ARC 6407C

ARC 6407C

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Proposing rule making related to disability services management

and providing an opportunity for public comment

The Human Services Department hereby proposes to amend Chapter 25, "Disability Services Management," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is proposed under the authority provided in Iowa Code chapter 225C.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code chapter 225C.

Purpose and Summary

This proposed rule making is a result of the five-year rules review for Chapter 25. Rules that are outdated or redundant are proposed to be eliminated. The proposed amendments also update definitions, terminology and cross-references, and ambiguous rules are clarified.

Fiscal Impact

This rule making has no fiscal impact to the State of Iowa.

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).

Public Comment

Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m.on August 2, 2022. Comments should be directed to:

Public Hearing

No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)"b," an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members.

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).

The following rule-making actions are proposed:

Item 1. Amend rule 441—25.1(331), definitions of "Emergency care," "Evidence-based services," "Family support peer specialist," "Homeless," "Mental health professional," "Peer support specialist," "Respite services," "Routine care" and "Urgent nonemergency need," as follows:

"Emergency care services" means the same as defined in rule 441—88.21(249A) 441—subrule 24.4(15).

"Evidence-based services" or "evidence-based practices" means using interventions that have been rigorously tested,; have yielded consistent, replicable results,; and have proven safe, beneficial and effective and have established standards for fidelity of the practice.

"Family support peer specialist" means a parent, primary caregiver, foster parent or family member of an individual who has successfully completed standardized training to provide family support through the medical assistance program or the Iowa Behavioral Health Care Plan.

"Homeless" means the same as "homeless person" as defined in rule 441—25.11(331) Iowa Code section 48A.2.

"Mental health professional" means the same as defined in Iowa Code section 228.1(6) 228.1(7).

"Peer support specialist" means an individual who has experienced a severe and persistent mental illness and who has successfully completed standardized training to provide peer support services through the medical assistance program or the Iowa Behavioral Health Care Plan.

"Respite services" means a temporary period of relief and support for individuals and their families provided in a variety of settings. The intent is to provide a safe environment with staff assistance for individuals who lack an adequate support system to address current issues related to a disability. Respite may be provided for a defined period of time; respite is either planned or provided in response to a crisis.

"Routine care" means the same as defined in rule 441—88.21(249A) care which is not urgent or emergent in nature and can wait for a regularly scheduled appointment without risk to the individual. A condition requiring routine care is not likely to substantially worsen without immediate intervention.

"Urgent nonemergency need" means the same as defined in rule 441—88.21(249A) existence of conditions that are not emergent in nature but that require expeditious treatment because of the prospect of the condition worsening without immediate intervention.

Item 2. Rescind the definitions of "Community-based crisis intervention service," "State board," "Strengths-based case management," "Telephone crisis service" and "Walk-in crisis service" in rule 441—25.1(331).

Item 3. Rescind and reserve rule 441—25.3(331).

Item 4. Amend paragraph 25.4(2)"c" as follows:

c. Crisis stabilization residential services. An individual who has been determined to need CSRS shall receive CSRS within 120 minutes of referral. The service CSRS shall be located within 120 miles from the residence of the individual or be available within 120 minutes from the time of the determination that the individual needs CSRS.

Item 5. Amend paragraph 25.4(2)"e" as follows:

e. Twenty-three-hour observation and holding. An adult who has been determined to need 23-hour observation and holding shall receive 23-hour observation and holding within 120 minutes of referral. The service Twenty-three-hour observation and holding shall be located within 120 miles from the residence of the individual or be available within 120 minutes from the time of the determination that the individual needs 23-hour observation and holding.

Item 6. Amend paragraph 25.4(3)"a" as follows:

a. Outpatient.

(1)Emergency services: During an emergency, outpatient services shall be initiated to an individual within 15 minutes of telephone contact.

(2)Urgent: Outpatient services shall be provided to an individual within one 1 hour of presentation or 24 hours of telephone contact.

