441—77.39 (249A) HCBS brain injury waiver service providers. Providers shall be eligible to participate in the Medicaid brain injury waiver program if they meet the requirements in this rule and the subrules applicable to the individual service. Providers and each of their staff members involved in direct consumer service must have training regarding or experience with consumers who have a brain injury, with the exception of providers of home and vehicle modification, specialized medical equipment, transportation, personal emergency response, financial management, independent support brokerage, self-directed personal care, individual-directed goods and services, and self-directed community supports and employment.
Services shall be rendered by a person who is at least 16 years old (except as otherwise provided in this rule) and is not the spouse of the consumer served or the parent or stepparent of a consumer aged 17 or under. People who are 16 or 17 years old must be employed and supervised by an enrolled HCBS provider unless they are employed to provide self-directed personal care services through the consumer choices option. A person hired for self-directed personal care services need not be supervised by an enrolled HCBS provider. A person hired through the consumer choices option for independent support brokerage, self-directed personal care, individual-directed goods and services, or self-directed community support and employment is not required to enroll as a Medicaid provider and is not subject to review under subrule 77.39(11). Consumer-directed attendant care and interim medical monitoring and treatment providers must be at least 18 years of age.
In addition, behavioral programming, supported community living, and supported employment providers shall meet the outcome-based standards set forth below in subrules 77.39(1) and 77.39(2) evaluated according to subrules 77.39(8) to 77.39(10), and the requirements of subrules 77.39(3) to 77.39(7). Respite providers shall also meet the standards in subrule 77.39(1).
	 77.39(1) Organizational standards (Outcome 1). Organizational outcome-based standards for HCBS BI providers are as follows:
	  a.   	 The organization demonstrates the provision and oversight of high-quality supports and services to consumers.
	  b.   	 The organization demonstrates a defined mission commensurate with consumers’ needs, desires, and abilities.
	  c.   	 The organization establishes and maintains fiscal accountability.
	  d.   	 The organization has qualified staff commensurate with the needs of the consumers they serve. These staff demonstrate competency in performing duties and in all interactions with clients.
	  e.   	 The organization provides needed training and supports to its staff. This training includes at a minimum:
	 (1) 	 Consumer rights.
	 (2) 	 Confidentiality.
	 (3) 	 Provision of consumer medication.
	 (4) 	 Identification and reporting of child and dependent adult abuse.
	 (5) 	 Individual consumer support needs.
	  f.   	 The organization has a systematic, organizationwide, planned approach to designing, measuring, evaluating, and improving the level of its performance. The organization:
	 (1) 	 Measures and assesses organizational activities and services annually.
	 (2) 	 Gathers information from consumers, family members, and staff.
	 (3) 	 Conducts an internal review of consumer service records, including all major and minor incident reports according to subrule 77.37(8).
	 (4) 	 Tracks incident data and analyzes trends annually to assess the health and safety of consumers served by the organization.
	 (5) 	 Identifies areas in need of improvement.
	 (6) 	 Develops a plan to address the areas in need of improvement.
	 (7) 	 Implements the plan and documents the results.
	  g.   	 Consumers and their legal representatives have the right to appeal the provider’s implementation of the 20 outcomes, or staff or contractual person’s action which affects the consumer. The provider shall distribute the policies for consumer appeals and procedures to consumers.
	  h.   	 The provider shall have written policies and procedures and a staff training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.
	  i.   	 The governing body has an active role in the administration of the agency.
	  j.   	 The governing body receives and uses input from a wide range of local community interests and consumer representation and provides oversight that ensures the provision of high-quality supports and services to consumers.
