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I.EXECUTIVE ORDERS - page 192 / 359

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Services Financing, LR 30:2035 (September 2004), amended by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 32:2256 (December 2006), LR 34:2161 (October 2008).

§2107.Programmatic Allocation of Waiver Opportunities

A.When funding is appropriated for a new ADHC Waiver opportunity or an existing opportunity is vacated, the department shall send a written notice to an individual on the registry indicating that a waiver opportunity is available. That individual shall be evaluated for a possible ADHC Waiver opportunity assignment.

B.Adult day health care waiver opportunities shall be offered based upon the date of first request for services, with priority given to individuals who are in nursing facilities but could return to their home if ADHC Waiver services are provided. Priority shall also be given to those individuals who have indicated that they are at imminent risk of nursing facility placement.

1.A person is considered to be at imminent risk of nursing facility placement when he:
a.is likely to require admission to a nursing facility within the next 120 days;
b.faces a substantial posibility of deterioration in mental condition, physical condition or functioning if either home and community-based services or nursing facility services are not provided within 120 days; or
c.has a primary caregiver who has a disability or is age 70 or older.

C.Remaining waiver opportunities, if any, shall be offered on a first-come, first-serve basis to individuals who qualify for nursing facility level of care, but who are not at imminent risk of nursing facility placement.

D.If an applicant is determined to be ineligible for any reason, the next individual on the registry is notified and the process continues until an individual is determined eligible. An ADHC Waiver opportunity is assigned to an individual when eligibility is established and the individual is certified

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and pursuant to Title XIX of the Social Security Act.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 34:2162 (October 2008).

Chapter 23.Services

§2301.Covered Services

A.The following services are available to recipients in the ADHC Waiver. All services must be provided in accordance with the approved comprehensive plan of care (CPOC). No services shall be provided until the CPOC has been approved.

1.Adult Day Health Care. ADHC services are a planned, diverse daily program of individual services and group activities structured to enhance the recipient’s physical functioning and to provide mental stimulation. Services are furnished for five or more hours per day (exclusive of transportation time to and from the ADHC center) on a regularly scheduled basis for one or more days per week (not to exceed five days per week), or as specified in the individualized service plan. An adult day health care center shall, at a minimum, furnish the following services:
a.individualized training or assistance with the activities of daily living (toileting, grooming, eating, ambulation, etc.);
b.health and nutrition counseling;
c.an individualized, daily exercise program;
d.an individualized, goal directed recreation program;
e.daily health education;
f.medical care management;
g.one nutritionally-balanced hot meal and two snacks served each day;
h.nursing services that include the following individualized health services;
i.monitoring vital signs appropriate to the diagnosis and medication regimen of each recipient no less frequently than monthly;
ii.administering medications and treatments in accordance with physicians’ orders;
iii.monitoring self-administration of medications while the recipient is at the ADHC center;

NOTE: All nursing services shall be provided in accordance with acceptable professional practice standards.

i.transportation to and from the center at the beginning and end of the program day; and
j.transportation to and from medical and social activities when the participant is accompanied by center staff;

NOTE: If transportation services that are prescribed in any individual’s approved ISP are not provided by the ADHC center, the center’s reimbursement rate shall be reduced accordingly.

2.Support Coordination. These services assist participants in gaining access to necessary waiver and other State Plan services, as well as medical, social, educational and other services, regardless of the funding source for these services. This is a mandatory service.
3.Transition Intensive Support Coordination. These services will assist participants currently residing in nursing facilities who want to transition into the community. These services assist participants in gaining access to needed medical, social, educational and other services, regardless of the funding source for these services.
4.Transition Service. These services that will assist an individual transition from a nursing facility to a living arrangement in a private residence where the individual is directly responsible for his/her own living expenses.
5.Other Services. ADHC providers may provide other services and activities as identified in the current ADHC provider manual that enhance the participant’s independence and community involvement.

B.An individual must require and maintain the need for two waiver services.

C. - I.5.Repealed.

AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:2036 (September 2004), amended by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 34:2162 (October 2008).

§2303.Individualized Service Plan

A.All ADHC services shall:

1.be provided according to the individualized service plan;
2.be a result of an interdisciplinary staffing in which the participant and direct care staff participate;

Louisiana Register   Vol. 34, No. 10   October 20, 2008

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