200.000
LIFE360 HOMES GENERAL INFORMATION
201.000
Arkansas Medicaid Life360 HOMEs
Overview
This provider manual (manual) offers guidance for eligible
Arkansas Medicaid-enrolled hospitals to enroll as a Life360 HOME provider
(Life360). The Life360 will ensure clients in target populations are connected
to medical services and nonmedical supports in their communities to address
their health-related social needs (HRSN) through intensive care coordination.
Life360s are designed to supplement not supplant existing supports and
services. Medical care will continue to be delivered and billed as it is today.
There are three types of Life360s that will target populations to receive
intensive care coordination services and supports specifically designed to meet
those populations' unique needs (Life360 refers to all three types unless
otherwise specified):
A.
Maternal Life360 will support women whose Medicaid or
Medicaid-funded Qualified Health Plan (QHP) claims reflect a diagnosis code of
needing supervision for high-risk pregnancy. They will be supported either
through direct provision of evidence-based maternal and child home visitation
or through contract with evidence-based home visitation programs.
B.
Rural Life360 will support
individuals with mental illness as defined in this manual or substance use
disorder (SUD) who live in rural areas of the state by providing intensive care
coordination through care coordination coaches.
C.
Success Life360 will support
young adults most at risk of long-term poverty and associated poor health
outcomes due to prior incarceration, involvement with the foster care system,
or involvement with the juvenile justice system and young adult veterans who
are at high-risk of homelessness. The Success Life360 will provide intensive
care coordination directly or contract with community organizations to do
so.
201.100
Life360
Provider Eligibility
To be eligible to apply for enrollment as a Life360 provider
with Arkansas Medicaid, the entity must:
A. Be a current Arkansas Medicaid hospital
provider.
1. Maternal Life360 must be a
birthing hospital as defined within this manual.
2. Rural Life360 must be a small rural
hospital as defined within this manual.
3. Success Life360 must be an acute care
hospital as defined within this manual.
203.000
APPLICATION AND APPROVAL
PROCESS203.100
Letter of
Intent
The approval to be a Life360 happens in a four-phase process.
The process is designed to ensure that eligible providers demonstrate capacity
and ability to implement the program requirements outlined in this manual to
achieve the goals and outcomes of the Life360 program.
Submitting all required information in the application process
does not guarantee approval as a Life360. The Arkansas Department of Human
Services (DHS) Division of Medical Services (DMS) will review and determine
whether approval is warranted for all applicants.
To become an approved Life360, a hospital must first submit a
letter of intent (LOI) to DMS that includes:
A. The type(s) of Life360 the hospital is
applying to become;
B. Hospital
location, Medicaid provider ID, and proposed service area (counties to be
served); and
C. Name and contact
information for staff member serving as program lead.
D.
For a Maternal
Life360, the LOI must include
1. Estimated number of individuals the
hospital expects to serve with home-visiting supports and services in the
proposed service area and a description of how the hospital arrived at that
estimate. (Indicators could include local birth rates, number of child-bearing
age women in poverty, Medicaid enrollment or healthcare access, and other HRSN
needs and health outcomes);
2.
Number of women receiving maternity or obstetric services annually through the
hospital and/or its clinics (note: "hospital" in this section means the
hospital submitting the LOI);
3.
The name of the evidence-based home visiting model(s) the hospital intends to
use;
4. Whether the hospital will
use its own staff to conduct home-visiting OR contract with an external
organization to provide home-visiting; and
5. If contracting with an external
organization(s), name, and contact information of organization(s).
E.
For a Rural
Life360, the LOI must include:
1. Estimated number of adults in the service
area with mental illness and/or substance use disorder, the hospital expects to
serve and a description of how the hospital arrived at that estimate.
2. Estimated number of adults in the proposed
service area likely to be eligible due to mental illness and/or substance use
disorder;
3. Brief description of
the mental health and substance use disorder services provided by the hospital
or its clinics;
4. Names of
behavioral health service providers in the proposed service area and brief
description of services and/or supports they could provide to Life360 clients;
and
5. Number of acute crisis unit
beds the hospital currently operates or will develop.
F.
For a Success
Life360, the LOI must include:
1. Names of community service organizations
currently serving the employment, educational, or training needs of the
proposed service area and the estimated number served by the programs, if
available;
2. Estimated number of
adults in the proposed service area likely to be eligible for Success
Life360;
3. Identification of
community service organizations, if using
DMS will review the LOI to determine if the hospital meets the
eligibility criteria and provided all requested information. DMS reserves the
right to refuse an LOI if necessary to allow time to process Life360
applications previously submitted. DMS will inform the hospital either:
A. The LOI is approved and the hospital may
move to the application phase
B.
More information is needed before approval can be made; or
C. The hospital does not meet the criteria
outlined in this manual to move forward to application, for reasons including
but not limited to proposing to serve too few clients or proposing a service
area that is already adequately being served by other Life360s.
203.200
Application
Upon approval of the LOI, the hospital will submit a Life360
application within ninety (90) calendar days. The application must include
a:
A. A program narrative that
describes:
1. How intensive care coordination
will be designed and delivered according to requirements in this
manual;
2. Staff and organizational
experience;
3. Subcontractor
experience, if applicable; and
4.
Description of community partners
B. A community network assessment (template
provided) (see section 203.210 for more details);
C. A copy of the hospital's most recent
Community Needs Analysis (if available);
D. At least two letters of support from
potential community partner organizations;
E. Plan for community outreach, education,
and client communication;
F. How
services will supplement, not supplant, services already provided in the
community;
G. Description of
proposed referral network and signed agreements with community partner
organization, pending approval of the Life360 application (See section
203.210);
H. Plan for monitoring
client milestones and goals, collecting data on client outcomes, and monitoring
other quality improvement measures identified by DMS;
I. Startup and first-year program budget and
narrative justification; and
J.
Proposed screening tool(s) and a description of the screening processes
DMS will review the hospital's application and materials upon
receipt of a complete application package and will respond within a specified
timeframe in writing to approve, deny, or request additional information. If
additional information is needed, the applicant hospital will have thirty (30)
calendar days to provide the additional information. DMS will review and
approve or deny any application within a specified timeframe.
The following sections 203.210-203.230 provide criteria for
each application requirement.
203.210
Community Network
Assessment
As part of the application, the hospital will:
A. Complete an assessment of the service area
population demographics and a community resource inventory to determine the
available community resources and gaps. That inventory should include community
medical providers, community service organizations, and social service
providers to whom the Life360 can refer clients to access appropriate services
and supports.
1. Once a hospital becomes a
Life360, the hospital will update this information annually as a requirement of
the annual Life360 HOME agreement and will be responsible for ongoing program
and resource development.