	 77.39(2) Rights and dignity. Outcome-based standards for rights and dignity are as follows:
	  a.   	 (Outcome 2) Consumers are valued.
	  b.   	 (Outcome 3) Consumers live in positive environments.
	  c.   	 (Outcome 4) Consumers work in positive environments.
	  d.   	 (Outcome 5) Consumers exercise their rights and responsibilities.
	  e.   	 (Outcome 6) Consumers have privacy.
	  f.   	 (Outcome 7) When there is a need, consumers have support to exercise and safeguard their rights.
	  g.   	 (Outcome 8) Consumers decide which personal information is shared and with whom.
	  h.   	 (Outcome 9) Consumers make informed choices about where they work.
	  i.   	 (Outcome 10) Consumers make informed choices on how they spend their free time.
	  j.   	 (Outcome 11) Consumers make informed choices about where and with whom they live.
	  k.   	 (Outcome 12) Consumers choose their daily routine.
	  l.   	 (Outcome 13) Consumers are a part of community life and perform varied social roles.
	  m.   	 (Outcome 14) Consumers have a social network and varied relationships.
	  n.   	 (Outcome 15) Consumers develop and accomplish personal goals.
	  o.   	 (Outcome 16) Management of consumers’ money is addressed on an individualized basis.
	  p.   	 (Outcome 17) Consumers maintain good health.
	  q.   	 (Outcome 18) The consumer’s living environment is reasonably safe in the consumer’s home and community.
	  r.   	 (Outcome 19) The consumer’s desire for intimacy is respected and supported.
	  s.   	 (Outcome 20) Consumers have an impact on the services they receive.
	 77.39(3) The right to appeal. Consumers and their legal representatives have the right to appeal the provider’s application of policies or procedures, or any staff or contractual person’s action which affects the consumer. The provider shall distribute the policies for consumer appeals and procedures to consumers.
	 77.39(4) Storage and provision of medication. If the provider stores, handles, prescribes, dispenses or administers prescription or over-the-counter medications, the provider shall develop procedures for the storage, handling, prescribing, dispensing or administration of medication. For controlled substances, procedures shall be in accordance with department of inspections and appeals rule 481—63.18(135).
	 77.39(5) Research. If the provider conducts research involving consumers, the provider shall have written policies and procedures addressing the research. These policies and procedures shall ensure that consumers’ rights are protected.
	 77.39(6) Reporting requirements.
	  a.   	 Abuse reporting. The provider shall have written policies and procedures and a staff training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.
	  b.   	 Incident reporting. The provider shall document major and minor incidents and make the incident reports and related documentation available to the department upon request. The provider shall ensure cooperation in providing pertinent information regarding incidents as requested by the department.
	 (1) 	 Major incident defined. A “major incident” means an occurrence involving a consumer of services that:
	  1. 	 Results in a physical injury to or by the consumer that requires a physician’s treatment or admission to a hospital;
	  2. 	 Results in someone’s death;
	  3. 	 Requires emergency mental health treatment for the consumer;
	  4. 	 Requires the intervention of law enforcement;
	  5. 	 Requires a report of child abuse pursuant to Iowa Code section 232.69 or a report of dependent adult abuse pursuant to Iowa Code section 235B.3; or
	  6. 	 Constitutes a prescription medication error or a pattern of medication errors that could lead to the outcome in numbered paragraph “1,” “2,” or “3.”
	 (2) 	 Minor incident defined. A “minor incident” means an occurrence involving a consumer of services that is not a major incident and that:
	  1. 	 Results in the application of basic first aid;
	  2. 	 Results in bruising;
	  3. 	 Results in seizure activity;
	  4. 	 Results in injury to self, to others, or to property; or
	  5. 	 Constitutes a prescription medication error.
	 (3) 	 Report form. Each major or minor incident shall be recorded on an incident report form that is completed and signed by the staff who were directly involved at the time of the incident or who first became aware of the incident. The report shall include the following information:
	  1. 	 The name of the consumer involved.
	  2. 	 The date and time the incident occurred.
	  3. 	 A description of the incident.
	  4. 	 The names of all provider staff and others who were present at the time of the incident or responded after becoming aware of the incident. The confidentiality of other consumers who are involved in the incident must be maintained by the use of initials or other means.
