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), and 77.25(4) 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:
  1. Results in a physical injury to or by the member that requires a physician’s treatment or admission to a hospital;
  2. Results in the death of any person;
  3. Requires emergency mental health treatment for the member;
  4. Requires the intervention of law enforcement;
  5. 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;
  6. Constitutes a prescription medication error or a pattern of medication errors that leads to the outcome in paragraph “1,� “2,� or “3�; or
  7. 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:
  1. Results in the application of basic first aid;
  2. Results in bruising;
  3. Results in seizure activity;
  4. Results in injury to self, to others, or to property; or
  5. Constitutes a prescription medication error.
  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:
  1. The staff member’s supervisor.
  2. 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.
  3. The member’s case manager.
  (2)  By the end of the next calendar day after the incident, the staff member who observed or first became aware of the incident shall also report as much information as is known about the incident to the member’s managed care organization in the format defined by the managed care organization. If the member is not enrolled with a managed care organization, the staff member shall report the information to the department’s bureau of long-term care either:
  1. By direct data entry into the Iowa Medicaid Provider Access System, or
  2. By faxing or mailing Form 470-4698, Critical Incident Report, according to the directions on the form.
  (3)  The following information shall be reported:
  1. The name of the member involved.
  2. The date and time the incident occurred.
  3. A description of the incident.
  4. 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.
  5. The action that the provider staff took to manage the incident.
  6. The resolution of or follow-up to the incident.
  7. The date the report is made and the handwritten or electronic signature of the person making the report.
  (4)  Submission of the initial report will generate a workflow in the Individualized Services Information System (ISIS) for follow-up by the case manager. When complete information about the incident is not available at the time of the initial report, the provider must submit follow-up reports until the case manager is satisfied with the incident resolution and follow-up. The completed report shall be maintained in a centralized file with a notation in the member’s file.
  c.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of members served and determine if changes need to be made for service implementation or if staff training is needed to reduce the number or severity of incidents.
  77.25(4)    Restraint, restriction, and behavioral intervention.  The provider shall have in place a system for the review, approval, and implementation of ethical, safe, humane, and efficient behavioral intervention procedures. All members receiving home- and community-based habilitation services shall be afforded the protections imposed by these rules when any restraint, restriction, or behavioral intervention is implemented.  a.  The system shall include procedures to inform the member and the member’s legal guardian of the restraint, restriction, and behavioral intervention policy and procedures at the time of service approval and as changes occur.  b.  Restraint, restriction, and behavioral intervention shall be used only for reducing or eliminating maladaptive target behaviors that are identified in the member’s restraint, restriction, or behavioral intervention program.  c.  Restraint, restriction, and behavioral intervention procedures shall be designed and implemented only for the benefit of the member and shall never be used as punishment, for the convenience of the staff, or as a substitute for a nonaversive program.  d.  Restraint, restriction, and behavioral intervention programs shall be time-limited and shall be reviewed at least quarterly.  e.  Corporal punishment and verbal or physical abuse are prohibited.  77.25(5)    Case management.  A provider is eligible to participate in the home- and community-based habilitation services program as a provider of case management services if accredited as a case management provider pursuant to 441—Chapter 24.  77.25(6)    Day habilitation.  The following providers may provide day habilitation:  a.  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide services that qualify as day habilitation under 441—subrule 78.27(8).  b.  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide other services and began providing services that qualify as day habilitation under 441—subrule 78.27(8) since the agency’s last accreditation survey. The agency may provide day habilitation services until the current accreditation expires. When the current accreditation expires, the agency must qualify under paragraph “a,â€� “d,â€� “g,â€� or “h.â€�  c.  An agency that is not accredited by the Commission on Accreditation of Rehabilitation Facilities but has applied to the Commission within the last 12 months for accreditation to provide services that qualify as day habilitation under 441—subrule 78.27(8). An agency that has not received accreditation within 12 months after application to the Commission is no longer a qualified provider.  d.  An agency that is accredited by the Council on Quality and Leadership in Supports for People with Disabilities.  e.  An agency that has applied to the Council on Quality and Leadership in Supports for People with Disabilities for accreditation within the last 12 months. An agency that has not received accreditation within 12 months after application to the Council is no longer a qualified provider.  f.  An agency that is accredited under 441—Chapter 24 to provide day treatment or supported community living services.  g.  An agency that is certified by the department to provide day habilitation services under the home- and community-based services intellectual disability waiver pursuant to rule 441—77.37(249A).  h.  An agency that is accredited by the International Center for Clubhouse Development.  i.  An agency that is accredited by the Joint Commission on Accreditation of Healthcare Organizations.  77.25(7)    Home-based habilitation.  The following agencies may provide home-based habilitation services:  a.  An agency that is certified by the department to provide supported community living services under:  (1)  The home- and community-based services intellectual disability waiver pursuant to rule 441—77.37(249A); or  (2)  The home- and community-based services brain injury waiver pursuant to rule 441—77.39(249A).  b.  An agency that is accredited under 441—Chapter 24 to provide supported community living services.  c.  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities as a community housing or supported living service provider.  d.  An agency that is accredited by the Council on Quality and Leadership in Supports for People with Disabilities.  e.  An agency that is accredited by the Council on Accreditation of Services for Families and Children.  f.  An agency that is accredited by the Joint Commission on Accreditation of Healthcare Organizations.  77.25(8)    Prevocational habilitation.    a.  The following providers may provide prevocational services:  (1)  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities as an organizational employment service provider or a community employment service provider.  (2)  An agency that is accredited by the Council on Quality and Leadership.  (3)  An agency that is accredited by the International Center for Clubhouse Development.  (4)  An agency that is certified by the department to provide prevocational services under:
