Elder Care Waiver of Liability by osp19998

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									      IOWA Department of Human Services                                                           MEDICAID HOME AND COMMUNITY BASED SERVICES PROGRAM                                                                                              Page 1
                                                                                                                WAIVER COMPARISON CHART

            ELEMENT                    HCBS ILL AND HANDICAPPED                   HCBS ELDERLY                            HCBS AIDS/HIV                   HCBS MENTAL RETARDATION                HCBS BRAIN INJURY             HCBS PHYSICAL DISABILITY

WHERE TO APPLY                                                                                                     DEPARTMENT OF HUMAN SERVICES (DHS) LOCAL OFFICE
AGE                          UNDER 65                                  AGE 65 OR OLDER                       NO AGE LIMIT                NO AGE LIMIT                                    1 MONTH THROUGH AGE 64             AGE 18 TO AGE 65
LIMITATIONS ON NUMBER SERVED 2110                                      12,052                                50                          10,430                                          472                                444

MENU OF HOME AND COMMUNITY                                                                            THE SERVICES LISTED IDENTIFY THOSE THAT ARE AVAILABLE THROUGH THAT WAIVER.
BASED SERVICES

ADULT DAY CARE                      Adult Day Care                     Adult Day Care                        Adult Day Care                         Adult Day Care                       Adult Day Care
ASSISTIVE DEVICES                                                      Assistive Devices
BEHAVIORAL PROGRAMMING                                                                                                                                                                   Behavioral Programming
CASE MANAGEMENT SERVICES                                                                                                                                                                 Case Management
CDAC                                Consumer-Directed Attendant Care   Consumer-Directed Attendant Care      Consumer-Directed Attendant Care       Consumer-Directed Attendant Care     Consumer-Directed Attendant Care   Consumer-Directed Attendant Care
CHORE                                                                  Chore
COUNSELING                          Counseling                                                               Counseling
DAY HABILITATION                                                                                                                                    Day Habilitation
EMERGENCY RESPONSE                  Emergency Response                 Emergency Response                                                           Emergency Response                   Emergency Response                 Emergency Response
FAMILY COUNSELING & TRNING                                                                                                                                                               Family Counseling and Training
HOME DELIVERED MEALS                Home Delivered Meals               Home Delivered Meals                  Home Delivered Meals
HOME HEALTH AIDE                    Home Health Aide                   Home Health Aide                      Home Health Aide                       Home Health Aide
HOMEMAKER                           Homemaker                          Homemaker                             Homemaker
HOME/VEHICLE MODIFICATIONS          Home/Vehicle Modifications         Home/Vehicle Modifications                                                   Home/Vehicle Modifications           Home/Vehicle Modifications         Home/Vehicle Modifications
INTERIM MEDICAL MONITORING & Interim Medical Monitoring &                                                                                           Interim Medical Monitoring &         Interim Medical Monitoring &
TREATMENT                           Treatment                                                                                                       Treatment                            Treatment
MENTAL HEALTH OUTREACH                                                 Mental Health Outreach
NURSING                             Nursing                            Nursing                               Nursing                                Nursing
NUTRITIONAL COUNSELING              Nutritional Counseling             Nutritional Counseling
PREVOCATIONAL SERVICES                                                                                                                              Prevocational Services               Prevocational Services
BASIC INDIVIDUAL RESPITE            Basic Individual Respite           Basic Individual Respite              Basic Individual Respite               Basic Individual Respite             Basic Individual Respite
GROUP RESPITE                       Group Respite                      Group Respite                         Group Respite                          Group Respite                        Group Respite
SPECIALIZED RESPITE                 Specialized Respite                Specialized Respite                   Specialized Respite                    Specialized Respite                  Specialized Respite
SENIOR COMPANION                                                       Senior Companion
SPECIALIZED MEDICAL                                                                                                                                                                      Specialized Medical Equipment      Specialized Medical Equipment
EQUIPMENT
SUPPORTED COMMUNITY LIVING (1-                                                                                                                      Supported Community Living           Supported Community Living
5 PERSONS)
SUPPORTED COMMUNITY LIVING                                                                                                                          Supported Community Living
(RESIDENTIAL-BASED)                                                                                                                                 (Residential-based)
SUPPORTED EMPLOYMENT                                                                                                                                Supported Employment                 Supported Employment
TRANSPORTATION                                                         Transportation                                                               Transportation                       Transportation                     Transportation
* HHA and Nursing Services are
available to persons age 21 and
under through the regular Medicaid
or with prior authorization through
EPSDT (Care for Kids).




