Current through September 24, 2024
A. The Division of
Medicaid covers the following services through the Independent Living (IL)
Waiver:
1. Case Management services are
mandatory services provided by a Registered Nurse (RN) and/or a Case Manager
and include the following activities:
a) Must
initiate and oversee the process of assessment and reassessment of the
participant's level of care and review the Plan of Services and Supports (PSS)
to ensure services specified on the PSS are appropriate and reflective of the
participant's individual needs, preferences, and goals.
b) Must assist waiver applicants/participants
in gaining access to needed waiver and other State plan services, as well as
needed medical, social, educational, and other services, regardless of the
funding source for the services to which access is gained.
c) Are responsible for ongoing monitoring of
the provision of services included in the participant's PSS.
d) Must conduct quarterly face-to-face
reviews to determine the appropriateness and adequacy of the services and to
ensure that the services furnished are consistent with the nature and severity
of the participant's disability and make monthly phone contact with the person
to ensure that services remain in place without issue and to identify any
problems or changes that are required. More frequent visits are expected in the
event of alleged abuse, neglect or exploitation of waiver participants.
e) Are responsible for ensuring
that all personal care attendants for the waiver meet basic competencies that
include both academic requirements (i.e. infection control, principles of
safety, disability awareness, etc.) and functional requirements (i.e. bathing,
transferring, skin care, dressing, bowel and bladder programs).
B. Case Management must
be provided by Registered Nurses (RN) and Rehabilitation Counselors who must
meet the following qualifications:
The Registered Nurse must:
Have a current and active unencumbered Registered Nurse
license to practice in the state of Mississippi or be working in Mississippi on
a privilege with a valid compact RN license; and
Have at least one (1) year of experience with the aged and/or
individuals with disabilities; and
Not have a history of a criminal offense which precludes
him/her from working with the vulnerable population; and
Not appear on the Mississippi Nurse Aide Abuse Registry or
the Office of Inspector General (OIG) exclusion list.
The Rehabilitation Counselor must:
Possess at a minimum a Bachelor's degree in Rehabilitation
Counseling or other related field; and
Have one (1) year of experience working with individuals with
disabilities; and
Be free of a history of a criminal offense which would
preclude him/her from working with a vulnerable population; and
Not appear on the Nurse Aide Abuse Registry or the Office of
the Inspector General's (OIG) exclusion list.
Mississippi Department of Rehabilitation Services (MDRS) is
responsible for validating qualifications of the Registered Nurse and
Rehabilitation Counselor. MDRS must subscribe with the Mississippi Board of
Nursing to receive immediate electronic notification of adverse or disciplinary
action taken occurring against nurse employees.
MDRS must verify provider qualifications upon hire and at
least annually.
C. Personal
Care Attendant (PCA) services are non-medical, hands-on care of both a
supportive and health related nature. PCA services are provided to meet daily
living needs to ensure adequate support for optimal functioning at home or in
the community, but only in non-institutional settings.
1. PCA services must be provided in
accordance with the approved PSS, cannot be purely diversional in nature, and
may include:
a) Support for activities of
daily living such as, but not limited to, bathing (sponge/ tub), personal
grooming and dressing, personal hygiene, toileting, transferring, and assisting
with ambulation.
b) Assistance
with housekeeping that is directly related to the person's disability, and
which is necessary for the health and well-being of the person such as, but not
limited to, changing bed linens, straightening area used by the person, doing
the personal laundry of the person, preparation of meals for the person,
cleaning the person's equipment such as wheelchairs or walkers.
c) Food shopping, meal preparation and
assistance with eating, but does not include the cost of the meals themselves;
d) Support for community
participation by accompanying and assisting the person as necessary to access
community resources; participate in community activities; including
appointments, shopping, and community recreation/leisure resources, and
socialization opportunities, but does not include the price of the activities
themselves.
2. If the
person/representative has not located or chosen a PCA within six months after
admission to the waiver, or after being without a PCA for six (6) consecutive
months, the person is reevaluated for the need for waiver services to determine
if the waiver can meet the needs of this person.
D. Specialized Medical Equipment and Supplies
include devices, controls, or appliances, specified in the PSS, which enable
individuals to increase their abilities to perform activities of daily living,
or to perceive, control, or communicate with the environment in which they
live.
1. The need for use of such items must
be documented in the assessment/case file, ordered by a physician and approved
on the PSS.
2. Items reimbursed
with waiver funds are in addition to specialized medical equipment and supplies
furnished under Medicaid State Plan. Items not of direct medical or remedial
benefit to the person are excluded.
3. Specialized medical equipment and supplies
must meet the applicable standards of manufacture, design and installation.
4. Requests for specialized
medical equipment and supplies must be evaluated by the Mississippi Department
of Rehabilitation Services (MDRS) counselor or the Division of Medicaid to
determine if an Assistive Technology (AT) evaluation and recommendation is
needed. If an AT evaluation is performed, it must be submitted to the Division
of Medicaid along with the PSS and the request for specialized medical
equipment and/or supplies for approval.
5. Medicaid waiver funds are utilized as the
payor of last resort.
E. Transition Assistance Services are
provided to a Mississippi Medicaid eligible nursing facility (NF) resident to
assist in transitioning from the nursing facility into the IL Waiver program.
