Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Adult"
means a person 18 years of age or
				  older on the first day of the month in which service begins.
"Applicant"
means a person who has applied
				  for an HCBS waiver or habilitation program.
"Care coordination"
means the case
				  management services provided by an integrated health home to members who are
				  also receiving home- and community-based habilitation services pursuant to
				  441-Chapter 78 or HCBS children's mental health waiver services pursuant to
				  441-Chapter 83.
"Case management"
means the categories of
				  case management: targeted case management, case management provided to members
				  enrolled in a 1915(c) waiver, community-based case management provided through
				  managed care, and integrated health home (IHH) care coordination provided to
				  the habilitation and children's mental health waiver populations.
"Case manager"
means the staff person
				  providing all categories of case management services regardless of the entity
				  providing the service or the program in which the member is enrolled, including
				  IHH care coordination.
"Child"
means a person other than an
				  adult.
"Chronic mental illness"
means a condition
				  present in adults who have a persistent mental or emotional disorder that
				  seriously impairs their functioning relative to such primary aspects of daily
				  living as personal relations, living arrangements, or employment. The
				  definition of chronic mental illness and qualifying criteria are found in
				  441-Chapter 24. For purposes of this chapter, people with mental disorders
				  resulting from Alzheimer's disease or substance abuse shall not be considered
				  chronically mentally ill.
"Community-based case manager"
means the
				  employee of a Medicaid-contracted managed care organization (MCO) who provides
				  case management services to MCO-enrolled members.
"Core standardized assessment"
or
"CSA"
means an assessment instrument for determining the
				  suitability of non-institutionally based long-term services and supports for an
				  individual. The instrument shall be used in a uniform manner throughout the
				  state to determine an applicant's or member's needs for training, support
				  services, medical care, transportation, and other services and to develop an
				  individual service plan to address such needs. The core standardized assessment
				  shall be performed by a contractor under the direction of the department for
				  the fee-for-service population. MCOs shall perform core standardized
				  assessments for MCO-enrolled members or shall delegate the responsibility for
				  completion of assessments. 441-Chapter 83 designates the assessment and
				  reassessment tools to be used for each HCBS waiver. 441-Chapter 78 designates
				  the assessment and reassessment tools to be used for habilitation.
"Department"
means the department of human
				  services.
"Developmental disability"
means a severe,
				  chronic disability that is determined through professionally administered
				  screening and evaluations and that:
1.
				Is attributable to a mental or physical impairment or combination of mental and
				physical impairments;
2. Is
				manifested before the age of 22;
3.
				Is likely to continue indefinitely;
4. Results in substantial functional
				limitations in three or more of the following areas of major life activity:
(a) self-care,
(b) receptive and expressive
				language,
(c) learning,
(d) mobility,
(e) self-direction,
(f) capacity for independent living,
				and
(g) economic self-sufficiency;
				and