Transcript Slide 1

Funding For Special Needs Child Care
BECOMING A MEDICAID HCBS
WAIVER PROVIDER
Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment.
Retrieved May 1, 2011, from
http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Docu
ments/Rules/441-80.pdf
Presented by:
 Deborah VanderGaast, RN
 Owner - Tipton Adaptive Daycare
 Home Care Case Manager, Girling Health
 Home care services for adults and children with
disabilities
 Skilled nursing care for acute and chronic health
care needs
Tipton Adaptive Daycare
• Category B Family Daycare Home
• Medicaid Waiver Provider for IMMT &
•
•
•
•
Respite
Child Care Assistance
Promise Jobs
Protective Daycare
Skilled Child Care for Children with Special
Health Care Needs
www.TiptonAdaptiveDaycare.com
Special Needs Child Care
Providing care for children with special
needs in an inclusive environment with
their typically-developing peers.
Least Restrictive
Environment
 The Individuals with Disabilities Education
Act (IDEA) of 1975 requires that children with
disabilities be provided education and
services in the least restrictive environment.
 Amended in 1997 to include specific guidelines for
infants and toddlers
 Guidelines state they should receive care and
services in “natural environments”
Natural Environments
 Defined as, “settings that are natural or
normal for the child’s age peers with no
disabilities”.
Smith, Barbara J., & Rapport, Mary Jane K. (1999, September). IDEA and early
childhood inclusion. Collaborative Planning Project. Retrieved July 15, 2009, from
http://www.nectac.org/~pdfs/topics/inclusion/ideaec.pdf
Special Health Care Needs
Children and youth with special health care needs
(CYSHCN) are defined by the Department of Health and
Human Services (HHS), Health Resources and Services
Administration (HRSA), Maternal and Child Health
Bureau (MCHB) as:
 “Those who have or are at increased risk for a
chronic physical, development, behavioral, or
emotional condition and who also require health
and related services of a type or amount beyond
that required by children generally”
McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Perrin, J. M., et al. (1998, July). A new definition of children
with special health care needs. Pediatrics, 102(1), 137-141.
Statistics:
 Approximately 20% of American households
with children have one or more children with
special health care needs (SHCN) [1.]
 In 2008, there was an estimated 535,000
children with SHCN living in the United States
[2.]
[1.]Looman, Wendy S., O'Conner-Von, Susan, & Lindeke, Linda L. (2008, July 11). Caring for children with special health care
needs and their families: What advanced practice nurses need to know. The Journal for Nurse Practitioners, 4,
512-517.
[2.] Kogan, Michael D., Strickland, Bonnie B., Blumberg, Stephen J., Singh, Gopal K., Perrin, James M., & van Dyck, Peter C.
(2008, December). A national profile of the health care experiences and family impact of autism spectrum
disorder among children in the United States, 2005-2006. Pediatrics, 122(6), e1149-e1158.
Medicaid HCBS Waivers
 The Medicaid Home and Community Based
Services are designed to allow individuals
with disabilities to receive the care they need
to remain living in their homes.
How the Waivers Were Created
 The Medicaid Waivers started in 1981 with a 3year-old girl in a hospital and the president who
was angered when he learned that federal rules
prevented her from going home.

Shapiro, J. (2010, November 8). Katie Beckett: Patient turned home-care advocate.
National Public Radio. Retrieved April 2, 2011, from
http://www.npr.org/templates/story/story.php?storyId=131145687
Katie Beckett
“Katie Becket, had contracted viral encephalitis, a brain infection,
when she was just five months old. She'd gone into a coma for ten days,
and when she came out she suffered a paralysis that left her unable to
breathe without the help of a ventilator most of the day.
After more than two years living in St. Luke's Methodist Hospital in
Cedar Rapids, Iowa, the family reached the limit of what its private
insurance would pay for Katie's care. Medicaid, the state and federal
health insurance for the needy, started picking up the cost of that
expensive breathing machine and other care.
