Iowa Admin. Code r. 441-83.102 - Eligibility
To be eligible for
(1)
Eligibility
criteria. All of the following criteria must be met. The person must:
a. Have a physical disability .
b. Be blind or disabled as determined by the
receipt of social security disability benefits or by a disability determination
made through the department . Disability determinations are made according to
supplemental security income guidelines under Title XVI of the Social Security
Act or the disability guidelines for the Medicaid employed people with
disabilities coverage group.
c. Be
ineligible for the HCBS intellectual disability waiver.
d. Have the ability to hire, supervise, and
fire the provider as determined by the service worker, and be willing to do so,
or have a parent or guardian named by probate court, or attorney in fact under
a durable power of attorney for health care who will take this responsibility
on behalf of the consumer .
e. Be
eligible for Medicaid under 441-Chapter 75.
f. Be aged 18 years to 64 years.
g. Rescinded IAB 2/7/01, effective
2/1/01.
h. Be in need of skilled
nursing or intermediate care facility level of care based on information
submitted on a completed interRAI - Pediatric Home Care (PEDS-HC) for those
aged 18 to 20 or the interRAI - Home Care (HC) for those aged 21 and over and
other supporting documentation as relevant. The interRAI - Pediatric Home Care
(PEDS-HC) and the interRAI - Home Care (HC) are available on request from the
IME medical services unit . Copies of the completed information submission tool
for an individual are available to that individual from the individual's case
manager or managed care organization .
(1)
Initial decisions on level of care shall be made for the department by the IME
medical services unit within two working days of receipt of medical
information. The IME medical services unit determines whether the level of care
requirement is met based on medical necessity and the appropriateness of the
level of care under 441-subrules 79.9(1) and 79.9(2).
(2) Adverse decisions by the IME medical
services unit may be appealed to the department pursuant to 441-Chapter 7.
i. Choose HCBS .
j. Use a minimum of one unit of service per
calendar quarter under this program .
k. For the consumer choices option as set
forth in 441-subrule 78.46(6), not be living in a residential care
facility.
(2)
Need for services.
a. The
applicant shall have a service plan which is developed by the applicant and a
department service worker. The plan must be completed and approved before
service provision.
(1) The designated case
manager shall identify the need for service based on the needs of the
applicant, as documented in the information submission tool listed in
83.102(1)"h," as well as the availability and appropriateness
of services.
(2) The service worker
shall have a face-to-face visit with the member at least annually.
b. The total cost of physical
disability waiver services, excluding the cost of home and vehicle
modifications, shall not exceed $761.95 per month.
(3)
Slots. The total number
of persons receiving HCBS physical disability waiver services in the state
shall be limited to the number provided in the waiver approved by the Secretary
of the U.S. Department of Health and Human Services. These slots shall be
available on a first-come, first-served basis.
(4)
County payment slots for persons
requiring the ICF/MR level of care. Rescinded IAB 10/6/99, effective
10/1/99.
(5)
Securing a
slot.
a. The county department
office shall enter all waiver applications into the individualized services
information system (ISIS) to determine if a slot is available for all new
applicants for the HCBS physical disability waiver program .
(1) For applicants not currently receiving
Medicaid, the county department office shall make the entry by the end of the
fifth working day after receipt of a completed Form 470-2927 or 470-2927(S),
Health Services Application, or within five working days after receipt of
disability determination, whichever is later.
(2) For current Medicaid members, the county
department office shall make the entry by the end of the fifth working day
after receipt of a written request signed and dated by the waiver
applicant.
b. If no slot
is available, the department shall enter applicants on the HCBS physical
disabilities waiver waiting list according to the following:
(1) Applicants not currently eligible for
Medicaid shall be entered on the basis of the date a completed Form 470-2927 or
470-2927(S), Health Services Application, is received by the department or upon
receipt of disability determination, whichever is later. Applicants currently
eligible for Medicaid shall be added on the basis of the date the applicant
requests HCBS physical disability program services. In the event that more than
one application is received on the same day, applicants shall be entered on the
waiting list on the basis of the day of the month of their birthday, the lowest
number being first on the list. Any subsequent tie shall be decided by the
month of birth, January being month one and the lowest number.
(2) Persons who do not fall within the
available slots shall have their applications rejected but their names shall be
maintained on the waiting list. As slots become available, persons shall be
selected from the waiting list to maintain the number of approved persons on
the program based on their order on the waiting list.
(6)
Securing a county
payment slot. Rescinded IAB 10/6/99, effective 10/1/99.
(7)
HCBS physical disability waiver
waiting list. When services are denied because the limit on the number
of slots is reached, a notice of decision denying service based on the limit
and stating that the person's name shall be put on a waiting list shall be sent
to the person by the department .
Notes
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