	  5. 	 The action that the staff took to handle the incident.
	  6. 	 The resolution of or follow-up to the incident.
	 (4) 	 Reporting procedure for major incidents. When a major incident occurs, provider staff shall notify the consumer or the consumer’s legal guardian within 72 hours of the incident and shall distribute the completed incident report form as follows:
	  1. 	 Forward the report to the supervisor within 24 hours of the incident.
	  2. 	 Send a copy of the report to the consumer’s Medicaid targeted case manager and the department’s bureau of long-term care within 72 hours of the incident.
	  3. 	 File a copy of the report in a centralized location and make a notation in the consumer’s file.
	 (5) 	 Reporting procedure for minor incidents. When a minor incident occurs, provider staff shall distribute the completed incident report form as follows:
	  1. 	 Forward the report to the supervisor within 24 hours of the incident.
	  2. 	 File a copy of the report in a centralized location and make a notation in the consumer’s file.
	 77.39(7) Intake, admission, service coordination, discharge, and referral.
	  a.   	 The provider shall have written policies and procedures according to state and federal laws for intake, admission, service coordination, discharge and referral.
	  b.   	 The provider shall ensure the rights of persons applying for services.
	 77.39(8) Certification process. Reviews of compliance with standards for initial certification and recertification shall be conducted by the department of human services’ bureau of long-term care quality assurance staff. Certification carries no assurance that the approved provider will receive funding.
	  a.   	 Rescinded IAB 9/1/04, effective 11/1/04.
	  b.   	 Rescinded IAB 9/1/04, effective 11/1/04.
	  c.   	 Rescinded IAB 9/1/04, effective 11/1/04.
	  d.   	 The department may request any information from the prospective service provider which is considered pertinent to arriving at a certification decision. This may include, but is not limited to:
	 (1) 	 Current accreditations, evaluations, inspections and reviews by regulatory and licensing agencies and associations.
	 (2) 	 Fiscal capacity of the prospective provider to initiate and operate the specified programs on an ongoing basis.
	 (3) 	 The prospective provider’s written agreement to work cooperatively with the state and central point of coordination in the counties and the state to be served by the provider.
	 77.39(9) Initial certification. The department shall review the application and accompanying information to see if the provider has the necessary framework to provide services in accordance with all applicable requirements and standards.
	  a.   	 The department shall make a determination regarding initial certification within 60 days of receipt of the application and notify the provider in writing of the decision unless extended by mutual consent of the parties involved. Providers shall be responsible for notifying the appropriate county and the appropriate central point of coordination of the determination.
	  b.   	 The decision of the department on initial certification of the providers shall be based on all relevant information, including:
	 (1) 	 The application for status as an approved provider according to requirements of rules.
	 (2) 	 A determination of the financial position of the prospective provider in relation to its ability to meet the stated need.
	 (3) 	 The prospective provider’s coordination of service design, development, and application with the applicable local county central point of coordination and other interested parties.
	  c.   	 Providers applying for initial certification shall be offered technical assistance.
	 77.39(10) Period of certification. Provider certification shall become effective on the date identified on the certificate of approval and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.
	  a.   	 Initial certification. Providers eligible for initial certification by the department shall be issued an initial certification for 270 calendar days based on documentation provided.
	  b.   	 Recertification. After the initial certification, the level of certification shall be based on an on-site review unless the provider has been accredited for similar services by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Quality and Leadership in Supports for People with Disabilities (The Council), or the Council on Accreditation of Services for Families and Children (COA). The on-site reviews for supported community living and supported employment use interviews with consumers and significant people in the consumer’s life to determine whether or not the 20 individual value-based outcomes set forth in subrules 77.39(1) and 77.39(2) and corresponding processes are present for the consumer. Respite services are required to meet Outcome 1 and participate in satisfaction surveys.
Once the outcomes and processes have been determined for all the consumers in the sample, a review team then determines which of the 20 outcomes and processes are present for the provider. A specific outcome is present for the provider when the specific outcome is determined to be present for 75 percent or more of the consumers interviewed. A specific process is present for the provider when the process is determined to be present for 75 percent or more of the consumers interviewed. Since the processes are in the control of the provider and the outcomes are more in the control of the consumer, length of certification will be based more heavily on whether or not the processes are in place to help consumers obtain desired outcomes.
