Iowa Admin. Code r. 441-78.43 - HCBS brain injury waiver services
Payment shall be approved for the following services to members eligible for the HCBS brain injury waiver services as established in 441-Chapter 83 and as identified in the member's service plan. Effective March 17, 2022, payment shall only be made for services provided in integrated, community-based settings that support full access of members receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
(1)
Case management
services. Individual case management services means services that
assist members who reside in a community setting or are transitioning to a
community setting in gaining access to needed medical, social, educational,
housing, transportation, vocational, and other appropriate services in order to
ensure the health, safety, and welfare of the member.
a. Case management services shall be provided
as set forth in rules
441-90.4 (249A) through
441-90.7 (249A).
b. The service shall be delivered in such a
way as to enhance the capabilities of consumers and their families to exercise
their rights and responsibilities as citizens in the community. The goal is to
enhance the ability of the consumer to exercise choice, make decisions, take
risks that are a typical part of life, and fully participate as members of the
community.
c. The case manager must
develop a relationship with the consumer so that the abilities, needs and
desires of the consumer can be clearly identified and communicated and the case
manager can help to ensure that the system and specific services are responsive
to the needs of the individual consumers.
d. Members who are eligible for targeted case
management are not eligible for case management as a waiver service.
(2)
Supported community
living services. Supported community living services are provided by
the provider within the member's home and community, according to the
individualized member need as identified in the service plan.
a. The basic components of the service may
include, but are not limited to, personal and home skills training services,
individual advocacy services, community skills training services, personal
environment support services, transportation, and treatment services.
(1) Personal and home skills training
services are activities which assist a member to develop or maintain skills for
self-care, self-directedness, and care of the immediate environment.
(2) Individual advocacy is the act or process
of representing the member's rights and interests in order to realize the
rights to which the member is entitled and to remove barriers to meeting the
member's needs.
(3) Community
skills training services are activities which assist a member to develop or
maintain skills allowing better participation in the community. Services shall
focus on the following areas as they apply to the member being served:
1. Personal management skills training
services are activities which assist a member to maintain or develop skills
necessary to sustain the member in the physical environment and are essential
to the management of the member's personal business and property. This includes
self-advocacy skills. Examples of personal management skills are the ability to
maintain a household budget, plan and prepare nutritional meals, use community
resources such as public transportation and libraries, and select foods at the
grocery store.
2. Socialization
skills training services are activities which assist a member to develop or
maintain skills which include self-awareness and self-control, social
responsiveness, community participation, social amenities, and interpersonal
skills.
3. Communication skills
training services are activities which assist a member to develop or maintain
skills including expressive and receptive skills in verbal and nonverbal
language and the functional application of acquired reading and writing
skills.
(4) Personal and
environmental support services are those activities and expenditures provided
to or on behalf of a member in the areas of personal needs in order to allow
the member to function in the least restrictive environment.
(5) Transportation services are activities
and expenditures designed to assist the member to travel from one place to
another to obtain services or carry out life's activities. The services exclude
transportation provided as nonemergency medical transportation pursuant to rule
441-78.13(249A).
(6) Treatment
services are activities designed to assist the member to maintain or improve
physiological, emotional and behavioral functioning and to prevent conditions
that would present barriers to the member's functioning. Treatment services
include physical or physiological treatment and psychotherapeutic treatment.
1. Physiological treatment includes
medication regimens designed to prevent, halt, control, relieve, or reverse
symptoms or conditions which interfere with the normal functioning of the human
body. Physiological treatment shall be provided by or under the direct
supervision of a certified or licensed health care professional.
2. Psychotherapeutic treatment means
activities provided to assist a member in the identification or modification of
beliefs, emotions, attitudes, or behaviors in order to maintain or improve the
member's functioning in response to the physical, emotional, and social
environment.
b.
The supported community living services are intended to provide for the daily
living needs of the member and shall be available as needed during any 24-hour
period. Activities do not include those associated with vocational services,
academics, day care, medical services, Medicaid case management or other case
management. Services are individualized supportive services provided in a
variety of community-based, integrated settings.
(1) Supported community living services shall
be available at a daily rate to members living outside the home of their
family, legal representative, or foster family and for whom a provider has
primary responsibility for supervision or structure during the month. This
service shall provide supervision or structure in identified periods when
another resource is not available.
(2) Supported community living services shall
be available at a 15-minute rate to members for whom a daily rate is not
established.
c. Services
may be provided to a child or an adult. Children must first access all other
services for which they are eligible and which are appropriate to meet their
needs before accessing the HCBS brain injury waiver services. A maximum of four
persons may reside in a living unit.
