MI-CHOICE

 

HOME AND

COMMUNITY

BASED SERVICES

WAIVER

for the

ELDERLY AND

DISABLED

 

Northeast Michigan Community Service Agency

2375 Gordon Rd.

Alpena, MI 49707

 

(989) 356-3474

1-800-219-2273

 

REVISED 11/09/04

I. General Information

A. History

The Home and Community Based Services to the Elderly and Disabled (HCBS E/D) Waiver Program began in March 1992 with seven waiver agents. On October 1, 1998, the HCBS E/D Waiver became available statewide with services delivered through 22 regional waiver agents (25 contracts).

 

Four Hundred Sixty-nine participants were served in 1992-93. The program was approved for 11,500 participants in fiscal year 1998-99 and it increased to 15,000 for fiscal year 1999-2000.  Since that time, funding has been decreased.  In fiscal year 2003-2004, NEMCSA served 206 Waiver participants.

 

B. Overview

The HCBS E/D Waiver program is funded through the federal Health Care Financing Administration (HCFA) and the Michigan Department of Community Health (MDCH). The Waiver funds home and community based services to eligible aged and disabled individuals over the age of 18. Without the provision of Waiver services this population would require a nursing facility level of care, the cost of which would be reimbursed under the approved Medicaid State plan.

 

The Waiver provides alternative services to a target population traditionally served in a nursing facility.  Waiver agents contract with MDCH and function as Medicaid administrative agents for Waiver services. Waiver agent requirements include serving all areas in the region and developing and maintaining an adequate service delivery network.

 

C. Regional Agent

The Northeast Michigan Community Service Agency (NEMCSA) is a contracted agent. The region served by NEMCSA consists of twelve counties;

II. WAIVER ELIGIBILITY CRITERIA

A. FINANCIAL ELIGIBILITY

All individuals must meet Medicaid financial eligibility criteria as stated in the FIA Program Eligibility Manual.

    • Financial Eligibility Determination Process:

    • Conducted through local FIA offices

    • Medicaid (MA) applications submitted by waiver agents on behalf of applicants.

    • FIA workers review applications and determine MA income and asset eligibility.

    • Waiver participant is a group of one, even when he/she lives with a spouse, in the household of a child, or in the household of some other relative or friend.

    • Income is 300% of SSI ($1,642 per month). This amount is adjusted annually. Only the income of the participant is used to determine eligibility.

    • Waiver participants can have no more that $2,000 in countable assets.

    • Special MA asset rules apply spousal protections for splitting joint assets held by a married couple.

B. MEDICAL ELIGIBILITY

Medical eligibility is initially determined via a telephone screen which is followed by an in-person, in home assessment.

 

The screening protocol uses key variables to determine a nursing home level of care and medical eligibility for the waiver and nursing home admission.

 

C. SERVICE ELIGIBILITY

The waiver agent documents (through standardized assessment and reassessment functions) the need for one (or more) waiver services as a condition of participation. The waiver participant must receive at least one waiver service on a continual basis to maintain eligibility.

III. WAIVER SERVICE DEFINITIONS

The following thirteen waiver services are approved for inclusion when determining the waiver participant's plan of care.

  

Chore Service:

Services needed to maintain the home in a clean, sanitary and safe environment.

    • Replacing fuses, light bulbs, electric plugs, frayed cords; Replacing door locks, window catches.

    • Replacing/repairing pipes.

    • Replacing faucet washers or faucets.

    • Installing screens and storm windows.

    • Caulking windows.

    • Moving heavy items of furniture to provide safe access inside the home for the recipient.

    • Installing window shades and curtain rods.

    • Cleaning appliances.

    • Tacking down loose rugs and tiles.

    • Washing walls and windows, scrubbing floors.

    • Cleaning attics and basements to remove fire and health hazards.

    • Grass cutting and leaf raking.

    • Clearing walkways of ice, snow and leaves.

    • Trimming overhanging tree branches for safety purposes.

In the cases of rental property, the responsibility of the landlord, pursuant to the lease agreement, will be examined prior to any authorization of chore service.

 

Homemaker Service:

 

Routine household tasks to maintain an adequate living environment for individuals with functional limitations.

    • Laundry

    • Ironing

    • Meal preparation

    • Shopping for necessities, including groceries

    • Light housekeeping (dusting vacuuming, mopping floors, cleaning bathrooms and kitchen, making beds, maintaining safe environment)

    • Observing, reporting and recording any change in a participant's condition and home environment.

Services are to be used when the individual regularly responsible for these activities is temporarily absent or the participant is unable to manage the home and care for himself or herself or others in the home.

 

Home Delivered Meals:

 

The provision of nutritious meals to homebound persons unable to care for their nutritional needs.

    • There is no adult living at the same residence or in the vicinity that is able and willing to prepare all meals.

    • The program can appropriately meet the participants' special dietary needs.

    • Must be able to feed him/herself.

    • Eligible person must agree to be home when meals are delivered, or contact the program when absence is unavoidable.

    • Up to 2 1/2meals per day may be supplied.

    • Hot/frozen, cold or liquid meals are available.

Personal Care Supervision:

 

Supervising the care of the participant.

    • Reminding.

