CHAPTER 25
DISABILITY SERVICES MANAGEMENT
Preamble
This chapter provides for reporting of county expenditures, development and submission of management plans, data collection, and applications for funding as they relate to county service systems for people with mental illness, chronic mental illness, intellectual disabilities, developmental disabilities, or brain injury.
[ARC 0576C, IAB 2/6/13, effective 1/8/13]
DIVISION I
DETERMINATION OF STATE PAYMENT AMOUNT
[Rescinded IAB 1/16/08, effective 2/20/08]
441—25.1 to 25.10 Reserved.
DIVISION II
COUNTY MANAGEMENT PLAN
Preamble
These rules define the standards for county management plans for mental health, mental retardation, and developmental disability services, including the single point of entry process for accessing services and supports paid from the county mental health, mental retardation, and developmental disability services fund (Iowa Code section 331.424A). Each county must complete a plan in order to meet the requirements of Iowa Code section 331.439. The single point of entry process is hereinafter called the central point of coordination (CPC). The CPC is an administrative gatekeeper to the service’s fund and is not meant to replace case management or service coordination. The county management plan describes how persons with disabilities receive appropriate services and supports within the financial limitations of federal, state, and county resources. In partnership with the state, the county develops a management plan that describes the capacities of the county to manage the county mental health, mental retardation, and developmental disability services fund in a manner that is cost-efficient. These rules are designed to give counties maximum flexibility to manage the public mental health and developmental disabilities (MH/DD) system themselves or, if a county so chooses, to contract with a private managed care company to manage all or part of the county’s system. However, even when a county contracts with a private entity to manage its system, the county must approve the county management plan in which it defines the parameters of consumer eligibility and service criteria to be used by the contractor. The county management plan shall be guided by the following principles: choice, empowerment, and community.
441—25.11(331) Definitions.
“Access point” means a part of the service system or the community that shall be trained to complete applications for persons with a disability and forward them to the central point of coordination. Access points may include, but need not be limited to, providers, public or private institutions, advocacy organizations, legal representatives, and educational institutions.
“Applicant” means a person who applies to receive services and supports from the service system.
“Assistive technology account” means funds in contracts, savings, trust or other financial accounts, financial instruments, or other arrangements with a definite cash value that are set aside and designated for the purchase, lease, or acquisition of assistive technology, assistive technology services, or assistive technology devices. Assistive technology accounts must be held separately from other accounts. Funds must be used to purchase, lease, or otherwise acquire assistive technology services or devices for a working person with a disability. Any withdrawal from an assistive technology account other than for the designated purpose becomes a countable resource.
“Authorized representative” means a person designated by the consumer or by Iowa law to act on the person’s behalf in specified affairs to the extent prescribed by law.
“Board” means a county board of supervisors.
“Central point of coordination (CPC)” means the administrative entity designated by a board, or the boards of a consortium of counties, to act as the single entry point to the service system as required in Iowa Code section 331.440.
“Clinical assessment” means those activities conducted by a qualified professional to identify the consumer’s current level of functioning and to identify the appropriate type and intensity of services and supports.
“Commission” means the mental health, mental retardation, developmental disabilities, and brain injury commission established in Iowa Code section 225C.5.
“Consortium” means two or more counties that join together to carry out the responsibilities of this division.
“Consumer” means a person who is eligible to receive services and supports from the service system.
“Countable resource” means real or personal property that has a cash value that is available to the owner upon disposition and is capable of being liquidated.
“Countable value” means the equity value of a resource, which is the current fair market value minus any legal debt on the item.
“County” means a single county or a consortium of counties legally organized to develop and implement the county management plan.
“County management plan” means the county plan, developed pursuant to Iowa Code section 331.439, for organizing, financing, delivering, and evaluating mental health, mental retardation, and developmental disabilities services and supports in a manner that deliberately seeks to control costs while delivering high-quality mental health, mental retardation, and developmental disabilities services and supports. The plan shall consist of three parts: (1) a policies and procedures manual, (2) a three-year strategic plan, and (3) an annual plan review.
“County of residence” means the county in Iowa where, at the time an adult applies for or receives services, the adult is living and has established an ongoing presence with the declared, good-faith intention of living permanently or for an indefinite period. The county where a person is “living” does not mean the county where a person is present for the purpose of receiving services in a hospital, a correctional facility, a halfway house for community corrections or substance abuse treatment, a nursing facility, an intermediate care facility for persons with mental retardation, or a residential care facility or for the purpose of attending a college or university. For an adult who is an Iowa resident and who falls within the exclusion for county where a person is “living” as described in this rule, the county where the adult is physically present and receiving services shall be the county of residence. The county of residence of an adult who is a homeless person is the county where the adult usually sleeps.
“CPC administrator” means a person who possesses a baccalaureate degree from an accredited school and has demonstrated competency in human services program administration and planning and has two years of experience working with people with disabilities. A person continually employed by a county to implement a central point of coordination process or to perform similar duties, prior to April 1, 1996, shall be considered to be a qualified CPC administrator. This exemption shall only be valid for a person initially appointed as CPC administrator for fiscal year 1997. An individual employed under this exemption and continually employed as a CPC administrator may be employed by any county as a CPC administrator.
“Department” means the Iowa department of human services.
“Director” means the director of the Iowa department of human services.
“Emergency service” means a service needed immediately to protect the life or safety of a consumer or others.
“Evaluation” means evaluation services as described in 441—subrule 24.4(16).
“Exempt resource” means a resource that is disregarded in the determination of eligibility for public funding assistance and in the calculation of client participation amounts.
“Household,” for consumers who are 18 years of age or over, means the consumer, the consumer’s spouse or domestic partner, and any children, stepchildren, or wards under the age of 18 who reside with the consumer. For consumers under the age of 18, “household” means the consumer, the consumer’s parents (or parent and domestic partner), stepparents or guardians, and any children, stepchildren, or wards under the age of 18 of the consumer’s parents (or parent and domestic partner), stepparents, or guardians who reside with the consumer.
“Income” means all gross income received by the consumer’s household, including but not limited to wages, income from self-employment, retirement benefits, disability benefits, dividends, annuities, public assistance, unemployment compensation, alimony, child support, investment income, rental income, and income from trust funds.
“Individualized services” means services and supports that are tailored to meet the individual needs of the consumer.
“Legal settlement” is as defined in Iowa Code sections 252.16 and 252.17.
“Liquid assets” means assets that can be converted to cash in 20 days. These include but are not limited to cash on hand, checking accounts, savings accounts, stocks, bonds, cash value of life insurance, individual retirement accounts, certificates of deposit, and other investments.
“Managed care” means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors:
	1.	Achieving high-quality outcomes for participants.
	2.	Coordinating access.
	3.	Containing costs.
“Managed system” means a system that integrates planning, administration, financing, and service delivery. The system consists of the financing or governing organization, the entity responsible for care management, and the network of service providers.
“Management organization” means an organization contracted to manage part or all of the service system for a county.
“Medical savings account” means an account that is exempt from federal income taxation pursuant to Section 220 of the United States Internal Revenue Code (26 U.S.C. §220) as supported by documentation provided by the bank or other financial institution. Any withdrawal from a medical savings account other than for the designated purpose becomes a countable resource.
“Nonliquid assets” means assets that cannot be converted to cash in 20 days. Nonliquid assets include, but are not limited to, real estate, motor vehicles, motor vessels, livestock, tools, machinery, and personal property.
“Provider” means a person or group of persons or agency providing services for people with disabilities.
“Qualified professional” means a person who has education, training, licensure, certification, or experience to make the particular decision at issue as required by federal or state law.
“Resources” means all liquid and nonliquid assets owned in part or in whole by the consumer household that could be converted to cash to use for support and maintenance and that the consumer household is not legally restricted from using for support and maintenance.
“Retirement account” means any retirement or pension fund or account listed in Iowa Code section 627.6(8)“f.”
“Retirement account in the accumulation stage” means a retirement account into which a deposit was made in the previous tax year. Any withdrawal from a retirement account becomes a countable resource.
“Screening” means the process used by the central point of coordination to determine eligibility for the service system.
“Service coordinator” means a person as defined in rule 441—22.1(225C). For purposes of these rules this may include department social workers providing social casework as defined in rule 441—130.6(234), county caseworkers, county social workers, or qualified case managers as defined in rule 441—24.1(225C).
“Services fund” means the county mental health, mental retardation, and developmental disability services fund created in Iowa Code section 331.424A, subsection 2.
“Service system” refers to the services and supports administered and paid from the county mental health, mental retardation, and developmental disability services fund.
“State case status” is the status of a person who does not have a county of legal settlement as defined in Iowa Code sections 252.16 and 252.17.
“System principles” means:
	1.	“Choice” which means the consumer or authorized representative chooses the services, supports, and goods needed to best meet the consumer’s individual goals and accepts the responsibility and consequences of those choices.
	2.	“Community” which means that the system ensures the rights and abilities of all consumers to live, learn, work, and recreate in natural communities of their choice.
	3.	“Consumer empowerment” which means that the service system ensures the rights, dignity, and ability of consumers and their families to exercise choices, take risks, provide input, and accept responsibility.
“Unique identifier” means the social security number or the personal identifier for a consumer determined using a methodology adopted by the state-county management committee.
[ARC 7768B, IAB 5/20/09, effective 7/1/09]
441—25.12(331) County management plan—general criteria. A county shall develop a plan for providing an array of cost-effective, individualized services and supports that assist the consumers to be as independent, productive, and integrated into the community as possible within the constraints of the services fund.
	25.12(1) Geographical area. The plan shall define the geographical area covered by the plan.
	25.12(2) Three-part plan. The plan shall consist of three parts:
	a. 	A policies and procedures manual.
	b. 	A management plan annual review.
	c. 	A three-year strategic plan.
441—25.13(331) Policies and procedures manual. The policies and procedures manual shall describe system management and plan administration.
	25.13(1) System management section. The system management section of the manual shall describe, but shall not be limited to, the following:
	a. 	Plan development. The process for the development of the policies and procedures manual, the strategic plan, and amendments to those documents shall involve the various stakeholders in a meaningful way. These stakeholders shall include, but not be limited to, consumers, family members, county officials, advocates, and providers. The process used to involve the stakeholders shall be documented in the strategic plan including how stakeholder input was considered in the development of the final plan. Each process shall include at least one public hearing.
	b. 	Plan administration. A statement that the county will directly administer the plan or a description of the management organization responsible for plan administration shall be included in the plan. If the county contracts for plan administration, the plan shall contain a description of how the county will monitor the management organization’s performance through designated county staff or through another contractor independent of the management organization. The management organization shall comply with Iowa Code section 331.439(1)“c.”
	c. 	The financial accountability process. The process to ensure the ongoing financial accountability of the plan shall be included. Financial accountability shall include the rate-setting and reimbursement methods used to reimburse service and support providers, which may include vouchers and other nontraditional payment mechanisms.
	d. 	Risk-bearing managed care contracts. A county that enters a risk-bearing contract shall include the methodology used to determine the solvency of any plan administered by a management organization in its policies and procedures manual. This shall include, but not be limited to:
	(1)	A required annual independent audit of the management organization responsible for plan administration.
	(2)	The rate-setting and reimbursement methods used by the county to reimburse the management organization.
