whether
				  or not the deficiencies constitute immediate jeopardy.
The department of inspections and appeals may impose a civil
				  money penalty for the number of days of past noncompliance since the last
				  standard survey, including the number of days of immediate
				  jeopardy.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.47 - Civil Money Penalties-when Penalty Is Collected

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
When facility requests a
				hearing.
a. A facility shall request
				a hearing on the determination of the noncompliance that is the basis for
				imposition of the civil money penalty within the time limit specified in
				subrule 81.35(7).
b. If a facility
				requests a hearing within the time specified in subrule 81.35(7), the
				department of inspections and appeals initiates collection of the penalty when
				there is a final administrative decision that upholds the department of
				inspections and appeals' determination of noncompliance after the facility
				achieves substantial compliance or is terminated.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.48 - Civil Money Penalties-notice of Penalty

Current through Register Vol. 47, No. 3, July 24, 2024
The department of inspections and appeals shall notify the
				  facility of intent to impose a civil money penalty in writing. The notice shall
				  include, at a minimum, the following information:
1. The nature of the noncompliance.
2. The statutory basis for the
				penalty.
3. The amount of penalty
				per day of noncompliance.
4. Any
				factors specified in subrule 81.50(6) that were considered when determining the
				amount of the penalty.
5. The date
				on which the penalty begins to accrue.
6. When the penalty stops accruing.
7. When the penalty is collected.
8. Instructions for responding to the notice,
				including a statement of the facility's right to a hearing, and the implication
				of waiving a hearing, as provided in rule
				441-81.49
				(249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.49 - Civil Money Penalties-waiver of Hearing, Reduction of Penalty Amount

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Waiver
				of a hearing.
The facility may waive the right to a hearing, in
				writing, within 60 days from the date of the notice of intent to impose the
				civil money penalty.
(2)
Reduction of penalty amount.
a. If the facility waives its right to a
				hearing, the department of inspections and appeals reduces the civil money
				penalty amount by 35 percent.
b. If
				the facility does not waive its right to a hearing, the civil money penalty is
				not reduced by 35 percent.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.50 - Civil Money Penalties-amount of Penalty

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Amount of penalty.
The
				penalties are within the following ranges, set at $50 increments:
a. Upper range-$3,050 to $10,000. Penalties
				in the range of $3,050 to $10,000 per day are imposed for deficiencies
				constituting immediate jeopardy, as specified in 81.50(4)
"b."
b. Lower
				range-$50 to $3,000. Penalties in the range of $50 to $3,000 per day are
				imposed for deficiencies that do not constitute immediate jeopardy, but either
				caused actual harm, or caused no actual harm, but have the potential for more
				than minimal harm.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.51 - Civil Money Penalties-effective Date and Duration of Penalty

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
When
				penalty begins to accrue.
The civil money penalty may start accruing
				as early as the date the facility was first out of compliance, as determined by
				the department of inspections and appeals.
(2)
Duration of penalty.
The
				civil money penalty is computed and collectible, as specified in rules
				441-81.47
				(249A) and
				441-81.52
				(249A), for the number of days of noncompliance until the date the facility
				achieves substantial compliance or, if applicable, the date of termination
				when:
a. The department of inspections and
				appeals' decision of noncompliance is upheld after a final administrative
				decision;
b. The facility waives
				its right to a hearing in accordance with rule
				441-81.49
				(249A); or
c. The time for
				requesting a hearing has expired and the department of inspections and appeals
				has not received a hearing request from the facility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.52 - Civil Money Penalties-due Date for Payment of Penalty

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
When payments are due.
a. A civil money penalty payment is due 15
				days after a final administrative decision is made when:
(1) The facility achieves substantial
				compliance before the final administrative decision; or
(2) The effective date of termination occurs
				before the final administrative decision.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.53 - Use of Penalties Collected by the Department

Current through Register Vol. 47, No. 3, July 24, 2024
Civil money penalties collected by the department shall be
				  applied to the protection of the health or property of residents of facilities
				  that the department of inspections and appeals finds deficient. Funds may be
				  used for:
1. Time-limited expenses
				incurred in the process of relocating residents to home- and community-based
				settings or other facilities when a facility is closed or downsized pursuant to
				an agreement with the department;
2. Recovery of state costs related to the
				operation of a facility pending correction of deficiencies or
				closure;
3. Support and protection
				of residents of a facility that closes;
4. Funding of projects to improve the quality
				of life and quality of care of nursing facility residents through quality
				improvement initiative grants awarded pursuant to 441-Chapter 166;
5. Projects that support resident and family
				councils and other consumer involvement in ensuring quality care in facilities;
				and
6. Reasonable expenses incurred
				by the department to administer, monitor, or evaluate the effectiveness of
				grants utilizing civil money penalty funds.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.54 - Continuation of Payments to a Facility With Deficiencies

