Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-081 - ElderChoices Update Transmittal #59

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
ElderChoices Home and Community-Based 2176 Waiver
212.000
Eligibility Assessment
The client in-take and assessment process for the ElderChoices
				Program includes a determination of categorical eligibility, a level of care
				determination, the development of a plan of care and the client's notification
				of his or her choice between home and community-based services and
				institutional services. Costs effectiveness of the waiver program is determined
				annually in the aggregate and submitted to the Center for Medicare and Medicaid
				Services (CMS).
212.100
Financial Eligibility Determination
Financial eligibility for the Arkansas Medicaid Program must be
				verified as part of the client intake and assessment process for admission into
				the ElderChoices Program. Medicaid eligibility is determined by the DHHS county
				office located in the client's county of residence.
212.200
Level of Care Determination
The intermediate level of care determination is performed by
				medical staff assigned to the Department of Health and Human Services (DHHS)
				Utilization Review Team with the Office of Long Term Care. The intermediate
				level of care criteria provides an objective and consistent method for
				evaluating the need for nursing home placement in the absence of community
				alternatives. The level of care determination, in accordance to 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.
Reevaluations will be performed annually by the Department of
				Health and Human Services medical team to determine the client's continuing
				need for an intermediate level of care. The results of the level of care
				determination and the reevaluation are documented on form DHHS-704.
212.300
Plan of Care
Each client eligible for ElderChoices must have an
				individualized plan of care. The authority to develop an ElderChoices plan of
				care is given to the Medicaid State Agency's designee, the Department of Health
				and Human Services Registered Nurse (DHHS RN). The ElderChoices plan of care
				developed by the DHHS RN supersedes all other plans of care developed for an
				ElderChoices client. The information in the plan of care must include:
A. Client identification information,
			 including full name and address, date of birth, Medicaid number and effective
			 date of ElderChoices waiver eligibility;
B. The medical and other services to be
			 provided, their frequency and duration and the name of the service provider
			 chosen by the client to provide each service;
C. The election of community services by the
			 waiver participant and
D. The name
			 and title of the DHHS RN responsible for the development of the client's plan
			 of care.
A copy of the plan of care signed by the DHHS RN and the waiver
				participant will be forwarded to the ElderChoices service provider(s) chosen by
				the client, family member, or DHHS RN, according to policy. Each provider is
				responsible for developing an implementation plan in accordance with the
				client's plan of care. The original plan of care will be maintained by the DHHS
				RN.
The implementation plan must be designed to ensure that
				services are:
A.
			 Individualized to the client's unique circumstances;
B. Provided in the least restrictive
			 environment possible;
C. Developed
			 within a process ensuring participation of those concerned with the client's
			 welfare;
D. Monitored and adjusted
			 to reflect changes in the client's need;
E. Provided within a system that safeguards
			 the client's rights and
F.
			 Documented carefully, with assurance that appropriate records will be
			 maintained.
NOTE: Each service included on the ElderChoices plan of
				care must be justified by the DHHS RN. This justification is based on medical
				necessity, the client's physical, mental and functional status, other support
				services available to the client, cost effectiveness and other factors deemed
				appropriate by the DHHS RN.
REVISIONS TO A CLIENT'S PLAN OF CARE MAY ONLY BE MADE BY
				THE DHHS RN.
Each ElderChoices service must be provided according to the
				client's plan of care. As detailed in the Medicaid Program provider contract,
				providers may bill only after services are provided.
NOTE: All revisions to the plan of care must be
				authorized by the DHHS RN. A revised plan of care will be sent to each provider
				who is authorized to provide services under the plan of care. 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. Reimbursement 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 participant. The Targeted Case Manager
				is responsible for monitoring the client's status on a regular basis for
				changes in their service need, reporting any client complaints to the DHHS RN
				or Program Administrator and reporting any changes to the DHHS RN. The waiver
				provider and the Targeted Case Manager are responsible for reporting
any
changes in services or changes in the client's
				status to the DHHS RN immediately upon learning of the change.
In addition to the monitoring performed by Targeted Case
				Managers, the DHHS RN's also routinely monitor caseloads as required through
				the Quality Managements Strategies established for the waiver program.
