Iowa Admin. Code r. 441-83.83 - Application

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

(1) Application for financial eligibility. The application process as specified in rules 441-76.1 (249A) to 441-76.6 (249A) shall be followed.
(2) Approval of application for eligibility.
a. Applications for the determination of ability of the consumer to have all medically necessary service needs met within the scope of this waiver shall be initiated on behalf of the consumer and with the consumer's consent or with the consent of the consumer's legal representative by the discharge planner of the medical facility where the consumer resides at the time of application or the case manager. The discharge planner or case manager shall provide to the IME medical services unit all appropriate information needed regarding all the medically necessary service needs of the consumer. After completing the determination of ability to have all medically necessary service needs met within the scope of this waiver, the IME medical services unit shall inform the discharge planner or case manager on behalf of the consumer or the consumer's legal representative and send to the income maintenance worker a copy of the decision as to whether all of the consumer's service needs can be met in a home- or community-based setting.
b. Eligibility for the HCBS BI waiver shall be effective as of the date when both the service eligibility and financial eligibility have been completed. Decisions shall be mailed or given to the consumer or the consumer's legal representative on the date when each eligibility determination is completed.
c. An applicant shall be given the choice between waiver services and institutional care. The applicant or legal representative shall sign the applicable information submission tool listed in paragraph 83.82(1)"f " indicating that the applicant has elected home- and community-based services. This shall be arranged by the medical facility discharge planner or case manager.
d. The medical facility discharge planner, if there is one involved, shall contact the consumer's managed care organization or the designated case manager to initiate development of the consumer's service plan and initiation of waiver services.
e. HCBS BI waiver services provided prior to both approvals of eligibility for the waiver cannot be paid.
f. HCBS BI waiver services are not available in conjunction with other HCBS waiver programs or group foster care services.
g. The Medicaid case manager shall establish an HCBS BI waiver interdisciplinary team for each consumer and, with the team, identify the consumer's "need for service" based on the consumer's needs and desires as well as the availability and appropriateness of services.
(3) Effective date of eligibility.
a. 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 all of the criteria set forth in rule 441-83.82 (249A).
b. 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 all of the criteria set forth in rule 441-83.82 (249A) and when the eligibility factors set forth in 441-subrule 75.1(7) and for married persons, in rule 441-75.5 (249A), have been satisfied.
c. Eligibility for the waiver continues until the consumer fails to meet eligibility criteria listed in rule 441-83.82 (249A). Consumers who return to inpatient status in a medical institution for more than 120 consecutive days shall be reviewed by the IME medical services unit to determine additional inpatient needs for possible termination from the brain injury waiver. The consumer shall be reviewed for eligibility under other Medicaid coverage groups in accordance with rule 441-76.11 (249A). The consumer shall 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 consumer's condition has not substantially changed, the denial may be rescinded and eligibility may continue.

(4) Attribution of resources. For the purposes of attributing resources as provided in rule 441-75.5 (249A), the date on which the waiver consumer meets 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. 441-83.83
ARC 0306C, IAB 9/5/12, effective 11/1/12 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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