Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.07-025 - ElderChoices Home and Community-Based (H&CB) 2176 Waiver Provider Manual Update Transmittal #79

A. ElderChoices H&CB Waiver providers must be certified by the Division of Aging and Adult Services (DAAS) as having met all Centers for Medicare and Medicaid Services (CMS) approved provider criteria for the service(s) they wish to enroll to provide.

B. The provider must complete and submit to the EDS Provider Enrollment Unit a provider application (form DMS-652), a Medicaid contract (form DMS-653) and a Request for Taxpayer Identification Number and Certification (Form W-9). A copy of the current certification must accompany the provider application and Medicaid contract. Subsequent certification renewals must be submitted upon receipt. View or print a provider application (form DMS-652), Medicaid contract (form DMS-653) and Request for Taxpayer Identification Number and Certification (Form W-9).

Certification by the Division of Aging and Adult Services does not guarantee enrollment in the Medicaid program.

C. Enrollment as a Medicaid provider is conditioned upon approval of a completed provider application and the execution of a Medicaid provider contract. Persons and entities that are excluded or debarred under any state or federal law, regulation or rule are not eligible to enroll, or to remain enrolled, as Medicaid providers.

All providers must maintain their provider files at the EDS Provider Enrollment Unit by submitting current certification, licensure, etc., all DAAS-issued certification renewals and any other renewals affecting their status as a Medicaid-eligible provider. Failure to submit required documents will result in termination of the provider's eligibility for reimbursement of services. Providers may avoid a cancellation of provider eligibility by timely submission of required materials to the EDS Medicaid Provider Enrollment Unit. View or print the Provider Enrollment Unit contact information.

Copies of certifications and renewals required by DAAS must be maintained by DAAS to avoid loss of provider certification. These copies must be submitted to DAAS ElderChoices Provider Certification. View or print the Division of Aging and Adult Services ElderChoices Provider Certification contact information.

211.000 Scope

The Arkansas Medical Assistance (Medicaid) Program offers certain home and community-based outpatient services as an alternative to nursing home placement. These services are available to individuals aged 65 years or older who require an intermediate level of care in a nursing facility. The community-based services offered through the ElderChoices Home and Community-Based 2176 Waiver, described herein as ElderChoices, are as follows:

212.320 Physician Authorization Of The ElderChoices Plan Of Care with Personal Care Services

The following applies to individuals receiving both personal care services and ElderChoices services.

212.321 Internal Procedures

212.322 Revisions when the Plan Of Care Contains Personal Care Services

Requested changes to the personal care services included in the plan of care may originate with the personal care RN or the DHHS RN, depending on the participant's circumstances.

If the change is requested by the DHHS RN, a copy of the revised ElderChoices plan of care and form AAS-9510 will be mailed to the personal care provider. The personal care agency is responsible for securing the required physician's order, according to Arkansas Medicaid Personal Care policy. Once the personal care service begins, the DHHS RN must be notified via the AAS-9511. If any problems are encountered with implementing the requested revisions, the DHHS RN will contact the personal care provider to discuss possible alternatives. These discussions and the final decision regarding the requested revisions must be documented in the nurse's narrative. The final decision, as stated above, rests with the DHHS RN.

212.410 Institutionalization

An individual cannot receive ElderChoices waiver services while in an institution. However, the following policy will apply to active waiver cases when the individual is hospitalized or enters a nursing facility.

212.420 Non-lnstitutionalization

When a waiver participant is absent from the home for reasons other than institutionalization, the county office will not be notified unless the participant does not return home within 30 days. If after 30 days the participant has not returned home and the providers can no longer deliver services as prescribed by the plan of care (e.g., the participant has left the state and the return date is unknown), the DHHS RN will notify the county office and action will be taken by the county office to close the waiver case.

213.000 Description of Services

213.100 Adult Foster Care

Adult foster care provides a family living environment for one or two participants who are functionally impaired and who, due to the severity of their functional impairments, are considered to be at imminent risk of death or serious bodily harm and, as a consequence, are not capable of fully independent living.

