the Entry Path to Service Provision
To help visualize the entry options for becoming a Children’s Mental
Health (CMH) Waiver service provider, we have developed a provider
enrollment flow chart
help you choose the path that most closely applies to your circumstances. If you do not have software for reading this file, an Acrobat
Reader can be downloaded via the
Internet free from Adobe.
The goal of
the CMH Waiver is to provide services at the point where other community and service
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
must be woven
through every stage related to services.
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
Modifications and Adaptive Devices
Iowa Administrative Code Reference: IAC
The following agencies may
provide environmental modifications and adaptive devices
under the CMH Waiver:
community business with all the licenses and permits under IA Code 490 and
that has submitted
verification of current liability and workers’ compensation insurance
retail or wholesale business that otherwise participates as a provider
in the Medicaid program
home and vehicle modification provider enrolled under another HCBS
a provider enrolled under
the HCBS mental retardation or brain injury waiver as a supported
community living provider
provider enrolled under the HCBS children’s mental health waiver as a
family and community supports service provider.
checklist for agencies wanting to
provide environmental modifications, adaptive devices and therapeutic
resources under the CMH Waiver.
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
and community support services
and/or in-home family therapy
services under the CMH Waiver:
the applicable Enrollment Checklist for your agency:
Iowa Administrative Code Reference:
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
home care agencies meeting
requirements in Dept. of Public Health rules, 641-80.7(135)
certified adult day care
certified assisted living
licensed residential care
facilities for persons with mental retardation
intermediate care facilities for the mentally retarded and hospitals
enrolled as providers in the Iowa Medicaid program
checklist for agencies wanting to
provide respite care services under the CMH Waiver.
Waiver Provider Enrollment
Once enrolled, agencies are
added to a list from which children/families can select service providers.
process occurs in collaboration with the Targeted Case Manager (TCM)
assigned to assist the child and family.
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
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
Providers may wish to contact the targeted case
managers in their area, to introduce them to the
services they provide.
CMH Waiver Standards to
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:
must demonstrate the fiscal capacity to provide services on an ongoing
care staff must be at least 18 years of age.
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.
care staff may not be the spouse of the consumer, or the parent or
stepparent of the consumer.
and community support service providers, in-home family therapy providers and
providers have the following requirements for intake, admission, and
provider will have written policies and procedures according to state
and federal laws for intake, admission, and discharge.
provider will ensure the rights of persons seeking services.
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.
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.
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.
One Month of Hire, Staff Shall Receive An:
regarding the agency’s mission, policies, and procedures
regarding HCBS philosophy and outcomes for rights and dignity
children’s mental health waiver in 77.46(1)“c.”
Four Months of Hire, Staff Shall Receive Training Related To:
emotional disturbance in children and provision of services to
children with serious emotional disturbance
of medication according to agency policy and procedure
and reporting of child abuse
of service provision
ethics (beginning 5/3/06 pending approval of rule change)
Year of Hire, Staff Shall Receive:
Each Subsequent Year of Hire, Staff Shall Receive:
can be downloaded to assist in tracking staff training as it is
completed. Contact your certification
specialist for technical assistance in
establishing your policies and procedures around training requirements.
Child's Service Plan and Crisis Plan
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.
the IDT meeting, the child’s service plan is developed collaboratively
with the child and family. The
plan is then compiled (generated) by the TCM.
A crisis plan is also generated during the IDT meeting.
Providers need to have a clear understanding of the crisis plan.
Additionally CMH Waiver providers will be
responsible for implementing the service plan and crisis plan in relation to
assigned goals and service activities agreed upon by the interdisciplinary
team. For technical assistance regarding this implementation contact
your certification specialist.
Policies and Procedures
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
If implemented successfully, we will be able to see their impact on
Crisis Intervention Planning
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
provider’s policies and procedures must address the following:
information pertinent to the development of the child’s crisis
intervention plan with the targeted case manager and IDT
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
that all staff have access to a written copy of the most current crisis
intervention plan during service provision
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
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.
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:
documentation is handwritten, all narrative needs to be legible
date of the service
(length of time) of the service
service was provided
action(s) used to provide the service
provided the service (the legible signature of the provider)
progress, if any, resulted from the service
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.
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
Modifications and Adaptive Devices
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.
and Community Support Services
support the annual reporting requirements in
441—79.1(15)“a”(1) (re: the financial and statistical report)
therapeutic resource receipts and other documentation that verify
purchase and use of those resources (beginning 5/3/06 pending approval of rule change)
to Provide Services
enroll to provide Children's Mental Health Waiver services, the "Iowa
Medicaid HCBS Waiver Provider Application Form" should be completed and
Provider Services Correspondence
P.O. Box 36450
Des Moines, IA 50315
application can be downloaded in either Microsoft Word
regarding completion of this application should be directed to Iowa Medicaid
Enterprise (IME) Provider Services at 1-800-338-7909
Iowa Administrative Code Chapters
The Iowa Administrative Code chapters that contain the rules on which the
CMH Waiver is based are:
Conditions of Participation for Providers of the four CMH services
Amount, Duration, and Scope of Medical and Remedial Services
Identifies the types of reimbursement
Eligibility criteria for approval of waiver services
Case management for CMH