Iowa Admin. Code r. 441-83.68 - Adverse service actions
(1)
Denial. An application for services shall be denied when it is
determined by the department that:
a. The
applicant is not eligible for the services.
b. Service needs exceed the service unit or
reimbursement maximums.
c. Service
needs are not met by the services provided.
d. Needed services are not available or
received from qualifying providers.
e. No HCBS intellectual disability waiver
service is identified in the applicant's service plan.
f. There is another community resource
available to provide the service or a similar service free of charge to the
applicant that will meet the applicant's needs.
g. Completion or receipt of required
documents by the department for the HCBS program applicant has not
occurred.
(2)
Reduction. A particular service may be reduced when the
department determines that the provisions of 441-subrule 130.5(3),
paragraph"a" or"b, " apply.
(3)
Termination. A
particular service may be terminated when the department determines that:
a. The provisions of 441-subrule 130.5(2),
paragraph"d," "g, " or"h, " apply.
b. Needed services are not available or
received from qualifying providers.
c. No HCBS intellectual disability waiver
service is identified in the member's annual service plan.
d. Service needs are not met by the services
provided.
e. Services needed exceed
the service unit or reimbursement maximums.
f. Completion or receipt of required
documents by the department for the HCBS program consumer has not
occurred.
g. The consumer receives
services from other Medicaid waiver programs.
h. The consumer or legal representative
through the interdisciplinary process requests termination from the
services.
Notes
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