135.22B - BRAIN INJURY SERVICES PROGRAM.
135.22B BRAIN INJURY SERVICES PROGRAM.
1. Definitions. For the purposes of this section:
a. "Brain injury services waiver" means the state's medical
assistance home and community-based services waiver for persons with
brain injury implemented under chapter 249A.
b. "Program administrator" means the division of the
department designated to administer the brain injury services program
in accordance with subsection 2.
2. Program created.
a. A brain injury services program is created and shall be
administered by a division of the Iowa department of public health in
cooperation with counties and the department of human services.
b. The division of the department assigned to administer the
advisory council on brain injuries under section 135.22A shall be the
program administrator. The division duties shall include but are not
limited to serving as the fiscal agent and contract administrator for
the program and providing program oversight.
c. The division shall consult with the advisory council on
brain injuries, established pursuant to section 135.22A, regarding
the program and shall report to the council concerning the program at
least quarterly. The council shall make recommendations to the
department concerning the program's operation.
3. Purpose. The purpose of the brain injury services program
is to provide services, service funding, or other support for persons
with a brain injury under the cost-share program component or other
components established pursuant to this section. Implementation of
the cost-share component or any other component of the program is
subject to the funding made available for the program.
4. General requirements -- cost-share component. The
cost-share component of the brain injury services program shall be
directed to persons who have been determined to be ineligible for the
brain injury services waiver or persons who are eligible for the
waiver but funding was not authorized or available to provide waiver
eligibility for the persons. The cost-share component is subject to
general requirements which shall include but are not limited to all
of the following:
a. Services offered are consistent with the services offered
through the brain injury services waiver.
b. Each service consumer has a service plan developed prior
to service implementation and the service plan is reviewed and
updated at least quarterly.
c. All other funding sources for which the service consumer
is eligible are utilized to the greatest extent possible. The
funding sources potentially available include but are not limited to
community resources and public and private benefit programs.
d. The maximum monthly cost of the services provided shall be
based on the maximum monthly amount authorized for the brain injury
services waiver.
e. Assistance under the cost-share component shall be made
available to a designated number of service consumers who are
eligible, as determined from the funding available for the cost-share
component, on a first-come, first-served basis.
f. Nothing in this section shall be construed or is intended
as, or shall imply, a grant of entitlement to services to persons who
are eligible for participation in the cost-share component based upon
the eligibility provisions adopted consistent with the requirements
of this section. Any obligation to provide services pursuant to this
section is limited to the extent of the funds appropriated or
provided for the cost-share component.
5. Cost-share component eligibility. An individual must meet
all of the following requirements in order to be eligible for the
cost-share component of the brain injury services program:
a. The individual is age one month through sixty-four years.
b. The individual has a diagnosis of brain injury that meets
the diagnosis eligibility criteria for the brain injury services
waiver.
c. The individual is a resident of this state and either a
United States citizen or a qualified alien as defined in 8 U.S.C. §
1641.
d. The individual meets the cost-share component's financial
eligibility requirements and is willing to pay a cost-share for the
cost-share component.
e. The individual does not receive services or funding under
any type of medical assistance home and community-based services
waiver.
6. Cost-share requirements.
a. The cost-share component's financial eligibility
requirements shall be established in administrative rule. In
establishing the requirements, the department shall consider the
eligibility and cost-share requirements used for the hawk-i program
under chapter 514I.
b. An individual's cost-share responsibility for services
under the cost-share component shall be determined on a sliding scale
based upon the individual's family income. An individual's
cost-share shall be assessed as a copayment, which shall not exceed
thirty percent of the cost payable for the service.
c. The service provider shall bill the department for the
portion of the cost payable for the service that is not covered by
the individual's copayment responsibility.
7. Application process.
a. The application materials for services under the
cost-share component of the brain injury services program shall use
the application form and other materials of the brain injury services
waiver. In order to apply for the brain injury services program, the
applicant must authorize the department of human services to provide
the applicant's waiver application materials to the brain injury
services program. The application materials provided shall include
but are not limited to the waiver application and any denial letter,
financial assessment, and functional assessment regarding the person.
b. If a functional assessment for the waiver has not been
completed due to a person's financial ineligibility for the waiver,
the brain injury services program may provide for a functional
assessment to determine the person's needs by reimbursing the
department of human services for the assessment.
c. The program administrator shall file copies of the
individual's application and needs assessment with the program
resource facilitator assigned to the individual's geographic area.
d. The department's program administrator shall make a final
determination as to whether program funding will be authorized under
the cost-share component.
8. Service providers and reimbursement. All of the following
requirements apply to service providers and reimbursement rates
payable for services under the cost-share component:
a. A service provider must either be certified to provide
services under the brain injury services waiver or have a contract
with a county to provide services and will become certified to
provide services under such waiver within a reasonable period of time
specified in rule.
b. The reimbursement rate payable for the cost of a service
provided under the cost-share component is the rate payable under the
medical assistance program. However, if the service provided does
not have a medical assistance program reimbursement rate, the rate
shall be the amount payable under the county contract.
9. Resource facilitation. The program shall utilize resource
facilitators to facilitate program services. The resource
facilitator shall be available to provide ongoing support for
individuals with brain injury in coping with the issues of living
with a brain injury and in assisting such individuals in
transitioning back to employment and living in the community. The
resource facilitator is intended to provide a linkage to existing
services and increase the capacity of the state's providers of
services to persons with brain injury by doing all of the following:
a. Providing brain injury-specific information, support, and
resources.
b. Enhancing the usage of support commonly available to an
individual with brain injury from the community, family, and personal
contacts and linking such individuals to appropriate services and
community resources.
c. Training service providers to provide appropriate brain
injury services.
d. Accessing, securing, and maximizing the private and public
funding available to support an individual with a brain injury. Section History: Recent Form
2006 Acts, ch 1114, §1; 2007 Acts, ch 126, §35; 2008 Acts, ch
1058, § 3; 2008 Acts, ch 1187, § 106--108