Iowa Admin. Code r. 441-77.46 - HCBS children's mental health waiver service providers
HCBS children's mental health waiver services shall be rendered by provider agencies that meet the general provider standards in subrule 77.46(1) and the integrated, community-based settings standards in subrule 77.25(5) and also meet the standards in subrules 77.46(2) to 77.46(5) that are specific to the waiver services provided. A provider that is approved for the same service under another HCBS Medicaid waiver shall be eligible to enroll for that service under the children's mental health waiver.
(1)
General provider
standards. All providers of HCBS children's mental health waiver
services shall meet the following standards:
a.
Fiscal capacity.
Providers must demonstrate the fiscal capacity to provide services on an
ongoing basis.
b.
Direct
care staff.
(1) Direct care staff
must be at least 18 years of age.
(2) Providers must complete child abuse,
dependent adult abuse, and criminal background screenings pursuant to Iowa Code
section
249A.29
before employment of a staff member who will provide direct care.
(3) Direct care staff may not be the spouse
of the consumer or the parent or stepparent of the consumer.
c.
Outcome-based standards
and quality assurance.
(1) Providers
shall implement the following outcome-based standards for the rights and
dignity of children with serious emotional disturbance:
1. Consumers are valued.
2. Consumers are a part of community
life.
3. Consumers develop
meaningful goals.
4. Consumers
maintain physical and mental health.
5. Consumers are safe.
6. Consumers and their families have an
impact on the services received.
(2) The department's quality assurance staff
shall conduct random quality assurance reviews to assess the degree to which
the outcome-based standards have been implemented in service provision. Results
of outcome-based quality assurance reviews shall be forwarded to the certifying
or accrediting entity.
(3) A
quality assurance review shall include interviews with the consumer and the
consumer's parents or legal guardian, with informed consent, and interviews
with designated targeted case managers.
(4) A quality assurance review may include
interviews with provider staff, review of case files, review of staff training
records, review of compliance with the general provider standards in this
subrule, and review of other organizational policies and procedures and
documentation.
(5) Corrective
action shall be required if the quality assurance review demonstrates that
service provision or provider policies and procedures do not reflect the
outcome-based standards. Technical assistance for corrective action shall be
available from the department's quality assurance staff.
d.
Incident management and
reporting. As a condition of participation in the medical assistance
program, HCBS children's mental health 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 must
comply with the following incident management and reporting requirements.
EXCEPTION: The conditions in this paragraph do not apply to providers of
environmental modifications and adaptive devices.
(1) 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.
(2) 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.
(3) Notification procedure for major
incidents. When a major incident occurs or a staff member becomes aware of a
major incident, 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.
(4) Reporting procedure for major
incidents. By the end of the next calendar day after a major 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.
(5) Information to be reported.
The following information shall be reported about a major incident:
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.
(6) Response to report. 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 a major 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.
(7) 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.
(2)
Environmental modifications,
adaptive devices, and therapeutic resources providers. The following
agencies may provide environmental modifications, adaptive devices, and
therapeutic resources under the children's mental health waiver:
a. A community business that:
(1) Possesses all necessary licenses and
permits to operate in conformity with federal, state, and local statutes and
regulations, including Iowa Code chapter 490; and
(2) Submits verification of current liability
and workers' compensation insurance.
b. A retail or wholesale business that
otherwise participates as a provider in the Medicaid program.
c. A home and vehicle modification provider
enrolled under another HCBS Medicaid waiver.
d. A provider enrolled under the HCBS home-
and community-based services intellectual disability or brain injury waiver as
a supported community living provider.
e. A provider enrolled under the HCB S
children's mental health waiver as a family and community support services
provider.
(3)Family and community support
services providers.
a.
Qualified providers. The following agencies may provide family and
community support services under the children's mental health waiver:
(1) Behavioral health intervention providers
qualified under
441-77.12 (249A).
(2) Community mental health
centers accredited in good standing as providers of outpatient psychotherapy
and counseling under 441-Chapter 24.
b.
Staff training. The
agency shall meet the following training requirements as a condition of
providing family and community support services under the children's mental
health waiver:
(1) Within one month of
employment, staff members must receive the following training:
1. Orientation regarding the agency's
mission, policies, and procedures; and
2. Orientation regarding HCBS philosophy and
outcomes for rights and dignity found in 77.36(1)"c" for the
children's mental health waiver.
(2) Within four months of employment, staff
members must receive training regarding the following:
1. Serious emotional disturbance in children
and provision of services to children with serious emotional
disturbance;
2.
