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About Habilitation Services
Habilitation Services is a program that helps Iowans with long-term mental health challenges live more independently at home and in their communities. Made possible by a 2005 federal law, Iowa started offering these services in 2007. The program was created with help from the Centers for Medicare and Medicaid Services (CMS) to support people in building daily living, social, and coping skills.
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Provides service coordination and monitoring. Available as a Habilitation service when the individual does not otherwise qualify for targeted case management.
Services provided in the person's home and community. Typical examples would be assistance with medication management, budgeting, grocery shopping, personal hygiene skills, etc.
Services that are usually provided in a day program setting outside the home. Focuses on areas such as social skills, communication skills, behavior management, etc.
Can be provided in a variety of settings and focus on developing generalized skills that prepare a person for employment. Typical examples include attendance, safety skills, following directions, and staying on task.
Assists in obtaining and keeping a job in the community. Assists in placing the individual in a job in a regular work setting with persons without disabilities at minimum wage or higher and provides support to maintain the job. Typical examples would include skills assessments, consultation with the employer, job coaching, and behavior management.
Frequently Asked Questions (FAQ)
Administrative Rules
The rules are all available on the HHS website.
- Rules concerning provider qualifications are found in 441 IAC Chapter 77. Information specific to Habilitation Services is in section 77.25.
- Rules concerning covered services and general program operation are found in 441 IAC Chapter 78. Rules specific to Habilitation Services are in section 78.27.
- Rules concerning provider reimbursement are found in 441 IAC Chapter 79. Information specific to Habilitation Services is in sections 79.1(2) and 79.1(24)
Member Enrollment
The enrollment process begins with a case manager.
Generally, the process will follow these steps:
The case manager starts the request for Habilitation Services by going into ISIS, selecting the "Add/Cancel Program" tab, entering the needed information, and clicking "Initiate Program."
ISIS will then check if the person is eligible for Medicaid and meets the financial criteria. If financial eligibility can’t be confirmed, ISIS will email the Income Maintenance worker to update the person’s poverty level. If that happens, the case manager should wait 2–3 days before trying again. (See the Eligibility section for more details.)
Once eligibility is confirmed, IME’s slot manager will check for open slots. If none are available, the person will be placed on a waiting list.
For adults, their county of legal settlement will also be identified.
The case manager completes a functional assessment using a tool that meets state standards (441 IAC - Chapter 24.4(2)). Tools used by accredited TCM providers should meet this standard.
The assessment is sent to IME, where Medical Services staff (through the Iowa Foundation for Medical Care) will decide if the person meets needs-based criteria. They may request more information if needed. (See the Eligibility section for criteria.)
If approved, the case manager will use that same assessment to help develop the Individual Comprehensive Plan with the member’s interdisciplinary team.
Finally, the case manager enters the service plan into ISIS. IME Medical Services will review it for authorization, and ISIS will notify both the case manager and, for adults, the county CPC.
I tried to enter my consumer in ISIS and it gave me an error message saying the % of federal poverty level is missing, or is 000 or 999. What does this mean and what should I do about it?
The message you received means that the calculation of federal poverty level that the Income Maintenance worker enters is either 000 or 999. These are both generic codes that don't give the real poverty level. When you get that message, ISIS sends a message to the IM worker asking them to enter the correct poverty level calculation. It may take up to a week for this to be entered and carried over to ISIS, so when you get this message, wait a week and try again. Knowing the poverty level is necessary for ISIS to start the case because the federal law that authorizes the Habilitation program limits eligibility to persons at or below 150% of the federal poverty level (FPL). See the eligibility FAQs below for more information on this requirement.
Needs Based Assessment
The Case Management Comprehensive Assessment (Form 470-4694). The case manager can also send a social history as an attachment if it is felt that additional information is needed.
Submit it to the Iowa Medicaid Medical Services Unit by FAX at (515)-725-0931. Please be sure it is clearly marked as being for Habilitation Services. Do not batch requests under one fax cover sheet; send each request with a separate cover sheet. Response to requests will be completed by fax only. It is necessary to provide your fax number to us on your cover sheet.
Questions regarding assessments can be sent by email to: habilitationservices@hhs.iowa.gov
Do NOT submit assessments to this address.
Use the above FAX number only.
Initial assessments will be responded to within 2 business days. Annual reviews will be responded to within 5 business days. In some cases, the reviewer may ask for additional information to be sent.
Provider Enrollment
Do current Medicaid providers need to re-enroll to provide Habilitation Services?
Yes. All current providers will need to enroll separately as a Habilitation Services provider because some qualifications may be different than for other programs a provider is currently enrolled for. Targeted case management providers who wish to provide case management as a service under this program must also enroll in order to establish a provider number that is different from their TCM provider number.
