The State uses the post-eligibility rules of §1924(d) of the Act (spousal impoverishment protection) to determine the contribution of a participant with a community spouse toward the cost of home and community-based care if it determines the individual's eligibility under §1924 of the Act. There is deducted from the participant’s monthly income a personal needs allowance (as specified below), a community spouse's allowance, a family allowance, and an amount for incurred expenses for medical or remedial care, as specified in the State plan.
i. Allowance for the personal needs of the waiver participant (select one):
Optional State Supplement standard
Medically Needy Income Standard
The special income level for institutionalized persons
The following formula is used to determine the needs allowance:
ii. If the allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual’s maintenance allowance under 42 CFR §435.726 or
42 CFR §435.735, explain why this amount is reasonable to meet the individual’s maintenance needs in the community.
Appendix B-6: Evaluation/Reevaluation of Level of Care
a.Evaluation of Level of Care. As specified in 42 CFR §441.302(c), the State provides for an evaluation (and periodic reevaluations) of the need for the level(s) of care specified for this waiver, when there is a reasonable indication that an individual may need such services in the near future (one month or less), but for the availability of home and community-based waiver services.
Reasonable Indication of Need for Services. In order for an individual to be determined to need
waiver services: (a) the individual must require the provision of at least
service(s) offered under the waiver; and, (b) the individual must require the provision of waiver services at least monthly or, if less frequently, require regular monthly monitoring as documented in the service plan.
c. Fair Hearing. As specified in Appendix F, the State provides an opportunity to request a Fair Hearing under 42 CFR Part 431, Subpart E to individuals who are determined not to meet the level of care requirements for this waiver.
d.Responsibility for Performing Evaluations and Reevaluations. Level of care evaluations and reevaluations are performed (select one):
Directly by the Medicaid agency
By the operating agency specified in Appendix A
By an entity under contract with the Medicaid agency. Specify the entity:
An assessment shall be completed by the case manager. Medical services through the Iowa Medicaid Enterprise shall be responsible for determining the level of care based on the completed assessment tool and supporting documentation from the case manager.
e. Qualifications of Individuals Performing Initial Evaluation: Per 42 CFR §441.303(c)(1), specify the educational/professional qualifications of individuals who perform the initial evaluation of level of care for waiver applicants:
Individuals who perform the assessments must have:
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.
Medical Services requires that the individuals who determine the level of care are licensed registered nurses
f. Level of Care Criteria. Fully specify the level of care criteria that are used to evaluate and reevaluate whether an individual needs services through the waiver and that serve as the basis of the State’s level of care instrument/tool. Specify the level of care instrument/tool that is employed. State laws, regulations, and policies concerning level of care criteria are available through the Medicaid agency or the operating agency (if applicable), including the instrument/tool utilized.
The case manager use the Outcome and Assessment Information Set (OASIS) tool to perform the assessment. This assessment reviews patient history, living arrangements, supportive assistance, sensory status, integument status, respiratory status, elimination status, neuro/emotional behavioral status, activities of daily living, medication, equipment management, and therapy. The information obtained by the assessment tool is then used by Medical Services through the Iowa Medicaid Enterprise in conjunction with the Criteria from the Assessment and Services Evaluation (ASE) 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.
g. Level of Care Instrument(s). Per 42 CFR §441.303(c)(2), indicate whether the instrument/tool used to evaluate level of care for the waiver differs from the instrument/tool used to evaluate institutional level of care (select one):
The same instrument is used in determining the level of care for the waiver and for institutional care under the State Plan.
A different instrument is used to determine the level of care for the waiver than for institutional care under the State plan. Describe how and why this instrument differs from the form used to evaluate institutional level of care and explain how the outcome of the determination is reliable, valid, and fully comparable.
The Assessment and Services Evaluation (ACE) is the same criteria used to evaluate both waiver and institutional level of care. The OASIS tool used for waiver services is a different tool because this also identifies the different care needs in the home setting that are not the same for an institutional setting. The results of the assessment then are used to develop the plan of care. Because the same criteria are used for both institutional care and waiver services, the outcome is reliable, valid and fully comparable.
h. Process for Level of Care Evaluation/Reevalaution. Per 42 CFR §441.303(c)(1), describe the process for evaluating waiver applicants for their need for the level of care under the waiver. If the reevaluation process differs from the evaluation process, describe the differences:
The reevaluation is the same process and the same guidelines are used
i. Reevaluation Schedule. Per 42 CFR §441.303(c)(4), reevaluations of the level of care required by a participant are conducted no less frequently than annually according to the following schedule
Every three months
Every six months
Every twelve months or as needs change
Other schedule (specify):
j. Qualifications of Individuals Who Perform Reevaluations. Specify the qualifications of individuals who perform reevaluations (select one):
The qualifications of individuals who perform reevaluations are the same as individuals who perform initial evaluations.