(1) A
member may live in the home of the member's family or legal representative or
in another typical community living arrangement.
(2) A member living with the member's family
or legal representative is not subject to the maximum of four residents in a
living unit.
(3) A member may not
live in a licensed medical or health care facility or in a setting that is
required to be licensed as a medical or health care facility.
d. A member aged 17 or under
living in the home of the member's family, legal representative, or foster
family shall receive services based on development of adaptive, behavior, or
health skills. Duration of services shall be based on age-appropriateness and
individual attention span.
e.
Provider budgets shall reflect all staff-to-member ratios and shall reflect
costs associated with members' specific support needs for travel and
transportation, consulting, instruction, and environmental modifications and
repairs, as determined necessary by the interdisciplinary team for each member.
The specific support needs must be identified in the Medicaid case manager's
service plan, the total costs shall not exceed $1570 per member per year, and
the provider must maintain records to support the expenditures. A unit of
service is:
(1) One full calendar day when a
member residing in the living unit receives on-site staff supervision for eight
or more hours per day as an average over a calendar month and the member's
service plan identifies and reflects the need for this amount of
supervision.
(2) Fifteen minutes
when subparagraph 78.43(2)"e"(1) does not apply.
f. The maximum number of units
available per member is as follows:
(1) 365
daily units per state fiscal year except a leap year, when 366 daily units are
available.
(2) 33,580 15-minute
units per state fiscal year except a leap year, when 33,672 15-minute units are
available.
g. The service
shall be identified in the member's service plan.
h. Supported community living services shall
not be simultaneously reimbursed with other residential services or with
respite, transportation, personal assistance, nursing, or home health aide
services provided through Medicaid or the HCBS brain injury waiver.
(3)
Respite care
services. Respite care services are services provided to the member
that give temporary relief to the usual caregiver and provide all the necessary
care that the usual caregiver would provide during that period. The purpose of
respite care is to enable the member to remain in the member's current living
situation.
a. Services provided outside the
member's home shall not be reimbursable if the living unit where respite is
provided is reserved for another person on a temporary leave of
absence.
b. Member-to-staff ratios
shall be appropriate to the individual needs of the member as determined by the
member's interdisciplinary team.
c.
A unit of service is 15 minutes.
d.
Respite care is not to be provided to members during the hours in which the
usual caregiver is employed except when the member is attending a 24-hour
residential camp. Respite care shall not be used as a substitute for a child's
day care. Respite care cannot be provided to a member whose usual caregiver is
a consumer-directed attendant care provider for the member.
e. The interdisciplinary team shall determine
if the member will receive basic individual respite, specialized respite or
group respite as defined in 441-Chapter 83.
f. A maximum of 14 consecutive days of
24-hour respite care may be reimbursed.
g. Respite services provided for a period
exceeding 24 consecutive hours to three or more individuals who require nursing
care because of a mental or physical condition must be provided by a health
care facility licensed as described in Iowa Code chapter 135C.
h. Respite services shall not be provided
simultaneously with other residential, supported community living services,
nursing, or home health aide services provided through the medical assistance
program.
(4)
Supported employment services. Supported employment services
are service activities provided pursuant to subrule 78.27(10).
(5)
Home and vehicle
modification. Covered home or vehicle modifications are physical
modifications to the member's home or vehicle that directly address the
member's medical or remedial need. Covered modifications must be necessary to
provide for the health, welfare, or safety of the member and enable the member
to function with greater independence in the home or vehicle.
a. Modifications that are necessary or
desirable without regard to the member's medical or remedial need and that
would be expected to increase the fair market value of the home or vehicle,
such as furnaces, fencing, or adding square footage to the residence, are
excluded except as specifically included below. Purchasing or leasing of a
motorized vehicle is excluded. Home and vehicle repairs are also
excluded.
b. Only the following
modifications are covered:
(1) Kitchen
counters, sink space, cabinets, special adaptations to refrigerators, stoves,
and ovens.
(2) Bathtubs and toilets
to accommodate transfer, special handles and hoses for shower heads, water
faucet controls, and accessible showers and sink areas.
(3) Grab bars and handrails.
(4) Turnaround space adaptations.
(5) Ramps, lifts, and door, hall and window
widening.
(6) Fire safety alarm
equipment specific for disability.
(7) Voice-activated, sound-activated,
light-activated, motion-activated, and electronic devices directly related to
the member's disability.
