Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-012 - ARChoices Transition Plan

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II ARChoices In Homecare Home and Community-Based Waiver
201.010 ARChoices Transition Plan
The ARChoices Program began January 1, 2016. The program is the
				combination of the ElderChoices and Alternatives for Adults with Physical
				Disabilities (AAPD) waivers. Beginning January 1, 2016, beneficiaries enrolled
				in the ElderChoices and AAPD waiver programs became beneficiaries of the
				ARChoices program. The following transition plan explains the process of how
				services will be executed and billed until the beneficiary receives a new
				Person-Centered Service Plan (PCSP).
Individuals currently in the ElderChoices waiver will continue
				receiving current services at the same level and from the same provider until
				the next scheduled reassessment with the following exceptions:
* Homemaker and Adult Companion - Individuals will continue
				receiving Homemaker and Adult Companion hours as shown on the plan of care,
				except the services will be billed by the provider as Attendant Care in
				ARChoices.
* Respite - Individuals will continue receiving Respite and the
				definition will remain the same, but providers will bill for ARChoices
				Respite.
* Chore - This service is being eliminated due to
				underutilization. The number of participants who utilized the Chore service in
				State Fiscal Year 2015 was zero. Chore providers will be notified of the
				elimination of Chore services.
At reassessment, the DAAS RN will complete a new ARChoices PCSP
				and indicate any changes in services. A new service will be available to
				ElderChoices recipients, Environmental Accessibility Adaptations/Adaptive
				Equipment.
Individuals currently in the Alternatives for Adults with
				Physical Disabilities (AAPD) waiver will be converted to ARChoices in Homecare
				when changes are implemented with no lapse in coverage or services. Recipients
				will be notified of the changes at least 30 days in advance of implementation.
				During the reassessment and PCSP development, the AAPD individual will choose a
				TCM provider, and the DAAS RN will make a referral to the TCM provider of
				choice. The TCM provider will then make arrangements to visit the participant.
				The IndependentChoices counseling provider will also begin a series of visits
				to ensure proper support for self-direction under 1915Q). At reassessment, the
				DAAS RN and the recipient will complete a new ARChoices PCSP and indicate any
				changes in services.
Participants receiving AAPD Attendant Care under the
				Participant-Directed (PD) model will continue to receive the same services from
				the same provider until reassessment, at which time the service may continue
				under ARChoices Attendant Services as a PD service. The PD model for ARChoices
				will be different from the PD model for AAPD as ARChoices will use the 1915(j)
				authority approved by CMS for the operation of the IndependentChoices program
				and the self-directed supports offered to program participants. The same
				Attendant Care provider will continue to provide services under the
				IndependentChoices program. At the next reassessment, the IndependentChoices
				Counseling Support and Financial Management Services (FMS) provider will work
				with the recipient and Attendant Caregiver to provide training, support and
				assistance in understanding the changes in the PD model and in completing the
				paperwork necessary to transition to the new model.
Provider training will be offered to current ElderChoices and
				AAPD providers regarding these changes as well as training on the new billing
				requirements. Training will be provided to HCBS waiver staff regarding the
				transition from the existing waivers to one waiver.
Beginning with the first reassessment, the individual will have
				an expanded array of services from which to choose. Individuals will also be
				able to keep the same services and providers when turning age 65.
Arkansas Medicaid does not provide ARChoices Waiver services in
				non-bordering states.
201.105 Provider Assurances
A. Agency Staffing
The Provider agrees that he or she will maintain adequate
				staffing levels to ensure timely and consistent delivery of services to all
				beneficiaries for whom they have accepted an ARChoices Waiver Person-Centered
				Service Plan (PCSP).
The Provider agrees:
1. Personnel responsible for direct service
			 delivery will be properly trained and in compliance with all applicable
			 licensure requirements. The Provider agrees to require personnel to participate
			 in any appropriate training provided by, or requested by, the Department of
			 Human Services. The Department of Human Services (DHS), Division of Aging and
			 Adult Services (DAAS), requires mandatory training. The provider must attend
			 one of the two provider workshop trainings in the calendar year. "Provider" in
			 this context means at least one provider representative who will be able to
			 inform the rest of the provider staff of what was covered in training. Failure
			 to attend one of these trainings could jeopardize the provider's certification
			 for the waiver. The Provider acknowledges the cost of training courses for
			 certification and/or licensure is not reimbursable through DHS. Direct care
			 workers must be trained prior to providing services to an ARChoices
			 beneficiary.
2. Each service worker
			 possesses the necessary skills to perform the specific services required to
			 meet the needs of the beneficiary he/she is to serve.
3. Staff is required to attend orientation
			 training prior to allowing the employee to deliver any ARChoices Waiver
			 service(s). This orientation shall include, but not be limited to:
a. Description of the purpose and philosophy
			 of the ARChoices Waiver Program;
b.
			 Discussion and distribution of the provider agency's written code of
			 ethics;
c. Discussion of activities
			 which shall and shall not be performed by the employee;
d. Discussion, including instructions,
			 regarding ARChoices Waiver record keeping requirements;
e. Discussion of the importance of the
			 PCSP;
f. Discussion of the agency's
			 procedure for reporting changes in the beneficiary's condition;
g. Discussion, including potential legal
			 ramifications, of the beneficiary's right to confidentiality;
h. Discussion of the beneficiary's rights
			 regarding HCBS Settings as discussed in C of this section.
B. Code of Ethics
The Provider agrees to follow and/or enforce for each employee
				providing services to an ARChoices Waiver beneficiary a written code of ethics
				that shall include, but not be limited to, the following:
1. No consumption of the beneficiary's food
			 or drink;
2. No use of the
			 beneficiary's telephone for personal calls;
3. No discussion of one's personal problems,
			 religious or political beliefs with the beneficiary;
4. No acceptance of gifts or tips from the
			 beneficiary or their caregiver;
5.
			 No friends or relatives of the employee or unauthorized beneficiaries are to
			 accompany the employee to beneficiary's residence;
6. No consumption of alcoholic beverages or
			 use of non-prescribed drugs prior to or during service delivery;
7. No smoking in the beneficiary's
			 residence;
8. No solicitation of
			 money or goods from the beneficiary;
9. No breach of the beneficiary's privacy or
			 confidentiality of records.
C. Home and Community-Based Services (HCBS)
			 Settings
All providers must meet the following Home and Community-Based
				Services (HCBS) Settings regulations as established by CMS. The federal
				regulation for the new rule is
				42 CFR
				441.301(c)(4)-(5).
Settings that are HCBS must be integrated in and support full
				access of beneficiaries receiving Medicaid HCBS to the greater community,
				including opportunities to seek employment and work in competitive integrated
				settings, engage in community life, control personal resources and receive
				services in the community, to the same degree of access as beneficiaries not
				receiving Medicaid HCBS.
HCBS settings must have the following characteristics:
1. Chosen by the individual from among
			 setting options including non-disability specific settings (as well as an
			 independent setting) and an option for a private unit in a residential setting.
a. Choice must be identified and included in
			 the PCSP.
b. Choice must be based
			 on the individual's needs, preferences and, for residential settings, resources
			 available for room and board.
2. Ensures an individual's rights of privacy,
			 dignity and respect and freedom from coercion and restraint.
3. Optimizes, but does not regiment,
			 individual initiative, autonomy and independence in making life choices,
			 including but not limited to, daily activities, physical environment and with
			 whom to interact.
4. Facilitates
			 individual choice regarding services and supports and who provides
			 them.
5. The setting is integrated
			 in and supports full access of beneficiaries receiving Medicaid HCBS to the
			 greater community, including opportunities to seek employment and work in
			 competitive integrated settings, engage in community life, control personal
			 resources and receive services in the community, to the same degree of access
			 as beneficiaries not receiving Medicaid HCBS.
6. In a provider-owned or controlled
			 residential setting (e.g., Adult Family Homes), in addition to the qualities
			 specified above, the following additional conditions must be met:
a. The unit or dwelling is a specific
			 physical place that can be owned, rented, or occupied under a legally
			 enforceable agreement by the individual receiving services, and the individual
			 has, at a minimum, the same responsibilities and protections from eviction that
			 tenants have under the landlord/tenant law of the State, county, city, or other
			 designated entity. For settings in which landlord tenant laws do not apply, the
			 State must ensure that a lease, residency agreement or other form of written
			 agreement will be in place for each HCBSparticipant and that the document
			 provides protections that address eviction processes and appeals comparable to
			 those provided under the jurisdiction's landlord tenant law.
b. Each individual has privacy in their
			 sleeping or living unit:
i. Units have
			 entrance doors lockable by the individual, with only appropriate staff having
			 keys to doors.
ii. Beneficiaries
			 sharing units have a choice of roommates in that setting.
iii. Beneficiaries have the freedom to
			 furnish and decorate their sleeping or living units within the lease or other
			 agreement.
c.
