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    CHAPTER 77CONDITIONS OF PARTICIPATION FOR PROVIDERSOF MEDICAL AND REMEDIAL CARE[Prior to 7/1/83, Social Services[770] Ch 77][Prior to 2/11/87, Human Services[498]]441—77.1(249A)  Physicians.  All physicians (doctors of medicine and osteopathy) licensed to practice in the state of Iowa are eligible to participate in the program. Physicians in other states are also eligible if duly licensed to practice in that state.441—77.2(249A)  Retail pharmacies.  Retail pharmacies are eligible to participate if they meet the requirements of this rule.  77.2(1)    Licensure.  Participating retail pharmacies must be licensed in the state of Iowa or duly licensed in another state. Out-of-state retail pharmacies delivering, dispensing, or distributing drugs by any method to an ultimate user physically located in Iowa must be duly licensed by Iowa as a nonresident pharmacy for that purpose.  77.2(2)    Survey participation.  As a condition of participation, retail pharmacies are required to make available drug acquisition cost invoice information, product availability information if known, dispensing cost information, and any other information deemed necessary by the department to assist in monitoring and revising reimbursement rates pursuant to 441—subrule 79.1(8) or for the efficient operation of the pharmacy benefit.  a.  A pharmacy shall produce and submit all requested information in the manner and format requested by the department or its designee at no cost to the department or its designee.  b.  A pharmacy shall submit information to the department or its designee within the time frame indicated following receipt of a request for information unless the department or its designee grants an extension upon written request of the pharmacy.  c.  Any dispensing or acquisition cost information submitted to the department that specifically identifies a pharmacy’s individual costs shall be held confidential.Related ARC(s): 0485C441—77.3(249A)  Hospitals.    77.3(1)    Qualifications.  All hospitals licensed in the state of Iowa or in another state and certified as eligible to participate in Part A of the Medicare program (Title XVIII of the Social Security Act) are eligible to participate in the medical assistance program, subject to the additional requirements of this rule.  77.3(2)    Referral to health home services provider.  As a condition of participation in the medical assistance program, hospitals must establish procedures for referring to health home services providers any members who seek or need treatment in the hospital emergency department and who are eligible for health home services pursuant to 441—subrule 78.53(2).  77.3(3)    Psychiatric bed tracking system.  As a condition of participation in the medical assistance program, hospitals must establish procedures for participating in and updating the statewide psychiatric bed tracking system.  a.  Definitions.
    "Adult beds" means the number of staffed and available psychiatric beds ready for admission to individuals 18 years of age to 60 years of age.
    "Child beds" means the number of staffed and available psychiatric beds ready for admission to individuals up to the age of 18.
    "Gender" means female or male.
    "Geriatric beds" means the number of staffed and available psychiatric beds ready for admission to individuals 60 years of age and older.
    "Hospital," for purposes of this subrule, means any licensed hospital providing inpatient psychiatric services and the state mental health institutes.
    "Psychiatric bed tracking system" means a web-based electronic system managed by the department that can be searched to locate inpatient psychiatric services at an Iowa hospital.
      b.  Hospitals are required to participate in the psychiatric bed tracking system.  c.  Hospitals shall update the psychiatric bed tracking system, at a minimum, two times per day. The first update shall be entered between 12:00:01 a.m.and 9:59:59 a.m.each day; the second update shall be entered between 8:00:00 p.m.and 11:59:59 p.m.each day.  d.  Each update must include the number of child beds by gender, the number of adult beds by gender, and the number of geriatric beds by gender.  e.  Failure to comply with the psychiatric bed tracking reporting may result in sanctions in accordance with rule 441—79.2(249A).    This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 0198C, 3789C441—77.4(249A)  Dentists.  All dentists licensed to practice in the state of Iowa are eligible to participate in the program. Dentists in other states are also eligible if duly licensed to practice in that state.NOTE: DENTAL LABORATORIES—Payment will not be made to a dental laboratory.441—77.5(249A)  Podiatrists.  All podiatrists licensed to practice in the state of Iowa are eligible to participate in the program. Podiatrists in other states are also eligible if duly licensed to practice in that state.441—77.6(249A)  Optometrists.  All optometrists licensed to practice in the state of Iowa are eligible to participate in the program. Optometrists in other states are also eligible if duly licensed to practice in that state.441—77.7(249A)  Opticians.  All opticians in the state of Iowa are eligible to participate in the program. Opticians in other states are also eligible to participate.NOTE: Opticians in states having licensing requirements for this professional group must be duly licensed in that state.441—77.8(249A)  Chiropractors.  All chiropractors licensed to practice in the state of Iowa are eligible to participate providing they have been determined eligible to participate in Title XVIII of the Social Security Act (Medicare) by the Social Security Administration. Chiropractors in other states are also eligible if duly licensed to practice in that state and determined eligible to participate in Title XVIII of the Social Security Act.441—77.9(249A)  Home health agencies.  Home health agencies are eligible to participate providing they are certified to participate in the Medicare program (Title XVIII of the Social Security Act) and, unless exempted under subrule 77.9(5), have submitted a surety bond as required by subrules 77.9(1) to 77.9(6).  77.9(1)    Definitions.  
    "Assets" includes any listing that identifies Medicaid members to whom home health services were furnished by a participating or formerly participating home health agency.
    "Rider" means a notice issued by a surety that a change in the bond has occurred or will occur.
    "Uncollected overpayment" means a Medicaid overpayment, including accrued interest, for which the home health agency is responsible that has not been recouped by the department within 60 days from the date of notification that an overpayment has been identified.
      77.9(2)    Parties to surety bonds.  The surety bond shall name the home health agency as the principal, the Iowa department of human services as the obligee and the surety company (and its heirs, executors, administrators, successors and assignees, jointly and severally) as surety. The bond shall be issued by a company holding a current Certificate of Authority issued by the U.S. Department of the Treasury in accordance with 31 U.S.C. Sections 9304 to 9308 and 31 CFR Part 223 as amended to November 30, 1984, Part 224 as amended to May 29, 1996, and Part 225 as amended to September 12, 1974. The bond shall list the surety’s name, street address or post office box number, city, state and ZIP code. The company shall not have been determined by the department to be unauthorized in Iowa due to:  a.  Failure to furnish timely confirmation of the issuance of and the validity and accuracy of information appearing on a surety bond that a home health agency presents to the department that shows the surety company as surety on the bond.  b.  Failure to timely pay the department in full the amount requested, up to the face amount of the bond, upon presentation by the department to the surety company of a request for payment on a surety bond and of sufficient evidence to establish the surety company’s liability on the bond.  c.  Other good cause.The department shall give public notice of a determination that a surety company is unauthorized in Iowa and the effective date of the determination by publication of a notice in the newspaper of widest circulation in each city in Iowa with a population of 50,000 or more. A list of surety companies determined by the department to be unauthorized in Iowa shall be maintained and shall be available for public inspection by contacting the division of medical services of the department. The determination that a surety company is unauthorized in Iowa has effect only in Iowa and is not a debarment, suspension, or exclusion for the purposes of Federal Executive Order No.12549.  77.9(3)    Surety company obligations.  The bond shall guarantee payment to the department, up to the face amount of the bond, of the full amount of any uncollected overpayment, including accrued interest, based on payments made to the home health agency during the term of the bond. The bond shall provide that payment may be demanded from the surety after available administrative collection methods for collecting from the home health agency have been exhausted.  77.9(4)    Surety bond requirements.  Surety bonds secured by home health agencies participating in Medicaid shall comply with the following requirements:  a.    Effective dates and submission dates.    (1)  Home health agencies participating in the program on June 10, 1998, shall secure either an initial surety bond for the period January 1, 1998, through the end of the home health agency’s fiscal year or a continuous bond which remains in effect from year to year.  (2)  Home health agencies seeking to participate in Medicaid and Medicare for the first time after June 10, 1998, shall secure an initial surety bond for the period from Medicaid certification through the end of the home health agency’s fiscal year or a continuous bond which remains in effect from year to year.  (3)  Medicare-certified home health agencies seeking to participate in Medicaid for the first time after June 10, 1998, shall secure an initial surety bond for the period from Medicaid certification through the end of the home health agency’s fiscal year or a continuous bond which remains in effect from year to year.  (4)  Home health agencies seeking to participate in Medicaid after purchasing the assets of or an ownership interest in a participating or formerly participating agency shall secure an initial surety bond effective as of the date of purchase of the assets or the transfer of the ownership interest for the balance of the current fiscal year of the home health agency or a continuous bond which remains in effect from year to year.  (5)  Home health agencies which continue to participate in Medicaid after the period covered by an initial surety bond shall secure a surety bond for each subsequent fiscal year of the home health agency or a continuous bond which remains in effect from year to year.  b.    Amount of bond.  Bonds for any period shall be in the amount of $50,000 or 15 percent of the home health agency’s annual Medicaid payments during the most recently completed state fiscal year, whichever is greater. After June 1, 2005, all bonds shall be in the amount of $50,000. At least 90 days before the start of each home health agency’s fiscal year, the department shall provide notice of the amount of the surety bond to be purchased and submitted to the Iowa Medicaid enterprise provider services unit.  c.    Other requirements.  Surety bonds shall meet the following additional requirements. The bond shall:  (1)  Guarantee that upon written demand by the department to the surety for payment under the bond and the department’s furnishing to the surety sufficient evidence to establish the surety’s liability under the bond, the surety shall within 60 days pay the department the amount so demanded, up to the stated amount of the bond.  (2)  Provide that the surety’s liability for uncollected overpayments is based on overpayments determined during the term of the bond.  (3)  Provide that the surety’s liability to the department is not extinguished by any of the following:
    1. Any action by the home health agency or the surety to terminate or limit the scope or term of the bond unless the surety furnishes the department with notice of the action not later than 10 days after the date of notice of the action by the home health agency to the surety and not later than 60 days before the effective date of the action by the surety.
    2. The surety’s failure to continue to meet the requirements in subrule 77.9(2) or the department’s determination that the surety company is an unauthorized surety under subrule 77.9(2).
    3. Termination of the home health agency’s provider agreement.
    4. Any action by the department to suspend, offset, or otherwise recover payments to the home health agency.
    5. Any action by the home health agency to cease operations, sell or transfer any assets or ownership interest, file for bankruptcy, or fail to pay the surety.
    6. Any fraud, misrepresentation, or negligence by the home health agency in obtaining the surety bond or by the surety (or the surety’s agent, if any) in issuing the surety bond; except that any fraud, misrepresentation, or negligence by the home health agency in identifying to the surety (or the surety’s agent) the amount of Medicaid payments upon which the amount of the surety bond is determined shall not cause the surety’s liability to the department to exceed the amount of the bond.
    7. The home health agency’s failure to exercise available appeal rights under Medicaid or assign appeal rights to the surety.
      (4)  Provide that if a home health agency fails to furnish a bond following the expiration date of an annual bond or if a home health agency fails to furnish a rider for a year in which a rider is required or if the home health agency’s provider agreement with the department is terminated, the surety shall remain liable under the most recent annual bond or rider to a continuous bond for two years from the date the home health agency was required to submit the annual bond or rider to a continuous bond or for two years from the termination date of the provider agreement.  (5)  Provide that actions under the bond may be brought by the department or by an agent designated by the department.  (6)  Provide that the surety may appeal department decisions.      77.9(5)    Exemption from surety bond requirements for government-operated home health agencies.  A home health agency operated by a federal, state, local, or tribal government agency is exempt from the bonding requirements of this rule if, during the preceding five years, the home health agency has not had any uncollected overpayments. Government-operated home health agencies having uncollected overpayments during the preceding five years shall not be exempted from the bonding requirements of this rule.  77.9(6)    Government-operated home health agency that loses its exemption.  A government-operated home health agency which has met the criteria for an exemption under subrule 77.9(6) but is later determined by the department not to meet the criteria shall submit a surety bond within 60 days of the date of the department’s written notification to the home health agency that it no longer meets the criteria for an exemption, for the period and in the amount required in the notice from the department.    441—77.10(249A)  Medical equipment and appliances, prosthetic devices and medical supplies.  All dealers in medical equipment and appliances, prosthetic devices and medical supplies in Iowa or in other states are eligible to participate in the program.441—77.11(249A)  Ambulance service.  Providers of ambulance service are eligible to participate providing they meet the eligibility requirements for participation in the Medicare program (Title XVIII of the Social Security Act).441—77.12(249A)  Behavioral health intervention.  A provider of behavioral health intervention is eligible to participate in the medical assistance program when the provider is accredited by one of the following bodies:
    1. The Joint Commission accreditation (TJC), or
    2. The Healthcare Facilities Accreditation Program (HFAP), or
    3. The Commission on Accreditation of Rehabilitation Facilities (CARF), or
    4. The Council on Accreditation (COA), or
    5. The Accreditation Association for Ambulatory Health Care (AAAHC), or
    6. Iowa Administrative Code 441—Chapter 24, “Accreditation of Providers of Services to Persons with Mental Illness, Intellectual Disabilities, or Developmental Disabilities.”
    This rule is intended to implement Iowa Code section 249A.4 and 2010 Iowa Acts, chapter 1192, section 31.    Related ARC(s): 7741B, 9487B, 2361C441—77.13(249A)  Hearing aid dispensers.  Hearing aid dispensers are eligible to participate if they are duly licensed by the state of Iowa. Hearing aid dispensers in other states will be eligible to participate if they are duly licensed in that state.This rule is intended to implement Iowa Code section 249A.4.441—77.14(249A)  Audiologists.  Audiologists are eligible to participate in the program when they are duly licensed by the state of Iowa. Audiologists in other states will be eligible to participate when they are duly licensed in that state. In states having no licensure requirement for audiologists, an audiologist shall obtain a license from the state of Iowa.This rule is intended to implement Iowa Code section 249A.4.441—77.15(249A)  Community mental health centers.  Community mental health centers are eligible to participate in the medical assistance program when they comply with the standards for mental health centers in the state of Iowa established by the Iowa mental health authority.This rule is intended to implement Iowa Code section 249A.4.441—77.16(249A)  Screening centers.  Public or private health agencies are eligible to participate as screening centers when they have the staff and facilities needed to perform all of the elements of screening specified in 441—78.18(249A) and meet the department of public health’s standards for a child health screening center. The staff members must be employed by or under contract with the screening center. Screening centers shall direct applications to participate to the Iowa Medicaid enterprise provider services unit.This rule is intended to implement Iowa Code section 249A.4.441—77.17(249A)  Physical therapists.  Physical therapists are eligible to participate when they are licensed, in independent practice; and are eligible to participate in the Medicare program.This rule is intended to implement Iowa Code section 249A.4.441—77.18(249A)  Orthopedic shoe dealers and repair shops.  Establishments eligible to participate in the medical assistance program are retail dealers in orthopedic shoes prescribed by physicians or podiatrists and shoe repair shops specializing in orthopedic work as prescribed by physicians or podiatrists.This rule is intended to implement Iowa Code section 249A.4.441—77.19(249A)  Rehabilitation agencies.  Rehabilitation agencies are eligible to participate providing they are certified to participate in the Medicare program (Title XVIII of the Social Security Act).This rule is intended to implement Iowa Code section 249A.4.441—77.20(249A)  Independent laboratories.  Independent laboratories are eligible to participate providing they are certified to participate as a laboratory in the Medicare program (Title XVIII of the Social Security Act). An independent laboratory is a laboratory that is independent of attending and consulting physicians’ offices, hospitals, and critical access hospitals.This rule is intended to implement Iowa Code section 249A.4.441—77.21(249A)  Rural health clinics.  Rural health clinics are eligible to participate providing they are certified to participate in the Medicare program (Title XVIII of the Social Security Act).441—77.22(249A)  Psychologists.    77.22(1)  All psychologists licensed to practice in the state of Iowa and meeting the current credentialing requirements of the National Register of Health Service Psychologists are eligible to participate in the medical assistance program. Psychologists in other states are eligible to participate when they are duly licensed to practice in that state and meet the current credentialing requirements of the National Register of Health Service Psychologists.  77.22(2)  A psychologist provisionally licensed to practice in the state of Iowa pursuant to Iowa Code section 154B.6 is eligible to participate in the medical assistance program when the person:  a.  Possesses a doctoral degree in psychology from an institution approved by the board of psychology; and  b.  Provides treatment under the supervision of a licensed psychologist pursuant to Iowa Code section 154B.6. Claims for payment for such services must be submitted by the licensed psychologist.  77.22(3)  A psychologist provisionally licensed in another state is eligible to participate when the person:  a.  Possesses a doctoral degree in psychology from an institution approved by the board of psychology; and  b.  Provides treatment under the supervision of a licensed psychologist pursuant to Iowa Code section 154B.6. Claims for payment for such services must be submitted by the licensed psychologist who is duly licensed to practice in that state.This rule is intended to implement Iowa Code sections 249A.4 and 249A.15.Related ARC(s): 2165C, 4165C441—77.23(249A)  Maternal health centers.  A maternal health center is eligible to participate in the Medicaid program if the center provides a team of professionals to render prenatal and postpartum care and enhanced perinatal services (see rule 441—78.25(249A)). The prenatal and postpartum care shall be in accordance with the latest edition of the American College of Obstetricians and Gynecologists, Standards for Obstetric Gynecologic Services. The team must have at least a physician, a registered nurse, a licensed dietitian and a person with at least a bachelor’s degree in social work, counseling, sociology or psychology. Team members must be employed by or under contract with the center.This rule is intended to implement Iowa Code section 249A.4.441—77.24(249A)  Ambulatory surgical centers.  Ambulatory surgical centers that are not part of hospitals are eligible to participate in the medical assistance program if they are certified to participate in the Medicare program (Title XVIII of the Social Security Act). Freestanding ambulatory surgical centers providing only dental services are also eligible to participate in the medical assistance program if the board of dental examiners has issued a current permit pursuant to 650—Chapter 29 for any dentist to administer deep sedation or general anesthesia at the facility.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:
    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.
