"Assessment" means the review of the
consumer's current functioning in regard to the consumer's situation, needs,
abilities, desires, and goals.
"Care coordinator" means the professional
who assists members in care coordination as described in 441-paragraph
78.53(1)"b."
"Case manager" means the person designated
to provide Medicaid targeted case management services for the consumer.
"CMS" means the Centers for Medicare and
Medicaid Services, a division of the U.S. Department of Health and Human
Services.
"Consumer" means an individual up to the age
of 18 who is included in a Medicaid coverage group listed in
441-75.1 (249A) and is a
recipient of children's mental health waiver services.
"Deeming" means considering parental or
spousal income or resources as income or resources of a consumer in determining
eligibility for a consumer according to Supplemental Security Income program
guidelines.
"Department" means the Iowa department of
human services.
"Electronic visit verification system"
means, with respect to personal care services or home health care services
defined in Section 12006 of the 21st Century Cures Act, a system under which
visits conducted as part of such services are electronically verified with
respect to:
(1) the type of service
performed,
(2) the individual
receiving the service,
(3) the date
of the service,
(4) the location of
service delivery,
(5) the individual
providing the service, and
(6) the
time the service begins and ends.
"Guardian" means a parent of a consumer or a
legal guardian appointed by the court.
"HCBS" means home- and community-based
services provided under a Medicaid waiver.
"IME" means the Iowa Medicaid
enterprise.
"IME medical services unit" means the
contracted entity in the Iowa Medicaid enterprise that determines level of care
for consumers initially applying for or continuing to receive children's mental
health waiver services.
"Integrated health home" means the provision
of services to enrolled members as described in 441-subrule 78.53(1).
"Interdisciplinary team" means the consumer,
the consumer's family, and persons of varied professional and nonprofessional
backgrounds with knowledge of the consumer's needs, as designated by the
consumer and the consumer's family, who meet to develop a service plan based on
the individualized needs of the consumer.
"ISIS" means the department's individualized
services information system.
"Local office" means a department of human
services office as described in 441-subrule 1.4(2).
"Managed care organization" means an entity
that (1) is under contract with the department to provide services to Medicaid
recipients and (2) meets the definition of "health maintenance organization" as
defined in Iowa Code section
514B.1.
"Medical institution" means a nursing
facility, an intermediate care facility for persons with an intellectual
disability, a psychiatric hospital or psychiatric medical institution for
children, or a state mental health institute that has been approved as a
Medicaid vendor.
"Mental health professional" means a person
who meets all of the following conditions:
1. Holds at least a master's degree in a
mental health field including, but not limited to, psychology, counseling and
guidance, psychiatric nursing and social work; or is a doctor of medicine or
osteopathic medicine; and
2. Holds
a current Iowa license when required by the Iowa professional licensure laws
(such as a psychiatrist, a psychologist, a marital and family therapist, a
mental health counselor, an advanced registered nurse practitioner, a
psychiatric nurse, or a social worker); and
3. Has at least two years of postdegree
experience supervised by a
mental health professional in assessing mental
health problems, mental illness, and service needs and in providing mental
health services.
"Psychiatric medical institution for children level
of care" means that the member has been diagnosed with a serious
emotional disturbance and an independent team as identified in 441-subrule
85.22(3) has certified that ambulatory care resources available in the
community do not meet the treatment needs of the recipient, that proper
treatment of the recipient's psychiatric condition requires services on an
inpatient basis under the direction of a physician, and that the services can
reasonably be expected to improve the recipient's condition or prevent further
regression so that the services will no longer be needed.
"Serious emotional disturbance" means a
diagnosable mental, behavioral, or emotional disorder that (1) is of sufficient
duration to meet diagnostic criteria for the disorder specified by the current
version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
published by the American Psychiatric Association; and (2) has resulted in a
functional impairment that substantially interferes with or limits a consumer's
role or functioning in family, school, or community activities. "Serious
emotional disturbance" shall not include neurodevelopmental disorders,
substance-related disorders, or conditions or problems classified in the
current version of the DSM as "other conditions that may be a focus of clinical
attention," unless these conditions co-occur with another diagnosable serious
emotional disturbance.
"Service plan" means a person-centered,
outcome-based plan of services that is written by the member's case manager
with input and direction from the member and that addresses all relevant
services and supports being provided. The service plan is developed by the
interdisciplinary team, which includes the member and, if appropriate, the
member's legal representative, member's family, service providers, and others
directly involved with the member.
"Skill development" means that the service
provided is habilitative and is intended to impart an ability or capacity to
the consumer. Supervision without habilitation is not skill development.
"Targeted case management" means Medicaid
case management services accredited under 441-Chapter 24 and provided according
to 441-Chapter 90 for consumers eligible for the children's mental health
waiver.
"Waiver year" for the children's mental
health waiver means a 12-month period commencing on July 1 of each
year.
Notes
Iowa Admin. Code r. 441-83.121
Amended by
IAB
September 30, 2015/Volume XXXVIII, Number 07, effective
10/1/2015
Amended by
IAB
January 06, 2016/Volume XXXVIII, Number 14, effective
1/1/2016
Amended by
IAB
July 5, 2017/Volume XL, Number 01, effective
8/9/2017
Amended by
IAB
July 4, 2018/Volume XLI, Number 1, effective
8/8/2018
Amended by
IAB
May 5, 2021/Volume XLIII, Number 23, effective
7/1/2021
