ࡱ> q sbjbjt+t+ 5AAo%]|||||||8NNN1s$bV|NNNNN:||4:::N"||||||N::V 2||D`o@pj. HOME AND COMMUNITY BASED SERVICES ILL & HANDICAPPED WAIVER INFORMATION PACKET The Medicaid Home and Community Based Services Ill & Handicapped Waiver (HCBS IH) provides service funding and individualized supports to maintain eligible consumers in their own homes or communities who would otherwise require care in a medical institution. Provision of these services must be cost effective. GENERAL PARAMETERS Ill & Handicapped Waiver services are individualized to meet the needs of each consumer. The following services are available: Adult Day Care Consumer Directed Attendant Care Counseling Services Home and Vehicle Modification Home-Delivered Meals Home Health Aide Homemaker Interim Medical Monitoring and Treatment Nursing Nutritional Counseling Personal Emergency Response Respite The services that are considered necessary and appropriate for the consumer will be determined through an interdisciplinary team consisting of the consumer, DHS service worker, service provider(s), Iowa Child Health Specialty Clinics regional nurse, and other persons the consumer chooses. All consumers will have a service plan developed by a DHS service worker in cooperation with the consumer. This plan must be completed prior to implementation of services. The service plan for consumers aged 20 or under must be developed or reviewed taking into consideration those services that may be provided through the individual education plan (IEP) and EPSDT (Care For Kids) plan(s). Consumers shall access all other services for which they are eligible and which are appropriate to meet their needs as a precondition of eligibility for the Ill and Handicapped Waiver. A service plan must be developed, at least, annually or more often, if necessary. The consumer must choose HCBS services as an alternative to institutional services. In order to receive I &H Waiver services, an approved I&H Waiver service provider must be available to provide those services. Ill and Handicapped Waiver services cannot be provided when a person is an inpatient of a medical institution. Consumers must need and use, at least, one unit of Adult Day Care, Consumer Directed Attendant Care, Counseling, Homemaker, Home Health Aide, Interim Medical Monitoring and Treatment, Nursing or Respite during each quarter of the calendar year. The total costs of Ill & Handicapped Waiver services cannot exceed the following: Nursing Level of Care $852.00 per month Skilled Level of Care $2480.00 per month ICF/MR Level of Care $3019.00 per month A designated the number of consumers (payment slots) can be served under the HCBS IH program. The Ill & Handicapped Waiver has an advisory committee that meets regularly to make recommendations and takes action to ensure the waiver best meets the need of the persons it serves. Following is the hierarchy for accessing waiver services: Private insurance Medicaid and/or EPSDT (Care For Kids) I&H Waiver services In-Home Health Related Care There is a 180-day waiver processing time limit. The I&H Waiver must be accessed within 180 days of the assignment of the payment slot. Assistance may be available through the Rent Subsidy Program in addition to services available through the Ill and Handicapped Waiver. IH Waiver consumers upon reaching the age of 65 will continue to receive waiver services through the Elderly Waiver. CONSUMER ELIGIBILITY CRITERIA Consumers may be eligible for the HCBS Ill & Handicapped waiver services by meeting the following criteria: Be an Iowa resident and a United States citizen or a person of foreign birth with legal entry into the United States Be determined blind or disabled by the Disability Determination Services or in some exceptions receive Social Security disability benefits May be eligible for other Medicaid coverage groups but choose to receive waiver services. SSI Requirements All applicants (age 21 and over and applicants under age 21) must meet the following SSI requirements: Meet all non-financial requirements for SSI Applicant income cannot exceed 300% of SSI Applicant resources for age 18 and over cannot exceed $2000.00 IN ADDITION TO THE ABOVE LISTED REQUIREMENTS: Applicants age 21 and over: Must be ineligible for SSI for either or both of the following circumstances: Excess income Deeming of a spouses income or resources Applicants under age 21 Can be eligible for SSI Can be ineligible for SSI for either or both of the following circumstances: Excess income Deeming of a spouse or parents income or resources Be determined by the Iowa Foundation for Medical Care (IFMC) to need Nursing Facility, Skilled Nursing Facility or Intermediate Care Facility for the Mentally Retarded level of care SERVICE DESCRIPTIONS PLEASE NOTE: I&H Waiver services are individualized to meet the needs of each consumer. However, decisions regarding what services are appropriate, the number of units or the dollar amounts of the appropriate services are based on the consumers needs as determined by the consumer and an interdisciplinary team. ADULT DAY CARE WHAT: Adult day care is an organized program of supportive care in a group environment. The care is provided to consumers who need a degree of supervision and assistance on a regular or intermittent basis in a day care center. WHERE: Adult day program in the community UNITS: A unit is: Half day - 1 to 4 hours or Full day - 4 to 8 hours or Extended day - 8 to 12 hours CONSUMER-DIRECTED ATTENDANT CARE (CDAC) WHAT: Assistance to the consumer with self-care tasks, which the consumer would typically do independently if the consumer were otherwise able. The service may be provided by an