Application for financial eligibility.
The application process
as specified in rules
(249A) shall be followed.
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
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
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.
Effective date of
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
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
when the eligibility factors set forth in 441-subrule 75.1(7) and for married
persons, in rule
(249A), have been satisfied.
Eligibility for the waiver continues until the consumer fails to meet
eligibility criteria listed in rule
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
(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.
For the purposes of attributing resources as provided in
(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.
Iowa Admin. Code r. 441-83.83
ARC 0306C, IAB 9/5/12,
July 5, 2017/Volume XL, Number 01, effective
August 2, 2017/Volume XL, Number 3, effective