FAQs


Frequently Asked Questions

Administrative Rules

Q: Where can I find the Adminitrative Rules for the program?
A: The rules are all available on the DHS website.
  • Rules concerning provider qualifications are found in 441 IAC Chapter 77. Information specific to Habilitation Services is in section 77.25.
  • Rules concerning covered services and general program operation are found in 441 IAC Chapter 78. Rules specific to Habilitation Services are in section 78.27.
  • Rules concerning provider reimbursement are found in 441 IAC Chapter 79. Information specific to Habilitation Services is in sections 79.1(2) and 79.1(24)
 

Member Enrollment

Q: How do consumers enroll for Habilitation Services? 
A: The enrollment process begins with a case manager. In general the process will follow these steps:
 
  • The case manager will make a request for Habilitation Services through ISIS. This will be done by going to the "Add/Cancel Program" tab in ISIS, entering the required information and clicking the "Initiate Program" button.
  • ISIS will then check for Medicaid eligibility and that the member meets the financial eligibility criteria. If financial eligibility cannot be determined, ISIS will send an email to the Income Maintenance worker asking them to enter the correct poverty level (FPL) for the person. If this happens, the case manager should wait 2 to 3 days before trying again. (See the Eligibility section below for more information on financial eligibility).
  • After Medicaid eligibility and financial eligibility are confirmed, the slot manager for IME will check for slot availability. If no slot is available, the member will be placed on the waiting list.
  • For adults, the county of legal settlement will be determined.
  • The case manager completes an assessment of the individuals functioning. The assessment must be one that meets the standards in 441 IAC - Chapter 24.4(2). The assessments being used by any accredited TCM provider should meet this criteria.
  • The assessment will then be submitted to the IME where our Medical Services staff, (from the Iowa Foundation for Medical Care), will make the determination of whether or not the individual meets the needs-based criteria. (See the Eligibility section below for the criteria). In some cases, the reviewer may ask for more information.
  • If the person is determined eligible, the case manager will then use the same assessment to develop the Individual Comprehensive Plan with the member's interdisciplinary team.
  • The case manager will then enter the participant's service plan with all relevant services into ISIS.
  • The service plan will then be reviewed for authorization by IME Medical Services.
  • ISIS send a notification to the case manager and the county CPC for adults.
 
Q: I tried to enter my consumer in ISIS and it gave me an error message saying the % of federal poverty level is missing, or is 000 or 999. What does this mean and what should I do about it?
A: The message you received means that the calculation of federal poverty level that the Income Maintenance worker enters is either 000 or 999. These are both generic codes that don't give the real poverty level. When you get that message, ISIS sends a message to the IM worker asking them to enter the correct poverty level calculation. It may take up to a week for this to be entered and carried over to ISIS, so when you get this message, wait a week and try again. Knowing the poverty level is necessary for ISIS to start the case because the federal law that authorizes the Habilitation program limits eligibility to persons at or below 150% of the federal poverty level (FPL). See the eligibility FAQs below for more intformation on this requirement.
 

Needs Based Assessment

Q: What assessment form is used? 
A: The Case Management Comprehensive Assessment (Form 470-4694). The case manager can also send a social history as an attachment if it is felt that additional information is needed.
 
Q: Where should the assessment be sent? 
A: Submit it to the IME Medical Services Unit by FAX at (515)725-0931. Please be sure it is clearly marked as being for Habilitation Services. Do not batch requests under one fax cover sheet; send each request with a separate cover sheet. Response to requests will be completed by fax only. It is necessary to provide your fax number to us on your cover sheet. A universal fax cover page is available here.
 
Questions regarding assessments can be sent by email to: habilitationservices@dhs.state.ia.us.  Do NOT submit assessments to this address. Use the above FAX number only. 
 
Q: How soon will the assessment be processed? 
A: Initial assessments will be responded to within 2 business days. Annual reviews will be responded to within 5 business days. In some cases, the reviewer may ask for additional information to be sent.
 

Provider Enrollment

Q: Do current Medicaid providers need to re-enroll to provide Habilitation Services? 
A: Yes. All current providers will need to enroll separately as a Habilitation Services provider because some qualifications may be different than for other programs a provider is currently enrolled for. Targeted case management providers who wish to provide case management as a service under this program must also enroll in order to establish a provider number that is different from their TCM provider number.
 
Q: What is the enrollment process? 
A: Providers must complete the Organizational Provider application form, a provider agreement form, and an IRS W-9 form. These forms can all be found at the IME Provider enrollment webpage. Alternately, you can contact the IME Provider Enrollment Unit by e-mail at imeproviderservices@dhs.state.ia.us or call 1-800-338-7909 (Option 2) or 515-725-1004 from Des Moines.
 
