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Social Service Districts are required to follow the “some” and “total” assistance definitions contained in the Personal Care Services regulations (505.14). In addition, Administrative Directive 92ADM-15, Provision of Title XIX Home Care Services in Adult Care Facilities and Implementation of Retention Standards Waiver Program in Adult Home and Enriched Housing Programs, is the source of the State’s policy that adult homes are responsible for providing some assistance with personal care tasks and that Medicaid personal care services may only be provided when a resident requires total assistance. This Administrative Directive also made clear that all adult home residents who are Medicaid eligible are entitled to the same scope of Medicaid funded home services as all Medicaid recipients. Service eligibility is not determined by the scope of what a particular provider is eligible to provide.

Instructions to providers on the use of MA-reimbursable services give ACF operators responsibility for basic activities, i.e. housekeeping, meals, shopping, laundry. This demarcation is clear and does not seem to pose problems for users. The standard used to draw the line for personal activities, i.e. bathing, toileting, medications, et al., however, has presented some difficulties. Under current rules the ACF is responsible for “some” assistance while home care providers may provide “total” assistance. The definitions of some and total are those used for MA personal care: “some” means that the tasks get accomplished with help from another; “total” means that another does the task for the recipient. The difficulties occasioned by this standard are multi-layered and complex. At the most basic level the distinction by “some” and “total” is an arbitrary representation of client need. An individual with need of some assistance with several tasks may present the same level of resource demand, staff expertise and “medical necessity” as an individual with need for total assistance in one task.

  • Expanded Medication Assistance Tasks. The LLHCSA statute authorizes the administration of medications as a billable service. However, the initial Administrative Directive to Commissioners of Social Services #98 OCC/ADM-1 limits what can be billed to the LLHCSA to intramuscular and subcutaneous injections. Other medications are routinely provided to adult home residents by the operator. Consequently, the scope of the LLHCSA, in regards to medication assistance, was restricted to reflect CHHA medication assistance Medicaid billing at that time. Department data indicates CHHAs are now billing Medicaid for some medication tasks, especially in situations where a small number of individuals in the ACF need this service.

  • Medicare payment. Medicare payment cannot be received for services rendered by this provider type but need to be delivered through a CHHA. Otherwise Medicaid would be billed.

  • Medicaid and the Mentally Disabled. There is some concern that current federal program restrictions do not allow federal participation for Medicaid services delivered in Institutions for the Mentally Disabled. Many adult care facilities have over 25% of their residents with a diagnosis of psychiatric disability. The LLHCSA

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