441—78.46 (249A) Physical disability waiver service. Payment shall be approved for the following services to consumers eligible for the HCBS physical disability waiver established in 441—Chapter 83 when identified in the consumer’s service plan. All services shall include the applicable and necessary instructions, supervision, assistance and support as required by the consumer in achieving the goals written specifically in the service plan and those delineated in Form 470-3372, HCBS Consumer-Directed Attendant Care Agreement. The service shall be delivered in the least restrictive environment consistent with the consumer’s needs and in conformity with the consumer’s service plan.
Reimbursement shall not be available under the waiver for any services that the consumer can obtain through regular Medicaid or from any other funding source.
All services shall be billed in whole units as specified in the following subrules.
	 78.46(1) Consumer-directed attendant care service. Consumer-directed attendant care services are service activities listed below performed by a person to help a consumer with self-care tasks which the consumer would typically do independently if the consumer were otherwise able. The services must be cost-effective and necessary to prevent institutionalization.
Providers must demonstrate proficiency in delivery of the services in the consumer’s plan of care. Proficiency must be demonstrated through documentation of prior training or experience or a certificate of formal training. All training or experience will be detailed on Form 470-3372, HCBS Consumer-Directed Attendant Care Agreement, which must be reviewed and approved by the service worker for appropriateness of training or experience prior to the provision of services. Form 470-3372 becomes an attachment to and part of the case plan. Consumers shall give direction and training for activities which are not medical in nature to maintain independence. Licensed registered nurses and therapists must provide on-the-job training and supervision to the provider for skilled activities listed below and described on Form 470-3372. The training and experience must be sufficient to protect the health, welfare and safety of the consumer.
	  a.   	 Nonskilled service activities covered are:
	 (1) 	 Help with dressing.
	 (2) 	 Help with bath, shampoo, hygiene, and grooming.
	 (3) 	 Help with access to and from bed or a wheelchair, transferring, ambulation, and mobility in general. Certification for this is available through the area community colleges.
	 (4) 	 Toilet assistance, including bowel, bladder, and catheter assistance which includes emptying the catheter bag, collecting a specimen and cleaning the external area around the catheter. Certification of training which includes demonstration of competence for catheter assistance is available through the area community colleges.
	 (5) 	 Meal preparation, cooking, eating and feeding assistance but not the cost of meals themselves.
	 (6) 	 Housekeeping services which are essential to the consumer’s health care at home.
	 (7) 	 Help with medications ordinarily self-administered including those ordered by a physician or other qualified health care provider. Certification of training in a medication aide course is available through the area community colleges.
	 (8) 	 Minor wound care which does not require skilled nursing care.
	 (9) 	 Assistance needed to go to or return from a place of employment and assistance with job-related tasks while the consumer is on the job site. The cost of transportation for the consumer and assistance with understanding or performing the essential job functions are not included in consumer-directed attendant care services.
	 (10) 	 Cognitive assistance with tasks such as handling money and scheduling.
	 (11) 	 Fostering communication through interpreting and reading services as well as assistance in use of assistive devices for communication.
	 (12) 	 Assisting and accompanying a consumer in using transportation essential to the health and welfare of the consumer, but not the cost of the transportation.
	  b.   	 Skilled service activities covered are the following performed under the supervision of a licensed nurse or licensed therapist working under the direction of a licensed physician. The licensed nurse or therapist shall retain accountability for actions that are delegated. The licensed nurse or therapist shall ensure appropriate assessment, planning, implementation, and evaluation. The licensed nurse or therapist shall make on-site supervisory visits every two weeks with the provider present. The cost of the supervision provided by the licensed nurse or therapist shall not be included in the reimbursement for consumer-directed attendant care services.
	 (1) 	 Tube feedings of consumers unable to eat solid foods.
	 (2) 	 Assistance with intravenous therapy which is administered by a registered nurse.
	 (3) 	 Parenteral injections required more than once a week.
	 (4) 	 Catheterizations, continuing care of indwelling catheters with supervision of irrigations, and changing of Foley catheters when required.
	 (5) 	 Respiratory care including inhalation therapy and tracheotomy care or tracheotomy care and ventilator.
	 (6) 	 Care of decubiti and other ulcerated areas, noting and reporting to the nurse or therapist.
	 (7) 	 Rehabilitation services including bowel and bladder training, range of motion exercises, ambulation training, restorative nursing services, reteaching the activities of daily living, respiratory care and breathing programs, reality orientation, reminiscing therapy, remotivation, and behavior modification.
