Chapter 83. MEDICAID WAIVER SERVICES

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…

Members who are financially eligible under 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 de…

A complete financial redetermination of eligibility for the physical 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 wi…

The services allowable under the physical disability waiver are member-directed attendant care, home and vehicle modification, personal emergency response system, transportation, specialized medical equipment, financial management, independent support brokerage, self- directed pe…

An individualized service plan will be prepared and used for 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 bei…

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…

Notice of adverse action will be given in accordance with rule 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] 441—83.110 to 83.120 Reserved. These rules are intended to implement Iowa Code sections …

“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…

To be eligible for children’s mental health waiver services, a member must 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 certifica…

The Medicaid application process as specified in rules 441—76.1(249A) 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 he…

A member must contribute to the cost of children’s mental 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]

The department will redetermine a member’s eligibility for the 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 …

Services allowable under the children’s mental health waiver will 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; an…

The member’s case manager will prepare an individualized service plan 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 …

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…

Notice of adverse action will be given in accordance with rule 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…

To be eligible for health and disability waiver services, a person must meet 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 determine…

“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: …

To be eligible for elderly waiver services a person must meet certain 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 …

83.23(1) Application for HCBS elderly waiver. The application process as specified in rules 441—76.1(249A) through 441—76.6(249A) shall be followed. 83.23(2) Approval of application. a. Applications for the elderly waiver program will be processed in 30 days unless the worker can…

Persons must contribute their predetermined client participation 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 t…

A complete redetermination of eligibility for elderly waiver services 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…

Services allowable under the elderly waiver are case management, 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 counseli…

The service plan will be completed jointly by the member, the elderly 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 cho…

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 …

Notice of adverse action will be given in accordance with rule 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…

When a household has one person receiving service in accordance 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 service…

Persons must contribute their predetermined financial 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 a…

“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…

To be eligible for AIDS/HIV waiver services a person must meet certain 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 physicia…

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…

Persons must contribute their predetermined financial 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 tha…

A complete redetermination of eligibility for AIDS/HIV waiver 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 r…

Services allowable under the AIDS/HIV waiver are counseling, 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-di…

A service plan will be prepared for AIDS/HIV waiver members in 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 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 …

Notice of adverse action shall be given in accordance with rule 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] 441—83.50 to 83.59 Reserved. These rules are intended to implement Iowa Code section 2…

A complete redetermination of eligibility for the health and disability 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 accorda…

Services allowable under the health and disability waiver are 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, …

“Adaptive” means age-appropriate skills related to taking care of one’s self and one’s 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-dir…

To be eligible for HCBS intellectual disability waiver services, a person 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 …

83.62(1) Application for HCBS intellectual disability waiver services. The application process as specified in rules 441—76.1(249A) through 441—76.6(249A) will be followed. 83.62(2) Approval of application. a. Applications for the HCBS intellectual disability waiver program will …

Persons who are eligible under the 300 percent group must contribute a predetermined client participation amount to the costs of the services. 83.63(1) Computation of client participation. Client participation will be computed by deducting an amount for the maintenance needs of t…

A redetermination of nonfinancial eligibility for HCBS intellectual disability waiver services will be completed at least once every 12 months. In years in which an interRAI assessment is not completed, the core standardized assessment contractor shall conduct a review in collabo…

Services allowable under the HCBS intellectual disability waiver are supported community living, respite, personal emergency response system, nursing, home health aide, home and vehicle modification, supported employment, consumer-directed attendant care, interim medical monitori…