Iowa Admin. Code r. 441-83.67

Current through Register Vol. 47, No. 6, September 18, 2024

Rule 441-83.67 - Service plan

A service plan shall be prepared for each HCBS intellectual disability waiver consumer.

(1)Development. The service plan shall be developed by the interdisciplinary team, which includes the consumer, and, if appropriate, the legal representative, consumer's family, case manager or service worker, service providers, and others directly involved.

(2)Retention. The service plan shall be stored by the case manager for a minimum of three years.

(3)Interdisciplinary team meeting. The interdisciplinary team meeting shall be conducted before the current service plan expires.

(4)Information in plan. The plan shall be in accordance with 441-subrule 24.4(3) and shall additionally include the following information to assist in evaluating the program:

a. A listing of all services received by a consumer at the time of waiver program enrollment.

b. For supported community living:

(1) The consumer's living environment at the time of waiver enrollment.

(2) The number of hours per day of on-site staff supervision needed by the consumer.

(3) The number of other waiver consumers who will live with the consumer in the living unit.

c. An identification and justification of any restriction of the consumer's rights including, but not limited to:

(1) Maintenance of personal funds.

(2) Self-administration of medications.

d. The name of the service provider responsible for providing each service.

e. The service funding source.

f. The amount of the service to be received by the consumer.

g. Whether the consumer has elected the consumer choices option and, if so:

(1) The independent support broker selected by the consumer; and

(2) The financial management service selected by the consumer.

h. A plan for emergencies and identification of the supports available to the consumer in an emergency.

i. For members receiving daily supported community living, day habilitation or adult day care: the following standard scores from the most recently completed SIS assessment:

(1) Score on subsection 1A: Exceptional Medical Support Needs.

(2) Score on subsection IB: Exceptional Behavioral Support Needs.

(3) Sum total of standard scores on the following subsections:

1. Subsection 2A: Home Living Activities;

2. Subsection 2B: Community Living Activities;

3. Subsection 2E: Health and Safety Activities; and

4. Subsection 2F: Social Activities.

(5)Documentation. The Medicaid case manager shall ensure that the consumer's case file contains the consumer's service plan and documentation supporting the diagnosis of mental retardation.

(6)Approval of plan. The plan shall be approved through the Individualized Services Information System (ISIS). Services shall be entered into ISIS based on the service plan.

a. Services must be authorized and entered into ISIS before the plan implementation date.

b. The department has 15 working days after receipt of the summary and service costs in which to approve the services and service cost or request modification of the service plan unless the parties mutually agree to extend that time frame.

c. If the department and the service worker or case manager are unable to agree on the terms of the services or service cost within 10 days, the department has final authority regarding the services and service cost.

Iowa Admin. Code r. 441-83.67

ARC 9650B, lAB 8/10/11, effective 10/1/11; ARC 0191C, lAB 7/11/12, effective 7/1/12; ARC 0359C, lAB 10/3/12, effective 12/1/12

Amended by IAB December 6, 2017/Volume XL, Number 12, effective 12/1/2017

Amended by IAB May 9, 2018/Volume XL, Number 23, effective 6/13/2018