Iowa Administrative Code

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 monitoring and treatment, transportation, adult day care, day habilitatio…

waiver member. 83.67(1) Development. The service plan will be developed by the interdisciplinary team that includes the member, and, if appropriate, the legal representative, member’s family, case manager or service worker, service providers, and others directly involved. 83.67(2…

83.68(1) Denial. An application for services will be denied when it is determined by the department that: a. The applicant is not eligible for the services. b. Service needs exceed the service unit or reimbursement maximums. c. Service needs are not met by the services provided. …

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]

in accordance with 441—paragraph 90.4(1)“b.” Service plans for both children and adults shall be completed every 12 months or when there is significant change in the person’s situation or condition. 83.7(1) The service plan shall include the frequency of the health and disability…

may be eligible for a rent subsidy. More information can be found in 265—Chapter 24. [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 V—BRAIN INJURY WAIVER SERVICES

83.8(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. Needed services are not available or received from qualified providers. c. Service needs exceed the aggregate mont…

“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 and be determined to need a service allowable under the program. 83.82(1) Eligibility criteria. All of the following criteria must be met. The person must: a. Have a diagnosis of brain injury. b. Be eligible for Medicaid under supplemental security income (SS…

83.83(1) Application for financial eligibility. The application process as specified in rules 441—76.1(249A) through 441—76.6(249A) shall be followed. 83.83(2) Approval of application for eligibility. a. Applications for the determination of ability of the member to have all medi…

441—paragraph 75.6(4)“b” (the 300 percent group) must contribute a predetermined participation amount to the cost of brain injury waiver services. 83.84(1) Computation of client participation. Client participation will be computed by deducting an amount for the maintenance needs …

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—83.82(249A). A redetermination will contain the components listed in…

management, respite, personal emergency response, supported community living, behavioral programming, family counseling and training, home and vehicle modification, specialized medical equipment, prevocational services, transportation, supported employment, adult day care, member…

member. The service plan will be developed by an interdisciplinary team that includes the member, and, if appropriate, the legal representative, member’s family, case manager, providers, and others directly involved. The service plan will be stored by the case manager for a minim…

83.88(1) Denial. An application for services will be denied when it is determined by the department that: a. The member is not eligible for the services because all of the medically necessary service needs cannot be met in a home- or community-based setting. b. Service needs exce…

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—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 VI—PHYSICAL DISABILITY WAIVER SERVICES

“Diagnosis” is the determination of the nature of physical or mental disease or abnormality. “Interperiodic screen” means a screen that occurs between the times stated in the periodicity schedule in 441—subrule 78.18(3). “Screening” is the use of quick, simple procedures to sort …

and periodic screening, diagnosis, and treatment. [ARC 9067C, IAB 4/2/25, effective 6/1/25]

§441.56 as amended to August 1, 2024, and may be done by a screening center or other qualified providers. Other qualified providers are physicians, advanced registered nurse practitioners, rural health centers, federally qualified health centers, laboratories, clinics, and dentis…

84.4(1) The availability of early and periodic screening will be discussed with the payee for any Medicaid-eligible child under the age of 21 at the time of application and periodically thereafter in compliance with federal regulations at Title 42, Part 441, Subpart B, as amended…

accepted, but 60 days have elapsed and no screening examination has been performed, and when a screening examination discloses a possible abnormal condition and a referral was made for further diagnosis or treatment and such diagnosis or treatment has not been received within a p…

for the difference between that countable income and $55 if the legislature has appropriated funding specifically for this purpose. This payment shall not be considered a benefit under Title XIX of the Social Security Act (as amended to August 1, 2024). This rule is intended to i…

psychiatric units. 85.1(1) Psychiatric hospitals serving persons aged 21 and older. A psychiatric hospital serving persons aged 21 and older shall meet the federal criteria for an institution for mental disease and shall be licensed pursuant to rule 481—51.23(135B). An out-of-sta…

