reglab/statecodes huggingface dataset:
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.17 - Audits

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Audits of financial and statistical report.
Authorized
				representatives of the department or the Department of Health and Human
				Services shall have the right, upon proper identification, to audit, using
				generally accepted auditing procedures, the general financial records of a
				facility to determine if expenses reported on the Financial and Statistical
				Report, Form 470-0030, are reasonable and proper according to the rules set
				forth in 441-82.5 (249A). These audits
				may be done either on the basis of an on-site visit to the facility, their
				central accounting office, or office(s) of their agents.
a. When a proper per diem rate cannot be
				determined, through generally accepted auditing procedures, the auditor shall
				examine and adjust the report to arrive at what appears to be an acceptable
				rate and shall recommend to the department that the indicated per diem should
				be reduced to 75 percent of the established payment rate for the ensuing fiscal
				period and if the situation is not remedied on the subsequent Financial and
				Statistical Report, Form 470-0030, the facility shall be suspended and
				eventually canceled from the intermediate care facility program, or
b. When a facility continues to include as an
				item of cost an item or items which had in a prior audit been removed by an
				adjustment in the total audited costs, the auditor shall recommend to the
				department that the per diem be reduced to 75 percent of the current payment
				rate for the ensuing fiscal period. The department may, after considering the
				seriousness of the exception, make the reduction.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.18 - Out-of-state Facilities

Current through Register Vol. 47, No. 3, July 24, 2024
Payment will be made for care in out-of-state intermediate
				  care facilities for the mentally retarded. Out-of-state facilities shall abide
				  by the same policies as in-state facilities with the following
				  exceptions:
(1) Out-of-state providers
				will be reimbursed at the same intermediate care facility rate they are
				receiving for their state of residence.
(2) Out-of-state facilities shall not submit
				financial and statistical reports as required in rule
				441-81.6
				(249A).
(3) Payment for periods
				when residents are absent for visitation or hospitalization will be made to
				out-of-state facilities at 80 percent of the rate paid to the facility by the
				Iowa Medicaid program. Out-of-state facilities with 15 or fewer beds shall be
				reimbursed at 95 percent of the rate paid to the facility by the Iowa Medicaid
				program.
This rule is intended to implement Iowa Code section 249A.12.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 82 - Intermediate Care Facilities for Persons With an Intellectual Disability › Rule 441-82.19 - State-funded Personal Needs Supplement

Current through Register Vol. 47, No. 3, July 24, 2024
A Medicaid member living in an intermediate care facility for
				  persons with mental retardation who has countable income for purposes of rule
				  441-75.16
				  (249A) of less than $50 per month shall receive a state-funded payment from the
				  department for the difference between that countable income and $50 if the
				  legislature has appropriated funding specifically for this purpose. This
				  payment shall not be considered a benefit under Title XIX of the Social
				  Security Act.
This rule is intended to implement Iowa Code Supplement
				  section
				  249A.30A.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.3 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Application for HCBS health and
				disability waiver services.
The application process as specified in
				rules
				441-76.1 (249A) to
				441-76.6
				(249A) shall be followed.
(2)
Application and services program
				limit.
The number of persons who may be approved for the HCBS health
				and disability waiver shall be subject to the number of members to be served as
				set forth in the federally approved HCBS health and disability waiver. The
				number of members to be served is set forth at the time of each five-year
				renewal of the waiver or in amendments to the waiver approved by the Centers
				for Medicare and Medicaid Services (CMS). When the number of applicants exceeds
				the number of members specified in the approved waiver, the applicant's name
				shall be placed on a waiting list maintained by the bureau of long-term care.
a. The county department office shall enter
				all waiver applications into the individualized services information system
				(ISIS) to determine if a payment slot is available.
(1) For applicants not currently receiving
				Medicaid, the county department office shall make the entry by the end of the
				fifth working day after receipt of a completed Form 470-2927 or 470-2927(S),
				Health Services Application, or within five working days after receipt of
				disability determination, whichever is later.
(2) For current Medicaid members, the county
				department office shall make the entry by the end of the fifth working day
				after receipt of a written request signed and dated by the applicant.
(3) A payment slot shall be assigned to the
				applicant upon confirmation of an available slot.
(4) Once a payment slot is assigned, the
				county department office shall give written notice to the applicant. The
				department shall hold the payment slot for the applicant as long as reasonable
				efforts are being made to arrange services and the applicant has not been
				determined to be ineligible for the program. If services have not been
				initiated and reasonable efforts are no longer being made to arrange services,
				the slot shall revert for use by the next person on the waiting list, if
				applicable. The applicant originally assigned the slot must reapply for a new
				slot.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.4 - Financial Participation

