SKILL-BUILDING AND HABILITATION SERVICES PROVIDER IN IOWA

EMPOWERING PARTICIPANTS THROUGH DAILY LIVING SKILLS, SOCIAL DEVELOPMENT, AND PERSONAL GROWTH SUPPORTS

Skill-Building and Habilitation Services in Iowa help individuals with intellectual, developmental, or acquired disabilities develop, retain, and improve the skills needed for daily living and community participation. These services are authorized under Iowa Medicaid’s Home and Community-Based Services (HCBS) Waiver programs and Habilitation Services program.

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1. GOVERNING AGENCIES

Agency: Iowa Department of Health and Human Services (HHS) — Iowa Medicaid Enterprise (IME)

Role: Administers HCBS waivers and Habilitation Services, oversees provider enrollment, service authorization, reimbursement, and compliance

Agency: Managed Care Organizations (MCOs)

Role: Coordinate service approvals and payment for Habilitation and HCBS services under Iowa’s Medicaid managed care system

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Habilitation and Skill-Building Services align with HCBS Settings Rule and person-centered care requirements

2. SERVICE OVERVIEW

Skill-Building and Habilitation Services support individuals in achieving greater independence through structured learning, support, and community-based practice.

Approved providers may deliver:

• Support with Activities of Daily Living (ADLs): bathing, grooming, dressing, toileting, and eating

• Instruction in Instrumental Activities of Daily Living (IADLs): cooking, laundry, household cleaning, and money management

• Social skills development, including communication, decision-making, and relationship building

• Community integration support,t such as using public transportation, navigating public spaces, or attending events

• Behavioral and emotional regulation skills using positive behavior support

• Health and safety awareness, including medication reminders and emergency response skills

• Habilitation training focused on functional, adaptive, and social development for individuals not eligible for waiver services

All services must align with the participant’s Individualized Service Plan (ISP) or Person-Centered Service Plan (PCSP), and focus on long-term independence.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Iowa Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Enroll as an HCBS and/or Habilitation Services provider via the Iowa Medicaid Provider Portal (IMPA)

• Develop policies compliant with HCBS Settings Rule and Habilitation program standards

• Maintain general and professional liability insurance

• Ensure all staff complete background checks, mandatory training, and supervised practice before direct service

4. IOWA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit the provider enrollment application for HCBS Waiver or Habilitation Services through IMPA

• Coordinate service authorizations through Iowa’s MCOs for managed Medicaid participants

Documentation Submission:

• Provide Articles of Incorporation, EIN/NPI confirmation, policy manual, insurance certificates, staff training records, and job descriptions

Program Readiness Review:

• Iowa HHS and/or MCO may conduct service readiness reviews, policy checks, and compliance interviews

Approval & Medicaid Enrollment:

• Upon approval, billing codes will be assigned based on daily, hourly, or 15-minute units for Habilitation and Skill-Building Services

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Iowa Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Skill-Building and Habilitation Policy & Procedure Manual, including:

  • Participant intake, assessment, and goal-setting procedures

  • ADL/IADL instruction protocols and community-based safety practices

  • Crisis response and behavioral support strategies

  • Participant rights, HIPAA compliance, and grievance policies

  • Staff credentialing, background checks, and competency evaluations

  • Medicaid billing, service tracking, and audit readiness documentation

6. STAFFING REQUIREMENTS

Role: Skill-Building Program Supervisor

Requirements: Bachelor’s degree in social work, education, or human services preferred; experience in habilitation services; background screening clearance

Role: Direct Support Professionals / Habilitation Aides

Requirements: High school diploma or GED; training in ADL/IADL support, behavior management, and person-centered planning; background check clearance

All staff must complete:

• Abuse prevention and mandatory reporting training

• HIPAA confidentiality and participant rights training

• Emergency preparedness and incident response training

• Annual continuing education and competency assessments

7. MEDICAID PROGRAMS

Skill-Building and Habilitation Services are reimbursable under:

• HCBS Waivers:

  • Intellectual Disability (ID) Waiver

  • Brain Injury (BI) Waiver

  • Health and Disability (HD) Waiver

  • Elderly Waiver (limited personal support)

• Iowa Habilitation Services Program (for individuals who are not eligible for waiver services but meet functional impairment and mental health criteria)

Approved providers may deliver:

• Daily habilitation skill-building

• Community and home-based personal skill support

• Functional and behavioral skills reinforcement

• Staff-supported daily routines to increase independence

8. TIMELINE TO LAUNCH

Phase: Business Formation and Policy Development

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Habilitation Program Setup

Timeline: 1–2 months

Phase: Medicaid Enrollment and MCO Contracting

Timeline: 60–90 days

Phase: Billing Configuration and Skill-Building Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Iowa Medicaid Enterprise (IME)

Website: https://ime.iowa.gov/providers

Iowa Department of Health and Human Services (HHS)

Website: https://hhs.iowa.gov

Managed Care Organizations (MCOs):

• Amerigroup Iowa: https://www.myamerigroup.com/ia

• Iowa Total Care: https://www.iowatotalcare.com

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — IOWA SKILL-BUILDING & HABILITATION SERVICES PROVIDER

WCG assists habilitation providers, behavioral health organizations, and HCBS service agencies in launching Medicaid-compliant Skill-Building and Habilitation programs in Iowa.

Scope of Work:

• Business registration, Medicaid, and MCO enrollment

• Policy & Procedure Manual development for Habilitation and Skill-Building

• Staff credentialing templates, daily skill logs, and ISP-aligned tracking tools

• Medicaid billing system setup and audit-ready documentation support

• Website, domain, and professional branding

• Quality assurance systems for ISP goal tracking, documentation audits, and participant feedback

• Referral development strategies with MCO care coordinators, hospitals, and support agencies

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