Q: What are the qualifications needed to become a provider for Habilitation Services? 
A: Requirements shown in the chart below reflect the requirements in effect as of 4/1/07:
 
Case Management
Accredited under 441 IAC Chapter 24
 
Home-Based Habilitation
Meet any of the following:
  • Certified by the department to provide Supported Community Living (SCL) under the HCBS Mental Retardation Waiver or Brain Injury Waiver.
  • Certified under 441-Chapter 24 to provide supported community living.
  • Accredited by the Commission on Accreditation of Rehabilitation Facilities as a community housing or supported living service provider.
  • Accredited by the Council on Accreditation of Services for Families and Children (COA).
  • Accredited by the Council for Quality and Leadership in Supports for People with Disabilities(CQL).
  • Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
  • A licensed residential care facility of 16 or fewer beds that was enrolled as a provider of rehabilitation services for adults with chronic mental illness before December 31, 2006, and has applied for accreditation through one of the above accrediting bodies.

Day Habilitation

Meet any of the following:

 

  • Accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) to provide services that qualify as day habilitation.
  • Accredited by CARF to provide a different service, but since the last accreditation survey has begun providing services that qualify as day habilitation. When the current accreditation runs out, the new CARF accreditation must include services that qualify as day habilitation, or the provider must become accredited under one of the other accreditation options.
  • Not accredited by CARF, but has applied for CARF accreditation. The accreditation process must be completed within 12 months.
  • Accredited by the Council for Quality and Leadership in Supports for People with Disabilities (CQL).
  • Not accredited by CQL, but has applied for CQL accreditation. The accreditation process must be completed within 12 months.
  • Certified under 441-Chapter 24 to provide day treatment or supported community living services.
  • Certified by DHS to provide Day Habilitation under the MR Waiver.
  • Accredited by the International Center for Clubhouse Development (ICCD).
  • A licensed residential care facility of more than 16 beds that was enrolled as a provider of rehabilitation services for adults with chronic mental illness before December 31, 2006, and has applied for accreditation through one of the above accrediting bodies.

Prevocational Habilitation

Meet any of the following:
  • Accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)as an organizational employment service provider or community employment service provider.
  • Accredited by the Council for Quality and Leadership in Supports for People with Disabilities (CQL).
  • Accredited by the International Center for Clubhouse Development (ICCD).
  • Certified by the department to provide Prevocational services under the HCBS Mental Retardation Waiver or Brain Injury Waiver.

Supported Employment Habilitation

 

Meet any of the following:
  • Certified by the department to provide supported employment services under the HCBS Mental Retardation Waiver or Brain Injury Waiver.
  • Accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) as an organizational employment service provider or community employment service provider.
  • Accredited by the Council on Accreditation of Services for Families and Children (COA).
  • Accredited by the Council for Quality and Leadership in Supports for People with Disabilities(CQL).
  • Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
  • Accredited by the International Center for Clubhouse Development (ICCD).

Eligibility

Q: Who is eligible to receive these services? 
A: The federal law that the program will operate under prohibits targeting a specific population group to be served. However, the program provides the type of services typically needed by adults with a chronic mental illness. Anyone seeking services through this program must be eligible for Medicaid and have a need for such services which will be demonstrated by meeting the following Needs-Based Criteria:
 
The individual meets at least one of the following risk factors:
  • Has undergone or is currently undergoing psychiatric treatment more intensive than outpatient care, more than once in a lifetime (e.g., emergency services, alternative home care, partial hospitalization or inpatient hospitalization).
  • Has a history of psychiatric illness resulting in at least one episode of continuous, professional supportive care other than hospitalization.
In addition, the person has a need for assistance typically demonstrated by meeting at least two of the following criteria on a continuing or intermittent basis for at least two years:
  • Is unemployed, or employed in a sheltered setting, or have markedly limited skills and a poor work history.
  • Requires financial assistance for out-of-hospital maintenance and may be unable to procure this assistance without help.
  • Shows severe inability to establish or maintain a personal social support system.
  • Requires help in basic living skills such as self-care, money management, housekeeping, cooking, or medication management.
  • Exhibits inappropriate social behavior that results in demand for intervention.
 
Q: Can children receive Habilitation Services?
A: There is no age restriction on the receipt of Habilitation Services; anyone who meets all eligibility requirements for the program can receive the service. However, the needs-based criteria are functional criteria that most likely would not be applicible to most younger children regardless of disability. Adolescents who are transitioning from children's services to adult services would likely benefit from the program without the need to make an abrupt transition at the age of eighteen.
 
Q: What are the financial eligibility requirements? 
A: Federal law restricts eligibility to individuals whose household income does not exceed 150% of the federal poverty level.
 
Q: Are there slots for this program? 
A: No, as of January 1, 2011 there are no slots or waiting lists for the program. 
 
Q: Can a person receive services through this program and through an HCBS Waiver program? 
A: As of June 1, 2008 there is no longer a rule that prohibits a person from receiving Habilitation Services and Waiver services. A person must still meet all eligibility criteria for both programs, and services may not be duplicitive between the two programs.