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



Download 1.76 Mb.
Page15/23
Date conversion03.05.2018
Size1.76 Mb.
1   ...   11   12   13   14   15   16   17   18   ...   23

For each service listed in Appendix C-1, provide the information specified below. State laws, regulations and policies referenced in the specification are readily available through the Medicaid agency or the operating agency (if applicable).


Service Specification

Service Title:

Senior Companion

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):

Senior companion services are non medical care supervision, oversight, and respite. Companions may assist with such tasks as meal preparation, laundry, shopping and light housekeeping tasks. This Services cannot provide hands on nursing or medical care


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

A unit of service is one hour and has an upper limit per hour that is subject to change each year. The individuals service plan will 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:




Senior companion programs designated by the Corporation for National and Community Services











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)

Senior companion program







Designated by the Corporation for National and Community Services























Verification of Provider Qualifications


Provider Type:

Entity Responsible for Verification:

Frequency of Verification

Senior companion program

Iowa Department of Human Services Iowa Medicaid Enterprise

Verified based on the length of certification



















Service Delivery Method

Service Delivery Method (check each that applies):




Participant-directed as specified in Appendix E

x

Provider managed


Service Title:


Case Management

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



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

O

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

XX

Service is not included in the current elderly waiver and requesting to add as a waiver service.

Service Definition (Scope):

Case Management services are activities that assist consumers in gaining access to needed medical, social, and other appropriate service. Case Management is provided at the direction of the consumer and the interdisplinary team. Case Management include:

  • A comprehensive assessment of the consumer’s needs which must be made within 30 days of the referral.

  • Development and implementation of a services plan to meet those needs,

  • Coordination, authorizing and monitoring of all service delivery,

  • Monitoring the consumer’s health and welfare,

  • Evaluating outcomes,

  • Periodic reassessment and revision of the service plan as needed but at least annually
  • On going advocacy on behalf of the consumer.


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

Payment for case management may not be made until the consumer is enrolled in the waiver. Payment can also only be made if case management activity is performed on behalf of the consumer during the month. Case Managers are required to have at least quarterly face-to-face contacts. There is an upper pay limit per month.

Provider Specifications

Provider Category(s)

(check one or both):




Individual. List types:

X

Agency. List the types of agencies:




Area Agency on Aging




A case management provider agency







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)

A case management provider agency




An agency that meets Iowa Administrative code 441.24 for case management Services and/ or an agency that is certified through either CARF, CCO, the Council or JCAHO for case management.




Area agency on aging and/or a provider agency of case management




An agency that meets Iowa Administrative code 321.21 for case management services and is approved to provide case management by the Department of Elder Affairs
















Verification of Provider Qualifications

Provider Type:


Entity Responsible for Verification:

Frequency of Verification

Area Agency on Aging and/or case manager provider agency

Department of Elder Affairs. If an agency subcontracts case management services to another entity, that entity must also meet the provider qualifications and the contractor is responsible for verification. The Entity that provides case management cannot provide direct services to the consumer. Contracts must contain provisions that require case management entities to have written conflict of interest policies that include but are not limited to:

  • Specific procedures to identify where conflicts could exist.

  • Upon identification of situations that might indicate conflict of interest could exist or potentially could exist, procedures to eliminate or minimize the conflicts;

  • When a conflict of interest arises or a complaint of conflict of interest is received, that steps that must be taken to resolve the issue.

  • Written documentation follow-up letters that show that the outcome was satisfactory to all parties involved.




Based on the length of verification

A case management provider agency


Department of Human Services. If an agency subcontracts case management services to another entity, that entity must also meet the provider qualifications and the contractor is responsible for verification. The Entity that provides case management cannot provide direct services to the consumer. Contracts must contain provisions that require case management entities to have written conflict of interest policies that include but are not limited to:

  • Specific procedures to identify where conflicts could exist.

  • Upon identification of situations that might indicate conflict of interest could exist or potentially could exist, procedures to eliminate or minimize the conflicts;

  • When a conflict of interest arises or a complaint of conflict of interest is received, that steps that must be taken to resolve the issue.

  • Written documentation follow-up letters that show that the outcome was satisfactory to all parties involved.




Based on the length of verification










Service Delivery Method

Service Delivery Method (check each that applies):




Participant-directed as specified in Appendix E

X


Provider managed



1   ...   11   12   13   14   15   16   17   18   ...   23


The database is protected by copyright ©hestories.info 2017
send message

    Main page