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northeast iowa mental health & disabilities services ... - Fayette County

northeast iowa mental health & disabilities services ... - Fayette County

acquired conditions with

acquired conditions with high probability of resulting in developmental disabilities if services are not provided. Brain Injury (Per Iowa Administrative Code, Chap. 22): Persons with clinically evident damage to the brain resulting directly or indirectly from trauma, infection, anoxia, vascular lesions or tumor of the brain, not primarily related to the degenerative or aging processes, which temporarily or permanently impairs a person’s physical, cognitive, or behavioral functions. 4. Determination of Legal Settlement and County of Residence Legal settlement refers to a legal concept that determines which county is legally responsible for the cost of an individual’s service. Individuals may reside in a county but not have legal settlement in that county. To establish legal settlement an individual must live in an Iowa county for one year without receiving any mental health or substance abuse treatment. If someone moves to a county for less than one year, he or she will not have established legal settlement in that county. If someone moves from out of state and has not lived in a county for one year without services, he or she will have legal settlement with the State of Iowa. Eligibility for services is determined according to the county of residence plan. “County of Residence” means the county in Iowa where, at the time an adult applies for or receives services; the adult is living and has established an ongoing presence with the declared, good-faith intention of living permanently or for an indefinite period. The “county where a person is living” does not mean the county where a person is present for the purposes of receiving services in a hospital, correctional facility, halfway houses for community corrections and/or substance abuse treatment, nursing facility, intermediate care facility for persons with mental retardation, or residential care facility, nor for the purpose of attending a college or university. The “county of residence” for persons receiving residential services, as described in the preceding sentence, is the county where the person lived at the time of the residential placement. For persons who are Iowa residents but who fall within an exclusion for county of residence as described in this definition, the county where the person is physically present shall be the county of residence. The county of residence of an adult who is a homeless person is the county where the adult usually sleeps. 5. Notice of Eligibility A Notice of Eligibility (Form B) will be mailed to the applicant and providers within 10 working days of receipt of the completed CPC application. The notice will state whether the application has been approved or denied for funding, or if the decision is pending and more information is needed. Failure to return a completed CPC application or requested information within 30 days from the date of the Notice of Eligibility may result in denial of service funding. E. SERVICE FUNDING AUTHORIZATION Once an individual is determined eligible for county funded services, a service coordinator will be assigned. Service coordinators will be assigned based on the following premises: 1. If the applicant has a Medicaid Targeted Case Manager or a county social worker, that person is the service coordinator. 2. If not, then a worker from a residential provider. 7

3. If not, then a worker from a vocational provider. 4. If not, then a worker from the outpatient mental health provider. The service coordinator will work with the applicant through the following process to determine how much and what kinds of services are appropriate. 1. Assessment The service coordinator will do an assessment. An assessment is information collected through interviews with the applicant, and other interested people or providers to give the best picture of the applicant’s needs. Other assessments may be used instead of, or in addition to, the service coordinator’s assessment. 2. Development of an Individual Comprehensive Plan After the assessment, the service coordinator will work with the applicant and others identified by the applicant as being part of the treatment team to develop a plan to meet the needs and accomplish goals. 3. Service Funding Request (Form C) After the service coordinator verifies that county funded services are the least restrictive and most cost effective services appropriate for the individual’s needs, and that alternative funding and supports were considered first, a service funding request is submitted to the Central Point of Coordination (CPC) Administrator in the individual’s county of residence. The CPC Administrator will then decide if the treatment, rehabilitative or supportive services are as follows: 1. Appropriate and necessary to the symptoms, diagnoses or treatment 2. Within standards of good practice for the type of service requested 3. Not primarily for the convenience of the individual or that of the service provider 4. The most appropriate level of service which can safely be provided 5. Of benefit to the individual and not available from alternative sources 6. For a service available to the individual’s covered diagnosis 7. When deemed appropriate, the CPC Administrator may contract with a qualified professional to review the plan for requested services The funding request decision will not supersede approval of services mandated by federal or state statue, code, or rule and be within current service utilization guidelines of 24 individual therapy session per year (including the initial evaluation) and 12 psychiatric visits per year. 4. Service Funding Notice of Decision (Form C) A Notice of Decision will be mailed to the applicant and providers of the services requested within 10 working days after receiving the service funding request. This may be completed at the same time as the Eligibility Notice of Decision is sent. If approved, funding is for the time frame requested on the request form (not to exceed one year) unless otherwise stated. Only services with prior approval by the CPC Administrator will be reimbursed. If funding is reduced or denied, the reason will be stated along with the individual’s right to appeal and the procedure to do so. 8

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