Iowa Admin. Code r. 441-77.37 - Home- and community-based services intellectual disability waiver service providers
Providers shall be eligible to participate in the Medicaid HCBS intellectual disability waiver program if they meet the requirements in this rule and the subrules applicable to the individual service.
The standards in subrule 77.37(1) apply only to providers of supported employment, respite providers certified according to subparagraph 77.37(15) "a "(8), and providers of supported community living services that are not residential-based. The standards and certification processes in subrules 77.37(2) through 77.37(7) and 77.37(9) through 77.37(12) apply only to supported employment providers and non-residential-based supported community living providers.
The requirements in subrule 77.37(13) apply to all providers. EXCEPTION: A person hired through the consumer choices option for independent support brokerage, self-directed personal care, individual-directed goods and services, or self-directed community support and employment is not required to enroll as a Medicaid provider and is not subject to the review requirements in subrule 77.37(13). Also, services must be rendered by a person who is at least 16 years old (except as otherwise provided in this rule) and is not the spouse of the consumer served or the parent or stepparent of a consumer aged 17 or under. People who are 16 or 17 years old must be employed and supervised by an enrolled HCBS provider unless they are employed to provide self-directed personal care services through the consumer choices option. A person hired for self-directed personal care services need not be supervised by an enrolled HCBS provider. Consumer-directed attendant care and interim medical monitoring and treatment providers must be at least 18 years of age.
The integrated, community-based settings standards in subrule 77.25(5) apply to all HCBS intellectual disability waiver service providers.
(1)
Organizational
standards (Outcome 1). Organizational outcome-based standards for
home- and community-based services intellectual disability providers are as
follows:
a. The organization demonstrates the
provision and oversight of high-quality supports and services to
consumers.
b. The organization
demonstrates a defined mission commensurate with consumer's needs, desires, and
abilities.
c. The organization
establishes and maintains fiscal accountability.
d. The organization has qualified staff
commensurate with the needs of the consumers they serve. These staff
demonstrate competency in performing duties and in all interactions with
clients.
e. The organization
provides needed training and supports to its staff. This training includes at a
minimum:
(1) Consumer rights.
(2) Confidentiality.
(3) Provision of consumer
medication.
(4) Identification and
reporting of child and dependent adult abuse.
(5) Individual consumer support needs.
f. The organization has a
systematic, organizationwide, planned approach to designing, measuring,
evaluating, and improving the level of its performance. The organization:
(1) Measures and assesses organizational
activities and services annually.
(2) Gathers information from consumers,
family members, and staff.
(3)
Conducts an internal review of consumer service records, including all major
and minor incident reports according to subrule 77.37(8).
(4) Tracks incident data and analyzes trends
annually to assess the health and safety of consumers served by the
organization.
(5) Identifies areas
in need of improvement.
(6)
Develops a plan to address the areas in need of improvement.
(7) Implements the plan and documents the
results.
g. Consumers and
their legal representatives have the right to appeal the provider's
implementation of the 20 outcomes, or staff or contractual person's action
which affects the consumer. The provider shall distribute the policies for
consumer appeals and procedures to consumers.
h. The provider shall have written policies
and procedures and a staff training program for the identification and
reporting of child and dependent adult abuse to the department pursuant to
441-Chapters 175 and 176.
i. The
governing body has an active role in the administration of the
agency.
j. The governing body
receives and uses input from a wide range of local community interests and
consumer representation and provides oversight that ensures the provision of
high-quality supports and services to consumers.
(2)
Rights and dignity.
Outcome-based standards for rights and dignity are as follows:
a. (Outcome 2) Consumers are
valued.
b. (Outcome 3) Consumers
live in positive environments.
c.
(Outcome 4) Consumers work in positive environments.
d. (Outcome 5) Consumers exercise their
rights and responsibilities.
e.
(Outcome 6) Consumers have privacy.
f. (Outcome 7) When there is a need,
consumers have support to exercise and safeguard their rights.
g. (Outcome 8) Consumers decide which
personal information is shared and with whom.
h. (Outcome 9) Consumers make informed
choices about where they work.
i.
(Outcome 10) Consumers make informed choices on how they spend their free
time.
j. (Outcome 11) Consumers
make informed choices about where and with whom they live.
k. (Outcome 12) Consumers choose their daily
routine.
l. (Outcome 13) Consumers
are a part of community life and perform varied social roles.
m. (Outcome 14) Consumers have a social
network and varied relationships.
n. (Outcome 15) Consumers develop and
accomplish personal goals.
o.
