Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.121 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Assessment"
means the review of the
				  consumer's current functioning in regard to the consumer's situation, needs,
				  abilities, desires, and goals.
"Care coordinator"
means the professional
				  who assists members in care coordination as described in 441-paragraph
				  78.53(1)
"b."
"Case manager"
means the person designated
				  to provide Medicaid targeted case management services for the consumer.
"CMS"
means the Centers for Medicare and
				  Medicaid Services, a division of the U.S. Department of Health and Human
				  Services.
"Consumer"
means an individual up to the age
				  of 18 who is included in a Medicaid coverage group listed in
				  441-75.1 (249A) and is a
				  recipient of children's mental health waiver services.
"Deeming"
means considering parental or
				  spousal income or resources as income or resources of a consumer in determining
				  eligibility for a consumer according to Supplemental Security Income program
				  guidelines.
"Department"
means the Iowa department of
				  human services.
"Electronic visit verification system"
means, with respect to personal care services or home health care services
				  defined in Section 12006 of the 21st Century Cures Act, a system under which
				  visits conducted as part of such services are electronically verified with
				  respect to:
(1) the type of service
				performed,
(2)  the individual
				receiving the service,
(3) the date
				of the service,
(4) the location of
				service delivery,
(5) the individual
				providing the service, and
(6) the
				time the service begins and ends.
"Guardian"
means a parent of a consumer or a
				  legal guardian appointed by the court.
"HCBS"
means home- and community-based
				  services provided under a Medicaid waiver.
"IME"
means the Iowa Medicaid
				  enterprise.
"IME medical services unit"
means the
				  contracted entity in the Iowa Medicaid enterprise that determines level of care
				  for consumers initially applying for or continuing to receive children's mental
				  health waiver services.
"Integrated health home"
means the provision
				  of services to enrolled members as described in 441-subrule 78.53(1).
"Interdisciplinary team"
means the consumer,
				  the consumer's family, and persons of varied professional and nonprofessional
				  backgrounds with knowledge of the consumer's needs, as designated by the
				  consumer and the consumer's family, who meet to develop a service plan based on
				  the individualized needs of the consumer.
"ISIS"
means the department's individualized
				  services information system.
"Local office"
means a department of human
				  services office as described in 441-subrule 1.4(2).
"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.
"Medical institution"
means a nursing
				  facility, an intermediate care facility for persons with an intellectual
				  disability, a psychiatric hospital or psychiatric medical institution for
				  children, or a state mental health institute that has been approved as a
				  Medicaid vendor.
"Mental health professional"
means a person
				  who meets all of the following conditions:
1. Holds at least a master's degree in a
				mental health field including, but not limited to, psychology, counseling and
				guidance, psychiatric nursing and social work; or is a doctor of medicine or
				osteopathic medicine; and
2. Holds
				a current Iowa license when required by the Iowa professional licensure laws
				(such as a psychiatrist, a psychologist, a marital and family therapist, a
				mental health counselor, an advanced registered nurse practitioner, a
				psychiatric nurse, or a social worker); and
3. Has at least two years of postdegree
				experience supervised by a mental health professional in assessing mental
				health problems, mental illness, and service needs and in providing mental
				health services.
"Psychiatric medical institution for children level
				  of care"
means that the member has been diagnosed with a serious
				  emotional disturbance and an independent team as identified in 441-subrule
				  85.22(3) has certified that ambulatory care resources available in the
				  community do not meet the treatment needs of the recipient, that proper
				  treatment of the recipient's psychiatric condition requires services on an
				  inpatient basis under the direction of a physician, and that the services can
				  reasonably be expected to improve the recipient's condition or prevent further
				  regression so that the services will no longer be needed.
"Serious emotional disturbance"
means a
				  diagnosable mental, behavioral, or emotional disorder that (1) is of sufficient
				  duration to meet diagnostic criteria for the disorder specified by the current
				  version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
				  published by the American Psychiatric Association; and (2) has resulted in a
				  functional impairment that substantially interferes with or limits a consumer's
				  role or functioning in family, school, or community activities. "Serious
				  emotional disturbance" shall not include neurodevelopmental disorders,
				  substance-related disorders, or conditions or problems classified in the
				  current version of the DSM as "other conditions that may be a focus of clinical
				  attention," unless these conditions co-occur with another diagnosable serious
				  emotional disturbance.
"Service plan"
means a person-centered,
				  outcome-based plan of services that is written by the member's case manager
				  with input and direction from the member and that addresses all relevant
				  services and supports being provided. The service plan is developed by the
				  interdisciplinary team, which includes the member and, if appropriate, the
				  member's legal representative, member's family, service providers, and others
				  directly involved with the member.
"Skill development"
means that the service
				  provided is habilitative and is intended to impart an ability or capacity to
				  the consumer. Supervision without habilitation is not skill development.
"Targeted case management"
means Medicaid
				  case management services accredited under 441-Chapter 24 and provided according
				  to 441-Chapter 90 for consumers eligible for the children's mental health
				  waiver.
"Waiver year"
for the children's mental
				  health waiver means a 12-month period commencing on July 1 of each
				  year.