249A.12 - ASSISTANCE TO PERSONS WITH MENTAL RETARDATION -- STATE CASES.
249A.12 ASSISTANCE TO PERSONS WITH MENTAL RETARDATION
-- STATE CASES.
1. Assistance may be furnished under this chapter to an otherwise
eligible recipient who is a resident of a health care facility
licensed under chapter 135C and certified as an intermediate care
facility for persons with mental retardation.
2. A county shall reimburse the department on a monthly basis for
that portion of the cost of assistance provided under this section to
a recipient with legal settlement in the county, which is not paid
from federal funds, if the recipient's placement has been approved by
the appropriate review organization as medically necessary and
appropriate. The department's goal for the maximum time period for
submission of a claim to a county is not more than sixty days
following the submission of the claim by the provider of the service
to the department. The department's goal for completion and
crediting of a county for cost settlement for the actual costs of a
service under a home and community-based services waiver is within
two hundred seventy days of the close of a fiscal year for which cost
reports are due from providers. The department shall place all
reimbursements from counties in the appropriation for medical
assistance, and may use the reimbursed funds in the same manner and
for any purpose for which the appropriation for medical assistance
may be used.
3. If a county reimburses the department for medical assistance
provided under this section and the amount of medical assistance is
subsequently repaid through a medical assistance income trust or a
medical assistance special needs trust as defined in section 633C.1,
the department shall reimburse the county on a proportionate basis.
The department shall adopt rules to implement this subsection.
4. a. Effective July 1, 1995, the state shall be responsible
for all of the nonfederal share of the costs of intermediate care
facility for persons with mental retardation services provided under
medical assistance to minors. Notwithstanding subsection 2 and
contrary provisions of section 222.73, effective July 1, 1995, a
county is not required to reimburse the department and shall not be
billed for the nonfederal share of the costs of such services
provided to minors.
b. Effective July 1, 1995, the state shall be responsible for
all of the nonfederal share of medical assistance home and
community-based services waivers for persons with mental retardation
services provided to minors and a county is not required to reimburse
the department and shall not be billed for the nonfederal share of
the costs of the services.
c. Effective February 1, 2002, the state shall be responsible
for all of the nonfederal share of the costs of intermediate care
facility for persons with mental retardation services provided under
medical assistance attributable to the assessment fee for
intermediate care facilities for individuals with mental retardation
imposed pursuant to section 249A.21. Notwithstanding subsection 2,
effective February 1, 2003, a county is not required to reimburse the
department and shall not be billed for the nonfederal share of the
costs of such services attributable to the assessment fee.
5. a. The mental health, mental retardation, developmental
disabilities, and brain injury commission shall recommend to the
department the actions necessary to assist in the transition of
individuals being served in an intermediate care facility for persons
with mental retardation, who are appropriate for the transition, to
services funded under a medical assistance home and community-based
services waiver for persons with mental retardation in a manner which
maximizes the use of existing public and private facilities. The
actions may include but are not limited to submitting any of the
following or a combination of any of the following as a request for a
revision of the medical assistance home and community-based services
waiver for persons with mental retardation in effect as of June 30,
1996:
(1) Allow for the transition of intermediate care facilities for
persons with mental retardation licensed under chapter 135C as of
June 30, 1996, to services funded under the medical assistance home
and community-based services waiver for persons with mental
retardation. The request shall be for inclusion of additional
persons under the waiver associated with the transition.
(2) Allow for reimbursement under the waiver for day program or
other service costs.
(3) Allow for exception provisions in which an intermediate care
facility for persons with mental retardation which does not meet size
and other facility-related requirements under the waiver in effect on
June 30, 1996, may convert to a waiver service for a set period of
time such as five years. Following the set period of time, the
facility would be subject to the waiver requirements applicable to
services which were not operating under the exception provisions.
b. In implementing the provisions of this subsection, the
mental health, mental retardation, developmental disabilities, and
brain injury commission shall consult with other states. The waiver
revision request or other action necessary to assist in the
transition of service provision from intermediate care facilities for
persons with mental retardation to alternative programs shall be
implemented by the department in a manner that can appropriately meet
the needs of individuals at an overall lower cost to counties, the
federal government, and the state. In addition, the department shall
take into consideration significant federal changes to the medical
assistance program in formulating the department's actions under this
subsection. The department shall consult with the mental health,
mental retardation, developmental disabilities, and brain injury
commission in adopting rules for oversight of facilities converted
pursuant to this subsection. A transition approach described in
paragraph "a" may be modified as necessary to obtain federal
waiver approval.
6. a. Effective July 1, 2003, the provisions of the home and
community-based services waiver for persons with mental retardation
shall include adult day care, prevocational, and transportation
services. Transportation shall be included as a separately payable
service.
b. The department of human services shall seek federal
approval to amend the home and community-based services waiver for
persons with mental retardation to include day habilitation services.
Inclusion of day habilitation services in the waiver shall take
effect upon receipt of federal approval and no later than July 1,
2004.
c. The person's county of legal settlement shall pay for the
nonfederal share of the cost of services provided under the waiver,
and the state shall pay for the nonfederal share of such costs if the
person has no legal settlement or the legal settlement is unknown so
that the person is deemed to be a state case.
d. The county of legal settlement shall pay for one hundred
percent of the nonfederal share of the costs of care provided for
adults which is reimbursed under a home and community-based services
waiver that would otherwise be approved for provision in an
intermediate care facility for persons with mental retardation
provided under the medical assistance program.
7. When paying the necessary and legal expenses for intermediate
care facility for persons with mental retardation services, the cost
requirements of section 222.60 shall be considered fulfilled when
payment is made in accordance with the medical assistance payment
rates established by the department for intermediate care facilities
for persons with mental retardation, and the state or a county of
legal settlement shall not be obligated for any amount in excess of
the rates.
8. If a person with mental retardation has no legal settlement or
the legal settlement is unknown so that the person is deemed to be a
state case and services associated with the mental retardation can be
covered under a medical assistance home and community-based services
waiver or other medical assistance program provision, the nonfederal
share of the medical assistance program costs for such coverage shall
be paid from the appropriation made for the medical assistance
program. Section History: Early Form
[C77, 79, 81, § 249A.12] Section History: Recent Form
83 Acts, ch 123, § 96, 209; 84 Acts, ch 1297, § 6; 94 Acts, ch
1120, §2; 94 Acts, ch 1163, §1; 95 Acts, ch 68, § 3; 96 Acts, ch
1129, § 113; 96 Acts, ch 1183, § 30, 31; 2002 Acts, ch 1146, §5, 6;
2003 Acts, ch 62, § 4, 8; 2003 Acts, ch 118, §1; 2004 Acts, ch 1086,
§45--47; 2004 Acts, ch 1090, §15, 16; 2005 Acts, ch 38, §55; 2005
Acts, ch 175, §109--111; 2006 Acts, ch 1066, §1; 2006 Acts, ch 1115,
§15; 2007 Acts, ch 22, §56
Referred to in § 331.402, 426B.1
Appropriations to fund the costs under subsection 4 from the
property tax relief fund; see § 426B.1(3)