Iowa Admin. Code r. 441-83.43 - Application

Current through Register Vol. 44, No. 12, December 15, 2021

(1) Application for HCBS AIDS/HIV waiver services. The application process as specified in rules 441-76.1 (249A) to 441-76.6 (249A) shall be followed.
(2) Application for services. Rescinded IAB 12/6/95, effective 2/1/96.
(3) Approval of application.
a. Applications for the HCBS AIDS/HIV waiver program shall be processed in 30 days unless one or more of the following conditions exist:
(1) The application is pending because the department has not received information, which is beyond the control of the client or the department.
(2) The application is pending because a level of care determination has not been made although the completed assessment has been submitted to the IME medical services unit.
(3) Rescinded IAB 3/7/01, effective 5/1/01.
b. Decisions shall be mailed or given to the applicant on the date when income maintenance eligibility and level of care determinations and the consumer service plan are completed.
c. An applicant must be given the choice between HCBS AIDS/HIV 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.
(4) Effective date of eligibility.
a. The effective date of eligibility for the AIDS/HIV waiver for persons who are already determined eligible for Medicaid is the date on which the income and resource eligibility and level of care determinations are completed.
b. The effective date of eligibility for the AIDS/HIV waiver for persons who qualify for Medicaid due to eligibility for the waiver services and to whom 441-subrule 75.1(7) and rule 441-75.5 (249A) do not apply is the date on which income and resource eligibility and level of care determinations are completed.
c. Eligibility for the waiver continues until the recipient has been in a medical institution for 120 consecutive days for other than respite care or fails to meet eligibility criteria listed in rule 441-83.42 (249A). Recipients who are inpatients in a medical institution for 120 or more consecutive days for other than respite care shall be reviewed for eligibility for other Medicaid coverage groups and terminated from AIDS/HIV waiver services if found eligible under another coverage group. The recipient will be notified of that decision through Form 470-0602, Notice of Decision. If the consumer returns home before the effective date of the notice of decision and the person's condition has not substantially changed, the denial may be rescinded and eligibility may continue.
d. The effective date of eligibility for the AIDS/HIV waiver for persons who qualify for Medicaid due to eligibility for the waiver services and to whom the eligibility factors set forth in 441-subrule 75.1(7) and, for married persons, in rule 441-75.5 (249A) have been satisfied is the date on which the income eligibility and level of care determinations are completed but shall not be earlier than the first of the month following the date of application.
(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

Iowa Admin. Code r. 441-83.43
ARC 0306C, IAB 9/5/12, effective 11/1/12 Amended by IAB January 06, 2016/Volume XXXVIII, Number 14, effective 1/1/2016 Amended by IAB July 5, 2017/Volume XL, Number 01, effective 8/9/2017 Amended by IAB August 2, 2017/Volume XL, Number 3, effective 9/6/2017

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