Iowa Admin. Code r. 441-77.25 - Home- and community-based habilitation services
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.
(2)
Organization
and staff.
a. The prospective
provider shall demonstrate the fiscal capacity to initiate and operate the
specified programs on an ongoing basis.
b. The provider shall complete child abuse,
dependent adult abuse, and criminal background screenings pursuant to Iowa Code
section
249A.29
before employing a person who will provide direct care.
c. A person providing direct care shall be at
least 16 years of age.
d. A person
providing direct care shall not be an immediate family member of the
member.
(3)
Incident management and reporting. As a condition of
participation in the medical assistance program, HCBS habilitation service
providers must comply with the requirements of Iowa Code sections
232.69
and
235B.3
regarding the reporting of child abuse and dependent adult abuse and with the
incident management and reporting requirements in this subrule.
a.
Reporting procedure for minor
incidents. Minor incidents may be reported in any format designated by
the provider. When a minor incident occurs or a staff member becomes aware of a
minor incident, the staff member involved shall submit the completed incident
report to the staff member's supervisor within 72 hours of the incident. The
completed report shall be maintained in a centralized file with a notation in
the member's file.
b.
Reporting procedure for major incidents. When a major incident
occurs or a staff member becomes aware of a major incident:
(1) The staff member involved shall notify
the following persons of the incident by the end of the next calendar day after
the incident:
1. The staff member's
supervisor.
2. The member or the
member's legal guardian. Exception: Notification to the member is required only
if the incident took place outside of the provider's service provision.
Notification to the guardian, if any, is always required.
3. The member's case manager.
(2) By the end of the next
calendar day after the incident, the staff member who observed or first became
aware of the incident shall also report as much information as is known about
the incident to the member's managed care organization in the format defined by
the managed care organization. If the member is not enrolled with a managed
care organization, the staff member shall report the information to the
department's bureau of long-term care either:
1. By direct data entry into the Iowa
Medicaid Provider Access System, or
2. By faxing or mailing Form 470-4698,
Critical Incident Report, according to the directions on the form.
(3) The following information
shall be reported:
1. The name of the member
involved.
2. The date and time the
incident occurred.
3. A description
of the incident.
4. The names of
all provider staff and others who were present at the time of the incident or
who responded after becoming aware of the incident. The confidentiality of
other members or nonmembers who were present must be maintained by the use of
initials or other means.
5. The
action that the provider staff took to manage the incident.
6. The resolution of or follow-up to the
incident.
7. The date the report is
made and the handwritten or electronic signature of the person making the
report.
(4) Submission of
the initial report will generate a workflow in the Individualized Services
Information System (ISIS) for follow-up by the case manager. When complete
information about the incident is not available at the time of the initial
report, the provider must submit follow-up reports until the case manager is
satisfied with the incident resolution and follow-up. The completed report
shall be maintained in a centralized file with a notation in the member's
file.
c.
Tracking
and analysis. The provider shall track incident data and analyze
trends to assess the health and safety of members served and determine if
changes need to be made for service implementation or if staff training is
needed to reduce the number or severity of incidents.
(4)
Restraint, restriction, and
behavioral intervention. The provider shall have in place a system for
the review, approval, and implementation of ethical, safe, humane, and
efficient behavioral intervention procedures. All members receiving home- and
community-based habilitation services shall be afforded the protections imposed
by these rules when any restraint, restriction, or behavioral intervention is
implemented.
a. The system shall include
procedures to inform the member and the member's legal guardian of the
restraint, restriction, and behavioral intervention policy and procedures at
the time of service approval and as changes occur.
b. Restraint, restriction, and behavioral
intervention shall be used only for reducing or eliminating maladaptive target
behaviors that are identified in the member's restraint, restriction, or
behavioral intervention program.
c.
Restraint, restriction, and behavioral intervention procedures shall be
designed and implemented only for the benefit of the member and shall never be
used as punishment, for the convenience of the staff, or as a substitute for a
nonaversive program.
d. Restraint,
restriction, and behavioral intervention programs shall be time-limited and
shall be reviewed at least quarterly.
e. Corporal punishment and verbal or physical
abuse are prohibited.
