Iowa Admin. Code r. 441-83.62 - Application

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

(1) Application for HCBS intellectual disability waiver services. The application process as specified in rules 441-76.1 (249A) to 441-76.6 (249A) shall be followed.
(2) Rescinded IAB 6/5/96, effective 8/1/96.
(3) Approval of application.
a. Applications for the HCBS intellectual disability waiver program shall be processed in 30 days unless the case manager or worker can document difficulty in locating and arranging services or other circumstance beyond the worker's control. In these cases a decision shall be made as soon as possible.
b. Decisions shall be mailed or given to the applicant on the date when both service and income maintenance eligibility determinations are completed.
c. An applicant shall be given the choice between HCBS waiver services and ICF/ID care. The case manager or worker shall have the consumer or legal representative indicate the consumer's choice of care.
d. HCBS intellectual disability waiver services provided before eligibility for the waiver is approved shall not be reimbursed by the HCBS waiver program.
e. Services provided when the person is a consumer of group foster care services or is an inpatient in a medical institution shall not be reimbursed.
f. HCBS intellectual disability waiver services are not available in conjunction with other Medicaid waiver services or group foster care services.
g. Rescinded IAB 5/6/09, effective 7/1/09.
(4) Effective date of eligibility.
a. Deeming of parental income and resources ceases the month following the month in which a person requires care in a medical institution.
b. The effective date of eligibility for the waiver for persons who are already determined eligible for Medicaid is the date on which the person is determined to meet the criteria set forth in rule 441-83.61 (249A).
c. The effective date of eligibility for the waiver for persons who qualify for Medicaid due to eligibility for the waiver services is the date on which the person is determined to meet criteria set forth in rule 441-83.61 (249A) and when the eligibility factor set forth in 441-subrule 75.1(7) and for married persons, in rule 441-75.5 (249A) have been satisfied.
d. Eligibility continues until the consumer fails to meet eligibility criteria listed in rule 441-83.61 (249A). Consumers who are inpatients in a medical institution for 120 consecutive days shall receive a review by the interdisciplinary team to determine additional inpatient needs for possible termination from the HCBS program. Consumers shall be reviewed for eligibility under other Medicaid coverage groups. The consumer or legal representative shall participate in the review and receive formal notification 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 consumer's needs can still be met by the HCBS waiver services, the denial may be rescinded and eligibility may continue.

e. Eligibility and service reimbursement are effective through the last day of the month of the previous annual service plan staffing meeting and the corresponding long-term care need determination.
(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. 441-83.62
ARC 7741B, lAB 5/6/09, effective 7/1/09; ARC 9650B, lAB 8/10/11, effective 10/1/11 Amended by IAB September 30, 2015/Volume XXXVIII, Number 07, effective 11/4/2015 Amended by IAB August 2, 2017/Volume XL, Number 3, effective 9/6/2017

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