Current through Register Vol. 51, No. 19, September 20, 2024
A. Reimbursement
for Personal Emergency Response System is limited to participants who:
(1) Live alone; or
(2) Have no regular caregiver for extended
parts of the day and would otherwise require extensive routine supervision to
ensure the participant's health and safety.
B. The Department shall establish a budget
for personal assistance services and home-delivered meals that may be included
in the participant's plan of service, based on each participant's assessed
need.
C. The Program does not cover
the following services:
(1) Service primarily
for the purpose of housekeeping unrelated to the participant's activities of
daily living, such as:
(a) Cleaning of the
floor and furniture in areas not occupied by the participant;
(b) Laundry other than that incidental to
services for the participant; and
(c) Shopping for groceries or household items
unless in the company of the participant;
(2) Services provided by providers not
approved for participation by the Department;
(3) Expenses incurred while escorting
participants:
(a) To obtain medical diagnosis
or treatment;
(b) To or from the
participant's workplace; or
(c) For
participation in social or community activities;
(4) Expenses related to room and board for
either the participant or the worker,
(5) Transition services more than 60 days
post transition;
(6) Personal
assistance services provided outside the State for more than 30 days per
calendar year;
(7) Environmental
adaptations to the home which:
(a) Are of
general maintenance, such as carpeting, roof repair, and central air
conditioning;
(b) Are not of direct
medical or remedial benefit to the participant;
(c) Add to the home's total square footage;
or
(d) Modify the exterior of the
home, other than the provision of ramps, lifts, sidewalks necessary to utilize
a ramp or lift, and railings; or
(8) Experimental technology or
equipment.
D. Payment for
supports planning and nurse monitoring services shall be limited to direct
services to the participant and may not be made for:
(1) Administrative overhead;
(2) Travel;
(3) Internal quality monitoring
activities;
(4) Staff supervision,
training, or consultation; or
(5)
Services rendered by an individual supports planner or nurse monitor in excess
of 7 hours per day unless preauthorized by the Department in writing.
E. Payment for environmental
adaptations and technology that substitutes for human assistance is limited to
a combined reimbursement of up to $15,000 over a 3-year period per
participant.
F. For technology
items or services above $1,000, multiple quotes from providers are
required.
