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



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Service Specification

Service Title:

Financial Management Service

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.




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

x

Service is not included in the current waiver.

Service Definition (Scope):

The Financial Management Service (FMS) will be required for all consumers choosing the self-direction option, and will be available only to those who self direct. The FMS will enroll as a Medicaid Provider The FMS will receive Medicaid funds in an electronic transfer and will pay all service providers and employees electing the self-direction option. The FMS services are provided to ensure that the individualized budgets are managed and distributed according to the budget developed by each consumer and to facilitate the employment of service workers by consumers. The Iowa Department of Human Services will designate the Financial Management Service entities as Organized health care delivery system. For those consumers who self-direct, the FMS will


  • Establish and manage consumers and directly hired workers documents and files

  • Manage and monitor timesheets and invoices to assure that they match the written budget

  • Provide monthly and quarterly status reports for the Department and for the consumer that include a summary of expenditures paid and amounts of budgets unused

  • Assist consumers in understanding their fiscal/payroll related responsibilities

  • Assist consumers in completing required federal, state and local tax and insurance forms

  • Assist consumers in conducting criminal background checks on potential employees, if requested

  • Assist consumers in verifying service workers citizenship or alien status

  • Prepares and disburses payroll if program consumers hires workers. Key employer-related tasks include:

    • Verifying that service workers' hourly wages are in compliance with federal and state Department of Labor rules;

    • Collecting and processing services workers' timesheets;

    • Withholding, filing and paying federal, state and local income, Medicare and Social Security (FICA), federal (FUTA) and state (SUTA) unemployment and disability insurance (as applicable) taxes'

    • Computing and processing other benefits, as applicable;

    • Preparing and issuing service workers' payroll checks;

    • Refunding over collected FICA, when appropriate (Fiscal/Employer Agent)

    • Refunding over collected FUTA, when appropriate (Fiscal/Employer Agent)

    • Processing all judgments, garnishments, tax levies, or any related holds on workers' pay as may be required by federal, state or local laws, and

    • Prepare and disburse IRS Forms W-2 and W-3 annually.
  • Process and pay invoices for approved goods and services included in program consumers' budgets;


  • Assists in implementing the state's quality management strategy related to FMS

  • Establish an accessible customer service system and communication path for the consumer and the Individual Support Broker

  • Provide monthly statements of Individual Budget account balances to both the Individual Support Broker and the Consumer

  • Provide real time Individual Budget account balances, at a minimum during normal business hours (9-5, Monday –Friday)

  • Ability to interface with the tracking system chosen by the Iowa Department of Human Services

 



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

This FMS will have an upper limit of $65 a month


Provider Specifications

Provider Category(s)

(check one or both):



Individual. List types:

X

Agency. List the types of agencies:




Credit Unions


Banking Institutions








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)

Credit Unions







A Financial institution that is cooperative, non-for profit, member owned and controlled, federally insured and charted by either the National Credit Union Administration (NCUA) or the Credit Union Division of the Iowa Department of Commerce. In addition the FMS must successfully pass a readiness review of certification approved by the Iowa Department of Human Services

Banking Institutions





A financial institution charted by the Office of the Comptroller of the Currency, a Bureau of the United States Department of the Treasury, is a member of the Federal Reserve; and/or is federally insured by the Federal Deposit Corporation (FDIC). The entity providing the direct FMS services must have an IRS FEIN dedicated to the Financial Management Service. In addition the FMS must successfully pass a readiness review of certification approved by the Iowa Department of Human Services














Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification

Credit Union

Iowa Department of Human Services, Iowa Medicaid Enterprise

Annually

Bank

Iowa Department of Human Services, Iowa Medicaid Enterprise

Annually








Service Delivery Method


Service Delivery Method (check each that applies):




Participant-directed as specified in Appendix E

X

Provider managed




Service Specification

Service Title:

Independent Support Brokerage Service

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.




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

X

Service is not included in the current waiver.

Service Definition (Scope):

Independent Support Brokerage service is required for all consumers who chose the self-direction option. This will be a service that is included in the Individual Budget. The Independent Support Brokerage will be individuals chosen and hired by the consumers that will work with the consumers to guide them through the person centered planning process and offer technical assistance and expertise for selecting and hiring employees and/or providers and purchasing supports. The Independent Support Broker, as needed, will:


  • Assists consumers develop their individual budgets

  • Assist participants interview potential service providers and work through human resource management issues (recruiting, interviewing, hiring evaluation and firing).