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Criteria.
a. The department may continue payments to a
				facility that is not in substantial compliance for the periods specified in
				subrule 81.54(3) if the following criteria are met:
(1) The department of inspections and appeals
				finds that it is more appropriate to impose alternative remedies than to
				terminate the facility;
(2) The
				department of inspections and appeals has submitted a plan and timetable for
				corrective action approved by CMS; and
(3) The facility agrees to repay the
				department for all payments received under this provision if corrective action
				is not taken in accordance with the approved plan and timetable for corrective
				action and posts a bond acceptable to the department to guarantee agreement to
				repay.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.55 - State and Federal Disagreements Involving Findings Not in Agreement When There Is No Immediate Jeopardy

Current through Register Vol. 47, No. 3, July 24, 2024
This rule applies when CMS and the department of inspections
				  and appeals disagree over findings of noncompliance or application of
				  remedies.
(1)
Disagreement
				over whether facility has met requirements.
a. The department of inspections and appeals'
				finding of noncompliance takes precedence when:
(1) CMS finds the facility is in substantial
				compliance with the participation requirements; and
(2) The department of inspections and appeals
				finds the facility has not achieved substantial compliance.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.56 - Duration of Remedies

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Remedies continue.
Except as specified in subrule 81.56(2),
				alternative remedies continue until:
a. The
				facility has achieved substantial compliance as determined by the department of
				inspections and appeals based upon a revisit or after an examination of
				credible written evidence that it can verify without an on-site visit;
				or
b. The provider agreement is
				terminated.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 81 - Nursing Facilities › Rule 441-81.57 - Termination of Provider Agreement

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Effect of termination.
Termination of the provider agreement ends payment to the facility and any
				ahemative remedy.
(2)
Basis
				of termination.
a. A facility's
				provider agreement may be terminated if a facility:
(1) Is not in substantial compliance with the
				requirements of participation, regardless of whether or not immediate jeopardy
				is present; or
(2) Fails to submit
				an acceptable plan of correction within the time frame specified by the
				department of inspections and appeals.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.1 - Definition

Current through Register Vol. 47, No. 3, July 24, 2024
"Department"
means the Iowa department of
				  human services.
"Intermediate care facility for persons with an
				  intellectual disability (ICF/ID)"
means an institution that is
				  primarily for the diagnosis, treatment, or rehabilitation of persons with an
				  intellectual disability or persons with related conditions and that provides,
				  in a protected residential setting, ongoing evaluation, planning, 24-hour
				  supervision, coordination and integration of health or related services to help
				  each person function at the greatest ability and is an approved Medicaid
				  vendor.
"Intermediate care facility for persons with an
				  intellectual disability level of care"
means that the individual has a
				  diagnosis of intellectual disability made in accordance with the criteria
				  provided in the current version of the Diagnostic and Statistical Manual of
				  Mental Disorders published by the American Psychiatric Association; or has a
				  related condition as defined in
				  42 CFR
				  435.1009 as amended to March 29, 2022; and
				  needs assistance in at least three of the following major life areas: mobility,
				  musculoskeletal skills, activities of daily living, domestic skills, toileting,
				  eating skills, vision, hearing or speech or both, gross/fine motor skills,
				  sensory-taste, smell, tactile, academic skills, vocational skills,
				  social/community skills, behavior, and health care.
"Intermediate care facility for persons with medical
				  complexity"
means an intermediate care facility for persons with an
				  intellectual disability which provides health and rehabilitation services to
				  individuals who require a skilled nursing level of care, have either a multiple
				  organ dysfunction or severe single organ dysfunction, and require daily use of
				  medical resources or technology.
"Managed care organization"
means an entity
				  that (1) is under contract with the department to provide services to Medicaid
				  recipients and (2) meets the definition of "health maintenance organization" as
				  defined in Iowa Code section
				  514B.1.
This rule is intended to implement Iowa Code section
				  249A.12.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.2 - Licensing and Certification

Current through Register Vol. 47, No. 3, July 24, 2024
In order to participate in the program, a facility shall be
				  licensed as an intermediate care facility for persons with an intellectual
				  disability by the department of inspections and appeals under the department of
				  inspections and appeals rules found in 481-Chapter 64. The facility shall meet
				  the following conditions of participation:
(1)
Governing body and
				management.
a.
Governing
				body.
The facility shall identify an individual or individuals to
				constitute the governing body of the facility. The governing body shall:
(1) Exercise general policy, budget, and
				operating direction over the facility.
(2) Set the qualifications (in addition to
				those already set by state law) for the administrator of the
				facility.
(3) Appoint the
				administrator of the facility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.3 - Conditions of Participation for Intermediate Care Facilities for Persons With an Intellectual Disability