(8)
Vehicle lifts, driver-specific adaptations, remote-start systems, including
such modifications already installed in a vehicle.
(9) Keyless entry systems.
(10) Automatic opening device for home or
vehicle door.
(11) Special door and
window locks.
(12) Specialized
doorknobs and handles.
(13)
Plexiglas replacement for glass windows.
(14) Modification of existing stairs to
widen, lower, raise or enclose open stairs.
(15) Motion detectors.
(16) Low-pile carpeting or slip-resistant
flooring.
(17) Telecommunications
device for the deaf or hard of hearing.
(18) Exterior hard-surface
pathways.
(19) New door
opening.
(20) Pocket
doors.
(21) Installation or
relocation of controls, outlets, switches.
(22) Air conditioning and air filtering if
medically necessary.
(23)
Heightening of existing garage door opening to accommodate modified
van.
(24) Bath chairs.
c. A unit of service is the
completion of needed modifications or adaptations.
d. All modifications and adaptations shall be
provided in accordance with applicable federal, state, and local building and
vehicle codes.
e. Services shall be
performed following prior department approval of the modification as specified
in 441-subrule 79.1(17) and a binding contract between the provider and the
member.
f. All contracts for home
or vehicle modification shall be awarded through competitive bidding. The
contract shall include the scope of work to be performed, the time involved,
supplies needed, the cost, diagrams of the project whenever applicable, and an
assurance that the provider has liability and workers' compensation coverage
and the applicable permit and license.
g. Service payment shall be made to the
enrolled home or vehicle modification provider. If applicable, payment will be
forwarded to the subcontracting agency by the enrolled home or vehicle
modification provider following completion of the approved modifications.
Payment of up to $6,872.85 per year may be made to certified providers upon
satisfactory completion of the service.
h. Services shall be included in the member's
service plan and shall exceed the Medicaid state plan services.
(6)
Personal emergency
response or portable locator system.
a. A personal emergency response system is an
electronic device that transmits a signal to a central monitoring station to
summon assistance in the event of an emergency.
(1) The necessary components of a system are:
1. An in-home medical communications
transceiver.
2. A remote, portable
activator.
3. A central monitoring
station with backup systems staffed by trained attendants at all
times.
4. Current data files at the
central monitoring station containing response protocols and personal, medical
and emergency information for each member.
(2) The service shall be identified in the
member's service plan.
(3) A unit
is a one-time installation fee or one month of service.
(4) Maximum units per state fiscal year shall
be the initial installation and 12 months of service.
b. A portable locator system is an electronic
device that transmits a signal to a monitoring device. The system allows a
member to access assistance in the event of an emergency and allows law
enforcement or the monitoring system provider to locate a member who is unable
to request help or to activate a system independently. The member must be
unable to access assistance in an emergency situation due to the member's age
or disability.
(1) The required components of
the portable locator system are:
1. A portable
communications transceiver or transmitter to be worn or carried by the
member.
2. Monitoring by the
provider at a central location with response protocols and personal, medical,
and emergency information for each member as applicable.
(2) The service shall be identified in the
member's service plan.
(3) Payable
units of service are purchase of equipment, an installation or set-up fee, and
monthly fees.
(4) Maximum units per
state fiscal year shall be one equipment purchase, one installation or set-up
fee, and 12 months of service.
(7)
Transportation.
Transportation services may be provided for members to conduct business errands
and essential shopping, to travel to and from work or day programs, and to
reduce social isolation. A unit of service is one mile of transportation or one
one-way trip. Transportation may not be reimbursed simultaneously with HCBS
brain injury waiver supported community living service when the transportation
costs are included within the supported community living reimbursement
rate.
(8)
Specialized
medical equipment.
a. Specialized
medical equipment shall include medically necessary items which are for
personal use by members with a brain injury and which:
(1) Provide for health and safety of the
member,
(2) Are not ordinarily
covered by Medicaid,
(3) Are not
funded by educational or vocational rehabilitation programs, and
(4) Are not provided by voluntary
means.
b. Coverage
includes, but is not limited to:
(1)
Electronic aids and organizers.
(2)
Medicine dispensing devices.
(3)
Communication devices.
(4) Bath
aids.
(5) Noncovered environmental
control units.
