APPLICATION PROCESS &
SERVICE DELIVERY
To apply for any of the above programs, you must contact the CPC/General Assistance Director or designee. The Mental Health program and General Assistance program vary in the fact that for the Mental Health Program, there are five (5) other access points to which you can apply for services (please see Management Plan for a listing). The General Assistance program requires that you directly apply to the CPC/General Assistance Director. The application for each program is as follows:
MENTAL HEALTH
To apply for Mental Health Services, you must first complete a CPC application. These applications are available at the five (5) access points. You may complete the application at our office or any of the access points. We can also mail the application directly to you. The CPC can also assist you with filling out the application. If you like, you may bring along a friend, family member, guardian, or other representatives to assist as well.
You may be asked to give information about disability, health, education, work history, income, benefits, insurance, etc. Some of this is classified as Protected Health Information. We may use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services. In order to keep this information secure, KCCS adheres to all HIPAA policies that are designed to protect an individual’s health information. We want to assure that your privacy will be respected. You may asked to sign Authorization for Disclosure of Protected Health Information an Authorization to Obtain Information form(s) that requests permission to disclose or obtain information to assist with making a determination for your request for services (see Authorization section). No information will be used or disclosed unless you give us specific written authorization or we are required by law to do so. These authorizations are valid for one year unless you otherwise specify. A Restriction Agreement Form (see Restriction section) is available to you if you would like to specifically restrict a part or parts of your Protected Health Information. You will be asked to complete the form which will be kept in your personal file in the KCCS office. You may also utilize a Revocation of Authorization form (see Revocation section) if you would like to revoke any authorizations you previously signed. The service you receive will not be affected by this revocation, however, please take note that it may be difficult to make determinations in regards to eligibility or funding in that instance and may delay operations. KCCS also utilizes a disclosure log which tracks any disclosures in regards to your Protected Health Information (see Disclosures section). The information disclosed follows a “Minimum Necessary” policy which means that only the amount of Protected Health Information necessary to accomplish the intended purpose of the requested use or disclosure will be utilized. You can inspect your file by completing an Access Request Form (see Access section). There are exceptions. You can inspect the file in the Jury Room on the 3rd floor of the courthouse. Please note that you may also receive copies of information found in your file. You may access copies at a rate of $0.25 per page under 80 copies and a $20.00 flat fee over 80 copies. You may also request an amendment to your file by completing an Amendment Request Form (see Amendments section). This is either approved or denied. You will then receive an approval or denial letter explaining the decision. You may not amend information in your file that is not generated by KCCS. You must contact the agency or individual which generated that information. All of the requests mentioned above will be directed and then processed through the Keokuk County CPC and/or Keokuk County Privacy/Security Officer.
In some instances, there is a Business Associates
Agreement between KCCS and another organization/person. A Business Associates Contract (see Business
Associates section) is utilized when another organization/person performs
certain functions that involve the use or disclosure of Protected Health
Information on behalf of, or provides services to
Please note however that in medical and psychological emergencies you may be unable to give authorization for disclosure of information. When this happens, our first priority is to see that you receive the emergency services that you need. We will only use or disclose the “Minimum Necessary” information referred to before and after the emergency ends, you will receive the documentation that details who received the information and why they were entitled to receive that information upon your request. This information is tracked through a disclosure log which explains that information. To request an accounting for these disclosure logs, you must complete a Keokuk County Community Services Request for Accounting of Disclosures (See Disclosures section). You may also receive the accounting of disclosures free for the first request within a 12 month time period. Any subsequent requests will be charged to you at a $0.25 per copy charge during that time period.
After we review the information needed, we will
decide if you are eligible to receive county services. If you are, you will receive a written notice
explaining your approval. If not, you
will also receive a written notice of decision explaining the denial. Please refer to the Management Plan for more
information on this process. If you are
placed on a waiting list due to prohibited funding levels, you will be notified
and when an opening occurs, you will be notified. If dissatisfied with the decision you may
appeal the decision. This is provided
with the Notice of Decision. You may
also have access to the Appeals procedure by directing questions to the CPC or
requesting the Appeals procedure from the KCCS office. You may appeal your
decision to the #1-CPC, #2-Board of Supervisors, and the #3-Multi-County
Appeals Board. The Multi-County Appeals
Board has an individual appointed from
The next step is service planning and funding. Once you are deemed eligible, your needs are
assessed to determine which services you need and which agency will provide
said services to you if not already determined.
You will be given your choice of providers of those available to
you. There is a listing of available
service providers and a matrix of the available services located in the
Management Plan, please see for more details.
Once this has been completed, the CPC will review what services are
requested and either approve or deny requests.
