Covered Services

Covered Services A. The Division of Medicaid covers the following services through the Assisted Living Waiver: 1. Case Management services include the identification of resources as well as the coordination and monitoring of resources and services by case managers to ensure the health, social needs, preferences and goals of beneficiaries are met throughout the person- centered planning process and service provision. The Division of Medicaid case manager is responsible for implementation of the PSS. The Division of Medicaid is responsible for monitoring the PSS and the health and welfare of the participants. The Division of Medicaid, as the administrative agency of the waiver, has the overall oversight responsibility of assuring that processes are in place for PSS implementation. Monitoring the implementation of the PSS includes on site review activity, record reviews, annual recertification reviews, beneficiary phone calls from the Medicaid agency, and other strategies as needed. a) Case Management services are provided by a social worker licensed to practice in the State of Mississippi with at least two (2) years of full-time experience in direct services to elderly and disabled individuals. Case managers will conduct the following activities. 1) Conduct face-to-face visits using comprehensive long-term services and supports (LTSS) assessment instrument at the time of admission and recertification. 2) Complete face-to-face visits with a beneficiary at the facility on a quarterly basis to review the Plan of Services and Supports. 3) Complete monthly contacts with the participant. Monthly contacts may be completed telephonically or virtually; however, in person visits for monthly contacts must be completed with beneficiaries if any of the following concerns are identified: (a) Beneficiary/representative is unable to communicate by phone due to an auditory, speech or cognitive impairment. (b) Beneficiary has unmet needs that cannot be resolved by phone; (c) Beneficiary has identified risks for Abuse, Neglect, or Exploitation including the use of restraints or seclusion that require in person monitoring. (d) Beneficiary/representative is unable to be reached by phone. B. AL Services include the following: 1. Personal care services rendered by personnel of the licensed facility, 2. Homemaker services, 3. Attendant care services, 4. Medication oversight/administration with personnel operating within the scope of applicable licenses and/or certifications, 5. Therapeutic, social, and recreational programming services, 6. Intermittent skilled nursing services and interventions ordered by the physician and provided: a. At least eight (8) hours a day, including weekends and holidays, to assess and assist the waiver person with services including, but not limited to, medication administration and oversight, and b. By a nurse acting within their scope of practice. If the facility employs a Licensed Practical Nurse (LPN), the LPN must have supervision by either a Registered Nurse (RN), nurse practitioner, or physician. 7. Medication Assistance is defined as any form of delivering medication which has been prescribed, but is not defined as “medication administration”, including, but not limited to, the physical act of handing an oral prescription medication to the patient along with liquids to assist the patient in swallowing. Medication assistance is monitored by the licensed nurse and all facility staff are required to receive training upon hire prior to rendering services. 8. Transportation services may be provided through the Division of Medicaid’s Non- Emergency Transportation (NET) program if the waiver person has not reached the maximum NET service limits. The AL Waiver provider must provide transportation to all waiver beneficiaries who have reached the maximum NET service limits or who choose not to use the NET program. 9. An electronic emergency attendant call system in each Personal Care Home-Assisted Living (PCH-AL) facility which: a) Is available to waiver beneficiaries who are: 1) At risk of falling, 2) At risk of becoming disoriented, or 3) Experiencing some disorder placing them in physical, mental, or emotional jeopardy. b) Includes twenty-four (24) hour on-site response staff to meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence, and provides for supervision, safety, and security. 10. Provision of normal, daily personal hygiene items including, at a minimum, deodorant, soap, shampoo, toilet paper, facial tissue, laundry soap and dental hygiene products. C. AL Waiver providers must provide: 1. A setting physically accessible to the person but not located in: a) A nursing facility, b) An institution for mental diseases, c) An intermediate care facility for individuals with intellectual disabilities (ICF/IID), d) A hospital providing long-term care services, or e) Any other location that has qualities of an institutional setting, as determined by the Division of Medicaid including, but not limited to, any setting: 1) Located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, 2) Located in a building on the grounds of or immediately adjacent to a public institution, or 3) Any other setting that has the effect of isolating beneficiaries receiving Medicaid Home and Community-Based Services (HCBS). 2. A private, home-like living quarter with a bathroom consisting of a toilet and sink and must: a) Be a unit or room in a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the waiver beneficiary, and the beneficiary has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the Division of Medicaid must ensure that: (1) A lease, residency agreement or other form of written agreement will be in place for each HCBS beneficiary, and (2) That the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law. b) Provide each waiver beneficiary privacy in their sleeping or living unit with: 1) Lockable entrance doors with only appropriate staff having keys to doors, and 2) The option to share living units only at the choice of the beneficiary. The beneficiary choosing cohabitation per room removes the reasonable expectation of privacy. 3. A setting which integrates and facilitates the beneficiary’s full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community in the same manner as individuals without disabilities, 4. A setting selected by the beneficiary from among all available alternatives and is identified in the person-centered Plan of Services and Supports (PSS), 5. Protection of a beneficiary’s essential personal rights of privacy, dignity and respect, and freedom from coercion and restraint, 6. Individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact, 7. Individual choice regarding services and supports, and who provides them, 8. An assessment of safety needs of a beneficiary with cognitive impairment supported by a specific assessed need and addressed in the PSS, 9. Freedom and support of beneficiary to control their own schedules and activities and have access to food at any time, 10. Freedom to have visitors of their choosing at any time, 11. A living environment supportive of the beneficiary to exercise their rights to: a. Attend religious and other activities of their choice, b. Manage their own personal financial affairs or receive a quarterly accounting of financial transactions made on their behalf, c. Not be required to perform services for the facility, d. Send and receive mail or packages unopened or in compliance with the facility policy, e. Be treated with consideration, kindness, respect and full recognition of their dignity and individuality, f. Retain and use personal clothing and possessions as space permits, unless doing so infringes upon the rights or health and safety of other residents, g. Voice grievances and recommend changes in licensed facility policies and services without the fear of discrimination or reprisal, h. Not be confined to the licensed facility against their will and allowed to move about in the community at liberty, i. Free from physical and/or chemical restraints, j. Allowed to choose a pharmacy or pharmacist provider in accordance with State law, k. Decide his or her own sleep schedule, l. Furnish and decorate their sleeping or living space within the lease or other agreement, m. Allows the person to eat at non-traditional times or outside regular scheduled mealtime consistent with the beneficiary’s plan of care, n. Have snacks that adhere to the federal government’s Dietary Guidelines for Americans available at all times, and o. Use the dining room for congregate meals and socialization at the person’s choosing.