Iowa

Prevocational services means services that provide career exploration, learning and work experiences, including volunteer opportunities, where the member can develop non-job-task-specific strengths and skills that lead to paid employment in individual community settings.

Scope. Prevocational services are provided to persons who are expected to be able to join the general workforce with the assistance of supported employment. Prevocational services are intended to develop and teach general employability skills relevant to successful participation in individual employment. These skills include but are not limited to the ability to communicate effectively with supervisors, coworkers and customers; an understanding of generally accepted community workplace conduct and dress; the ability to follow directions; the ability to attend to tasks; workplace problem-solving skills and strategies; general workplace safety and mobility training; the ability to navigate local transportation options; financial literacy skills; and skills related to obtaining employment.

Prevocational services include career exploration activities to facilitate successful transition to individual employment in the community. Participation in prevocational services is not a prerequisite for individual or small- group supported employment services.

Career exploration. Career exploration activities are designed to develop an individual career plan and facilitate the member’s experientially based informed choice regarding the goal of individual employment. Career exploration may be authorized for up to 34 hours, to be completed over 90 days in the member’s local community or nearby communities and may include but is not limited to the following activities:

Meeting with the member, and their family, guardian or legal representative to introduce them to supported employment and explore the member’s employment goals and experiences

business tours,

informational interviews,

job shadows,

benefits education and financial literacy,

assistive technology assessment, and

other job exploration events.

Expected outcome of service.

The expected outcome of prevocational services is individual employment in the general workforce, or self- employment, in a setting typically found in the community, where the member interacts with individuals without disabilities, other than those providing services to the member or other individuals with disabilities, to the same extent that individuals without disabilities in comparable positions interact with other persons; and for which the member is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

The expected outcome of the career exploration activity is a written career plan that will guide employment services which lead to community employment or self-employment for the member.

Setting. Prevocational services shall take place in community-based nonresidential settings.

Concurrent services. A member’s individual service plan may include two or more types of nonresidential habilitation services (e.g., individual supported employment, long-term job coaching, small-group supported employment, prevocational services, and day habilitation); however, more than one service may not be billed during the same period of time (e.g., the same hour).

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but

consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Unit of service: hour

Exclusions. Prevocational services payment shall not be made for the following:

Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Documentation that funding is not available to the individual for the service under these programs shall be maintained in the service plan of each member receiving prevocational services.

Services available to the individual that duplicate or replace education or related services defined in the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

Compensation to members for participating in prevocational services.

Support for members volunteering in for-profit organizations and businesses other than for-profit organizations, or businesses that have formal volunteer programs in place (e.g. hospitals, nursing homes), and support for members volunteering to benefit the service provider is prohibited.

The provision of vocational services delivered in facility-based settings where individuals are supervised for the primary purpose of producing goods or performing services or where services are aimed at teaching skills for specific types of jobs rather than general skills.

A prevocational service plan with the goal or purpose of the service documented as maintaining or supporting the individual in continuing prevocational services or any employment situation similar to sheltered employment.

Limitations.

Time limitation for members starting prevocational services. Members participation in these services is limited to 24 calendar months. This time limit can be extended to continue beyond 24 months if one or more of the following conditions apply:

The member who is in Prevocational Services is also working in either individual or small group community employment for at least the number of hours per week desired by the member, as identified in the member’s current service plan; or

The member who is in Prevocational Services is also working in either individual or small group community employment for less than the number of hours per week the member wants, as identified in the member’s current service plan, but the member has services documented in his/her current service plan, or through another identifiable funding source (e.g. IVRS), to increase the number of hours the member is working in either individual or small group community employment; or

The member is actively engaged in seeking individual or small group community employment or individual self- employment, and services for this are included in his/her current service plan, or services funded through another identifiable funding source (e.g. IVRS) are documented in the member’s service plan; or

The member has requested supported employment services from Medicaid and IVRS in the past 24 months and has been denied and/or placed on a waiting list by both Medicaid and IVRS; or

The member has been receiving Individual Supported Employment service (or comparable services available through IVRS) for at least 18 months without obtaining seeking individual or small group community employment or individual self-employment.

The member is participating in career exploration activities.

Time limitation for members enrolled in prevocational services.

For member participation in these services is limited to 90 business days beyond the completion of the career exploration activity including the development of the career plan. This time limit can be extended as stated in paragraphs )“1” through “6.” If the criteria in paragraphs 1” through “6” do not apply, the member will not be

reauthorized to continue prevocational services.

Individual supported employment. Individual supported employment involves supports provided to, or on behalf of, the member that enable the member to obtain and maintain individual employment. Services are provided to members who need support because of their disabilities.

Scope. Individual supported employment services are services provided to, or on behalf of, the member that enable the member to obtain and maintain an individual job in competitive employment, customized employment or self- employment in an integrated work setting in the general workforce.

Expected outcome of service. The expected outcome of this service is sustained employment, or self-employment, paid at or above the minimum wage or the customary wage and level of benefits paid by an employer, in an integrated setting in the general workforce, in a job that meets personal and career goals. Successful transition to long-term job coaching, if needed, is also an expected outcome of this service. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time.

Setting. Individual supported employment services shall take place in integrated work settings. For self-employment, the member’s home can be considered an integrated work setting. Employment in the service provider’s organization (not including a sheltered workshop or similar type of work setting where members are paid for the production of goods or services) can be considered employment in an integrated work setting in the general workforce if the employment occurs in a work setting where interactions are predominantly with coworkers or business associates who do not have disabilities or with the general public.

Individual employment strategies include but are not limited to: customized employment, individual placement and support, and supported self-employment. Service activities are individualized and may include any combination of the following:

Benefits education

Career exploration (e.g., tours, informational interviews, job shadows).

Employment assessment.

Assistive technology assessment.

Trial work experience.

Person-centered employment planning.

Development of visual/traditional résumés.

Job-seeking skills training and support.

Outreach to prospective employers on behalf of the member (e.g., job development; negotiation with prospective employers to customize, create or

carve out a position for the member; employer needs analysis).

Job analysis (e.g., work site assessment or job accommodations evaluation).

Identifying and arranging transportation.

Career advancement services (e.g., assisting a member in making an upward career move or seeking promotion from an existing employer).

Re-employment services (if necessary due to job loss).

Financial literacy and asset development.

Other employment support services deemed necessary to enable the member to obtain employment.

Systematic instruction and support during initial on-the-job training including initial on the job training to stabilization.

Engagement of natural supports during initial period of employment.

Implementation of assistive technology solutions during initial period of employment.

Transportation of the member during service hours.

Self-employment. Individual employment may also include support to establish a viable self-employment opportunity, including home-based self-employment. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time. In addition to the activities listed under subparagraph 78.27(10)“a”(4), assistance to establish self- employment may include:

Aid to the member in identifying potential business opportunities.

Assistance in the development of a business plan, including identifying potential sources of business financing and other assistance in developing

and launching a business.

Identification of the long-term supports necessary for the individual to operate the business.

Long-term job coaching. Long-term job coaching is support provided to, or on behalf of, the member that enables the member to maintain an individual job in competitive employment, customized employment or self-employment in an integrated work setting in the general workforce.

Scope. Long-term job coaching services are provided to or on behalf of members who need support because of their disabilities and who are unlikely to maintain and advance in individual employment absent the provision of supports. Long-term job coaching services shall provide individualized and ongoing support contacts at intervals necessary to promote successful job retention and advancement.

Expected outcome of service. The expected outcome of this service is sustained employment paid at or above the minimum wage in an integrated setting in the general workforce, in a job that meets the member’s personal and career goals. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time.

Setting. Long-term job coaching services shall take place in integrated work settings. For self-employment, the member’s home can be considered an integrated work setting. Employment in service provider’s organization (not including a sheltered workshop or similar type of work setting) can be considered employment in an integrated work setting in the general workforce if the employment occurs in a work setting where interactions are predominantly with coworkers or business associates who do not have disabilities, or with the general public, and if the position would exist within the provider’s organization were the provider not being paid to provide the job coaching to the member.

Service activities. Long-term job coaching services are designed to assist the member with learning and retaining individual employment, resulting in workplace integration, and which allows for the reduction of long-term job coaching over time. Services are individualized and service plan are adjusted as support needs change.

may include any combination of the following activities with or on behalf of the member:

Job analysis.

Job training and systematic instruction.

Training and support for use of assistive technology/adaptive aids.

Engagement of natural supports.

Transportation coordination.

Job retention training and support.

Benefits education and ongoing support.

Supports for career advancement.

Financial literacy and asset development.

Employer consultation and support.

Negotiation with employer on behalf of the member (e.g., accommodations; employment conditions; access to natural supports; and wage and benefits).

Other workplace support services may include services not specifically related to job skill training that enable the waiver member to be successful in integrating into the job setting.

Transportation of the member during service hours.

Career exploration services leading to increased hour or career advancement.

Self-employment long-term job coaching. Self-employment long-term job coaching may include support to maintain a self-employment opportunity, including home-based self-employment. In addition to the activities listed under subparagraph 78.27(10)“b”(4), assistance to maintain self-employment may include:

Ongoing identification of the supports necessary for the individual to operate the business;

Ongoing assistance, counseling and guidance to maintain and grow the business; and

Ongoing benefits education and support.

The hours of support tier assignment for long-term job coaching is based on the identified needs of the member as documented in the member’s comprehensive service plan and adjusted when higher support needs are determined.

Small-group supported employment. Small-group supported employment services are training and support activities provided in regular business or industry settings for groups of two to eight workers with disabilities. The outcome of this service is sustained paid employment experience, skill development, career exploration and planning leading to referral for services to obtain individual integrated employment or self-employment for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

Scope. Small-group supported employment services must be provided in a manner that promotes integration into the workplace and interaction between members and people without disabilities (e.g., customers, coworkers, natural supports) in those workplaces. Examples include but are not limited to mobile crews and other business-based workgroups employing small groups of workers with disabilities in employment in integrated business settings; and small-group activities focused on career exploration, or development of strengths and skills that contribute to successful participation in individual community employment.

Expected outcome of service. Small-group supported employment services are expected to enable the member to make reasonable and continued progress toward individual employment. Participation in small-group supported employment services is not a prerequisite for individual supported employment services. The expected outcome of the service is sustained paid employment and skill development which leads to individual employment in the community.

Setting. Small-group supported employment services shall take place in integrated, community-based nonresidential settings separate from the member’s residence.

Service activities. Small-group supported employment services may include any combination of the following activities:

Employment assessment.

Person-centered employment planning.

Job placement (limited to service necessary to facilitate hire into individual employment paid at minimum wage or higher for a member in small-group supported employment who receives an otherwise unsolicited offer of a job from a business where the member has been working in a mobile crew or enclave).

Job analysis.

On-the-job training and systematic instruction.

Job coaching.

Transportation planning and training.

Benefits education.

Career exploration services leading to career advancement outcomes.

Other workplace support services may include services not specifically related to job skill training that enable the waiver member to be successful in integrating into the individual or community setting.

Transportation of the member during service hours.

