reglab/statecodes huggingface dataset:
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.12 - Payment to the Php

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Capitation rate.
In consideration for all services rendered by
				a PHP under a contract with the department, the PHP will receive a payment each
				month for each enrolled recipient. This capitation rate represents the total
				obligation of the department with respect to the costs of medical care and
				services provided to enrolled recipients under the contract.
(2)
Determination of rate.
The capitation rate is actuarially determined by the department for the
				beginning of the new fiscal year using statistics and data about Medicaid
				fee-for-service expenses for PHP-covered services to a similar population
				during the preceding fiscal year. (For example, fiscal year 1990 rates are
				predicted with fiscal year 1988 dates of service for Medicaid fee-for-service
				expenditures.) The capitation rate may not exceed the cost to the department of
				providing the same services on a fee-for-service basis to an actuarially
				equivalent nonenrolled population group. A 1 percent incentive will be
				available to PHPs who contract to cover all services except those specified in
				subrule 88.5(3). PHPs electing to share risk with the department will have
				their payment rates reduced by an amount reflecting the department's experience
				for high cost fee-for-service recipients.
(3)
Amounts not included in
				rate.
The capitation rate does not include any amounts for the
				recoupment of losses suffered by the PHP for risks assumed under the current or
				any previous contract. The PHP accepts the rate as payment in full for the
				contracted services. Any savings realized by the PHP due to lower utilization
				from a less frequent incidence of health problems among the enrolled population
				shall be wholly retained by the PHP.
(4)
Third-party liability.
If an enrolled recipient has health coverage or a responsible party other than
				the Medicaid program available for purposes of payment for medical expenses, it
				is the right and responsibility of the PHP to investigate these third-party
				resources and attempt to obtain payment. The PHP shall retain all funds
				collected through third-party sources. A complete record of all income from
				these sources must be maintained and made available to the
				department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.13 - Quality Assurance

Current through Register Vol. 47, No. 3, July 24, 2024
The PHP shall have in effect an internal quality assurance
				  system that meets the requirements of 42 CFR 434.44 as amended to December 31,
				  1996, and a system of periodic medical audits meeting the requirements of 42
				  CFR 434.53 as amended to December 13, 1990.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.21 - Scope and Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Purpose.
A program of all-inclusive care for the elderly
				(PACE) organization provides prepaid, capitated, comprehensive health care
				services designed to meet the following objectives:
a. Enhance the quality of life and autonomy
				of frail older adults.
b. Maximize
				the dignity of and respect for frail older adults.
c. Enable frail older adults to live in the
				community as long as medically and socially feasible.
d. Preserve and support frail older adults'
				family units.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.22 - Pace Organization Application and Waiver Process

Current through Register Vol. 47, No. 3, July 24, 2024
This rule sets forth the application requirements for an
				  entity that seeks approval from the department as a PACE organization and the
				  process by which a prospective PACE organization may request department review
				  and approval of requests to CMS for waiver of federal requirements.
(1)
Application
				requirements.
A person authorized to act on behalf of an entity
				seeking approval as a PACE organization shall prepare an application in the
				format suggested by CMS at:
http://www.cms.hhs.gov/PACE/06ProviderApplicationandRelatedResources.asp
.
a. The application shall:
(1) Describe how the entity meets the
				requirements of this division and of the federal PACE regulations;
				and
(2) Identify the counties in
				which the entity proposes to provide PACE services.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.23 - Pace Program Agreement