(3)Routine care: Outpatient services shall be provided to an individual within four weeks of request for appointment.

(4)Distance: Outpatient services shall be offered within 30 miles for an individual residing in an urban community and 45 miles for an individual residing in a rural community.

Item 7. Amend subrule 25.4(5) as follows:

25.4(5) Support for community living for adults. The first appointment shall occur within four weeks of the individual's request of support for community living services, including a home health aide, home and vehicle modifications, respite, and supportive community living.

Item 8. Amend subrule 25.4(6) as follows:

25.4(6) Support for employment for adults. The initial referral shall take place within 60 days of the individual's request of support for employment services, including day habilitation, job development, supported employment, and prevocational services.

Item 9. Amend subrule 25.4(7) as follows:

25.4(7) Recovery services for adults. An individual receiving recovery services, including family support and peer support, shall not have to travel more than 30 miles if residing in an urban area or 45 miles if residing in a rural area to receive services.

Item 10. Amend subrule 25.5(3) as follows:

25.5(3) Regions must have evidence-based practices that the region has independently verified as meeting established fidelity to evidence-based service practice models including, but not limited to, assertive community treatment or strengths-based case management; integrated treatment of for co-occurring substance use and mental health disorders; supported employment; family psychoeducation; illness management and recovery; and permanent supportive housing.

Item 11. Amend paragraph 25.6(1)"c" as follows:

c. Eligibility for access center services. To be eligible to receive access center services, an individual shall meet all of the following criteria:

(1)The individual is an adult in need of screening, assessment, services or treatment related to a mental health or substance use crisis.

(2)The individual shows no obvious signs of illness or injury indicating a need for immediate medical attention.

(3)The individual has not been determined not to need an acute inpatient psychiatric hospital level of care hospitalization.

(4)The individual does not have immediate access to alternative, safe, and effective services.

Item 12. Adopt the following new subparagraph 25.6(8)"a"(4):

(4)Regional reimbursement rates for non-Medicaid individuals receiving intensive residential services shall be negotiated by the region and the provider and shall be no less than the minimum Medicaid rate.

Item 13. Amend subparagraph 25.6(8)"b"(1) as follows:

(1)Be enrolled as an HCBS 1915(i) habilitation provider or an HCBS 1915(c) intellectual disability waiver supported community living provider and in good standing with the Iowa Medicaid enterprise.

Item 14. Amend subparagraph 25.6(8)"b"(5), introductory paragraph, as follows:

(5)Ensure that within the first year of employment, staff members complete 48 hours of competency-based training in mental health and multi-occurring conditions. During each consecutive year of employment, staff members shall complete 24 hours of competency-based training in mental health and multi-occurring conditions. Staff training shall include, but is not limited to, the following:

Item 15. Rescind subparagraph 25.6(8)"c"(2).

Item 16. Renumber subparagraph 25.6(8)"c"(3) as 25.6(8)"c"(2).

Item 17. Amend 441—Chapter 25, Division II preamble, as follows:

Preamble

These rules define the standards for a regional service system. The mental health and disability services and children's behavioral health services provided by counties operating as a region shall be delivered in accordance with a regional service system management plan approved by the region's governing board and implemented by the regional administrator (Iowa Code section 331.393). Iowa counties are encouraged to enter into a regional system when the regional approach is likely to increase the availability of services to residents of the state who need the services. It is the intent of the Iowa general assembly that the adult residents of this state should have access to needed mental health and disability services and that Iowa children should have access to needed behavioral health services regardless of the location of their residence.

Item 18. Amend rule 441—25.11(331), definitions of "Emergency service," "Medical savings account," "Mental health professional" and "Regional services fund," as follows:

"Emergency service services" means the same as defined in rule 441—88.21(249A) 441—subrule 24.4(15).

