441—78.52 (249A) HCBS children’s mental health waiver services. Payment will be approved for the following services to consumers eligible for the HCBS children’s mental health waiver as established in 441—Chapter 83. All services shall be provided in accordance with the general standards in subrule 78.52(1), as well as standards provided specific to each waiver service in subrules 78.52(2) through 78.52(5).
	 78.52(1) General service standards. All children’s mental health waiver services shall be provided in accordance with the following standards:
	  a.   	 Services must be based on the consumer’s needs as identified in the consumer’s service plan developed pursuant to 441—83.127(249A).
	 (1) 	 Services must be delivered in the least restrictive environment consistent with the consumer’s needs.
	 (2) 	 Services must include the applicable and necessary instruction, supervision, assistance and support as required by the consumer to achieve the consumer’s goals.
	  b.   	 Payment for services shall be made only upon departmental approval of the services. Waiver services provided before approval of the consumer’s eligibility for the waiver shall not be paid.
	  c.   	 Services or service components must not be duplicative.
	 (1) 	 Reimbursement shall not be available under the waiver for any services that the consumer may obtain through the Iowa Medicaid program outside of the waiver.
	 (2) 	 Reimbursement shall not be available under the waiver for any services that the consumer may obtain through natural supports or community resources.
	 (3) 	 Services may not be simultaneously reimbursed for the same period as nonwaiver Medicaid services or other Medicaid waiver services.
	 (4) 	 Costs for waiver services are not reimbursable while the consumer is in a medical institution.
	 78.52(2) Environmental modifications and adaptive devices.
	  a.   	 Environmental modifications and adaptive devices include items installed or used within the consumer’s home that address specific, documented health, mental health, or safety concerns.
	  b.   	 A unit of service is one modification or device.
	  c.   	 For each unit of service provided, the case manager shall maintain in the consumer’s case file a signed statement from a mental health professional on the consumer’s interdisciplinary team that the service has a direct relationship to the consumer’s diagnosis of serious emotional disturbance.
	 78.52(3) Family and community support services. Family and community support services shall support the consumer and the consumer’s family by the development and implementation of strategies and interventions that will result in the reduction of stress and depression and will increase the consumer’s and the family’s social and emotional strength.
	  a.   	 Dependent on the needs of the consumer and the consumer’s family members individually or collectively, family and community support services may be provided to the consumer, to the consumer’s family members, or to the consumer and the family members as a family unit.
	  b.   	 Family and community support services shall be provided under the recommendation and direction of a mental health professional who is a member of the consumer’s interdisciplinary team pursuant to 441—83.127(249A).
	  c.   	 Family and community support services shall incorporate recommended support interventions and activities, which may include the following:
	 (1) 	 Developing and maintaining a crisis support network for the consumer and for the consumer’s family.
	 (2) 	 Modeling and coaching effective coping strategies for the consumer’s family members.
	 (3) 	 Building resilience to the stigma of serious emotional disturbance for the consumer and the family.
	 (4) 	 Reducing the stigma of serious emotional disturbance by the development of relationships with peers and community members.
	 (5) 	 Modeling and coaching the strategies and interventions identified in the consumer’s crisis intervention plan as defined in 441—24.1(225C) for life situations with the consumer’s family and in the community.
	 (6) 	 Developing medication management skills.
	 (7) 	 Developing personal hygiene and grooming skills that contribute to the consumer’s positive self-image.
	 (8) 	 Developing positive socialization and citizenship skills.
	  d.   	 Family and community support services may include an amount not to exceed $1500 per consumer per year for transportation within the community and purchase of therapeutic resources. Therapeutic resources may include books, training materials, and visual or audio media.
	 (1) 	 The interdisciplinary team must identify the transportation or therapeutic resource as a support need.
	 (2) 	 The annual amount available for transportation and therapeutic resources must be listed in the consumer’s service plan.
	 (3) 	 The consumer’s parent or legal guardian shall submit a signed statement that the transportation or therapeutic resource cannot be provided by the consumer or the consumer’s family or legal guardian.
	 (4) 	 The consumer’s Medicaid targeted case manager shall maintain a signed statement that potential community resources are unavailable and shall list the community resources contacted to fund the transportation or therapeutic resource.
	 (5) 	 The transportation or therapeutic resource must not be otherwise eligible for Medicaid reimbursement.
	 (6) 	 Family and community support services providers shall maintain records to:
	  1. 	 Ensure that the transportation and therapeutic resources provided to not exceed the maximum amount authorized; and
	  2. 	 Support the annual reporting requirements in 441—subparagraph 79.1(15)“a”(1).
	  e.   	 The following components are specifically excluded from family and community support services:
	 (1) 	 Vocational services.
	 (2) 	 Prevocational services.
	 (3) 	 Supported employment services.
	 (4) 	 Room and board.
	 (5) 	 Academic services.
	 (6) 	 General supervision and consumer care.
	  f.   	 A unit of family and community support services is one hour.
	 78.52(4) In-home family therapy. In-home family therapy provides skilled therapeutic services to the consumer and family that will increase their ability to cope with the effects of serious emotional disturbance on the family unit and the familial relationships. The service must support the family by the development of coping strategies that will enable the consumer to continue living within the family environment.
	  a.   	 The goal of in-home family therapy is to maintain a cohesive family unit.
	  b.   	 In-home family therapy is exclusive of and cannot serve as a substitute for individual therapy, family therapy, or other mental health therapy that may be obtained through the Iowa Plan or other funding sources.
	  c.   	 A unit of in-home family therapy service is one hour. Any period less than one hour shall be prorated.
	 78.52(5) Respite care services. Respite care services are services provided to the consumer that give temporary relief to the usual caregiver and provide all the necessary care that the usual caregiver would provide during that period. The “usual caregiver” means a person or persons who reside with the consumer and are available on a 24-hour-per-day basis to assume responsibility for the care of the consumer.
	  a.   	 Respite care shall not be provided to consumers during the hours in which the usual caregiver is employed, except when the consumer is attending a camp.
	  b.   	 The usual caregiver cannot be absent from the home for more than 14 consecutive days during respite provision.
	  c.   	 Staff-to-consumer ratios shall be appropriate to the individual needs of the consumer as determined by the consumer’s interdisciplinary team. The team shall determine the type of respite care to be provided according to these definitions:
	 (1) 	 Basic individual respite is provided on a ratio of one staff to one consumer. The consumer does not have specialized medical needs that require the direct services of a registered nurse or licensed practical nurse.
	 (2) 	 Specialized respite is provided on a ratio of one or more nursing staff to one consumer. The consumer has specialized medical needs that require the direct services of a registered nurse or licensed practical nurse.
	 (3) 	 Group respite is provided on a ratio of one staff to two or more consumers receiving respite. These consumers do not have specialized medical needs that require the direct services of a registered nurse or licensed practical nurse.
	  d.   	 Respite services provided for a period exceeding 24 consecutive hours to three or more consumers who require nursing care because of a mental or physical condition must be provided by a health care facility licensed under Iowa Code chapter 135C.
	  e.   	 Respite services provided outside the consumer’s home shall not be reimbursable if the living unit where respite care is provided is reserved for another person on a temporary leave of absence.
	  f.   	 A unit of service is one hour.
This rule is intended to implement Iowa Code section 249A.4 and 2005 Iowa Acts, chapter 167, section 13, and chapter 117, section 3.