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