You will then receive another written notice of decision explaining the
approval or denial. If approved,
services will begin as soon as possible and a funding agreement (see appendix)
will be authorized by the CPC and given to the provider which is providing the
services to you. The CPC and/or Case
Manager completes the initial agreement and the CPC and/or Case Manager will
complete subsequent ones thereafter if there is a Case Manager. (Mental Health
Centers complete agreements and submit to the CPC). If you receive services under the HCBS-MR
waiver service, the CPC has access to the Individualized Service Information
System (ISIS) operated by the Iowa Department of Human Services. This system allows the CPC to approve funding
plans via the Internet. As this system
is operated through the Iowa Department of Human Services, that agency is
charged with assuring all privacy and HIPAA regulations are followed as
required by law. The CPC has a user ID
and password that must be utilized to gain access. No other individual has access to that ID or
password. The Iowa Department of Human
Services has access to each users screen for maintenance reasons as they
operate the system. The Iowa Department
of Human Services also shares the cost of each individual utilizing the HCBS-MR
waiver with each
The second step is completion of an initial ICP/IPP/ELP except for those consumers served by Mental Health Centers. This simply means that a plan will be written explaining what services you will receive, how it will be provided, and what goals of services and objectives to meet those goals of services will be done. Please refer to Management Plan for more details.
Your services will be continually monitored for needed changes, appropriateness, and cost effectiveness. Ongoing communication between the CPC and other organizations may be needed. The initial authorization(s) you signed will be reviewed periodically or as requested as well as any Business Associate Contracts. You may request that KCCS communicates with you in alternative means or locations. This simply means that you have a choice in how we communicate information to you or the provider. You may choose such ways as via telephone, mail, etc. You can do so by completing a Communications Request for Alternative Means or Locations Form (see Alternate Communications section).
GENERAL
ASSISTANCE
To apply for General Assistance (which includes State Papers and the FEMA program), you must contact the General Assistance Director. At that time, an appointment will be scheduled to complete the application. In special circumstances, an application can be sent to you; however, it will be requested if at all possible to meet directly with the Director.
We may request some confidential information such as financial information, health, insurance, work history, etc. Some of this information is classified as Protected Health Information and is necessary to disclose to provide the assistance you need. You will be requested to sign Authorization for Disclosure of Protected Health Information or Authorization to Obtain Information form(s) that request permission to disclose or Obtain the information listed above depending on your needs (see Authorization section). These are used when determining eligibility for the General Assistance, State Papers, or FEMA. Again, the “Minimum Necessary” information will be used or disclosed. KCCS will keep a disclosure log on your behalf that accounts for all disclosures (see Disclosures section). To request an accounting of these disclosures, you must complete an Accounting of Disclosures Form (see same section). There is no charge for a request for accounting disclosures for the first time in a 12 month time period, but there is a cost of $0.25 for any subsequent disclosure in that time period. You may request a restriction on your PHI which is disclosed by completing a Restriction Agreement Form which is then kept in your file in the KCCS office. You are also entitled to revoke any previous authorizations signed by completing a Revocation of Authorization Form (see Revocation section). You can review your file at any time by submitting a Request to Access Form (see Access section). There are exceptions. You can view your file in a private location. This location is the Jury Room in the Courthouse on the 3rd floor. To receive copies, you will be charged $0.25 per copy under 80 copies and a $20.00 flat fee over 80 copies. If you would like to amend any information found in your file, you must complete a Request to Amend Form (see Amendments section). Your request will be either denied or approved by receiving an Amendment Approval Letter or an Amendment Denial Letter (see same section). You may not amend any information in the file not generated by KCCS. You must contact the agency or individual which generated that information. If you would like to request an alternate way in which we communicate information to you or a provider, you must complete a Communications Request for Alternative Means or Locations Form (see Alternate Communications section) as in the Mental Health program. All of the above mentioned requests are to be directed and processed through the General Assistance and/or Keokuk County Privacy/Security Officer.
Once deemed eligible and able to receive assistance, authorization is given by the Director to the organization/individual for whom funds are to be dispersed to or in the case of State Papers, the University of Iowa Hospitals and Clinics (UIHC). No payment will be made directly to the person or family unit but only to the organization/person who is classified as the provider or vendor providing the assistance or service. UIHC relies on KCCS to determine eligibility and from that point they administer the program. Please refer to the General Assistance Ordinance and/or FEMA manual for specific application process information. If you disagree with a decision of the Director, there is an appeals process available to you. You may appeal to the #1-CPC, and the #2-Board of Supervisors in this order. That process is found in the General Assistance Ordinance and is also given with a Notice of Decision after the determination is made. You may also direct specific questions to the Director or request a copy from the KCCS office.
You may apply for General Assistance each fiscal
year which runs from July 1st to June 30th. You have access of up to $450 through the
General Assistance program. Exceptions
can be granted by the Director or Keokuk County Board of Supervisors. Also note that there are limitations in the
amount of assistance that you can receive.
Please refer to Ordinance for specific information. State Papers can be authorized once during a
fiscal year which follows the above schedule and can also be authorized or
issued for past years if any State Papers remain. Currently,