441—77.33 (249A) HCBS elderly waiver service providers. HCBS elderly waiver services shall be rendered by a person who is at least 16 years old (except as otherwise provided in this rule) and is not the spouse of the consumer served or the parent or stepparent of a consumer aged 17 or under. People who are 16 or 17 years old must be employed and supervised by an enrolled HCBS provider unless they are employed to provide self-directed personal care services through the consumer choices option. A person hired for self-directed personal care services need not be supervised by an enrolled HCBS provider. A person hired through the consumer choices option for independent support brokerage, self-directed personal care, individual-directed goods and services, or self-directed community support and employment is not required to enroll as a Medicaid provider. The following providers shall be eligible to participate in the Medicaid HCBS elderly waiver program if they meet the standards set forth below:
	 77.33(1) Adult day care providers. Adult day care providers shall be agencies that are certified by the department of inspections and appeals as being in compliance with the standards for adult day services programs adopted by the department of elder affairs at 321—Chapter 24.
	 77.33(2) Emergency response system providers. Emergency response system providers must meet the following standards:
	  a.   	 The agency shall provide an electronic component to transmit a coded signal via digital equipment over telephone lines to a central monitoring station. The central monitoring station must operate receiving equipment and be fully staffed by trained attendants, 24 hours a day, seven days per week. The attendants must process emergency calls and ensure the timely notification of appropriate emergency resources to be dispatched to the person in need.
	  b.   	 The agency, parent agency, institution or corporation shall have the necessary legal authority to operate in conformity with federal, state and local laws and regulations.
	  c.   	 There shall be a governing authority which is responsible for establishing policy and ensuring effective control of services and finances. The governing authority shall employ or contract for an agency administrator to whom authority and responsibility for overall agency administration are delegated.
	  d.   	 The agency or institution shall be in compliance with all legislation relating to prohibition of discriminatory practices.
	  e.   	 There shall be written policies and procedures established to explain how the service operates, agency responsibilities, client responsibilities and cost information.
	 77.33(3) Home health aide providers. Home health aide providers shall be agencies certified to participate in the Medicare program as home health agencies.
	 77.33(4) Homemaker providers. Homemaker providers shall be agencies which meet the home care standards and requirements set forth in department of public health rules 641—80.5(135), 641—80.6(135), and 641—80.7(135) or which are certified as a home health agency under Medicare.
	 77.33(5) Nursing care. Nursing care providers shall be agencies which are certified to participate in the Medicare program as home health agencies.
	 77.33(6) Respite care providers.
	  a.   	 The following agencies may provide respite services:
	 (1) 	 Home health agencies that are certified to participate in the Medicare program.
	 (2) 	 Nursing facilities and hospitals enrolled as providers in the Iowa Medicaid program.
	 (3) 	 Camps certified by the American Camping Association.
	 (4) 	 Respite providers certified under the HCBS MR waiver.
	 (5) 	 Home care agencies that meet the conditions of participation set forth in subrule 77.33(4).
	 (6) 	 Adult day care providers that meet the conditions set forth in subrule 77.33(1).
	 (7) 	 Assisted living programs certified by the department of inspections and appeals.
	  b.   	 Respite providers shall meet the following conditions:
	 (1) 	 Providers shall maintain the following information that shall be updated at least annually:
	  1. 	 The consumer’s name, birth date, age, and address and the telephone number of the spouse, guardian or primary caregiver.
	  2. 	 An emergency medical care release.
	  3. 	 Emergency contact telephone numbers such as the number of the consumer’s physician and the spouse, guardian, or primary caregiver.
	  4. 	 The consumer’s medical issues, including allergies.
	  5. 	 The consumer’s daily schedule which includes the consumer’s preferences in activities or foods or any other special concerns.
	 (2) 	 Procedures shall be developed for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications administered. Home health agencies must follow Medicare regulations for medication dispensing.
All medications shall be stored in their original containers, with the accompanying physician’s or pharmacist’s directions and label intact. Medications shall be stored so they are inaccessible to consumers and the public. Nonprescription medications shall be labeled with the consumer’s name.
In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription.
	 (3) 	 Policies shall be developed for:
	  1. 	 Notifying the spouse, guardian, or primary caregiver of any injuries or illnesses that occur during respite provision. A spouse’s, guardian’s or primary caregiver’s signature is required to verify receipt of notification.
