Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 78 - Amount, Duration and Scope of Medical and Remedial Services › Rule 441-78.27 - Home- and Community-based Habilitation Services

Current through Register Vol. 47, No. 3, July 24, 2024
Payment for habilitation services will only be made to
				  providers enrolled to provide habilitation through the Iowa Medicaid
				  enterprise. Effective March 17, 2022, payment shall only be made for services
				  provided to members in integrated, community-based settings that support full
				  access of members receiving Medicaid HCBS to the greater community, including
				  opportunities to seek employment and work in competitive integrated settings,
				  engage in community life, control personal resources, and receive services in
				  the community, to the same degree of access as individuals not receiving
				  Medicaid HCBS.
(1)
Definitions.
"Adult"
means a person who is 18 years of
				  age or older.
"Assessment"
means the review of the current
				  functioning of the member using the service in regard to the member's
				  situation, needs, strengths, abilities, desires, and goals.
"Benefits education"
means providing basic
				  information to understand and access appropriate resources to pursue
				  employment, and knowledge of work incentives and the Medicaid for employed
				  persons with disabilities (MEPD) program. Benefits education may include
				  gathering information needed to pursue work incentives and offering basic
				  financial management information to members, families, guardians and legal
				  representatives.
"Care coordinator"
means the professional
				  who assists members in care coordination as described in paragraph
				  78.53(2)
"b."
"Career exploration,"
also referred to as
				  "career planning," means a person-centered, comprehensive employment planning
				  and support service that provides assistance for waiver program participants to
				  obtain, maintain or advance in competitive employment or self-employment.
				  Career exploration is a focused, time-limited service engaging a participant in
				  identifying a career direction and developing a plan for achieving competitive,
				  integrated employment at or above the state's minimum wage. The outcome of this
				  service is documentation of the participant's stated career objective and a
				  career plan used to guide individual employment support.
"Career plan"
means a written plan
				  documenting the member's stated career objective and used to guide individual
				  employment support services for achieving competitive, integrated employment at
				  or above the state's minimum wage.
"Case management"
means case management
				  services accredited under 441-Chapter 24 and provided according to 441-Chapter
				  90.
"Certified employment specialist"
or
"CES"
means a person who has demonstrated a sufficient level
				  of knowledge and skill to provide integrated employment support services to a
				  variety of client populations and has earned a CES certification through a
				  nationally recognized accrediting body.
"Child and Adolescent Level of Care Utilization
				  System"
or
"CALOCUS"
means the comprehensive
				  functional assessment tool utilized to determine eligibility for the
				  habilitation program and service authorization for the home-based habilitation
				  service for individuals aged 16 to 18.
"Comprehensive service plan"
means an
				  individualized, person-centered, and goal-oriented plan of services written in
				  language understandable by the member using the service and developed
				  collaboratively by the member and the case manager.
"Customized employment"
means an approach to
				  supported employment which individualizes the employment relationship between
				  employees and employers in ways that meet the needs of both. Customized
				  employment is based on an individualized determination of the strengths, needs,
				  and interests of the person with a disability and is also designed to meet the
				  specific needs of the employer. Customized employment may include employment
				  developed through job carving, self-employment or entrepreneurial initiatives,
				  or other job development or restructuring strategies that result in job
				  responsibilities being customized and individually negotiated to fit the needs
				  of the individual with a disability. Customized employment assumes the
				  provision of reasonable accommodations and supports necessary for the
				  individual to perform the functions of a job that is individually negotiated
				  and developed.
"Department"
means the Iowa department of
				  human services.
"Emergency"
means a situation for which no
				  approved individual program plan exists that, if not addressed, may result in
				  injury or harm to the member or to other persons or in significant amounts of
				  property damage.
"HCBS"
means home- and community-based
				  services.
"Individual employment"
means employment in
				  the general workforce where the member interacts with the general public to the
				  same degree as nondisabled persons in the same job, and for which the member is
				  paid at or above minimum wage, but not less than the customary wage and level
				  of benefits paid by the employer for the same or similar work performed by
				  persons without disabilities.
"Individual placement and support"
or
"IPS"
means the evidence-based practice of supported
				  employment that is guided by IPS practice principles outlined by the IPS
				  Employment Center at Westat, and as measured by its most recently published
				  25-item supported employment fidelity scale available online at
				  ipsworks.org/wp-content/uploads/2017/08/ips-fidelity-manual-3rd-edition_2-4-16.pdf.
				  The IPS practice principles are:
1.