2. Access
to medical services and availability of non-medical supports should be
described (i.e., number of primary care/specialists, number of organizations
providing supports and type of supports, data on wait times or distance to
care, if available).
B.
Identify providers and others in the service area who can serve as a referral
network to refer someone for Life360 services.
1. Referrals can be from a diverse array of
health and social service organizations, medical providers, and non-medical
supports in the community through formal and informal agreements and based on
the target population served.
2.
Determine which organizations will require formal community partner agreements,
particularly an entity that would share personal client information, to ensure
health information is protected. Applicant hospital will submit those
agreements as part of the application, and DMS will review them as part of the
application and/or readiness review process.
203.220
Referral Network
Outreach
After application approval, the selected applicant and its
partners will be responsible for community outreach to ensure entities that can
make referrals are aware of Life360 services and the referral process, for
general outreach and awareness activities directed at the target population as
well as key community groups that would have direct contact with and are
trusted by the Life360 target population.
203.230
Community Partner Organization
Criteria
To be eligible to contract with a Life360 hospital to provide
intensive care coordination services, an organization must meet the
qualifications for the relevant Life360 type, as described below. Hospitals are
responsible for confirming the organization has a tax identification number, is
in good standing with relevant government entities, and other due diligence of
partner organizations. Community partner organizations will work with the
Life360s to conduct outreach to ensure providers and local entities are aware
that they can refer clients for services.
A.
Maternal Life360 - The
Life360 or the organization with which the Life360 contracts to provide
home-visiting services and supports must use an evidence-based maternal and
child home visitation model. The selected model(s) must cover home visiting
services from pregnancy through at least the first two (2) years of the baby's
life.
B.
Success
Life360 - The organization with which the Life360 contracts must be
experienced in working with young adults most at risk of long-term poverty to
build their skills to be physically, socially, and emotionally healthy in order
to live in and contribute to their communities.
This section criteria does not apply to Rural
Life360. Hospitals will directly provide intensive care coordination to
the target population. Providers of behavioral health services will be engaged
by the hospital as key partners for referrals and delivery of services.
203.300
Startup
Once an application is approved, the selected applicant must
sign a startup agreement before DMS will release the first round of startup
funding. For information about the amount of startup funding allowed, see the
rate sheet. After the agreement is signed the selected applicant will be in the
startup phase, and DMS will release the first installment of startup funds. The
hospital must follow the startup plan and budget outlined in the approved
application. Hospitals may not receive more than one package of startup funding
for more than one application of the same type of Life360s.
For both Maternal Life360s and Rural
Life360s, startup funds will be:
A. Provided in two initial payments to be
used for the cost of starting the program.
1.
The first upon DMS approval of the application
2. The second after successful completion of
the readiness review
B.
Based on the approved program budget and contained in the startup
agreement.
C. Allowed to cover the
cost of staff, equipment, and supports identified in the selected applicant's
startup budget or otherwise approved by DMS. Expenditures will be subject to
audit.
For Success Life360s, startup funds will
be:
A. Provided in three initial
payments to be used for the cost of starting up the program.
1. The first upon DMS approval of the
application and signed startup agreement
2. The second after successful completion of
the readiness review
3. The third
payment will be released by DMS in accordance with the selected applicant's
approved startup agreement
B. Based on the approved annual program
budget contained in the startup agreement.
C. Allowed to cover the cost of staff,
equipment, and supports identified in the applicant's startup plan budget or
other uses approved by DMS. Expenditures will be subject to audit.
Each selected applicant must complete the startup phase within
the timeframe specified in its startup plan, not to exceed one-hundred-eighty
(180) days from the receipt of startup funds, or funds may be subject to
recoupment. During the startup phase, DMS and the hospital working to become a
Life360 will meet monthly to assess progress toward readiness review. DMS will
schedule readiness review at the end of the startup phase.
203.400
Readiness
Review
After approval of the application and completion of the startup
phase, a readiness review will be conducted by DMS or its contractor to
determine the selected applicant's readiness to fully implement the Life360
program. Readiness review will include an onsite visit to each location. Each
selected applicant will demonstrate that it is operationally ready to fulfill
all Life360 requirements including:
A.
Having the ability to submit enrollment requests to DHS and accept results of
client eligibility verification
B.
Having the ability to report required data to DMS in the format
requested
C. Having an HRSN
screening tool and the necessary staff training to administer it, a platform
for capturing results, and a process for linking clients to resources
D. Providing any other client assessment
tools to be used by the program
E.
Having a person-centered action plan (PCAP) template and plan for updating the
PCAP regularly, at a minimum annually
F. Having adequate program staff and
appropriate staff training
G.
Having fully executed community partner agreements
H. Having a referral network, agreements, and
a process for accepting and transferring protected health information
I. Demonstrating that the Life360 and its
partners have a communication, outreach, and referral plan
J. Having fund controls to correctly submit
payment for Life360 funding that is separate from medical services paid for by
Medicaid, Medicare, other insurance, and any other third-party payer
K. Having an operational acute crisis bed(s),
for Rural Life360 only
DMS will schedule the readiness review within five (5) business
days after being notified by the selected applicant that it is ready to
complete the review. DMS will complete readiness review and provide the outcome
of the review in writing within a specified timeframe of the onsite visit.
Following the completion of the readiness review, DMS will either:
A. Enroll the hospital as a Life360 provider,
enter into the Life360 HOME agreement, and release the second installment of
startup funds;
B. Release all or a
portion of the second installment of startup funds and provide in writing a
list of deficiencies and the timeframe by which the deficiencies must be
addressed for the hospital to demonstrate readiness; or
C. Deny enrollment as a Life360 for failure
to successfully complete readiness review.
203.500
Life360 HOME Agreement
To enroll in the Life360 program, applicants that successfully
complete the application process and readiness review will provide their tax ID
number and enter into the Life360 HOME agreement. The agreement will outline
required program obligations and legal requirements pertaining to the Life360
scope of work. Through execution of the agreement, providers agree to adhere to
all requirements in this manual and all applicable federal regulations and
state statutes.
203.700
Electronic Signatures
Medicaid will accept electronic signatures, provided the
electronic signatures comply with Arkansas Code §
25-31-103 et seq.
210.000
PROGRAM
REQUIREMENTS210.100
Client
Eligibility
Life360 client participation is voluntary. An individual is not
required or entitled to receive services from a Life360 as a condition of
Medicaid eligibility. To be screened for HRSN and/or Life360 eligibility,
clients must live in the service area served by the Life360. Residence can be
determined by the person's geographic residence, shelter residence or other
temporary residence, such as a health facility. If experiencing homelessness,
residence may be established by the last documented residence or shelter, work
history/place of employment, or child's school/childcare enrollment.
