Iowa Admin. Code r. 441-83.87 - Service plan

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

A service plan shall be prepared and utilized for each HCBS BI waiver consumer. The service plan shall be developed by an interdisciplinary team, which includes the consumer, and, if appropriate, the legal representative, consumer's family, case manager, providers, and others directly involved. The service plan shall be stored by the case manager for a minimum of three years. The service plan staffing shall be conducted before the current service plan expires.

(1)Information in plan. The plan shall be in accordance with 441-subrule 24.4(3) and shall additionally include the following information to assist in evaluating the program:
a. A listing of all services received by a consumer at the time of waiver program enrollment.
b. For supported community living:
(1) The consumer's living environment at the time of waiver enrollment.
(2) The number of hours per day of on-site staff supervision needed by the consumer.
(3) The number of other waiver consumers who will live with the consumer in the living unit.
c. An identification and justification of any restriction of a consumer's rights including, but not limited to:
(1) Maintenance of personal funds.
(2) Self-administration of medications.
d. The names of all providers responsible for providing all services.
e. All service funding sources.
f. The amount of the service to be received by the consumer.
g. Whether the consumer has elected the consumer choices option and, if so:
(1) The independent support broker selected by the consumer; and
(2) The financial management service selected by the consumer.
h. A plan for emergencies and identification of the supports available to the consumer in an emergency.
(2) Use of nonwaiver services. Service plans must be developed to reflect use of all appropriate nonwaiver Medicaid services and so as not to replace or duplicate those services. Service plans for members aged 20 or under which include supported community living services beyond intermittent must be approved (signed and dated) by the designee of the bureau of long-term care. The Medicaid case manager shall attach a written request for a variance from the limitation on supported community living to intermittent.
(3) Annual assessment. The IME medical services unit shall assess the member annually and certify the member's need for long-term care services. The IME medical services unit shall be responsible for determining the level of care based on the completed information submission tool listed in paragraph 83.82(1)"f" and other supporting documentation as relevant.
a. The IME medical services unit or the member's managed care organization shall be responsible for annual redetermination of the level of care.
b. 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.
(4)Service file. The Medicaid case manager must ensure that the consumer service file contains the consumer's service plan.

a. tod. Rescinded IAB 8/7/02, effective 10/1/02.

Notes

Iowa Admin. Code r. 441-83.87
ARC 0191C, IAB 7/11/12, effective 7/1/12; ARC 0306C, IAB 9/5/12, effective 11/1/12 Amended by IAB January 06, 2016/Volume XXXVIII, Number 14, effective 1/1/2016 Amended by IAB July 5, 2017/Volume XL, Number 01, effective 8/9/2017

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