PUBLIC NOTICE: Public Comment Period for State Plan Amendment (SPA) 1915(i) HCBS Habilitation

Pursuant to the authority of Iowa Code Section 249A.4, the Iowa Department of Human Services (DHS) has proposed changes to the state plan under Medicaid State Plan Amendment (SPA) Attachment 3.1-C 1915(i) State Plan HCBS Habilitation (IA-21-010).

The State of Iowa’s Medicaid program currently operates the 1915(i) State Plan HCBS Habilitation program. The changes to the 1915(i) SPA listed below were developed in partnership and collaboration with the Managed Care Organizations (MCOs), provider association and Habilitation providers. The proposed changes in each SPA are summarized below:

This SPA is intended to:

• Replace the InterRAI-CMH with the Level of Care Utilization System (LOCUS) for applicants and participants age 19 and older.
• Replace the interRAICYMH with the Child Adolescent Level of Care Utilization System (CALOUS) for adults age 16 and older.
• Amend the 1915(i) risk and needs based eligibility criteria.
• Amend the provider qualifications and service standards for Home-Based Habilitation (HBH).
• Add provider qualifications and service standards for Intensive Residential Habilitation services.
• Add provider qualifications and service standards for Individual Placement and Support (IPS) Supported Employment (SE) Model.
• Amend the HBH member eligibility criteria to provide for HBH Tier authorization based on the Actual Disposition Score of the LOCUS/CALOCUS.
• Implement Fee Schedules effective July 1, 2021.

The annual cost of the utilization change by HBH tier based on the LOCUS/CALOUC Actual Disposition Score is $5.5 million.

The fiscal impact of implementing IPS cannot be determined because the degree to which providers/members will transition to IPS is not known. Based on the above, the annual state share cost is expected to be between $12,652 and $419,535, and likely closer to the low-end at initial implementation.