  • Assist participants with understanding the terms of the contracts with providers, services and payments mechanisms/methods

  • Assist participants with solving problems with providers

  • Assures that the participant has an emergency back up plan in place

  • As delegated by the participant, assists with negotiating with providers

  • Provides monitoring to assure consumers are satisfied with providers

  • Assists the consumer in addressing health and safety concerns, as appropriate, assist’s consumer with a risk and safety self-assessment.

  • Reviews monthly reports from the financial management services and provides advice and guidance on expenditures



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

This service is required for consumers who choose the self-direction option at a maximum of 26 hours a year. The independent support broker will be reimbursed for up to six hours of services for helping the consumer develop the first initial budget. When a consumer first initiates the self-direction option, the Independent Support Broker will be required to meet with the consumer at least monthly for the first three months and quarterly after that. If a consumer needs additional support brokerage service, the consumer will need prior authorization from the state. There is an upper limit per hour for this service that is subject to change each year. The independent support broker needs to be identified on the service plan


Provider Specifications

Provider Category(s)

(check one or both):

X

Individual. List types:



Agency. List the types of agencies:



















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



Legally Responsible Person

X

Relative/Legal Guardian

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

Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Individual







All Independent Support Brokers must be at least 18 years of age. To avoid conflict of interest, the Independent Support Broker cannot be a current service provider for the participant. They will be required to successfully complete Independent Support Broker Certification. In addition they will be required to complete a criminal background check. The information obtained from the criminal background checks will be shared with the consumer to assist the participant with making informed decisions whether to hire a potential Independent Support.

























Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification

Individual

Iowa Department of Human Services Iowa Medicaid Enterprise

Once initially trained, the Individual Support Broker is placed on a Independent Support Brokerage registry that is maintained at the Iowa Department of Human Services Iowa Medicaid Enterprise. The independent Support Broker will be responsible for attending one support broker training a year held at the HCBS regional meetings




















Service Delivery Method

Service Delivery Method (check each that applies):

X

Participant-directed as specified in Appendix E



Provider managed




Service Specification

Service Title:

Self-directed personal care

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.





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

X

Service is not included in the current waiver.

Service Definition (Scope):

Self directed personal attendant care services are services and/or goods that provide a range of assistance in the consumer’s home or community; activities of daily living and incidental activities of daily living that help the person remain in the home and in their community. These services are only available for those that self direct. The consumer will have budget authority over Self directed personal attendant care services. The dollar amount available for this service will be based on the needs identified on the services plan for the following services

  • Consumer Directed Attendant Care (unskilled)

  • Home and Vehicle Modification

  • Home Delivered Meals

  • Homemaker

  • Basic Respite

  • Senior Companion

  • Transportation

  • Assistive Devices

  • Chore services


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

Self directed personal care services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Please see Section E-2- b ii



Provider Specifications

Provider Category(s)

(check one or both):

X

Individual. List types:

X

Agency. List the types of agencies:



















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



Legally Responsible Person

X

Relative/Legal Guardian

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

Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Employee







All persons providing these services must be at least 16 years of age. All persons must be able to demonstrate to the consumer the ability to successfully communicate with consumer. Individuals and businesses providing services and shall have all the necessary licenses required by federal, state and local laws and regulations. The consumer and the independent support broker are responsible for determining provider qualifications for the individual employees identified on the individual budget

























Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification




The consumer, the Independent support broker and the financial management service

As necessary



















Service Delivery Method

Service Delivery Method (check each that applies):

X

Participant-directed as specified in Appendix E



Provider managed




Service Specification

Service Title:

Self Directed Community Support and Employment

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.



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

x

Service is not included in the current waiver.

Service Definition (Scope):

Self Directed Community Support and Employment Services are services that support the consumer in developing and maintaining life and community integration This service is only available for those that self direct. Consumers will have budget authority over Community Support and Employment services. The dollar amount available for this service will be based on the needs identified on the services plan for the following services

  • Consumer Directed Attendant Care (unskilled)

  • Home and Vehicle Modification

  • Home Delivered Meals

  • Homemaker

  • Basic Respite

  • Senior Companion

  • Transportation

  • Assistive Devices

  • Chore services




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

Community support and employment services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Please see Section E-2- b ii


Provider Specifications


Provider Category(s)

(check one or both):

X

Individual. List types:

X

Agency. List the types of agencies:



















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



Legally Responsible Person

X

Relative/Legal Guardian

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

Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Individual or agency





All persons providing these services must be at least 18 years of age. All persons must be able to demonstrate to the consumer the ability to perform the task or tasks hire to perform. All persons hired must have the availability to successfully communicate with the consumer. Individuals and businesses providing services and supports shall have all the necessary licenses required by federal state and local laws and regulations

























Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification




The consumer, the independent support broker and the financial management service

As necessary

















Service Delivery Method

Service Delivery Method (check each that applies):

X

Participant-directed as specified in Appendix E



Provider managed




Service Specification

Service Title:

Individual directed goods and services

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.


