ARC 1850C
HUMAN SERVICES DEPARTMENT[441]
Adopted and Filed
Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services amends Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” and Chapter 88, “Managed Health Care Providers,” Iowa Administrative Code.
These amendments replace references to the multi-axial classification of mental disorders used prior to the implementation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 with appropriate references to the new DSM-5.
Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 1729C on November 12, 2014. The Department received comments from one respondent on these amendments. The respondent requested that the Department modify the proposed amendments to include licensed physician assistant (PA) in the definition of “licensed practitioner of the healing arts.”
The Department agrees with the respondent’s proposed change to the amendments. In Item 2, subrule 78.12(1), the definition of “‘Licensed practitioner of the healing arts’ or ‘LPHA,’” was changed to include “a physician assistant (PA).”
The Council on Human Services adopted these amendments on January 14, 2015.
These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).
After analysis and review of this rule making, no impact on jobs has been found.
These amendments are intended to implement Iowa Code section 249A.4.
These amendments will become effective April 1, 2015.
The following amendments are adopted.
	Item 1. Amend rule 441—78.12(249A), introductory paragraph, as follows:
441—78.12(249A) Behavioral health intervention. Payment will be made for behavioral health intervention services not otherwise covered under this chapter that are designed to minimize or, if possible, eliminate the symptoms or causes of an Axis I psychological a mental disorder, subject to the limitations in this rule.
	Item 2. Amend subrule 78.12(1) as follows:
	78.12(1) Definitions.
“Axis I disorder” means a diagnosed mental disorder, except for personality disorders and mental retardation, as set forth in the “Diagnostic and Statistical Manual IV-TR,” Fourth Edition.
“Behavioral health intervention” means skill-building services that focus on:
	1.	Addressing the mental and functional disabilities that negatively affect a member’s integration and stability in the community and quality of life;
	2.	Improving a member’s health and well-being related to the member’s Axis I mental disorder by reducing or managing the symptoms or behaviors that prevent the member from functioning at the member’s best possible functional level; and
	3.	Promoting a member’s mental health recovery and resilience through increasing the member’s ability to manage symptoms.
“Licensed practitioner of the healing arts” or “LPHA,” as used in this rule, means a practitioner such as a physician (M.D. or D.O.), a physician assistant (PA), an advanced registered nurse practitioner (ARNP), a psychologist, a social worker (LMSW or LISW), a marital and family therapist (LMFT), or a mental health counselor (LMHC) who:
	1.	Is licensed by the applicable state authority for that profession;
	2.	Is enrolled in the Iowa Plan for Behavioral Health (Iowa Plan) pursuant to 441—Chapter 88, Division IV; and
	3.	Is qualified to provide clinical assessment services (Current Procedural Terminology code 90801) under the Iowa Plan pursuant to 441—Chapter 88, Division IV.
“Mental disorder” means a disorder, dysfunction, or dysphoria diagnosed pursuant to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association, excluding intellectual disabilities, personality disorders, medication-induced movement disorders and other adverse effects of medication, and other conditions that may be a focus of clinical attention.
	Item 3. Amend paragraph 78.12(6)“a” as follows:
	a. 	Consistent with the diagnosis and treatment of the member’s condition and specific to a daily impairment caused by an Axis I a mental disorder;
	Item 4. Amend paragraph 78.45(1)“c” as follows:
	c. 	The member has a validated principal DSM-IV-TR Axis I mental health diagnosis consistent with a severe and persistent mental illness. For this purpose, a mental health diagnosis means a disorder, dysfunction, or dysphoria diagnosed pursuant to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association, excluding neurodevelopmental disorders, substance-related disorders, personality disorders, medication-induced movement disorders and other adverse effects of medication, and other conditions that may be a focus of clinical attention. Members with a primary diagnosis of substance-related disorder, developmental disability, or organic disorder are not eligible for ACT services.
	Item 5. Amend subrule 88.65(5) as follows:
	88.65(5) Covered diagnoses. Services for a covered diagnosis cannot be denied solely on the basis of an individual’s also having a noncovered diagnosis. Mental health services, including inpatient care, cannot be denied solely on the basis of an individual’s having no Axis I diagnosis pursuant to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association. The contractor will be responsible for ensuring, arranging, monitoring, and reimbursing services necessary for the behavioral care and treatment of the covered diagnoses for Iowa Plan enrollees who are diagnosed with a covered diagnosis and a noncovered diagnosis.
The services defined at subrules 88.65(3) and 88.65(4) shall be provided to all Iowa Plan enrollees who meet the diagnostic criteria for the following disorders listed in the International Classification of Diseases—Ninth Edition (ICD-9):
	1.	Mental health: 290-302.9; 306-309.9; 311-314.9.
	2.	Substance abuse: 303-305.9.
[Filed 1/15/15, effective 4/1/15]
[Published 2/4/15]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/4/15.