Providers delivering this service via the Telehealth service delivery option must demonstrate policies and procedures that include:

•HIPAA compliant platforms;

•Client support given when client needs include: accessibility, translation, or limited auditory or visual capacities are present;

•Have a contingency plan for provision of services if technology fails;

•Professionals do not practice outside of their respective scope; and

•Assessment of clients and caregivers that identifies a client’s ability to participate in and outlines any accommodations needed while using Telehealth.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

In-person contact is not required as a prerequisite for payment.

Additional information for telehealth can be found in Main B. Optional

Limits on the amount, duration, or frequency of this service:

A unit of service for Individual SE is 15 minutes

A unit of service for Small Group Employment is 15 minutes

A unit of service for Long-Term Job Coaching is a monthly unit of service or hourly for individuals requiring 25 or more hours of service per month. The hours of support tier assignment for long-term job coaching is based on the identified needs of the member as documented in the member’s comprehensive service plan and adjusted when higher support needs are determined based on the hours of support the member requires each month.

Service requirements for all supported employment

Community transportation options (e.g., transportation provided by family, coworkers, carpools, volunteers, self or public transportation) shall be identified by the member’s interdisciplinary team and utilized before the service provider provides the transportation to and from work for the member. If none of these options are available to a member, transportation between the member’s place of residence and the employment or service location may be included as a component part of supported employment services.

Personal care or personal assistance and protective oversight may be a component part of supported employment services, but may not comprise the entirety of the service.

Activities performed on behalf of a member receiving long-term job coaching or individual or small-group supported employment shall not comprise the entirety of the service.

Concurrent services. A member’s individual service plan may include two or more types of nonresidential services (e.g., individual supported employment, long-term job coaching, small-group supported employment, prevocational services, and day habilitation); however, more than one service may not be billed during the same period of time (e.g., the same hour).

Integration requirements. In the performance of job duties, the member shall have regular contact with other employees or members of the general public who do not have disabilities, unless the absence of regular contact with other employees or the general public is typical for the job as performed by persons without disabilities.

Compensation. Members receiving these services are compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. For supported self-employment, the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time. For small-group supported employment, if the member is not compensated at or above minimum wage, the compensation to the member shall be in accordance with all applicable state and federal labor laws and regulations.

Limitations. Supported employment services are limited as follows:

Total monthly costs of supported employment may not exceed the monthly cap on the cost of waiver services set for the individual waiver program.

In absence of a monthly cap on the cost of waiver services, the total monthly cost of all supported employment services may not exceed $3,029.00 per month. 441 -1.8(17A, 217) provides for waiver of administrative rules in exceptional circumstances.

Individual supported employment is limited to 240 units per calendar year.

Long-term job coaching is limited in accordance with 441—subrule 79.1(2).

Exclusions. Supported employment services payments shall not be made for the following:

Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Documentation that the service is not available to the individual under these programs shall be maintained in the service plan of each member receiving individual supported employment or long-term job coaching services.

Incentive payments, not including payments for coworker supports, made to an employer to encourage or subsidize the employer’s participation in a supported employment program.

Subsidies or payments that are passed through to users of supported employment programs.

Training that is not directly related to a member’s supported employment program.

Services involved in placing and stabilizing members in day activity programs, work activity programs, sheltered workshop programs or other similar types of vocational or prevocational services furnished in specialized facilities that are not a part of the general workplace.

Supports for placement and stabilization in volunteer positions or unpaid internships. Such volunteer learning and unpaid training activities that prepare a person for entry into the general workforce are addressed through prevocational services and career exploration activities.

Tuition for education or vocational training.

Individual advocacy that is not related to integrated individual employment participation or is not member- specific.

Medicaid funds may not be used to defray the expenses associated with starting up or operating a business.

For member’s choosing the Consumer Choices Option, the individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget.

Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. These services must be identified in the member’s service plan developed by the member’s case manager. Services may include payment for social skills development, career placement, vocational planning, and independent daily living activity skill development. The outcome of this service is to maintain integrated living in the community or to sustain competitive employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1) incentive payments made to an employer to encourage or subsidize the employer’s participation in supported employment; or 2) payments that are passed through to users of supported employment services.

Transportation may be covered for members from their place of residence and the employment site as a component of this service and the cost may be included in the rate.

The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Work place personal assistance

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Work place personal assistance

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services. These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Limits

Community support and employment services must be identified on the individual budget plan. The

individual budget limit will be based on the member’s authorized service plan and the need for the

services available to be converted to the CCO budget. The BI waiver allows for the following eight

BI waiver services to be converted to create a CCO budget:

Consumer-directed attendant care (unskilled).

Home and vehicle modification.

Prevocational services.

Basic individual respite care.

Specialized medical equipment.

Supported community living.

Supported employment.

Transportation

Once authorized in the monthly CCO budget, the member must use the budget to get their assessed needs met. It is the responsibility of the member’s case manager or community-based case manager to monitor the member’s CCO use to assure that the member is using the budget to get their service needs met.

Self-directed personal care services are services and/or goods that provide a range of assistance in the member’s home or community that they would normally do themselves if they did not have a disability; activities of daily living and incidental activities of daily living that help the person remaining the home and in their community. This assistance may take the form of hands-on assistance (actually performing a task for a person) or cuing to prompt the participant to perform a task. Personal care may be provided on an episodic or on a continuing basis.

Health-related services that are provided may include skilled or nursing care and medication administration to the extent that the individual holds the appropriate certification and/or licensure and as permitted by State law. These services are only available for those that self-direct. The member will have budget authority over self-directed personal care services. The dollar amount available for this service will be based on the needs identified on the service plan. Overlapping of services is avoided by the use of a case manager who manages all services and the entry into the IoWANS system. The case manager and interdisciplinary team determine which service is necessary and authorize services for both HCBS and self-directed services.

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Self-directed personal care services need to be identified on the individual budget plan. A monthly individual budget amount shall be established for each member based on the assessed needs of the member and based on the services and supports authorized in the member’s service plan. The member shall be informed of the individual budget amount during the development of the service plan. The Case Manger oversees the services authorized to develop the monthly CCO budget as well as traditional services accessed.

Transportation costs within this service is billed separately and not included in the scope of personal care. Please see Section E-2- b ii. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

Consumer-directed attendant care services are service activities performed by a person to help a member with self- care tasks which the member would typically do independently if the member were otherwise able. Consumer- directed attendant care may occur in the member’s home or community.

The service activities may include helping the member with any of the following nonskilled service activities:

Dressing.

Bath, shampoo, hygiene, and grooming.

Access to and from bed or a wheelchair, transferring, ambulation, and mobility in general. It is recommended that the provider receive certification of training and return demonstration for transferring. Certification for this is available through the area community colleges.

Toilet assistance, including bowel, bladder, and catheter assistance. It is recommended that the provider receive certification of training and return demonstration for catheter assistance. Certification for this is available through the area community colleges.

Meal preparation, cooking, eating and feeding but not the cost of meals themselves.

Housekeeping services which are essential to the members health care at home.

Medications ordinarily self-administered including those ordered by a physician or other qualified health care provider. It is recommended the provider successfully complete a medication aide course administered by an area community college.

Wound care.

Assistance needed to go to or return from a place of employment and assistance with job-related tasks while the member is on the job site. The cost of transportation for the member and assistance with understanding or performing the essential job functions are not included in consumer-directed attendant care services.

Cognitive assistance with tasks such as handling money and scheduling.

Fostering communication through interpreting and reading services as well as assistive devices for communication.

Assisting or accompanying a member in using transportation essential to the health and welfare of the member. The cost of the transportation is not included.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

A unit of services is 15 minutes. Services are billed in whole units. There are upper rate limits which are subject to change on a yearly basis.

The first line of prevention of duplicative billing for similar types of services, such as home health aide, is the member’s case manager. The case manager is responsible for the authorization and monitoring of services in a member’s plan of care. If the case manager authorizes similar services, they are responsible to assure that the services are being delivered as ordered. The IoWANS system generates a review report to assist the case manager. The report identifies all services that have been billed for a specific time period (ex. one month). The case manager is able to view the service billed to the individual member, the amount of the service billed and the provider. The case manager is able to compare what has been billed by the provider to what is ordered in the plan of care. The department also conducts post audit reviews of providers to review the billing of providers to assure that the services provided have documentation to support the billing.

Transportation services may be provided for members to conduct business errands and essential shopping, to travel to and from work or day programs, and to reduce social isolation. Whenever possible, family, neighbors, friends, or community agencies that can provide this service without charge are utilized. The case manager responsible for service plan development and authorization will identify the availability of alternative sources of transportation in the member’s comprehensive service plan. This service does not include transportation to Medicaid covered medical services which is provided under the state plan covered benefit called Non Emergency Medical Transportation (NEMT). These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

A unit of service is either per mile, per trip. Transportation may not be reimbursed simultaneously with any other transportation service and may not be duplicative of any transportation service provided under the State plan. Transportation shall not be reimbursed simultaneously with supported community living services when the SCL rate paid to provider includes the cost of member’s transportation. There is an upper rate limit that is subject to change on a yearly basis.

Consumer-directed attendant care services are service activities performed by a person to help a member with self- care tasks which the member would typically do independently if the member were otherwise able. This service may be provided in the private residence or assisted living. This service is not a duplication of Home Health Aide or Homemaker services; and is monitored by the service worker manager as part of inclusion in the member’s plan. The service activities may include helping the member with any of the following non-skilled service activities:

Dressing.

Bath, shampoo, hygiene, and grooming.

Access to and from bed or a wheelchair, transferring, ambulation, and mobility in general.

Toilet assistance, including bowel, bladder, and catheter assistance.

Meal preparation, cooking, eating and feeding but not the cost of meals themselves.

Housekeeping services which are essential to the members health care at home, includes shopping and laundry.

Medications ordinarily self-administered including those ordered by a physician or other qualified health care provider.

Wound care.

Assistance needed to go to or return from a place of employment and assistance with job related tasks while the member is on the job site. The cost of transportation for the member and assistance with understanding or performing the essential job functions are not included in member directed attendant care services.

Tasks such as financial management and scheduling that require cognitive or physical assistance.

Communication essential to the health and welfare of the member, through interpreting and reading services and use of assistive devices for communication.

(12) Using transportation essential to the health and welfare of the member. The cost of the transportation is not included.

Authorization of this service must be made after assuring that there is no duplication or overlapping of services. These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

A unit of service is 15 minutes. The member’s plan of care will address how the member’s health care needs are being met. The case manager and the MCO CBCM will monitor the plan. Members enrolled in the waiver have access to Iowa’s Medicaid Exception to Policy option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. These services must be identified in the member’s service plan developed by the member’s service worker. Services may include payment for social skills development, career placement, vocational planning, and independent daily living activity skill development. The outcome of this service is to maintain integrated living in the community or to sustain competitive employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1) incentive payments made to an employer to encourage or subsidize the employer’s participation in supported employment; or 2) payments that are passed through to users of supported employment services.