Providers must complete the Organizational Provider application form, a provider agreement form, and an IRS W-9 form. These forms can all be found at the IME Provider enrollment webpage. Alternately, you can contact the IME Provider Enrollment Unit by e-mail at imeprovideroutreach@hhs.iowa.gov or call 1-800-338-7909 (Option 2) or 515-725-1004 from Des Moines.
What are the qualifications needed to become a provider for Habilitation Services?
Requirements shown in the chart below reflect the requirements in effect as of 4/1/07:
Case Management
Accredited under 441 IAC Chapter 24
Home-Based Habilitation
Meet any of the following:
- Certified by the department to provide Supported Community Living (SCL) under the HCBS Mental Retardation Waiver or Brain Injury Waiver.
- Certified under 441-Chapter 24 to provide supported community living.
- Accredited by the Commission on Accreditation of Rehabilitation Facilities as a community housing or supported living service provider.
- Accredited by the Council on Accreditation of Services for Families and Children (COA).
- Accredited by the Council for Quality and Leadership in Supports for People with Disabilities(CQL).
- Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
- A licensed residential care facility of 16 or fewer beds that was enrolled as a provider of rehabilitation services for adults with chronic mental illness before December 31, 2006, and has applied for accreditation through one of the above accrediting bodies.
Day Habilitation
Meet any of the following:
- Accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) to provide services that qualify as day habilitation.
- Accredited by CARF to provide a different service, but since the last accreditation survey has begun providing services that qualify as day habilitation. When the current accreditation runs out, the new CARF accreditation must include services that qualify as day habilitation, or the provider must become accredited under one of the other accreditation options.
- Not accredited by CARF, but has applied for CARF accreditation. The accreditation process must be completed within 12 months.
- Accredited by the Council for Quality and Leadership in Supports for People with Disabilities (CQL).
- Not accredited by CQL, but has applied for CQL accreditation. The accreditation process must be completed within 12 months.
- Certified under 441-Chapter 24 to provide day treatment or supported community living services.
- Certified by DHS to provide Day Habilitation under the MR Waiver.
- Accredited by the International Center for Clubhouse Development (ICCD).
- A licensed residential care facility of more than 16 beds that was enrolled as a provider of rehabilitation services for adults with chronic mental illness before December 31, 2006, and has applied for accreditation through one of the above accrediting bodies.
Prevocational Habilitation
Meet any of the following:
- Accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)as an organizational employment service provider or community employment service provider.
- Accredited by the Council for Quality and Leadership in Supports for People with Disabilities (CQL).
- Accredited by the International Center for Clubhouse Development (ICCD).
- Certified by the department to provide Prevocational services under the HCBS Mental Retardation Waiver or Brain Injury Waiver.
Supported Employment Habilitation
Meet any of the following:
- Certified by the department to provide supported employment services under the HCBS Mental Retardation Waiver or Brain Injury Waiver.
- Accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) as an organizational employment service provider or community employment service provider.
- Accredited by the Council on Accreditation of Services for Families and Children (COA).
- Accredited by the Council for Quality and Leadership in Supports for People with Disabilities (CQL).
- Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
- Accredited by the International Center for Clubhouse Development (ICCD).
Eligibility
Federal law doesn’t allow this program to target a specific group of people. However, it offers services that are often helpful for adults with chronic mental illness. To qualify, a person must be on Medicaid and show a need for these services based on the following:
The person must meet at least one of these risk factors:
- Has received or is receiving psychiatric treatment more intense than outpatient care more than once (like emergency care, inpatient hospitalization, or similar services).
- Has a history of mental illness that required ongoing professional support (not including hospitalization).
And they must meet at least two of the following needs, either consistently or off and on, for at least two years:
- Has trouble keeping a job, works in a sheltered setting, or has limited job skills and work history.
- Needs help with money or housing and can’t get it without support.
- Struggles to build or keep a social support system.
- Needs help with daily living skills like self-care, cooking, budgeting, or managing medications.
- Shows behaviors that often require outside intervention.
There is no age limit for receiving Habilitation Services—anyone who meets the eligibility requirements can qualify. However, the needs-based criteria are based on functional abilities and usually don’t apply to most young children, even those with disabilities. Teens moving from children’s services to adult services may benefit from this program and avoid a sudden change when they turn 18.
Federal law restricts eligibility to individuals whose household income does not exceed 150% of the federal poverty level.
No. There are no slots or waiting lists for the program.
Can a person receive services through this program and through an HCBS Waiver program?
There is no rule that prohibits a person from receiving Habilitation Services and Waiver services.
A person must still meet all eligibility criteria for both programs, and services may not be duplicative between the two programs.
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