Chapter 83. MEDICAID WAIVER SERVICES

determinations are completed. c. Eligibility for the waiver continues until the recipient has been in a medical institution for 120 consecutive days for other than respite care or fails to meet eligibility criteria listed in rule 441—83.42(249A). Recipients who are inpatients in …

83.23(2) Approval of application. a. Applications for the elderly waiver program will be processed in 30 days unless the worker can document difficulty in locating and arranging services or circumstances beyond the worker’s control. In these cases a decision will be made as soon …

“Blind” means an individual has a central visual acuity of 20/200 or less in the better eye with the use of a corrective lens or visual field restriction to 20 degrees or less. “Client participation” means the amount of the recipient income that the person must contribute to the …

These rules are intended to implement Iowa Code sections 249A.3 and 249A.4. DIVISION II—HCBS ELDERLY WAIVER SERVICES

“Adaptive” means age-appropriate skills related to taking care of one’s self and the ability to relate to others in daily living situations. These skills include limitations that occur in the areas of communication, self-care, home living, social skills, community use, self-direc…

eligibility criteria set forth in subrule 83.102(1) and be determined to need a service allowable under the program per subrule 83.102(2). 83.102(1) Eligibility criteria. All of the following criteria must be met. The person must: a. Have a physical disability. b. Be blind or dis…

83.103(1) Application for financial eligibility. The application process as specified in rules 441—76.1(249A) through 441—76.6(249A) will be followed. 83.103(2) Approval of application for eligibility. a. Applications for this waiver will be initiated on behalf of the applicant w…

441—paragraph 75.6(4)“b” (the 300 percent group) must contribute a client participation amount to the cost of physical disability waiver services. 83.104(1) Computation of client participation. Client participation will be computed by deducting a maintenance needs allowance equal…

disability waiver will be completed at least once every 12 months. A redetermination of continuing eligibility factors will be made when a change in circumstances occurs that affects eligibility in accordance with rule 441—83.102(249A). A redetermination will contain the componen…

member-directed attendant care, home and vehicle modification, personal emergency response system, transportation, specialized medical equipment, financial management, independent support brokerage, self- directed personal care, self-directed community supports and employment, an…

each HCBS physical disability waiver member. The service plan will be developed and approved by the member, the member’s interdisciplinary team and the designated case manager prior to services beginning and payment being made to the provider. 83.107(1) Information in plan. The p…

83.108(1) Denial. An application for services will be denied when it is determined by the department that: a. All of the medically necessary service needs cannot be met in a home- or community-based setting. b. Service needs exceed the reimbursement maximums. c. Service needs are…

441—16.2(17A). The right to appeal will be given in accordance with 441—Chapter 2506. [ARC 0318D, IAB 5/27/26, effective 7/1/26]

These rules are intended to implement Iowa Code sections 249A.3 and 249A.4. DIVISION VII—HCBS CHILDREN’S MENTAL HEALTH WAIVER SERVICES

“Assessment” means the review of the member’s current functioning in regard to the member’s situation, needs, abilities, desires, and goals. “Case manager” means the person designated to provide Medicaid targeted case management services for the member. “CMS” means the Centers fo…

meet all of the following requirements: 83.122(1) Age. The member must be under 18 years of age. 83.122(2) Diagnosis. The member must be diagnosed with a serious emotional disturbance. a. Initial certification. For initial application to the HCBS children’s mental health waiver p…

through 441—76.6(249A) will be followed for an application for HCBS children’s mental health waiver services. 83.123(1) Program limit. The number of persons who may be approved for the HCBS children’s mental health waiver shall be subject to the number of members to be served as …

health waiver services to the extent of the member’s total income less 300 percent of the maximum monthly payment for one person under the federal SSI program. [ARC 0318D, IAB 5/27/26, effective 7/1/26]

children’s mental health waiver at least once every 12 months or when there is significant change in the member’s situation or condition. 83.125(1) Eligibility review. a. Every 12 months, the department will review a member’s eligibility in accordance with procedures in rule 441—…

be provided as set forth in rule 441—78.52(249A) and will include: 1. Environmental modifications, adaptive devices and therapeutic resources; 2. Family and community support services; 3. In-home family therapy; and 4. Respite care. [ARC 0318D, IAB 5/27/26, effective 7/1/26]…

for each member that meets the requirements set for case plans in rule 441—130.7(234). 83.127(1) The service plan will be developed through an interdisciplinary team process. 83.127(2) The service plan will be developed annually or when there is significant change in the member’s…

83.128(1) Denial. An application for children’s mental health waiver services will be denied when the department determines that: a. The member is not eligible for or in need of waiver services. b. Needed services are not available or received from qualified providers. c. Service…

441—16.2(17A). The right to appeal will be given in accordance with 441—Chapter 2506. [ARC 0318D, IAB 5/27/26, effective 7/1/26] These rules are intended to implement Iowa Code section 249A.4. [Filed emergency 8/31/84—published 9/26/84, effective 10/1/84] [Filed 1/22/86, Notice 1…

certain eligibility criteria and be determined to need a service(s) allowable under the program. 83.2(1) Eligibility criteria. a. The person must be under the age of 65 and blind or disabled as determined by the receipt of social security disability benefits or by a disability de…

