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[TCM]
Application
Process (for the Child)
Q:
What
can a TCM do to expedite the CMH application process and help children avoid
being placed on the waiting list who will not meet basic eligibility
requirements (or whose family truly does not intend to access the waiver
even if assigned a slot for their child)?
A:
1) The TCM should assist in explaining the CMH Waiver program to
the child/youth and family, and obtaining the parent(s)/legal
representative’s signature on Part A of the CMH assessment.
2) The TCM should emphasize that the child/youth must have a diagnosis of
serious emotional disturbance (SED) that is current within the past twelve
months and that it is important the family undertake necessary steps to
obtain that documentation for the approval process if not already in their
possession.
3) The TCM should emphasize that a SED diagnosis does not include
developmental disorders. Developmental disorders may include Autistic
Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's
Disorder or Pervasive Developmental Disorder.
A child who has only a single diagnosis of a developmental
disorder will not be eligible for the CMH Waiver.
Q:
How
current must the child’s mental health diagnosis documentation be?
A:
For
initial eligibility, the psychological documentation that substantiates a
mental health diagnosis of serious emotional disturbance as determined by
a mental health professional must be current within the 12 month period
before the application date.
For ongoing eligibility, a mental health professional must complete
an annual evaluation that substantiates a mental health diagnosis of
serious emotional disturbance.
Q:
When
can an application be completed for a child?
A:
The
application process can be initiated at any time. A parent or legal
representative can apply through the income maintenance worker at the local
DHS office.
Child
Eligibility
/ Level of Care
Q:
Iowa Administrative Code Rule 83.125 (2) says a child who is
hospitalized for longer than 30 consecutive days must re-apply. Will
the child be put on the waiting list or will s/he automatically be
reinstated?
A:
If
the child returns home by the 30th consecutive day,
the waiver is re-instated.
If the child returns home after 30 days but by the 60th day, the
waiver will be re-instated with the completion of a new CMH waiver
application and new level of care assessment.
If the child is absent from the waiver for 61 days or more, then
the child will lose his/her waiver slot and will have to go back on the
waiting list.
Q:
A child is receiving services through a PMIC. His name has
been entered on the CMH Waiver waiting list. He and his family have
just been notified by the DHS income maintenance worker that he has been
granted a CMH Waiver funding slot. How many days do the child and
family have to respond to the income maintenance worker that they would
like to utilize that funding slot and apply for the CMH Waiver?
A:
30
days.
Q:
A child and his family have just been notified by the DHS income
maintenance worker that he has been granted a CMH Waiver funding slot.
Is there a limit to the number of days in which the CMH Waiver
application must be completed and the child begins receiving CMH Waiver
services?
A:
No
--
IAC 441-83.123(1)b.(1) and (2) state:
1) The
department shall hold the payment slot for the child as long as reasonable
efforts are being made to arrange services and the child has not been
determined to be ineligible for the program.
2) If services have not been initiated and reasonable efforts are no
longer being made to arrange services, the slot shall revert for use by
the next child on the waiting list, if applicable.
The child must reapply for a new slot.
Q:
A child is receiving services through the CMH Waiver. The
interdisciplinary team (that includes the child and her family) has
determined that the child is in need of more intensive programming offered
through a PMIC for what is expected to be a limited period of time.
Will this child lose his/her CMH Waiver funding slot when he/she enters
the PMIC for services?
A:
No.
IAC 441-83.125(2)c. states: Eligibility shall continue until the
following condition occurs: The child does not reside at the
child’s natural home for a period of 60 consecutive days.
Q:
Can a child receive A5 supervision (aka “eyes and ears”
service) and remain eligible for the CMH waiver?
A:
It
is acceptable for a child on the CMH Waiver to receive A5 supervision (aka
" eyes and ears”). A5 is a supportive family centered child welfare
service and is not-Medicaid funded.
