Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-024 - Changes to the following three Home and Community -Based Services waiver programs: ElderChoices, Alternatives for Adults with Physical Disabilities (AAPD) , and Living Choices Assisted Living (LCAL) waiver

Current through Register Vol. 49, No. 6, June, 2024
Section II
ElderChoices Home and
			 Community-Based 2176 Waiver
201.000
Arkansas Medicaid Certification Requirements for ElderChoices
H&CB Waiver Program
All ElderChoices home and community-based (H&CB) waiver
				providers must meet the Provider Participation and enrollment requirements
				contained within Section 140.000 of this manual as well as the following
				criteria to be eligible to participate in the Arkansas Medicaid Program:
ElderChoices H&CB Waiver providers must be certified by the
				Division of Aging and Adult Services (DAAS) as having met all Centers for
				Medicare and Medicaid Services (CMS) approved provider criteria for the
				service(s) they wish to enroll to provide.
Certification by the Division of Aging and Adult Services
				does not guarantee enrollment in the Medicaid program.
All providers must maintain their provider files at the HP
				Enterprise Services Provider Enrollment Unit by submitting current
				certification, licensure, etc.,
all DAAS-issued certification
				renewals and any other renewals affecting their status as a Medicaid-eligible
				provider
.
Copies of certifications and renewals required by DAAS must be
				maintained by DAAS to avoid loss of provider certification. These copies must
				be submitted to DAAS ElderChoices Provider Certification. View or print the
				Division of Aging and Adult Services ElderChoices Provider Certification
				contact information. Payment cannot be authorized for services provided beyond
				the certification period.
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 ElderChoices Waiver Plan of
				Care.
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 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 ElderChoices
			 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 are required to attend orientation
			 training prior to allowing the employee to deliver any ElderChoices Waiver
			 service(s). This orientation shall include, but not be limited to, a:
a. Description of the purpose and philosophy
			 of the ElderChoices 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 ElderChoices Waiver record keeping requirements;
e. Discussion of the importance of the Plan
			 of Care;
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.
B. Code of Ethics
The Provider agrees to follow and/or enforce for each employee
				providing services to an ElderChoices 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 individuals 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.
211.000
Scope
The Arkansas Medical Assistance (Medicaid) Program offers
				certain home and community-based outpatient services as an alternative to
				nursing home placement. These services are available to individuals aged 65
				years or older who require an intermediate level of care in a nursing facility.
				The community-based services offered through the ElderChoices Home and
				Community-Based 2176 Waiver, described herein as ElderChoices, are as
				follows:
A. Adult Family
			 Homes
B. Homemaker
			 Services
C. Chore
			 Services
D. Home-Delivered
			 Meals
E. Personal Emergency
			 Response System
F. Adult Day
			 Care
G. Adult Day Health
			 Care
H.  Respite Care
I. Adult Companion Services
These services are designed to maintain Medicaid eligible
				beneficiaries at home in order to preclude or postpone institutionalization of
				the individual.
In accordance with
				42 CFR
				441.301(b)(1)(ii)
				ElderChoices services may not be provided to inpatients of nursing facilities,
				hospitals or other inpatient institutions.
212.000
Eligibility for the
			 ElderChoices Program
A. To qualify for
			 the ElderChoices Program, an individual must meet the targeted population as
			 described in this manual, and must be found to require a nursing facility
			 intermediate level of care. Individuals determined to meet the skilled level of
			 care, as determined by the Office of Long Term Care, are not eligible for the
			 ElderChoices Program.
The beneficiary intake and assessment process for the
				ElderChoices Program includes a determination of categorical eligibility, a
				nursing facility level of care determination, the development of a Plan of Care
				and the beneficiary's notification of his or her choice between home and
				community-based services and institutional services.
B. Candidates 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 is based on non-medical and medical criteria.
			 Income and resources comprise the non-medical criteria. Medically, the
			 candidate must be an individual with a functional disability.
C. To be determined an individual with a
			 functional disability, 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. Medical assessment results in a
			 score of three or more on Cognitive Performance Scale; or
3. Medical assessments results in a Changes
			 in Health, End-Stage Disease and Symptoms and Signs (CHESS) score of three or
			 more.
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. Individuals diagnosed with
			 a serious mental illness or mental retardation are not eligible for the
			 ElderChoices program unless they have medical needs unrelated to the diagnosis
			 of mental illness or mental retardation and meet the other qualifying criteria.
			 A diagnosis of severe mental illness or mental retardation must not bar
			 eligibility for individuals having medical needs unrelated to the diagnosis of
			 serious mental illness or mental retardation when they meet the other
			 qualifying criteria.
F. Eligibility
			 for the ElderChoices waiver program is determined as the latter of the date of
			 application for the program or the date the plan of care is signed by the DAAS
			 RN and beneficiary. (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 ElderChoices waiver provides for the
			 entrance of all eligible persons on a first-come, first-served basis, once
			 individuals meet all medical and financial eligibility requirements.
However, the waiver dictates a maximum number of unduplicated
				participants who can be served in any waiver year. Once the maximum number of
				unduplicated participants 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 ElderChoices 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.
212.100
Reserved
212.200
Level of Care Determination
A prospective ElderChoices beneficiary must require a nursing
				facility intermediate level of care. Registered Nurses employed by the Division
				of Aging and Adult Services (DAAS RNs) perform a comprehensive assessment of
				each applicant to determine his or her personal assistance and health care
				needs. The assessment tool is ArPath, the electronic interRAI home care
				instrument, which evaluates the candidate's level of care need.
The intermediate level of care determination is made by medical
				staff with the Department of Human Services. Office of Long Term Care. The
				determination is based on the comprehensive assessment performed by the DAAS
				RN, using standard criteria for functional disability in evaluating an
				individual's need for nursing home placement in the absence of community
				alternatives. The level of care determination, in accordance with nursing home
				admission criteria, must be completed and the individual deemed eligible for an
				intermediate level of care by a licensed medical professional prior to
				receiving ElderChoices services.