	  2. 	 Requiring the spouse, guardian or primary caregiver to notify the respite provider of any injuries or illnesses that occurred prior to respite provision.
	  3. 	 Documenting activities and times of respite. This documentation shall be made available to the spouse, guardian or primary caregiver upon request.
	  4. 	 Ensuring the safety and privacy of the individual. Policies shall at a minimum address threat of fire, tornado, or flood and bomb threats.
	  c.   	 A facility providing respite under this subrule shall not exceed the facility’s licensed capacity, and services shall be provided in locations consistent with licensure.
	  d.   	 Respite provided outside the consumer’s home or the facility covered by the licensure, certification, accreditation, or contract must be approved by the spouse, guardian or primary caregiver and the interdisciplinary team and must be consistent with the way the location is used by the general public. Respite in these locations shall not exceed 72 continuous hours.
	 77.33(7) Chore providers. The following providers may provide chore services:
	  a.   	 Area agencies on aging as designated in 321—4.4(231). Chore providers subcontracting with area agencies on aging or with letters of approval from the area agencies on aging stating the organization is qualified to provide chore services may also provide chore services.
	  b.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  c.   	 Home health aide providers meeting the standards set forth in subrule 77.33(3). Home health aide providers contracting with the department of public health shall be considered to have met these standards.
	  d.   	 Nursing facilities licensed pursuant to Iowa Code chapter 135C.
	  e.   	 Providers certified under the HCBS MR waiver.
	 77.33(8) Home-delivered meals. The following providers may provide home-delivered meals:
	  a.   	 Area agencies on aging as designated in 321—4.4(231). Home-delivered meals providers subcontracting with area agencies on aging or with letters of approval from the area agencies on aging stating the organization is qualified to provide home-delivered meals services may also provide home-delivered meals services.
	  b.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  c.   	 Nursing facilities licensed pursuant to Iowa Code chapter 135C.
	  d.   	 Restaurants licensed and inspected under Iowa Code chapter 137B.
	  e.   	 Hospitals enrolled as Medicaid providers.
	  f.   	 Home health aide providers meeting the standards set forth in subrule 77.33(3).
	  g.   	 Medical equipment and supply dealers certified to participate in the Medicaid program.
	  h.   	 Home care providers meeting the standards set forth in subrule 77.33(4).
	 77.33(9) Home and vehicle modification providers. The following providers may provide home and vehicle modification:
	  a.   	 Area agencies on aging as designated in 321—4.4(231).
	  b.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  c.   	 Providers eligible to participate as home and vehicle modification provides under the ill and handicapped waiver, enrolled as home and vehicle modification providers under the physical disability waiver, or certified as home and vehicle modification providers under the mental retardation or brain injury waiver.
	  d.   	 Community businesses that have all necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations, and that submit verification of current liability and workers’ compensation coverage.
	 77.33(10) Mental health outreach providers. Community mental health centers or other mental health providers accredited by the mental health and developmental disabilities commission pursuant to 441—Chapter 24 may provide mental health outreach services.
	 77.33(11) Transportation providers. The following providers may provide transportation:
	  a.   	 Area agencies on aging as designated in 321—4.4(231). Transportation providers subcontracting with area agencies on aging or with letters of approval from the area agencies on aging stating the organization is qualified to provide transportation services may also provide transportation services.
	  b.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  c.   	 Regional transit agencies as recognized by the Iowa department of transportation.
	  d.   	 Rescinded IAB 3/10/99, effective 5/1/99.
	  e.   	 Nursing facilities licensed pursuant to Iowa Code chapter 135C.
	 77.33(12) Nutritional counseling. The following providers may provide nutritional counseling by a licensed dietitian:
	  a.   	 Hospitals enrolled as Medicaid providers.
	  b.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  c.   	 Nursing facilities licensed pursuant to Iowa Code chapter 135C.
	  d.   	 Home health agencies certified by Medicare.
	  e.   	 Licensed dietitians approved by an area agency on aging.
	 77.33(13) Assistive devices providers. The following providers may provide assistive devices:
	  a.   	 Medicaid-eligible medical equipment and supply dealers.
	  b.   	 Area agencies on aging as designated according to department of elder affairs rules 321—4.3(249D) and 321—4.4(249D).
	  c.   	 Assistive devices providers with a contract with an area agency on aging or with a letter of approval from an area agency on aging stating the organization is qualified to provide assistive devices.