(6) Repair and
maintenance of items purchased through the waiver.
c. Payment of up to $6,872.85 per year may be
made to enrolled specialized medical equipment providers upon satisfactory
receipt of the service.
d. The need
for specialized medical equipment shall be:
(1) Documented by a health care professional
as necessary for the member's health and safety, and
(2) Identified in the member's service
plan.
e. Payment for most
items shall be based on a fee schedule. The amount of the fee shall be
determined as directed in 441-subrule 79.1(17).
(9)
Adult day care services.
Adult day care services provide an organized program of supportive care in a
group environment to persons who need a degree of supervision and assistance on
a regular or intermittent basis in a day care center. A unit of service is 15
minutes (up to four units per day), a half day (1.25 to 4 hours per day), a
full day (4.25 to 8 hours per day), or an extended day (8.25 to 12 hours per
day). Components of the service include health-related care, social services,
and other related support services.
(10)
Family counseling and training
services. Family counseling and training services are face-to-face
mental health services provided to the consumer and the family with whom the
consumer lives, or who routinely provide care to the consumer to increase the
consumer's or family members' capabilities to maintain and care for the
consumer in the community. Counseling may include helping the consumer or the
consumer's family members with crisis, coping strategies, stress reduction,
management of depression, alleviation of psychosocial isolation and support in
coping with the effects of a brain injury. It may include the use of treatment
regimes as specified in the ITP. Periodic training updates may be necessary to
safely maintain the consumer in the community.
Family may include spouse, children, friends, or in-laws of the consumer. Family does not include individuals who are employed to care for the consumer.
(11)
Prevocational services. Prevocational services are service
activities provided pursuant to subrule 78.27(9).
(12)
Behavioral programming.
Behavioral programming consists of individually designed strategies to increase
the consumer's appropriate behaviors and decrease the consumer's maladaptive
behaviors which have interfered with the consumer's ability to remain in the
community. Behavioral programming includes:
a.
A complete assessment of both appropriate and maladaptive behaviors.
b. Development of a structured behavioral
intervention plan which should be identified in the ITP.
c. Implementation of the behavioral
intervention plan.
d. Ongoing
training and supervision to caregivers and behavioral aides.
e. Periodic reassessment of the plan.
Types of appropriate behavioral programming include, but are not limited to, clinical redirection, token economies, reinforcement, extinction, modeling, and over-learning.
(13)
Consumer-directed attendant care
service. Consumer-directed attendant care services are service
activities performed by a person to help a member with self-care tasks which
the member would typically do independently if the member were otherwise able.
Covered service activities are limited to the nonskilled activities listed in
paragraph 78.43(13)"f" and the skilled activities listed in
paragraph 78.43(13)"g." Covered service activities must be
essential to the health, safety, and welfare of the member. Services may be
provided in the absence of a parent or guardian if the parent or guardian has
given advance direction for the service provision.
a.
Service planning.
(1) The member, parent, guardian, or attorney
in fact under a durable power of attorney for health care shall:
1. Select the individual or agency that will
provide the components of the attendant care services.
2. Determine with the selected provider what
components of attendant care services the provider shall perform, subject to
confirmation by the service worker or case manager that those components are
consistent with the assessment and are authorized covered services.
3. Complete, sign, and date Form 470-3372,
HCBS Consumer-Directed Attendant Care Agreement, to indicate the frequency,
scope, and duration of services (a description of each service component and
the time agreed on for that component). The case manager or service worker and
provider shall also sign the agreement.
4. Submit the completed agreement to the
service worker or case manager. The agreement shall be part of the member's
service plan and shall be kept in the member's records, in the provider's
records, and in the service worker's or case manager's records. Any service
component that is not listed in the agreement shall not be payable.
(2) Whenever a legal
representative acts as a provider of consumer-directed attendant care as
allowed by 441-paragraph 79.9(7)"b," the following shall
apply:
1. The payment rate for the legal
representative must be based on the skill level of the legal representative and
may not exceed the median statewide reimbursement rate for the service unless
the higher rate receives prior approval from the department;
2. The legal representative may not be paid
for more than 40 hours of service per week; and
3. A contingency plan must be established in
the member's service plan to ensure service delivery in the event the legal
representative is unable to provide services due to illness or other unexpected
event.
b.
Supervision of skilled services. Skilled consumer-directed
attendant care services shall be provided under the supervision of a licensed
nurse or licensed therapist working under the direction of a physician. The
licensed nurse or therapist shall:
(1) Retain
accountability for actions that are delegated.
(2) Ensure appropriate assessment, planning,
implementation, and evaluation.
(3)
Make on-site supervisory visits every two weeks with the service provider
present.
c.