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


X

Service is not included in the current waiver.

Service Definition (Scope):

Individual directed goods and services are services, equipment or supplies not otherwise provided through the Medicaid state plan that address an identified need in the service plan. The item or services would either decrease the need for other Medicaid services; and/or promote inclusion in the community; and/or increase the participant’s safety in the community or home. Individual directed goods and services are services that the consumer has budget authority over. This service is only available for those that self direct. The dollar amount available for this service will be based on the needs identified on the services plan for the following services.

  • Consumer Directed Attendant Care (unskilled)

  • Home and Vehicle Modification

  • Home Delivered Meals

  • Homemaker

  • Basic Respite

  • Senior Companion

  • Transportation

  • Assistive Devices

  • Chore services




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

Individual directed goods and services must be documented on the individual budget. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Please see Section E-2- b ii

Provider Specifications


Provider Category(s)

(check one or both):

X

Individual. List types:

X

Agency. List the types of agencies:



















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



Legally Responsible Person

X

Relative/Legal Guardian

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

Provider Type:

License (specify)

Certificate (specify)

Other Standard (specify)

Individual or agency





All persons providing these services must be at least 18 years of age. All persons must be able to demonstrate to the consumer the ability to successfully communicate with the consumer. Individuals and businesses providing services and supports shall have all the necessary licenses required by federal, state and local laws and regulations

























Verification of Provider Qualifications

Provider Type:

Entity Responsible for Verification:

Frequency of Verification




The consumer, the independent support brokers and the financial management service

As necessary

















Service Delivery Method

Service Delivery Method (check each that applies):

x

Participant-directed as specified in Appendix E




Provider managed

Appendix C-4: Additional Limits on Amount of Waiver Services

Additional Limits on Amount of Waiver Services. Indicate whether the waiver employs any of the following additional limits on the amount of waiver services (check each that applies).

When a limit is employed, specify: (a) the waiver services to which the limit applies; (b) the basis of the limit, including its basis in historical expenditure/utilization patterns and, as applicable, the processes and methodologies that are used to determine the amount of the limit to which a participant’s services are subject; (c) how the limit will be adjusted over the course of the waiver period; (d) provisions for adjusting or making exceptions to the limit based on participant health and welfare needs or other factors specified by the state; (e) the safeguards that are in effect when the amount of the limit is insufficient to meet a participant’s needs; (f) how participants are notified of the amount of the limit; and, (g) the procedures for notifying participants of the right to request a Fair Hearing in the event that the participant is denied waiver services due to the limit:



Limit(s) on Set(s) of Services. There is a limit on the maximum dollar amount of waiver services that is authorized for one or more sets of services offered under the waiver. Furnish the information specified above.







Prospective Individual Budget Amount. There is a limit on the maximum dollar amount of waiver services authorized for each specific participant. Furnish the information specified above.




X

Budget Limits by Level of Support. Based on an assessment process and/or other factors, participants are assigned to funding levels that are limits on the maximum dollar amount of waiver services. Furnish the information specified above.

The total monthly costs of the Elderly Services cannot exceed the established aggregate monthly costs for level of care

Nursing level of care $1052 per month

Skilled Level (sub category of Nursing level of care) $2480.00 per month.

The Level of care is determined by the Iowa Medicaid Enterprise Medical Services from the information obtained on the Outcome and Assessment Information (OASIS) by the case manager. Medical Services uses the Assessment and Services Evaluation (A.S.E) tool in conjunction with the (OASIS) which reviews the entire body system to specify level of care. The ACE tool looks at the following criteria: Cognitive, Mood and Behavior Patterns, Physical Functioning- Mobility; Skin condition; Pulmonary Status; Continence; Dressing and Personal Hygiene-ADLS; Physical Functioning-Eating; Medications; Communication/Hearing/Vision Patterns; Prior Living –Psycho- Social. If a consumer or representative who disagrees with the level of care determination made by Medical Services, they may ask for a reconsideration. If a mutually agreed upon decision cannot by reached with Medical Services, the person can appeal the Department of Human Services and receive an appeal hearing before an administrative law judge. If needs of the consumer have changed and it is felt that the consumer would be determined at a higher level of care, they may also request a reconsideration.