The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Work place personal assistance

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

In order to comply with 42 CFR §441.301(b)(4), this waiver will be amended in the future so that Employment and other Habilitation services will be unbundled into separate standalone services. This amendment will be submitted following the end of the ARPA MOE period but no later than 6/30/2024.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but

consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Community support and employment services must be identified on the individual budget plan. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget. The HD waiver allows for the following five waiver services to be converted to create a CCO budget:

1. Consumer-directed attendant care (unskilled).

2. Home and vehicle modification.

3. Basic individual respite care.

4. Home delivered meals.

5. Homemaker services.

A utilization adjustment rate is applied to the individual budget amount. Please see Section E- 2-b ii for details on how the CCO budget is created. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

Self-directed personal care services are services that provide a range of assistance in the member’s home or community; activities of daily living and incidental activities of daily living that help the person remain in the home and in their community. Individual-directed goods are equipment or supplies not otherwise provided through the Medicaid program that address an assessed need or goal identified in the member’s service plan. Self-directed personal care services are services and/or goods that provide a range of assistance in the member’s home or community that they would normally do themselves if they did not have a disability; activities of daily living and incidental activities of daily living that help the person remaining the home and in their community. This assistance may take the form of hands-on assistance (actually performing a task for a person) or cueing to prompt the participant to perform a task. Personal care may be provided on an episodic or on a continuing basis.

The member will have budget authority over self-directed personal care services. The dollar amount available for this service will be based on the needs identified on the service plan. Overlapping of services is avoided by the use of a HHS TCM or MCO CBCM who manages all services and includes into the members’ service plans. The HHS TCM or the MCO CBCM and interdisciplinary team determine which services are necessary and authorize transportation for both HCBS and self-directed services.

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their TCM or CBCM and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Self-directed personal care services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Transportation costs within this service is billed separately and not included in the scope of personal care. Please see Section E-2- b ii.

Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services. Overlapping of services is avoided by the use of a service worker who manages all services and the entry into the IoWANS system. The service worker is required to check to make sure that EPSDT is used whenever possible for children under the age of 21 before going to waiver services. Where there is a potential for overlap, services must first be exhausted under IDEA or the Rehabilitation Act of 1973.

Consumer-directed attendant care services are service activities performed by a person to help a member with self- care tasks which the member would typically do independently if the member were otherwise able. Consumer- directed attendant care may occur in the member’s home or community.

The service activities may include helping the member with any of the following nonskilled service activities:

Dressing.

Bath, shampoo, hygiene, and grooming.

Access to and from bed or a wheelchair, transferring, ambulation, and mobility in general. It is recommended that the provider receive certification of training and return demonstration for transferring. Certification for this is available through the area community colleges.

Toilet assistance, including bowel, bladder, and catheter assistance. It is recommended that the provider receive certification of training and return demonstration for catheter assistance. Certification for this is available through the area community colleges.

Meal preparation, cooking, eating and feeding but not the cost of meals themselves.

Housekeeping services which are essential to the members health care at home.

Medications ordinarily self-administered including those ordered by a physician or other qualified health care provider. It is recommended the provider successfully complete a medication aide course administered by an area community college.

Wound care.

Assistance needed to go to or return from a place of employment and assistance with job-related tasks while the member is on the job site. The cost of transportation for the member and assistance with understanding or performing the essential job functions are not included in consumer-directed attendant care services.

Cognitive assistance with tasks such as handling money and scheduling.

Fostering communication through interpreting and reading services as well as assistive devices for communication.

Assisting or accompanying a member in using transportation essential to the health and welfare of the member. The cost of the transportation is not included.

A unit of services is 15 minutes. Services are billed in whole units. There are upper rate limits which are subject to change on a yearly basis.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

The first line of prevention of duplicative billing for similar types of services, such as home health aide, is the member’s case manager. The case manager is responsible for the authorization and monitoring of services in a members plan of care. If the case manager authorizes similar services, they are responsible to assure that the services are being delivered as ordered. The IoWANS system generates a review report to assist the case manager. The report identifies all services that have been billed for a specific time period (ex. one month). The case manager is able to view the service billed to the individual member, the amount of the service billed and the provider. The case manager is able to compare what has been billed by the provider to what is ordered in the plan of care. The department also conducts post audit reviews of providers to review the billing of providers to assure that the services provided have documentation to support the billing. Members enrolled in the Physical Disability waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Self-directed personal care services are services that provide a range of assistance in the member’s home or community that they would normally do themselves if they did not have a disability; activities of daily living and incidental activities of daily living that help the person remaining the home and in their community. This assistance may take the form of hands-on assistance (actually performing a task for a person) or cuing to prompt the participant to perform a task. Personal care may be provided on an episodic or on a continuing basis.

These services are only available for those that self-direct. The member will have budget authority over self-directed personal care services. The dollar amount available for this service will be based on the needs identified on the service plan. Overlapping of services is avoided by the use of a case manager who manages all services and the entry into the IoWANS system. The case manager and interdisciplinary team determine which service is necessary and authorize transportation for both HCBS and self-directed services.

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

Individual-directed goods are equipment or supplies not otherwise provided through the Medicaid program that address an assessed need or goal identified in the member’s service plan.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT.

Limits on the amount, duration, or frequency of this service:

Self-directed personal care services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Transportation costs within this service is billed separately and not included in the scope of personal care. Please see Section E-2- b ii. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. They include ongoing supports to member who because of their disabilities, need intensive on-going support to obtain and maintain an individual job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce at or above the state’s minimum wage, at or above the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. These services must be identified in the member’s service plan developed by the member’s service worker. Services may include payment for social skills development, career placement, vocational planning, and independent daily living activity skill development. The outcome of this service is to maintain integrated living in the community or to sustain competitive employment at or above the state’s minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1) incentive payments made to an employer to encourage or subsidize the employer’s participation in supported employment; or 2) payments that are passed through to users of supported employment services.

Transportation may be covered for members from their place of residence and the employment site as a component of this service and the cost may be included in the rate.

The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Work place personal assistance

Members(or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their service worker and independent support broker (ISB) to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

Documentation is maintained in the file of each individual receiving service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C 1401 et seq.). The service worker will monitor the plan.

In order to comply with 42 CFR §441.301(b)(4), this waiver will be amended in the future so that Employment and other Habilitation services will be unbundled into separate standalone services. This amendment will be submitted following the end of the ARPA MOE period but no later than 6/30/2024.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Community support and employment services must be identified on the individual budget plan. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget. The waiver allows for the following five waiver services to be converted to create a CCO budget:

Consumer-directed attendant care (unskilled).

Home and vehicle modification.

Basic individual respite care.

Home delivered meals.

Homemaker services.

A utilization adjustment rate is applied to the individual budget amount. Please see Section E- 2- b ii for details on how the CCO budget is created. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

Transportation services may be provided for members to conduct business errands and essential shopping, to travel to and from work or day programs, and to reduce social isolation. A unit of service is one mile of transportation or one one-way trip. This service is offered in addition to medical transportation required under 42 CFR §431.53 and transportation services under the state plan, defined at 42 CFR §440.170(a), and does not replace them. Transportation services under the waiver are offered in accordance with the participant’s service plan. These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Consumer-directed attendant care (CDAC) services are service activities performed by a person to help a member with self-care tasks which the member would typically do independently if the member were otherwise able. This service may be provided in the private residence. This service is not duplicative of Home Health Aide and is monitored by the case manager as part of inclusion in the member’s plan. CDAC is not duplicative of self-directed personal care services. CDAC–unskilled is one of four AID/HIV waiver services that may be used to create a self- directed budget amount CCO. When CDAC is authorized in the CCO budget, the case manager is responsible to assure that the service needs are being met and there is no duplication of services.

The service activities may include helping the member with any of the following non-skilled service activities:

Dressing.

Bath, shampoo, hygiene, and grooming.

Access to and from bed or a wheelchair, transferring, ambulation, and mobility in general.

Toilet assistance, including bowel, bladder, and catheter assistance.

Meal preparation, cooking, eating and feeding but not the cost of meals themselves.

Housekeeping services which are essential to the member’s health care at home, includes shopping and laundry.

Medications ordinarily self-administered including those ordered by a physician or other qualified health care provider.

Wound care.

Assistance needed to go to or return from a place of employment and assistance with job related tasks while the member is on the job site. The cost of transportation for the member and assistance with understanding or performing the essential job functions are not included in member directed attendant care services.

Tasks such as financial management and scheduling that require cognitive or physical assistance.

Communication essential to the health and welfare of the member, through interpreting and reading services and use of assistive devises for communication.

Using transportation essential to the health and welfare of the member. The cost of the transportation is not included.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

A unit of service is 15 minutes provided by an individual or an agency.

Each service shall be billed in whole units.

CDAC may be provided to a recipient of in-home health related care services, but not at the same time. There is an upper limit for both agency and individual providers. These are subject to change on a yearly basis.

d. The member, parent, guardian, or attorney in fact under a durable power of attorney for health care shall be responsible for selecting the person or agency who will provide the components of the attendant care services to be provided.

e. The member, parent, guardian, or attorney in fact under a durable power of attorney for health care shall determine the components of the attendant care services to be provided with the person who is providing the services to the member.

These services may not duplicate services provided under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).

The services under the AIDS/HIV waiver are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Members enrolled in the waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. These services must be identified in the member’s service plan developed by the member’s case manager. Services may include payment for social skills development, career placement, vocational planning, and independent daily living activity skill development. The outcome of this service is to maintain integrated living in the community or to sustain competitive employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1) incentive payments made to an employer to encourage or subsidize the employer’s participation in supported employment; or 2) payments that are passed through to users of supported employment services.

Transportation may be covered for members from their place of residence and the employment site as a component of this service and the cost may be included in the rate.

The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Workplace personal assistance

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Community support and employment services must be identified on the individual budget plan. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget. The AIDS/HIV waiver allows for the following four waiver services to be converted to create a CCO budget:

Consumer-directed attendant care (unskilled).

Home-delivered meals.

Homemaker service.

Basic individual respite care.

Once authorized in the monthly CCO budget, the member must use the budget to get their assessed needs met. It is the responsibility of the member’s case manager or community-based case manager to monitor the member’s CCO use to assure that the member is using the budget to get their service needs met.

Self-Directed Community Support and Employment do not included or duplicate services provided via the Rehabilitation Act of 1973 or IDEA.

Members enrolled in the waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Self-directed personal care services are services and/or goods that provide a range of assistance in the member’s home or community that they would normally do themselves if they did not have a disability; activities of daily living and incidental activities of daily living that help the person remaining the home and in their community. This assistance may take the form of hands-on assistance (actually performing a task for a person) or cuing to prompt the participant to perform a task. Personal care may be provided on an episodic or on a continuing basis.

The member will have budget authority over self-directed personal care services. The dollar amount available for this service will be based on the needs identified on the service plan. Overlapping of services is avoided by the use of a case manager who manages all services and the entry into the IoWANS system. The case manager and interdisciplinary team determine which service is necessary and authorize transportation for both HCBS and self- directed services.

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Self-directed personal care services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Transportation costs within this service is billed separately and not included in the scope of personal care. Please see Section E-2- b ii. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

The services under the AIDS/HIV Waiver are limited to the additional services not otherwise covered under the state plan, including EPSDT, but consistent with the waiver objectives of avoiding institutionalization.