			 Beneficiaries have the freedom and support to control their own schedules and
			 activities and have access to food at any time.
d. Beneficiaries are able to have visitors of
			 their choosing at any time.
e. The
			 setting is physically accessible to the individual.
f. Any modification of the additional
			 conditions specified in items 1 through 4 above must be supported by a specific
			 assessed need and justified in the PCSP. The following requirements must be
			 documented in the PCSP:
i. Identify a specific
			 and individualized assessed need.
ii. Document the positive interventions and
			 supports used prior to any modifications to the PCSP.
iii. Document less intrusive methods of
			 meeting the need that have been tried but did not work.
iv. Include a clear description of the
			 condition that is directly proportionate to the specific assessed
			 need.
v. Include regular collection
			 and review of data to measure the ongoing effectiveness of the
			 modification.
vi. Include
			 established time limits for periodic reviews to determine if the modification
			 is still necessary or can be terminated.
vii. Include the informed consent of the
			 individual.
viii. Include an
			 assurance that interventions and supports will cause no harm to the
			 individual.
212.000 Eligibility for the ARChoices Program
A. To qualify for the ARChoices Program, a
			 person must be age 21 through 64 and who are determined to have a physical
			 disability through the Social Security Administration or the Department of
			 Human Services (DHS) Medical Review Team (MRT) and require an intermediate
			 level of care in a nursing facility, or be 65 years of age or older and require
			 an intermediate level of care in a nursing facility. Persons determined to meet
			 the skilled level of care, as determined by the Office of Long Term Care, are
			 not eligible for the ARChoices Program.
The beneficiary intake and assessment process for the ARChoices
				Program includes a determination of categorical eligibility, financial
				eligibility, a nursing facility level of care determination, the development of
				a PCSP and the beneficiary's notification of his or her choice between home and
				community-based services and institutional services.
B. Applicants for participation in the
			 program (or their representatives) must make application for services at the
			 DHS office in the county of their residence. Medicaid eligibility is determined
			 by the DHS County Office, and the DAAS Long-Term Services and Supports (LTSS)
			 Program Eligibility Specialist and is based on non-functional and functional
			 criteria. Income and resources comprise the non-functional criteria. The
			 individual must be an individual with a functional need.
C. To be determined an individual with a
			 functional need; an individual must meet at least one of the following three
			 criteria, as determined by a licensed medical professional:
1. The individual is unable to perform either
			 of the following:
a. At least 1 of the 3
			 activities of daily living (ADLs) of transferring/locomotion, eating or
			 toileting without extensive assistance from, or total dependence upon another
			 person; or
b. At least 2 of the 3
			 ADLs of transferring/locomotion, eating, or toileting without limited
			 assistance from another person; or
2. Functional assessment results in a score
			 of three or more on Cognitive Performance Scale; or
3. Functional assessments results in a Change
			 in Health, End-Stage Disease and Signs and Symptoms (CHESS) score of three or
			 more.
4. Definitions:
a.
CHESS
means the
			 Changes in Health, End-Stage Disease, Signs and Symptoms Scale was designed to
			 identify individuals at risk of serious decline. It can serve as an outcome
			 where the objective is to minimize problems related to declines in function, or
			 as a pointer to identify persons whose conditions are unstable.
CHESS, originally developed for use with nursing home
				residents, has been adapted for use with other instruments in the interRAI
				suite. It creates a 6-point scale from 0 = not at all unstable to 5 = highly
				unstable, with higher levels predictive of adverse outcomes such as mortality,
				hospitalization, pain, caregiver stress and poor self-rated health.
(RE:
http://www.interrai.org/scales.htmn
b.
COGNITIVE
			 PERFORMANCE SCALE (CPS)
combines information on memory impairment,
			 level or consciousness and executive function, with scores ranging from 0
			 (intact) to 6 (very severe impairment). The CPS has been shown to be highly
			 correlated with the MMSE in a number of validation studies. (RE:
http://www.interrai.org/scales.html
)
c.
EATING
means the
			 intake of nourishment and fluid, excluding tube feeding and total parenteral
			 (outside the intestines) nutrition. This definition does not include meal
			 preparation.
d.
EXTENSIVE ASSISTANCE
means that the individual would
			 not be able to perform or complete the activity of daily living (ADL) without
			 another person to aid in performing the complete task, by providing
			 weight-bearing assistance.
e.
LICENSED MEDICAL PROFESSIONAL
means a licensed nurse,
			 physician, physical therapist, or occupational therapist.
f.
LIMITED
			 ASSISTANCE
means that the individual would not be able to perform
			 or complete the activity of daily living (ADL) three or more times per week
			 without another person to aid in performing the complete task by guiding or
			 maneuvering the limbs of the individual or by other non-weight bearing
			 assistance.
g.
LOCOMOTION
means the act of moving from one location
			 to another, regardless of whether the movement is accomplished with aids or
			 devices.
h.
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
means a
			 level of intellectual disability as described in the American Association on
			 Intellectual and Developmental Disabilities' Manual on Intellectual Disability:
			 Definition Classification, and systems and supports. For further clarification,
			 see 42 CFR § 483.100 -102, Subpart C - Preadmission Screening and Annual
			 Resident Review (PASARR) of Individuals with Mental Illness and Intellectual
			 Disability.
i.
SERIOUS
			 MENTAL ILLNESS OR DISORDER
means schizophrenia, mood, paranoid,
			 panic or other severe anxiety disorder; somatoform disorder; personality
			 disorder; or other psychotic disorder. For further clarification, see 42 CFR
			 § 483.100 -102, Subpart C - Preadmission Screening and Annual Resident
			 Review (PASARR) of Individuals with Mental Illness and Intellectual Disability.
j.
SKILLED LEVEL OF
			 CARE
means the following services when delivered by licensed
			 medical personnel in accordance with a medical care plan requiring a continuing
			 assessment of needs and monitoring of response to plan of care; and such
			 services are required on a 24-hour/day basis. The services must be reasonable
			 and necessary to the treatment of the individual's illness or injury, i.e., be
			 consistent with the nature and severity of the individual's illness or injury,
			 the individual's particular medical needs, accepted standards of medical
			 practice and in terms of duration and amount.
i. Intermuscular or subcutaneous injections
			 if the use of licensed medical personnel is necessary to teach an individual or
			 the individual's caregiver the procedure.
ii. Intravenous injections and
			 hypodermoclysis or intravenous feedings.
iii. Levin tubes and nasogastric
			 tubes.
iv. Nasopharyngeal and
			 tracheostomy aspiration.
v.
			 Application of dressings involving prescription medication and aseptic
			 techniques.
vi. Treatment of Stage
			 III or Stage IV decubitus ulcers or other widespread skin disorders that are in
			 Stage III or Stage IV.
vii. Heat
			 treatments which have been specifically ordered by a physician as a part of
			 active treatment and which require observation by nurses to adequately evaluate
			 the individual's progress.
viii.
			 Initial phases of a regimen involving administration of medical
			 gases.
ix. Rehabilitation
			 procedures, including the related teaching and adaptive aspects of
			 nursing/therapies that are part of active treatment, to obtain a specific goal
			 and not as maintenance of existing function.
x. Ventilator care and maintenance.
xi. The insertion, removal and maintenance of
			 gastrostomy feeding tubes.
k.
SUBSTANTIAL
			 SUPERVISION
means the prompting, reminding or guidance of another
			 person to perform the task.
l.
TOILETING
means the act of voiding of the individual's
			 bowels or bladder and includes the use of a toilet, commode, bedpan or urinal;
			 transfers on and off a toilet, commode, bedpan or urinal; the cleansing of the
			 individual after the act; changes of incontinence devices such as pads or
			 diapers; management of ostomy or catheters and adjustment to
			 clothing.
m.
TOTAL
			 DEPENDENCE
means the individual needs another person to completely
			 and totally perform the task for the individual.
n.
TRANSFERRING
means the act of an individual in moving from one surface to another and
			 includes transfers to and from bed, wheelchairs, walkers and other locomotive
			 aids and chairs.
D. No individual who is otherwise eligible
			 for waiver services shall have his or her eligibility denied or terminated
			 solely as the result of a disqualifying episodic medical condition that is
			 temporary and expected to last no more than 21 days. However, that individual
			 shall not receive waiver services or benefits when subject to a condition or
			 change of condition that would render the individual ineligible if the
			 condition or change in condition is expected to last more than 21
			 days.
E. Beneficiaries diagnosed
			 with a serious mental illness or intellectual disability are not eligible for
			 the ARChoices Program unless they have medical needs unrelated to the diagnosis
			 of mental illness or intellectual disability and meet the other qualifying
			 criteria. A diagnosis of severe mental illness or intellectual disability must
			 not bar eligibility for beneficiaries having medical needs unrelated to the
			 diagnosis of serious mental illness or intellectual disability when they meet
			 the other qualifying criteria.
F.
			 Eligibility for the ARChoices Waiver program begins the date the DAAS LTSS
			 Program Specialist approves the application unless there is a provisional plan
			 of care. (If a waiting list is implemented in order to remain in compliance
			 with the waiver application as approved by CMS, the eligibility date
			 determination will be based on the waiting list process.)
G. The ARChoices Waiver provides for the
			 entrance of all eligible persons on a first-come, first-served basis, once
			 beneficiaries meet all functional and financial eligibility requirements.