Current through Register Vol. 47, No. 3, July 24, 2024
Persons must contribute their predetermined financial
				  participation to the cost of health and disability waiver services or other
				  Medicaid services, as applicable.
(1)
Maintenance needs of the individual.
The maintenance needs of
				the individual shall be computed by deducting an amount which is 300 percent of
				the maximum monthly payment for one person under supplemental security income
				(SSI) from the client's total income.
(2)
Limitation on payment.
If the sum of the third-party payment and client participation equals or
				exceeds the reimbursement established by the service worker or targeted case
				manager for health and disability waiver services, Medicaid shall make no
				payments to health and disability waiver service providers. However, Medicaid
				shall make payments to other medical vendors, as applicable.
(3)
Maintenance needs of spouse and
				other dependents.
Rescinded IAB 4/9/97, effective 6/1/97.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.5 - Redetermination

Current through Register Vol. 47, No. 3, July 24, 2024
A complete redetermination of eligibility for the health and
				  disability waiver shall be completed at least once every 12 months or when
				  there is significant change in the person's situation or condition.
A redetermination of continuing eligibility factors shall be
				  made in accordance with rules
				  441-76.7
				  (249A) and
				  441-83.2 (249A). A
				  redetermination shall include verification of the existence of a current
				  service plan meeting the requirements listed in rule
				  441-83.7
				  (249A).
(1) The IME medical services
				unit or the member's managed care organization shall be responsible for annual
				redetermination of the level of care.
(2) The managed care organization must submit
				documentation to the IME medical services unit for all reassessments, performed
				at least annually, which indicate a change in the member's level of care. The
				IME medical services unit shall make a final determination for any
				reassessments which indicate a change in the level of care. If the level of
				care reassessment indicates no change in level of care, the member is approved
				to continue at the already established level of care.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.6 - Allowable Services

Current through Register Vol. 47, No. 3, July 24, 2024
Services allowable under the health and disability waiver are
				  homemaker, home health, adult day care, respite care, nursing, counseling,
				  consumer-directed attendant care, interim medical monitoring and treatment,
				  home and vehicle modification, personal emergency response system,
				  home-delivered meals, nutritional counseling, financial management, independent
				  support brokerage, self-directed personal care, self-directed community
				  supports and employment, and individual-directed goods and services as set
				  forth in rule
				  441-78.34
				  (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.7 - Service Plan

Current through Register Vol. 47, No. 3, July 24, 2024
A service plan shall be prepared for health and disability
				  waiver members in accordance with 441-paragraph 90.4(1)
"b"
Service plans for both children and adults shall be completed every 12 months
				  or when there is significant change in the person's situation or
				  condition.
(1) The service plan shall
				include the frequency of the health and disability waiver services and the
				types of providers who will deliver the services.
(2) The service plan shall indicate whether
				the member has elected the consumer choices option. If the member has elected
				the consumer choices option, the service plan shall identify:
a. The independent support broker selected by
				the member; and
b. The financial
				management service selected by the member.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.8 - Adverse Service Actions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Denial. An application for services shall be denied when it is determined by
				the department that:
a. The client is not
				eligible for or in need of services.
b. Needed services are not available or
				received from qualified providers.
c. Service needs exceed the aggregate monthly
				costs established in 83.2(2)
"b,"
or are not met by the
				services provided.
d. Needed
				services are not available or received from qualifying providers.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.9 - Appeal Rights