An exit conference shall be held with the organization to share preliminary findings of the certification review. A review report shall be written and sent to the provider within 30 calendar days unless the parties mutually agree to extend that time frame.
Provider certification shall become effective on the date identified on the Certificate of Approval, Form 470-3410, and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.
	  c.   	 The department may issue four categories of recertification:
	 (1) 	 Three-year certification with excellence. An organization is eligible for certification with excellence if the number of processes present is 18 or higher and the number of outcomes and corresponding processes present together is 12 or higher. Both criteria need to be met to receive three-year certification with excellence. Corrective actions may be required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.
	 (2) 	 Three-year certification with follow-up monitoring. An organization is eligible for this type of certification if the number of processes present is 17 or higher and the number of outcomes and corresponding processes present together is 11 or higher. Both criteria need to be met to receive three-year certification. Corrective actions are required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.
	 (3) 	 One-year certification. An organization is eligible for this type of certification when the number of processes present is 14 or higher and the number of outcomes and processes present together is 9 or higher. Both criteria need to be met to receive one-year certification. One-year certification may also be given in lieu of longer certification when previously required corrective actions have not been implemented or completed. Corrective actions are required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.
	 (4) 	 Probational certification. A probational certification may be issued to those providers who cannot meet requirements for a one-year certification. This time period shall be granted to the provider to establish and implement corrective actions and improvement activities. During this time period the department may require monitoring of the implementation of the corrective actions through on-site visits, written reports or technical assistance. Probational certification issued for 270 calendar days shall not be renewed or extended and shall require a full on-site follow-up review to be completed. The provider shall be required to achieve at least a one-year certification status at the time of the follow-up review in order to maintain certification.
	  d.   	 During the course of the review, if a team member encounters a situation that places a consumer in immediate jeopardy, the team member shall immediately notify the provider, the department, and other team members. “Immediate jeopardy” refers to circumstances where the life, health, or safety of a consumer will be severely jeopardized if the circumstances are not immediately corrected. The provider shall correct the situation within 24 to 48 hours. If the situation is not corrected within the prescribed time frame, that portion of the provider’s services that was the subject of the notification shall not be certified. The department, the county of residence, and the central point of coordination shall be notified immediately to discontinue funding for that provider’s service. If this action is appealed and the consumer, legal guardian, or attorney in fact under a durable power of attorney for health care wants to maintain the provider’s services, funding can be reinstated. At that time the provider shall take appropriate action to ensure the life, health, and safety of the consumers deemed to be at risk as a result of the provider’s inaction.
	  e.   	 As a mandatory reporter, each team member shall be required to follow appropriate procedure in all cases where a condition reportable to child and adult protective services is observed.
	  f.   	 The department may grant an extension to the period of approval for the following reasons:
	 (1) 	 A delay in the department’s approval decision which is beyond the control of the provider or department.
	 (2) 	 A request for an extension from a provider to permit the provider to prepare and obtain department approval of corrective actions. The department shall establish the length of extensions on a case-by-case basis.
	  g.   	 The department may revoke the provider’s approval at any time for any of the following reasons:
	 (1) 	 Findings of a site visit indicate that the provider has failed to implement the corrective actions submitted pursuant to paragraph 77.39(11)“d.”
	 (2) 	 The provider has failed to provide information requested pursuant to paragraph 77.39(11)“e.”
	 (3) 	 The provider refuses to allow the department to conduct a site visit pursuant to paragraph 77.39(11)“f.”
	 (4) 	 There are instances of noncompliance with the standards which were not identified from information submitted on the application.
	  h.   	 An approved provider shall immediately notify the department, applicable county, the applicable mental health and developmental disabilities planning council, and other interested parties of a decision to withdraw from an HCBS BI waiver service.
	  i.   	 Following certification, any provider may request technical assistance from the department to bring into conformity those areas found in noncompliance with HCBS requirements. If multiple deficiencies are noted during a review, the department may require that technical assistance be provided to a provider to assist in the implementation of the provider’s corrective actions. Providers may be given technical assistance as needed.
	  j.   	 Appeals. Any adverse action can be appealed by the provider under 441—Chapter 7.