(Outcome 16) Management of consumers' money is addressed on an individualized
basis.
p. (Outcome 17) Consumers
maintain good health.
q. (Outcome
18) The consumer's living environment is reasonably safe in the consumer's home
and community.
r (Outcome 19) The
consumer's desire for intimacy is respected and supported.
s. (Outcome 20) Consumers have an impact on
the services they receive.
(3)
Contracts with
consumers. The provider shall have written procedures which provide
for the establishment of an agreement between the consumer and the provider.
a. The agreement shall define the
responsibilities of the provider and the consumer, the rights of the consumer,
the services to be provided to the consumer by the provider, all room and board
and copay fees to be charged to the consumer and the sources of
payment.
b. Contracts shall be
reviewed at least annually.
(4)
The right to appeal.
Consumers and their legal representatives have the right to appeal the
provider's application of policies or procedures, or any staff or contractual
person's action which affects the consumer. The provider shall distribute the
policies for consumer appeals and procedures to consumers.
(5)
Storage and provision of
medication. If the provider stores, handles, prescribes, dispenses or
administers prescription or over-the-counter medications, the provider shall
develop procedures for the storage, handling, prescribing, dispensing or
administration of medication. For controlled substances, procedures shall be in
accordance with department of inspections and appeals rule
481-63.18 (135).
If the provider has a physician on staff or under contract, the physician shall review and document the provider's prescribed medication regime at least annually in accordance with current medical practice.
(6)
Research. If
the provider conducts research involving human subjects, the provider shall
have written policies and procedures for research which ensure the rights of
consumers and staff.
(7)
Abuse reporting requirements. The provider shall have written
policies and procedures and a staff training program for the identification and
reporting of child and dependent adult abuse to the department pursuant to
441-Chapters 175 and 176.
(8)
Incident management and reporting. As a condition of
participation in the medical assistance program, HCBS intellectual disability
waiver 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. Exception: The
conditions in this subrule do not apply to providers of goods and services
purchased under the consumer choices option or providers of home and vehicle
modification, personal emergency response, and transportation.
a.
Definitions.
"Major incident" means an occurrence involving a consumer during service provision that:
1. Results in a physical injury to or by the
consumer 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 consumer;
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
consumer's location being unknown by provider staff who are assigned protective
oversight.
"Minor incident" means an occurrence involving a consumer 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.
b.
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 consumer's
file.
c.
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 consumer's supervisor.
2. The consumer or the consumer's legal
guardian. EXCEPTION: Notification to the consumer 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 consumer'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
consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer's
file.
d.
Tracking and analysis. The provider shall track incident data
and analyze trends to assess the health and safety of consumers 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.
(9)
Intake, admission, service coordination, discharge, and
referral.
a. The provider shall have
written policies and procedures according to state and federal laws for intake,
admission, service coordination, discharge and referral. Service coordination
means activities designed to help individuals and families locate, access, and
coordinate a network of supports and services that will allow them to live a
full life in the community.
b. The
provider shall ensure the rights of persons applying for services.
(10)
Certification
process. Reviews of compliance with standards for initial
certification and recertification shall be conducted by the department of human
services' bureau of long-term care quality assurance staff. Certification
carries no assurance that the approved provider will receive funding.
a. Rescinded IAB 9/1/04, effective
11/1/04.
b. Rescinded IAB 9/1/04,
effective 11/1/04.
c. Rescinded IAB
9/1/04, effective 11/1/04.
d. The
department may request any information from the prospective service provider
which is considered pertinent to arriving at a certification decision. This may
include, but is not limited to:
(1) Current
accreditations, evaluations, inspections and reviews by regulatory and
licensing agencies and associations.
(2) Fiscal capacity of the prospective
provider to initiate and operate the specified programs on an ongoing
basis.
(11)
Initial certification. The department shall review the
application and accompanying information to see if the provider has the
necessary framework to provide services in accordance with all applicable
requirements and standards.
a. The department
shall make a determination regarding initial certification within 60 days of
receipt of the application and notify the provider in writing of the decision
unless extended by mutual consent of the parties involved. Providers shall be
responsible for notifying the appropriate county and the appropriate central
point of coordination of the determination.
b. The decision of the department on initial
certification of the providers shall be based on all relevant information,
including:
(1) The application for status as
an approved provider according to requirements of rules.
(2) A determination of the financial position
of the prospective provider in relation to its ability to meet the stated
need.
(3) The prospective
provider's coordination of service design, development, and application with
the applicable region and other interested parties.
(4) The prospective provider's written
agreement to work cooperatively with the state, counties and regions to be
served by the provider.
c. Providers applying for initial
certification shall be offered technical assistance.
