Iowa Code r. 441-22.2 - Eligibility and application requirements
To be determined eligible for funding for services through the autism support program, an individual must meet the following requirements:
(1) An individual shall
submit an application to the department using a standardized application form
available through the administrator's and the department's websites, members of
the provider network, the regional autism assistance program, and advocacy
organizations.
(2) An applicant for
autism program services shall be less than the age of 14 at the time of
application for the program. Proof of age must be provided at the time of
application. An individual who reaches the age of 14 prior to receipt of the
maximum benefits of the program may continue to receive services from the
program in accordance with the individual's treatment plan, up to a maximum of
24 months of applied behavioral analysis treatment.
(3) An individual shall have a diagnosis of
autism based on a diagnostic assessment of autism dated 24 months or less from
the date of application for the program.
(4) An individual shall be determined
ineligible for coverage of applied behavioral analysis services under the
medical assistance program, Iowa Code section
514C.28, Iowa Code section
514C.31, or other private
insurance coverage. Proof of insurance coverage and noneligibility for coverage
for applied behavioral analysis shall be provided at the time of application
and shall include a written denial of coverage or a benefits summary indicating
that the applied behavioral analysis treatment or applied behavior analysis
treatment is not a covered benefit for which the applicant is eligible under
the Medicaid program, Iowa Code section
514C.28, Iowa Code section
514C.31, or other private
insurance coverage.
(5) An
individual shall have a household income equal to or less than 500 percent of
the federal poverty level. Information needed to determine household income
using modified adjusted gross income methodology shall be identified on the
program application. Household size will be determined according to the
standards in this chapter. The information shall be provided at the time of
application.
(6) The department
shall provide to the parent or guardian a written notice of decision
determining initial eligibility or denial within 30 calendar days of receipt of
the application.
(7) The department
shall refer an applicant determined to be an eligible individual to care
coordination services. The referral will occur within 5 business days of
determination of eligibility for the program. Care coordination services will
be provided by the University of Iowa regional autism assistance program (RAP)
or an integrated health home. Eligible individuals who reside in counties where
integrated health homes for children with a serious emotional disturbance are
operational may choose to receive care coordination through the University of
Iowa RAP program or an integrated health home that serves residents of the
eligible individual's county of residence. Care coordination is not required as
a condition of receiving services through the autism support program.
(8) The department shall provide information
to an applicant determined to be an eligible individual regarding all available
administrators. The eligible individual may choose any available
administrator.
(9) The
administrator shall maintain a list of individuals determined eligible for the
program but unable to access services due to lack of available providers and
shall work to connect eligible individuals on the list to network
providers.
(10) The department
shall stop processing applications at the point where available funds are fully
obligated for eligible individuals and additional eligible individuals would
cause expenditures in excess of the funds available to the program. The
department shall maintain a waiting list of individuals denied access to the
program due to lack of available funds. If additional funds become available,
the department shall contact individuals on the list in order of the earliest
date and time of the receipt of the original application. The applicant shall
be allowed 30 calendar days to submit an updated application and any required
information needed to determine eligibility. If the applicant does not submit
required information, the applicant will be denied eligibility and removed from
the waiting list maintained for individuals denied access to the program due to
lack of funding. The age of the applicant at the time of the most recent
application will be used when determining eligibility for the
program.
Notes
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