			 However, the waiver dictates a maximum number of unduplicated, and active,
			 beneficiaries who can be served in any waiver year. Once the maximum number of
			 unduplicated, or active, beneficiaries is projected to be reached considering
			 the number of active cases and the number of pending applications, a waiting
			 list will be implemented for this program and the following process will apply:
1. Each ARChoices application will be
			 accepted and medical and financial eligibility will be determined.
2. If all waiver slots are filled, the
			 applicant will be notified of his or her eligibility for services, that all
			 waiver slots are filled and that the applicant is number X in line for an
			 available slot.
3. Entry to the
			 waiver will then be prioritized based on the following criteria:
a. Waiver application determination date for
			 persons inadvertently omitted from the waiver waiting list due to
			 administrative error;
b. Waiver
			 application determination date for persons being discharged from a nursing
			 facility after a 90- day stay; waiver application determination date for
			 persons residing in an approved Level II Assisted Living Facility for the past
			 six months or longer;
c. Waiver
			 application determination date for persons in the custody of DHS Adult
			 Protective Services (APS);
d.
			 Waiver application determination date for all other persons.
212.300
			 Person-Centered Service Plan (PCSP)
A. Each
			 beneficiary in the ARChoices Program must have an individualized ARChoices
			 PCSP. The authority to develop an ARChoices PCSP is given to the Medicaid State
			 agency's designee, the Division of Aging and Adult Services Registered Nurse
			 (DAAS RN). At the discretion of the beneficiary, the ARChoices PCSP is
			 developed with the ARChoices beneficiary, representative, the participant's
			 family or anyone requested by the participant, including the provider, if
			 requested by the beneficiary. At the request of the beneficiary or their
			 representative, the DAAS RN can assist in coordinating and inviting any
			 requested beneficiaries.
B. When
			 developing the waiver PCSP, the beneficiary may freely choose a family member
			 or individual to appoint as a representative. The beneficiary and
			 representative may participate in all decisions regarding the types, amount and
			 frequency of services included in the PCSP. The representative may participate
			 in choosing the provider(s) for the beneficiary. If anyone other than the
			 beneficiary chooses the provider, the DAAS RN will identify that individual on
			 the PCSP. Should the self-directed service delivery model be selected by an
			 individual other than the beneficiary, that individual may not be the paid
			 employee for one year unless the DAAS approves a release based upon extenuating
			 circumstances and in the best interest of the beneficiary.
C. The ARChoices PCSP developed by the DAAS
			 RN includes, but is not limited to:
1.
			 Beneficiary identification and contact information, including full name and
			 address, phone number, date of birth, Medicaid number and the effective date of
			 ARChoices Waiver eligibility;
2.
			 Contact person;
3. Physician's name
			 and address;
4. The amount,
			 frequency and duration of ARChoices Waiver services to be provided and the name
			 of the service provider chosen by the beneficiary or representative to provide
			 the services.
Note: Attendant Care hours are authorized on the waiver
			 PCSP based on the Resource Utilization Group (RUG) score produced from the
			 ArPath assessment. Attendant Care hours are authorized in a monthly amount on
			 the waiver PCSP. The provider and beneficiary determine how to use the
			 Attendant Care hours based on the beneficiary's needs and
			 preferences.
5. Other
			 services outside the ARChoices services, regardless of payment source,
			 identified and/or ordered to meet the beneficiary's needs including the option
			 for the self-directed service delivery model;
6. The election of community services by the
			 waiver beneficiary or representative; and,
7. The name and title of the DAAS RN
			 responsible for the development of the beneficiary's PCSP.
D. If waiver eligibility is approved by the
			 DHS county office, and the DAAS Long-Term Services and Supports (LTSS) Program
			 Eligibility Specialist, a copy of the PCSP signed by the DAAS RN and the waiver
			 beneficiary or representative, will be forwarded to the beneficiary or
			 representative and the Medicaid enrolled service provider(s) included in the
			 PCSP. The service provider and the ARChoices beneficiary must review and follow
			 the signed authorized PCSP. Services cannot begin until the Medicaid provider
			 receives the authorized PCSP from the DAAS RN. The original PCSP will be
			 maintained by the DAAS RN.
The implementation of the PCSP by a provider must ensure that
				services are:
1. Individualized to the
			 beneficiary's unique circumstances;
2. Provided in the least restrictive
			 environment possible;
3. Developed
			 within a process ensuring participation of those concerned with the
			 beneficiary's welfare;
4. Monitored
			 and adjusted as needed, based on changes authorized and reported by the DAAS RN
			 regarding the waiver PCSP;
5.
			 Provided within a system that safeguards the beneficiary's rights to quality
			 services as authorized on the waiver PCSP; and,
6. Documented carefully, with assurance that
			 required information is recorded and maintained.
NOTE: Each service included on the ARChoices PCSP must be
				justified by the
DAAS RN. This justification is based on medical
				necessity, the beneficiary's physical, cognitive and functional status, other
				support services available to the beneficiary and other factors deemed
				appropriate by the DAAS RN.
Each ARChoices service must be provided according to the
				beneficiary PCSP. For services included in the waiver PCSP, Medicaid
				reimbursement is limited to the amount and frequency that is authorized in the
				PCSP. As detailed in the Medicaid Program provider contract, providers may bill
				only after services are provided.
NOTE: PCSPs are updated annually by the DAAS RN and sent
				to the ARChoices provider prior to the expiration of the current PCSP. However,
				the provider has the responsibility for monitoring the PCSP expiration date and
				ensuring that services are delivered according to a valid PCSP. At least 30 and
				no more than 45 days before the expiration of each PCSP, the provider shall
				notify the DAAS RN via email and copy the RN supervisor of the PCSP expiration
				date.
Services are not compensable unless there is a valid and
				current PCSP in effect on the date of service.
REVISIONS TO A BENEFICIARY PCSP MAY ONLY BE MADE BY THE
				DAAS RN.
NOTE: All revisions to the waiver PCSP must be authorized
				by the DAAS RN. A revised PCSP will be sent to each appropriate provider.
				Regardless of when services are provided, unless the provider and the service
				are authorized on an ARChoices PCSP, services are considered non-covered and do
				not qualify for Medicaid reimbursement. Medicaid expenditures paid for services
				not authorized on the ARChoices PCSP are subject to
				recoupment.
212.310
Provisional
Person-Centered Service
Plan (PCSP)
The ARChoices registered nurse (DAAS RN) may develop a
				provisional PCSP prior to establishment of Medicaid eligibility, based on
				information obtained during the in-home functional assessment, when
				recommending functional approval based on the nursing home criteria. The DAAS
				RN must discuss the provisional PCSP policy and have the approval of the
				applicant prior to completing and processing the provisional PCSP. The PCSP
				will be developed by the applicant and the DAAS RN and signed by the applicant
				or the applicant's representative and the DAAS RN.
The provisional PCSP will include all current PCSP information,
				except for the waiver eligibility date and the Medicaid beneficiary ID
				number.
The provisional PCSP will be mailed to the waiver applicant and
				each provider included on the PCSP. If the beneficiary and the provider accept
				the risk of ineligibility, the provider must begin services within an
				established time frame as determined by the Division of Aging and Adult
				Services (DAAS) and notify the DAAS RN, via Start Services form AAS-9510, that
				services have started. The DAAS RN will track the start of care dates and give
				the applicant options when services are not started.
The provisional PCSP will expire 60 days from the
				date signed by the applicant and the DAAS RN.
A PCSP that has been
				approved with a Medicaid number and waiver eligibility date must be in place no
				later than the expiration date of the provisional PCSP.
A. A provisional PCSP may be developed and
			 sent to providers only when the assessment outcome indicates functional
			 eligibility and the DAAS RN believes, in his or her professional judgment, that
			 the applicant meets the level of care criteria for an adult with a functional
			 need, as explained in Section
			 212.000, Eligibility for the
			 ARChoices Program.
The waiver eligibility date will be established retroactively,
				effective on the day the provisional PCSP was signed by the applicant or
				applicant's representative and the DAAS RN, if:
1. At least one waiver service begins within
			 30 days of the development of the provisional PCSP
AND
2. The
			 waiver application is approved by the Division of County Operations.
B. If waiver services
			 begin within 31 through 60 days of the development of the provisional PCSP, the
			 retroactive eligibility date will be the effective date that a waiver service
			 is started.
C. If waiver services
			 do not begin within 60 days from the date the provisional PCSP is signed by the
			 DAAS RN, the DAAS Long-Term Services and Supports (LTSS) Program Eligibility
			 Specialist will establish the waiver eligibility date as the date the
			 application is entered into the system as an approved application. There will
			 be no retroactive eligibility.
D.
			 Provisional PCSPs may not include the non-waiver self-directed service delivery
			 model.
212.311 Denied
			 Eligibility Application
A. If the DHS county
			 office, and the DAAS Long-Term Services and Supports (LTSS) Program Eligibility
			 Specialist denies the Medicaid eligibility application for any reason, Medicaid
			 and waiver services provided during a period of ineligibility will be the
			 financial responsibility of the applicant. The DAAS LTSS Program Eligibility
			 Specialist will notify the DAAS RN. The DAAS RN will notify the providers via
			 form AAS-9511 immediately upon learning of the denial. Reasons for denial
			 include but are not limited to:
1. Failure to
			 meet the nursing home admission criteria
2. Failure to meet financial eligibility
			 criteria
3. Withdrawal of the
			 application by the applicant
4.