The DAAS RN performs a comprehensive assessment periodically
				(at least annually), and the Office of Long Term Care re-determines level of
				care annually. The results of the level of care determination and the
				reevaluation are documented on form DHS-704, Decision for Nursing Home
				Placement.
NOTE: While federal guidelines require level of care
				reassessment at least annually, DAAS may reassess a beneficiary's level of care
				and/or need any time it is deemed appropriate by the DAAS RN to ensure that a
				beneficiary is appropriately placed in the ElderChoices program and is
				receiving services suitable to his or her needs.
212.300
Plan of Care
A. Each beneficiary in the ElderChoices
			 program must have an individualized ElderChoices
Plan of Care. The authority to develop an ElderChoices Plan of
				Care 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 ElderChoices Plan of Care developed with the ElderChoices
				beneficiary, representative, the participant's family, or anyone requested by
				the participant.
B. When
			 developing the waiver Plan of Care, 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 Plan of Care. 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 Plan of Care.
C.
			 The ElderChoices Plan of Care 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 ElderChoices waiver
			 eligibility;
2. Primary and
			 secondary diagnosis;
3. Contact
			 person;
4. Physician's name and
			 address;
5. The amount, frequency
			 and duration of ElderChoices waiver services to be provided, and the name of
			 the service provider chosen by the beneficiary or representative to provide the
			 services;
6. Other services outside
			 the ElderChoices services, regardless of payment source, identified and/or
			 ordered to meet the beneficiary's needs;
7. The election of community services by the
			 waiver beneficiary or representative; and,
8. The name and title of the DAAS RN
			 responsible for the development of the beneficiary's Plan of Care.
D. If waiver eligibility is
			 approved by the DHS county office, a copy of the Plan of Care 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 Plan of Care. The service provider and the ElderChoices
			 beneficiary must review and follow the signed authorized Plan of Care. Services
			 cannot begin until the Medicaid provider receives the authorized Plan of Care
			 from the DAAS RN. The original plan of care will be maintained by the DAAS RN.
The implementation of the Plan of Care 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 Plan of Care;
5. Provided within a system that safeguards
			 the beneficiary's rights to quality services as authorized on the waiver Plan
			 of care; and,
6. Documented
			 carefully, with assurance that required information is recorded and maintained.
NOTE: Each service included on the ElderChoices Plan of
				Care must be justified by the DAAS RN. This justification is based on medical
				necessity, the beneficiary's physical, mental and functional status, other
				support services
available to the beneficiary, and other factors deemed
				appropriate by the DAAS RN.
Each ElderChoices service must be provided according to the
				beneficiary Plan of Care. For services included in the waiver Plan of Care,
				Medicaid reimbursement is limited to the amount and frequency that is
				authorized in the Plan of Care. As detailed in the Medicaid Program provider
				contract, providers may bill only after services are provided.
REVISIONS TO A BENEFICIARY PLAN OF CARE MAY ONLY BE MADE
				BY THE DHS RN.
NOTE: All revisions to the Plan of Care must be
				authorized by the DAAS RN. A revised Plan of Care will be sent to each
				appropriate provider. Regardless of when services are provided, unless the
				provider and the service are authorized on an ElderChoices Plan of Care,
				services are considered non-covered and do not qualify for Medicaid
				reimbursement. Medicaid expenditures paid for services not authorized on the
				ElderChoices Plan of Care are subject to recoupment.
212.305
Targeted
			 Case Management Services (Non-Waiver Service)
Each ElderChoices Plan of Care will include Targeted Case
				Management, unless refused by the waiver beneficiary. The Targeted Case Manager
				is responsible for managing the ElderChoices Plan of care, monitoring the
				beneficiary's status on a regular basis for changes in their service need,
				referring the beneficiary for reassessment, if necessary, and reporting any
				beneficiary complaints and changes in status to the DAAS RN or Nurse Manager
				immediately upon learning of the change.
In addition to the monitoring performed by Targeted Case
				Managers, the DAAS RNs also monitor caseloads on an as-needed basis, as
				required through the Quality Management Strategies established for the waiver
				program.
212.310
Provisional Plan of Care
The ElderChoices registered nurse (DAAS RN) may develop a
				provisional Plan of Care prior to establishment of Medicaid eligibility, based
				on information obtained during the in-home medical assessment, when
				recommending medical approval based on the nursing home criteria. The DAAS RN
				must discuss the provisional Plan of Care policy and have the approval of the
				applicant prior to completing and processing the provisional Plan of Care. The
				Plan of Care 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 Plan of Care will include all current plan of
				care information, except for the waiver eligibility date and the Medicaid
				beneficiary ID number.
The provisional Plan of Care will be mailed to the waiver
				applicant and each provider included on the Plan of Care. 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 Plan of Care will expire 60 days
				from the date signed by the applicant and the DAAS RN.
A Plan of
				Care 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 Plan of
				Care.
A. A provisional Plan of Care
			 may be developed and sent to providers only when the assessment outcome
			 indicates medical 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 disability, as explained in Section 212.000,
			 Eligibility for the ElderChoices Program.
The waiver eligibility date will be established retroactively,
				effective on the day the provisional Plan of Care 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 Plan of Care
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 Plan of Care, 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 Plan of Care is signed
			 by the DAAS RN, the county office 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.
212.311
Denied Eligibility Application
A. If the DHS county office 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 DHS county office 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
			 ElderChoices 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 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 Plan of Care is
				signed by the DAAS RN, and the applicant or the applicant's representative,
				whichever is later.
212.312
Comprehensive Plan of Care
Prior to the expiration date of the provisional Plan of Care,
				the DAAS RN will mail the comprehensive Plan of Care to the waiver beneficiary
				and all providers included on the Plan of Care. The comprehensive Plan of Care
				will replace the provisional Plan of Care. The comprehensive Plan of Care will
				include the Medicaid beneficiary ID number, the waiver eligibility date
				established according to policy and the comprehensive Plan of Care expiration
				date.
