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Appendix II 219mine whether new or additional modifications are needed, or whether existing (or newly installed)arrangements continue to be sufficient to meet the individual’s needs.C. Environmental Modifications: It may be necessary to make environmental modifications to an individual’shome before an individual transitions from an institution to the community. For example, awheelchair ramp may need to be built and doors may need to be widened to permit the individual toaccess his/her home. In such cases, the home modification begun while the person was institutionalizedis not considered complete until the date the individual leaves the institution and is enrolled in the waiver.A State may claim FFP for home modifications (including actual construction costs) furnished as awaiver service for up to 180 days prior to discharge when (a) these modifications have been initiatedbefore the individual leaves the institution and enrolls in HCBS waiver, (b) home modifications areincluded in the approved HCBS waiver. The claim for FFP must indicate the date the individual leavesthe institution and enrolls in the waiver as the date of service for allowable expenses incurred during theprevious 180 days.D. Policy Change: Modifications Interrupted by Recipient’s Death: The HCBS waivers serve a vulnerablepopulation. Individuals who have chosen to relocate from an institutional to a community residencesometimes die before the relocation can occur. We believe that it would have a chilling effect if Stateswere denied FFP for environmental assessments or modifications for individuals who died before theirtransition to home or community-based services. Therefore, we will allow the State to claim FFP at theadministrative rate for services which would have been necessary for relocation to have taken placewhen the person has:1) applied for waiver services,2) been found eligible for the waiver by the State (but for the person’s status as an inpatient in aninstitution), but3) died before the actual delivery of the waiver services.Any questions concerning this attachment may be referred to Mary Jean Duckett at (410) 786-3294 orMary Clarkson at (410) 786-5918.
220 UNDERSTANDING MEDICAID HOME AND COMMUNITY SERVICES: A PRIMERAttachment 3-cSubject: Personal Assistance RetainerPolicy ChangeDate: July 25, 2000Medicaid regulations at 42 CFR 447.40 permit States to make payment to “hold” an institutional bedopen for a resident while that individual is hospitalized or away from the facility for a short period.States which make this payment must indicate their intentions (and applicable time limits) in their Stateplans. We are writing this guideline to inform you that you may choose to implement a similar policy toallow payment for personal assistance services (such as personal care or attendant services) under HCBSwaivers. This would enable beneficiaries to have parity between nursing home care and HCBS care interms of assuring continuity of care and services.Individuals with disabilities utilize personal assistance services provided under a HCBS waiver to supportvarious activities of daily living. These services are furnished by individuals employed by community-basedagencies, or by persons who are self-employed or employed directly by the waiver participant.Typically low payment rates make it unlikely that a provider could afford to give up a day’s orweek’s salary because the waiver consumer is hospitalized or otherwise absent. Rather than wait for thewaiver consumer to return, providers are more likely to find permanent employment elsewhere. Thosewho are employed by agencies are often reassigned to other agency clients - and may not return. Lackof providers can be catastrophic for an individual with disabilities.Personal assistance retainer payments, as described in this attachment, are limited to services furnishedunder HCBS waivers. To enable waiver participants to continue to receive services in the most integratedsetting appropriate to their needs, we will permit continued payment to personal caregivers underthe waiver while a person is hospitalized or absent from his or her home. If a State chooses to make suchpayments, it must clearly indicate this in its HCBS waiver request.States that choose to make payments to be made for personal assistance retainers must also specify thelimits that will be applied to this service. The personal assistance retainer time limit may not exceed thelesser of 30 consecutive days or the number of days for which the State authorizes a payment for “bedhold”in nursing facilities.Any questions concerning this attachment may be referred to Mary Jean Duckett at (410) 786-3294 orMary Clarkson at (410) 786-5918.
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Understanding MedicaidHome and Comm
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IntroductionPeople of all ages with
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Introduction 31998—is the group m
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CHAPTER 1Medicaid Coverage of Home
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Medicaid Coverage of Home and Commu
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CHAPTER 2Financial Eligibility Rule
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Financial Eligibility Rules and Opt
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Health and Functional Criteria for
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Options for Designing Service Cover
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