Iowa Admin. Code r. 441-83.103 - Application
(1)
Application for financial eligibility. The application process
as specified in rules
441-76.1 (249A) to
441-76.6
(249A) shall be followed. Applications for this program may only be filed on or
after April 1, 1999.
(2)
Approval of application for eligibility.
a. Applications for this waiver shall be
initiated on behalf of the applicant who is a resident of a medical institution
with the applicant's consent or with the consent of the applicant's legal
representative by the discharge planner of the medical facility where the
applicant resides at the time of application.
(1) The discharge planner shall contact the
member's managed care organization or designated case manager to arrange for
completion of the appropriate information submission tool as listed in
paragraph 83.102(1)"h."
(2) After completing the determination of the
level of care needed by the applicant, the IME medical services unit shall
inform the income maintenance worker and the discharge planner of the IME
medical services unit's decision.
b. Applications for this waiver shall be
initiated by the applicant, the applicant's parent or legal guardian, or the
applicant's attorney in fact under a durable power of attorney for health care
on behalf of the applicant who is residing in the community.
(1) The applicant's managed care organization
or the designated case manager shall arrange for the completion of the
appropriate information submission tool as listed in paragraph
83.102(1)"h" and submit it to the IME medical services
unit.
(2) After completing the
determination of the level of care needed by the applicant, the IME medical
services unit shall inform the income maintenance worker and the applicant, the
applicant's parent or legal guardian, or the applicant's attorney in fact under
a durable power of attorney for health care.
c. Eligibility for this waiver shall be
effective as of the date when both the eligibility criteria in subrule
83.102(1) and need for services in subrule 83.102(2) have been established.
Decisions shall be mailed or given to the applicant, the applicant's parent or
legal guardian, or the applicant's attorney in fact under a durable power of
attorney for health care on the date when each eligibility determination is
completed.
d. An applicant shall be
given the choice between waiver services and institutional care. The applicant
or the applicant's parent, legal guardian, or attorney in fact under a durable
power of attorney for health care shall sign the information submission tool,
indicating that the applicant has elected home-and community-based
services.
e. The applicant, the
applicant's parent or guardian, or the applicant's attorney in fact under a
durable power of attorney for health care shall cooperate with the designated
case manager in the development of the service plan prior to the start of
services.
f. HCBS physical
disability waiver services provided prior to both approvals of eligibility for
the waiver cannot be paid.
g. HCBS
physical disability waiver services are not available in conjunction with other
HCBS waiver programs. The consumer may also receive in-home health-related care
service if eligible for that program.
(3)
Effective date of
eligibility.
a. The effective date
of eligibility for the waiver for persons who are already determined eligible
for Medicaid is the date on which the person is determined to meet all of the
criteria set forth in subrule 83.102(1).
b. The effective date of eligibility for the
waiver for persons who qualify for Medicaid due to eligibility for the waiver
services is the date on which the person is determined to meet all of the
criteria set forth in subrule 83.102(1) and when the eligibility factors set
forth in 441-subrule 75.1(7) and, for married persons, in rule
441-75.5
(249A), have been satisfied.
c.
Eligibility for the waiver continues until the consumer fails to meet
eligibility criteria listed in subrule 83.102(1). Consumers who return to
inpatient status in a medical institution for more than 120 consecutive days
shall be reviewed by the IME medical services unit to determine additional
inpatient needs for possible termination from the physical disability waiver.
The consumer shall be reviewed for eligibility under other Medicaid coverage
groups in accordance with rule
441-76.11
(249A). The consumer shall be notified of that decision through Form 470-0602,
Notice of Decision.
If the consumer returns home before the effective date of the notice of decision and the consumer's condition has not substantially changed, the denial may be rescinded and eligibility may continue.
(4)
Attribution of
resources. For the purposes of attributing resources as provided in
rule
441-75.5
(249A), the date on which the waiver consumer meets the institutional level of
care requirement as determined by the IME medical services unit or an appeal
decision shall be used as the date of entry to the medical institution. Only
one attribution of resources shall be completed per person. Attributions
completed for a prior institutionalization shall be applied to the waiver
application.
Notes
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