Current through Register Vol. 47, No. 3, July 24, 2024
All intermediate care facilities for persons with an
				  intellectual disability must enter into a contractual agreement with the
				  department which sets forth the terms under which they will participate in the
				  program.
(1)
Procedures for
				establishing health care facilities as Title XIX facilities.
All
				survey procedures and the certification process shall be in accordance with
				Department of Health and Human Services publication "Providers Certification
				State Operations Manual."
a. The facility
				shall obtain the applicable license from the department of inspections and
				appeals.
b. The facility shall
				request an application, Form 470-0254, from the Iowa Medicaid provider services
				unit.
c. The department shall
				transmit an application form and copies of standards to the facility.
d. The facility shall complete its portion of
				the application form and submit it to the department.
e. The department shall review the
				application form and forward it to the department of inspections and
				appeals.
f. The department of
				inspections and appeals shall schedule and complete a survey of the
				facility.
g. The department of
				inspections and appeals shall notify the facility of any deficiencies and ask
				for a plan for the correction of the deficiencies.
h. The facility shall submit a plan of
				correction within ten days after receipt of written deficiencies from the
				health facilities division, department of inspections and appeals. This plan
				must be approved before the facility can be certified.
i. The department of inspections and appeals
				shall evaluate the survey findings and plan of correction and either recommend
				the facility for certification or recommend denial of certification. The date
				of certification will be the date of approval of the plan of
				corrections.
j. When certification
				is recommended, the department of inspections and appeals shall notify the
				department recommending terms and conditions of a provider agreement.
k. The department shall review the
				certification data and:
(1) Transmit the
				provider agreement as recommended, or
(2) Transmit the provider agreement for a
				term less than recommended by the department of inspections and appeals or
				elect not to execute an agreement for reasons of good cause as defined in
				82.3(2)
"c."
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.6 - Eligibility for Services

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Interdisciplinary team.
The initial evaluation for admission
				shall be conducted by an interdisciplinary team. The team shall consist of a
				physician, a social worker, and other professionals. At least one member of the
				team shall be a qualified intellectual disability professional.
(2)
Evaluation.
The
				evaluation shall include a comprehensive medical, social, and psychological
				evaluation. The comprehensive evaluation shall include:
a. Diagnoses, summaries of present medical,
				social and where appropriate, developmental findings, medical and social family
				history, mental and physical functional capacity, prognoses, range of service
				needs, and amounts of care required.
b. An evaluation of the resources available
				in the home, family, and community.
c. An explicit recommendation with respect to
				admission or in the case of persons who make application while in the facility,
				continued care in the facility. Where it is determined that intermediate care
				facility for persons with an intellectual disability services are required by
				an individual whose needs might be met through the use of alternative services
				which are currently unavailable, this fact shall be entered in the record, and
				plans shall be initiated for the active exploration of alternatives.
d. An individual plan for care shall include
				diagnosis, symptoms, complaints or complications indicating the need for
				admission, a description of the functional level of the resident; written
				objective; orders as appropriate for medications, treatments, restorative and
				rehabilitative services, therapies, diet, activities, social services, and
				special procedures designed to meet the objectives; and plans for continuing
				care, including provisions for review and necessary modifications of the plan,
				and discharge.
e. Written reports
				of the evaluation and the written individual plan of care shall be delivered to
				the facility and entered in the individual's record at the time of admission
				or, in the case of individuals already in the facility, immediately upon
				completion.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.7 - Initial Approval for Icf/id Care

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Referral through targeted case management.
Persons seeking
				ICF/ID placement shall be referred through targeted case management. The case
				management program shall:
a. Identify
				appropriate service alternatives;
b. Inform the person of the alternatives;
				and
c. Refer a person without
				appropriate alternatives to the department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.8 - Determination of Need for Continued Stay

Current through Register Vol. 47, No. 3, July 24, 2024
For clients not enrolled with a managed care organization,
				  certification of need for continued stay shall be made according to procedures
				  established by the Iowa Medicaid QIO unit. For all clients enrolled with a
				  managed care organization, the managed care organization shall review the
				  Medicaid client's need for continued care in an ICF/ID at least annually. The
				  managed care organization must submit documentation to the Iowa Medicaid QIO
				  unit for all reviews that indicate a change in the client's level of care. The
				  Iowa Medicaid QIO unit shall make a final determination for any reviews that
				  indicate a change in the level of care.
This rule is intended to implement Iowa Code section
				  249A.12.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.10 - Discharge and Transfer