212.310
Provisional Plan of
			 Care
The ElderChoices registered nurse (DHHS RN) will develop a
				provisional plan of care, based on information obtained during the in-home
				medical assessment, when recommending medical approval based on the following
				nursing home criteria.
To be determined a functionally disabled elderly individual,
				the individual must meet at least one of the following criteria, as determined
				by a licensed medical professional. The individual is unable to perform either
				of the following:
A. At least one (1)
			 of the three (3) activities of daily living (ADLs) of transferring/locomotion,
			 eating or toileting without extensive assistance from or total dependence upon
			 another person
B. At least two (2)
			 of the three (3) ADLs of transferring/locomotion, eating or toileting without
			 limited assistance from or total dependence upon another person
Applicable definitions of limited and extensive assistance
				remain unchanged.
The provisional plan of care will include all current plan of
				care information except for the waiver eligibility date and the Medicaid
				recipient ID number.
The provisional plan of care will expire after 60
				days
. The provisional plan of care expiration date will be entered
				on page 1 of the plan of care and will be calculated as 60 days from the date
				the provisional plan of care is signed by the DHHS RN and the applicant.
A signed copy of the provisional plan of care will be mailed to
				each provider included on the plan of care. If the provider chooses to
				implement the provisional plan of care, the provider must begin services within
				an established time frame as determined by the Division of Aging and Adult
				Services and notify the DHHS RN via form AAS-9510 that services have started.
				The DHHS RN will continue the current practice of tracking the start of care
				dates and giving the applicant options when services are not
				started.
A. Services Begin
			 Based on the Provisional Plan of Care
A provisional plan of care will be sent to providers only when
				the DHHS RN recommends the applicant for medical approval and only when the
				recommendation is based on the medical criteria shown above.
The waiver eligibility date will be established retroactively,
				effective on the day the provisional plan of care was signed by the applicant
				and the DHHS 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. Services Do Not Begin Based on the
			 Provisional Plan of Care
If at least one waiver service does not begin within 30 days of
				the date the provisional plan of care is signed by the DHHS RN, the DHHS county
				office will establish the waiver eligibility date as follows:
1. According to current policy, i.e., the
			 date the application is keyed into the system as an approved application
AND
2. Retroactively, effective on the day a
			 waiver service started, as verified by the DHHS
			 RN.
212.311
Denied Eligibility Application
A. If the DHHS 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 DHHS
				county office will notify the DHHS RN. The DHHS 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 client 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 DHHS 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 DHHS county office completes the case.
2. If the individual has unpaid waiver
			 charges and services were authorized by the DHHS 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 DHHS RN and the applicant, whichever is
				later.
212.312
Comprehensive Plan Of Care
Prior to the expiration date of the provisional plan of care,
				the DHHS RN will mail the comprehensive plan of care to all providers included
				on the plan of care. The comprehensive plan of care will replace the
				provisional plan of care. If the DHHS county office has approved the
				application, the comprehensive plan of care will include the Medicaid recipient
				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 DHHS RN's signature on form AAS-9503, the ElderChoices
				plan of care. If the application is still pending at the county office when the
				comprehensive plan of care is mailed to the providers, the waiver eligibility
				date and the Medicaid recipient ID number will not be included. Once the
				application is either approved or denied by the DHHS county office, the
				providers will be notified by the DHHS 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.
212.320
Physician 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 DHHS RN is responsible for developing
			 an ElderChoices plan of care that includes both waiver and non-waiver
			 services.
B. If a physician's
			 signature is obtained on an ElderChoices plan of care and personal care
			 services are included on the ElderChoices plan of care when the physician signs
			 it and returns it to the DHHS RN, the signed ElderChoices plan of care will
			 suffice as the "Physician Authorization" for services required in the Personal
			 Care Program. The signature on the ElderChoices plan of care only replaces the
			 need for the physician's signature authorizing personal care services. No other
			 requirements under the Personal Care Program regarding the personal care
			 service plan are modified. The personal care services plan is still
			 required.