	(3)	Description of contract requirements prohibiting a management organization from achieving administrative costs or profit from elimination or reduction of services appropriate to consumer needs.
	e. 	A funding policy. A policy shall be included indicating that the county is responsible for funding only those services and supports that are authorized in accordance with the process described in the county management plan (including those that are required by law).
	f. 	Conflict of interest policy. The manual shall describe a conflict of interest policy that shall, at a minimum, ensure that service authorization decisions are either made by individuals or organizations which have no financial interest in the services or supports to be provided, or that such interest is fully disclosed to consumers, counties, and other stakeholders. The process for this disclosure shall be described in the manual.
	g. 	Provider network selection. The manual shall require that providers that are subject to license, accreditation or approval meet established standards. The manual shall detail the approval process, including criteria, developed to select providers that are not currently subject to license, accreditation or approval standards. The manual shall identify the process the county will use to contract with providers.
	h. 	Delegated functions. A county may contract with providers to perform functions of the central point of coordination for persons coming to the designated provider for service or may contract with a management organization to carry out the functions of the central point of coordination. When delegation is made, the county shall be responsible for ensuring that the contractor complies with Iowa Code section 331.440 as well as 441—Chapter 25 for any delegated duties and responsibilities.
	i. 	Access points. The county shall designate access points and their function in the enrollment process. A process shall be included to ensure that applications received by an access point are forwarded by the end of the working day during which they are received to the consumer’s county of residence. The county shall provide training to designated access points on the intake process and use of the application form.
	j. 	Staffing plan. The county shall employ, directly or through contract, an adequate number of staff persons to administer the plan. At least one person who meets the qualifications of a central point of coordination administrator shall be designated to implement the central point of coordination process. Elected county or state officials shall not be hired or appointed as the central point of coordination administrator.
	k. 	Application form. The policies and procedures manual shall designate the use of an application form, which shall be available in formats and languages appropriate to consumers’ needs.
	l. 	Consumer access. The manual shall describe how the county will provide access to appropriate, flexible, cost-effective community services and supports to meet the consumer needs in the least restrictive environment possible. This may include guidelines for individualized services and supports and may vary by eligibility group and type of service and support. The manual shall describe how the county of residence will ensure access to services and supports while legal settlement is determined or in dispute.
	m. 	Consumer eligibility. The manual shall describe the eligibility criteria for services and supports. This description shall include, but not be limited to, a description of who is eligible to receive services and supports by eligibility group and type of service or support. Financial eligibility and copayment criteria shall meet the requirements of rule 441—25.20(331).
	n. 	Confidentiality. The manual shall describe a confidentiality policy that shall ensure compliance with all applicable state and federal statutes on confidentiality.
	o. 	Emergency services. The manual shall specify the policy for accessing emergency services, including the county’s protocol for voluntary and involuntary commitments. The policy shall include the criteria and time frames for application for emergency services.
	p. 	Waiting lists. The policies and procedures manual shall specify if the county will use waiting lists, when needed. If the policies and procedures manual specifies the use of waiting lists for funding services and supports, it shall specify criteria for the use and review of each waiting list, including the criteria to be used to determine how and when a consumer will be placed on a waiting list. The manual shall specify how waiting list data will be used in future planning. If the county enters into a risk-bearing contract with a management organization, the contract shall specify that the management organization shall not use waiting lists.
	q. 	Quality assurance. The policies and procedures manual shall describe a detailed quality improvement process that provides for ongoing and periodic evaluation of the service system and of the providers of services and supports in the system. The stakeholders shall be involved in the development and implementation of the quality assurance process and evaluation of the system with emphasis on consumer input. The quality assurance policies shall include, but not be limited to, the following:
	(1)	System evaluation. The system evaluation shall include, but not be limited to, an evaluation of consumer satisfaction, including empowerment and quality of life; provider satisfaction; patterns of service utilization; responsiveness to consumer needs and desires; the number and disposition of consumer appeals and the implementation of corrective action plans based on these appeals; and cost-effectiveness.
	(2)	Quality of provider services. The services and supports evaluation shall include, but not be limited to, an evaluation of the quality of provider services and supports based on consumer satisfaction and achievement of desired consumer outcomes; the number and disposition of appeals of provider actions and the implementation of corrective action plans based on these appeals; and the cost-effectiveness of the services and supports developed and provided by individual providers. The evaluation shall ensure that services and supports are provided in accordance with provider contracts.
	r. 	Collaboration. The policies shall describe the county’s collaboration with other funders, service providers, consumers and their families or authorized representatives, and advocates to ensure that authorized services and supports are responsive to consumers’ needs and desires and are cost-efficient. The manual shall specifically describe the process for collaboration with the court to ensure that the court is aware of the services and supports available through the county management plan as alternatives to commitment and to coordinate funding for services to persons who are under court-ordered commitment pursuant to Iowa Code chapter 222 or 229.
	s. 	The ongoing education process. The plan shall include the process the county will use to provide ongoing education, in various accessible formats, on its planning process and the intake and service authorization process to the community, including consumers, family members, and providers.
	25.13(2) Plan administration section. The plan administration section of the policies and procedures manual shall specifically outline procedures for administering the plan at the consumer level. These procedures shall include, but shall not be limited to:
	a. 	Application (intake) procedure. The plan administration section of the manual shall describe an application process that is readily accessible to applicants and their families or authorized representatives. This procedure shall describe where applicants can apply for services and how and when the applications will reach the CPC office. It shall outline an application review process including, but not limited to, how additional needed information shall be gathered to complete an application, a timeline for the review process, and qualifications of the professional reviewing the application.
	(1)	Applications shall be accepted and processed by the applicant’s county of residence. If an applicant applies to the CPC of the county of residence and has legal settlement in another county, the application process shall be performed by the CPC of the applicant’s county of residence in accordance with the county of residence’s management plan, and the applicant’s county of legal settlement shall be responsible for the cost of the services or other supports authorized at the rates reimbursed by the county of residence.
	(2)	If the county of legal settlement has implemented a waiting list in accordance with Iowa Code section 331.439(5), the services and other supports for the person shall be authorized by the county of residence in accordance with the county of legal settlement’s waiting list provisions.
	(3)	If the county of residence has implemented a waiting list, the services and other supports for the person shall be authorized by the county of residence in accordance with the county of residence’s waiting list provisions.
	b. 	Eligibility determination. Eligibility determination shall include, but not be limited to, the criteria used to authorize or deny funding for services and supports. This may include guidelines for individualized services and supports and may vary by eligibility group and type of service and support. The procedure shall specify the time frames for conducting eligibility determination that provides for timely access to services, including necessary and immediate services.
	c. 	Notice of decision. The review process shall ensure a prompt screening for eligibility and initial decision to approve or reject the application or to gather more information. The policies and procedures manual shall include the process for development of a written notice of decision. The time frame for sending a written notice of decision shall be included.
	(1)	The notice of decision shall:
	1.	Explain the action taken on the application and the reasons for that action;
	2.	State what services are approved and name the service providers;
	3.	Outline the applicant’s right to appeal; and
	4.	Describe the appeal process.
	(2)	If the applicant is placed on the county of residence’s waiting list for funding, the notice issued by the county of residence shall also include:
	1.	An explanation of waiting-list status;
	2.	An estimate of how long the applicant is expected to be on the waiting list; and
	3.	The process for the applicant or authorized representative to obtain information regarding the applicant’s status on the waiting list.
	(3)	The county of residence shall send the notice of decision to:
	1.	The applicant (or the family in the case of a minor) or the applicant’s authorized representative;
	2.	The applicant’s county of legal settlement (if different from the county of residence); and
	3.	The listed service providers.
	(4)	If the applicant’s county of legal settlement is different from the county of residence, the county of legal settlement shall sign the notice of decision accepting legal settlement and return it to:
	1.	The county of residence; and
	2.	The listed service providers.
	(5)	If the applicant is placed on the county of legal settlement’s waiting list for funding, the county of legal settlement shall add to the notice of decision:
	1.	An explanation of waiting-list status;
	2.	An estimate of how long the applicant is expected to be on the waiting list; and
	3.	The process for the applicant or authorized representative to obtain information regarding the consumer’s status on the waiting list.
	d. 	Referral. The plan administration section of the manual shall describe to whom and for what purpose referral of the application is made. This may include, but is not limited to, description of referral directly to a provider for services and supports, referral for service coordination, or referral for clinical assessment.
	e. 	Consumer plan development. The plan administration section of the manual shall describe the role of the service coordinator in consumer plan development and how the service coordinator will interface with the CPC. If review of the service request is deemed necessary, a qualified professional shall do the review.
	f. 	Request for funding. The plan administration section shall indicate the process and format for a funding request.
	g. 	Service funding authorization and reauthorization. The plan administration section of the manual shall describe who makes the funding authorization and reauthorization decisions and the qualifications of that individual. The procedures shall describe the criteria for authorization and reauthorization of funding and a timeline for responding to the request for funding. For consumers whose county of residence differs from the county of legal settlement, the following procedures shall be used:
	(1)	The county of legal settlement may continue to authorize services for any consumer receiving services on or before June 30, 2007, even if the service is not in the management plan of the county of residence.
	(2)	The consumer shall apply for additional services with the CPC of the county of residence. The same procedure shall be followed as for a new applicant.
	(3)	Once an applicant has been enrolled with the county of legal settlement, the county of legal settlement shall manage reauthorizations of enrollment, such as gathering annual updates of income and resources to confirm continuing eligibility.
	(4)	The county of legal settlement may also work directly with the consumer or service provider to do periodic service reauthorizations. Services and supports funding must be reauthorized in accordance with the management plan of the county of residence.
	(5)	A written notice of reauthorization for service funding shall be sent to:
	1.	The consumer;
	2.	The county of residence; and
	3.	The listed service providers.
	h. 	Service and cost tracking. The plan administration section of the manual shall include a description of a system to track services and supports and payments made on behalf of all approved consumers. The tracking system shall provide an unduplicated consumer count and expenditure data. The tracking system shall also record denials of services and supports and indicate the reason why the applications were denied.
	i. 	Service monitoring. The plan administration section of the manual shall outline the process of service and funding monitoring.
	j. 	Appeals. The county shall develop and implement a process for appealing the decisions of the county or its agent. This appeal process shall be based on objective criteria, specify time frames, provide for notification in accessible formats of the decisions to all parties, and provide some assistance to consumers in using the process. Responsibility for the final administrative decision on an appeal shall not rest with the county board of supervisors. If the appellant has state case status, responsibility for the final administrative decision on an appeal shall rest with the department, following the procedures established in 441—Chapter 7.
	25.13(3) Management plan annual review. The policies and procedures manual shall address the process for preparation and distribution of the management plan annual review.
	25.13(4) Three-year strategic plan. The policies and procedures manual shall address the process for development and approval of the three-year strategic plan.
[ARC 7768B, IAB 5/20/09, effective 7/1/09]
441—25.14(331) Policies and procedures manual review. The policies and procedures manual shall be submitted by April 1, 2000, as a part of the county’s management plan for the fiscal year beginning July 1, 2000. The director, in consultation with the commission, shall review all county management plans submitted by the dates specified. Based on the recommendations of the commission, and if the director finds the county policies and procedures manual in compliance with these rules and state and federal laws, the director may approve the manual. A manual approved by the director for the fiscal year beginning July 1, 2000, shall remain in effect subject to amendment.
	25.14(1) Criteria for acceptance. The director shall determine a manual is acceptable when it contains all the required information, meets the criteria described in this division, and is in compliance with all applicable state and federal laws. The director may request additional information to determine whether or not the manual contains all the required information and meets criteria described in this division.