The comprehensive Plan of Care expiration date will be 365 days
				from the date of the DAAS RN's signature on form AAS-9503, the ElderChoices
				Plan of Care. Once the application is either approved or denied by the DHS
				county office, the providers will be notified by the DAAS RN. The notification
				for the approval will be in writing via a Plan of Care 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.
212.313
ElderChoices Applicants Leaving
			 an Institution
The policy regarding retroactive eligibility applies to
				applicants entering the waiver program from the community and to applicants
				entering the program from an institution. The same process and the same policy
				determining the waiver eligibility date will apply to applications of each
				type.
EXCEPTION:
No waiver eligibility date may be
				established prior to an applicant's discharge date from an institution.
				Therefore, if a provisional Plan of Care is developed while an applicant is a
				resident of a nursing home or an inpatient in an institution, the earliest
				waiver eligibility date will be the day the applicant is discharged from the
				facility.
NOTE: For inpatients, if a waiver application is filed at
				the local DHS county office prior
to discharge AND if a provisional Plan of Care is
				developed by the DAAS RN prior to discharge, it may be possible to establish
				retroactive eligibility back to the date the applicant returned to his or her
				home if the applicant is ultimately found eligible for the
				program.
If no waiver application is filed and no medical
				assessment or provisional Plan of Care is completed by the DAAS RN prior to an
				applicant's discharge from an institution, retroactive eligibility will not be
				possible back to the date the applicant returned to his home.
Medical assessments and plans of care may be completed
				during a period of institutionalization; however, a discharge date must be
				scheduled. Since the purpose of the assessment and the Plan of Care is to
				depict the applicant's condition and needs in the home, premature assessments
				and plan of care development do not meet the intent of the
				program.
This policy applies to applicants leaving hospitals or nursing
				facilities.
212.314
Optional Participation
Neither waiver providers nor waiver applicants are required to
				begin or receive services prior to an eligibility determination by the Division
				of County Operations. When services are started based on the receipt of a
				provisional Plan of Care, it is the responsibility of each provider to explain
				the process and financial liability to the applicant and/or representative
prior to beginning services
. The decision to begin services prior
				to an eligibility determination must be a joint decision between the provider
				and the applicant, both of whom must understand the financial liability of the
				applicant if eligibility is not established.
NOTE: Regardless of the reason for the denial and
				regardless of when a new waiver application may be filed, a provisional Plan of
				Care will only be utilized on a current waiver application. Once an application
				is denied, a new provisional Plan of Care must be developed if a subsequent
				waiver application is filed.
212.320
Authorization Of The
			 ElderChoices Plan Of Care with Personal Care Services
The following applies to individuals receiving both personal
				care services and ElderChoices services.
A. The DAAS RN is responsible for developing
			 an ElderChoices plan of care that includes both waiver and non-waiver services.
			 Once developed, the plan of care is signed by the DAAS RN authorizing the
			 services.
B. The ElderChoices plan
			 of care signed by the DAAS RN will suffice as the "Personal Care Authorization"
			 for services required in the Personal Care Program. The personal care service
			 plan developed by the Personal care provider is still required.
The responsibility of developing a personal care service plan
				is not placed with the DAAS RN. The personal care provider is still required to
				complete a service plan, as described in the Arkansas Medicaid Personal Care
				Provider Manual.
NOTE: For ElderChoices participants who have chosen to
				receive their personal
care services through the IndependentChoices Program, the
				ElderChoices plan of care, signed by a DAAS RN, will serve as the authorization
				for personal care services for one year from the date of the DAAS RN's
				signature, as described above.
C. The ElderChoices Plan of Care is effective
			 for one year, once signed by the DAAS RN; the authorization for personal care
			 services, when included on the ElderChoices Plan of Care, will be for one year
			 from the date of the DAAS RN's signature, unless revised by the DAAS RN. If
			 personal care services continue unchanged as authorized on the ElderChoices
			 Plan of Care, a new service plan is not required at the 6-month interval.
212.321
Internal
			 Procedures
A. If personal care
			 services are not currently being provided when the DAAS RN develops the
			 ElderChoices Plan of Care, the DAAS RN will determine if personal care services
			 are needed. If so, the service, amount, frequency, duration and the
			 beneficiary's provider of choice will be included on the ElderChoices Plan of
			 Care. A copy of the Plan of Care and a start of care form (AAS-9510) will be
			 forwarded to the personal care provider, as is current practice for waiver
			 services. The start of care form must be returned to the DAAS RN within 10
			 working days from mailing, or action may be taken by the DAAS RN to secure
			 another personal care provider or to modify the ElderChoices Plan of Care. (The
			 ElderChoices Plan of Care is dated per the date it is mailed.) Before the DAAS
			 RN takes action to secure another provider or modify the Plan of Care, the
			 applicant and/or family members will be contacted to discuss possible
			 alternatives.
B. If the DAAS RN is
			 aware that personal care services are currently being provided when the
			 ElderChoices Plan of Care is developed, the DAAS RN will contact the personal
			 care provider to obtain information regarding the amount of personal care
			 services currently being provided. It is the personal care provider's
			 responsibility to provide this information to the DAAS RN immediately upon
			 receipt of the request. If this information is not received within five working
			 days of the request, the DAAS RN will take necessary steps to submit the
			 ElderChoices Plan of Care, as developed by the DAAS RN. The DAAS RN will not
			 alter the current number of personal care units unless a waiver Plan of Care
			 cannot be developed without duplicating services or a change in services is
			 necessary in order to establish eligibility. If personal care units must be
			 altered, the DAAS RN will contact the personal care provider to discuss
			 available alternatives prior to making any revisions. The ElderChoices Plan of
			 Care and the required justification for each service remain the responsibility
			 of the DAAS RN. Therefore, final decisions regarding services included on the
			 ElderChoices Plan of Care rest with the DAAS RN.
