Iowa Code r. 441-25.21 - Policies and procedures manual for the regional service system
The policies and procedures manual shall describe the policies and process developed to direct the management and administration of the regional service system.
(1)
Content. The manual shall include but not be limited to:
a. Financing and delivery of services and
supports. A description of the region's process used to develop and ensure the
ongoing financial accountability and delivery of services outlined in the
region's annual service and budget plan shall be included.
b. Enrollment. The application and enrollment
process that is readily accessible to individuals and their families or
authorized representatives shall be included. This procedure shall identify
regional access points and where individuals can apply for services and how and
when the applications will reach the regional administrative entity's
designated staff for processing.
c.
Eligibility. The process utilized to determine eligibility shall be included in
the manual and shall include but not be limited to:
(1) The criteria used to authorize or deny
funding for services and supports. This shall include guidelines for who is
eligible to receive services and supports by eligibility group, and type of
service or support.
(2) Financial
eligibility and copayment criteria, which shall meet the requirements of rule
441-25.16 (225C).
(3) The time frames for conducting
eligibility determination that provide for timely access to services, including
necessary and immediate services not to exceed ten days.
(4) The process for development of a written
notice of decision. The time frame for sending a written notice of decision to
the individual and guardian (if applicable) and the service providers
identified in the notice shall be included. The notice of decision shall:
1. Explain the action taken on the
application and the reasons for that action.
2. State what services are approved and name
the service providers.
3. Outline
the individual's right to appeal.
4.
Describe the appeal process.
d. Utilization of and access to services. The
process for managing utilization of and access to services and other assistance
shall be included. The process shall describe how coordination between the
services included in the annual service and budget plan and the disability
services administered by the state and others will be managed.
e. Quality management and improvement
process. The quality management and improvement process shall at a minimum meet
the requirements of the department's outcome and performance measures process
as outlined in Iowa Code sections
225C.4(1)
"k" and 225C.6A.
f. Risk management and fiscal viability. If
the region contracts with a private entity, the manual must include risk
management provisions and fiscal viability of the annual services and budget
plan.
g. Targeted case management.
(1) Designation of targeted case management
providers. The process used to identify and designate targeted case management
providers for the region shall be described. This process shall include the
requirement for the implementation of evidence-based practice models of case
management within the region. Requirements of this practice include:
1. Providing the individual receiving the
case management with a choice of providers.
2. Allowing a service provider to be the case
manager but prohibiting the provider from referring that individual only to
services administered by the provider.
3. Provisions to ensure compliance with, but
not exceed, federal requirements for conflict-free case
management.
(2)
Qualifications of targeted case managers. A region's manual shall require that
any targeted case managers or other persons providing service coordination
while working for the designated provider meet the qualifications of qualified
case managers and supervisors as defined in rule
441-24.1 (225C).
(3) Targeted case management and service
coordination services. Targeted case management and service coordination
services utilized in a regional service system shall include but are not
limited to the following as defined in Iowa Code section
225C.60(4)
"g":
1. Performance and
outcome measures relating to the health, safety, school attendance and
performance, work performance, and community residency of the individuals
receiving the services.
2.
Standards for delivery of the services, including but not limited to the social
history, assessment, service planning, incident reporting, crisis planning,
coordination, and monitoring for individuals receiving the services.
3. Methodologies for complying with the
requirements of paragraph 25.21(1)"g." Methodologies may
include the use of electronic record keeping and remote or Internet-based
training.
h.
System of care approach plan.
i.
Decentralized service provision. Measures to provide services in a dispersed
manner that meet the minimum access standards of core services and that utilize
the strengths and assets of the service providers within and available to the
region shall be included.
j.
Provider network formation and management. The manual shall require that
providers that are subject to license, accreditation or approval meet
established standards. The manual shall detail the approval process, including
criteria, developed to select providers that are not currently subject to
license, accreditation or approval standards. The manual shall identify the
process the regional administrative entity will use to contract with providers
and manage the provider network to ensure it meets the needs of the individuals
in the region. The provider network will include but is not limited to the
following:
(1) A contract with a community
mental health center that provides services in the individual's region or with
a federally qualified health center that provides psychiatric and outpatient
mental health services in the individual's region.
(2) Contracts with licensed and accredited
providers to provide each service in the required core service
domains.
(3) Adequate numbers of
licensed and accredited providers to ensure availability of core services so
that there is no waiting list for services due to lack of available
providers.
(4) A contract with an
inpatient psychiatric hospital unit or state mental health institute within
reasonably close proximity.
k. Service provider payment provisions. A
policy for payment of service providers which describes the method and process
of paying for services and supports delivered to the region shall be
included.
l. Grievance processes.
The manual shall develop and implement processes for appealing the decisions of
the regional administrative entity in the following circumstances:
(1) Nonexpedited appeal process. The appeal
process shall be based on objective criteria, specify time frames, provide for
notification in accessible formats of the decisions to all parties, and provide
some assistance to individuals with disabilities using the process.