	25.14(2) Notification. Except as specified in subrule 25.14(3), the director shall notify the county in writing of the decision on the manual by June 1, 2000. The decision shall specify that either:
	a. 	The manual is approved as it was submitted, either with or without supplemental information already requested and received.
	b. 	The manual will not be approved until revisions are made. The letter will specify the nature of the revisions requested and the time frames for their submission. The director may authorize a county to continue operation, for up to 90 days, using the previously approved county management plan. The extension begins on July 1, 2000.
	25.14(3) Review of late submittals. The director may review manuals not submitted by April 1, 2000, after all manuals submitted by that date have been reviewed. The director will proceed with the late submittals in a timely manner.
[ARC 7768B, IAB 5/20/09, effective 7/1/09]
441—25.15(331) Amendments. An amendment to the manual shall be submitted to the department at least 45 days before the date of implementation. Before implementation of any amendment to the manual, the director must approve the amendment. When an amendment substantially changes a county’s policies and procedures manual, the department shall present the amendment to the commission.
	25.15(1) Criteria for acceptance. The director shall determine an amendment is acceptable when it contains all the required information and meets the criteria described in this division for the applicable part of the policies and procedures manual and is in compliance with all applicable state and federal laws. The director may request additional information to determine whether or not the amendment contains all the required information and meets criteria described in this division.
	25.15(2) Notification. The director shall notify the county, in writing, of the decision on the amendment within 45 days of receipt of the amendment. The decision shall specify either that:
	a. 	The amendment is approved as it was submitted, either with or without supplemental information already requested and received.
	b. 	The amendment is not approved. The notification will include why the amendment is not approved.
[ARC 7768B, IAB 5/20/09, effective 7/1/09]
441—25.16(331) Reconsideration. Counties dissatisfied with the director’s decision on a manual or an amendment may file a letter with the director requesting reconsideration. The letter of reconsideration must be received within 30 working days of the date of the notice of decision and shall include a request for the director to review the decision and the reasons for dissatisfaction. Within 30 working days of the receipt of the letter requesting reconsideration, the director, in consultation with the commission, will review both the reconsideration request and evidence provided. The director shall issue a final decision in writing.
[ARC 7768B, IAB 5/20/09, effective 7/1/09]
441—25.17(331) Management plan annual review. The county shall prepare a management plan annual review for the county stakeholders, the department of human services and the commission. The management plan annual review shall be submitted to the department for informational purposes by December 1. The management plan annual review shall incorporate an analysis of the data associated with the services managed during the preceding fiscal year by the county or by a managed care entity on behalf of the county. The management plan annual review shall include, but not be limited to:
	1.	Progress toward goals and objectives.
	2.	Documentation of stakeholder involvement.
	3.	Actual provider network.
	4.	Actual expenditures.
	5.	Actual scope of services.
	6.	Number, type, and resolution of appeals.
	7.	Quality assurance implementation, findings and impact on plan.
	8.	Waiting list information.
[ARC 7768B, IAB 5/20/09, effective 7/1/09]
441—25.18(331) Strategic plan. The strategic plan shall describe the county’s vision for its mental health, mental retardation, and developmental disabilities system for the ensuing three fiscal years. The strategic plan development shall follow the process outlined in the policies and procedures manual. The strategic plan shall be submitted, for informational purposes, to the department by April 1, 2000, and by April 1 of every third year thereafter. The strategic plan shall include, but not be limited to:
	25.18(1) Needs assessment. The strategic plan shall include an assessment of current needs. This plan shall describe how information from the annual reports from the previous years was incorporated into the current strategic plan and how the information will be used to develop future plans for the funding and provision of services to eligible groups.
	25.18(2) Goals and objectives. The strategic plan shall list goals and objectives that are guided by the system principles of choice, empowerment, and community. The goals and objectives shall reflect the system which the county plans to have in place in three years, the action steps which will be taken to develop the future system, and how progress toward implementation will be measured. Projected costs for future projects should be included.
	25.18(3) Services and supports. The strategic plan shall list services and supports that the county will fund, when requested, by eligibility group.
	25.18(4) Provider network. The strategic plan shall include a list of providers used to provide the scope of services and supports described in the plan.
	25.18(5) Access points. The strategic plan shall list designated access points and their function in the enrollment process.
441—25.19(331) Technical assistance. The department shall provide technical assistance and other necessary support to counties to assist in the development and implementation of the county management plans and completion of reports.
441—25.20(331) Consumer financial eligibility and payment responsibility. The county management plan shall identify basic financial eligibility standards for disability services consistent with this rule. The county may choose to assign responsibility for copayment to the consumer consistent with this rule. Nothing in this rule shall preclude a consumer from voluntarily paying a greater copayment than is provided in the county management plan.
	25.20(1) General requirements. The basic financial eligibility standards identified in this rule are the minimum standards allowable. A county management plan may establish less restrictive financial standards, but shall not establish standards that are more restrictive.
	a. 	The county management plan shall provide that a consumer who is eligible under all other eligibility standards of the county management plan shall be eligible for county disability services paid with public funding if the consumer meets the basic financial eligibility standards set forth in this rule.
	b. 	The county management plan shall require no copayments by consumers, whether collected by the county or a provider, except as defined in this rule.
	c. 	The county management plan may establish a policy to allow exceptions to the basic or extended financial eligibility standards on a case-by-case basis to benefit an individual consumer.
	d. 	The income and resource standards in this rule shall not supersede the eligibility guidelines of any other federal, state, county, or municipal program, including general assistance guidelines adopted by the county board of supervisors.
	e. 	Nothing in this rule shall be construed as relieving any consumer of financial obligations incurred pursuant to a Social Security Administration interim assistance agreement.
	25.20(2) Basic eligibility standards. Except as otherwise provided in these rules, an applicant shall be financially eligible for county funding when the applicant meets the following standards:
	a. 	If the applicant is eligible for federally funded or state-funded services or supports, the applicant has applied for and accepted those services and supports.
	b. 	The applicant’s household has:
	(1)	Income that is equal to or less than 150 percent of the federal poverty level, as defined by the most recently revised poverty income guidelines published by the United States Department of Health and Human Services; and
	(2)	Resources that are equal to or less than $2,000 in countable value for a single-person household or $3,000 in countable value for a multiperson household.
	25.20(3) Resource standards. Basic financial eligibility standards shall include the following provisions for determining financial eligibility:
	a. 	The countable value of all countable resources, both liquid and nonliquid, shall be included in the eligibility determination except as exempted in this subrule.
	b. 	A transfer of property or other assets within five years of the time of application with the result of, or intent to, qualify for assistance may result in denial or discontinuation of funding.
	c. 	The following resources shall be exempt:
	(1)	The homestead, including equity in a family home or farm that is used as the consumer household’s principal place of residence. The homestead shall include all land that is contiguous to the home and the buildings located on the land.
	(2)	One automobile used for transportation.
	(3)	Tools of an actively pursued trade.
	(4)	General household furnishings and personal items.
	(5)	Burial spaces.
	(6)	Cash surrender value of life insurance with a face value of less than $1,500 on any one person.
	(7)	Any resource determined excludable by the Social Security Administration as a result of an approved Social Security Administration work incentive.
	d. 	Additional exemptions. If a person does not qualify for federally funded or state-funded services or other support, but meets all income, resource, and functional eligibility requirements of this chapter, the following types of resources shall additionally be considered exempt from consideration in eligibility determination:
	(1)	A retirement account that is in the accumulation stage.
	(2)	A medical savings account.
	(3)	An assistive technology account.
	25.20(4) Basic copayment standards. Any copayments or other client participation required by any federal, state, county, or municipal program in which the consumer participates shall be required. Such copayments include, but are not limited to:
	a. 	Client participation for maintenance in a residential care facility through the state supplementary assistance program.
	b. 	Client participation for an intermediate care facility or an intermediate care facility for persons with mental retardation.
	c. 	A portion of rent in conjunction with a rental assistance program consistent with guidelines of the United States Department of Housing and Urban Development.
	d. 	A copayment, deductible, or spenddown required by the Medicare or Medicaid programs or any other third-party insurance coverage.
	e. 	The financial liability for institutional services paid by counties as provided in Iowa Code sections 222.31 and 230.15.
	f. 	The financial liability for attorney fees related to commitment as provided by Iowa Code section 229.19.
	25.20(5) Copayment for services provided by a facility participating in the state supplementary assistance program. A county may require a copayment for a disability service provided to a consumer by a licensed residential care facility that participates in the state supplementary assistance program as follows:
	a. 	A consumer who is approved for state supplementary assistance and pays client participation as determined through the state supplementary assistance program shall be considered eligible for disability services with no additional copayment.
	b. 	A consumer who is ineligible for state supplementary assistance due to income or resources may be eligible for financial assistance under the county management plan through determination and payment of client participation as follows.
	(1)	Client participation in the service payment shall be determined by allowing the following deductions from available income and resources:
	1.	Any income earned by the consumer in a supported employment, sheltered workshop, day habilitation, or adult day care program.
	2.	A personal allowance equivalent to the personal allowance provided under the state supplementary assistance program.
	3.	Room and board payment made by the consumer to the facility at the state supplementary assistance rate.
	4.	Payment for any medical expenses for which the consumer is financially responsible.
	(2)	Any income remaining after deduction of the expenses allowed in subparagraph (1) and any resources in excess of $2,000 shall be considered the required client participation toward the service in the facility. For any consumer whose client participation does not equal 100 percent of the service cost, the county shall participate in payment to the facility up to that level.
	25.20(6) Extended eligibility and copayment standards. Each county management plan shall indicate if additional, less restrictive financial eligibility standards will be applied. The county management plan may permit a person with an income above 150 percent of the federal poverty level or resources above the basic resource limits to be eligible for public funding provided that the plan meets the requirements in this subrule. To apply less restrictive financial eligibility standards, the county management plan shall include:
	a. 	Policies relating to any income or resource limits that are different from the basic income and resource standards.
	b. 	Policies relating to any resource exemptions that are different from the basic financial eligibility standards.
	c. 	Policies relating to any other factors included in determination of financial eligibility and calculation of client participation.
	d. 	Policies defining procedures for calculation and collection of client participation.
	e. 	Policies providing for a copayment or other cost-sharing arrangement determined on a sliding fee scale based on household income and resources. Any sliding fee scale used for copayments shall be graduated and shall be based on the federal poverty guidelines. Policies shall address updates to the sliding fee scale.
	f. 	Policies regarding any county payment of third-party insurance copayment.
	g. 	Policies relating to exception provisions for financial eligibility determination and client participation calculation.
	h. 	Policies relating to informing consumers of the client participation required.
These rules are intended to implement Iowa Code sections 331.424A, 331.439, and 331.440.
441—25.21 to 25.40 Reserved.
DIVISION III
MINIMUM DATA SET
441—25.41(331) Minimum data set. Each county shall maintain data on all clients served through the MH/DD services fund.
	25.41(1) Submission of data. Each county shall submit to DHS a copy of the data regarding each individual that the county serves through the central point of coordination process.
	a. 	DHS state payment program, state supplementary assistance program, mental health institutes, state resource centers, Medicaid program, and Medicaid managed care contractors shall provide the equivalent data in a compatible format on the same schedule as the required submission from the counties.
	b. 	DHS shall maintain the data in the data analysis unit for research and analysis purposes only. Only summary data shall be reported to policymakers or the public.