    "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:
    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)    Residential and nonresidential settings.   Effective March 17, 2022, all home- and community-based services (HCBS), whether residential or nonresidential, shall be provided in integrated, community-based settings that support full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS. Settings shall optimize individual initiative, autonomy, and independence in making life choices, including but not limited to daily activities, physical environment, and with whom to interact.  a.  Nursing facilities, institutions for mental diseases, intermediate care facilities for persons with an intellectual disability, and hospitals are not considered integrated, community-based settings.   b.  Any HCBS setting that is located in a building that is also a publicly or privately operated facility, identified in paragraph 77.25(5)“a,” that provides inpatient treatment or in a building on the grounds of, or immediately adjacent to, a public institution, identified in paragraph 77.25(5)“a,” or any setting that has the effect of isolating members receiving Medicaid HCBS from the broader community will be presumed to be a setting that has the qualities of an institution unless the department conducts a site-specific review and determines otherwise.   c.  Residential services may be provided in provider-owned or controlled settings. In provider-owned or controlled residential settings:   (1)  The member selects the setting from among setting options, including non-disability-specific settings and an option for a private unit in a residential setting.   (2)  The setting options are identified and documented in the person-centered service plan and are based on the member’s needs, preferences, and resources available for room and board.  (3)  Members have choices regarding services and supports received and who provides them.   (4)  Members are assured the rights of privacy, dignity, respect, and freedom from coercion and undue restraint.  (5)  Services and supports shall optimize, but not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to daily activities, physical environment, and with whom to interact.  (6)  Each member shall be afforded privacy in the member’s sleeping and living unit. Living unit entrance doors and bedroom doors may be locked by the member, and only appropriate staff shall have keys. Staff access to keys must be identified in the member’s person-centered plan.   (7)  Members shall have a choice of roommates in that setting.  (8)  Members shall have the freedom to furnish and decorate their sleeping or living areas as desired as permitted by any operative lease or other agreement.   (9)  Members shall have the freedom and support to control their own schedules and activities and shall have access to food at any time.  (10)  Members may have visitors of their choosing at any time.  (11)  The setting shall be physically accessible to the member.  77.25(6)    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(7)    Day habilitation.    a.  The following providers may provide day habilitation:  (1)  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).  (2)  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 subparagraph 77.25(7)“a”(1), 77.25(7)“a”(4), or 77.25(7)“a”(7).  (3)  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.  (4)  An agency that is accredited by the Council on Quality and Leadership in Supports for People with Disabilities.  (5)  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.  (6)  An agency that is accredited under 441—Chapter 24 to provide day treatment or supported community living services.  (7)  An agency that is accredited by the International Center for Clubhouse Development.  (8)  An agency that is accredited by the Joint Commission on Accreditation of Healthcare Organizations.  b.  Direct support staff providing day habilitation 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 six months of hire or within six months of February 1, 2021, complete at least 9.5 hours of training in supporting members in the activities listed in 701—paragraph 78.27(8)“a,” as offered through DirectCourse or Relias or other nationally recognized training curriculum.  (4)  A person providing direct support shall annually complete 4 hours of continuing education in supporting members in the activities listed in 701—paragraph 78.27(8)“a,” as offered through DirectCourse or Relias or other nationally recognized training curriculum.  77.25(8)    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(9)    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(10)    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.    This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 0848C, 1051C, 2361C, 2471C, 3184C, 3874C, 5307C441—77.26(249A)  Behavioral health services.  The following persons are eligible to participate in the Medicaid program as providers of behavioral health services.  77.26(1)    Licensed marital and family therapists (LMFT).  Any person licensed by the board of behavioral science as a marital and family therapist pursuant to 645—Chapter 31 is eligible to participate. A marital and family therapist in another state is eligible to participate when duly licensed to practice in that state.  77.26(2)    Temporarily licensed marital and family therapists.  Any person who holds a temporary license to practice marital and family therapy pursuant to Iowa Code section 154D.7 is eligible to participate when the temporarily licensed marital and family therapist provides treatment under the supervision of a qualified marital and family therapist as determined by the board of behavioral science by rule. Claims for payment for such services must be submitted by the supervising licensed marital and family therapist.  77.26(3)    Licensed independent social workers (LISW).  Any person licensed by the board of social work as an independent social worker pursuant to 645—Chapter 280 is eligible to participate. An independent social worker in another state is eligible to participate when duly licensed to practice in that state.  77.26(4)    Licensed master social workers (LMSW).    a.  A person licensed by the board of social work as a master social worker pursuant to 645—Chapter 280 is eligible to participate when the person:  (1)  Holds a master’s or doctoral degree as approved by the board of social work; and  (2)  Provides treatment under the supervision of an independent social worker licensed pursuant to 645—Chapter 280.  b.  A master social worker in another state is eligible to participate when the person:  (1)  Is duly licensed to practice in that state; and  (2)  Provides treatment under the supervision of an independent social worker duly licensed in that state.  77.26(5)    Licensed mental health counselors (LMC).  Any person licensed by the board of behavioral science as a mental health counselor pursuant to Iowa Code chapter 154D and 645—Chapter 31 is eligible to participate. A mental health counselor in another state is eligible to participate when duly licensed to practice in that state.  77.26(6)    Temporarily licensed mental health counselors.  Any person temporarily licensed by the board of behavioral science as a mental health counselor pursuant to Iowa Code section 154D.7 is eligible to participate when the temporarily licensed mental health counselor provides treatment under the supervision of a qualified mental health counselor as determined by the board of behavioral science by rule. Claims for payment for such services must be submitted by the supervising licensed mental health counselor.  77.26(7)    Certified alcohol and drug counselors.  Any person certified by the nongovernmental Iowa board of substance abuse certification as an alcohol and drug counselor is eligible to participate.  77.26(8)    Licensed behavior analysts.  Any person licensed by the board of behavioral science as a behavior analyst pursuant to Iowa Code chapter 154D is eligible to participate. A licensed behavior analyst in another state is eligible to participate when duly licensed to practice in that state.  77.26(9)    Licensed assistant behavior analysts.  A person licensed by the board of behavioral science as an assistant behavior analyst pursuant to Iowa Code chapter 154D is eligible to participate when the licensed assistant behavior analyst:  a.  Holds current certification as an assistant behavior analyst by a certifying entity; and  b.  Provides treatment under the supervision of a behavior analyst licensed pursuant to Iowa Code chapter 154D. Claims for payment for such services must be submitted by the supervising licensed behavior analyst.This rule is intended to implement Iowa Code chapter 249A.Related ARC(s): 9649B, 4165C441—77.27(249A)  Birth centers.  Birth centers are eligible to participate in the Medicaid program if they are licensed or receive reimbursement from at least two third-party payors.This rule is intended to implement Iowa Code section 249A.4.441—77.28(249A)  Area education agencies.  An area education agency is eligible to participate in the Medicaid program when it has a plan for providing comprehensive special education programs and services approved by the Iowa department of education. Covered services shall be provided by personnel who are licensed, endorsed, or registered as provided in this rule and shall be within the scope of the applicable license, endorsement, or registration.  77.28(1)  Personnel providing audiological or speech-language services shall be licensed by the Iowa board of speech pathology and audiology as a speech pathologist or audiologist pursuant to 645—Chapters 299, 300 and 303 through 305.  77.28(2)  Personnel providing physical therapy shall be licensed by the Iowa board of physical and occupational therapy as a physical therapist pursuant to 645—Chapters 199 through 204.  77.28(3)  Personnel providing occupational therapy shall be licensed by the Iowa board of physical and occupational therapy as an occupational therapist pursuant to 645—Chapters 205 through 210.  77.28(4)  Personnel providing psychological evaluations and counseling or psychotherapy services shall be:  a.  Endorsed by the Iowa board of educational examiners as a school psychologist pursuant to 282—subrule 27.3(3);  b.  Licensed by the Iowa board of psychology as a psychologist pursuant to 645—Chapters 239 through 243;  c.  Licensed by the Iowa board of social work as a social worker pursuant to 645—Chapters 279 through 284;  d.  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11; or  e.  Registered by the Iowa nursing board as an advanced registered nurse practitioner pursuant to 655—Chapter 7.  77.28(5)  Personnel providing nursing services shall be licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6.  77.28(6)  Personnel providing vision services shall be:  a.  Licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6;  b.  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11; or  c.  Licensed by the Iowa board of optometry as an optometrist pursuant to 645—Chapter 180.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 1807C441—77.29(249A)  Case management provider organizations.  Case management provider organizations are eligible to participate in the Medicaid program provided that they meet the standards for the populations being served. Providers shall meet the following standards:  77.29(1)    Standards in 441—Chapter 24.  Providers shall be accredited as case management providers pursuant to 441—Chapter 24 as a condition of providing case management services to persons with an intellectual disability, developmental disabilities or chronic mental illness.  77.29(2)    Standards in .  Rescinded IAB 10/12/05, effective 10/1/05.Related ARC(s): 3184C441—77.30(249A)  HCBS health and disability waiver service providers.  HCBS health and disability 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 member served or the parent or stepparent of a member 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 provider 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 health and disability waiver program if they meet the standards in subrule 77.30(18) and the integrated, community-based settings standards in subrule 77.25(5) and also meet the standards set forth below for the service to be provided:  77.30(1)    Homemaker providers.  Homemaker providers shall be agencies that are:  a.  Certified as a home health agency under Medicare, or  b.  Authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  77.30(2)    Home health aide providers.  Home health aide providers shall be agencies which are certified to participate in the Medicare program.  77.30(3)    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 at 481—Chapter 70.  77.30(4)    Nursing care providers.  Nursing care providers shall be agencies which are certified to participate in the Medicare program as home health agencies.  77.30(5)    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)  Respite providers certified under the home- and community-based services intellectual disability or brain injury waiver.  (3)  Nursing facilities, intermediate care facilities for the mentally retarded, and hospitals enrolled as providers in the Iowa Medicaid program.  (4)  Group living foster care facilities for children licensed by the department according to 441—Chapters 112 and 114 to 116 and child care centers licensed according to 441—Chapter 109.  (5)  Camps certified by the American Camping Association.  (6)  Home care agencies that meet the conditions of participation set forth in subrule 77.30(1).  (7)  Adult day care providers that meet the conditions of participation set forth in subrule 77.30(3).  (8)  Residential care facilities for persons with mental retardation licensed by the department of inspections and appeals.  (9)  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 each parent, 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 parents, 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 parent, guardian or primary caregiver of any injuries or illnesses that occur during respite provision. A parent’s, guardian’s or primary caregiver’s signature is required to verify receipt of notification.
    2. Requiring the parent, 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 parent, 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 parent, 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.      77.30(6)    Counseling providers.  Counseling providers shall be:  a.  Agencies which are certified under the community mental health center standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and III.  b.  Agencies which are licensed as meeting the hospice standards and requirements set forth in department of inspections and appeals rules 481—Chapter 53 or which are certified to meet the standards under the Medicare program for hospice programs.  c.  Agencies which are accredited under the mental health service provider standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and IV.  77.30(7)    Consumer-directed attendant care providers.  The following providers may provide consumer-directed attendant care service:  a.  An individual who contracts with the member 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 member’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.  (3)  Not the spouse of the member or a parent or stepparent of a member aged 17 or under.  (4)  Not the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  b.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  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 certified by the department of inspections and appeals under 481—Chapter 69.  h.  Adult day service providers that are certified by the department of inspections and appeals under 481—Chapter 70.  77.30(8)    Interim medical monitoring and treatment providers.    a.  The following providers may provide interim medical monitoring and treatment services:  (1)  Home health agencies certified to participate in the Medicare program.  (2)  Supported community living providers certified according to subrule 77.37(14) or 77.39(13).  b.  Staff requirements. Staff members providing interim medical monitoring and treatment services to members shall meet all of the following requirements:  (1)  Be at least 18 years of age.  (2)  Not be the spouse of the member or a parent or stepparent of the member if the member is aged 17 or under.  (3)  Not be a usual caregiver of the member.  (4)  Be qualified by training or experience to provide medical intervention or intervention in a medical emergency necessary to carry out the member’s plan of care. The training or experience required must be determined by the member’s usual caregivers and a licensed medical professional on the member’s interdisciplinary team and must be documented in the member’s service plan.  c.  Service documentation. Providers shall maintain clinical and fiscal records necessary to fully disclose the extent of services furnished to members. Records shall specify by service date the procedures performed, together with information concerning progress of treatment.  77.30(9)    Home and vehicle modification providers.  The following providers may provide home and vehicle modification:  a.  Area agencies on aging as designated in 17—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 providers under the elderly waiver, enrolled as home and vehicle modification providers under the physical disability waiver, or certified as home and vehicle modification providers under the home- and community-based services intellectual disability 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.  77.30(10)    Personal emergency response system providers.  Personal emergency response system providers shall be agencies that meet the conditions of participation set forth in subrule 77.33(2).  77.30(11)    Home-delivered meals.  The following providers may provide home-delivered meals:  a.  Area agencies on aging as designated in 17—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 137F.  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).  77.30(12)    Nutritional counseling.  The following providers may provide nutritional counseling by a dietitian licensed under 645—Chapter 81:  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.  Independent licensed dietitians approved by an area agency on aging.  77.30(13)    Financial management service.  Members who elect the consumer choices option shall work with a financial institution that meets the following qualifications.  a.  The financial institution shall either:  (1)  Be cooperative, nonprofit, member-owned and member-controlled, and federally insured through and chartered by either the National Credit Union Administration (NCUA) or the credit union division of the Iowa department of commerce; or  (2)  Be chartered by the Office of the Comptroller of the Currency, a bureau of the U.S. Department of the Treasury, and insured by the Federal Deposit Insurance Corporation (FDIC).  b.  The financial institution shall complete a financial management readiness review and certification conducted by the department or its designee.  c.  The financial institution shall obtain an Internal Revenue Service federal employee identification number dedicated to the financial management service.  d.  The financial institution shall enroll as a Medicaid provider.  77.30(14)    Independent support brokerage.  Members who elect the consumer choices option shall work with an independent support broker who meets the following qualifications.  a.  The broker must be at least 18 years of age.  b.  The broker shall not be the member’s guardian, conservator, attorney in fact under a durable power of attorney for health care, power of attorney for financial matters, trustee, or representative payee.  c.  The broker shall not provide any other paid service to the member.  d.  The broker shall not work for an individual or entity that is providing services to the member.  e.  The broker must consent to a criminal background check and child and dependent adult abuse checks. The results shall be provided to the member.  f.  The broker must complete independent support brokerage training approved by the department.  77.30(15)    Self-directed personal care.  Members who elect the consumer choices option may choose to purchase self-directed personal care services from an individual or business that meets the following requirements.  a.  A business providing self-directed personal care services shall:  (1)  Have all the necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations; and  (2)  Have current liability and workers’ compensation coverage.  b.  An individual providing self-directed personal care services shall have all the necessary licenses required by federal, state, and local laws, including a valid driver’s license if providing transportation.  c.  All personnel providing self-directed personal care services shall:  (1)  Be at least 16 years of age.  (2)  Be able to communicate successfully with the member.  (3)  Not be the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  (4)  Not be the recipient of respite services paid through the consumer choices option on behalf of a member who receives the consumer choices option.  (5)  Not be the parent or stepparent of a minor child member or the spouse of a member.  d.  The provider of self-directed personal care services shall:  (1)  Prepare timecards or invoices approved by the department that identify what services were provided and the time when services were provided.  (2)  Submit invoices and timesheets to the financial management service no later than 30 calendar days from the date when the last service in the billing period was provided. Payment shall not be made if invoices and timesheets are received after this 30-day period.  77.30(16)    Individual-directed goods and services.  Members who elect the consumer choices option may choose to purchase individual-directed goods and services from an individual or business that meets the following requirements.  a.  A business providing individual-directed goods and services shall:  (1)  Have all the necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations; and  (2)  Have current liability and workers’ compensation coverage.  b.  An individual providing individual-directed goods and services shall have all the necessary licenses required by federal, state, and local laws, including a valid driver’s license if providing transportation.  c.  All personnel providing individual-directed goods and services shall:  (1)  Be at least 18 years of age.  (2)  Be able to communicate successfully with the member.  (3)  Not be the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  (4)  Not be the recipient of respite services paid through the consumer choices option on behalf of a member who receives the consumer choices option.  (5)  Not be the parent or stepparent of a minor child member or the spouse of a member.  d.  The provider of individual-directed goods and services shall:  (1)  Prepare timecards or invoices approved by the department that identify what services were provided and the time when services were provided.  (2)  Submit invoices and timesheets to the financial management service no later than 30 calendar days from the date when the last service in the billing period was provided. Payment shall not be made if invoices and timesheets are received after this 30-day period.  77.30(17)    Self-directed community supports and employment.  Members who elect the consumer choices option may choose to purchase self-directed community supports and employment from an individual or business that meets the following requirements.  a.  A business providing community supports and employment shall:  (1)  Have all the necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations; and  (2)  Have current liability and workers’ compensation coverage.  b.  An individual providing self-directed community supports and employment shall have all the necessary licenses required by federal, state, and local laws, including a valid driver’s license if providing transportation.  c.  All personnel providing self-directed community supports and employment shall:  (1)  Be at least 18 years of age.  (2)  Be able to communicate successfully with the member.  (3)  Not be the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  (4)  Not be the recipient of respite services paid through the consumer choices option on behalf of a member who receives the consumer choices option.  (5)  Not be the parent or stepparent of a minor child member or the spouse of a member.  d.  The provider of self-directed community supports and employment shall:  (1)  Prepare timecards or invoices approved by the department that identify what services were provided and the time when services were provided.  (2)  Submit invoices and timesheets to the financial management service no later than 30 calendar days from the date when the last service in the billing period was provided. Payment shall not be made if invoices and timesheets are received after this 30-day period.  77.30(18)    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS health and disability waiver 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. Exception: The conditions in this subrule do not apply to providers of goods and services purchased under the consumer choices option or providers of home and vehicle modification, home-delivered meals, or personal emergency response.  a.    Definitions.  
