Iowa Admin. Code r. 441-83.122 - Eligibility
To be eligible for children's mental
(1)
Age. The consumer must
be under 18 years of age.
(2)
Diagnosis. The consumer must be diagnosed with a serious
emotional disturbance .
a.
Initial
certification. For initial application to the HCBS children's mental
health waiver program , psychological documentation that substantiates a mental
health diagnosis of serious emotional disturbance as determined by a mental
health professional must be current within the 12-month period before the
application date.
b.
Ongoing certification. A mental health professional must
complete an annual evaluation that substantiates a mental health diagnosis of
serious emotional disturbance .
(3)
Level of care. The
applicant must be certified as being in need of a level of care that, but for
the waiver, would be provided in a psychiatric hospital serving children under
the age of 21. The IME medical services unit or a managed care organization
shall certify the applicant's level of care annually based on information
submitted on Form 470-4694, Case Management Comprehensive Assessment , for
children aged 3 and under or on the interRAI - Child and Youth Mental Health
(ChYMH) for those aged 4 to 20 and other supporting documentation as relevant.
For those aged 12 to 18, the interRAI -Adolescent Supplement shall also be
completed in addition to the interRAI - Child and Youth Mental Health (ChYMH).
Form 470-4694, the interRAI - Child and Youth Mental Health (ChYMH), and the
interRAI - Adolescent Supplement 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 ,
integrated health home care coordinator or managed care organization .
(4)
Financial eligibility.
The consumer must be eligible for Medicaid as follows:
a. Be eligible for Medicaid under an SSI,
SSI-related, FMAP, or FMAP-related coverage group; or
b. Be eligible under the special income level
(300 percent) coverage group; or
c.
Become eligible through application of the institutional deeming rules;
or
d. Would be eligible for
Medicaid if in a medical institution . For this purpose, deeming of parental or
spousal income or resources ceases in the month after the month of
application.
(5)
Choice of program . The applicant must choose HCBS children's
mental health waiver services over institutional care, as indicated by the
signature of the applicant's parent or legal guardian on the
assessment .
(6)
Need for
service. The consumer must have service needs that can be met under
the children's mental health waiver program , as documented in the service plan
developed in accordance with rule
441-83.12 (249A).
a. The consumer must be a recipient of case
management or integrated health home services or be identified to receive case
management or integrated health home services immediately following program
enrollment.
b. The total cost of
children's mental health waiver services needed to meet the member's needs,
excluding the cost of environmental modifications, adaptive devices and
therapeutic resources, may not exceed $2,165.87 per month.
c. At a minimum, each consumer must receive
one billable unit of a children's mental health waiver service per calendar
quarter.
d. A consumer may not
receive children's mental health waiver services and foster family care
services under 441-Chapter 202 at the same time.
e. A consumer may be enrolled in only one
HCBS waiver program at a time.
Notes
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