IHHRC CAN ALSO BE USED TO                                                                                                                        Yes
MEET CONSUMER NEEDS
CONSUMER APPLICATION:                                                                         470-2927 or 470-2927(Spanish) Health Services Application    Reference: Employees Manual 8-N and Appendix.
INCOME MAINTENANCE WORKER
     WAIVER COMPARISON CHART 4-05
     IOWA Department of Human Services                                                            MEDICAID HOME AND COMMUNITY BASED SERVICES PROGRAM                                                                                                                 Page 2
                                                                                                                WAIVER COMPARISON CHART

ELIGIBLE FOR SSI OR MEDICAID     Can only be on SSI through                 Only SSI related coverage groups can Can be on SSI-related, FMAP-related, Can be on SSI or FMAP (not required) Can be on SSI, FMAP, or Medically                 Can be on SSI or FMAP (not required)
                                 institutional deeming of parent's          be assigned.                         or Medically Needy if the level of care                                   Needy.
                                 income while in medical facility. Can                                           is hospital level.
                                 transfer from Medically Needy.
                                 Persons age 21 or over who are
                                 eligible for SSI are ineligible for this
                                 waiver. However, Consumers age 21
                                 and over who are currently receiving
                                 services from the IH Waiver and are
                                 SSI eligible may remain on the waiver
                                 through age 24. Only SSI-related
                                 coverage groups can be assigned.
INCOME, SINGLE PERSON            Maximum for 1 person 300% of SSI           Maximum for 1 person 300% of SSI      Maximum for 1 person 300% of SSI          Maximum for 1 person 300% of SSI        Maximum for 1 person 300% of SSI         Maximum for 1 person 300% of SSI
                                 ($579 x 300% or $1737) unless MEPD         ($579 x 300% or $1737) unless MEPD    ($579 x 300% or $1737) unless person      ($579 x 300% or $1737) unless person    ($579 x 300% or $1737) unless MEPD       ($579 x 300% or $1737) unless MEPD
                                 eligible. Limit is $1995 (250% of          eligible. Limit is $1995 (250% of     is eligible on basis of Medically Needy   is eligible on basis of FMAP or FMAP    eligible. Limit is $1995 (250% of        eligible. Limit is $1995 (250% of
                                 poverty level)                             poverty level)                        and has a spenddown. Or unless            related program. Or unless MEPD         poverty level)                           poverty level)
                                                                                                                  MEPD eligible. Limit is $1995 (250%       eligible. Limit is $1995 (250% of
                                                                                                                  of poverty level)                         poverty level)

