Iowa Department of Human Services

Level of Care

As of July 1, 2005, there has been a change in the process for determining level of care (medical necessity) for Medicaid-eligible members or applicants. Below you will find information regarding the process change:

LOC Info Releases:

Name:	Description:	Release Date:	Accurate as of:	Size:
Info Release #565	Informational release describing the Level of Care Certification form for AIDS/HIV, ELderly, Ill and Handicapped and Physical Disability HCBS Waivers.	01/05/07	01/2007	^{_{^_[ 41kb]}}
Info Release #536	Informational Release providing clarification on the Level of Care Process for Nursing Facility and ICF MR programs.	11/01/06	01/2007	^_[ 53kb]
Info Release #524	Revised Level of Care Process for Nursing Facility and ICF/MR program.	08/29/06	12/2006	^_[ 59kb]
Info Release #523	New Home and Community Based Services Elderly Waiver Level of Care Process.	08/28/06	12/2006	^_[ 55kb]
Info Release #520	Informational release targeted to facility providers describing the revised Level of Care Process for nursing facility, ICF/MR and Home and Community Based Services (HCBS) Elderly Waiver Programs.	08/21/06	12/2006	^_[ 57kb]
Info Release #519	Informational release describing the revised Level of Care Process for nursing facility, ICF/MR and Home and Community Based Services (HCBS) Elderly Waiver Programs.	08/21/06	12/2006	^_[ 63kb]
Info Release #516	Informational release describing the revised Home and Community Based Services (HCBS) Waiver Level of Care Process for the AIDS/HIV, Ill and Handicapped (IH) and Physical Disability (PD) waivers.	07/28/06	12/2006	^_[ 49kb]
Info Release #515	Informational release describing the revised Home and Community Based Services (HCBS) Waiver Level of Care Process for AIDS, Ill & Handicapped and Physical Disability waivers (July 31, 2006)	07/31/06	12/2006	^{_{^_[ 55kb]}}
Info Release #511	Informational release describing the revised Home and Community Based Services (HCBS) Waiver Level of Care Process for the Children's Mental Health (CMH) waiver.	07/20/06	12/2006	^_[ 52kb]
Info Release #502	Informational release describing the revised Home and Community Based Services (HCBS) Waiver Level of Care Process for Brain Injury (BI) and Mental Retardation (MR) waivers.	07/22/06	12/2006	^_[ 47kb]

LOC Documents:

Name:	Description:	Size:
ASE Criteria	Criteria used by IME Medical Services review staff to determine NF level of care. IME review staff take the information from the LOC certification forms (form 470-4392 or 470-4393) and apply this criteria. The IME reviewer then uses his/her clinical judgement to determine if the care needs identified on the LOC certification form meet the criteria to support the requested level of care.	^_[ 87kb]
ICF MR Criteria	Criteria used by IME Medical Services review staff to determine ICF MR level of care. IME review staff take the information from the LOC certification form (470-4393) or MR Functional Assessment Tool (470-3073) and apply this criteria. The IME reviewer then uses his/her clinical judgement to determine if the care needs identified on the applicable assessment form meet the criteria to support the requested level of care.	^_[ 96kb]
Level of Care Certification for Facility Care, Form 470-4393	Form to be completed by medical professional to determine level of care for nursing facility and ICF MR programs.	^_[ 661kb]
Certification for Level of Care for Home and Community Based Services (HCBS), Form 470-4392	Form to be completed by medical professional to determine level of care for the AIDS/HIV, Elderly, Ill and Handicapped and Physical Disability HCBS waivers.	^_[ 1,542kb]
Medical Services Performance Measures (January 2006)	IME Medical Services Performance Measure information specific to the long term care assesment process, reported for the first 6 months of operation.	^_[ 212kb]
Memo on Long Term Care Assessment Process	Memo released by the Bureau of Long Term Care on April 19, 2005 that describes the changes to the long term care (level of care) assessment process effective July 1, 2005.	^_[ 49kb]
LTC Assessment Scenarios	This document describes several common scenarios/examples when a level of care determination is needed, and what needs to be done for each scenario.	^_[ 44kb]
LTC Assessment Team	This document lists the Iowa Medicaid Enterprise (IME) Long Term Care Nurse Reviewers and the counties they will cover. Includes nurses names, phone numbers and e-mail addresses.	^_[ 28kb]
NF Tool for Level of Care	This is the assessment tool that will be completed by the IME Long Term Care Nurse Reviewers when assessing Medicaid Members requesting nursing facility services. This is the same tool used to determine level of care prior to July 1, 2005.	^_[ 41kb]
Final Bill Language HF 841 on LOC Criteria Change	In an effort to re-balance long-term care, and as part of the Iowa Medicaid Reform, legislation was passed that would change the criteria needed to qualify for Medicaid funding for identified long-term care services. This document is a copy of the bill language that describes the criteria change. This change is still pending federal approval by the Centers for Medicare and Medicaid services (CMS), and will not be implemented until approval is received.	^_[ 24kb]
Commonly Asked Questions and Answer Document	Document released by the Bureau of Long Term Care that includes the commonly asked questions and answers related to the changes with the long term care (level of care) assessment process effective July 1, 2005.	^_[ 116kb]
LTC Facility - Steps Required for Level of Care	Document includes clarification on necessary steps for new level of care/long term care assessment process for facility services.	^_[ 36kb]
Commonly Asked Questions and Answer Document # 2 (9-19-05)	2nd Q & A document released by the Bureau of Long Term Care that includes commonly asked questions and answers related to the changes with the long term care (level of care) assessment process effective July 1, 2005.	^_[ 52kb]