				Focus on competitive employment: Agencies providing IPS services are committed
				to competitive employment as an attainable goal for people with behavioral
				health conditions seeking employment. Mainstream education and specialized
				training may enhance career paths.
2. Zero exclusion criteria based on client
				choice: People are not excluded on the basis of readiness, diagnoses, symptoms,
				substance use history, psychiatric hospitalizations, homelessness, level of
				disability, or legal system involvement.
3. Integration of rehabilitation and mental
				health services: IPS programs are closely integrated with mental health
				treatment teams.
4. Attention to
				worker preferences: Services are based on each person's preferences and
				choices, rather than providers' judgments.
5. Personalized benefits counseling:
				Employment specialists help people obtain personalized, understandable, and
				accurate information about their social security, Medicaid, and other
				government entitlements.
6. Rapid
				job search: IPS programs use a rapid job search approach to help job seekers
				obtain jobs directly, rather than providing lengthy preemployment assessment,
				training, and counseling. If further education is part of their plan, IPS
				specialists assist in these activities as needed.
7. Systematic job development: Employment
				specialists systematically visit employers, who are selected based on job
				seeker preferences, to learn about their business needs and hiring
				preferences.
8. Time-unlimited and
				individualized support: Job supports are individualized and continue for as
				long as each worker wants and needs the support.
"Integrated community employment"
means work
				  (including self-employment) for which an individual with a disability is paid
				  at or above minimum wage and not less than the customary wage and level of
				  benefits paid by the employer for the same or similar work performed by
				  employees who are not disabled, where the individual interacts with other
				  persons who are not disabled to the same extent as others who are in comparable
				  positions, and which presents opportunities for advancement that are similar to
				  those for employees who are not disabled. In the case of an individual who is
				  self-employed, the business results in an income that is comparable to the
				  income received by others who are not disabled and are self-employed in similar
				  occupations.
"Integrated health home services"
means the
				  provision of services to enrolled members as described in subrule
				  78.53(2).
"Intensive residential service homes"
or
"intensive residential services"
means intensive,
				  community-based services provided 24 hours per day, 7 days per week, 365 days
				  per year to individuals with a severe and persistent mental illness who have
				  functional impairments and may also have multi-occurring conditions. Providers
				  of intensive residential service homes are enrolled with Medicaid as providers
				  of HCBS habilitation or HCBS intellectual disability waiver supported community
				  living and meet additional criteria specified in 441-subrule 25.6(8).
"Interdisciplinary team"
means a group of
				  persons with varied professional backgrounds who meet with the member to
				  develop a comprehensive service plan to address the member's need for
				  services.
"ISIS"
means the department's individualized
				  services information system.
"Level of Care Utilization System"
or
"LOCUS"
means the comprehensive functional assessment tool
				  utilized to determine eligibility for the habilitation program and service
				  authorization for the home-based habilitation service for individuals aged 19
				  and older.
"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.
"Member"
means a person who has been
				  determined to be eligible for Medicaid under 441-Chapter 75.
"Program"
means a set of related resources
				  and services directed to the accomplishment of a fixed set of goals for
				  qualifying members.
"Severe and persistent mental illness"
means
				  the same as defined in rule
				  441-25.1 (331).
"Supported employment"
means the ongoing
				  supports to participants who, because of their disabilities, need intensive
				  ongoing support to obtain and maintain an individual job in competitive or
				  customized employment, or self-employment, in an integrated work setting in the
				  general workforce at or above the state's minimum wage or at or above the
				  customary wage and level of benefits paid by the employer for the same or
				  similar work performed by individuals without disabilities. The outcome of this
				  service is sustained paid employment at or above the minimum wage in an
				  integrated setting in the general workforce in a job that meets personal and
				  career goals. Supported employment services can be provided through many
				  different service models.
"Supported self-employment"
includes
				  services and supports that assist the participant in achieving self-employment
				  through the operation of a business; however, Medicaid funds may not be used to
				  defray the expenses associated with starting up or operating a business.
				  Assistance for self-employment may include aid to the individual in identifying
				  potential business opportunities; assistance in the development of a business
				  plan, including potential sources of business financing and other assistance in
				  developing and launching a business; identification of the supports necessary
				  for the individual to operate the business; and ongoing assistance, counseling
				  and guidance once the business has been launched.
"Sustained employment"
means an individual
				  employment situation that the member maintains over time but not for less than
				  90 calendar days following the receipt of employment services and
				  supports.