and/or durable medical equipment. In an enriched housing program, a resident may be eligible to receive Medicaid funded personal care services only if the resident requires total assistance with bathing, grooming, and/or dressing. Enriched housing program residents may also be entitled to Medicaid funded services providing some assistance with toileting walking, transferring and/or feeding.
Approval of Organizations as Limited Licensed Home Care Services Agencies
The approval of an entity to provide LLHCSA services requires initial Public Health establishment approval and licensure under Article 36 of the Public Health Law. Only those eligible ACF operators in good standing with the Department are approvable. For those adult home operators which already had an approved licensed agency, an approval process was developed which did not require reapproval by the Public Health Council (Appendix A contains the list of “conversion” facilities).
In order to be able to apply for licensure as a LLHCSA, the agency must first obtain a contract with the LDSS in which it will operate. The New York City Human Resources Administration, through a Memorandum of Understanding, delegated local social services district LLHCSA contracting responsibilities to the Department of Health.
Once approved, an applicant needs to request an enrollment package and enroll in the Medicaid Management Information System (MMIS) in order to bill Medicaid for services provided. In addition, in order to bill for Title XIX personal care services, a physician’s order must first be obtained which identifies the medical need for the service(s). The social services district must then conduct/arrange for necessary assessments, and if determined appropriate, the social services district must prior authorize the type, amount, and duration of services provided. If the social services district determines that a LLHCSA is the most cost effective means of providing the needed care, the social services district would then include the LLHCSAs provider ID on the MMIS prior authorization of service.
Rates of Payment
Section 367-p of the Social Services Law, as amended by Section 69 of Chapter 433 of the Laws of 1997, required the Commissioner of Health, subject to the approval of the director of the budget, to establish rates of payment for services provided by LLHCSAs. Subdivision (2) provided that reimbursement must be significantly less than the current costs of providing such services through a personal care provider or certified home health agency in the same area. The legislation also required social services districts to determine that home care services provided by a LLHCSA were more cost-effective than other appropriate service delivery options available in the district, prior to authorizing payment for services.
LLHCSAs could directly provide personal care services authorized in accordance with the rules and regulations of the department; and the administration of medications and