	25.41(2) Data required. The data to be submitted are as follows:
	a. 	Basic client information including a unique identifier, name, address, county of residence and county of legal settlement.
	b. 	The state I.D. number for state payment cases.
	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, DSM IV diagnosis, ICD-9 diagnosis, disability group (i.e., mental retardation, developmental disability, chronic mental illness, mental illness), central point of coordination (county number preceded by A 1), and central point of coordination (CPC) name.
	d. 	Service information including the decision on services, date of decision, date client terminated from CPC services and reason for termination, residence, approved service, service beginning dates, service ending dates, reason for terminating each service, approved units of services, unit rate for service, expenditure data, and provider data.
	e. 	Counties shall not be penalized in any fashion for failing to collect data elements in situations of crisis or in outreach efforts to identify or engage people in needed mental health services. For the purposes of this rule:
	(1)	Situations of crisis include but are not limited to voluntary and involuntary hospitalizations, legal and transportation services associated with involuntary hospitalizations, emergency outpatient services, mobile crisis team services, jail diversion services, mental health services provided in a county jail, and other services for which the county is required to pay but does not have access to the client to collect the required information.
	(2)	Outreach efforts to identify or engage people in needed mental health services include but are not limited to mental health advocate services; services for homeless persons, refugees, or other legal immigrants; services for state cases who do not have documentation with them and are unable to help the county locate appropriate records; consultation; education to raise public awareness; 12-step or other support groups for persons with dual disorders; and drop-in centers.
	f. 	Although all of the data in the minimum data set are important to provide support for program analysis, a county shall be penalized for noncompliance with this rule if the county does not provide 100 percent reporting of the data elements listed in this paragraph. Beginning with the data reported for state fiscal year 2008, less than 100 percent reporting for the following items shall be viewed as noncompliance unless the data are exempted by paragraph “e”:
	(1)	Client identifiers:
	1.	Lname3 (the first three letters of the client’s last name).
	2.	Last4SSN (the last four digits of the client’s social security number).
	3.	SEX (the client’s sex).
	4.	BDATE (the client’s birth date).
	(2)	CPC (central point of coordination).
	(3)	Payment information:
	1.	PYMTDATE (CoMIS payment date).
	2.	FUND CODE (CoMIS fund code).
	3.	DG (CoMIS diagnosis).
	4.	COACODE (CoMIS chart of accounts code).
	5.	BEGDATE (CoMIS service beginning date).
	6.	ENDDATE (CoMIS service ending date).
	7.	UNITS (CoMIS units of service).
	8.	COPD (CoMIS county paid).
	(4)	ValidSSN (valid social security number indicator).
	(5)	IsPerson (IsPerson indicator).
	g. 	Although all of the data in the minimum data set are important to provide support for program analysis, a county shall be penalized for noncompliance with this rule if the county does not provide 90 percent reporting of the data elements listed in this paragraph beginning with the data reported for fiscal year 2008. Less than 90 percent reporting for the following items shall be viewed as noncompliance unless the data are exempted by paragraph “e”:
	(1)	Application Date (application date).
	(2)	RESCO (residence county).
	(3)	LEGCO (legal county).
	(4)	Provider ID (vendor number).
	h. 	The department shall analyze the data received on or before December 1 each year by December 15 or by the next business day if December 15 falls on a weekend or holiday.
	(1)	When a county’s data submission does not meet the specifications in paragraph “f” or “g,” the department will notify the county by E-mail.
	(2)	The county shall have 30 days from the date of the E-mail notice to submit the missing data or to provide an explanation of why the data cannot be reported.
	(3)	If the county does not report the data or provide an adequate explanation within 30 days, the department shall find the county in noncompliance.
	i. 	The department shall post the aggregate reports received by December 1 on the department’s Web site within 90 days.
	25.41(3) Method of data collection. A county may choose to collect this information using the county management information system (CoMIS) that was designed by the department or may collect the information through some other means. If a county chooses to use another system, the county must be capable of supplying the information in the same format as CoMIS.
	a. 	Except as provided in subparagraph (3), each county shall submit the following files in Microsoft Excel format (version 97 to 2000) or comma-delimited text file (CSV) format using data from the associated CoMIS table or from the county’s chosen management information system:

Files to submit	Associated CoMIS Table	
WarehouseClient.xls or WarehouseClient.csv	Client Data	
WarehouseIncome.xls or WarehouseIncome.csv	Income Review	
WarehousePayment.xls or WarehousePayment.csv	Payment	
WarehouseProvider.xls or WarehouseProvider.csv	Provider	
WarehouseProviderServices.xls or WarehouseProviderServices.csv	tblProviderServices	
WarehouseService.xls or WarehouseService.csv	Service Authorizations	
	(1)	Paragraphs “b” through “g” list the data required in each file and specify the structure or description for each data item to be reported.
	(2)	The field names used in the report files must be exactly the same as indicated in the corresponding paragraph, including spaces, and must be entered in the first row for each sheet.
	(3)	The file labeled WarehouseService.xls or WarehouseService.csv or service authorization (described in paragraph “g” of this subrule) shall be removed from this requirement on June 30, 2011, if data from this file have not been used by that date.
	b. 	File name: WarehouseClient.xls or WarehouseClient.csv.
Sheet name: Warehouse_Client_Transfer_Query.

Field Name	Data Type	Field Size	Format	Description	
CPC	Number	3	0 decimal places	Central point of coordination number: county number preceded by a 1	
RESCO	Number	3	0 decimal places	Residence county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	
LEGCO	Number	3	0 decimal places	Legal county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	

Lname3	Text	3	 	The first 3 characters of the last name	
Last4SSN	Text	4	 	The last 4 digits of the client’s social security number. If that number is unknown, then use the last 4 digits of the client id# field and mark column “ValidSSN” with the value “No.”	
BDATE	Date	10	mm/dd/yyyy	Date of client’s birth	
SEX	Text	1	 	Sex of client:
M = Male
F = Female	
Last Update	Date	10	mm/dd/yyyy	Date of last update to client record	
SID	Text	8	9999999a	State identification number of client, if applicable (format of a valid number is 7 digits plus 1 alphabetical character).	
ADD1	Text	50	 	First address line	
ADD2	Text	50	 	Second address line (if applicable)	
CITY	Text	50	 	City address line	
STATE	Text	2	 	State code	
ZIP	Number	5	0 decimal places	5-digit ZIP code	
ETHN	Number	1	0 decimal places	Ethnicity of client:
0 = Unknown
1 = White, not Hispanic
2 = African-American, not Hispanic
3 = American Indian or Alaskan native
4 = Asian or Pacific Islander
5 = Hispanic
6 = Other (biracial; Sudanese; etc.)	
MARITAL	Number	1	0 decimal places	Marital status of client:
1 = Single, never married
2 = Married (includes common-law marriage)
3 = Divorced
4 = Separated
5 = Widowed	
EDUC	Number	2	0 decimal places	Education level of the client	
RARG	Number	2	0 decimal places	Residential arrangement of client:
1 = Private residence/household
2 = State MHI
3 = State resource center
4 = Community supervised living
5 = Foster care or family life home
6 = Residential care facility
7 = RCF/MR
8 = RCF/PMI
9 = Intermediate care facility
10 = ICF/MR
11 = ICF/PMI
12 = Correctional facility
13 = Homeless shelter or street
14 = Other	
LARG	Number	1	0 decimal places	Living arrangement of client:
1 = Lives alone
2 = Lives with relatives
3 = Lives with persons unrelated to client	
INS	Number	1	0 decimal places	Health insurance owned by client:
1 = Client pays
3 = Medicaid
4 = Medicare
5 = Private third party
6 = Not insured
7 = Medically Needy	
INSCAR	Text	50	 	First insurance company name, if applicable	
INSCAR1	Text	50	 	Second insurance company name, if applicable	
INSCAR2	Text	50	 	Third insurance company name, if applicable	
VET	Text	1	 	Veteran status of client:
Y = Yes
N = No	
CONSERVATOR	Number	1	0 decimal places	Conservator status of client:
1 = Self
2 = Other	
GUARDIAN	Number	1	0 decimal places	Guardian status of client:
1 = Self
2 = Other	
LEGSTAT	Number	1	0 decimal places	Legal status of client:
1 = Voluntary
2 = Involuntary, civil commitment
3 = Involuntary, criminal commitment	
REFSO	Number	1	0 decimal places	Referral source of client:
1 = Self
2 = Family or friend
3 = Targeted case management
4 = Other case management
5 = Community corrections
6 = Social service agency other than case management
7 = Other	
DSMIV	Text	50	 	DSM IV diagnosis code of client	
ICD9	Text	50	 	ICD-9 diagnosis code (optional for county use; not tied to CoMIS entry)	
DG	Number	2	0 decimal places	Disability group of client:
40 = Mental illness
41 = Chronic mental illness
42 = Mental retardation
43 = Other developmental disability
44 = Other categories	
Application Date	Date	10	mm/dd/yyyy	Date of client’s initial application	
Outcome decision	Number	1	0 decimal places	Decision on client’s application:
1 = Application accepted
2 = Application denied
3 = Decision pending	
Decision date	Date	10	mm/dd/yyyy	Date decision was made on client’s application	
Denial reason	Text	2	 	Denial reason code:
00 = Not applicable
01 = Over income guidelines
1A = Over resource guidelines
02 = Does not meet county plan criteria
2A = Legal settlement in another county
2B = State case
3A = Brain injury
3B = Alzheimer’s
3C = Substance abuse
3D = Other
04 = Does not meet service plan criteria
05 = Client desires to discontinue process
5A = Client fails to return requested information	
Client exit date from CPC	Date	10	mm/dd/yyyy	Date client was terminated from CPC services	
Exit reason	Number	1	0 decimal places	Reason client left the CPC system:
0 = Unknown
1 = Client voluntarily withdrew
2 = Client deceased
3 = Unable to locate consumer
4 = Ineligible due to reasons other than income
5 = Ineligible, over income guidelines
6 = Client moved out of state
7 = Client no longer needs service
8 = Client has legal settlement in another county	
Review Date	Date	10	mm/dd/yyyy	Date of last application review	
PhoneNumber	Text	50	 	Phone number of client	
ValidSSN	Text	3	Generated for CoMIS users in the data extract only	Populate this field with YES if the client has a valid social security number. If the client does not have a valid social security number, populate this field with NO.	
IsPerson	Text	3	Generated for CoMIS users in the data extract only	Populate this field with YES if the client is a person. If the client entry represents a nonperson such as administrative costs, populate this field with NO.	
	c. 	File name: WarehouseIncome.xls or WarehouseIncome.csv.
Sheet name: Warehouse_Income_Transfer_Query.

Field Name	Data Type	Field Size	Format	Description	
CPC	Number	3	0 decimal places	Central point of coordination number: county number preceded by a 1	
RESCO	Number	3	0 decimal places	Residence county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	
LEGCO	Number	3	0 decimal places	Legal county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	
Lname3	Text	3	 	The first 3 characters of the last name	
Last4SSN	Text	4	 	The last 4 digits of the client’s social security number. If that number is unknown, then use the last 4 digits of the client id# field and mark column “ValidSSN” with the value “No.”	