Current through Register Vol. 47, No. 3, July 24, 2024
An entity that has been approved by the department and CMS
				  to be a PACE organization must enter into an agreement with CMS and the
				  department for the operation of a PACE program under Medicare and Medicaid. The
				  agreement must be signed by an authorized official of CMS, the PACE
				  organization, and the department.
(1)
Content and terms of agreement.
a.
Required content.
A PACE
				program agreement must include the following information:
(1) A designation of the service area of the
				PACE organization's program, identified by county. The department and CMS must
				approve any change in the designated service area.
(2) The PACE organization's commitment to
				meet all applicable requirements under federal, state, and local laws and
				regulations, including provisions of the Civil Rights Act, the Age
				Discrimination Act, and the Americans with Disabilities Act.
(3) The effective date and term of the
				agreement.
(4) A description of the
				organizational structure of the PACE organization and information on the
				organization's administrative contacts.
(5) An enrollee bill of rights approved by
				CMS and an assurance that the listed rights and protections will be
				provided.
(6) A description of the
				process for handling enrollee grievances and appeals.
(7) A statement of the PACE organization's
				policies on eligibility, enrollment, voluntary disenrollment, and involuntary
				disenrollment.
(8) A description of
				the services available to enrollees.
(9) A description of the PACE organization's
				quality assessment and performance improvement program.
(10)A statement of the levels of performance
				required in CMS standard quality measures.
(11) A statement of the data and information
				required by the department and CMS to be collected on enrollee care.
(12)The Medicaid capitation rate and the
				methodology used to calculate the Medicare capitation rate.
(13)A description of procedures that the PACE
				organization will follow if the PACE program agreement is terminated, including
				how the organization will:
1. Inform
				enrollees, the community, CMS, and the department, in writing, about the
				organization's termination and transition procedures.
2. Initiate contact with income maintenance
				staff in the local department office and assist enrollees in obtaining
				reinstatement of conventional Medicare and Medicaid benefits.
3. Transition enrollees' care to other
				providers.
4. Terminate marketing
				and enrollment activities.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.24 - Enrollment and Disenrollment

Current through Register Vol. 47, No. 3, July 24, 2024
A PACE organization must comply with the federal enrollment
				  requirements stated in 42 CFR Sections 460.152 through 460.156 as amended to
				  December 8, 2006.
(1)
Eligibility for Medicaid enrollees.
To enroll in a PACE
				program as an Iowa Medicaid enrollee, a person must meet the eligibility
				requirements specified in this subrule.
a.
Basic eligibility requirements.
(1) The person must be 55 years of age or
				older.
(2) The person must reside
				in the service area of the PACE organization.
(3) The person must be eligible for Medicaid
				pursuant to the provisions in 441-Chapter 75 for persons in a medical
				institution.
(4) The department
				must determine that the person is eligible for Iowa Medicaid pursuant to
				441-Chapter 76.
(5) The department
				must determine that the person needs the nursing facility level of
				care.
(6) The person must meet any
				additional program-specific eligibility conditions imposed under the PACE
				program agreement. These additional conditions shall not modify the
				requirements stated in this subrule.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.25 - Program Services

Current through Register Vol. 47, No. 3, July 24, 2024
A PACE organization shall furnish comprehensive medical,
				  health, and social services that integrate acute and long-term care.
(1)
Required services.
The
				PACE benefit package for all enrollees, regardless of the source of payment,
				must include the following:
a. All
				Medicare-covered items and services.
b. All Medicaid-covered items and services as
				specified in 441-Chapters 78, 81, 82, 85, and 90. Medicaid benefit limitations
				and conditions relating to amount, duration, scope of services, deductibles,
				copayments, coinsurance, or other cost sharing do not apply to PACE
				services.
c. Other services
				determined necessary by the enrollee's interdisciplinary team to improve or
				maintain the enrollee's overall health status.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.26 - Access to Pace Services

Current through Register Vol. 47, No. 3, July 24, 2024
An enrollee's access to PACE services is governed by a
				  comprehensive plan of care developed for each enrollee by an interdisciplinary
				  team based on a comprehensive assessment of the enrollee's health and social
				  status.
(1)
Interdisciplinary
				team.
A PACE organization shall establish an interdisciplinary team at
				each PACE center to comprehensively assess and meet the individual needs of
				each enrollee.
a.
Team
				composition.
The members of the interdisciplinary team must primarily
				serve PACE enrollees. At a minimum, the interdisciplinary team shall be
				composed of the following members:
(1)
				Primary care physician.
(2)
				Registered nurse.
(3)
				Master's-level social worker.
(4)
				Physical therapist.
(5)
				Occupational therapist.
(6)
				Recreational therapist or activity coordinator.
(7) Dietitian.
(8) PACE center manager.
(9) Home care coordinator.
(10)Personal care attendant or attendant's
				representative.
(11)Driver or
				driver's representative.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.27 - Program Administrative Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
A PACE organization shall comply with the federal
				  administrative requirements stated in 42 CFR Sections 460.60 through 460.82 as
				  amended to December 8, 2006, including requirements relating to organizational
				  structure, governing body, qualifications for staff who have direct contact
				  with enrollees, training, program integrity, contracted services, oversight of
				  direct care services, physical environment, infection control, transportation
				  services, dietary services, fiscal soundness, and marketing.
(1)
Enrollee rights.
A PACE
				organization shall comply with the federal participant rights requirements
				stated in 42 CFR Sections 460.110 through 460.124 as amended to December 8,
				2006. Upon exhaustion of the PACE organization's appeal process, a Medicaid
				enrollee has the right to appeal to the department any adverse coverage or
				payment decision regarding any service, including any denial, reduction, or
				termination of any service, pursuant to 441-Chapter 7.
(2)
Data collection, record
				maintenance, and reporting.
A PACE organization shall comply with
				federal data collection, records maintenance, and reporting requirements stated
				in 42 CFR Sections 460.200 through 460.210 as amended to December 8,
				2006.
(3)
Quality
				assessment and performance improvement.
A PACE organization shall
				comply with the federal quality assessment and performance improvement
				requirements stated in 42 CFR Sections 460.130 through 460.140 as amended to
				November 24, 1999.
(4)
Federal and state monitoring.
a. The PACE program shall cooperate with
				federal and state monitoring pursuant to 42 CFR Sections 460.190 through
				460.196 as amended to Nov. 24, 1999, including:
(1) Corrective action required pursuant to 42
				CFR Section 460.194; and
(2)
				Disclosure of review results pursuant to 42 CFR Section 460.196(c) and
				(d).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 88 - Specialized Managed Care Programs › Rule 441-88.28 - Payment

