The number of persons who may be approved for the HCBS
children's mental health waiver shall be subject to the number of consumers to
be served as set forth in the federally approved HCBS children's mental health
waiver. When the number of applicants exceeds the number of consumers specified
in the approved waiver, the consumer's application shall be rejected and the
consumer's name shall be placed on a waiting list.
The local office shall determine if a
payment slot is available by the end of the fifth working day after receipt of:
(1) A completed Form 470-2297, Health
Services Application, from a consumer who is not currently a Medicaid member;
(2) A written request signed and
dated by a Medicaid member's parent or legal guardian.
When a payment slot is available, the
local office shall enter the application into ISIS to begin the waiver approval
(1) The department shall hold the
payment slot for the consumer as long as reasonable efforts are being made to
arrange services and the consumer has not been determined to be ineligible for
(2) If services have
not been initiated and reasonable efforts are no longer being made to arrange
services, the slot shall revert for use by the next consumer on the waiting
list, if applicable. The consumer must reapply for a new
If no payment
slot is available, the department shall enter the names of persons on a waiting
list according to the following:
(1) The names
of applicants not currently eligible for Medicaid shall be entered on the
waiting list on the basis of the date a completed Form 470-2927 or 470-2927(S),
Health Services Application, is received by the department;
(2) The names of Medicaid members shall be
added to the waiting list on the date as specified in paragraph
In the event that more than one application is received at one time, the names
of consumers shall be entered on the waiting list on the basis of the month of
birth, January being month one and the lowest number.
Consumers whose names are on the waiting
list shall be contacted to reapply as slots become available, based on the
order of the waiting list, so that the number of approved consumers on the
program is maintained.
(1) Once a payment slot
is assigned, the department shall give written notice to the consumer within
five working days.
department shall hold the payment slot for 30 days for the consumer to file a
(3) If an
application has not been filed within 30 days, the slot shall revert for use by
the next consumer on the waiting list, if applicable. The consumer originally
assigned the slot must reapply for a new slot.
The state reserves payment slots each
waiver year (October 1 to September 30) for use by members living in a state of
Iowa mental health institute (MHI), a psychiatric residential treatment
facility (PRTF), or an out-of-state facility placement who choose to access
services in the children's mental health waiver program and leave the MHI,
PRTF, or out-of-state placement to live within their family home. For the
purpose of reserved capacity within the children's mental health waiver
program, an MHI is defined in Iowa Code section
PRTF is defined in
(1) Applicants who currently reside in an
MHI, PRTF, or out-of-state placement and have resided in that setting for four
or more months may request a reserved capacity slot through the children's
mental health waiver program.
Applicants shall be allocated a reserved capacity slot on the basis of the date
the request is received by the income maintenance worker or the waiver slot
(3) In the event that more
than one request for a reserved capacity slot is received at one time,
applicants shall be allocated the next available reserved capacity slot on the
basis of the month of birth, January being month one and the lowest
(4) Persons who do not fall
within the available reserved capacity slots shall have their names maintained
on the reserved capacity slot waiting list. As reserved capacity slots become
available at the beginning of the next waiver year, persons shall be selected
from the reserved capacity slot waiting list to utilize the number of approved
reserved capacity slots based on their order on the waiting list.
Applications for the HCBS children's mental health waiver
program shall be processed within 30 days unless one or more of the following
(1) An application has been
filed and is pending for federal Supplemental Security Income (SSI)
(2) The application is
pending because the department has not received information for a reason that
is beyond the control of the consumer or the department.
(3) The application is pending because the
assessment has not been completed. When a determination is not completed 90
days after the date of application due to the lack of a completed assessment,
the application shall be denied.
Notice of decisions. The
department shall mail or give decisions to the applicant on the dates when
eligibility and level of care determinations are completed.
Effective date of
The effective date of a consumer's eligibility for
children's mental health waiver services shall be the first date that all of
the following conditions exist:
eligibility requirements are met; and
b. Eligibility and level of care
determinations have been made.