If a child is on the CMH Waiver and also meets one of the
“triggers” to be eligible for A5 (either: DHS doing a child abuse
assessment; family meets the age of child, finding and risk status or the
child abuse report meets criteria for DHS to offer services and open a
case; child is adjudicated CINA, delinquent, or subject of a consent
decree) then A5 could be provided. Children on the CMH Waiver who do not
meet one of the above criteria for A5 however (no abuse or court history)
would NOT be eligible for A5.
Q:
A child currently on the CMH waiver recently had testing and
received an IQ score of
70 and is now diagnosed with Mild Mental Retardation. Is there a
period that can be used to transition the child off the CMH waiver and onto
the MR waiver?
A:
The
targeted case manager will need to initiate a level of care review because
there is now documentation that may indicate a diagnosis of mental
retardation.
The case manager will also need to begin the application process
for the MR Waiver as soon as possible. If IME Medical Services determines
that the child no longer meets CMH Level Of Care (because s/he
presents with a diagnosis of MR-as in this case), the case manager will
need to submit an exception to policy to IAC 83.122(3) regarding level of
care to allow the child to continue to receive CMH Waiver services until MR
Waiver eligibility and funding can be obtained or other services that can
meet her needs are obtained.
Q:
Will a list of serious emotional disorders be distributed?
A:
The
Children’s Mental Health waiver does not specify a list of disorders
like the Brain Injury Waiver specifies “acceptable brain injury
diagnoses.” All children must meet a diagnosis of serious emotional
disturbance (SED). This definition states that SED means a diagnosable
mental, behavioral, or emotional disorder that meets the following:
-
Is
of sufficient duration to meet diagnostic criteria for the disorder
specified by the DSM-IV-TR published by the American Psychiatric
Association.
-
Has
resulted in a functional impairment that substantially interferes
with or limits a consumer's role or functioning in family, school,
or community activities.
Q:
What
type of professional can make a mental health diagnosis?
A:
A
psychologist, psychiatrist or a mental health professional.
Q:
What
is the definition of a mental health professional?
A:
Iowa
Administrative Code
441-83.121(249A)
states that a "mental health
professional" means a person who meets all of the following
conditions:
1. Holds at least a
masters degree in a mental health field,
including, but not limited to, psychology, counseling and
guidance, psychiatric nursing and social work; or is a doctor of
medicine or osteopathic medicine; and
2.
Holds
a current Iowa license when required by the Iowa professional licensure
laws; and
3. Has at least two years of post degree
experience supervised by a
mental health professional in assessing mental health problems, mental
illness and service needs and in providing appropriate mental health
services for those individuals.
Q:
What
is the meaning of the rule that says “a child must receive
one billable unit of a CMH Waiver service per calendar
quarter to maintain eligibility?”
A:
From
the final CMH approval date the child/family has
until the end of the current
calendar quarter to use one unit of service.
The child/family must continue to use one unit of service every
calendar quarter to maintain eligibility.
(Example: Final CMH
Waiver approval was given on February 1, 2006.
The child/family has until March 31, 2006 to use one unit of
service. The child/family
must continue to use one unit each calendar quarter: April-June,
July-September, October-December, January–March.)
Q:
When children qualify for the waiver and there is current court
involvement does this prevent or delay the child from entering waiver
services?
A:
No.
The DHS Service Unit will be working to end court
involvement.
Q:
What
if the child has a need for mobile crisis services or mobile counseling
services?
A:
When the child’s needs indicate this possibility, the
availability of needed services must be presented and discussed in the
interdisciplinary team meeting and incorporated into the child’s
crisis plan. The family and child are the focus and the main source of
information for needed services. The availability of local emergency
services needs to be known by TCM for their area. Magellan has mobile crisis/counseling services that can be approved through the Iowa
Plan.
Q:
Will
the designated county be where the parent(s) or
the legal guardian(s) live, or where the child currently lives?
A:
The
county in which the child will reside with his/her family when CMH
Waiver services begin will be the designated county. However, the
non-Federal share of CMH Waiver services is the responsibility of the
State not the county. The county of legal settlement will be of
importance to the child and the family when the child reaches the age of
18.