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Medicaid payment to PACE organization.
Under a PACE program
				agreement, the department shall make a prospective monthly payment to the PACE
				organization of a capitation amount for each Medicaid enrollee. The monthly
				capitation payment amount shall be negotiated between the PACE organization and
				the department and shall be specified in the PACE program agreement.
a. The amount of the capitation payment:
(1) Shall be less than the amount that would
				otherwise have been paid under the Medicaid program if the enrollees were not
				enrolled under the PACE program.
(2) Shall be a fixed amount regardless of
				changes in the enrollee's health status.
(3) May be renegotiated on an annual
				basis.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Department"
shall mean the department of
				  human services.
"Dwelling "
shall mean real property in
				  which a person has an ownership interest and which serves as the person's
				  principal place of residence. Real property shall include the shelter in which
				  the person lives, the land on which the shelter is located and related
				  buildings on the land.
"Fair market value "
shall mean the price
				  for which property or an item could have been sold on the open market at the
				  time of transfer
"Medical assistance"
shall mean "medical
				  assistance," "additional medical assistance," "discretionary medical
				  assistance" or "Medicare cost sharing" as each is defined in Iowa Code section
				  249A. 2 which is provided to a person pursuant to Iowa Code chapter 249A and
				  Title XIX of the federal Social Security Act.
"Property"
shall mean anything of value,
				  including both tangible and intangible property, real property and personal
				  property.
"Transfer "
shall mean the disposal of
				  property for less than fair market value through gifting, sale or any transfer
				  or assignment of a legal or equitable interest in property.
"Transferee "
shall mean the person who
				  receives a transfer or assignment of a legal or equitable interest in property
				  for less than fair market value.
"Transferor "
shall mean the person who
				  makes a transfer of a legal or equitable interest in property for less than
				  fair market value.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.2 - Creation of Debt

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Transfer
				of property.
Except as provided in rule
				441-89.3 (249F), any transfer of
				property for less than fair market value creates a debt due and owing to the
				department from the transferee if:
a. The
				transfer is made while the transferor is receiving medical assistance or within
				five years prior to application for medical assistance and between July 1,
				1993, and December 31, 2018.
b. The
				transfer is made with the intent on the part of the transferee of enabling the
				transferor to obtain or maintain eligibility for medical assistance.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.3 - Exceptions