Confidentiality;
3. Provision of
medication according to agency policy and procedure;
4. Identification and reporting of child
abuse;
5. Incident
reporting;
6. Documentation of
service provision;
7. Appropriate
behavioral interventions; and
8.
Professional ethics.
(3)
Until a staff member receives the training identified in subparagraphs (1) and
(2), the staff member shall not provide any direct service without the presence
of experienced staff.
(4) Within
the first year of employment, staff members must complete 24 hours of training
in children's mental health issues.
(5) During each consecutive year of
employment, staff members must complete 12 hours of training in children's
mental health issues.
c.
Support of crisis intervention plan. As a condition of
providing services under the children's mental health waiver, a family and
community support provider shall develop and implement policies and procedures
for maintaining the integrity of the individualized crisis intervention plan as
defined in
441-24.1 (225C) that
is developed by each consumer's interdisciplinary team. The policies and
procedures shall address:
(1) Sharing with
the case manager and the interdisciplinary team information pertinent to the
development of the consumer's crisis intervention plan.
(2) Training staff before service provision,
in cooperation with the consumer's parents or legal guardian, regarding the
consumer's individual mental health needs and individualized supports as
identified in the crisis intervention plan.
(3) Ensuring that all staff have access to a
written copy of the most current crisis intervention plan during service
provision.
(4) Ensuring that the
plan contains current and accurate information by updating the case manager
within 24 hours regarding any circumstance or issue that would have an impact
on the consumer's mental health or change the consumer's crisis intervention
plan.
d.
Intake,
admission, and discharge. As a condition of providing services under
the children's mental health waiver, a family and community support provider
shall have written policies and procedures for intake, admission, and
discharge.
(4)In-home family therapy
providers.
a.
Qualified
providers. The following agencies may provide in-home family therapy
under the children's mental health waiver:
(1)
Community mental health centers accredited in good standing as providers of
outpatient psychotherapy and counseling under 441-Chapter 24.
(2) Mental health professionals licensed
pursuant to 645-Chapter 31, 240, or 280 or possessing an equivalent license in
another state.
b.
Staff training. The agency shall meet the following training
requirements as a condition of providing in-home family therapy under the
children's mental health waiver:
(1) Within
one month of employment, staff members must receive the following training:
1. Orientation regarding the agency's
mission, policies, and procedures; and
2. Orientation regarding HCBS philosophy and
outcomes for rights and dignity found in 77.46(1)"c" for the
children's mental health waiver.
(2) Within four months of employment, staff
members must receive training regarding the following:
1. Serious emotional disturbance in children
and service provision to children with serious emotional disturbance;
2. Confidentiality;
3. Provision of medication according to
agency policy and procedure;
4.
Identification and reporting of child abuse;
5. Incident reporting;
6. Documentation of service
provision;
7. Appropriate
behavioral interventions; and
8.
Professional ethics.
(3)
Until a staff member receives the training identified in subparagraphs (1) and
(2), the staff member shall not provide any direct service without the presence
of experienced staff.
(4) Within
the first year of employment, staff members must complete 24 hours of training
in children's mental health issues.
(5) During each consecutive year of
employment, staff members must complete 12 hours of training in children's
mental health issues.
c.
Support of crisis intervention plan. As a condition of
providing services under the children's mental health waiver, an in-home family
therapy provider shall develop and implement policies and procedures for
maintaining the integrity of the individualized crisis intervention plan as
defined in
441-24.1 (225C) that
is developed by each consumer's interdisciplinary team. The policies and
procedures shall address:
(1) Sharing with
the case manager and the interdisciplinary team information pertinent to the
development of the consumer's crisis intervention plan.
(2) Training staff before service provision,
in cooperation with the consumer's parents or legal guardian, regarding the
consumer's individual mental health needs and individualized supports as
identified in the crisis intervention plan.
(3) Ensuring that all staff have access to a
written copy of the most current crisis intervention plan during service
provision.
(4) Ensuring that the
plan contains current and accurate information by updating the case manager
within 24 hours regarding any circumstance or issue that would have an impact
on the consumer's mental health or change the consumer's crisis intervention
plan.
d.
Intake,
admission, and discharge. As a condition of providing services under
the children's mental health waiver, an in-home family therapy provider shall
have written policies and procedures for intake, admission, and
discharge.
(5)Respite care providers.
a.
Qualified providers. The
following agencies may provide respite services under the children's mental
health waiver:
(1) Providers certified or
enrolled as respite providers under another Medicaid HCBS waiver.