INCOME-MARRIED PERSON            When both both spouses are on waiver, treat as living in an institution & in the same room. Income $3474 ($1737 X 2 or 300% of SSI X 2). If only one on waiver, treat as institutionalized spouse and community spouse. Limit $1737 (300%
RESOURCES-SINGLE ADULT                                                                                                                   $2000 (unless MEPD eligible-$12,000)
RESOURCES-SINGLE CHILD                                                                         Resources are disregarded for certain Medicaid coverage groups. Contact your local DHS income maintenance worker.
RESOURCES-MARRIED PERSON         When both spouses are on waiver, treat as living in an institution & in the same room. Resource limit $3,000 for couple for the first 6 months, then choice of being individuals. If only one on waiver, treat as institutionalized spouse and
                                 community spouse. Spousal impoverishment applies.
TARGET POPULATION GROUP          Disabled. SSI-related coverage groups Age 65 or over                               Diagnosis of AIDS/HIV by a physician Primary disability of mental retardation Diagnosis of brain injury per IAC 83         Have a physical disability as
                                                                                                                                                           as determined by a psychologist or         definitions                              determined by Disability Determination
                                                                                                                                                           psychiatrist.                                                                       Services
DISABILITY TRANSMITTAL           Disability Transmittal, Form 470-2472 Not applicable                               Not applicable.                        Disability Transmittal, Form 470-2472 Disability Transmittal, Form 470-2472 Disability Transmittal, Form 470-2472
DISABILITY REPORT                Disability Report, Form 470-2465       Not applicable                              Not applicable.                        Disability Report, Form 470-2465 Used Disability Report, Form 470-2465              Disability Report, Form 470-2465
                                 Used by income maintenance worker                                                                                         by income maintenance worker to            Used by income maintenance worker Used by income maintenance worker
                                 to establish disability for 300% group                                                                                    establish disability for 300% group        to establish disability for 300% group   to establish disability for 300% group
                                 unless Social Security has already                                                                                        unless Social Security has already         unless Social Security has already       unless Social Security has already
                                 determined disability.                                                                                                    determined disability. Not necessary       determined disability. Not necessary     determined disability. Not necessary
                                                                                                                                                           for FMAP.                                  for FMAP.                                for FMAP.
IOWA FOUNDATION FOR MEDICAL      Determines the level of care needed by Determines the level of care needed by Determines the level of care needed by Determines the level of care needed by Determines the level of care needed by Determines the level of care needed by
CARE (IFMC)                      each applicant after review of the     each applicant after review of the          each applicant after review of the     each applicant after review of the         each applicant after review of the       each applicant after review of the
                                 assessment form, 470-0659 HCBS         assessment form, I-OASIS                    assessment form, 470-0659 HCBS         assessment form, 470-3073 Mental           assessment form, 470-3349 Brain          assessment form, 470-3502 Physical
                                 Assessment or Reassessment.                                                        Assessment or Reassessment.            Retardation Functional Assessment          Injury Functional Assessment.            Disability Waiver Assessment Tool
                                                                                                                                                           Tool                                       Determines if all of the medically
                                                                                                                                                                                                      necessary service needs of the
                                                                                                                                                                                                      applicant can be met in the HCBS
                                                                                                                                                                                                      setting.
LEVEL OF CARE REQUIRED:          SNF, NF, ICF/MR                        SNF OR NF                                   NF OR HOSPITAL                         ICF/MR                                     SNF, NF, ICF/MR                          SNF, NF
IFMC - REDETERMINATION OF        Completed, at least, annually REDETERMINATION can be completed more                Completed annually or every 4 days for                 Completed annually. REDETERMINATION can be completed more frequently if warranted
LEVEL OF CARE                    frequently , if warranted.                                                         acute (hospital).
SUPPLEMENTAL INSURANCE                                                                                   Income maintenance worker sends to Third Party Liability in Central Office to report health insurance.
QUESTIONNAIRE FORM 470-2826

HEALTH INSURANCE PREMIUM                                                               Form 470-2875, HIPP booklet & Comm 91 are distributed. Persons with Medicare supplemented insurance policies should be referred.
PAYMENT PROGRAM APPLICATION
(HIPP)



     WAIVER COMPARISON CHART 4-05
      IOWA Department of Human Services                                                                 MEDICAID HOME AND COMMUNITY BASED SERVICES PROGRAM                                                                                                                 Page 3
                                                                                                                      WAIVER COMPARISON CHART

