Frequently Asked HCBS Questions

Waiver or Program-Related Questions

Other Programs

• Consumer Choices Option (CCO)
• Creating a CCO Budget and Prior Authorization - (Updated 6/8/2011)
• Habilitation Services
• Remedial Services Program

Department of Human Services

• Bureau of Long-Term Care

Technical Questions

• Individualized Services Information System  (ISIS)

HOME AND COMMUNITY BASED SERVICES (HCBS) FAQ:

1. What do the HCBS Specialists do? 5/11

• HCBS Specialists provide Quality Management Oversight through a contract with Iowa Medicaid Enterprise (IME). Federal and state regulations require that providers contracting with IME as HCBS agencies are reviewed regularly and that provider oversight meets the standards set by the State of Iowa and the Center for Medicaid and Medicare Services. Iowa has developed the four areas of review that the Specialist is responsible for completing. For more information on CMS requirements: http://www.ncdhhs.gov/mhddsas/statspublications/reports/hcbsqualityframework.pdf
• An HCBS review is a chance for HCBS Specialists to assist your agency in a partnership to provide quality services.
• The first method of oversight requires providers to complete the Provider Quality Management Self-Assessment. The Provider Quality Management Self-Assessment gives providers an opportunity to self-assess and evaluate the quality framework of the organization.
• The second method of oversight will consist of a focused review. This review will relate to randomly selected focus areas or when issues are identified through the self-assessment.
• The third method of oversight will be targeted reviews. These reviews will be initiated as a result of concerns arising from another review, incident reports, member interviews, or as the result of a filed complaint regarding a specific provider's service delivery. The outcome of this review could result in recommendations, corrective actions or sanctions.
• In addition to the first three methods, providers will receive a periodic review once every five years. The review will be done on-site for providers currently serving members under the waiver programs. The purpose of the periodic review is to evaluate the accuracy of the self-assessment as well as the provider's compliance with Federal regulations, Iowa Administrative Code and Iowa Code standards.
• The self-assessment is required annually of each agency provider. However, the other three reviews listed are chosen randomly. Each provider should experience both a periodic and a focused review every five years.
• HCBS Specialists also conduct IPES (Iowa Participant Experience Surveys) and MFP (Money Follows the Person) interviews. HCBS Specialists hold ISB (Independent Support Broker) trainings each quarter for the CCO (Consumer choices Option) program. In addition, HCBS Specialists assist with supported employment trainings through the WISE program.
• HCBS Staff also provide technical assistance to case management and service providers upon request. Technical assistance is provided to clarify rule and Code provisions, as well as give advice on policy and procedural issues.

2. Can my agency get one-to-one training from my HCBS Specialist? 5/11

Training requests are handled as resources are available. Unfortunately the large number of providers in the state do not allow for one-to-one training opportunities at this time.

3. How can my agency find out about upcoming rules changes? 5/11

Information on upcoming rules changes can be found at: http://www.dhs.state.ia.us/policyanalysis/rulespages/Dockets.htm

4. How do I file a complaint about HCBS waiver services? 5/11

You may file a complaint by contacting your HCBS Specialist through telephone, email or other correspondence. You can find contact information for HCBS Specialists at http://www.ime.state.ia.us/docs/HCBS_Specialists.pdf.

If you have a complaint regarding a service provider or from a member, you report that complaint directly to the HCBS Specialist assigned to that area. The HCBS Specialist will then determine if there needs to be an investigation. If it is determined that there is a health and safety issue present, the HCBS Specialist will conduct an investigation and prepare a report of findings, which will be sent to the complainant.

If you have a complaint regarding a Specialist, please contact the HCBS Supervisor to address the concern. Contact Misheal Waller at mwaller@dhs.state.ia.us.

If this is an issue of suspected abuse, report the complaint to Protective Services. You may report child abuse or dependent adult abuse by phone. The statewide hotline is 1-800-362-2178. The names of reporters of abuse are never made public.

5. How do I find the HCBS Specialist for my area? 5/11

The list of HCBS Specialists has been updated on the Iowa Medicaid Enterprise (IME) website. You may find the lists of Specialists by geographic area at: http://www.ime.state.ia.us/docs/HCBS_Specialists.pdf.