	 (8) 	 Colostomy care.
	 (9) 	 Care of medical conditions such as brittle diabetes and comfort care of terminal conditions.
	 (10) 	 Postsurgical nurse-delegated activities under the supervision of the registered nurse.
	 (11) 	 Monitoring medication reactions requiring close supervision because of fluctuating physical or psychological conditions, e.g., antihypertensives, digitalis preparations, mood altering or psychotropic drugs or narcotics.
	 (12) 	 Preparing and monitoring response to therapeutic diets.
	 (13) 	 Recording and reporting of changes in vital signs to the nurse or therapist.
	  c.   	 A unit of service is 1 hour for up to 7 hours per day or one 8- to 24-hour day provided by an individual or an agency. Each service shall be billed in whole units.
	  d.   	 The consumer, parent, guardian, or attorney in fact under a durable power of attorney for health care shall be responsible for selecting the person or agency who will provide the components of the attendant care services to be provided.
	  e.   	 The consumer, parent, guardian, or attorney in fact under a durable power of attorney for health care shall determine the components of the attendant care services to be provided with the person who is providing the services to the consumer.
	  f.   	 The service activities may not include parenting or child care on behalf of the consumer.
	  g.   	 The consumer, parent, guardian, or attorney in fact under a durable power of attorney for health care and the provider shall complete and sign Form 470-3372, HCBS Consumer-Directed Attendant Care Agreement. A copy of the completed agreement shall be attached to the service plan, which is signed by the service worker prior to the initiation of services, and kept in the consumer’s and department’s records.
	  h.   	 If the consumer has a guardian or attorney in fact under a durable power of attorney for health care, the care plan shall address how consumer-directed attendant care services will be monitored to ensure the consumer’s needs are being adequately met. If the guardian or attorney in fact is the service provider, the service plan shall address how the service worker or case manager shall oversee service provision.
	  i.   	 If the consumer has a guardian or attorney in fact under a durable power of attorney for health care, the guardian or attorney in fact shall sign the claim form in place of the consumer, indicating that the service has been provided as presented on the claim.
	  j.   	 The frequency or intensity of services shall be indicated in the service plan.
	  k.   	 Consumer-directed attendant care services may not be simultaneously reimbursed with any other HCBS waiver services.
	  l.   	 Consumer-directed attendant care services may be provided to a recipient of in-home health-related care services, but not at the same time.
	  m.   	 Services may be provided in the absence of a parent or guardian if the parent or guardian has given advanced direction for the service provision.
	 78.46(2) Home and vehicle modifications. Covered home and vehicle modifications are those physical modifications to the consumer’s home or vehicle listed below that directly address the consumer’s medical or remedial need. Covered modifications must be necessary to provide for the health, welfare, or safety of the consumer and enable the consumer to function with greater independence in the home or vehicle.
	  a.   	 Modifications that are necessary or desirable without regard to the consumer’s medical or remedial need and that would be expected to increase the fair market value of the home or vehicle, such as furnaces, fencing, roof repair, or adding square footage to the residence, are excluded except as specifically included below. Repairs are also excluded.
	  b.   	 Only the following modifications are covered:
	 (1) 	 Kitchen counters, sink space, cabinets, special adaptations to refrigerators, stoves, and ovens.
	 (2) 	 Bathtubs and toilets to accommodate transfer, special handles and hoses for shower heads, water faucet controls, and accessible showers and sink areas.
	 (3) 	 Grab bars and handrails.
	 (4) 	 Turnaround space adaptations.
	 (5) 	 Ramps, lifts, and door, hall and window widening.
	 (6) 	 Fire safety alarm equipment specific for disability.
	 (7) 	 Voice-activated, sound-activated, light-activated, motion-activated, and electronic devices directly related to the consumer’s disability.
	 (8) 	 Vehicle lifts, driver-specific adaptations, remote-start systems, including such modifications already installed in a vehicle.
	 (9) 	 Keyless entry systems.
	 (10) 	 Automatic opening device for home or vehicle door.
	 (11) 	 Special door and window locks.
	 (12) 	 Specialized doorknobs and handles.
	 (13) 	 Plexiglas replacement for glass windows.
	 (14) 	 Modification of existing stairs to widen, lower, raise or enclose open stairs.
	 (15) 	 Motion detectors.
	 (16) 	 Low-pile carpeting or slip-resistant flooring.