Current through Register Vol. 47, No. 3, July 24, 2024
Notwithstanding rule
				  441-89.2 (249F),
				  exceptions for transfers that occur between July 1, 1993, and June 30, 1996,
				  are in accordance with the rules during that time period. Notwithstanding rule
				  441-89.2 (249F),
				  the following exceptions apply to transfers that occur on or after July 1,
				  1996. The following transfers do not create a debt to the department:
1. Transfers to or for the sole benefit of
				the transferor's spouse, including a transfer to a spouse by an
				institutionalized spouse pursuant to Section 1924(f)(1) of the federal Social
				Security Act.
2. Transfers to or
				for the sole benefit of the transferor's child who is blind or disabled, as
				defined in Section 1614 of the federal Social Security Act.
3. Transfer of a dwelling, which serves as
				the transferor's home as defined in 20 CFR Section 416.1212, as amended to
				August 23, 1994, to a child of the transferor under 21 years of age.
4. Transfer of a dwelling, which serves as
				the transferor's home as defined in 20 CFR Section 416.1212, as amended to
				August 23, 1994, after the transferor is institutionalized, to either of the
				following:
* A sibling of the transferor who has an equity interest in
				  the dwelling and who was residing in the dwelling for a period of at least one
				  year immediately prior to the date the transferor became
				  institutionalized.
* A child of the transferor who was residing in the dwelling
				  for a period of at least two years immediately prior to the date the transferor
				  became institutionalized and who provided care to the transferor which
				  permitted the transferor to reside at the dwelling rather than in an
				  institution or facility.
5.
				Transfers of less than $2,000. All transfers by the same transferor during the
				five-year period prior to the application for medical assistance by the
				transferor shall be aggregated. If a transferor transfers property to more than
				one transferee during the five-year period prior to application for medical
				assistance by the transferor, the $2,000 exemption shall be divided equally
				between the transferees for the five-year period prior to application for
				medical assistance.
6. Transfers
				that would, at the time of the transferor's application for medical assistance,
				have been exempt from consideration as a resource if they had been retained by
				the transferor, pursuant to 42 U.S.C. Section 1382(b)(a).
7. Transfers to a trust established solely
				for the benefit of the transferor's child who is blind or permanently and
				totally disabled as defined in Section 1614 of the federal Social Security
				Act.
8. Transfers to a trust
				established solely for the benefit of a person under 65 years of age who is
				disabled, as defined in Section 1614 of the federal Social Security
				Act.
9. Rescinded lAB 11/29/00,
				effective 1/3/01.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.4 - Presumption of Intent

Current through Register Vol. 47, No. 3, July 24, 2024
Any transfer of property for less than fair market
				  consideration made while the transferor is receiving medical assistance or
				  within five years prior to an application for medical assistance is presumed to
				  be made with the intent, on the part of the transferee, of enabling the
				  transferor to obtain or maintain eligibility for medical assistance. This
				  presumption can be rebutted only by clear and convincing evidence that the
				  transferor's eligibility or potential eligibility for medical assistance was no
				  part of the transferee's reason for accepting the transfer of
				  property.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.5 - Notice of Debt

Current through Register Vol. 47, No. 3, July 24, 2024
The department may issue a notice establishing and demanding
				  payment of an accrued or accruing debt due and owing to the department as
				  provided in rule
				  441-89.2 (249F).
				  The notice shall be sent by restricted certified mail, as defined in Iowa Code
				  section 618T5, to the transferee at the transferee's last-known address. If
				  service of the notice is unable to be completed by restricted certified mail,
				  the notice shall be served upon the transferee in accordance with the Iowa
				  Rules of Civil Procedure. The notice shall include all of the following:
(1)
Amount of debt.
The
				amount of medical assistance provided to the transferor to date which creates
				the debt.
(2)
Computation
				of debt. A
computation of the debt due and owing.
(3)
Demand for payment. A
demand for immediate payment of the debt.
(4)
Request for conference.
a. A statement that if the transferee desires
				to discuss the notice, the transferee may contact the department and request an
				informal conference.
b. A statement
				that, if a conference is requested, the transferee has until 10 days after the
				date set for the conference or until 20 days after the date of service of the
				original notice, whichever is later, to send a written request for a hearing to
				the department.
c. A statement that
				after the conference, the department may issue a new notice to be sent to the
				transferee or the transferee's attorney.
d. A statement that if the department issues
				a new notice the transferee has until 10 days after the date of mailing of the
				new notice or until 20 days after the date of service of the original notice to
				send a written request for a hearing to the department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.6 - No Timely Request of a Hearing

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Entering of order.
If a
				timely written request for hearing is not received by the department, the
				department may enter an order in accordance with the latest notice. The order
				is final, and action by the department to enforce and collect upon the order
				may be taken from the date of the issuance of the order
(2)
Order
The transferee
				shall be sent a copy of the order by first-class mail addressed to the
				transferee at the transferee's last known address or, if applicable, to the
				transferee's attorney at the last known address of the transferee's attorney.
				The order shall specify:
a. The amount to be
				paid with directions as to the manner of payment.
b. The amount of the debt accrued and
				accruing in favor of the department.
c. Notice that the property of the transferee
				is subject to collection action including, but not limited to, wage
				withholding, garnishment, attachment of a lien, issuance of a distress warrant,
				and execution.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.7 - Timely Request for a Hearing