	 77.39(11) Departmental reviews. Reviews of compliance with standards as indicated in this chapter shall be conducted by the division of mental health and developmental disabilities quality assurance review staff. This review may include on-site case record audits, administrative procedures, clinical practices, and interviews with staff, consumers, and board of directors consistent with the confidentiality safeguards of state and federal laws.
	  a.   	 Reviews shall be conducted annually with additional reviews conducted at the discretion of the department.
	  b.   	 Following a departmental review, the department shall submit a copy of the department’s determined survey report to the service provider, noting service deficiencies and strengths.
	  c.   	 The service provider shall develop a plan of corrective action identifying completion time frames for each survey deficiency.
	  d.   	 The corrective action plan shall be submitted to the Division of Mental Health and Developmental Disabilities, 5th Floor, Hoover State Office Building, Des Moines, Iowa 50319-0114, and include a statement dated and signed, if applicable, by the chief administrative officer and president or chairperson of the governing body that all information submitted to the department is accurate and complete.
	  e.   	 The department may request the provider to supply subsequent reports on implementation of a corrective action plan submitted pursuant to paragraphs 77.39(11)“c” and “d.”
	  f.   	 The department may conduct a site visit to verify all or part of the information submitted.
	 77.39(12) Case management service providers. Case management provider organizations are eligible to participate in the Medicaid HCBS brain injury waiver program provided that they meet the standards in 441—Chapter 24 and they are the department of human services, a county or consortium of counties, or a provider under subcontract to the department or a county or consortium of counties.
	 77.39(13) Supported community living providers.
	  a.   	 The department shall certify only public or private agencies to provide the supported community living service. The department does not recognize individuals as service providers under the supported community living program.
	  b.   	 Providers of services meeting the definition of foster care shall also be licensed according to applicable 441—Chapters 108, 112, 114, 115, and 116, which deal with foster care licensing.
	  c.   	 Providers of service may employ or contract with individuals meeting the definition of foster family homes to provide supported community living services. These individuals shall be licensed according to applicable 441—Chapters 112 and 113, which deal with foster care licensing.
	  d.   	 The department shall approve living units designed to serve four consumers if the geographic location of the program does not result in an overconcentration of programs in an area.
	 (1) and (2) 	Rescinded IAB 8/7/02, effective 10/1/02.
	 1  e.   	 Living units designed to serve more than three supported community living consumers shall be approved as follows:
	 (1) 	 The department shall approve living units designed to serve four consumers if the geographic location of the program does not result in an overconcentration of such programs in the area.
	 (2) 	 The department may approve living units designed to serve more than four supported community living consumers under an exception to policy pursuant to rule 441—1.8(17A,217), subject to the following additional requirements:
	  1. 	 The provider shall provide verification from the department of inspections and appeals that the program is not required to be licensed as a health care facility under Iowa Code chapter 135C.
	  2. 	 The provider shall provide justification of the need for the service to be provided in a larger living unit instead of a living unit for four persons or less.
	  3. 	 The geographic location of the program shall not result in an overconcentration of supported community living programs in the area.
	 77.39(14) Respite service providers. Respite providers are eligible to be providers of respite service in the HCBS brain injury waiver if they have documented training or experience with persons with a brain injury.
	  a.   	 The following agencies may provide respite services:
	 (1) 	 Respite providers certified under the HCBS mental retardation waiver.
	 (2) 	 Adult day care providers that meet the conditions of participation set forth in subrule 77.39(20).
	 (3) 	 Group living foster care facilities for children licensed by the department according to 441—Chapters 112 and 114 to 116 and child care centers licensed according to 441—Chapter 109.
	 (4) 	 Camps certified by the American Camping Association.
