Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 78 - Amount, Duration and Scope of Medical and Remedial Services › Rule 441-78.53 - Health Home Services

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Definitions.
"Chronic condition"
means, for purposes of
				  this rule, one of the conditions outlined in subparagraph
				  78.53(3)
"a"
(1).
"Chronic condition health home"
means a
				  health home that meets the criteria in 441-subrule 77.47(2).
"Health home"
means a chronic condition
				  health home or an integrated health home.
"Integrated health home"
means a health home
				  that meets the criteria in 441-subrule 77.47(3).
"Person-centered care plan"
means a care
				  plan created through the person-centered planning process, directed by the
				  member or the member's guardian or representative, for a member receiving
				  non-intensive care management or chronic condition health home services, to
				  identify the member's strengths, capabilities, preferences, needs, goals, and
				  desired outcomes.
"Person-centered service plan"
or
"service plan"
means a service plan (1) created through the
				  person-centered planning process in accordance with subrule 78.27(4), rule
				  441-83.127(249A) and
				  441-paragraph 90.4(1)
"b"
; (2) directed by the member or the
				  member's guardian or representative; (3) for a member receiving intensive care
				  management services; and (4) for the purposes of identifying the member's
				  strengths, capabilities, preferences, needs, and desired
				  outcomes.
(2)
Covered services.
A health home provides team-based, whole
				person, person-centered, coordinated care for all aspects of the member's life
				and for transitions of care that the member may experience. A health home
				provides the following core services:
a.
Comprehensive care management.
Comprehensive care management
				is the initial and ongoing assessment and care management services aimed at the
				integration of primary, behavioral and specialty health care, and community
				support services, using a comprehensive person-centered care plan or service
				plan that addresses all clinical and nonclinical needs and promotes wellness
				and management of chronic conditions in pursuit of optimal health
				outcomes.
b.
Care
				coordination.
Care coordination includes assisting members with
				medication adherence, appointments, referral scheduling, understanding health
				insurance coverage, reminders, transition of care, wellness education, health
				support, lifestyle modification, and behavior changes. The health home must
				work with providers to coordinate, direct, and ensure results are communicated
				back to the health home.
c.
Health promotion.
Health promotion includes the education and
				engagement of a member in making decisions that promote health management,
				improved disease outcomes, disease prevention, safety, and an overall healthy
				lifestyle.
d.
Comprehensive
				transitional care.
Comprehensive transitional care is the facilitation
				of services for the member that provides support when the member is
				transitioning between levels of care (nursing facility, hospital,
				rehabilitation facility, community-based group home, family, self-care, or
				another health home).
e.
Individual and family support.
Individual and family support
				services include communication with the member and the member's family and
				caregivers to maintain and promote quality of life, with particular focus on
				community living options. Support will be provided in a culturally appropriate
				manner.
f.
Referral to
				community and social support services.
Referral to community and
				social support services includes coordinating or providing recovery services
				and social health services available in the community, including resources for
				understanding eligibility for various health care programs, disability
				benefits, and identifying housing programs.