But Medicaid would pay only as long as the little girl lived in the
pediatric intensive care unit at the hospital.” [1]

[1] Shapiro, J. (2010, November 8). Katie Beckett: Patient turned home-care advocate.
National Public Radio. Retrieved April 2, 2011, from
http://www.npr.org/templates/story/story.php?storyId=131145687
 “By what sense do we have a regulation in
government that says we'll pay $6,000 a
month to keep someone in a hospital that we
believe would be better off at home, but the
family cannot afford one-sixth that amount
to keep them at home?”
- President Ronald Reagan, Nov. 10, 1981

Shapiro, J. (2010, November 8). Katie Beckett: Patient turned home-care advocate.
National Public Radio. Retrieved April 2, 2011, from
http://www.npr.org/templates/story/story.php?storyId=131145687
Eligible Waivers
Waivers that fund services that can be provided by
day care centers and registered day care centers.
HCBS Ill & Handicapped (IH) Waiver
The IH waiver provides services for persons who are blind
or disabled. An applicant must be less than 65 years of
age. The following services are available:
● Adult Day Care
● Consumer Directed
Attendant Care
● Counseling
● Home & Vehicle
Modification
● Home Delivered Meals
● Home Health Aide

● Homemaker
● Interim Medical
Monitoring & Treatment
● Nursing
● Nutritional Counseling
● Personal Emergency
Response
● Respite
Iowa Department of Human Services. (2006, September). Are Home & Community Based Services Right
for You? Retrieved April 1, 2011, from http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf
HCBS Intellectual Disability (ID) Waiver
The ID waiver provides services for persons with a
diagnosis of intellectual disability. The following services
are available:
● Adult Day Care
● Consumer Directed
Attendant Care
● Day Habilitation
● Home & Vehicle
Modification
● Home Health Aide
● Interim Medical
Monitoring & Treatment
● Nursing

● Personal Emergency
Response
● Prevocational
● Respite
● Supported Community
Living
● Supported Community
Living-Residential Based
● Supported Employment
● Transportation
Iowa Department of Human Services. (2006, September). Are Home & Community Based Services Right
for You?.Retrieved April 1, 2011, from http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf
HCBS Brain Injury (BI) Waiver
The BI waiver provides services for persons who have a brain
injury diagnosis due to an accident or illness. An applicant must be
at least one month of age but less than 65 years of age. The
following services are available:
● Adult Day Care
● Behavioral Programming
● Case Management
● Consumer Directed Attendant
Care
● Family Counseling & Training
● Home & Vehicle Modification
● Interim Medical Monitoring &
Treatment
● Personal Emergency Response

● Prevocational Services
● Respite
● Specialized Medical Equipment
● Supported Community Living
● Supported Employment
● Transportation
Iowa Department of Human Services. (2006, September). Are Home & Community Based Services Right
for You?.Retrieved April 1, 2011, from http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf
B.I. Waiver Requirements:
 Those wishing to provide services under the
Brain Injury waiver need to submit
documentation indicating training or experience
with persons with brain injury.
 Providers must demonstrate proficiency in
delivery of the services included in a consumer’s
service plan. Proficiency must be demonstrated
through documentation of prior training and
experience or a certificate of formal training.
 Training classes are available through DHS. To
receive training call (515) 281-8061.
http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Documents/Provman/ill.pdf
Service Plan
 All consumers will have a service plan developed
by a DHS service worker or Medicaid case
manager in cooperation with the consumer.
 This plan must be completed prior to
implementation of services.
 The service plan for consumers aged 20 or under
must be developed or reviewed taking into
consideration those services that may be
provided through the individual education plan
(IEP) and EPSDT (Care For Kids) plan(s).
Special Needs Child Care
 The only Medicaid waiver service that can be
accessed for child care while their parents are
working is interim medical monitoring and
treatment (IMMT)
 Children with problem behaviors due to
autism or intellectual disabilities cannot use
IMMT because their need for additional care
and monitoring is a behavioral need and not a
medical need.
IMMT Services
What is IMMT?
