ŠĻą”±į>ž’ ŠŒž’’’ˆ‰’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„Į7 šæĢWbjbjUU <Š7|7|•S6’’’’’’l”””””””Ø$$$8\xœØł_¶  666666;(=(=(=(E‚(`āC`B_$Æ` Ļbf_”66666f_v””66{_6vvv6"”6”6;(v6;(vōvj%ŖD'æ””'(6 †±žÓĒØ|$X:('(±_Hł_(Ļc’äĻc'(vØØ””””Ł HOME AND COMMUNITY BASED SERVICES AIDS/HIV WAIVER INFORMATION PACKET The Medicaid Home and Community Based Services Acquired Immunodeficiency Syndrome/Human Immunodeficiency Virus Waiver (HCBS AIDS/HIV) provides service funding and individualized supports to maintain eligible consumers in their own homes or communities who would otherwise require care in a medical institution. Provision of these services must be cost effective. GENERAL PARAMETERS Aids/HIV services are individualized to meet the needs of each consumer. The following services are available: Adult Day Care Consumer Directed Attendant Care Counseling Services Home Delivered Meals Home Health Aide Homemaker Nursing Respite The services that are considered necessary and appropriate to meet the consumer’s needs will be determined through an interdisciplinary team consisting of the consumer, DHS service worker, service provider(s), representative from AIDS Coalition of HIV Consortia and other persons the consumer chooses. All consumers will have a service plan developed by a DHS service worker in cooperation with the consumer. This plan must be completed prior to implementation of services. The service plan for consumers aged 20 or under must be developed or reviewed taking into consideration those services that may be provided through the individual education plan (IEP) and EPSDT (Care For Kids) plan(s). Consumers shall access all other services for which they are eligible and which are appropriate to meet their needs as a precondition of eligibility for the AIDS/HIV Waiver. A service plan must be developed and reviewed annually. The consumer must choose HCBS services as an alternative to institutional services. In order to receive AIDS/HIV Waiver services, an approved AIDS/HIV Waiver service provider must be available to provide those services. AIDS/HIV Waiver services cannot be provided when the consumer is an inpatient of a medical institution. Consumers must need and use one of the available AIDS/HIV Waiver services during each quarter of the calendar year. The total monthly cost of HCBS AIDS/HIV Waiver services cannot exceed $1700.00 per month. A designated number of consumers (payment slots) is designated to be served under the HCBS AIDS/HIV program. A Medicaid waiver service cannot be simultaneously reimbursed with another Medicaid waiver service or a Medicaid service. The combined total cost of AIDS/HIV waiver services and Medicaid services shall not exceed the average cost of the consumer’s level of care provided in a medical institution. AIDS/HIV Waiver services are available to both children and adults. Following is the hierarchy for accessing waiver services: Private insurance Medicaid and/or EPSDT (Care For Kids) AIDS/HIV Waiver services The HIV CARE Consortia serves as an advisory committee. This consortia meets regularly to make recommendations and to take action to ensure the waiver program, as a whole, best meets the needs of the consumers it serves. Assistance may be available through the In-Home Health Related Care program and the Rent Subsidy Program in addition to services available through the AIDS/HIV Waiver. CONSUMER ELIGIBILITY CRITERIA Consumers may be eligible for HCBS AIDS/HIV Waiver services by meeting the following criteria: Be an Iowa resident and a United States citizen or a person of foreign birth with legal entry into the United States Be diagnosed by a physician as having AIDS or HIV infection. The Iowa Foundation for Medical Care is responsible for contacting the physician to establish the diagnosis. A determination of disability is not required. Be determined eligible for Medicaid (Title XIX). Consumers may be eligible prior to accessing waiver services or be determined eligible through the application process for the waiver program. Additional opportunities to access Medicaid may be available through the waiver program even if the consumer has previously been determined ineligible. Be determined by the Iowa Medicaid Enterprise, Medical Services to need Nursing Facility or Hospital level of care SERVICE DESCRIPTIONS PLEASE NOTE: AIDS/HIV Waiver services are individualized to meet the needs of each consumer. However, decisions regarding what services are appropriate and the number of units or the dollar amounts of the appropriate services are based on the consumer’s needs as determined by the consumer and an interdisciplinary team. ADULT DAY CARE WHAT: Adult day care is an organized program of supportive care in a group environment. The care is provided to consumers who need a degree of supervision and assistance on a regular or intermittent basis in a day care center. WHERE: In an adult day program UNITS: A unit is: Half day - 1 to 4 hours or Full day - 4 to 8 hours or Extended day - 8 to 12 hours CONSUMER DIRECTED ATTENDANT CARE (CDAC) WHAT: Assistance to the consumer with self-care tasks that the consumer would typically do independently if the consumer was otherwise able. An individual or agency, depending on the consumer’s needs may provide the service. The consumer, parent, or guardian shall be responsible for selecting