A client may be enrolled in only one Life360 program at any
time.
A client who moves from one Life360 service area to another may
continue receiving services through the new Life360 if the new Life360 type is
the same as the previous (e.g., Maternal to Maternal). If the Life360 type in
the new service area is different, the client may receive services from the new
Life360 only if the client qualifies for those services.
Additional eligibility requirements by Life360 type
include:
A. A woman is eligible for
Maternal Life360 intensive care coordination supports if she:
1. Is enrolled in Arkansas Medicaid or was
enrolled in Arkansas Medicaid when she began receiving Maternal Life360
services and is either pregnant with a high-risk pregnancy (a diagnosis of
needing supervision for high-risk pregnancy. High-risk pregnancy must be
verified through a completed referral form from the client's physician that
includes the most current clinical note.) OR
2. If enrolled in ARHOME at any point during
enrollment in the Maternal Life360 program, was enrolled in the Maternal
Life360 while pregnant with a high-risk pregnancy and delivered the baby within
the previous twenty-four (24) months
OR If enrolled in a Medicaid program that is not ARHOME for the
full duration of enrollment in the Maternal Life360 program, was enrolled in
the Maternal Life360 while pregnant with a high-risk pregnancy and delivered
the baby within the previous twelve (12) months.
3. Is not currently receiving state- or
federally funded home visiting services through a provider whose services cover
pregnancy or the first two (2) years of a baby's life.
B. An individual who needs assistance
confirming a high-risk pregnancy diagnosis will be eligible for assistance in
connecting with medical services until the need for supervision for high-risk
pregnancy is confirmed. The Life360 HOME will not receive per member per month
(PMPM) funding until the woman's pregnancy and eligibility for the program are
confirmed.
C. All adults living in
the
Rural Life360 service area are eligible for HRSN screening and
referrals to needed community supports. To be eligible for intensive care
coordination, the individual must:
1. Be
enrolled in ARHOME (through a qualified health plan [QHP] or Medicaid
fee-for-service [FFS]);
2. Have a
mental health and/or substance use disorder diagnosis;
3. Not be enrolled in the Provider-led
Arkansas Shared Services Entity (PASSE) program.
D. An individual is eligible for
Success Life360 intensive care coordination and supports if the
person:
1. Is enrolled in ARHOME (through a
QHP or Medicaid FFS);
2. Is at risk
of poor health due to poverty, meaning under one hundred thirty eight percent
(138%) Federal poverty level;
3. Is
not enrolled in the Provider-led Arkansas Shared Services Entity (PASSE)
program; and
4. Meets the criteria
for at least one of the following categories:
a. Is between nineteen (19) and twenty-four
(24) years of age and has been previously placed under the supervision of the
DHS Division of Youth Services as verified by DHS.
b Is between nineteen (19) and twenty-four
(24) years of age and has been previously placed under the supervision of the
Arkansas Department of Corrections, as verified by the Arkansas Department of
Corrections or DHS.
c Is between
nineteen (19) and twenty-seven (27) years of age and has been previously placed
under the supervision of the DHS Division of Children and Family Services, as
verified by DHS.
d Is between
nineteen (19) and thirty (30) years of age and is a veteran verified by DD214
Certificate or Release of Discharge from Active Duty.
210.200
General
Program Requirements
All Life360s must:
A.
Submit an annual budget and budget narrative, including staff, to DMS for
approval.
B. Provide an explanation
of how the Life360 will meet targeted number of clients to be served, if it
failed to meet expected numbers in the previous year
C. Provide service projections (e.g., the
number of clients the Life360 expects to serve, the number of visits
anticipated for each client, the number of individuals screened,
etc.)
D. Provide all other required
supports specified in the Life360 HOME agreement.
E. Provide or contract to provide supports
that demonstrate cultural competency and are provided in the languages
frequently spoken by the targeted population as identified in the community
assessment.
F. Comply with all
reporting requirements and deadlines specified in the Life360 HOME agreement
and any additional reporting requirements required by the Centers for Medicare
and Medicaid Services and/or the Arkansas Legislature.
G. Maintain fund controls to correctly submit
payment for Life360 funding that is separate from medical services paid for by
Medicaid, Medicare, other insurance, and any other third-party payer.
H. Provide a monthly expenditure report. The
expenditure report must provide all expenditures compared against budgeted
categories. Maternal Life360s will provide all program expenditures, but only
the expenditures for startup and transportation funding will be compared
against budgeted categories. For Rural and Success
Life360s, the monthly expenditure report also must include an estimate
of funds the Life360 anticipates will be unspent by the end of the program
year. DHS may adjust the annual budget in the middle of the year, if necessary,
to bring the Life360's operations in line with actual spending
patterns.
I. For Rural
and Success Life360s, unspent funds will be applied to the
Life360's budget for the following year, and DMS will reduce new funds provided
by the amount of unspent funds the Life360 is carrying forward. Life360s with
unspent funds cannot submit a budget in the subsequent year that exceeds the
budget for the year in which the unspent funds accumulated. DMS may make an
exception for circumstances that were unique to a particular program
year.
210.300
Service Area Criteria
The Life360 may define its service area. It must include the
county in which the Life360 is located and may include one or more counties
contiguous to that county or to each other. As part of the application process,
DHS will assess whether the applicant hospital can serve the selected service
area adequately or it needs to be adjusted.
Rural Life360 service areas may include counties containing a
Metropolitan Statistical Area (MSA), but the Life360 must be established to
primarily serve the hospital's patient population and non-MSA counties. DHS
will assess whether the applicant hospital's selected service area adequately
serves rural populations.
Success Life360 service areas must include the county in which
the hospital is located and the county in which the community partner
organization is located. If the hospital and the community partner organization
are in separate counties, the counties must adjoin.
210.400
Required Maternal Life360
Activities
The Maternal Life360 will provide directly or
through its selected community partner organization(s) the following services
and supports for their clients:
A.
Request from DHS enrollment and eligibility verification for individuals
referred or identified for home-visiting supports, including assisting
individuals with the diagnosis of need for supervision for high-risk pregnancy.
B Obtain a signed consent form from
clients to participate in the program and to authorize the Life360 HOME to
share their personal information with DHS, partner organizations, relevant
community service providers, and relevant health care providers.
C Administer screenings that include HRSN
screenings (upon client enrollment in Life360 and every six (6) months during
program participation) as well as other required health screenings for all
eligible clients that will help inform the supports delivered to improve
outcomes in:
1. Maternal Health
2. Child Health
3. Family Economic Self-Sufficiency
4. Positive Parenting Practices
D Provide home visitation
services with fidelity to an evidence-based home visiting model and linkages to
community resources and supports. Home visiting may be provided directly by the
hospital or through contract with evidence-based home visitation
program.