Members enrolled in the waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Consumer-directed attendant care services are service activities performed by a person to help a member with self- care tasks which the member would typically do independently if the member were otherwise able. This service may be provided in the private residence or assisted living. This service is not duplicative of Home Health Aide or Homemaker services; and is monitored by the case manager, CBCM, or integrated health home care coordinator as part of inclusion in the member’s plan. The service activities may include helping the member with any of the following non-skilled service activities:

Dressing.

Bath, shampoo, hygiene, and grooming.

Access to and from bed or a wheelchair, transferring, ambulation, and mobility in general.

Toilet assistance, including bowel, bladder, and catheter assistance.

Meal preparation, cooking, eating and feeding but not the cost of meals themselves.

Housekeeping services which are essential to the members health care at home, includes shopping and laundry.

Medications ordinarily self-administered including those ordered by a physician or other qualified health care provider.

Wound care.

Assistance needed to go to or return from a place of employment and assistance with job related tasks while the member is on the job site. The cost of transportation for the member and assistance with understanding or performing the essential job functions are not included in member directed attendant care services.

Tasks such as financial management and scheduling that require cognitive or physical assistance.

Communication essential to the health and welfare of the member, through interpreting and reading services and use of assistive devises for communication.

Using transportation essential to the health and welfare of the member. The cost of the transportation is not included.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

A unit of service is 15-minutes. The member’s plan of care will address how the member’s health care needs are being met. The case manager, CBCM, or integrated health home care coordinator will monitor the plan.

Members enrolled in the Elderly waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Supported Employment-Individual Employment Support services are the ongoing support to members who, because of their disabilities, need intensive on-going support to obtain and maintain an individual job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce at or above the state’s minimum wage, at or above the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

The outcome of this service is sustained paid employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.

Supported employment services can be provided through many different service models. Some of these models can include evidence-based supported employment for individuals with mental illness, or customized employment for individuals with significant disabilities.

Supported employment individual employment supports may also include support to establish or maintain self- employment, including home-based self- employment. Supported employment services are individualized and may include any combination of the following services: vocational/job –related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, job carving, training and systematic instruction, job coaching , benefits and work-incentives planning and management, transportation, asset development and career advancement services. Other workplace support services including services not specifically related to job skill training that enable the waiver participant to be successful in integrating into the job setting.

Documentation is maintained in the file of each member receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA ( 20 U.S.C. 1401 et seq.)

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses, such as the following:

Incentive payments made to an employer to encourage or subsidize the employer’s participation in supported employment; or

Payments that are passed through to users of supported employment services.

Self-directed community supports and employment are services must be identified in the member’s service plan developed by the member’s case manager or CBCM. Transportation may be covered for members from their place of residence and the employment site as a component of this service and the cost may be included in the rate. The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Work place personal assistance

Members (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Members or their guardians must review all timecards to ensure accuracy and work with their case manager, CBCM, and ISB to budget services. If a member is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

In order to comply with 42 CFR §441.301(b)(4), this waiver will be amended in the future so that Employment and other Habilitation services will be unbundled into separate standalone services. This amendment will be submitted following the end of the ARPA MOE period but no later than 6/30/2024.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Community support and employment services must be identified on the individual budget plan. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget. The elderly waiver allows for the following waiver services to be converted to create a CCO budget:

Consumer-directed attendant care (unskilled).

Assistive devices

Home and vehicle modification.

Chore Service

Basic individual respite care.

Home delivered meals

Homemaker service

Transportation

Senior companion

A utilization adjustment rate is applied to the individual budget amount. Please see Section E- 2- b ii for details on how the CCO budget is created. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

Members enrolled in the waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Self-directed personal care services are services that provide a range of assistance in the member’s home or community; activities of daily living and incidental activities of daily living that help the person remain in the home and in their community. Individual-directed goods are equipment or supplies not otherwise provided through the Medicaid program that address an assessed need or goal identified in the member’s service plan. Self-directed personal care services are services and/or goods that provide a range of assistance in the member’s home or community that they would normally do themselves if they did not have a disability; activities of daily living and incidental activities of daily living that help the person remaining the home and in their community. This assistance may take the form of hands-on assistance (actually performing a task for a person) or cueing to prompt the participant to perform a task. Personal care may be provided on an episodic or on a continuing basis.

The member will have budget authority over self-directed personal care services. The dollar amount available for this service will be based on the needs identified on the service plan. Overlapping of services is avoided by the use of a DHS TCM or MCO CBCM who manages all services and includes into the members’ service plans. The DHS TCM or the MCO CBCM and interdisciplinary team determine which services are necessary and authorize transportation for both HCBS and self-directed services.

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their TCM or CBCM and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Self-directed personal care services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Transportation costs within this service is billed separately and not included in the scope of personal care. Please see Section E-2- b ii. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services.

Members enrolled in the waiver have access to Iowa’s Medicaid Exception to Policy (ETP) option. ETPs can be requested to Iowa Administrative Code (IAC) rules but cannot be requested for Federal requirements or state law. Members needing additional services in order to ensure health, safety, or other issues can request ETPs. The request must substantiate the exceptional need and also address why no other Medicaid or waiver service can address the issue. Decisions regarding ETP requests are approved by the Department of Health and Human Services director.

Transportation services are also available under this waiver to support access to community activities as identified through the individual’s person-centered plan.

Services designed to assist participants in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings.

Components of this service include the following:

Day Habilitation means services that provide opportunities and support for community inclusion and build interest in and develop skills for active participation in recreation, volunteerism and integrated community employment. Day habilitation provides assistance with acquisition, retention, or improvement of socialization, community participation, and daily living skills.

Scope. Day habilitation activities and environments are designed to foster the acquisition of skills, positive social behavior, greater independence, and personal choice. Services focus on supporting the member to participate in the community, develop social roles and relationships, and increase independence and the potential for employment. Services are designed to assist the member to attain or the member’s individual goals as identified in the member’s comprehensive service plan. Services may also provide wraparound support secondary to community employment. Day habilitation activities may include:

Identifying the member’s interests, preferences, skills, strengths and contributions,

Identifying the conditions and supports necessary for full community inclusion and the potential for competitive integrated employment,

Planning and coordination of the member’s individualized daily and weekly day habilitation schedule,

Developing skills and competencies necessary to pursue competitive integrated employment

Participating in community activities related to hobbies, leisure, personal health, and wellness,

Participating in community activities related to cultural, civic, and religious interests,

Participating in adult learning opportunities,

Participating in volunteer opportunities,

Training and education in self-advocacy and self-determination to support the member’s ability to make informed choices about where to live, work, and recreate,

Assistance with behavior management and self-regulation,

Use of transportation and other community resources,

Assistance with developing and maintaining natural relationships in the community,

Assistance with identifying and using natural supports,

Assistance with accessing financial literacy and benefits education,

Other day habilitation activities deemed necessary to assist the member with full participation in the community.

Family training option. Day habilitation services may include training families in treatment and support methodologies or in the care and use of equipment. Family training may be provided in the member’s home. The unit of service is 15 minutes.

Expected outcome of service. The expected outcome of day habilitation services is active participation in the community in which the member lives, works, and recreates. Members are expected to have opportunities to interact with individuals without disabilities in the community, other than those providing direct services, to the same extent as individuals without disabilities.

Setting. Day habilitation shall take place in community-based, nonresidential settings separate from the member’s residence. Family training may be provided in the member’s home.

Duration. Day habilitation services shall be furnished for four or more hours per day on a regularly scheduled basis for one or more days per week or as specified in the member’s comprehensive service plan. Meals provided as part of day habilitation shall not constitute a full nutritional regimen (three meals per day).

Concurrent services. A member’s comprehensive service plan may include two or more types of nonresidential habilitation services (e.g., day habilitation, individual supported employment, long-term job coaching, small-group supported employment, and prevocational services). However, more than one service may not be billed during the same period of time (e.g., the same hour).

Transportation. When transportation is provided to the day habilitation service location from the member’s home and from the day habilitation service location to the member’s home, the day habilitation provider may bill for the time spent transporting the member.

A unit of service may be a 15-minute unit or a full day (4.25 to 8 hours). For the family training option, a unit of service is a 15-minute unit.

Meals provided as part of this service shall not constitute a full nutritional regimen of 3 meals per day. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget.

Exclusions. Day habilitation payment shall not be made for the following:

(1) Vocational or prevocational services. Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Documentation that funding is not available to the individual for the service under these programs shall be maintained in the service plan of each member receiving day habilitation services.

(2) Compensation to members for participating in day habilitation services.

(3) Support for members volunteering in for-profit organizations and businesses.

(4) Support for members volunteering to benefit the day habilitation service provider

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

The units of family training option services are limited to a maximum of 40, 15-minute units per month. If additional family training service units are needed, an exception to policy (ETP) may be requested by the member, case manager or community-based case manager. An ETP requires the Department to review and prior authorization any additional services above the 40 units. .

“Prevocational services” means services that provide career exploration, learning and work experiences, including volunteer opportunities, where the member can develop non-job-task-specific strengths and skills that lead to paid employment in individual community settings.

Scope. Prevocational services are provided to persons who are expected to be able to join the general workforce with the assistance of supported employment. Prevocational services are intended to develop and teach general employability skills relevant to successful participation in individual employment. These skills include but are not limited to the ability to communicate effectively with supervisors, coworkers and customers; an understanding of generally accepted community workplace conduct and dress; the ability to follow directions; the ability to attend to tasks; workplace problem-solving skills and strategies; general workplace safety and mobility training; the ability to navigate local transportation options; financial literacy skills; and skills related to obtaining employment.

Prevocational services include career exploration activities to facilitate successful transition to individual employment in the community. Participation in prevocational services is not a prerequisite for individual or small- group supported employment services.

Career exploration. Career exploration activities are designed to develop an individual career plan and facilitate the member’s experientially based informed choice regarding the goal of individual employment. Career exploration may be authorized for up to 34 hours, to be completed over 90 days in the member’s local community or nearby communities and may include but is not limited to the following activities:

Meeting with the member, and their family, guardian or legal representative to introduce them to supported employment and explore the member’s employment goals and experiences

business tours,

informational interviews,

job shadows,

benefits education and financial literacy,

assistive technology assessment, and

other job exploration events.

Expected outcome of service.

1. The expected outcome of prevocational services is individual employment in the general workforce, or self- employment, in a setting typically found in the community, where the member interacts with individuals without disabilities, other than those providing services to the member or other individuals with disabilities, to the same extent that individuals without disabilities in comparable positions interact with other persons; and for which the member is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

2. The expected outcome of the career exploration activity is a written career plan that will guide employment services which lead to community employment or self-employment for the member.

Setting. Prevocational services shall take place in community-based nonresidential settings.

Concurrent services. A member’s individual service plan may include two or more types of nonresidential habilitation services (e.g., individual supported employment, long-term job coaching, small-group supported employment, prevocational services, and day habilitation); however, more than one service may not be billed during the same period of time (e.g., the same hour).

Transportation provided as a component of prevocational services and the cost of transportation is included in the rate paid to providers of prevocational services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

A unit of service is one hour.

Exclusions. Prevocational services payment shall not be made for the following:

Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Documentation that funding is not available to the individual for the service under these programs shall be maintained in the service plan of each member receiving prevocational services.

Services available to the individual that duplicate or replace education or related services defined in the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

Compensation to members for participating in prevocational services.