(12)
Period of
certification. Provider certification shall become effective on the
date identified on the certificate of approval and shall terminate in 270
calendar days, one year, or three calendar years from the month of issue. The
renewal of certification shall be contingent upon demonstration of continued
compliance with certification requirements.
a.
Initial certification. Providers eligible for initial certification by the
department shall be issued an initial certification for 270 calendar days based
on documentation provided.
b.
Recertification. After the initial certification, the level of certification
shall be based on an on-site review unless the provider has been accredited for
similar services by the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), the Commission on Accreditation of Rehabilitation
Facilities (CARF), the Council on Quality and Leadership in Supports for People
with Disabilities (The Council), or the Council on Accreditation of Services
for Families and Children (COA). The on-site reviews for supported community
living and supported employment use interviews with consumers and significant
people in the consumer's life to determine whether or not the 20 individual
value-based outcomes set forth in subrules 77.37(1) and 77.37(2) and
corresponding processes are present for the consumer. Respite services are
required to meet Outcome 1 and participate in satisfaction surveys.
Once the outcomes and processes have been determined for all the consumers in the sample, a review team then determines which of the 20 outcomes and processes are present for the provider. A specific outcome is present for the provider when the specific outcome is determined to be present for 75 percent or more of the consumers interviewed. A specific process is present for the provider when the process is determined to be present for 75 percent or more of the consumers interviewed. Since the processes are in the control of the provider and the outcomes are more in the control of the consumer, length of certification will be based more heavily on whether or not the processes are in place to help consumers obtain desired outcomes.
An exit conference shall be held with the organization to share preliminary findings of the certification review. A review report shall be written and sent to the provider within 30 calendar days unless the parties mutually agree to extend that time frame.
Provider certification shall become effective on the date identified on the Certificate of Approval, Form 470-3410, and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.
c. The department may issue four categories
of recertification:
(1) Three-year
certification with excellence. An organization is eligible for certification
with excellence if the number of processes present is 18 or higher and the
number of outcomes and corresponding processes present together is 12 or
higher. Both criteria need to be met to receive three-year certification with
excellence. Corrective actions may be required which may be monitored through
the assignment of follow-up monitoring either by written report, a plan of
corrective actions and improvements, an on-site review, or the provision of
technical assistance.
(2)
Three-year certification with follow-up monitoring. An organization is eligible
for this type of certification if the number of processes present is 17 or
higher and the number of outcomes and corresponding processes present together
are 11 or higher. Both criteria need to be met to receive three-year
certification. Corrective actions are required which may be monitored through
the assignment of follow-up monitoring either by written report, a plan of
corrective actions and improvements, an on-site review, or the provision of
technical assistance.
(3) One-year
certification. An organization is eligible for this type of certification when
the number of processes present is 14 or higher and the number of outcomes and
processes together is 9 or higher. Both criteria need to be met to receive
one-year certification. One-year certification may also be given in lieu of
longer certification when previously required corrective actions have not been
implemented or completed. Corrective actions are required which may be
monitored through the assignment of follow-up monitoring either by written
report, a plan of corrective actions and improvements, an on-site review, or
the provision of technical assistance.
(4) Probational certification. A probational
certification may be issued to those providers who cannot meet requirements for
a one-year certification. This time period shall be granted to the provider to
establish and implement corrective actions and improvement activities. During
this time period the department may require monitoring of the implementation of
the corrective actions through on-site visits, written reports or technical
assistance. Probational certification issued for 270 calendar days shall not be
renewed or extended, and shall require a full on-site follow-up review to be
completed. The provider shall be required to achieve at least a one-year
certification status at the time of the follow-up review in order to maintain
certification.
d. During
the course of the review, if a team member encounters a situation that places a
member in immediate jeopardy, the team member shall immediately notify the
provider, the department, and other team members. "Immediate jeopardy" refers
to circumstances where the life, health, or safety of a member will be severely
jeopardized if the circumstances are not immediately corrected.
(1) The provider shall correct the situation
within 24 to 48 hours. If the situation is not corrected within the prescribed
time frame, that portion of the provider's services that was the subject of the
notification shall not be certified. The department shall be notified
immediately to discontinue funding for that provider's service. If a member is
in immediate jeopardy, the case manager or department service worker shall
notify the county or region in the event the county or region is funding a
service that may assist the member in the situation.
(2) If this action is appealed and the
member, legal guardian, or attorney in fact under a durable power of attorney
for health care wants to maintain the provider's services, funding can be
reinstated. At that time the provider shall take appropriate action to ensure
the life, health, and safety of the members deemed to be at risk as a result of
the provider's inaction.
e. As a mandatory reporter, each team member
shall be required to follow appropriate procedure in all cases where a
condition reportable to child and adult protective services is observed.
f. The department may grant an
extension to the period of approval for the following reasons:
(1) A delay in the department's approval
decision which is beyond the control of the provider or department.
