Iowa Code 135.22B – Brain injury services program
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1.
Definitions.
For the purposes of this section, “brain injury services waiver” means the state‘s medical assistance home and community-based services waiver for persons with brain injury implemented under chapter 249A.
Terms Used In Iowa Code 135.22B
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the department of inspections, appeals, and licensing. See Iowa Code 154A.1
- Department: means the department of health and human services. See Iowa Code 135.108
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- month: means a calendar month, and the word "year" and the abbreviation "A. See Iowa Code 4.1
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- Oversight: Committee review of the activities of a Federal agency or program.
- Person: means a natural person. See Iowa Code 154A.1
- Rule: includes "regulation". See Iowa Code 4.1
- State: means a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico. See Iowa Code 152E.3
- United States: includes all the states. See Iowa Code 4.1
2.
Program created.
a. A brain injury services program is created and shall be administered by the department in cooperation with counties.
b. The department‘s duties shall include but are not limited to serving as the fiscal agent and contract administrator for the program and providing program oversight.
c. The department shall consult with the advisory council on brain injuries, established pursuant to section 135.22A, regarding the program and shall report to the council concerning the program at least quarterly. The council shall make recommendations to the department concerning the program’s operation.
3.
Purpose.
The purpose of the brain injury services program is to provide services, service funding, or other support for persons with a brain injury under the cost-share program component or other components established pursuant to this section. Implementation of the cost-share component or any other component of the program is subject to the funding made available for the program.
4.
General requirements – cost-share component.
The cost-share component of the brain injury services program shall be directed to persons who have been determined to be ineligible for the brain injury services waiver or persons who are eligible for the waiver but funding was not authorized or available to provide waiver eligibility for the persons. The cost-share component is subject to general requirements which shall include but are not limited to all of the following:
a. Services offered are consistent with the services offered through the brain injury services waiver.
b. Each service consumer has a service plan developed prior to service implementation and the service plan is reviewed and updated at least quarterly.
c. All other funding sources for which the service consumer is eligible are utilized to the greatest extent possible. The funding sources potentially available include but are not limited to community resources and public and private benefit programs.
d. The maximum monthly cost of the services provided shall be based on the maximum monthly amount authorized for the brain injury services waiver.
e. Assistance under the cost-share component shall be made available to a designated number of service consumers who are eligible, as determined from the funding available for the cost-share component, on a first-come, first-served basis.
f. Nothing in this section shall be construed or is intended as, or shall imply, a grant of entitlement to services to persons who are eligible for participation in the cost-share component based upon the eligibility provisions adopted consistent with the requirements of this section. Any obligation to provide services pursuant to this section is limited to the extent of the funds appropriated or provided for the cost-share component.
5.
Cost-share component eligibility.
An individual must meet all of the following requirements in order to be eligible for the cost-share component of the brain injury services program:
a. The individual is age one month through sixty-four years.
b. The individual has a diagnosis of brain injury that meets the diagnosis eligibility criteria for the brain injury services waiver.
c. The individual is a resident of this state and either a United States citizen or a qualified alien as defined in 8 U.S.C. § 1641.
d. The individual meets the cost-share component’s financial eligibility requirements and is willing to pay a cost-share for the cost-share component.
e. The individual does not receive services or funding under any type of medical assistance home and community-based services waiver.
6.
Cost-share requirements.
a. The cost-share component’s financial eligibility requirements shall be established in administrative rule. In establishing the requirements, the department shall consider the eligibility and cost-share requirements used for the Hawki program under chapter 514I.
b. An individual’s cost-share responsibility for services under the cost-share component shall be determined on a sliding scale based upon the individual’s family income. An individual’s cost-share shall be assessed as a copayment, which shall not exceed thirty percent of the cost payable for the service.
c. The service provider shall bill the department for the portion of the cost payable for the service that is not covered by the individual’s copayment responsibility.
7.
Application process.
a. The application materials for services under the cost-share component of the brain injury services program shall use the application form and other materials of the brain injury services waiver. In order to apply for the brain injury services program, the applicant must authorize the department to provide the applicant’s waiver application materials to the brain injury services program. The application materials provided shall include but are not limited to the waiver application and any denial letter, financial assessment, and functional assessment regarding the person.
b. If a functional assessment for the waiver has not been completed due to a person’s financial ineligibility for the waiver, the brain injury services program may provide for a functional assessment to determine the person’s needs by reimbursing the department for the assessment.
c. The department shall file copies of the individual’s application and needs assessment with the program resource facilitator assigned to the individual’s geographic area.
d. The department shall make a final determination as to whether program funding will be authorized under the cost-share component.
8.
Service providers and reimbursement.
All of the following requirements apply to service providers and reimbursement rates payable for services under the cost-share component:
a. A service provider must either be certified to provide services under the brain injury services waiver or have a contract with a county to provide services and will become certified to provide services under such waiver within a reasonable period of time specified in rule.
b. The reimbursement rate payable for the cost of a service provided under the cost-share component is the rate payable under the medical assistance program. However, if the service provided does not have a medical assistance program reimbursement rate, the rate shall be the amount payable under the county contract.
9.
Resource facilitation.
The program shall utilize resource facilitators to facilitate program services. The resource facilitator shall be available to provide ongoing support for individuals with brain injury in coping with the issues of living with a brain injury and in assisting such individuals in transitioning back to employment and living in the community. The resource facilitator is intended to provide a linkage to existing services and increase the capacity of the state’s providers of services to persons with brain injury by doing all of the following:
a. Providing brain injury-specific information, support, and resources.
b. Enhancing the usage of support commonly available to an individual with brain injury from the community, family, and personal contacts and linking such individuals to appropriate services and community resources.
c. Training service providers to provide appropriate brain injury services.
d. Accessing, securing, and maximizing the private and public funding available to support an individual with a brain injury.