 I = Interim
 M = Medical
 M = Monitoring
 T = Treatment
Legal Definition:
 Interim medical monitoring and treatment
services are monitoring and treatment of a
medical nature requiring specially trained
caregivers beyond what is normally available
in a day care setting.
Iowa Human Services Department. (2009, June 17) Medicaid waiver services, (ch.83).
Retrieved July 11, 2009, from http://www.legis.state.ia.us/aspx/ACODocs/DOCS/6-17-2009.441.83.pdf
IMMT Eligibility
e. To be eligible for interim medical monitoring and
treatment services the consumer must be:
(1) Under the age of 21;
(2) Currently receiving home health agency services under rule 44178.9(249A) and require medical assessment, medical monitoring,
and regular medical intervention or intervention in a medical
emergency during those services;
(3) Residing in the consumer’s family home or foster family home;
(4) In need of interim medical monitoring and treatment as ordered
by a physician.
Iowa Human Services Department. (2009) Medicaid waiver services, (ch.83).
Retrieved February 5, 2010, from
http://www.legis.state.ia.us/aspx/ACODocs/DOCS/6-17-2009.441.83.pdf
IMMT Services:
♦ Provide experiences for each member’s social,
emotional, intellectual, and physical
development.
♦ Include developmental care and any special
services for a member with special needs.
♦ Include medical assessment, medical
monitoring, and medical intervention as needed
on a regular or emergency basis.
♦ May include supervision during transportation to
and from school if not available through other
sources.

Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services.
Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Service Times:
 The services must be needed to allow the
consumer’s usual caregivers to be employed
or, for a limited period of time, for academic
or vocational training of a usual caregiver;
due to the hospitalization, treatment for
physical or mental illness, or death of a usual
caregiver; or during a search for employment
by a usual caregiver.

Iowa Human Services Department. (2009) Medicaid waiver services, (ch.83). Retrieved February
5, 2010, from http://www.legis.state.ia.us/aspx/ACODocs/DOCS/6-17-2009.441.83.pdf
Service Locations:
Services may not duplicate any regular
Medicaid or waiver services provided
under the state plan. They may be
provided only:
♦ In the member’s home,
♦ In a registered child development home,
♦ In a licensed child care center, or
♦ During transportation to and from school.

Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services.
Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Service Providers
The following providers may provide IMMT
services:
♦ Licensed child-care centers
♦ Registered child-care homes
♦ Home health agencies certified to participate
in the Medicare program
♦ Supported community living providers under
the ID waiver

Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services.
Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Ratios and Billing Units:
 The staff-to-member ratio shall not be less
than one to six.
 A unit of service is one hour.
 A maximum of 12 one-hour units of service is
available per day.

Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services.
Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Respite Services
Respite Care
 Respite care services are services provided to
the member that give temporary relief to the
usual caregivers and provide all the necessary
care that the usual caregiver would provide
during that period. The purpose of respite
care is to enable members to remain in their
current living situation.

Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services.
Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Usual Caregiver
 The “usual caregiver” is defined as a person
or persons who reside with the member and
are available on a 24-hour-per-day basis to
assume responsibility for the care of the
member.
 Respite care is not to be provided to
members during the hours in which the
member’s usual caregiver is employed,
except when the provider is a camp.
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Respite Units of Service
 A unit of service is one hour for all respite
services. A maximum of 14 consecutive days
of 24-hour respite care may be reimbursed.
 When respite care is provided, the provision
of or payment for other duplicative services
under the waiver is precluded.
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Respite may be provided by:
♦ A camp certified by the American Camping Association
♦ A child development home registered with DHS
♦ A child-care center licensed by DHS
♦ A group living foster care facility for children licensed by DHS
♦ A home health agency certified to participate in Medicare
♦ A hospital enrolled in Medicaid
♦ A nursing facility enrolled in Medicaid
♦ A preschool
♦ A residential care facility for persons with mental retardation (RCF/MR)
♦ An adult day care provider certified by DIA
♦ An agency with a local public health services contract for similar services
♦ An assisted living program certified by DIA
♦ An intermediate care facility for the mentally retarded (ICF/MR)
♦ Any agency certified to provide care in a member’s home under the ID
waiver
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Day Care vs. Home Care
 Private duty nurses meet the child’s medical
needs and the child’s home is considered a
natural environment.