“Basic individual respite” means respite provided on a staff-to-member ratio of one to one or higher to individuals without specialized needs requiring the care of a licensed registered nurse or licensed practical nurse. “Case management” means the categories of case management: …

eligibility criteria and be determined to need a service(s) allowable under the program. 83.22(1) Eligibility criteria. All of the following criteria must be met. The person must be: a. Sixty-five years of age or older. b. A resident of the state of Iowa. c. Eligible for Medicaid…

83.23(1) Application for HCBS elderly waiver. The application process as specified in rules

to the cost of elderly waiver services. 83.24(1) Computation of client participation. Client participation will be computed by deducting an amount for the maintenance needs of the individual that is 300 percent of the maximum supplemental security income (SSI) grant for an indivi…

will be done at least once every 12 months. A redetermination of continuing eligibility factors will be made when a change in circumstances occurs that affects eligibility in accordance with rule 441—83.22(249A). A redetermination will contain the components listed in rule 441—83…

adult day care, emergency response system, homemaker, home health aide, nursing, respite care, chore, home-delivered meals, home and vehicle modification, mental health outreach, transportation, nutritional counseling, assistive devices, senior companions, consumer-directed atten…

waiver case manager, and any other person identified by the member. 83.27(1) The service plan will indicate whether the member has elected the consumer choices option. If the member has elected the consumer choices option, the service plan will identify: a. The independent suppor…

83.28(1) Denial. An application for services will be denied when it is determined by the department that: a. The client is not eligible for or in need of services. b. Except for respite care, the elderly waiver services are not needed on a regular basis. c. Service needs are not …

441—16.2(17A). The right to appeal shall be given in accordance with 441—Chapter 2506. [ARC 0318D, IAB 5/27/26, effective 7/1/26]

83.3(1) Application for HCBS health and disability waiver services. The application process as specified in rules 441—76.1(249A) through 441—76.6(249A) shall be followed. 83.3(2) Application and services program limit. The number of persons who may be approved for the HCBS health…

with rules set forth in 441—Chapter 24 and another receiving elderly waiver services, the persons providing case management will cooperate to make the best plan for both clients. When a person is eligible for services as set forth in 441—Chapter 24 and eligible for services under…

These rules are intended to implement Iowa Code sections 249A.3 and 249A.4. DIVISION III—HCBS AIDS/HIV WAIVER SERVICES

participation to the cost of health and disability waiver services or other Medicaid services, as applicable. 83.4(1) Maintenance needs of the individual. The maintenance needs of the individual will be computed by deducting an amount that is 300 percent of the maximum monthly pa…

“AIDS” means a medical diagnosis of acquired immunodeficiency syndrome based on the Centers for Disease Control “Revision of the CDC Surveillance Case Definition for Acquired Immunodeficiency Syndrome,” August 14, 1987, Vol. 36, No. 1S issue of “Morbidity and Mortality Weekly Rep…

eligibility criteria and be determined to need a service(s) allowable under the program. 83.42(1) Eligibility criteria. All of the following criteria must be met. The person must: a. Be diagnosed by a physician as having AIDS or HIV infection. b. Be certified in need of the level…

83.43(1) Application for HCBS AIDS/HIV waiver services. The application process as specified in rules 441—76.1(249A) through 441—76.6(249A) shall be followed. 83.43(2) Approval of application. a. Applications for the HCBS AIDS/HIV waiver program will be processed in 30 days unles…

participation to the cost of AIDS/HIV waiver services or other Medicaid services, as applicable. 83.44(1) Maintenance needs of the individual. The maintenance needs of the individual will be computed by deducting an amount that is 300 percent of the maximum monthly payment for on…

services will be completed at least once every 12 months or when there is significant change in the person’s situation or condition. A redetermination of continuing eligibility factors will be made in accordance with rules 441—76.17(249A) and 441—83.42(249A). A redetermination wi…

home health aide, homemaker, nursing care, respite care, home-delivered meals, adult day care, consumer- directed attendant care, financial management, independent support brokerage, self-directed personal care, self-directed community supports and employment, and individual-dire…

accordance with rule 441—130.7(234) except that service plans for both children and adults will be completed every 12 months or when there is significant change in the person’s situation or condition. 83.47(1) The service plan will include the frequency of the AIDS/HIV waiver ser…

83.48(1) Denial. An application for services will be denied when it is determined by the department that: a. The client is not eligible for or in need of services. b. Except for respite care, the AIDS/HIV waiver services are not needed on a regular basis. c. Service needs exceed …

441—16.2(17A). The right to appeal shall be given in accordance with 441—Chapter 2506. [ARC 0318D, IAB 5/27/26, effective 7/1/26]

waiver shall be completed at least once every 12 months or when there is significant change in the person’s situation or condition. A redetermination of continuing eligibility factors shall be made in accordance with rules 441—76.17(249A) and 441—83.2(249A). A redetermination sha…

These rules are intended to implement Iowa Code section 249A.4. DIVISION IV—HCBS INTELLECTUAL DISABILITY WAIVER SERVICES

homemaker, home health, adult day care, respite care, nursing, counseling, consumer-directed attendant care, interim medical monitoring and treatment, home and vehicle modification, personal emergency response system, home-delivered meals, nutritional counseling, financial manage…

must meet certain eligibility criteria and be determined to need a service(s) available under the program. 83.61(1) Eligibility criteria. All of the following criteria must be met. The person must: a. Have a diagnosis of intellectual disability as defined in rule 441—83.60(249A).…