Iowa Admin. Code r. 441-83.68

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

Rule 441-83.68 - Adverse service actions

(1)Denial. An application for services shall be denied when it is determined by the department that:

a. The applicant is not eligible for the services.

b. Service needs exceed the service unit or reimbursement maximums.

c. Service needs are not met by the services provided.

d. Needed services are not available or received from qualifying providers.

e. No HCBS intellectual disability waiver service is identified in the applicant's service plan.

f. There is another community resource available to provide the service or a similar service free of charge to the applicant that will meet the applicant's needs.

g. Completion or receipt of required documents by the department for the HCBS program applicant has not occurred.

(2)Reduction. A particular service may be reduced when the department determines that the provisions of 441-subrule 130.5(3), paragraph"a" or"b, " apply.

(3)Termination. A particular service may be terminated when the department determines that:

a. The provisions of 441-subrule 130.5(2), paragraph"d," "g, " or"h, " apply.

b. Needed services are not available or received from qualifying providers.

c. No HCBS intellectual disability waiver service is identified in the member's annual service plan.

d. Service needs are not met by the services provided.

e. Services needed exceed the service unit or reimbursement maximums.

f. Completion or receipt of required documents by the department for the HCBS program consumer has not occurred.

g. The consumer receives services from other Medicaid waiver programs.

h. The consumer or legal representative through the interdisciplinary process requests termination from the services.

Iowa Admin. Code r. 441-83.68

ARC 9650B, lAB 8/10/11, effective 10/1/11