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 441-77.25 - Home- and Community-based Habilitation Services

Current through Register Vol. 47, No. 3, July 24, 2024
To be eligible to participate in the Medicaid program as an
				  approved provider of home- and community-based habilitation services, a
				  provider shall meet the general requirements in subrules 77.25(2), 77.25(3),
				  77.25(4), and 77.25(5) and shall meet the requirements in the subrules
				  applicable to the individual services being provided.
(1)
Definitions.
"Certified employment specialist"
or
"CES"
means a person who has demonstrated a sufficient level
				  of knowledge and skill to provide integrated employment support services to a
				  variety of client populations and has earned a CES certification through a
				  nationally recognized accrediting body.
"Guardian"
means a guardian appointed in
				  probate or juvenile court.
"Individual placement and support"
or
"IPS"
means the evidence-based practice of supported
				  employment that is guided by IPS practice principles outlined by the IPS
				  Employment Center at Westat, and as measured by its most recently published
				  25-item supported employment fidelity scale available online at
				  ipsworks.org/wp-content/uploads/2017/08/ips-fidelity-manual-3rd-edition_2-4-16.pdf.
				  The IPS practice principles are:
1.
				Focus on competitive employment: Agencies providing IPS services are committed
				to competitive employment as an attainable goal for people with behavioral
				health conditions seeking employment. Mainstream education and specialized
				training may enhance career paths.
2. Zero exclusion criteria based on client
				choice: People are not excluded on the basis of readiness, diagnoses, symptoms,
				substance use history, psychiatric hospitalizations, homelessness, level of
				disability, or legal system involvement.
3. Integration of rehabilitation and mental
				health services: IPS programs are closely integrated with mental health
				treatment teams.
4. Attention to
				worker preferences: Services are based on each person's preferences and
				choices, rather than providers' judgments.
5. Personalized benefits counseling:
				Employment specialists help people obtain personalized, understandable, and
				accurate information about their social security, Medicaid, and other
				government entitlements.
6. Rapid
				job search: IPS programs use a rapid job search approach to help job seekers
				obtain jobs directly, rather than providing lengthy preemployment assessment,
				training, and counseling. If further education is part of their plan, IPS
				specialists assist in these activities as needed.
7. Systematic job development: Employment
				specialists systematically visit employers, who are selected based on job
				seeker preferences, to learn about their business needs and hiring
				preferences.
8. Time-unlimited and
				individualized support: Job supports are individualized and continue for as
				long as each worker wants and needs the support.
"Intensive residential service homes"
or
"intensive residential services"
means intensive,
				  community-based services provided 24 hours per day, 7 days per week, 365 days
				  per year to individuals with a severe and persistent mental illness who have
				  functional impairments and may also have multi-occurring conditions. Providers
				  of intensive residential service homes are enrolled with Medicaid as providers
				  of HCBS habilitation or HCBS intellectual disability waiver supported community
				  living and meet additional criteria specified in 441-subrule 25.6(8).
"IPS 25-item supported employment fidelity
				  scale"
means the fidelity scale published by the IPS Employment Center
				  at Westat, resulting in scores of exemplary fidelity, good fidelity, fair
				  fidelity, or not supported employment.
"IPS implementation"
means the process
				  advocated by the IPS Employment Center at Westat, which consists of the
				  following phases:
1. Formation of IPS
				team steering group and one-day meeting with the IPS trainer and team
				members.
2. Completion of the IPS
				Readiness Assessment developed by the IPS Employment Center at Westat and
				individual review with the IPS trainer.
3. Completion of a one-day IPS kick-off team
				training with the IPS trainer and team members.
4. Participation in individual team training
				and monthly consultations as follows:
* Two-and-a-half-day individual team training with the IPS
				  trainer and team members.
* Virtual training by the IPS Employment Center at Westat for
				  at least three people per team.
* Leadership training for two people per team at the IPS
				  Employment Center at Westat.
* Virtual monthly technical assistance for two hours per
				  month per team.
5.
				Participation in the International Learning Collaborative, including:
* Participation in the International Learning Collaborative
				  annual conference by two people per state.