To determine the limit amounts per month, the state looks at what it would on average cost per month to live in a nursing home, Skilled facility or ICF/MR and deduct the average amount of Medicaid State Plan Services people use in the community.

The person must be certified as being in need of nursing facility, or skilled nursing facility level of care.

The consumer is notified of the limits at the time that their service plan of care is developed. The service plan is developed by the consumer, the Case Manager and their interdisciplinary team. This plan addresses the consumer’s health and welfare and looks at all sources of funding and supports available to the consumer, including Medicaid (waiver and state plan) and non-Medicaid funds. If the amount of the Medicaid waiver limit is insufficient to meet the needs of the consumer, the consumer, their guardian or their service worker may request an exception to policy from the Department. These are granted at the discretion of the Director. A consumer may also file an appeal if they disagree with the decision.




Other Type of Limit. The State employs another type of limit. Describe the limit and furnish the information specified above.






Not applicable. The State does not impose a limit on the amount of waiver services except as provided in Appendix C-3.


Appendix D: Participant-Centered Planning

and Service Delivery

Appendix D-1: Service Plan Development

State Participant-Centered Service Plan Title:

Service Plan



a. Responsibility for Service Plan Development. Per 42 CFR §441.301(b)(2), specify who is responsible for the development of the service plan and the qualifications of these individuals (check each that applies):



Registered nurse, licensed to practice in the State



Licensed practical or vocational nurse, acting within the scope of practice under State law



Licensed physician (M.D. or D.O)



Case Manager (qualifications specified in Appendix C-3)

X

Case Manager (qualifications not specified in Appendix C-3). Specify qualifications:

Case Managers must be:
  • A bachelor’s degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least one year of experience in the delivery of services to the population groups that the person is hired as a case manager or case management supervisor to serve or


  • An Iowa license to practice as a registered nurse and at least three years of experience in the delivery of services to the population group the person is hired as a case manager or case management supervisor to serve.






Social Worker. Specify qualifications:





Other (specify the individuals and their qualifications):



b. Service Plan Development Safeguards. Select one:

X

Entities and/or individuals that have responsibility for service plan development may not provide other direct waiver services to the participant.




Entities and/or individuals that have responsibility for service plan development may provide other direct waiver services to the participant. The State has established the following safeguards to ensure that service plan development is conducted in the best interests of the participant. Specify:



c. Supporting the Participant in Service Plan Development. Specify: (a) the supports and information that are made available to the participant (and/or family or legal representative, as appropriate) to direct and be actively engaged in the service plan development process and (b) the participant’s authority to determine who is included in the process.

The service plan development is done with the consumer and their interdisciplinary team consisting of the consumer, the case manager, service providers, and other persons the consumer the person chooses. This information is available to the consumer in the information packet they receive when they apply for the waiver. In addition, for those choosing the self direction option, consumers will also work with a Independent Support Broker to assist with development of the independent budget





d. Service Plan Development Process and Scope. The service plan contains: (a) the waiver services that are furnished to the participant, their projected amount, frequency and duration, and the type of provider who furnishes each service and (b) the other services (regardless of funding source, including State plan services) and informal supports that complement waiver services in meeting the needs of the participant. Specify the process that is employed to develop the service plan and the scope of the plan. State laws, regulations, and policies cited that affect the service plan development process are available through the Medicaid agency or other operating agency (if applicable):

The service plan is developed by the consumer, the case manager, and the interdisciplinary team (which consists of people chosen by the consumer). The service plan must be completed prior to services delivered and annually afterwards or when ever there is a significant change in the persons situation or condition. The case manager performs the assessment and obtains the level of care determination from medical services. A summary of the assessment becomes part of the service plan. The case manager uses information gathered from the assessment and then works with the consumer to identify individual and family strengths, needs, capacities, preferences and desired outcomes and health status and risk factors. This is used to identify the scope of services needed. The case manage informs the consumer of all available non-Medicaid and Medicaid services including waiver services. The case manager will also discuss with the consumer the self-direction option and give the consumer the option of self-directing services available. The consumer and the interdisciplinary team choose services and supports that meet the consumer’s needs and preferences. This becomes part of the service plan. The service plan shall include


  • All Medicaid and non-Medicaid services and supports.