Service documentation. The consumer-directed attendant care
provider shall document evidence of compliance with the requirements of this
chapter and rule 441-79.3 (249A). The
documentation or copies of the documentation must be maintained or be
electronically accessible by the consumer-directed attendant care provider.
Providers must use an electronic visit verification system that captures all
documentation requirements of the Consumer-Directed Attendant Care (CDAC)
Service Record (Form 470-4389) or use Form 470-4389. Any service component that
is not documented in accordance with rule
441-79.3 (249A) shall not be
payable.
d.
Role of
guardian or attorney. If the member has a guardian or attorney in fact
under a durable power of attorney for health care:
(1) The service worker's or case manager's
service plan shall address how consumer-directed attendant care services will
be monitored to ensure that the member's needs are being adequately met. If the
guardian or attorney in fact is the service provider, the service plan shall
address how the service worker or case manager shall oversee service
provision.
(2) The guardian or
attorney in fact shall sign the claim form in place of the member, indicating
that the service has been provided as presented on the claim.
e.
Service units and
billing. A unit of service is 15 minutes provided by an individual or
agency. Each service shall be billed in whole units.
f.
Nonskilled services.
Covered nonskilled service activities are limited to help with the following
activities:
(1) Dressing.
(2) Bathing, shampooing, hygiene, and
grooming.
(3) Access to and from
bed or a wheelchair, transferring, ambulation, and mobility in
general.
(4) Toileting, including
bowel, bladder, and catheter assistance (emptying the catheter bag, collecting
a specimen, and cleaning the external area around the catheter).
(5) Meal preparation, cooking, and assistance
with feeding, not including the cost of meals themselves. Meal preparation and
cooking shall be provided only in the member's home.
(6) Housekeeping, laundry, and shopping
essential to the member's health care at home.
(7) Taking medications ordinarily
self-administered, including those ordered by a physician or other qualified
health care provider.
(8) Minor
wound care.
(9) Going to or
returning from a place of employment and job-related tasks while the member is
on the job site. Transportation for the member and assistance with
understanding or performing the essential job functions are not included in
consumer-directed attendant care services.
(10) Tasks, such as financial management and
scheduling, that require cognitive or physical assistance.
(11) Communication essential to the health
and welfare of the member, through interpreting and reading services and use of
assistive devices for communication.
(12) Using transportation essential to the
health and welfare of the member. The cost of the transportation is not
included.
g.
Skilled services. Covered skilled service activities are
limited to help with the following activities:
(1) Tube feedings of members unable to eat
solid foods.
(2) Intravenous
therapy administered by a registered nurse.
(3) Parenteral injections required more than
once a week.
(4) Catheterizations,
continuing care of indwelling catheters with supervision of irrigations, and
changing of Foley catheters when required.
(5) Respiratory care including inhalation
therapy and tracheotomy care or tracheotomy care and ventilator.
(6) Care of decubiti and other ulcerated
areas, noting and reporting to the nurse or therapist.
(7) Rehabilitation services including, but
not limited to, bowel and bladder training, range of motion exercises,
ambulation training, restorative nursing services, respiratory care and
breathing programs, reality orientation, reminiscing therapy, remotivation,
behavior modification, and reteaching of the activities of daily
living.
(8) Colostomy
care.
(9) Care of uncontrolled
medical conditions, such as brittle diabetes, and comfort care of terminal
conditions.
(10) Postsurgical
nursing care.
(11) Monitoring
medications requiring close supervision because of fluctuating physical or
psychological conditions, e.g., antihypertensives, digitalis preparations,
mood-altering or psychotropic drugs, or narcotics.
(12) Preparing and monitoring response to
therapeutic diets.
(13) Recording
and reporting of changes in vital signs to the nurse or therapist.
h.
Excluded services and
costs. Services, activities, costs and time that are not covered as
consumer-directed attendant care include the following (not an exclusive list):
(1) Any activity related to supervising a
member. Only direct services are billable.
(2) Any activity that the member is able to
perform.
(3) Costs of
food.
(4) Costs for the supervision
of skilled services by the nurse or therapist. The supervising nurse or
therapist may be paid from private insurance, Medicare, or other third-party
payment sources, or may be paid as another Medicaid service, including early
and periodic screening, diagnosis and treatment services.
(5) Exercise that does not require skilled
services.
(6) Parenting or child
care for or on behalf of the member.
(7) Reminders and cueing.
(8) Services provided simultaneously with any
other similar service regardless of funding source, including other waiver
services and state supplementary assistance in-home health-related care
services.