           ELEMENT                       HCBS ILL AND HANDICAPPED                        HCBS ELDERLY                                  HCBS AIDS/HIV                 HCBS MENTAL RETARDATION                     HCBS BRAIN INJURY                   HCBS PHYSICAL DISABILITY
CLIENT PARTICIPATION (CP)             Generally none. May have client participation from Veteran's Aid and                 Generally none. May have client                  Generally none. May have client participation from Veteran's Aid and Attendance or Medicaid trust.
                                      Attendance or Medicaid trust                                                         participation from Veteran's Aid and
                                                                                                                           Attendance or Medicaid trust.
                                                                                                                           Exception: Persons eligible on the
                                                                                                                           basis of Medically Needy will have a
NOTICE OF ATTRIBUTION OF                                                                                                   spendown.
                                      The date to determine the attribution is the first of the month that the waiver services are to begin and the month that IFMC determines that the consumer meets level of care.
RESOURCES FORM 470-2588
                                      Waiver services provided before approval of eligibility for the waiver cannot be paid. Do not approve a case until the case plan is approved and level of care and financial (income & resource) eligibility are established. Waiver eligibility
                                      begins on the date when all 3 eligibility requirements are complete. For persons eligible on the basis of the 300% coverage group, eligibility shall not be earlier than the first of the month following the date of application. The IM worker may
                                      establish Medicaid eligibility retroactively but waiver services cannot be paid retroactively.
APPLICATION FOR SERVICES              None. IM application serves as application for HCBS services. See Employees Manual 16-K
CASE MANAGEMENT SERVICES                        DHS service worker                      Area Agency on Aging Case                    DHS service worker         Initial: DHS service worker or Medicaid              Medicaid case manager              DHS service worker or Medicaid Case
PROVIDED BY:                                                                       Management Project for Frail Elderly                                                      case manager                                                                              Manager
                                                                                                 (CMPFE)                                                           Ongoing: Medicaid Case Manager
LEVEL OF CARE INSTRUMENT      Home and Community Based Services I-OASIS followed by the OASIS-B1.            Home and Community Based Services Mental Retardation Functional                               The Brain Injury Waiver Assessment      Form 470-3502 Physical Disability
                              Assessment or Reassessment. Under CMPFE case managers have                     Assessment or Reassessment. DHS Assessment Tool (FASST). DHS                                 Tool (BIWAT). Medicaid case              Waiver Assessment Tool is initially
                              age 21, Child Health Specialty Clinics responsibility for completion.          service workers have responsibility for service workers have responsibility for              management has responsibility for        completed by the facility discharge
                              staff have responsibility for completion.                                      completion.                             completion unless a Medicaid case                    completion.                              planner and by the DHS service worker
                              For age 21 and over, DHS service                                                                                       management is already assigned.                                                               or Medicaid Case Manager annually
                              workers have responsibility for                                                                                                                                                                                      thereafter.
                              completion.
SERVICE PLAN                  Children - Use Form 470-1020, 427-        Use form 470-3156, Long Term Care Children - Use Form 470-1020, 427-1022 or 427-1023, Permanency Plan.                            Children - Use Form 470-1020, 427-       Children - Use Form 470-1020, 427-
(A service plan is completed  1022 or 427-1023, Permanency Plan. Coordinator Common Care Plan.               Adults - Use Form SS-0607-0, Individual Client Service Plan and Progress for                 1022 or 427-1023, Permanency Plan.       1022 or 427-1023, Permanency Plan.
annually.)                    Adults - Use Form SS-0607-0,                                                   Continuation or Closing for Adults.                                                          Adults - Use Form SS-0607-0,             Adults - Use Form SS-0607-0,
                              Individual Client Service Plan and                                                                                                                                          Individual Client Service Plan and       Individual Client Service Plan and
                              Progress for Continuation or Closing                                                                                                                                        Progress for Continuation or Closing     Progress for Continuation or Closing
                              for Adults.                                                                                                                                                                 for Adults.                              for Adults.
MAXIMUM WAIVER SERVICE        ICF - $852                                ICF - $1052                          $1,650                                  ICF/MR - Amount based on services                    $2,650                                   $621
DOLLARS AVAILABLE PER MONTH SNF - $2480                                 SNF - $2480                                                                  upper limit
AS DETERMINED BY LEVEL OF     ICF/MR - $3019
CARE
NOTICE OF DECISION : SERVICES Not used when initial application denied by IM worker. Use when service worker in conjunction with IM worker determines date client eligible for HCBS services.             HCBS services CANNOT be paid before level of care determination date and
FORM 470-0602                 service plan is developed and signed by DHS.
PROVIDER ENROLLMENT                              Agencies enroll with Affiliated Computer Services (ACS), the fiscal agent for DHS, to be providers of service and are reimbursed through ACS. Agencies or individual providers must be enrolled prior to service provision.

