Iowa Department of Human Services / CMH Waiver


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The goal of the CMH Waiver is to provide services at the point where other community and service supports have proven to be unavailable or inadequate in meeting the consumer needs. Service options available to children via the CMH Waiver have very specific parameters that must be observed in order for service provision to meet the intent of the service.  Attention to outcome-based standards must be woven through every stage related to services.  

CMH Waiver Service Options
As a service provider, to “get started” with the CMH Waiver, you first need to determine which services you want to provide.  Those options are:

• Environmental Modification and Adaptive Devices
• Family & Community Support Services
• In-Home Family Therapy Services
• Respite Care Services

Environmental Modifications and Adaptive Devices
Iowa Administrative Code Reference: IAC 441-77.46(2).

The following agencies may provide environmental modifications and adaptive devices under the CMH Waiver:

• a community business with all the licenses and permits under IA Code 490 and that has submitted 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 children’s mental health waiver as a family and community supports service provider.

See the enrollment checklist for agencies wanting to provide environmental modifications, adaptive devices and therapeutic resources under the CMH Waiver.

Family and Community Support Services and/or In-Home Family Therapy Services
Iowa Administrative Code Reference: IAC 441-77.46(3) & (4)

The following agencies may provide family and community support services and/or in-home family therapy services under the CMH Waiver:

• rehabilitative treatment services providers

• community mental health centers

See the applicable Enrollment Checklist for your agency:

• if you are a currently certified RTS provider or community mental health center wanting to add CMH Waiver family and community support services and/or in-home family therapy services

• if you are a new provider of both RTS and CMH Waiver family and community support services and/or in-home family therapy services

• if you are a new provider wanting only to provide CMH Waiver family and community support services and/or in-home family therapy services

Respite Care Services
Iowa Administrative Code Reference: IAC 441-77.46(5)

The following agencies may provide respite services:

• providers enrolled as a respite provider under another Medicaid HCBS waiver

• licensed group living foster care facilities for children

• licensed child care centers

• certified camps

• home care agencies meeting requirements in Dept. of Public Health rules, 641-80.7(135)

• certified adult day care providers

• certified assisted living programs

• licensed residential care facilities for persons with mental retardation

• nursing facilities, intermediate care facilities for the mentally retarded and hospitals enrolled as providers in the Iowa Medicaid program

See the enrollment checklist for agencies wanting to provide respite care services under the CMH Waiver.

CMH Waiver Provider Enrollment
Once the application process for Rehabilitative Treatment Services (RTS) has begun or the enrollment process for CMH Waiver services, providers will be assigned a certification specialist most likely based on the county where they are located.  The certification specialist is available to provide technical assistance at any time. More information about RTS can be found within this web.  The CMH Waiver Handbook (when available) will provide further information about the CMH Waiver program and services.

CMH Waiver Standards to Guide Services
All providers (except environmental modification and adaptive devices) must meet general provider standards and requirements for training, documentation, reporting, and establishment of policies and procedures.  These standards (from IAC 441-77.46) include:

• Providers must demonstrate the fiscal capacity to provide services on an ongoing basis.
• Direct care staff must be at least 18 years of age.
• 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 that will provide direct care.
• Direct care staff may not be the spouse of the consumer, or the parent or stepparent of the consumer.

Entrance/Exit Needs
Family and community support service providers, in-home family therapy providers and respite care providers have the following requirements for intake, admission, and discharge:

• The provider will have written policies and procedures according to state and federal laws for intake, admission, and discharge.
• The provider will ensure the rights of persons seeking services.
• Discharge planning will begin as soon as a child begins CMH Waiver services.
• Discharge planning will be discussed at the interdisciplinary team (IDT) meeting.  All members will have knowledge of what needs to happen during services to achieve progress and discharge from waiver services.

Provider Training Requirements
If providing family and community support services or in-home therapy services, until staff members receive the required training they are not eligible to provide any direct service without the presence of experienced staff.

For respite care services, until staff members receive the required training, they 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.

Within One Month of Hire, Staff Shall Receive An:

• orientation regarding the agency’s mission, policies, and procedures

• orientation regarding HCBS philosophy and outcomes for rights and dignity for the children’s mental health waiver in 77.46(1)“c.”

