Objective

1. Coordinate and advocate access to substance abuse treatment for the poor.
2. Reduce unnecessary hospital charges related to substance abuse.
3. Allow suspected substance abusers to begin their recovery as soon as possible with their full participation.
4. Reduce the number of court order interventions by offering other alternatives.
5. Reduce conflict to families and the stigma of being adjudicated a substance abuser.
6. Coordinate access to mental health and other social services to reduce the stress and likelihood of relapse.

The Black Hawk County Board of Supervisors has designated Black Hawk County Community Services as the responsible county department to administer all county funds for prevention, treatment, hospital or residential detoxification and court costs for substance abusers and persons suffering from chemical dependency as required or allowed under Iowa Code Chapter 125.

The contact information for Black Hawk County Community Services is:
Community Services Director
Black Hawk County Community Services
1407 Independence Avenue
Waterloo, IA 50703
Ph: 319-292-2261 / Fax: 319-291-2628 / Email: blincoln@mhddcpc.org

The Director is appointed by and reports directly to the Black Hawk County Board of Supervisors.

Procedure

The Black Hawk County Board of Supervisors allocates a certain amount of funds from its annual budget toward services for individuals with a chemical dependency. Community Services is responsible for administering these funds for Black Hawk County.

Eligibility

Diagnostic Eligibility:

Eligible persons must be diagnosed as Chronic Substance Abusers. Chronic Substance Abusers are defined as persons who consistently lack self-control as to the use of chemical substances to the scope that the person is likely to seriously endanger their own health or to physically injure themselves or others, if they do not receive intervention and/or treatment.

For involuntary commitments, the court system will make the ultimate determination as to whether the individual meets the above criteria based upon evidence presented by applicants for commitment.

Financial Eligibility:

Gross income will not exceed 150% of current Federal Poverty Guidelines. This will include earned and unearned income for the entire household. Because these guidelines are subject to change annually, please see Community Services Staff for specific information.
Resources will not exceed $2,000 for single persons or $3,000 for married couples or households over one (1). Persons are allowed one vehicle and one homestead. The value and equity beyond these allowable resources will be assessed and considered during eligibility determinations. Any attempt to control income and/or resource levels or false statements may result in denial of funding. Any resources transferred within the previous 36 months of application may be considered.

Black Hawk County reserves the right to request reimbursement from the individual or those responsible if the above income and resource guidelines are exceeded.

1. Black Hawk County will only fund commitment related expenses for eligible applicants who reside in Black Hawk County.
2. Any individuals requesting funding that have private insurance coverage, Medicaid, Medicare, etc.; must access facilities accepting those private insurances or Department of Public Health funds. Black Hawk County will not subsidize third party payers.
3. All individuals applying for funding must apply for, actively pursue, and accept any and all other financial/medical assistance programs and maintain eligibility of said programs prior to approval of county funding to assure the county is the payer of last resort. Failure to do so may result in denial of funding.
4. Veterans should access inpatient substance abuse services through the Veteran’s Administration Medical System; Knoxville, Iowa City or Des Moines.

5. Department of Corrections or Criminal Court ordered services of any kind, that are required as a condition of parole or probation, or services required to avoid prosecution; Community Services shall not fund.
6. Non-United States citizens or illegal aliens are not eligible.
7. The Community Services Director and/or Black Hawk County Board of Supervisors reserve the option of granting an exception to policy in any situation as deemed appropriate.

The following services are a benefit of Black Hawk County for individuals with a chemical dependency if all criteria for eligibility are met and the service is in accordance with this policy:

1. Sheriff Transportation as ordered under Chapter 125.

2. Attorney Fees for representation under Chapter 125 Civil Commitment proceedings.

3. Hospital detoxification as medically necessary and ordered under Chapter 125 if notified within 24 hours of admission to a private hospital under contract with Black Hawk County.

4. Court ordered outpatient evaluation to determine if an individual is a “chronic substance abuser” requiring court ordered treatment.

5. Residential placement at a facility licensed to serve individuals with mental illness for a period necessary to complete an assessment under Chapter 125 prior to civil commitment hearing.

6. Service Coordination to help individuals access treatment options; monitor aftercare; and coordinate assistance with co-occurring conditions and basic needs.

7. Client co-payments to Department of Public Health Regional Substance Abuse Agencies when the individual is destitute and their inability to pay prevents them from inpatient discharge or that puts them at risk for relapse and more costly intervention.

8. Medications specific to recovery from addiction and if not supplied may result in more costly interventions.

9. Prevention services as contracted with the Department of Public Health (Iowa Code 125.59).

Individuals needing emergency services and/or care may present themselves or be taken to the nearest hospital emergency room (ER) for immediate attention by family, friends, concerned parties, or local law enforcement as specified in Iowa Code. Once the individual is stabilized, the ER physician will evaluate whether an involuntary commitment is needed and contact an available Court Magistrate. If an involuntary commitment occurs, the admission will follow the process outlined within this policy. If a voluntary admission is recommended, the admission will also follow the process outlined in this policy.

