Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1001 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Activities of
				daily living" (ADL) means basic personal everyday activities limited to
				bathing, personal hygiene, transferring, positioning, eating, dressing,
				toileting, assistance with exercise routine performed in home,
				self-administered medication, including medication reminders, and meal
				preparation.
(2) "Agency-based
				services" means services provided by a qualified personal care provider agency.
				The agency works with the member to establish the schedule for service
				provision and provides the trained staff necessary for the delivery of
				care.
(3) "Annual review" means a
				member review conducted by a licensed nurse from the designated quality
				improvement organization once every 365 days. The review of the member's health
				status includes the completion of a functional assessment and service
				profile.
(4) "Case manager" means a
				nurse or social worker who is responsible for managing services provided to
				eligible members under the Home and Community Based Services (HCBS Waiver)
				Program. These case managers plan, implement, and monitor the delivery of
				services available through the program to the member.
(5) "Community First Choice Program" (CFCP)
				means a program developed in accordance with 1915(k) of the Social Security
				Act, which allows states the option of providing home and community-based
				attendant services and supports through an approved state plan. The CFC Program
				is developed to deliver attendant-based services through the use of a
				person-centered planning process that includes service coordination and member
				involvement to provide long-term services and supports (LTSS) to individuals in
				their homes or communities rather than in institutional settings.
(6) "Community First Choice Services" (CFCS)
				means the delivery of medically necessary in-home and community-based services
				provided to Medicaid eligible members whose health conditions cause them to be
				functionally limited in performing activities of daily living and instrumental
				activities of daily living.
(7)
				"Department" means the Montana Department of Public Health and Human
				Services.
(8) "Direct-Care Wage"
				means funding which is a supplemental payment made to Community First Choice
				service providers for the purpose of providing direct-care wage increases,
				benefits, or lump-sum payments to workers that provide direct services. These
				funds are distributed proportionately based on a pro rata share of appropriated
				funding to participating providers of CFCS. The distribution is based on the
				number of units of Medicaid CFCS provided by each provider agency for the
				distribution year relative to the total number of units provided statewide by
				all providers of CFCS.
(9)
				"Functional assessment" means an assessment that is performed by the designated
				quality improvement organization licensed nurse to determine if the member
				qualifies for CFCS and requires assistance with activities of daily living,
				instrumental activities of daily living, and health maintenance
				activities.
(10) "Health Care for
				Health Care Workers" means funding which is designated for the purpose of
				Medicaid provider rate increases when health insurance is provided for
				direct-care workers in the Community First Choice, personal assistance services
				and private duty nursing programs. The funds must be used to cover premiums for
				health insurance that meet defined benchmark criteria established by the
				department. These funds are distributed proportionately based on a pro rata
				share of appropriated funding to participating providers of CFCS based on the
				number of units of Medicaid CFCS provided by each provider for the distribution
				year relative to the total number of units provided statewide by all providers
				of service.
(11) "Health care
				professional" means a medical doctor, certified physician assistant, nurse
				practitioner or registered nurse, occupational therapist or a medical social
				worker, who is familiar with the member's activities of daily living. The
				health care professional may not be a paid employee of the CFCS provider
				agency.
(12) "Health maintenance
				activities" means health-related tasks that may be reimbursed through the Nurse
				Practice Act exemption in accordance with ARM
				24.159.1616 and
				37-8-103,
				MCA. These tasks are limited to bowel programs, wound care, urinary system
				management, and administration of medication. These activities are delivered by
				the member's personal care attendant when the activities, in the opinion of the
				physician or other health care professional, can be performed by the person if
				the person were physically capable and if the procedure could be safely
				performed in the home. A member is only able to receive these services from a
				personal care attendant using the self-direct model.
(13) "Instrumental activities of daily
				living" means activities which are limited to activities provided in accordance
				with the service plan, which are directly related to the member's
				person-centered needs. These activities are limited to the following:
(a) household tasks which are limited to
				cleaning the area used by the member, changing the member's bed linens, and
				doing the member's laundry;
(b)
				shopping;
(c) community integration
				which provides assistance so the member can participate in recreational and
				community activities;
(d) yard
				hazard removal which provides safe access to the member's home; and
(e) correspondence assistance which provides
				a member, capable of directing the service, with assistance opening mail,
				filing records, and completing paperwork.