E. Assist with any needs
for coordination of medical services including support identifying and
connecting both the client and her baby to a PCP or OB/GYN and any other needed
medical and behavioral health providers or culturally relevant
supports.
F. Document home-visiting
services provided.
G. Disenroll
individuals who have asked to stop receiving services or who are uncooperative
with receiving services after three consecutive attempts to schedule a visit.
Disenrolled clients can re-enroll at their request within their pregnancy or,
for ARHOME enrollees, within the first twenty-four (24) months after delivery
and for participants in any other Medicaid aid category, within the first
twelve (12) months after delivery.
H. Ensure coordination with other home
visiting programs as applicable.
210.500
Required Rural Life360 Care
Coordination Activities
The Rural Life360 will provide the following
community screening and referral supports to the general population and care
coordination to identified clients.
A.
Create a plan and implement the plan to screen anyone in the community for HRSN
needs and provide support for community providers to complete and submit HRSN
screens for the people they serve.
B. Connect individuals whose HRSN screen
identifies an HRSN need to local medical and non-medical resources, including
food, housing, and transportation.
C. Accept referrals for care coordination
supports for eligible clients from health care providers treating individuals
with mental illness or substance use disorder.
The Rural Life360 will provide the following
healthcare capacity building activities:
A. Develop and operate an acute crisis unit
that meets the requirements of 218.400 of the Arkansas Medicaid Hospital
Provider Manual or a psychiatric care unit that meets the requirements
specified in the Rules for Hospitals and Related Institutions in Arkansas. The
ACU or psychiatric unit must serve individuals in need of mental health or
substance use crisis services in the Rural Life360 hospital. The Rural Life360
hospital must begin acute crisis unit or psychiatric services within the
timeframe approved by DMS.
The Rural Life360 will provide the following care
coordination supports:
A. Request from
DHS enrollment and eligibility verification for individuals referred or
identified for intensive care coordination supports.
B. Obtain a signed consent form from clients
to participate in the program and to authorize the Life360 HOME to share their
personal information with DHS, partner organization, relevant community service
providers, and relevant health care providers.
C. Provide intensive care coordination and
coaching supports for enrolled clients. Intensive care coordination and
coaching include:
1. Collecting or completing
an HRSN screen upon client enrollment in Life360 and every six (6) months
during program participation.
2.
Conducting an in-depth personal interview related to the health-related social
needs identified in the screening and the barriers to resolving health-related
social needs. The Rural Life360 is responsible for developing the interview
tool to be used, the implementation process and the staff training process for
engaging clients.
3. Developing and
maintaining a person-centered action plan (PCAP) for each client that includes:
a. The client's goals and preferences for
addressing needs. Goals must include accessing a PCP and all needed medical
providers and services. Goals also may include mental and emotional wellness,
financial goals, applying for or completing workforce training or education
programs, obtaining or maintaining employment, and obtaining or sustaining safe
housing.
b. Results of the HRSN
screen and personal interview including strengths and relevant personal
history, for example, criminal justice involvement.
c. Plan for overcoming barriers for accessing
services and for avoidance of non-emergency ED visits.
d. Unmet needs for medical services and
non-medical community supports and a plan for meeting those needs.
4. Working directly with clients
and their families to improve their skills to be healthy physically, socially,
emotionally and to thrive in their communities. Follow up supports may include
the following activities as specified in the PCAP:
a. Engaging clients in promoting their own
health
b. Coordinating with
external medical and non-medical providers to connect clients with needed
health services and community supports
c. Assisting clients with applying for
services including scheduling and completing assessments for entry into the
PASSE program, if needed
d.
Assisting clients in obtaining services that reduce preventable utilization of
emergency departments and inpatient hospital settings
e. Increasing client engagement in
educational and employment opportunities and other supports that reduce the
risk of poverty
f. Transporting
clients to non-medical appointments. Life360 funds cannot be used for costs
incurred transporting a client or assisting with transportation of a client to
a job interview
5.
Providing supports through any of the following:
a. Home visits in such frequency as is
necessary to assist the client meet his/her documented PCAP goals
b. Office visits
c. Video-supported visits
d. Telephone or text message contacts in
conjunction with in-person visits
6. Documenting client's progress toward
meeting goals established on person-centered action plan, including:
a. Weekly update of client and staff
activities
b. Gaps in available
community services
c.
Responsiveness from client
d. Any
completed or newly identified goals or unmet needs
210.600
Required
Success Life360 Care Coordination Activities
The Success Life360 will work with its partner
organization to provide the following services:
A. Request from DHS enrollment and
eligibility verification for individuals referred or identified for intensive
care coordination and supports.
B.
Obtain a signed consent form from client to participate in the program and to
authorize the Life360 HOME to share the client's personal information with DHS,
partner organizations, relevant community service providers, and relevant
healthcare providers.
C. Provide
intensive care coordination and coaching supports for clients to include:
1. Collecting or completing a HRSN screen
(upon client enrollment in Life360 and every six (6) months during program
participation)
2. Conducting an
in-depth personal interview related to HRSN identified in the screening and the
barriers to addressing those needs. The Life360 is responsible for developing
the interview tool to be used, the implementation process and the staff
training process for engaging clients
3. Developing and maintaining a PCAP for each
client that includes:
a. Client goals and
preferences for addressing needs. Goals should address:
i. Obtaining a primary care physician and
addressing unmet medical needs
ii.
Mental and emotional wellness
iii.
Financial needs, including applying for or completing workforce training or
education programs
iv. Obtaining or
maintaining employment, and
v.
Obtaining or sustaining safe housing
b. Identified HRSN needs and personal
interview results, including strengths and personal history if applicable, such
as criminal justice involvement
c.
Plan for overcoming barriers for accessing services and avoidance of
non-emergent emergency department visits
d. Unmet needs for non-medical community
supports and a plan for meeting those needs
4. Working directly with clients and their
families to improve their skills to be healthy physically, socially,
emotionally, and to thrive in their communities. Services may include the
following activities as specified in the PCAP:
a. Engaging clients in promoting their own
health
b. Coordinating with
external medical and non-medical providers to connect clients with needed
health services and community supports
c. Assisting clients in obtaining services
that reduce preventable utilization of emergency departments and inpatient
hospital settings
d. Strengthening
client life skills and implement plan to maximize participation in education,
employment training and other supports that reduce the risk of
poverty
e. Transporting clients to
non-medical appointments. Life360 funds cannot be used for costs transporting a
client or assisting with transportation of a client to a job
interview.