(2) A request for an extension from a
provider to permit the provider to prepare and obtain department approval of
corrective actions. The department shall establish the length of extensions on
a case-by-case basis.
g.
The department may revoke the provider's approval at any time for any of the
following reasons:
(1) Findings of a site
visit indicate that the provider has failed to implement the corrective actions
submitted pursuant to paragraph 77.37(13)"e."
(2) The provider has failed to provide
information requested pursuant to paragraph 77.37(13)"f."
(3) The provider refuses to allow
the department to conduct a site visit pursuant to paragraph
77.37(13)'%."
(4) There are
instances of noncompliance with the standards which were not identified from
information submitted on the application.
h. An approved provider shall immediately
notify the department, applicable county, or region, the applicable mental
health and developmental disabilities planning council, and other interested
parties of a decision to withdraw from a home- and community-based services
intellectual disability waiver service.
i. Following certification, any provider may
request technical assistance from the department to bring into conformity those
areas found in noncompliance with HCBS requirements. If multiple deficiencies
are noted during a review, the department may require that technical assistance
be provided to a provider to assist in the implementation of the provider's
corrective actions. Providers may be given technical assistance as
needed.
j. Appeals. Any adverse
action can be appealed by the provider under 441-Chapter 7.
(13)
Review of
providers. Reviews of compliance with standards as indicated in this
chapter shall be conducted by designated members of the HCBS staff.
a. This review may include on-site case
record audits; review of administrative procedures, clinical practices,
personnel records, performance improvement systems and documentation; and
interviews with staff, consumers, the board of directors, or others deemed
appropriate, consistent with the confidentiality safeguards of state and
federal laws.
b. A review visit
shall be scheduled with the provider with additional reviews conducted at the
discretion of the department.
c.
The on-site review team will consist of designated members of the HCBS
staff.
d. Following a certification
review, the certification review team leader shall submit a copy of the
department's written report of findings to the provider within 30 working days
after completion of the certification review.
e. The provider shall develop a plan of
corrective action, if applicable, identifying completion time frames for each
review recommendation.
f. Providers
required to make corrective actions and improvements shall submit the
corrective action and improvement plan to the Bureau of Long-Term Care, 1305
East Walnut Street, Des Moines, Iowa 50319-0114, within 30 working days after
the receipt of a report issued as a result of the review team's visit. The
corrective actions may include: specific problem areas cited, corrective
actions to be implemented by the provider, dates by which each corrective
measure will be completed, and quality assurance and improvement activities to
measure and ensure continued compliance.
g. The department may request the provider to
supply subsequent reports on implementation of a corrective action plan
submitted pursuant to 77.37(13)"e" and 77.37(13)"f.
"
h. The department may
conduct a site visit to verify all or part of the information
submitted.
(14)
Supported community living providers.
a. The department will contract only with
public or private agencies to provide the supported community living service.
The department does not recognize individuals as service providers under the
supported community living program.
b. Providers of services meeting the
definition of foster care shall also be licensed according to applicable
441-Chapters 108, 112, 114, 115, and 116.
c. Providers of service may employ or
contract with individuals meeting the definition of foster family homes to
provide supported community living services. These individuals shall be
licensed according to applicable 441-Chapters 112 and 113.
d. All supported community living providers
shall meet the following requirements:
(1) The
provider shall demonstrate how the provider will meet the outcomes and
processes in rule 441-77.37 (249A) for each of the consumers being served. The
provider shall supply timelines showing how the provider will come into
compliance with rules 441-77.37 (249A),
441-78.41 (249A), and
441-83.60 (249A) to
441-83.70 (249A) and 441-subrule 79.1(15) within one year of certification.
These timelines shall include:
1.
Implementation of necessary staff training and consumer input.
2. Implementation of provider system changes
to allow for flexibility in staff duties, services based on what each
individual needs, and removal of housing as part of the service.
(2) The provider shall demonstrate
that systems are in place to measure outcomes and processes for individual
consumers before certification can be given.
e. 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.
f. 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.
(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;
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.
(15)
Respite care providers.
a.
The following agencies may provide respite services:
(1) Group living foster care facilities for
children licensed by the department according to 441-Chapters 112 and 114 to
116 and child care centers licensed according to 441-Chapter 109.
(2) Nursing facilities, intermediate care
facilities for the mentally retarded, and hospitals enrolled as providers in
the Iowa Medicaid program.