(5)
Residential and nonresidential settings. Effective March 17,
2022, all home- and community-based services (HCBS), whether residential or
nonresidential, shall be provided in integrated, community-based settings that
support full access of individuals receiving Medicaid HCBS to the greater
community, including opportunities to seek employment and work in competitive
integrated settings, engage in community life, control personal resources, and
receive services in the community, to the same degree of access as individuals
not receiving Medicaid HCBS. Settings shall optimize individual initiative,
autonomy, and independence in making life choices, including but not limited to
daily activities, physical environment, and with whom to interact.
a. Nursing facilities, institutions for
mental diseases, intermediate care facilities for persons with an intellectual
disability, and hospitals are not considered integrated, community-based
settings.
b. Any HCBS setting that
is located in a building that is also a publicly or privately operated
facility, identified in paragraph 77.25(5)"a," that provides
inpatient treatment or in a building on the grounds of, or immediately adjacent
to, a public institution, identified in paragraph 77.25(5)"a,"
or any setting that has the effect of isolating members receiving Medicaid HCBS
from the broader community will be presumed to be a setting that has the
qualities of an institution unless the department conducts a site-specific
review and determines otherwise.
c.
Residential services may be provided in provider-owned or controlled settings.
In provider-owned or controlled residential settings:
(1) The member selects the setting from among
setting options, including non-disability-specific settings and an option for a
private unit in a residential setting.
(2) The setting options are identified and
documented in the person-centered service plan and are based on the member's
needs, preferences, and resources available for room and board.
(3) Members have choices regarding services
and supports received and who provides them.
(4) Members are assured the rights of
privacy, dignity, respect, and freedom from coercion and undue
restraint.
(5) Services and
supports shall optimize, but not regiment, individual initiative, autonomy, and
independence in making life choices, including but not limited to daily
activities, physical environment, and with whom to interact.
(6) Each member shall be afforded privacy in
the member's sleeping and living unit. Living unit entrance doors and bedroom
doors may be locked by the member, and only appropriate staff shall have keys.
Staff access to keys must be identified in the member's person-centered
plan.
(7) Members shall have a
choice of roommates in that setting.
(8) Members shall have the freedom to furnish
and decorate their sleeping or living areas as desired as permitted by any
operative lease or other agreement.
(9) Members shall have the freedom and
support to control their own schedules and activities and shall have access to
food at any time.
(10) Members may
have visitors of their choosing at any time.
(11) The setting shall be physically
accessible to the member.
(6)
Case management. A
provider is eligible to participate in the home- and community-based
habilitation services program as a provider of case management services if
accredited as a case management provider pursuant to 441-Chapter 24.
(7)
Day habilitation.
a. The following providers may provide day
habilitation:
(1) An agency that is accredited
by the Commission on Accreditation of Rehabilitation Facilities to provide
services that qualify as day habilitation under 441-subrule 78.27(8).
(2) An agency that is accredited by the
Commission on Accreditation of Rehabilitation Facilities to provide other
services and began providing services that qualify as day habilitation under
441-subrule 78.27(8) since the agency's last accreditation survey. The agency
may provide day habilitation services until the current accreditation expires.
When the current accreditation expires, the agency must qualify under
subparagraph 77.25(7)"a"(1), 77.25(7)"a"(4),
or 77.25(7)"a"(7).
(3) An agency that is not accredited by the
Commission on Accreditation of Rehabilitation Facilities but has applied to the
Commission within the last 12 months for accreditation to provide services that
qualify as day habilitation under 441-subrule 78.27(8). An agency that has not
received accreditation within 12 months after application to the Commission is
no longer a qualified provider.
(4)
An agency that is accredited by the Council on Quality and Leadership in
Supports for People with Disabilities.
(5) An agency that has applied to the Council
on Quality and Leadership in Supports for People with Disabilities for
accreditation within the last 12 months. An agency that has not received
accreditation within 12 months after application to the Council is no longer a
qualified provider.
(6) An agency
that is accredited under 441-Chapter 24 to provide day treatment or supported
community living services.
(7) An
agency that is accredited by the International Center for Clubhouse
Development.
(8) An agency that is
accredited by the Joint Commission on Accreditation of Healthcare
Organizations.
b. Direct
support staff providing day habilitation services shall meet the following
minimum qualifications in addition to other requirements outlined in
administrative rule:
(1) A person providing
direct support without line-of-sight supervision shall be at least 18 years of
age and possess a high school diploma or equivalent degree. A person providing
direct support with line-of-sight supervision shall be 16 years of age or
older.
(2) A person providing
direct support shall not be an immediate family member of the member.
(3) A person providing direct support shall,
within six months of hire or within six months of February 1, 2021, complete at
least 9.5 hours of training in supporting members in the activities listed in
701-paragraph 78.27(8)"a," as offered through DirectCourse or
Relias or other nationally recognized training curriculum.
(4) A person providing direct support shall
annually complete 4 hours of continuing education in supporting members in the
activities listed in 701-paragraph 78.27(8)"a," as offered
through DirectCourse or Relias or other nationally recognized training
curriculum.
(8)
Home-based habilitation.
a.