(2) Group living foster care facilities for
children licensed in good standing by the department according to 441-Chapters
112 and 114 to 116.
(3) Camps
certified in good standing by the American Camping Association.
(4) Home health agencies that are certified
in good standing to participate in the Medicare program.
(5) 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.
(6) Adult day care providers that are
certified in good standing by the department of inspections and appeals as
being in compliance with the standards for adult day services programs at
481-Chapter 70.
(7) Assisted living
programs certified in good standing by the department of inspections and
appeals.
(8) Residential care
facilities for persons with mental retardation licensed in good standing by the
department of inspections and appeals.
(9) Nursing facilities, intermediate care
facilities for the mentally retarded, and hospitals enrolled as providers in
the Iowa Medicaid program.
b.
Staff training. The
agency shall meet the following training requirements as a condition of
providing respite care under the children's mental health waiver:
(1) Within one month of employment, staff
members must receive the following training:
1. Orientation regarding the agency's
mission, policies, and procedures; and
2. Orientation regarding HCBS philosophy and
outcomes for rights and dignity for the children's mental health waiver in
77.46(1)"c. "
(2) Within four months of employment, staff
members must receive training regarding the following:
1. Serious emotional disturbance in children
and provision of services to children with serious emotional
disturbance;
2.
Confidentiality;
3. Provision of
medication according to agency policy and procedure;
4. Identification and reporting of child
abuse;
5. Incident
reporting;
6. Documentation of
service provision;
7. Appropriate
behavioral interventions; and
8.
Professional ethics.
(3)
Until a staff member receives the training identified in subparagraphs (1) and
(2), the staff member shall not provide any direct service without the
oversight of supervisory staff and shall obtain feedback from the family within
24 hours of service provision.
(4)
Within the first year of employment, staff members must complete 24 hours of
training in children's mental health issues.
(5) During each consecutive year of
employment, staff members must complete 12 hours of training in children's
mental health issues.
c.
Consumer-specific information. The following information must
be written, current, and accessible to the respite provider during service
provision:
(1) The consumer's legal and
preferred name, birth date, and age, and the address and telephone number of
the consumer's usual residence.
(2)
The consumer's typical schedule.
(3) The consumer's preferences in activities
and foods or any other special concerns.
(4) The consumer's crisis intervention
plan.
d.
Written
notification of injury. The respite provider shall inform the parent,
guardian or usual caregiver that written notification must be given to the
respite provider of any recent injuries or illnesses that have occurred before
respite provision.
e.
Medication dispensing. Respite providers shall develop
policies and procedures for the dispensing, storage, and recording of all
prescription and nonprescription medications administered during respite
provision. Home health agencies must follow Medicare regulations regarding
medication dispensing.
f.
Support of crisis intervention plan. As a condition of
providing services under the children's mental health waiver, a respite
provider shall develop and implement policies and procedures for maintaining
the integrity of the individualized crisis intervention plan as defined in
441-24.1 (225C) that
is developed by each consumer's interdisciplinary team. The policies and
procedures shall address:
(1) Sharing with
the case manager and the interdisciplinary team information pertinent to the
development of the consumer's crisis intervention plan.
(2) Training staff before service provision,
in cooperation with the consumer's parents or legal guardian, regarding the
consumer's individual mental health needs and individualized supports as
identified in the crisis intervention plan.
(3) Ensuring that all staff have access to a
written copy of the most current crisis intervention plan during service
provision.
(4) Ensuring that the
plan contains current and accurate information by updating the case manager
within 24 hours regarding any circumstance or issue that would have an impact
on the consumer's mental health or change the consumer's crisis intervention
plan.
g.
Service
documentation. Documentation of respite care shall be made available
to the consumer, parents, guardian, or usual caregiver upon request.
h.
Capacity. A facility
providing respite care under this subrule shall not exceed the facility's
licensed capacity, and services shall be provided in a location and for a
duration consistent with the facility's licensure.
i.
Service provided outside home or
facility. For respite care to be provided in a location other than the
consumer's home or the provider's facility:
(1) The care must be approved by the parent,
guardian or usual caregiver;
(2)
The care must be approved by the interdisciplinary team in the consumer's
service plan;
(3) The care must be
consistent with the way the location is used by the general public;
and
(4) Respite care in these
locations shall not exceed 72 continuous hours.
This rule is intended to implement Iowa Code section 249A.4 and 2005 Iowa Acts, chapter 167, section 13, and chapter 117, section 3.
Notes
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