			 Death of the applicant when no waiver services were provided
NOTE: If waiver services were provided and the applicant
				dies prior to approval of the application, waiver eligibility will begin (if
				all other eligibility requirements are met) on the date waiver service(s) began
				and end on the date of death.
B. The applicant has the right to appeal by
			 filing for a fair hearing. When an appeal ruling is made in favor of the
			 applicant, the actions to be taken by the DHS county office are as follows:
1. If the individual has no unpaid ARChoices
			 Waiver charges, Medicaid coverage will begin on the date of the appeal
			 decision. However, the waiver portion of the case will not be approved until
			 the date the DHS county office, and the DAAS LTSS Program Eligibility
			 Specialist completes the case.
2.
			 If the individual has unpaid waiver charges and services were authorized by the
			 DAAS RN, eligibility for both Medicaid and waiver services will begin on the
			 date service began unless the hearing decision sets a begin date.
NOTE: Under no circumstances will waiver eligibility
				begin prior to the date of application or the date the provisional PCSP is
				signed by the DAAS RN and the applicant or the applicant's representative,
				whichever is later.
212.312 Comprehensive Person-Centered Service
			 Plan (PCSP)
Prior to the expiration date of the provisional PCSP, the DAAS
				RN will send the comprehensive PCSP to the waiver beneficiary and all providers
				included on the PCSP. The comprehensive PCSP will replace the provisional PCSP.
				The comprehensive PCSP will include the Medicaid beneficiary ID number, the
				waiver eligibility date established according to policy and the comprehensive
				PCSP expiration date.
The comprehensive PCSP expiration date will be 365 days from
				the date of the DAAS RN's signature on form AAS-9503, the ARChoices PCSP. Once
				the application is either approved or denied by the DAAS Long-Term Services and
				Supports (LTSS) Program Eligibility Specialist, the providers will be notified
				by the DAAS RN. The notification for the approval will be in writing via a PCSP
				that includes the waiver eligibility date and Medicaid ID number. The
				notification for a denial will be via a form AAS-9511 reflecting the date of
				denial.
212.322 Revisions
			 when the Person-Centered Service Plan (PCSP) Contains Personal Care Services
Requested changes to the personal care services included on the
				ARChoices PCSP may originate with the personal care RN or the DAAS RN, based on
				the recipient's circumstances. Unless requested by an IndependentChoices
				beneficiary, the individual or agency requesting revisions to the Personal Care
				services on the ARChoices PCSP is responsible for securing any required
				signatures authorizing the change prior to the ARChoices PCSP being
				revised.
If revised by the DAAS RN, a copy of the revised ARChoices PCSP
				and a Start of Care Form (AAS-9510) will be mailed to the personal care
				provider within 10 working days after being revised. If authorization is
				secured by the Personal Care agency, a copy of the revised personal care order,
				signed by the physician, must be sent to the DAAS RN prior to implementing any
				revisions. Once received, the ARChoices PCSP will be revised accordingly within
				10 working days of its receipt. If any problems are encountered with
				implementing the requested revisions, the DAAS RN will contact the personal
				care provider to discuss possible alternatives. These discussions and the final
				decision regarding the requested revisions must be documented in the nurse
				narrative. The final decision rests with the DAAS RN.
212.400
Temporary
Absences
			 from the Home
Once an ARChoices eligibility application has been approved,
				waiver services must be provided in a home and community-based services setting
				for eligibility to continue. Unless stated otherwise below, the county
				Department of Human Services (DHS) office must be notified immediately by the
				Division of Aging and Adult Services Registered Nurse (DAAS RN) when waiver
				services are discontinued and action will be initiated by the DAAS LTSS Program
				Eligibility Specialist to close the waiver case. Providers will be notified by
				the DAAS RN.
A. Absence from the Home
			 due to Institutionalization
An individual cannot receive ARChoices Waiver services while in
				an institution. The following policy applies to any inpatient stay where
				Medicaid pays the facility for the date of admission, i.e., hospitals, nursing
				homes, rehab facilities, etc., for active waiver cases when the beneficiary is
				hospitalized or enters a nursing facility for an expected stay of short
				duration.
1. When a waiver beneficiary
			 is admitted to a hospital, the DAAS LTSS Program Eligibility Specialist will
			 not take action to close the waiver case unless the beneficiary does not return
			 home within 30 days from the date of admission. If, after 30 days, the
			 beneficiary has not returned home, the DAAS RN will notify the DAAS LTSS
			 Program Eligibility Specialist and action will be initiated to close the waiver
			 case.
2. If the DHS county office
			 becomes aware that a beneficiary has been admitted to a nursing facility and it
			 is anticipated that the stay will be short (30 days or less), the waiver case
			 will be closed effective the date of the admission, but the Medicaid case will
			 be left open. When the beneficiary returns home, the waiver case may be
			 reopened effective the date the beneficiary returns home. A new assessment and
			 medical eligibility determination will not be required unless the last review
			 was completed more than 6 months prior to the beneficiary's admission to the
			 facility.
NOTE: Nursing facility admissions, when referenced in this
				section, do not include ARChoices beneficiaries admitted to a nursing facility
				to receive facility-based respite services.
NOTE: The Arkansas Medicaid Program considers an individual an
				inpatient of a facility beginning with the date of admission. Therefore,
				payment to the inpatient facility begins on the date of admission. Payment to
				the inpatient facility does not include the date of discharge.
Payment for ARChoices services may be allowed for the date of a
				beneficiary's admission to an inpatient facility if the provider can provide
				verification that services were provided before the beneficiary was admitted.
				In order for payment to be allowed, providers are responsible for obtaining the
				following:
* Copies of claim forms or timesheets listing the times that
				services were provided
* A statement from the inpatient facility showing the time that
				the beneficiary was admitted
* This information must be submitted to DAAS within 10 working
				days of receiving a request for verification.
If providers are unable to provide proof that ARChoices
				services were provided before the beneficiary was admitted to the inpatient
				facility, then payments will be subject to recoupment. ARChoices services
				provided on the same day the beneficiary is discharged from the inpatient
				facility are billable when provided according to policy and after the
				beneficiary was discharged.
B. Absence due to Reasons Other than
			 Institutionalization
When a waiver beneficiary is absent from the home for reasons
				other than institutionalization, the DAAS LTSS Program Eligibility Specialist
				will not be notified unless the beneficiary does not return home within 30
				days. If, after 30 days, the beneficiary has not returned home and the
				providers can no longer deliver services as authorized on the Person-Centered
				Service Plan (PCSP) (e.g., the beneficiary has left the state and the return
				date is unknown), the DAAS RN will notify the DAAS LTSS Program Eligibility
				Specialist. Action will be taken by the DAAS LTSS Program Eligibility
				Specialist to close the waiver case.
NOTE: It is the responsibility of the provider to notify the
				DAAS RN immediately via form AAS-9511 upon learning of a change in the
				beneficiary's status.
212.500 Reporting Changes in Beneficiary's
			 Status
Because the provider has more frequent contact with the
				beneficiary, many times the provider becomes aware of changes in the
				beneficiary's status sooner than the Division of Aging and Adult Services
				Registered Nurse (DAAS RN), Case Manager, or DAAS Long-Term Services and
				Supports (LTSS) Program Eligibility Specialist. It is the provider's
				responsibility to report these changes immediately so proper action may be
				taken. Providers must complete the Waiver Provider Communication - Change of
				Participant Status Form (AAS-9511) and send it to the DAAS RN. A copy must be
				retained in the provider's beneficiary case record. Regardless of whether the
				change may result in action by the DAAS LTSS Program Eligibility Specialist,
				providers must immediately report all changes in the beneficiary's status to
				the DAAS RN.
The Targeted Case Manager is responsible for monitoring the
				beneficiary's status on a regular basis for changes in service need, referring
				the beneficiary for reassessment if necessary and reporting any beneficiary
				complaints and changes in status to the DAAS RN, or DAAS RN Supervisor
				immediately upon learning of the change.
213.100 Adult Family Homes
Procedure Code
Modifier
Description
S5140
U1
Adult Family Homes Level A
S5140
U2
Adult Family Homes Level B
S5140
U3
Adult Family Homes Level C
Adult Family Homes services are personal care and supportive
				services (e.g., Attendant Care, transportation and medication oversight (to the
				extent permitted under State Law)), provided in a certified private home by a
				principal care provider who lives in the home.
Payment for Adult Family Home services is not made for room and
				board, items of comfort or convenience, or the costs of facility maintenance,
				upkeep and improvement. Payment for Adult Family Home services does not include
				payments made, directly or indirectly, to members of the beneficiary's
				immediate family.
Adult Family Home services provide a family living environment
				for adults who are functionally impaired and who, due to the severity of their
				functional impairments, are considered to be at imminent risk of death or
				serious bodily harm and, as a consequence, are not capable of fully independent
				living.