Q:
Does
the child have to be institutionalized
before
a family can apply and fill out an application?
A:
No.
Q:
Does
the child have to have had certain number of psychiatric hospitalizations
in order to be eligible?
A:
No.
Q:
Will
the child have to be SSI-eligible or have a disability determination in
order to be eligible for CMH Waiver services?
A:
Neither
is required. The child can be determined Medicaid eligible for the CMH
Waiver under either SSI-related or FMAP related-coverage. If SSI-related
coverage is chosen, then the child would need a disability
determination. If FMAP-related, the child does not need a disability
determination.
Q:
Can
CMH Waiver services be provided prior to the child returning to
his/her home?
A:
No.
Q:
One
of the primary eligibility requirements for the CMH Waiver is that the
child must be determined by IME Medical Services to meet hospital level of
care. If the child is deemed appropriate for hospital level of care, why
would we need CMH Waiver services?
A:
The
intent of a Medicaid waiver is to allow a child or an individual to live
in his/her own home instead of an institution so that institutional care
can be avoided. CMH Waiver services would support the child
and family at home instead of an institution that provided hospital
level of care.
Q:
A mother received notification that her child was NOT
eligible for the CMH Waiver due to a diagnosis of mild mental retardation,
despite a primary diagnosis of being bi-polar.
The mother was advised to apply for the MR waiver, however the
child’s IQ makes them ineligible for the MR waiver.
How does this child receive appropriate services?
A:
If a child has a diagnosis of mental retardation and could be served
through the MR waiver, the funding for services should come from that
waiver. However, if the child’s IQ level and functioning level is
too high for MR waiver eligibility, the child – if meeting all CMH
eligibility requirements – should be able to access CMH waiver.
The child can request a re-determination of the level of care by
requesting a review per IAC
441-83-129(249A).
Q:
Can a single episode, major
depressive disorder be accepted as a diagnosis for the CMH Waiver?
A:
Major depressive disorders can be a CMH diagnosis, however it must
meet other criteria as specified in the definition of “serious
emotional disturbance.”
Services
General Questions
Q:
Can supported employment be a part of this waiver?
A:
No. It is
not currently included in the approved menu of services.
Q:
Can a child be the recipient of both RTS and CMH Waiver services?
A:
No.
IAC
441-83.122(6) states, “a consumer may not be the recipient of
children’s mental health waiver services and be the recipient of
rehabilitative treatment services under 441-Chapter 185.”
Family and Community Supports (FCSS)
Q:
Can
family and community support services be provided to a group of children?
A:
FCSS
is intended to be provided on an individual basis.
Q:
Can
a child approved for CMH Waiver also receive day treatment provided
through the Iowa Plan?
A:
Yes,
but not during the same time of day. Children utilizing CMH Waiver are also eligible to receive
needed services under the Iowa Plan.
Q:
Can the family and community supports component be provided on-site
during
day treatment services?
A:
No.
CMH Waiver rules state
that services must not be duplicative and cannot be simultaneously
reimbursed for the same period as other services.
Q:
How
is “community” interpreted
for family and community support services?
A:
“Community”
means within the child’s home and/or integrated community setting and
must relate to supporting and achieving goals applicable to the needs of
the child and family.
Q:
Can
a provider transport the child? If
so, how can the provider be reimbursed for transportation costs?
A:
Yes,
if the
interdisciplinary team identifies transportation as a support
need. Family
and Community Support Service may include an amount not to exceed
$1500 per child per year for transportation within the community when
identified as a need that cannot be provided by other natural supports.
The provider must incorporate these costs into their prospective
rate and reconcile costs annually.
In-Home Family Therapy (IFT)
Q:
In
order to give the parent a break and to prevent placement, a child is
temporarily residing outside the home.
Can in-home family therapy be provided in that home to help the
child prepare to return home?
A:
Since
the temporary home is not the child’s "usual home,” an
exception to policy must be granted.
Q:
A
child is staying with a non-custodial biological parent.