"Medical savings account" means an account that is exempt from federal income taxation pursuant to Section 220 223 of the U.S. Internal Revenue Code (26 U.S.C. §220§223) as supported by documentation provided by the bank or other financial institution. Any withdrawal from a medical savings account other than for the designated purpose becomes a countable resource.

"Mental health professional" means the same as defined in Iowa Code section 228.1(6) 228.1(7).

"Regional services service fund" means the mental health and disability regional services service fund created in Iowa Code section 225C.7A.

Item 19. Amend subrule 25.12(2) as follows:

25.12(2) Regional administrator. The formation of the regional administrator shall be as defined in Iowa Code sections 331.388, and 331.390, and 331.399.

a. No change.

b. The regional administrative entity shall enter into and manage performance-based contracts in accordance with Iowa Code section 225C.4(1)"u." 225C.4(1)"x."

c. No change.

d. The regional administrative entity functions as a lead agency utilizing shared county or regional staff or other means of limiting administrative costs.

e. and f. No change.

Item 20. Adopt the following new paragraph 25.14(1)"k":

k. Methods for reimbursing member counties if county employees are conducting regional work.

Item 21. Amend paragraph 25.14(3)"g" as follows:

g. A process for performance of an annual independent audit of the regional administrator, and methods for submitting the audit to the department upon completion.

Item 22. Amend paragraph 25.15(3)"d" as follows:

d. The individual has a diagnosis of intellectual disability as defined by Iowa Code section 4.1(9A) rule 441—83.60(249A).

Item 23. Amend paragraph 25.15(7)"a" as follows:

a. Until funding is designated for other service populations, eligibility for the core service domains shall be as identified in Iowa Code section 331.397(1)"b." 331.397(2)"b."

Item 24. Amend paragraph 25.18(2)"e" as follows:

e. Children's behavioral health services. Identification of children's behavioral health services as described in subrule 25.2(4), including contact information for the agencies responsible and eligibility requirements or reference to where eligibility requirements can be found in the policies and procedures manual.

Item 25. Amend paragraph 25.18(2)"g" as follows:

g. Budget and financing provisions for the next year. The provisions shall address how county, regional, state and other funding sources will be used to meet the service needs within the region.

Item 26. Amend paragraph 25.18(2)"h" as follows:

h. Financial forecasting measures. A description of the financial forecasting measures used in the identification of service need and funding necessary for services and a financial statement of actual revenues and actual expenses by chart of account codes, including levies by county.

Item 27. Amend rule 441—25.21(331), introductory paragraph, as follows:

441—25.21(331) Policies and procedures manual for the regional service system. The policies and procedures manual shall describe the policies and process developed to direct the management and administration of the regional service system. The initial manual is due on April 1, 2014, and will remain in effect subject to amendment.

Item 28. Amend paragraph 25.21(1)"e" as follows:

e. Quality management and improvement process. The quality management and improvement process shall at a minimum meet the requirements of the department's outcome and performance measures process as outlined in Iowa Code sections 225C.4(1)"j" 225C.4(1)"k" and 225C.6A.

Item 29. Amend subrule 25.21(2) as follows:

25.21(2) Approval. The manual shall be submitted by April 1, 2014, as a part of the region's management plan for the fiscal year beginning July 1, 2014. The manual A region's policy and procedures manual shall be approved by the region's governing board and is subject to approval by the director of human services. The director shall review all regional annual service and budget plans submitted by the dates specified. If the director finds the manual in compliance with these rules and state and federal laws, the director may approve the plan. A plan policy and procedures manuals. Manuals approved by the director for the fiscal year beginning July 1, 2014, shall remain in effect subject to amendment.

a. Criteria for acceptance. The director shall determine a plan is acceptable when it contains all the required information, meets the criteria described in this division, and is in compliance with all applicable state and federal laws. The director may request additional information to determine whether or not the plan contains all the required information and meets criteria described in this division.

b. Notification.

