Children’s Mental Health (CMH) Waiver services are individualized to meet
the unique needs of each child. These
services are considered necessary and appropriate for a child based on a
determination by the child’s interdisciplinary team (IDT).
CMH Waiver services include:
All
providers of CMH Waiver services (except Environmental and Adaptive Devices)
must meet the 1-month and 4-month training
requirements before providing services without the
supervision of experienced staff.
Environmental
Modifications, Adaptive Devices and Therapeutic Resources
Iowa
Administrative Code (IAC) 441-78.52(2)
Environmental
modifications, adaptive devices and therapeutic resources include items installed or used within the child’s home that address specific
documented health, mental health, or safety concerns.
Items
may include, but are not limited to smoke alarms, window/door alarms,
pager supports, motions sensors and fencing. Not included are
adaptations available through Medicaid
Durable Medical Equipment and Supplies.
A
unit of service is one environmental modification, adaptive device, or one
therapeutic resource.
Who
May Provide Environmental Modification, Adaptive Devices and Therapeutic
Resources?
IAC
441-77.46(2)
- A community
business that possesses all the necessary licenses and permits to
operate in conformity with federal, state, and local statutes and
regulations (including Iowa Code chapter 490); and submits
verification of current liability and workers’ compensation insurance.
- A retail or
wholesale business that otherwise participates as a provider in the
Medicaid program.
- A home and vehicle modification provider enrolled under another HCBS
Medicaid waiver.
- A provider
enrolled under the HCBS Mental Retardation or Brain Injury Waiver
as a supported community living provider.
- A
provider enrolled under the HCBS CMH Waiver as a family and community
supports service provider (beginning on 5/3/06 pending rule adoption).
Family
and Community Support Services
IAC
441-78.52(3)
Family
and community support services support the child and the
child’s family by helping them develop and implement strategies and
interventions that will result in a reduction of stress and depression and
will increase the child and family’s social and emotional strength.
Who
May Receive These Services?
Depending on the needs of the
child and the child’s family
members (individually or collectively), family and community support
services may be provided to the child, to the
child’s family members, or to the child and the family members as a
family unit.
Who May
Provide Family & Community Support Services?
IAC
441-77.46(3)
-
Rehabilitative
treatment services skill development providers certified in good
standing under 441-185.10(234).
-
Community
mental health centers accredited in good standing as providers of
outpatient psychotherapy and counseling under IAC
441-24.
A billable unit of family and community support
services is one hour. Any period less than one-hour shall be prorated.
Strategies
and Interventions That Make Up Services
Family and community support services are provided
under the recommendation and direction of the mental health professionals
that are included on the child’s interdisciplinary team pursuant
to IAC
441-83.127(249A).
Family and community support services incorporate
recommended support interventions and activities that may include the
following:
-
developing
and maintaining a crisis support network for the child and for the
child’s family
-
modeling
and coaching of effective coping strategies for the child’s family
members
-
building
resilience to the stigma of serious emotional disturbance for the child
and the family
-
reducing
the stigma of serious emotional disturbance by the development of
relationships with peers and community members
-
modeling
and coaching the strategies and interventions identified in the
child’s crisis intervention plan as defined in IAC
441-24.1(225C) for life situations with the child’s
family and in the community
-
developing
medication management skills
-
developing
personal hygiene and grooming skills that contribute to the child’s
positive self image
-
developing
positive socialization and citizenship skills
(beginning 5/3/06, pending rule adoption)
Transportation
and Therapeutic Resources
Family
and community support services has funds available for transportation and
therapeutic resources (not to exceed $1570 per child per year; beginning
5/3/06 this will change to $1500 pending approval of rule change).
Contact your certification specialist
about these resources, as 5/3/06 rule changes for this are pending.
EXCLUDED
Services
The following components are specifically excluded
from family and community support services:
-
vocational
and pre-vocational services
-
supported
employment services
-
room
and board
-
academic
services
-
general
supervision and child care
In-Home
Family Therapy Services
IAC
441-78.52(4)
In-home
family therapy services are skilled therapeutic services to the child and
family. These services are to
be provided at the child’s home. Services
will increase the child and family’s ability to cope with the effects of
serious emotional disturbance on the family relationships. The goal of
in-home family therapy is to maintain a cohesive family unit.