BDATE	Date	10	mm/dd/yyyy	Date of client’s birth	
SEX	Text	1	 	Sex of client:
M = Male
F = Female	
EMPL	Number	2	0 decimal places	Employment situation of client:
1 = Unemployed, available for work
2 = Unemployed, unavailable for work
3 = Employed full-time
4 = Employed part-time
5 = Retired
6 = Student
7 = Work activity employment
8 = Sheltered work employment
9 = Supported employment
10 = Vocational rehabilitation
11 = Seasonally employed
12 = In the armed forces
13 = Homemaker
14 = Other or not applicable
15 = Volunteer	
House Hold Size	Number	2	0 decimal places	Number of people in client’s household	
INCSOUR	Number	2	0 decimal places	Primary income source of client:
1 = Family and friends
2 = Private relief agency
3 = Social security disability benefits
4 = Supplemental Security Income
5 = Social security benefits
6 = Pension
7 = Food assistance
8 = Veterans benefits
9 = Workers compensation
10 = General assistance
11 = Family investment program (FIP)
12 = Wages	
Public Assistance Payments	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Social Security	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Social Security Disability	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
SSI	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
VA Benefits	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
R/R Pension	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Child Support	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Employment Wages	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Dividend Interest	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Other Income	Currency	14	2 decimal places	Monthly dollar amount for this income source (where applicable)	
Description 1	Text	50	 	Description of “Other Income”	
Cash on hand	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Checking	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Savings	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Stocks/Bonds	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Time Certificates	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Trust Funds	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Other Resources	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Description 2	Text	50	 	Description of “Other Resources” (where applicable)	
Other Resources 2	Currency	14	2 decimal places	Dollar amount for this resource type (where applicable)	
Description 3	Text	50	 	Description of “Other Resources 2”	
Date reviewed	Date	10	mm/dd/yyyy	Date income was last reviewed (where applicable)	
	d. 	File name: WarehousePayment.xls or WarehousePayment.csv. Sheet name: Warehouse_Payment_Transfer_Quer.

Field Name	Data Type	Field Size	Format	Description	
CPC	Number	3	0 decimal places	Central point of coordination number: county number preceded by a 1	
RESCO	Number	3	0 decimal places	Residence county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	
LEGCO	Number	3	0 decimal places	Legal county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	
Lname3	Text	3	 	The first 3 characters of the last name	
Last4SSN	Text	4	 	The last 4 digits of the client’s social security number. If that number is unknown, use the last 4 digits of the client id# field and mark column “ValidSSN” with the value “No.”	
BDATE	Date	10	mm/dd/yyyy	Date of client’s birth	
SEX	Text	1	 	Sex of client:
M = Male
F = Female	
PYMTDATE	Date	10	mm/dd/yyyy	Date county approves or makes payment	
VENNAME	Text	50	 	Vendor or provider paid	
COCODE	Number	3	0 decimal places	County where service was provided	
FUND CODE	Text	10	 	Fund code for payment	
DG	Number	2	0 decimal places	Disability group code for payment:
40 = Mental illness
41 = Chronic mental illness
42 = Mental retardation
43 = Other developmental disability
44 = Other categories	
COACODE	Number	5	0 decimal places	Chart of accounts code for payment	
BEGDATE	Date	10	mm/dd/yyyy	Beginning date of payment period	
ENDDATE	Date	10	mm/dd/yyyy	Ending date of payment period	
UNITS	Number	4	0 decimal places	Number of service units for payment	
COPD	Currency	14	2 decimal places	Amount paid by the county	
RECEIVED	Currency	14	2 decimal places	Amount received for reimbursement (if applicable)	
	e. 	File name: WarehouseProvider.xls or WarehouseProvider.csv. Sheet name: Warehouse_Provider_Transfer_Que. (If the provider has more than one office location, enter information for the headquarters office.)

Field Name	Data Type	Field Size	Format	Description	
Provider ID	Text	50	 	Provider identifier (tax ID code)	
Provider Name	Text	50	 	Provider name	
Provider Address1	Text	50	 	Provider address line 1	
Provider Address2	Text	50	 	Provider address line 2 (if applicable)	
City	Text	50	 	Provider city	
State	Text	2	 	Provider state code	
Zip	Text	10	 	Provider ZIP code	
COCODE	Number	3	0 decimal places	Provider county code	
PhoneNumber	Text	50	 	Provider phone number	
Date of Last Update	Date	10	mm/dd/yyyy	Provider last updated date	
	f. 	File name: WarehouseProviderServices.xls or WarehouseProviderServices.csv. Sheet name: Warehouse_Provider_Services_Tra.

Field Name	Data Type	Field Size	Format	Description	
Provider ID	Text	50	 	Provider identifier (tax ID code)	
Provider Name	Text	50	 	Provider name	
FUND CODE	Text	10	 	Fund code for payment	
DG	Number	2	0 decimal places	Disability group code for payment:
40 = Mental illness
41 = Chronic mental illness
42 = Mental retardation
43 = Other developmental disability
44 = Other categories	
COACODE	Number	5	0 decimal places	Chart of accounts code for service	
RATE	Currency	14	2 decimal places	Payment rate	
	g. 	File name: WarehouseService.xls or WarehouseService.csv. Sheet name: Warehouse_Service_Transfer_Quer.

Field Name	Data Type	Field Size	Format	Description	
CPC	Number	3	0 decimal places	Central point of coordination number: county number preceded by a 1	
RESCO	Number	3	0 decimal places	Residence county of client:
1-99 = County number
100 = State of Iowa
900 = Undetermined or in dispute	
LEGCO	Number	3	0 decimal places	Legal county of client:
1-99 = County number
100 = State of Iowa
200 = Iowa nonresident
900 = Undetermined or in dispute	
Lname3	Text	3	 	The first 3 characters of the last name	
Last4SSN	Text	4	 	The last 4 digits of the client’s social security number. If that number is unknown, then use the last 4 digits of the client id# field and mark column “ValidSSN” with the value “No.”	
BDATE	Date	10	mm/dd/yyyy	Date of client’s birth	
SEX	Text	1	 	Sex of client:
M = Male
F = Female	
FUND CODE	Text	10	 	Fund code for service	
DG	Number	2	0 decimal places	Disability group code for payment:
40 = Mental illness
41 = Chronic mental illness
42 = Mental retardation
43 = Other developmental disability
44 = Other category	
COACODE	Number	5	0 decimal places	Chart of accounts code for service	
Begin Date	Date	10	mm/dd/yyyy	Beginning date of service period	
End Date	Date	10	mm/dd/yyyy	Ending date of service period	
Ending Reason	Number	1	0 decimal places	Reason for terminating approval of service:
0 = NA
1 = Voluntary withdrawal
2 = Client no longer needs service
3 = Ineligible, over income guidelines
4 = Ineligible due to other than income
5 = Client moved out of state
6 = Client deceased
7 = Reauthorization	
Units	Number	4	0 decimal places	Average number of service units approved monthly	
Rate	Currency	14	2 decimal places	Dollar amount per service unit	
Review Date	Date	10	mm/dd/yyyy	Date for next service review	
This rule is intended to implement Iowa Code sections 331.438 and 331.439.
441—25.42 to 25.50 Reserved.
DIVISION IV
INCENTIVE AND EFFICIENCY POOL FUNDING
Preamble
These rules establish requirements for counties to receive funding from the incentive and efficiency pool. To be eligible for these funds, a county must select five performance indicators, submit a proposal, collect data, report data, and show improvement over time on the selected performance indicators.
441—25.51(77GA,HF2545) Desired results areas. In order to receive funds from the incentive and efficiency pool established in 1998 Iowa Acts, House File 2545, section 8, subsection 2, each county shall collect and report performance measure data in the following areas:
	25.51(1) Equity of access. Each county shall measure the extent to which services are available and used. Each county shall:
	a. 	Report annually the total number of consumers served, as well as an unduplicated total of the number of consumers served by disability category.
	b. 	Calculate and report annually the percentage of service provision by dividing the number of consumers served in a year by the county’s population as defined in 1998 Iowa Acts, House File 2545, section 7.
	c. 	Calculate and report annually the percentage of denial of access by dividing the number of new, completed applications denied by the total number of new applications for service that year. A new, completed application shall be defined as an initial application of a consumer or any former consumer who is reapplying for service eligibility after more than 30 days of not being enrolled in the system, for which the consumer has supplied the information required on the application form.
	d. 	Report annually the county’s eligibility guidelines, which may include, but are not limited to, the income level below which an individual or family must be in order to be eligible for county-funded services, the maximum amount of resources which an individual or family may have in order to be eligible for county-funded services, covered populations, and service access criteria.
	25.51(2) Community-based supports. Each county shall measure the extent to which community-based supports are available and used. Each county shall calculate and report annually:
	a. 	The service setting percentage by dividing the unduplicated number of persons served in each of the following service settings in a fiscal year by the total unduplicated number of consumers served, both in total and by population group: mental health institutes, state hospital schools, intermediate care facilities for the mentally retarded, other living arrangements over five beds as captured by the county chart of accounts, and employment settings which include sheltered workshops, enclaves and supported employment.
	b. 	The home-based percentage by subtracting the number of consumers currently being served in residential placements from the total unduplicated number of consumers served, and dividing the difference by the total number of consumers served. The calculation shall be made both in total and by population group.
	c. 	The inpatient spending percentage by dividing the amount the county spent for inpatient services by the amount the county spent for outpatient services. Each county shall also divide the unduplicated number of consumers who received inpatient services during the fiscal year by the total unduplicated number of consumers who received services during that same fiscal year. Inpatient services shall be defined as any acute care for which the county is wholly or partially financially responsible.
	25.51(3) Consumer participation. Each county shall measure the extent to which consumers participate in all aspects of the service system.
	a. 	Each county shall report annually on the number of opportunities during the year for consumers to participate in planning activities, which may include, but are not limited to, open forums, focus groups, consumer advisory committee meetings, and planning council meetings by calculating the total number of consumers participating in these activities and dividing by the unduplicated number of consumers served and also by the total population of the county. In addition, the county shall report duplicated and unduplicated total attendance at all of these meetings. These calculations shall be made for consumers and family members separately.
	b. 	Each county which has a planning group shall calculate and report annually the planning group percentage by dividing the number of consumers who actively serve on the planning group by the total number of people on the planning group. This calculation shall be made for consumers and family members separately. For the purposes of this subrule, a planning group is any group of individuals designated by the board of supervisors, or if no designation has been made, any group acknowledged by the central point of coordination administrator as assisting in the development of the county management plan.
	c. 	Each county shall conduct a consumer satisfaction survey following adoption of more detailed rules for the survey.
	25.51(4) Administration. Each county shall measure the extent to which the county services system is administered efficiently and effectively. Each county shall:
	a. 	Calculate and report annually the administrative cost percentage by dividing the amount spent administering the county services system by the total amount spent from the services fund for the fiscal year.
	b. 	Calculate and report annually the service responsiveness average by measuring the number of days between the date a new, completed application was submitted and the date a notice of decision of eligibility was sent to the consumer, adding all of these numbers of days, and dividing by the total number of new, completed applications for the fiscal year. A new, completed application shall be defined as an initial application of a consumer or an application of any former consumer who is reapplying for service eligibility after more than 30 days of not being enrolled in the system, for which the consumer has supplied the information required on the application form.
	c. 	Report annually the number of appeals filed as a percent of the unduplicated total number of consumers served per year.
