Adult Day Service (ADS) centers community-based group programs designed to meet the needs of individuals who benefit from structured, social integration through comprehensive, nonresidential programs. The purpose of ADS is to provide social engagement, recreational activities, supervision, support services, and personal care. Breakfast, lunch, and nutritious snacks are provided. Participants attend ADS on a scheduled basis. ADS is not available to waiver recipients who reside in an assisted living facility.

AFC is a comprehensive service in which a participant resides with an unrelated caregiver. The participant and up to three other participants who have physical and/or cognitive disabilities and are not members of the provider’s or primary caregiver’s family, reside in a home that is owned, rented, or managed by the AFC provider. Participants receiving AFC may also receive care management, adult day service, specialized medical equipment and supplies, and healthcare coordination through waiver.

The assisted living service consists of therapeutic social and recreational programming, assistance with personal care and services, home and community assistance, and medication oversight (to the extent permitted under State law) provided in a congregate residential setting in conjunction with the provision of participant-paid room and board. Participants selecting the AL service may also receive case management and specialized medical equipment and supplies.

Attendant care (ATTC) is provided to participants who meet nursing facility level-of-care. ATTC provides direct, hands-on care to participants to assist with activities of daily living (ADLs).

Attendant care includes all nonskilled ADL care, which includes but is not limited to the following:

Assistance with personal care

•  Bathing, partial bathing

• Oral hygiene

• Hair care including clipping of hair

• Shaving

• Hand and foot care

•  Intact skin care

• Application of cosmetics

• Dressing

Assistance with mobility

• Transfers

• Ambulation

• Use of assistive devices

Assistance with elimination

• Assistance with bedpan, bedside commode, toilet

• Incontinent or involuntary care

•  Emptying urine collection and colostomy bags

•  Assistance with nutrition:

• Meal planning

• Meal preparation

•  Clean-up

Assistance with safety

• Use of the principles of health and safety in relation to self and individual

• Identification and elimination of safety hazards

• Practicing health protection and cleanliness by appropriate techniques of hand washing

• Waste disposal and household tasks

• Reminding the participant to self-administer medications

• Providing assistance with correspondence and bill paying

Transportation

• Transportation of individuals to nonmedical activities in the community

Case management is a process of assessment, planning, facilitation, advocacy, collaboration, and monitoring of the holistic needs of each individual participant. Case managers will monitor an individuals' progress from identifying his or her needs to meeting goals and/or preferences identified by him or her. Case managers will direct collaboration and coordination with providers to ensure that services are within the participant’s preferences and adjust service plans according to an individual's changing needs.

Community transition services include reasonable setup expenses for participants who transition from an institution to their own home, where the person is directly responsible for his or her own living expenses in the community. Community transition services will not be reimbursable on any subsequent move. To clarify, “own home” is defined as any dwelling – including a house, apartment, condominium, trailer, or other lodging – that is owned, leased, or rented by the participant or the participant’s guardian or family, or a home that is owned or operated by the agency providing supports.

Items purchased through community transition are the property of the participant individual receiving the service, and the participant takes the property with him or her when moving to another residence, even if the residence from which he or she is moving is owned by a provider agency. Nursing facilities are not reimbursed for community transition.

The following activities are allowed under community transition services:

•  Security deposits and application fees that are required to obtain a lease on an apartment or home

•  Essential (not luxury) furnishings and moving expenses required to occupy a home, including but not limited to a bed, table and chairs, window coverings, one land-line telephone, eating utensils, housekeeping supplies, food preparation items, microwave, hygiene products, and bed and bath linens

• Setup fees or deposits for utility or service access including telephone, electricity, heating, internet, and water

• Health and safety assurances, including pest eradication, allergen control, or one-time cleaning prior to occupancy

Reimbursement for community transition is limited to a lifetime cap of $1,500. Community transition funds must be used within 3 months of discharge from a facility. If all $1,500 is not used within 3 months, the remaining funds will be made available should the participant admit to a nursing facility in the future and need the funds to transition back home.

Home and community assistance (HCA) provides help with instrumental activities of daily living (IADL) for waiver participants in their home.

The following activities are allowed under HCA:

• Dusting and straightening furniture

• Mopping and vacuuming floors and rugs

• Cleaning the kitchen, including washing dishes; cleaning the outside of appliances, counters, cupboards; cleaning ovens; and defrosting and cleaning refrigerators

• Cleaning the bathroom, including the tub, shower, sink, toilet bowl, and medicine cabinet; emptying and cleaning commode chair or urinal

• Laundering clothing in the home or laundromat, including washing, drying, folding, putting them away

• Changing linen and making beds

• Washing insides of windows

• Removing trash from the home

• Assistance with meal planning and preparation

• Completing essential errands and/or unassisted transportation for nonmedical, community activities

• Assistance with correspondence and bill paying

• Minor pet care

• Assistance with outdoor tasks such as raking leaves, snow removal, lawn mowing, and weeding

A home-delivered meal is a nutritionally balanced meal that is delivered either weekly or biweekly to the client's home. A client can received up to two meals per day through waiver.

The home modification assessment will assess the client's home for physical adaptations to the home to ensure the health, welfare, and safety of the individual and promote greater independence in the home. This service is used to objectively determine the specifications for a home modification to ensure accurate bids and workmanship. All participants must receive a home modification assessment prior to a home modification being completed, as well as an inspection of the work upon completion.

