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441—77.25(249A) Home- and community-based habilitation services. To be eligible to participate in the Medicaid program as an approved provider of home- and community-based habilitation services, a provider shall meet the general requirements in subrules 77.25(2), 77.25(3), 77.25(4), and 77.25(5) and shall meet the requirements in the subrules applicable to the individual services being provided. 77.25(1) Definitions.
"Guardian" means a guardian appointed in probate or juvenile court.
"Major incident" means an occurrence involving a member during service provision that:
- Results in a physical injury to or by the member that requires a physician’s treatment or admission to a hospital;
- Results in the death of any person;
- Requires emergency mental health treatment for the member;
- Requires the intervention of law enforcement;
- Requires a report of child abuse pursuant to Iowa Code section 232.69 or a report of dependent adult abuse pursuant to Iowa Code section 235B.3;
- Constitutes a prescription medication error or a pattern of medication errors that leads to the outcome in paragraph “1,� “2,� or “3�; or
- Involves a member’s location being unknown by provider staff who are assigned protective oversight.
"Managed care organization" means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization� as defined in Iowa Code section 514B.1.
"Member" means a person who has been determined to be eligible for Medicaid under 441—Chapter 75.
"Minor incident" means an occurrence involving a member during service provision that is not a major incident and that:
- Results in the application of basic first aid;
- Results in bruising;
- Results in seizure activity;
- Results in injury to self, to others, or to property; or
- Constitutes a prescription medication error.
"Provider-owned or controlled setting" means a setting where the HCBS provider owns the property where the member resides, leases the property from a third party, or has a direct or indirect financial relationship with the property owner that impacts either the care provided to or the financial conditions applicable to the member. The unit or dwelling is a specific physical space that can be owned, rented, or occupied under a legally enforceable agreement by the member receiving services, and the member has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the state, county, city, or other designated entity. For the settings in which landlord tenant laws do not apply, the state must ensure that a lease, residency agreement or other form of written agreement will be in place for each HCBS member and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law.
77.25(2) Organization and staff. a. The prospective provider shall demonstrate the fiscal capacity to initiate and operate the specified programs on an ongoing basis. b. The provider shall complete child abuse, dependent adult abuse, and criminal background screenings pursuant to Iowa Code section 249A.29 before employing a person who will provide direct care. c. A person providing direct care shall be at least 16 years of age. d. A person providing direct care shall not be an immediate family member of the member. 77.25(3) Incident management and reporting. As a condition of participation in the medical assistance program, HCBS habilitation service providers must comply with the requirements of Iowa Code sections 232.69 and 235B.3 regarding the reporting of child abuse and dependent adult abuse and with the incident management and reporting requirements in this subrule. a. Reporting procedure for minor incidents. Minor incidents may be reported in any format designated by the provider. When a minor incident occurs or a staff member becomes aware of a minor incident, the staff member involved shall submit the completed incident report to the staff member’s supervisor within 72 hours of the incident. The completed report shall be maintained in a centralized file with a notation in the member’s file. b. Reporting procedure for major incidents. When a major incident occurs or a staff member becomes aware of a major incident: (1) The staff member involved shall notify the following persons of the incident by the end of the next calendar day after the incident:- The staff member’s supervisor.
- The member or the member’s legal guardian. Exception: Notification to the member is required only if the incident took place outside of the provider’s service provision. Notification to the guardian, if any, is always required.
- The member’s case manager.
- By direct data entry into the Iowa Medicaid Provider Access System, or
- By faxing or mailing Form 470-4698, Critical Incident Report, according to the directions on the form.
- The name of the member involved.
- The date and time the incident occurred.
- A description of the incident.
- The names of all provider staff and others who were present at the time of the incident or who responded after becoming aware of the incident. The confidentiality of other members or nonmembers who were present must be maintained by the use of initials or other means.
- The action that the provider staff took to manage the incident.
- The resolution of or follow-up to the incident.
- The date the report is made and the handwritten or electronic signature of the person making the report.
- The home- and community-based services intellectual disability waiver pursuant to rule 441—77.37(249A); or
- The home- and community-based services brain injury waiver pursuant to rule 441—77.39(249A).
- The home- and community-based services intellectual disability waiver pursuant to rule 441—77.37(249A); or
- The home- and community-based services brain injury waiver pursuant to rule 441—77.39(249A).