  • The funding source for each service and support

  • The name of the service provider responsible for providing the service

  • Who is responsible for implementing each goal on the plan. The responsibilities of the consumer, worker, providers and others involved in the service plan related to specific services, i.e. once the service plan is in place, the service worker shall assist with coordination of services, and follow along in the progress of the consumer to ensure that services continue to be appropriate and accessible

  • Time frames for each services

  • Health and safety concerns which will include an emergency back up plan

The case manager will be responsible for monitoring and overseeing the implementation of the service plan and all the services.


If a consumer chooses to self direct, the consumer with the help of a case manager needs to identify who will be providing independent support broker services. This will also become part of their service plan. The independent support broker helps the consumer plan for their individual budget which will be separate from the service plan. Please see Appendix C3 for a description of duties performed by the Independent Support Broker


e. Risk Assessment and Mitigation. Specify how potential risks to the participant are assessed during the service development process and how strategies to mitigate risk are incorporated into the service plan, subject to participant needs and preferences. In addition, describe how the service plan development process addresses backup plans and the arrangements that are used for backup.

During the evaluation/reevaluation of level of care, risks are assessed using the ASE tool in conjunction with the Outcome and Assessment Information Set (OASIS) A summary of the assessment becomes part of the service plan and the case manager, the consumer and the interdisciplinary team address any risks as part of the service plan development and the plan to mitigate risk including appropriate service providers available to reduce risk.

Iowa is in the process of submitting administrative rules that will require all service plans to address risks and identify emergency back up plans. Personal Emergency Response is an available service under the waiver and it is encouraged that this service be used as part of emergency back up plan when a scheduled support worker does not appear. Other providers may be listed on the service plan as source of back up as well.



All consumers choosing the self direction option will sign an individual risk agreement that permits the participant to acknowledge and accept certain responsibilities for addressing risks


f. Informed Choice of Providers. Describe how participants are assisted in obtaining information about and selecting from among qualified providers of the waiver services in the service plan.

This is part of the interdisciplinary team process when the service plan is developed. All available qualified providers in their community are communicated with the consumer and their interdisciplinary team. When appropriate, a list of providers will be provided for the consumer Consumers are encouraged to meet with the available providers before choosing a provider

g. Process for Making Service Plan Subject to the Approval of the Medicaid Agency. Describe the process by which the service plan is made subject to the approval of the Medicaid agency in accordance with 42 CFR §441.301(b)(1)(i):


The Iowa Department of Human Services has developed a computer program named the Individualized Services Information System (ISIS) to support waiver programs. This system assists the Medicaid Department with tracking information, and monitoring the service plan as well as approving the plan. This system requires the case manager to give the authority to make payments on behalf of the consumer. There are certain points in ISIS process that require contacting the designated Iowa Department of Human Services central office personnel for approval.


h. Service Plan Review and Update. The service plan is subject to at least annual periodic review and update to assess the appropriateness and adequacy of the services as participant needs change. Specify the minimum schedule for the review and update of the service plan:



Every three months or more frequently when necessary



Every six months or more frequently when necessary

X

Every twelve months or more frequently when necessary



Other schedule (specify):


i. Maintenance of Service Plan Forms. Written copies or electronic facsimiles of service plans are maintained for a minimum period of 3 years as required by 45 CFR §74.53. Service plans are maintained by the following (check each that applies):





Medicaid agency



Operating agency

X

Case manager




Other (specify):



j. Fair Hearing. As specified in Appendix F, the State provides the opportunity for a Fair Hearing under 42 CFR Part 431, subpart E, to individuals who are denied the service(s) of their choice or provider(s) of their choice.
Appendix D-2: Service Plan Implementation and Monitoring

a. Service Plan Implementation and Monitoring. Specify: (a) the entity (entities) responsible for monitoring the implementation of the service plan and participant health and welfare; (b) the monitoring and follow-up method(s) that are used; and, (c) the frequency with which monitoring is performed.

