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Brain Injury - Qualifying Diagnosis for HCBS Waiver - Iowa

To be eligible for the brain injury waiver, the person must have a diagnosis of brain injury. Following is a list of qualifying diagnoses:

·           Malignant neoplasms of brain, cerebrum

·           Malignant neoplasms of brain, frontal lobe

·           Malignant neoplasms of brain, temporal lobe

·           Malignant neoplasms of brain, parietal lobe

·           Malignant neoplasms of brain, occipital lobe

·           Malignant neoplasms of brain, ventricles

·           Malignant neoplasms of brain, cerebellum

·           Malignant neoplasms of brain, brain stem

·           Malignant neoplasms of brain, other part of brain, includes midbrain, peduncle, and medulla oblongata

·           Malignant neoplasms of brain, cerebral meninges

·           Malignant neoplasms of brain, cranial nerves

·           Secondary malignant neoplasm of brain

·           Secondary malignant neoplasm of other parts of the nervous system, includes cerebral meninges

·           Benign neoplasm of brain and other parts of the nervous system, brain

·           Benign neoplasm of brain and other parts of the nervous system, cranial nerves

·           Benign neoplasm of brain and other parts of the nervous system, cerebral meninges

·           Encephalitis, myelitis and encephalomyelitis

·           Intracranial and intraspinal abscess

·           Anoxic brain damage

·           Subarachnoid hemorrhage

·           Intracerebral hemorrhage

·           Other and unspecified intracranial hemorrhage

·           Occlusion and stenosis of precerebral arteries

·           Occlusion of cerebral arteries

·           Transient cerebral ischemia

·           Acute, but ill-defined, cerebrovascular disease

·           Other and ill-defined cerebrovascular diseases

·           Fracture of vault of skull

·           Fracture of base of skull

·           Other and unqualified skull fractures

·           Multiple fractures involving skull or face with other bones

·           Concussion

·           Cerebral laceration and contusion

·           Subarachnoid, subdural, and extradural hemorrhage following injury

·           Other and unspecified intracranial hemorrhage following injury

·           Intracranial injury of other and unspecified nature

·           Poisoning by drugs, medicinal and biological substances

·           Toxic effects of substances

·           Effects of external causes

·           Drowning and nonfatal submersion

·           Asphyxiation and strangulation

·           Child maltreatment syndrome

·           Adult maltreatment syndrome

The Iowa Foundation for Medical Care (IFMC) will verify the brain injury diagnosis. The waiver application will be denied if the brain injury is not on the list from IFMC.

See Also:

·           HCBS Waivers Overview

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter N, pages 32 & 33

Regulation citations: 441 IAC, 83.81(249A)

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