	 (5) 	 Home care agencies that meet the conditions of participation set forth in subrule 77.30(1).
	 (6) 	 Nursing facilities, intermediate care facilities for the mentally retarded, and hospitals enrolled as providers in the Iowa Medicaid program.
	 (7) 	 Residential care facilities for persons with mental retardation licensed by the department of inspections and appeals.
	 (8) 	 Home health agencies that are certified to participate in the Medicare program.
	 (9) 	 Agencies certified by the department to provide respite services in the consumer’s home that meet the requirements of subrules 77.39(1) and 77.39(3) through 77.39(7).
	 (10) 	 Child care facilities, which are defined as child care centers, preschools, or child development homes registered pursuant to 441—Chapter 110.
	 (11) 	 Assisted living programs certified by the department of inspections and appeals.
	  b.   	 Respite providers shall meet the following conditions:
	 (1) 	 Providers shall maintain the following information that shall be updated at least annually:
	  1. 	 The consumer’s name, birth date, age, and address and the telephone number of each parent, guardian or primary caregiver.
	  2. 	 An emergency medical care release.
	  3. 	 Emergency contact telephone numbers such as the number of the consumer’s physician and the parents, guardian, or primary caregiver.
	  4. 	 The consumer’s medical issues, including allergies.
	  5. 	 The consumer’s daily schedule which includes the consumer’s preferences in activities or foods or any other special concerns.
	 (2) 	 Procedures shall be developed for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications administered. Home health agencies must follow Medicare regulations for medication dispensing.
All medications shall be stored in their original containers, with the accompanying physician’s or pharmacist’s directions and label intact. Medications shall be stored so they are inaccessible to consumers and the public. Nonprescription medications shall be labeled with the consumer’s name.
In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription.
	 (3) 	 Policies shall be developed for:
	  1. 	 Notifying the parent, guardian or primary caregiver of any injuries or illnesses that occur during respite provision. A parent’s, guardian’s or primary caregiver’s signature is required to verify receipt of notification.
	  2. 	 Requiring the parent, guardian or primary caregiver to notify the respite provider of any injuries or illnesses that occurred prior to respite provision.
	  3. 	 Documenting activities and times of respite. This documentation shall be made available to the parent, guardian or primary caregiver upon request.
	  4. 	 Ensuring the safety and privacy of the individual. Policies shall at a minimum address threat of fire, tornado, or flood and bomb threats.
	  c.   	 A facility providing respite under this subrule shall not exceed the facility’s licensed capacity, and services shall be provided in locations consistent with licensure.
	  d.   	 Respite provided outside the consumer’s home or the facility covered by the licensure, certification, accreditation, or contract must be approved by the parent, guardian or primary caregiver and the interdisciplinary team and must be consistent with the way the location is used by the general public. Respite in these locations shall not exceed 72 continuous hours.
	 77.39(15) Supported employment providers.
	  a.   	 Providers responsible for the payroll of consumers shall have policies that include, but are not limited to:
	 (1) 	 Consumer vacation, sick leave and holiday compensation.
	 (2) 	 Procedures for payment schedules and pay scale.
	 (3) 	 Procedures for provision of workers’ compensation insurance.
	 (4) 	 Procedures for the determination and review of commensurate wages.
	 (5) 	 Both state and federal department of labor requirements.
	  b.   	 The department shall certify only public or private agencies to provide supported employment services. The department does not recognize individuals as service providers under the supported employment program.
	 77.39(16) Home and vehicle modification providers. The following providers may provide home and vehicle modification:
	  a.   	 Providers eligible to participate as home and vehicle modification providers under the elderly or ill and handicapped waiver, enrolled as home and vehicle modification providers under the physical disability waiver, or certified as home and vehicle modification providers under the physical disability waiver.
	  b.   	 Community businesses that have all necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations and that submit verification of current liability and workers’ compensation insurance.