the individual or agency that will provide the components of the CDAC services to be provided. The CDAC service may include assistance with non-skilled and skilled services. The skilled services must be done under the supervision of a professional registered nurse or licensed therapist working under the direction of a physician. The registered nurse or therapist shall retain accountability for actions that are delegated. Skilled services may include but are not limited to: Tube feedings, intravenous therapy, parenteral injections, catherizations, respiratory care, care of decubiti & other ulcerated areas, rehabilitation services, colostomy care, care of medical conditions out of control, postsurgical nursing care, monitoring medications, preparing and monitoring response to therapeutic diets, and recording and reporting of changes in vital signs. Non-skilled services may include but are not limited to: Dressing, hygiene, grooming, bathing supports, wheelchair transfer, ambulation and mobility, toileting assistance, meal preparation, cooking, eating and feeding, housekeeping, medications ordinarily self-administered, minor wound care, employment support, cognitive assistance, fostering communication, and transportation. A determination must be made regarding what services will benefit and assist the consumer. Those services will be recorded in The HCBS Consumer Directed Attendant Care Agreement Form 470-3372. This Agreement becomes part of the service plan developed for the consumer. This service is only available if the consumer, parent, guardian, or attorney in fact under a durable power of attorney for health care has the ability to and is willing to manage all aspects of the service. WHERE: In the consumer’s home or community. Not the provider’s home. DOES NOT Daycare, baby-sitting, respite, room and board, parenting or case management INCLUDE: CDAC cannot replace a less expensive service. A CDAC provider may not be the spouse of the consumer or a parent or stepparent of a consumer aged 17 or under. An individual CDAC provider cannot be the recipient of respite services provided on behalf of a consumer receiving HCBS AIDS/HIV services. The cost of nurse supervision, if needed UNITS: A unit is: One hour or One 8 to 24 hour day MAXIMUM The social worker, working with the consumer and the interdisciplinary team, establishes an amount of dollars that UNITS: may be used for CDAC. The amount is then entered into the service plan along with information about other HCBS services the consumer may receive. This monetary information is also entered into The HCBS Consumer Directed Attendant Care Agreement Form 470-3372 along with the responsibilities of the consumer and the provider and the activities for which the provider will be reimbursed. The consumer and the provider come to agreement on an hourly or daily billing unit and the cost per unit. A completed copy of the Agreement is distributed to the consumer, the provider and the service worker. The Agreement becomes part of the service plan. These steps must be completed prior to service provision. When CDAC is provided by an assisted living facility, please note the following: The service worker or case manager should be aware of and have knowledge of the specific services included in the assisted living facility contract to ensure the following: That assisted living facility services are not duplicative of CDAC services Knowledge of how consumer needs are being addressed Awareness of consumer unmet needs that must be included in the care plan CDAC payment does not include costs of room and board Each consumer must be determined by IFMC to meet nursing facility or hospital level of care The CDAC fee is calculated based on the needs of the consumer and may differ from individual to individual. PROVIDER The provider must be enrolled with the Department’s fiscal agent and certified as a CDAC provider prior to the ENROLL.: completion of the HCBS Directed Attendant Care Agreement. It may be important for the consumer to enlist more than one CDAC provider. Back up services may be necessary in case of an emergency. BILLING: The consumer as well as the provider must sign the Claim for Targeted Medical Care before it is submitted for payment. This verifies that the services were provided as shown on the billing form. COUNSELING SERVICES WHAT: Counseling services are face-to-face mental health services to facilitate home management of the consumer and prevent institutionalization. Counseling services may be provided to the consumer’s caregiver only when included in the service plan for the consumer. Counseling services are non-psychiatric services necessary for the management of depression, assistance with a grief process, alleviation of psychosocial isolation and support in coping with disability or illness, including terminal illness. WHERE: A community mental health center or other location used by a provider that meets accreditation under the Mental Health and Disabilities Commission UNITS: A unit is: Individual counseling for the consumer or the consumer and their caregiver – 15 minute increment or Group counseling - 1 hour Payment for group counseling is based on the group rate divided by six or, if the number of persons who comprise the group exceeds six, the actual number of persons which comprises the