441—25.52(77GA,HF2545) Methodology for applying for incentive funding. Beginning with the county management plan for the fiscal year which begins July 1, 1999, each county applying for funding under 1998 Iowa Acts, House File 2545, section 8, subsection 2, shall include with its county management plan a performance improvement proposal for improving the county’s performance on at least five performance measures. Three of the measures must be selected from at least two of the desired results areas stated in rule 441—25.51(77GA,HF2545). For the remaining two measures, the county either may propose measures not identified in these rules or may use measures described in these rules. A performance improvement proposal is not a mandatory element of a county management plan.
	25.52(1) Performance improvement proposal. Each county shall identify the performance measures which the county has targeted for improvement and shall propose a percentage change for each indicator. The proposal shall include the county’s rationale for selecting the indicators and may include any supporting information the county deems necessary. The proposal shall describe the process the county will use to involve consumers in the evaluation.
	25.52(2) Committee responsibility. The state county management committee shall review all county proposals, and may either accept the proposal, request modifications, or reject the proposal. In order to interpret and provide context for each county’s performance improvement proposal, the state county management committee shall, by January 1, 1999, establish the background data to be collected and aggregated for all counties.
	25.52(3) County ineligibility. A county which does not have an accepted proposal prior to July 1 will be ineligible to receive incentive funds for that fiscal year. A county may apply for an extension by petitioning the state county management committee prior to July 1. The petition shall describe the circumstances which will cause the proposal to be delayed and identify the date by which the proposal will be submitted. In addition, the state county management committee may grant an extension for the purposes of negotiation.
441—25.53(77GA,HF2545) Methodology for awarding incentive funding. Each county shall report on all performance measures listed in this division, plus any additional performance measures the county has selected, by December 1 of each year.
	25.53(1) Reporting. Each county shall report performance measure information on forms, or by electronic means, developed for the purpose by the department in consultation with the state county management committee.
	25.53(2) Scoring. The department shall analyze each county’s report to determine the extent to which the county achieved the levels contained in the proposal accepted by the state county management committee. Prior to distribution of incentive funding to counties, results of the analysis shall be shared with the state county management committee.
	25.53(3) County ineligibility. A county which does not report performance measure data by December 1 will be ineligible to receive incentive funds for that fiscal year. A county may apply for an extension by petitioning the state county management committee prior to December 1. The petition shall describe the circumstances which will cause the report to be delayed and identify the date by which the report will be submitted.
441—25.54(77GA,HF2545) Subsequent year performance factors. For any fiscal year which begins after July 1, 1999, the state county management committee shall not apply any additional performance measures until the county management information system (CoMIS) developed and maintained by the division of mental health and developmental disabilities has been modified, if necessary, to collect and calculate required data elements and performance measures and each county has been given the opportunity to establish baseline measures for those measures.
441—25.55(77GA,HF2545) Phase-in provisions.
	25.55(1) State fiscal year 1999. For the fiscal year which begins July 1, 1998, each county shall collect data as required above in order to establish a baseline level on all performance measures. A county which collects and reports all required data by December 1, 1999, shall be deemed to have received a 100 percent score on the county’s performance indicators.
	25.55(2) State fiscal year 2000. A county which submits a proposal with its management plan for the fiscal year which begins July 1, 1999, and reports the levels achieved on the selected performance measures by December 1, 2000, shall be deemed to have received a 100 percent score on the county’s performance indicators, regardless of the actual levels achieved.
These rules are intended to implement 1998 Iowa Acts, House File 2545, section 8, subsection 2.
441—25.56 to 25.60 Reserved.
DIVISION V
RISK POOL FUNDING
Preamble
These rules establish a risk pool board to administer the risk pool fund established by the legislature and set forth the requirements for counties for receiving and repaying funding from the fund.
441—25.61(426B) Definitions.
“Available pool” means those funds remaining in the risk pool less any actuarial and other direct administrative costs.
“Central point of coordination (CPC)” means the administrative entity designated by a county board of supervisors, or the boards of a consortium of counties, to act as the single entry point to the service system as required in Iowa Code section 331.440.
“Commission” means the mental health, mental retardation, developmental disabilities, and brain injury commission.
“Division” means the mental health and disability services division of the department of human services.
“Mandated services” means those services for which a county is required to pay. Mandated services include, but may not be limited to, the following:
	1.	The costs for commitments for persons with mental illness, chronic mental illness, mental retardation, or developmental disabilities.
	2.	Inpatient services at the state mental health institutes for persons with mental illness or chronic mental illness.
	3.	Inpatient services at the state resource centers for persons with mental retardation or developmental disabilities.
	4.	Medicaid-funded care in an intermediate care facility for persons with mental retardation.
	5.	Medicaid-funded partial hospitalization and day treatment services for persons with chronic mental illness.
	6.	Medicaid-funded case management services for persons with mental retardation or developmental disabilities and for anyone not covered under the Iowa Plan.
	7.	Services provided under the Medicaid home- and community-based services mental retardation waiver.
	8.	Services provided under the Medicaid home- and community-based services brain injury waiver for which the county is responsible according to rule 441—83.90(249A).
	9.	Medicaid habilitation services for persons with chronic mental illness.
“Services fund” means a county’s mental health, mental retardation, and developmental disabilities services fund created in Iowa Code section 331.424A.
441—25.62(426B) Risk pool board. This ten-member board consists of two county supervisors, two county auditors, a member of the commission who is not a member of a county board of supervisors, a member of the county finance committee created in Iowa Code chapter 333A who is not an elected official, a representative of a provider of mental health or developmental disabilities services selected from nominees submitted by the Iowa Association of Community Providers, and two central point of coordination administrators, all appointed by the governor, subject to confirmation by two-thirds of the members of the senate, and one member appointed by the director of the department of human services.
	25.62(1) Organization.
	a. 	The members of the board shall annually elect from the board’s voting membership a chairperson and vice-chairperson of the board.
	b. 	Members appointed by the governor shall serve three-year terms.
	25.62(2) Duties and powers of the board. The board’s powers and duties are to make policy and to provide direction for the administration of the risk pool established by Iowa Code section 426B.5, subsection 2. In carrying out these duties, the board shall do all of the following:
	a. 	Recommend to the commission for adoption rules governing the risk pool fund.
	b. 	Determine application requirements to ensure prudent use of risk pool assistance.
	c. 	Accept or reject applications for assistance in whole or in part.
	d. 	Review the fiscal year-end financial records for all counties that are granted risk pool assistance and determine if repayment is required.
	e. 	Approve actuarial and other direct administrative costs to be paid from the pool.
	f. 	Compile a list of requests for risk pool assistance that are beyond the amount available in the risk pool fund for a fiscal year and the supporting information for those requests and submit the list and supporting information to the commission, the department of human services, and the general assembly.
	g. 	Perform any other duties as mandated by law.
	25.62(3) Board action.
	a. 	A quorum shall consist of two-thirds of the membership appointed and qualified to vote.
	b. 	When a quorum is present, an action is carried by a majority of the qualified members of the board.
	25.62(4) Board minutes.
	a. 	Copies of administrative rules and other materials considered are made part of the minutes by reference.
	b. 	Copies of the minutes are kept on file in the office of the administrator of the division.
	25.62(5) Board meetings.
	a. 	The board shall meet in August of each year and may hold special meetings at the call of the chairperson or at the request of a majority of the voting members.
	b. 	Any county making application for risk pool funds must be represented at the board meeting for awarding funds when that request is considered.
	(1)	The division shall notify the county of the date, time and location of the meeting.
	(2)	Any other persons with questions about the date, time or location of the meeting may contact the Administrator, Division of Mental Health and Disability Services, Department of Human Services, Hoover State Office Building, Fifth Floor, 1305 East Walnut Street, Des Moines, Iowa 50319-0114, telephone (515)281-7277.
	c. 	The board shall comply with applicable provisions of Iowa’s open meetings law, Iowa Code chapter 21.
	25.62(6) Records. Any records maintained by the board or on behalf of the board shall be made available to the public for examination in compliance with Iowa’s open records law, Iowa Code chapter 22. To the extent possible, before submitting applications, records and documents, applicants shall delete any confidential information. These records shall be maintained in the office of the division.
	25.62(7) Conflict of interest. A board member cannot be a part of any presentation to the board of that board member’s county’s application for risk pool funds nor can the board member be a part of any action pertaining to that application.
	25.62(8) Robert’s Rules of Order. In cases not covered by these rules, Robert’s Rules of Order shall govern.
	25.62(9) Report. On or before March 1 and September 1 of each fiscal year, the department of human services shall provide the risk pool board with a report of the financial condition of each funding source administered by the board. The report shall include, but is not limited to, an itemization of the funding source’s balances, types and amount of revenues credited and payees and payment amounts for the expenditures made from the funding source during the reporting period.
[ARC 7879B, IAB 6/17/09, effective 6/1/09]
441—25.63(426B) Application process.
	25.63(1) Applicants. A county may be eligible for risk pool assistance when the county demonstrates that it meets the conditions in this subrule.
	a. 	Basic eligibility.
	(1)	The county complies with the requirements of Iowa Code section 331.439.
	(2)	The county levied the maximum amount allowed for the county’s services fund under Iowa Code section 331.424A for the fiscal year of application.
	(3)	In the fiscal year that commenced two years before the fiscal year of distribution, the county’s services fund ending balance under generally accepted accounting principles was equal to or less than 20 percent of the county’s actual gross expenditures for that fiscal year.
	b. 	Circumstances indicating need for assistance. Risk pool assistance is needed for one or more of the following purposes:
	(1)	To continue support for mandated services.
	(2)	To avoid the need for reduction or elimination of:
	1.	Critical services, creating risk to a consumer’s health or safety;
	2.	Critical emergency or mobile crisis services, creating risk to the public’s health or safety;
	3.	Services or other support provided to an entire disability category; or
	4.	Services or other support provided to maintain consumers in a community setting, creating risk of placement in a more restrictive, higher-cost setting.
	25.63(2) Application procedures.
	a. 	Format for submission. The county shall submit the application package electronically or send an original plus 15 copies to the division. Facsimiles are not acceptable.
	b. 	Deadline. The division must receive the application no later than 4:30 p.m.	on July 1 of each year; or, if July 1 is a holiday, Saturday or Sunday, the division must receive the application no later than 4:30 p.m.	on the first working day thereafter.
	c. 	Signature. The application shall be signed and dated by both the chairperson of the county board of supervisors and the central point of coordination administrator.
	d. 	Notice of receipt. Staff of the division shall notify each county of receipt of the county’s application.
	e. 	Content. In addition to Form 470-3723, Risk Pool Application, the application package shall include the following forms for the fiscal year that commenced two years before the fiscal year of distribution:
	(1)	Form 634C, Service Area 4 Supporting Detail (pages 1 to 8).
	(2)	Form 638R, Statement of Revenues, Expenditures, and Changes in Fund Balance—Actual and Budget (pages 1 and 2).
	(3)	If the budget has been amended, Form 653A-R, Record of Hearing and Determination on the Amendment to County Budget (sheet 2), as last amended.
	25.63(3) Request for additional information. Staff shall review all applications for completeness. If an application is not complete, staff of the division shall contact the county within four working days after July 1 to request the information needed to complete the application. If July 1 is a holiday, Saturday or Sunday, the division shall make this contact within five working days after July 1. The county shall submit the required information within five working days from the date of the division’s request for the additional information.