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Notice.
When a Medicaid member requests transfer or discharge
				to a community setting, or another person requests this for the member, the
				administrator shall promptly notify a targeted case management provider Names
				of local providers are available from the department's local office. This shall
				be done in sufficient time to permit a case manager to assist in the decision
				and planning for the transfer or discharge.
(2)
Case activity report.
A
				Case Activity Report, Form 470-0042, shall be submitted to the department
				whenever a Medicaid applicant or member enters the facility, changes level of
				care, or is discharged from the facility.
(3)
Plan.
The administrator
				and staff shall assist the resident in planning for transfer or discharge
				through development of a discharge plan.
(4)
Transfer records.
When a
				resident is transferred to another facility, transfer information shall be
				summarized from the facility's records in a copy to accompany the resident.
				This information shall include:
a. A transfer
				form of diagnosis.
b. Aid to daily
				living information.
c. Transfer
				orders.
d. Nursing care
				plan.
e. Physician's or qualified
				mental retardation professional's orders for care.
f. The resident's personal records.
g. When applicable, the personal needs fund
				record.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.13 - Records

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Content.
The facility shall at a minimum maintain the
				following records:
a. All records required by
				the department of public health and the department of inspections and
				appeals.
b. Medical records as
				required by Section 1902(a)(31) of Title XIX of the Social Security
				Act.
c. Records of all treatments,
				drugs and services for which vendors' payments have been made or are to be made
				under the medical assistance program, including the authority for and the date
				of administration of the treatment, drugs, or services.
d. Documentation in each resident's records
				which will enable the department to verify that each charge is due and proper
				prior to payment.
e. Financial
				records maintained in the standard, specified form including the facility's
				most recent audited cost report.
f.
				All other records as may be found necessary by the department in determining
				compliance with any federal or state law or rule or regulation promulgated by
				the United States Department of Health and Human Services or by the
				department.
g. Census records to
				include the date, number of residents at the beginning of each day, names of
				residents admitted, and names of residents discharged.
(1) Census information shall be provided for
				residents in skilled, intermediate, and residential care.
(2) Census figures for each type of care
				shall be totaled monthly to indicate the number admitted, the number
				discharged, and the number of patient days.
(3) Failure to maintain acceptable census
				records shall result in the per diem rate being computed on the basis of 100
				percent occupancy and a request for refunds covering indicated recipients of
				nursing care which have not been properly accounted for.
h. Resident accounts.
i. Inservice education program
				records.
j. Inspection reports
				pertaining to conformity with federal, state, and local laws.
k. Residents' personal records.
l. Residents' medical records.
m. Disaster preparedness reports.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.14 - Payment Procedures

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Method of payment.
Facilities shall be reimbursed under a
				cost-related vendor payment program. A per diem rate shall be established based
				on information submitted according to rule
				441-82.5 (249A).
(2) and
82.14(3)
Reserved.
(4)
Periods
				authorized for payment.
a. Payment
				shall be made on a per diem basis for the portion of the month the resident is
				in the facility.
b. Payment will be
				authorized as long as the resident is certified as needing care in an
				intermediate care facility for persons with an intellectual
				disability.
c. Payment will be
				approved for the day of admission but not the day of discharge or
				death.
d. Payment will be approved
				for periods the resident is absent to visit home for a maximum of 30 days
				annually. Additional days may be approved for special programs of evaluation,
				treatment or habilitation outside the facility. Documentation as to the
				appropriateness and therapeutic value of resident visits and outside
				programming, signed by a physician or qualified intellectual disability
				professional, shall be maintained at the facility.
e. Payment will be approved for a period not
				to exceed ten days in any calendar month when the resident is absent due to
				hospitalization. Medicaid payment to the facility may not be initiated while a
				resident is on reserve bed days unless the person was residing in the facility
				as a private pay resident prior to the hospitalization and returns to the
				facility as a resident.
f. Payment
				for periods when residents are absent for visitation or hospitalization from
				facilities with more than 15 beds will be made at 80 percent of the allowable
				audited costs for those beds. Facilities with 15 or fewer beds will be
				reimbursed at 95 percent of the allowable audited costs for those
				beds.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.15 - Billing Procedures

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Claims.
Claims for service for clients not enrolled with a
				managed care organization must be sent to the Iowa Medicaid after the month of
				service and within 365 days of the date of service. Such claims must be
				submitted electronically through Iowa Medicaid's electronic clearinghouse.
a. A remittance advice of the claims paid may
				be obtained through the Iowa Medicaid portal access (IMPA) system.
b. Adjustments to claims may be made
				electronically as provided for by the Iowa Medicaid.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.16 - Closing of Facility

Current through Register Vol. 47, No. 3, July 24, 2024
When a facility is planning on closing, the department and
				  the department's contracted managed care organizations with which the facility
				  is enrolled shall be notified at least 60 days in advance of the closing. Plans
				  for the transfer of residents receiving Medicaid shall be approved by the
				  resident's managed care organization or by the Iowa Medicaid enterprise for
				  residents not enrolled with a managed care organization.
This rule is intended to implement Iowa Code section
				  249A.12.