group. HOME DELIVERED MEALS WHAT: Home-delivered meals are meals prepared outside of the consumer’s home and delivered to the consumer. Each meal must ensure that the consumer receives a minimum of one-third of the daily-recommended dietary allowance as established by the Food and Nutrition Research Council of the National Academy of Sciences. Each meal may also be a liquid supplement, which meets the minimum one-third standard. WHERE: Delivered to the home UNIT: A unit is one meal. MAXIMUM: Fourteen (14) meals may be delivered during any week. HOME HEALTH AIDE SERVICES (HHA) WHAT: Unskilled medical services that provide direct personal care. This service may include observation and reporting of physical or emotional needs, assisting with bathing, shampoo, oral hygiene, toileting, ambulation, helping individuals in and out of bed, reestablish activities of daily living, assisting with oral medications ordinarily self administered and ordered by a physician, performing incidental household services that are essential to the individual’s health care at home and are necessary to prevent or postpone institutionalization in order to complete a full unit of service. Home health aide as a waiver service may be accessed after accessing services under the Medicaid State plan. WHERE: In the consumer’s home. Not the provider’s home. DOES NOT Homemaker services such as cooking and cleaning or services which meet the intermittent guidelines or those INCLUDE: provided under the EPSDT authority. May not duplicate any regular Medicaid or waiver services provided under the state plan. Medicaid intermittent coverage: Regular Medicaid provides for intermittent coverage of skilled nursing and home health aide services provided in the person’s home for both children and adults. Services are usually provided two to three hours per day for two to three days per week. Intermittent skilled nursing coverage includes visits up to five days per week and daily or multiple daily visits for wound care or insulin injections. Intermittent home health aide coverage includes visits twice per day up to seven days per week for persons attending school or working or when ordered by the physician and included in the plan of care, not to exceed 28 hours per week. EPSDT (Care For Kids) program: EPSDT services for persons under age 21 only include private duty nursing and personal care services which meet the definition of medical necessity as provided by CMS for EPSDT. Services may be provided to a child outside of the child’s residence when normal life activities take the child outside the residence. Services not covered by EPSDT include: Services to children with Medicaid HMO coverage Mental health services to children enrolled in the Iowa Plan Well child care Respite Transportation Homework assistance Services to other household members UNIT: A unit is a visit. HOMEMAKER SERVICES WHAT: Homemaker services are those services provided when the consumer lives alone or when the person who usually performs these functions for the consumer needs assistance. Homemaker service is limited to the following components: Essential shopping; limited house cleaning, accompaniment to medical or psychiatric services; meal preparation, and bathing and dressing for self-directing consumers. WHERE: In the consumer’s home and community. Not the provider’s home. UNIT: A unit is one hour. Homemaker services must be billed in whole units. There are no partial hours. NURSING SERVICES WHAT: A licensed nurse employed by an agency provides Nursing services. The services are ordered by and included in the plan of treatment established by the physician. The services shall be based on the medical necessity of the consumer and the Iowa Board of Nursing scope of practice guidelines. WHERE: In the consumer’s home. Not the provider’s home. DOES NOT Nursing services provided outside of the home or services that meet the intermittent guidelines or those provided INCLUDE: under the EPSDT authority Medicaid intermittent coverage: Regular Medicaid provides for intermittent coverage of skilled nursing and home health aide services provided in the person’s home for both children and adults. Services are usually provided two to three hours per day for two to three days per week. Intermittent skilled nursing coverage includes visits up to five days per week and daily or multiple daily visits for wound care or insulin injections. Intermittent home health aide coverage includes visits twice per day up to seven days per week for persons attending school or working or when ordered by the physician and included in the plan of care, not to exceed 28 hours per week. EPSDT (Care For Kids) program: EPSDT services for persons under age 21 only include private duty nursing and personal care services which meet the definition of medical necessity as provided by CMS for EPSDT. Services may be provided to a child outside of the child’s residence when normal life activities take the child outside the residence. Services not covered by EPSDT include: Services to children with Medicaid HMO coverage Mental health services to children enrolled in the Iowa Plan Well child care Respite Transportation Homework assistance Services to other household members This nursing service shall not be simultaneously reimbursed with other Medicaid services. Exception: