441—83.2 (249A) Eligibility. To be eligible for ill and handicapped waiver services a person must meet certain eligibility criteria and be determined to need a service(s) allowable under the program.
	 83.2(1) Eligibility criteria.
	  a.   	 The person must be under the age of 65 and blind or disabled as determined by the receipt of social security disability benefits or by a disability determination made through the department. Disability determinations are made according to supplemental security income guidelines under Title XVI of the Social Security Act.
	  b.   	 The person must be ineligible for Supplemental Security Income (SSI) if the person is 21 years of age or older, except that persons who are receiving ill and handicapped waiver services upon reaching the age of 21 may continue to be eligible regardless of SSI eligibility until they reach the age of 25.
	  c.   	 Persons shall meet the eligibility requirements of the supplemental security income program except for the following:
	 (1) 	 The person is under 18 years of age, unmarried and not the head of a household and is ineligible for supplemental security income because of the deeming of the parent’s(s’) income.
	 (2) 	 The person is married and is ineligible for supplemental security income because of the deeming of the spouse’s income or resources.
	 (3) 	 The person is ineligible for supplemental security income due to excess income and the person’s income does not exceed 300 percent of the maximum monthly payment for one person under supplemental security income.
	 (4) 	 The person is under 18 years of age and is ineligible for supplemental security income because of excess resources.
	  d.   	 The person must be certified as being in need of nursing facility or skilled nursing facility level of care or as being in need of care in an intermediate care facility for the mentally retarded. The IME medical services unit shall be responsible for approval of the certification of the level of care.
Ill and handicapped waiver services will not be provided when the individual is an inpatient in a medical institution.
	  e.   	 To be eligible for interim medical monitoring and treatment services the consumer must be:
	 (1) 	 Under the age of 21;
	 (2) 	 Currently receiving home health agency services under rule 441—78.9(249A) and require medical assessment, medical monitoring, and regular medical intervention or intervention in a medical emergency during those services. (The home health aide services for which the consumer is eligible must be maximized before the consumer accesses interim medical monitoring and treatment.);
	 (3) 	 Residing in the consumer’s family home or foster family home; and
	 (4) 	 In need of interim medical monitoring and treatment as ordered by a physician.
	  f.   	 The person must meet income and resource guidelines for Medicaid as if in a medical institution pursuant to 441—Chapter 75. When a husband and wife who are living together both apply for the waiver, income and resource guidelines as specified at paragraphs 441—75.5(2)“b” and 441—75.5(4)“c” shall be applied.
	  g.   	 The person must have service needs that can be met by this waiver program. At a minimum a person must receive one billable unit of service under the waiver per calendar quarter.
	  h.   	 To be eligible for the consumer choices option as set forth in 441—subrule 78.34(13), a person cannot be living in a residential care facility.
	 83.2(2) Need for services.
	  a.   	 The consumer shall have a service plan approved by the department which is developed by the service worker identified by the county of residence. This service plan must be completed prior to services provision and annually thereafter.
The service worker shall establish the interdisciplinary team for the consumer and, with the team, identify the consumer’s need for service based on the consumer’s needs and desires as well as the availability and appropriateness of services using the following criteria:
	 (1) 	 This service plan shall be based, in part, on information in the completed Home- and Community-Based Services Assessment or Reassessment, Form 470-0659. Form 470-0659 is completed annually, or more frequently upon request or when there are changes in the consumer’s condition. The service worker shall have a face-to-face visit with the consumer at least annually.
	 (2) 	 Service plans for persons aged 20 or under shall be developed to reflect use of all appropriate nonwaiver Medicaid services and so as not to replace or duplicate those services. The service worker shall list all nonwaiver Medicaid services in the service plan.
	 (3) 	 Service plans for persons aged 20 or under that include home health or nursing services shall not be approved until a home health agency has made a request to cover the consumer’s service needs through nonwaiver Medicaid services.
	  b.   	 Except as provided below, the total monthly cost of the ill and handicapped waiver services shall not exceed the established aggregate monthly cost for level of care as follows:

Skilled level of care	Nursing level of care	ICF/MR	
$2,631	$904	$3,203	
	 (1) 	 For consumers eligible for SSI who remain eligible for ill and handicapped waiver services until the age of 25 because they are receiving ill and handicapped waiver services upon reaching the age of 21, these amounts shall be increased by the cost of services for which the consumer would be eligible under 441—subrule 78.9(10) if still under 21 years of age.
	 (2) 	 If more than $500 is paid for home and vehicle modification services, the service worker shall encumber up to $500 per month within the monthly dollar cap allowed for the consumer until the total amount of the modification is reached within a 12-month period.
	  c.   	 Interim medical monitoring and treatment services must be needed because all usual caregivers are unavailable to provide care due to one of the following circumstances:
	 (1) 	 Employment. Interim medical monitoring and treatment services are to be received only during hours of employment.
	 (2) 	 Academic or vocational training. Interim medical monitoring and treatment services provided while a usual caregiver participates in postsecondary education or vocational training shall be limited to 24 periods of no more than 30 days each per caregiver as documented by the service worker. Time spent in high school completion, adult basic education, GED, or English as a second language does not count toward the limit.
	 (3) 	 Absence from the home due to hospitalization, treatment for physical or mental illness, or death of the usual caregiver. Interim medical monitoring and treatment services under this subparagraph are limited to a maximum of 30 days.
	 (4) 	 Search for employment.
	  1. 	 Care during job search shall be limited to only those hours the usual caregiver is actually looking for employment, including travel time.
	  2. 	 Interim medical monitoring and treatment services may be provided under this paragraph only during the execution of one job search plan of up to 30 working days in a 12-month period, approved by the department service worker or targeted case manager pursuant to 441—subparagraph 170.2(2)“b”(5).
	  3. 	 Documentation of job search contacts shall be furnished to the department service worker or targeted case manager.