441—83.102 (249A) Eligibility. To be eligible for physical disability waiver services, a consumer must meet eligibility criteria set forth in subrule 83.102(1) and be determined to need a service allowable under the program per subrule 83.102(2).
	 83.102(1) Eligibility criteria. All of the following criteria must be met. The person must:
	  a.   	 Have a physical disability.
	  b.   	 Be 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 or the disability guidelines for the Medicaid employed people with disabilities coverage group.
	  c.   	 Be ineligible for the HCBS intellectual disability waiver.
	  d.   	 Have the ability to hire, supervise, and fire the provider as determined by the service worker, and be willing to do so, or have a parent or guardian named by probate court, or attorney in fact under a durable power of attorney for health care who will take this responsibility on behalf of the consumer.
	  e.   	 Be eligible for Medicaid under 441—Chapter 75.
	  f.   	 Be aged 18 years to 64 years.
	  g.   	 Rescinded IAB 2/7/01, effective 2/1/01.
	  h.   	 Be in need of skilled nursing or intermediate care facility level of care. Initial decisions on level of care shall be made for the department by the IME medical services unit within two working days of receipt of medical information. After notice of an adverse decision by the IME medical services unit, the Medicaid applicant or recipient or the applicant’s or recipient’s representative may request reconsideration by the IME medical services unit pursuant to subrule 83.109(2). On initial and reconsideration decisions, the IME medical services unit determines whether the level of care requirement is met based on medical necessity and the appropriateness of the level of care under 441—subrules 79.9(1) and 79.9(2). Adverse decisions by the IME medical services unit on reconsiderations may be appealed to the department pursuant to 441—Chapter 7 and rule 441—83.109(249A).
	  i.   	 Choose HCBS.
	  j.   	 Use a minimum of one unit of service per calendar quarter under this program.
	  k.   	 For the consumer choices option as set forth in 441—subrule 78.46(6), not be living in a residential care facility.
	 83.102(2) Need for services.
	  a.   	 The consumer shall have a service plan which is developed by the consumer and a department service worker. This must be completed and approved prior to service provision and at least annually thereafter.
The service worker shall identify the need for service based on the needs of the consumer as well as the availability and appropriateness of services.
	  b.   	 The total cost of physical disability waiver services shall not exceed $659 per month. If more than $505 is paid for home and vehicle modification services, the service worker shall encumber up to $505 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.
	 83.102(3) Slots. The total number of persons receiving HCBS physical disability waiver services in the state shall be limited to the number provided in the waiver approved by the Secretary of the U.S. Department of Health and Human Services. These slots shall be available on a first-come, first-served basis.
	 83.102(4) County payment slots for persons requiring the ICF/MR level of care. Rescinded IAB 10/6/99, effective 10/1/99.
	 83.102(5) Securing a slot.
	  a.   	 The county department office shall contact the bureau of long-term care for all cases to determine if a slot is available for all new applications for the HCBS physical disability waiver program.
	 (1) 	 For applicants not currently receiving Medicaid, the county department office shall contact the bureau by the end of the second working day after receipt of a completed Form 470-2927 or 470-2927(S), Health Services Application, submitted on or after April 1, 1999.
	 (2) 	 For current Medicaid recipients, the county department office shall contact the bureau by the end of the second working day after receipt of Form 470-3502, Physical Disability Waiver Assessment Tool, with the choice of HCBS waiver indicated by the signature of the consumer or a written request signed and dated by the consumer.
	  b.   	 On the third day after the receipt of the completed Form 470-2927 or 470-2927(S), Health Services Application, if no slot is available, the bureau of long-term care shall enter consumers on the HCBS physical disabilities waiver waiting list according to the following:
	 (1) 	 Consumers not currently eligible for Medicaid shall be entered on the basis of the date a completed Form 470-2927 or 470-2927(S), Health Services Application, is submitted on or after April 1, 1999, and date-stamped in the county department office. Consumers currently eligible for Medicaid shall be added on the basis of the date the consumer requests HCBS physical disability program services as documented by the date of the consumer’s signature on Form 470-2927 or 470-2927(S). In the event that more than one application is received on the same day, consumers shall be entered on the waiting list on the basis of the day of the month of their birthday, the lowest number being first on the list. Any subsequent tie shall be decided by the month of birth, January being month one and the lowest number.
	 (2) 	 Persons who do not fall within the available slots shall have their applications rejected but their names shall be maintained on the waiting list. As slots become available, persons shall be selected from the waiting list to maintain the number of approved persons on the program based on their order on the waiting list.
	 83.102(6) Securing a county payment slot. Rescinded IAB 10/6/99, effective 10/1/99.
	 83.102(7) HCBS physical disability waiver waiting list. When services are denied because the limit on the number of slots is reached, a notice of decision denying service based on the limit and stating that the person’s name shall be put on a waiting list shall be sent to the person by the department.
[ARC 9650B, IAB 8/10/11, effective 10/1/11]