IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements

What this rule requires your agency to do

• 1The member must have a service plan approved by the department and developed by the designated case manager, completed prior to service provision and annually thereafter (83.2(2)"a").(IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements)
• 2Service plans for persons aged 20 or under that include home health or nursing services shall not be approved until a home health agency has requested to cover the member's needs through nonwaiver Medicaid services (83.2(2)"a"(3)).(IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements)
• 3The designated case manager must establish the interdisciplinary team and, with the team, identify the member's need for service based on need, desires, and availability/appropriateness of services, and must have a face-to-face visit with the member at least quarterly (83.2(2)"a" and (1)).(IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements)
• 4The member must be certified as needing nursing facility, skilled nursing facility, or ICF/ID level of care based on the applicable information submission tool (Form 470-4694, interRAI PEDS-HC, or interRAI HC) and supporting documentation (83.2(1)"d").(IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements)
• 5Except as provided, the total monthly cost of waiver services (excluding home and vehicle modification) shall not exceed the established aggregate monthly cost for the member's level of care (83.2(2)"b").(IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements)
• 6Service plans for persons aged 20 or under must reflect use of all appropriate nonwaiver Medicaid services without replacing or duplicating them, and the case manager must list all nonwaiver Medicaid services in the plan (83.2(2)"a"(2)).(IAC 441—83.2(249A) — Health and disability waiver: eligibility and service plan requirements)