5. Providing
supports through:
a. home or community
visits
b. office visits including
career center
c. video-supported
visits
d. telephone or text message
contacts, though not exclusively so
6. Documenting client's progress toward
meeting goals established in the PCAP, including:
a. Weekly update of client and staff
activities
b. Gaps in available
community services
c.
Responsiveness from client
d. Any
completed or newly identified goals or unmet needs
210.700
Program
Funding
After the startup phase and successful completion of
readiness review, Maternal Life360 will receive the following
payments:
A.
A
PMPM: global payment will be made to a Maternal Life360 to cover
the costs of all home visiting services necessary to implement home visiting
model fidelity and administrative costs of operating the program (staff
recruitment and training, data collection and reporting, financial management,
etc.). The global payment will be actuarially sound and made to each Maternal
Life360 on a per member per month (PMPM) basis. The global capitation payment
amount is determined by Arkansas Medicaid.
B.
Transportation:
An annual amount specified in the Life360 HOME agreement. DMS will divide the
amount into equal monthly amounts and pay the Life360 monthly. The funding may
be used for transportation costs incurred during home visits to clients, to
transport clients to non-medical appointments (excluding transportation to job
interviews), or to obtain other HRSN-related supports. Allowable uses of this
funding include:
1. Gasoline or mileage for
the Life360s travel
2. Bus travel,
car rental, and taxi or other driver service for non-medical appointments for
clients necessary to meeting the client's documented HRSN needs (excluding
transportation to job interviews)
3. Staff time for operating a vehicle for
transporting clients to and from non-medical appointments
C. The Maternal Life360 will
receive a prorated PMPM for clients beginning upon client enrollment in in the
Maternal Life360. Payments will be prorated for the number of days in the month
from the client enrollment date.
Rural Life360s will receive three (3) additional
types of payments following startup costs for:
A.
Transportation:
An annual amount specified in the Life360 HOME agreement. DMS will divide the
amount into equal monthly amounts and pay the Life360 monthly. The funding may
be used for transportation costs incurred during home visits to clients, to
transport clients to non-medical appointments (excluding transportation to job
interviews), or to obtain other HRSN-related supports. Medicaid clients should
utilize non-emergency transportation services for medical appointments.
Allowable uses of this transportation funding include:
1. Gasoline and mileage for the Life360s
travel
2. Bus travel, car rental,
and taxi or other driver service for client transportation to non-medical
appointments necessary to meeting the client's documented HRSN needs (excluding
transportation to job interviews).
B.
Emergency Equipment and
Training: In a monthly amount based on the approved annual program
budget and specified in the Life360 HOME agreement. DMS will divide the annual
amount by twelve (12) and pay the Life360 monthly up to the annual allotment
amount.
The funding may be used for costs related to improving
emergency medical services in the rural communities that the Life360 serves,
including enhanced equipment and staff training, and to support improvements in
equipment necessary for the delivery of medical services through telemedicine.
An accounting of these funds must be provided as part of the monthly
expenditure reports.
C.
Intensive Care Coordination: In a monthly amount based
on the approved program budget and specified in the Life360 HOME agreement. DMS
will pay an all-inclusive flat rate monthly to pay for assisting clients
through intensive care coordination, one-on-one engagement, community HRSN
screening and referrals, the cost of supervisors, and other program costs. The
fee includes both direct program costs and indirect costs as outlined in the
program payment section. Allowable uses include staff, equipment, and supports
identified in startup plan and budget, and other uses approved by DMS.
Time-limited expenses to enable a client to access services or supports to meet
an identified HRSN also are allowable program costs. Refer to the glossary
under HRSN reimbursable costs. The all-inclusive rate will include an amount up
to 20 percent of the direct staff costs for indirect costs associated with
managing the program.
D.
Acute Care Unit Observation and Stabilization Staff:
In a monthly amount based on the approved program budget and specified in the
Life360 HOME agreement. DMS will divide the annual amount used for costs
related to maintaining continuous clinical staff in the acute care unit into
monthly amounts. This funding is intended to assist the hospital with paying
for the ACU to be staffed and available even when patient services are not
immediately needed.
Success Life360 will receive three additional
types of payments following the startup payments:
A.
Technology: An
annual amount based on the approved annual program budget and specified in the
Life360 HOME agreement. DMS will divide the amount into equal monthly amounts
and pay the Life360 monthly. The funding may be used for technology costs
incurred to support data-sharing with partner organizations and providers that
serve clients, including equipment, infrastructure, and technology and data
services.
B.
Intensive
Care Coordination: In an annual amount based on the approved
program budget and specified in the Life360 HOME agreement. DMS will pay an
all-inclusive flat rate monthly to pay for assisting clients through intensive
care coordination, one-on-one engagement, the cost of supervisors, and other
program costs. The fee includes both direct program costs and indirect costs as
outlined in the program payment section (See 230.000, Payment Details).
Allowable uses include staff, equipment, and supports identified in the startup
plan and budget, and other uses approved by DMS. Time-limited expenses to
enable a client to access services or supports to meet an identified HRSN also
are allowable program costs. Refer to the glossary under HRSN reimbursable
costs. The all-inclusive rate will include an amount up to 20 percent (20%) of
the direct staff costs for indirect costs associated with managing the
program.
C.
Success
Payments: DHS will award a success payment to the Life360 for each
enrolled client who achieves the following goal(s):
1. Clients who were formerly in the custody
of the DHS Division of Youth Services or the Arkansas Department of Corrections
remain out of the judicial system (no arrests or criminal charges) and out of
incarceration for twelve (12) consecutive months after enrollment in the
Life360.
2. Attains an educational
diploma, certificate, or degree, including a General Educational Development
certificate, high school diploma, associate degree, certificate program through
an accredited institution of higher education, or completes a workforce
training, trade, or other work certification program after enrollment in the
Life360.
3. Achieves full-time
employment and maintains it for twelve (12) consecutive months after enrollment
in the Life360.
4. Maintains
full-time employment for twelve (12) consecutive months after enrollment in the
Life360.
5. Clients who have a
diagnosis of SUD and maintain sobriety for twelve (12) consecutive months as
confirmed by a treatment program, rehabilitation program, sponsor, or support
group leader after enrollment in the Life360.
Success Life360s will inform DHS of any clients
who have achieved any of these milestones. DHS will review and determine
whether the Life360 may receive one (1) or multiple success payments for a
single client who achieves in more than one (1) category. The amount of the
payments will be established annually and published in the Life360 HOME
agreement. Life360s may provide enrolled clients nominal incentives valued at
no more than two-hundred and fifty dollars ($250) annually for achieving
milestones or goals.
Maternal, Rural and Success Life360 expenditures will be
subject to audit.
