ARC 4209C
HUMAN SERVICES DEPARTMENT[441]
Adopted and Filed
Rule making related to health and disability waiver
The Human Services Department hereby amends Chapter 83, “Medicaid Waiver Services,” Iowa Administrative Code.
Legal Authority for Rule Making
This rule making is adopted under the authority provided in Iowa Code section 249A.4.
State or Federal Law Implemented
This rule making implements, in whole or in part, Iowa Code section 249A.4 and 42 U.S.C. Section 1396n(d).
Purpose and Summary
These amendments change the eligibility criteria for health and disability waiver participation. This change to the criteria will broaden the population that will be eligible for the waiver. While the change will not increase the number of members served at one time, the change will allow for an expanded population.
These amendments also revise the language regarding increasing the waiver budgets by putting in place specific guidelines for the process and cost limitations. Providers, members, case managers, and managed care organizations will have greater clarity regarding how the waiver service is to be administered because the amendments further define the benefits associated with the waiver.
Public Comment and Changes to Rule Making
Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on October 24, 2018, as ARC 4089C. The Department received no comments during the public comment period. No changes from the Notice have been made.
Adoption of Rule Making
This rule making was adopted by the Council on Human Services on December 12, 2018.
Fiscal Impact
This rule making has no fiscal impact to the State of Iowa.
Jobs Impact
After analysis and review of this rule making, no impact on jobs has been found.
Waivers
Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).
Review by Administrative Rules Review Committee
The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).
Effective Date
This rule making will become effective on February 6, 2019.
The following rule-making actions are adopted:
	Item 1. Rescind and reserve paragraph 83.2(1)“b.”
	Item 2. Amend paragraph 83.2(2)“b” as follows:
	b. 	Except as provided below, the total monthly cost of the health and disability waiver services, excluding the cost of home and vehicle modification services, shall not exceed the established aggregate monthly cost for level of care as follows:

Skilled level of care	Nursing level of care	ICF/ID	
$2,792.65	$959.50	$3,742.93	
For members eligible for SSI who remain eligible for health and disability waiver services until the age of 25 because they are receiving health and disability waiver services upon reaching the age of 21, these amounts shall be increased by the cost of services for which the member would be eligible under 441—subrule 78.9(10) if still under 21 years of age.
For members enrolled in the health and disability waiver in accordance with subrule 83.2(1), when a member turns 21 years of age, the average monthly cost of services received through 441—subrule 78.9(10) (state plan private duty nursing or personal care services for persons aged 20 and under) shall be used to increase the monthly waiver budget in accordance with the following:
	(1)	The member must request the revised waiver budget through the member’s case manager no earlier than two months before, and no later than six months after, the member’s twenty-first birthday. A renewal request must be received annually no earlier than two months before, and no later than six months after, each subsequent birthday.
	(2)	The member’s waiver budget shall be increased by the average monthly cost of state plan private duty nursing or personal care services for the member that was billed to and paid by Iowa Medicaid or an Iowa Medicaid-contracted managed care organization during the year in which the member is 20 years of age.
	(3)	Once the request is received by the department, the department shall determine the average monthly cost pursuant to the claims data available at the time of the request. No subsequent claims data shall be considered.
	(4)	The revised waiver budget reflecting the average cost of state plan private duty nursing or personal care services shall become effective on the later of the first day of the month of the member’s twenty-first birthday or the first day of the month of the completed review.
	(5)	The revised waiver budget shall extend up to the first of the month following the member’s twenty-fifth birthday and shall remain at the initially authorized amount for the member while aged 21 through 24.
[Filed 12/12/18, effective 2/6/19]
[Published 1/2/19]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 1/2/19.