The service must support the family in developing coping strategies
that will enable the child to continue living within the family environment.
A
billable unit of in-home family therapy service is one hour.
Any period less than one-hour shall be prorated.
Who
May Provide In-Home Family Therapy Services
IAC
441-77.46(4)
-
Community
mental health centers accredited in good standing as providers of
outpatient psychotherapy and counseling under 441-Chapter 24.
-
Rehabilitative
treatment services therapy and counseling providers certified in good
standing under 441-185.10(234).
Respite
Care Services
IAC
441-78.52(5)
Respite
services are
provided for a temporary (short term) period.
Services give relief to the usual caregiver and provide all the
necessary care that a usual caregiver would provide during that period.
The “usual
caregiver” means a person
or persons who reside with the child and are available on a 24-hour-per-day
basis to assume responsibility for the care of the child.Respite
Service Parameters
-
Respite
care shall not be provided to children during the hours in which the
usual caregiver is employed, except when the child is attending a camp.
-
The
usual caregiver cannot be absent from the home for more than 14
consecutive days during respite provision.
-
Staff-to-child
ratios shall be appropriate to the individual needs of the child as
determined by the child’s interdisciplinary team.
The
IDT shall determine the type of respite to be provided according to
these definitions:
-
Basic
individual respite is provided on a ratio of one staff to one child.
The child does not have specialized medical needs that require
the direct services of a registered nurse or licensed practical nurse.
-
Specialized
respite is provided on a ratio of one or more nursing staff to one
child.
The child has specialized medical needs that require the direct
services of a registered nurse or licensed practical nurse.
-
Group
respite is provided on a ratio of one staff to two or more children
receiving respite.
These children do not have specialized medical needs that require
the direct services of a registered nurse or licensed practical nurse.
Note:
Respite services provided for a period exceeding 24 consecutive
hours to three or more children who require nursing care because of a
mental or physical condition must be provided by a health care facility
licensed under Iowa Code chapter 135C.
Who
May Provide Respite Services?
IAC
441-77.46(5)
-
Certified
or enrolled respite providers under another Medicaid HCBS waiver
-
Group
living foster care facilities for children (licensed in good standing by
the department according to IAC 441, Chapters 112
and
114
to 116
-
Child
care centers licensed in good standing by the department according to IAC
441-109 and child
development homes registered pursuant to IAC
441-110
-
Camps
certified in good standing by the American Camping Association
-
Home
health agencies that are certified in good standing to participate in
the Medicare program
-
Home
care agencies that meet the requirements set forth in Department of
public health rules at IAC 641-80.7(135)
-
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 adopted by the Department of Elder Affairs
at IAC 321-24
-
Assisted
living programs certified in good standing by the department of
inspections and appeals
-
Residential
care facilities for persons with mental retardation licensed in good
standing by the department of inspections and appeals
-
Nursing
facilities, intermediate care facilities for the mentally retarded, and
hospitals enrolled as providers in the Iowa Medicaid program
Services
provided outside the child’s home will not be reimbursable
if the living unit where respite is provided is reserved for a person who is
temporarily absent.
A
unit of respite service is one hour.
Any period less than one-hour shall be prorated.
Additional Requirements for
Respite Providers
Respite providers have requirements for child-specific
information to ensure that all children are
safe and respite providers are aware of the child’s specific needs.
The following information must be written, current, and
accessible to the respite provider during service provision:
-
The
child’s legal and preferred name, birth date, age, address, and the
telephone number of the child’s usual residence
-
The
child’s typical schedule
-
The
child’s preferences in activities and foods or any other special
concerns
-
The
child’s crisis intervention plan
-
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
-
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
-
Support
each child’s crisis intervention plan
-
Documentation
of respite services shall be made available to the child, parent, guardian,
or usual caregiver upon request
Requirements
When Respite Provided Outside The Home or Facility
-
Respite provided outside a facility or the child’s home needs
approval by the parent, guardian (or usual caregiver) and the IDT
-
The respite in that location is clearly written into the child’s service plan
-
The respite in that location is consistent with the way the location is used by the general
public
-
Services shall not exceed 72 continuous hours
Special
Requirements for Facilities That Provide Respite
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Service Parameters