ࡱ> wyv7 <bjbjUU *b7|7|7Cl8tcll([,],],],E,`H`bc$d fcc4c444"[,4[,44r!$ G,` P .+,G,c0c9,gPgG,4 HOME AND COMMUNITY BASED SERVICES PHYSICAL DISABILITY WAIVER INFORMATION PACKET The Medicaid Home and Community Based Services Physical Disability Waiver (HCBS PD) provides service funding and individualized supports to maintain eligible persons 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 PD Waiver services are designed to be flexible to meet the needs of each consumer. The following services are available: Consumer Directed Attendant Care Home and Vehicle Modification Personal Emergency Response Specialized Medical Equipment Transportation The services that are considered necessary and appropriate to meet the consumers needs will be determined through an interdisciplinary team consisting of the consumer, DHS service worker, service provider(s) and other persons the consumer chooses. All consumers will have a service plan developed by a DHS service worker in cooperation with the consumer. The consumer must have a physical impairment as their disability 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 PD 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 PD Waiver services, an approved PD Waiver service provider must be available to provide those services. Medicaid waiver service cannot be simultaneously reimbursed with another Medicaid waiver service or a Medicaid service. PD Waiver services cannot be provided when a person is an inpatient of a medical institution. The consumer must need and use, at a minimum, one unit of waiver service during each quarter of the calendar year. The total cost of the array of services cannot exceed $640 per month. The consumer must be ineligible for the Mental Retardation Waiver. The consumer must be eligible for Medicaid under SSI, SSI-related, FIP, or FIP related coverage groups or eligible under the special income level of 300 percent of the maximum monthly Supplemental Security Income coverage group consistent with a level of care in a medical institution. Following is the hierarchy for accessing waiver services: Private insurance Medicaid and/or EPSDT (Care For Kids) Physical Disability Waiver services Assistance may be available through the In Home Health Related Care program and the Rent Subsidy program in addition to services available through the PD Waiver. CONSUMER ELIGIBILITY CRITERIA Consumers may be eligible for HCBS PD 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 Have a physical disability Be between the age of 18 through 64 years Be blind or disabled as determined by the receipt of Social Security Disability benefits or by a disability determination made through the Division of Medical Services Be ineligible for the HCBS MR Waiver Be determined eligible for Medicaid (Title XIX). Consumers may be Medicaid 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. Have the ability to hire, supervise, and fire the HCBS PD service provider as determined by the DHS service worker. The consumer must be willing to do so or have a guardian named by probate court or an attorney in fact under a durable power of attorney for health care who will assume this responsibility on behalf of the consumer Be determined by the Iowa Medicaid Enterprise, Medical Services to need one of the following levels of care: Intermediate Care Facility (ICF) Skilled Nursing Facility (SNF) SERVICE DESCRIPTIONS PLEASE NOTE: PD Waiver services are designed to be flexible 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 an interdisciplinary team. CONSUMER DIRECTED ATTENDANT CARE WHAT: Assistance to the consumer with self-care tasks, which the consumer would typically do independently if the consumer was otherwise able. An individual or agency, depending on the consumers needs may provide the service. The consumer, parent, or guardian for health care 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 consumers home or community. Not the providers 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 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 PD services. The cost of nurse supervision, if needed 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 Iowa Medicaid Enterprise, Medical Services to meet intermediate care facility or skilled nursing facility level of care The CDAC fee is calculated based on the needs of the consumer and may differ from individual to individual. 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. 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. HOME AND VEHICLE MODIFICATION (HVM) WHAT: Physical modifications to the home and/or vehicle to assist with the health, safety and welfare needs of the consumer and to increase or maintain independence. All modification requests are reviewed individually and a determination is made regarding the appropriateness of the modification request. WHERE: In/on the consumer's home and/or vehicle DOES NOT Modifications, which increase the square footage of the home, items for replacement which are the responsibility of INCLUDE: the homeowner/landlord, vehicle purchase, fences, furnaces or any modifications or adaptations available through regular Medicaid. UNIT: A unit is the cost of the completed modification or adaptation. MAXIMUM: The consumer is eligible for up to $6000 per year. PERSONAL EMERGENCY RESPONSE SYSTEM (PERS) WHAT: An electronic device connected to a 24-hour staffed system which allows the consumer to access assistance in the event of an emergency. WHERE: The PERS is connected to the consumer's home phone and includes a portable emergency button carried by the consumer. UNITS: A unit is: One time installation fee and/or One month of service MAXIMUM UNITS: 12 months of service per State fiscal year (July 1-June 30) SPECIALIZED MEDICAL EQUIPMENT WHAT: Medically necessary equipment (as determined by a medical professional, i.e. PT, OT, nurse, licensed psychologist, speech therapist, etc.) for personal use by the consumer which provides for the safety and health of the individual but are normally not funded by Medicaid, the educational system or vocational rehabilitation programs and are not provided by voluntary means. This includes, but is not limited to: Electronic aids and organizers, medicine-dispensing devices, communication devices, bath aids and non-covered environmental control units. Repair and maintenance costs of the specialized medical equipment purchased WHERE: In the consumers home or community. Not the providers home. UNIT: A unit is the cost of the item. MAXIMUM: Up to $6000 per year may be allocated for the purchase and repair of specialized medical equipment. TRANSPORTATION WHAT: Transportation services may be provided for consumers to conduct business errands, to complete essential shopping, to receive medical services not reimbursed through medical transportation, to travel to and from work or day programs, and to reduce social isolation. WHERE: In the community as identified in the service plan DOES NOT Cost of medical transportation reimbursable through medical transportation funding INCLUDE: UNITS: The units are as follows: State per mile rate for individual providers or Rate established by an Area Agency on Aging for all others APPLICATION PROCESS The application process for the PD 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 DHS service worker. This will decrease the amount of time needed to complete the application process and assist in communication. 1. Application for Medicaid (Title XIX) and the PD Waiver is made with an Income Maintenance worker (IM) at the local DHS office. The IM Worker will secure a payment slot or put the consumer's name on a waiting list. Upon availability of a payment slot, the IM will process the application and refer the consumer to a DHS service worker. For adults applying for the PD Waiver, an appointment will be scheduled with the IM worker. 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. 2. The Iowa Medicaid Enterprise, Medical Services will review the Physical Disability Waiver Assessment Tool to determine if consumer needs require ICF or skilled nursing 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. 3. An interdisciplinary team meeting is 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/family, the DHS service worker, PD waiver service provider(s), and may also include other professional or support persons. The end result of the interdisciplinary team decisions will be a service plan developed by the DHS service worker. 4. The DHS service worker will issue a Notice of Decision if the consumer is approved to receive PD Waiver services. 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