Adult foster care adds a dimension of family living to the provision of supportive services such as:

213.700 Respite Care

Respite care services provide temporary relief to persons providing long-term care for participants in their homes. Respite care may be provided outside of the participant's home to meet an emergency need or to schedule relief periods in accordance with the regular caregiver's need for temporary relief from continuous caregiving. If there is no primary caregiver, respite care services will not be deemed appropriate and subsequently will not be prescribed by the participant's physician.

In the event the in-home medical assessment performed by the DHHS RN substantiates a need for respite care services, the service will be prescribed as needed, via the participant's plan of care, not to exceed an hourly maximum. The DHHS RN will establish the service limitation based on the participant's medical need, other services included on the plan of care and support services available to the client. Respite care services must be provided according to the participant's written plan of care.

213.711 Facility-Based Respite Care

Facility-based respite care may be provided outside the participant's home on a short- or long-term basis by licensed adult foster care homes, residential care facilities, nursing facilities, adult day care facilities, adult day health care facilities. Level I and Level II Assisted Living Facilities, and hospitals.

Facility-based providers rendering services for eight (8) hours or less per date of service must bill S5135 for short-term, facility-based respite care. One (1) unit of service for procedure code ,S5135 equals 15 minutes. Eligible participants may receive up to 32 units of short-term, facility-based respite care per date of service.

Facility-based providers rendering services for twenty-four (24) hours per date of service must bill T1005 for long-term, facility-based respite care. One (1) unit of service for procedure code T1005 equals 15 minutes. Providers must render provide 96 units of service per date of service in order to bill procedure code T1005.

The benefit limit for facility-based respite care services is 2,400 units occurring from July 1 to June 30 of any state fiscal year. This benefit limit is inclusive of procedure code S5135 or 11005 or any combination of the two. Facility-based respite care services include short-term and long-term respite care services.

Parti cipants receiving long-term, facility-based respite care services may receive only ElderChoices PERS services concurrently.

Please refer to the NOTE found in section 213.500 regarding Home-Delivered Meals and facility-based respite services.

213.713 Facility-Based Respite Care Certification Requirements

To be certified by the Division of Aging and Adult Services as a provider of facility-based respite care services, a provider must be licensed in their state as one or more of the following:

213.800 Adult Companion Services

Adult companion services are non-medical care, supervision and socialization services provided to a functionally impaired adult. Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services. The provision of companion services does not entail hands-on nursing care. Providers may also perform light housekeeping tasks which are incidental to the care and supervision of the individual. This service is provided in accordance with a therapeutic goal in the plan of care, and is not purely diversional in nature. When required and in accordance with a therapeutic goal in the plan of care, a companion who meets state standards for providing assistance with bathing, eating, dressing and personal hygiene may provide these services when they are essential to the health and welfare of the individual and in the absence of the individual's family. Companion services must be furnished outside the timeframe of other waiver services and state plan personal care. An individual receiving adult companion services cannot receive waiver adult foster care or in-home respite services.

Services must be provided according to the participant's written ElderChoices plan of care.

Providers of Adult Companion Services must bill procedure code S5135 and the required modifier U1. One (1) unit of service for procedure code S5135 equals 15 minutes. Eligible participants may receive up to 1200 hours per SFY of Adult Companion Services, In-Home Respite, Facility Based Respite Care or a combination of the three.

213.810 Adult Companion Services Certification Requirements

To be certified by the Division of Aging and Adult Services as a provider of adult companion services, a provider must hold a current Class A and/or Class B license as providers of home health services as issued by the Division of Health Facility Services, Arkansas Department of Health and Human Services and be enrolled as a Medicaid personal care provider.

214.000 Documentation

In addition to the service-specific documentation requirements previously listed, ElderChoices providers must develop and maintain sufficient written documentation to support each service for which billing is made. This documentation, at a minimum, must consist of:

262.000 CMS-1500 Billing Procedures

262.100 HCPCS Procedure Codes

The following procedure codes must be billed for ElderChoices Services:

* Place of service code