d. Provision of Personal Care or Similar Services by Legally Responsible Individuals. A legally responsible individual is any person who has a duty under State law to care for another person and typically includes: (a) the parent (biological or adoptive) of a minor child or the guardian of a minor child who must provide care to the child or (b) a spouse of a waiver participant. Except at the option of the State and under extraordinary circumstances specified by the State, payment may not be made to a legally responsible individual for the provision of personal care or similar services that the legally responsible individual would ordinarily perform or be responsible to perform on behalf of a waiver participant. Select one:
No. The State does not make payment to legally responsible individuals for furnishing personal care or similar services.
Yes. The State makes payment to legally responsible individuals for furnishing personal care or similar services. Specify in Appendix C-3 the personal care or similar services for which such payment may be made to legally responsible individuals, the legally responsible individuals who may furnish such services, State policies that specify the extraordinary circumstances when such payments may be authorized, and the controls that are employed to ensure that payments are made only for services rendered:
e. Other State Policies Concerning Payment for Waiver Services Furnished by Relatives/Legal Guardians. Specify State policies concerning making payment to relatives/legal guardians for the provision of waiver services over and above the policies addressed in Item C-2-d. Select one:
The State does not make payment to relatives/legal guardians for furnishing waiver services.
The State makes payment to relatives/legal guardians under exceptional circumstances. Specify the exceptional circumstances under which payment is made and the types of relatives/legal guardians to whom payment may be made. Specify in Appendix C-3 each waiver service for which payment may be made to relatives/legal guardians. Specify the controls that are employed to ensure that payments are made only for services rendered:
Relatives/legal guardians may be paid for providing waiver services whenever the relative/legal guardian is qualified to provide service. Specify the controls that are employed to ensure that payments are made only for services rendered.
Other policy. Specify: Any Relatives/legal guardians, excluding the spouse or the parent of a minor child may be paid for providing only Consumer Directed Care, Self directed personal Care, Individual directed goods and services and self directed Community Support and Employment waiver services whenever the relative/legal guardian is qualified to provide service. Any relative excluding a legal guardian, the parent of a minor child or a spouse, can provide the Independent Support Broker training. Through the service plan development process by the case manager, consumer and the interdisplinary team, it is assured that the provision of services provided by the relative/legal guardian are in the best interest of the consumer. Through our quality assurance process and provider audits we ensure that payment is made only for services rendered.
f. Open Enrollment of Providers. Specify the processes that are employed to assure that all willing and qualified providers have the opportunity to enroll as waiver service providers:
Iowa has a Medicaid providers outreach services through provider enrollment that markets enrollment. Potential providers may access application on line through the website or by calling the providers customer service number. In addition, waiver quality assurance staff as well as county and state case managers and workers market qualified providers to enroll in Medicaid
Appendix C-3: Waiver Services Specifications
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).
Adult Day Care (Adult Day Health)
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.
Service is not included in the current waiver.
Service Definition (Scope):
Adult day care services are furnished four or more hours per days on a regularly scheduled basis for one or more days per week, in an outpatient setting, encompassing both health and social services needed to ensure the optimal functions of the individual. Meals provided as part of these services shall not constitute a full nutritional day. Transportation between the individual’s place of residence and the adult day care center will be provided as a component part of adult day health services. The cost of this transportation is included in the rate paid to providers of adult day health services provide an organized program of supportive care in a group environment to persons who need a degree of supervision and assistance on regular or intermittent basis in a day care center.
Adult day services has an upper limit per half day, and an upper limit per full day or per extended day if no Veterans Administration contract. These limits are subject to change each year. A unit of service is a half day (1 to 4 hours), a full day ( 4 to 8 hours) or an extended day (8 to 12 hours). The individual’s plan of care will address how the consumer health care needs are being met. All services must be authorized in the service plan The case manager will be responsible for monitoring the plan