HCBS REGIONAL SPECIALISTS             HOLST, JASON                             SOUTH CENTRAL AREA                       PHONE: (515) 725-1140                    FAX: (515) 725-1010                      E-MAIL: jholst@dhs.state.ia.us
                                      DUFFY, LINDA                             NORTH EAST AREA                          PHONE: (563) 690-0078                    FAX: (563) 557-9177                      E-MAIL: lduffy@dhs.state.ia.us
                                      HAMAND, LORI                             NORTH CENTRAL AREA (WEST)                PHONE: (515) 332-1421                    FAX: (515) 332-2211                      E-MAIL: lhamand@dhs.state.ia.us
                                      JAY GREY                                 EAST CENTRAL AREA                        PHONE: (515) 294-8224                    FAX: (515) 294-2638                      E-MAIL: Jgrey@dhs.state.ia.us
                                      KRYUCHKOV, ALEXX                         PROVIDER ENROLLMENT/BILLING              PHONE: (515) 725-1134                    FAX: (515) 725-1010                      E-MAIL: akryuch@dhs.state.ia.us
                                                                               SOUTHWEST AREA
                                      STOWE, SHERRY                            NORTHWEST AREA                           PHONE: (712) 423-9563                    FAX: (712) 423-9503                      E-MAIL: cstowe@dhs.state.ia.us
                                      KIM WILSON                               DM AREA                                  PHONE: (515) 725-1139                    FAX: (515) 725-1010                      E-MAIL: kwilson@dhs.state.ia.us
                                      TURNER, NANCY                            WEST CENTRAL AREA                        PHONE: (712) 769-2640                    FAX: (712) 769-2610                      E-MAIL: nlturn@iastate.edu
                                      WOOD, JANET                              NORTH CENTRAL AREA (EAST)                PHONE: (319) 433-1285                    FAX: (319) 234-5581                      E-MAIL: jwood@dhs.state.ia.us
                                      KOZAK, GINGER                            SOUTHEAST AREA                           PHONE: (641) 682-0747                    FAX; (641) 682-8347                      E-MAIL: gkozak@dhs.state.ia.us
HCBS REG. SPEC. SUPERVISOR            WINES, BRIAN                             HCBS SUPERVISOR                          PHONE: (515) 725-1132                    FAX: (515) 725-1010                      EMAIL: bwines@dhs.state.ia.ua

HCBS PROGRAM MANAGERS        IH WAIVER & MR WAIVER                             ELDERLY WAIVER                           AIDS/HIV, BI & PD WAIVERS
                             SUE STAIRS                                        MICHAELA FUNARO                          JO ANN KAZOR
                             (515) 725-1146                                    (515) 725-1147                           (515) 725-1150
      WAIVER COMPARISON CHARTsstairs@dhs.state.ia.us
                              4-05                                             mfunaro@dhs.state.ia.us                  jkazor@dhs.state.ia.us
     IOWA Department of Human Services                                                         MEDICAID HOME AND COMMUNITY BASED SERVICES PROGRAM                                                                        Page 4
                                                                                                             WAIVER COMPARISON CHART