(1)Except as specified in subparagraph 25.21(2)"b"(2), the director shall notify the region in writing of the decision on the plan by June 1, 2014. The decision shall specify that either:

1.The policies and procedures manual is approved as it was submitted, either with or without supplemental information already requested and received.

2.The policies and procedures manual will not be approved until revisions are made. The letter will specify the nature of the revisions requested and the time frames for their submission.

(2)Review of late submittals. The director may review manuals not submitted by April 1, 2014, after all manuals submitted by that date have been reviewed. The director will proceed with the late submittals in a timely manner.

Item 30. Amend rule 441—25.41(331) as follows:

441—25.41(331) Minimum data set. Each county region shall maintain data on all clients served through the MH/DD services fund.

25.41(1) Submission of data. Each county region shall submit to DHS the department a copy of the data regarding each individual that the county region serves through the central point of coordination process.

a. DHS state payment program, The state supplementary assistance program, mental health institutes, state resource centers, Medicaid program, and Medicaid managed care contractors shall provide the equivalent data in a compatible format on the same schedule as the required submission from the counties regions.

b. DHS The department shall maintain the data in the data analysis unit for research and analysis purposes only. Only summary data shall be reported to policymakers or the public.

25.41(2) Data required. The data to be submitted are as follows:

a. Basic client individual information including a unique identifier, name, address, and county of residence and county of legal settlement.

b. The state I.D. number for state payment cases when applicable.

c. Demographic information including date of birth, sex, ethnicity, marital status, education, residential living arrangement, current employment status, monthly income, income sources, type of insurance, insurance carrier, veterans' status, guardianship status, legal status in the system, source of referral, diagnosis in the current version of the DSM, diagnosis code in the current version of the ICD, disability group (i.e., intellectual disability, developmental disability, chronic mental illness, mental illness , brain injury), central point of coordination ( and county of residence number preceded by A 1), and central point of coordination (CPC) name.

d. Service information including the decision on services, date of decision, date client terminated from CPC services termination date and reason for termination, residence, approved service, service beginning dates, service ending dates, reason for terminating each service, approved units of services, unit rate for service, expenditure data, and provider data.

e. Counties shall not be penalized in any fashion for failing to collect data elements in situations of crisis or in outreach efforts to identify or engage people in needed mental health services. For the purposes of this rule:

(1)Situations of crisis include but are not limited to voluntary and involuntary hospitalizations, legal and transportation services associated with involuntary hospitalizations, emergency outpatient services, mobile crisis team services, jail diversion services, mental health services provided in a county jail, and other services for which the county is required to pay but does not have access to the client to collect the required information.

(2)Outreach efforts to identify or engage people in needed mental health services include but are not limited to mental health advocate services; services for homeless persons, refugees, or other legal immigrants; services for state cases who do not have documentation with them and are unable to help the county locate appropriate records; consultation; education to raise public awareness; 12-step or other support groups for persons with dual disorders; and drop-in centers.

f. e.Although all of the data in the minimum data set are important to provide support for program analysis, a county shall be penalized for noncompliance with this rule if the county does not provide 100 percent reporting of the data elements listed in this paragraph. Beginning with the data reported for state fiscal year 2008, less than 100 percent reporting for the following items shall be viewed as noncompliance unless the data are exempted by paragraph "e": Regions shall submit data according to the file layouts, format, and naming conventions prescribed by the department. Any changes to the data submission requirements will be made in consultation with the regional administrators.

(1)Client identifiers:

1.Lname3 (the first three letters of the client's last name).

2.Last4SSN (the last four digits of the client's social security number).

3.SEX (the client's sex).

4.BDATE (the client's birth date).

(2)CPC (central point of coordination).

(3)Payment information:

1.PYMTDATE (CoMIS payment date).

2.FUND CODE (CoMIS fund code).

3.DG (CoMIS diagnosis).

4.COACODE (CoMIS chart of accounts code).

