ARC 2164C
HUMAN SERVICES DEPARTMENT[441]
Adopted and Filed Emergency After Notice
Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services amends Chapter 24, “Accreditation of Providers of Services to Persons with Mental Illness, Intellectual Disabilities, or Developmental Disabilities,” Chapter 25, “Disability Services Management,” Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Chapter 83, “Medicaid Waiver Services,” Chapter 88, “Managed Health Care Providers,” and Chapter 90, “Targeted Case Management,” Iowa Administrative Code.
Current administrative rules do not comply with the current versions of medically related resource manuals as specified by the Centers for Medicare and Medicaid Services, pursuant to the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II). Specifically, the administrative rules stipulating services covered under the Iowa Medicaid program currently refer to outdated versions of the following resource manuals: International Classification of Diseases (ICD-10), Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Code on Dental Procedures and Nomenclature (CDT), and American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Addictive, Substance-Related and Co-Occurring Conditions (ASAM-PPC). In order to keep these references current without having to amend them in the future, the Department is amending the administrative rules to refer to the “current version” of the resource.
In addition, the amendments:
• Update the definitions of “mental retardation” and “serious emotional disturbance” and the term “developmental disorders,” pursuant to the current version of the DSM.
• Eliminate the references to “V codes,” pursuant to the change of that designation in the current version of the ICD.
• Update ICD diagnoses listed in subrule 78.8(2) regarding coverage of chiropractic manipulative therapy (CMT), pursuant to the current version of the ICD.
• Update coverage of mental health and substance abuse services in rule 441—88.61(249A) and subrule 88.65(5), pursuant to the current version of the ICD.
• Change the diagnosis of “bulimia” to “bulimia nervosa,” pursuant to the current version of the DSM.
• Eliminate the diagnosis of “bulimarexia,” pursuant to the current version of the DSM.
• Rescind the definition of “International classifications of diseases—fourth edition, ninth revision (ICD-9)” in paragraph 79.1(16)“a” because the term is not used in the current version of subrule 79.1(16) and, therefore, is being removed because it is obsolete.
Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 2062C on July 22, 2015. The Department received comments from one respondent regarding these amendments. The respondent’s comments and the Department’s response are as follows:
The respondent’s comments were regarding Item 4 under this rule making, which generally makes various technical corrections to various current rules, including in Item 4. Item 4 amends subrule 78.1(24), which is related to the application of topical fluoride varnish. The amendment to the subrule updates technical references to the Code on Dental Procedures and Nomenclature. The current version of subrule 78.1(24) and the amended subrule as published under Notice both use the term “physician,” as it relates to such practitioners providing these services. The respondent asserted that the subrule’s language limiting practitioners to “physicians” would exclude other appropriately licensed and competent health professionals from providing these services within the scope of their professional licensure. In this regard, the respondent recommended revising the amendment to 78.1(24) to add the phrase “or auxiliary personnel” after the word “physicians.”
The Department’s response is as follows: It is important to note that the use of the term “physicians” in the context of both the current version of subrule 78.1(24) and the amended version adopted herein is related to the fact that the subrule is under the broader rule 441—78.1(249A) pertaining to “physicians services.” That fact notwithstanding, the Department understands the respondent’s concerns and agrees with the respondent’s reason for revision and has revised the introductory paragraph of subrule 78.1(24) to read as follows:
“78.1(24) Topical fluoride varnish. Payment shall be made for application of an FDA-approved topical fluoride varnish, as defined by the current version of the Code on Dental Procedures and Nomenclature (CDT) published by the American Dental Association, for the purpose of preventing the worsening of early childhood caries in children aged 0 to 36 months of age, when rendered by physicians or other appropriately licensed practitioners under the supervision of or in collaboration with a physician and who are acting within the scope of their practice, licensure, and other applicable state law, subject to the following provisions and limitations:”
Pursuant to Iowa Code section 17A.5(2)“b”(2) as amended by 2015 Iowa Acts, House File 536, section 27, the Department finds that the normal effective date of these amendments, 35 days after the publication, should be waived and the amendments should be made effective October 1, 2015. The normal effective date can be waived since these amendments will confer a benefit on the public. The amendments confer a benefit on the public by ensuring that state regulations remain in compliance with federal regulations and requirements in accordance with federal law. These updates to references were mandated by the Centers for Medicare and Medicaid Services.
