ARC 4792C

ARC 4792C

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Rule making related to brain injury waiver

The Human Services Department hereby amends Chapter 77, "Conditions of Participation for Providers of Medical and Remedial Care," Chapter 78, "Amount, Duration and Scope of Medical and Remedial Services," and Chapter 83, "Medicaid Waiver Services," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is adopted under the authority provided in Iowa Code section 249A.3.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code section 249A.3.

Purpose and Summary

The Department is clarifying the brain injury (BI) waiver provider qualifications to align with the services and supports that are rendered by qualified brain injury professionals and accredited brain injury rehabilitation programs. The Department began evaluating core standardized assessments for the BI waiver in 2011 as part of the Balancing Incentive Payment Program (BIPP), and the Iowa Medicaid Enterprise (IME) adopted the interRAI Home Care Assessment Tool for the purposes of determining level of care for BI waiver eligibility. The Department adopted this tool recognizing that an additional or alternative tool would need to be identified which would address the cognitive disabilities related to brain injury. The primary goal of moving forward with adoption of the most current version of the Mayo-Portland Adaptability Inventory Scale is to fulfill the purposes of a valid and appropriate assessment of need, possible allocation of resources and comprehensive community-based, person-centered service planning for both the Home- and Community-Based Services (HCBS) brain injury waiver and the community-based neurobehavioral rehabilitation service.

Public Comment and Changes to Rule Making

Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on August 28, 2019, as ARC 4628C. No public comments were received. No changes from the Notice have been made.

Adoption of Rule Making

This rule making was adopted by the Council on Human Services on November 13, 2019.

Fiscal Impact

This rule making has a fiscal impact of $100,000 annually or $500,000 over five years to the State of Iowa. The fiscal impact for family training and counseling and behavior programming providers cannot be determined at this time because the number of new providers that will enroll and the number of members who will access the service are not known.

Jobs Impact

After analysis and review of this rule making, no impact on jobs has been found.

Waivers

Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee's meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

Effective Date

This rule making will become effective on January 8, 2020.

The following rule-making actions are adopted:

Item 1. Adopt the following new paragraph 77.39(21)"f":

f. Agencies which are accredited by a department-approved, nationally recognized accreditation organization as specialty brain injury rehabilitation service providers.

Item 2. Adopt the following new subparagraphs 77.39(23)"b"(6) and (7):

(6)Agencies which are accredited by a department-approved, nationally recognized accreditation organization as specialty brain injury rehabilitation service providers.

(7)Individuals who meet the definition of "qualified brain injury professional" as set forth in rule 441—83.81(249A).

Item 3. Amend subrule 77.52(3) as follows:

77.52(3) Provider standards. All community-based neurobehavioral rehabilitation service providers shall meet the following criteria:

a. The organization meets the outcome-based standards for community-based neurobehavioral rehabilitation service providers as follows:

(1) to (3) No change.

(4)The program administrator shall be a certified brain injury specialist trainer (CBIST) through the Academy of Certified Brain Injury Specialists or a certified brain injury specialist under the direct supervision of a CBIST or a qualified brain injury professional as defined in rule 441—83.81(249A) with additional certification as approved by the department. The administrator shall be present in the assigned location for 25 hours per week. In the event of an absence from the assigned location exceeding four weeks, the organization shall designate a qualified replacement to act as administrator for the duration of the assigned administrator's absence.

(5)A minimum of 75 percent of the organization's administrative and direct care personnel shall meet one of the following criteria:

1. to 3. No change.

4.Be a certified brain injury specialist (CBIS) certified through the Academy for the Certification of Brain Injury Specialists (ACBIS) or have other nationally recognized brain injury certification as approved by the department.

(6)No change.

b. No change.

c. Within 30 days of commencement of direct service provision, employees shall complete nationally recognized cardiopulmonary resuscitation (CPR) training certification, a first-aid course, fire prevention and reaction training and universal precautions training. These training courses shall be completed no less than annually, with the exception of CPR certification, which must be renewed prior to expiration of the certification.

d. Within the first six months of commencement of direct service provision, employees shall complete training required by 441—subparagraph 78.54(3)"a"(6) subparagraph 77.52(3)"a"(6).

e. Within 12 months of the commencement of direct service provision, employees shall complete a department-approved, nationally recognized certified brain injury specialist training. A majority of eligible employees within 12 months of the commencement of direct service provision shall be CBISs certified through ACBIS or have other nationally recognized brain injury certification as approved by the department.

f. to j. No change.

k. The organization shall implement the following outcome-based standards for rights and dignity:

(1) to (4) No change.