210.800
Acceptable Performance and
Performance Measures
Life360's supports must meet acceptable performance, which will
be determined based on whether it has been able to fulfill the program
requirements and performance measures outlined in the Life360 HOME agreement
with DMS, including:
A. Serving the
targeted number of clients, number of visits, number of individuals screened,
as specified in the Life360 HOME agreement
B. Meeting all reporting requirements
specified in the Life360 HOME agreement in the specified timelines
C. Demonstrating client success as evidenced
by meeting annual targets outlined in the Life360 provider agreement.
Life360 performance measures are proposed and subject to change
based on the final evaluation and monitoring plan approved by CMS.
DHS will ensure that Life360s meet acceptable performance and
that action is taken to address any identified non-compliance with Life360
funding parameters. If DHS determines that a Life360 has failed to demonstrate
appropriate performance, including enrolling an insufficient number of clients,
DHS may impose corrective actions that could include:
A. A corrective action plan
B. Caps on funding
C. Recoupment of funds
D. Discontinuation of Life360 funding
DHS also may impose corrective actions for a Life360 if it
determines the Life360 is out of compliance with requirements included in the
Life360 HOME agreement and/or policy letters or guidance set forth by DHS or
CMS ARHOME 1115 Demonstration Special Terms & Conditions or the CMS 1915(b)
Standard Terms & Conditions. Prior to initiating any corrective action on a
provider, DHS shall provide the provider notice and an opportunity to comment
regarding the identified area of
non-compliance.
220.000
DELIVERY OF SERVICES
220.100
Life360 Client
Engagement
This manual is not exhaustive of what will need to be in place
to ensure consistency and integrity of services provided to Life360 clients.
Programs are expected to establish policies and procedures prior to
implementation to ensure successful client engagement, safety, and adherence to
all applicable laws and/or requirements in serving clients. To that end,
Life360s will be responsible for ensuring the following guidance for services
as well as any requirements contained in the Life360 HOME agreement, or in this
manual pertaining to provision of services, are incorporated.
220.200
Consent
Each client who is confirmed eligible by the Life360 will
complete a consent form prior to intensive care coordination services
beginning. Clients must be informed of relevant program policies and procedures
relative to their participation in the program including client and staff
safety, confidentiality, how long/frequent services are available, program
expectations, and that services are voluntary. This program communication must
be approved by DHS.
The program must notify clients at the time of consent if there
will be a delay in starting services for any reason (i.e., program at capacity,
facility, or staff issue), inform the client of the wait time, and the referral
partner, if applicable. The Life360 should connect waiting clients with other
supports/services until Life360 services may begin. Life360s will not receive a
PMPM payment for clients awaiting Life360 services. The Life360 must notify its
referral network when clients cannot be assigned to a care coordinator due to
capacity limitations or other factors. The Life360 must notify DHS if the
program is delaying services for new clients or suspending services to existing
clients. The notification must be made within five days of denying or
suspending services to eligible clients.
220.300
Duration of Services
The total length of time in which clients can receive intensive
care coordination services is as follows:
A.
Maternal Life360 - Services
begin during pregnancy through home-visiting and continue up to two years after
birth of the baby for clients enrolled in a QHP through ARHOME and one year for
clients enrolled in any other Medicaid category of assistance and based upon
continued need of home-visiting support.
B.
Rural Life360 - Services can
be provided by care coordination coaches for up to twenty-four (24) months if
the individual is actively working towards his or her goals and the individual
remains eligible for the ARHOME program. DMS may extend the amount of time
someone is eligible for a Rural Life360 based on a review of goals and progress
toward those goals. If an enrolled client moves to another Medicaid aid
category, the client will be disenrolled from the Rural Life360
program.
C.
Success
Life360 - Services are based upon PCAP goals, and obtainment of goals is
expected to be achieved in twenty-four (24) months or less. If an enrolled
client moves to another Medicaid aid category, the client will be disenrolled
from the Success Life360 program.
220.400
Person-Centered Action Plan
(PCAP)
Rural Life360 and Success Life360
clients will develop an individualized person-centered action plan (PCAP)
facilitated by their care coordination coach or community partner organization
to address health needs and HRSN. The PCAP will be updated regularly to reflect
goals met, new circumstances or needs, annually at a minimum. The PCAP must
describe the client's strengths, preferences, and HRSN as identified by the
HRSN screen as well as needs for linkage with medical providers. The plan must
include short-term (less than 6 months) goals, a crisis plan, and longer-term
goals (more than 6 months). Each PCAP must include goals in areas identified
through screening and ongoing interaction with the client, including but not
limited to:
A. Safe housing including
utilities, if necessary
B. Food
security and nutrition
C.
Employment and/or education
D.
Financial stability and any needed social services
E. Health and emotional wellness
F. Establishing a relationship with a PCP and
all needed healthcare providers for preventative care (and to avoid
non-emergent emergency department visits)
G. Criminal justice involvement, if
applicable
H. Transportation
Maternal Life360 will implement the approaches of
the evidence-based model selected and/or processes set by the program that
utilize best practices and tools for quality and effectiveness of home visits
and to document observations and assessments of maternal/child health and any
other family outcomes included. Therefore, a separate PCAP will not be
required.
220.500
HRSN Screening and Other Assessments
A HRSN screening will be conducted with every Life360 client as
part of the initial eligibility determination within fifteen (15) calendar days
of referral and every six (6) months during program participation. This
screening also starts the process to identify areas for intensive care
coordination. The screening should be done in a manner that is consistent, or
asks the same questions across individual clients, is accessible or engaging
for the client, and is coordinated with any additional screening and assessment
that may part of the program. The screening tool must address the following
core elements.
A. Housing
instability
B. Food
insecurity
C. Utility
needs
D. Interpersonal
safety
E. Transportation
needs
F. Financial strain
G. Employment
H. Family and community support
I. Education
J. Physical activity
K. Substance use
L. Mental health
M. Disabilities
DHS will review the screening tool(s) during the application
process. DHS may provide feedback on the tools and require revisions to ensure
alignment with program goals. If a Life360 changes its HRSN screening tool, it
must submit its new tool before making the change to DHS for approval. Life360s
may only change screening tools at the beginning of a calendar year.
220.600
Intensive
Care Coordination
Care coordination will be conducted by:
A. Home-visiting staff who meet the
qualifications of the evidence-based home-visiting model the Life360 implements
for the Maternal Life360 program
B.
Care coordination coaches for the Rural Life360 program who are vetted and
approved by the hospital. Individuals may be a peer or someone with lived
experience, and/or an individual familiar with local resources
C. Staff or volunteers vetted and approved by
community partner organizations for Success Life360 program
The individuals in these roles are expected to form a trusting
relationship with the client and serve as a significant source of support to
the client. Individuals in these roles will meet with the client as frequently
as needed and provide life skills development and training as appropriate and
directly connect the client with medical, educational, and social services and
supports needed to meet the client's goals. They also will actively assist the
client in obtaining services and supports, communicating with providers about
referrals and outcomes of services and supports, encourage and motivate the
client to set and attain goals and meet milestones, and provide advocacy as
needed.
