2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
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Long-Term CareAbility to perform BADL, including bathing <strong>and</strong>showering (washing the body), bowel <strong>and</strong>bladder management (recognizing the need torelieve oneself), dressing, eating (includingchewing <strong>and</strong> swallowing), feeding (setting upfood <strong>and</strong> bringing it to the mouth), functionalmobility (moving from one place to anotherwhile performing activities), personal devicecare, personal hygiene <strong>and</strong> grooming(including washing hair), sexual activity, <strong>and</strong>toilet hygiene (completing the act of relievingoneself)Ability to perform IADL, including doinghousework <strong>and</strong> laundry, preparing meals,taking medications as prescribed, managingmoney, shopping for groceries or clothing,using the telephone or other form ofcommunication, scheduling appointments,using technology (as applicable), <strong>and</strong> usingtransportation within the communityComprehensive Needs Assessment<strong>Presbyterian</strong> conducts a Comprehensive NeedsAssessment (CNA) for everyone meeting NF LOCeligibility criteria to determine the level of need forlong-term care services. The CNA places peopleinto either a low-needs or high-needs group. Thisassessment also applies to eligibility for existingslots. Slots available for those not otherwiseMedicaid-eligible are divided into low-needs slots<strong>and</strong> high-needs slots with the respective lowexpenditure<strong>and</strong> high-expenditure limits.Member ChoiceMembers eligible for the Community Benefit areeducated on <strong>and</strong> have the option to select eitherthe Agency-Based Community Benefit or the Self-Directed Community Benefit.Agency-Based Community BenefitThe Agency-Based Community Benefit is aconsolidation of HCBS <strong>and</strong> personal care services<strong>and</strong> is available to members meeting NF LOCeligibility criteria. Members selecting the Agency-Based Community Benefit have the option to selecttheir personal care service provider. <strong>Presbyterian</strong>Centennial Care makes the following HCBSavailable through the Agency-Based CommunityBenefit:Adult day health careAssisted livingBehavior support consultationCommunity transition servicesEmergency responseEmployment supportEnvironmental modificationsHome health aidePersonal care services (may be self-directed)Private duty nursing for adultsRespiteSkilled maintenance therapy servicesEach <strong>Presbyterian</strong> Centennial Care memberenrolled in the Agency-Based Community Benefitare assigned a <strong>Presbyterian</strong> care coordinator. Thiscare coordinator helps the member underst<strong>and</strong> the10-32014 <strong>Practitioner</strong> <strong>and</strong> <strong>Provider</strong> <strong>Manual</strong> - Ver. 3
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