Unlicensed staff who meet training requirements may assist with self-administration of medications. Assistance includes taking previously dispensed, properly labeled containers from where they are stored and bringing it to the resident; reading the label, opening the container, removing a prescribed amount of medication, and closing the container; placing an oral dosage in the resident’s hand or in another container and helping the resident lift the container to his or her mouth; applying topical medications; returning the medication container to proper storage; and keeping a record of when a resident receives assistance with self-administration. Licensed nursing staff may administer medications.
Services are in residential settings are reimbursed for low income residents through SSI, SSDI, OSS, an OSS to the federal SSI payment, Medicaid ACS, which is a Medicaid state plan service, and two Medicaid programs: an ALE waiver and the Nursing Home Diversion program.
The OSS payment standard is $647.40 a month including a PNA of $54.
Coverage of ACS under the state plan was implemented in September 2001 in all ALFs and in AFHs in January 2002. ACS includes health support; assistance with ADLs; assistance with IADLs and assistance with self-administration of medication. This Medicaid program is optional state plan service for individuals in ALFs, AFCHs, and RTFs. The payment rate is $9.28 for each day the recipient was receiving services in the facility.
ALE waiver services are available in ALFs licensed for ECC and/or LNS. Providers receive $32.20 a day ($966 per 30-day month) for services. Payments are calculated to maintain a total provider reimbursement rate of $1,556 per 30-day month. The payment for case managements is $100 a month and incontinence supplies are reimbursed $125 a month.
To be eligible for the waiver program, ALE recipients must be 60 years of age or older, require a nursing home LOC, receive SSI or have income under 300% of the federal SSI benefit, or have income under 88% of the federal poverty level.
Only facilities with an ECC or LNS license may participate in the waiver program. The State allows and caps the amount of supplemental income that may be received. ALE waiver beneficiaries must be offered a private room or apartment or a unit that is shared with the approval of the beneficiary. Additionally, to be eligible for participation, a facility may not have had a Class I or Class II violation during the past five years, nor have had uncorrected Class III violations during the past two years.
Services reimbursed include: attendant call system; attendant care; behavior management; personal care services; chore and homemaker services; medication administration; intermittent