The Council on Human Services adopted these amendments on September 9, 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 October 1, 2015.
The following amendments are adopted.
	Item 1. Amend rule 441—24.1(225C), definitions of “Mental retardation” and “Serious emotional disturbance,” as follows:
“Mental retardation Intellectual disability” means a diagnosis of mental retardation intellectual disability (intellectual developmental disorder), global developmental delay, or unspecified intellectual disability (intellectual developmental disorder) under these rules which shall be made only when the onset of the person’s condition was before the age of 18 years during the developmental period and shall be based on an assessment of the person’s intellectual functioning and level of adaptive skills. A licensed psychologist or psychiatrist who is professionally trained to administer the tests required to assess intellectual functioning and to evaluate a person’s adaptive skills shall make the diagnosis. A diagnosis of mental retardation intellectual disability shall be made in accordance with the criteria provided in the current version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association.
“Serious emotional disturbance” means a diagnosable mental, behavioral, or emotional disorder that (1) is of sufficient duration to meet diagnostic criteria for the disorder specified by the current version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), published by the American Psychiatric Association; and (2) has resulted in a functional impairment that substantially interferes with or limits a consumer’s role or functioning in family, school, or community activities. “Serious emotional disturbance” shall not include developmental neurodevelopmental disorders, substance-related disorders, or conditions or problems classified in the current version of the DSM-IV-TR as “other conditions that may be a focus of clinical attention,” (V codes), unless those conditions co-occur with another diagnosable serious emotional disturbance.
	Item 2. Amend paragraph 25.41(2)“c” as follows:
	c. 	Demographic information including date of birth, sex, ethnicity, marital status, education, residential living arrangement, current employment status, monthly income, income sources, type of insurance, insurance carrier, veterans’ status, guardianship status, legal status in the system, source of referral, diagnosis in the current version of the DSM IV diagnosis, diagnosis in the current version of the ICD-9 diagnosis, disability group (i.e., mental retardation intellectual disability, developmental disability, chronic mental illness, mental illness), central point of coordination (county number preceded by A 1), and central point of coordination (CPC) name.
	Item 3. Amend paragraph 25.41(3)“b,” table entries for “DSMIV” and “ICD9,” as follows:

Field Name	Data Type	Field Size	Format	Description	
DSMIV DSM
(current version)	Text	50	 	DSM IV (current version) diagnosis code of client	
ICD9 ICD
(current version)	Text	50	 	ICD-9 (current version) diagnosis code (optional for county use; not tied to CoMIS entry)	
	Item 4. Amend subrule 78.1(24) as follows:
	78.1(24) Topical fluoride varnish. Payment shall be made for application of an FDA-approved topical fluoride varnish, as defined by the current version of the Current Dental Terminology, Third Edition Code on Dental Procedures and Nomenclature (CDT-3), published by the American Dental Association, for the purpose of preventing the worsening of early childhood caries in children aged 0 to 36 months of age, when rendered by physicians or other appropriately licensed practitioners under the supervision of or in collaboration with a physician and who are acting within the scope of their practice, licensure, and other applicable state law, subject to the following provisions and limitations:
	a.  to d.  No change.
	Item 5. Rescind paragraph 78.8(2)“a” and adopt the following new paragraph in lieu thereof:
	a. 	The subluxation must have resulted in a neuromusculoskeletal condition set forth in the table below for which CMT is appropriate treatment. The symptoms must be directly related to the subluxation that has been diagnosed. The mere statement or diagnosis of “pain” is not sufficient to support the medical necessity of CMT. CMT must have a direct therapeutic relationship to the patient’s condition. No other diagnostic or therapeutic service furnished by a chiropractor is covered under the Medicaid program.