Current through Register Vol. 47, No. 3, July 24, 2024
If a timely written request for a hearing is received by the
				  department, the department shall certify the matter for hearing to the district
				  court where the transferee resides or to the district court where the
				  transferor resides if the transferee is not an Iowa resident. If neither the
				  transferor nor the transferee resides in Iowa, the order may be filed in any
				  county in which the transferor formerly resided.
The certification shall include true copies of the original
				  notice, the return of service, any request for an informal conference, if
				  applicable, any subsequent notices, the written request for hearing, and true
				  copies of any administrative orders previously entered.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.8 - Department-requested Hearing

Current through Register Vol. 47, No. 3, July 24, 2024
The department may also request a hearing on its own motion
				  regarding the determination of a debt at any time prior to entry of an
				  administrative order
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.9 - Filing and Docketing of the Order

Current through Register Vol. 47, No. 3, July 24, 2024
A true copy of an order entered by the department, pursuant
				  to this chapter, along with a true copy of the return of service, if
				  applicable, may be filed in the office of the clerk of the district court in
				  the county in which the transferee resides or, if the transferee resides in
				  another state, in the office of the district court in the county in which the
				  transferor resides. The department's order shall be presented, ex parte, to the
				  district court for review and approval.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 89 - Debts Due From Transfers of Assets › Rule 441-89.10 - Exemption From Iowa Code Chapter 17a

Current through Register Vol. 47, No. 3, July 24, 2024
Actions initiated under Iowa Code chapter 249F are not
				  subject to Iowa Code chapter 17A. Review by the district court shall be an
				  original hearing before the district court.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.2 - Targeted Case Management

Current through Register Vol. 47, No. 3, July 24, 2024
Rule
				  441-90.2 (249A) applies only to
				  the case management category of targeted case management and the defined
				  targeted population.
(1)
Eligibility for targeted case management.
A person who meets
				all of the following criteria shall be eligible for targeted case management:
a. The person is eligible for Medicaid or is
				conditionally eligible under 441-Chapter 75;
b. The person is a member of a targeted
				population;
c. The person resides
				in a community setting or qualifies for transitional case management as set
				forth in subrule 90.2(4);
d. The
				person has applied for targeted case management in accordance with the policies
				of the provider;
e. The person's
				need for targeted case management has been determined in accordance with rule
				441-90.2(249A); and
f. The person
				is not eligible for, or enrolled in, Medicaid managed care.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.3 - Termination of Targeted Case Management Services

Current through Register Vol. 47, No. 3, July 24, 2024
Rule
				  441-90.3 (249A) applies only to
				  the case management category of targeted case management and the defined
				  targeted population.
(1) Targeted case
				management shall be terminated when:
a. The
				member does not meet eligibility criteria under rule
				441-90.2 (249A);
b. The member has achieved all goals and
				objectives of the service;
c. The
				member has no ongoing need for targeted case management;
d. The member is receiving targeted case
				management based on eligibility under an HCBS program but is no longer eligible
				for the program;
e. The member or
				the member's guardian or representative requests termination;
f. The member is unwilling or unable to
				accept further services; or
g. The
				member or the member's guardian or representative fails to provide access to
				information necessary for the development of the service plan or for
				implementation of targeted case management.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.5 - Rights Restrictions

Current through Register Vol. 47, No. 3, July 24, 2024
Rule 441-90.5 (249A) applies to all categories of case
				  management and all populations covered by case management. Any effort to
				  restrict the rights of a member to realize the member's preferences or goals
				  must be justified by a specific individualized assessed safety need and
				  documented in the person-centered service plan. The following requirements must
				  be documented in the plan when a safety need has been identified that warrants
				  a rights restriction:
1. The specific
				and individualized assessed safety need;
2. The positive interventions and supports
				used prior to any modifications or additions to the person-centered service
				plan regarding safety needs;
3. The
				less intrusive methods of meeting the safety needs that have been tried but
				were not successful;
4. A clear
				description of the rights restriction that is directly proportionate to the
				specific assessed safety need;
5.
				The regular collection and review of data to measure the ongoing effectiveness
				of the rights restriction;
6. The
				established time limits for periodic reviews to determine whether the rights
				restriction is still necessary or can be terminated;
7. The informed consent of the member to the
				proposed rights restriction; and
8.
				An assurance that the rights restriction itself will not cause undue harm to
				the member.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.6 - Documentation and Billing