    • Prompting.

    • Cueing.

    • Eating.

    • Bathing.

    • Dressing.

    • Toileting.

    • Personal hygiene.

    • Taking medications.

Respite Care:

 

Services provide a break from the daily routine of caring for a loved one and the individual is unable to care for themselves.  Respite is provided on a short-term basis because of the absence or need for relief of those persons normally providing the care.

    • In-home respite (participant's home or place of residence)

    • Out-of-home respite (facility approved by the state which is not a private residence such as a licensed Adult Foster Care Home).

    • Only 20 days per participant per waiver year are allowed in a facility.

    • Facilities approved for out-of-home respite consists of hospitals and group homes.

 

Personal Emergency Response System:

 

The system is an electronic device, which enables certain

high-risk individuals to secure help in the event of an emergency.

    • Portable "help" button may be worn to allow for mobility.

    • The system is connected to a participant's phone and programmed to signal a response center once the button is activated.

    • Response center is staffed 24 hours a day, 365 days per year with trained person.

Adult Day Care:

 

Services are furnished in an outpatient setting, encompassing both health and social services of the participant.

    • 4 or more hours per day on a regularly scheduled basis.

    • 1 or more days per week.

    • Meal(s) may be provided.

    • Physical, occupational and speech therapies as indicated in the plan or care will be furnished as part of this service.

    • Transportation can be arranged through the waiver agency or the facility.

Environmental 

Modifications:

 

Service consists of physical adaptations to the home, required by the plan of care, to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home to prevent institutionalization.

    • Ramps.

    • Grab-bars.

    • Widening of doorways.

    • Modification of bathroom facilities.

    • Installation of specialized electrical and plumbing systems to accommodate functional limitations.

    • Medical equipment and supplies necessary for the welfare of the recipient.

    • It shall exclude those adaptation or improvements to the home which are not of direct medical or remedial benefit to the waiver client, such as;

    • Carpeting.

    • Roof repair.

    • Central air conditioning, etc.

This service is necessary to prevent the institutionalization of the participant.

 

Transportation:

 

Services offered in order to enable the waiver participant to gain access to waiver and other community services and resources, required by the plan of care.

    • To receive support services.

    • Reduce isolation.

    • Promote independent living.

       

      • Does not include transportation for the purpose of medical appointments, i.e. hospital, doctors visits, etc.

       

      • Does not reimburse family, neighbors, friends or community agencies, which can provide the service.

By enabling participants to gain physical access to community services, institutionalization can be avoided.

 

Specialized Medical Equipment and Supplies:

    • Wheelchairs.

    • Ancillary Supplies.

    • Items or supplies as specified in the Plan of Care.

Includes devices, controls, or appliances, specified in the plan of care, which enable a participant to increase their abilities to perform activities of daily living or to perceive, control, or communicate with the environment in which they live.

    • Life support items.

    • Equipment necessary to the proper functioning of such items.

    • Durable and non-durable medical equipment not available under Medicare, the Medicaid state plan or other third-party insurers.

This shall exclude those items which are not of direct medical remedial benefit to the participant. This service is necessary to prevent institutionalization.

 

Counseling Services:

 

Professional level counseling services seek to improve the waiver participant's emotional and social well-being through the resolution of personal problems and/or change in a participant's social situation.

  • Waiver participants who are experiencing emotional distress or diminished ability to function.

  • Adult children, spouse or relatives who are appropriate for family counseling in order to resolve the problems of the waiver participant, i.e. sibling, niece, nephew.

  • Services must not duplicate services available under Medicare, Medicaid state plan or other third party resources.

  • At a minimum, providers receiving waiver funds, must provide the following service components:

  • Psycho-social evaluation to determine  appropriateness of therapy.

  • Treatment plan which states goals and objectives.

  • Frequency and duration of service.

  • Individual, family, and/or group counseling sessions.

  • Home visits and on-site counseling.

  • Case conference with case manager.

Services must be provided by persons having a master's degree in social work or bachelor's degree under the supervision of professional with a master's degree.

 

Private Duty Nursing:

 

Consists of nursing procedures to meet an individual's health needs which are provided by a licensed nurse.

    • Provision of nursing treatments.

    • Observation.

    • Teaching.

    • Provided to an individual at home.

    • Under physician's orders and in consultation with waiver case management team.

 

Private Duty Nursing services are necessary to prevent institutionalization.

 

Training:

 

Instruction provided to a waiver participant or caregiver in either a (one-to one) situation or a group setting to teach a variety of independent living skills, including the use of specialized or adaptive equipment or medically related procedures.

 

These needs must be identified in the assessment or a professional evaluation and be part of the participant's care plan, such as:

    • Activities of daily living (ADL).

    • Adjustment to home or community living.

    • Adjustment to mobility impairment.

    • Adjustment to serious impairment.

    • Management of personal care needs, i.e. development of skills to deal with care providers and attendants.

    • Use of adaptive equipment (for either participant or caregiver)

    • Providers must possess credentials required by Michigan laws or federal regulations.

Referrals can be made by contacting the NEMCSA Care Management Office, Area Agency on Aging or local Senior Centers.

 

The MI Choice Waiver Program is not able to provide 24 hour care.