(3)
Residential care facilities for persons with mental retardation licensed by the
department of inspections and appeals.
(4) Home health agencies that are certified
to participate in the Medicare program.
(5) Camps certified by the American Camping
Association.
(6) Adult day care
providers that meet the conditions of participation set forth in subrule
77.37(25).
(7) Agencies authorized
to provide similar services through a contract with the department of public
health (IDPH) for local public health services. The agency must provide a
current IDPH local public health services contract number.
(8) Agencies certified by the department to
provide respite services in the consumer's home that meet the requirements of
77.37(1) and 77.37(3) through 77.37(9).
(9) Assisted living programs certified by the
department of inspections and appeals.
b. Respite providers shall meet the following
conditions:
(1) Providers shall maintain the
following information that shall be updated at least annually:
1. The consumer's name, birth date, age, and
address and the telephone number of each parent, guardian or primary
caregiver.
2. An emergency medical
care release.
3. Emergency contact
telephone numbers such as the number of the consumer's physician and the
parents, guardian, or primary caregiver.
4. The consumer's medical issues, including
allergies.
5. The consumer's daily
schedule which includes the consumer's preferences in activities or foods or
any other special concerns.
(2) Procedures shall be developed for the
dispensing, storage, authorization, and recording of all prescription and
nonprescription medications administered. Home health agencies must follow
Medicare regulations for medication dispensing.
All medications shall be stored in their original containers, with the accompanying physician's or pharmacist's directions and label intact. Medications shall be stored so they are inaccessible to consumers and the public. Nonprescription medications shall be labeled with the consumer's name.
In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription.
(3) Policies shall be developed for:
1. Notifying the parent, guardian or primary
caregiver of any injuries or illnesses that occur during respite provision. A
parent's, guardian's or primary caregiver's signature is required to verify
receipt of notification.
2.
Requiring the parent, guardian or primary caregiver to notify the respite
provider of any injuries or illnesses that occurred prior to respite
provision.
3. Documenting
activities and times of respite. This documentation shall be made available to
the parent, guardian or primary caregiver upon request.
4. Ensuring the safety and privacy of the
individual. Policies shall at a minimum address threat of fire, tornado, or
flood and bomb threats.
c. A facility providing respite under this
subrule shall not exceed the facility's licensed capacity, and services shall
be provided in locations consistent with licensure.
d. Respite provided outside the consumer's
home or the facility covered by the licensure, certification, accreditation, or
contract must be approved by the parent, guardian or primary caregiver and the
interdisciplinary team and must be consistent with the way the location is used
by the general public. Respite in these locations shall not exceed 72
continuous hours.
(16)
Supported employment providers.
a. The following agencies may provide
supported employment services:
(1) An agency
that is accredited by the Commission on Accreditation of Rehabilitation
Facilities as an organizational employment service provider, a community
employment service provider, or a provider of a similar service.
(2) An agency that is accredited by the
Council on Accreditation for similar services.
(3) An agency that is accredited by the Joint
Commission for similar services.
(4) An agency that is accredited by the
Council on Quality and Leadership for similar services.
(5) 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. Individuals may not provide
supported employment services except when the services are purchased through
the consumer choices option.
d.
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 a 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.
(17)
Home and vehicle modification
providers. The following providers may provide home and vehicle
modification:
a. Providers certified to
participate as supported community living service providers under the home- and
community-based services intellectual disability or brain injury
waiver.
b. Providers eligible to
participate as home and vehicle modification providers under the elderly or
health and disability waiver, enrolled as home and vehicle modification
providers under the physical disability waiver, or certified as home and
vehicle modification providers under the brain injury waiver.
c. Community businesses that have all
necessary licenses and permits to operate in conformity with federal, state,
and local laws and regulations and that submit verification of current
liability and workers' compensation insurance.
(18)
Personal emergency response
system providers. Personal emergency response system providers shall
be agencies which meet the conditions of participation set forth in subrule
77.33(2) to maintain certification.
(19)
Nursing providers.
Nursing providers shall be agencies that are certified to participate in the
Medicare program as home health agencies.
(20)
Home health aide
providers. Home health aide providers shall be agencies which are
certified to participate in the Medicare program as home health agencies and
which have an HCBS agreement with the department.
(21)
Consumer-directed attendant care
providers. The following providers may provide consumer-directed
attendant care service:
a. An individual who
contracts with the member to provide attendant care service and who is:
(1) At least 18 years of age.
(2) Qualified by training or experience to
carry out the member's plan of care pursuant to the department-approved case
plan or individual comprehensive plan.
