Iowa Admin. Code r. 441-77.39 - HCBS brain injury waiver service providers
Providers shall be eligible to participate in the Medicaid brain injury waiver program if they meet the requirements in this rule and the subrules applicable to the individual service. Beginning January 1, 2015, providers initially enrolling to deliver BI waiver services and each of their staff members involved in direct consumer service must have completed the department's brain injury training modules one and two within 60 days from the beginning date of service provision, with the exception of staff members who are certified through the Academy of Certified Brain Injury Specialists (ACBIS) as a certified brain injury specialist (CBIS) or certified brain injury specialist trainer (CBIST), providers of home and vehicle modification, specialized medical equipment, transportation, personal emergency response, financial management, independent support brokerage, self-directed personal care, individual-directed goods and services, and self-directed community supports and employment. Providers enrolled to provide BI waiver services and each of their staff members involved in direct consumer service on or before December 31, 2014, shall be deemed to have completed the required training.
Services shall 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. 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 review under subrule 77.39(11). Consumer-directed attendant care and interim medical monitoring and treatment providers must be at least 18 years of age.
In addition, behavioral programming, supported community living, and supported employment providers shall meet the outcome-based standards set forth below in subrules 77.39(1) and 77.39(2) evaluated according to subrules 77.39(8) to 77.39(10), and the requirements of subrules 77.39(3) to 77.39(7). Respite providers shall also meet the standards in subrule 77.39(1).
The integrated, community-based settings standards in subrule 77.25(5) apply to all HCBS brain injury waiver service providers.
(1)
Organizational standards (Outcome
1). Organizational outcome-based standards for HCBS BI 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 consumers' 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)
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.
(4)
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).
(5)Research. If the provider
conducts research involving consumers, the provider shall have written policies
and procedures addressing the research. These policies and procedures shall
ensure that consumers' rights are protected.
(6)Incident management and
reporting. As a condition of participation in the medical assistance
program, HCBS brain injury 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 member'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.
(7)
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.
b. The provider shall ensure the rights of
persons applying for services.
(8)
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.
(9)
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.
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.
c. Providers
applying for initial certification shall be offered technical
assistance.
(10)
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 77.39(1) and 77.39(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 is 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 present 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 consumer 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 immediately
discontinue funding for that provider's service.
(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 77.39(11)"d."
(2) The provider has failed to provide
information requested pursuant to paragraph 77.39(11)"e."
(3) The provider refuses to allow
the department to conduct a site visit pursuant to paragraph
77.39(11)"f."
(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 an HCBS BI 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.
(11)Departmental
reviews. Reviews of compliance with standards as indicated in this
chapter shall be conducted by the division of mental health and developmental
disabilities quality assurance review staff. This review may include on-site
case record audits, administrative procedures, clinical practices, and
interviews with staff, consumers, and board of directors consistent with the
confidentiality safeguards of state and federal laws.
a. Reviews shall be conducted annually with
additional reviews conducted at the discretion of the department.
b. Following a departmental review, the
department shall submit a copy of the department's determined survey report to
the service provider, noting service deficiencies and strengths.
c. The service provider shall develop a plan
of corrective action identifying completion time frames for each survey
deficiency.
d. The corrective
action plan shall be submitted to the Division of Mental Health and
Developmental Disabilities, 5th Floor, Hoover State Office Building, Des
Moines, Iowa 50319-0114, and include a statement dated and signed, if
applicable, by the chief administrative officer and president or chairperson of
the governing body that all information submitted to the department is accurate
and complete.
e. The department may
request the provider to supply subsequent reports on implementation of a
corrective action plan submitted pursuant to paragraphs
77.39(11)"c" and "d."
f. The department may conduct a site visit to
verify all or part of the information submitted.
(12)
Case management service
providers. Case management provider organizations are eligible to
participate in the Medicaid HCBS brain injury waiver program provided that they
meet the standards in 441-Chapter 24 and they are the department of human
services, a county or consortium of counties, or a provider under subcontract
to the department or a county or consortium of counties.
(13)
Supported community living
providers.
a. The department shall
certify only 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, which deal with foster care
licensing.
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, which deal with
foster care licensing.
d. The
department shall approve living units designed to serve four consumers if the
geographic location of the program does not result in an overconcentration of
programs in an area.
(1) and (2) Rescinded IAB 8/7/02, effective 10/1/02.
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.
(14)
Respite service
providers. Respite providers are eligible to be providers of respite
service in the HCBS brain injury waiver if they have documented training or
experience with persons with a brain injury.
a. The following agencies may provide respite
services:
(1) Respite providers certified
under the HCBS intellectual disability waiver.
(2) Adult day care providers that meet the
conditions of participation set forth in subrule 77.39(20).
(3) 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.
(4) Camps certified by the American Camping
Association.
(5) Home care agencies
that meet the conditions of participation set forth in subrule
77.30(1).
(6) Nursing facilities,
intermediate care facilities for the mentally retarded, and hospitals enrolled
as providers in the Iowa Medicaid program.