The following agencies may provide home-based habilitation services:
(1) An agency that is certified by the
department to provide supported community living services under:
1. The home- and community-based services
intellectual disability waiver pursuant to rule
441-77.37 (249A); or
2. The home- and community-based services
brain injury waiver pursuant to rule
441-77.39 (249A).
(2) An agency
that is accredited under 441-Chapter 24 to provide supported community living
services.
(3) An agency that is
accredited by the Commission on Accreditation of Rehabilitation Facilities as a
community housing or supported living service provider.
(4) An agency that is accredited by the
Council on Quality and Leadership in Supports for People with
Disabilities.
(5) An agency that is
accredited by the Council on Accreditation of Services for Families and
Children.
(6) An agency that is
accredited by the Joint Commission on Accreditation of Healthcare
Organizations.
b. Direct
support staff providing home-based habilitation services shall meet the
following minimum qualifications in addition to the other requirements outlined
in this rule:
(1) A person providing direct
support shall be at least 18 years old and have a high school diploma or its
equivalent.
(2) A person providing
direct support shall not be an immediate family member of the member receiving
services.
(3) A person providing
direct support to members receiving intensive residential habilitation services
shall complete 48 hours of training within the first year of employment and 24
hours of training each year thereafter in mental health and multi-occurring
conditions pursuant to 441-subrule 25.6(8).
(4) A person providing direct support to
members receiving home-based habilitation services shall complete a minimum of
24 hours of training within the first year of employment in mental health and
multi-occurring conditions, including but not limited to the following topics:
1. Mental health diagnoses, symptomology, and
treatment;
2. Intervention
strategies that may include applied behavioral analysis, motivational
interviewing, or other evidence-based practices;
3. Crisis management, intervention, and
de-escalation;
4. Psychiatric
medications, common medications, and potential side effects;
5. Member-specific medication protocols,
supervision of self-administration of medication, and documentation;
6. Substance use disorders and
treatment;
7. Other diagnoses or
conditions present in the population served; and
8. Individual-person-centered service plan,
crisis plan, and behavioral support plan implementation.
(5) A person providing direct support to
members receiving home-based habilitation services shall complete a minimum of
12 hours of training annually on the topics listed in subparagraph
77.25(8)"b"(4) or other topics related to serving individuals
with severe and persistent mental illness.
c. The department shall approve living units
designed to serve up to four persons except as necessary to prevent an
overconcentration of supported community living units in a geographic
area.
d. The department shall
approve a living unit designed to serve five persons if both of the following
conditions are met:
(1) Approval will not
result in an overconcentration of supported community living units in a
geographic area; and
(2) The county
in which the living unit is located provides to the bureau of long-term care
verification in writing that the approval is needed to address one or more of
the following issues:
1. The quantity of
services currently available in the county is insufficient to meet the need;
or
2. The quantity of affordable
rental housing in the county is insufficient to meet the need; or
3. Approval will result in a reduction in the
size or quantity of larger congregate settings.
(9)
Prevocational
habilitation.
a. The following
providers may provide prevocational services:
(1) An agency that is accredited by the
Commission on Accreditation of Rehabilitation Facilities as an organizational
employment service provider or a community employment service
provider.
(2) An agency that is
accredited by the Council on Quality and Leadership.
(3) An agency that is accredited by the
International Center for Clubhouse Development.
b.
Providers responsible for the payroll of members shall have policies that
ensure compliance with state and federal labor laws and regulations, which
include, but are not limited to:
(1)
Subminimum wage laws and regulations, including the Workforce Investment
Opportunity Act.
(2) Member
vacation, sick leave and holiday compensation.
(3) Procedures for payment schedules and pay
scale.
(4) Procedures for provision
of workers' compensation insurance.
(5) Procedures for the determination and
review of commensurate wages.
c. Direct support staff providing
prevocational services shall meet the following minimum qualifications in
addition to other requirements outlined in administrative rule:
(1) A person providing direct support without
line-of-sight supervision shall be at least 18 years of age and possess a high
school diploma or equivalent degree. A person providing direct support with
line-of-sight supervision shall be 16 years of age or older.
(2) A person providing direct support shall
not be an immediate family member of the member.
(3) A person providing direct support shall,
within 6 months of hire or within 6 months of May 4, 2016, complete at least
9.5 hours of employment service training as offered through DirectCourse or
through the Association of Community Rehabilitation Educators (ACRE) certified
training program.
(4) Prevocational
direct support staff shall complete 4 hours of continuing education in
employment services annually.
(10)
Supported employment
habilitation.
a. The following
agencies may provide supported employment services:
(1) An agency that is certified by the
department to provide supported employment services under:
1. The home- and community-based services
intellectual disability waiver pursuant to rule
441-77.37 (249A); or
2. The home- and community-based services
brain injury waiver pursuant to rule
441-77.39 (249A).