	 77.39(17) Personal emergency response system providers. Personal emergency response system providers shall be agencies which meet the conditions of participation set forth in subrule 77.33(2).
	  a.   	 Providers shall be certified annually.
	  b.   	 The service provider shall submit documentation to the department supporting continued compliance with the requirements set forth in subrule 77.33(2) 90 days before the expiration of the current certification.
	 77.39(18) Transportation service providers. This service is not to be provided at the same time as supported community service, which includes transportation. The following providers may provide transportation:
	  a.   	 Area agencies on aging as designated in rule 321—4.4(231) or with letters of approval from the area agencies on aging stating the organization is qualified to provide transportation services.
	  b.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  c.   	 Regional transit agencies as recognized by the Iowa department of transportation.
	  d.   	 Providers with purchase of service contracts to provide transportation pursuant to 441—Chapter 150.
	  e.   	 Nursing facilities licensed pursuant to Iowa Code chapter 135C.
	 77.39(19) Specialized medical equipment providers. The following providers may provide specialized medical equipment:
	  a.   	 Medical equipment and supply dealers participating as providers in the Medicaid program.
	  b.   	 Retail and wholesale businesses participating as providers in the Medicaid program which provide specialized medical equipment as defined in 441—subrule 78.43(8).
	 77.39(20) Adult day care providers. Adult day care providers shall be agencies that are certified by the department of inspections and appeals as being in compliance with the standards for adult day services programs adopted by the department of elder affairs at 321—Chapter 24.
	 77.39(21) Family counseling and training providers. Family counseling and training providers shall be one of the following:
	  a.   	 Providers certified under the community mental health center standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and III, and that employ staff to provide family counseling and training who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).
	  b.   	 Providers licensed as meeting the hospice standards and requirements set forth in department of inspections and appeals rules in 481—Chapter 53 or certified to meet the standards under the Medicare program for hospice programs, and that employ staff who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).
	  c.   	 Providers accredited under the mental health service provider standards established by the mental health and developmental and disabilities commission, set forth in 441—Chapter 24, Divisions I and IV, and that employ staff to provide family counseling and training who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).
	  d.   	 Individuals who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).
	  e.   	 Agencies certified as brain injury waiver providers pursuant to rule 441—77.39(249A) that employ staff to provide family counseling who meet the definition of a qualified brain injury professional as set forth in rule 441—83.81(249A).
	 77.39(22) Prevocational services providers. Providers of prevocational services must meet the Commission on Accreditation of Rehabilitation Facilities standards for work adjustment service providers.
	 77.39(23) Behavioral programming providers. Behavioral programming providers shall be required to have experience with or training regarding the special needs of persons with a brain injury. In addition, they must meet the following requirements.
	  a.   	 Behavior assessment, and development of an appropriate intervention plan, and periodic reassessment of the plan, and training of staff who shall implement the plan must be done by a qualified brain injury professional as defined in rule 441—83.81(249A). Formal assessment of the consumers’ intellectual and behavioral functioning must be done by a licensed psychologist or a psychiatrist who is certified by the American Board of Psychiatry.
	  b.   	 Implementation of the plan and training and supervision of caregivers, including family members, must be done by behavioral aides who have been trained by a qualified brain injury professional as defined in rule 441—83.81(249A) and who are employees of one of the following:
	 (1) 	 Agencies which are certified under the community mental health center standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and III.
	 (2) 	 Agencies which are licensed as meeting the hospice standards and requirements set forth in department of inspections and appeals rules 481—Chapter 53 or which are certified to meet the standards under the Medicare program for hospice programs.
	 (3) 	 Agencies which are accredited under the mental health service provider standards established by the mental health and disabilities commission, set forth in 441—Chapter 24, Divisions I and IV.
	 (4) 	 Home health aide providers meeting the standards set forth in subrule 77.33(3). Home health aide providers certified by Medicare shall be considered to have met these standards.
	 (5) 	 Brain injury waiver providers certified pursuant to rule 441—77.39(249A).