	 (17) 	 Telecommunications device for the deaf.
	 (18) 	 Exterior hard-surface pathways.
	 (19) 	 New door opening.
	 (20) 	 Pocket doors.
	 (21) 	 Installation or relocation of controls, outlets, switches.
	 (22) 	 Air conditioning and air filtering if medically necessary.
	 (23) 	 Heightening of existing garage door opening to accommodate modified van.
	 (24) 	 Bath chairs.
	  c.   	 A unit of service is the completion of needed modifications or adaptations.
	  d.   	 All modifications and adaptations shall be provided in accordance with applicable federal, state, and local building and vehicle codes.
	  e.   	 Services shall be performed following department approval of a binding contract between the enrolled home and vehicle modification provider and the consumer.
	  f.   	 The contract shall include, at a minimum, the work to be performed, cost, time frame for work completion, and assurance of liability and workers’ compensation coverage.
	  g.   	 Service payment shall be made to the enrolled home and vehicle modification provider. If applicable, payment will be forwarded to the subcontracting agency by the enrolled home and vehicle modification provider following completion of the approved modifications. Payment of up to $6,060 per year may be made to certified providers upon satisfactory completion of the service. The service worker shall encumber up to $505 per month within the monthly dollar cap allowed for the consumer until the amount of the modification is reached within the 12-month period.
	  h.   	 Services shall be included in the consumer’s service plan and shall exceed the Medicaid state plan services.
	 78.46(3) Personal emergency response system. The personal emergency response system allows a consumer experiencing a medical emergency at home to activate electronic components that transmit a coded signal via digital equipment over telephone lines to a central monitoring station. The service shall be identified in the consumer’s service plan. A unit is a one-time installation fee or one month of service. Maximum units per state fiscal year are the initial installation and 12 months of service. The necessary components of a system are:
	  a.   	 An in-home medical communications transceiver.
	  b.   	 A remote, portable activator.
	  c.   	 A central monitoring station with backup systems staffed by trained attendants 24 hours per day, seven days a week.
	  d.   	 Current data files at the central monitoring station containing response protocols and personal, medical, and emergency information for each consumer.
	 78.46(4) Specialized medical equipment. Specialized medical equipment shall include medically necessary items for personal use by consumers with a physical disability which provide for the health and safety of the consumer that are not covered by Medicaid, are not funded by vocational rehabilitation programs, and are not provided by voluntary means. This includes, but is not limited to: electronic aids and organizers, medicine-dispensing devices, communication devices, bath aids and noncovered environmental control units. This includes repair and maintenance of items purchased through the waiver in addition to the initial costs.
	  a.   	 Consumers may receive specialized medical equipment once a month until a maximum yearly usage of $6,060 has been reached.
	  b.   	 The need for specialized medical equipment shall be documented by a health care professional as necessary for the consumer’s health and safety and shall be identified in the consumer’s service plan.
	 78.46(5) Transportation. Transportation services may be provided for consumers to conduct business errands and essential shopping, to receive medical services when not reimbursed through Medicaid as medical transportation, to travel to and from work or day programs, and to reduce social isolation. A unit of service is either per mile, per trip, or the unit established by an area agency on aging.
	 78.46(6) Consumer choices option. The consumer choices option provides a member with a flexible monthly individual budget that is based on the member’s service needs. With the individual budget, the member shall have the authority to purchase goods and services to meet the member’s assessed needs and may choose to employ providers of services and supports. The services, supports, and items that are purchased with an individual budget must be directly related to a member’s assessed need or goal established in the member’s service plan. Components of this service are set forth below.
	  a.   	 Agreement. As a condition of participating in the consumer choices option, a member shall sign Form 470-4289, HCBS Consumer Choices Informed Consent and Risk Agreement, to document that the member has been informed of the responsibilities and risks of electing the consumer choices option.
	  b.   	 Individual budget amount. A monthly individual budget amount shall be established for each member based on the assessed needs of the member and on the services and supports authorized in the member’s service plan. The member shall be informed of the individual budget amount during the development of the service plan.
	 (1) 	 Services that may be included in determining the individual budget amount for a member in the HCBS physical disability waiver are:
	  1. 	 Consumer-directed attendant care (unskilled).
	  2. 	 Home and vehicle modification.
	  3. 	 Specialized medical equipment.
	  4. 	 Transportation.
	 (2) 	 The department shall determine an average unit cost for each service listed in subparagraph 78.46(6)“b”(1) based on actual unit costs from the previous fiscal year plus a cost-of-living adjustment.