Current through Register Vol. 47, No. 3, July 24, 2024
Notice of adverse action and right to appeal shall be given
				  in accordance with 441-Chapter 7, rule 441-16.3 (17A) and rule
				  441-130.5 (234). The applicant
				  or recipient is entitled to have a review of the level of care determination by
				  the IME medical services unit by sending a letter requesting a review to the
				  IME medical services unit. If dissatisfied with that decision, the applicant or
				  recipient may file an appeal with the department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.22 - Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
To be eligible for elderly waiver services a person must meet
				  certain eligibility criteria and be determined to need a service(s) allowable
				  under the program.
(1)
Eligibility criteria.
All of the following criteria must be
				met. The person must be:
a. Sixty-five years
				of age or older.
b. A resident of
				the state of Iowa.
c. Eligible for
				Medicaid as if in a medical institution pursuant to 441-Chapter 75. When a
				husband and wife who are living together both apply for the waiver, income and
				resource guidelines as specified at 441-paragraphs 75.5(2)
"b "
and 75.5(4)
"c"
shall be applied.
d. Certified as being in need of the
				intermediate or skilled level of care based, in part, on information submitted
				on the interRAI - Home Care (HC). The interRAI - Home Care (HC) is available on
				request from IME medical services unit and other supporting documentation as
				relevant. Copies of the completed interRAI - Home Care (HC) for an individual
				are available to that individual from the individual's case manager or managed
				care organization.
(1) The assessment shall be
				completed when the person applies for waiver services, upon request to report a
				significant change in the person's condition, and annually for reassessment of
				the person's level of care. The IME medical services unit shall be responsible
				for determination of the initial level of care.
(2) The IME medical services unit or the
				member's managed care organization shall be responsible for annual
				redetermination of the level of care.
(3) Elderly waiver services will not be
				provided when the person is an inpatient in a medical institution.
(4) The managed care organization must submit
				documentation to the IME medical services unit for all reassessments, performed
				at least annually, which indicate a change in the member's level of care. The
				IME medical services unit shall make a final determination for any
				reassessments which indicate a change in the level of care. If the level of
				care reassessment indicates no change in level of care, the member is approved
				to continue at the already established level of care.
e. Determined to need services as described
				in subrule 83.22(2).
f. Rescinded
				IAB 10/11/06, effective 10/1/06.
g.
				For the consumer choices option as set forth in rule 441-subrule 78.37(16),
				residing in a living arrangement other than a residential care
				facility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.23 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Application for HCBS elderly waiver.
The application process
				as specified in rules
				441-76.1 (249A) to
				441-76.6
				(249A) shall be followed.
(2)
Application for services.
Rescinded IAB 12/6/95, effective
				2/1/96.
(3)
Approval of
				application.
a. Applications for the
				elderly waiver program shall be processed in 3 0 days unless the worker can
				document difficulty in locating and arranging services or circumstances beyond
				the worker's control. In these cases a decision shall be made as soon as
				possible.
b. Decisions shall be
				mailed or given to the applicant on the date when both service and income
				maintenance eligibility determinations are completed.
c. An applicant must be given the choice
				between elderly waiver services and institutional care. The applicant,
				guardian, or attorney in fact under a durable power of attorney for health care
				shall sign the information submission tool specified in
				83.22(1)
"d,"
indicating that the applicant has elected waiver
				services.
d. Waiver services
				provided prior to approval of eligibility for the waiver cannot be
				paid.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.24 - Client Participation

Current through Register Vol. 47, No. 3, July 24, 2024
Persons must contribute their predetermined client
				  participation to the cost of elderly waiver services.
(1)
Computation of client
				participation.
Client participation shall be computed by deducting an
				amount for the maintenance needs of the individual which is 300 percent of the
				maximum SSI grant for an individual from the client's total income.
(2)
limitation on payment.
If the sum of the third-party payment and client participation equals or
				exceeds the reimbursement established by the service worker, Medicaid will make
				no payments for elderly waiver service providers. However, Medicaid will make
				payments to other medical vendors.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.25 - Redetermination

Current through Register Vol. 47, No. 3, July 24, 2024
A complete redetermination of eligibility for elderly waiver
				  services shall be done at least once every 12 months.
A redetermination of continuing eligibility factors shall be
				  made when a change in circumstances occurs that affects eligibility in
				  accordance with rule
				  441-83.22 (249A). A
				  redetermination shall contain the components listed in rule
				  441-83.27
				  (249A).
(1) The IME medical services
				unit or the member's managed care organization shall be responsible for annual
				redetermination of the level of care.
(2) The managed care organization must submit
				documentation to the IME medical services unit for all reassessments, performed
				at least annually, which indicate a change in the member's level of care. The
				IME medical services unit shall make a final determination for any
				reassessments which indicate a change in the level of care. If the level of
				care reassessment indicates no change in level of care, the member is approved
				to continue at the already established level of care.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.26 - Allowable Services

