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Iowa Department of Human Services / CMH Waiver
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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

  • A facility providing respite under CMH will not exceed the approved or licensed capacity, and services shall be provided in a location and for the duration consistent with the facility’s licensure

 

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This page last updated: 4/18/2007

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