85.10(1) Age. To be eligible for payment for the cost of care provided by a psychiatric medical institution for children, the person shall be under 21 years of age. When treatment in the facility is provided immediately preceding the individual’s twenty-first birthday, coverage c…

third party shall be paid toward the total cost of care on a monthly basis. The state will pay the balance of the cost of care for the month. The facility shall make arrangements directly with the resident for payment of client participation. Client participation is determined ac…

85.12(1) Medical record requirements. The medical records maintained by psychiatric medical institutions for children shall permit determination of the degree and intensity of the treatment provided to persons who are furnished services in the facility. a. Development of assessme…

medical institution for children will be approved for day treatment services for persons aged 20 or under if the psychiatric medical institution for children is certified by the department of inspections, appeals, and licensing for day treatment services and the services are prov…

be licensed pursuant to 481—Chapter 65, or, if the facility is a distinct part of a hospital, pursuant to rule 481—51.24(135B). A distinct part of a general hospital may be considered a psychiatric institution. In addition, the facility shall be certified to participate in the Io…

mental illness is not payable. [ARC 9312C, IAB 5/28/25, effective 8/1/25]

care provided by nursing facilities for persons with mental illness, persons must be aged 65 or over and be eligible under one of the coverage groups listed in 441—Chapter 75, except for medically needy. [ARC 9312C, IAB 5/28/25, effective 8/1/25]

third party shall be paid toward the total cost of care on a monthly basis. The state will pay the balance of the cost of care for the month. The facility shall make arrangements directly with the resident for payment of client participation. Client participation is determined ac…

85.18(1) Medical record requirements. The facility shall obtain a PRO determination that a person requires psychiatric care when the person applying or eligible for Medicaid enters the facility, returns from an acute care hospital stay longer than 10 days, or enters the facility …

reimbursement shall be the same for nursing facilities for persons with mental illness as for nursing facilities as set forth in 441—Chapter 81. [ARC 9312C, IAB 5/28/25, effective 8/1/25]

requires prior department approval and must be approved only if special services are not available in Iowa. [ARC 9312C, IAB 5/28/25, effective 8/1/25]

intermediate care facility for persons with mental illness who has countable income for purposes of rule

85.3(1) Age. To be eligible for payment for the cost of care provided by a psychiatric hospital, the person shall be under 21 years of age. When treatment in the hospital is provided immediately preceding the person’s twenty-first birthday, coverage continues to be available unti…

provided by an institution for mental disease, persons must be aged 65 or over and be eligible under one of the coverage groups listed in 441—Chapter 75. [ARC 9312C, IAB 5/28/25, effective 8/1/25]

of care, and no client participation amount shall be deducted from the state payment to the hospital. [ARC 9312C, IAB 5/28/25, effective 8/1/25]

85.6(1) Medical record requirements. The medical records maintained by the psychiatric hospital shall permit determination of the degree and intensity of the treatment provided to persons who are furnished services in the hospital. a. Development of assessment and diagnostic data…

85.7(1) Reimbursement formula. Acute care in psychiatric hospitals will be reimbursed on a per diem rate based on Medicare principles. a. The reimbursement principles follow and comply with the retrospective Principles of Medicare reimbursement found in Title 18 of the Social Sec…

85.8(1) Facility. Acute care in a psychiatric hospital is covered for persons aged 21 through 64 only at the state mental health institutes at Cherokee and Independence. 85.8(2) Basis of eligibility. To be eligible for payment for the cost of care provided by one of the covered f…

Psychiatric medical institutions for children will be issued a license by the department of inspections, appeals, and licensing under Iowa Code chapter 135H and will hold either a license from the department under Iowa Code section 237.3(2)“a”(3), or, for facilities that provide …

“Administrative error” means an action of the department that results in incorrect payment of benefits, including premiums paid to a health or dental plan, due to one or more of the following circumstances: 1. Misfiled or lost form or document. 2. Error in typing or copying. 3. C…