ICD	CATEGORY I	ICD	CATEGORY II	ICD	CATEGORY III	
G44.1	Vascular headache NEC<fo:wrapper font-size=".69em" baseline-shift=".33em">*</fo:wrapper>	G54.0-
G54.4	Nerve root and plexus disorders, brachial plexus disorders, lumbosacral plexus disorders, cervical root disorders NEC, thoracic root disorders NEC, lumbosacral root disorders NEC	M48.30-
M48.33	Traumatic spondylopathy, site unspecified, occipito-atlanto-axial region, cervical region, cervicothoracic region	
G44.209	Tension headache, unspecified, not intractable	G54.8	Other nerve root and plexus disorders	M48.35-
M48.38	Traumatic spondylopathy, thoracolumbar region, lumbar region, lumbosacral region, sacral and sacrococcygeal region	
M47.21-
M47.28	Other spondylosis with radiculopathy, occipito-atlanto-axial region, cervical region, cervicothoracic region, thoracic region, thoracolumbar region, lumbar region, lumbosacral region, sacral and sacrococcygeal region	G54.9	Nerve root and plexus disorder, unspecified	M50.20-
M50.23	Other cervical disc displacement	

M47.811-
M47.818	Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region, cervical region, cervicothoracic region, thoracic region, thoracolumbar region, lumbar region, lumbosacral region, sacral and sacrococcygeal region	G55	Nerve root and plexus compressions in diseases classified elsewhere	M50.30-
M50.33	Other cervical disc degeneration	
M47.891-
M47.898	Other spondylosis, occipito-atlanto-axial region, cervical region, cervicothoracic region, thoracic region, thoracolumbar region, lumbar region, lumbosacral region, sacral and sacrococcygeal region	M43.00-
M43.28	Spondylolysis; spondylolisthesis; fusion of spine	M51.24-
M51.27	Other thoracic, thoracolumbar and lumbosacral intervertebral disc displacement	
M54.2	Cervicalgia	M43.6	Torticollis	M51.34-
M51.37	Other thoracic, thoracolumbar and lumbosacral intervertebral disc degeneration	
M54.5	Low back pain	M46.00-
M46.09	Spinal enthesopathy	M54.30-
M54.32	Sciatica	
M54.6	Pain in the thoracic spine	M46.41-
M46.47	Discitis, unspecified, occipito-atlanto-axial region, cervical region, cervicothoracic region, thoracic region, thoracolumbar region, lumbar region, lumbosacral region	M54.40-
M54.42	Lumbago with sciatica	
M54.81	Occipital neuralgia	M48.00-
M48.08	Spinal stenosis	M96.1	Postlaminectomy syndrome, NEC	
M54.89	Other dorsalgia	M48.34	Traumatic spondylopathy, thoracic region	 	 	
M54.9	Dorsalgia, unspecified	M50.10-
M50.13	Cervical disc disorder with radiculopathy	 	 	
R51	Headache	M50.80-
M50.83	Other cervical disc disorders	 	 	
 	 	M50.90-
M50.93	Cervical disc disorder, unspecified	 	 	
 	 	M51.14-
M51.17	Intervertebral disc disorders with radiculopathy, thoracic region, thoracolumbar region, lumbar region, lumbosacral region	 	 	
 	 	M51.84-
M51.87	Other thoracic, thoracolumbar and lumbosacral intervertebral disc disorders	 	 	
 	 	M53.0	Cervicocranial syndrome	 	 	
 	 	M53.1	Cervicobrachial syndrome	 	 	
 	 	M53.2X1-
M53.2X9	Spinal instabilities	 	 	
 	 	M53.3	Sacrococcygeal disorders NEC	 	 	
 	 	M53.80	Other specified dorsopathies, site unspecified	 	 	
 	 	M53.84-
M53.88	Other specified dorsopathies, thoracic region, thoracolumbar region, lumbar region, lumbosacral region, sacral and sacrococcygeal region	 	 	
 	 	M53.9	Dorsopathy, unspecified	 	 	
 	 	M54.10-
M54.18	Radiculopathy	 	 	