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      b.    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 consumer’s file.  c.    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 consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’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 consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer’s file.      d.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.    This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 0757C, 1149C, 2361C, 3874C441—77.31(249A)  Occupational therapists.  Occupational therapists are eligible to participate if they are licensed and in private practice independent of the administrative and professional control of an employer such as a physician, institution, or rehabilitation agency. Licensed occupational therapists in an independent group practice are eligible to enroll.  77.31(1)  Occupational therapists in other states are eligible to participate if they are licensed in that state and meet the Medicare criteria for enrollment.  77.31(2)  Occupational therapists who provide services to Medicaid members who are also Medicare beneficiaries must be enrolled in the Medicare program.This rule is intended to implement Iowa Code section 249A.4.441—77.32(249A)  Hospice providers.  Hospice providers are eligible to participate in the Medicaid program providing they are certified to participate in the Medicare program.This rule is intended to implement Iowa Code section 249A.4.441—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 in subrule 77.33(22) and the integrated, community-based settings standards in subrule 77.25(5) and also meet the standards set forth below for the service to be provided:  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 at 481—Chapter 70.  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 that are:  a.  Certified as a home health agency under Medicare, or  b.  Authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  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 home- and community-based services intellectual disability 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.  Home health agencies certified under Medicare.  b.  Community action agencies as designated in Iowa Code section 216A.93.  c.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  d.  Nursing facilities licensed pursuant to Iowa Code chapter 135C.  e.  Providers that were enrolled as chore providers as of June 30, 2010, based on a subcontract with or letter of approval from an area agency on aging.  f.  Community businesses that are engaged in the provision of chore services and that:  (1)  Have all necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations, and  (2)  Submit verification of current liability and workers’ compensation coverage.  77.33(8)    Home-delivered meals.  The following providers may provide home-delivered meals:  a.  Area agencies on aging as designated in 17—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 137F.  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 17—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 providers under the health and disability waiver, enrolled as home and vehicle modification providers under the physical disability waiver, or certified as home and vehicle modification providers under the home- and community-based services intellectual disability 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 17—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.  f.  Transportation providers contracting with the nonemergency medical transportation contractor.  77.33(12)    Nutritional counseling.  The following providers may provide nutritional counseling by a dietitian licensed under 645—Chapter 81:  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.  Independent licensed dietitians.  77.33(13)    Assistive device providers.  The following providers may provide assistive devices:  a.  Medicaid-enrolled medical equipment and supply dealers.  b.  Area agencies on aging as designated according to department on aging rules 17—4.4(231) and 17—4.9(231).  c.  Providers that were enrolled as assistive device providers as of June 30, 2010, based on a contract with or letter of approval from an area agency on aging.  d.  Community businesses that are engaged in the provision of assistive devices and that:  (1)  Have all necessary licenses and permits to operate in conformity with federal, state, and local laws and regulations, and  (2)  Submit verification of current liability and workers’ compensation coverage.  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 providers.  The following providers may provide consumer-directed attendant care service:  a.  An individual who contracts with the member 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 member’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.  (3)  Not the spouse of the member or a parent or stepparent of a member aged 17 or under.  (4)  Not the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  b.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  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 certified by the department of inspections and appeals under 481—Chapter 69.  h.  Adult day service providers that are certified by the department of inspections and appeals under 481—Chapter 70.  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 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 (CQL) to provide case management; or  (5)  Is approved by the department on aging as meeting the standards for case management services in 17—Chapter 21; or  (6)  Is authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services and that:
    1. Meets the qualifications for case managers in 641—subrule 80.6(1); and
    2. Provides a current IDPH local public health services contract number.
      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.      77.33(22)    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS elderly waiver 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. Exception: The conditions in this subrule do not apply to providers of assistive devices, chore service, goods and services purchased under the consumer choices option, home and vehicle modification, home-delivered meals, personal emergency response, or transportation.  a.    Definitions.  
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      b.    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 consumer’s file.  c.    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 consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’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 consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer’s file.      d.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.      77.33(23)    Assisted living on-call service.  Assisted living on-call service providers shall be assisted living programs that are certified by the department of inspections and appeals under 481—Chapter 69.This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 0545C, 0757C, 1071C, 2361C, 3874C441—77.34(249A)  HCBS AIDS/HIV waiver service providers.  HCBS AIDS/HIV 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 AIDS/HIV waiver program if they meet the standards in subrule 77.34(14) and the integrated, community-based settings standards in subrule 77.25(5) and also meet the standards set forth below for the service to be provided:  77.34(1)    Counseling providers.  Counseling providers shall be:  a.  Agencies which are certified under the community mental health center standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and III.  b.  Agencies which are licensed as meeting the hospice standards and requirements set forth in department of inspections and appeals rules 481—Chapter 53 or which are certified to meet the standards under the Medicare program for hospice programs.  c.  Agencies which are accredited under the mental health service provider standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and IV.  77.34(2)    Home health aide providers.  Home health aide providers shall be agencies which are certified to participate in the Medicare program.  77.34(3)    Homemaker providers.  Homemaker providers shall be agencies that are:  a.  Certified as a home health agency under Medicare, or  b.  Authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  77.34(4)    Nursing care providers.  Nursing care providers shall be agencies which are certified to meet the standards under the Medicare program for home health agencies.  77.34(5)    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, intermediate care facilities for the mentally retarded, or hospitals enrolled as providers in the Iowa Medicaid program.  (3)  Respite providers certified under the home- and community-based services intellectual disability or brain injury waiver.  (4)  Group living foster care facilities for children licensed by the department according to 441—Chapters 112 and 114 to 116 and child care centers licensed according to 441—Chapter 109.  (5)  Camps certified by the American Camping Association.  (6)  Home care agencies that meet the conditions of participation set forth in subrule 77.34(3).  (7)  Adult day care providers that meet the conditions of participation set forth in subrule 77.34(7).  (8)  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 each parent, 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 parents, 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 parent, guardian or primary caregiver of any injuries or illnesses that occur during respite provision. A parent’s, guardian’s or primary caregiver’s signature is required to verify receipt of notification.
    2. Requiring the parent, 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 parent, 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 parent, 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.      77.34(6)    Home-delivered meals.  The following providers may provide home-delivered meals:  a.  Home health aide providers meeting the standards set forth in subrule 77.34(2).  b.  Home care providers meeting the standards set forth in subrule 77.34(3).  c.  Hospitals enrolled as Medicaid providers.  d.  Nursing facilities licensed pursuant to Iowa Code chapter 135C.  e.  Restaurants licensed and inspected under Iowa Code chapter 137F.  f.  Community action agencies as designated in Iowa Code section 216A.93. Home-delivered meals providers subcontracting with community action agencies or with letters of approval from the community action agencies stating the organization is qualified to provide home-delivered meals services may also provide home-delivered meals services.  g.  Area agencies on aging as designated in 17—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.  h.  Medical equipment and supply dealers certified to participate in the Medicaid program.  77.34(7)    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 at 481—Chapter 70.  77.34(8)    Consumer-directed attendant care providers.  The following providers may provide consumer-directed attendant care service:  a.  An individual who contracts with the member 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 member’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.  (3)  Not the spouse of the member or a parent or stepparent of a member aged 17 or under.  (4)  Not the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  b.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  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 certified by the department of inspections and appeals under 481—Chapter 69.  h.  Adult day service providers that are certified by the department of inspections and appeals under 481—Chapter 70.  77.34(9)    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).  77.34(10)    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).  77.34(11)    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).  77.34(12)    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).  77.34(13)    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).  77.34(14)    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS AIDS/HIV waiver 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. Exception: The conditions in this subrule do not apply to providers of goods and services purchased under the consumer choices option or to home-delivered meals.  a.    Definitions.  
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      b.    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 consumer’s file.  c.    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 consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’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 consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer’s file.      d.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.    This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 1149C, 2361C, 3874C441—77.35(249A)  Federally qualified health centers.  Federally qualified health centers are eligible to participate in the Medicaid program when the Centers for Medicare and Medicaid Services has notified the Medicaid program of their eligibility as allowed by Section 6404(b) of Public Law 101-239.This rule is intended to implement Iowa Code section 249A.4.441—77.36(249A)  Advanced registered nurse practitioners.  Advanced registered nurse practitioners are eligible to participate in the Medicaid program if they are duly licensed and registered by the state of Iowa as advanced registered nurse practitioners certified pursuant to board of nursing rules 655— Chapter 7.  77.36(1)  Advanced registered nurse practitioners in another state shall be eligible to participate if they are duly licensed and registered in that state as advanced registered nurse practitioners with certification in a practice area consistent with board of nursing rules 655—Chapter 7.  77.36(2)  Advanced registered nurse practitioners who have been certified eligible to participate in Medicare shall be considered as having met these guidelines.  77.36(3)  Licensed nurse anesthetists who have graduated from a nurse anesthesia program meeting the standards set forth by a national association of nurse anesthetists within the past 18 months and who are awaiting initial certification by a national association of nurse anesthetists approved by the board of nursing shall be considered as having met these guidelines.This rule is intended to implement Iowa Code section 249A.4.441—77.37(249A)  Home- and community-based services intellectual disability waiver service providers.  Providers shall be eligible to participate in the Medicaid HCBS intellectual disability waiver program if they meet the requirements in this rule and the subrules applicable to the individual service.The standards in subrule 77.37(1) apply only to providers of supported employment, respite providers certified according to subparagraph 77.37(15)“a”(8), and providers of supported community living services that are not residential-based. The standards and certification processes in subrules 77.37(2) through 77.37(7) and 77.37(9) through 77.37(12) apply only to supported employment providers and non-residential-based supported community living providers.The requirements in subrule 77.37(13) apply to all providers. Exception: 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 and is not subject to the review requirements in subrule 77.37(13). Also, services must 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. Consumer-directed attendant care and interim medical monitoring and treatment providers must be at least 18 years of age.The integrated, community-based settings standards in subrule 77.25(5) apply to all HCBS intellectual disability waiver service providers.  77.37(1)    Organizational standards (Outcome 1).  Organizational outcome-based standards for home- and community-based services intellectual disability providers are as follows:  a.  The organization demonstrates the provision and oversight of high-quality supports and services to consumers.  b.  The organization demonstrates a defined mission commensurate with consumer’s needs, desires, and abilities.  c.  The organization establishes and maintains fiscal accountability.  d.  The organization has qualified staff commensurate with the needs of the consumers they serve. These staff demonstrate competency in performing duties and in all interactions with clients.  e.  The organization provides needed training and supports to its staff. This training includes at a minimum:  (1)  Consumer rights.  (2)  Confidentiality.  (3)  Provision of consumer medication.  (4)  Identification and reporting of child and dependent adult abuse.  (5)  Individual consumer support needs.  f.  The organization has a systematic, organizationwide, planned approach to designing, measuring, evaluating, and improving the level of its performance. The organization:  (1)  Measures and assesses organizational activities and services annually.  (2)  Gathers information from consumers, family members, and staff.  (3)  Conducts an internal review of consumer service records, including all major and minor incident reports according to subrule 77.37(8).  (4)  Tracks incident data and analyzes trends annually to assess the health and safety of consumers served by the organization.  (5)  Identifies areas in need of improvement.  (6)  Develops a plan to address the areas in need of improvement.  (7)  Implements the plan and documents the results.  g.  Consumers and their legal representatives have the right to appeal the provider’s implementation of the 20 outcomes, or staff or contractual person’s action which affects the consumer. The provider shall distribute the policies for consumer appeals and procedures to consumers.  h.  The provider shall have written policies and procedures and a staff training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.  i.  The governing body has an active role in the administration of the agency.  j.  The governing body receives and uses input from a wide range of local community interests and consumer representation and provides oversight that ensures the provision of high-quality supports and services to consumers.  77.37(2)    Rights and dignity.  Outcome-based standards for rights and dignity are as follows:  a.  (Outcome 2) Consumers are valued.  b.  (Outcome 3) Consumers live in positive environments.  c.  (Outcome 4) Consumers work in positive environments.  d.  (Outcome 5) Consumers exercise their rights and responsibilities.  e.  (Outcome 6) Consumers have privacy.  f.  (Outcome 7) When there is a need, consumers have support to exercise and safeguard their rights.  g.  (Outcome 8) Consumers decide which personal information is shared and with whom.  h.  (Outcome 9) Consumers make informed choices about where they work.  i.  (Outcome 10) Consumers make informed choices on how they spend their free time.  j.  (Outcome 11) Consumers make informed choices about where and with whom they live.  k.  (Outcome 12) Consumers choose their daily routine.  l.  (Outcome 13) Consumers are a part of community life and perform varied social roles.  m.  (Outcome 14) Consumers have a social network and varied relationships.  n.  (Outcome 15) Consumers develop and accomplish personal goals.  o.  (Outcome 16) Management of consumers’ money is addressed on an individualized basis.  p.  (Outcome 17) Consumers maintain good health.  q.  (Outcome 18) The consumer’s living environment is reasonably safe in the consumer’s home and community.  r.  (Outcome 19) The consumer’s desire for intimacy is respected and supported.  s.  (Outcome 20) Consumers have an impact on the services they receive.  77.37(3)    Contracts with consumers.  The provider shall have written procedures which provide for the establishment of an agreement between the consumer and the provider.  a.  The agreement shall define the responsibilities of the provider and the consumer, the rights of the consumer, the services to be provided to the consumer by the provider, all room and board and copay fees to be charged to the consumer and the sources of payment.  b.  Contracts shall be reviewed at least annually.  77.37(4)    The right to appeal.  Consumers and their legal representatives have the right to appeal the provider’s application of policies or procedures, or any staff or contractual person’s action which affects the consumer. The provider shall distribute the policies for consumer appeals and procedures to consumers.  77.37(5)    Storage and provision of medication.  If the provider stores, handles, prescribes, dispenses or administers prescription or over-the-counter medications, the provider shall develop procedures for the storage, handling, prescribing, dispensing or administration of medication. For controlled substances, procedures shall be in accordance with department of inspections and appeals rule 481—63.18(135).If the provider has a physician on staff or under contract, the physician shall review and document the provider’s prescribed medication regime at least annually in accordance with current medical practice.  77.37(6)    Research.  If the provider conducts research involving human subjects, the provider shall have written policies and procedures for research which ensure the rights of consumers and staff.  77.37(7)    Abuse reporting requirements.  The provider shall have written policies and procedures and a staff training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.  77.37(8)    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS intellectual disability waiver 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. Exception: The conditions in this subrule do not apply to providers of goods and services purchased under the consumer choices option or providers of home and vehicle modification, personal emergency response, and transportation.  a.    Definitions.  
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      b.    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 consumer’s file.  c.    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 consumer’s supervisor.