Current through Register Vol. 47, No. 3, July 24, 2024
Services allowable under the elderly waiver are case
				  management, adult day care, emergency response system, homemaker, home health
				  aide, nursing, respite care, chore, home-delivered meals, home and vehicle
				  modification, mental health outreach, transportation, nutritional counseling,
				  assistive devices, senior companions, consumer-directed attendant care,
				  financial management, independent support brokerage, self-directed personal
				  care, self-directed community supports and employment, and individual-directed
				  goods and services as set forth in rule
				  441-78.37
				  (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.27 - Service Plan

Current through Register Vol. 47, No. 3, July 24, 2024
The service plan shall be completed jointly by the consumer,
				  the elderly waiver case manager, and any other person identified by the
				  consumer
(1) The service plan shall
				indicate whether the consumer has elected the consumer choices option. If the
				consumer has elected the consumer choices option, the service plan shall
				identify:
a. The independent support broker
				selected by the consumer; and
b.
				The financial management service selected by the consumer
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.28 - Adverse Service Actions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Denial.
An application for services shall be denied when it is
				determined by the department that:
a. The
				client is not eligible for or in need of services.
b. Except for respite care, the elderly
				waiver services are not needed on a regular basis.
c. Service needs are not met by services
				provided.
d. Needed services are
				not available or received from qualifying providers.
e. Rescinded IAB 3/2/94, effective
				3/1/94.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.29 - Appeal Rights

Current through Register Vol. 47, No. 3, July 24, 2024
Notice of adverse action and right to appeal shall be given
				  in accordance with 441-Chapter 7, rule 441-16.3 (17A) and rule
				  441-130.5
				  (234).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.30 - Enhanced Services

Current through Register Vol. 47, No. 3, July 24, 2024
When a household has one person receiving service in
				  accordance with rules set forth in 441-Chapter 24 and another receiving elderly
				  waiver services, the persons providing case management shall cooperate to make
				  the best plan for both clients. When a person is eligible for services as set
				  forth in 441-Chapter 24 and eligible for services under the elderly waiver, the
				  person's primary diagnosis will determine which services shall be
				  used.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.42 - Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
To be eligible for AIDS/HIV waiver services a person must
				  meet certain eligibility criteria and be determined to need a service(s)
				  allowable under the program.
(1)
Eligibility criteria.
All of the following criteria must be
				met. The person must:
a. Be diagnosed by a
				physician as having AIDS or HIV infection.
b. Be certified in need of the level of care
				that, but for the waiver, would otherwise be provided in a nursing facility or
				hospital based, in part, on information submitted on a completed Form 470-4694
				for children aged 3 and under, the interRAI - Pediatric Home Care (PEDS-HC) for
				those aged 4 to 20, or the interRAI - Home Care (HC) for those aged 21 and over
				and other supporting documentation as relevant. Form 470-4694, the interRAI -
				Pediatric Home Care (PEDS-HC), and the interRAI - Home Care (HC) are available
				on request from the IME medical services unit. Copies of the completed
				information submission tool for an individual are available to that individual
				from the individual's case manager or managed care organization.
(1) The assessment as listed in
				83.42(1)
"b"
shall be completed when the person applies for
				waiver services, upon request to report a significant change in the person's
				condition, and annually for reassessment of the person's level of
				care.
(2) The IME medical services
				unit shall be responsible for approval of the certification of the level of
				care, and the IME medical services unit or a managed care organization will be
				responsible for annual redeterminations.
(3) AIDS/HIV waiver services shall not be
				provided when the person is an inpatient in a medical institution.
c. Be eligible for medical
				assistance under SSI, SSI-related, FMAP, or FMAP-related coverage groups;
				medically needy at hospital level of care; or a special income level (300
				percent group); or become eligible through application of the institutional
				deeming rules.
d. Require, and use
				at least quarterly, one service available under the waiver as determined
				through an evaluation of need described in subrule 83.42(2).
e. Have service needs such that the costs of
				the waiver services are not likely to exceed the costs of care that would
				otherwise be provided in a medical institution.
f. Have income which does not exceed 300
				percent of the maximum monthly payment for one person under supplemental
				security income.
g. For the
				consumer choices option as set forth in 441-subrule 78.38(9), not be living in
				a residential care facility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.43 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Application for HCBS AIDS/HIV waiver services.
The application
				process as specified in rules
				441-76.1 (249A) to
				441-76.6
				(249A) shall be followed.
(2)
Application for services.
Rescinded IAB 12/6/95, effective
				2/1/96.
(3)
Approval of
				application.
a. Applications for the
				HCBS AIDS/HIV waiver program shall be processed in 30 days unless one or more
				of the following conditions exist:
(1) The
				application is pending because the department has not received information,
				which is beyond the control of the client or the department.
(2) The application is pending because a
				level of care determination has not been made although the completed assessment
				has been submitted to the IME medical services unit.
(3) Rescinded IAB 3/7/01, effective
				5/1/01.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.44 - Financial Participation

