Iowa Admin. Code r. 441-83.3 - Application
(1)Application for HCBS health and
disability waiver services. The application process as specified in
rules
441-76.1 (249A) to
441-76.6
(249A) shall be followed.
(2)Application and services program
limit. The number of persons who may be approved for the HCBS health
and disability waiver shall be subject to the number of members to be served as
set forth in the federally approved HCBS health and disability waiver. The
number of members to be served is set forth at the time of each five-year
renewal of the waiver or in amendments to the waiver approved by the Centers
for Medicare and Medicaid Services (CMS). When the number of applicants exceeds
the number of members specified in the approved waiver, the applicant's name
shall be placed on a waiting list maintained by the bureau of long-term care.
a. The county department office shall enter
all waiver applications into the individualized services information system
(ISIS) to determine if a payment slot is available.
(1) For applicants not currently receiving
Medicaid, the county department office shall make the entry by the end of the
fifth working day after receipt of a completed Form 470-2927 or 470-2927(S),
Health Services Application, or within five working days after receipt of
disability determination, whichever is later.
(2) For current Medicaid members, the county
department office shall make the entry by the end of the fifth working day
after receipt of a written request signed and dated by the applicant.
(3) A payment slot shall be assigned to the
applicant upon confirmation of an available slot.
(4) Once a payment slot is assigned, the
county department office shall give written notice to the applicant. The
department shall hold the payment slot for the applicant as long as reasonable
efforts are being made to arrange services and the applicant has not been
determined to be ineligible for the program. 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 person on the waiting list, if
applicable. The applicant originally assigned the slot must reapply for a new
slot.
b. If no payment
slot is available, the department shall enter persons on a waiting list
according to the following:
(1) 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 or upon receipt of disability
determination, whichever is later.
(2) Applicants currently eligible for
Medicaid shall be added to the waiting list on the basis of the date a request
as specified in 83.3(2)"a"(2) is received by the
department .
(3) In the event that
more than one application is received at one time, persons shall be entered on
the waiting list on the basis of the month of birth, January being month one
and the lowest number.
(4)
Applicants who do not fall within the available slots shall have their
application rejected, and their names shall be maintained on the waiting list.
They shall be contacted to reapply as slots become available based on their
order on the waiting list so that the number of approved persons on the program
is maintained. The bureau of long-term care shall contact the county department
office when a slot becomes available.
(5) Once a payment slot is assigned, the
county department office shall give written notice to the person within five
working days. The department shall hold the payment slot for 30 days for the
person to file a new application. If an application has not been filed within
30 days, the slot shall revert for use by the next person on the waiting list,
if applicable. The person originally assigned the slot must reapply for a new
slot.
c. The county
department office shall notify the bureau of long-term care within five working
days of the receipt of an application and of any action on or withdrawal of an
application.
(3)Approval of application.
a. Applications for the HCBS health and
disability waiver program shall be processed in 30 days unless one or more of
the following conditions exist:
(1) An
application has been filed and is pending for federal supplemental security
income benefits.
(2) The
application is pending because the department has not received information
which is beyond the control of the client or the department .
(3) The application is pending due to the
disability determination process performed through the department .
(4) The application is pending because a
level of care determination has not been made although the required assessment
has been submitted to the IME medical services unit.
(5) The application is pending because the
required assessment has not been completed. When a determination is not
completed 90 days from the date of application due to the lack of a completed
assessment , the application shall be denied.
b. Decisions shall be mailed or given to the
applicant on the date when income maintenance eligibility and level of care
determinations are completed.
c. An
applicant must be given the choice between HCBS health and disability waiver
services and institutional care. The applicant, parent, guardian , or attorney
in fact under a durable power of attorney for health care shall sign the
assessment and indicate that the applicant has elected home- and
community-based services.
d. Waiver
services provided prior to approval of eligibility for the waiver cannot be
paid.
e. A member may be enrolled
in only one waiver program at a time. Costs for waiver services are not
reimbursable while the member is in a medical institution (hospital or nursing
facility) or residential facility. Services may not be simultaneously
reimbursed for the same time period as Medicaid or other Medicaid waiver
services.
(4)Effective date of
eligibility.
a. Deeming of parental
or spousal income and resources ceases and eligibility shall be effective on
the date the income and resource eligibility and level of care determinations
are completed but shall not be earlier than the first of the month following
the date of application.
b. The
effective date of eligibility for the health and disability waiver for persons
who qualify for Medicaid due to eligibility for the waiver services and to whom
paragraphs 83.3(4)"a" and "c" do not apply is
the date on which the income eligibility and level of care determinations are
completed.
c. Eligibility for
persons covered under subparagraph 83.2(1)"c" (3) shall exist
on the date the income and resource eligibility and level of care
determinations are completed but shall not be earlier than the first of the
month following the date of application.
d. Eligibility continues until the member has
been in a medical institution for 30 consecutive days for other than respite
care. Members who are inpatients in a medical institution for 30 or more
consecutive days for other than respite care shall be terminated from health
and disability waiver services and reviewed for eligibility for other Medicaid
coverage groups. The member will be notified of that decision through Form
470-0602, Notice of Decision. If the member returns home before the effective
date of the notice of decision and the member's condition has not substantially
changed, the denial may be rescinded and eligibility may continue.
(5)Attribution of
resources. For the purposes of attributing resources as provided in
rule
441-75.5
(249A), the date on which the waiver applicant met the level of care criteria
in a medical institution as established by the peer review organization shall
be used as the date of entry to the medical institution . Only one attribution
of resources shall be completed per person. Attributions completed for prior
institutionalizations shall be applied to the waiver application.
Notes
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