Iowa Admin. Code r. 441-83.22 - Eligibility
To be eligible for elderly waiver services a person must meet certain eligibility criteria and be determined to need a service(s) allowable under the program.
(1)
Eligibility criteria. All of the following criteria must be
met. The person must be:
a. Sixty-five years
of age or older.
b. A resident of
the state of Iowa.
c. Eligible for
Medicaid as if in a medical institution pursuant to 441-Chapter 75. When a
husband and wife who are living together both apply for the waiver, income and
resource guidelines as specified at 441-paragraphs 75.5(2)"b "
and 75.5(4)"c" shall be applied.
d. Certified as being in need of the
intermediate or skilled level of care based, in part, on information submitted
on the interRAI - Home Care (HC). The interRAI - Home Care (HC) is available on
request from IME medical services unit and other supporting documentation as
relevant. Copies of the completed interRAI - Home Care (HC) for an individual
are available to that individual from the individual's case manager or managed
care organization.
(1) The assessment shall be
completed when the person applies for waiver services, upon request to report a
significant change in the person's condition, and annually for reassessment of
the person's level of care. The IME medical services unit shall be responsible
for determination of the initial level of care.
(2) The IME medical services unit or the
member's managed care organization shall be responsible for annual
redetermination of the level of care.
(3) Elderly waiver services will not be
provided when the person is an inpatient in a medical institution.
(4) The managed care organization must submit
documentation to the IME medical services unit for all reassessments, performed
at least annually, which indicate a change in the member's level of care. The
IME medical services unit shall make a final determination for any
reassessments which indicate a change in the level of care. If the level of
care reassessment indicates no change in level of care, the member is approved
to continue at the already established level of care.
e. Determined to need services as described
in subrule 83.22(2).
f. Rescinded
IAB 10/11/06, effective 10/1/06.
g.
For the consumer choices option as set forth in rule 441-subrule 78.37(16),
residing in a living arrangement other than a residential care
facility.
(2)
Need for services, service plan, and cost.
a.
Case management.
Consumers under the elderly waiver shall receive case management services from
a provider qualified pursuant to rule
441-77.29 (249A). Case
management services shall be provided as set forth in rules
441-90.4 (249A) through
441-90.7(249A).
b.
Interdisciplinary team. The case manager shall establish an
interdisciplinary team for the consumer.
(1)
Composition. The interdisciplinary team shall include the case manager and the
consumer and, if appropriate, the consumer's legal representative, family,
service providers, and others directly involved in the consumer's
care.
(2) Role. The team shall
identify:
1. The consumer's need for services
based on the consumer's needs and desires.
2. Available and appropriate services to meet
the consumer's needs.
3. Health and
safety issues for the consumer that indicate the need for an emergency plan,
based on a risk assessment conducted before the team meeting.
4. Emergency backup support and a crisis
response system to address problems or issues arising when support services are
interrupted or delayed or when the consumer's needs change.
c.
Service
plan. An applicant for elderly waiver services shall have a service
plan developed by a qualified provider of case management services under the
elderly waiver.
(1) Services included in the
service plan shall be appropriate to the problems and specific needs or
disabilities of the consumer.
(2)
Services must be the least costly available to meet the service needs of the
member.
(3) The service plan must
be completed before services are provided.
(4) The service plan must be reviewed at
least annually and when there is any significant change in the consumer's
needs.
d.
Content of service plan. The service plan shall include the
following information based on the consumer's current assessment and service
needs:
(1) Observable or measurable
individual goals.
(2) Interventions
and supports needed to meet those goals.
(3) Incremental action steps, as
appropriate.
(4) The names of
staff, people, businesses, or organizations responsible for carrying out the
interventions or supports.
(5) The
desired individual outcomes.
(6)
The identified activities to encourage the consumer to make choices, to
experience a sense of achievement, and to modify or continue participation in
the service plan.
(7) Description
of any restrictions on the consumer's rights, including the need for the
restriction and a plan to restore the rights. For this purpose, rights include
maintenance of personal funds and self-administration of medications.
(8) A list of all Medicaid and non-Medicaid
services that the consumer received at the time of waiver program enrollment
that includes:
1. The name of the service
provider responsible for providing the service.
2. The funding source for the
service.
3. The amount of service
that the consumer is to receive.
(9) Indication of whether the consumer has
elected the consumer choice option and, if so, the independent support broker
and the financial management service that the consumer has selected.
(10) The determination that the services
authorized in the service plan are the least costly.
(11) A plan for emergencies that identifies
the supports available to the consumer in situations for which no approved
service plan exists and which, if not addressed, may result in injury or harm
to the consumer or other persons or in significant amounts of property damage.
Emergency plans shall include:
1. The
consumer's risk assessment and the health and safety issues identified by the
consumer's interdisciplinary team.
2. The emergency backup support and crisis
response system identified by the interdisciplinary team.
3. Emergency, backup staff designated by
providers for applicable services.
(3)
Providers-standards.
Rescinded IAB 10/11/06, effective 10/1/06.
Notes
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