Current through Register Vol. 47, No. 3, July 24, 2024
Persons must contribute their predetermined financial
				  participation to the cost of AIDS/HIV waiver services or other Medicaid
				  services, as applicable.
(1)
Maintenance needs of the individual.
The maintenance needs of
				the individual shall be computed by deducting an amount which is 300 percent of
				the maximum monthly payment for one person under supplemental security income
				(SSI) from the client's total income.
(2)
limitation on payment.
If the amount of the financial participation equals or exceeds the
				reimbursement established by the service worker for AIDS/HIV services, Medicaid
				will make no payments to AIDS/HIV waiver service providers. Medicaid will,
				however, make payments to other medical vendors.
(3)
Maintenance needs of spouse and
				other dependents.
Rescinded lAB 4/9/97, effective 6/1/97.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.45 - Redetermination

Current through Register Vol. 47, No. 3, July 24, 2024
A complete redetermination of eligibility for AIDS/HIV waiver
				  services shall be completed at least once every 12 months or when there is
				  significant change in the person's situation or condition. A redetermination of
				  continuing eligibility factors shall be made in accordance with rules
				  441-76.7
				  (249A) and
				  441-83.42 (249A). A
				  redetermination shall include the components listed in rule
				  441-83.47
				  (249A).
(1) The IME medical services
				unit or the member's managed care organization shall be responsible for annual
				redetermination of the level of care.
(2) The managed care organization must submit
				documentation to the IME medical services unit for all reassessments, performed
				at least annually, which indicate a change in the member's level of care. The
				IME medical services unit shall make a final determination for any
				reassessments which indicate a change in the level of care. If the level of
				care reassessment indicates no change in level of care, the member is approved
				to continue at the already established level of care.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.46 - Allowable Services

Current through Register Vol. 47, No. 3, July 24, 2024
Services allowable under the AIDS/HIV waiver are counseling,
				  home health aide, homemaker, nursing care, respite care, home-delivered meals,
				  adult day care, consumer-directed attendant care, financial management,
				  independent support brokerage, self-directed personal care, self-directed
				  community supports and employment, and individual-directed goods and services
				  as set forth in rule
				  441-78.38
				  (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.47 - Service Plan

Current through Register Vol. 47, No. 3, July 24, 2024
A service plan shall be prepared for AIDS/HIV waiver
				  consumers in accordance with rule
				  441-130.7 (234) except
				  that service plans for both children and adults shall be completed every 12
				  months or when there is significant change in the person's situation or
				  condition.
(1) The service plan shall
				include the frequency of the AIDS/HIV waiver services and the types of
				providers who will deliver the services.
(2) The service plan shall indicate whether
				the consumer has elected the consumer choices option. If the consumer has
				elected the consumer choices option, the service plan shall identify:
a. The independent support broker selected by
				the consumer; and
b. The financial
				management service selected by the consumer
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.48 - Adverse Service Actions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Denial. An application for services shall be denied when it is determined by
				the department that:
a. The client is not
				eligible for or in need of services.
b. Except for respite care, the AIDS/HIV
				waiver services are not needed on a regular basis.
c. Service needs exceed the aggregate monthly
				costs established in 83.42(2)
"b"
or cannot be met by the
				services provided under the waiver.
d. Needed services are not available from
				qualified providers.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.49 - Appeal Rights