    2. The consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’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 consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer’s file.      d.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.      77.37(9)    Intake, admission, service coordination, discharge, and referral.    a.  The provider shall have written policies and procedures according to state and federal laws for intake, admission, service coordination, discharge and referral. Service coordination means activities designed to help individuals and families locate, access, and coordinate a network of supports and services that will allow them to live a full life in the community.  b.  The provider shall ensure the rights of persons applying for services.  77.37(10)    Certification process.  Reviews of compliance with standards for initial certification and recertification shall be conducted by the department of human services’ bureau of long-term care quality assurance staff. Certification carries no assurance that the approved provider will receive funding.  a.  Rescinded IAB 9/1/04, effective 11/1/04.  b.  Rescinded IAB 9/1/04, effective 11/1/04.  c.  Rescinded IAB 9/1/04, effective 11/1/04.  d.  The department may request any information from the prospective service provider which is considered pertinent to arriving at a certification decision. This may include, but is not limited to:  (1)  Current accreditations, evaluations, inspections and reviews by regulatory and licensing agencies and associations.  (2)  Fiscal capacity of the prospective provider to initiate and operate the specified programs on an ongoing basis.  77.37(11)    Initial certification.  The department shall review the application and accompanying information to see if the provider has the necessary framework to provide services in accordance with all applicable requirements and standards.  a.  The department shall make a determination regarding initial certification within 60 days of receipt of the application and notify the provider in writing of the decision unless extended by mutual consent of the parties involved. Providers shall be responsible for notifying the appropriate county and the appropriate central point of coordination of the determination.  b.  The decision of the department on initial certification of the providers shall be based on all relevant information, including:  (1)  The application for status as an approved provider according to requirements of rules.  (2)  A determination of the financial position of the prospective provider in relation to its ability to meet the stated need.  (3)  The prospective provider’s coordination of service design, development, and application with the applicable region and other interested parties.  (4)  The prospective provider’s written agreement to work cooperatively with the state, counties and regions to be served by the provider.  c.  Providers applying for initial certification shall be offered technical assistance.  77.37(12)    Period of certification.  Provider certification shall become effective on the date identified on the certificate of approval and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.  a.  Initial certification. Providers eligible for initial certification by the department shall be issued an initial certification for 270 calendar days based on documentation provided.  b.  Recertification. After the initial certification, the level of certification shall be based on an on-site review unless the provider has been accredited for similar services by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Quality and Leadership in Supports for People with Disabilities (The Council), or the Council on Accreditation of Services for Families and Children (COA). The on-site reviews for supported community living and supported employment use interviews with consumers and significant people in the consumer’s life to determine whether or not the 20 individual value-based outcomes set forth in subrules 77.37(1) and 77.37(2) and corresponding processes are present for the consumer. Respite services are required to meet Outcome 1 and participate in satisfaction surveys.Once the outcomes and processes have been determined for all the consumers in the sample, a review team then determines which of the 20 outcomes and processes are present for the provider. A specific outcome is present for the provider when the specific outcome is determined to be present for 75 percent or more of the consumers interviewed. A specific process is present for the provider when the process is determined to be present for 75 percent or more of the consumers interviewed. Since the processes are in the control of the provider and the outcomes are more in the control of the consumer, length of certification will be based more heavily on whether or not the processes are in place to help consumers obtain desired outcomes.An exit conference shall be held with the organization to share preliminary findings of the certification review. A review report shall be written and sent to the provider within 30 calendar days unless the parties mutually agree to extend that time frame.Provider certification shall become effective on the date identified on the Certificate of Approval, Form 470-3410, and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.  c.  The department may issue four categories of recertification:  (1)  Three-year certification with excellence. An organization is eligible for certification with excellence if the number of processes present is 18 or higher and the number of outcomes and corresponding processes present together is 12 or higher. Both criteria need to be met to receive three-year certification with excellence. Corrective actions may be required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.  (2)  Three-year certification with follow-up monitoring. An organization is eligible for this type of certification if the number of processes present is 17 or higher and the number of outcomes and corresponding processes present together are 11 or higher. Both criteria need to be met to receive three-year certification. Corrective actions are required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.  (3)  One-year certification. An organization is eligible for this type of certification when the number of processes present is 14 or higher and the number of outcomes and processes together is 9 or higher. Both criteria need to be met to receive one-year certification. One-year certification may also be given in lieu of longer certification when previously required corrective actions have not been implemented or completed. Corrective actions are required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.  (4)  Probational certification. A probational certification may be issued to those providers who cannot meet requirements for a one-year certification. This time period shall be granted to the provider to establish and implement corrective actions and improvement activities. During this time period the department may require monitoring of the implementation of the corrective actions through on-site visits, written reports or technical assistance. Probational certification issued for 270 calendar days shall not be renewed or extended, and shall require a full on-site follow-up review to be completed. The provider shall be required to achieve at least a one-year certification status at the time of the follow-up review in order to maintain certification.  d.  During the course of the review, if a team member encounters a situation that places a member in immediate jeopardy, the team member shall immediately notify the provider, the department, and other team members. “Immediate jeopardy” refers to circumstances where the life, health, or safety of a member will be severely jeopardized if the circumstances are not immediately corrected.  (1)  The provider shall correct the situation within 24 to 48 hours. If the situation is not corrected within the prescribed time frame, that portion of the provider’s services that was the subject of the notification shall not be certified. The department shall be notified immediately to discontinue funding for that provider’s service. If a member is in immediate jeopardy, the case manager or department service worker shall notify the county or region in the event the county or region is funding a service that may assist the member in the situation.  (2)  If this action is appealed and the member, legal guardian, or attorney in fact under a durable power of attorney for health care wants to maintain the provider’s services, funding can be reinstated. At that time the provider shall take appropriate action to ensure the life, health, and safety of the members deemed to be at risk as a result of the provider’s inaction.  e.  As a mandatory reporter, each team member shall be required to follow appropriate procedure in all cases where a condition reportable to child and adult protective services is observed.  f.  The department may grant an extension to the period of approval for the following reasons:  (1)  A delay in the department’s approval decision which is beyond the control of the provider or department.  (2)  A request for an extension from a provider to permit the provider to prepare and obtain department approval of corrective actions. The department shall establish the length of extensions on a case-by-case basis.  g.  The department may revoke the provider’s approval at any time for any of the following reasons:  (1)  Findings of a site visit indicate that the provider has failed to implement the corrective actions submitted pursuant to paragraph 77.37(13)“e.”  (2)  The provider has failed to provide information requested pursuant to paragraph 77.37(13)“f.”  (3)  The provider refuses to allow the department to conduct a site visit pursuant to paragraph 77.37(13)“h.”  (4)  There are instances of noncompliance with the standards which were not identified from information submitted on the application.  h.  An approved provider shall immediately notify the department, applicable county, or region, the applicable mental health and developmental disabilities planning council, and other interested parties of a decision to withdraw from a home- and community-based services intellectual disability waiver service.  i.  Following certification, any provider may request technical assistance from the department to bring into conformity those areas found in noncompliance with HCBS requirements. If multiple deficiencies are noted during a review, the department may require that technical assistance be provided to a provider to assist in the implementation of the provider’s corrective actions. Providers may be given technical assistance as needed.  j.  Appeals. Any adverse action can be appealed by the provider under 441—Chapter 7.  77.37(13)    Review of providers.  Reviews of compliance with standards as indicated in this chapter shall be conducted by designated members of the HCBS staff.  a.  This review may include on-site case record audits; review of administrative procedures, clinical practices, personnel records, performance improvement systems and documentation; and interviews with staff, consumers, the board of directors, or others deemed appropriate, consistent with the confidentiality safeguards of state and federal laws.  b.  A review visit shall be scheduled with the provider with additional reviews conducted at the discretion of the department.  c.  The on-site review team will consist of designated members of the HCBS staff.  d.  Following a certification review, the certification review team leader shall submit a copy of the department’s written report of findings to the provider within 30 working days after completion of the certification review.  e.  The provider shall develop a plan of corrective action, if applicable, identifying completion time frames for each review recommendation.  f.  Providers required to make corrective actions and improvements shall submit the corrective action and improvement plan to the Bureau of Long-Term Care, 1305 East Walnut Street, Des Moines, Iowa 50319-0114, within 30 working days after the receipt of a report issued as a result of the review team’s visit. The corrective actions may include: specific problem areas cited, corrective actions to be implemented by the provider, dates by which each corrective measure will be completed, and quality assurance and improvement activities to measure and ensure continued compliance.  g.  The department may request the provider to supply subsequent reports on implementation of a corrective action plan submitted pursuant to 77.37(13)“e” and 77.37(13)“f.”  h.  The department may conduct a site visit to verify all or part of the information submitted.  77.37(14)    Supported community living providers.    a.  The department will contract only with public or private agencies to provide the supported community living service. The department does not recognize individuals as service providers under the supported community living program.  b.  Providers of services meeting the definition of foster care shall also be licensed according to applicable 441—Chapters 108, 112, 114, 115, and 116.  c.  Providers of service may employ or contract with individuals meeting the definition of foster family homes to provide supported community living services. These individuals shall be licensed according to applicable 441—Chapters 112 and 113.  d.  All supported community living providers shall meet the following requirements:  (1)  The provider shall demonstrate how the provider will meet the outcomes and processes in rule 441—77.37(249A) for each of the consumers being served. The provider shall supply timelines showing how the provider will come into compliance with rules 441—77.37(249A), 441—78.41(249A), and 441—83.60(249A) to 441—83.70(249A) and 441—subrule 79.1(15) within one year of certification. These timelines shall include:
    1. Implementation of necessary staff training and consumer input.
    2. Implementation of provider system changes to allow for flexibility in staff duties, services based on what each individual needs, and removal of housing as part of the service.
      (2)  The provider shall demonstrate that systems are in place to measure outcomes and processes for individual consumers before certification can be given.      e.  The department shall approve living units designed to serve up to four persons except as necessary to prevent an overconcentration of supported community living units in a geographic area.  f.  The department shall approve a living unit designed to serve five persons if both of the following conditions are met:  (1)  Approval will not result in an overconcentration of supported community living units in a geographic area.  (2)  The county in which the living unit is located provides to the bureau of long-term care verification in writing that the approval is needed to address one or more of the following issues:
    1. The quantity of services currently available in the county is insufficient to meet the need;
    2. The quantity of affordable rental housing in the county is insufficient to meet the need; or
    3. Approval will result in a reduction in the size or quantity of larger congregate settings.
      77.37(15)    Respite care providers.    a.  The following agencies may provide respite services:  (1)  Group living foster care facilities for children licensed by the department according to 441—Chapters 112 and 114 to 116 and child care centers licensed according to 441—Chapter 109.  (2)  Nursing facilities, intermediate care facilities for persons with an intellectual disability, and hospitals enrolled as providers in the Iowa Medicaid program.  (3)  Residential care facilities for persons with an intellectual disability licensed by the department of inspections and appeals.  (4)  Home health agencies that are certified to participate in the Medicare program.  (5)  Camps certified by the American Camping Association.  (6)  Adult day care providers that meet the conditions of participation set forth in subrule 77.37(25).  (7)  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  (8)  Agencies certified by the department to provide respite services in the consumer’s home that meet the requirements of 77.37(1) and 77.37(3) through 77.37(9).  (9)  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 each parent, 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 parents, 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 parent, guardian or primary caregiver of any injuries or illnesses that occur during respite provision. A parent’s, guardian’s or primary caregiver’s signature is required to verify receipt of notification.
    2. Requiring the parent, 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 parent, 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 parent, 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.      77.37(16)    Supported employment providers.    a.  The following agencies may provide supported employment services:  (1)  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities as an organizational employment service provider, a community employment service provider, or a provider of a similar service.  (2)  An agency that is accredited by the Council on Accreditation for similar services.  (3)  An agency that is accredited by the Joint Commission for similar services.  (4)  An agency that is accredited by the Council on Quality and Leadership for similar services.  (5)  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.  Individuals may not provide supported employment services except when the services are purchased through the consumer choices option.  d.  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 a 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.  77.37(17)    Home and vehicle modification providers.  The following providers may provide home and vehicle modification:  a.  Providers certified to participate as supported community living service providers under the home- and community-based services intellectual disability or brain injury waiver.  b.  Providers eligible to participate as home and vehicle modification providers under the elderly or health and disability waiver, enrolled as home and vehicle modification providers under the physical disability waiver, or certified as home and vehicle modification providers under the brain injury waiver.  c.  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 insurance.  77.37(18)    Personal emergency response system providers.  Personal emergency response system providers shall be agencies which meet the conditions of participation set forth in subrule 77.33(2) to maintain certification.  77.37(19)    Nursing providers.  Nursing providers shall be agencies that are certified to participate in the Medicare program as home health agencies.  77.37(20)    Home health aide providers.  Home health aide providers shall be agencies which are certified to participate in the Medicare program as home health agencies and which have an HCBS agreement with the department.  77.37(21)    Consumer-directed attendant care providers.  The following providers may provide consumer-directed attendant care service:  a.  An individual who contracts with the member 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 member’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.  (3)  Not the spouse of the member or a parent or stepparent of a member aged 17 or under.  (4)  Not the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  b.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  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 certified by the department of inspections and appeals under 481—Chapter 69.  h.  Adult day service providers that are certified by the department of inspections and appeals under 481—Chapter 70.  77.37(22)    Interim medical monitoring and treatment providers.    a.  The following providers may provide interim medical monitoring and treatment services:  (1)  Home health agencies certified to participate in the Medicare program.  (2)  Supported community living providers certified according to subrule 77.37(14) or 77.39(13).  b.  Staff requirements. Staff members providing interim medical monitoring and treatment services to members shall meet all of the following requirements:  (1)  Be at least 18 years of age.  (2)  Not be the spouse of the member or a parent or stepparent of the member if the member is aged 17 or under.  (3)  Not be a usual caregiver of the member.  (4)  Be qualified by training or experience to provide medical intervention or intervention in a medical emergency necessary to carry out the member’s plan of care. The training or experience required must be determined by the member’s usual caregivers and a licensed medical professional on the member’s interdisciplinary team and must be documented in the member’s service plan.  c.  Service documentation. Providers shall maintain clinical and fiscal records necessary to fully disclose the extent of services furnished to members. Records shall specify by service date the procedures performed, together with information concerning progress of treatment.  77.37(23)    Residential-based supported community living service providers.    a.  The department shall contract only with public or private agencies to provide residential-based supported community living services.  b.  Subject to the requirements of this rule, the following agencies may provide residential-based supported community living services:  (1)  Agencies licensed as group living foster care facilities under 441—Chapter 114.  (2)  Agencies licensed as residential facilities for children with an intellectual disability or brain injury under 441—Chapter 116.  (3)  Other agencies providing residential-based supported community living services that meet the following conditions:
    1. The agency must provide orientation training on the agency’s purpose, policies, and procedures within one month of hire or contracting for all employed and contracted treatment staff and must provide 24 hours of training during the first year of employment or contracting. The agency must also provide at least 12 hours of training per year after the first year of employment for all employed and contracted treatment staff. Annual training shall include, at a minimum, training on children’s intellectual disabilities and developmental disabilities services and children’s mental health issues. Identification and reporting of child abuse shall be covered in training at least every three years, in accordance with Iowa Code section 232.69.
    2. The agency must have standards for the rights and dignity of children that are age-appropriate. These standards shall include the following:
    3. Children, their families, and their legal representatives decide what personal information is shared and with whom.
    4. Children are a part of family and community life and perform varied social roles.
    5. Children have family connections, a social network, and varied relationships.
    6. Children develop and accomplish personal goals.
    7. Children are valued.
    8. Children live in positive environments.
    9. Children exercise their rights and responsibilities.
    10. Children make informed choices about how they spend their free time.
    11. Children choose their daily routine.
    12. The agency must use methods of self-evaluation by which:
    13. Past performance is reviewed.
    14. Current functioning is evaluated.
    15. Plans are made for the future based on the review and evaluation.
    16. The agency must have a governing body that receives and uses input from a wide range of local community interests and consumer representatives and provides oversight that ensures the provision of high-quality supports and services to children.
    17. Children, their parents, and their legal representatives must have the right to appeal the service provider’s application of policies or procedures or any staff person’s action that affects the consumer. The service provider shall distribute the policies for consumer appeals and procedures to children, their parents, and their legal representatives.
      c.  As a condition of participation, all providers of residential-based supported community living services must have the following on file:  (1)  Current accreditations, evaluations, inspections, and reviews by applicable regulatory and licensing agencies and associations.  (2)  Documentation of the fiscal capacity of the provider to initiate and operate the specified programs on an ongoing basis.  (3)  The provider’s written agreement to work cooperatively with the department.  d.  As a condition of participation, all providers of residential-based supported community living services must develop, review, and revise service plans for each child, as follows:  (1)  The service plan shall be developed in collaboration with the social worker or case manager, child, family, and, if applicable, the foster parents, unless a treatment rationale for the lack of involvement of one of these parties is documented in the plan. The service provider shall document the dates and content of the collaboration on the service plan. The service provider shall provide a copy of the service plan to the family and the case manager, unless otherwise ordered by a court of competent jurisdiction.  (2)  Initial service plans shall be developed after services have been authorized and within 30 calendar days of initiating services.  (3)  The service plan shall identify the following:
    1. Strengths and needs of the child.
    2. Goals to be achieved to meet the needs of the child.
    3. Objectives for each goal that are specific, measurable, and time-limited and include indicators of progress toward each goal.
    4. Specific service activities to be provided to achieve the objectives.
    5. The persons responsible for providing the services. When daily living and social skills development is provided in a group care setting, designation may be by job title.
    6. Date of service initiation and date of individual service plan development.
    7. Service goals describing how the child will be reunited with the child’s family and community.
      (4)  Individuals qualified to provide all services identified in the service plan shall review the services identified in the service plan to ensure that the services are necessary, appropriate, and consistent with the identified needs of the child, as listed on the Supports Intensity Scale® (SIS) assessment.  (5)  The service worker or case manager shall review all service plans to determine progress toward goals and objectives 90 calendar days from the initiation of services and every 90 calendar days thereafter for the duration of the services.At a minimum, the provider shall submit written reports to the service worker or case manager at six-month intervals and when changes to the service plan are needed.  (6)  The individual service plan shall be revised when any of the following occur:
    1. Service goals or objectives have been achieved.
    2. Progress toward goals and objectives is not being made.
    3. Changes have occurred in the identified service needs of the child, as listed on the Supports Intensity Scale® (SIS) assessment.
    4. The service plan is not consistent with the identified service needs of the child, as listed in the service plan.
      (7)  The service plan shall be signed and dated by qualified staff of each reviewing provider after each review and revision.  (8)  Any revisions of the service plan shall be made in collaboration with the child, family, case manager, and, if applicable, the foster parents and shall reflect the needs of the child. The service provider shall provide a copy of the revised service plan to the family and case manager, unless otherwise ordered by a court of competent jurisdiction.      e.  The residential-based supportive community living service provider shall also furnish residential-based living units for all recipients of the residential-based supported community living services. Except as provided herein, living units provided may be of no more than four beds. Service providers who receive approval from the bureau of long-term care may provide living units of up to eight beds. The bureau shall approve five- to eight-bed living units only if all of the following conditions are met:  (1)  Rescinded IAB 8/7/02, effective 10/1/02.  (2)  There is a need for the service to be provided in a five- to eight-person living unit instead of a smaller living unit, considering the location of the programs in an area.  (3)  The provider supplies the bureau of long-term care with a written plan acceptable to the department that addresses how the provider will reduce its living units to four-bed units within a two-year period of time. This written plan shall include the following:
    1. How the transition will occur.
    2. What physical change will need to take place in the living units.
    3. How children and their families will be involved in the transitioning process.
    4. How this transition will affect children’s social and educational environment.
      f.  Certification process and review of service providers.  (1)  The certification process for providers of residential-based supported community living services shall be pursuant to subrule 77.37(10).  (2)  The initial certification of residential-based supported community living services shall be pursuant to subrule 77.37(11).  (3)  Period and conditions of certification.
    1. Initial certification. Providers eligible for initial certification by the department shall be issued an initial certification for 270 calendar days, effective on the date identified on the certificate of approval, based on documentation provided.
    2. Recertification. After the initial certification, recertification shall be based on an on-site review and shall be contingent upon demonstration of compliance with certification requirements.An exit conference shall be held with the provider to share preliminary findings of the recertification review. A review report shall be written and sent to the provider within 30 calendar days unless the parties mutually agree to extend that time frame.Recertification shall become effective on the date identified on the Certificate of Approval, Form 470-3410, and shall terminate one year from the month of issuance.Corrective actions may be required in connection with recertification and may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.
    3. Probational certification. Probational certification for 270 calendar days may be issued to a provider who cannot demonstrate compliance with all certification requirements on recertification review to give the provider time to establish and implement corrective actions and improvement activities.During the probational certification period, the department may require monitoring of the implementation of the corrective actions through on-site visits, written reports, or technical assistance.Probational certification shall not be renewed or extended and shall require a full on-site follow-up review to be completed. The provider must demonstrate compliance with all certification requirements at the time of the follow-up review in order to maintain certification.
    4. Immediate jeopardy. If, during the course of any review, a review team member encounters a situation that places a member in immediate jeopardy, the team member shall immediately notify the provider, the department, and other team members. “Immediate jeopardy” refers to circumstances where the life, health, or safety of a member will be severely jeopardized if the circumstances are not immediately corrected.The provider shall correct the situation within 24 to 48 hours. If the situation is not corrected within the prescribed time frame, the provider shall not be certified. The department shall immediately discontinue funding for that provider’s service. If this action is appealed and the member or legal guardian wants to maintain the provider’s services, funding can be reinstated. At that time the provider shall take appropriate action to ensure the life, health, and safety of the members deemed to be at risk. The case manager or department service worker shall notify the county or region in the event the county or region is funding a service that may assist the member in the situation.
    5. Abuse reporting. As a mandatory reporter, each review team member shall follow appropriate procedure in all cases where a condition reportable to child and adult protective services is observed.