	 77.33(14) Senior companions. Senior companion programs designated by the Corporation for National and Community Service may provide senior companion service.
	 77.33(15) Consumer-directed attendant care service providers. The following providers may provide consumer-directed attendant care service:
	  a.   	 An individual who contracts with the consumer to provide attendant care service and who is:
	 (1) 	 At least 18 years of age.
	 (2) 	 Qualified by training or experience to carry out the consumer’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.
	 (3) 	 Not the spouse of the consumer.
	 (4) 	 Not the recipient of respite services paid through home- and community-based services on the behalf of a consumer who receives home- and community-based services.
	  b.   	 Home care providers that have a contract with the department of public health or have written certification from the department of public health stating they meet the home care standards and requirements set forth in department of public health rules 641—80.5(135), 641—80.6(135), and 641—80.7(135).
	  c.   	 Home health agencies which are certified to participate in the Medicare program.
	  d.   	 Chore providers subcontracting with area agencies on aging or with letters of approval from the area agencies on aging stating that the organization is qualified to provide chore services.
	  e.   	 Community action agencies as designated in Iowa Code section 216A.93.
	  f.   	 Providers certified under an HCBS waiver for supported community living.
	  g.   	 Assisted living programs that are voluntarily accredited or certified by the department of elder affairs.
	  h.   	 Adult day service providers which meet the conditions of participation for adult day care providers as specified at 441—subrule 77.30(3), 77.33(1), 77.34(7), or 77.39(20) and which have provided a point-in-time letter of notification from the department of elder affairs or an area agency on aging stating the adult day service provider also meets the requirements of department of elder affairs rules in 321—Chapter 25.
	 77.33(16) Financial management service. Consumers who elect the consumer choices option shall work with a financial institution that meets the qualifications in subrule 77.30(13).
	 77.33(17) Independent support brokerage. Consumers who elect the consumer choices option shall work with an independent support broker who meets the qualifications in subrule 77.30(14).
	 77.33(18) Self-directed personal care. Consumers who elect the consumer choices option may choose to purchase self-directed personal care services from an individual or business that meets the requirements in subrule 77.30(15).
	 77.33(19) Individual-directed goods and services. Consumers who elect the consumer choices option may choose to purchase individual-directed goods and services from an individual or business that meets the requirements in subrule 77.30(16).
	 77.33(20) Self-directed community supports and employment. Consumers who elect the consumer choices option may choose to purchase self-directed community supports and employment from an individual or business that meets the requirements in subrule 77.30(17).
	 77.33(21) Case management providers. A case management provider organization is eligible to participate in the Medicaid HCBS elderly waiver program if the organization meets the following standards:
	  a.   	 The case management provider organization shall be an agency or individual that:
	 (1) 	 Is accredited by the mental health, mental retardation, developmental disabilities, and brain injury commission as meeting the standards for case management services in 441—Chapter 24; or
	 (2) 	 Is accredited through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to provide case management; or
	 (3) 	 Is accredited through the Council on Accreditation of Rehabilitation Facilities (CARF) to provide case management; or
	 (4) 	 Is accredited through the Council on Quality and Leadership in Supports for People with Disabilities (The Council) to provide case management; or
	 (5) 	 Is approved by the department of elder affairs as meeting the standards for case management services in 321—Chapter 21; or
	 (6) 	 Is approved by the department of public health as meeting the standards for case management services in 641—Chapter 80.
	  b.   	 A case management provider shall not provide direct services to the consumer. The department and the Centers for Medicare and Medicaid Services deem the provision of direct services to case management consumers to be a conflict of interest. A person cannot be the first-line supervisor of both case managers and direct service staff who are providing services to elderly waiver consumers. The provider must have written conflict of interest policies that include, but are not limited to:
	 (1) 	 Specific procedures to identify conflicts of interest.
	 (2) 	 Procedures to eliminate any conflict of interest that is identified.
	 (3) 	 Procedures for handling complaints of conflict of interest, including written documentation.
	  c.   	 If the case management provider organization subcontracts case management services to another entity:
	 (1) 	 That entity must also meet the provider qualifications in this subrule; and
	 (2) 	 The contractor is responsible for verification of compliance.
This rule is intended to implement Iowa Code section 249A.4.