Iowa Code r. 441-83.103 - Application
(1)
Application for financial eligibility. The application process
as specified in rules
441-76.1 (249A) to
441-76.6 (249A) shall be
followed. Applications for this program may only be filed on or after April 1,
1999.
(2)
Approval of
application for eligibility.
a.
Applications for this waiver shall be initiated on behalf of the applicant who
is a resident of a medical institution with the applicant's consent or with the
consent of the applicant's legal representative by the discharge planner of the
medical facility where the applicant resides at the time of application.
(1) The discharge planner shall contact the
member's managed care organization or designated case manager to arrange for
completion of the appropriate information submission tool as listed in
paragraph 83.102(1)"h."
(2) After completing the determination of the
level of care needed by the applicant, the IME medical services unit shall
inform the income maintenance worker and the discharge planner of the IME
medical services unit's decision.
b. Applications for this waiver shall be
initiated by the applicant, the applicant's parent or legal guardian, or the
applicant's attorney in fact under a durable power of attorney for health care
on behalf of the applicant who is residing in the community.
(1) The applicant's managed care organization
or the designated case manager shall arrange for the completion of the
appropriate information submission tool as listed in paragraph
83.102(1)"h" and submit it to the IME medical services
unit.
(2) After completing the
determination of the level of care needed by the applicant, the IME medical
services unit shall inform the income maintenance worker and the applicant, the
applicant's parent or legal guardian, or the applicant's attorney in fact under
a durable power of attorney for health care.
c. Eligibility for this waiver shall be
effective as of the date when both the eligibility criteria in subrule
83.102(1) and need for services in subrule 83.102(2) have been established.
Decisions shall be mailed or given to the applicant, the applicant's parent or
legal guardian, or the applicant's attorney in fact under a durable power of
attorney for health care on the date when each eligibility determination is
completed.
d. An applicant shall be
given the choice between waiver services and institutional care. The applicant
or the applicant's parent, legal guardian, or attorney in fact under a durable
power of attorney for health care shall sign the information submission tool,
indicating that the applicant has elected home- and community-based
services.
e. The applicant, the
applicant's parent or guardian, or the applicant's attorney in fact under a
durable power of attorney for health care shall cooperate with the designated
case manager in the development of the service plan prior to the start of
services.
f. HCBS physical
disability waiver services provided prior to both approvals of eligibility for
the waiver cannot be paid.
g. HCBS
physical disability waiver services are not available in conjunction with other
HCBS waiver programs. The consumer may also receive in-home health-related care
service if eligible for that program.
(3)
Effective date of
eligibility.
a. 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 subrule 83.102(1).
b. 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 subrule 83.102(1) and when the eligibility factors set
forth in 441-subrule 75.1(7) and, for married persons, in rule
441-75.5 (249A), have been
satisfied.
c. Eligibility for the
waiver continues until the consumer fails to meet eligibility criteria listed
in subrule 83.102(1). 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 physical disability waiver. The consumer shall be reviewed
for eligibility under other Medicaid coverage groups in accordance with rule
441-76.11 (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.
(4)
Attribution of resources. For the purposes of attributing
resources as provided in rule
441-75.5 (249A), the date on
which the waiver consumer meets the institutional level of care requirement as
determined by the IME medical services unit or an appeal decision 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 a prior
institutionalization shall be applied to the waiver application.
Notes
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