	 (3) 	 In aggregate, costs for individual budget services shall not exceed the current costs of waiver program services. In order to maintain cost neutrality, the department shall apply a utilization adjustment factor to the amount of service authorized in the member’s service plan before calculating the value of that service to be included in the individual budget amount.
	 (4) 	 The department shall compute the utilization adjustment factor for each service by dividing the net costs of all claims paid for the service by the total of the authorized costs for that service, using at least 12 consecutive months of aggregate service data. The utilization adjustment factor shall be no lower than 60 percent. The department shall analyze and adjust the utilization adjustment factor at least annually in order to maintain cost neutrality.
	 (5) 	 Individual budgets for respite services shall be computed based on the average cost for services identified in subparagraph 78.46(6)“b”(2). Respite services are not subject to the utilization adjustment factor in subparagraph 78.46(6)“b”(3).
	 (6) 	 Anticipated costs for home and vehicle modification and specialized medical equipment are not subject to the average cost in subparagraph 78.46(6)“b”(2) or the utilization adjustment factor in subparagraph 78.46(6)“b”(3). Anticipated costs for home and vehicle modification and specialized medical equipment shall not include the costs of the financial management services or the independent support broker. Before becoming part of the individual budget, all home and vehicle modifications and specialized medical equipment shall be identified in the member’s service plan and approved by the case manager or service worker. Costs for home and vehicle modification and specialized medical equipment may be paid to the financial management services provider in a one-time payment.
	 (7) 	 The individual budget amount may be changed only at the first of the month and shall remain fixed for the entire month.
	  c.   	 Required service components. To participate in the consumer choices option, a member must hire an independent support broker and must work with a financial management service that is enrolled as a Medicaid provider. Before hiring the independent support broker, the member shall receive the results of the background check conducted pursuant to 441—Chapter 119.
	  d.   	 Optional service components. A member who elects the consumer choices option may purchase the following goods, services and supports, which shall be provided in the member’s home or at an integrated community setting:
	 (1) 	 Self-directed personal care services. Self-directed personal care services are services or goods that provide a range of assistance in activities of daily living and incidental activities of daily living that help the member remain in the home and community. These services must be identified in the member’s service plan developed by the member’s case manager or service worker.
	 (2) 	 Self-directed community supports and employment. Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. These services must be identified in the member’s service plan developed by the member’s case manager or service worker.
	 (3) 	 Individual-directed goods and services. Individual-directed goods and services are services, equipment, or supplies not otherwise provided through the Medicaid program that address an assessed need or goal identified in the member’s service plan. The item or service shall meet the following requirements:
	  1. 	 Promote opportunities for community living and inclusion.
	  2. 	 Increase independence or substitute for human assistance, to the extent the expenditures would otherwise be made for that human assistance.
	  3. 	 Be accommodated within the member’s budget without compromising the member’s health and safety.
	  4. 	 Be provided to the member or directed exclusively toward the benefit of the member.
	  5. 	 Be the least costly to meet the member’s needs.
	  6. 	 Not be available through another source.
	  e.   	 Development of the individual budget. The independent support broker shall assist the member in developing and implementing the member’s individual budget. The individual budget shall include:
	 (1) 	 The costs of the financial management service.
	 (2) 	 The costs of the independent support broker. The independent support broker may be compensated for up to 6 hours of service for assisting with the implementation of the initial individual budget. The independent support broker shall not be paid for more than 30 hours of service for an individual member during a 12-month period without prior approval by the department.
	 (3) 	 The costs of any optional service component chosen by the member as described in paragraph 78.46(6)“d.” Costs of the following items and services shall not be covered by the individual budget:
	  1. 	 Child care services.
	  2. 	 Clothing not related to an assessed medical need.
	  3. 	 Conference, meeting or similar venue expenses other than the costs of approved services the member needs while attending the conference, meeting or similar venue.
