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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.
"Certified employment specialist" "CES" means a person who has demonstrated a sufficient level of knowledge and skill to provide integrated employment support services to a variety of client populations and has earned a CES certification through a nationally recognized accrediting body.
"Guardian" means a guardian appointed in probate or juvenile court.
"Individual placement and support" "IPS" means the evidence-based practice of supported employment that is guided by IPS practice principles outlined by the IPS Employment Center at Westat, and as measured by its most recently published 25-item supported employment fidelity scale available online at ipsworks.org/wp-content/uploads/2017/08/ips-fidelity-manual-3rd-edition_2-4-16.pdf. The IPS practice principles are:
- Focus on competitive employment: Agencies providing IPS services are committed to competitive employment as an attainable goal for people with behavioral health conditions seeking employment. Mainstream education and specialized training may enhance career paths.
- Zero exclusion criteria based on client choice: People are not excluded on the basis of readiness, diagnoses, symptoms, substance use history, psychiatric hospitalizations, homelessness, level of disability, or legal system involvement.
- Integration of rehabilitation and mental health services: IPS programs are closely integrated with mental health treatment teams.
- Attention to worker preferences: Services are based on each person’s preferences and choices, rather than providers’ judgments.
- Personalized benefits counseling: Employment specialists help people obtain personalized, understandable, and accurate information about their social security, Medicaid, and other government entitlements.
- Rapid job search: IPS programs use a rapid job search approach to help job seekers obtain jobs directly, rather than providing lengthy preemployment assessment, training, and counseling. If further education is part of their plan, IPS specialists assist in these activities as needed.
- Systematic job development: Employment specialists systematically visit employers, who are selected based on job seeker preferences, to learn about their business needs and hiring preferences.
- Time-unlimited and individualized support: Job supports are individualized and continue for as long as each worker wants and needs the support.
"Intensive residential service homes" or "intensive residential services" means intensive, community-based services provided 24 hours per day, 7 days per week, 365 days per year to individuals with a severe and persistent mental illness who have functional impairments and may also have multi-occurring conditions. Providers of intensive residential service homes are enrolled with Medicaid as providers of HCBS habilitation or HCBS intellectual disability waiver supported community living and meet additional criteria specified in 441—subrule 25.6(8).
"IPS 25-item supported employment fidelity scale" means the fidelity scale published by the IPS Employment Center at Westat, resulting in scores of exemplary fidelity, good fidelity, fair fidelity, or not supported employment.
"IPS implementation" means the process advocated by the IPS Employment Center at Westat, which consists of the following phases:
- Formation of IPS team steering group and one-day meeting with the IPS trainer and team members.
- Completion of the IPS Readiness Assessment developed by the IPS Employment Center at Westat and individual review with the IPS trainer.
- Completion of a one-day IPS kick-off team training with the IPS trainer and team members.
- Participation in individual team training and monthly consultations as follows:
- Two-and-a-half-day individual team training with the IPS trainer and team members.
- Virtual training by the IPS Employment Center at Westat for at least three people per team.
- Leadership training for two people per team at the IPS Employment Center at Westat.
- Virtual monthly technical assistance for two hours per month per team.
- Participation in the International Learning Collaborative, including:
- Participation in the International Learning Collaborative annual conference by two people per state.
- Virtual monthly technical assistance calls with the IPS Employment Center at Westat mentor assigned to the team.
- Participation in the prescribed data tracking and management activities.
- Completion of one baseline fidelity review per IPS team, with two IPS reviewers on site for two days per review.
- Evaluation and development of next steps, with an on-site half-day meeting for the IPS trainer and the team.
"IPS reviewer" means a person who is qualified to complete fidelity reviews of IPS services and is one of the following:
- A person who has provided IPS services or has supervised an IPS team in Iowa which has obtained a fidelity score of “good� or better, has completed the IPS Employment Center at Westat’s training to become an IPS reviewer, and has shadowed one or more IPS fidelity reviews;
- An existing IPS reviewer from a state which is a member of the IPS International Learning Collaborative;
- An IPS reviewer contracted directly from the IPS Employment Center at Westat;
- A CES with a bachelor’s degree who has completed the IPS Employment Center at Westat’s training to become an IPS reviewer and has shadowed one or more IPS fidelity reviews.
"IPS team" means, at a minimum, an IPS employment specialist, a behavioral health specialist, Iowa Vocational Rehabilitation Services (IVRS) counselor, and a case manager or care coordinator.
"IPS trainer" means a person who is qualified to provide training and technical assistance for IPS implementation and is one of the following:
- A person who has provided IPS services or has supervised an IPS team in Iowa which has obtained a fidelity score of “good� or better, and has completed the IPS Employment Center at Westat’s training to become an IPS trainer;
- An existing IPS trainer from a state which is a member of the IPS International Learning Collaborative;
- An IPS trainer contracted directly from the IPS Employment Center at Westat;
- A CES with a bachelor’s degree who has completed the IPS Employment Center at Westat’s training to become an IPS trainer.
"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.
"Prospective IPS team" means a group that is forming an IPS team to deliver IPS services but who has not yet completed implementation phase 4a.
"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.
"Provisionally approved IPS team" means a group that has (1) formed a team to deliver IPS services, (2) completed implementation phase 4a, and (3) begun to deliver IPS services.
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).