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