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Iowa Department of Human Services / CMH Waiver
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What is a waiver?
The 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.

Information about HCBS and Iowa’s six other waivers is available from the Iowa Medicaid Enterprise (IME).


The Children’s Mental Health Waiver
The 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.  The 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 g
uide the overall implementation of CMH Waiver services.

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.


Implementation of Services
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.

The Roles and Responsibilities chart outlines some of these key contacts and their roles and responsibilities with the CMH Waiver.

Accountability is 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.


The Interdisciplinary Team
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

  • a targeted case manager

  • one or more service providers (chosen by the family to implement services and supports)

  • mental health professional(s)

  • any other person(s) the child and family choose to include

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 a crisis.


What Outcomes Are Expected 
As A Result of the CMH Waiver?

Desired 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 services received

In addition, 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

  • providers have 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.


Review Committee
The CMH Waiver has a review committee 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).


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This page last updated: 4/18/2007

Copyright 2002 - 2007 ~ Iowa State University, Child Welfare Research and Training Project for the Iowa Department of Human Services

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