individual or agency, depending on the consumers needs. The consumer, parent, or guardian shall be responsible for selecting the individual or agency that will provide the components of the CDAC services to be provided. The CDAC service may include assistance with non-skilled and skilled services. The skilled services must be done under the supervision of a professional registered nurse or licensed therapist working under the direction of a physician. The registered nurse or therapist shall retain accountability for actions that are delegated. Skilled services may include: Tube feedings, intravenous therapy, parenteral injections, catherizations, respiratory care, care of decubiti & other ulcerated areas, rehabilitation services, colostomy care, care of medical conditions out of control, postsurgical nursing care, monitoring medications, preparing and monitoring response to therapeutic diets, and recording and reporting of changes in vital signs. Non-skilled services may include: Dressing, hygiene, grooming, bathing supports, wheelchair transfer, ambulation and mobility, toileting assistance, meal preparation, cooking, eating and feeding, housekeeping, medications ordinarily self-administered, wound care, employment support, cognitive assistance, fostering communication, and transportation. A determination must be made regarding what services will benefit and assist the consumer. Those services will be recorded in The HCBS Consumer Directed Attendant Care Agreement Form 470-3372. This Agreement becomes part of the service plan developed for the consumer. The consumers or the consumers parent(s)or guardian(s) ability to manage all aspects of Consumer Directed Attendant Care is a measure of whether this service is appropriate for the consumer. The consumer or the consumers parents(s) or guardian(s) must be able and willing to manage for the consumer to receive Consumer Directed Attendant Care. WHERE: In the home or community DOES NOT Daycare, baby-sitting, respite, room and board, parenting or case management INCLUDE: CDAC cannot replace a less expensive service. A CDAC provider may not be the spouse of the consumer, parent, stepparent or guardian of a consumer aged 17 or under. An individual CDAC provider cannot be the recipient of respite services provided on behalf of a consumer receiving HCBS IH services. The cost of nurse supervision, if needed UNITS: A unit is: One hour or One 8 to 24 hour day MAXIMUM The social worker, working with the consumer and the interdisciplinary team, establishes an amount of dollars that UNITS: may be used for CDAC. The amount is then entered into the service plan along with information about other HCBS services the consumer may receive. This monetary information is, also, entered into The HCBS Consumer Directed Attendant Care Agreement Form 470-3372 along with the responsibilities of the consumer and the provider and the activities for which the provider will be reimbursed. The consumer and the provider come to agreement on an hourly or daily billing unit and the cost per unit. A completed copy of the Agreement is distributed to the consumer, the provider and the service worker. The Agreement becomes part of the service plan. These steps must be completed prior to service provision. When CDAC is provided by an assisted living facility, please note the following: The service worker or case manager should be aware of and have knowledge of the specific services included in the assisted living facility contract to ensure the following: That assisted living facility services are not duplicative of CDAC services Knowledge of how consumer needs are being addressed Awareness of consumer unmet needs that must be included in the care plan CDAC payment does not include costs of room and board Each consumer must be determined by IFMC to meet ICF/MR, nursing facility or skilled nursing facility level of care The CDAC fee is calculated based on the needs of the consumer and may differ from individual to individual. PROVIDER The provider must be enrolled with the Departments fiscal agent and certified as a CDAC provider prior to the ENROLL.: completion of the HCBS Directed Attendant Care Agreement. It may be important for the consumer to enlist more than one CDAC provider. Back up services may be necessary in case of an emergency. BILLING: The consumer as well as the provider must sign the Claim for Targeted Medical Care before it is submitted for payment. This verifies that the services were provided as shown on the billing form. COUNSELING SERVICES WHAT: Counseling services are face to face mental health services that facilitate home management of the consumer and prevent institutionalization. Counseling services may be provided to the consumers caregiver only when included in the service plan for the consumer. Counseling services are nonpsychiatric services necessary for the management of depression, assistance with the grief process, alleviation of psychosocial isolation and support in coping with disability or illness, including terminal illness. WHERE: The community mental health center or other location used by a provider that meets accreditation under the Mental Health and Disabilities Commission. UNITS: A unit is: A 15 minute increment for individual counseling for the consumer or the consumer and the caregiver or 1 hour for group counseling Payment for group counseling is based on the group rate divided by six or, if the number of persons who comprise the group exceeds six, the actual number of persons which comprises the group. HOME AND VEHICLE MODIFICATION (HVM) WHAT: Physical modifications to the home and/or vehicle to assist with the health, safety