 	 	M60.80	Other myositis, unspecified site	 	 	
 	 	M60.811,
M60.812	Other myositis, shoulder, right, left	 	 	
 	 	M60.819	Other myositis, unspecified shoulder	 	 	
 	 	M60.821,
M60.822	Other myositis, upper arm, right, left	 	 	
 	 	M60.829	Other myositis, unspecified upper arm	 	 	
 	 	M60.831,
M60.832	Other myositis, forearm, right, left	 	 	
 	 	M60.839	Other myositis, unspecified forearm	 	 	
 	 	M60.841,
M60.842	Other myositis, hand, right, left	 	 	
 	 	M60.849	Other myositis, unspecified hand	 	 	
 	 	M60.851,
M60.852	Other myositis, thigh, right, left	 	 	
 	 	M60.859	Other myositis, unspecified thigh	 	 	
 	 	M60.861,
M60.862	Other myositis, lower leg, right, left	 	 	
 	 	M60.869	Other myositis, unspecified lower leg	 	 	
 	 	M60.871,
M60.872	Other myositis, ankle and foot, right, left	 	 	
 	 	M60.879	Other myositis, unspecified ankle and foot	 	 	
 	 	M60.88,
M60.89	Other myositis, other site, multiple sites	 	 	
 	 	M60.9	Myositis, unspecified	 	 	
 	 	M62.830	Muscle spasm of back	 	 	
 	 	M72.9	Fibroblastic disorder, unspecified	 	 	
 	 	M79.1	Myalgia	 	 	
 	 	M79.2	Neuralgia and neuritis, unspecified	 	 	
 	 	M79.7	Fibromyalgia	 	 	
 	 	M99.20-
M99.23	Subluxation stenosis of neural canal, head region, cervical region, thoracic region, lumbar region	 	 	
 	 	M99.30-
M99.33	Osseous stenosis of neural canal, head region, cervical region, thoracic region, lumbar region	 	 	
 	 	M99.40-
M99.43	Connective tissue stenosis of neural canal, head region, cervical region, thoracic region, lumbar region	 	 	
 	 	M99.50-
M99.53	Intervertebral disc stenosis of neural canal, head region, cervical region, thoracic region, lumbar region	 	 	
 	 	M99.60-
M99.63	Osseous and subluxation stenosis of intervertebral foramina, head region, cervical region, thoracic region, lumbar region	 	 	
 	 	M99.70-
M99.73	Connective tissue and disc stenosis of intervertebral foramina, head region, cervical region, thoracic region, lumbar region	 	 	
 	 	Q76.2	Congenital spondylolisthesis	 	 	
 	 	S13.4XXA,
S13.4XXD	Sprain of ligaments of cervical spine, initial encounter, subsequent encounter	 	 	
 	 	S13.8XXA,
S13.8XXD	Sprain of joints and ligaments of other parts of neck, initial encounter, subsequent encounter	 	 	
 	 	S16.1XXA,
S16.1XXD	Strain of muscle, fascia and tendon at neck level, initial encounter, subsequent encounter	 	 	
 	 	S23.3XXA,
S23.3XXD	Sprain of ligaments of thoracic spine, initial encounter, subsequent encounter	 	 	
 	 	S23.8XXA,
S23.8XXD	Sprain of other specified parts of thorax, initial encounter, subsequent encounter	 	 	
 	 	S33.5XXA,
S33.5XXD	Sprain of ligaments of lumbar spine, initial encounter, subsequent encounter	 	 	
 	 	S33.6XXA,
S33.6XXD	Sprain of sacroiliac joint, initial encounter, subsequent encounter	 	 	
* NEC means not elsewhere classified.
	Item 6. Amend subrule 78.12(1), definition of “Mental disorder,” as follows:
“Mental disorder” means a disorder, dysfunction, or dysphoria diagnosed pursuant to the current version of 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 7. Amend subparagraph 78.31(4)“b”(1) as follows:
	(1)	General characteristics. Eating disorders are characterized by gross disturbances in eating behavior. Eating disorders include anorexia nervosa, or bulimia, or bulimarexia nervosa. Compulsive overeaters are not acceptable approved for this program.
