Home- and Comunity-Based Services (HCBS)

1 Home- and Community- based Services ( hcbs ). Provider Manual Provider Page Iowa Home- and Community- based 1. Department of Human Services ( hcbs ) Date Services August 1, 2014. TABLE OF CONTENTS. Chapter I. General Program Policies Chapter II. Member Eligibility Chapter III. Provider-Specific Policies Chapter IV. Billing Iowa Medicaid Appendix III. Provider-Specific Policies Provider and Chapter Page Iowa Home- and Community- based 1. Department of Human Services ( hcbs ) Date Services Chapter III. Provider-Specific Policies July 1, 2017. TABLE OF CONTENTS. Page CHAPTER III. PROVIDER-SPECIFIC POLICIES .. 1. A. HOME- AND COMMUNITY- based SERVICE WAIVERS .. 1. 1. Legal Basis .. 1. 2. Definitions .. 2. 3. Service Eligibility ..16a 4. Slot Assignment .. 17. 5.

2 Summary of Waiver Services .. 18. 6. Waiver Prior 19. 7. Person-Centered Service Planning .. 19. 8. hcbs Waiver Comprehensive Service 21. 9. Adverse Service Actions .. 23. a. Denial of Application .. 24. b. Reduction of Service .. 25. c. Termination of Service .. 25. B. WAIVER SERVICE DESCRIPTIONS .. 27. 1. Adult Day Care .. 27. 2. Assisted Living .. 27. 3. Assistive Devices .. 28. 4. Behavioral Programming ..28a 5. Brain Injury Waiver Case 29. 6. Elderly Waiver Case 31. 7. Chore 32. 8. Consumer-Directed Attendant Care (CDAC) .. 33. a. Covered Services .. 34. b. Relationship to Other Services .. 37. c. Excluded Services and Costs .. 37. 9. Consumer Choices Option Services .. 38. 10. Counseling .. 40. 11. Day Habilitation .. 41. 12. Environmental Modification and Adaptive Devices.

3 43. 13. Family and Community Support 44. 14. Family Counseling and 46. 15. Financial Management Service (FMS) .. 47. 16. Home and Vehicle 49. 17. Home- Delivered Meals .. 52. 18. Home Health Aide .. 52. 19. Homemaker Service .. 54. Provider and Chapter Page Iowa Home- and Community- based 2. Department of Human Services ( hcbs ) Date Services Chapter III. Provider-Specific Policies July 1, 2017. Page 20. Independent Support Broker .. 55. 21. Individual-Directed Goods and Services .. 57. 22. In-Home Family Therapy Services .. 59. 23. Interim Medical Monitoring and 60. 24. Mental Health Outreach .. 61. 25. Nursing Care .. 61. 26. Nutritional Counseling .. 62. 27. Personal Emergency Response System or Portable Locator System .. 63. 28. Prevocational Services .

4 64. a. Career Exploration .. 64b b. Expected Outcome of Service .. 64c c. Setting .. 64c d. Concurrent Services .. 64c e. Exclusions .. 64c f. 64d g. Unit of Service .. 65. 29. Residential- based Supported Community Living Services .. 65. 30. Respite Care .. 67. 31. Self-Directed Community Supports and Employment .. 69. 32. Self-Directed Personal Care .. 71. 33. Senior Companion Services .. 73. 34. Specialized Medical 73. 35. Supported Community Living Services .. 74. a. Service Components .. 77. b. Living Arrangements .. 79. 36. Supported Employment Services .. 80. a. Supported Employment Individual Supported 81. b. Supported Self-Employment .. 83. c. Small-Group Employment (2 to 8 Individuals).. 86. d. Service Requirements for All Supported Employment 88.

5 E. Resource Sharing Between Iowa Medicaid and Iowa Vocational Rehabilitation Services .. 90b f. Employment Resources for Case Managers, Care Managers, Service Coordinators, and Integrated Health Home Coordinators .. 90b 37. a. hcbs Transportation and Supported Community Living (SCL). Services .. 90d b. Non-Emergency Medical Transportation (NEMT) and Waiver Transportation Services .. 90d Provider and Chapter Page Iowa Home- and Community- based 3. Department of Human Services ( hcbs ) Date Services Chapter III. Provider-Specific Policies July 1, 2017. Page C. PROVIDER ENROLLMENT WITH IOWA MEDICAID ..90e 1. Certification and Enrollment of New Providers .. 90e 2. Adding a New Service for Existing Provider .. 91. 3. Changes .. 92. 4. Change in Ownership, Agency Name, or Satellite Offices.