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Documentation of contacts.
Subrule 90.6(1) applies to all
				categories of case management and all populations covered by case management.
a. Documentation of case management services
				contacts shall include:
(1) The name of the
				individual case manager;
(2) The
				need for, and occurrences of, coordination with other case managers within the
				same agency or referral or transition to another case management agency;
				and
(3) Other requirements as
				outlined in 441-Chapter 79 to support payment of services.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.7 - Case Management Services Provider Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
Rule
				  441-90.7 (249A) applies to all
				  categories of case management and all populations covered by case management.
(1)
Reporting procedures for
				major incidents.
a. When a major
				incident occurs or a staff member becomes aware of a major incident:
(1) The staff member shall notify the
				following persons of the incident by midnight of the next calendar day after
				the incident:
1. The staff member's
				supervisor;
2. The member or
				member's legal guardians; and
3.
				The member's case manager. The case manager shall create an incident report if
				a provider has not submitted a report.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 90 - Case Management Services › Rule 441-90.8 - Provider Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Incident reporting.
a. When
				a major incident occurs during the provision of case management services:
(1) The case management provider shall notify
				the following persons of the incident by the end of the next calendar day after
				the incident:
1. The case management
				supervisor.
2. The member's legally
				authorized representative.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
As used in this chapter:
"Applicant"
means a person applying for a
				  Medicare drug subsidy through the department and includes a responsible person
				  or authorized representative acting for an applicant, except for the purposes
				  of subrule 91.2(2).
"Application"
or
"Medicare drug
				  subsidy application"
means the federal Social Security
				  Administration's Form SSA-1020B-OCR-SM, Application for Help with Medicare
				  Prescription Drug Plan Costs.
"Authorized representative"
means a person
				  representing an applicant or recipient as described in 441-subrule
				  76.9(2).
"Department"
means the Iowa department of
				  human services and includes any local office of the department.
"Local office"
means a department office as
				  described in 441-subrule 1.4(2).
"Recipient"
means a person receiving a
				  Medicare drug subsidy based on an application filed with the department and
				  includes a responsible person or authorized representative acting for a
				  recipient, except for the purposes of subrule 91.2(2).
"Responsible person"
means a person acting
				  on an applicant's or recipient's behalf as described at 441-subrule
				  76.9(1).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.2 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
Any person may apply for the Medicare drug subsidy through
				  the department.
(1)
Date,
				method, and place of filing.
An application is considered filed on the
				date an identifiable signed application is received and date-stamped in any
				local office.
a. When an application is
				delivered to a closed local office, the application will be considered received
				on the first day that is not a weekend or state holiday following the day that
				the office was last open.
b. A copy
				of an application received by fax shall be given the same effect as the
				original application.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.3 - Eligibility Determination

Current through Register Vol. 47, No. 3, July 24, 2024
The department shall determine eligibility for the Medicare
				  drug subsidy pursuant to Section 1860D-14 of the Social Security Act and
				  implementing federal regulations at 20 CFR Part 418. The department shall base
				  decisions with respect to initial and ongoing eligibility primarily on
				  information furnished by the applicant or recipient.
(1)
Cooperation.
An
				applicant must cooperate with the department in the application process.
				Cooperation may include providing additional information or verification of
				information, participating in an interview, or signing documents. Failure to
				cooperate in the application process shall be a basis for denial of an
				application.
(2)
Additional
				information and verification.
The department shall notify the
				applicant or recipient in writing of any additional information or verification
				that is required to maintain or establish eligibility. This notice shall be
				delivered to the applicant or recipient by personal delivery, mail, or
				facsimile transmission.
a. The applicant or
				recipient shall have ten working days to supply the information or verification
				requested by the department. The local office may extend the deadline for a
				reasonable period when the applicant or recipient is making every effort to
				secure the required information or verification from a third party but has been
				unable to do so.
b. Failure of the
				applicant or recipient to supply the information or verification, or refusal by
				the applicant or recipient to authorize the department to secure the
				information or verification from other sources, shall serve as a basis for
				denial of an application or cancellation or reduction of the Medicare drug
				subsidy.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.4 - Notice of Decision