Can in-home family therapy be provided in this home as long as both
parents agree to services?
A:
Assuming
the non-custodial parent has visitation rights, when the child visits
their home is considered the same as the custodial parents.
Q:
Does the child need to be present
during the delivery of in-home family therapy?
A:
If applicable to the child and the
family unit's needs, it is possible for the therapy to be conducted
without the child present. There may be interfamily relationships
identified that do not directly involve the child that may threaten the
cohesiveness of the family unit and the ability of the child to remain
in his/her home.
Q:
How is In-Home Family Therapy included in the
CMH Waiver different from outpatient therapy covered under the Iowa Plan?
A:
The service that the provider
delivers is different, even though in many areas of the state it may be
the same provider delivering both services. Outpatient Psychotherapy
covered under the Iowa Plan (Title XIX) is delivered in an office
setting whereas In-Home Family Therapy covered under the CMH waiver is
delivered in a home setting. Requirements of the provider's credentials
and qualifications for each service are also different.
Q:
A child receiving CMH services is in the hospital.
Can we provide in-home family therapy with the mother while the
child is out of the home?
A:
No.
Waiver
services are suspended during the child’s hospitalization to allow for
facility payment. Service
delivery during this time would not be authorized/billable.
Q:
Can in-home family therapy services
(IFT) be provided outside the home?
A:
The
rules do not specify that the service cannot be provided outside the
home. However, the intent of the service remains to maintain a
cohesive family unit and the therapeutic interventions on behalf of the
child and family must reflect that intent. The
following outlines what must be considered when ordering and
providing this service:
·
In
Home Family Therapy can be provided outside of the home in
individualized cases if documentation is clearly define the need and
is included in the TCM's case file for the child/youth.
·
The
TCM case file documentation must clearly explain the individualized
family situation of the child, the SED diagnosis and the medical
necessity of providing the IFT outside of the home and any other
pertinent information that would justify providing the service outside
of the home.
·
There
is a reasonable expectation that the IFT would be reasonably
time-limited in accordance with the needs of the child/youth and
his/her family. The case file documentation must identify the
length of time anticipated.
·
The
IFT therapeutic plan must identify how the other family members will
be transitioned into the therapy sessions in the future.
·
The TCM
case file documentation
must state that the IFT service provided outside of the home is
exclusive of and does not serve as a substitute for individual
therapy, family therapy, or other mental health therapy that may
be obtained through the Iowa Plan of other funding sources
(441--IAC 78.52(4)b.)
Q:
Some children are dealing with family issues where they do not want the
family present during all of the therapy time.
Can in-home family therapy be done with the child when the family is NOT present?
A:
Yes, the therapy can be completed without the family present.
However since the goal of IFT is family stabilization and a positive
home environment, at some point the issues raised in therapy with the
child need to be addressed by the family members as well.
Respite Care Services
Q:
Family and community support, in-home family therapy, and youth shelter
providers do not currently meet the enrollment criteria to provide CMH Waiver
respite. Is there any way they can enroll to provide this service?
A:
Yes. They can seek certification to be a respite
provider under the mental retardation or brain injury waiver with
submission of policies and procedures. This certification will
allow enrollment for CMH waiver respite. Providers need to
develop a respite program to meet the intent of the service and to
individualize services to meet the needs of recipients. Shelters
cannot use respite as an effort to fill empty beds without developing a
respite program.
Provider steps include:
1)
Go to the IME
website. Print off the provider application 2)
Complete the provider application, checking off number 46 under
respite. Circle both MR and CMH. You will be contacted in
regards to submitting policies, procedures and forms. 3)
Submit the completed provider application to IME. IME will
assign a waiver specialist to review your policies, procedures and
forms. 4)
A waiver
specialist will contact you (or the provider can contact their
specialist in advance). 5)
Submit policies and procedures directly to your waiver specialist
Q:
A sibling group
receives respite and each child is allowed up to forty hours of respite
per month. What is the billing procedure for the respite agency?