The qualifications are different. The qualifications of individuals who perform reevaluations are (specify):
k. Procedures to Ensure Timely Reevaluations. Per 42 CFR §441.303(c)(4), specify the procedures that the State employs to ensure timely reevaluations of level of care (specify):
The reevaluations are tracked in the Iowa Department of Human Services Individualized Services Information System (ISIS). A reminder tickler is sent out to the person responsible for the evaluation 60 days before the reevaluation is due. A continued State Review report is available through ISIS to track if reevaluations are overdue that is monitored by Medical Services and the Bureau of Long Term Care with the Iowa Medicaid Enterprise.
l. Maintenance of Evaluation/Reevaluation Records. Per 42 CFR §441.303(c)(3), the State assures that written and/or electronically retrievable documentation of all evaluations and reevaluations are maintained for a minimum period of 3 years as required in 45 CFR §74.53. Specify the location(s) where records of evaluations and reevaluations of level of care are maintained:
Evaluations are kept in the Case Manager File. An electronic copy can also be accessed in the department of Elder Affairs seamless system. Medical services has access to this system
Medical Services at the Iowa Medicaid Enterprise
Appendix B-7: Freedom of Choice
a. Freedom of Choice. When an individual is determined to be likely to require a level of care for this waiver, the individual or his or her legal representative is:
i. informed of any feasible alternatives under the waiver; and
ii. given the choice of either institutional or home and community-based services.
b. Fair Hearing. As specified in Appendix F, the State provides an opportunity to request a Fair Hearing under 42 CFR Part 431, subpart E, to individuals who are not informed of any feasible alternatives under the waiver or given the choice of home or community-based waiver services.
c.Procedures. Per 42 CFR §441.303(d), specify the State’s procedures for informing eligible individuals (or their legal representatives) of the feasible alternatives available under the waiver and allowing these individuals to choose either institutional or waiver services.
During the enrollment process, one of the required milestones to completed by the DHS Income Maintenance worker is to explain to the consumer and or the consumer’s legal representative the choice between HCBS or institutional services. In addition, during the assessment and reassessment, the designated case manager discusses with the consumer available options and obtains the consumer’s signature on the Verification of Consumer’s Choice to Receive Home and Community Based Services .
d.Freedom of Choice Documentation. Attachment #1 to Appendix B-7 contains a copy of the form used to document freedom of choice.
e. Maintenance of Forms. Per 45 CFR §74.53, written copies or electronically retrievable facsimiles of Freedom of Choice forms are maintained for a minimum of three years. Specify the locations where copies of these forms are maintained.
At the local Department of Human Services Service worker office. An electronic copy is also kept in the Department of Elder Affairs Seamless system
Appendix B-8: Access to Services by Limited English Proficiency Persons Access to Services by Limited English Proficiency Persons. Specify the methods that the State uses to provide meaningful access to the waiver by Limited English Proficiency persons in accordance with the Department of Health and Human Services “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons” (68 FR 47311 - August 8, 2003):
Iowa Department of Human Services adopts the policy as set forth in Title VI of the Civil Rights Act prohibiting national origin discrimination as it affects people with limited English proficiency. The Department shall provide for communication with people with limited English proficiency, including current and prospective patients or clients, family members and consumers to ensure them an equal opportunity to benefit from services. The Department has developed policies and procedures to ensure meaningful access for people with limited English proficiency. This includes procedures to:
Identify the points of contact where language assistance is needed
Identify translation and interpretation resources, including their location and their availability
Determine the written materials and vital documents to be translated, based on the populations with limited English proficiency and ensure their transition
Determining effective means for notifying people with limited English proficiency of available translation services available at no cost.
Training Department staff on limited English proficiency requirements and ensure their ability to carry them out, and
Monitoring the application of these policies on at least an annual basis to ensure ongoing meaningful access to service
The Department includes this policy as part of their Policy on Nondiscrimination that can be found the Iowa Department of Human Services Title 1 General Departmental Procedures in the Department Employee manual
Attachment #1 to Appendix B-7
Include the form used to document Freedom of Choice
Please see attachment #1 B-7 the IFMC Notification sheet