* Virtual monthly technical assistance calls with the IPS
				  Employment Center at Westat mentor assigned to the team.
* Participation in the prescribed data tracking and
				  management activities.
6.
				Completion of one baseline fidelity review per IPS team, with two IPS reviewers
				on site for two days per review.
7.
				Evaluation and development of next steps, with an on-site half-day meeting for
				the IPS trainer and the team.
"IPS reviewer"
means a person who is
				  qualified to complete fidelity reviews of IPS services and is one of the
				  following:
1. A person who has provided
				IPS services or has supervised an IPS team in Iowa which has obtained a
				fidelity score of "good" or better, has completed the IPS Employment Center at
				Westat's training to become an IPS reviewer, and has shadowed one or more IPS
				fidelity reviews;
2. An existing
				IPS reviewer from a state which is a member of the IPS International Learning
				Collaborative;
3. An IPS reviewer
				contracted directly from the IPS Employment Center at Westat;
4. A CES with a bachelor's degree who has
				completed the IPS Employment Center at Westat's training to become an IPS
				reviewer and has shadowed one or more IPS fidelity reviews.
"IPS team"
means, at a minimum, an IPS
				  employment specialist, a behavioral health specialist, Iowa Vocational
				  Rehabilitation Services (IVRS) counselor, and a case manager or care
				  coordinator.
"IPS trainer"
means a person who is
				  qualified to provide training and technical assistance for IPS implementation
				  and is one of the following:
1. A
				person who has provided IPS services or has supervised an IPS team in Iowa
				which has obtained a fidelity score of "good" or better, and has completed the
				IPS Employment Center at Westat's training to become an IPS trainer;
2. An existing IPS trainer from a state which
				is a member of the IPS International Learning Collaborative;
3. An IPS trainer contracted directly from
				the IPS Employment Center at Westat;
4. A CES with a bachelor's degree who has
				completed the IPS Employment Center at Westat's training to become an IPS
				trainer.
"Major incident"
means an occurrence
				  involving a member during service provision that:
1. Results in a physical injury to or by the
				member that requires a physician's treatment or admission to a
				hospital;
2. Results in the death
				of any person;
3. Requires
				emergency mental health treatment for the member;
4. Requires the intervention of law
				enforcement;
5. Requires a report
				of child abuse pursuant to Iowa Code section
				232.69
				or a report of dependent adult abuse pursuant to Iowa Code section
				235B.3;
6. Constitutes a prescription medication
				error or a pattern of medication errors that leads to the outcome in paragraph
				"1," "2," or "3"; or
7. Involves a
				member's location being unknown by provider staff who are assigned protective
				oversight.
"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.
"Member"
means a person who has been
				  determined to be eligible for Medicaid under 441-Chapter 75.
"Minor incident"
means an occurrence
				  involving a member during service provision that is not a major incident and
				  that:
1. Results in the application of
				basic first aid;
2. Results in
				bruising;
3. Results in seizure
				activity;
4. Results in injury to
				self, to others, or to property; or
5. Constitutes a prescription medication
				error.
"Prospective IPS team"
means a group that is
				  forming an IPS team to deliver IPS services but who has not yet completed
				  implementation phase 4a.
"Provider-owned or controlled setting"
means
				  a setting where the HCBS provider owns the property where the member resides,
				  leases the property from a third party, or has a direct or indirect financial
				  relationship with the property owner that impacts either the care provided to
				  or the financial conditions applicable to the member. The unit or dwelling is a
				  specific physical space that can be owned, rented, or occupied under a legally
				  enforceable agreement by the member receiving services, and the member has, at
				  a minimum, the same responsibilities and protections from eviction that tenants
				  have under the landlord/tenant law of the state, county, city, or other
				  designated entity. For the settings in which landlord tenant laws do not apply,
				  the state must ensure that a lease, residency agreement or other form of
				  written agreement will be in place for each HCBS member and that the document
				  provides protections that address eviction processes and appeals comparable to
				  those provided under the jurisdiction's landlord tenant law.
"Provisionally approved IPS team"
means a
				  group that has (1) formed a team to deliver IPS services, (2) completed
				  implementation phase 4a, and (3) begun to deliver IPS services.