Reimbursement

Black Hawk County reserves the option to request reimbursement for inpatient treatment, outpatient evaluation costs, sheriff transportation costs, and attorney fees. In these instances, Black Hawk County will make payment directly to the vendor unless otherwise arranged prior to provision of service. Any reimbursement requirement shall be related to the ability of the individual to pay for these costs. The individual must meet the financial criteria (resources and income) as outlined in the current Black Hawk County Mental Health & Disability Services Management Plan. The individual will be required to sign a reimbursement agreement detailing the terms of the reimbursement. Collection of payments may be accomplished through a payment plan which may include up to payment in whole by the individual or their representative, or other arrangements as approved by Community Services and/or the Board of Supervisors. If payment is not made, Black Hawk County reserves the right to take further legal action as allowed in the Code of Iowa.

Appeals

A consumer, advocate, family member or legal representative may appeal the decision of the Community Services Office by:

A. Submitting a request for appeal in writing to the Community Services Director within five (5) working days from the date they received the decision. The Director shall set a review hearing within ten (10) working days of the receipt of the appeal, with all concerned parties. The Director, upon hearing all relevant information, shall issue a written statement to the concerned parties of the decision regarding the dispute, within five (5) working days of the meeting.
B. If the dispute is not satisfactorily resolved at Step A, the dispute may go to the next step in the appeal process. The appeal must be submitted to the Community Services Director within ten (10) working days of receiving the decision from Step A. Upon receiving the appeal, the Community Services Director shall schedule an administrative law review hearing within ten (10) working days. The applicant shall be allowed to present any evidence desired in support of the appeal by personal testimony, witness testimony, documentary evidence, and by reasonable cross examination of other witnesses, if present. The administrative law judge shall make a decision on the appeal within thirty (30) working days after the hearing. The Judge’s findings of fact and decision shall be based only on the evidence submitted during the hearing. Immediately after making the decision the Judge shall mail the applicant at his/her last known address, by ordinary mail its decision in writing.
C. The decision shall state the reasons for the action and will also state that an appeal can be made to the District Court from the Administrative Law Judge’s determination.

Funding decisions are made by the Director based upon the criteria of the policy. It is the intent that funding decisions are not made by an individual or organization which has a financial interest in the services provided. In the event that such a situation occurs, that interest will be fully disclosed in writing to all parties.

If a conflict of interest occurs, the conflict will be disclosed to all parties. The Black Hawk County Board of Supervisors shall make decisions regarding funding in such cases in a closed session.

Confidentiality

All information and records obtained by Community Services are confidential and are protected by law. All consumer information obtained for purposes of service management and data collection are considered confidential, which means this record is not available as a matter of right for examination and copying by members of the public under applicable provisions of the law. Confidential records include records or information contained in records that the agency is prohibited by law from making available for examination by members of the public, and records or information contained in records that are specified as confidential by the Iowa Code or other provision of law, but that may be disclosed upon order of a court, the lawful custodian of the record, or by another person duly authorized to release the record. Community Services Staff has been trained in confidential issues and will read and sign the confidentiality policy with a copy maintained in their personnel file kept in the Black Hawk County Human Resource Office.

Before any information is released by Community Services, an “Authorization to Obtain and/or Disclose Information” must be signed by the individual or legal representative and documented in the individual’s record.

Community Services will adhere to all Federal, State, and Local laws governing personal health information to assure security of Private Health Information. Community Services is considered a “Covered Entity” according to HIPAA guidelines and Black Hawk County a “Hybrid Entity”. Only the “minimum necessary information” will be disclosed both internally and externally to assure that only the requested information is disclosed to the appropriate person and to assure security in regards to Private Health Information.

Repealer

All ordinances, resolutions or parts of ordinances and resolutions in conflict with the provisions of these policies are hereby repealed.

Severability Clause

If any section, provision, or part of these policies shall be judged invalid or unconstitutional, such adjudication shall not affect the validity of these policies as a whole or any section, provision or part thereof not judged invalid or unconstitutional. It shall be up to the discretion of the Board of Supervisors to limit or make changes for the services provided as stated in these regulations.

Exceptions

The Black Hawk County Board of Supervisors and/or the Community Services Director reserve the right of granting an exception to policy in any situation as deemed appropriate with any section or sections of the policies contained herein.

Claims

Claims submitted against Black Hawk County Substance Abuse funds must be received by Community Services within 90 days of service provision. The claims shall include the following information:

1. Name and SSN and/or Unique Identifier of each individual served