NOTE: It is the personal care provider's responsibility
				to place information
regarding the agency's presence in the home in a
				prominent location so that the DAAS RN will be aware that the provider is
				serving the beneficiary. Preferably, the provider will place the information
				atop the refrigerator or under the phone the beneficiary uses, unless the
				beneficiary objects. If so, the provider will place the information in a
				location satisfactory to the beneficiary, as long as it is readily available to
				and easily accessible by the DAAS RN.
212.322
Revisions when the Plan Of Care
			 Contains Personal Care Services
Requested changes to the personal care services included on the
				ElderChoices Plan of Care 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 ElderChoices Plan of Care is responsible
				for securing any required signatures authorizing the change prior to the
				ElderChoices Plan of Care being revised. The DAAS RN will obtain electronic
				signatures for dates of service on or after January 1, 2013.
If revised by the DAAS RN, a copy of the revised ElderChoices
				Plan of Care 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 ElderChoices Plan of Care will be revised
				accordingly within 10 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, as stated above, rests with the DAAS RN.
212.323
Medicaid Audit
			 Requirements
When the Medicaid Program, as authorized by the ElderChoices
				Plan of Care, reimburses for personal care services, all Medicaid audits will
				be performed based on that authorization. Therefore, all documentation by the
				personal care provider must tie services rendered to authorized services as
				reflected on the ElderChoices Plan of Care.
212.400
Temporary Absences from the
			 Home
Once an ElderChoices eligibility application has been approved,
				waiver services must be provided in the home for eligibility to continue.
				Unless stated otherwise below, the county Department of Human Services (DHS)
				office must be notified immediately by the DAAS RN when waiver services are
				discontinued, and action will be initiated by the DHS county office 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 ElderChoices 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 DHS county office 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 DHS county office and action will be
			 initiated by the DHS county office 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 ElderChoices 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 ElderChoices 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
				ElderChoices services were provided before the beneficiary was admitted to the
				inpatient facility, then payments will be subject to recoupment. ElderChoices
				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 DHS county office 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 prescribed by the Plan of Care (e.g., the beneficiary has left the
				state and the return date is unknown), the DAAS RN will notify the county
				office. Action will be taken by the county office 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.
212.410
Reserved
212.420
Reserved
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 DAAS RN, Targeted Case Manager, or DHS
				county office. 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 DHS county
				office, providers must immediately report all changes in the beneficiary's
				status to the DAAS RN.
The TCM 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 Nurse Manager, immediately upon learning of the
				change.
212.600
Relatives Providing ElderChoices Services
All ElderChoices services, except for Adult Family Homes, may
				be provided by a beneficiary's relative, unless stated otherwise in this
				manual. No Adult Family Home provider, employee, or family member of the
				provider may be related to the AFH waiver beneficiary.
For the purposes of this section, a relative or family member
				shall be defined as all persons related to the beneficiary by virtue of blood,
				marriage, or adoption. The following is applicable for all waiver
				services:
Under no circumstances may Medicaid payment be made for any
				waiver service rendered by the waiver beneficiary's:
1. Spouse
2. Legal guardian of the person
3. Attorney-in-fact granted authority to
			 direct the beneficiary's care
All providers, including relatives, are required to meet all
				ElderChoices provider certification requirements, Arkansas Medicaid enrollment
				requirements, and provider services according to the beneficiary's plan of care
				and any established benefit limits for that specific service.
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., homemaker, chore, attendant care, companion, 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 AFH
				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 ElderChoices services.
Adult Family Home services shall be included in the plan of
				care only when it is necessary to prevent the permanent institutionalization of
				a beneficiary as determined by the 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 ElderChoices plan of care.
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 ElderChoices 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 ElderChoices waiver, ElderChoices 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, and Medicaid will cover the 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 recipients in
				long term care facilities.
The Adult Family Home waiver beneficiary may receive up to
				2,400 units (600 hours) 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 ELDERCHOICES SERVICE, EXCEPT FOR LONG-TERM
				FACILITY-BASED RESPITE.
213.110
Adult Family Homes
			 Certification Requirements
Enrollment as an ElderChoices Adult Family Homes provider
				requires certification by the Department of Human Services, Division of Aging
				and Adult Services (DAAS), as an Adult Family Home. Providers must recertify
				with DAAS annually.
An Adult Family Home, for the purpose of the ElderChoices
				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.
213.210
Homemaker Services
Procedure Code
Description
S5130
Homemaker Services
In-home 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.
Homemaker services provide basic upkeep and management of the
				home and household assistance, such as:
A. Menu planning,
B. Meal preparation,
C. Laundry,
D. Essential shopping and errands
			 and
E. Simple household tasks.
Simple household tasks may include, but are not limited to,
				washing windows, cleaning ceiling fans and light fixtures, cleaning the
				refrigerator and washing inside walls.
Medically oriented personal care tasks are not included as a
				part of this service.
Homemaker services must be provided according to the
				beneficiary ElderChoices written plan of care.
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.
One (1) unit of service equals 15 minutes. Homemaker services
				are limited to a maximum of 4 hours (16 units) per day, not to exceed an
				overall benefit limit of 172 units per month.
An ElderChoices beneficiary who spends more than five (5)
				hours at an adult day care or adult day health care facility or who is
				receiving short-term, facility-based respite care will not be eligible for
				homemaker services on the same date of service unless authorized by the DAAS
				RN.
An ElderChoices beneficiary receiving long-term,
				facility-based respite care is not eligible for homemaker services on the same
				date of service.
213.220
Chore Services
Procedure Code
Description
S5120
Chore Services
Chore services provide heavy cleaning and/or yard and sidewalk
				maintenance only in extreme, specific and individual circumstances
when lack of these services would make the home
				uninhabitable
.
Chore services do not include small outside painting jobs,
				routine lawn mowing or trimming, raking or mulching of leaves for aesthetic
				purposes.
Chore services must be provided according to the beneficiary's
				written ElderChoices plan of care.
When justified and included on the plan of care by the DAAS RN,
				the chore service must be specific, naming the chore authorized and the
				estimated amount of time for completion.
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. Family members of the beneficiary may not be
				reimbursed by Medicaid for chore services. Section
				214.000 contains information
				regarding additional documentation requirements.