HCBS CLERICAL                    KROTZ, DENISE                             CENTRAL OFFICE                 PHONE: (515) 725-1138              FAX: (515) 725-1010
                                 TATE, LEZLIE                              CENTRAL OFFICE                 PHONE: (515) 725-1133              FAX: (515) 725-1010

ADDITIONAL RESOURCES:
CHILD HEALTH SPECIALTY CLINICS

REGIONAL OFFICES:                              IOWA CITY                              CARROLL                      COUNCIL BLUFFS                        CRESTON                     DAVENPORT                  DES MOINES
                                              866-219-9119                          (712) 792-5530          (712) 328-6798 OR 866-652-0041             (641) 782-3838               (563) 421-2141             (515) 727-4121
                                               DUBUQUE                              FORT DODGE                      MASON CITY                           OTTUMWA                     SIOUX CITY                   SPENCER
                                             (319) 588-0981                         (515) 955-8326                 (641) 422-7388                      (641) 682-8145               (712) 279-3411         (712) 264-6362 OR 6363
                                                                                                               OR 800-433-3883 X 73688                                          OR 800-352-4660 X 3411
                                              WATERLOO                             W BURLINGTON
                                             (319) 272-2315                         (319 752-6313

DEPARTMENT OF ELDER AFFAIRS                  (515) 242-3333


AREA AGENCIES ON AGING                    AREA I: DECORAH                     AREA II-V-XII: MASON CITY          AREA III: SPENCER                 AREA IV: SIOUX CITY         AREA VI-VII: WATERLOO       AREA VIII: DUBUQUE
                                            (319) 382-2941                           (641)424-0678                 (712) 262-1775                      (712)279-6900                (319) 272-2244            (563) 588-3970
                                   AREA IX: DAVENPORT (563) 324-               AREA X: CEDAR RAPIDS             AREA XI: DES MOINES             AREA XIII: COUNCIL BLUFFS        AREA XIV: CRESTON         AREA XV: OTTUMWA
                                                  9085                               (319) 398-5559                (515) 225-1310                      (712-328-2540                (641) 782-4040            (641) 682-2270
                                        AREA XVI: BURLINGTON
                                            (319) 752-5433
DEPARTMENT OF PUBLIC HEALTH       State Coordinator: Ryan White Title II
                                            (515) 242-5316

HIV C.A.R.E. CONSORTIA           WESTERN IA CARE CONSORTIUM                   SIOUXLAND COMM. HEALTH            NEBRASKA AIDS PROJECT
PROVIDER                                                                    CENTER SIOUX CITY (712) 202-        OMAHA, NE (800) 782-2437
                                                                                         1027
                                 CENTRAL IA CARE CONSORTIUM                AIDS PROJECT OF CENTRAL IOWA MID-IOWA COMM. ACTION AGENCY MID-IOWA COMM. ACTION AGENCY             FORT DODGE AREA HIV/AIDS
                                                                              DES MOINES (515 ) 284-0245    AMES (515) 956-3312 OR 1-800-890- MARSHALLTOWN (641) 752-7162      COALITION (515) 573-4107
                                                                                                                           8230
                                 NE IOWA CARE CONSORTIUM                       CEDAR VALLEY HOSPICE          DUBUQUE REG. AIDS COALITION          RAPIDS AIDS PROJECT
                                                                               WATERLOO (319) 272-2437           (563) 557-4444 EXT. 234       CEDAR RAPIDS (319) 393-3500
                                 SE IOWA CARE CONSORTIUM                     SE IA HIV CARE CONSORTIUM              UI HIV PROGRAM                       ICARE                AIDS PROJECT QUAD CITIES
                                                                            IOWA CITY (319) 356-6038 EXT. 1  IOWA CITY (319) 384-7307 or 353-   IOWA CITY (319) 338-2135     DAVENPORT (563) 421-4265 OR
                                                                                                                           7917                                                     (563) 421-4241




     WAIVER COMPARISON CHART 4-05

								
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