 The majority of time is often spent in front of the
television rather than engaging in age-appropriate
activities with other children.
 May not be in compliance with the least restrictive
environment requirement and may not be in the
child’s best interest
Etscheidt, Susan . (2006). Least restrictive and natural environments for young children with
disabilities: A legal analysis of issues. Topics in Early Childhood Special Education, 26(3), 167-178.
Applying to be a Medicaid Provider
http://www.ime.state.ia.us/
How to enroll as a Medicaid
waiver provider
 The provider application and instructions
can be found on Iowa Medicaid Enterprise’s
(IME) web site. Any questions regarding the
completion of the application can be directed
to Iowa Medicaid Enterprise Provider Services
1-800-338-7909 or 515-725-1004 (from Des
Moines).
Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training
Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm
Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment.
Retrieved May 1, 2011, from
http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Docu
ments/Rules/441-80.pdf
Provider Handbook
A Medicaid provider handbook that covers
provider and member eligibility, waiver
service policies, service rate information, and
claim submission is available on the Internet
either through the IME web site or through
the Department’s Policy Analysis Web site at:
http://www.dhs.iowa.gov/policyanalysis/Policy
ManualPages/MedProvider.htm
Provider Online Tools
 The IME provides you the opportunity to use
the Web Portal through the Internet to Verify
Member Eligibility (HIPAA Transaction 270),
Check the Status of Your Claims (HIPAA
Transaction 276), or submit a Request For
Prior Authorization (HIPAA Transaction 278).
You must register through EDISS Total
Onboarding to use the Web Portal.
http://www.ime.state.ia.us/Providers/OnlineTools.html
Developing A Plan of Care
Provider Qualifications:
 The provider must be qualified by training or
experience to provide medical intervention or
intervention in a medical emergency
necessary to carry out the member’s plan of
care.
 This must be determined by the usual
caregivers and a licensed medical
professional on the member’s
interdisciplinary team and documented in the
service plan.

Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services.
Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Member’s Interdisciplinary Team
“Depending on an individual's age and disability, the exact composition
of the interdisciplinary team will vary. An interdisciplinary team
consists of the family and professionals who are engaged in supporting
the individual.” [1]
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Primary Physician
Social Workers
Specialists & Therapists
Home Care Nurse
School Nurse
Physical, Occupational & Speech Therapists
Area Education Agency (AEA)
Home and Community-Based Service Providers
Direct Care Providers
Special Education Teachers
Child Care Provider ?
[1] National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC). (2011). Interdisciplinary teams; Communication
services and supports for individuals with severe disabilities: FAQs. Retrieved April 20, 2011, from http://www.asha.org/NJC/faqs-i
nterdisciplinary.htm#39
Sample IMMT Daycare Plan
 SERVICES PROVIDED AT DAYCARE
IMMT services funded by the Ill and Handicap Waiver for a ##
year-old female with cerebral palsy. Child is wheelchair bound
and wears bilateral AFOs. She has a MIC-KEY Gastrostomy
Feeding Tube for supplemental feeding QHS PRN for inadequate
oral intake and medications. Daycare provider will provide safety
supervision at all times, monitor and adjust positioning hourly,
monitor oral intake daily, teach and assist with safe pivot transfer
from wheelchair to toilet as needed, assist with toileting, hygiene
and clothing adjustment as needed, perform stretching and
passive range of motion to lower extremities daily, remove AFOs
and provide floor time for at least one hour per day, reapply AFOs
before returning to wheelchair, assess skin integrity daily, and
report client's care and condition to client's mother daily.
Provider will also encourage independent mobility, physical
activity, and interactions with peers as appropriate to develop
age-appropriate social and self-care skills.
