Iowa Admin. Code r. 441-83.5 - Redetermination

A complete redetermination of eligibility for the health and disability waiver shall be completed at least once every 12 months or when there is significant change in the person's situation or condition.

A redetermination of continuing eligibility factors shall be made in accordance with rules 441-76.7 (249A) and 441-83.2 (249A). A redetermination shall include verification of the existence of a current service plan meeting the requirements listed in rule 441-83.7 (249A).

(1) The IME medical services unit or the member's managed care organization shall be responsible for annual redetermination of the level of care.

(2) 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.

Notes

Iowa Admin. Code r. 441-83.5

ARC 0757C, IAB 5/29/2013, effective 8/1/2013 Amended by IAB January 06, 2016/Volume XXXVIII, Number 14, effective 1/1/2016