441—83.128(249A) Adverse service actions.
	83.128(1) Denial. An application for children’s mental health waiver services shall be denied when the department determines that:
	a. 	The consumer is not eligible for or in need of waiver services.
	b. 	Needed services are not available or received from qualified providers.
	c. 	Service needs exceed the limit on aggregate monthly costs established in 83.122(6)“c” or are not met by the services provided.
	83.128(2) Termination. A consumer’s participation in the children’s mental health waiver program may be terminated when the department determines that:
	a. 	The provisions of 441—paragraph 130.5(2)“a,” “b,” “c,” “g,” or “h” apply.
	b. 	The costs of the children’s mental health waiver services for the consumer exceed the aggregate monthly costs established in 83.122(6)“c.”
	c. 	The consumer receives care in a hospital, nursing facility, psychiatric hospital serving children under the age of 21, or psychiatric medical institution for children for 30 days in any one stay.
	d. 	The physical or mental condition of the consumer requires more care than can be provided in the consumer’s own home, as determined by the consumer’s case manager or integrated health home care coordinator.
	e. 	Service providers are not available.
	83.128(3) Reduction. Reduction of services shall apply as specified in 441—paragraphs 130.5(3)“a” and “b.”
[ARC 3184C, IAB 7/5/17, effective 8/9/17]