	Item 8. Amend subparagraph 78.31(4)“b”(4), introductory paragraph, as follows:
	(4)	Admission criteria. In order to be accepted for treatment, the patient shall meet the diagnostic criteria for anorexia nervosa or bulimia nervosa as established by the current version of the DSM III R (Diagnostic and Statistical Manual of Mental Disorders , Third Edition, Revised) published by the American Psychiatric Association.
	Item 9. Amend paragraph 78.45(1)“c” as follows:
	c. 	The member has a validated principal 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 current version of 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 10. Rescind the definition of “International classifications of diseases—fourth edition, ninth revision (ICD-9)” in paragraph 79.1(16)“a.”
	Item 11. Amend subrule 79.1(20) as follows:
	79.1(20) Dentists. The dental fee schedule is based on the definitions of dental and surgical procedures given in the Current Dental Terminology, Third Edition current version of the Code on Dental Procedures and Nomenclature (CDT-3) published by the American Dental Association.
	Item 12. Amend rule 441—83.121(249A), definition of “Serious emotional disturbance,” as follows:
“Serious emotional disturbance” means a diagnosable mental, behavioral, or emotional disorder that (1) is of sufficient duration to meet diagnostic criteria for the disorder specified by the current version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), published by the American Psychiatric Association; and (2) has resulted in a functional impairment that substantially interferes with or limits a consumer’s role or functioning in family, school, or community activities. “Serious emotional disturbance” shall not include developmental neurodevelopmental disorders, substance-related disorders, or conditions or problems classified in the current version of the DSM-IV-TR as “other conditions that may be a focus of clinical attention,” (V codes), unless these conditions co-occur with another diagnosable serious emotional disturbance.
	Item 13. Amend rule 441—88.61(249A), definitions of “ASAM-PPC-2R,” “Mental health services,” “Service necessity” and “Substance abuse services,” as follows:
“ASAM-PPC-2R” shall mean the current version of the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Addictive, Substance-Related Disorders, Second Edition Revised, and Co-Occurring Conditions published by the American Society of Addiction Medicine in 2001.
“Mental health services” shall mean those clinical, rehabilitative, or supportive services provided by an individual, agency, or other entity that is licensed, accredited, certified, or otherwise approved as required by law to treat any mental disorder listed in the current version of the International Classification of Diseases—Ninth Edition (ICD-9) published by the World Health Organization. At a minimum, covered disorders include the following ranges of the ICD-9: 290-302.9; 306-309.9; and 311-314.9 F01, F03 to F06 (mental disorders due to known physiological conditions: vascular dementia, amnestic disorder due to physiological condition, delirium due to physiological condition, other mental disorders due to physiological conditions); F20 to F25, F28, F29 (schizophrenia, schizotypal, delusional and other non-mood psychotic disorders); F30 to F34, F39 (mood (affective) disorders); F40 to F45, F48 (anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders); F50 to F53, F59 (behavioral syndromes associated with physiological disturbances and physical factors: eating disorders, sleep disorders not due to substance/known physiological condition, sexual dysfunction not due to substance/known physiological condition, puerperal psychosis); F60, F63 to F66, F68, F69 (disorders of adult personality and behavior); F84 (except F84.2) (pervasive developmental disorders); and F90 to F95, F98, F99 (behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Additional code ranges may be included in the contract. Mental health services shall include, but not be limited to, those services listed at subrule 88.65(3).
“Service necessity” shall mean that substance abuse services for the treatment of conditions related to substance abuse meet the following requirements according to the criteria of the current version of the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Addictive, Substance-Related, and Co-Occurring Conditions (ASAM-PPC-2R) published by the American Society of Addiction Medicine. The services shall be:
	1. to 5. No change.	
“Substance abuse services” shall mean those clinical, rehabilitative, supportive and other services provided in response to and to alleviate the symptoms of any substance abuse disorder listed in the current version of the International Classification of Diseases—Ninth Edition (ICD-9), published by the World Health Organization, disorders 303 through 305.9 F10 to F19, F55 (mental and behavioral disorders due to known psychoactive substance use), provided by an individual, agency, or other entity that is licensed, accredited, certified, or otherwise approved as required by law to treat any of these substance abuse disorders. Services include, but are not limited to, services listed at subrule 88.65(4).
