The Iowa Cares Program, officially known as the Private Duty Nursing/Personal Cares (PDN/PC) program, is designed to provide essential in-home healthcare services for Iowa’s children. This program operates under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) umbrella, ensuring that eligible children receive the necessary care within the comfort of their homes. Administered by Medicare-certified home health agencies, the Iowa Cares Program is a vital resource for families requiring skilled nursing and personal care services for their children.
Who is Eligible for the Iowa Cares Program?
Eligibility for the Iowa Cares Program extends to children up to 21 years of age who are Iowa residents and demonstrate a medical need for private duty nursing or personal care services. Crucially, to receive support from the Iowa Cares Program, a child does not need to be classified as homebound. The program is designed to support families in various circumstances, ensuring access to care based on medical necessity rather than location confinement.
To initiate the process, a physician must confirm the child’s medical need for PDN/PC services through a face-to-face consultation. This medical certification is a foundational step in accessing the Iowa Cares Program benefits.
Services Provided Under the Iowa Cares Program
The Iowa Cares Program offers two primary services: Private Duty Nursing (PDN) and Personal Cares (PC).
- Private Duty Nursing (PDN): This service, delivered by skilled nurses, encompasses medical care that requires professional nursing expertise. It includes administering medications, wound care, and managing complex medical conditions within the home setting.
- Personal Cares (PC): Provided by home health aides, Personal Cares services assist with daily living activities. This can include bathing, dressing, feeding, and mobility assistance, ensuring the child’s comfort and well-being.
It’s important to note that the Iowa Cares Program is intended to address medical needs that cannot be adequately met by unpaid caregivers such as family members, friends, or community volunteers. The program supplements, rather than replaces, natural support systems. The intensity of services is determined by medical necessity, with a maximum authorization of 16 hours per day, based on individual needs assessments.
Accessing the Iowa Cares Program: Prior Authorization
To access services through the Iowa Cares Program, prior authorization from Iowa Medicaid Enterprise (IME) Medical Services is mandatory. This process ensures that services are medically necessary and appropriately authorized.
Providers seeking prior authorization must submit specific documentation to IME Medical Services, including:
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Request for Prior Authorization Form (Form 470-0829): This form must be completed and signed by the healthcare provider requesting the services. It serves as the formal application for accessing the Iowa Cares Program.
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Plan of Care (POC): A detailed Plan of Care, signed by the physician, is required. This POC must include the start date for the requested prior authorization and be reviewed and signed by the physician every 60 days. The physician’s signature on the POC validates the assessed medical needs and authorizes the services under the Iowa Cares Program.
All documentation for prior authorization should be faxed to IME Medical Services at 515-725-1356.
Billing and Rates for Iowa Cares Program Services
The Iowa Cares Program utilizes specific billing codes for service reimbursement. These codes ensure proper categorization and payment for the services rendered.
| Billing Code | Service | Billing Unit |
|---|---|---|
| T1000 | Private Duty Nursing (Skilled Nursing) | Per 15 minute unit |
| S9122 | Personal Cares (Home Health Aid) | Per hour unit |
Rates for PDN/PC services under the Iowa Cares Program are determined through a cost report mechanism. Rates are prospectively set with a retrospective cost settlement, ensuring financial accountability and sustainability of the program.
For additional support and information regarding the Iowa Cares Program, individuals can utilize Relay Iowa TTY at 1-800-735-2942. Language accessibility resources and telephone accessibility assistance are also available through Iowa Medicaid.
This comprehensive overview of the Iowa Cares Program aims to provide clarity and direction for families and healthcare providers seeking to utilize this valuable resource for children’s in-home healthcare needs in Iowa.