Current through Register Vol. 47, No. 3, July 24, 2024
The department shall notify the applicant or recipient in
				  writing of any decision regarding the applicant's or recipient's subsidy
				  eligibility or level of subsidy.
(1)
				The department shall issue a written notice of decision to an applicant by the
				next working day following a determination of subsidy eligibility and level of
				subsidy.
(2) The department shall
				give a recipient timely and adequate written notice as provided in rule
				441-16.3(17A) when any decision or action is taken that adversely affects
				subsidy eligibility or the level of subsidy.
(3) In the circumstances described in
				441-subrule 16.3(3), the department may dispense with timely notice but shall
				send adequate notice no later than the effective date of action.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.5 - Effective Date

Current through Register Vol. 47, No. 3, July 24, 2024
A Medicare prescription drug subsidy shall be effective
				  beginning with the first day of the month of application or the first day of
				  the first month in which all eligibility requirements are met, whichever is
				  later, but no earlier than January 1, 2006.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.6 - Changes in Circumstances

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Responsibility to report changes.
A Medicare drug subsidy
				applicant or recipient shall timely report to the department any changes in the
				following circumstances:
a. Care of
				dependents.
b. Household
				composition.
c. Household
				income.
d. Household
				resources.
e. Marital
				status.
f. Medicare eligibility or
				enrollment.
g. Place of
				residence.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.7 - Reinvestigation

Current through Register Vol. 47, No. 3, July 24, 2024
The department shall reinvestigate eligibility as often as
				  the recipient's circumstances indicate, but in no instance shall the period
				  between reinvestigations exceed 12 months.
(1)
Application requested.
When requested to do so by the department, the recipient shall complete the
				Medicare drug subsidy application as part of the reinvestigation process. The
				application shall be completed within ten working days from the date a written
				request is issued. Failure to complete the application shall be a basis for
				cancellation or reduction of the subsidy.
(2)
Additional information
				requested.
The recipient shall supply additional information needed to
				establish eligibility or level of subsidy within ten working days from the date
				a written request is issued.
a. The recipient
				shall give written permission for the release of information when the recipient
				is unable to furnish information needed to establish eligibility.
b. Failure to supply requested information or
				authorize the department to secure the information from other sources shall be
				a basis for cancellation or reduction of the subsidy.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 91 - Medicare Drug Subsidy › Rule 441-91.8 - Appeals

Current through Register Vol. 47, No. 3, July 24, 2024
An applicant or recipient shall have the right to appeal any
				  adverse action by the department regarding the Medicare drug subsidy, pursuant
				  to 441-Chapter 7.
Iowa Administrative Code › Agency 441 - Human Services Department › Title IX - Work Incentive Demonstration › Chapter 93 - Promise Jobs Program › Rule 441-93.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Applicant"
means a child for whom
				  assistance is being requested under the family investment program, any parent
				  living in the home with the child, and any nonparental relative as defined in
				  441-subrule 41.22(3) who is requesting assistance for the child.
"FaDSS"
means the family development and
				  self-sufficiency program operated under 421-Chapter 24, which provides in-home
				  family development services to families at risk of instability or long-term FIP
				  dependency.
"Family investment agreement"
or
"FIA"
means the agreement developed with a participant in
				  accordance with Iowa Code section
				  239B.8.
"FIA-responsible person"
means any member of
				  the FIP applicant family unless exempt as described at 441-subrule 41.24(2).
				  See subrule 93.4(2) for more information.
"FIP"
means the family investment program
				  authorized in Iowa Code chapter 239B.
"Limited benefit plan"
or
"LBP"
means a period of time in which a participant or member
				  of a participant's family is either ineligible for any assistance under the
				  family investment program or eligible for reduced assistance in accordance with
				  Iowa Code section
				  239B.9.
"Needy specified relative"
means a
				  nonparental specified relative as defined in 441-subrule 41.22(3) who meets all
				  the eligibility requirements to be included in the family investment
				  program.
"Participant"
for purposes of the PROMISE
				  JOBS program means a person who has signed an FIA and is approved to receive
				  FIP benefits, a parent or relative living in the home of a child approved to
				  receive FIP benefits, or a person reconsidering a subsequent limited benefit
				  plan.
"PROMISE JOBS program"
means the promoting
				  independence and self-sufficiency through employment, job opportunities, and
				  basic skills program created in Iowa Code section
				  239B.17.
Iowa Administrative Code › Agency 441 - Human Services Department › Title IX - Work Incentive Demonstration › Chapter 93 - Promise Jobs Program › Rule 441-93.2 - Program Administration