Tipton Adaptive Daycare
118 Parkview Court
Tipton, IA 52772
Phone / Fax: 563-886-3143
[email protected]
DAYCARE PERSONAL CARE PLAN FOR CHILD WITH SPECIAL NEEDS
Child's Name:
Date of Birth:
Social Security #:
Street Address:
City, State, Zip:
Home Phone Number:
Parent(s)/Guardian(s) Name(s):
Parent(s)/Guardian(s) Cell Phone #:
Parent(s)/Guardian(s) Email:
Parent(s)/Guardian(s) Employer(s):
Employer Address:
Employer Phone Number:
Medical/Psychiatric Diagnosis:
Allergies:
Safety Precautions:
Activity Restrictions:
Cerebral Palsy
Penicillin, Sulfa, Augmentin
wheelchair precautions, fall precautions, supervision at all times
Provide assistance for partial weightbearing, transferrs, and wheelchair
mobility on uneven surfaces.
MEDICATIONS TO BE GIVEN AT DAYCARE
FREQUENCY:
ROUTE:
SCHEDULED TIMES / PRN INDICATORS:
Q 6-8 hrs PRN
PO / GT
as needed for pain
MEDICATION:
Ibuprofen
STRENGTH:
100mg/5ml
DOSE:
10 ml
MEDICATION:
Miralax
STRENGTH:
ADDITIONAL PRESCRIPTION MEDICATIONS TAKEN AT HOME
DOSE:
FREQUENCY:
ROUTE:
SCHEDULED TIMES / PRN INDICATORS:
2 oz
Daily
GT
QAM for constipation
SERVICES PROVIDED AT DAYCARE
IMMT services funded by the Ill and Handicap Waiver for a ## year-old female with cerebral palsy. Child is wheelchair bound and wears bilateral AFOs. She has a
MIC-KEY Gastrostomy Feeding Tube for supplimental feeding QHS PRN for inadequate oral intake and medications. Daycare provider will provide safety
supervision at all times, monitor and adjust positioning hourly, monitor oral intake daily, teach and assist with safe pivot transfer from wheelchair to toilet as needed,
assist with toileting, hygene and clothing adjustment as needed, perform stretching and passive range of motion to lower extremeties daily, remove AFOs and provide
floor time for at least one hour per day, reapply AFOs before returning to wheelchair, assess skin integrity daily, and report client's care and condition to client's
mother daily. Provider will also encourage independant mobility, physical activity, and interactions with peers as appropriate to develop age-appropriate social and
self-care skills.
PARENT SIGNATURE:___________________________________________________________ DATE:_______________
CHILD CARE PROVIDER SIGNATURE:_____________________________________________ DATE:_______________
Deborah VanderGaast, RN, Owner/Operator
Physician:
Clinic Name:
Address:
City, State, Zip:
Phone:
Fax:
PHYSICIAN SIGNATURE:___________________________________________________ DATE:____________________
Care plan will expire one year from date of physician signature. Updates in orders and medications will be attached to care plan.
Tipton Adaptive Daycare
Weekly Personal Care and Medical Monitoring Record
NAME:
MONTH: ____________________20_____
Orders from Care Plan:
IMMT services funded by the Ill and Handicap Waiver for a ## year-old female with cerebral palsy. Child is wheelchair
bound and wears bilateral AFOs. She has a MIC-KEY Gastrostomy Feeding Tube for nightly supplemental feeding and
medications. Daycare provider will provide safety supervision at all times, monitor and adjust positioning hourly, monitor
oral intake daily, teach and assist with safe pivot transfer from wheelchair to toilet as needed, assist with toileting, hygiene
and clothing adjustment as needed, perform stretching and passive range of motion to lower extremities daily, remove
AFOs and provide floor time for at least one hour per day, reapply AFOs before returning to wheelchair, assess skin
integrity daily, and report client's care and condition to client's mother daily. Provider will also encourage independent
mobility, physical activity, and interactions with peers as appropriate to develop age-appropriate social and self-care skills.