C. If a physician's
			 signature is not obtained on an ElderChoices plan of care, the personal care
			 provider must secure a physician's order as provided in Medicaid Personal Care
			 Program policy.
D. The ElderChoices
			 plan of care is effective for one year, from the date of the DHHS RN's
			 signature. This signature does not meet the requirements of the Medicaid
			 Personal Care Program. If the ElderChoices plan of care does include an MD's
			 signature, the authorization for personal care services, included on the
			 ElderChoices plan of care, is for one year from the date of the physician's
			 signature, unless revised by the DHHS RN. This policy supersedes information
			 currently found in the Arkansas Medicaid Personal Care provider manual.
This policy does not place the responsibility of developing a
				personal care service plan with the DHHS RN. The personal care provider is
				still required to complete a service plan, as described in the Arkansas
				Medicaid Personal Care provider manual.
212.321
Internal Procedures
A. If personal care services are not
			 currently being provided when the DHHS RN develops the ElderChoices plan of
			 care, the DHHS RN will determine if personal care services are needed. If so,
			 the service, amount, frequency duration and the recipient's provider of choice
			 will be included on the ElderChoices plan of care. After the physician signs
			 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
			 DHHS RN within 10 working days from mailing, or action may be taken by the DHHS
			 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 DHHS 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
			 DHHS RN is aware that personal care services are currently being provided when
			 the ElderChoices plan of care is developed, the DHHS RN will contact the
			 personal care provider to obtain the amount of personal care services currently
			 being provided. It is the personal care provider's responsibility to provide
			 this information to the DHHS RN immediately upon receipt of the request. If
			 this information is not received within five working days of the request, the
			 DHHS RN will take necessary steps to submit the ElderChoices plan of care, as
			 developed by the DHHS RN, to the physician for signature.
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 DHHS RN will be aware that the provider is
				serving the applicant. Preferably, the provider will place the information atop
				the refrigerator or under the phone the applicant uses, unless the applicant
				objects. If so, the provider will place the information in a location
				satisfactory to the applicant, as long as it is readily available to and easily
				accessible by the DHHS RN.
C. The personal care service plan provided to
			 the DHHS RN must meet all requirements as detailed in the personal care
			 provider manual. These include, but are not limited to, the amount of personal
			 care services, personal care tasks, frequency and duration. The DHHS 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 DHHS 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 DHHS RN. Therefore, final decisions regarding services included on the
			 ElderChoices plan of care rest with the DHHS RN.
212.322
Revisions when the Plan Of Care
			 Contains Personal Care Services
Requested changes to the personal care services included in the
				plan of care may originate with the personal care RN or the DHHS RN, depending
				on the recipient's circumstances. The individual or agency requesting revisions
				to the personal care services on the ElderChoices plan of care is responsible
				for securing the required physician order authorizing the change before the
				ElderChoices plan of care is revised.
If authorization is secured by the DHHS RN, a copy of the
				revised ElderChoices plan of care and form AAS-9510 will be mailed to the
				personal care provider within ten working days of authorization by the
				physician. If authorization is secured by the personal care agency, a copy of
				the revised personal care service plan, signed by the physician, must be sent
				to the DHHS RN before the personal care provider implements any revisions. Once
				received, the ElderChoices plan of care will be revised accordingly, within ten
				days of its receipt, and a copy will be mailed to the personal care provider
				and the targeted case manager, if applicable. If any problems are encountered
				with implementing the requested revisions, the DHHS 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 DHHS
				RN.
213.100
Adult
			 Foster Care
Procedure Code
Description
S5140
Adult Foster Care
Adult foster care provides a family living environment for one
				or two clients 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.
Adult foster care adds a dimension of family living to the
				provision of supportive services such as:
A. Bathing,
B. Dressing,
C. Grooming,
D. Care for occasional incontinence
			 (bowel/bladder),
E. Assistance with
			 eating and
F. Enhancement of skills
			 and independence in daily living.
Services are provided in a home-like setting. The provider must
				include the client in the life of the family as much as possible. The provider
				must assist the client in becoming or remaining active in the community.
Services must be provided according to the client's written
				ElderChoices plan of care.
One (1) unit of service equals one (1) day. Adult foster care
				is 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 client.
