Iowa Admin. Code r. 441-83.122 - Eligibility

To be eligible for children's mental health waiver services, a consumer must meet all of the following requirements:

(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.


Iowa Admin. Code r. 441-83.122
ARC 7741B, IAB 5/6/09, effective 7/1/09; ARC 0306C, IAB 9/5/12, effective 11/1/12; ARC 0548C, IAB 1/9/2013, effective 1/1/2013; ARC 0665C, IAB 4/3/2013, effective 6/1/2013; ARC 0842C, IAB 7/24/2013, effective 7/1/2013; ARC 1056C, IAB 10/2/2013, effective 11/6/2013; ARC 1445C, IAB 4/30/2014, effective 7/1/2014 Amended by IAB January 06, 2016/Volume XXXVIII, Number 14, effective 1/1/2016 Amended by IAB December 7, 2016/Volume XXXIX, Number 12, effective 11/15/2016 Amended by IAB February 1, 2017/Volume XXXIX, Number 16, effective 3/8/2017 Amended by IAB July 5, 2017/Volume XL, Number 01, effective 8/9/2017 Amended by IAB September 8, 2021/Volume XLIV, Number 5, effective 8/17/2021 Amended by IAB December 29, 2021/Volume XLIV, Number 13, effective 3/1/2022 Amended by IAB March 8, 2023/Volume XLV, Number 18, effective 5/1/2023

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