	 77.39(24) Consumer-directed attendant care service providers. The following providers may provide consumer-directed attendant care service:
	  a.   	 An individual who contracts with the consumer to provide attendant care service and who is:
	 (1) 	 At least 18 years of age.
	 (2) 	 Qualified by training or experience to carry out the consumer’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.
	 (3) 	 Not the spouse of the consumer or a parent or stepparent of a consumer aged 17 or under.
	 (4) 	 Not the recipient of respite services paid through home- and community-based services on the behalf of a consumer who receives home- and community-based services.
	  b.   	 Home care providers that have a contract with the department of public health or have written certification from the department of public health stating they meet the home care standards and requirements set forth in department of public health rules 641—80.5(135), 641—80.6(135), and 641—80.7(135).
	  c.   	 Home health agencies which are certified to participate in the Medicare program.
	  d.   	 Chore providers subcontracting with area agencies on aging or with letters of approval from the area agencies on aging stating that the organization is qualified to provide chore services.
	  e.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  f.   	 Providers certified under an HCBS waiver for supported community living.
	  g.   	 Assisted living programs that are voluntarily accredited or certified by the department of elder affairs.
	  h.   	 Adult day service providers that meet the conditions of participation for adult day care providers as specified at 441—subrule 77.30(3), 77.33(1), 77.34(7), or 77.39(20) and that have provided a point-in-time letter of notification from the department of elder affairs or an area agency on aging stating the adult day service provider also meets the requirements of department of elder affairs rules in 321—Chapter 25.
	 77.39(25) Interim medical monitoring and treatment providers.
	  a.   	 The following providers may provide interim medical monitoring and treatment services:
	 (1) 	 Child care facilities, which are defined as child care centers, preschools, or child development homes registered pursuant to 441—Chapter 110.
	 (2) 	 Rescinded IAB 9/1/04, effective 11/1/04.
	 (3) 	 Rescinded IAB 9/1/04, effective 11/1/04.
	 (4) 	 Home health agencies certified to participate in the Medicare program.
	 (5) 	 Supported community living providers certified according to subrule 77.37(14) or 77.39(13).
	  b.   	 Staff requirements. Staff members providing interim medical monitoring and treatment services to consumers shall meet all of the following requirements:
	 (1) 	 Be at least 18 years of age.
	 (2) 	 Not be the spouse of the consumer or a parent or stepparent of the consumer if the consumer is aged 17 or under.
	 (3) 	 Not be a usual caregiver of the consumer.
	 (4) 	 Be qualified by training or experience, as determined by the usual caregivers and a licensed medical professional on the consumer’s interdisciplinary team and documented in the service plan, to provide medical intervention or intervention in a medical emergency necessary to carry out the consumer’s plan of care.
	  c.   	 Service documentation. Providers shall maintain clinical and fiscal records necessary to fully disclose the extent of services furnished to consumers. Records shall specify by service date the procedures performed, together with information concerning progress of treatment.
	 77.39(26) Financial management service. Consumers who elect the consumer choices option shall work with a financial institution that meets the qualifications in subrule 77.30(13).
	 77.39(27) Independent support brokerage. Consumers who elect the consumer choices option shall work with an independent support broker who meets the qualifications in subrule 77.30(14).
	 77.39(28) Self-directed personal care. Consumers who elect the consumer choices option may choose to purchase self-directed personal care services from an individual or business that meets the requirements in subrule 77.30(15).
	 77.39(29) Individual-directed goods and services. Consumers who elect the consumer choices option may choose to purchase individual-directed goods and services from an individual or business that meets the requirements in subrule 77.30(16).
	 77.39(30) Self-directed community supports and employment. Consumers who elect the consumer choices option may choose to purchase self-directed community supports and employment from an individual or business that meets the requirements in subrule 77.30(17).
This rule is intended to implement Iowa Code section 249A.4.
1	Effective date of December 15, 2002, delayed 70 days by the Administrative Rules Review Committee at its meeting held December 10, 2002; at its meeting held February 21, 2003, the Committee delayed the effective date until adjournment of the 2003 Session of the General Assembly.