and welfare needs of the consumer and to increase or maintain independence. All modification requests are reviewed individually and a determination is made regarding the appropriateness of the modification request. WHERE: In/on the consumers home and/or vehicle. Kitchen counters, sink space, cabinets, special adaptations to refrigerators, stoves, and ovens. Bathtubs and toilets to accommodate transfer, special handles and hoses for showerheads, water faucet controls, and accessible showers and sink areas. Grab bars and handrails. Turnaround space adaptations Ramps, lifts, and door, hall and window widening. Fire safety alarm equipment specific for disability. Voice activated, sound activated, light activated, motion activated and electronic devices directly related to the consumers disability. Vehicle lifts, driver specific adaptations, remote start systems, including such modifications already installed in a vehicle. Keyless entry systems Automatic opening device for home or vehicle door. Special door and window locks Specialized doorknobs and handles. Plexiglas replacement for glass windows. Modification of existing stairs to widen, lower, raise or enclose open stairs. Motion detectors. Low pile carpeting or slip resistant flooring. Telecommunications device for people who are deaf. Exterior hard surface pathway. New door opening. Pocket doors. Installation or relocation of controls, outlets, switches. Air conditioning and air filtering if medically necessary. Heightening of existing garage door opening to accommodate modified van. Bath chairs. DOES NOT Modifications which increase the square footage of the home, items for replacement which are the responsibility of INCLUDE: the homeowner/landlord, vehicle purchase, fences, furnaces or any modifications or adaptations available through regular Medicaid. UNIT: A unit is the cost of the completed modification or adaptation. MAXIMUM: The consumer is eligible for $500 per month not to exceed $6000 per year. If the amount of the modification is allocated monthly, the monthly amount must be included in the monthly dollar cap according to the dollar amount established for the level of care. HOME DELIVERED MEALS WHAT: Home-delivered meals are prepared outside of the consumers home and delivered to the consumer. Each meal must ensure that the consumer receives a minimum of one-third of the daily-recommended dietary allowance as established by the Food and Nutrition Research Council of the National Academy of Sciences. Each meal may, also, be a liquid supplement, which meets the minimum one-third standard. When a restaurant provides home delivered meals, a nutritional consultation must be completed. The nutritional consultation includes contact with the restaurant to explain the dietary needs of the client and explain what constitutes the minimum one-third daily dietary allowance. WHERE: Delivered to the consumers home UNIT: A unit is one meal. MAXIMUM Fourteen (14) meals may be delivered during any week. UNITS: HOME HEALTH AIDE (HHA) WHAT: Unskilled medical services which provide direct personal care This service may include assistance with oral medications, eating, bathing, dressing, personal hygiene, accompaniment to medical services, transport to and from school or medical appointments, and other necessary activities of daily living that are intended to prevent or postpone institutionalization. Home health aide as a waiver service may be accessed after accessing services under the Medicaid State plan. Transportation as a home health aide waiver service may be accessed after all transportation services available under the Medicaid medical transportation program have been utilized. WHERE: In the home except when transporting to or from school or medical appointments DOES NOT Homemaker services such as cooking and cleaning or services that meet intermittent guidelines or those INCLUDE: provided under the EPSDT authority. May not duplicate any regular Medicaid or waiver services provided under the state plan Medicaid intermittent coverage: Regular Medicaid provides for intermittent coverage of skilled nursing and home health aide services provided in the persons home for both children and adults. Services are usually provided two to three hours per day for two to three days per week. Intermittent skilled nursing coverage includes visits up to five days per week and daily or multiple daily visits for wound care or insulin injections. Intermittent home health aide coverage includes visits twice per day up to seven days per week for persons attending school or working or when ordered by the physician and included in the plan of care, not to exceed 28 hours per week. EPSDT (Care For Kids) program: EPSDT services for persons under age 21 only include private duty nursing and personal care services that meet the definition of medical necessity as provided by HCFA for EPSDT. Services may be provided to a child outside of the childs residence when normal life activities take the child outside the residence. Services not covered by EPSDT include: Services to children with Medicaid HMO coverage Mental health services to children enrolled in the Iowa Plan Well child care Respite Transportation Homework assistance Services to other household members UNIT: A unit is a visit. HOMEMAKER SERVICES WHAT: Homemaker services are those services provided when the consumer lives alone or when the person who usually performs these functions for the consumer needs assistance. Homemaker service is limited to the following components: essential shopping; limited house cleaning and meal preparation. WHERE: In the home and community DOES NOT Services shall not be