DATE:
Care Provided:
Monitor and adjust positioning hourly
Time
9 am
10 am
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Assess skin integrity daily
% of breakfast eaten
% of AM snack eaten
% of lunch eaten
% of PM snack eaten
Pivot transfer to/from toilet PRN
Ax Ix
Ax Ix
Ax Ix
Ax Ix
Ax Ix
Toileting, clothing adjust, hygene PRN
Ax Ix
Ax Ix
Ax Ix
Ax Ix
Ax Ix
to
to
to
to
to
Floor time
Time AFOs removed
Time AFOs applied
Stretching and PROM to L.E.
Report client's care and condition to
mother
Time In:
Time Out:
Provider Initials:
X = done, INT = Intact without erythema or ecchymoses, Note = see note on back, A = assisted, I = independent
w/supervision
Sample Protective Daycare Plan
 SERVICES PROVIDED AT DAYCARE Protective daycare
services funded by the Department of Human Services for
## year-old female with risk for behavior disorders and risk
for injury related to altered family process: mental illness.
Child requires adult supervision at all times. Provider will
provide continuous supervision, age appropriate activities,
and homework supervision daily, homework assistance as
needed, redirection to appropriate activities as needed,
develop and implement behavior modification plans as
needed for maladaptive behaviors, report absences to
child's social worker immediately, communicate child's
progress to parent as needed, give written or oral progress
report to social worker monthly, and keep written record of
incidents as needed.
Required Documentation
What are the basic documentation requirements
that Waiver providers must meet?
Information necessary to support each item of service reported on the
Medicaid claim form. For instance:
1) Full name of child receiving service
2) Name of the service provided
3) First and last name of the staff providing services
4) Full date and time frames/duration of service delivery
5) Signature of staff providing the service
6) Activities during respite
7) Documentation of Medical Monitoring and Treatment on care plan
Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training
Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm
Respite Client Records
Providers shall maintain the following information that shall
be updated at least annually:
♦ The member’s name, birth date, age, and address and the
telephone number of each parent, guardian, or primary
caregiver.
♦ An emergency medical care release.
♦ Emergency contact telephone numbers such as the number
of the member’s physician and the parents, guardian, or
primary caregiver.
♦ The member’s medical issues, including allergies.
♦ The member’s daily schedule which includes the member’s
preferences in activities, food preferences, or any other
special concerns.
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Medications:
Procedures shall be developed for the dispensing, storage,
authorization, and recording of all prescription and
nonprescription medications administered. Home health
agencies must follow Medicare regulations for medication
dispensing.
♦ All medications shall be stored in their original containers, with
the accompanying physician or pharmacist’s directions and label
intact.
♦ Medications shall be stored so they are inaccessible to members
and the public.
♦ Non-prescription medications shall be labeled with the member’s
name.
♦ In the case of medications that are administered on an ongoing,
long-term basis, authorization shall be obtained for a period not
to exceed the duration of the prescription.
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Policies shall be developed for:
♦ Notifying the parent, guardian, or primary caregiver of any
injuries or illness that occur during respite provision. A
signature by the parent, guardian, or primary caregiver is
required to verify receipt of notification.
♦ Requiring the parent, guardian, or primary caregiver to
notify the respite provider of any injuries or illnesses that
occurred before respite provision.
♦ Documenting activities and times of respite. This
documentation shall be made available to the parent,
guardian, or primary caregiver upon request.
♦ Ensuring the safety and privacy of the person. Policies shall
at a minimum address fire, tornado, flood and bomb
threats.