(3) Not the spouse of the member or a parent
or stepparent of a member aged 17 or under.
(4) Not the recipient of respite services
paid through home- and community-based services on behalf of a member who
receives home- and community-based services.
b. Agencies authorized to provide similar
services through a contract with the department of public health (IDPH) for
local public health services. The agency must provide a current IDPH local
public health services contract number.
c. Home health agencies which are certified
to participate in the Medicare program.
d. Chore providers subcontracting with area
agencies on aging or with letters of approval from the area agencies on aging
stating that the organization is qualified to provide chore services.
e. Community action agencies as designated in
Iowa Code section
216A.93.
f. Providers certified under an HCBS waiver
for supported community living.
g.
Assisted living programs that are certified by the department of inspections
and appeals under 481-Chapter 69.
h. Adult day service providers that are
certified by the department of inspections and appeals under 481-Chapter
70.
(22)
Interim
medical monitoring and treatment providers.
a. The following providers may provide
interim medical monitoring and treatment services:
(1) Home health agencies certified to
participate in the Medicare program.
(2) Supported community living providers
certified according to subrule 77.37(14) or 77.39(13).
b. Staff requirements. Staff members
providing interim medical monitoring and treatment services to members shall
meet all of the following requirements:
(1) Be
at least 18 years of age.
(2) Not
be the spouse of the member or a parent or stepparent of the member if the
member is aged 17 or under.
(3) Not
be a usual caregiver of the member.
(4) Be qualified by training or experience to
provide medical intervention or intervention in a medical emergency necessary
to carry out the member's plan of care. The training or experience required
must be determined by the member's usual caregivers and a licensed medical
professional on the member's interdisciplinary team and must be documented in
the member's service plan.
c. Service documentation. Providers shall
maintain clinical and fiscal records necessary to fully disclose the extent of
services furnished to members. Records shall specify by service date the
procedures performed, together with information concerning progress of
treatment.
(23)
Residential-based supported community living service
providers.
a. The department shall
contract only with public or private agencies to provide residential-based
supported community living services.
b. Subject to the requirements of this rule,
the following agencies may provide residential-based supported community living
services:
(1) Agencies licensed as group
living foster care facilities under 441-Chapter 114.
(2) Agencies licensed as residential
facilities for mentally retarded children under 441-Chapter 116.
(3) Other agencies providing
residential-based supported community living services that meet the following
conditions:
1. The agency must provide
orientation training on the agency's purpose, policies, and procedures within
one month of hire or contracting for all employed and contracted treatment
staff and must provide 24 hours of training during the first year of employment
or contracting. The agency must also provide at least 12 hours of training per
year after the first year of employment for all employed and contracted
treatment staff. Annual training shall include, at a minimum, training on
children's mental retardation and developmental disabilities services and
children's mental health issues. Identification and reporting of child abuse
shall be covered in training at least every five years, in accordance with Iowa
Code section
232.69.
2. The agency must have standards for the
rights and dignity of children that are age-appropriate. These standards shall
include the following:
* Children, their families, and their legal representatives decide what personal information is shared and with whom.
* Children are a part of family and community life and perform varied social roles.
* Children have family connections, a social network, and varied relationships.
* Children develop and accomplish personal goals.
* Children are valued.
* Children live in positive environments.
* Children exercise their rights and responsibilities.
* Children make informed choices about how they spend their free time.
* Children choose their daily routine.
3. The agency must use methods of
self-evaluation by which:
* Past performance is reviewed.
* Current functioning is evaluated.
* Plans are made for the future based on the review and evaluation.
4. The agency
must have a governing body that receives and uses input from a wide range of
local community interests and consumer representatives and provides oversight
that ensures the provision of high-quality supports and services to
children.
5. Children, their
parents, and their legal representatives must have the right to appeal the
service provider's application of policies or procedures or any staff person's
action that affects the consumer. The service provider shall distribute the
policies for consumer appeals and procedures to children, their parents, and
their legal representatives.
c. As a condition of participation, all
providers of residential-based supported community living services must have
the following on file:
(1) Current
accreditations, evaluations, inspections, and reviews by applicable regulatory
and licensing agencies and associations.
(2) Documentation of the fiscal capacity of
the provider to initiate and operate the specified programs on an ongoing
basis.
(3) The provider's written
agreement to work cooperatively with the department.
d. As a condition of participation, all
providers of residential-based supported community living services must
develop, review, and revise service plans for each child, as follows:
(1) The service plan shall be developed in
collaboration with the social worker or case manager, child, family, and, if
applicable, the foster parents, unless a treatment rationale for the lack of
involvement of one of these parties is documented in the plan. The service
provider shall document the dates and content of the collaboration on the
service plan. The service provider shall provide a copy of the service plan to
the family and the case manager, unless otherwise ordered by a court of
competent jurisdiction.