6 92. 5. Recertification .. 92. 6. Deemed Status Providers .. 93. 7. Certified Providers .. 93. D. STANDARDS FOR PROVIDERS OF SERVICE .. 94. 1. Home- and Community- based Services ( hcbs ) Provider Quality Management Self-Assessment .. 95. 2. Adult Day Care Providers .. 99. 3. Assisted Living Providers .. 100. 4. Behavioral Programming Providers .. 100. 5. Case Management Service 101. 6. Chore Service Providers .. 102. 7. Consumer Choices Option 103. a. Financial Management Service .. 103. b. Independent Support Brokerage .. 104. c. Self-Directed Personal Care .. 105. d. Individual-Directed Goods and Services .. 106. e. Self-Directed Community Supports and Employment .. 107. 8. Consumer-Directed Attendant Care 108. 9. Counseling Providers .. 111. 10.

7 Family Counseling and Training Providers .. 111. 11. Home and Vehicle Modification Providers .. 112. 12. Home- Delivered Meals Providers .. 113. 13. Home Health Aide Providers .. 113. 14. Homemaker Providers .. 114. 15. Interim Medical Monitoring and Treatment (IMMT) Providers .. 114. 16. Nursing Care Providers .. 115. 17. Nutritional Counseling 115. 18. Personal Emergency Response Services and Portable Locator Providers .. 116. 19. Prevocational Service 116. 20. Residential- based Supported Community Living Service Providers .. 116a 21. Respite Care 120. 22. Senior Companions Providers .. 122. 23. Specialized Medical Equipment Providers .. 122. 24. Supported Community Living Providers .. 122. 25. Supported Employment 124. Provider and Chapter Page Iowa Home- and Community- based 4.

8 Department of Human Services ( hcbs ) Date Services Chapter III. Provider-Specific Policies July 1, 2017. Page 26. Transportation Providers .. 126. a. Maintenance of Records .. 126. b. Provider Requirements for Service 127. c. Service Documentation .. 127. d. Outcome of 128. e. Basis of Service .. 128. E. AUDITS OR REVIEW OF PROVIDER RECORDS .. 129. F. AUTHORIZATION FOR PROVISION OF Services .. 132. G. QUALITY MANAGEMENT ACTIVITIES .. 134. H. INCIDENT REPORTING .. 135. 1. Reporting Procedure for Minor Incidents .. 136. 2. Reporting Procedure for Major Incidents .. 136. I. FINANCIAL PARTICIPATION .. 137. 1. Client Participation and Financial Participation .. 137. 2. Limit on 139. 3. Third-Party Payments .. 139. J. BASIS OF 140. 1. Types of Reimbursement.

9 140. a. Fee Schedules .. 140. b. Fee for Service with Cost Settlement .. 141. c. Retrospectively Limited Prospective Rate (See (15)) .. 141. 2. Maintenance and Retention of Financial and Statistical Record .. 142. 3. Submission of the Financial and Statistical Reports .. 143. 4. Forms 470-0664 and 470-3449 .. 145. a. Instructions for hcbs Supplemental Schedule D-4, Form 470-3449 . 145. b. Instructions for Site Daily Rate 146. c. Instructions for Individual Daily Rate Worksheet .. 147. d. Instructions for Financial and Statistical Report for Purchase of Service Contracts, Form 470-0664 .. 149. e. Instructions for Certification Page .. 150. f. Instructions for Schedule A .. 151. g. Instructions for Schedule B .. 153. h. Instructions for Schedule C.

10 154. i. Instructions for Schedule D .. 156. j. Instructions for Supplemental Schedule D-1 .. 163. k. Instructions for Supplemental Schedule D-2 .. 164. Provider and Chapter Page Iowa Home- and Community- based 5. Department of Human Services ( hcbs ) Date Services Chapter III. Provider-Specific Policies July 1, 2017. Page l. Instructions for Supple mental Schedule D-3 .. 165. m. Instructions for Schedule E .. 166. n. Instructions for Schedule 166. 5. Rates based Upon the Submitted Report .. 167. K. PROCEDURE CODES AND NOMENCLATURE .. 168. L. BILLING POLICIES AND CLAIM FORM INSTRUCTIONS .. 174. M. RESOURCE SHARING BETWEEN IOWA MEDICAID AND IOWA VOCATIONAL. REHABILITATION Services (IVRS) .. 174. 1. Resource Sharing for Employment Services .. 174. 2. Resource Sharing Between DHS and IVRS for Supported Employment Services .