1. Transition Assistance services include the
following:
a) Security deposits required to
obtain a lease on an apartment or home.
b) Essential furnishings required to occupy
and use a community domicile. Televisions or cable TV access are not essential
furnishings.
c) Moving expenses.
d) Fees/deposits for utilities and
service access for a telephone.
e)
Health and safety assurances including, but not limited to, pest eradication,
allergen control, or one-time cleaning prior to occupancy.
2. Transition Assistance is a one
(1) time initial expense required for setting up a household and is capped at
eight hundred dollars ($800.00) per lifetime. These expenses must be included
in the approved PSS.
3. To be
eligible for Transition Assistance, the beneficiary must meet all of the
following criteria:
a) Be currently residing
in a nursing facility whose services are paid for by the Division of Medicaid;
b) Have no other source to fund or
obtain the necessary items/supports;
c) Be moving from a nursing facility where
these items/services were provided;
d) Be moving to a residence where these
items/services are not normally furnished.
4. Transition Assistance must be completed by
the day the person relocates from the institution.
5. Persons whose NF stay is temporary or
rehabilitative, or whose services are covered by Medicare or other insurance,
wholly or partially, are not eligible for this service.
F. Environmental Accessibility Adaptations
are physical adaptations to the home, required by the individual's PSS,
necessary to ensure the health, welfare, and safety of the individual, or
enables the individual to function with greater independence in the home.
1. Environmental accessibility adaptations
must be included in the approved PSS.
2. Environmental accessibility adaptations
include the following:
a) Installation of
ramps and grab bars.
b) Widening
of doorways.
c) Modification of
bathroom facilities.
d)
Installation of specialized electric and plumbing systems necessary to
accommodate medical equipment and supplies.
3. Environmental accessibility adaptations
exclude the following:
a) Adaptations or
improvements to the home which are not of direct medical or remedial benefit to
the beneficiary.
b) Adaptations
which add to the square footage of the home.
4. Requests for environmental accessibility
adaptations must be evaluated by the MDRS Rehabilitation Counselor to determine
if an Assistive Technology (AT) evaluation is indicated. If an AT evaluation is
performed, it must be submitted to the Division of Medicaid along with the PSS
and the request for environmental accessibility adaptation.
5. MDRS must certify and document that
providers meet the criteria/standards in the waiver.
G. Financial Management Service (FMS):
1. FMS is a support service to assist the
waiver participant who chooses the Participant- Directed Personal Care service.
Participant-Directed Personal Care service recognizes the waiver participant as
the employer of record.
2. The
waiver participant performs budgetary and employer functions and has the
ability to negotiate salaries and benefits with the personal care
attendants.
3. The FMS agent
assists the waiver participant with employer and budget authority by ensuring
federal, state and local employment taxes and labor and worker's compensation
insurance rules related to household employment and payroll are implemented in
an accurate and timely manner as related to the personal care
attendant.
4. The FMS agent ensures
that the necessary employer related duties and tasks, including payroll, are
carried out. The service must ensure initial orientation and ongoing training
is provided related to responsibilities of being an employer and adhering to
legal requirements for employers.
5. The FMS provider must:
a) Serve as the participant's employer agent
which is the IRS designation of the entity responsible for IRS related
responsibilities on behalf of the participant.
b) Provide assistance determining personal
care attendant wages and benefits.
c) Provide assistance in hiring by verifying
employees' citizenship status, conducting criminal background checks, and
verifying the employee is not on the Mississippi Nurse Aide Abuse Registry or
the Office of Inspector General (OIG) exclusion lists.
d) Verify and maintain documentation of
employee qualifications, citizenship status, and documentation of services
delivered.
e) Provide education on
recruiting, hiring and terminating employees as well as identifying the need
for special skills and determining duties and schedules.
f) Ensure appropriate payment by:
1) Collecting timesheets,
2) Processing timesheets,
3) Processing payroll and payables,
and
4) Making withholdings for and
payment of applicable and federal, state and local employment related
taxes.
g) Provide
quarterly written reports to the waiver participant of all expenditures and the
status of the waiver participant's budget.
h) Maintain a separate account for each
waiver participant.
i) Make
services available only to those persons deemed eligible and referred by
MDRS,
j) Establish contact with the
participant within five (5) working days of the referral from MDRS,
k) Conduct a face-to-face visit to initiate
the FMS process within five (5) working days of establishing contact with the
participant,
l) Conduct at least
one (1) face-to-face meeting annually with each participant to review and
update the overall function of the FMS,
m) Ensure Division of Medicaid (DOM) access
to the participant's case files.
n)
Employ staff members with knowledge, experience and abilities to sufficiently
carry out the FMS component of service.
o) Have Medicaid provider agreements with the
Division of Medicaid with the following requirements.
1) Have a minimum of five (5) years of
billing and payroll experience relevant to participant-directed medical
care,
2) Have a working knowledge
of disability etiquette, psychology, and social aspects of disability,
vulnerable persons act including reporting requirements, HCBS waivers,
especially the plans of care, and W-2 employee tax reporting requirements. If
the FMS lacks a working knowledge of disability etiquette, psychology and
social aspects of disability, vulnerable person's act and home and community
based waivers, training must be provided to ensure the FMS has a solid
foundation for working with individuals with disabilities.
p) Develop and maintain policies and
procedures for the delivery of Financial Management Services.
q) Have qualifications verified by DOM
initially and monitored annually or more frequently as indicated.
42 U.S.C.
1396n; 42 C.F.R. §§ 440.180,
441.302; Miss. Code Ann. §§
37-33-157,
43-13-117,
43-13-121.