(2) Initial
service plans shall be developed after services have been authorized and within
30 calendar days of initiating services.
(3) The service plan shall identify the
following:
1. Strengths and needs of the
child.
2. Goals to be achieved to
meet the needs of the child.
3.
Objectives for each goal that are specific, measurable, and time-limited and
include indicators of progress toward each goal.
4. Specific service activities to be provided
to achieve the objectives.
5. The
persons responsible for providing the services. When daily living and social
skills development is provided in a group care setting, designation may be by
job title.
6. Date of service
initiation and date of individual service plan development.
7. Service goals describing how the child
will be reunited with the child's family and community.
(4) Individuals qualified to provide all
services identified in the service plan shall review the services identified in
the service plan to ensure that the services are necessary, appropriate, and
consistent with the identified needs of the child, as listed on the Supports
Intensity Scale® (SIS) assessment.
(5) The service worker or case manager shall
review all service plans to determine progress toward goals and objectives 90
calendar days from the initiation of services and every 90 calendar days
thereafter for the duration of the services.
At a minimum, the provider shall submit written reports to the service worker or case manager at six-month intervals and when changes to the service plan are needed.
(6) The individual service plan shall be
revised when any of the following occur:
1.
Service goals or objectives have been achieved.
2. Progress toward goals and objectives is
not being made.
3. Changes have
occurred in the identified service needs of the child, as listed on the
Supports Intensity Scale® (SIS) assessment.
4. The service plan is not consistent with
the identified service needs of the child, as listed in the service
plan.
(7) The service
plan shall be signed and dated by qualified staff of each reviewing provider
after each review and revision.
(8)
Any revisions of the service plan shall be made in collaboration with the
child, family, case manager, and, if applicable, the foster parents and shall
reflect the needs of the child. The service provider shall provide a copy of
the revised service plan to the family and case manager, unless otherwise
ordered by a court of competent jurisdiction.
e. The residential-based supportive community
living service provider shall also furnish residential-based living units for
all recipients of the residential-based supported community living services.
Except as provided herein, living units provided may be of no more than four
beds. Service providers who receive approval from the bureau of long-term care
may provide living units of up to eight beds. The bureau shall approve five- to
eight-bed living units only if all of the following conditions are met:
(1) Rescinded IAB 8/7/02, effective
10/1/02.
(2) There is a need for
the service to be provided in a five- to eight-person living unit instead of a
smaller living unit, considering the location of the programs in an
area.
(3) The provider supplies the
bureau of long-term care with a written plan acceptable to the department that
addresses how the provider will reduce its living units to four-bed units
within a two-year period of time. This written plan shall include the
following:
1. How the transition will
occur.
2. What physical change will
need to take place in the living units.
3. How children and their families will be
involved in the transitioning process.
4. How this transition will affect children's
social and educational environment.
f. Certification process and review of
service providers.
(1) The certification
process for providers of residential-based supported community living services
shall be pursuant to subrule 77.37(10).
(2) The initial certification of
residential-based supported community living services shall be pursuant to
subrule 77.37(11).
(3) Period and
conditions of certification.
1. Initial
certification. Providers eligible for initial certification by the department
shall be issued an initial certification for 270 calendar days, effective on
the date identified on the certificate of approval, based on documentation
provided.
2. Recertification. After
the initial certification, recertification shall be based on an on-site review
and shall be contingent upon demonstration of compliance with certification
requirements.
An exit conference shall be held with the provider to share preliminary findings of the recertification review. A review report shall be written and sent to the provider within 30 calendar days unless the parties mutually agree to extend that time frame.
Recertification shall become effective on the date identified on the Certificate of Approval, Form 470-3410, and shall terminate one year from the month of issuance.
Corrective actions may be required in connection with recertification and may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.
3. Probational
certification. Probational certification for 270 calendar days may be issued to
a provider who cannot demonstrate compliance with all certification
requirements on recertification review to give the provider time to establish
and implement corrective actions and improvement activities.
During the probational certification period, the department may require monitoring of the implementation of the corrective actions through on-site visits, written reports, or technical assistance.
Probational certification shall not be renewed or extended and shall require a full on-site follow-up review to be completed. The provider must demonstrate compliance with all certification requirements at the time of the follow-up review in order to maintain certification.