(9) Transportation
costs.
(10) Wait times for any
activity.
(14)
Interim medical monitoring and treatment services. Interim
medical monitoring and treatment (IMMT) services are monitoring and treatment
of a medical nature for children or adults aged 18 to 20 whose medical needs
make alternative care unavailable, inadequate, or insufficient. IMMT services
are not intended to provide day care but to supplement available resources.
Services must be ordered by a physician.
a.
Need for service. The member must be currently receiving home health agency
services under rule 441-78.9 (249A) and require
medical assessment, medical monitoring, and regular medical intervention or
intervention in a medical emergency during those services. The service worker
or case manager must identify the need for IMMT services after evaluating the
member's living environment, family and natural supports, ability to perform
activities of daily living, and health care needs. The services must be needed:
(1) To allow the member's usual caregivers to
be employed,
(2) During a search
for employment by a usual caregiver,
(3) To allow for academic or vocational
training of a usual caregiver,
(4)
Due to the hospitalization of a usual caregiver for treatment for physical or
mental illness, or
(5) Due to the
death of a usual caregiver.
b. Service requirements. Interim medical
monitoring and treatment services shall:
(1)
Provide experiences for each member's social, emotional, intellectual, and
physical development;
(2) Include
comprehensive developmental care and any special services for a member with
special needs; and
(3) Include
medical assessment, medical monitoring, and medical intervention as needed on a
regular or emergency basis. Medical intervention means the ability to assess
the situation and contact the appropriate medical professional, not the direct
application of medical care.
c. Interim medical monitoring and treatment
services may include supervision while the member is being transported to and
from school.
d. Limitations.
(1) A maximum of 12 hours of service is
available per day.
(2) Covered
services do not include a complete nutritional regimen.
(3) Interim medical monitoring and treatment
services may not duplicate any regular Medicaid or waiver services provided
under the state plan. Services under the state plan, including home health
agency services under rule
441-78.9 (249A), must be
exhausted before IMMT services are accessed.
(4) Interim medical monitoring and treatment
services shall be provided in the following settings that are approved by the
department as integrated, community-based settings: the member's home; a
registered child development home; a licensed child care center, residential
care facility, or adult day care facility; or during the time when the member
is being transported to and from school.
(5) The member-to-staff ratio shall not be
more than six members to one staff person.
(6) The parent or guardian of the member
shall be responsible for the usual and customary nonmedical cost of day care
during the time in which the member is receiving IMMT services. Medical care
necessary for monitoring and treatment is an allowable IMMT cost. If the cost
of care goes above the usual and customary cost of day care services due to the
member's medical condition, the costs above the usual and customary cost shall
be covered as IMMT services.
e. A unit of service is 15 minutes.
(15)
Consumer choices
option. The consumer choices option is service activities provided
pursuant to subrule 78.34(13).
(16)
General service standards. All brain injury waiver services
must be provided in accordance with the following standards:
a. Reimbursement shall not be available under
the waiver for any services that the member can obtain as other nonwaiver
Medicaid services or through any other funding source.
b. All services provided under the waiver
must be delivered in the least restrictive environment possible and in
conformity with the member's service plan.
c. All rights restrictions must be
implemented in accordance with 441-subrule 77.25(4). The member service plan or
treatment plan shall include documentation of:
(1) Any restrictions on the member's rights,
including the rights of privacy, dignity, respect, and freedom from coercion
and restraint.
(2) The need for the
restriction.
(3) The less intrusive
methods of meeting the need that have been tried but did not work.
(4) Either a plan to restore those rights or
written documentation that a plan is not necessary or appropriate.
(5) Established time limits for periodic
reviews to determine if the restriction is still necessary or can be
terminated.
(6) The informed
consent of the member.
(7) An
assurance that the interventions and supports will cause no harm to the
member.
(8) A regular collection
and review of data to measure the ongoing effectiveness of the restriction.
d. Services must be
billed in whole units.
e. For all
services with a 15-minute unit of service, the following rounding process will
apply:
(1) Add together the minutes spent on
all billable activities during a calendar day for a daily total.
(2) For each day, divide the total minutes
spent on billable activities by 15 to determine the number of full 15-minute
units for that day.
(3) Round the
remainder using these guidelines: Round 1 to 7 minutes down to zero units;
round 8 to 14 minutes up to one unit.
(4) Add together the number of full units and
the number of rounded units to determine the total number of units to bill for
that day.
This rule is intended to implement Iowa Code section 249A.4.
Notes
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