A:
A ratio higher than 1 staff to 1 child must be billed as group
respite at the agreed upon group respite rate.
Q:
Can an enrolled CMH
waiver respite provider subcontract with foster parents to do respite
services?
A:
There is nothing in the Rules that would prohibit an enrolled
agency from subcontracting with a foster family home.
If the enrolled agency is intending to use a foster home
they must make that known to the CMH Case Manager in advance of the
respite service provision. The enrolled agency is
responsible to ensure the foster parents do not exceed the foster
home’s licensed bed capacity. The Case Manager must do the
following before making a decision on the respite authorization with the
agency and foster home:
1) Contact the Foster Home Licensing Worker in the Service Delivery Area
where the foster home is located and share information regarding the
potential respite child: age, sex, diagnosis, medical needs,
behavior, specific safety concerns, history of abuse, physical
aggression, etc. (Will require a release from the child's parent).
2) The Foster Home Licensing Worker can provide information
regarding the number of children currently in the foster home,
their age, sex, sleeping arrangements (shared bedroom space), medical
needs, and behavior concerns for each child currently in the respite
foster family home, including the foster parent's own children.
3) The Case Manager should factor in all pertinent information,
including: the licensed capacity of the foster home; the number of
children in the home, their age and the ability of the foster
parents to handle another child; how placing the CMH child will
impact the other children currently living in the home; projected length
of stay.
4) The respite should be planned in advance and be part of the service
and/or crisis intervention plan.
5) If the home is OK'd by the foster home licensing worker for provision
of respite services, the CMH Case Manager should send an email to the
licensing worker prior to each respite use with the projected respite
dates, name of the child on respite, and details of the
respite stay.
Q:
As a provider of respite services, can a provider take a client home
overnight?
A:
It depends. Contact
your certification
specialist. Your
specialist will provide you with technical assistance based on the
specific details of the request.
Q:
Do the ratios for group respite need to be different than the ratios the
providers are already RTS-certified for?
A:
There are no specified ratios in rule.
Basically, if the established ratios are adequate to meet the child’s
need, there is no need for a different ratio.
When a child attends respite in a group care environment, all
children on site must be counted in the group care staff to client
ratio.
Q:
Where can I discover what rates have been established for respite?
A:
There are general rates established for all waivers – they
are listed under IAC
441-79.1(2), starting on page 4. If you are doing
respite in the consumer home, you will look at the rates listed under
“respite when provided by Non-facility care.”
Environmental
Modifications, Adaptive Devices, and Therapeutic Resources
Q:
Can
purchases of environmental modification and adaptive devices be reimbursed
retroactively?
A:
No.
All
EMADs should be discussed prior to purchase, and authorized in the
service plan by the interdisciplinary team and Targeted Case Manager
under direction of the mental health professional on the team.
Q: Who
determines the financial responsibility of the family to assist in paying
for environmental modification, adaptive devices and therapeutic
resources?
A:
The
interdisciplinary team (IDT) determines if the family is able to assist
in the financial responsibility for this service. The family and child,
of course, are part of the
interdisciplinary team. Federal Medicaid
regulations require that the hierarchy of financial responsibility is as
follows:
1) the family
2) other community supports
3) the CMH Waiver service
Q:
Who has final approval for environmental modification expenses? Can an agency be assured they will be reimbursed for each
item purchased?
A:
The
interdisciplinary team (IDT),
with the mental health professional’s recommendation, must
support the purchase. The
targeted case manager (TCM) must authorize it in the service plan (and
subsequently into the ISIS system). The agency will be assured of
payment provided
they bill according to the authorized amount entered in the service
plan. All environmental modifications must meet the needs of
the child and be related to the serious
emotional disturbance (SED). Documentation
of the need must be maintained in the TCM’s case file.
Q:
How
can we know if a certain environmental modification,
adaptive device or therapeutic resource is
ok to approve?