simultaneously reimbursed with waiver services. INCLUDE: UNIT: A unit is one hour. This service must be billed in whole units. INTERIM MEDICAL MONITORING AND TREATMENT (IMMT) WHAT: Monitoring and treatment of a medical nature requiring specially trained caregivers beyond what is normally available in a day care setting for persons age 20 and under. Interim medical monitoring and treatment services shall provide experiences for each consumers social, emotional, intellectual, and physical development. The service will include comprehensive development care and any special services for a consumer with special needs; and will include medical assessment, medical monitoring, and medical intervention as needed on a regular or emergency basis. The service allows the consumer's usual caregivers to be employed. Interim medical monitoring and treatment may also be used after the death of a usual caregiver. Interim medical monitoring and treatment services may include supervision for the child during transportation to and from school when not available through school or other sources. Interim medical monitoring and treatment services may also be provided for a limited period of time when the usual caregiver is involved in the following circumstances: Attendance at academic or vocational training Employment search Hospitalization Treatment for physical or mental illness WHERE: In the home, a registered group child care home, a registered family child care home, a licensed child care center, or during transportation to and from school. Providers of this service must be at least 18 years of age, not be the spouse of the consumer or parent or stepparent of a consumer age 17 or under, not be the usual caregiver, be qualified by training or experience as determined by the usual caregiver, and a licensed medical professional on the consumers interdisciplinary team to provide medical intervention or intervention in a medical emergency DOES NOT May not duplicate any regular Medicaid or waiver services provided under the state plan INCLUDE: Medicaid intermittent coverage: Regular Medicaid provides for intermittent coverage of skilled nursing and home health aide services provided in the persons home for both children and adults. Services are usually provided two to three hours per day for two to three days per week. Intermittent skilled nursing coverage includes visits up to five days per week and daily or multiple daily visits for wound care or insulin injections. Intermittent home health aide coverage includes visits twice per day up to seven days per week for persons attending school or working or when ordered by the physician and included in the plan of care, not to exceed 28 hours per week. EPSDT (Care For Kids) program: EPSDT services for persons under age 21 only include private duty nursing and personal care services which meet the definition of medical necessity as provided by HCFA for EPSDT. Services may be provided to a child outside of the childs residence when normal life activities take the child outside the residence. Services not covered by EPSDT include: Services to children with Medicaid HMO coverage Mental health services to children enrolled in the Iowa Plan Well child care Respite Transportation Homework assistance Services to other household members UNIT: A unit is one hour. MAXIMUM: Twelve (12) one-hour units of service per day NURSING SERVICES WHAT: Nursing care services are provided by a licensed nurse. The services are ordered by and included in the plan of treatment established by the physician. The services shall be based on the medical necessity of the consumer and the Iowa Board of Nursing scope of practice guidelines. WHERE: In the home DOES NOT Nursing services provided outside of the home or services which meet the intermittent guidelines or those provided INCLUDE: under the EPSDT authority Medicaid intermittent coverage: Regular Medicaid provides for intermittent coverage of skilled nursing and home health aide services provided in the persons home for both children and adults. Services are usually provided two to three hours per day for two to three days per week. Intermittent skilled nursing coverage includes visits up to five days per week and daily or multiple daily visits for wound care or insulin injections. Intermittent home health aide coverage includes visits twice per day up to seven days per week for persons attending school or working or when ordered by the physician and included in the plan of care, not to exceed 28 hours per week. EPSDT (Care For Kids) program: EPSDT services for persons under age 21 only include private duty nursing and personal care services which meet the definition of medical necessity as provided by HCFA for EPSDT. Services may be provided to a child outside of the childs residence when normal life activities take the child outside the residence. Services not covered by EPSDT include: Services to children with Medicaid HMO coverage Mental health services to children enrolled in the Iowa Plan Well child care Respite Transportation Homework assistance Services to other household members This nursing service shall not be simultaneously reimbursed with other Medicaid services. UNIT: A unit is a visit. NUTRITIONAL COUNSELING WHAT: Nutritional counseling for a severe nutritional problem or condition, which is beyond standard medical management WHERE: In the home UNIT: A unit is a 15-minute increment. PERSONAL EMERGENCY RESPONSE SYSTEM WHAT: An electronic device connected to a 24-hour staffed system which allows the consumer to access assistance in the event of an emergency WHERE: The emergency response system is connected to the