The Case Manager is responsible for the monitoring of the implementation of the service plan and the health and welfare of the consumer. They are responsible for the following:



  • Monitoring service utilization

  • Making a face to face visit to the consumer at least quarterly
  • Participating in the development and approval of the service plan in coordination with the interdisciplinary team at least annually or as needs change. If services have not been meeting consumer’s needs the plan is changed to meet those needs. The effectiveness of the emergency back up plan is also addressed as the service plan is developed.

The consumer is encouraged during the time of the service plan development to call the case manager if there are any problems with either Medicaid or non-Medicaid services. The case manager will then follow up to solve any problems.

Monitoring service utilization includes:


  • Verifying that the consumer used the waiver service at least once a calendar quarter

  • That the services were provided in accordance with the plan

  • That the consumer is receiving the level of service or services needed.

The Iowa Department of Human Services has developed a computer program named the Individualized Services Information System (ISIS) to support waiver programs. This system assists the Medicaid Department and the case manager with tracking information, monitoring services, assuring services were provided and authorizing payments on behalf of the consumer. If the consumer is not receiving the services according to the plan or not receiving the services needed the case manager will contact the consumer and as necessary other interdisciplinary team members and providers immediately


HCBS specialists also monitor the service plan during the home and community quality assurance review process. Consumers are asked about their choice of providers and whether or not the service met consumers’ needs. HCBS specialists also review the effectiveness of emergency back up plans.
Information about monitoring results are complied by a HCBS quality assurance specialist dedicated for tracking and monitoring the quality of waiver services. This information is used to make recommendations for improvements and training.





b. Monitoring Safeguards. Select one:

X


Entities and/or individuals that have responsibility to monitor service plan implementation and participant health and welfare may not provide other direct waiver services to the participant.




Entities and/or individuals that have responsibility to monitor service plan implementation and participant health and welfare may provide other direct waiver services to the participant. The State has established the following safeguards to ensure that monitoring is conducted in the best interests of the participant. Specify:




Appendix E: Participant Direction of Services


[NOTE: Complete Appendix E only when the waiver provides for one or both of the participant direction opportunities specified below.]



Applicability (select one):

X

Yes. This waiver provides participant direction opportunities. Complete the remainder of the Appendix.



No. This waiver does not provide participant direction opportunities. Do not complete the remainder of the Appendix.

CMS urges states to afford all waiver participants the opportunity to direct their services. Participant direction of services includes the participant exercising decision-making authority over workers who provide services, a participant-managed budget or both. CMS will confer the Independence Plus designation when the waiver evidences an especially strong commitment to participant direction. Indicate whether this waiver should be considered for Independence Plus designation (select one):





Yes. The State requests that this waiver to be considered for Independence Plus designation.

X

No. Independence Plus designation is not requested.

Appendix E-1: Overview

a. Description of Participant Direction. In no more than two pages, provide an overview of the opportunities for participant direction in the waiver, including: (a) the nature of the opportunities afforded to participants; (b) how participants may take advantage of these opportunities; (c) the entities that support individuals who direct their services and the supports that they provide; and, (d) other relevant information about the waiver’s approach to participant direction.

At the time of the service plan development and/or at the consumers request, consumers enrolled in this waiver will have the option of converting the following services dollars into an individualized budget based on their service plan:

  • Consumer Directed Attendant Care (unskilled)

  • Assistive devices

  • Chore services

  • Home and Vehicle Modification

  • Home Delivered Meals

  • Homemaker

  • Basic Respite

  • Assistive devices

  • Senior companion

  • Transportation

With their individual budget amount consumers will be given the additional option to elect one of three consumer-directed options (self directed personal attendant care, individual directed goods and services, and community support and employment). Participants may elect one or any combination of these services. Each will have a separate procedure billing code. If any of the consumer-directed options is elected, an Independent Support Broker and a Financial Management Service (both are waiver services) must be involved. Two budgets will be developed as a result of the service plan development – traditional services budget (which will include their traditional services that the consumer does not have budget or employer authority) and the individual budget (which will include the services and supports that the consumer does have budget and employer authority)

Self directed personal attendant care services are services and/or goods that provide a range of assistance in the consumer’s home or community; activities of daily living and incidental activities of daily living that help the person remain in their home and in their community
Community Support and Employment are services that support the consumer in developing and maintaining life and community integration.
Individual directed goods and services are services, equipment or supplies not otherwise provided through the Medicaid state plan that address an identified need in the service plan. The item or services would decrease the need for other Medicaid services; and/or promote inclusion in the community; and/or increase the consumer’s safety in the community or home.





b.


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