    6. Extensions. The department shall establish the length of extensions on a case-by-case basis. The department may grant an extension to the period of certification for the following reasons:
    7. A delay in the department’s approval decision exists which is beyond the control of the provider or department.
    8. A request for an extension is received from a provider to permit the provider to prepare and obtain department approval of corrective actions.
    9. Revocation. The department may revoke the provider’s approval at any time for any of the following reasons:
    10. The findings of a site visit indicate that the provider has failed to implement the corrective actions submitted pursuant to paragraph 77.37(13)“e” and numbered paragraph 77.37(23)“f”(3)“4.”
    11. The provider has failed to provide information requested pursuant to paragraph 77.37(13)“f” and numbered paragraph 77.37(23)“f”(3)“4.”
    12. The provider refuses to allow the department to conduct a site visit pursuant to paragraph 77.37(13)“h” and subparagraph 77.37(23)“f”(3).
    13. There are instances of noncompliance with the standards that were not identified from information submitted on the application.
    14. Notice of intent to withdraw. An approved provider shall immediately notify the department, applicable county, the applicable mental health and developmental disabilities planning council, and other interested parties of a decision to withdraw as a provider of residential-based supported community living services.
    15. Technical assistance. Following certification, any provider may request technical assistance from the department regarding compliance with program requirements. The department may require that technical assistance be provided to a provider to assist in the implementation of any corrective action plan.
    16. Appeals. The provider can appeal any adverse action under 441—Chapter 7.
      (4)  Providers of residential-based supported community living services shall be subject to reviews of compliance with program requirements pursuant to subrule 77.37(13).      77.37(24)    Transportation service providers.  The following providers may provide transportation:  a.  Accredited providers of home- and community-based services.  b.  Regional transit agencies as recognized by the Iowa department of transportation.  c.  Transportation providers that contract with county governments.  d.  Community action agencies as designated in Iowa Code section 216A.93.  e.  Nursing facilities licensed under Iowa Code chapter 135C.  f.  Area agencies on aging as designated in rule 17—4.4(231), subcontractors of area agencies on aging, or organizations with letters of approval from the area agencies on aging stating that the organization is qualified to provide transportation services.  g.  Transportation providers contracting with the nonemergency medical transportation contractor.  77.37(25)    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 at 481—Chapter 70.  77.37(26)    Prevocational service providers.    a.  Providers of prevocational services must be accredited by one of the following:  (1)  The Commission on Accreditation of Rehabilitation Facilities as an organizational employment service provider or a community employment service provider.  (2)  The Council on Quality and Leadership accreditation in supports for people with disabilities.  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. 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 services 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.  77.37(27)    Day habilitation providers.  Day habilitation services may be provided by agencies meeting the qualifications in subrule 77.25(7).   77.37(28)    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).  77.37(29)    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).  77.37(30)    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).  77.37(31)    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).  77.37(32)    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).This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 0191C, 0359C, 0757C, 1071C, 1149C, 2361C, 2471C, 3874C, 5307C, 5361C441—77.38(249A)  Assertive community treatment.  Services in the assertive community treatment (ACT) program shall be rendered by a multidisciplinary team composed of practitioners from the disciplines described in this rule. The team shall be under the clinical supervision of a psychiatrist. The program shall designate an individual team member who shall be responsible for administration of the program, including authority to sign documents and receive payment on behalf of the program.  77.38(1)    Minimum composition.  At a minimum, the team shall consist of a nurse, a mental health service provider, and a substance abuse treatment professional.  77.38(2)    Psychiatrists.  A psychiatrist on the team shall be a physician (MD or DO) who:  a.  Is licensed under 653—Chapter 9,  b.  Is certified as a psychiatrist by the American Board of Medical Specialties’ Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry, and  c.  Has experience treating serious and persistent mental illness.  77.38(3)    Registered nurses.  A nurse on the team shall:  a.  Be licensed as a registered nurse under 655—Chapter 3, and  b.  Have experience treating persons with serious and persistent mental illness.  77.38(4)    Mental health service providers.  A mental health service provider on the team shall be:  a.  A mental health counselor or marital and family therapist who:  (1)  Is licensed under 645—Chapter 31, and  (2)  Has experience treating persons with serious and persistent mental illness; or  b.  A social worker who:  (1)  Is licensed as a master or independent social worker under 645—Chapter 280, and  (2)  Has experience treating persons with serious and persistent mental illness.  77.38(5)    Psychologists.  A psychologist on the team shall:  a.  Be licensed under 645—Chapter 240, and  b.  Have experience treating persons with serious and persistent mental illness.  77.38(6)    Substance abuse treatment professionals.  A substance abuse treatment professional on the team shall:  a.  Be an appropriately credentialed counselor pursuant to 641—paragraph 155.21(8)“i,” and  b.  Have at least three years of experience treating substance abuse.  77.38(7)    Peer specialists.  A peer specialist on the team shall be a person with serious and persistent mental illness who has met all requirements of a nationally standardized peer support training program, including at least 30 hours of training and satisfactory completion of an examination.  77.38(8)    Community support specialists.  A community support specialist on the team shall be a person who:  a.  Has a bachelor’s degree (BA or BS) in a human services field (sociology, social work, counseling, psychology, or human services), and  b.  Has experience supporting persons with serious and persistent mental illness.  77.38(9)    Case managers.  A case manager on the team shall be a person who:  a.  Has a bachelor’s degree (BA or BS) in a human services field (sociology, social work, counseling, psychology, or human services),  b.  Has experience managing care for persons with serious and persistent mental illness, and  c.  Meets the qualifications of“qualified case managers and supervisors” in rule 441—24.1(225C).  77.38(10)    Advanced registered nurse practitioners.  An advanced registered nurse practitioner on the team shall:  a.  Be licensed under 655—Chapter 7,  b.  Have a mental health certification, and  c.  Have experience treating serious and persistent mental illness.  77.38(11)    Physician assistants.  A physician assistant on the team shall:  a.  Be licensed under 645—Chapter 326,  b.  Have experience treating persons with serious and persistent mental illness, and  c.  Practice under the supervision of a psychiatrist.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 9440B441—77.39(249A)  HCBS brain injury waiver service providers.  Providers shall be eligible to participate in the Medicaid brain injury waiver program if they meet the requirements in this rule and the subrules applicable to the individual service. Beginning January 1, 2015, providers initially enrolling to deliver BI waiver services and each of their staff members involved in direct consumer service must have completed the department’s brain injury training modules one and two within 60 days from the beginning date of service provision, with the exception of staff members who are certified through the Academy of Certified Brain Injury Specialists (ACBIS) as a certified brain injury specialist (CBIS) or certified brain injury specialist trainer (CBIST), providers of home and vehicle modification, specialized medical equipment, transportation, personal emergency response, financial management, independent support brokerage, self-directed personal care, individual-directed goods and services, and self-directed community supports and employment. Providers enrolled to provide BI waiver services and each of their staff members involved in direct consumer service on or before December 31, 2014, shall be deemed to have completed the required training.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 and is not subject to review under subrule 77.39(11). Consumer-directed attendant care and interim medical monitoring and treatment providers must be at least 18 years of age.In addition, behavioral programming, supported community living, and supported employment providers shall meet the outcome-based standards set forth below in subrules 77.39(1) and 77.39(2) evaluated according to subrules 77.39(8) to 77.39(10), and the requirements of subrules 77.39(3) to 77.39(7). Respite providers shall also meet the standards in subrule 77.39(1).The integrated, community-based settings standards in subrule 77.25(5) apply to all HCBS brain injury waiver service providers.  77.39(1)    Organizational standards (Outcome 1).  Organizational outcome-based standards for HCBS BI providers are as follows:  a.  The organization demonstrates the provision and oversight of high-quality supports and services to consumers.  b.  The organization demonstrates a defined mission commensurate with consumers’ needs, desires, and abilities.  c.  The organization establishes and maintains fiscal accountability.  d.  The organization has qualified staff commensurate with the needs of the consumers they serve. These staff demonstrate competency in performing duties and in all interactions with clients.  e.  The organization provides needed training and supports to its staff. This training includes at a minimum:  (1)  Consumer rights.  (2)  Confidentiality.  (3)  Provision of consumer medication.  (4)  Identification and reporting of child and dependent adult abuse.  (5)  Individual consumer support needs.  f.  The organization has a systematic, organizationwide, planned approach to designing, measuring, evaluating, and improving the level of its performance. The organization:  (1)  Measures and assesses organizational activities and services annually.  (2)  Gathers information from consumers, family members, and staff.  (3)  Conducts an internal review of consumer service records, including all major and minor incident reports according to subrule 77.37(8).  (4)  Tracks incident data and analyzes trends annually to assess the health and safety of consumers served by the organization.  (5)  Identifies areas in need of improvement.  (6)  Develops a plan to address the areas in need of improvement.  (7)  Implements the plan and documents the results.  g.  Consumers and their legal representatives have the right to appeal the provider’s implementation of the 20 outcomes, or staff or contractual person’s action which affects the consumer. The provider shall distribute the policies for consumer appeals and procedures to consumers.  h.  The provider shall have written policies and procedures and a staff training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.  i.  The governing body has an active role in the administration of the agency.  j.  The governing body receives and uses input from a wide range of local community interests and consumer representation and provides oversight that ensures the provision of high-quality supports and services to consumers.  77.39(2)    Rights and dignity.  Outcome-based standards for rights and dignity are as follows:  a.  (Outcome 2) Consumers are valued.  b.  (Outcome 3) Consumers live in positive environments.  c.  (Outcome 4) Consumers work in positive environments.  d.  (Outcome 5) Consumers exercise their rights and responsibilities.  e.  (Outcome 6) Consumers have privacy.  f.  (Outcome 7) When there is a need, consumers have support to exercise and safeguard their rights.  g.  (Outcome 8) Consumers decide which personal information is shared and with whom.  h.  (Outcome 9) Consumers make informed choices about where they work.  i.  (Outcome 10) Consumers make informed choices on how they spend their free time.  j.  (Outcome 11) Consumers make informed choices about where and with whom they live.  k.  (Outcome 12) Consumers choose their daily routine.  l.  (Outcome 13) Consumers are a part of community life and perform varied social roles.  m.  (Outcome 14) Consumers have a social network and varied relationships.  n.  (Outcome 15) Consumers develop and accomplish personal goals.  o.  (Outcome 16) Management of consumers’ money is addressed on an individualized basis.  p.  (Outcome 17) Consumers maintain good health.  q.  (Outcome 18) The consumer’s living environment is reasonably safe in the consumer’s home and community.  r.  (Outcome 19) The consumer’s desire for intimacy is respected and supported.  s.  (Outcome 20) Consumers have an impact on the services they receive.  77.39(3)    The right to appeal.  Consumers and their legal representatives have the right to appeal the provider’s application of policies or procedures, or any staff or contractual person’s action which affects the consumer. The provider shall distribute the policies for consumer appeals and procedures to consumers.  77.39(4)    Storage and provision of medication.  If the provider stores, handles, prescribes, dispenses or administers prescription or over-the-counter medications, the provider shall develop procedures for the storage, handling, prescribing, dispensing or administration of medication. For controlled substances, procedures shall be in accordance with department of inspections and appeals rule 481—63.18(135).  77.39(5)    Research.  If the provider conducts research involving consumers, the provider shall have written policies and procedures addressing the research. These policies and procedures shall ensure that consumers’ rights are protected.  77.39(6)    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS brain injury waiver 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. Exception: The conditions in this subrule do not apply to providers of goods and services purchased under the consumer choices option or providers of home and vehicle modification, personal emergency response, and transportation.  a.    Definitions.  
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      b.    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 consumer’s file.  c.    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 consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’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 consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer’s file.      d.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.      77.39(7)    Intake, admission, service coordination, discharge, and referral.    a.  The provider shall have written policies and procedures according to state and federal laws for intake, admission, service coordination, discharge and referral.  b.  The provider shall ensure the rights of persons applying for services.  77.39(8)    Certification process.  Reviews of compliance with standards for initial certification and recertification shall be conducted by the department of human services’ bureau of long-term care quality assurance staff. Certification carries no assurance that the approved provider will receive funding.  a.  Rescinded IAB 9/1/04, effective 11/1/04.  b.  Rescinded IAB 9/1/04, effective 11/1/04.  c.  Rescinded IAB 9/1/04, effective 11/1/04.  d.  The department may request any information from the prospective service provider which is considered pertinent to arriving at a certification decision. This may include, but is not limited to:  (1)  Current accreditations, evaluations, inspections and reviews by regulatory and licensing agencies and associations.  (2)  Fiscal capacity of the prospective provider to initiate and operate the specified programs on an ongoing basis.  77.39(9)    Initial certification.  The department shall review the application and accompanying information to see if the provider has the necessary framework to provide services in accordance with all applicable requirements and standards.  a.  The department shall make a determination regarding initial certification within 60 days of receipt of the application and notify the provider in writing of the decision unless extended by mutual consent of the parties involved.  b.  The decision of the department on initial certification of the providers shall be based on all relevant information, including:  (1)  The application for status as an approved provider according to requirements of rules.  (2)  A determination of the financial position of the prospective provider in relation to its ability to meet the stated need.  c.  Providers applying for initial certification shall be offered technical assistance.  77.39(10)    Period of certification.  Provider certification shall become effective on the date identified on the certificate of approval and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.  a.  Initial certification. Providers eligible for initial certification by the department shall be issued an initial certification for 270 calendar days based on documentation provided.  b.  Recertification. After the initial certification, the level of certification shall be based on an on-site review unless the provider has been accredited for similar services by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Quality and Leadership in Supports for People with Disabilities (The Council), or the Council on Accreditation of Services for Families and Children (COA). The on-site reviews for supported community living and supported employment use interviews with consumers and significant people in the consumer’s life to determine whether or not the 20 individual value-based outcomes set forth in subrules 77.39(1) and 77.39(2) and corresponding processes are present for the consumer. Respite services are required to meet Outcome 1 and participate in satisfaction surveys.Once the outcomes and processes have been determined for all the consumers in the sample, a review team then determines which of the 20 outcomes and processes are present for the provider. A specific outcome is present for the provider when the specific outcome is determined to be present for 75 percent or more of the consumers interviewed. A specific process is present for the provider when the process is determined to be present for 75 percent or more of the consumers interviewed. Since the processes are in the control of the provider and the outcomes are more in the control of the consumer, length of certification will be based more heavily on whether or not the processes are in place to help consumers obtain desired outcomes.An exit conference shall be held with the organization to share preliminary findings of the certification review. A review report shall be written and sent to the provider within 30 calendar days unless the parties mutually agree to extend that time frame.Provider certification shall become effective on the date identified on the Certificate of Approval, Form 470-3410, and shall terminate in 270 calendar days, one year, or three calendar years from the month of issue. The renewal of certification shall be contingent upon demonstration of continued compliance with certification requirements.  c.  The department may issue four categories of recertification:  (1)  Three-year certification with excellence. An organization is eligible for certification with excellence if the number of processes present is 18 or higher and the number of outcomes and corresponding processes present together is 12 or higher. Both criteria need to be met to receive three-year certification with excellence. Corrective actions may be required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.  (2)  Three-year certification with follow-up monitoring. An organization is eligible for this type of certification if the number of processes present is 17 or higher and the number of outcomes and corresponding processes present together is 11 or higher. Both criteria need to be met to receive three-year certification. Corrective actions are required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.  (3)  One-year certification. An organization is eligible for this type of certification when the number of processes present is 14 or higher and the number of outcomes and processes present together is 9 or higher. Both criteria need to be met to receive one-year certification. One-year certification may also be given in lieu of longer certification when previously required corrective actions have not been implemented or completed. Corrective actions are required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.  (4)  Probational certification. A probational certification may be issued to those providers who cannot meet requirements for a one-year certification. This time period shall be granted to the provider to establish and implement corrective actions and improvement activities. During this time period the department may require monitoring of the implementation of the corrective actions through on-site visits, written reports or technical assistance. Probational certification issued for 270 calendar days shall not be renewed or extended and shall require a full on-site follow-up review to be completed. The provider shall be required to achieve at least a one-year certification status at the time of the follow-up review in order to maintain certification.  d.  During the course of the review, if a team member encounters a situation that places a consumer in immediate jeopardy, the team member shall immediately notify the provider, the department, and other team members. “Immediate jeopardy” refers to circumstances where the life, health, or safety of a member will be severely jeopardized if the circumstances are not immediately corrected.  (1)  The provider shall correct the situation within 24 to 48 hours. If the situation is not corrected within the prescribed time frame, that portion of the provider’s services that was the subject of the notification shall not be certified. The department shall immediately discontinue funding for that provider’s service.  (2)  If this action is appealed and the member, legal guardian, or attorney in fact under a durable power of attorney for health care wants to maintain the provider’s services, funding can be reinstated. At that time the provider shall take appropriate action to ensure the life, health, and safety of the members deemed to be at risk as a result of the provider’s inaction.  e.  As a mandatory reporter, each team member shall be required to follow appropriate procedure in all cases where a condition reportable to child and adult protective services is observed.  f.  The department may grant an extension to the period of approval for the following reasons:  (1)  A delay in the department’s approval decision which is beyond the control of the provider or department.  (2)  A request for an extension from a provider to permit the provider to prepare and obtain department approval of corrective actions. The department shall establish the length of extensions on a case-by-case basis.  g.  The department may revoke the provider’s approval at any time for any of the following reasons:  (1)  Findings of a site visit indicate that the provider has failed to implement the corrective actions submitted pursuant to paragraph 77.39(11)“d.”  (2)  The provider has failed to provide information requested pursuant to paragraph 77.39(11)“e.”  (3)  The provider refuses to allow the department to conduct a site visit pursuant to paragraph 77.39(11)“f.”  (4)  There are instances of noncompliance with the standards which were not identified from information submitted on the application.  h.  An approved provider shall immediately notify the department, applicable county, or region, the applicable mental health and developmental disabilities planning council, and other interested parties of a decision to withdraw from an HCBS BI waiver service.  i.  Following certification, any provider may request technical assistance from the department to bring into conformity those areas found in noncompliance with HCBS requirements. If multiple deficiencies are noted during a review, the department may require that technical assistance be provided to a provider to assist in the implementation of the provider’s corrective actions. Providers may be given technical assistance as needed.  j.  Appeals. Any adverse action can be appealed by the provider under 441—Chapter 7.  77.39(11)    Departmental reviews.  Reviews of compliance with standards as indicated in this chapter shall be conducted by the division of mental health and developmental disabilities quality assurance review staff. This review may include on-site case record audits, administrative procedures, clinical practices, and interviews with staff, consumers, and board of directors consistent with the confidentiality safeguards of state and federal laws.  a.  Reviews shall be conducted annually with additional reviews conducted at the discretion of the department.  b.  Following a departmental review, the department shall submit a copy of the department’s determined survey report to the service provider, noting service deficiencies and strengths.  c.  The service provider shall develop a plan of corrective action identifying completion time frames for each survey deficiency.  d.  The corrective action plan shall be submitted to the Division of Mental Health and Developmental Disabilities, 5th Floor, Hoover State Office Building, Des Moines, Iowa 50319-0114, and include a statement dated and signed, if applicable, by the chief administrative officer and president or chairperson of the governing body that all information submitted to the department is accurate and complete.  e.  The department may request the provider to supply subsequent reports on implementation of a corrective action plan submitted pursuant to paragraphs 77.39(11)“c” and “d.”  f.  The department may conduct a site visit to verify all or part of the information submitted.  77.39(12)    Case management service providers.  Case management provider organizations are eligible to participate in the Medicaid HCBS brain injury waiver program provided that they meet the standards in 441—Chapter 24 and they are the department of human services, a county or consortium of counties, or a provider under subcontract to the department or a county or consortium of counties.  77.39(13)    Supported community living providers.    a.  The department shall certify only public or private agencies to provide the supported community living service. The department does not recognize individuals as service providers under the supported community living program.  b.  Providers of services meeting the definition of foster care shall also be licensed according to applicable 441—Chapters 108, 112, 114, 115, and 116, which deal with foster care licensing.  c.  Providers of service may employ or contract with individuals meeting the definition of foster family homes to provide supported community living services. These individuals shall be licensed according to applicable 441—Chapters 112 and 113, which deal with foster care licensing.  d.  The department shall approve living units designed to serve four consumers if the geographic location of the program does not result in an overconcentration of programs in an area.  (1)  Rescinded IAB 8/7/02, effective 10/1/02.  (2)  Rescinded IAB 8/7/02, effective 10/1/02.  e.  The department shall approve living units designed to serve up to four persons except as necessary to prevent an overconcentration of supported community living units in a geographic area.  f.  The department shall approve a living unit designed to serve five persons if both of the following conditions are met:  (1)  Approval will not result in an overconcentration of supported community living units in a geographic area.  (2)  The county in which the living unit is located provides to the bureau of long-term care verification in writing that the approval is needed to address one or more of the following issues:
    1. The quantity of services currently available in the county is insufficient to meet the need;
    2. The quantity of affordable rental housing in the county is insufficient to meet the need; or
    3. Approval will result in a reduction in the size or quantity of larger congregate settings.
      77.39(14)    Respite service providers.  Respite providers are eligible to be providers of respite service in the HCBS brain injury waiver if they have documented training or experience with persons with a brain injury.  a.  The following agencies may provide respite services:  (1)  Respite providers certified under the HCBS intellectual disability waiver.  (2)  Adult day care providers that meet the conditions of participation set forth in subrule 77.39(20).  (3)  Group living foster care facilities for children licensed by the department according to 441—Chapters 112 and 114 to 116 and child care centers licensed according to 441—Chapter 109.  (4)  Camps certified by the American Camping Association.  (5)  Home care agencies that meet the conditions of participation set forth in subrule 77.30(1).  (6)  Nursing facilities, intermediate care facilities for the mentally retarded, and hospitals enrolled as providers in the Iowa Medicaid program.  (7)  Residential care facilities for persons with mental retardation licensed by the department of inspections and appeals.  (8)  Home health agencies that are certified to participate in the Medicare program.  (9)  Agencies certified by the department to provide respite services in the consumer’s home that meet the requirements of subrules 77.39(1) and 77.39(3) through 77.39(7).  (10)  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 each parent, 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 parents, 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 parent, guardian or primary caregiver of any injuries or illnesses that occur during respite provision. A parent’s, guardian’s or primary caregiver’s signature is required to verify receipt of notification.
    2. Requiring the parent, 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 parent, 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 parent, 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.      77.39(15)    Supported employment providers.    a.  The following agencies may provide supported employment services:  (1)  An agency that is accredited by the Commission on Accreditation of Rehabilitation Facilities as an organizational employment service provider, a community employment service provider or a provider of a similar service.  (2)  An agency that is accredited by the Council on Accreditation for similar services.  (3)  An agency that is accredited by the Joint Commission for similar services.  (4)  An agency that is accredited by the Council on Quality and Leadership for similar services.  (5)  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.  Individuals may not provide supported employment services except when the services are purchased through the consumer choices option.  d.  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 a 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.  77.39(16)    Home and vehicle modification providers.  The following providers may provide home and vehicle modification:  a.  Providers eligible to participate as home and vehicle modification providers under the elderly or health and disability waiver, enrolled as home and vehicle modification providers under the physical disability waiver, or certified as home and vehicle modification providers under the physical disability waiver.  b.  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 insurance.  77.39(17)    Personal emergency response system providers.  Personal emergency response system providers shall be agencies which meet the conditions of participation set forth in subrule 77.33(2).  a.  Providers shall be certified annually.  b.  The service provider shall submit documentation to the department supporting continued compliance with the requirements set forth in subrule 77.33(2) 90 days before the expiration of the current certification.  77.39(18)    Transportation service providers.  This service is not to be provided at the same time as supported community service, which includes transportation. The following providers may provide transportation:  a.  Area agencies on aging as designated in rule 17—4.4(231) or with letters of approval from the area agencies on aging stating the organization is qualified to 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.  Providers with purchase of service contracts to provide transportation pursuant to 441—Chapter 150.  e.  Nursing facilities licensed pursuant to Iowa Code chapter 135C.  f.  Transportation providers contracting with the nonemergency medical transportation contractor.  77.39(19)    Specialized medical equipment providers.  The following providers may provide specialized medical equipment:  a.  Medical equipment and supply dealers participating as providers in the Medicaid program.  b.  Retail and wholesale businesses participating as providers in the Medicaid program which provide specialized medical equipment as defined in 441—subrule 78.43(8).  77.39(20)    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 at 481—Chapter 70.  77.39(21)    Family counseling and training providers.  Family counseling and training providers shall be one of the following:  a.  Providers certified under the community mental health center standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and III, and that employ staff to provide family counseling and training who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).  b.  Providers licensed as meeting the hospice standards and requirements set forth in department of inspections and appeals rules in 481—Chapter 53 or certified to meet the standards under the Medicare program for hospice programs, and that employ staff who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).  c.  Providers accredited under the mental health service provider standards established by the mental health and developmental and disabilities commission, set forth in 441—Chapter 24, Divisions I and IV, and that employ staff to provide family counseling and training who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).  d.  Individuals who meet the definition of qualified brain injury professional as set forth in rule 441—83.81(249A).  e.  Agencies certified as brain injury waiver providers pursuant to rule 441—77.39(249A) that employ staff to provide family counseling who meet the definition of a qualified brain injury professional as set forth in rule 441—83.81(249A).  f.  Agencies which are accredited by a department-approved, nationally recognized accreditation organization as specialty brain injury rehabilitation service providers.  77.39(22)    Prevocational services providers.     a.  Providers of prevocational services must be accredited by one of the following:  (1)  The Commission on Accreditation of Rehabilitation Facilities as an organizational employment service provider or a community employment service provider.  (2)  The Council on Quality and Leadership accreditation in supports for people with disabilities.  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. 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 services training as offered through DirectCourse or through the Association of Community Rehabilitation Educators (ACRE) certified training program.  (4)  Supported employment direct support staff shall complete 4 hours of continuing education in employment services annually.  77.39(23)    Behavioral programming providers.  Behavioral programming providers shall be required to have experience with or training regarding the special needs of persons with a brain injury. In addition, they must meet the following requirements.  a.  Behavior assessment, and development of an appropriate intervention plan, and periodic reassessment of the plan, and training of staff who shall implement the plan must be done by a qualified brain injury professional as defined in rule 441—83.81(249A). Formal assessment of the consumers’ intellectual and behavioral functioning must be done by a licensed psychologist or a psychiatrist who is certified by the American Board of Psychiatry.  b.  Implementation of the plan and training and supervision of caregivers, including family members, must be done by behavioral aides who have been trained by a qualified brain injury professional as defined in rule 441—83.81(249A) and who are employees of one of the following:  (1)  Agencies which are certified under the community mental health center standards established by the mental health and developmental disabilities commission, set forth in 441—Chapter 24, Divisions I and III.  (2)  Agencies which are licensed as meeting the hospice standards and requirements set forth in department of inspections and appeals rules 481—Chapter 53 or which are certified to meet the standards under the Medicare program for hospice programs.  (3)  Agencies which are accredited under the mental health service provider standards established by the mental health and disabilities commission, set forth in 441—Chapter 24, Divisions I and IV.  (4)  Home health aide providers meeting the standards set forth in subrule 77.33(3). Home health aide providers certified by Medicare shall be considered to have met these standards.  (5)  Brain injury waiver providers certified pursuant to rule 441—77.39(249A).  (6)  Agencies which are accredited by a department-approved, nationally recognized accreditation organization as specialty brain injury rehabilitation service providers.  (7)  Individuals who meet the definition of “qualified brain injury professional” as set forth in rule 441—83.81(249A).  77.39(24)    Consumer-directed attendant care providers.  The following providers may provide consumer-directed attendant care service:  a.  An individual who contracts with the member 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 member’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.  (3)  Not the spouse of the member or a parent or stepparent of a member aged 17 or under.  (4)  Not the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  b.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  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 certified by the department of inspections and appeals under 481—Chapter 69.  h.  Adult day service providers that are certified by the department of inspections and appeals under 481—Chapter 70.  77.39(25)    Interim medical monitoring and treatment providers.    a.  The following providers may provide interim medical monitoring and treatment services:  (1)  Home health agencies certified to participate in the Medicare program.  (2)  Supported community living providers certified according to subrule 77.37(14) or 77.39(13).  b.  Staff requirements. Staff members providing interim medical monitoring and treatment services to members shall meet all of the following requirements:  (1)  Be at least 18 years of age.  (2)  Not be the spouse of the member or a parent or stepparent of the member if the member is aged 17 or under.  (3)  Not be a usual caregiver of the member.  (4)  Be qualified by training or experience to provide medical intervention or intervention in a medical emergency necessary to carry out the member’s plan of care. The training or experience required must be determined by the member’s usual caregivers and a licensed medical professional on the member’s interdisciplinary team and must be documented in the member’s service plan.  c.  Service documentation. Providers shall maintain clinical and fiscal records necessary to fully disclose the extent of services furnished to members. Records shall specify by service date the procedures performed, together with information concerning progress of treatment.  77.39(26)    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).  77.39(27)    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).  77.39(28)    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).  77.39(29)    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).  77.39(30)    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).This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 0191C, 0359C, 0757C, 1071C, 1149C, 1445C, 1638C, 2361C, 2471C, 3874C, 4792C441—77.40(249A)  Lead inspection agencies.  The Iowa department of public health and agencies certified by the Iowa department of public health pursuant to 641—subrule 70.5(5) are eligible to participate in the Medicaid program as providers of lead inspection services.This rule is intended to implement Iowa Code section 249A.4.441—77.41(249A)  HCBS physical disability waiver service providers.  Providers shall be eligible to participate in the Medicaid physical disability waiver program if they meet the requirements in this rule and the subrules applicable to the individual service. Enrolled providers shall maintain the certification listed in the applicable subrules in order to remain eligible providers. The integrated, community-based settings standards in subrule 77.25(5) apply to all HCBS physical disability waiver service providers. 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 and is not subject to the requirements of subrule 77.41(1).  77.41(1)    Enrollment process.  Reviews of compliance with standards for initial enrollment shall be conducted by the department’s quality assurance staff. Enrollment carries no assurance that the approved provider will receive funding.Review of a provider may occur at any time.The department may request any information from the prospective service provider that is pertinent to arriving at an enrollment decision. This may include, but is not limited to:  a.  Current accreditations, evaluations, inspection reports, and reviews by regulatory and licensing agencies and associations.  b.  Fiscal capacity of the prospective provider to initiate and operate the specified programs on an ongoing basis.  77.41(2)    Consumer-directed attendant care providers.  The following providers may provide consumer-directed attendant care service:  a.  An individual who contracts with the member to provide consumer-directed attendant care and who is:  (1)  At least 18 years of age.  (2)  Qualified by training or experience to carry out the member’s plan of care pursuant to the department-approved case plan or individual comprehensive plan.  (3)  Not the spouse or guardian of the member or a parent or stepparent of a member aged 17 or under.  (4)  Not the recipient of respite services paid through home- and community-based services on behalf of a member who receives home- and community-based services.  b.  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  c.  Home health agencies that 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.103.  f.  Providers certified under an HCBS waiver for supported community living.  g.  Assisted living programs that are certified by the department of inspections and appeals under 481—Chapter 69.  h.  Adult day service providers that are certified by the department of inspections and appeals under 481—Chapter 70.  77.41(3)    Home and vehicle modification providers.  The following providers may provide home and vehicle modifications:  a.  Providers eligible to participate as home and vehicle modification providers under the elderly or health and disability waiver or certified as home and vehicle modification providers under the home- and community-based services intellectual disability or brain injury waiver.  b.  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 insurance.  77.41(4)    Personal emergency response system providers.  Personal emergency response system providers shall be agencies which meet the conditions of participation set forth in subrule 77.33(2).  77.41(5)    Specialized medical equipment providers.  The following providers may provide specialized medical equipment:  a.  Medical equipment and supply dealers participating as providers in the Medicaid program.  b.  Retail and wholesale businesses participating as providers in the Medicaid program which provide specialized medical equipment as defined in 441—subrule 78.46(4).  77.41(6)    Transportation service providers.  The following providers may provide transportation:  a.  Area agencies on aging as designated in 17—4.4(231) or with letters of approval from the area agencies on aging stating the organization is qualified to 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.  Nursing facilities licensed pursuant to Iowa Code chapter 135C.  e.  Transportation providers contracting with the nonemergency medical transportation contractor.  77.41(7)    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).  77.41(8)    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).  77.41(9)    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).  77.41(10)    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).  77.41(11)    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 subrule requirements in 77.30(17).  77.41(12)    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS physical disability waiver 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. Exception: The conditions in this subrule do not apply to providers of goods and services purchased under the consumer choices option or providers of home and vehicle modification, specialized medical equipment, personal emergency response, and transportation.  a.    Definitions.  
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      b.    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 consumer’s file.  c.    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 consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’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 consumer 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 waiver-eligible or non-waiver-eligible consumers 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 consumer’s file.      d.    Tracking and analysis.  The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.    This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 7936B, 9314B, 0191C, 0359C, 0757C, 1071C, 2361C, 3874C441—77.42(249A)  Public health agencies.  Public health agencies are eligible to participate in the medical assistance program when they serve as a public health entity within the local board of health jurisdiction pursuant to 641—subrule 77.3(3).This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 0358C441—77.43(249A)  Infant and toddler program providers.  An agency is eligible to participate in the medical assistance program as a provider of infant and toddler program services under rule 441—78.49(249A) if the agency:
    1. Is in good standing under the infants and toddlers with disabilities program administered by the department of education, the department of public health, the department of human services, and the Iowa Child Health Specialty Clinics pursuant to the interagency agreement between these agencies under Subchapter III of the federal Individuals with Disabilities Education Act (IDEA); and
