Iowa Administrative Code › Agency 441 - Human Services Department › Title III - Mental Health › Chapter 22 - Autism Support Program › Rule 441-22.2 - Eligibility and Application Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
To be determined eligible for funding for services through
				  the autism support program, an individual must meet the following
				  requirements:
(1) An individual shall
				submit an application to the department using a standardized application form
				available through the administrator's and the department's websites, members of
				the provider network, the regional autism assistance program, and advocacy
				organizations.
(2) An applicant for
				autism program services shall be less than the age of 14 at the time of
				application for the program. Proof of age must be provided at the time of
				application. An individual who reaches the age of 14 prior to receipt of the
				maximum benefits of the program may continue to receive services from the
				program in accordance with the individual's treatment plan, up to a maximum of
				24 months of applied behavioral analysis treatment.
(3) An individual shall have a diagnosis of
				autism based on a diagnostic assessment of autism dated 24 months or less from
				the date of application for the program.
(4) An individual shall be determined
				ineligible for coverage of applied behavioral analysis services under the
				medical assistance program, Iowa Code section
				514C.28,
				Iowa Code section 514C.31, or other private insurance coverage. Proof of
				insurance coverage and noneligibility for coverage for applied behavioral
				analysis shall be provided at the time of application and shall include a
				written denial of coverage or a benefits summary indicating that the applied
				behavioral analysis treatment or applied behavior analysis treatment is not a
				covered benefit for which the applicant is eligible under the Medicaid program,
				Iowa Code section
				514C.28,
				Iowa Code section
				514C.31,
				or other private insurance coverage.
(5) An individual shall have a household
				income equal to or less than 500 percent of the federal poverty level.
				Information needed to determine household income using modified adjusted gross
				income methodology shall be identified on the program application. Household
				size will be determined according to the standards in this chapter. The
				information shall be provided at the time of application.
(6) The department shall provide to the
				parent or guardian a written notice of decision determining initial eligibility
				or denial within 30 calendar days of receipt of the application.
(7) The department shall refer an applicant
				determined to be an eligible individual to care coordination services. The
				referral will occur within 5 business days of determination of eligibility for
				the program. Care coordination services will be provided by the University of
				Iowa regional autism assistance program (RAP) or an integrated health home.
				Eligible individuals who reside in counties where integrated health homes for
				children with a serious emotional disturbance are operational may choose to
				receive care coordination through the University of Iowa RAP program or an
				integrated health home that serves residents of the eligible individual's
				county of residence. Care coordination is not required as a condition of
				receiving services through the autism support program.
(8) The department shall provide information
				to an applicant determined to be an eligible individual regarding all available
				administrators. The eligible individual may choose any available
				administrator.
(9) The
				administrator shall maintain a list of individuals determined eligible for the
				program but unable to access services due to lack of available providers and
				shall work to connect eligible individuals on the list to network
				providers.
(10) The department
				shall stop processing applications at the point where available funds are fully
				obligated for eligible individuals and additional eligible individuals would
				cause expenditures in excess of the funds available to the program. The
				department shall maintain a waiting list of individuals denied access to the
				program due to lack of available funds. If additional funds become available,
				the department shall contact individuals on the list in order of the earliest
				date and time of the receipt of the original application. The applicant shall
				be allowed 30 calendar days to submit an updated application and any required
				information needed to determine eligibility. If the applicant does not submit
				required information, the applicant will be denied eligibility and removed from
				the waiting list maintained for individuals denied access to the program due to
				lack of funding. The age of the applicant at the time of the most recent
				application will be used when determining eligibility for the
				program.