PUBLIC NOTICE: 1915(c) Home and Community Based Services (HCBS) AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly, Health and Disability (HD), Intellectual Disabilities (ID), and Physical Disability (PD) Waivers

The Iowa Department of Health and Human Services (HHS), pursuant to the requirements outlined in 42 CFR 441.304(f), hereby gives notice of the following intention to amend the Home and Community Based Services (HCBS) AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly, Health and Disability (HD), Intellectual Disabilities (ID), and Physical Disability (PD) Waivers. 

Summary of Submission:

The following technical changes are being made to the AIDS/HIV, Brain Injury (BI), Children’s Mental Health (CMH), Elderly (EW), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD) Waivers:

  • Updating the tool used for level of care determinations from Case Management Comprehensive Assessment to the interRAI-Early Years for 0–3-year-olds. (AIDS/HIV, BI, CMH, HD, ID, and PD)
  • Removed the individual Consumer Directed Attendant Care (CDAC) provider type, renamed the service to Attendant Care. (AIDS/HIV, BI, CMH, EW, HD, ID, and PD)
  • Amend the questions and scoring of the Waiver Priority Needs Assessment (WPNA) tool. (BI, CMH, HD, ID, and PD)
  • Align service definitions, scope, and limitations for alike services across Waivers. (AIDS/HIV, BI, CMH, EW, HD, ID, and PD)
    • Consumer Directed Attendant Care (CDAC) becomes Attendant Care
    • Senior Companion becomes Companion
    • Family Counseling and Training becomes Family Training
    • Homemaker and Chore becomes Home Maintenance Support
      • Combined similar components of Homemaker, Chore and Senior Companion services into the newly renamed Home Maintenance Support service.
    • Behavioral Programming becomes Positive Behavioral Support and Consultation
    • Removed Self-Directed Community Supports and Supported Employment from the ID and BI waiver because Supported Employment is a service available for self-direction under these waivers.
  • Add Community Business as a provider to Home Maintenance. (EW and HD)
  • Changing the self-directed ISB (Individual Support Broker) service from mandatory to optional, giving members the choice to work with an ISB or their case manager on their self-direction budget. (AIDS/HIV, BI, EW, HD, ID, and PD)
  • Update the term Exception to Policy (ETP) to Waiver of Iowa Administrative Rules (WoAR). (AIDS/HIV, BI, CMH, EW, HD, ID, and PD)
  • Supported Community Living: correct incorrect IAC code reference and update 15 min. unit of service per year limitation. (BI, and ID)
  • Supported Community Living: add Intensive Residential Service (IRS) standards under qualified providers and added the member service eligibility requirements for Intensive Residential Service SCL. (ID)
  • Added the Core Standardized Assessment vendor to the contracted entities listed in Appendix A. (AIDS/HIV, BI, CMH, EW, HD, ID, PD)
  • Align Point in Time counts in application to reflect the number of participants funded through fiscal appropriations. (BI, CMH, HD, ID, and PD)
  • Remove references to Integrated Health Home (IHH) and IHH Coordinators due to SPA sunsetting IHH 12/31/2025. (AIDS/HIV, BI, CMH, EW, HD, ID, PD)
  • Add the requirement that individuals with an intellectual disability or a developmental disability have face to face contact with the case manager at least every other month.  (AIDS/HIV, BI, CMH, EW, HD, ID, PD)

Fiscal Impact:

There is no expected fiscal impact.

Public Review and Comments

A copy of the Waiver amendments and this public notice are posted on the HHS website at the following link: https://hhs.iowa.gov/public-notice/2025-08-20/public-notice-1915c-home-and-community-based-services-hcbs-aidshiv-brain-injury-bi-childrens-mental. To reach all stakeholders, non-electronic copies will be made available for review at each local HHS office.

Prior to finalizing, HHS will consider all written comments received. The comments will be summarized and addressed in the final amendments submitted to CMS.

Submission of Comments

Written comments concerning this notice may be addressed to the Long-Term Services and Supports (LTSS) Policy Team, Department of Health and Human Services, Iowa Medicaid, 312 East 12th Street, Des Moines, IA 50319 or may be emailed to HCBS_Public_Comment@hhs.iowa.gov. Please indicate HCBS Waiver Amendment in the subject line of the email. 

All written and emailed comments must be received within 30 days from the issuance of this notice and no later than September 19, 2025, by 4:30 p.m.

Submitted by:

Rebecca Curtiss, Interim Medicaid Director

Iowa Department of Health and Human Services