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Physical Disability HCBS Waiver - Iowa

The physical disability (PD) waiver pays for services for people with a physical disability to allow them to return to the community from a medical institution. To be eligible for the physical disability waiver the person must meet all of the following requirements:

·           Be aged 18 through 64 years.

·           Have a physical disability.

·           Be blind or disabled as determined by the receipt of Social Security disability benefits, or by a disability determination made through the Division of Medical Services according to SSI guidelines.

·           Be eligible for Medicaid, including people eligible under the special income level (300 percent) coverage group consistent with a level of care in a medical institution.

·           Be ineligible for the HCBS MR waiver.

·           Be determined by the Iowa Foundation for Medical Care (IFMC) as in need of nursing facility care for the mentally retarded, skilled nursing facility, or nursing facility level of care.

·           Be a current resident of a medical institution at the time of application and have been a resident for at least 30 consecutive days at the time of the initial application for the PD waiver. Exception: During a waiver year, up to ten people (two per Departmental region) in need of the skilled nursing facility or nursing facility level of care who are not residents of a medical institution at the time of application may receive HCBS PD waiver services.

·           Be assessed by the service worker as able to live in a home- or community-based setting where all medically necessary service needs can be met within the scope of this waiver.

·           Have the ability to hire, supervise and fire the provider as determined by the service worker, and be willing to do so; or have a guardian named by the probate court who will take this responsibility on behalf of the consumer.

·           Choose HCBS.

·           Have a service plan completed annually.

·           Use one unit of consumer directed attendant care service or personal emergency response system service each quarter.

·           The total monthly cost of physical disability waiver program services the person needs as determined by the service worker and consumer cannot exceed $1,150.

PD Waiver Slots:

The physical disability waiver has limits to the number of people who will be served. The county of legal settlement (for nursing facility care for the mentally retarded level of care for adults) and the state (for all other) designate the number of people to be served under each waiver.

The total number of people receiving HCBS PD waiver services in the state is limited to the number provided in the waiver approved by the secretary of the U.S. Department of Health and Human Services.

Of this number, ten slots during any waiver year (two in each DHS region) are reserved for consumers who were not living in a medical institution at the time of their initial application for the PD waiver. These slots are available on a first-come, first-served basis.

Each county informs the Department by April 1 and October 1 of each year regarding the number of payment slots desired. These slots are part of the total number of slots available statewide. The county of legal settlement has financial responsibility for the state share of the costs of services for adults at the nursing facility for the mentally retarded level of care coming from a nursing facility for the mentally retarded. A county may choose to establish no payment slots under the HCBS PD waiver.

If there are no available payment slots available, the person’s name will be maintained on the state waiting list or on a regional waiting list for the slots reserved for people who are not institutionalized. The application will be denied.

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 53-60

Regulation citations: 441 IAC Chapter 83, Division V; 83.110(249A); 83.102(3), 83.102(4), 83.102(5)

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