220.700
Frequency and Duration
Frequency of interaction, or how much time lapses in between,
is to be determined based on the selected program model or evidence-based,
home-visiting model. Meetings/visits with client should be based on the
client's needs and occur consistently. The duration of client meetings/visits
(e.g., one (1) hour) should be sufficient to address client needs, follow any
program model guidance or policies, and be flexible enough to accommodate the
client's work schedule/life circumstances.
220.800
Setting and Location
Intensive care coordination may be delivered in the client's
home, the community partner organization facility, medical clinic, behavioral
health clinic, or hospital settings. For some clients, services may occur in a
shelter setting or educational/job training settings. Video-supported visits
also may be appropriate, particularly for Rural Life360 or clients
being served in remote areas or for clients experiencing contagious
illness.
220.900
Client Termination of Services
A client may terminate services at any time by informing the
DHS enrollment broker or Life360 provider if they no longer wish to
participate. Clients may be allowed to re-enroll at any time if they remain
eligible for the program.
Life360s must disenroll clients for the following
reasons:
A. Client moved outside of
the program's service area
B.
Client is living in an institution for more than thirty (30) days
C. Client is incarcerated or in
jail
D. Client has died
E. Client has an illness that does not allow
for continued participation
F.
Client continues to display disruptive or unsafe behavior that threatens staff
safety
G. Client is no longer
eligible for the program
H. Client
stops participating in services for thirty (30) days and is non-responsive to
Life360 contact efforts
I. Other
reasons approved by DMS
If the reason for disenrollment is failure to participate in
the program, the Life360 must attempt to contact the client at least three
times before moving forward with disenrollment. The Life360 must provide
notification of disenrollment to DHS for E, F, H, and I that provides the
reason for the disenrollment and supporting information.
Life360s may not terminate services because a client is
experiencing homelessness or housing instability. The Life360 or its community
partner organization should work with the client to identify resources to move
toward stable housing as well as arrange other safe settings for meetings where
client confidentiality can be maintained and that are safe. Clients who enter a
residential treatment program or who may have an illness for a brief period (60
days or less) can be temporarily suspended in the program and resume when the
client is able to participate in services.
220.950
Documentation of Intensive Care
Coordination in Client File
Providers must develop and maintain sufficient written
documentation for each client being served. This documentation, at a minimum,
must consist of:
A. Signed consent by
client, or client's legal guardian, to receive services and share data with
DHS, community partners
B. Date
services begin and referral documentation
C. A copy of all PCAPs, home-visiting
assessments, and HRSN assessments
D. Services or supports rendered or obtained
by client
E. Referrals and outcomes
of referrals for HRSN
F. The date
and time intensive care coordination occurs
G. The name and title of the individual who
provided the service
H. Updates for
each client contact describing the client's progress toward milestones and
goals and any concerns/issues with engagement
I. Completed forms as required by DHS or
other entity
Additional documentation and information may be required
depending on the service to be provided.
230.000
PAYMENT DETAILS
230.100
Allowable Life360 costs
Subject to the funding limits in the ARHOME 1115 Waiver, DHS
will review, approve, and make payments for Life360 funding in accordance with
the requirements in the 1115 demonstration Special Terms and Conditions and
other CMS requirements. DHS will make payments directly to the approved and
enrolled hospitals. Life360 funding must not supplant funding provided by other
federal, state, or local funding sources.
Providers must attest during readiness review to DHS that they
have appropriate fund controls to correctly submit payment for Life360 funding
that is separate from medical services paid for by Medicaid, Medicare, other
insurance, and any other third-party payer. Expenditure authority will make
funding available to selected Medicaid-enrolled hospitals for:
A. Intensive care coordination service for
target populations, including direct costs of recruiting, training, and
employing care coordinators to provide intensive care coordination to the
targeted Life360 population
B.
Indirect costs necessary to support ongoing project costs such as information
technology or personnel directly responsible for the project including fiscal,
programmatic, etc.
C. Startup costs
necessary for the development of capacity, infrastructure, and systems to begin
the program, complete a community network assessment, and formulate
partners/subcontractors, and
D.
Nonmedical client supports as outlined in this manual.
Medical care costs are not reimbursable and should
be billed as usual through the client's Medicaid program.
More details on included costs for each type of Life360 are
described in 210.700, Program Funding.
Capital improvement costs beyond specific allowed costs are not
allowable. Please refer to HRSN-reimbursable costs in this manual in 240.000,
Glossary and in 210.700, Program Funding sections for more details on allowable
expenditures.
230.200
Maternal Life360 Payment and
ReportingA. Arkansas Medicaid will pay
the Maternal Life360 a per member per month (PMPM) fee based on the established
program rates.
1. Providers must enroll
clients to receive the PMPM payment for each enrollee.
2. Refer to the Rate Sheet for the current
fee. Fees will be updated based on rate review on an as needed basis.
B. Startup payment and monthly
transportation fees will be paid to the hospital's provider ID.
C. Programs will be able to reconcile cost
differences at the end of the year (or more frequently) based on any changes to
their program that may warrant a rate adjustment within the established program
rate structure.
230.300
Rural Life360 Payment and Reporting
Startup payments and monthly payment will be made to the
hospital's provider ID and per the terms of the Life360 HOME agreement.
Reporting requirements by cost type:
A. Intensive Care
Coordination: The Life360 will complete monthly cost reports using
the DHS approved form. The report should be for the actual cost of care
coordination services and community HRSN screenings and indirect costs for that
month. The amount may vary based on ongoing expenditures/costs but will not
exceed the total approved annual budget in the Life360 HOME
agreement.
B.
Transportation/Emergency Equipment and Training: The
Life360 will prepare and submit a monthly cost report for the prorated annual
transportation and emergency equipment and training expenditures.
C.
Startup: The
Life360 shall provide start-up cost(s) once DHS approves successful completion
of the application or readiness review and the Life360 has submitted a signed
agreement. Startup costs will be reported monthly.
230.400
Success Life360 Payment and
Reporting
Monthly payment will be made to the hospital's provider ID per
the terms of the Life360 HOME agreement.
Reporting requirements by cost type:
A. Intensive Care
Coordination: The Life360 will complete monthly cost reports using
the DHS approved form. The report should be for the actual cost of care
coordination services and indirect costs for the month. The amount may vary
based on ongoing expenditures/costs but will not exceed the total approved
annual budget in the Life360 HOME agreement.
B.
