Children’s Mental Health (CMH) Waiver is a new category of waiver and has
its roots in Home and Community Based Waiver (HCBS) services. Home and
community-based services are
alternatives to institutional care. Inspired
25 years ago by a child from Iowa named Katie Beckett, this year
15,000 young people, older adults and persons with disabilities will benefit
in their own homes from supports offered through Iowa’s six other HCBS
waivers. The Centers for
Medicare and Medicaid Services (CMS)
provide the funding for HCBS services, with two-thirds coming from federal
Medicaid dollars and the remainder from the county or state.
about HCBS and Iowa’s six other waivers is available from the Iowa
Medicaid Enterprise (IME).
Children’s Mental Health Waiver
CMH Waiver exists to meet the needs of
children under 18 years old with serious
emotional disturbance (SED). Many children with serious emotional disturbances must leave
their homes to seek support in a medical institution. The parents of eligible children “waive” using services
in an institution and choose instead to use services and individual
supports to keep their children in their own home.
child, his or her family,
chosen providers, the targeted case manager, and others come together
to form an interdisciplinary team (IDT), which meets to plan the interventions and
supports a child and family needs to safely maintain the child’s physical
and mental health in her or his family’s home. They guide the overall implementation of CMH Waiver
The intent of the CMH Waiver is to identify services
and supports that are not available through other mental health
programs/services. CMH Waiver services can be utilized in conjunction with
traditional mental health services (not RTS) to develop a comprehensive support system
for children with SED. To
enable children in this population to
remain in their own homes and communities, the CMH Waiver offers a range of services that include:
To receive these services, within the past twelve months
a child must have a
diagnosis of serious emotional disturbance as
verified by a psychiatrist, psychologist, or mental health professional.
Each child’s unique needs merit
an individualized outcome achievement plan (OAP) or individual comprehensive
plan (ICP) actively developed with the child and
family’s collaborative input.
for a brief introduction to these services, or our information
packet for additional details.
Each child and family has an initial contact with an
Income Maintenance Worker at his or her local Department of Human Services
office to determine financial and medical eligibility. If
the child is eligible and chooses to enroll in the CMH Waiver, the Iowa Medicaid
Enterprise-Medical Services Unit completes initial and ongoing functional
needs assessments; Targeted Case Managers are assigned to assist the child
and family with coordinating services and convening the IDT; providers are
enrolled and enlisted to provide services and supports to each family.
and Responsibilities chart outlines some of these key contacts
and their roles and responsibilities with the CMH Waiver.
achieved through a variety of systematic tracking methods. Training, technical
assistance, quality assurance/ improvement are also part of the CMH Waiver’s unique quality framework to promote successful outcomes.
Each child and family is part of an interdisciplinary
team (IDT) of dedicated professionals, para-professionals, and others -
actively working together to achieve satisfactory outcomes.
Each IDT is comprised of people from the child’s own or nearby
community and includes:
the child and family
targeted case manager
one or more service providers
(chosen by the family to implement services and supports)
any other person(s) the child and family choose to
Collaboratively developed during the IDT meeting, each
child has an individualized outcome
achievement plan (OAP) - also referred to as an individual
comprehensive plan (ICP) - that documents the agreed upon goals,
objectives and service activities. Also collaboratively developed
during the IDT meeting, is an individualized crisis plan that is
designed to enable the individual to prevent, self manage, alleviate or end
Outcomes Are Expected
As A Result of the CMH Waiver?
results will be realized when quality services are planned, delivered and
evaluated with these outcomes in mind:
children are valued
children are part of community life
children develop and accomplish personal goals
children maintain physical and mental health
children are safe
children and their families have an impact on the
we will see that:
providers are qualified and equipped with up-to-date
information and resources
providers are in-step with practice incorporating
evidence-based methods and strategies to support each child and family
continuous quality improvement
practices/processes - internal checks and balances - to ensure
their services are quality services (because people who receive quality
services have better outcomes)
We have developed a reference chart that includes a comparison of the quality domains
identified by The
Centers for Medicare and Medicaid Services (CMS), CMH Waiver outcomes and
some of the possible indicators to measure quality and performance related
to these outcomes. Providers
can use this chart as a tool to prompt an examination of agency
structural/organizational practices, to help determine assets and needs.
The CMH Waiver has a review
to advise the Department of Human services regarding the implementation of the
CMH Waiver. The
review team will convene when there are a sufficient number of children
participating in the waiver for there to be implementation issues to
consider. The review team membership may include but is not limited to the
following: Juvenile judges, parents of CMH Waiver-eligible children, CMH
Waiver service providers, Department of Human Services staff, and two members
of the Iowa General Assembly (at a minimum).