(7) Residential care facilities for persons
with mental retardation licensed by the department of inspections and
appeals.
(8) Home health agencies
that are certified to participate in the Medicare program.
(9) Agencies certified by the department to
provide respite services in the consumer's home that meet the requirements of
subrules 77.39(1) and 77.39(3) through 77.39(7).
(10) 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.
(15)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.
(16)
Home and vehicle modification
providers. The following providers may provide home and vehicle
modification:
a. 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 physical disability waiver.
b. 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.
(17)
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).
a. Providers shall be certified
annually.
b. The service provider
shall submit documentation to the department supporting continued compliance
with the requirements set forth in subrule 77.33(2) 90 days before the
expiration of the current certification.
(18)
Transportation service
providers. This service is not to be provided at the same time as
supported community service, which includes transportation. The following
providers may provide transportation:
a. Area
agencies on aging as designated in rule
17-4.4 (231) or with letters of
approval from the area agencies on aging stating the organization is qualified
to provide transportation services.
b. Community action agencies as designated in
Iowa Code section
216A.93.
c. Regional transit agencies as recognized by
the Iowa department of transportation.
d. Providers with purchase of service
contracts to provide transportation pursuant to 441 -Chapter 150.
e. Nursing facilities licensed pursuant to
Iowa Code chapter 135C.
f.
Transportation providers contracting with the nonemergency medical
transportation contractor.
(19)
Specialized medical equipment
providers. The following providers may provide specialized medical
equipment:
a. Medical equipment and supply
dealers participating as providers in the Medicaid program.
b. Retail and wholesale businesses
participating as providers in the Medicaid program which provide specialized
medical equipment as defined in 441-subrule 78.43(8).
(20)
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.
(21)
Family counseling and training
providers. Family counseling and training providers shall be one of
the following:
a. Providers certified under
the community mental health center standards established by the mental health
and developmental disabilities commission, set forth in 441-Chapter 24,
Divisions I and III, and that employ staff to provide family counseling and
training who meet the definition of qualified brain injury professional as set
forth in rule 441-83.81 (249A).
b. Providers licensed as meeting the hospice
standards and requirements set forth in department of inspections and appeals
rules in 481-Chapter 53 or certified to meet the standards under the Medicare
program for hospice programs, and that employ staff who meet the definition of
qualified brain injury professional as set forth in rule
441-83.81 (249A).
c. Providers accredited under the mental
health service provider standards established by the mental health and
developmental and disabilities commission, set forth in 441-Chapter 24,
Divisions I and IV, and that employ staff to provide family counseling and
training who meet the definition of qualified brain injury professional as set
forth in rule 441-83.81 (249A).
d. Individuals who meet the definition of
qualified brain injury professional as set forth in rule
441-83.81 (249A).
e. Agencies certified as brain injury waiver
providers pursuant to rule 441-77.39 (249A) that employ staff to provide family
counseling who meet the definition of a qualified brain injury professional as
set forth in rule 441-83.81 (249A).
f. Agencies which are accredited by a
department-approved, nationally recognized accreditation organization as
specialty brain injury rehabilitation service providers.
(22)Prevocational services
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) Supported
employment direct support staff shall complete 4 hours of continuing education
in employment services annually.
(23)Behavioral programming
providers. Behavioral programming providers shall be required to have
experience with or training regarding the special needs of persons with a brain
injury. In addition, they must meet the following requirements.
a. Behavior assessment, and development of an
appropriate intervention plan, and periodic reassessment of the plan, and
training of staff who shall implement the plan must be done by a qualified
brain injury professional as defined in rule
441-83.81 (249A). Formal
assessment of the consumers' intellectual and behavioral functioning must be
done by a licensed psychologist or a psychiatrist who is certified by the
American Board of Psychiatry.
b.
Implementation of the plan and training and supervision of caregivers,
including family members, must be done by behavioral aides who have been
trained by a qualified brain injury professional as defined in rule
441-83.81 (249A) and who are
employees of one of the following:
(1)
Agencies which are certified under the community mental health center standards
established by the mental health and developmental disabilities commission, set
forth in 441-Chapter 24, Divisions I and III.
(2) Agencies which are licensed as meeting
the hospice standards and requirements set forth in department of inspections
and appeals rules 481-Chapter 53 or which are certified to meet the standards
under the Medicare program for hospice programs.
(3) Agencies which are accredited under the
mental health service provider standards established by the mental health and
disabilities commission, set forth in 441-Chapter 24, Divisions I and
IV.
(4) Home health aide providers
meeting the standards set forth in subrule 77.33(3). Home health aide providers
certified by Medicare shall be considered to have met these
standards.
(5) Brain injury waiver
providers certified pursuant to rule 441-77.39 (249A).
(6) Agencies which are accredited by a
department-approved, nationally recognized accreditation organization as
specialty brain injury rehabilitation service providers.
(7) Individuals who meet the definition of
"qualified brain injury professional" as set forth in rule
441-83.81 (249A).
(24)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.
(25)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.
(26)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).
(27)
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).
(28)
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).
(29)
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).
(30)
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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