Please remember to refer HCBS Waiver questions or concerns to the HCBS Specialist assigned to your area before contacting the Waiver Program Manager. You may refer general questions regarding HCBS to HCBSwaivers@dhs.state.ia.us, the questions will then be referred to the Specialist assigned to that area.

6. How does my agency terminate my enrollment to provide HCBS or other services through Medicaid? 5/11

If you wish to terminate enrollment, The Iowa Medicaid Enterprise's Provider Services Unit requires the provider to submit a written request that identifies:

• NPI number(s)
• Tax ID Number (EIN)
• Explanation of the action you want Provider Services to take, i.e., specific services and programs you want terminated-for example IMMT under the PD Waiver, CDAC under E Waiver etc
• Your fax number & phone number so that Provider Services can contact you if additional information is needed
• Termination date
• Provider request must be signed and dated.

Your request should be faxed to: provider services at 515-725-1155 Attn: Changes.

7. What is a periodic review? 5/11

The periodic review evaluates the accuracy of the self-assessment as well as the provider's compliance with federal regulations, Iowa Administrative Code, Iowa Code, HCBS standards, and best practices. The periodic review looks at the entire agency in regards to rules, regulations and standard practices. In most cases, a HCBS Specialist will come to your agency and review the documentation, records, and quality improvement practices. You will be given an opportunity to provide information to support the policies, procedures and quality improvement activities of your agency. You will also receive technical assistance in how you can develop a better quality service. Periodic reviews are performed on-site for all current agency providers of Home and Community Based Services, including waiver and habilitation. The agency providers have been placed into 5 yearly samples and randomly assigned to receive periodic reviews. The agency providers should expect to receive a periodic review at a minimum every 5 years, as well as a focused review in the same 5 year period.

8. What is a focused review? 5/11

A focused review evaluates an agency in a selected focus area. The purpose of the focused review is to verify the accuracy of the provider's self-assessment responses, as well as to evaluate the compliance with the Iowa Code and IAC in the selected focus area. Providers will be randomly selected by service, provider type, and geographical area. Focus areas will be identified and reviewed by the HCBS Quality Assurance Team. Focused review topics change annually based upon recommendations of the HCBS and IME Policy team through identified issues or concerns. The first year focused on participant access, participant centered service planning and delivery and provider capacity and capabilities. The second year will be focusing on incident reporting analysis. Based on an examination of the provider's policies, procedures and evidence of implementation of such, the outcome may result in corrective actions or an on-site review.

9. Why was my agency chosen for a Periodic, Focused or Targeted Review? 5/11

Periodic reviews are performed on-site for all current agency providers of Home and Community Based Services, including waiver and habilitation. The agency providers have been placed into 5 yearly samples and randomly assigned. The agency providers should expect to receive a periodic review at a minimum every 5 years, as well as a focused review in the same 5 year period.

Focused reviews are assigned monthly to each Specialist based upon the 5 yearly samples. The goal is to have 12 done each month, with an annual total of 125. This annual total allows for providers who have terminated and do not elect to participate in the sample.

Targeted reviews are commenced when a complaint is made that requires an investigation by an HCBS Specialist. The indicators which would require investigation include health, safety and welfare concerns.

10. Why the Provider Quality Management Self-Assessment isn't completely based on the Iowa Administrative Code? 5/11

The Provider Quality Management Self-Assessment is based on multiple sources. All HCBS waiver programs are federally regulated. The State of Iowa has assured CMS that services are being provided by qualified waiver providers and that those providers are engaging in continuous quality improvement. The Provider Quality Management Self-Assessment is a part of that assurance. The Provider Quality Management Self-Assessment and HCBS reviews are based on Iowa Code regulations, IAC, federal regulations and best practices.

11. Can my agency change their self-assessment answers? 5/11

Revisions and/or amendments of the annual Provider Quality Management Self-Assessment will be allowed until the Self-Assessment has been accepted by the HCBS Specialist assigned to the region. No revisions and/or amendments may be made by the provider after the Self-Assessment has been accepted. Beginning with the 2011 Provider Quality Management Self-Assessment, agencies will receive an email confirmation that their self-assessment has been accepted. Following that confirmation, no changes will be accepted.