Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 77 - Conditions of Participation for Providers of Medical and Remedial Care › Rule 441-77.46 - Hcbs Children's Mental Health Waiver Service Providers

Current through Register Vol. 47, No. 3, July 24, 2024
HCBS children's mental health waiver services shall be
				  rendered by provider agencies that meet the general provider standards in
				  subrule 77.46(1) and the integrated, community-based settings standards in
				  subrule 77.25(5) and also meet the standards in subrules 77.46(2) to 77.46(5)
				  that are specific to the waiver services provided. A provider that is approved
				  for the same service under another HCBS Medicaid waiver shall be eligible to
				  enroll for that service under the children's mental health waiver.
(1)
General provider
				standards.
All providers of HCBS children's mental health waiver
				services shall meet the following standards:
a.
Fiscal capacity.
Providers must demonstrate the fiscal capacity to provide services on an
				ongoing basis.
b.
Direct
				care staff.
(1) Direct care staff
				must be at least 18 years of age.
(2) Providers must complete child abuse,
				dependent adult abuse, and criminal background screenings pursuant to Iowa Code
				section
				249A.29
				before employment of a staff member who will provide direct care.
(3) Direct care staff may not be the spouse
				of the consumer or the parent or stepparent of the consumer.
c.
Outcome-based standards
				and quality assurance.
(1) Providers
				shall implement the following outcome-based standards for the rights and
				dignity of children with serious emotional disturbance:
1. Consumers are valued.
2. Consumers are a part of community
				life.
3. Consumers develop
				meaningful goals.
4. Consumers
				maintain physical and mental health.
5. Consumers are safe.
6. Consumers and their families have an
				impact on the services received.
(2) The department's quality assurance staff
				shall conduct random quality assurance reviews to assess the degree to which
				the outcome-based standards have been implemented in service provision. Results
				of outcome-based quality assurance reviews shall be forwarded to the certifying
				or accrediting entity.
(3) A
				quality assurance review shall include interviews with the consumer and the
				consumer's parents or legal guardian, with informed consent, and interviews
				with designated targeted case managers.
(4) A quality assurance review may include
				interviews with provider staff, review of case files, review of staff training
				records, review of compliance with the general provider standards in this
				subrule, and review of other organizational policies and procedures and
				documentation.
(5) Corrective
				action shall be required if the quality assurance review demonstrates that
				service provision or provider policies and procedures do not reflect the
				outcome-based standards. Technical assistance for corrective action shall be
				available from the department's quality assurance staff.
d.
Incident management and
				reporting.
As a condition of participation in the medical assistance
				program, HCBS children's mental health waiver service providers must comply
				with the requirements of Iowa Code sections
				232.69
				and
				235B.3
				regarding the reporting of child abuse and dependent adult abuse and must
				comply with the following incident management and reporting requirements.
				EXCEPTION: The conditions in this paragraph do not apply to providers of
				environmental modifications and adaptive devices.
(1) Definitions.
"Major incident"
means an occurrence
				  involving a consumer during service provision that:
1. Results in a physical injury to or by the
				consumer that requires a physician's treatment or admission to a
				hospital;
2. Results in the death
				of any person;
3. Requires
				emergency mental health treatment for the consumer;
4. Requires the intervention of law
				enforcement;
5. Requires a report
				of child abuse pursuant to Iowa Code section
				232.69
				or a report of dependent adult abuse pursuant to Iowa Code section
				235B.3;
6. Constitutes a prescription medication
				error or a pattern of medication errors that leads to the outcome in paragraph
				"1," "2," or "3"; or
7. Involves a
				consumer's location being unknown by provider staff who are assigned protective
				oversight.
"Minor incident"
means an occurrence
				  involving a consumer during service provision that is not a major incident and
				  that:
1. Results in the application of
				basic first aid;
2. Results in
				bruising;
3. Results in seizure
				activity;
4. Results in injury to
				self, to others, or to property; or
5. Constitutes a prescription medication
				error.
(2) Reporting
				procedure for minor incidents. Minor incidents may be reported in any format
				designated by the provider. When a minor incident occurs or a staff member
				becomes aware of a minor incident, the staff member involved shall submit the
				completed incident report to the staff member's supervisor within 72 hours of
				the incident. The completed report shall be maintained in a centralized file
				with a notation in the consumer's file.
(3) Notification procedure for major
				incidents. When a major incident occurs or a staff member becomes aware of a
				major incident, the staff member involved shall notify the following persons of
				the incident by the end of the next calendar day after the incident:
1. The staff member's supervisor.
2. The consumer or the consumer's legal
				guardian. EXCEPTION: Notification to the consumer is required only if the
				incident took place outside of the provider's service provision. Notification
				to the guardian, if any, is always required.
3. The consumer's case manager.
(4) Reporting procedure for major
				incidents. By the end of the next calendar day after a major incident, the
				staff member who observed or first became aware of the incident shall also
				report as much information as is known about the incident to the member's
				managed care organization in the format defined by the managed care
				organization. If the member is not enrolled with a managed care organization,
				the staff member shall report the information to the department's bureau of
				long-term care either:
1. By direct data
				entry into the Iowa Medicaid Provider Access System, or
2. By faxing or mailing Form 470-4698,
				Critical Incident Report, according to the directions on the form.
(5) Information to be reported.
				The following information shall be reported about a major incident:
1. The name of the consumer
				involved.
2. The date and time the
				incident occurred.
3. A description
				of the incident.
4. The names of
				all provider staff and others who were present at the time of the incident or
				who responded after becoming aware of the incident. The confidentiality of
				other waiver-eligible or non-waiver-eligible consumers who were present must be
				maintained by the use of initials or other means.
5. The action that the provider staff took to
				manage the incident.
6. The
				resolution of or follow-up to the incident.
7. The date the report is made and the
				handwritten or electronic signature of the person making the report.
(6) Response to report. Submission
				of the initial report will generate a workflow in the Individualized Services
				Information System (ISIS) for follow-up by the case manager. When complete
				information about a major incident is not available at the time of the initial
				report, the provider must submit follow-up reports until the case manager is
				satisfied with the incident resolution and follow-up. The completed report
				shall be maintained in a centralized file with a notation in the consumer's
				file.
(7) Tracking and analysis.
				The provider shall track incident data and analyze trends to assess the health
				and safety of consumers served and determine if changes need to be made for
				service implementation or if staff training is needed to reduce the number or
				severity of incidents.