Current through Register Vol. 47, No. 3, July 24, 2024
Notice of adverse action and right to appeal shall be given
				  in accordance with 441-Chapter 7, rule 441-16.3 (17A) and rule
				  441-130.5
				  (234).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.62 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Application for HCBS intellectual disability waiver services.
The application process as specified in rules
				441-76.1 (249A) to
				441-76.6
				(249A) shall be followed.
(2)
				Rescinded IAB 6/5/96, effective 8/1/96.
(3)
Approval of application.
a. Applications for the HCBS intellectual
				disability waiver program shall be processed in 30 days unless the case manager
				or worker can document difficulty in locating and arranging services or other
				circumstance beyond the worker's control. In these cases a decision shall be
				made as soon as possible.
b.
				Decisions shall be mailed or given to the applicant on the date when both
				service and income maintenance eligibility determinations are
				completed.
c. An applicant shall be
				given the choice between HCBS waiver services and ICF/ID care. The case manager
				or worker shall have the consumer or legal representative indicate the
				consumer's choice of care.
d. HCBS
				intellectual disability waiver services provided before eligibility for the
				waiver is approved shall not be reimbursed by the HCBS waiver
				program.
e. Services provided when
				the person is a consumer of group foster care services or is an inpatient in a
				medical institution shall not be reimbursed.
f. HCBS intellectual disability waiver
				services are not available in conjunction with other Medicaid waiver services
				or group foster care services.
g.
				Rescinded IAB 5/6/09, effective 7/1/09.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.63 - Client Participation

Current through Register Vol. 47, No. 3, July 24, 2024
Persons who are eligible under the 300 percent group must
				  contribute a predetermined client participation amount to the costs of the
				  services.
(1)
Computation of
				client participation.
Client participation shall be computed by
				deducting an amount for the maintenance needs of the individual which is 300
				percent of the maximum SSI grant for an individual from the client's total
				income.
(2)
limitation on
				payment.
If the sum of the third-party payment and client
				participation equals or exceeds the reimbursement for the specific HCBS waiver
				service, Medicaid will make no payments for the HCBS waiver service. However,
				Medicaid will make payments to other medical vendors.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.64 - Redetermination

Current through Register Vol. 47, No. 3, July 24, 2024
A redetermination of nonfinancial eligibility for HCBS
				  intellectual disability waiver services shall be completed at least once every
				  12 months. In years in which an SIS assessment is not completed for an
				  individual five years of age or older, the SIS contractor shall conduct a
				  review in collaboration with the case manager, documenting any changes in the
				  member's functional status since the previous SIS or other full assessment.
				  Form 470-4694 shall be completed annually for children under the age of
				  five.
A redetermination of continuing eligibility factors shall be
				  made when a change in circumstances occurs that affects eligibility in
				  accordance with rule
				  441-83.61
				  (249A).
(1) The IME medical services
				unit or the member's managed care organization shall be responsible for annual
				redetermination of the level of care.
(2) The managed care organization must submit
				documentation to the IME medical services unit for all reassessments, performed
				at least annually, which indicate a change in the member's level of care. The
				IME medical services unit shall make a final determination for any
				reassessments which indicate a change in the level of care. If the level of
				care reassessment indicates no change in level of care, the member is approved
				to continue at the already established level of care.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.66 - Allowable Services

Current through Register Vol. 47, No. 3, July 24, 2024
Services allowable under the HCBS intellectual disability
				  waiver are supported community living, respite, personal emergency response
				  system, nursing, home health aide, home and vehicle modification, supported
				  employment, consumer-directed attendant care, interim medical monitoring and
				  treatment, transportation, adult day care, day habilitation, prevocational
				  services, financial management, independent support brokerage, self-directed
				  personal care, self-directed community supports and employment, and
				  individual-directed goods and services as set forth in rule
				  441-78.41
				  (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.67 - Service Plan