	Item 14. Amend subrule 88.65(4) as follows:
	88.65(4) Covered and required substance abuse services. The contractor shall ensure, arrange, monitor and reimburse the following services for the treatment of substance abuse:
	a. 	Outpatient services (all Level I 1 services according to the current version of the ASAM-PPC-2R).
	b. 	Intensive outpatient and partial hospitalization services (all Level II 2 services according to the current version of the ASAM-PPC-2R).
	c. 	Residential or inpatient services (all Level III 3 services according to the current version of the ASAM-PPC-2R).
	d. 	Medically managed intensive inpatient services (all Level IV 4 services according to the current version of the ASAM-PPC-2R).
	e.  to j.  No change.
	Item 15. 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 diagnosis pursuant to the current version of 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 current version of the International Classification of Diseases—Ninth Edition (ICD-9) published by the World Health Organization:
	1. a.	Mental health: 290-302.9; 306-309.9; 311-314.9.
	(1)	Mental disorders due to known physiological conditions (vascular dementia, amnestic disorder due to physiological condition, delirium due to physiological condition, other mental disorders due to physiological conditions): ICD codes F01 and F03 to F06.
	(2)	Schizophrenia, schizotypal, delusional and other non-mood psychotic disorders: ICD codes F20 to F25, F28 and F29.
	(3)	Mood (affective) disorders: ICD codes F30 to F34 and F39.
	(4)	Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders: ICD codes F40 to F45 and F48.
	(5)	Behavioral syndromes associated with physiological disturbances and physical factors (eating disorders, sleep disorders not due to substance/known physiological condition, sexual dysfunction not due to substance/known physiological condition, puerperal psychosis): ICD codes F50 to F53 and F59.
	(6)	Disorders of adult personality and behavior: ICD codes F60, F63 to F66, F68 and F69.
	(7)	Pervasive developmental disorders: ICD codes F84 (except F84.2).
	(8)	Behavioral and emotional disorders with onset usually occurring in childhood and adolescence: ICD codes F90 to F95, F98 and F99.
	2. b.	Substance abuse: 303-305.9. Mental and behavioral disorders due to known psychoactive substance use: ICD codes F10 to F19 and F55.
	Item 16. Amend 441—Chapter 90, preamble, as follows:
Preamble
These rules define and structure medical assistance targeted case management services provided in accordance with Iowa Code section 225C.20 for Medicaid members with mental retardation an intellectual disability, a chronic mental illness, or a developmental disability and members eligible for the home- and community-based services (HCBS) children’s mental health waiver. Provider accreditation standards are set forth in 441—Chapter 24.
Case management is a method to manage multiple resources effectively for the benefit of Medicaid members. The service is designed to ensure the health, safety, and welfare of members by assisting them in gaining access to appropriate and necessary medical services and interrelated social, educational, housing, transportation, vocational, and other services.
	Item 17. Amend rule 441—90.1(249A), definitions of “Mental retardation” and “Targeted population,” as follows:
“Mental retardation Intellectual disability” means a diagnosis of mental retardation intellectual disability (intellectual developmental disorder), global developmental delay, or unspecified intellectual disability (intellectual developmental disorder) which:
	1.	Is made only when the onset of the person’s condition was before the age of 18 years during the developmental period;
	2.	Is based on an assessment of the person’s intellectual functioning and level of adaptive skills;
	3.	Is made by a licensed psychologist or psychiatrist who is professionally trained to administer the tests required to assess intellectual functioning and to evaluate a person’s adaptive skills; and
	4.	Is made in accordance with the criteria provided in the current version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association.
“Targeted population” means people who meet one of the following criteria:
	1.	An adult who is identified with a primary diagnosis of mental retardation intellectual disability, chronic mental illness or developmental disability; or
	2.	A child who is eligible to receive HCBS mental retardation intellectual disability waiver or HCBS children’s mental health waiver services according to 441—Chapter 83.
[Filed Emergency After Notice 9/10/15, effective 10/1/15]
[Published 9/30/15]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 9/30/15.