Technology: The
Life360 will prepare and submit a monthly report for the prorated annual
technology costs.
C.
Success payments: At the end of each year, Life360
will submit a request for payment for the number of clients who have been
approved for Success payments by DHS. See Program Funding section for more
details.
D.
Startup: The Life360 shall receive payment for the
approved startup cost(s) once DHS approves successful completion of the
application or readiness review and the Life360 has submitted a signed
agreement. Startup costs will be reported
monthly.
240.000
GLOSSARY
Acute care hospital means a hospital that:
A. Is licensed by the Department of Health
under § 20-9- 19 201 et seq., as a general hospital or a surgery and
general medical care hospital; and
B. Is enrolled as a provider with the
Arkansas Medicaid Program.
Birthing hospital means a hospital in this state
or in a border state that:
A. Is
licensed as a general hospital;
B.
Provides obstetrics services; and
C. Is enrolled as a provider with the
Arkansas Medicaid program.
Care coordination coaches mean those individuals
who establish relationships with their clients to ensure effective
participation in the Rural Life360 program. Coaches may work under various
titles including peer specialists, peer counselors, family support workers, and
home visitors. They work directly with clients and their families to improve
their life skills to be physically, socially, and emotionally healthy to live
successfully in their communities.
Community services mean any resource or services
provided by public or private organizations to community residents to assist
with a particular social need such as mental health or counseling or
health-related needs including housing or food or job training and employment.
It may also include other general services or programs offered through
libraries or other local government funding that benefit the community.
Evidence-based home visitation means a home
visitation program that is one of the models recognized by the U.S. Department
of Health and Human Services to be effective in improving maternal and child
health.
Healthcare coverage means coverage provided under
this subchapter through either an individual qualified health plan (QHP), a
risk-based provider organization, managed care organization, employer health
insurance coverage, or the fee-for-service (FFS) Medicaid program.
High-risk pregnancy means a pregnancy with a
diagnostic code of supervision of high-risk pregnancy, as evidenced by a
physician or Advanced Practice Registered Nurse (APRN) referral. High-risk
diagnosis includes medical and/or social risk.
Home-visiting means an evidence-based program that
provides direct support and intensive care coordination of services for clients
served by Maternal Life360s with the goals of improving maternal and infant
health outcomes, promoting child development and school readiness, connecting
families to needed community resources and supports, and increasing a family's
education and earning potential.
HRSN reimbursable cost means time-limited expenses
to enable a client to access services or supports to meet an identified HRSN
allowable under Life360. These must be identified through a Health-Related
Social Needs (HRSN) screening, or the client's engagement with the care
coordinator, and are transitional in nature. Examples include housing safety
inspections, pest control, security deposit and first month's rent that is
required to obtain a lease on an apartment or home, and nutritional instruction
for disease control/prevention.
HRSN screening means a standardized way of
capturing a Life360 client's health-related social needs to determine any needs
or barriers a client may experience at the time of screening. For example, an
individual may have trouble paying rent on time and be at risk of losing their
apartment. A pregnant individual may experience difficulty going to her
doctor's appointments due to not having a car and lack resources for food.
Information gathered through the screening may be used to help inform care
coordination plans or referrals to community services and supports.
Individual Qualified Health Plan (QHP) means an
individual health insurance benefit plan offered in the health insurance
marketplace to provide coverage in Arkansas that covers only essential health
benefits as defined by Arkansas rule and
45 C.F.R. §
156.110 and any federal insurance
regulations.
Intensive care coordination is an umbrella term
for a collaborative process in which a care coordinator or others assess, plan,
implement, coordinate, monitor and evaluate the options, services and supports
required to meet the client's health and HRSN needs. It is characterized by
advocacy, communication, and resource management, and promotes quality
interventions and outcomes. In addition to addressing medical services, care
coordination coaches ensure that clients have safe housing, employment,
education, financial stability, and emotional/mental wellness.
Mental illness refers to clients with a diagnosis
of one or more of the following: neurodevelopmental disorders, schizophrenia
spectrum and other psychotic disorders, bipolar and related disorders,
depressive disorders, anxiety disorders, obsessive-compulsive and related
disorders, trauma- and stressor-related disorders, dissociative disorders,
somatic symptom and related disorders, feeding and eating disorders, and
personality disorders.
Non-Reimbursable Community Contribution (NRCC)
means a payment, including an in-kind payment, for goods or services provided
to a client to assist the client with meeting a HRSN identified in the client's
person-centered action plan but is not a HRSN-reimbursable cost or reimbursable
through other Medicaid funds under the Life360 HOME agreement. NRCC may include
rent or utility costs for example, or excluded categories (i.e. job preparation
expenses such as clothing or personal care). The identification of sources of
NRCC and the types of NRCC provided shall be included in the application and in
program reports.
Partner agreement means the sub contractual
agreement executed between the Life360 and its partner subrecipients. The
subrecipient has its performance measured against whether the objectives of the
program as outlined in the Life360 HOME agreement between DHS and the Life360
are met; has responsibility for programmatic decision-making; and uses funds to
carry out the program by providing goods or supports to clients. Subrecipients
are identified in the application and in programmatic and financial reports.
Additional subrecipients can be requested during the program period by
contacting the Life360 program manager at DHS. Subrecipients will need to be
updated into the Life360 HOME agreement.
Person-Centered Action Plan (PCAP) means a plan
completed by the Life360 that identifies a client's strengths, preferences and
includes information from the HRSN screen and additional information gathered
from the client through meetings and any other tools utilized by the program.
The PCAP includes short and longer-term goals and objectives to address the
client's HRSN and other personal goals as well as details on how and what
services and supports will be obtained, a crisis plan, and documentation of
progress on goals and successes and barriers encountered. The PCAP is updated
as the client meets goals, circumstances change, or the sets new goals.
Life360 HOME agreement means the administrative
instrument to be executed between the Arkansas Department of Human Services
(DHS) Division of Medical Services (DMS) and an Arkansas Medicaid enrolled
hospital Life360 provider.
Rural area means an Arkansas county where a
hospital designated as a critical access hospital or participant in the Small
Rural Hospital Improvement Program is located or an Arkansas county with a
population of fifty-thousand (50,000) or less.
Small rural hospital means a critical access
hospital or a general hospital that:
A. Is located in a rural area;
B. Has fifty (50) or fewer staffed beds;
and
C. Is enrolled as a provider in
the Arkansas Medicaid program.
Health-Related Social Needs (HRSN) means
conditions in the environments where people are born, live, learn, work, play,
worship, and age that affect a wide range of health, functioning, and
quality-of-life outcomes and risks.
Veteran means a person who served in the active
military, naval, or air service and who was discharged or released there from
as verified by DD214 documentation.