CLIENTS RECEIVING ADULT FOSTER CARE SERVICES ARE NOT
				ELIGIBLE TO RECEIVE ANY OTHER ELDERCHOICES SERVICE.
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 client'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 client's
				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 client'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 172 units per month.
An ElderChoices client 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 DHHS
				RN.
An ElderChoices client 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 client's
				written ElderChoices plan of care.
When justified and included on the plan of care by the DHHS 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 client's case record. Family members of the client may not be reimbursed
				by Medicaid for chore services. Family members are not eligible for
				consideration as chore specialists. 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 per month.
An ElderChoices client 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 DHHS
				RN.
An ElderChoices client receiving long-term,
				facility-based respite care is not eligible for chore services on the same date
				of service.
213.310
Hot
			 Home-Delivered Meals
Hot Home-Delivered Meal services provide one daily nutritious
				meal to eligible clients who are homebound.
Homebound is defined as a person with normal inability to leave
				home; that leaving home requires considerable and taxing effort by the
				individual and for whom absences from the home are infrequent, relatively short
				in duration or are attributable to the need to receive medical
				treatment.
Additionally, the client 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. The provision of a home-delivered meal is
			 the most cost-effective method of ensuring a nutritiously adequate meal
			 and
D. Have the provision of the
			 home-delivered meals included in his or her plan of care.
Hot Home-Delivered Meals provide one meal per day of
				nutritional content equal to one-third of the Recommended Dietary Allowances
				(as recommended for an adult male 55 years or older) and comply with Dietary
				Guidelines for Americans. Meals must also comply with DAAS Nutrition Services
				Policy Number 206.
Hot Home-Delivered Meals may be provided to eligible clients
				daily. Additionally, clients may receive up to four (4) emergency meals per
				state fiscal year. A daily log sheet including the client's signature must be
				maintained by the provider to document receipt of the meal delivered. Section
				214.000 contains information
				regarding additional documentation requirements.
Hot Home-Delivered Meals must be provided according to the
				client's written ElderChoices plan of care.
One (1) unit of service equals one (1) meal. Home-delivered
				meals are limited to a maximum of thirty-one (31) units per month and four (4)
				emergency meals per state fiscal year.
213.321
Participant Requirements for
			 Frozen Home-Delivered Meals
A. Be
			 homebound, which is defined by the following requirements:
1. The person is normally unable to leave
			 home,
2. Leaving home requires
			 considerable and taxing effort by the individual and
3. 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 in the individual's plan of care,
			 as developed by the appropriate DHHS RN.
Frozen home-delivered meals must be prescribed by the
				recipient's attending physician, as documented on the ElderChoices plan of care
				by the DHHS RN, and must be provided in accordance with the individual's
				written ElderChoices plan of care.
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 DHHS RN must verify that the individual is capable,
				both physically and mentally, of operating the PERS unit.
PERS must be included in the client's written ElderChoices plan
				of care.
PERS providers must contact each client 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 client 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 client'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 clients 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.
213.500
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 clients' own
				homes.
When provided according to the client's written ElderChoices
				plan of care, ElderChoices clients 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 client's attending physician and provided
				according to the client'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, clients 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 clients 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, clients 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 DHHS 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 client 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 DHHS RN and/or DHHS 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 client 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 participants. 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 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 Health and 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.
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 client 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 clients 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 client'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.
Clients 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 clients 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, clients 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 DHHS
				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 client 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 DHHS RN and/or DHHS 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 client 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.
213.700
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 clients in their homes. Respite care may be
				provided in or outside of the client'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 caregiving.
If there is no primary
				caregiver, respite care services will not be deemed appropriate and
				subsequently will not be prescribed by the client's
				physician
.
In the event the in-home medical assessment performed by the
				DHHS RN substantiates a need for respite care services, the service will be
				prescribed as needed, via the client's plan of care, not to exceed an hourly
				maximum. The DHHS RN will establish the service limitation based on the
				client's medical need and the dollar amount available after calculating the
				client's total plan of care costs. Respite care services must be provided
				according to the client's written ElderChoices plan of
				care.