Iowa Admin. Code r. 441-83.107

Current through Register Vol. 47, No. 10, November 13, 2024

Rule 441-83.107 - Individual service plan

An individualized service plan shall be prepared and used for each HCBS physical disability waiver consumer. The service plan shall be developed and approved by the consumer, the consumer's interdisciplinary team and the designated case manager prior to services beginning and payment being made to the provider.

(1)Information in plan. The plan shall be in accordance with 441-subrule 24.4(3) and shall additionally include the following information to assist in evaluating the program:

a. A listing of all services received by a consumer at the time of waiver program enrollment.

b. The name of all providers responsible for providing all services.

c. All service funding sources.

d. The amount of the service to be received by the consumer.

e. Whether the consumer has elected the consumer choices option and, if so:

(1) The independent support broker selected by the consumer; and

(2) The financial management service selected by the consumer.

f. A plan for emergencies and identification of the supports available to the consumer in an emergency.

(2)Annual assessment. The IME medical services unit or a managed care organization shall review the member's need for continued care annually and recertify the member's need for long-term care services, pursuant to paragraph 83.102(1)"h" and the appeal process at rule 441-83.109 (249A), based on the appropriate information submission tool as listed in paragraph 83.102(1)"h" and other supporting documentation as relevant.

a. The IME medical services unit or the member's managed care organization shall be responsible for annual redetermination of the level of care.

b. The managed care organization must submit documentation to the IME medical services unit for all reassessments, performed at least annually, which indicate a change in the member's level of care. The IME medical services unit shall make a final determination for any reassessments which indicate a change in the level of care. If the level of care reassessment indicates no change in level of care, the member is approved to continue at the already established level of care.

(3)Case file. Rescinded IAB 8/7/02, effective 10/1/02.

Iowa Admin. Code r. 441-83.107

ARC 0306C, IAB 9/5/12, effective 11/1/12

Amended by IAB January 06, 2016/Volume XXXVIII, Number 14, effective 1/1/2016

Amended by IAB July 5, 2017/Volume XL, Number 01, effective 8/9/2017