A:
All environmental
modifications, adaptive devices and therapeutic resources must
somehow meet the needs of the child relating to the serious emotional
disturbance (SED). Your certification
specialist can provide you with technical assistance based on the
specific details of the request should you be uncertain.
Providers
Q:
How can our program enroll as a Medicaid
waiver provider?
A:
The
provider
application and instructions can be found on Iowa
Medicaid Enterprise’s (IME) web site. Any questions regarding the
completion of the application can be directed to Iowa Medicaid
Enterprise Provider Services 1-800-338-7909 or 515-725-1004 (from Des
Moines).
Q:
Is there assistance for providers with the
application process?
A:
Providers
may contact IME Provider Services at 1-800-338-7909 or 515-725-1004
(from Des Moines).
Q:
Will community businesses have to become
Medicaid providers in order to provide Environmental Modifications,
Adaptive Devices and Therapeutic Resources?
A:
Yes,
although the process is very simple. The community businesses would
merely attach current proof of liability and workers compensation
insurance to the provider application. IME Provider Services may also be contacted at 1-800-338-7909 or
515-725-1004 (from Des Moines).
Q:
What are the qualifications for
enrolling to provide In-Home
Family Therapy?
A:
Must be an RTSS provider of Therapy
and Counseling Services as designated by IAC
441-185.10(1)a, or be a Community Mental Health Center or Mental
Health Services Provider accredited to provide Outpatient Psychotherapy
and Counseling, as designated by IAC
441-24.4(14).
Q:
Do HCBS providers automatically become RTS providers?
A:
No. They first have to become
certified as an RTS provider and meet RTS criteria for therapy and
counseling or
skill development services.
Q:
How are the provider rates determined for the CMH waiver services?
A:
Environmental
Modifications, Adaptive Devices and Therapeutic Resources,
In-Home Family Therapy, and Respite provided by home
health agencies, facilities, and child-care facilities are based on a
fee schedule. Refer to IAC
441-79.1(1)c(1-2).
Family and Community Support Services and Respite provided
by non-facilities, home care agencies, camps, and group respite by Home
health agencies are based on retrospectively limited prospective rates.
Refer to IAC 441-79.1(1)e and IAC
441-79.1(15).
Q:
What are the basic documentation requirements that CMH Waiver providers
must meet?
A:
Information
necessary to support each item of service reported on the Medicaid claim
form. For instance:
1) Full name of child receiving service
2)
Name of the service provided
3)
First and last name of the staff providing services
4)
Full date and time frames/duration of service delivery
5)
Signature of staff providing the service
6) Documentation of service interventions that reflect the intent of
the service provided
7) Documented progress as a result of the service intervention if
applicable to the service being delivered
8) Documentation that reflects what the provider did during the
session - not just what the child said or did (e.g. If
family and community supports - document the skill development
activity and/or staff interventions and how they were implemented as
well as how the child responded).
Note: There is no "hold harmless" time period
regarding potential billing errors.
Q:
Who will be conducting the CMH Waiver provider billing audits?
A:
Tim Weltzin, or other assigned management analysts with the
Bureau of Purchased Services.
Q:
How long does a provider have to submit a bill/claim for delivered
services?
A:
Service providers have 12 months to bill from the time the
service was provided. The service had to be authorized in the
service plan and approved in ISIS and could not have been provided prior
to the ISIS approval date.
Q:
If my claim has been denied, what
are some initial things I should check?
A:
Providers
should cross reference their claim form with the service plan and
information received from the Targeted Case Manager authorizing their
services in ISIS. Check to see whether:
-
the
provider number is correct
-
the
procedure code on the claim form and the service plan match
-
the
service is billed according to the time spans authorized on the
service plan
-
the
correct number of units are billed according to what was provided
and authorized on the service plan
-
the
correct rate was billed according to the service plan authorization
-
the
service plan was approved at the time when the provider billed
-
the
bill was not submitted too early (services provided in one month
cannot be submitted for payment until the following month)
-
the
child was hospitalized or entered a facility (if so, the DHS Income
Maintenance Worker must have been notified so necessary changes can
be made in the payment system)
Q:
Who is the IME contact for questions regarding claim forms and claim
submission?
