Application for a §1915 (c) hcbs waiver Submitted by



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Service Specification

Service Title:

Home Health Aid

Complete this part for a renewal application or a new waiver that replaces an existing waiver. Select one:

X

Service is included in current waiver. There is no change in service specifications.



Service is included in current waiver. The service specifications have been modified.



Service is not included in the current waiver.

Service Definition (Scope):

Home health services are personal or direct care services provided

to the consumer which are not payable under Medicaid as set forth in rule 441—78.9(249A).


a. Components of the service include:

(1) Observation and reporting of physical or emotional needs.

(2) Helping a client with bath, shampoo, or oral hygiene.

(3) Helping a client with toileting.

(4) Helping a client in and out of bed and with ambulation.

(5) Helping a client reestablish activities of daily living.

(6) Assisting with oral medications ordered by the physician which are ordinarily self-administered.

(7) Performing incidental household services which are essential to the client’s health care at home

and are necessary to prevent or postpone institutionalization in order to complete a full unit of service.

(8) Accompaniment to medical services or transport to and from school..


b. Skilled nursing care is not covered.

IAC 10/2/05



Home health services are provided under the Medicaid State Plan services until the limitations have been reached


Specify applicable (if any) limits on the amount, frequency, or duration of this service:

A unit of service is a visit. The Upper limit is the maximum Medicare rate in effect 6/30/05 plus 3%. This is subject to change each year. The individuals’ plan of care will address how the consumer health care needs are being met. Services must be authorized in the service plan. The Case Manager will monitor the plan.


Provider Specifications

Provider Category(s)

(check one or both):



Individual. List types:

X

Agency. List the types of agencies:




Home health aide providers certified top participate in the Medicare Program as Home Health Agencies











Specify whether the service may be provided by (check each that applies):



Legally Responsible Person



Relative/Legal Guardian

Provider Qualifications (provide the following information for each type of provider):

Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Home Health Agencies




As Certified by Medicare


























Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification

Home Health Agencies

Iowa Department of Human Services Iowa Medicaid Enterprise

Verified based on the length of the Certification or license or other standards.



















Service Delivery Method

Service Delivery Method (check each that applies):



Participant-directed as specified in Appendix E

X

Provider managed




Service Specification

Service Title:

Homemaker

Complete this part for a renewal application or a new waiver that replaces an existing waiver. Select one:

X

Service is included in current waiver. There is no change in service specifications.



Service is included in current waiver. The service specifications have been modified.



Service is not included in the current waiver.

Service Definition (Scope):

Homemaker services are services that are provided when the client lives alone or when the person who usually performs these functions for the client needs assistance with performing the functions. Components of the service are directly related to the care of the clients and may include: essential shopping, limited house cleaning and meal preparation.

Specify applicable (if any) limits on the amount, frequency, or duration of this service:

A unit of service is one hour. The upper limit for reimbursement per hour. The upper limit is subject to change each year. The individuals’ plan of care will address how the consumer health care needs are being met. Services must be authorized in the service plan. The Case Manager will monitor the plan.




Provider Specifications

Provider Category(s)

(check one or both):



Individual. List types:

X

Agency. List the types of agencies:




Agencies that meet homecare standards













Specify whether the service may be provided by (check each that applies):



Legally Responsible Person



Relative/Legal Guardian

Provider Qualifications (provide the following information for each type of provider):


Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Agency







Meet the homecare standards set forth in Iowa Administrative rules with the Department of Public Health 641-80.5

























Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification

Agency

Iowa Department of Human Services Iowa Medicaid Department


Verified based on the length of the Certification or license or other standards.



















Service Delivery Method

Service Delivery Method (check each that applies):



Participant-directed as specified in Appendix E

X

Provider managed

Service Specification

Service Title:

Assistive devices

Complete this part for a renewal application or a new waiver that replaces an existing waiver. Select one:

X

Service is included in current waiver. There is no change in service specifications.



Service is included in current waiver. The service specifications have been modified.



Service is not included in the current waiver.

Service Definition (Scope):

Assistive devices are practical equipment products to assist persons with activities of daily living and instrumental activities of daily living to allow the person more independence. They include, but are not limited to: long-reach brush, extra long shoehorn, nonslip grippers to pick up and reach items, dressing aids, shampoo rinse tray and inflatable shampoo tray double-handled cup and sipper lid


Specify applicable (if any) limits on the amount, frequency, or duration of this service:

A unit of service is one item and is subject to an upper limit amount that may change each year. The individuals’ plan of care will address how the consumer health care needs are being met. The services must be authorized in the service plan The Case Manager will monitor the plan.



Provider Specifications

Provider Category(s)

(check one or both):



Individual. List types:

X

Agency. List the types of agencies:



Medicaid eligible medical dealers





Area agency on aging







Specify whether the service may be provided by (check each that applies):



Legally Responsible Person



Relative/Legal Guardian

Provider Qualifications (provide the following information for each type of provider):

Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Medicaid eligible medical dealers







Enrolled as a Medicaid eligible dealer

Area agencies on aging`






As designated in Iowa Administrative Code 321-4.4














Verification of Provider Qualifications



Provider Type:

Entity Responsible for Verification:

Frequency of Verification

Medicaid Eligible medical dealers

Iowa Department of Human Services Iowa Medicaid Enterprise

Verified based on the length of the Certification or license or other standards.

Area agencies on aging

Iowa Department of Human Services Iowa Medicaid Enterprise

Same as above










Service Delivery Method

Service Delivery Method (check each that applies):




Participant-directed as specified in Appendix E

X

Provider managed



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