One (1) unit of service equals 15 minutes. Chore services are
				limited to a maximum of 80 units (20 hours) per month.
An ElderChoices beneficiary who spends more than five (5)
				hours at an adult day care or adult day health care facility or who is
				receiving short-term, facility-based respite care will not be eligible for
				chore services on the same date of service unless authorized by the DAAS
				RN.
An ElderChoices beneficiary receiving long-term,
				facility-based respite care is not eligible for chore services on the same date
				of service.
An individual living in the home with the beneficiary is
				prohibited from serving as a Chore Services provider for the
				beneficiary.
213.230
Homemaker and/or Chore Certification Requirements
The following requirements must be met prior to certification
				by the Division of Aging and Adult Services (DAAS) by providers of homemaker
				and/or chore services. The provider must:
A. Hold a current Arkansas State Board of
			 Health Class A and/or Class B license,
or
Be a private or public incorporated entity whose stated purpose
				is to provide homemaker and/or chore services and
B. Employ and supervise direct care staff
			 who:
1. Prior to providing an ElderChoices
			 service, have received instruction regarding the general needs of the
			 elderly;
2. Possess the necessary
			 skills to perform the specific services required to meet the needs of the
			 beneficiary the direct care staff member is to serve and
3. Are placed under bond by the provider or
			 are covered by the professional medical liability insurance of the provider.
Each provider must maintain adequate documentation to support
				that direct care staff meet the training and, as applicable, testing
				requirements according to licensure, agency policy and DAAS
				certification.
Homemaker and/or Chore providers who hold a current Arkansas
				State Board of Health Class A and/or Class B license must recertify with DAAS
				every three years; however, DAAS must maintain a copy of the agency's current
				Home Health license at all times.
Homemaker and/or Chore providers who are a private or public
				incorporated entity whose stated purpose is to provide homemaker and/or chore
				services must recertify with DAAS annually.
213.310
Hot Home-Delivered
			 Meals
Hot Home-Delivered Meals provide one meal per day with a
				nutritional content equal to 33 1/3 percent of the Dietary Reference Intakes
				established by the Food and Nutrition Board of the National Academy of
				Sciences. The meals must comply with the Dietary Guidelines for Americans and
				with the DAAS Nutrition Services Program Policy Number 206.
Hot Home-Delivered Meal services provide one daily nutritious
				meal to eligible beneficiaries who are homebound. Homebound is defined as a
				person with normal inability to leave home without assistance (physical or
				mental) from another person; a person who is frail, homebound by reason of
				illness or incapacitating disability or otherwise isolated; or for whom leaving
				home requires considerable and taxing effort by the individual and absences
				from the home are infrequent, relatively short in duration or are attributable
				to the need to receive medical treatment.
Additionally, the beneficiary must:
A. Be unable to prepare some or all of his or
			 her own meals, and
B. Have no other
			 individual to prepare his or her own meals, and
C. Have the provision of the Home-Delivered
			 Meals included on his or her plan of care
The provision of a Home-Delivered Meal is the most
				cost-effective method of ensuring a nutritiously adequate meal.
The Home-Delivered Meals provider must maintain a log sheet
				signed by the beneficiary each time a meal is delivered to document receipt of
				the meal.
Hot Home-Delivered Meals must be provided according to the
				beneficiary's written ElderChoices plan of care.
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 plan of care.
				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.
F. The provider must contact the individual
			 either in person or by phone daily, Monday through Friday, to ensure the
			 individual's safety and well being. This is not required for individuals
			 receiving only the weekend Frozen Home-Delivered Meals service.
NOTE: This requirement DOES NOT apply to those
				ElderChoices beneficiaries
whose ElderChoices plan of care includes homemaker
				services or personal care services at least three (3) times per
				week.
Home-Delivered Meals, hot or frozen, shall be included in the
				beneficiary's plan of care 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.
213.320
Frozen Home-Delivered Meals
Frozen Home-Delivered Meals service provides one meal per day
				with a nutritional content equal to 33 1/3 percent of the Dietary Reference
				Intakes established by the Food and Nutrition Board of the National Academy of
				Sciences. The meals must comply with the Dietary Guidelines for Americans and
				with DAAS Nutrition Services Program Policy Number 206.
The goal of the Frozen Home-Delivered Meals service is to
				supplement, not replace, the Hot Home-Delivered Meal service by providing one
				daily nutritious meal to homebound persons at risk of being institutionalized
				who:
A. Reside in remote areas where
			 daily hot meals are not available,
B. Choose to receive a frozen meal rather
			 than a hot meal or
C. Are at
			 nutritional risk and are certified to receive a meal for use on weekends or
			 holidays when the hot meal provider is not in operation.
NOTE: While the individual has freedom of choice
				regarding this service, it is the responsibility of the DAAS RN developing the
				plan of care to ensure the appropriateness of the service. A hot meal delivered
				daily remains the food service of choice, when available. Therefore, a frozen
				meal must be approved by the DAAS RN. The service must be included on the plan
				of care. If the individual responsible for developing the plan of care does not
				think the frozen meals are appropriate for the individual, other options will
				be considered. Those options include removing the Home-Delivered Meal service
				rather than authorizing a frozen meal.
It is the certified provider's responsibility to deliver
				the meals regardless if they are hot or frozen. The meals cannot be mailed to
				the individual via United States Postal Service or delivered by paid carrier
				such as Fed Ex or UPS.
213.321
Beneficiary Requirements for
			 Frozen Home-Delivered Meals
The beneficiary must:
A. Be homebound, which is defined by the
			 following requirements:
1. The person is
			 normally unable to leave home without assistance (physical or mental) from
			 another person,
2. The person is
			 frail, homebound by reason of illness or incapacitating disability or otherwise
			 isolated,
3. Leaving home requires
			 considerable and taxing effort by the individual and
4. Absences of the individual from home are
			 infrequent, of relatively short duration or attributable to the need to receive
			 medical treatment.