Current through Register Vol. 47, No. 3, July 24, 2024
A service plan shall be prepared for each HCBS intellectual
				  disability waiver consumer.
(1)
Development.
The service plan shall be developed by the
				interdisciplinary team, which includes the consumer, and, if appropriate, the
				legal representative, consumer's family, case manager or service worker,
				service providers, and others directly involved.
(2)
Retention.
The service
				plan shall be stored by the case manager for a minimum of three
				years.
(3)
Interdisciplinary team meeting.
The interdisciplinary team
				meeting shall be conducted before the current service plan expires.
(4)
Information in plan.
The
				plan shall be in accordance with 441-subrule 24.4(3) and shall additionally
				include the following information to assist in evaluating the program:
a. A listing of all services received by a
				consumer at the time of waiver program enrollment.
b. For supported community living:
(1) The consumer's living environment at the
				time of waiver enrollment.
(2) The
				number of hours per day of on-site staff supervision needed by the
				consumer.
(3) The number of other
				waiver consumers who will live with the consumer in the living unit.
c. An identification and
				justification of any restriction of the consumer's rights including, but not
				limited to:
(1) Maintenance of personal
				funds.
(2) Self-administration of
				medications.
d. The name
				of the service provider responsible for providing each service.
e. The service funding source.
f. The amount of the service to be received
				by the consumer.
g. Whether the
				consumer has elected the consumer choices option and, if so:
(1) The independent support broker selected
				by the consumer; and
(2) The
				financial management service selected by the consumer.
h. A plan for emergencies and identification
				of the supports available to the consumer in an emergency.
i. For members receiving daily supported
				community living, day habilitation or adult day care: the following standard
				scores from the most recently completed SIS assessment:
(1) Score on subsection 1A: Exceptional
				Medical Support Needs.
(2) Score on
				subsection IB: Exceptional Behavioral Support Needs.
(3) Sum total of standard scores on the
				following subsections:
1. Subsection 2A: Home
				Living Activities;
2. Subsection
				2B: Community Living Activities;
3.
				Subsection 2E: Health and Safety Activities; and
4. Subsection 2F: Social
				Activities.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.68 - Adverse Service Actions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Denial.
An application for services shall be denied when it is
				determined by the department that:
a. The
				applicant is not eligible for the services.
b. Service needs exceed the service unit or
				reimbursement maximums.
c. Service
				needs are not met by the services provided.
d. Needed services are not available or
				received from qualifying providers.
e. No HCBS intellectual disability waiver
				service is identified in the applicant's service plan.
f. There is another community resource
				available to provide the service or a similar service free of charge to the
				applicant that will meet the applicant's needs.
g. Completion or receipt of required
				documents by the department for the HCBS program applicant has not
				occurred.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.69 - Appeal Rights

Current through Register Vol. 47, No. 3, July 24, 2024
Notice of adverse action and right to appeal shall be given
				  in accordance with 441-Chapter 7, rule 441-16.3 (17A) and rule
				  441-130.5
				  (234).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.72 - Rent Subsidy Program

Current through Register Vol. 47, No. 3, July 24, 2024
Members in the HCBS intellectual disability waiver program
				  may be eligible for a rent subsidy. See 265-Chapter 24.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.83 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Application for financial eligibility.
The application process
				as specified in rules
				441-76.1 (249A) to
				441-76.6
				(249A) shall be followed.
(2)
Approval of application for eligibility.
a. Applications for the determination of
				ability of the consumer to have all medically necessary service needs met
				within the scope of this waiver shall be initiated on behalf of the consumer
				and with the consumer's consent or with the consent of the consumer's legal
				representative by the discharge planner of the medical facility where the
				consumer resides at the time of application or the case manager. The discharge
				planner or case manager shall provide to the IME medical services unit all
				appropriate information needed regarding all the medically necessary service
				needs of the consumer. After completing the determination of ability to have
				all medically necessary service needs met within the scope of this waiver, the
				IME medical services unit shall inform the discharge planner or case manager on
				behalf of the consumer or the consumer's legal representative and send to the
				income maintenance worker a copy of the decision as to whether all of the
				consumer's service needs can be met in a home- or community-based
				setting.
b. Eligibility for the
				HCBS BI waiver shall be effective as of the date when both the service
				eligibility and financial eligibility have been completed. Decisions shall be
				mailed or given to the consumer or the consumer's legal representative on the
				date when each eligibility determination is completed.
c. An applicant shall be given the choice
				between waiver services and institutional care. The applicant or legal
				representative shall sign the applicable information submission tool listed in
				paragraph 83.82(1)
"f "
indicating that the applicant has
				elected home- and community-based services. This shall be arranged by the
				medical facility discharge planner or case manager.
d. The medical facility discharge planner, if
				there is one involved, shall contact the consumer's managed care organization
				or the designated case manager to initiate development of the consumer's
				service plan and initiation of waiver services.
e. HCBS BI waiver services provided prior to
				both approvals of eligibility for the waiver cannot be paid.
f. HCBS BI waiver services are not available
				in conjunction with other HCBS waiver programs or group foster care
				services.
g. The Medicaid case
				manager shall establish an HCBS BI waiver interdisciplinary team for each
				consumer and, with the team, identify the consumer's "need for service" based
				on the consumer's needs and desires as well as the availability and
				appropriateness of services.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.84 - Client Participation