    2. Meets the following additional requirements.
      77.43(1)    Licensure.  Covered services shall be provided by personnel who are licensed, endorsed, registered, recognized, or qualified as provided in this subrule and shall be within the scope of the applicable license, endorsement, registration, recognition, or qualification.  a.  Personnel providing audiological or speech-language services shall be licensed by the Iowa board of speech pathology and audiology as a speech pathologist or audiologist pursuant to 645—Chapters 299, 300 and 303 through 305.  b.  Personnel providing physical therapy shall be licensed by the Iowa board of physical and occupational therapy as a physical therapist pursuant to 645—Chapters 199 through 204.  c.  Personnel providing occupational therapy shall be licensed by the Iowa board of physical and occupational therapy as an occupational therapist pursuant to 645—Chapters 205 through 210.  d.  Personnel providing psychological evaluations and counseling or psychotherapy services shall be:  (1)  Endorsed by the Iowa board of educational examiners as a school psychologist pursuant to rule 282—15.11(272);  (2)  Licensed by the Iowa board of psychology as a psychologist pursuant to 645—Chapters 239 through 243;  (3)  Licensed by the Iowa board of social work as a social worker pursuant to 645—Chapters 279 through 284;  (4)  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11; or  (5)  Registered by the Iowa nursing board as an advanced registered nurse practitioner pursuant to 655—Chapter 7.  e.  Personnel providing nursing services shall be licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6.  f.  Personnel providing vision services shall be:  (1)  Licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6;  (2)  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11; or  (3)  Licensed by the Iowa board of optometry as an optometrist pursuant to 645—Chapter 180.  g.  Developmental services shall be provided by personnel who meet standards established pursuant to department of education rule 281—120.19(34CFR303).  h.  Medical transportation shall be provided by licensed drivers.  i.  Other services shall be provided by staff who are:  (1)  Recognized as a special education paraprofessional pursuant to department of education rule 281—41.403(256B);  (2)  Endorsed by the Iowa board of educational examiners as a school psychologist pursuant to rule 282—15.11(272);  (3)  Endorsed by the Iowa board of educational examiners as a speech-language pathologist pursuant to rule 282—15.12(272);  (4)  Endorsed by the Iowa board of educational examiners as an orientation and mobility specialist pursuant to rule 282—15.15(272);  (5)  Endorsed by the Iowa board of educational examiners as a school occupational therapist pursuant to rule 282—15.16(272);  (6)  Endorsed by the Iowa board of educational examiners as a school physical therapist pursuant to rule 282—15.17(272);  (7)  Endorsed by the Iowa board of educational examiners as a special education nurse pursuant to rule 282—15.18(272);  (8)  Endorsed by the Iowa board of educational examiners as a school social worker pursuant to rule 282—15.19(272);  (9)  Licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6; or  (10)  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11.  77.43(2)    Documentation requirements.  As a condition of participation, the provider shall be responsible for maintaining accurate and current documentation of services provided in the child’s record. Documentation of all services performed is required and must include:  a.  Date, time, location, and description of each service provided and identification of the individual rendering the service by name and professional or paraprofessional designation.  b.  An assessment and response to interventions and services.  c.  An individual family service plan (IFSP) including all changes and revisions, as developed by the service coordinator pursuant to rule 281—41.5(256B,34CFR300).  d.  Documentation of progress toward achieving the child’s or family’s action steps and outcomes as identified in the individual family service plan (IFSP).This rule is intended to implement Iowa Code section 249A.4.    441—77.44(249A)  Local education agency services providers.  School districts accredited by the department of education pursuant to 281—Chapter 12, the Iowa Braille and Sight Saving School governed by the state board of regents pursuant to Iowa Code section 262.7(4), and the State School for the Deaf governed by the state board of regents pursuant to Iowa Code section 262.7(5) are eligible to participate in the medical assistance program as providers of local education agency (LEA) services under rule 441—78.50(249A) if the following conditions are met.  77.44(1)    Licensure.  Covered services shall be provided by personnel who are licensed, endorsed, registered, recognized, or qualified as provided in this subrule and shall be within the scope of the applicable license, endorsement, registration, recognition, or qualification.  a.  Personnel providing audiological or speech-language services shall be licensed by the Iowa board of speech pathology and audiology as a speech pathologist or audiologist pursuant to 645—Chapters 299, 300 and 303 through 305.  b.  Personnel providing physical therapy shall be licensed by the Iowa board of physical and occupational therapy as a physical therapist pursuant to 645—Chapters 199 through 204.  c.  Personnel providing occupational therapy shall be licensed by the Iowa board of physical and occupational therapy as an occupational therapist pursuant to 645—Chapters 205 through 210.  d.  Personnel providing psychological evaluations and counseling or psychotherapy services shall be:  (1)  Endorsed by the Iowa board of educational examiners as a school psychologist pursuant to rule 282—15.11(272);  (2)  Licensed by the Iowa board of psychology as a psychologist pursuant to 645—Chapters 239 through 243;  (3)  Licensed by the Iowa board of social work as a social worker pursuant to 645—Chapters 279 through 284;  (4)  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11; or  (5)  Registered by the Iowa nursing board as an advanced registered nurse practitioner pursuant to 655—Chapter 7.  e.  Personnel providing nursing services shall be licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6.  f.  Personnel providing vision services shall be:  (1)  Licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6;  (2)  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11; or  (3)  Licensed by the Iowa board of optometry as an optometrist pursuant to 645—Chapter 180.  g.  Developmental services shall be provided by personnel who meet standards established pursuant to department of education rule 281—120.19(34CFR303).  h.  Medical transportation shall be provided by licensed drivers.  i.  Other services shall be provided by staff who are:  (1)  Recognized as a special education paraprofessional pursuant to department of education rule 281—41.403(256B);  (2)  Endorsed by the Iowa board of educational examiners as a school psychologist pursuant to rule 282—15.11(272);  (3)  Endorsed by the Iowa board of educational examiners as a speech-language pathologist pursuant to rule 282—15.12(272);  (4)  Endorsed by the Iowa board of educational examiners as an orientation and mobility specialist pursuant to rule 282—15.15(272);  (5)  Endorsed by the Iowa board of educational examiners as a school occupational therapist pursuant to rule 282—15.16(272);  (6)  Endorsed by the Iowa board of educational examiners as a school physical therapist pursuant to rule 282—15.17(272);  (7)  Endorsed by the Iowa board of educational examiners as a special education nurse pursuant to rule 282—15.18(272);  (8)  Endorsed by the Iowa board of educational examiners as a school social worker pursuant to rule 282—15.19(272);  (9)  Licensed by the Iowa nursing board as a registered or licensed practical nurse pursuant to 655—Chapters 3 through 6; or  (10)  Licensed by the Iowa board of medicine as a physician pursuant to 653—Chapters 9 through 11.  77.44(2)    Documentation requirements.  As a condition of participation, the provider shall be responsible for maintaining accurate and current documentation in the child’s record. Documentation of all services performed is required and must include:  a.  Date, time, duration, location, and description of each service delivered and identification of the individual rendering the service by name and professional or paraprofessional designation.  b.  An assessment and response to interventions and services.  c.  Progress toward goals in the individual education plan (IEP) or individual health plan (IHP) pursuant to 281—Chapter 41, Division VIII, or 281—subrule 41.96(1).This rule is intended to implement Iowa Code section 249A.4.441—77.45(249A)  Indian health facilities.  A health care facility operated by the U.S. Indian Health Service or under the Indian Self-Determination and Education Assistance Act (P.L. 93-638) by an “Indian tribe,” “tribal organization,” or “Urban Indian organization,” as those terms are defined in 25 U.S.C. 1603, is eligible to participate in the medical assistance program if the following conditions are met:  77.45(1)    Licensure.  Services must be rendered by practitioners who meet applicable professional licensure requirements.  77.45(2)    Documentation.  Medical records must be maintained at the same standards as are required for the applicable licensed medical practitioner.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 2930C441—77.46(249A)  HCBS children’s mental health waiver service providers.  HCBS children’s mental health waiver services shall be rendered by provider agencies that meet the general provider standards in subrule 77.46(1) and the integrated, community-based settings standards in subrule 77.25(5) and also meet the standards in subrules 77.46(2) to 77.46(5) that are specific to the waiver services provided. A provider that is approved for the same service under another HCBS Medicaid waiver shall be eligible to enroll for that service under the children’s mental health waiver.  77.46(1)    General provider standards.  All providers of HCBS children’s mental health waiver services shall meet the following standards:  a.    Fiscal capacity.  Providers must demonstrate the fiscal capacity to provide services on an ongoing basis.  b.    Direct care staff.    (1)  Direct care staff must be at least 18 years of age.  (2)  Providers must complete child abuse, dependent adult abuse, and criminal background screenings pursuant to Iowa Code section 249A.29 before employment of a staff member who will provide direct care.  (3)  Direct care staff may not be the spouse of the consumer or the parent or stepparent of the consumer.  c.    Outcome-based standards and quality assurance.    (1)  Providers shall implement the following outcome-based standards for the rights and dignity of children with serious emotional disturbance:
    1. Consumers are valued.
    2. Consumers are a part of community life.
    3. Consumers develop meaningful goals.
    4. Consumers maintain physical and mental health.
    5. Consumers are safe.
    6. Consumers and their families have an impact on the services received.
      (2)  The department’s quality assurance staff shall conduct random quality assurance reviews to assess the degree to which the outcome-based standards have been implemented in service provision. Results of outcome-based quality assurance reviews shall be forwarded to the certifying or accrediting entity.  (3)  A quality assurance review shall include interviews with the consumer and the consumer’s parents or legal guardian, with informed consent, and interviews with designated targeted case managers.  (4)  A quality assurance review may include interviews with provider staff, review of case files, review of staff training records, review of compliance with the general provider standards in this subrule, and review of other organizational policies and procedures and documentation.  (5)  Corrective action shall be required if the quality assurance review demonstrates that service provision or provider policies and procedures do not reflect the outcome-based standards. Technical assistance for corrective action shall be available from the department’s quality assurance staff.      d.    Incident management and reporting.  As a condition of participation in the medical assistance program, HCBS children’s mental health waiver 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 must comply with the following incident management and reporting requirements. Exception: The conditions in this paragraph do not apply to providers of environmental modifications and adaptive devices.  (1)  Definitions.
    "Major incident" means an occurrence involving a consumer during service provision that:
    1. Results in a physical injury to or by the consumer 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 consumer;
    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 consumer’s location being unknown by provider staff who are assigned protective oversight.
    "Minor incident" means an occurrence involving a consumer 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.
      (2)  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 consumer’s file.  (3)  Notification procedure for major incidents. When a major incident occurs or a staff member becomes aware of a major incident, 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 consumer or the consumer’s legal guardian. Exception: Notification to the consumer 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 consumer’s case manager.
      (4)  Reporting procedure for major incidents. By the end of the next calendar day after a major 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.
      (5)  Information to be reported. The following information shall be reported about a major incident:
    1. The name of the consumer 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 waiver-eligible or non-waiver-eligible consumers 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.
      (6)  Response to report. 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 a major 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 consumer’s file.  (7)  Tracking and analysis. The provider shall track incident data and analyze trends to assess the health and safety of consumers 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.      77.46(2)    Environmental modifications, adaptive devices, and therapeutic resources providers.  The following agencies may provide environmental modifications, adaptive devices, and therapeutic resources under the children’s mental health waiver:  a.  A community business that:  (1)  Possesses all necessary licenses and permits to operate in conformity with federal, state, and local statutes and regulations, including Iowa Code chapter 490; and  (2)  Submits verification of current liability and workers’ compensation insurance.  b.  A retail or wholesale business that otherwise participates as a provider in the Medicaid program.  c.  A home and vehicle modification provider enrolled under another HCBS Medicaid waiver.  d.  A provider enrolled under the HCBS home- and community-based services intellectual disability or brain injury waiver as a supported community living provider.  e.  A provider enrolled under the HCBS children’s mental health waiver as a family and community support services provider.  77.46(3)    Family and community support services providers.    a.    Qualified providers.  The following agencies may provide family and community support services under the children’s mental health waiver:  (1)  Behavioral health intervention providers qualified under 441—77.12(249A).  (2)  Community mental health centers accredited in good standing as providers of outpatient psychotherapy and counseling under 441—Chapter 24.  b.    Staff training.  The agency shall meet the following training requirements as a condition of providing family and community support services under the children’s mental health waiver:  (1)  Within one month of employment, staff members must receive the following training:
    1. Orientation regarding the agency’s mission, policies, and procedures; and
    2. Orientation regarding HCBS philosophy and outcomes for rights and dignity found in 77.36(1)“c” for the children’s mental health waiver.
      (2)  Within four months of employment, staff members must receive training regarding the following:
    1. Serious emotional disturbance in children and provision of services to children with serious emotional disturbance;
    2. Confidentiality;
    3. Provision of medication according to agency policy and procedure;
    4. Identification and reporting of child abuse;
    5. Incident reporting;
    6. Documentation of service provision;
    7. Appropriate behavioral interventions; and
    8. Professional ethics.
      (3)  Until a staff member receives the training identified in subparagraphs (1) and (2), the staff member shall not provide any direct service without the presence of experienced staff.  (4)  Within the first year of employment, staff members must complete 24 hours of training in children’s mental health issues.  (5)  During each consecutive year of employment, staff members must complete 12 hours of training in children’s mental health issues.      c.    Support of crisis intervention plan.  As a condition of providing services under the children’s mental health waiver, a family and community support provider shall develop and implement policies and procedures for maintaining the integrity of the individualized crisis intervention plan as defined in 441—24.1(225C) that is developed by each consumer’s interdisciplinary team. The policies and procedures shall address:  (1)  Sharing with the case manager and the interdisciplinary team information pertinent to the development of the consumer’s crisis intervention plan.  (2)  Training staff before service provision, in cooperation with the consumer’s parents or legal guardian, regarding the consumer’s individual mental health needs and individualized supports as identified in the crisis intervention plan.  (3)  Ensuring that all staff have access to a written copy of the most current crisis intervention plan during service provision.  (4)  Ensuring that the plan contains current and accurate information by updating the case manager within 24 hours regarding any circumstance or issue that would have an impact on the consumer’s mental health or change the consumer’s crisis intervention plan.  d.    Intake, admission, and discharge.  As a condition of providing services under the children’s mental health waiver, a family and community support provider shall have written policies and procedures for intake, admission, and discharge.      77.46(4)    In-home family therapy providers.    a.    Qualified providers.  The following agencies may provide in-home family therapy under the children’s mental health waiver:  (1)  Community mental health centers accredited in good standing as providers of outpatient psychotherapy and counseling under 441—Chapter 24.  (2)  Mental health professionals licensed pursuant to 645—Chapter 31, 240, or 280 or possessing an equivalent license in another state.  b.    Staff training.  The agency shall meet the following training requirements as a condition of providing in-home family therapy under the children’s mental health waiver:  (1)  Within one month of employment, staff members must receive the following training:
    1. Orientation regarding the agency’s mission, policies, and procedures; and
    2. Orientation regarding HCBS philosophy and outcomes for rights and dignity found in 77.46(1)“c” for the children’s mental health waiver.
      (2)  Within four months of employment, staff members must receive training regarding the following:
    1. Serious emotional disturbance in children and service provision to children with serious emotional disturbance;
    2. Confidentiality;
    3. Provision of medication according to agency policy and procedure;
    4. Identification and reporting of child abuse;
    5. Incident reporting;
    6. Documentation of service provision;
    7. Appropriate behavioral interventions; and
    8. Professional ethics.
      (3)  Until a staff member receives the training identified in subparagraphs (1) and (2), the staff member shall not provide any direct service without the presence of experienced staff.  (4)  Within the first year of employment, staff members must complete 24 hours of training in children’s mental health issues.  (5)  During each consecutive year of employment, staff members must complete 12 hours of training in children’s mental health issues.      c.    Support of crisis intervention plan.  As a condition of providing services under the children’s mental health waiver, an in-home family therapy provider shall develop and implement policies and procedures for maintaining the integrity of the individualized crisis intervention plan as defined in 441—24.1(225C) that is developed by each consumer’s interdisciplinary team. The policies and procedures shall address:  (1)  Sharing with the case manager and the interdisciplinary team information pertinent to the development of the consumer’s crisis intervention plan.  (2)  Training staff before service provision, in cooperation with the consumer’s parents or legal guardian, regarding the consumer’s individual mental health needs and individualized supports as identified in the crisis intervention plan.  (3)  Ensuring that all staff have access to a written copy of the most current crisis intervention plan during service provision.  (4)  Ensuring that the plan contains current and accurate information by updating the case manager within 24 hours regarding any circumstance or issue that would have an impact on the consumer’s mental health or change the consumer’s crisis intervention plan.  d.    Intake, admission, and discharge.  As a condition of providing services under the children’s mental health waiver, an in-home family therapy provider shall have written policies and procedures for intake, admission, and discharge.      77.46(5)    Respite care providers.    a.    Qualified providers.  The following agencies may provide respite services under the children’s mental health waiver:  (1)  Providers certified or enrolled as respite providers under another Medicaid HCBS waiver.  (2)  Group living foster care facilities for children licensed in good standing by the department according to 441—Chapters 112 and 114 to 116.  (3)  Camps certified in good standing by the American Camping Association.  (4)  Home health agencies that are certified in good standing to participate in the Medicare program.  (5)  Agencies authorized to provide similar services through a contract with the department of public health (IDPH) for local public health services. The agency must provide a current IDPH local public health services contract number.  (6)  Adult day care providers that are certified in good standing by the department of inspections and appeals as being in compliance with the standards for adult day services programs at 481—Chapter 70.  (7)  Assisted living programs certified in good standing by the department of inspections and appeals.  (8)  Residential care facilities for persons with mental retardation licensed in good standing by the department of inspections and appeals.  (9)  Nursing facilities, intermediate care facilities for the mentally retarded, and hospitals enrolled as providers in the Iowa Medicaid program.  b.    Staff training.  The agency shall meet the following training requirements as a condition of providing respite care under the children’s mental health waiver:  (1)  Within one month of employment, staff members must receive the following training:
    1. Orientation regarding the agency’s mission, policies, and procedures; and
    2. Orientation regarding HCBS philosophy and outcomes for rights and dignity for the children’s mental health waiver in 77.46(1)“c.”
