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 441-77.47 - Health Home Services Providers

Current through Register Vol. 47, No. 3, July 24, 2024
Subject to the requirements of this rule, a provider may
				  participate in the medical assistance program as a provider of health home
				  services.
(1)
Definitions.
"Chronic condition"
means, for purposes of
				  this rule, one of the conditions outlined in 441-subparagraph
				  78.53(3)
"a"
(1).
"Chronic condition health home"
means a
				  provider enrolled to deliver personalized, coordinated care for members with
				  one chronic condition and at risk of developing another.
"Functional impairment"
means the loss of
				  functional capacity that (1) is episodic, recurrent, or continuous; (2)
				  substantially interferes with or limits the achievement of or maintenance of
				  one or more developmentally appropriate social, behavioral, cognitive,
				  communicative, or adaptive skills; and (3) substantially interferes with or
				  limits the individual's functional capacity with family, employment, school, or
				  community. "Functional impairment" does not include difficulties resulting from
				  temporary and expected responses to stressful events in a person's environment.
				  The level of functional impairment must be identified by the assessment
				  completed by a mental health professional as defined in rule
				  441-24.1(225C).
"Health home"
means a chronic condition
				  health home or an integrated health home.
"Integrated health home"
means a provider
				  enrolled to integrate medical, social, and behavioral health care needs for
				  adults with a serious mental illness and children with a serious emotional
				  disturbance.
"Lead entity"
means a managed care
				  organization that supports and oversees the chronic condition health home and
				  the integrated health home network.
"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.
"Serious emotional disturbance"
means the
				  same as defined in rule
				  441-83.121(249A).
"Serious mental illness"
means, for an
				  adult, a persistent or chronic mental health, behavioral, or emotional disorder
				  that (1) is specified within the most current Diagnostic and Statistical Manual
				  of Mental Disorders published by the American Psychiatric Association or its
				  most recent International Classification of Diseases, and (2) causes serious
				  functional impairment and substantially interferes with or limits one or more
				  major life activities, including functioning in the family, school, employment
				  or community. "Serious mental illness" may co-occur with substance use
				  disorder, developmental disabilities, neurodevelopmental disabilities or
				  intellectual disabilities, but those diagnoses may not be the clinical focus
				  for health home services.
(2)
Chronic condition health home
				provider qualifications.
a. A
				chronic condition health home must be one of the following:
(1) Physician(s).
(2) Clinical practice or clinical group
				practice.
(3) Rural health
				clinic.
(4) Community health
				center.
(5) Community mental health
				center accredited under 441-Chapter 24.
(6) Federally qualified health
				clinic.