  1. The home- and community-based services intellectual disability waiver pursuant to rule 441—77.37(249A); or
  2. The home- and community-based services brain injury waiver pursuant to rule 441—77.39(249A).
  b.  Providers responsible for the payroll of members shall have policies that ensure compliance with state and federal labor laws and regulations, which include, but are not limited to:  (1)  Subminimum wage laws and regulations, including the Workforce Investment Opportunity Act.   (2)  Member vacation, sick leave and holiday compensation.  (3)  Procedures for payment schedules and pay scale.  (4)  Procedures for provision of workers’ compensation insurance.  (5)  Procedures for the determination and review of commensurate wages.  c.  Direct support staff providing prevocational services shall meet the following minimum qualifications in addition to other requirements outlined in administrative rule:  (1)  A person providing direct support without line-of-sight supervision shall be at least 18 years of age and possess a high school diploma or equivalent degree. A person providing direct support with line-of-sight supervision shall be 16 years of age or older.   (2)  A person providing direct support shall not be an immediate family member of the member.  (3)  A person providing direct support shall, within 6 months of hire or within 6 months of May 4, 2016, complete at least 9.5 hours of employment service training as offered through DirectCourse or through the Association of Community Rehabilitation Educators (ACRE) certified training program.  (4)  Prevocational direct support staff shall complete 4 hours of continuing education in employment services annually.
  77.25(9)    Supported employment habilitation.    a.  The following agencies may provide supported employment services:  (1)  An agency that is certified by the department to provide supported employment services under:
  1. The home- and community-based services intellectual disability waiver pursuant to rule 441—77.37(249A); or
  2. The home- and community-based services brain injury waiver pursuant to rule 441—77.39(249A).
  (2)  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities as an organizational employment service provider or a community employment service provider.  (3)  An agency that is accredited by the Council on Accreditation.  (4)  An agency that is accredited by the Joint Commission.  (5)  An agency that is accredited by the Council on Quality and Leadership.  (6)  An agency that is accredited by the International Center for Clubhouse Development.
  b.  Providers responsible for the payroll of members shall have policies that ensure compliance with state and federal labor laws and regulations, which include, but are not limited to:  (1)  Subminimum wage laws and regulations, including the Workforce Investment Opportunity Act.  (2)  Member vacation, sick leave and holiday compensation.  (3)  Procedures for payment schedules and pay scale.  (4)  Procedures for provision of workers’ compensation insurance.  (5)  Procedures for the determination and review of commensurate wages.  c.  Direct support staff providing individual or small-group supported employment or long-term job coaching services shall meet the following minimum qualifications in addition to other requirements outlined in administrative rule:  (1)  Individual supported employment: bachelor’s degree or commensurate experience, preferably in human services, sociology, psychology, education, human resources, marketing, sales or business. The person must also hold nationally recognized certification (ACRE or College of Employment Services (CES) or similar) as an employment specialist or must earn this credential within 24 months of hire.  (2)  Long-term job coaching: associate degree, or high school diploma or equivalent and 6 months’ relevant experience. A person providing direct support shall, within 6 months of hire or within 6 months of May 4, 2016, complete at least 9.5 hours of employment services training as offered through DirectCourse or through the ACRE certified training program. The person must also hold or obtain, within 24 months of hire, nationally recognized certification in job training and coaching.  (3)  Small-group supported employment: associate degree, or high school diploma or equivalent and 6 months’ relevant experience. A person providing direct support shall, within 6 months of hire or within 6 months of May 4, 2016, complete at least 9.5 hours of employment services training as offered through DirectCourse or through the ACRE certified training program. The person must also hold or obtain, within 24 months of hire, nationally recognized certification in job training and coaching.  (4)  Supported employment direct support staff shall complete 4 hours of continuing education in employment services annually.
  77.25(10)    Provider enrollment.  Rescinded IAB 1/6/16, effective 1/1/16.This rule is intended to implement Iowa Code section 249A.4.
Related ARC(s): 7936B, 9314B, 0848C, 1051C, 2361C, 2471C, 3184C