Support for members volunteering in for-profit organizations and businesses other than for-profit organizations, or businesses that have formal volunteer programs in place (e.g. hospitals, nursing homes), and support for members volunteering to benefit the service provider is prohibited.

The provision of vocational services delivered in facility-based settings where individuals are supervised for the primary purpose of producing goods or performing services or where services are aimed at teaching skills for specific types of jobs rather than general skills.

A prevocational service plan with the goal or purpose of the service documented as maintaining or supporting the individual in continuing prevocational services or any employment situation similar to sheltered employment.

Limits on the amount, duration, or frequency of this service:

Limitations.

Time limitation for members starting prevocational services. For members starting prevocational services after May 4, 2016, participation in these services is limited to 24 calendar months. This time limit can be extended to continue beyond 24 months if one or more of the following conditions apply:

The member who is in Prevocational Services is also working in either individual or small group community employment for at least the number of hours per week desired by the member, as identified in the member’s current service plan; or

The member who is in Prevocational Services is also working in either individual or small group community employment for less than the number of hours per week the member wants, as identified in the member’s current service plan, but the member has services documented in his/her current service plan, or through another identifiable funding source (e.g. IVRS), to increase the number of hours the member is working in either individual or small group community employment; or

The member is actively engaged in seeking individual or small group community employment or individual self- employment, and services for this are included in his/her current service plan, or services funded through another identifiable funding source (e.g. IVRS) are documented in the member’s service plan; or

The member has requested supported employment services from Medicaid and IVRS in the past 24 months and has been denied and/or placed on a waiting list by both Medicaid and IVRS; or

The member has been receiving Individual Supported Employment service (or comparable services available through IVRS) for at least 18 months without obtaining seeking individual or small group community employment or individual self-employment.

The member is participating in career exploration activities

(2) Time limitation for members enrolled in prevocational services. For members enrolled in prevocational services on or before May 4, 2016, participation in these services is limited to 90 business days beyond the completion of the career exploration activity including the development of the career plan This time limit can be extended as stated in paragraphs “1” through “6.” If the criteria in paragraphs 1” through “6” do not apply, the member will not be reauthorized to continue prevocational services.

Individual supported employment (SE) services are services provided to, or on behalf of, the member that enable the member to obtain and maintain an individual job in competitive employment, customized employment or self- employment in an integrated work setting in the general workforce.

The expected outcome of this service is sustained employment, or self-employment, paid at or above the minimum wage or the customary wage and level of benefits paid by an employer, in an integrated setting in the general workforce, in a job that meets personal and career goals. Successful transition to long-term job coaching, if needed, is also an expected outcome of this service. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time.

Individual SE services shall take place in integrated work settings. For self-employment, the member’s home can be considered an integrated work setting. Employment in the service provider’s organization (not including a sheltered workshop or similar type of work setting where members are paid for the production of goods or services) can be considered employment in an integrated work setting in the general workforce if the employment occurs in a work setting where interactions are predominantly with coworkers or business associates who do not have disabilities or with the general public.

Individual employment strategies include but are not limited to: customized employment, individual placement and support, and supported self-employment. Service activities are individualized and may include any combination of the following:

Benefits education

Career exploration (e.g., tours, informational interviews, job shadows).

Employment assessment.

Assistive technology assessment.

Trial work experience.

Person-centered employment planning.

Development of visual/traditional résumés.

Job-seeking skills training and support.

Outreach to prospective employers on behalf of the member (e.g., job development; negotiation with prospective employers to customize, create or carve out a position for the member; employer needs analysis).

Job analysis (e.g., work site assessment or job accommodations evaluation).

Identifying and arranging transportation.

Career advancement services (e.g., assisting a member in making an upward career move or seeking promotion from an existing employer).

Re-employment services (if necessary due to job loss).

Financial literacy and asset development.

Other employment support services deemed necessary to enable the member to obtain employment.

Systematic instruction and support during initial on-the-job training including initial on the job training to stabilization.

Engagement of natural supports during initial period of employment.

Implementation of assistive technology solutions during initial period of employment.

Transportation of the member during service hours.

Self-employment. Individual employment may also include support to establish a viable self-employment opportunity, including home- based self-employment. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time. In addition to the activities listed assistance to establish self-employment may include:

Aid to the member in identifying potential business opportunities.

Assistance in the development of a business plan, including identifying potential sources of business financing and other assistance in developing and launching a business.

Identification of the long-term supports necessary for the individual to operate the business.

Long-term job coaching is support provided to, or on behalf of, the member that enables the member to maintain an individual job in competitive employment, customized employment or self-employment in an integrated work setting in the general workforce.

Scope. Long-term job coaching services are provided to or on behalf of members who need support because of their disabilities and who are unlikely to maintain and advance in individual employment absent the provision of supports. Long-term job coaching services shall provide individualized and ongoing support contacts at intervals necessary to promote successful job retention and advancement.

The expected outcome of this service is sustained employment paid at or above the minimum wage in an integrated setting in the general workforce, in a job that meets the member’s personal and career goals. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time.

Setting. Long-term job coaching services shall take place in integrated work settings. For self-employment, the member’s home can be considered an integrated work setting. Employment in service provider’s organization (not including a sheltered workshop or similar type of work setting) can be considered employment in an integrated work setting in the general workforce if the employment occurs in a work setting where interactions are predominantly with coworkers or business associates who do not have disabilities, or with the general public, and if the position would exist within the provider’s organization were the provider not being paid to provide the job coaching to the member.

Service activities. Long-term job coaching services are designed to assist the member with learning and retaining individual employment, resulting in workplace integration, and which allows for the reduction of long-term job coaching over time. Services are individualized and service plan are adjusted as support needs change and may include any combination of the following activities with or on behalf of the member:

Job analysis.

Job training and systematic instruction.

Training and support for use of assistive technology/adaptive aids.

Engagement of natural supports.

Transportation coordination.

Job retention training and support.

Benefits education and ongoing support.

Supports for career advancement.

Financial literacy and asset development.

Employer consultation and support.

Negotiation with employer on behalf of the member (e.g., accommodations; employment conditions; access to natural supports; and wage and benefits).

Other workplace support services may include services not specifically related to job skill training that enable the waiver member to be successful in integrating into the job setting.

Transportation of the member during service hours.

Career exploration services leading to increased hours or career advancement.

Self-employment long-term job coaching. Self-employment long-term job coaching may include support to maintain a self-employment opportunity, including home-based self-employment. In addition to the activities listed under subparagraph 78.27(10)“b”(4), assistance to maintain self-employment may include:

Ongoing identification of the supports necessary for the individual to operate the business;

Ongoing assistance, counseling and guidance to maintain and grow the business; and

Ongoing benefits education and support.

The hours of support tier assignment for long-term job coaching is based on the identified needs of the member as documented in the member’s comprehensive service plan and adjusted when higher support needs are determined.

Small-group SE services are training and support activities provided in regular business or industry settings for groups of two to eight workers with disabilities. The outcome of this service is sustained paid employment experience, skill development, career exploration and planning leading to referral for services to obtain individual integrated employment or self-employment for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

Small-group SE services must be provided in a manner that promotes integration into the workplace and interaction between members and people without disabilities (e.g., customers, coworkers, natural supports) in those workplaces. Examples include but are not limited to mobile crews and other business-based workgroups employing small groups of workers with disabilities in employment in integrated business settings; and small-group activities focused on career exploration, or development of strengths and skills that contribute to successful participation in individual community employment.

Expected outcome of service. Small-group SE services are expected to enable the member to make reasonable and continued progress toward individual employment. Participation in small-group SE services is not a prerequisite for individual SE services. The expected outcome of the service is sustained paid employment and skill development which leads to individual employment in the community.

Setting. Small-group SE services shall take place in integrated, community-based nonresidential settings separate from the member’s residence.

Service activities. Small-group SE services may include any combination of the following activities:

1.Employment assessment.

Person-centered employment planning.

Job placement (limited to service necessary to facilitate hire into individual employment paid at minimum wage or higher for a member in small-group SE who receives an otherwise unsolicited offer of a job from a business where the member has been working in a mobile crew or enclave).

Job analysis.

On-the-job training and systematic instruction.

Job coaching.

Transportation planning and training.

Benefits education.

Career exploration services leading to career advancement outcomes.

Other workplace support services may include services not specifically related to job skill training that enable the waiver member to be successful in integrating into the individual or community setting.

Transportation of the member during service hours.

Providers delivering this service via the Telehealth service delivery option must demonstrate policies and procedures that include:

•HIPAA compliant platforms;

•Client support given when client needs include: accessibility, translation, or limited auditory or visual capacities are present;

•Have a contingency plan for provision of services if technology fails;

•Professionals do not practice outside of their respective scope; and

•Assessment of clients and caregivers that identifies a client’s ability to participate in and outlines any accommodations needed while using Telehealth.

•In-person contact is not required as a prerequisite for payment.”

Telehealth is an available service delivery modality when the member chooses to receive their services via telehealth and the service modality is clinically appropriate to the member’s assessed needs.

“Telehealth” means the delivery of SE services through the use of real-time interactive audio and video, or other real-time interactive electronic media, regardless of where the health care professional and the covered person are each located. “Telehealth” does not include the delivery of health care services delivered solely through an audio- only telephone, electronic mail message, or facsimile transmission.

Services delivered via telehealth will be delivered in a setting/location that protects the waiver participants privacy and therefore not permitted to be delivered in settings such as bathrooms.

Limits on the amount, duration, or frequency of this service:

A unit of service for Individual Supported Employment is 15 minutes

A unit of service for Small group Employment is 15 minutes

A unit of service for Long-Term Job Coaching is a monthly unit of service. The hours of support tier assignment for long-term job coaching is based on the identified needs of the member as documented in the member’s comprehensive service plan and adjusted when higher support needs are determined based on the hours of support the member requires each month.

Service requirements for all supported employment

Community transportation options (e.g., transportation provided by family, coworkers, carpools, volunteers, self or public transportation) shall be identified by the member’s interdisciplinary team and utilized before the service provider provides the transportation to and from work for the member. If none of these options are available to a member, transportation between the member’s place of residence and the employment or service location may be included as a component part of supported employment services.

Personal care or personal assistance and protective oversight may be a component part of supported employment services, but may not comprise the entirety of the service.

Activities performed on behalf of a member receiving long-term job coaching or individual or small-group supported employment shall not comprise the entirety of the service.

Concurrent services. A member’s individual service plan may include two or more types of nonresidential services (e.g., individual supported employment, long-term job coaching, small-group supported employment, prevocational services, and day habilitation); however, more than one service may not be billed during the same period of time (e.g., the same hour).

Integration requirements. In the performance of job duties, the member shall have regular contact with other employees or members of the general public who do not have disabilities, unless the absence of regular contact with other employees or the general public is typical for the job as performed by persons without disabilities.

Compensation. Members receiving these services are compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. For supported self-employment, the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time. For small-group supported employment, if the member is not compensated at or above minimum wage, the compensation to the member shall be in accordance with all applicable state and federal labor laws and regulations.

Limitations. Supported employment services are limited as follows:

In the ID waiver, the total monthly cost of all supported employment services may not exceed $3,029.00 per month.