      (2)  Within four months of employment, staff members must receive training regarding the following:
    1. Serious emotional disturbance in children and provision of services to children with serious emotional disturbance;
    2. Confidentiality;
    3. Provision of medication according to agency policy and procedure;
    4. Identification and reporting of child abuse;
    5. Incident reporting;
    6. Documentation of service provision;
    7. Appropriate behavioral interventions; and
    8. Professional ethics.
      (3)  Until a staff member receives the training identified in subparagraphs (1) and (2), the staff member shall not provide any direct service without the oversight of supervisory staff and shall obtain feedback from the family within 24 hours of service provision.  (4)  Within the first year of employment, staff members must complete 24 hours of training in children’s mental health issues.  (5)  During each consecutive year of employment, staff members must complete 12 hours of training in children’s mental health issues.      c.    Consumer-specific information.  The following information must be written, current, and accessible to the respite provider during service provision:  (1)  The consumer’s legal and preferred name, birth date, and age, and the address and telephone number of the consumer’s usual residence.  (2)  The consumer’s typical schedule.  (3)  The consumer’s preferences in activities and foods or any other special concerns.  (4)  The consumer’s crisis intervention plan.  d.    Written notification of injury.  The respite provider shall inform the parent, guardian or usual caregiver that written notification must be given to the respite provider of any recent injuries or illnesses that have occurred before respite provision.  e.    Medication dispensing.  Respite providers shall develop policies and procedures for the dispensing, storage, and recording of all prescription and nonprescription medications administered during respite provision. Home health agencies must follow Medicare regulations regarding medication dispensing.  f.    Support of crisis intervention plan.  As a condition of providing services under the children’s mental health waiver, a respite provider shall develop and implement policies and procedures for maintaining the integrity of the individualized crisis intervention plan as defined in 441—24.1(225C) that is developed by each consumer’s interdisciplinary team. The policies and procedures shall address:  (1)  Sharing with the case manager and the interdisciplinary team information pertinent to the development of the consumer’s crisis intervention plan.  (2)  Training staff before service provision, in cooperation with the consumer’s parents or legal guardian, regarding the consumer’s individual mental health needs and individualized supports as identified in the crisis intervention plan.  (3)  Ensuring that all staff have access to a written copy of the most current crisis intervention plan during service provision.  (4)  Ensuring that the plan contains current and accurate information by updating the case manager within 24 hours regarding any circumstance or issue that would have an impact on the consumer’s mental health or change the consumer’s crisis intervention plan.  g.    Service documentation.  Documentation of respite care shall be made available to the consumer, parents, guardian, or usual caregiver upon request.  h.    Capacity.  A facility providing respite care under this subrule shall not exceed the facility’s licensed capacity, and services shall be provided in a location and for a duration consistent with the facility’s licensure.  i.    Service provided outside home or facility.  For respite care to be provided in a location other than the consumer’s home or the provider’s facility:  (1)  The care must be approved by the parent, guardian or usual caregiver;  (2)  The care must be approved by the interdisciplinary team in the consumer’s service plan;  (3)  The care must be consistent with the way the location is used by the general public; and  (4)  Respite care in these locations shall not exceed 72 continuous hours.    This rule is intended to implement Iowa Code section 249A.4 and 2005 Iowa Acts, chapter 167, section 13, and chapter 117, section 3.    Related ARC(s): 7741B, 7936B, 9314B, 9487B, 1149C, 2361C, 3874C441—77.47(249A)  Health home services providers.  Subject to the requirements of this rule, a designated provider may participate in the medical assistance program as a provider of health home services.  77.47(1)    Qualifications.  A designated provider of health home services must be a Medicaid-enrolled entity or provider that is determined through the provider enrollment process to have the systems and infrastructure in place to provide health home services.  a.    Staffing.  At a minimum, a qualifying provider must fill the following roles:  (1)  Designated practitioner.  (2)  Dedicated care coordinator.  (3)  Health coach.  (4)  Clinic support staff.  b.    Data management.  A qualifying provider shall ensure that all clinical data related to the member are maintained with the member’s medical records through the use of health information technology.  c.    Collaboration with case managers.  Health homes providing services to members eligible pursuant to 441—subparagraph 78.53(2)“a”(1) or (2) must collaborate, at least quarterly, with targeted case managers, other case managers, or DHS service workers for each member receiving case management services. Strategies to prevent duplication of coordination efforts by the health home and case managers or service workers must be developed by the health home and documented upon request. Documentation may include but is not limited to records of joint staffing meetings where a member’s medical needs, current activities, and waiver services needs are reviewed and appropriately updated.  d.    Provision of integrated health home services.  Health homes providing services to members eligible pursuant to 441—subparagraph 78.53(2)“a”(3) or (4) must be integrated health homes that:  (1)  Consist of a team of health care professionals trained in providing health home services to members with a serious mental illness (SMI) and to members with a serious emotional disturbance (SED);  (2)  Have a direct agreement with an Iowa Medicaid managed care organization to provide health home services for members with SMI or SED;  (3)  Coordinate all community and social support services needs for members enrolled in the health home; and  (4)  Follow a system of care model in providing health home services to members with SED, including collaboration with the child welfare, public health, juvenile justice, and education systems.  77.47(2)    Report on quality measures.  As a condition of participation in the medical assistance program as a provider of health home services and of receiving payment for health home services provided, a designated provider must report to the Iowa Medicaid enterprise on measures for determining the quality of such services. When appropriate and feasible, a designated provider shall use health information technology in providing the Iowa Medicaid enterprise with such information.  77.47(3)    Selection.  As a condition of payment for health home services provided to a Medicaid member eligible to receive such services pursuant to 441—subrule 78.53(2), a designated provider must be selected by the member as the member’s health home, as reported by provider attestation.This rule is intended to implement Iowa Code section 249A.4 and 2011 Iowa Acts, chapter 129, section 10.Related ARC(s): 0198C, 0838C, 2361C441—77.48(249A)  Speech-language pathologists.  Speech-language pathologists who are enrolled in the Medicare program are eligible to participate in Medicaid. Speech-language pathologists who are not enrolled in the Medicare program are eligible to participate in Medicaid if they are licensed and in independent practice, as an individual or as a group.  77.48(1)  Speech-language pathologists in another state are eligible to participate if they are licensed in that state and meet the Medicare criteria for enrollment.  77.48(2)  Speech-language pathologists who provide services to Medicaid members who are also Medicare beneficiaries must be enrolled in the Medicare program.This rule is intended to implement Iowa Code section 249A.4 and 2012 Iowa Acts, Senate File 2158.Related ARC(s): 0360C441—77.49(249A)  Physician assistants.  All physician assistants licensed to practice in the state of Iowa are eligible for participation in the program. Physician assistants duly licensed to practice in other states are also eligible for participation. This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 0580C, 5418C441—77.50(249A)  Ordering and referring providers.  A provider who provides services, including orders and referrals, to a Medicaid member shall be enrolled as a Medicaid provider as a condition of payment eligibility for services rendered to that Medicaid member. A provider who does not individually bill for services rendered due to, for example, payment arrangements with a facility or supervising provider, shall also be required to enroll. Enrollment will be for the purpose of ordering or referring items and providing professional services to Medicaid members and will not affect the provider’s payment arrangements with such facilities or supervising providers.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 0580C441—77.51(249A)  Child care medical services.  Child care centers are eligible to participate in the medical assistance program when they comply with the standards of 441—Chapter 109. A child care center in another state is eligible to participate when duly licensed in that state. The provider of child care medical services implements a comprehensive protocol of care that is developed in conjunction with the parent or guardian and specifies the medical, nursing, psychosocial, developmental therapies and personal care required by the medically dependent or technologically dependent child served. Nursing services must be provided.Related ARC(s): 1698C, 2361C441—77.52(249A)  Community-based neurobehavioral rehabilitation services.    77.52(1)    Definitions.  
    "Assessment" means the review of the current functioning of the member using the service in regard to the member’s situation, needs, strengths, abilities, desires, and goals.
    "Brain injury" means a diagnosis in accordance with rule 441—83.81(249A).
    "Health care" means the services provided by trained and licensed health care professionals to restore or maintain the member’s health.
    "Intermittent community-based neurobehavioral rehabilitation services" means services provided to a Medicaid member on an as-needed basis to support the member and the member’s family or caregivers to assist the member to increase adaptive behaviors, decrease maladaptive behaviors, and adapt and accommodate to challenging behaviors to support the member to remain in the member’s own home and community.
    "Member" means a person who has been determined to be eligible for Medicaid under 441—Chapter 75.
    "Neurobehavioral rehabilitation" refers to a specialized category of neurorehabilitation provided by a multidisciplinary team that has been trained in, and delivers, services individually designed to address cognitive, medical, behavioral and psychosocial challenges, as well as the physical manifestations of acquired brain injury. Services concurrently work to optimize functioning at personal, family and community levels by supporting the increase of adaptive behaviors, decrease of maladaptive behaviors and adaptation and accommodation to challenging behaviors to support a member to maximize the member’s independence in activities of daily living and ability to live in the member’s home and community.
    "Program" means a set of related resources and services directed to the accomplishment of a fixed set of goals for eligible members.
    "Standardized assessment" means a valid, reliable, and comprehensive functional assessment tool(s) or process, or both, approved by the department for use in the assessment of a member’s needs.
      77.52(2)    Eligible providers.  The following agencies may provide community-based neurobehavioral rehabilitation residential and intermittent services:  a.  An organization that is accredited by a department-approved, nationally recognized accreditation organization as a specialty brain injury rehabilitation service provider.  b.  Agencies not accredited by a department-approved, nationally recognized accreditation organization as a specialty brain injury rehabilitation service provider that have applied for accreditation within the last 16 months to provide services may be enrolled. However, an organization that has not received accreditation within 16 months after application shall no longer be a qualified provider.  77.52(3)    Provider standards.  All community-based neurobehavioral rehabilitation service providers shall meet the following criteria:   a.  The organization meets the outcome-based standards for community-based neurobehavioral rehabilitation service providers as follows:  (1)  The organization shall provide high-quality supports and services to members.  (2)  The organization shall have a defined mission commensurate with members’ needs, desires, and abilities.  (3)  The organization shall be fiscally sound and shall establish and maintain fiscal accountability.  (4)  The program administrator shall be a certified brain injury specialist trainer (CBIST) through the Academy of Certified Brain Injury Specialists or a certified brain injury specialist under the direct supervision of a CBIST or a qualified brain injury professional as defined in rule 441—83.81(249A) with additional certification as approved by the department. The administrator shall be present in the assigned location for 25 hours per week. In the event of an absence from the assigned location exceeding four weeks, the organization shall designate a qualified replacement to act as administrator for the duration of the assigned administrator’s absence.   (5)  A minimum of 75 percent of the organization’s administrative and direct care personnel shall meet one of the following criteria:
    1. Have a bachelor’s degree in a human services-related field;
    2. Have an associate’s degree in human services with two years of experience working with individuals with brain injury;
    3. Be an individual who is in the process of seeking a degree in the human services field with two years of experience working with individuals with brain injury; or
    4. Be a certified brain injury specialist (CBIS) certified through the Academy for the Certification of Brain Injury Specialists (ACBIS) or have other nationally recognized brain injury certification as approved by the department.
      (6)  The organization shall have qualified personnel trained in the provision of direct care services to people with a brain injury. The training must be commensurate with the needs of the members served. Employees shall receive training and demonstrate competency in performing assigned duties and in all interactions with members, including but not limited to:
    1. Promotion of a program structure and support for persons served so they can re-learn or regain skills for community inclusion and access.
    2. Compensatory strategies to assist in managing ADLS (activities of daily living).
    3. Quality of life issues.
    4. Behavioral supports and identification of antecedent triggers.
    5. Health and medication management.
    6. Dietary and nutritional programming.
    7. Assistance with identifying and utilizing assistive technology.
    8. Substance abuse and addiction issues.
    9. Self-management and self-interaction skills.
    10. Flexibility in programming to meet members’ individual needs.
    11. Teaching adaptive and compensatory strategies to address cognitive, behavioral, physical, psychosocial and medical needs.
    12. Community accessibility and safety.
    13. Household maintenance.
    14. Service support to the member’s family or support system related to the member’s neurobehavioral care.
      b.  The organization provides training and supports to its personnel. Training shall be provided before direct service provision and must be ongoing. At a minimum the training includes the following:  (1)  Completion of the department-approved brain injury training modules.  (2)  Member rights.  (3)  Confidentiality and privacy.  (4)  Dependent adult and child abuse prevention and mandatory reporter training.  (5)  Individualized rehabilitation treatment plans.  (6)  Major mental health disorder basics.  c.  Within 30 days of commencement of direct service provision, employees shall complete nationally recognized cardiopulmonary resuscitation (CPR) certification, a first-aid course, fire prevention and reaction training and universal precautions training. These training courses shall be completed no less than annually, with the exception of CPR certification, which must be renewed prior to expiration of the certification.  d.  Within the first six months of commencement of direct service provision, employees shall complete training required by subparagraph 77.52(3)“a”(6).  e.  Within 12 months of the commencement of direct service provision, employees shall complete a department-approved, nationally recognized certified brain injury specialist training. A majority of eligible employees within 12 months of the commencement of direct service provision shall be CBISs certified through ACBIS or have other nationally recognized brain injury certification as approved by the department.  f.  The organization shall have in place an outcome management system which measures the efficiency and effectiveness of service provision, including members’ preadmission location of service, length of stay, discharge location, reason for discharge, member and stakeholder satisfaction, and access to services.   g.  The organization shall have in place a systematic, organization-wide, planned approach to designing, measuring, evaluating, and improving the level of its performance. The organization shall be required to:  (1)  Measure and analyze organizational activities and services quarterly.  (2)  Conduct satisfaction surveys with members, family members, employees and stakeholders, and share the information with the public.   (3)  Conduct an internal review of member service records at regular intervals.   (4)  Track major and minor incident data according to subrule 77.37(8) and unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof; and analyze the data to identify trends annually to ensure the health and safety of members served by the organization.  (5)  Continuously identify areas in need of improvement.  (6)  Develop a plan to address the identified areas in need of improvement.  (7)  Implement the plan, document the results, and report to the governing body annually.  h.  The organization shall have in place written policies and procedures and a personnel training program for the identification and reporting of child and dependent adult abuse to the department pursuant to 441—Chapters 175 and 176.  i.  The organization’s governing body shall have an active role in the administration of the organization.  j.  The organization’s governing body shall receive and use input from local community stakeholders, members participating in services, and employees and shall provide oversight that ensures the provision of high-quality supports and services to members.  k.  The organization shall implement the following outcome-based standards for rights and dignity:   (1)  Members are valued.  (2)  The member and the member’s treatment team mutually develop an individualized service plan (ISP) that takes into account the member’s individual strengths, barriers and interests. The service plan shall include goals which are based on the member’s need for services and shall address the neurobehavioral challenges and environmental needs as identified in the member’s individual standardized comprehensive functional neurobehavioral assessment.  (3)  The member and the member’s treatment team evaluate the member’s progress towards treatment goals regularly and no less than quarterly. Treatment plans are reviewed regularly, but not less than quarterly, and are revised as the member’s status or needs change to reflect the member’s progress and response to treatment.  (4)  The member and the member’s legal representative have the right to file grievances regarding the provider’s implementation of the organizational standards, or its employee’s or contractual person’s action which affects the member. The provider shall provide to members the policies and procedures for member grievances and appeals at the commencement of services and annually thereafter.  (5)  When a member requires any restrictive interventions, the interventions will be implemented in accordance with rules 481—63.21(135C), 481—63.27(135C), and 481—63.28(135C). When a member has a guardian or legal representative, the guardian or legal representative shall provide informed consent to treat and consent for any restrictive interventions that may be required to protect the health or safety of the member. Restrictive interventions include but are not limited to:
    1. Restraint, including chemical restraint, manual restraint or mechanical restraint;
    2. Alarms added to a member’s natural environment including doors, windows, refrigerators, cabinets, and other home appliances and fixtures;
    3. Exclusionary time out;
    4. Intensive staffing for control of behavior;
    5. Limited access or contingency access to preferred items or activities naturally available in the member’s environment;
    6. Reprimand;
    7. Response cost; and
    8. Use of psychotropic medications to control the occurrence of an unwanted behavior.
      (6)  Members receive individualized services.  (7)  Members or their legal representatives provide written consent regarding which personal information is shared and with whom.  (8)  Members receive assistance with accessing financial management services as needed.  (9)  Members receive assistance with obtaining preventive, appropriate and timely medical and dental care.  (10)  The member’s living environment is reasonably safe and located in the community.  (11)  The member’s desire for intimacy is respected and supported.    Related ARC(s): 2341C, 4792C441—77.53(249A)  Qualified Medicare beneficiary (QMB) providers.  Any Medicare provider not enrolled as an Iowa Medicaid provider for the general Medicaid population may enroll to be a QMB provider.   77.53(1)    Reimbursement.  A QMB provider may only bill the department for the QMB-eligible member’s Medicare cost-sharing obligations. Reimbursement is limited to coinsurance, copayments, and deductibles for Medicare-covered services.   77.53(2)    Definitions.  
    "Coinsurance" means a percentage of costs of a covered health care service that has to be paid.
    "Copayment" means a fixed amount a member pays for a covered health care service.
    "Deductible" means the amount paid for covered health care services before the insurance plan will effect payment.
    "Medicare cost sharing" means the Medicare member’s responsibility for a Medicare-covered service. “Medicare cost sharing” includes coinsurance, copayments, and deductibles.
    "Qualified Medicare beneficiary" "QMB" means an individual who has been determined eligible for the QMB program pursuant to 441—subrule 75.1(29). Under the QMB program, Medicaid pays the individual’s Medicare Part A and B premiums; coinsurance; copayment; and deductible (except for Part D).
    This rule is intended to implement Iowa Code section 249A.4.    Related ARC(s): 3494C441—77.54(249A)  Health insurance premium payment (HIPP) providers.  Any provider not enrolled as an Iowa Medicaid provider for the general Medicaid population may enroll to be a HIPP provider. A HIPP provider may bill the department for the HIPP-eligible member’s out-of-pocket cost-sharing obligations. Reimbursement is limited to in-network coinsurance, copayments, and deductibles of the HIPP-eligible member’s health insurance paid for through the HIPP program.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 3494C441—77.55(249A)  Crisis response services.    77.55(1)    Definitions.  The terms used in this rule shall have the same meaning as set out in 441—Chapter 24, Division II.  77.55(2)    Eligible providers.   Agencies which are accredited under the mental health service provider standards established by the mental health and disability services commission, set forth in 441—Chapter 24, Division II, are eligible to participate in the program by providing crisis response services, crisis stabilization community-based services, and crisis stabilization residential services.  77.55(3)    Provider standards.  All providers of crisis response services, crisis stabilization community-based services, and crisis stabilization residential services shall meet the standards criteria as set forth in 441—Chapter 24, Division II.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 3551C441—77.56(249A)  Subacute mental health services.    77.56(1)    Definitions.  The terms used in this rule shall have the same meaning as set out in Iowa Code section 135G.1.  77.56(2)    Subacute mental health services.  Subacute mental health services are intended to be short-term, intensive, recovery-oriented services designed to stabilize an individual who is experiencing a decreased level of functioning due to a mental health condition.  77.56(3)    Eligible provider.  Subacute mental health care facilities which are licensed by the department of inspections and appeals in accordance with 481—Chapter 71 are eligible to participate in the program by providing subacute mental health services.  77.56(4)    Provider standards.  All providers of subacute mental health services shall meet the standards criteria as set forth in 481—Chapter 71.This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 3551C441—77.57(249A)  Pharmacists.  An authorized pharmacist licensed to practice in the state of Iowa is eligible to participate in the program. This rule is intended to implement Iowa Code section 249A.4.Related ARC(s): 5175C    Related ARC(s): 7741B, 7936B, 9314B, 9440B, 9487B, 9649B, 0191C, 0198C, 0358C, 0360C, 0359C, 0485C, 0545C, 0580C, 0757C, 0838C, 0848C, 1071C, 1051C, 1149C, 1445C, 1638C, 1698C, 1807C, 2165C, 2361C, 2341C, 2471C, 2930C, 3184C, 3494C, 3551C, 3789C, 3874C, 4165C, 4792C, 5175C, 5307C, 5361C, 5418C