	  4. 	 Costs associated with shipping items to the member.
	  5. 	 Experimental and non-FDA-approved medications, therapies, or treatments.
	  6. 	 Goods or services covered by other Medicaid programs.
	  7. 	 Home furnishings.
	  8. 	 Home repairs or home maintenance.
	  9. 	 Homeopathic treatments.
	  10. 	 Insurance premiums or copayments.
	  11. 	 Items purchased on installment payments.
	  12. 	 Motorized vehicles.
	  13. 	 Nutritional supplements.
	  14. 	 Personal entertainment items.
	  15. 	 Repairs and maintenance of motor vehicles.
	  16. 	 Room and board, including rent or mortgage payments.
	  17. 	 School tuition.
	  18. 	 Service animals.
	  19. 	 Services covered by third parties or services that are the responsibility of a non-Medicaid program.
	  20. 	 Sheltered workshop services.
	  21. 	 Social or recreational purchases not related to an assessed need or goal identified in the member’s service plan.
	  22. 	 Vacation expenses, other than the costs of approved services the member needs while on vacation.
	 (4) 	 The costs of any approved home or vehicle modification or specialized medical equipment. When authorized, the budget may include an amount allocated for a home or vehicle modification or specialized medical equipment. Before becoming part of the individual budget, all home and vehicle modifications and specialized medical equipment shall be identified in the member’s service plan and approved by the case manager or service worker. The authorized amount shall not be used for anything other than the specific modification or equipment.
	 (5) 	 Any amount set aside in a savings plan to reserve funds for the future purchase of self-directed personal care, individual-directed goods and services, or self-directed community supports and services as defined in paragraph 78.46(6)“d.” The savings plan shall meet the requirements in paragraph 78.46(6)“f.”
	  f.   	 Savings plan. A member savings plan must be in writing and be approved by the department before the start of the savings plan. Amounts allocated to the savings plan must result from efficiencies in meeting identified needs of the member.
	 (1) 	 The savings plan shall identify:
	  1. 	 The specific goods, services, supports or supplies to be purchased through the savings plan.
	  2. 	 The amount of the individual budget allocated each month to the savings plan.
	  3. 	 The amount of the individual budget allocated each month to meet the member’s identified service needs.
	  4. 	 How the member’s assessed needs will continue to be met through the individual budget when funds are placed in savings.
	 (2) 	 With the exception of funds allocated for respite care, the savings plan shall not include funds budgeted for direct services that were not received. The budgeted amount associated with unused direct services other than respite care shall revert to the Medicaid program at the end of each month. Funds from unused respite services may be allocated to the savings plan but shall not be used for anything other than future respite care.
	 (3) 	 Funds accumulated under a savings plan shall be used only to purchase items that increase independence or substitute for human assistance to the extent that expenditures would otherwise be made for human assistance, including additional goods, supports, services or supplies. The self-directed personal care, individual-directed goods and services, or self-directed community supports and services purchased with funds from a savings plan must:
	  1. 	 Be used to meet a member’s identified need,
	  2. 	 Be medically necessary, and
	  3. 	 Be approved by the member’s case manager or service worker.
	 (4) 	 All funds allocated to a savings plan that are not expended by December 31 of each year shall revert to the Medicaid program.
	 (5) 	 The annual reassessment of a member’s needs must take into account the purchases of goods and services that substitute for human assistance. Adjustments shall be made to the services used to determine the individual budget based on the reassessment.
	  g.   	 Budget authority. The member shall have authority over the individual budget authorized by the department to perform the following tasks:
	 (1) 	 Contract with entities to provide services and supports as described in this subrule.
	 (2) 	 Determine the amount to be paid for services. Reimbursement rates shall be consistent with rates paid by others in the community for the same or substantially similar services. Reimbursement rates for the independent support broker and the financial management service are subject to the limits in 441—subrule 79.1(2).
	 (3) 	 Schedule the provision of services.
	 (4) 	 Authorize payment for waiver goods and services optional service components identified in the individual budget.
	 (5) 	 Reallocate funds among services included in the budget. Every purchase of a good or service must be identified and approved in the individual budget before the purchase is made.
	  h.   	 Delegation of budget authority. The member may delegate responsibility for the individual budget to a representative in addition to the independent support broker.
	 (1) 	 The representative must be at least 18 years old.
	 (2) 	 The representative shall not be a current provider of service to the member.
	 (3) 	 The member shall sign a consent form that designates who the member has chosen as a representative and what responsibilities the representative shall have.
	 (4) 	 The representative shall not be paid for this service.
	  i.   	 Employer authority. The member shall have the authority to be the common-law employer of employees providing services and support under the consumer choices option. A common-law employer has the right to direct and control the performance of the services. The member may perform the following functions:
	 (1) 	 Recruit employees.
	 (2) 	 Select employees from a worker registry.
	 (3) 	 Verify employee qualifications.
	 (4) 	 Specify additional employee qualifications.
	 (5) 	 Determine employee duties.