A:
IME Provider Services at 1-800-338-7909 (725-1004 if calling
from the Des Moines metropolitan area).
Q:
Is the respite rate itself and the rate setting process for CMH waiver the
same as for MR?
A:
Yes, the respite rates are the same for all the waivers that
have respite in their menu of services (all but PD Waiver). The
only rate that has to be projected for the CMH Waiver is the Family and
Community Support Services rate. As with the other waivers
providing respite, the rates do not have to be projected like SCL.
The respite provider can bill up to the cap established for each type of
respite. But all respite providers have to submit a Financial and
Statistical report each year that justifies the costs for their respite
service. The CMH Waiver only pays for their costs of providing the
respite service.
Q:
What CMH Waiver services require submission of a cost report and when is
the report due?
A:
Family and Community Support
Services and Respite.
By September 30 of each year, completion of a Financial and
Statistical Report (Forms 470-0664 and 470-3449) are due to the Iowa
Medicaid Enterprise (IME) Provider Audits and Rate Setting Unit for each
of these services. Details about the F&S
Report forms can be viewed on the DHS web, with details
beginning in Section V (Basis of Payment). Forms can be ordered by
contacting IME Provider Services at 1-800-338-7909, or 725-1004 if
calling from the Des Moines metropolitan area.
Q:
Are there training resources for assisting providers with completion of
the cost report?
A:
Yes. On July
11, the Provider Audits and Rate Setting Unit provided an F&S
training via the ICN. While the CMH Waiver services (which also need to
complete the F&S Report) were omitted from that presentation, the
PowerPoint has been revised to include
the CMH services and can be accessed at: www.ime.state.ia.us/docs/FSPresentation71106.pdf.
Also available is a PowerPoint developed in November of 2005, that specifically
addresses the
F&S Report for CMH Waiver providers.
Q:
Who is the IME contact for questions regarding rate determination and cost
reporting?
A:
Tom Donahue (of IME Provider Audits and Rate Setting).
Tom may be contacted at 515-725-1256 or tdonahu@dhs.state.ia.us
Following is the mailing and email addresses for submitting a
completed F&S Report:
IME
Provider Cost Audit Unit
P.O. Box 36450
Des Moines, IA 50315
costaudit@dhs.state.ia.us
Training
Q:
Are providers of respite in "camp" settings required to meet all
of the staff training requirements even though they are seasonal and
employ staff short-term?
A:
The Provider should apply for an exception to policy and include how
they will modify their staff training plan for seasonal staff to insure
they get the specific training pertaining to the child's needs.
Q:
We have been operating under RTS requirements, and now want to check
whether our initial and on-going training plan meets waiver requirements.
We are providing therapy services.
A:
In order
to provide in-home family therapy under the CMH Waiver, you must
be in compliance with RTS
standards for therapy and counseling.
If you are following the required training standards for RTS, you
are meeting the CMH Waiver standards. There
are, however, specific requirements for initial training to provide CMH waiver - contact your
specialist
if you have questions.
Q:
Is it a requirement of CMH to have a med manager on staff? If so, is
a trained medication manager eligible to train other staff to dispense
meds?
A:
Waiver has always encouraged providers to have staff trained as
medication managers, however this is not required in Iowa Administrative
Rule. Rule does
specify, however, for respite, in-home family therapy and family
and community supports staff persons providing those services must
be trained “in the provision of medication.”
Providers should have written policies in place that
clarify what that training shall consist of, and may elect to set
policies which extend beyond what is required in CMH Waiver rules.
Q:
If staff currently providing RTS will begin providing CMH services, do
they have to start over with the 24 hours of training or does the training
they already have for RTS count toward CMH?
A:
Training hours are not transferable from one agency to another, however
staff already providing RTS at an agency can count those training hours
toward CMH training requirements.
Q:
Is the staff training requirement the same for all three levels of
respite: individual, group and specialized?