consumers home phone or a portable emergency button carried by the consumer. UNITS: A unit is: One time installation fee and/or One month of service MAXIMUM 12 months of service per State fiscal year (July 1-June 30) UNITS: RESPITE WHAT: Respite care services are services provided to the consumer that gives temporary relief to the usual caregiver and provides all the necessary care that the usual caregiver would provide during that time period. The purpose of respite care is to enable the consumer to remain in the consumers current living situation. Specialized respite means respite provided on a staff to consumer ratio of one to one or higher for individuals with specialized medical needs requiring monitoring or supervision provided by a licensed registered nurse or licensed practical nurse. Group respite means respite provided on a staff to consumer ratio of less than one to one. Basic individual respite means respite provided on a staff to consumer ratio of one to one or higher for individuals without specialized medical needs that would require care by a licensed registered nurse or licensed practical nurse. WHERE: Respite may be provided in the consumer's home, another family's home, camps, organized community programs (YMCA, recreation centers, senior citizens centers, etc.), ICF/MR, RCF/MR, hospital, nursing facility, skilled nursing facility, adult day care center, foster group care, foster family home or DHS licensed daycare. Respite provided outside the consumers home or outside a facility in locations covered by the a facilitys licensure, certification, accreditation, or contract must be approved by the parent, guardian, or primary caregiver and interdisciplinary team, and must be consistent with the way the location is used by the general public. Respite in these locations may not exceed seventy-two (72) continuous hours. DOES NOT Services shall not be reimbursable if the living unit is otherwise reserved for persons on a temporary leave INCLUDE of absence. Respite cannot to be provided to consumers residing in the family, guardian or usual caregivers home during the hours in which the usual caregiver is employed unless it is in a camp setting. Respite shall not be simultaneously reimbursed or provided with duplicative services under the waiver. UNITS: A unit is one hour. Services are limited by the monthly maximum available for all waiver services. MAXIMUM Fourteen consecutive days of 24-hour respite care may be reimbursed UNITS: and Respite services provided to three or more individuals for a period exceeding 24 consecutive hours for individuals who require nursing care because of a mental or physical condition must be provided by a licensed health care facility as described in the Iowa Code chapter 135C. APPLICATION PROCESS The application process for the IH Waiver requires a coordinated effort between the local Department of Human Services and non-Department agencies on behalf of the prospective consumer. If you are currently working with your local Department of Human Services personnel, please contact that person regarding the application process. Please respond immediately to correspondence from an income maintenance worker or a service worker. This will decrease the amount of time needed to complete the application process and assist in communication. Application for Medicaid (Title XIX) and the Ill & Handicapped Waiver is made with an income maintenance worker (IM) at the local DHS office. For adults applying for the Ill & Handicapped Waiver, an appointment will be scheduled with the IM worker. For children applying for this waiver, telephone contact will be made to the family home. Documentation necessary to complete this contact may include: Financial records Title XIX card Letter of Medicaid eligibility Verification of Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI) or State Supplemental Assistance (SSA) eligibility or ineligibility. If assistance is not currently being received, the consumer should contact the local Social Security office for verification of ineligibility. A disability determination denial can be appealed. The DHS service worker will complete an assessment tool, Home and Community Based Services Assessment or Reassessment Form 470-0659 for consumers age 22 and older. Child Health Specialty Clinics staff will complete this assessment for consumers up to age 22. 3. The Iowa Foundation for Medical Care will review the, Home and Community Based Services Assessment or Reassessment Form 470-0659 to determine if consumer needs require a nursing facility, skilled nursing facility or intermediate care facility mentally retarded level of care. If the consumer does not meet the level of care, the IM worker will send a Notice of Decision (NOD) notifying the consumer of the denial. The consumer has the right to appeal the decision. The process for appealing is explained on the NOD. An interdisciplinary team meeting is conducted to determine the services that are needed, the amount of service to be provided and the provider(s) of the services. The interdisciplinary team meeting will be attended by the consumer/family, DHS service worker, I&H Waiver service provider(s), and may, also, include legal representatives, a regional nurse from the Iowa Child Health Specialty Clinics, school personnel, therapists or other professional or support persons. The result of the interdisciplinary team decisions will be a service plan developed by the service worker. The service worker will issue a Notice of Decision if the consumer is approved to receive Ill & Handicapped Waiver services. PAGE 1 11-18-02 rev. 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