(6) the
time the service begins and ends.
"Fiscal accountability" means the
development and maintenance of budgets and independent fiscal review.
"Group respite" is respite provided on a
staff-to-consumer ratio of less than one to one.
"Guardian" means a guardian appointed in
probate court.
"Health" means skills related to the
maintenance of one's health including eating; illness identification, treatment
and prevention; basic first aid; physical fitness; regular physical checkups
and personal habits.
"Immediate jeopardy" means circumstances
where the life, health, or safety of a person will be severely jeopardized if
the circumstances are not immediately corrected.
"Intellectual disability" means a diagnosis
of intellectual disability (intellectual developmental disorder), global
developmental delay, or unspecified intellectual disability (intellectual
developmental disorder) which shall be made only when the onset of the person's
condition was during the developmental period and shall be based on an
assessment of the person's intellectual functioning and level of adaptive
skills. The diagnosis shall be made by a person who is a licensed psychologist
or psychiatrist who is professionally trained to administer the tests required
to assess intellectual functioning and to evaluate a person's adaptive skills.
The diagnosis shall be made in accordance with the criteria provided in the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
published by the American Psychiatric Association.
"Intermediate care facility for persons with an
intellectual disability (ICF/ID)" means an institution that is
primarily for the diagnosis, treatment, or rehabilitation of persons with an
intellectual disability or persons with related conditions and that provides,
in a protected residential setting, ongoing evaluation, planning, 24-hour
supervision, coordination and integration of health or related services to help
each person function at the greatest ability and is an approved Medicaid
vendor.
"Intermediate care facility for persons with an
intellectual disability level of care" means that the individual has a
diagnosis of intellectual disability made in accordance with the criteria
provided in the current version of the Diagnostic and Statistical Manual of
Mental Disorders published by the American Psychiatric Association; or has a
related condition as defined in
42 CFR
435.1009; and needs assistance in at least
three of the following major life areas: mobility, musculoskeletal skills,
activities of daily living, domestic skills, toileting, eating skills, vision,
hearing or speech or both, gross/fine motor skills, sensory-taste, smell,
tactile, academic skills, vocational skills, social/community skills, behavior,
and health care.
"Intermittent supported community living
service" means supported community living service provided not more
than 52 hours per month.
"Maintenance needs" means costs associated
with rent or mortgage, utilities, telephone, food and household
supplies.
"Managed care" means a system that provides
the coordinated delivery of services and supports that are necessary and
appropriate, delivered in the least restrictive settings and in the least
intrusive manner. Managed care seeks to balance three factors:
1. Achieving high-quality outcomes for
participants.
2. Coordinating
access.
3. Containing costs.
"Managed care organization" means an entity
that (1) is under contract with the department to provide services to Medicaid
recipients and (2) meets the definition of "health maintenance organization" as
defined in Iowa Code section
514B.1.
"Medical assessment" means a visual and
physical inspection of the consumer, noting deviations from the norm, and a
statement of the consumer's mental and physical condition that can be amendable
to or resolved by appropriate actions of the provider.
"Medical institution" means a nursing
facility, intermediate care facility for persons with an intellectual
disability, or hospital which has been approved as a Medicaid vendor.
"Medical intervention" means consumer care
in the areas of hygiene, mental and physical comfort, assistance in feeding and
elimination, and control of the consumer's care and treatment to meet the
physical and mental needs of the consumer in compliance with the plan of care
in areas of health, prevention, restoration, and maintenance.
"Medical monitoring" means observation for
the purpose of assessing, preventing, maintaining, and treating disease or
illness based on the consumer's plan of care.
"Natural supports" means services and
supports identified as wanted or needed by the consumer and provider by persons
not for pay (family, friends, neighbors, coworkers, and others in the
community) and organizations or entities that serve the general public.
"Organization" means the entity being
certified.
"Organizational outcome" means a
demonstration by the organization of actions taken by the organization to
provide for services or supports to consumers.
"Outcome" means an action or event that
follows as a result or consequence of the provision of a service or
support.
"Procedures" means the steps to be taken to
implement a policy.
"Process" means service or support provided
by an agency to a consumer that will allow the consumer to achieve an outcome.
This can include a written, formal, consistent trackable method or an informal
process that is not written but is trackable.
"Program" means a set of related resources
and services directed to the accomplishment of a fixed set of goals and
objectives for the population ofa specified geographic area or for special
target populations. It can mean an agency, organization, or unit of an agency,
organization or institution.
"Qualified intellectual disability
professional" means a person who has at least one year of experience
working directly with persons with an intellectual disability or other
developmental disabilities and who is one of the following:
1. A doctor of medicine or
osteopathy.
2. A registered
nurse.
3. An occupational therapist
eligible for certification as an occupational therapist by the American
Occupational Therapy Association or another comparable body.
4. A physical therapist eligible for
certification as a physical therapist by the American Physical Therapy
Association or another comparable body.
5. A speech-language pathologist or
audiologist eligible for certification of Clinical Competence in
Speech-Language Pathology or Audiology by the American Speech-Language Hearing
Association or another comparable body or who meets the educational
requirements for certification and who is in the process of accumulating the
supervised experience required for certification.
6. A psychologist with a master's degree in
psychology from an accredited school.
7. A social worker with a graduate degree
from a school of social work, accredited or approved by the Council on Social
Work Education or another comparable body or who holds a bachelor of social
work degree from a college or university accredited or approved by the Council
of Social Work Education or another comparable body.
8. A professional recreation staff member
with a bachelor's degree in recreation or in a specialty area such as art,
dance, music or physical education.
9. A professional dietitian who is eligible
for registration by the American Dietetics Association.
10. A human services professional who must
have at least a bachelor's degree in a human services field including, but not
limited to, sociology, special education, rehabilitation counseling and
psychology.
"Related condition" means a severe, chronic
disability that meets all the following conditions:
1. It is attributable to cerebral palsy,
epilepsy, or any other condition, other than mental illness, found to be
closely related to intellectual disability because the condition results in
impairment of general intellectual functioning or adaptive behavior similar to
that of a person with an intellectual disability and requires treatment or
services similar to those required for a person with an intellectual
disability.
2. It is manifested
before the age of 22.
3. It is
likely to continue indefinitely.
4.
It results in substantial functional limitations in three or more of the
following areas of major life activity:
* Self-care.
* Understanding and use of language.
* Learning.
* Mobility.
* Self-direction.
* Capacity for independent living.
"Service plan" means a person-centered,
outcome-based plan of services which is written by the member's case manager
with input and direction from the member and which addresses all relevant
services and supports being provided. The service plan is developed by the
interdisciplinary team, which includes the member and, if appropriate, the
member's legal representative, member's family, service providers, and others
directly involved with the member.
"SIS assessment" means the Supports
Intensity Scale® assessment developed and licensed by the American
Association on Intellectual and Developmental Disabilities for use in the
assessment of the support and service needs of individuals.
"Specialized respite" means respite provided
on a staff-to-consumer ratio of one to one or higher to individuals with
specialized medical needs requiring the care, monitoring or supervision of a
licensed registered nurse or licensed practical nurse.
"Staff" means a person under the direction
of the organization to perform duties and responsibilities of the
organization.
"Third-party payments" means payments from
an attorney, individual, institution, corporation, insurance company, or public
or private agency which is liable to pay part or all of the medical costs
incurred as a result of injury, disease or disability by or on behalf of an
applicant or a past or present recipient of Medicaid.
"Usual caregiver" means a person or persons
who reside with the consumer and are available on a 24-hour-per-day basis to
assume responsibility for the care of the
consumer.