4. Immediate jeopardy. If, during the course
of any review, a review team member encounters a situation that places a member
in immediate jeopardy, the team member shall immediately notify the provider,
the department, and other team members. "Immediate jeopardy" refers to
circumstances where the life, health, or safety of a member will be severely
jeopardized if the circumstances are not immediately corrected.
The provider shall correct the situation within 24 to 48 hours. If the situation is not corrected within the prescribed time frame, the provider shall not be certified. The department shall immediately discontinue funding for that provider's service. If this action is appealed and the member or legal guardian wants to maintain the provider's services, funding can be reinstated. At that time the provider shall take appropriate action to ensure the life, health, and safety of the members deemed to be at risk. The case manager or department service worker shall notify the county or region in the event the county or region is funding a service that may assist the member in the situation.
5. Abuse
reporting. As a mandatory reporter, each review team member shall follow
appropriate procedure in all cases where a condition reportable to child and
adult protective services is observed.
6. Extensions. The department shall establish
the length of extensions on a case-by-case basis. The department may grant an
extension to the period of certification for the following reasons:
* A delay in the department's approval decision exists which is beyond the control of the provider or department.
* A request for an extension is received from a provider to permit the provider to prepare and obtain department approval of corrective actions.
7. Revocation. The
department may revoke the provider's approval at any time for any of the
following reasons:
* The findings of a site visit indicate that the provider has failed to implement the corrective actions submitted pursuant to paragraph 77.37(13)"e" and numbered paragraph 77.37(23) '/"(3)"4."
* The provider has failed to provide information requested pursuant to paragraph 77.37(13)"f" and numbered paragraph 77.37(23)"f"(3)"4."
* The provider refuses to allow the department to conduct a site visit pursuant to paragraph 77.37(13)'%" and subparagraph 77.37(23)"f"(3).
* There are instances of noncompliance with the standards that were not identified from information submitted on the application.
8. Notice of intent to withdraw.
An approved provider shall immediately notify the department, applicable
county, the applicable mental health and developmental disabilities planning
council, and other interested parties of a decision to withdraw as a provider
of residential-based supported community living services.
9. Technical assistance. Following
certification, any provider may request technical assistance from the
department regarding compliance with program requirements. The department may
require that technical assistance be provided to a provider to assist in the
implementation of any corrective action plan.
10. Appeals. The provider can appeal any
adverse action under 441-Chapter 7.
(4) Providers of residential-based supported
community living services shall be subject to reviews of compliance with
program requirements pursuant to subrule
77.37(13).
(24)
Transportation service providers. The following providers may
provide transportation:
a. Accredited
providers of home- and community-based services.
b. Regional transit agencies as recognized by
the Iowa department of transportation.
c. Transportation providers that contract
with county governments.
d.
Community action agencies as designated in Iowa Code section
216A.93.
e. Nursing facilities licensed under Iowa
Code chapter 135C.
f. Area agencies
on aging as designated in rule
17-4.4 (231), subcontractors of
area agencies on aging, or organizations with letters of approval from the area
agencies on aging stating that the organization is qualified to provide
transportation services.
g.
Transportation providers contracting with the nonemergency medical
transportation contractor.
(25)
Adult day care
providers. Adult day care providers shall be agencies that are
certified by the department of inspections and appeals as being in compliance
with the standards for adult day services programs at 481-Chapter 70.
(26)
Prevocational service
providers.
a. Providers of
prevocational services must be accredited by one of the following:
(1) The Commission on Accreditation of
Rehabilitation Facilities as an organizational employment service provider or a
community employment service provider.
(2) The Council on Quality and Leadership
accreditation in supports for people with disabilities.
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. 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 services 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.
(27)
Day habilitation
providers. Day habilitation services may be provided by agencies
meeting the qualifications in subrule 77.25(7).
(28)
Financial management
service. Consumers who elect the consumer choices option shall work
with a financial institution that meets the qualifications in subrule
77.30(13).
(29)
Independent
support brokerage. Consumers who elect the consumer choices option
shall work with an independent support broker who meets the qualifications in
subrule 77.30(14).
(30)
Self-directed personal care. Consumers who elect the consumer
choices option may choose to purchase self-directed personal care services from
an individual or business that meets the requirements in subrule
77.30(15).
(31)
Individual-directed goods and services. Consumers who elect
the consumer choices option may choose to purchase individual-directed goods
and services from an individual or business that meets the requirements in
subrule 77.30(16).
(32)
Self-directed community supports and employment. Consumers who
elect the consumer choices option may choose to purchase self-directed
community supports and employment from an individual or business that meets the
requirements in subrule 77.30(17).
This rule is intended to implement Iowa Code section 249A.4.
Notes
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