B. Be
			 unable to prepare some or all of his or her meals or require a special diet and
			 be unable to prepare it.
C. Have no
			 other individual available to prepare his or her meals, and the provision of a
			 Frozen Home-Delivered Meal is the most cost-effective method of ensuring a
			 nutritionally adequate meal.
D.
			 Have adequate and appropriate storage and be able to perform the simple tasks
			 associated with storing and heating a Frozen Home-Delivered Meal or have made
			 other appropriate arrangements approved by DAAS.
E. Have the provision of frozen meals
			 included on his or her plan of care, as developed by the appropriate DAAS RN.
Frozen Home-Delivered Meals must be documented on the
				ElderChoices plan of care by the DAAS RN, and must be provided in accordance
				with the beneficiary's written ElderChoices plan of care.
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 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 ElderChoices 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 senior beneficiary and
9. Are discarded after 30 days.
H. Verify quarterly that all
			 individuals 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 plan of care.
				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.
J. Contact individuals either in person or by
			 phone daily, Monday through Friday, to ensure the individual's safety and well
			 being. This is not required for individuals receiving only the weekend Frozen
			 Home-Delivered Meals service.
NOTE: This requirement DOES NOT apply to those
				ElderChoices beneficiaries whose ElderChoices plan of care includes Homemaker
				services and/or Personal Care services at least three (3) times per
				week.
Home-Delivered Meals, hot or frozen, shall be included in the
				beneficiary's plan of care 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.
213.330
Limitations on Home-Delivered
			 Meals
One unit of service equals one meal. The maximum number of
				Home-Delivered Meals 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 SFY is four (4). This
				includes hot, frozen or a combination of the two. There is no separate benefit
				limit for frozen emergency meals.
Frozen Home-Delivered Meals may be provided daily to eligible
				beneficiaries. A maximum of seven (7) meals may be delivered at one
				time.
Home-Delivered Meal providers may deliver more than seven meals
				at one time, if:
A. The waiver
			 beneficiary receives Homemaker, Respite or Personal Care at least three (3)
times per week,
B. Frozen Home-Delivered Meals are ordered on
			 the plan of care,
C. The waiver
			 beneficiary has the means of storing 14 frozen meals (as verified by the DAAS
			 RN).
Home-Delivered Meal providers delivering frozen meals may
				deliver 14 at one time if the DHS RN enters 14 meals delivery approved in the
				comments section of the HDM entry on the plan of care. If this statement is not
				on the plan of care, 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 ElderChoices individual may not be provided with a Hot or
				Frozen Home-Delivered Meal 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 Care or Adult Day Health Care. (Licensure mandates that
				providers of these services provide a meal or meals; therefore, a
				Home-Delivered Meal on these dates is a duplicative service and prohibited
				under waiver guidelines.)
NOTE: Medicaid reimbursement for Home-Delivered Meals is
				not allowed on the same day to individuals who are also attending Adult Day
				Care, Adult Day Health Care, or facility-based Respite care for more than five
				(5) hours. When applying this policy, the time of day the beneficiary receives
				day care or respite services is 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 Home-Delivered Meal is billable for
				an individual receiving day care, or facility-based Respite services, on a
				specific date of service, the following must be applied:
If an ElderChoices beneficiary is receiving day care 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 Home-Delivered meal is not allowable on the same date of service.
				This is true
regardless of the total number of day care or Respite hours
				provided.
213.340
Combination of Hot and Frozen
			 Home-Delivered Meals
In instances where the ElderChoices beneficiary wishes to
				receive a combination of hot and frozen meals, the DAAS RN shall evaluate the
				beneficiary's situation based on the criteria set forth in Section 213.320,
				Frozen Home-Delivered Meals. If the criteria are met, the DAAS RN may prescribe
				on the plan of care a combination of hot and frozen meals to be
				delivered.
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 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
D.
			 Be replaced by the provider after the beneficiary has been instructed to use it
			 to ensure that participants consistently have emergency meals on
			 hand.
213.400
Personal Emergency Response System
Procedure Code
Required Modifier
Description
S5161
UA
PERS Unit
S5160
-
PERS Installation
The Personal Emergency Response System (PERS) is an in-home,
				24-hour electric support system with two-way verbal and electronic
				communication with an emergency control center. PERS enables an elderly, infirm
				or homebound individual to secure immediate help in the event of a physical,
				emotional or environmental emergency.
PERS is specifically designed for
high-risk
				individuals
whose needs have been carefully determined based on
				their level of medical vulnerability, functional impairment and social
				isolation.
PERS is not intended to be a universal
				benefit
. The DAAS RN must verify that the individual is capable,
				both physically and mentally, of operating the PERS unit.
PERS must be included in the beneficiary's written ElderChoices
				plan of care.
PERS providers must contact each beneficiary at least once per
				month to test the system's operation. The provider shall maintain a log of test
				calls that includes the date and time of the test, specific test results,
				corrective actions and outcomes.
A log of all beneficiary calls received must be maintained by
				the emergency response center. The log must reflect the date, time and nature
				of the call and the response initiated by the center. All calls must be
				documented in the beneficiary's record. See Section
				214.000 for other documentation
				requirements.
One (1) unit of service equals one (1) day. PERS is limited to
				a maximum of thirty-one (31) units per month.
The installation of PERS will be allowed once per lifetime or
				period of eligibility. Claims submitted for the installation of PERS should use
				procedure code
S5160
. Procedure code
S5160
may be
				billed for ElderChoices beneficiaries who are accessing PERS services for their
				first time or for the current period of re-eligibility for ElderChoices Waiver
				Services. In the event of extenuating circumstances that result in the need for
				reinstallation, the provider may contact the Division of Aging and Adult
				Services for extension of the benefit.
View or print Division of Aging and Adult Services contact
				information.
213.410
Personal Emergency Response System 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
			 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 individuals who also provide instruction and training to
			 beneficiaries.
