1. DOCUMENTATION OF CMH WAIVER SERVICES

2. PLEASE NOTE: Before CMH Waiver Services Can Be Paid Waivers are paid through Title XIX funds. The following must be in place for a provider to be paid for services: –The provider must be enrolled as a waiver provider for the service –The consumer must be an eligible waiver consumer –The team must agree on the service –The service must be ordered in the plan and on ISIS –The funder must approve the service/cost on ISIS –The rate for the service shall be the rate agreed on by the team and meet the limitation guidelines under Chapter 79. –Units billed must meet the parameters of Chapter 78.

3. Any waiver provider must complete form 470-2965, Agreement Between Provider of Medical and Health Services and Iowa DHS Regarding Participation in Medical Assistance Program. This form completion is part of the enrollment process through IME Provider Services. Including other statements of agreement, the waiver provider assures the Iowa DHS of the following: –That complete service and fiscal records are kept to show the extent of goods and/or services provided to individuals receiving assistance under the Iowa Medical Assistance program. The Provider Agreement Form

4. IAC 441 -- 79.3(2) Service and Clinical Records Providers of service shall maintain complete service and clinical records. These records must fully document the extent of the Medicaid service provided. Clinical Records Of Service Provision

5. Each record must contain information necessary to support each item of service reported on the Medicaid claim form: –Name of the waiver service provided –Date of service –First and last name of staff providing the service –Duration, if applicable to the service –The service provided meets the patients need for the service billed. –Documented progress as a result of the service intervention, if applicable to the service Service or Clinical Record Requirements

6. IAC 441 -- 79.3(3) Failure to maintain supporting fiscal, service and clinical records may result in claim denials or recoupment. IF YOU DONT KEEP THIS INFORMATION ----

7. IAC 44179.3(249A) Maintenance of fiscal, service and clinical records by providers of service. The fiscal, service and clinical records shall be maintained for a minimum of five years from when a charge was made to the program. After five years, the fiscal and clinical records may be destroyed. Maintaining Agency Records