Individual supported employment is limited to 240 units per calendar year.

Long-term job coaching is limited in accordance with 441—subrule 79.1(2). which states that the total monthly cost for all supported employment services not to exceed $3,059.29 per month.

Exclusions. Supported employment services payments shall not be made for the following:

Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Documentation that the service is not available to the individual under these programs shall be maintained in the service plan of each member receiving individual supported employment or long-term job coaching services.

Incentive payments, not including payments for coworker supports, made to an employer to encourage or subsidize the employer’s participation in a supported employment program.

Subsidies or payments that are passed through to users of supported employment programs.

Training that is not directly related to a member’s supported employment program.

Services involved in placing and stabilizing members in day activity programs, work activity programs, sheltered workshop programs or other

similar types of vocational or prevocational services furnished in specialized facilities that are not a part of the general workplace.

Supports for placement and stabilization in volunteer positions or unpaid internships. Such volunteer learning and unpaid training

activities that prepare a person for entry into the general workforce are addressed through prevocational services and career exploration activities.

Tuition for education or vocational training.

Individual advocacy that is not related to integrated individual employment participation or is not member-specific.

Medicaid funds may not be used to defray the expenses associated with starting up or operating a business.

For member’s choosing the Consumer Choices Option, the individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget.

Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. These services must be identified in the member’s service plan developed by the member’s case manager. Services may include payment for social skills development, career placement, vocational planning, and independent daily living activity skill development. The outcome of this service is to maintain integrated living in the community or to sustain competitive employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1) incentive payments made to an employer to encourage or subsidize the employer’s participation in supported employment; or 2) payments that are passed through to users of supported employment services.

Transportation may be covered for members from their place of residence and the employment site as a component of this service and the cost may be included in the rate.

The following are examples of supports a member can purchase to help the member live and work in the community:

Career counseling

Career preparation skills development

Cleaning skills development

Cooking skills development

Grooming skills development

Job hunting and career placement

Personal and home skills development

Safety and emergency preparedness skills development

Self-direction and self-advocacy skills development

Social skills development training

Supports to attend social activities

Supports to maintain a job

Time and money management

Training on use of medical equipment

Utilization of public transportation skills development

Workplace personal assistance

Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Community support and employment services must be identified on the individual budget plan. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget. The ID waiver allows for the following eight ID waiver services to be converted to create a CCO budget:

Consumer-directed attendant care (unskilled).

Day habilitation.

Home and vehicle modification.

Prevocational services.

Basic individual respite care.

Supported community living.

Supported employment.

Transportation.

Once authorized in the monthly CCO budget, the member must use the budget to get their assessed needs met. It is the responsibility of the member’s case manager or community-based case manager to monitor the member’s CCO

use to assure that the member is using the budget to get their service needs met.

Self-directed personal care services are services and/or goods that provide a range of assistance in the member’s home or community that they would normally do themselves if they did not have a disability; activities of daily living and incidental activities of daily living that help the person remaining the home and in their community. This assistance may take the form of hands-on assistance (actually performing a task for a person) or cuing to prompt the participant to perform a task. Personal care may be provided on an episodic or on a continuing basis. The member will have budget authority over self-directed personal care services. The dollar amount available for this service will be based on the needs identified on the service plan. Overlapping of services is avoided by the use of a case manager who manages all services and the entry into the IoWANS system. The case manager and interdisciplinary team determine which service is necessary and authorize transportation for both HCBS and self-directed services. Participants (or guardians) who have chosen the self-direction program must be willing to take on the responsibility of employee supervision and training. Participants or their guardians must review all time cards to ensure accuracy and work with their case manager and ISB to budget services. If a participant is not satisfied with the work of their employee, they have full authority to terminate them as a provider of services. These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

Self-directed personal care services need to be identified on the individual budget plan. The individual budget limit will be based on the service plan and the need for the services available to be converted. A utilization adjustment rate will be applied to the individual budget amount. Transportation costs within this service is billed separately and not included in the scope of personal care. Please see Section E-2- b ii. Authorization of this service must be made after assuring that there is no duplication or overlapping of state plan services. The services under the Intellectual Disability Waiver are limited to the additional services not otherwise covered under the state plan, including EPSDT, but consistent with the waiver objectives of avoiding institutionalization.

Consumer-directed attendant care (CDAC) services are service activities performed by a person to help a member with self-care tasks which the member would typically do independently if the member were otherwise able. This service may be provided in the private residence. This service is not duplicative of Home Health Aide and is monitored by the case manager as part of inclusion in the member’s plan. CDAC is not duplicative of self-directed personal care services. CDAC–unskilled is one of eight ID waiver services that may be used to create a self-directed budget amount CCO. When CDAC is authorized in the CCO budget, the case manager is responsible to assure that the service needs are being met and there is no duplication of services.

The service activities may include helping the member with any of the following non-skilled service activities:

Dressing.

Bath, shampoo, hygiene, and grooming.

Access to and from bed or a wheelchair, transferring, ambulation, and mobility in general.

Toilet assistance, including bowel, bladder, and catheter assistance.

Meal preparation, cooking, eating and feeding but not the cost of meals themselves.

Housekeeping services which are essential to the member’s health care at home, includes shopping and laundry.

Medications ordinarily self-administered including those ordered by a physician or other qualified health care provider.

Wound care.

Assistance needed to go to or return from a place of employment and assistance with job related tasks while the member is on the job site. The cost of transportation for the member and assistance with understanding or performing the essential job functions are not included in member directed attendant care services.

Tasks such as financial management and scheduling that require cognitive or physical assistance.

Communication essential to the health and welfare of the member, through interpreting and reading services and use of assistive devises for communication.

Using transportation essential to the health and welfare of the member. The cost of the transportation is not included.

Self-directed services allows a member to manage and direct services to meet their assessed needs. The needs are identified through the authorization of a waiver service. The authorized service is converted to a monthly budget. The budget is used to purchase optional services through the CCO program. CCO services do not duplicate waiver services, but rather are designed to meet the needs of the authorized service. They are provided to meet the same need, but with CCO the service is called self-directed personal care and not CDAC – unskilled.

These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Limits on the amount, duration, or frequency of this service:

A unit of service is 15-minutes. The member’s plan of care will address how the member’s health care needs are being met. The case manager will monitor the plan. The individual budget limit will be based on the member’s authorized service plan and the need for the services available to be converted to the CCO budget. CDAC services, unskilled, may be authorize in a member’s service plan in conjunction with other self-direction services but must not be duplicative of the amount, duration, and scope of authorized personal care services in the service plan.

Transportation services are also available under this waiver to support access to community activities as identified through the individual’s person-centered plan.

Services designed to assist participants in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings.

Components of this service include the following:

1) Home-based Habilitation means individually tailored supports that assist with the acquisition, retention, or improvement in skills related to living, working and recreating in the community. Home-based habilitation services are individualized supportive services provided in the member’s home and community that assist the member to reside in the most integrated setting appropriate to the member’s needs. Services are intended to provide for the daily living needs of the member and shall be available as needed during any 24-hour period. The specific support needs for each member shall be determined necessary by the interdisciplinary team and shall be identified in the member’s comprehensive service plan.

Covered supports include: 1 ) Adaptive skill development; 2) Assistance with activities of daily living to address daily living needs; 3) Assistance with symptom management and participation in mental health treatment; 4) Assistance with accessing physical and mental health care treatment, communication, and implementation of health care recommendations and treatment; 5) Assistance with accessing and participating in substance use disorder treatment and services; 6) Assistance with medication administration and medication management; 7) Assistance with understanding communication whether verbal or written; 8) Community inclusion and active participation in the community; 9) Transportation; 10) Adult educational supports, which may include assistance and support with enrolling in educational opportunities and participation in education and training; 11) Social and leisure skill development; 12) Personal care; and 13) Protective oversight and supervision.

Setting requirements.

Home-based habilitation services shall occur in the member’s home and community.

1) A member may live in the member’s own home, within the home of the member’s family or legal representative, or in another community living arrangement that meets the criteria in 441-subrule 77.25(5).

2) A member living with the member’s family or legal representative is not subject to the criteria in 441-paragraphs 77 .25(8) “c” and 77 .25(8) “d .”

3) A member may not reside in a licensed medical or health care facility or in a setting that is required to be licensed as a medical or health care facility.

2. Day Habilitation means services that provide opportunities and support for community inclusion and build interest in and develop skills for active participation in recreation, volunteerism and integrated community employment. Day habilitation provides assistance with acquisition, retention, or improvement of socialization, community participation, and daily living skills.

Scope. Day habilitation activities and environments are designed to foster the acquisition of skills, positive social behavior, greater independence, and personal choice. Services focus on supporting the member to participate in the community, develop social roles and relationships, and increase independence and the potential for employment. Services are designed to assist the member to attain or the member’s individual goals as identified in the member’s comprehensive service plan. Services may also provide wraparound support secondary to community employment. Day habilitation activities may include: ( 1) Identifying the member’s interests, preferences, skills, strengths and contributions, (2) Identifying the conditions and supports necessary for full community inclusion and the potential for competitive integrated employment, (3) Planning and coordination of the member’s individualized daily and weekly day habilitation schedule, ( 4) Developing skills and competencies necessary to pursue competitive integrated employment\ (5) Participating in community activities related to hobbies, leisure, personal health, and wellness, (6) Participating in community activities related to cultural, civic, and religious interests, (7) Participating in adult learning opportunities, (8) Participating in volunteer opportunities, (9) Training and education in self-advocacy and self-determination to support the member’s ability to make informed choices about where to live, oork, and recreate, ( 10) Assistance with behavior management and self-regulation, (11) Use of transportation and other community resources, (12)Assistance with developing and maintaining natural relationships in the community, (13)Assistance with identifying and using natural supports, (14)Assistance with accessing financial literacy and benefits education, ( 15) Other activities deemed necessary to assist the member with full participation in the community

Family training option. Day habilitation services may include training families in treatment and support methodologies or in the care and use of equipment. Family training may be provided in the member’s home. The unit of service is 15 minutes. The units of services payable are limited to a maximum of 40 units per month.

Expected outcome of service. The expected outcome of day habilitation services is active participation in the community in which the member lives, works, and recreates. Members are expected to have opportunities to interact with individuals without disabilities in the community, other than those providing direct services, to the same extent as individuals without disabilities.

Setting. Day habilitation shall take place in community-based, nonresidential settings separate from the member’s residence. Family training may be provided in the member’s home.

Duration. Day habilitation services shall be furnished for four or more hours per day on a regularly scheduled basis for one or more days per week or as specified in the member’s comprehensive service plan. Meals provided as part of day habilitation shall not constitute a full nutritional regimen (three meals per day). Unit of service. A unit of day habilitation is 15 minutes (up to 16 units per day) or a full day (4.25 to 8 hours).

Concurrent services. A member’s comprehensive service plan may include too or more types of nonresidential habilitation services (e.g., day habilitation, individual supported employment, long-term job coaching, small-group supported employment, and prevocational services). However, more than one service may not be billed during the same period of time (e.g., the same hour).

Transportation. When transportation is provided to the day habilitation service location from the member’s home and from the day habilitation service location to the member’s home, the day habilitation provider may bill for the time spent transporting the member.

