To be eligible for AIDS/HIV waiver services a person must
meet certain eligibility criteria and be determined to need a service(s)
allowable under the program.
All of the following criteria must be
met. The person must:
a. Be diagnosed by a
physician as having AIDS or HIV infection.
Be certified in need of the level of care
that, but for the waiver, would otherwise be provided in a nursing facility or
hospital based, in part, on information submitted on a completed Form 470-4694
for children aged 3 and under, the interRAI - Pediatric Home Care (PEDS-HC) for
those aged 4 to 20, or the interRAI - Home Care (HC) for those aged 21 and over
and other supporting documentation as relevant. Form 470-4694, the interRAI -
Pediatric Home Care (PEDS-HC), and the interRAI - Home Care (HC) 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 or managed care organization.
(1) The assessment as listed in
83.42(1)"b" 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
(2) The IME medical services
unit shall be responsible for approval of the certification of the level of
care, and the IME medical services unit or a managed care organization will be
responsible for annual redeterminations.
(3) AIDS/HIV waiver services shall not be
provided when the person is an inpatient in a medical institution.
c. Be eligible for medical
assistance under SSI, SSI-related, FMAP, or FMAP-related coverage groups;
medically needy at hospital level of care; or a special income level (300
percent group); or become eligible through application of the institutional
d. Require, and use
at least quarterly, one service available under the waiver as determined
through an evaluation of need described in subrule 83.42(2).
e. Have service needs such that the costs of
the waiver services are not likely to exceed the costs of care that would
otherwise be provided in a medical institution.
f. Have income which does not exceed 300
percent of the maximum monthly payment for one person under supplemental
g. For the
consumer choices option as set forth in 441-subrule 78.38(9), not be living in
a residential care facility.
Need for services.
a. The designated case manager shall review
the assessment of the person's need for waiver services and determine the
availability and appropriateness of services. This review shall be based, in
part, on information in the completed information submission tool designated in
83.42(1)"b" and other supporting documentation as
b. The total monthly cost
of the AIDS/HIV waiver services shall not exceed the established aggregate
monthly cost for level of care. The monthly cost of AIDS/HIV waiver services
cannot exceed the established limit of $1,943.43.
Iowa Admin. Code r. 441-83.42
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
January 06, 2016/Volume XXXVIII, Number 14, effective
December 7, 2016/Volume XXXIX, Number 12, effective
February 1, 2017/Volume XXXIX, Number 16, effective
July 5, 2017/Volume XL, Number 01, effective
September 8, 2021/Volume XLIV, Number 5, effective
December 29, 2021/Volume XLIV, Number 13, effective