(5)When a member requires any restrictive interventions, the interventions will be implemented in accordance with 481—subrule 63.23(4), rule 481—63.33(135C), and rule 481—63.37(135C) rules 481—63.21(135C), 481—63.27(135C), and 481—63.28(135C). When a member has a guardian or legal representative, the guardian or legal representative shall provide informed consent to treat and consent for any restrictive interventions that may be required to protect the health or safety of the member. Restrictive interventions include but are not limited to:

1. to 8. No change.

(6) to (11) No change.

Item 4. Amend subrule 78.56(2) as follows:

78.56(2) Member eligibility. To be eligible to receive community-based neurobehavioral rehabilitation services, a member shall meet the following criteria:

a. to c. No change.

d. Needs assessment. The member shall have a standardized comprehensive functional neurobehavioral assessment reviewed or an assessment of need completed prior to admission. The member shall have the Mayo-Portland Adaptability Inventory (MPAI) assessment completed by a licensed neuropsychologist, neurologist, M.D., or D.O qualified trained assessor. The neurobehavioral assessment of need shall document the member's need for community-based neurobehavioral rehabilitation, and the medical services unit of the Iowa Medicaid enterprise or the member's managed care organization has determined that the member is in need of specialty neurobehavioral rehabilitation services.

e. Standards for assessment. Each member will have had a department-approved, standardized comprehensive functional neurobehavioral the MPAI assessment completed within the 90 days prior to admission. Each In addition to the functional assessment, the needs assessment will have been completed and will include the assessment of a member's individual physical, emotional, cognitive, medical and psychosocial residuals related to the member's brain injury , which and must include the following:

(1) to (10) No change.

f. No change.

Item 5. Amend rule 441—83.81(249A), definition of "Qualified brain injury professional," as follows:

"Qualified brain injury professional" means one of the following who meets the educational and licensure or certification requirements for the profession as required in the state of Iowa and who has two years' experience working with people living with a brain injury: a psychologist; psychiatrist; physician; physician assistant; registered nurse; certified teacher; licensed clinical social worker; mental health counselor; physical, occupational, recreational, or speech therapist; or a person with a bachelor of arts or science degree in human services, social work, psychology, sociology, or public health or rehabilitation services plus 4,000 hours of direct experience with people living with a brain injury.

Item 6. Amend paragraph 83.82(1)"f" as follows:

f. Be determined by the IME medical services unit as in need of intermediate care facility for persons with an intellectual disability (ICF/ID), skilled nursing, or ICF level of care based on information submitted on a completed Form 470-4694 for children aged 3 and under, the interRAI - Pediatric Home Care (PEDS-HC) for those aged 4 to 20, or the interRAI - Home Care (HC) for those aged 21 and over , the most recent version of the Mayo-Portland Adaptability Inventory (MPAI), and other supporting documentation as relevant. Form 470-4694, the interRAI - Pediatric Home Care (PEDS-HC), and the interRAI - Home Care (HC) , Form 470-4694, and Form 470-5572, the Mayo-Portland Adaptability Inventory (MPAI), are available on request from the member's managed care organization or the IME medical services unit. Copies of the completed information submission tool for an individual are available to that individual from the individual's case manager or managed care organization.

Item 7. Amend subrule 83.82(4) as follows:

83.82(4) Securing a state payment slot.

a. to c. No change.

d. Applicants who currently reside in a community-based neurobehavioral rehabilitation residential setting, an intermediate care facility for persons with an intellectual disability (ICF/ID), a skilled nursing facility, or an ICF and have resided in that setting for six or more months may request a reserved capacity slot through the brain injury waiver.

(1)Applicants shall be allocated a reserved capacity slot on the basis of the date the request is received by the income maintenance worker or the waiver slot manager.