3) Prevocational services means services that provide career exploration, learning and work experiences, including volunteer opportunities, where the member can develop non-job-task specific strengths and skills that lead to paid employment in individual community settings.

Prevocational services are provided to persons who are expected to be able to join the general workforce vvith the assistance of supported employment. Prevocational services are intended to develop and teach general employability skills relevant to successful participation in individual employment. These skills include but are not limited to: • The ability to communicate effectively with supervisors, coworkers and customers, • An understanding of generally accepted community workplace conduct and dress, • The ability to follow directions, • The ability to attend to tasks, • Workplace problem-solving skills and strategies, • General workplace safety and mobility training, • The ability to navigate local transportation options, • Financial literacy skills, and • Skills related to obtaining employment.

Prevocational services include career exploration activities to facilitate successful transition to individual employment in the community. Participation in prevocational services is not a prerequisite for individual or small-group supported employment services.

Career Exploration Career exploration activities are designed to develop an individual career plan and facilitate the member’s experientially-based informed choice regarding the goal of individual employment. Career exploration may be provided in small groups of no more than four members to participate in career exploration activities that include: • Business tours • Attending industry education events • Benefit information • Financial literacy classes • Attending career fairs

The expected outcome of Career Exploration is a documented Career Plan that will inform the member’s employment service planning going forward.

The expected outcome of prevocational services is individual employment in the general workforce, or self-employment, in a setting typically found in the community, where the member interacts with individuals without disabilities, other than those providing services to the member or other individuals with disabilities, to the same extent that individuals without disabilities in comparable positions interact with other persons; and for which the member is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities

Setting. Prevocational services shall take place in community-based nonresidential settings.

Concurrent Services. A member’s individual service plan may include tv,,o or more types of nonresidential habilitation services (e.g., individual supported employment long-term job coaching, small-group supported employment, prevocational services, and day habilitation). More than one service may not be billed during the same period of time (e.g., the same hour).

Prevocational Service Requirements

To participate in prevocational services:

(1) Member must be at least 16 years of age.

(2) The services must not be available to the member through one of the following: 1. Special education and related services as defined in the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.); or 2. A program funded under Section 110 of the Rehabilitation Act of 1973 (29 U.S.C. 730).

(3) Have documented in the waiver service plan a goal to achieve or to sustain individual employment.

(4) Have documented in the waiver service plan that the choice to receive individual supported employment services was offered and explained in a manner sufficient to

ensure informed choice, after which the choice to receive small-group supported employment services was made.

(5) Not reside in a medical institution.

Community transportation options (e.g., transportation provided by family, coworkers, carpools, volunteers, self or public transportation) shall be identified by the member’s interdisciplinary team and utilized before the service provider provides the transportation to and from the service site for the member. If none of these options are available to a member, transportation between the member’s place of residence and the service location may be included as a component part of prevocational services.

Personal care or personal assistance and protective oversight may be a component part of prevocational services, but may not comprise the entirety of the service

4) Supported Employment

Individual Supported Employment

Individual supported employment involves supports provided to, or on behalf of, the member that enable the member to obtain and maintain individual employment Services are provided to members who need support because of their disabilities. Individual supported employment services are services provided to, or on behalf of, the member that enable the member to obtain and maintain an individual job in competitive employment, customized employment or self-employment in an integrated work setting in the general workforce.

Expected Outcome of Service. The expected outcome of this service is sustained employment, or self-employment, paid at or above the minimum wage or the customary wage and level of benefits paid by an employer, in an integrated setting in the general workforce, in a job that meets personal and career goals. Successful transition to long term job coaching, if needed, is also an expected outcome of this service. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time.

Setting. Individual supported employment services shall take place in integrated work settings.

For self-employment, the member’s home can be considered an integrated work setting. Employment in the service provider’s organization (not including a sheltered workshop or similar type of work setting where members are paid for the production of goods or services) can be considered employment in an integrated work setting in the general workforce if the employment occurs in a \o\Ork setting where interactions are predominantly with coworkers or business associates who do not have disabilities or with the general public.

Individual employment strategies include but are not limited to:

Customized employment,

Individual placement and support, and

Supported self-employment.

Service activities are individualized and may include any combination of the following: Benefits education • Career exploration (e.g., tours, informational interviews, job shadows) • Employment assessment • Assistive technology assessment • Trial 1NOrk experience • Person-centered employment planning • Development of visual or traditional resumes • Job-seeking skills training and support • Outreach to prospective employers on behalf of the member (e.g., job development; negotiation INith prospective employers to customize, create or carve out a position for the member; employer needs analysis) • Job analysis (e.g., 1NOrk site assessment or job accommodations evaluation) • Identifying and arranging transportation • Career advancement services (e.g., assisting a member in making an upward career move or seeking promotion from an existing employer) • Reemployment services (if necessary due to job loss) • Financial literacy and asset development • Other employment support services deemed necessary to enable the member to obtain employment • Systematic instruction and support during initial on-the-job training including initial on-the-job training to stabilization • Engagement of natural supports during initial period of employment • Implementation of assistive technology solutions during initial period of employment • Transportation of the member during service hours • Initial on-the-job training to stabilization activity

Supported Self-Employment

Individual employment may also include support to establish a viable self-employment opportunity, including home-based self-employment.

An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time. In addition to the activities listed under Individual Supported Employment, assistance to establish self-employment may include: Aid to the member in identifying potential business opportunities. Assistance in the development of a business plan, including identifying potential sources of business financing and other assistance in developing and launching a business. Identification of the long-term supports necessary for the individual to operate the business.

Long-Term Job Coaching

Long-term job coaching is support provided to, or on behalf of, the member that enables the member to maintain an individual job in competitive employment, customized employment or self-employment in an integrated work setting in the general workforce.

Long-term job coaching services are provided to or on behalf of members who need support because of their disabilities and who are unlikely to maintain and advance in

individual employment absent the provision of supports. Long-term job coaching services shall provide individualized and ongoing support contacts at intervals necessary to promote successful job retention and advancement.

Expected Outcome of Long-Term Job Coaching. The expected outcome of this service is sustained employment paid at or above the minimum wage in an integrated setting in the general workforce, in a job that meets the member’s personal and career goals. An expected outcome of supported self-employment is that the member earns income that is equal to or exceeds the average income for the chosen business within a reasonable period of time.

Setting. Long-term job coaching services shall take place in integrated work settings. For self-employment, the member’s home can be considered an integrated work setting. Employment in the service provider’s organization (not including a sheltered workshop or similar type of work setting) can be considered employment in an integrated work setting in the general workforce if the employment occurs in a work setting where interactions are predominantly with coworkers or business associates who do not have disabilities, or with the general public, and if the position would exist within the provider’s organization were the provider not being paid to provide the job coaching to the member.

Service Activities

Long-term job coaching services are designed to assist the member with learning and retaining individual employment, resulting in workplace integration, and which allows for the reduction of long-term job coaching overtime. Services are individualized, and service plans are adjusted as support needs change and may include any combination of the following activities with or on behalf of the member: • Job analysis • Job training and systematic instruction • Training and support for use of assistive technology and adaptive aids • Engagement of natural supports • Transportation coordination • Job retention training and support • Benefits education and ongoing support • Supports for career advancement • Financial literacy and asset development • Employer consultation and support • Negotiation with employer on behalf of the member (e.g., accommodations, employment conditions, access to natural supports, and wage and benefits) • Other workplace support services may include services not specifically related to job skill training that enable the waiver member to be successful in integrating into the job setting • Transportation of the member during service hours • Career exploration services leading to increased hours or career advancement

Self-Employment Long-Term Job Coaching

Self-employment long-term job coaching may include support to maintain a self-employment opportunity including home-based self-employment.

In addition to the activities listed under subparagraph 78.27(10)”b” (4), assistance to maintain self-employment may include: • Ongoing identification of the supports necessary for the individual to operate the business; • Ongoing assistance, counseling and guidance to maintain and grow the business; and • Ongoing benefits education and support.

Small Group Employment (2 to 8 Individuals)

Small-group supported employment services are training and support activities provided in regular business or industry settings for groups of two to eight workers with disabilities. The outcome of this service is sustained paid employment experience, skill development, career exploration and planning leading to referral for services to obtain individual integrated employment or self-employment for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Small-group supported employment services must be provided in a manner that promotes integration into the workplace and interaction between members and people without disabilities (e.g., customers, coworkers, natural supports) in those workplace. Examples include, but are not limited to:

• Mobile crews and other business-based workgroups employing small groups of workers with disabilities in employment in integrated business settings.

• Small-group activities focused on career exploration and development of strengths and skills that contribute to successful participation in individual community employment.

Expected Outcome of Service.

Small-group supported employment services are expected to enable the member to make reasonable and continued progress toward individual employment. Participation in small-group supported employment services is not a prerequisite for individual supported employment services. The expected outcome of the service is sustained paid employment and skill development which leads to individual employment in the community.

Setting. Small-group supported employment services shall take place in integrated, community-based nonresidential settings separate from the member’s residence.

Service Activities. Small-group supported employment services may include any combination of the following activities: • Employment assessment • Person-centered employment planning • Job placement (limited to service necessary to facilitate hire into individual employment paid at minimum wage or higher for a member in small-group supported employment who receives an otherwise unsolicited offer of a job from a business where the member has been working in a mobile crew or enclave) • Job analysis • On-the-job training and systematic instruction • Job coaching • Transportation planning and training • Benefits education • Career exploration services leading to career advancement outcomes • Other workplace support services may include services not specifically related to job skill training that enable the waiver member to be successful in integrating into the individual or community setting • Transportation of the member during service hours

Individual Placement and Support

Individual Placement and Support (IPS) means the evidenced based practice of supported employment (SE) that is guided by IPS Practice principles outlined by the IPS Employment Center at Westat, and as measured to be “exemplary”, “good”, “fair , and “not supported employment” by their most recently published 25-item Fidelity Scale available on line at https://ipsworks.org/index.php/documents/ips-fidelity-scale/

IPS shall include:

1. Development of the career profile. The career profile includes previous work experience, goals, preferences, strengths, barriers, skills, disclosure preferences, career advancement education/plan for graduation.

2. IPS team members are fully integrated with the behavioral health team, including participation in routine staffing meetings regarding IPS clients.

3. Addressing barriers to employment. Barriers to employment may be actual or perceived and support may include addressing justice system involvement, a lack of work history, limited housing, childcare, and transportation.

4. Rapid job search and systematic job development. Certified Employment Specialists (CESs) help members seek jobs directly, and do not provide extensive pre-employment assessment and training, or intermediate work experiences. The job process begins early, \Nithin 30 days of starting IPS services. This rapid job search is supported by CESs developing relationships with employers through multiple face-to-face meetings. CESs take time to learn about the employers’ needs and the work environment while gathering information about job opportunities that might be a good fit for individuals they are working with.

5. Disclosure. Assuring that the individual makes an informed decision on disclosure of a disability to a prospective or current employer.

6. Job Accommodations and Assistive Technology. CESs identify and address job accommodations or technology needs.

7. Ongoing benefits counseling. CESs provide information on available work incentive programs, or referral to professional benefits counselors for a personalized work incentives plan for any state or federal entitlement.