The number of beneficiaries served by an Adult Family Home may
				not exceed three (3) and beneficiaries must be unrelated to the adult family
				home provider. "Unrelated" is defined as any person who is not related to the
				provider by virtue of blood, marriage, or adoption. Other than the Adult Family
				Home provider, immediate family members or caregivers residing in the adult
				family home with the waiver beneficiary are prohibited from receiving Medicaid
				reimbursement for direct provision of any ARChoices services.
Adult Family Home services shall be included in the
				Person-Centered Service Plan (PCSP) only when it is necessary to prevent the
				permanent institutionalization of a beneficiary as determined by the Division
				of Aging and Adult Services Registered Nurse (DAAS RN). The Adult Family Home
				provider is responsible for meeting the needs of the waiver beneficiary, as
				defined by this waiver service description, 24 hours/day, 7 days/week.
Adult Family Homes add a dimension of family living to the
				provision of supportive services and personal care services such as:
A. Bathing
B. Dressing
C. Grooming
D. Care for occasional incontinence
			 (bowel/bladder)
E. Assistance with
			 eating
F. Enhancement of skills and
			 independence in daily living
G.
			 Transportation to allow access to the community
Services are provided in a home-like setting. The provider must
				include the beneficiary in the life of the family as much as possible. The
				provider must assist the beneficiary in becoming or remaining active in the
				community.
Services must be provided according to the participant's
				written ARChoices PCSP.
There are three (3) different reimbursement rates for Adult
				Family Homes based on the Level of Care required for the individual
				beneficiary. Level of Care is indicated by using a modifier with CPT Code
S5140.
One (1) unit of service equals one (1) day. Adult Family Homes
				are limited to a maximum of thirty-one (31) units per month. Room and board
				costs are not included as a part of this service. Service payments are for the
				provision of daily living care to the beneficiary.
For any given year of the ARChoices Waiver, Adult Family Homes
				shall charge waiver residents no more than 90.8% of the current Individual SSI
				Benefit amount rounded to the nearest dollar for room and board. For any given
				year of the ARChoices Waiver, ARChoices Waiver beneficiaries shall receive 9%
				of the current Individual SSI Benefit amount rounded to the nearest dollar for
				personal needs allowance.
The waiver eligible person will cover the cost of room and
				board in the Adult Family Home. In addition, the DAAS Long-Term Services and
				Supports (LTSS) Program Eligibility Specialist will determine individual
				liability for care services based on the waiver eligible person's available
				resources. Medicaid will cover the remaining cost of waiver services provided
				to the waiver eligible person. The personal needs allowance is adequate to meet
				the other expenses of the waiver eligible person in the Adult Family Home and
				exceeds the personal needs allowance for beneficiaries in long term care
				facilities.
The Adult Family Home waiver beneficiary may receive up to 600
				hours (2,400 units) of long-term facility-based respite per state fiscal year.
				The service of Adult Family Home is not allowed on the same date of service as
				respite service.
BENEFICIARIES RECEIVING ADULT FAMILY HOMES SERVICES ARE NOT
				ELIGIBLE TO RECEIVE ANY OTHER ARCHOICES SERVICE, EXCEPT FOR LONG-TERM
				FACILITY-BASED RESPITE.
213.110 Adult Family Homes Certification
			 Requirements
Enrollment as an ARChoices Adult Family Homes provider requires
				certification by the Department of Human Services, Division of Aging and Adult
				Services (DAAS), as an Adult Family Home. Adult Family Homes providers must
				complete an application packet including Medicaid Provider forms; be tested
				over designated training materials and achieve a passing score and submit the
				home for inspection by designated DAAS staff. If substitute caregivers are
				identified, these beneficiaries must meet the same training and testing
				requirements as the Adult Family Homes provider. In addition, drug screens and
				background checks are required for the provider, substitute care givers and
				provider family members residing in the home and who are over the age of
				sixteen (16). Providers must recertify with DAAS annually. This requires
				submission of a renewal application packet and home inspection, as well as
				documentation of at least twelve hours of related training activities.
An Adult Family Home, for the purpose of the ARChoices Program,
				does not include any house, institution, hotel or other similar living
				situation that supplies room and board only, room only, or board only.
As a condition of certification, each Adult Family Homes
				provider shall execute with and provide to each beneficiary an admission
				agreement specifying services to be provided, the beneficiary's cost for room
				and board, conditions and rules governing the beneficiary and grounds for
				termination of residency. Each Adult Family Homes provider will also be
				required to develop and maintain written program policies. Program policies
				must include and comply with the HCBS Settings rules found in section C of
				201.105.
NOTE: The Adult Family Home provider's ElderChoices
				certification will be valid as an ARChoices Adult Family Home provider under
				the ARChoices Waiver program.
The provider will not be required to recertify until the
				expiration of the previous certification under ElderChoices.
NOTE: At the next annual certification, the Adult Family
				Home provider must have policies in place that include and comply with the Home
				and Community-Based Services (HCBS) Settings rules found in section C of
				201.105.
213.210
			 Attendant Care Services
Procedure Code
Modifier
Description
S5125
U2
Attendant Care Services
S5125
Attendant Care Self-Directed Model
Attendant Care services are designed to reduce or prevent
				inappropriate institutionalization by maintaining, strengthening or restoring
				an eligible beneficiary's functioning in his or her own home or elsewhere in
				the community where the beneficiary engages in activities, including
				work-related activities.
Attendant Care services consists of assistance with activities
				of daily living (ADLs), instrumental activities of daily living (lADLs) and
				health-related tasks through hands-on assistance, supervision and/ or
				cueing.
Hands-on assistance, supervision and/or cueing are defined as:
A. "Hands-on assistance" means a
			 provider physically performs all or part of an activity because the individual
			 is unable to do so.
B. "Set-up", a
			 form of hands on assistance, means getting personal effects, supplies, or
			 equipment ready so that an individual can perform an activity.
C. "Supervision" means a provider must be
			 near the individual to observe how the individual is completing a
			 task.
D. "Cueing and/or
			 reassurance" means giving verbal or visual clues and encouragement during the
			 activity to help the individual complete activities without hands-on
			 assistance.
E. "Monitoring", a form
			 of supervision, means a provider must observe the individual to determine if
			 intervention is needed.
F.
			 "Stand-by", a form of supervision, means a provider must be at the side of an
			 individual ready to step in and take over the task should the individual be
			 unable to complete the task independently.
G. "Support", a form of supervision, means to
			 enhance the environment to enable the individual to be as independent as
			 possible.
H. The following forms of
			 assistance combine elements of Hands-on assistance, supervision and/or
			 cueing:
I. "Redirection", a form of
			 supervision or cueing, means to divert the individual to another more
			 appropriate activity.
J. "Memory
			 care support", a blend of supervision, cueing and hands-on assistance. Includes
			 services related to observing behaviors, supervision and intervening as
			 appropriate in order to safeguard the service beneficiary against injury,
			 hazard or accident. These specific supports are designed to support
			 beneficiaries with cognitive impairments.
Activities of daily living include:
A. Eating
B. Bathing
C. Dressing
D. Personal hygiene (grooming, shampooing,
			 shaving, skin care, oral care, etc.)
E. Toileting
F. Mobility/ambulating, including mastering
			 the use of adaptive aids and equipment
Instrumental activities of daily living include:
A. Meal planning and preparation
B. Managing finances
C. Laundry
D. Shopping and errands
E. Communication
F. Traveling and participation in the
			 community
G. Housekeeping
H. Assistance with medications (to the extent
			 permitted by nursing scope of practice laws) The provision of ADLs and lADLs
			 does not entail nursing care.
Beneficiaries may choose to self-direct this service through
				Arkansas's IndependentChoices program under 1915(j) authority; or may receive
				services through an agency. The IndependentChoices Medicaid Provider Manual
				describes the self-directed service delivery model.
Attendant Care services must be provided according to the
				beneficiary ARChoices written PCSP.
A brief description of the service(s) provided, including the
				signature and title of the individual rendering the service, must be documented
				in the beneficiary's case record. See Section
				214.000 for additional
				documentation requirements.
Benefit limits will be determined on a client basis based on
				the assessed level of need by the DAAS RN. The highest RUG level allows a
				maximum allocation of 324 units (81 hours) per week, 1,436 units (359 hours)
				per month, or 16,848 units (4,212 hours) per year.
Fifteen (15) minutes of service equals one (1) unit.
An ARChoices beneficiary who spends more than five (5) hours
				(20 units) at an adult day services or adult day health services facility or
				who is receiving short-term, facility-based respite care will not be eligible
				for Attendant Care services on the same date of service unless authorized by
				the DAAS RN.
An ARChoices beneficiary receiving long-term, facility-based
				respite care is not eligible for Attendant Care services on the same date of
				service.
