Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services

What this rule requires your agency to do

• 1Nursing care service can pay for a maximum of eight nursing visits per month for intermediate level of care persons; there is no visit limit for skilled level of care persons (subrule 78.37(5)).(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 2Payment is made only for elderly waiver services provided in integrated, community-based settings supporting full community access to the same degree as individuals not receiving Medicaid HCBS, and as identified in the member's service plan (rule 441—78.37, opening paragraph).(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 3Senior companion service cannot provide hands-on nursing or medical care (subrule 78.37(9)).(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 4Attendant care services under the elderly waiver must be performed pursuant to subrule 78.34(7), incorporating its Attendant Care Agreement, supervision, EVV, and documentation requirements (subrule 78.37(10)).(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 5A day of assisted living service is billable only if the member was present in the facility during that day's bed census and the provider has documented at least one assisted living service encounter for that day (including the member's response) in accordance with rule 441—79.3(249A); the documented encounter cannot also be an authorized attendant care service (subrule 78.37(13)"b").(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 6Case management shall not include the provision of direct services by case managers, and payment is made only for services performed while the member is enrolled in the waiver (subrule 78.37(12)"b" and "c").(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 7All elderly waiver services must be delivered in the least restrictive environment possible and in conformity with the member's service plan, with all rights restrictions implemented per 441—subrule 77.30(4) (subrule 78.37(14)"b" and "c").(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)
• 8Reimbursement is not available for any service the member can obtain as other nonwaiver Medicaid services or through any other funding source; services must be billed in whole units (subrule 78.37(14)"a" and "d").(Iowa Administrative Code 441—78.37(249A) — HCBS Elderly Waiver Services)