Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.2 - Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
Tobe eligible for health and disability waiver services, a
				  person must meet certain eligibility criteria and be determined to need a
				  service(s) allowable under the program.
(1)
Eligibility criteria.
a. The person must be under the age of 65 and
				blind or disabled as determined by the receipt of social security disability
				benefits or by a disability determination made through the department.
				Disability determinations are made according to supplemental security income
				guidelines under Title XVI of the Social Security Act.
b. Rescinded IAB 1/2/19, effective
				2/6/19.
c. Persons shall meet the
				eligibility requirements of the supplemental security income program except for
				the following:
(1) The person is under 18
				years of age, unmarried and not the head of a household and is ineligible for
				supplemental security income because of the deeming of the parent's(s')
				income.
(2) The person is married
				and is ineligible for supplemental security income because of the deeming of
				the spouse's income or resources.
(3) The person is ineligible for supplemental
				security income due to excess income and the person's income does not exceed
				300 percent of the maximum monthly payment for one person under supplemental
				security income.
(4) The person is
				under 18 years of age and is ineligible for supplemental security income
				because of excess resources.
d. The person must be certified as being in
				need of nursing facility or skilled nursing facility level of care or as being
				in need of care in an intermediate care facility for persons with an
				intellectual disability, based on information submitted on a completed
				information submission tool Form 470-4694 for children aged 3 and under, the
				interRAI - Pediatric Home Care (PEDS-HC) for those aged 4 to 20, or the
				interRAI - Home Care (HC) for those aged 21 to 64 and other supporting
				documentation as relevant. Form 470-4694, the interRAI - Pediatric Home Care
				(PEDS-HC) and the interRAI - Home Care (HC) are available upon request from the
				IME medical services unit. Copies of the completed information submission tool
				for an individual are available to that individual from the individual's case
				manager or managed care organization.
(1) The
				member's designated case manager shall use the completed assessment to develop
				the comprehensive service plan as specified in 441-paragraph
				90.4(1)
"b."
(2)
				The IME medical services unit shall be responsible for the initial
				determination of the member's level of care certification. The IME medical
				services unit or the member's managed care organization shall be responsible
				for annual redetermination of the level of care.
(3) Health and disability waiver services
				will not be provided when the person is an inpatient in a medical
				institution.
(4) The managed care
				organization must submit documentation to the IME medical services unit for all
				reassessments, performed at least annually, which indicate a change in the
				member's level of care. The IME medical services unit shall make a final
				determination for any reassessments which indicate a change in the level of
				care. If the level of care reassessment indicates no change in level of care,
				the member is approved to continue at the already established level of
				care.
e. To be eligible
				for interim medical monitoring and treatment services the consumer must be:
(1) Under the age of 21;
(2) Currently receiving home health agency
				services under rule 441-78.9 (249A) and require
				medical assessment, medical monitoring, and regular medical intervention or
				intervention in a medical emergency during those services. (The home health
				aide services for which the consumer is eligible must be maximized before the
				consumer accesses interim medical monitoring and treatment.);
(3) Residing in the consumer's family home or
				foster family home; and
(4) In need
				of interim medical monitoring and treatment as ordered by a physician, nurse
				practitioner, clinical nurse specialist, or physician assistant.
f. The person must meet income and
				resource guidelines for Medicaid as ifin a medical institution pursuant to
				441-Chapter 75. When a husband and wife who are living together both apply for
				the waiver, income and resource guidelines as specified at 441-paragraphs
				75.5(2)
"b"
and 75.5(4)
"c"
shall be
				applied.
g. The person must have
				service needs that can be met by this waiver program. At a minimum a person
				must receive one billable unit of service under the waiver per calendar
				quarter.
h. To be eligible for the
				consumer choices option as set forth in 441-subrule 78.34(13), a person cannot
				be living in a residential care facility.