Coverage Document. (Supports Facilitation) planning and delivery process. The facilitator counsels, facilitates, and assists in development of a self-directed care plan which includes both paid and unpaid services and supports designed to allow the individual to live in the home and participate in the community. A back-up plan is also developed to assure that the needed assistance will be provided if regular services identified in the self-directed care plan are temporarily unavailable. Self-Directed Goods and Services Self-directed goods and services are services, equipment or supplies not otherwise provided through LTSS or through the Medicaid State Plan that address an identified need and are in the approved self-directed care plan (including improving and maintaining the individual’s opportunities for full membership in the community) and meet the following requirements: the item or service would decrease the need for other Medicaid services and/or promote inclusion in the community; and/or the item or service would increase the individual’s ability to perform ADLs or IADLs and/or increase the person’s safety in the home environment; and, alternative funding sources are not available. Individual goods and services are purchased from the person’s self-directed budget through the fiscal intermediary when approved as part of the self-directed care plan. Examples include a laundry service for a person unable to launder and fold clothes or a microwave for a person unable to use a stove due to their disability. This will not include any good/service that would be restrictive to the individual or strictly experimental in nature. Financial Management Services (Fiscal Intermediary) Payroll services for the self-directed care program individuals: responsible for all taxes, fees, and insurances required for the self- directed care program. The individual is to act as an employer of record; manage all non-labor related payments for goods and services authorized in the participant’s approved spending plan; assure that all payments made comply with the person’s approved spending plan and conduct criminal background and abuse registry screens of all Enrollee’s employees. Senior Companion (Adult Companion Services) Non-medical care, supervision, and socialization, provided to a functionally impaired adult individual. Companions may assist or supervise the person with such tasks as meal preparation, laundry, and shopping. The provision of companion services does not entail hands-on nursing care. Companions may also perform light housekeeping tasks, which are incidental to the care and supervision of the person. This service is provided in accordance with a therapeutic goal in the LTSS Care Plan. Assisted Living Personal care and services, homemaker, chore, attendant care, companion services, medication oversight (to the extent permitted Certification Standards, Service Benefit Detail Reference Coverage Document under State law), therapeutic social and recreational programming, provided in a home-like environment in a licensed community care facility in conjunction with residing in the facility. This service 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 to provide supervision, safety, and security. Other individuals or agencies may also furnish care directly, or under arrangement with the community care facility but the care provided by these other entities supplements that provided by the community care facility and does not supplant it. Personalized care is furnished to individuals who reside in their own living units (which may include dually occupied units when both occupants consent to the arrangement) which may or may not include kitchenette and/or living rooms and which contain bedrooms and toilet facilities. The individual has a right to Privacy. Living units may be locked at the discretion of the person, except when a physician or mental health professional has certified in writing that the person is sufficiently cognitively impaired as to be a danger to self or others if given the opportunity to lock the door. (This requirement does not apply where it conflicts with fire code.) Each living unit is separate and distinct from each other. The facility must have a central dining room, living room, or parlor, and common activity center(s) (which may also serve as living rooms or dining rooms). The individual retains the right to assume risk, tempered only by their ability to assume responsibility for that risk. Care must be furnished in a way which fosters the independence of each Enrollee to facilitate aging in place. Routines of care provision and service delivery must be consumer-driven to the maximum extent possible and treat each person with dignity and respect. Costs of room and board are excluded from payments for assisted living services. Billing Reference Guide and Tier Application
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