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Information included on the
notice of decision:
♦ Services authorized
♦ Units of service
♦ Rates for services
♦ Providers authorized
♦ Start and end date for each service
authorized
♦ Information about client participation, if any
Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver
Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf
Provider Quality Management
Self-Assessment
TO: Iowa Medicaid Habilitation, Remedial Services and
HCBS Waiver Providers (Excluding Individual CDAC)
The Department of Human Services has
implemented a quality management process for
providers of each of the services identified below. As
a provider enrolled for one or more of these services
you are required to complete the 2010 Provider
Quality Management Self-Assessment. Failure to
complete the self-assessment may jeopardize
your status as a Medicaid provider of these
services.
 http://www.ime.state.ia.us/docs/935_InformationalLetter.pdf
Which Self-Assessment to Use:
 There are five versions of the self-assessment
 Sole Proprietor (Individual that has no direct service or
subcontracted employees, and services are provided
by the owner); enrolled only for Respite and/or Interim
Medical Monitoring and Treatment (IMMT) Services
 Provider enrolled only for Support Services (agency
CDAC, IMMT, Respite, Adult Day Care)
 This form is setup as a Microsoft Word template
and is to be completed electronically and
submitted as directed in the form instructions.
 http://www.ime.state.ia.us/HCBS/ReviewTools.html
Billing for Medicaid Services
PROCEDURE AND METHOD OF PAYMENT
441—80.2(249A) Submission of claims. Providers of medical and remedial
care participating in the program shall submit claims for services rendered
to the Iowa Medicaid enterprise on at least a monthly basis. All nursing
facilities and providers of home- and community-based services shall
submit claims for services after end of the calendar month in which the
services are provided.
• Providers of home- and community-based waiver services, including home
health agencies, shall submit claims on Form 470-2486, Claim for Targeted
Medical Care.
• Providers are encouraged to submit claims electronically whenever
possible.
Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. 441 Iowa Admin Code Chapter 80.
Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis
/PolicyManualPages/Manual_Documents/Rules/441-80.pdf
Time Limits
 441—80.4(249A) Time limit for submission of claims
and claim adjustments.
 80.4(1) Submission of claims. Payment will not be
made on any claim where the amount of time that has
elapsed between the date the service was rendered
and the date the initial claim is received by the Iowa
Medicaid enterprise exceeds 365 days.
Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. 441 Iowa Admin Code Chapter 80.
Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis
Electronic Billing
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As a medical provider are you interested in increasing your cash flow? Would you
like to do away with the burden of filling out paperwork and the expense of
mailing your paper claims? Then now may be the time to consider filing your
Medicaid claims electronically.
Iowa Medicaid Enterprise (IME) supports the electronic submission of claims.
Through electronic submission, you are able to submit claims more accurately.
You also receive your Medicaid payments sooner than if you submitted paper
claims.
Effective July 1, 2005, the Iowa Medicaid Enterprise (IME) has contracted with a
new company to process Medicaid claims currently being processed by ACS, the
current fiscal agent.
As part of this change, there is a new clearinghouse to receive electronic claims
transactions.
The new clearinghouse is EDI Support Services (EDISS To begin the enrollment
process for electronic claims to IME all offices must complete these steps:
Fill out the appropriate EDI paperwork Complete claims registration forms (837P,
837I, or 837D) along with the EDI Enrollment form If you will be using PC-ACE
Pro32, the PC-ACE Pro32 Software Sublicense Agreement will need to be
completed as well All forms must be filled out completely and signed in ink by
the provider
http://www.ime.state.ia.us/Providers/BillingInstructions.html
Paper Billing
 Submit Claim Forms to:
IME Claims
P.O. Box 150001
Des Moines, IA 50315
Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment.
Retrieved May 1, 2011, from
http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Docu
ments/Rules/441-80.pdf
What are the Healthcare
Provider Taxonomy Codes (HPTC)?
 The Healthcare Provider Taxonomy code set divides
health care providers into hierarchical groupings by
type, classification, and specialization, and assigns a
code to each grouping.
 All codes are alphanumeric and are 10 positions in
length.
 Iowa Medicaid assigns the taxonomy code(s) that most
closely represents the provider’s education, license, or
certification.