8. Time unlimited follow along supports. These supports are planned for early in the employment process, are personalized, and follow the individual for as long as they need support. The focus is supporting the individual in becoming as independent as possible, and involving family members, co-workers, and other natural supports.

These supports can be provided on or off the job site and focus on the continued acquisition and development of skills needed to maintain employment.

Service Requirements for All Supported Employment Services

Community transportation options (e.g., transportation provided by family, coworkers, carpools, volunteers, self or public transportation) shall be identified by the member’s interdisciplinary team and utilized before the service provider provides the transportation to and from work for the member. If none of these options are available to a member, transportation between the member’s place of residence and the employment or service location may be included as a component part of supported employment services.

Personal care or personal assistance and protective oversight may be a component part of supported employment services but may not comprise the entirety of the service.

Activities performed on behalf of a member receiving long-term job coaching or individual or small-group supported employment shall not comprise the entirety of the service.

Concurrent services. A member’s individual service plan may include two or more types of non-residential services (e.g., individual supported employment, long-term job coaching, small-group supported employment, prevocational services, and day habilitation). More than one service may not be billed during the same period of time (e.g., the same hour).

Integration requirements. In the performance of job duties, the member shall have regular contact with other employees or members of the general public who do not have disabilities, unless the absence of regular contact with other employees or the general public is typical for the job as performed by persons without disabilities.

Compensation. Members receiving these services are compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

For supported self-employment, the member earns income that is equal to or exceeds the average income for the chosen business 1Mthin a reasonable period of time.

For small-group supported employment, if the member is not compensated at or above minimum wage, the compensation to the member shall be in accordance 1Mth all applicable state and federal labor laws and regulations.

Individuals receiving supported employment must have documented in the service plan a goal to achieve or to sustain individual employment

Limits on the amount, duration, or frequency of this service:

Categorically needy:

Home-based habilitation payment shall not be made for the following: m 17 to 24 hours per day (1) Room and board and maintenance costs, including the cost of rent or mortgage, utilities, telephone, food, household supplies, and building maintenance, upkeep, or improvement. (2) Service activities associated with vocational services, daycare, medical services, or case management. (3) Transportation to and from a day program. (4) Services provided to a member who Lives in a licensed residential care facility ofn10re than 16 persons. (5) Services provided to a member who lives in a facility that provides the same service as part of an inclusive or “bundled” service rate, such as a nursing facility or an intermediate care facility for persons with mental retardation. (6) Personal care and protective oversight and supervision may be a component part of home-based habilitation services but may not comprise the entirety of the service.

The current Fee schedule for Home Based Habilitation may be located online at: http://dhs.iowa.gov/ime/providers/csrp/fee-schedule

Day Habilitation is reimbursed at 15 min unit of service up to 16units per day, or Daily (4.25 to 8 hours) The rates for Day habilitation are located at 441 lAC 79.1(2) https://www.legis.iowa.gov/docs/iac/rule/0705-2017.441.79. l.pdf

Day habilitation payments shall not be made for the following: (1) Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 140 I et seq.). Documentation that funding is not available to the individual for the service under these programs shall be maintained in the se1viceplan of each member receiving day habilitation se1vices. (2) Compensation to members for participating in day habilitation. (3) Support for members volunteering in for-profit organizations and businesses. (4) Support for members volunteering to benefit the day habilitation service provider. Prevocational services are reimbursed as an hourly unit of service. Career exploration is an hourly unit of service. The current HCBS Prevocational and Supported Employment fee schedule may be located at: http://dhs.iowa.gov/ime/providers/csrp/fee-schedule

Prevocational Service Limitation

There is a time limitation for members starting prevocational services. For members starting prevocational services after May 1, 2017, participation in these services is limited to 24 calendar months. This time limit can be extended to continue beyond 24 months if one or more of the following conditions apply:

• The member who is in prevocational services is also working in either individual or small-group community employment for at least the number of hours per week desired by the member, as identified in the member’s current service plan; or

• The member who is in prevocational services is also working in either individual or small-group community employment for less than the number of hours per week the member desires, as identified in the member’s current service plan, but the member has services documented in the member’s current service plan, or through another identifiable funding source (e.g., Iowa vocational rehabilitation services (IVRS)), to increase the number of hours the member is working in either individual or small-group community employment; or

• The member is actively engaged in seeking individual or small-group community employment or individual self-employment, and services for this are included in the member’s current service plan or services funded through another identifiable funding source (e.g., IVRS) are documented in the member’s service plan; or

• The member has requested supported employment services from Medicaid and IVRS in the past 24 months, and the member’s request has been denied or the member has been placed on a waiting list by both Medicaid and IVRS; or

• The member has been receiving individual supported employment services (or comparable services available through IVRS) for at least 18 months without obtaining individual or small-group community employment or individual self employment; or

• The member is participating in career exploration activities.

Exclusions

• Prevocational services payment shall not be made for the following:

• Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

• Documentation that funding is not available to the individual for the service under these programs shall be maintained in the service plan of each member receiving prevocational services.

• Services available to the individual that duplicate or replace education or related services defined in the Individuals Vll’ith Disabilities Education Act (20 U.S.C. 1401 et seq.).

• Compensation to members for participating in prevocational services.

• Support for members volunteering in for-profit organizations and businesses

Supported Employment (SE) services.

Individual SE is reimbursed as an hourly unit of service. Small Group SE is reimbursed as a 15 min unit of service. Long Term Job Coaching SE is reimbursed as a monthly unit of service. Individual Placement and Support (IPS) SE is reimbursed for each outcome achieved for the member participating in the IPS SE model

The current HCBS Prevocational and Supported Employment fee schedule may be located at: http://dhs.iowa.gov/ime/providers/csrp/fee-schedule

Individual SE

40 units for the initial authorization and 20 units for an extended authorization.

One initial and, if necessary, one extended authorization permitted per year not to exceed a total of 60 hourly units per year.

Long Term Job Coaching

Tier 1 = 1 contact/month

Tier 2 = 2-8 hours/month

Tier 3 = 9-16 hours/month

Tier 4 = 17-25 hours/month

Tier 5 = 26 or more hours per month

Small Group SE

Tier 1 – Groups of 2-4

Tier 2 – Groups of 5-6

Tier 3 – Groups of 7-8

Individual Placement and Support (IPS) SE. Outcomes are as follows:

1 . Outcome #1 completed employment plan

2. Outcome #2 first day of successful job placement

3. Outcome #3 forty-five days successful job retention

4. Outcome #4 ninety days successful job retention.

Medically needy:

Home-based habilitation payment shall not be made for the following : (1) Room and board and maintenance costs, including the cost of rent or mortgage, utilities, telephone, food, household supplies, and building maintenance, upkeep, or improvement. (2) Service activities associated with vocational services, day care, medical services, or case management. (3) Transportation to and from a day program. (4) Services provided to a member ‘Nho lives in a licensed residential care facility of more than 16 persons. (5) Services provided to a member who lives in a facility that provides the same service as part of an inclusive or “bundled” service rate, such as a nursing facility or an intermediate care facility for persons with mental retardation. (6) Personal care and protective oversight and supervision may be a component part of home-based habilitation services but may not comprise the entirety of the service. The current Fee schedule for Home Based Habilitation may be located on line at: http://dhs.iowa.gov/ime/providers/csrp/fee-schedule

Day Habilitation is reimbursed at 15 min unit of service up to 16 units per day, or Daily (4.25 to 8 hours) The rates for Day habilitation are located at 441 IAC 79.1 (2) https://www.legis.iowa.gov/docs/iac/rule/07-05-2017.441.79.1.pdf

Day habilitation payment shall not be made for the following:

(1) Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals ‘with Disabilities Education Act (20 U.S.C. 1401 et seq.).

Documentation that funding is not available to the individual for the service under these programs shall be maintained in the service plan of each member receiving day habilitation services.

(2) Compensation to members for participating in day habilitation.

(3) Support for members volunteering in for-profit organizations and businesses.

(4) Support for members volunteering to benefit the day habilitation service provider.

Prevocational services are reimbursed as an hourly unit of service. Career exploration is an hourly unit of service. The current HCBS Prevocational and Supported Employment fee schedule may be located at: https://hhs.iowa.gov/medicaid/provider-services/covered-services-rates-and-payments/fee-schedules

Prevocational Service Limitations

There is a time limitation for members starting prevocational services. For members starting prevocational services after May 1, 2017, participation in these services is limited to 24 calendar months. This time limit can be extended to continue beyond 24 months if one or more of the following conditions apply:

• The member who is in prevocational services is also working in either individual or small-group community employment for at least the number of hours per week desired by the member, as identified in the member’s current service plan; or

• The member who is in prevocational services is also 1NOrking in either individual or small-group community employment for less than the number of hours per week the member desires, as identified in the member’s current service plan, but the member has services documented in the member’s current service plan, or through another identifiable funding source (e.g., Iowa vocational rehabilitation services (IVRS)), to increase the number of hours the member is 1NOrking in either individual or small-group community employment; or

• The member is actively engaged in seeking individual or small-group community employment or individual self-employment, and services for this are included in the member’s current service plan or services funded through another identifiable funding source (e.g., IVRS) are documented in the member’s service plan; or

• The member has requested supported employment services from Medicaid and IVRS in the past 24 months, and the member’s request has been denied or the member has been placed on a waiting list by both Medicaid and IVRS; or

• The member has been receiving individual supported employment services (or comparable services available through IVRS) for at least 18 months without obtaining individual or small-group community employment or individual self-employment; or

• The member is participating in career exploration activities.

Exclusions

• Prevocational services payment shall not be made for the following:

• Services that are available to the individual under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

• Documentation that funding is not available to the individual for the service under these programs shall be maintained in the service plan of each member receiving prevocational services.

• Services available to the individual that duplicate or replace education or related services defined in the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

• Compensation to members for participating in prevocational services.

• Support for members volunteering in for-profit organizations and businesses Supported Employment (SE) services. Individual SE is reimbursed as an hourly unit of service. Small Group SE is reimbursed as a 15 min unit of service. Long Term Job Coaching SE is reimbursed as a monthly unit of service. Individual Placement and Support (IPS) SE is reimbursed for each outcome achieved for the member participating in the IPS SE model The current HCBS Prevocational and Supported Employment fee schedule may be located at: http://dhs.iowa.gov/ime/providers/csrp/fee-schedule

Individual SE

40 units for the initial authorization and 20 units for an extended authorization. One initial and, if necessary, one extended authorization permitted per year not to exceed a total of 60 hourly units per year.

Long Term Job Coaching

Tier 1 = 1 contact/month

Tier 2 = 2-8 hours/month

Tier 3 = 9-16 hours/month

Tier 4 = 17-25 hours/month

Tier 5 = 26 or more hours per month

Small Group SE

Tier 1 – Groups of 2-4

Tier 2 – Groups of 5-6

Tier 3- Groups of 7-8

Individual Placement and Support (IPS) SE Outcomes are as follows:

1. Outcome #1 completed employment plan

2. Outcome #2 first day of successful job placement

3. Outcome #3 forty-five days successful job retention

4. Outcome #4 ninety days successful job retention.