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 441-77.39 - Hcbs Brain Injury Waiver Service Providers

Current through Register Vol. 47, No. 3, July 24, 2024
Providers shall be eligible to participate in the Medicaid
				  brain injury waiver program if they meet the requirements in this rule and the
				  subrules applicable to the individual service. Beginning January 1, 2015,
				  providers initially enrolling to deliver BI waiver services and each of their
				  staff members involved in direct consumer service must have completed the
				  department's brain injury training modules one and two within 60 days from the
				  beginning date of service provision, with the exception of staff members who
				  are certified through the Academy of Certified Brain Injury Specialists (ACBIS)
				  as a certified brain injury specialist (CBIS) or certified brain injury
				  specialist trainer (CBIST), providers of home and vehicle modification,
				  specialized medical equipment, transportation, personal emergency response,
				  financial management, independent support brokerage, self-directed personal
				  care, individual-directed goods and services, and self-directed community
				  supports and employment. Providers enrolled to provide BI waiver services and
				  each of their staff members involved in direct consumer service on or before
				  December 31, 2014, shall be deemed to have completed the required
				  training.
Services shall be rendered by a person who is at least 16
				  years old (except as otherwise provided in this rule) and is not the spouse of
				  the consumer served or the parent or stepparent of a consumer aged 17 or under.
				  People who are 16 or 17 years old must be employed and supervised by an
				  enrolled HCBS provider unless they are employed to provide self-directed
				  personal care services through the consumer choices option. A person hired for
				  self-directed personal care services need not be supervised by an enrolled HCBS
				  provider. A person hired through the consumer choices option for independent
				  support brokerage, self-directed personal care, individual-directed goods and
				  services, or self-directed community support and employment is not required to
				  enroll as a Medicaid provider and is not subject to review under subrule
				  77.39(11). Consumer-directed attendant care and interim medical monitoring and
				  treatment providers must be at least 18 years of age.
In addition, behavioral programming, supported community
				  living, and supported employment providers shall meet the outcome-based
				  standards set forth below in subrules 77.39(1) and 77.39(2) evaluated according
				  to subrules 77.39(8) to 77.39(10), and the requirements of subrules 77.39(3) to
				  77.39(7). Respite providers shall also meet the standards in subrule
				  77.39(1).
The integrated, community-based settings standards in subrule
				  77.25(5) apply to all HCBS brain injury waiver service providers.
(1)
Organizational standards (Outcome
				1).
Organizational outcome-based standards for HCBS BI providers are
				as follows:
a. The organization demonstrates
				the provision and oversight of high-quality supports and services to
				consumers.
b. The organization
				demonstrates a defined mission commensurate with consumers' needs, desires, and
				abilities.
c. The organization
				establishes and maintains fiscal accountability.
d. The organization has qualified staff
				commensurate with the needs of the consumers they serve. These staff
				demonstrate competency in performing duties and in all interactions with
				clients.
e. The organization
				provides needed training and supports to its staff. This training includes at a
				minimum:
(1) Consumer rights.
(2) Confidentiality.
(3) Provision of consumer
				medication.
(4) Identification and
				reporting of child and dependent adult abuse.
(5) Individual consumer support needs.
f. The organization has
				a systematic, organizationwide, planned approach to designing, measuring,
				evaluating, and improving the level of its performance. The organization:
(1) Measures and assesses organizational
				activities and services annually.
(2) Gathers information from consumers,
				family members, and staff.
(3)
				Conducts an internal review of consumer service records, including all major
				and minor incident reports according to subrule 77.37(8).
(4) Tracks incident data and analyzes trends
				annually to assess the health and safety of consumers served by the
				organization.
(5) Identifies areas
				in need of improvement.
(6)
				Develops a plan to address the areas in need of improvement.
(7) Implements the plan and documents the
				results.
g. Consumers and
				their legal representatives have the right to appeal the provider's
				implementation of the 20 outcomes, or staff or contractual person's action
				which affects the consumer. The provider shall distribute the policies for
				consumer appeals and procedures to consumers.
h. The provider shall have written policies
				and procedures and a staff training program for the identification and
				reporting of child and dependent adult abuse to the department pursuant to
				441-Chapters 175 and 176.
i. The
				governing body has an active role in the administration of the
				agency.
j. The governing body
				receives and uses input from a wide range of local community interests and
				consumer representation and provides oversight that ensures the provision of
				high-quality supports and services to consumers.