(2)In the event that more than one request for a reserved capacity slot is received at one time, applicants shall be allocated the next available reserved capacity slot on the basis of the month of birth, January being month one and the lowest number.

(3)Persons who do not fall within the available reserved capacity slots shall have their names maintained on the reserved capacity slot waiting list. As reserved capacity slots become available at the beginning of the next waiver year, persons shall be selected from the reserved capacity slot waiting list to utilize the number of approved reserved capacity slots based on their order on the waiting list.

e. The department shall reserve a set number of funding slots each waiver year for emergency need for all applicants who are on the waiting list maintained by the state on July 1, 2019, and for all new applications received on or after July 1, 2019. Applicants may request an emergency need reserved capacity slot by submitting the completed Home- and Community-Based Services (HCBS) Brain Injury Waiver Emergency Need Assessment, Form 470-5583, to the IME medical services unit.

(1)Emergency need criteria are as follows:

1.The usual caregiver has died or is incapable of providing care, and no other caregivers are available to provide needed supports.

2.The applicant has lost primary residence or will be losing housing within 30 days and has no other housing options available.

3.The applicant is living in a homeless shelter, and no alternative housing options are available.

4.There is founded abuse or neglect by a caregiver or others living within the home of the applicant, and the applicant must move from the home.

5.The applicant cannot meet basic health and safety needs without immediate supports.

(2)Urgent need criteria are as follows:

1.The caregiver will need support within 60 days in order for the applicant to remain living in the current situation.

2.The caregiver will be unable to continue to provide care within the next 60 days.

3.The caregiver is 55 years of age or older and has a chronic or long-term physical or psychological condition that limits the ability to provide care.

4.The applicant is living in temporary housing and plans to move within 31 to 120 days.

5.The applicant is losing permanent housing and plans to move within 31 to 120 days.

6.The caregiver will be unable to be employed if services are not available.

7.There is a potential risk of abuse or neglect by a caregiver or others within the home of the applicant.

8.The applicant has behaviors that put the applicant at risk.

9.The applicant has behaviors that put others at risk.

10.The applicant is at risk of facility placement when needs could be met through community-based services.

(3)Applicants who meet an emergency need criterion shall be placed on the emergency reserved capacity priority waiting list based on the total number of criteria in subparagraph 83.82(4)"e"(1) that are met. If applicants meet an equal number of criteria, the position on the waiting list shall be based on the date of application and the age of the applicant. The applicant who has been on the waiting list longer shall be placed higher on the waiting list. If the application date is the same, the older applicant shall be placed higher on the waiting list.

(4)Applicants who meet an urgent need criterion shall be placed on the priority waiting list after applicants who meet emergency need criteria. The position on the waiting list shall be based on the total number of criteria in subparagraph 83.82(4)"e"(2) that are met. If applicants meet an equal number of criteria, the position on the waiting list shall be based on the date of application and the age of the applicant. The applicant who has been on the waiting list longer shall be placed higher on the waiting list. If the application date is the same, the older applicant shall be placed higher on the waiting list.

(5)Applicants who do not meet emergency or urgent need criteria shall remain on the waiting list, based on the date of application. If the application date is the same, the older applicant shall be placed higher on the waiting list.

(6)Applicants shall remain on the waiting list until a payment slot has been assigned to them for use, they withdraw from the list, or they become ineligible for the waiver. If there is a change in an applicant's need, the applicant may contact the local department office and request that a new emergency needs assessment be completed. The outcome of the assessment shall determine placement on the waiting list as directed in this subrule.

f. To maintain the approved number of members in the program, persons shall be selected from the waiting list as payment slots become available, based on their priority order on the waiting list.

(1)Once a payment slot is assigned, the department shall give written notice to the person within five working days.

(2)The department shall hold the payment slot for 30 days for the person to file a new application. If an application has not been filed within 30 days, the slot shall revert for use by the next person on the waiting list, if applicable. The person originally assigned the slot must reapply for a new slot.

[Filed 11/13/19, effective 1/8/20]

[Published 12/4/19]

Editor's Note: For replacement pages for IAC, see IAC Supplement 12/4/19.