Current through Register Vol. 47, No. 3, July 24, 2024
Consumers who are financially eligible under 441-subrule
				  75.1(7) (the 300 percent group) must contribute a predetermined participation
				  amount to the cost of brain injury waiver services.
(1)
Computation of client
				participation.
Client participation shall be computed by deducting an
				amount for the maintenance needs of the consumer which is 300 percent of the
				maximum SSI grant for an individual from the consumer's total income. For a
				couple, client participation is determined as if each person were an
				individual.
(2)
limitation
				on payment.
If the sum of the third-party payment and client
				participation equals or exceeds the reimbursement for the specific brain injury
				waiver service, Medicaid shall make no payments for the waiver service.
				However, Medicaid shall make payments to other medical providers.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.85 - Redetermination

Current through Register Vol. 47, No. 3, July 24, 2024
A complete financial redetermination of eligibility for brain
				  injury waiver shall be completed at least once every 12 months. A
				  redetermination of continuing eligibility factors shall be made when a change
				  in circumstances occurs that affects eligibility in accordance with rule
				  441-83.82 (249A). A
				  redetermination shall contain the components listed in rule
				  441-83.82
				  (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.86 - Allowable Services

Current through Register Vol. 47, No. 3, July 24, 2024
Services allowable under the brain injury waiver are case
				  management, respite, personal emergency response, supported community living,
				  behavioral programming, family counseling and training, home and vehicle
				  modification, specialized medical equipment, prevocational services,
				  transportation, supported employment, adult day care, consumer-directed
				  attendant care, interim medical monitoring and treatment, financial management,
				  independent support brokerage, self-directed personal care, self-directed
				  community supports and employment, and individual-directed goods and services
				  as set forth in rule
				  441-78.43
				  (249A).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 83 - Medicaid Waiver Services › Rule 441-83.87 - Service Plan

Current through Register Vol. 47, No. 3, July 24, 2024
A service plan shall be prepared and utilized for each HCBS
				  BI waiver consumer. The service plan shall be developed by an interdisciplinary
				  team, which includes the consumer, and, if appropriate, the legal
				  representative, consumer's family, case manager, providers, and others directly
				  involved. The service plan shall be stored by the case manager for a minimum of
				  three years. The service plan staffing shall be conducted before the current
				  service plan expires.
(1)
Information in plan.
The
				plan shall be in accordance with 441-subrule 24.4(3) and shall additionally
				include the following information to assist in evaluating the program:
a. A listing of all services received by a
				consumer at the time of waiver program enrollment.
b. For supported community living:
(1) The consumer's living environment at the
				time of waiver enrollment.
(2) The
				number of hours per day of on-site staff supervision needed by the
				consumer.
(3) The number of other
				waiver consumers who will live with the consumer in the living unit.
c. An identification and
				justification of any restriction of a consumer's rights including, but not
				limited to:
(1) Maintenance of personal
				funds.
(2) Self-administration of
				medications.
d. The
				names of all providers responsible for providing all services.
e. All service funding sources.
f. The amount of the service to be received
				by the consumer.
g. Whether the
				consumer has elected the consumer choices option and, if so:
(1) The independent support broker selected
				by the consumer; and
(2) The
				financial management service selected by the consumer.
h. A plan for emergencies and identification
				of the supports available to the consumer in an emergency.