Payment may be made for supervisory visits when a registered nurse, acting in a supervisory capacity, provides supervisory visits of services provided by a home health aide under a home health agency plan of treatment. UNIT: A unit is a visit. RESPITE WHAT: Respite care services are services provided to the consumer that gives temporary relief to the usual caregiver and provides all the necessary care that the usual caregiver would provide during that time period. The purpose of respite care is to enable the consumer to remain in the consumer’s current living situation. Specialized respite means respite provided on a staff to consumer ratio of one to one or higher for individuals with specialized medical needs requiring monitoring or supervision provided by a licensed registered nurse or licensed practical nurse. Group respite means respite provided on a staff to consumer ratio of less than one to one. Basic individual respite means respite provided on a staff to consumer ratio of one to one or higher for individuals without specialized medical needs that would require care by a licensed registered nurse or licensed practical nurse. WHERE: Respite may be provided in the consumer's home, another family's home, camps, organized community programs (YMCA, recreation centers, senior citizens centers, etc.), ICF/MR, RCF/MR, hospital, nursing facility, skilled nursing facility, assisted living program, adult day care center, foster group care, foster family home or DHS licensed daycare. Respite provided outside the consumer’s home or outside a facility in locations covered by the facility’s licensure, certification, accreditation, or contract must be approved by the parent, guardian, or primary caregiver and interdisciplinary team, and must be consistent with the way the location is used by the general public. Respite in these locations may not exceed seventy-two (72) continuous hours. DOES NOT Services shall not be reimbursable if the living unit is otherwise reserved for persons on a temporary leave of INCLUDE: absence. Respite cannot be provided to consumers residing in the family, guardian or usual caregiver’s home during the hours in which the usual caregiver is employed unless it is in a camp setting. Respite shall not be simultaneously reimbursed or provided with duplicative services under the waiver. UNITS: A unit is one hour. Services are limited by the monthly maximum available for all waiver services. MAXIMUM Fourteen consecutive days of 24-hour respite care may be reimbursed UNITS: and Respite services provided to three or more individuals for a period exceeding 24 consecutive hours for individuals who require nursing care because of a mental or physical condition must be provided by a licensed health care facility as described in the Iowa Code chapter 135C. APPLICATION PROCESS The application process for the AIDS/HIV Waiver requires a coordinated effort between the Department of Human Services and non-Department agencies on behalf of the prospective consumer. If you are currently working with Department of Human Services personnel, please contact that person regarding the application process. Please respond immediately to correspondence from an income maintenance worker or a service worker. This will decrease the amount of time needed to complete the application process and assist in communication. Application for Medicaid (Title XIX) and the AIDS/HIV Waiver is made with an Income Maintenance worker (IM) at the local DHS office. For adults applying for the AIDS/HIV Waiver, an appointment will be scheduled with the IM worker. For children applying for this waiver, telephone contact will be made to the family home. Documentation necessary to complete this contact may include: Financial records Title XIX card Letter of Medicaid eligibility Verification of Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI) or State Supplemental Assistance (SSA) eligibility, if applicable. If assistance is not currently being received, a request may be made to apply at the local Social Security office. The DHS service worker will complete an assessment tool, the Home and Community Based Services Assessment or Reassessment Form 470-0659. The Iowa Medicaid Enterprise, Medical Services will review the Home and Community Based Services Assessment or Reassessment Form 470-0659 to determine if consumer needs require nursing or hospital level of care. If the consumer does not meet level of care, the IM will send a Notice of Decision (NOD) notifying the consumer of the denial. The consumer has the right to appeal the decision. The appeal process is explained on the NOD. An interdisciplinary team meeting will be conducted to determine the services that are needed, the amount of service to be provided and the provider(s) of the services. The interdisciplinary team meeting will be attended by the consumer, the DHS service worker, AIDS/HIV service provider(s), legal representatives, a representative from an AIDS Coalition of HIV Consortia and other support persons the consumer may choose to attend. The end result of the interdisciplinary team decisions will be a service plan developed by the DHS service worker. The service worker will issue a Notice of Decision if the consumer is approved to receive AIDS/HIV Waiver services. 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