Home modifications are physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the participant, and which enable the participant to function with greater independence in their home. Without these home modifications, the participant would require institutionalization.

Modifications allowed under the home modifications service may include but are not limited to the following:

• Adaptive door openers and locks

• Bathroom modification – including the removal of existing bathtub, toilet, and/or sink; installation of roll-in shower, grab bars, toilet, and sink; and installation of replacement incidental items (such as flooring, storage space, and cabinets) that are necessary due to the bath modification

• Home control units - Adaptive switches and buttons to operate medical equipment, communication devices, heat and air conditioning, and lights for an individual living alone or who is alone without a caregiver for a substantial portion of the day.

• Kitchen modification, including the removal of existing cabinets and sink; installation of sink and cabinet; and installation of replacement incidental items (such as flooring, storage space, and cabinets) if necessary due to kitchen modification

• Home safety devices such as door alarms, anti-scald devices, hand-held shower head, and grab bars for the bathroom

• Ramps

• Single room air or portable conditioner(s)/single room air purifier(s)

• Vertical lift and/or stair lift

• Widening of doorways, including exterior doors and interior bedroom, bathroom, kitchen door, or any internal doorway as needed to allow for access. Pocket doors may be requested.

• Windows - Replacement of glass with plexiglass or other shatterproof material when there is a documented medical or behavioral reason

Integrated healthcare coordination is designed improve a participant's health status and quality of life, delay/prevent deterioration of health, manage chronic conditions in collaboration with physicians, and integrate medical and social services. Healthcare coordination includes medical coordination provided by an RN, LPN, or licensed social worker (LSW) to manage the individual's healthcare, including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan.

Nonmedical transportation services are offered to enable waiver participants to gain access to waiver and other nonmedical community services, activities, and resources.

Transportation services are reimbursed in three different ways:

• Nonassisted Transportation - The individual does not require mechanical assistance to transfer in and out of the vehicle.

• Assisted Transportation - The individual requires mechanical assistance to transfer into and out of the vehicle.

• Adult Day Service Transportation - The individual requires round-trip transportation to and from adult day service.

Nutritional (dietary) supplements include liquid supplements, such as Boost or Ensure, to maintain an individual’s health, so that they are able to remain in the community. Nutritional supplements must be prescribed by a physician, physician assistant, or nurse practitioner. Approved nutritional supplement expenditures are reimbursed through the local AAA or through an independent case management company, which maintains all receipts and verifies the delivery of services.

The personal emergency response system (PERS) is an electronic device that enables waiver participants to secure help in an emergency. The participant may wear a portable help button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center if the button is activated. The response center is staffed 24 hours a day, 7 days a week by trained professionals.

Pest control services are designed to prevent, suppress, or eradicate issues with pests including roaches, mosquitoes, bed bugs, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice. Reimbursement for approved pest control expenditures is through the local AAA or through an independent case management company, which maintains all receipts and verifies the delivery of services.

Respite services are provided temporarily or periodically in the place of the usual caregiver. Respite can occur in home and community-based settings other than adult family care and assisted living.

The following activities are allowed under respite services:

•  Home health aide services

•  Skilled nursing services

The specialized medical equipment and supplies service includes medically prescribed items required by an individual’s service plan, which assist the participant in maintaining his or her health and safety and enable the participant to function with greater independence in the home.

The following are allowable activities under specialized medical equipment and supplies:

• Lift Chairs

• Medication dispensers

• Toileting and/or incontinence supplies that do not duplicate Medicaid State Plan Services

• Slip-resistant socks

• Self-help devices – including over-the-bed tables, reachers, adaptive plates, bowls, cups, drinking glasses, and eating utensils

• Strollers – when needed because participant’s primary mobility device does not fit into the participant’s vehicle/mode of transportation, or when the participant does not require the full time use of a mobility device, but a stroller is needed to meet the mobility needs of the participant outside of the home setting.

• Voice active smart devices

• Interpreter service – provided in circumstances where the interpreter assists the individual in communication during scheduled meetings for service planning (for example during required waiver case management visits) and is not available to facilitate communication for other service provision.

Structured family caregiving is an arrangement in which a participant lives with a primary caregiver who provides daily care and support based on the participant’s daily care needs. The primary caregiver may be a family member or a nonfamily member who lives with the participant in the home of the participant or the primary caregiver. Caregivers must be qualified to meet all federal and state regulatory guidelines and be able to provide care and support to the participant based on his or her assessed needs. Caregivers receive training and are paid a daily stipend for the care and support they provide.

Vehicle modifications are the addition of adaptive equipment or structural changes to a motor vehicle that will allow a participant to have safe transportation in a motor vehicle. Justification is required to demonstrate that the modification is necessary to meet the participant’s need(s).

The following are allowable under the vehicle modifications service:

• Wheelchair lifts

• Wheelchair tie-downs (if not included with lift)

• Wheelchair/scooter hoist

• Wheelchair/scooter carrier for roof or back of vehicle

• Raised roof and raised door openings

• Power transfer seat base

The vehicle to be modified must meet all the following:

• The participant or primary caregiver is the titled owner.

• The vehicle is registered and/or licensed under state law.

• The vehicle has appropriate insurance as required by state law.

• The vehicle is the participant’s sole or primary means of transportation.

• The vehicle is not registered to or titled by an FSSA-approved provider.

• Only one vehicle per a participant’s household may be modified.