213.500
Adult Day Care
Procedure Code
Required Modifier
Description
S5100
U1
Adult Day Care, 4-5 Hours Per Date of Service
S5100
-
Adult Day Care, 6-8 Hours Per Date of Service
Adult day care 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
				ElderChoices plan of care, ElderChoices beneficiaries may receive adult day
				care services for four (4) or more hours per day, not to exceed eight (8) hours
				per day, when the services are prescribed by the beneficiary's attending
				physician and provided according to the beneficiary's written plan of care.
				Adult day care services of less than four (4) hours per day are not
				reimbursable by Medicaid. Adult day care may be utilized up to forty (40) hours
				per week, not to exceed one hundred eighty-four (184) hours per month. One (1)
				unit of service equals fifteen (15) minutes.
As required, beneficiaries who are present in the facility for
				more than five (5) hours a day (procedure code
S5100
) must be
				served a nutritious meal that equals one-third of the Recommended Daily
				Allowance. Therefore, ElderChoices beneficiaries are not eligible to receive a
				home-delivered meal on the same day they receive more than five (5) hours of
				adult day care. Additionally, beneficiaries who attend an adult day care for
				more than five (5) hours are not eligible to receive homemaker or chore
				services on the same date of service unless authorized by the 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 care,
				adult day health care, or facility-based respite care for more than 5 hours.
				The time of day the beneficiary is receiving day care 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 DHS audit staff and considered
				when determining any duplication in services for individuals participating in
				the ElderChoices Program.
Providers must consider the following to determine whether a
				home-delivered meal is billable for an individual receiving day care or
				facility-based respite services on a specific date of service.
If an ElderChoices beneficiary is receiving day care 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 care or respite hours
				provided
.
Adult day care providers are required to maintain a daily
				attendance log of beneficiaries. Section
				214.000 contains information
				regarding additional documentation requirements.
213.510
Adult Day Care Certification
			 Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of adult day care 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.
Adult Day Care 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.
213.600
Adult Day Health Care
			 (ADHC)
Procedure Code
Required Modifier
Description
S5100
TD, U1
Adult Day Health Care, 4-5 Hours Per Date of
						  Service
S5100
TD
Adult Day Health Care, 6-8 Hours Per Date of
						  Service
Adult day health care facilities are licensed to provide a
				continuing, organized program of rehabilitative, therapeutic and supportive
				health services, social services and activities to individuals who are
				functionally impaired and who, due to the severity of their functional
				impairment, are not capable of fully independent living.
Adult day health care 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 care is appropriate only for individuals 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.
ElderChoices beneficiaries may receive adult day health care
				services for four (4) or more hours per day, not to exceed eight (8) hours per
				day when the service is provided according to the beneficiary's written
				ElderChoices plan of care. Adult day health care services of less than four (4)
				hours per day are not reimbursable by Medicaid. Adult day health care may be
				utilized up to forty (40) hours (160 units) per week, not to exceed one hundred
				eighty-four (184) hours (736 units) per month.
Beneficiaries who are present in the facility for more than
				five (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, ElderChoices
				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 care. Additionally,
				beneficiaries who attend an adult day health care for more than five (5) hours
				are not eligible to receive homemaker or chore services on the same date of
				service unless authorized by the DAAS RN.
Adult day health care providers are required by licensure to
				maintain a daily attendance log of participants. 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 care,
				adult day health care, or facility-based respite care for more than 5 hours.
				The time of day the beneficiary is receiving day care 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 DHS audit staff and considered when determining
				any duplication in services for individuals participating in the ElderChoices
				Program.
Providers must consider the following to determine whether a
				home-delivered meal is billable for an individual receiving day care or
				facility-based respite services on a specific date of service.
If an ElderChoices beneficiary is receiving day care 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 care or respite hours provided.
213.610
Adult Day Health
			 Care Provider Certification Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of adult day health care 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.
Adult Day Health Care 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.
NOTE: Adult day care and adult day health care are not
				allowed on the same date of service.
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 prescribed by the beneficiary's
				physician
.
In the event the in-home medical assessment performed by the
				DAAS RN substantiates a need for respite care services, the service will be
				prescribed as needed, via the beneficiary's plan of care, 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 plan of care and
				support services available to the beneficiary. Respite care services must be
				provided according to the beneficiary's written plan of care.
An individual living in the home with the beneficiary is
				prohibited from serving as a Respite Services provider for the
				beneficiary.
213.710
In-Home Respite Care
In-home respite care may be provided by licensed personal care
				or home health agencies and certified homemaker agencies. Reimbursement will be
				made for direct care rendered according to the beneficiary's plan of care by
				trained respite workers employed and supervised by certified in-home respite
				providers.
Providers rendering respite care services in the beneficiary's
				home must bill procedure code
S5150
. One (1) unit of service for
				procedure code
S5150
equals 15 minutes. Eligible beneficiaries may
				receive up to 96 units of
in-home respite care
per
				date of service. For the state fiscal year (SFY), July 1 through June 30 each
				year, eligible beneficiaries may receive up to 4800 units (1200 hours) of
				In-Home Respite Care, Facility-Based Respite Care, Adult Companion Service or a
				combination of the three services.
When respite care is provided, the provision of or payment for
				other duplicate services under the waiver is prohibited. When a respite care
				provider is in the home to provide respite care services, the provider is
				responsible for all other in-home ElderChoices services included on the
				beneficiary's plan of care. For example, if homemaker, chore and/or
				home-delivered meals or meal preparation are included on the plan of care, the
				respite provider must provide these services while in the home. No other
				ElderChoices service, other than PERS, may be reimbursed for
the
				same time period
.
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 licensed adult foster care
				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 of short-term, facility-based respite care per date of service.
Facility-based providers rendering services for more than 8
				hours/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 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
or
T1005
. A single provider may provide
				both long-term and short-term facility-based respite care services for a
				particular beneficiary.
Eligible participants may receive up to 4800 units (1200 hours)
				per SFY of Facility-Based Respite Care, In-Home Respite Care, Adult Companion
				Services or a combination of the three. Adult Family Home beneficiaries are
				limited to 2,400 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 ElderChoices PERS services concurrently.