213.240
			 Environmental Accessibility Adaptations/Adaptive Equipment
Environmental Accessibility Adaptations/Adaptive Equipment
				services enable the individual to increase, maintain and/or improve his or her
				functional capacity to perform daily life tasks that would not be possible
				otherwise. Environmental Accessibility Adaptations/Adaptive Equipment is
				physical adaptations to the home that are necessary to ensure the health,
				welfare and safety of the beneficiary, to function with greater independence in
				the home and preclude or postpone institutionalization. Adaptive equipment also
				enables the ARChoices beneficiary to increase, maintain and/or improve his/her
				functional capacity to perform daily life tasks that would not be possible
				otherwise and perceive, control or communicate with the environment in which he
				or she lives.
Excluded are adaptations or improvements to the home which are
				of general utility and are not of direct medical or remedial benefit to the
				individual, such as carpeting, roof repair, air conditioning and others.
				Adaptations which add to the total square footage of the home are excluded from
				this benefit. All services must be in accordance with applicable state or local
				building codes. All dwellings that receive adaptations must be in good repair
				and have the appearance of sound structure.
Permanent fixtures are not allowed on rented or leased
				properties.
213.290
			 Environmental Modifications/Adaptive Equipment
Prior to payment for this service, the waiver beneficiary is
				required to secure 3 separate itemized bids for the same service. The bids are
				reviewed by the Division of Aging and Adult Services Registered Nurse (DAAS RN)
				or designee prior to submission for Medicaid payment. If only two bids can be
				secured due to a shortage of qualified providers in the service area,
				documentation attesting to the attempt to secure bids and the shortage of
				providers must be provided. All modification funds must be verified by the DAAS
				Provider Certification Unit prior to receiving services.
Each claim must be signed by the provider, the waiver
				beneficiary and DAAS RN, or designee. A statement of satisfaction form must be
				signed by the waiver beneficiary prior to any claim being submitted. All claim
				forms, bids and client satisfaction statement forms must be submitted to the
				DAAS Provider Certification Unit prior to submission for payment.
NOTE: The Environmental Modification provider's
				Alternatives for Adults with Physical Disabilities (AAPD) certification will be
				valid as an ARChoices Environmental Modification provider under the ARChoices
				Waiver program. The provider will not be required to recertify until the
				expiration of the previous certification under AAPD.
213.311 Hot Home-Delivered Meal Provider
			 Certification Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of Hot Home-Delivered Meal services, a provider
				must:
A. Be a nutrition services
			 provider whose kitchen is approved by the Department of Health and whose meals
			 are approved by a Registered Dietitian who has verified by nutrient analysis
			 that meals provide 33 1/3 percent of the Dietary Reference Intakes established
			 by the Food and Nutrition Board of the National Academy of Sciences and comply
			 with the Dietary Guidelines for Americans and DAAS Nutrition Services Program
			 Policy Number 206.*
B. Comply with
			 all federal, state, county and local laws and regulations concerning the safe
			 and sanitary handling of food, equipment and supplies used in the storage,
			 preparation, handling, service, delivery and transportation of
			 meals;*
C. If applicable, assure
			 that the provider's intermediate source of delivery meets or exceeds federal,
			 state and local laws regarding food transportation and delivery;*
D. Procure and have available all necessary
			 licenses, permits and food handlers' cards as required by law;*
*NOTE: For providers located in Arkansas, all
				requirements must meet applicable Arkansas laws and regulations. For
				Home-Delivered Meal providers located in bordering states, all requirements
				must meet their states' applicable laws and
				regulations.
E.
			 Notify the DAAS RN immediately if:
1. There
			 is a problem with delivery of service
2. The beneficiary is not consuming the
			 meals
3. A change in the
			 individual's condition is noted
NOTE: Changes in service delivery must receive prior
				approval by the DAAS RN who is responsible for the individual's Person-Centered
				Service Plan (PCSP). Requests must be submitted in writing to the DAAS RN. Any
				changes in the individual's circumstances must be reported to the DAAS RN via
				form AAS-9511
.
Home-Delivered Meals, hot or frozen, shall be included in the
				beneficiary's PCSP only when they are necessary to prevent the
				institutionalization of an individual.
Hot Home-Delivered Meals providers must recertify with DAAS
				every three years; however, DAAS must maintain a copy of the agency's current
				Food Establishment Permit at all times.
NOTE: The Home-Delivered Meals provider's ElderChoices
				certification will be valid as an ARChoices Home-Delivered Meals provider under
				the ARChoices Waiver program. The provider will not be required to recertify
				until the expiration of the previous certification under
				ElderChoices.
213.323
Frozen
Home-Delivered
			 Meal
Provider
Certification Requirements
In order to become approved providers of frozen meals,
				providers must meet all applicable requirements of the Division of Aging and
				Adult Services (DAAS) Nutrition Services Program Policy Number 206.
To be certified by DAAS as a provider of Home-Delivered Meal
				services, a meal provider must:
A. Be
			 a nutrition services provider whose kitchen is approved by the Department of
			 Health and whose meals are approved by a Registered Dietitian who has verified
			 by nutrient analysis that meals provide 33 1/3 percent of the Dietary Reference
			 Intakes established by the Food and Nutrition Board of the National Academy of
			 Sciences and comply with the Dietary Guidelines for Americans and DAAS
			 Nutrition Services Program Policy Number 206.*
B. Comply with all federal, state, county and
			 local laws and regulations concerning the safe and sanitary handling of food,
			 equipment and supplies used in the storage, preparation, handling, service,
			 delivery and transportation of meals;*
C. If applicable, ensure that intermediate
			 sources of delivery meet or exceed federal, state and local laws regarding food
			 transportation and delivery*
D.
			 Procure and have available all necessary licenses, permits and food handlers'
			 cards as required by law*
*NOTE: For providers located in Arkansas, all
				requirements must meet applicable Arkansas laws and regulations. For
				Home-Delivered Meal providers located in bordering states, all requirements
				must meet their states' applicable laws and regulations.
E. Provide frozen meals that:
1. Were prepared or purchased according to
			 the Department of Health and DAAS Nutrition Services Program Policy guidelines
			 in freezer-safe containers that can be reheated in the oven or
			 microwave.
2. Are kept frozen from
			 the time of preparation through placement in the individual's
			 freezer.
3. Have a remaining
			 freezer life of at least three months from the date of delivery to the
			 home.
4. Are part of a meal cycle
			 of at least four weeks (i.e., four weeks of menus that differ).
5. Are properly labeled, listing food items
			 included and non-frozen items that are delivered with the frozen components to
			 complete the meal (which must include powdered or fluid milk, whichever is
			 preferred by the ARChoices beneficiary), menu analysis as required by DAAS
			 Nutrition Services Program Policy if other than DAAS menus are used and both
			 packaging and expiration dates.
NOTE: The milk must be delivered to the beneficiary at
				least seven (7) days prior to its expiration date.
F. Instruct each individual, both verbally
			 and in writing, in the handling and preparation required for frozen meals and
			 provide written re-heating instructions with each meal, preferably in large
			 print.
G. Ensure that meals that
			 are not commercially prepared but produced on-site in the production kitchen:
1. Are prepared and packaged only in a
			 central kitchen or on-site preparation kitchen;
2. Are prepared specifically to be
			 frozen;
3. Are frozen as quickly as
			 possible;
4. Are cooled to a
			 temperature of below 40 degrees Fahrenheit within four hours;
5. Have food temperatures taken and recorded
			 at the end of food production, at the time of packaging and throughout the
			 freezing process, with temperatures recorded and kept on file for
			 audit;
6. Are packaged in
			 individual trays, properly sealed and labeled with the date, contents and
			 instructions for storage and reheating;
7. Are frozen in a manner that allows air
			 circulation around each individual tray;
8. Are kept frozen throughout storage,
			 transport and delivery to the beneficiary; and
9. Are discarded after 30 days.
H. Verify quarterly that all
			 beneficiaries receiving Frozen Home-Delivered Meals continue to have the
			 capacity to store and heat meals and are physically and mentally capable of
			 performing simple associated tasks unless other appropriate arrangements have
			 been made and approved by DAAS. Any changes in the individual's circumstances
			 must be reported to the DAAS RN via form AAS-9511.
I. Notify the appropriate DAAS RN immediately
			 if:
1. There is a problem with delivery of
			 service
2. The individual is not
			 consuming the meals
3. A change in
			 an individual's condition is noted
NOTE: Changes in service delivery must receive prior
				approval by the DAAS RN who is responsible for the individual's Person-Centered
				Services Plan (PCSP). Requests must be submitted in writing to the DAAS RN.
				Any
changes in the individual's circumstances must be
				reported to the DAAS RN via form AAS-9511
.
Home-Delivered Meals, hot or frozen, shall be included in the
				beneficiary's PCSP only when they are necessary to prevent the
				institutionalization of an individual.
Frozen Home-Delivered Meals providers must recertify with DAAS
				every three years; however, DAAS must maintain a copy of the agency's current
				Food Establishment Permit at all times.
NOTE: The Home-Delivered Meals ElderChoices provider's
				certification will be valid as an ARChoices Home-Delivered Meals provider under
				the ARChoices Waiver program. The provider will not be required to recertify
				until the expiration of the previous certification under
				ElderChoices.