(2) An agency
that is accredited by the Commission on Accreditation of Rehabilitation
Facilities as an organizational employment service provider or a community
employment service provider.
(3) An
agency that is accredited by the Council on Accreditation.
(4) An agency that is accredited by the Joint
Commission.
(5) An agency that is
accredited by the Council on Quality and Leadership.
(6) An agency that is accredited by the
International Center for Clubhouse Development.
b. Providers responsible for the payroll of
members shall have policies that ensure compliance with state and federal labor
laws and regulations, which include, but are not limited to:
(1) Subminimum wage laws and regulations,
including the Workforce Investment Opportunity Act.
(2) Member vacation, sick leave and holiday
compensation.
(3) Procedures for
payment schedules and pay scale.
(4) Procedures for provision of workers'
compensation insurance.
(5)
Procedures for the determination and review of commensurate wages.
c. Direct support staff providing
individual or small-group supported employment or long-term job coaching
services shall meet the following minimum qualifications in addition to other
requirements outlined in administrative rule:
(1) Individual supported employment:
bachelor's degree or commensurate experience, preferably in human services,
sociology, psychology, education, human resources, marketing, sales or
business. The person must also hold nationally recognized certification (ACRE
or College of Employment Services (CES) or similar) as an employment specialist
or must earn this credential within 24 months of hire.
(2) Long-term job coaching: associate degree,
or high school diploma or equivalent and 6 months' relevant experience. A
person providing direct support shall, within 6 months of hire or within 6
months of May 4, 2016, complete at least 9.5 hours of employment services
training as offered through DirectCourse or through the ACRE certified training
program. The person must also hold or obtain, within 24 months of hire,
nationally recognized certification in job training and coaching.
(3) Small-group supported employment:
associate degree, or high school diploma or equivalent and 6 months' relevant
experience. A person providing direct support shall, within 6 months of hire or
within 6 months of May 4, 2016, complete at least 9.5 hours of employment
services training as offered through DirectCourse or through the ACRE certified
training program. The person must also hold or obtain, within 24 months of
hire, nationally recognized certification in job training and
coaching.
(4) Supported employment
direct support staff shall complete 4 hours of continuing education in
employment services annually.
d. Providers qualified to offer IPS services
shall meet the following requirements:
(1)
Providers shall meet the provider qualifications listed in this
subrule.
(2) Providers shall be
accredited to provide supported employment and have provided supported
employment for a minimum of two years.
(3) Providers shall demonstrate adequate
funding has been secured for the training and technical assistance required for
IPS implementation. Adequate funding is defined as at least the amount required
for the start-up of one IPS team to complete all phases of IPS implementation.
Evidence of such funding shall be made available to the department at the time
of enrollment. Evidence may include a written funding agreement or other
documentation from the funder.
(4)
Providers shall receive training and technical assistance throughout IPS
implementation from an IPS trainer. Evidence of the IPS team's agreement for
such training and technical assistance shall be made available to the
department at the time of enrollment.
(5) Prospective IPS teams shall complete IPS
implementation as defined in subrule 77.25(1) and as outlined by the IPS
Employment Center at Westat.
(6)
Prospective IPS teams are provisionally approved until the IPS team has
obtained at least a "fair" score on a baseline fidelity review completed by IPS
reviewers.
(7) Provisionally
approved IPS teams shall complete IPS implementation phases 1 through 4a within
12 months of enrolling.
(8) Upon
completion of IPS implementation phase 4a, provisionally approved IPS teams
shall deliver IPS services according to the IPS outcomes model.
(9) Upon completion of IPS implementation
phase 7, IPS teams are qualified to deliver IPS services, subject to the
following:
1. IPS teams must obtain a baseline
fidelity review score of "fair" or better within 14 months of completion of IPS
implementation phase 1. The fidelity review must be completed by IPS reviewers.
The fidelity reviews shall be provided to the department upon receipt by the
IPS team.
2. In the event an IPS
team fails to achieve a fidelity score of "fair" or better, the IPS team shall
receive technical assistance to address areas recommended for improvement as
identified in the fidelity review. If the subsequent fidelity review results in
a score of less than "fair" fidelity, the IPS team will be provisionally
approved for no more than 12 months or until the fidelity score again reaches
"fair" fidelity, whichever date is earliest.
3. IPS teams who do not achieve a "fair"
fidelity score within 12 months from being provisionally approved will no
longer be qualified to deliver IPS services until they again reach the minimum
"fair" fidelity score.
This rule is intended to implement Iowa Code section 249A.4.
Notes
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