Current through Register Vol. 47, No. 3, July 24, 2024
The department of human services shall administer an
				  employment and training program known as PROMISE JOBS. To the extent compatible
				  with resources available, the department's bureau of refugee services shall
				  provide PROMISE JOBS services to persons who entered the United States with
				  refugee status until those persons obtain United States citizenship.
(1)
Availability of service.
PROMISE JOBS services shall include, but are not limited to, those listed in
				paragraph 93.4(4)
"b."
a. The
				program shall be available statewide. If the department of human services
				determines that sufficient funds are not available to offer services on
				location in each county, the department shall prioritize the availability of
				services to those counties having the largest FIP populations.
b. Because of state and federal budgetary
				limitations, federal mandatory work requirements, requirements for minimum
				participation rates, and other TANF requirements imposed on the PROMISE JOBS
				program, the department of human services shall have the administrative
				authority to:
(1) Determine agency and
				geographical breakdowns for service;
(2) Designate specific groups for priority
				services; and
(3) Designate
				specific PROMISE JOBS components or supportive service levels for a waiting
				list.
Iowa Administrative Code › Agency 441 - Human Services Department › Title IX - Work Incentive Demonstration › Chapter 93 - Promise Jobs Program › Rule 441-93.3 - Registration and Referral

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Registration for PROMISE JOBS.
Unless the department of human
				services determines a person is exempt as specified in 441-subrule 41.24(2), an
				application for FIP assistance constitutes a registration for the PROMISE JOBS
				program and acceptance of the requirement to enter into an FIA for all members
				of the FIP case and all other persons responsible for the FIA as specified at
				rule 441-41.24 (239B).
(2)
Referral.
The department
				of human services shall refer all FIA-responsible persons from FIP applicant
				and participant households to PROMISE JOBS pursuant to 441-subrule
				41.24(4).
(3)
Initial
				appointment.
a.
FIP
				applicants.
FIP applicants, including those who are in a limited
				benefit plan, shall be offered an appointment with the PROMISE JOBS provider
				agency for orientation, assessment, and FIA development at the earliest
				available time. The provider agency shall make sufficient appointment times
				available to allow the applicant to be scheduled no later than ten calendar
				days after the date of the notice that FIA responsibility has begun, as
				required by rule 441-93.4 (239B) and
				441-paragraphs 41.24(1)
"c,"
41.24(1)
"d,"
and
				41.24(10)
"g."
b.
Exempt status change.
Persons who become FIA-responsible while
				receiving FIP shall initiate PROMISE JOBS orientation and FIA development by
				contacting the appropriate PROMISE JOBS office to schedule an appointment
				within ten calendar days of the mailing date of the letter explaining that
				exempt status has been lost and FIA responsibility has begun, as required by
				441-subrule 41.24(5). If the person fails to schedule an appointment or fails
				to appear for an appointment, PROMISE JOBS shall send one written reminder
				letter that informs the person that those who do not develop a family
				investment agreement shall enter into a limited benefit plan. If the person
				fails to schedule an appointment within ten calendar days of the written
				reminder letter or fails to appear for an appointment scheduled after the
				written reminder letter is sent, the person shall enter into a limited benefit
				plan as described at 441-paragraph 41.24(8)
"c."
Iowa Administrative Code › Agency 441 - Human Services Department › Title IX - Work Incentive Demonstration › Chapter 93 - Promise Jobs Program › Rule 441-93.4 - The Family Investment Agreement (FIA)

Current through Register Vol. 47, No. 3, July 24, 2024
The family investment agreement (FIA) is the condition of and
				  basis for PROMISE JOBS services and is an eligibility requirement for the
				  family investment program as specified in rule
				  441-41.24 (239B).
(1)
Development.
An initial
				FIA shall be developed during the orientation and assessment process through
				discussion between the FIA-responsible person and the PROMISE JOBS worker. For
				the FIA to be considered completed, Form 470-3095, Family Investment Agreement,
				and Form 470-3096, FIA Steps to Achieve Self-Sufficiency, shall be signed by
				all of the following:
a. The FIA-responsible
				person or persons.
b. Other family
				members who are referred to PROMISE JOBS.
c. The PROMISE JOBS worker.
d. The PROMISE JOBS supervisor.