A:
Yes.
Misc.
Other
Q:
What are the main differences between the MR
Waiver and the CMH Waiver?
A: The main
difference is the targeted population. For the MR Waiver, one of the primary
eligibility requirements is a documented diagnosis of mental
retardation. For the CMH Waiver, there must be a diagnosis of serious
emotional disturbance. Also, a person of any age may qualify for the MR
Waiver. The age limit for children eligible for the CMH Waiver is under
the age of 18.
Q:
Can any or all portions of services that are
currently funded through RTS be funded through CMH waiver dollars?
A:
CMH
Waiver and RTS are two separately funded programs. Within the RTS
program, there will not be any CMH waiver funding.
Q:
Do you envision the child having several
providers?
A:
That
is very possible, depending on the needs of the child.
Q:
The
CMH monthly cap seems low compared to other waivers. Why is that?
A:
The
Federal government requires the cost of waiver services not exceed the
cost of institutional services. The cost neutrality schedules developed
could not support a higher monthly cap. Children eligible for CMH Waiver
services are also eligible for Title XIX State Plan Services, mental
health services provided through the Iowa Plan, targeted Medicaid case
management, and DECAT funded services. For CMH Waiver services to be
successful, a team concept and the concept of wraparound services must
be coordinated to utilize all available service options to meet the
child's needs.
Q:
If
the family of a child previously considered a child in need of assistance
(CINA) no longer agrees to be involved with CMH Waiver services can the
parent terminate waiver? Is the CMH Waiver case manager required to notify DHS?
A:
Yes,
the family/parent can always request the waiver
case be closed. If it is
believed that closure of waiver services will compromise the health,
safety or welfare of the child, the targeted case manager should follow
guidelines for mandatory reporting.
Q:
Can a child on the CMH waiver also receive Title V services?
A:
Yes,
they can receive those services (Medicaid reimburses the Title V agency
for covered services). Screening centers and maternal health
centers are Title V agencies. Title V services are provided by the
health department.
Targeted
Case Management (TCM)
Q:
How far back can a targeted case management prior authorization go?
A:
For
CMH Waiver consumers, TCM prior authorizations can go back no more than
4 months, to the start date of the CMH waiver services.
Any TCM provided before the approved start date has to be built
into the TCM administrative costs when they reconcile their costs at the
end of the year.
Q:
How are modification and devices entered into ISIS (the waiver payment
system) and the dollars tracked by the Targeted Case Manager?
A:
To
allow the provider a single full payment, following a satisfactorily
completed installation the total amount of the modification or device
should be entered into ISIS. The date entered would be the
completion date of the installation. Note: The date
that the provider enters on the billing form must be the same date or
after the date of installation. Additionally, within the service
plan the case manager must manually track (outside of ISIS) the cost of
the modification or device over the number of months needed until it is
"paid off." This is to ensure services authorized do not
exceed the monthly level of care (1765) and yearly cap (6000) maximums.
Note: Another modification or device cannot be authorized
in the service plan until the previous one is "paid off". IAC
78.52(2)c also states for each modification or device provided, the case
manager shall maintain in the child’s case file a signed statement
from a mental health professional on the child’s interdisciplinary
team that the modification or device has a direct relationship to the
child’s diagnosis of serious emotional disturbance.
(e.g. Modification costs $1000.00. Child has only $100
of his monthly $1765 that can be devoted to EMAD. ($1675 has been
ordered in other CMH services). The provider is reimbursed up
front when installation is completed satisfactorily. The case
manager enters the full $1000.00 amount in ISIS and authorizes payment
during the month of completion. The case manager must manually
track when the first $100 is applied against the $1000.00 for a total of
10 months until the EMAD is "paid off". During this
10-month period the case manager must ensure total monthly service
authorizations factor in this $100 and the $1765 level of care cap is
not exceeded).
Q:
How do I complete the Level of Care (LOC)
assessment?
A:
Follow
the guidelines presented at the CMH Waiver Level
of Care training.
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