213.330 Limitations on Home-Delivered Meals
			 (HDMs)
One unit of service equals one meal. The maximum number of HDMs
				eligible for Medicaid reimbursement per month equals 31 meals. This includes
				hot, frozen or a combination of the two. There is no separate benefit limit for
				frozen meals.
The maximum number of emergency meals per State Fiscal Year is
				four (4).
Frozen HDMs may be provided daily to eligible beneficiaries. A
				maximum of seven (7) meals may be delivered at one time.
HDM providers may deliver more than seven meals at one time,
				if:
A. The waiver beneficiary receives
			 Attendant Care services or Personal Care at least three (3) times per
			 week,
B. Frozen HDMs are ordered on
			 the Person-Centered Services Plan (PCSP),
C. The waiver beneficiary has the means of
			 storing 14 frozen meals (as verified by the DAAS RN).
HDM providers delivering frozen meals may deliver 14 at one
				time if the DAAS RN enters 14 meals delivery approved in the comments section
				of the HDM entry on the PCSP. If this statement is not on the PCSP, or if any
				of the other factors above are not in place, the meal providers cannot deliver
				more than seven (7) meals at one time.
An ARChoices beneficiary may not be provided with a Hot or
				Frozen HDM on any day during which the individual receives more than five (5)
				hours of in-home or facility-based Respite care or more than five (5) hours of
				Adult Day Services or Adult Day Health Services. (Licensure mandates that
				providers of these services provide a meal or meals; therefore, a HDM on these
				dates is a duplicative service and prohibited under waiver guidelines.)
NOTE: Medicaid reimbursement for HDMs is not allowed on
				the same day to beneficiaries who are also attending Adult Day Services, Adult
				Day Health Services, or facility-based Respite care for more than five (5)
				hours. When applying this policy, the time of day the beneficiary receives day
				services or respite services are also a factor. Whether there is duplication of
				services will be determined by comparing the time of day during which services
				occur.
When considering whether a HDM is billable for an individual
				receiving Adult Day Services, Adult Day Health Services or facility-based
				Respite services, on a specific date of service, the following must be
				applied:
If an ARChoices beneficiary is receiving Adult Day Services,
				Adult Day Health Services or facility-based Respite at any time between the
				hours of 11:00 a.m. and 1:30 p.m.
and
the noon meal is routinely
				served to others at the facility during this timeframe, the noon meal must also
				be served to this individual. A HDM is not allowable on the same date of
				service. This is true regardless of the total number of Adult Day Services,
				Adult Day Health Services or Respite hours provided.
NOTE: Medicaid reimbursement for HDMs is not allowed on
				the same day to beneficiaries who are also attending Adult Day Services, Adult
				Day Health Services, or facility-based Respite care for more than five (5)
				hours. When applying this policy, the time of day the beneficiary receives day
				services or respite services are also a factor. Whether there is duplication of
				services will be determined by comparing the time of day during which services
				occur.
When considering whether a HDM is billable for an individual
				receiving Adult Day Services, Adult Day Health Services or facility-based
				Respite services, on a specific date of service, the following must be
				applied:
If an ARChoices beneficiary is receiving Adult Day Services,
				Adult Day Health Services or facility-based Respite at any time between the
				hours of 11:00 a.m. and 1:30 p.m.
and
the noon meal is routinely
				served to others at the facility during this timeframe, the noon meal must also
				be served to this individual. A HDM is not allowable on the same date of
				service. This is true regardless of the total number of Adult Day Services,
				Adult Day Health Services or Respite hours provided.
213.350 Emergency Meals
Beneficiaries may receive up to four (4) emergency meals per
				state fiscal year. The meals must:
A.
			 Contain 33 1/3 percent of the Dietary Reference intakes established by the Food
			 and Nutrition Board of the National Academy of Sciences and comply with the
			 Dietary Guidelines for Americans and Division of Aging and Adult Services
			 (DAAS) Nutrition Services Program Policy Number 206.
B. Be labeled "Emergency Meal" in large
			 print, with instruction on use of the meal.
C. Be used within the limits of their shelf
			 life, usually within six months.
213.410 Personal Emergency Response System
			 (PERS) Certification Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of personal emergency response services, a provider
				must:
A. Provide, install and maintain
			 Federal Communications Commission (FCC) approved equipment which meets all
			 Underwriter Laboratories Safety Standards;
B. Designate or operate an emergency response
			 center to receive signals and respond according to specified operating
			 protocol;
C. Establish a response
			 system for each beneficiary and ensure responders receive necessary instruction
			 and training; and
D. Ensure that
			 equipment is installed by qualified providers who also provide instruction and
			 training to beneficiaries.
PERS providers must recertify annually with DAAS.
NOTE: The PERS ElderChoices provider's certification will
				be valid as an ARChoices PERS provider under the ARChoices Waiver program. The
				provider will not be required to recertify until the expiration of the previous
				certification under ElderChoices.
213.500 Adult Day Services
Procedure Code
Required Modifier
Description
S5100
U1
Adult Day Services, 8-20 Units Per Date of
						  Service
S5100
?
Adult Day Services, 21-40 Units Per Date of
						  Service
Adult day services facilities are licensed by the Office of
				Long-Term Care (OLTC) to provide care and supervision to meet the needs of four
				(4) or more functionally impaired adults for periods of less than 24 hours but
				more than two (2) hours per day, in a place other than the beneficiaries' own
				homes.
When provided according to the beneficiary's written ARChoices
				Person-Centered Service Plan (PCSP), ARChoices beneficiaries may receive adult
				day services for 8 or more units (2 or more hours) per day, not to exceed 40
				units (10 hours) per day, according to the beneficiary's written PCSP. Adult
				day services of less than 8 units (2 hours) per day are not reimbursable by
				Medicaid. Adult day services may be utilized up to 200 units (50 hours) per
				week, not to exceed 920 units (230 hours) per month. One (1) unit of service
				equals 15 minutes.
As required, beneficiaries who are present in the facility for
				more than 20 units (5 hours) a day (procedure code
S5100)
must be
				served a nutritious meal that equals one-third of the Recommended Daily
				Allowance. Therefore, ARChoices beneficiaries are not eligible to receive a
				home-delivered meal on the same day they receive more than 20 units (5 hours)
				of adult day services. Additionally, beneficiaries who attend an adult day
				service for more than 20 units (5 hours) are not eligible to receive Attendant
				Care services on the same date of service unless authorized by the Division of
				Aging and Adult Services Registered Nurse (DAAS RN).
NOTE: As stated in this manual, home-delivered meals may
				not be provided on the same day for an individual who attends adult day
				services, adult day health services, or facility-based respite care for more
				than 20 units (5 hours). The time of day the beneficiary is receiving day
				services, day health services or respite services is also a factor in the
				application of this policy. The time of day services are received will be
				reviewed by the DAAS RN and/or Department of Human Services (DHS) audit staff
				and considered when determining any duplication in services for beneficiaries
				participating in the ARChoices Program.
Providers must consider the following to determine whether a
				home-delivered meal is billable for an individual receiving day services, day
				health services or facility-based respite services on a specific date of
				service.
If an ARChoices beneficiary is receiving day services, day
				health services or
facility-based
respite between the hours of
				11:00 a.m. and 1:30 p.m. and the noon meal is routinely served to others at the
				facility during this time frame, the noon meal must also be served to this
				individual. A home-delivered meal is not allowable on the same date of service.
				This is true
regardless of the total number of day services or respite
				units provided.
Adult day services and day health services providers are
				required to maintain a daily attendance log of beneficiaries. Section
				214.000 contains information
				regarding additional documentation requirements.
213.510 Adult Day Services Certification
			 Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of adult day services in Arkansas, a provider must be a
				person, corporation, partnership, association or organization licensed by the
				Arkansas Department of Human Services, Office of Long-Term Care as a long-term
				adult day care facility. Providers in the designated trade area cities in
				states that border Arkansas must be licensed and/or certified by the
				appropriate state agency as an Adult Day Care Facility.
In order to be certified by DAAS, Adult Day Services providers
				must meet the Home and Community-Based Services (HCBS) Settings rules found in
				section C of 201.105.
Adult Day Services providers must recertify with DAAS every
				three years; however, DAAS must maintain a copy of the agency's current Adult
				Day Care license at all times.
In order to be recertified by DAAS, Adult Day Services
				providers must meet the HCBS Settings rules found in section C of
				201.105.
Providers are required to submit copy of renewed license to
				DAAS.
NOTE: The Adult Day Services ElderChoices provider's
				certification will be valid as an ARChoices Adult Day Services provider under
				the ARChoices Waiver program. The provider will not be required to recertify
				until the expiration of the previous certification under
				ElderChoices.
213.600
			 Adult Day Health Services (ADHS)
Procedure Code
Required Modifier
Description
S5100
TD, U1
Adult Day Health Services, 8-20 Units Per Date of
						  Service
S5100
TD
Adult Day Health Services, 21-40 Units Per Date of
						  Service
Adult day health services facilities are licensed to provide a
				continuing, organized program of rehabilitative, therapeutic and supportive
				health services, social services and activities to beneficiaries who are
				functionally impaired and who, due to the severity of their functional
				impairment, are not capable of fully independent living.