[ARC 7879B, IAB 6/17/09, effective 6/1/09]
441—25.64(426B) Methodology for awarding risk pool funding. The risk pool board shall make an eligibility decision on each application within 45 days after receiving the application and shall make a funding decision no later than August 15.
	25.64(1) Notice of decision. The risk pool board shall send a notice of decision of the board’s action to the chairperson of the applying county’s board of supervisors. Copies of the notice of decision shall be sent to the county auditor and the central point of coordination administrator.
	25.64(2) Distribution of funds. The total amount of the risk pool shall be limited to the available pool for a fiscal year.
	a. 	If the total dollar amount of the approved applications exceeds the available pool, the board shall prorate the amount paid for an approved application. The funds will be prorated to each county based upon the proportion of each approved county’s request to the total amount of all approved requests.
	b. 	The division shall authorize the issuance of warrants payable to the county treasurers for the amounts due. The warrants shall be issued on or before September 15.
[ARC 7879B, IAB 6/17/09, effective 6/1/09]
441—25.65(426B) Repayment provisions.
	25.65(1) Required repayment. Counties shall be required to repay risk pool funds if the county’s actual need for risk pool assistance was less than the amount of risk pool assistance granted to the county. The county shall refund the lesser of:
	a. 	The amount of assistance awarded; or
	b. 	An amount such that the fund balance after refund will not exceed 5 percent of the expenditures for the year as determined on a modified accrual basis.
	25.65(2) Year-end report. Each county granted risk pool funds shall complete a year-end financial report as required by Iowa Code section 225C.6A(2)(c)(3). The division shall review the accrual information and notify the mental health risk pool board if any county that was granted assistance in the prior year received more than the county’s actual need based on the submitted financial report.
	25.65(3) Notification to county. The chairperson of the mental health risk pool board shall notify each county by January 1 of each fiscal year of the amount to be reimbursed. The county shall reimburse the risk pool within 30 days of receipt of notification by the chairperson of the mental health risk pool board. If a county fails to reimburse the mental health risk pool, the board may request a revenue offset through the department of revenue. Copies of the overpayment and request for reimbursement shall be sent to the county auditor and the central point of coordination administrator of the county.
[ARC 7879B, IAB 6/17/09, effective 6/1/09]
441—25.66(426B) Appeals. The risk pool board may accept or reject an application for assistance from the risk pool fund in whole or in part. The decision of the board is final and is not appealable.
These rules are intended to implement Iowa Code section 426B.5, subsection 2.
441—25.67 to 25.70 Reserved.
DIVISION VI
TOBACCO SETTLEMENT FUND RISK POOL FUNDING
Preamble
These rules provide for use of an appropriation from the tobacco settlement fund to establish a risk pool fund which may be used by counties with limited county mental health, mental retardation and developmental disabilities services funds to pay for increased compensation of the service staff of eligible purchase of service (POS) providers and establish the requirements for counties for receiving and repaying the funding. Implementation of the rate increases contemplated by the tobacco settlement fund in a timely manner will require cooperation among all eligible counties and providers.
441—25.71(78GA,ch1221) Definitions.
“Adjusted actual cost” means a POS provider’s cost as computed using the financial and statistical report for the provider’s fiscal year which ended during the state fiscal year beginning July 1, 1998 (state fiscal year 1999), as adjusted by multiplying those actual costs by 103.4 percent or the percentage adopted by the risk pool board in accordance with 2000 Iowa Acts, chapter 1221, section 3, subsection 3, paragraph “c.”
“Department” means the Iowa department of human services.
“Division” means the mental health and developmental disabilities division of the department of human services.
“Financial and statistical report” means a report prepared by a provider and submitted to host counties that is prepared in accordance with department rules for cost determination set forth in 441—Chapter 150.
“Host county” means the county in which the primary offices of a POS provider are located. However, if a POS provider operates separate programs in more than one county, “host county” means each county in which a separate program is operated.
“Purchase of service provider” or “POS provider” means a provider of sheltered work, work activity, supported employment, job placement, enclave services, adult day care, transportation, supported community living services, or adult residential services paid by a county from the county’s services fund created in Iowa Code section 331.424A under a state purchase of service or county contract.
“Risk pool board” means that board established by Iowa Code section 426B.5, subsection 3.
“Separate program” means a POS service operated in a county other than the county in which the provider’s home office is located and for which the provider allocates costs separately from similar programs located in the county where the provider’s home office is located.
“Services fund” means the fund defined in Iowa Code section 331.424A.
“Tobacco settlement fund loan” or “TSF loan” means the tobacco settlement fund risk pool funds a county received in a fiscal year in which the county did not levy the maximum amount allowed for the county’s mental health, mental retardation, and developmental disabilities services fund under Iowa Code section 331.424A. The repayment amount shall be limited to the amount by which the actual amount levied was less than the maximum amount allowed.
441—25.72(78GA,ch1221) Risk pool board. The risk pool board is organized and shall take action and keep minutes and records as set out in rule 441—25.62(426B).
A risk pool board member cannot be a part of any presentation to the board of that board member’s county’s application for tobacco settlement fund risk pool funds nor can the board member be a part of any action pertaining to that application. If a risk pool board member is employed by or is a board member of a POS provider whose increases in compensation caused the host county to apply to the fund, the board member cannot be a part of any presentation to the board nor can the board member be a part of any action pertaining to that application.
441—25.73(78GA,ch1221) Rate-setting process. For services provided on or after July 1, 2000, each county shall increase its reimbursement rates for each program to the lesser of the adjusted actual cost or 105 percent of the rate paid for services provided on June 30, 2000.
	25.73(1) Financial and statistical report. Each provider of POS services shall submit a financial and statistical report to each host county for each program that the provider operates within that county. These reports shall include actual costs for each separate program for the provider’s fiscal year that ended during state fiscal year 1999 and state fiscal year 2000. These reports shall be submitted to the central point of coordination (CPC) administrator of the host county or counties no later than August 15, 2000.
	25.73(2) Rate determination. The CPC administrator in each host county shall receive and review provider financial and statistical reports for each separate program for which that county is the host county. If the host county determines that all or part of the provider’s increase in costs is attributable to increases in service staff compensation and that the adjusted actual cost is more than the rate paid by the county on June 30, 2000, the CPC administrator shall notify the provider in writing of the new rate for each program no later than September 1, 2000.
If a rate paid for services provided on June 30, 2000, exceeds the adjusted actual cost, the county shall not be required to adjust the rate for services provided on or after July 1, 2000.
The provider shall, no later than September 11, 2000, send to the CPC administrator of any other counties with consumers in those programs a copy of the rate determination signed by the CPC administrator of the host county. A county may delay payment of the reimbursement rate established pursuant to this subrule until the risk pool board has completed action as to adopting or not adopting a different percentage for the definition of adjusted actual cost, provided however that any increased rates required by 2000 Iowa Acts, chapter 1221, section 3, subsection 2, paragraph “c,” shall be paid retroactively for all services provided on or after July 1, 2000.
	25.73(3) Exemptions.
	a. 	A POS provider that has negotiated a reimbursement rate increase with a host county as of July 1, 2000, has the option of exemption from the provisions of these rules. However, a county shall not be eligible to receive tobacco settlement funds for any rates established outside of the process established in these rules.
	b. 	Nothing in these rules precludes a county from increasing reimbursement rates of POS providers by an amount that is greater than that specified in these rules. However, a county shall not be eligible for tobacco settlement funds for the amount of any rate increase in excess of the amount established pursuant to these rules.
441—25.74(78GA,ch1221) Application process.
	25.74(1) Who may apply. If a county determines that payment of POS provider rates in accordance with these rules will cause the county to expend more funds in FY2001 than budgeted for POS services, the county may apply for assistance from the tobacco settlement fund. However, any fiscal year 2000 projected accrual basis fund balances in excess of 25 percent of fiscal year 2000 services fund gross expenditures will reduce the amount for which a county is eligible. In considering the cost of implementing these provisions, a county shall not include the cost of rate increases granted to any providers who fail to complete financial and statistical reports as provided in these rules.
	25.74(2) How to apply. The county shall send the original and 15 copies of Form 470-3768, Tobacco Settlement Fund Risk Pool Application, to the division. The division must receive the application no later than 4:30 p.m.	on September 25, 2000. Facsimiles and electronic mail are not acceptable. The application shall be signed and dated by the chairperson of the county board of supervisors, the county auditor, and the CPC administrator. Staff of the division shall notify each county of receipt of the county’s application.
	25.74(3) Request for additional information. Staff shall review all applications for completeness. If an application is not complete, staff of the division shall contact the county by October 5, 2000, and request the information needed to complete the application. The county shall submit the required information by October 16, 2000.
441—25.75(78GA,ch1221) Methodology for awarding tobacco settlement fund risk pool funding.
	25.75(1) Review of applications. The risk pool board shall review all of the applications from counties for assistance from the tobacco settlement fund. If the total amount requested from the tobacco settlement fund does not exceed $2 million, eligible counties shall be awarded funding pursuant to this division. The risk pool board shall determine for each county whether any or all of the assistance granted to that county is a TSF loan.
	25.75(2) Notice of decision. The risk pool board shall notify the chair of the applying county’s board of supervisors of the board’s action no later than November 3, 2000. Copies shall be sent to the county auditor and the CPC administrator.
	25.75(3) Distribution of funds. The total amount of the risk pool shall be limited to $2 million. If the total dollar amount of the eligible applications exceeds the available pool, the risk pool board shall revise the percentage adjustment to actual cost to arrive at adjusted actual cost as defined in this division and prorate funding to the eligible counties. If it becomes necessary to revise the percentage adjustment used to determine adjusted actual cost, the risk pool board shall determine if applicant counties remain eligible under this program.
	25.75(4) Notification of adjustment. If the risk pool board rolls back the percentage adjustment used to determine adjusted actual cost, the risk pool board shall notify the chair of the board of supervisors of all counties, and copies shall be sent to the county auditor and the CPC administrator of each county. Each host county shall recalculate the reimbursement rate under this division using the revised adjusted actual cost percentage and notify each provider in writing of the revised rate within 30 days of receiving notice of the percentage adjustment. The provider shall, within 30 days of receipt of notice, send to the CPC administrator of any other counties with consumers in those programs a copy of the revised rate determination signed by the CPC administrator of the host county.
441—25.76(78GA,ch1221) Repayment provisions.
	25.76(1) Required repayment. Counties shall be required to repay TSF loans by January 1, 2002. Repayments shall be credited to the tobacco settlement fund.
	25.76(2) Notification to county. In the notice of decision provided pursuant to these rules, the chairperson of the risk pool board shall notify each county of the portion, if any, of the assistance that is considered a TSF loan. If a county fails to reimburse the tobacco settlement fund by January 1, 2002, the board may request a revenue offset through the department of revenue. Copies of the overpayment and request for reimbursement shall be sent to the county auditor and the CPC administrator of the county.
441—25.77(78GA,ch1221) Appeals. The risk pool board may accept or reject an application for assistance from the tobacco settlement fund risk pool fund in whole or in part. The decision of the board is final and is not appealable.
These rules are intended to implement 2000 Iowa Acts, chapter 1221, section 3, as amended by chapter 1232, section 4.
441—25.78 to 25.80 Reserved.
DIVISION VII
COMMUNITY MENTAL HEALTH CENTER WAIVER REQUEST
Preamble
This division establishes a process for the mental health and developmental disabilities commission to grant a waiver to any county not affiliated with a community mental health center.