	 (6) 	 Determine employee wages and benefits.
	 (7) 	 Schedule employees.
	 (8) 	 Train and supervise employees.
	  j.   	 Employment agreement. Any person employed by the member to provide services under the consumer choices option shall sign an employment agreement with the member that outlines the employee’s and member’s responsibilities.
	  k.   	 Responsibilities of the independent support broker. The independent support broker shall perform the following services as directed by the member or the member’s representative:
	 (1) 	 Assist the member with developing the member’s initial and subsequent individual budgets and with making any changes to the individual budget.
	 (2) 	 Have monthly contact with the member for the first four months of implementation of the initial individual budget and have quarterly contact thereafter.
	 (3) 	 Complete the required employment packet with the financial management service.
	 (4) 	 Assist with interviewing potential employees and entities providing services and supports if requested by the member.
	 (5) 	 Assist the member with determining whether a potential employee meets the qualifications necessary to perform the job.
	 (6) 	 Assist the member with obtaining a signed consent from a potential employee to conduct background checks if requested by the member.
	 (7) 	 Assist the member with negotiating with entities providing services and supports if requested by the member.
	 (8) 	 Assist the member with contracts and payment methods for services and supports if requested by the member.
	 (9) 	 Assist the member with developing an emergency backup plan. The emergency backup plan shall address any health and safety concerns.
	 (10) 	 Review expenditure reports from the financial management service to ensure that services and supports in the individual budget are being provided.
	 (11) 	 Document in writing on the independent support broker timecard every contact the broker has with the member. Contact documentation shall include information on the extent to which the member’s individual budget has addressed the member’s needs and the satisfaction of the member.
	  l.   	 Responsibilities of the financial management service. The financial management service shall perform all of the following services:
	 (1) 	 Receive Medicaid funds in an electronic transfer.
	 (2) 	 Process and pay invoices for approved goods and services included in the individual budget.
	 (3) 	 Enter the individual budget into the Web-based tracking system chosen by the department and enter expenditures as they are paid.
	 (4) 	 Provide real-time individual budget account balances for the member, the independent support broker, and the department, available at a minimum during normal business hours (9 a.m. to 5 p.m., Monday through Friday).
	 (5) 	 Conduct criminal background checks on potential employees pursuant to 441—Chapter 119.
	 (6) 	 Verify for the member an employee’s citizenship or alien status.
	 (7) 	 Assist the member with fiscal and payroll-related responsibilities including, but not limited to:
	  1. 	 Verifying that hourly wages comply with federal and state labor rules.
	  2. 	 Collecting and processing timecards.
	  3. 	 Withholding, filing, and paying federal, state and local income taxes, Medicare and Social Security (FICA) taxes, and federal (FUTA) and state (SUTA) unemployment and disability insurance taxes, as applicable.
	  4. 	 Computing and processing other withholdings, as applicable.
	  5. 	 Processing all judgments, garnishments, tax levies, or other withholding on an employee’s pay as may be required by federal, state, or local laws.
	  6. 	 Preparing and issuing employee payroll checks.
	  7. 	 Preparing and disbursing IRS Forms W-2 and W-3 annually.
	  8. 	 Processing federal advance earned income tax credit for eligible employees.
	  9. 	 Refunding over-collected FICA, when appropriate.
	  10. 	 Refunding over-collected FUTA, when appropriate.
	 (8) 	 Assist the member in completing required federal, state, and local tax and insurance forms.
	 (9) 	 Establish and manage documents and files for the member and the member’s employees.
	 (10) 	 Monitor timecards, receipts, and invoices to ensure that they are consistent with the individual budget. Keep records of all timecards and invoices for each member for a total of five years.
	 (11) 	 Provide to the department, the independent support broker, and the member monthly and quarterly status reports that include a summary of expenditures paid and amount of budget unused.
	 (12) 	 Establish an accessible customer service system and a method of communication for the member and the independent support broker that includes alternative communication formats.
	 (13) 	 Establish a customer services complaint reporting system.
	 (14) 	 Develop a policy and procedures manual that is current with state and federal regulations and update as necessary.
	 (15) 	 Develop a business continuity plan in the case of emergencies and natural disasters.
	 (16) 	 Provide to the department an annual independent audit of the financial management service.
	 (17) 	 Assist in implementing the state’s quality management strategy related to the financial management service.
This rule is intended to implement Iowa Code section 249A.4.
[ARC 9045B, IAB 9/8/10, effective 11/1/10]