Please refer to the NOTE found in Section
				213.500 regarding Home-Delivered
				Meals and facility-based respite services.
213.712
In-Home Respite Care
			 Certification Requirements
To be certified by the Division of Aging and Adult Services
				(DAAS) as a provider of
in-home respite care
services,
				a provider must:
A. Hold a current
			 Class A and/or Class B license to provide personal care and/or home health
			 services as issued by the state licensing authority; or
B. Hold a current DAAS Homemaker
			 certification; and
C. Employ and
			 supervise direct care staff trained and qualified to provide respite care
			 services and
D. Agree to the
			 minimum Assurances of Providers of ElderChoices Waiver Services.
In-Home Respite Care providers as described in A. above must
				recertify with DAAS every three years; however, DAAS must maintain a copy of
				the agency's current Home Health license at all times. In-Home Respite Care
				providers as described in B. above must recertify with DAAS annually.
213.713
Facility-Based Respite Care Certification Requirements
To be certified by the Division of Aging and Adult Services as
				a provider of
facility-based respite care
services, a
				provider must be licensed in their state as one or more of the
				following:
A. A certified adult family
			 home
B. A licensed adult day care
			 facility
C. A licensed adult day
			 health care facility
D. A licensed
			 nursing facility
E. A licensed
			 residential care facility
F. A
			 licensed Level I or Level II Assisted Living Facility
G. A licensed hospital
Facility-Based Respite Care providers as listed above, with the
				exception of a certified adult family home, must recertify with DAAS every
				three years; however, DAAS must maintain a current copy of the facility's
				current license at all times.
A certified and Medicaid enrolled adult family home which is
				also certified by DAAS to provide facility-based respite services must
				recertify with DAAS annually.
213.800
Adult Companion Services
Procedure Code
Required Modifier
Description
S5135
U1
Adult Companion Services
Adult companion services include non-medical care, supervision
				and socialization services provided to a functionally impaired adult.
				Companions may assist or supervise the individual with such tasks as meal
				preparation, laundry and shopping, but do not perform these activities as
				discrete services. The provision of companion services does not entail hands-on
				nursing care. Providers may also perform light housekeeping tasks which are
				incidental to the care and supervision of the individual. This service is
				provided in accordance with a therapeutic goal in the plan of care, and is not
				diversionary in nature. When required and in accordance with a therapeutic goal
				in the plan of care, a companion who meets state standards for providing
				assistance with bathing, eating, dressing and personal hygiene may provide
				these services when they are essential to the health and welfare of the
				individual and in the absence of the individual's family. Companion services
				must be furnished outside the timeframe of other waiver services and state plan
				personal care. An individual receiving Adult Family Homes services cannot
				receive waiver adult companion services or any other waiver services, with the
				exception of Long-Term Facility-Based Respite services.
Services must be provided according to the beneficiary's
				written ElderChoices plan of care.
Providers of Adult Companion Services must bill procedure code
S5135 and the required modifier U1
. One (1) unit of service for
				procedure code
S5135
equals 15 minutes. Eligible beneficiaries may
				receive up to 4800 units (1200 hours) per SFY of Adult Companion Services,
				In-Home Respite, Facility Based Respite Care or any combination of the
				three.
213.810
Adult
			 Companion Services Certification Requirements
Providers who hold a current Class A or Class B Home Health
				Agency license from the Arkansas Department of Health and are certified by the
				Arkansas Department of Human Services, Division of Aging and Adult Services
				(DAAS) as an ElderChoices waiver provider of Adult Companion Services may apply
				to enroll as a Medicaid Adult Companion Services provider. To be certified,
				providers must provide a copy of their current class A or Class B Home Health
				Agency license through the Arkansas Department of Health.
Private Care agencies licensed by the Arkansas Department of
				Health as a Private Care Agency-Medicaid Personal Care and certified by the
				Arkansas Department of Human Services, Division of Aging and Adult Services as
				an ElderChoices waiver provider of Adult Companion Services may apply to enroll
				as a Medicaid Adult Companion Services provider. To be certified, providers
				must provide a copy of their current private care agency-Medicaid personal care
				license through the Arkansas Department of Health.
Adult Companion Services providers must recertify with DAAS
				every three years; however, DAAS must maintain a copy of the agency's current
				Home Health Agency license or Private Care - Medicaid Personal Care license at
				all times.
214.000
Documentation
In addition to the service-specific documentation requirements
				previously listed, ElderChoices providers must develop and maintain sufficient
				written documentation to support each service for which billing is made. This
				documentation, at a minimum, must consist of:
A. A copy of the beneficiary's plan of
			 care
B. A brief description of the
			 specific service(s) provided
C. The
			 signature and title of the individual rendering the service(s)
D. The date and actual time the service(s)
			 was rendered
If more than one category of service is provided on the same
				date of service, such as homemaker, personal care, and respite care, the
				documentation must specifically delineate items A through D above for each
				service billed. For audit purposes, the auditor must readily be able to discern
				which service was billed in a particular time period based upon supporting
				documentation for that particular billing.
A provider's failure to maintain sufficient documentation to
				support his or her billing practices may result in recoupment of Medicaid
				payment.
No documentation for ElderChoices services, as with all
				Medicaid services, may be made in pencil.
215.000
ElderChoices Forms
ElderChoices providers are required to utilize all program
				forms as appropriate and as instructed by the Division of Medical Services and
				the Division of Aging and Adult Services. These forms include but are not
				limited to:
A. Plan of Care -
			 AAS-9503
B. Start Services -
			 AAS-9510
C. Beneficiary Change of
			 Status - AAS-9511
Providers may request form AAS-9511 by writing to the Division
				of Aging and Adult Services.
View or print the Division of Aging and Adult Services contact
				information.
Forms AAS-9503 and AAS-9510 will be mailed to the provider by
				the DAAS RN.
Instructions for completion and retention are included with
				each form. If there are questions regarding any ElderChoices form, providers
				may contact the DAAS RN in your area.