Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-005 - State Plan Amendment #2014-012 & OMIG Updates

Current through Register Vol. 49, No. 6, June, 2024
1915(j) Self-Directed Personal Assistance Services
vi. Involuntary Disenrollment
A. The circumstances under which a
			 participant may be involuntarily disenrolled from self-directing personal
			 assistance services, and returned to traditional service delivery model are
			 noted below.
Parti cipants may be disenrolled for the following
				reasons:
1. Health and Welfare: Any
			 time DAAS feels the health and welfare of the participant is compromised by
			 continued participation in the IndependentChoices Program, the participant may
			 be returned to the traditional personal care program. Prior to this point the
			 counselor has worked with the participant offering suggestions, identifying or
			 changing representatives or employees to better meet the needs of the consumer,
			 making in-home visits as needed by APS or HCBS RNs, and working to resolve
			 these concerns. If no resolution is available, meeting the participant's health
			 and well-being needs is of most importance; including referral back to the
			 traditional model.
2. Change in
			 Condition: Should the participant's cognitive ability to direct his/her own
			 care diminish to a point where the participant can no longer self-direct and
			 there is no responsible representative available to direct the care the
			 counselor will seek out sources of support. If no resources are available, the
			 IndependentChoices case will be closed. The participant will be informed of the
			 pending closure by letter. The letter will include a list of traditional
			 personal care agencies serving the participant's area. If the participant is
			 also a 1915(c) waiver recipient, an e-mail will be auto generated to the HCBS
			 RN or targeted case manager. The e-mail to the HCBS RN or targeted case manager
			 is auto generated and populated with the appropriate names once a closure date
			 is entered in the database. The e-mail will inform the HCBS RN or targeted case
			 manager of the pending closure of the IndependentChoices case necessitating a
			 change in the HCBS service plan. Within five days of sending the letter the
			 counselor will follow up with the participant to determine which agency the
			 participant may wish to choose. The counselor will coordinate the referral with
			 the agency provider. However, if the participant declines agency services, the
			 counselor will respect the choice made by the participant. The participant may
			 choose to have their needs met by informal caregivers.
3. Misuse of Allowance: A notice will be
			 issued should the participant or the representative who manages their cash
			 allowance:
1) fail to pay related state and
			 federal payroll taxes;
2) use the
			 allowance to purchase items unrelated to personal care needs;
3) fail to pay the salary of a personal
			 assistant; or
4) misrepresent
			 payment of a personal assistant's salary. The counselor will discuss the
			 violations with the participant and allow the participant to take corrective
			 action including restitution if applicable. The participant will be permitted
			 to remain in the program, but will be assigned to the fiscal intermediary, who
			 will provide maximum bookkeeping support and services. The participant or
			 representative will be notified that further failure to follow the expenditure
			 plan will result in disenrollment and a report filed with
Office of
			 Medicaid Inspector General
when applicable.