5.BEGDATE (CoMIS service beginning date).

6.ENDDATE (CoMIS service ending date).

7.UNITS (CoMIS units of service).

8.COPD (CoMIS county paid).

(4)ValidSSN (valid social security number indicator).

(5)IsPerson (IsPerson indicator).

g. f.Although all of the data in the minimum data set are important to provide support for program analysis, a county shall be penalized for noncompliance with this rule if the county does not provide 90 percent reporting of the data elements listed in this paragraph beginning with the data reported for fiscal year 2008. Less than 90 percent reporting for the following items shall be viewed as noncompliance unless the data are exempted by paragraph "e": Regions must submit their data for each fiscal year by December 1 of the following fiscal year.

(1)Application Date (application date) When a region's data is incomplete or is not compliant with the prescribed file layouts, format, or naming conventions the region will be notified by email.

(2)RESCO (residence county) The region shall resubmit corrected files or provide an explanation for noncompliant data within 30 days of the date of the email notice.

(3)LEGCO (legal county) If the region remains noncompliant after the 30-day time period, the department may take action as allowable under the performance-based contracts established pursuant to rule 441—25.23(331).

(4)Provider ID (vendor number).

h. The department shall analyze the data received on or before December 1 each year by December 15 or by the next business day if December 15 falls on a weekend or holiday.

(1)When a county's data submission does not meet the specifications in paragraph "f" or "g," the department will notify the county by email.

(2)The county shall have 30 days from the date of the email notice to submit the missing data or to provide an explanation of why the data cannot be reported.

(3)If the county does not report the data or provide an adequate explanation within 30 days, the department shall find the county in noncompliance.

i. The department shall post the aggregate reports received by December 1 on the department's website within 90 days.

25.41(3) Method of data collection. A county may choose to collect this information using the county management information system (CoMIS) that was designed by the department or may collect the information through some other means. If a county chooses to use another system, the county must be capable of supplying the information in the same format as CoMIS.

a. Except as provided in subparagraph (3), each county shall submit the following files in Microsoft Excel format (version 97 to 2000) or comma-delimited text file (CSV) format using data from the associated CoMIS table or from the county's chosen management information system:

(1)Paragraphs "b" through "g" list the data required in each file and specify the structure or description for each data item to be reported.

(2)The field names used in the report files must be exactly the same as indicated in the corresponding paragraph, including spaces, and must be entered in the first row for each sheet.

(3)The file labeled WarehouseService.xls or WarehouseService.csv or service authorization (described in paragraph "g" of this subrule) shall be removed from this requirement on June 30, 2011, if data from this file have not been used by that date.

b. File name: WarehouseClient.xls or WarehouseClient.csv.

Sheet name: Warehouse_Client_Transfer_Query.

c. File name: WarehouseIncome.xls or WarehouseIncome.csv.

Sheet name: Warehouse_Income_Transfer_Query.

d. File name: WarehousePayment.xls or WarehousePayment.csv. Sheet name: Warehouse_Payment_Transfer_Quer.

e. File name: WarehouseProvider.xls or WarehouseProvider.csv. Sheet name: Warehouse_Provider_Transfer_Que. (If the provider has more than one office location, enter information for the headquarters office.)

f. File name: WarehouseProviderServices.xls or WarehouseProviderServices.csv. Sheet name: Warehouse_Provider_Services_Tra.

g. File name: WarehouseService.xls or WarehouseService.csv. Sheet name: Warehouse_Service_Transfer_Quer.

This rule is intended to implement Iowa Code sections 331.438 and 331.439.

Item 31. Amend subrule 25.54(4) as follows:

25.54(4) The advocate shall file with the court Iowa Ct.R.12.36—Form 30, quarterly reports in a form prescribed by the court as the advocate feels necessary or as required for each individual assigned to the advocate. The report shall state the actions taken with the individual and amount of time spent on behalf of the individual.