Adult day health services programs provide rehabilitative and
				health services directed toward meeting the health restoration and maintenance
				needs of the beneficiary that cannot be provided by adult day care programs.
				Adult day health services are appropriate only for beneficiaries whose
				facility-developed care plans specify one or more of the following health
				services:
A. Rehabilitative therapies
			 (e.g., physical therapy, occupational therapy),
B. Pharmaceutical supervision,
C. Diagnostic evaluation or
D. Health monitoring
ARChoices beneficiaries may receive adult day health services
				for 8 or more units (2 or more hours) per day, not to exceed 40 units (10
				hours) per day when the service is provided according to the beneficiary's
				written ARChoices Person-Centered Service Plan (PCSP). Adult day health
				services of less than 8 units (2 hours) per day are not reimbursable by
				Medicaid. Adult day health services may be utilized up to 200 units (50 hours)
				per week, not to exceed 920 units (230 hours) per month.
Beneficiaries who are present in the facility for more than 20
				units (5 hours) a day (procedure code
S5100,
modifier
TD)
must be served a nutritious meal that equals one-third of the
				Recommended Daily Dietary Allowances. Therefore, ARChoices beneficiaries are
				not eligible to receive a home-delivered meal on the same day they receive more
				than five (5) hours of adult day health services. Additionally, beneficiaries
				who attend an adult day health services for more than 20 units (5 hours) are
				not eligible to receive Attendant Care services on the same date of service
				unless authorized by the Division of Aging and Adult Services Registered Nurse
				(DAAS RN).
Adult day health services providers are required by licensure
				to maintain a daily attendance log of beneficiaries. See Section
				214.000 for additional
				documentation requirements.
NOTE: As stated in this manual, home-delivered meals may
				not be provided on the same day for an individual who attends adult day
				services, adult day health services, or facility-based respite care for more
				than 20 units (5 hours). The time of day the beneficiary is receiving day
				services or respite services is also a factor in the application of this
				policy. The time of day services are received will be reviewed by the DAAS RN
				and/or Department of Human Services (DHS) audit staff and considered when
				determining any duplication in services for beneficiaries participating in the
				ARChoices Program.
Providers must consider the following to determine whether a
				home-delivered meal is billable for an individual receiving day services or
				facility-based respite services on a specific date of service.
If an ARChoices beneficiary is receiving day services or
				facility-based respite between the hours of 11:00 a.m. and 1:30 p.m. and the
				noon meal is routinely served to others at the facility during this time frame,
				the noon meal must also be served to the individual. A home-delivered meal is
				not allowable on the same date of service.
This is true regardless of the
				total number of day services or respite units provided.
213.610 Adult Day Health Services
			 (ADHS) Provider Certification Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of adult day health services in Arkansas, a provider must
				be a person, corporation, partnership, association or organization licensed by
				Arkansas Department of Human Services, Office of Long-term Care as a long-term
				adult day health care facility. Providers in the designated trade area cities
				in states that border Arkansas must be licensed and/or certified by the
				appropriate state agency as an Adult Day Health Care Facility.
In order to be certified by DAAS, Adult Day Health Services
				providers must meet the Home and Community-Based Services (HCBS) Settings rules
				found in section C of 201.105.
Adult Day Health Services providers must recertify with DAAS
				every three years; however, DAAS must maintain a copy of the agency's current
				Adult Day Health Care license at all times. In order to be recertified, Adult
				Day Health Services providers must meet the HCBS Settings rules found in
				section C of 201.105.
Providers are required to submit copy of renewed license to
				DAAS.
NOTE: Adult day services and adult day health services
				are not allowed on the same date of service.
NOTE: The Adult Day Health Services ElderChoices
				provider's certification will be valid as an ARChoices Adult Day Health
				Services provider under the ARChoices Waiver program. The provider will not be
				required to recertify until the expiration of the previous certification under
				ElderChoices.
213.700
			 Respite Care
Procedure Code
Description
T1005
Long-Term Facility-Based Respite Care
S5135
Short-Term Facility-Based Respite Care
S5150
In-Home Respite Care
Respite care services provide temporary relief to persons
				providing long-term care for beneficiaries in their homes. Respite care may be
				provided outside of the beneficiary's home to meet an emergency need or to
				schedule relief periods in accordance with the regular caregiver's need for
				temporary relief from continuous care giving.
If there is no
				primary caregiver, respite care services will not be deemed appropriate and
				subsequently will not be authorized on the Person-Centered Service Plan
				(PCSP)
.
In the event the in-home functional assessment performed by the
				Division of Aging and Adult Services Registered Nurse (DAAS RN) substantiates a
				need for respite care services, the service will be authorized as needed, via
				the beneficiary's PCSP, not to exceed an hourly maximum. The DAAS RN will
				establish the service limitation based on the beneficiary's medical need, other
				services included on the PCSP and support services available to the
				beneficiary. Respite care services must be provided according to the
				beneficiary's written PCSP.
An individual living in the home with the beneficiary is
				prohibited from serving as a Respite Services provider for the
				beneficiary.
213.711
			 Facility-Based Respite Care
Facility-based respite care may be provided outside the
				beneficiary's home on a short- or long-term basis by certified adult family
				homes, residential care facilities, nursing facilities, adult day care
				facilities, adult day health care facilities, Level I and Level II Assisted
				Living Facilities and hospitals.
Facility-based providers rendering services for eight (8) hours
				or less per date of service must bill
S5135
for short-term,
				facility-based respite care. One (1) unit of service for procedure code
S5135
equals 15 minutes. Eligible beneficiaries may receive up to
				32 units (8 hours) of short-term, facility-based respite care per date of
				service.
Facility-based providers rendering services for more than 32
				units (8 hours) per day must bill
T1005
for long-term,
				facility-based respite care. One (1) unit of service for procedure code
T1005
equals 15 minutes. A beneficiary may receive up to 96 units
				(24 hours) of service per date of service if the provider bills procedure code
T1005.
Facility-based respite care services include short-term and
				long-term respite care services and can include any combination of billing
				codes
S5135 orT1005.
A single provider may provide both long-term
				and short-term facility-based respite care services for a particular
				beneficiary, but not on the same date of service.
Eligible beneficiaries may receive up to 4800 units (1200
				hours) per State Fiscal Year of Facility-Based Respite Care- or In-Home Respite
				Care, or a combination of the two. Adult Family Home beneficiaries are limited
				to 2400 units (600 hours) of long-term facility-based respite per state fiscal
				year.
Beneficiaries receiving long-term, facility-based respite care
				services may receive only ARChoices Personal Emergency Response System (PERS)
				services concurrently.
Please refer to the NOTE found in Section
				213.500 regarding Home-Delivered
				Meals and facility-based respite services.
261.000
Introduction
to
			 Billing
Section III of this manual contains information about Provider
				Electronic Solutions (PES) and other available options for electronic claim
				submission.
ARChoices providers use the CMS-1500 form to bill the Arkansas
				Medicaid Program on paper for services provided to eligible Medicaid
				beneficiaries. Each claim may contain charges for only one
				beneficiary.
262.100
HCPCS
Procedure Codes
The following procedure codes must be billed for ARChoices
				Services. Electronic and paper claims now require the same National Place of
				Service code.
Procedure Code
Modifiers
Description
Unit of Service
National POS for Claims
S5140
Level A- U1 Level B - U2 Level C - U3
Adult Family Homes
1
day
99
S5125
Attendant Care Services
15 minutes
12
S5125
U2
Agency Attendant Care Traditional
15 minutes
12,99
S5170
U2
Home-Delivered Meals
1 meal
12
S5170
Frozen Home-Delivered Meal
1 meal
12
S5170
U1
Emergency Home Delivered Meals
1 meal
12
S5161
UA
Personal Emergency Response System
1 day
12
S5160
Personal Emergency Response System -Installation
One install
12
S5100
U1
Adult Day Services, 8 to 20 units per date of
						  service
15 minutes
99
S5100
Adult Day Services, 21 to 40 units per date of
						  service
15 minutes
99
S5100
TD.U1
Adult Day Health Services, 8 to 20 units per date of
						  service
15 minutes
99
S5100
TD
Adult Day Health Services, 21 to 40 units per date of
						  service
15 minutes
99
S5150
Respite Care - In-Home
15 minutes
12
S5135
Respite Care - Short-Term Facility-Based
15 minutes
99,21,32
T1005
Respite Care - Long-Term Facility-Based
15
minutes
21,32,99
262.400 Special Billing Procedures -
			 Environmental Modifications/Adaptive Equipment
Prior to payment for this service, the ARChoices beneficiary is
				required to secure three separate itemized bids for the same service. The bids
				are reviewed by the Division of Aging and Adult Services Registered Nurse (DAAS
				RN) or designee prior to submission for Medicaid payment. If only two bids can
				be secured due to a shortage of qualified providers in the service area,
				documentation attesting to the attempt to secure bids and the shortage of
				providers must be provided.
Each claim must be signed by the provider, the ARChoices
				beneficiary, and DAAS RN, or designee. A statement of satisfaction form must be
				signed by the ARChoices beneficiary prior to any claim being submitted. Please
				refer to 213.290 for additional information.