Within Four Months of Hire, Staff Shall Receive Training Related To:

• serious emotional disturbance in children and provision of services to children with serious emotional disturbance

• confidentiality

• provision of medication according to agency policy and procedure

• identification and reporting of child abuse

• incident reporting

• documentation of service provision

• appropriate behavioral interventions

• professional ethics (beginning 5/3/06 pending approval of rule change)

Within First Year of Hire, Staff Shall Receive:

• 24 hours of training in children’s mental health issues

Within Each Subsequent Year of Hire, Staff Shall Receive:

• 12 hours of training in children’s mental health issues

The Child's Service Plan and Crisis Plan
Children and families participate in the CMH Waiver by choice.  Outcomes are better when children and families help plan and implement the services they receive.

Each provider (chosen by the child/family) becomes a member of the child’s interdisciplinary team and needs to attend IDT meetings.  It is vital to quality of care they have interaction with other team members.  Periodically the family is asked whether the provider is meeting their needs.

Provider Policies and Procedures
Written policies and procedures need to be developed for crisis intervention planning and documentation of services.  The policies and procedures the agency develops need to embrace the CMH Waiver outcomes.  If implemented successfully, we will be able to see their impact on outcomes.

Crisis Intervention Planning
Family and community support providers, in-home family therapy providers, and respite providers need to develop and implement policies and procedures for maintaining the integrity of the individualized crisis intervention plan as defined in IAC 441-24.1(225C).

Crisis Plan Supports
The provider’s policies and procedures must address the following:

• sharing information pertinent to the development of the child’s crisis intervention plan with the targeted case manager and IDT

• training staff (before service provision) in cooperation with the child’s parents or legal guardians, regarding the child’s individual mental health needs and individualized supports as identified in the crisis intervention plan

• ensuring that all staff have access to a written copy of the most current crisis intervention plan during service provision

• ensuring that the plan contains current and accurate information by updating the targeted case manager within 24 hours regarding any circumstance or issue that would have an impact on the child’s mental health

Documentation of Services
Documentation of all services to children and families is completed before services are billed to Iowa Medicaid.  For questions about billing, contact IME provider Services at 1-800-725-1004.  A unit of service is one hour for in-home family therapy, family and community support services, and respite services.  Services under one hour are prorated.  

Each provider needs to include in their policies and procedures expectations for quality record keeping.  Quality documentation includes (but is not limited to) some essential elements:

• if documentation is handwritten, all narrative needs to be legible

• the date of the service

• the amount (length of time) of the service

• what service was provided

• the action(s) used to provide the service

• who provided the service (the legible signature of the provider)

• what progress, if any, resulted from the service
  
  Progress updates usually include progress made toward the goals but may also include the child’s or family’s response to the services provided each session.

The TCM generates progress reports every 90 days and will determine the type and frequency of information needed from the provider to assist with these reports.  At discharge, a summary needs to be prepared and sent to the TCM.

Environmental Modifications and Adaptive Devices
Providers need to maintain fiscal records to support the services for which a charge is made to the program.  These records will need to be made available to the department or its duly authorized representative upon request.

In addition:
Family and Community Support Services
providers will:

• support the annual reporting requirements in 441—79.1(15)“a”(1) (re: the financial and statistical report)

• maintain therapeutic resource receipts and other documentation that verify purchase and use of those resources (beginning 5/3/06 pending approval of rule change)

Enrolling to Provide Services

To enroll to provide Children's Mental Health Waiver services, the "Iowa Medicaid HCBS Waiver Provider Application Form" should be completed and sent to:

IME Provider Services Correspondence
P.O. Box 36450
Des Moines, IA 50315

The application can be downloaded in either Microsoft Word or PDF formats.

Questions regarding completion of this application should be directed to Iowa Medicaid Enterprise (IME) Provider Services at 1-800-338-7909 or 515-725-1004.

Related Iowa Administrative Code Chapters
The Iowa Administrative Code chapters that contain the rules on which the CMH Waiver is based are:

441-77	Chapter 77 Conditions of Participation for Providers of the four CMH services
441-78	Chapter 78 Amount, Duration, and Scope of Medical and Remedial Services
441-79	Chapter 79 Identifies the types of reimbursement
441-83	Chapter 83 Eligibility criteria for approval of waiver services
441-90	Chapter 90 Case management for CMH

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This page last updated: 4/18/2007

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