Centers for Medicare & Medicaid Services. (2003, October 3). What are the Healthcare Provider Taxonomy Codes
(HPTC)? Where may I obtain a copy of the codes?. Retrieved April 20, 2011, from
https://questions.cms.hhs.gov/app/answers/detail/a_id/2356/~/what-are-the-healthcare-provider-taxonomycodes-%28hptc%29%3F-where-may-i-obtain-a
 Taxonomy codes are assigned to you when
you apply to be a Medicaid provider.
 The Healthcare Provider Taxonomy code set
is available at no charge from the Washington
Publishing Company’s website:
http://www.wpc-edi.com/codes/taxonomy
Sample Taxonomy Code: 385HR2060X
 Respite Care, Mental Retardation and/or
Developmental Disabilities, Child:
A facility or distinct part of a facility that
provides short term, residential care to
children, diagnosed with mental retardation
and/or developmental disabilities as respite
for the regular caregivers.
Sample Taxonomy Code: 385HR2065X
385HR2065X
Respite Care, Physical Disabilities, Child - 385HR2065X
 Respite Care, Physical Disabilities, Child:
A facility or distinct part of a facility that
providers short term, residential care to
children, diagnosed with complex or
profound disabilities as respite for the regular
caregivers.
Q: How long does a provider
have to submit a bill/claim
for delivered services?
 A: Service providers have 12 months to bill
from the time the service was provided. The
service had to be authorized in the service
plan and approved in ISIS and could not have
been provided prior to the ISIS approval date.
Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training
Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm
Q: If my claim has been denied, what are
some initial things I should check?
A: Providers should cross reference their claim form with the service plan
and information received from the Targeted Case Manager authorizing
their services in ISIS. Check to see whether:
 the provider number is correct
 the procedure code on the claim form and the service plan match
 the service is billed according to the time spans authorized on the
service plan
 the correct number of units are billed according to what was provided
and authorized on the service plan
 the correct rate was billed according to the service plan authorization
 the service plan was approved at the time when the provider billed
 the bill was not submitted too early (services provided in one month
cannot be submitted for payment until the following month)
 the child was hospitalized or entered a facility (if so, the DHS Income
Maintenance Worker must have been notified so necessary changes can
be made in the payment system)
Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training
Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from
http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm
Resources
 Children with Special Needs Standards from
Caring for Our Children, 2nd Ed.
 This document is a compilation of the 101 standards
on providing child care to children with special
needs.
 Available free online at http://nrckids.org/SPINOFF/CSN/CSN.htm
 Print copy can be ordered from American Academy of Pediatrics for
$24.95 plus shipping and handling
Child Care Nurse Consultants
 Healthy Child Care Iowa supports Child Care
Nurse Consultants (registered nurses) who
are experts in child health, child care, and
child safety. Child Care Nurse Consultants
work with child care and early education
businesses. Businesses may call or send
questions to a child care nurse consultant
about health and safety policies, health
programs, health of personnel, and specific
child health or safety issues.
Healthy Child Care Iowa has a toll free talkline for
child care providers, (800) 369-2229.
Locating Regional Child Care Consultants
 Resources for Children With Special Needs
 All Kids Count: Child Care and the ADA (DBTAC Rocky Mtn. ADA
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Center)
Children and Youth with Special Health Care Needs Knowledge
Path (The Maternal & Child Health Library at Georgetown
University)
Children with Diabetes (Family Support Network)
Developmental Behavioral Pediatrics Online (AAP)
Diabetes in Children and Adolescents (Maternal and Child Health
Library Knowledge Path)
The Division for Early Childhood (of the Council for Exceptional
Children)
Family Village: A Global Community of Disability-Related
Resources
Family Voices
Healthy Kids, Healthy Care: Children with Special Needs
National Center on Birth Defects and Developmental Disabilities
The National Dissemination Center for Children with Disabilities
 http://nrckids.org/RESOURCES/list.htm#Consultants
Resources on Facebook
 National Dissemination Center for
Children with Disabilities (NICHCY)
 SpecialQuest Birth-Five: Early Childhood
Inclusion Training Resources
 Centers for Disease Control (CDC)
 Grant Wood Area Education Agency (AEA)
 Disability Rights Iowa
 Iowa Compass