Responsibility for the final step in the appeal process shall be a state
administrative law judge in nonexpedited appeals.
(2) Expedited appeal process. This appeal
process is to be used when the decision of the regional administrative entity
concerning an individual varies from the type and amount of service identified
to be necessary for the individual in a clinical determination made by a mental
health professional and the mental health professional believes that the
failure to provide the type and amount of service identified could cause an
immediate danger to an individual's health or safety. This appeal process shall
be performed by a mental health professional who is either the administrator of
the division of mental health and disability services of the department of
human services or the administrator's designee.
1. The appeal shall be filed within five days
of receipt of the notice of decision by the regional administrative
entity.
2. The expedited review by
the division administrator or designee shall take place within two days of
receipt of the request, unless more information is needed. There is an
extension of two days from the time the new information is received.
3. The administrator shall issue an order,
including a brief statement of findings of fact, conclusions of law, and policy
reasons for the order, to justify the decision made concerning the expedited
review. If the decision concurs with the contention that there is an immediate
danger to the individual's health or safety, the order shall identify the type
and amount of service which shall be provided for the individual. The
administrator or designee shall give such notice as is practicable to
individuals who are required to comply with the order. The order is effective
when issued.
4. The decision of the
administrator or designee shall be considered a final agency action and is
subject to judicial review in accordance with Iowa Code section
17A.19.
m. Implementation of interagency and
multisystem collaboration and care coordination. The policies and procedures
manual shall describe how the region will collaborate with other funders, other
regional service systems, service providers, case management, individuals and
their families or authorized representatives, and advocates to ensure that
authorized services and supports are responsive to individuals' needs,
consistent with system principles, and cost-efficient. The manual shall
describe the process for collaboration with the court to ensure alternatives to
commitment and to coordinate funding for services to individuals who are under
court-ordered commitment services pursuant to Iowa Code chapter 229.
n. Addressing multioccurring needs. The
policies and procedures manual shall include criteria and measures to be used
to address the needs of individuals who have two or more co-occurring mental
health, intellectual or other developmental disability, brain injury, or
substance-related disorders. The manual shall also include criteria and
measures to be used to address the needs of individuals with specialized
needs.
o. Service management and
functional assessment. The policies and procedures manual shall describe how
functional assessments and service management will be incorporated in
accordance with applicable requirements.
p. Service system management. The policies
and procedures manual shall identify whether the region will be directly
implementing a system of service management or will contract with a private
entity to manage the regional service system. If the region contracts with a
private entity, the region will ensure that all requirements of Iowa Code
section 225C.60 and these administrative
rules are fulfilled.
q. Assistance
to other than core service populations. The policies and procedures manual
shall specify the services populations, other than core service populations, to
whom the region will provide assistance if funding is available.
r. Waiting list criteria. The policies and
procedures manual shall specify whether the region will use waiting lists. If
the policy and procedures manual specifies the use of waiting lists for funding
services and supports, it shall specify criteria for the use and review of each
waiting list, including the criteria to be used to determine how and when an
individual will be placed on a waiting list. The criteria will include how core
services and additional core services will be impacted the least by budgetary
limitations. The manual shall specify how waiting list data will be used in
future planning.
(2)
Approval. A region's policy and procedures manual shall be
approved by the region's governing board and is subject to approval by the
director of human services. The director shall review all regional policy and
procedures manuals. Manuals approved by the director shall remain in effect
subject to amendment.
(3)
Amendments. An amendment to the policy and procedures manual
shall be approved by the regional governance board and submitted to the
department at least 45 days before the date of implementation. Before
implementation of any amendment to the manual, the director must approve the
amendment.
a.
Criteria for
acceptance. The director, in consultation with the state commission,
shall determine an amendment is acceptable when it contains all the required
information and meets the criteria described in this division for the
applicable part of the policy and procedures manual and is in compliance with
all applicable state and federal laws. The director may request additional
information to determine whether or not the amendment contains all the required
information and meets criteria described in this division.
b.
Notification. The
director shall notify the region, in writing, of the decision on the amendment
within 45 days of receipt of the amendment. The decision shall specify either
that:
(1) The amendment is approved as it was
submitted, either with or without supplemental information already requested
and received.
(2) The amendment is
not approved. The notification will explain why the amendment is not
approved.
(4)
Reconsideration. Regions dissatisfied with the director's
decision on a manual or an amendment may file a letter with the director
requesting reconsideration. The letter of reconsideration must be received
within 30 working days of the date of the notice of decision and shall include
a request for the director to review the decision and the reasons for
dissatisfaction. Within 30 working days of the receipt of the letter requesting
reconsideration, the director will review both the reconsideration request and
evidence provided. The director shall issue a final decision in
writing.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.