441—25.81(225C) Waiver request. Counties that have not established or that are not affiliated with a community mental health center under Iowa Code chapter 230A are required to expend a portion of the money received from the MI/MR/DD/BI community services fund to contract with a community mental health center for services. When a county determines that a contractual arrangement is undesirable or unworkable, it may request a waiver from this requirement for a fiscal year. The waiver request and justification may be submitted to the mental health and developmental disabilities commission with the application for MI/MR/DD/BI community services funds on Form 470-0887, Waiver Request, or it may be submitted separately. The commission may grant a waiver if the request successfully demonstrates that all of the following conditions are met:
	25.81(1) Accreditation of provider. The provider or network of providers that the county has contracted with to deliver the identified mental health services is accredited as another mental health provider pursuant to 441—Chapter 24.
	25.81(2) Contracted services. The county has contracted to provide services that are equal to or greater than the smallest set of services provided by an accredited community mental health center in the department’s service area for that county.
	25.81(3) Eligible populations. The county contract includes the following eligible populations:
	a. 	Children.
	b. 	Adults.
	c. 	Elderly.
	d. 	Chronically mentally ill.
	e. 	Mentally ill.
This rule is intended to implement Iowa Code section 225C.7.
441—25.82 to 25.90 Reserved.
DIVISION VIII
CRITERIA FOR EXEMPTING COUNTIES FROM JOINING INTO REGIONS TO ADMINISTER
MENTAL HEALTH AND DISABILITY SERVICES
441—25.91(331) Exemption from joining into mental health and disability services region.
	25.91(1) Definitions.
“Applicant” means a single county or two counties that submit an application for an exemption from the requirement to join a region of three or more contiguous counties.
“Clear lines of accountability” means the governing board’s organizational structure makes it evident that the ultimate responsibility for the administration of non-Medicaid-funded mental health and disability services lies with the governing board and that the governing board directly and solely supervises the organization’s chief executive officer.
“Coordinator of disability services” means a person who meets the qualifications of a coordinator of disability services as defined in Iowa Code section 331.390(3)“b” and is responsible for ensuring that individuals receive effective service coordination consistent with the county’s or counties’ management plan.
“Core services” means core services mandated to be provided by the regional service system as defined in Iowa Code section 331.397.
“Department” means the Iowa department of human services.
“Director” means the director of the department.
“Evidence-based practice” means interventions that have been rigorously tested, have yielded consistent, replicable results, and have proven safe, beneficial, and effective.
“Penetration rate,” for the purposes of this rule, means the per capita number of adults in the adult population of a county who are receiving mental health and disability services.
“Reasonably close proximity” means a distance of 100 miles or less or a driving distance of two hours or less from the county seat or county seats of the applicant.
“Trauma-informed care” means services that are based on an understanding of the vulnerabilities or triggers of individuals who have experienced trauma, recognize the role trauma has played in the lives of those individuals, are supportive of trauma recovery, and avoid retraumatization.
	25.91(2) Application for exemption from the requirement to form a region of three or more contiguous counties. The following requirements apply to an application for exemption from the requirement to form a region of three or more contiguous counties:
	a. 	The applicant shall submit a written statement that the applicant intends to apply for an exemption from the requirement to form a region of three or more contiguous counties. The statement must be signed by the chairperson of the county board of supervisors of the applicant’s county. The signed written statement of intent must be received by the department on or before May 1, 2013, at 4:30 p.m.
	b. 	The applicant shall submit a written application on forms specified by the department with required supporting documentation. The department shall only accept applications that are complete, signed by the applicant’s chairperson of the county board of supervisors, dated, and received by the department on or before June 30, 2013, at 4:30 p.m.
	c. 	The director of the department shall issue a decision on the application within 45 days of receiving the application. The director shall deny an application if the application does not meet the criteria described in Iowa Code or rule.
	25.91(3) Applicant criteria. The application shall include written documentation and evidence that the applicant has:
	a. 	The capacity to provide required core services and perform required functions described in Iowa Code section 331.397.
	b. 	A contract with a community mental health center or a federally qualified health center that provides psychiatric and outpatient mental health services in the applicant’s county or counties or written intent from the community mental health center or federally qualified health center to enter into such a contract.
	c. 	A contract with a hospital with an inpatient psychiatric unit or a state mental health institute located in or within reasonably close proximity that has the capacity to provide inpatient services to the applicant or written intent from the state mental health institute or inpatient psychiatric unit to enter into such a contract.
	d. 	An administrative structure with clear lines of accountability. A description of the applicant’s administrative functions shall be included with the application.
	e. 	Taken steps to determine and demonstrate that forming a region of three or more contiguous counties is not workable.
	25.91(4) Core services and required functions standards. The department shall review the application to determine if the applicant has provided written documentation and evidence for the availability of:
	a. 	A 24-hour, 7-day-a-week, 365-days-per-year telephone response system for mental health and disability-related emergencies in the applicant’s county or counties.
	b. 	Service providers in the applicant’s county or counties that demonstrate the capability of providing evidence-based practices that the applicant has independently verified meet established fidelity to evidence-based service models including, but not limited to:
	(1)	Assertive community treatment or strengths-based case management.
	(2)	Integrated treatment of co-occurring substance abuse and mental health disorders.
	(3)	Supported employment.
	(4)	Family psychoeducation.
	(5)	Illness management and recovery.
	(6)	Permanent supportive housing.
	c. 	Service providers in the applicant’s county or counties that are trained to provide effective services to persons with two or more of the following co-occurring conditions: mental illness, intellectual disability, developmental disability, brain injury, or substance use disorder. Training for serving persons with co-occurring conditions shall be training identified by the Substance Abuse and Mental Health Services Administration, the Dartmouth Psychiatric Research Center or other generally recognized professional organization specified in the application.
	d. 	Service providers in the applicant’s county or counties that are trained to provide effective trauma-informed care. Trauma-informed care training shall be training identified by the National Center for Trauma-Informed Care or other generally recognized professional organization specified in the application.
	25.91(5) Service capacity. The department shall review the material provided in the application and by the applicant and other counties in their required county reports to determine if the applicant demonstrates that it has:
	a. 	Sufficient financial resources to fund required core services.
	b. 	A penetration rate that is at least equal to or exceeds the statewide per capita average for individuals with a mental illness or individuals with an intellectual disability.
	c. 	A per capita use of inpatient psychiatric hospital services that is less than or equal to the statewide per capita average.
	d. 	A per capita use of intermediate care facilities for individuals with intellectual disabilities that is less than or equal to the statewide per capita average.
	e. 	A per capita use of outpatient mental health services that is greater than or equal to the statewide per capita average.
	f. 	A per capita use of supported community living services that is greater than or equal to the statewide per capita average.
	g. 	An average cost of service per individual served that is equal to or less than the statewide average.
	h. 	Administrative costs, as a percentage of non-Medicaid service expenditures, that are less than or equal to the statewide average.
	25.91(6) Provider network sufficiency. The department shall review the application to determine if the applicant provided written documentation and evidence of:
	a. 	A contract with a community mental health center that provides services in the applicant’s county or counties or a federally qualified health center that provides psychiatric and outpatient mental health services in the applicant’s county or counties or written intent by a community mental health center or federally qualified health center to enter into such a contract.
	b. 	Contracts with licensed and accredited providers to provide each service in the required core service domains or written intent by providers to enter into such contracts.
	c. 	Adequate numbers of licensed and accredited providers to ensure availability of core services so that there is no waiting list for services due to lack of available providers.
	d. 	A contract with an inpatient psychiatric hospital unit or state mental health institute within reasonably close proximity or written intent by an inpatient psychiatric hospital unit or state mental health institute to enter into such a contract.
	25.91(7) to 25.91(9) Reserved.
	25.91(10) Staffing. The department shall review the application to determine if the applicant provided written documentation and evidence of:
	a. 	Clear lines of accountability.
	b. 	The inclusion of one or more coordinators of disability services on the county administrator staff.
	25.91(11) Reserved.
	25.91(12) Determination that formation of a region is unworkable. The department shall review the application to determine if the applicant has provided documentation and convincing evidence that the applicant has evaluated the feasibility of forming into a region of three or more contiguous counties and that forming into such a region is unworkable.
	25.91(13) Compliance with requirements of a mental health and disability services region. The applicant shall continuously fulfill all of the requirements of a region under Iowa Code chapters 331 and 225C for a regional service system, regional service system management plan, regional governing board, and regional administrator and any other requirements applicable to a region of counties providing local mental health and disability services. If the applicant does not fulfill these requirements, the department may address the deficiencies in the following order:
	a. 	Require compliance with a corrective action plan that may include, but is not limited to, participation in technical assistance provided or arranged by the department, revision of the regional management plan, or other corrective actions required by the department.
	b. 	Reduce the amount of the annual state funding provided through the mental health and disabilities regional services fund for the regional service system, not to exceed 15 percent of the amount of the annual state funding.
	c. 	Withdraw approval for the county exemption.
This rule is intended to implement Iowa Code section 331.389.
[ARC 0576C, IAB 2/6/13, effective 1/8/13]
[Filed emergency 12/14/94—published 1/4/95, effective 12/14/94]
[Filed 2/16/95, Notice 1/4/95—published 3/15/95, effective 5/1/95]
[Filed 1/10/96, Notice 11/22/95—published 1/31/96, effective 4/1/96]
[Filed 12/12/96, Notice 11/6/96—published 1/1/97, effective 3/1/97]
[Filed emergency 6/25/98—published 7/15/98, effective 7/1/98]
[Filed 9/3/98, Notice 7/15/98—published 9/23/98, effective 11/1/98]
[Filed 2/9/00, Notice 12/29/99—published 3/8/00, effective 4/12/00]
[Filed emergency 3/8/00—published 4/5/00, effective 3/8/00]
[Filed emergency 7/5/00—published 7/26/00, effective 8/1/00]
[Filed 9/6/00, Notice 4/5/00—published 10/4/00, effective 11/8/00]
[Filed 10/23/00, Notice 7/26/00—published 11/15/00, effective 1/1/01]
[Filed 11/14/01, Notice 9/19/01—published 12/12/01, effective 2/1/02]◊
[Filed 5/9/02, Notice 3/6/02—published 5/29/02, effective 7/3/02]
[Filed emergency 12/22/03 after Notice 10/15/03—published 1/21/04, effective 1/1/04]
[Filed 5/4/05, Notice 1/19/05—published 5/25/05, effective 7/1/05]
[Filed emergency 1/19/07—published 2/14/07, effective 1/20/07]
[Filed emergency 6/22/07—published 7/18/07, effective 7/1/07]
[Filed emergency 9/27/07—published 10/24/07, effective 10/10/07]
[Filed 11/16/07, Notice 8/1/07—published 12/19/07, effective 2/1/08]
[Filed 12/14/07, Notice 7/18/07—published 1/16/08, effective 2/20/08]
[Filed 12/14/07, Notice 10/24/07—published 1/16/08, effective 2/20/08]
[Filed emergency 9/19/08—published 10/8/08, effective 10/1/08]
[Filed ARC 7768B (Notice ARC 7626B, IAB 3/11/09), IAB 5/20/09, effective 7/1/09]
[Filed Emergency ARC 7879B, IAB 6/17/09, effective 6/1/09]
[Filed Emergency ARC 0576C, IAB 2/6/13, effective 1/8/13]
◊	Two or more ARCs