0810.040.00 THE RESPITE CARE PROGRAM (IN-HOME AND INSTITUTIONAL)
The respite care program has been designed to provide services for families that are trying to maintain individuals in their own homes, who would otherwise require ICF/SNF care. These services allow the usual caregivers a break from the confines that such care imposes.
In-home respite services are available for 8 to 12 consecutive hours, while institutionalized respite care allows for care on a 24-hour basis for the individual.
810.040.05 IN-HOME RESPITE CARE
In-home respite care provides required care to an elderly individual while providing temporary relief to the usual caregiver(s) within the confines of the claimant's normal living situation.
Services are oriented toward maintenance/supervision and include:
- meal preparation;
- minor chores;
- minor personal care; and
A unit of service for in-home care is from eight to twelve consecu-tive hours of service to one individual, of which no more than four hours entail personal care or homemaker activities.
An eligible claimant is allowed a maximum of 42 days per calendar year with the restriction that the cost of respite care, in any given month, combined with all other waivered Medicaid Services provided in that month, not exceed the average statewide cost, per resident per month, of ICF care. (These costs will be approved and monitored through the Division of Senior Services system).
In-home respite care services are obtained through authorized Title XIX providers.
NOTE: Respite services provided by members of the claimant's household or immediate family are not covered by Medicaid.
810.040.10 INSTITUTIONAL RESPITE CARE
Institutional respite care allows an eligible Medicaid claimant admission to a certified nursing facility for periods covering up to a maximum of six weeks (42 days) in any calendar year. The cost of respite care in any given month, combined with all other waivered Medicaid Services provided in that month, cannot exceed the average statewide cost per resident, per month of ICF care. (These costs will be approved and monitored through the Division of Senior Services.)
A unit of care is defined as one 24-hour day of respite care to an individual.
NOTE: Medicaid (MA spend down/Non-spend down) claimants approved for institutional respite care will not:
- have to apply for vendor payments; or
- be subject to pre-admission screening.
810.040.15 BASIC ELIGIBILITY GUIDELINES FOR RESPITE CARE
To be eligible for the program a claimant must be:
- Currently eligible for Medicaid benefits;
- Age 65 years of age or older;
- Assessed by the Division of Senior Services to have certain impairments and unmet needs, i.e. (s)he would require admission to an ICF/SNF if respite care and/or other waivered services were not provided; and
- Willing to receive comprehensive assessment and case management services through the Division of Senior Services.
810.040.20 ELIGIBILITY DETERMINATION (DIVISION OF SENIOR SERVICES)
If the initial request is received through the Division of Senior Services, the Senior Services worker will:
- Inform the claimant of the necessity for Title XIX eligibility.
- Contact the FSD worker, by using the (IM-54) Referral for Services form, requesting an application for Medical Assistance or one of the cash programs.
- If the claimant is found to be ineligible for Title XIX services, the Senior Services worker will explore other resources.
- Complete an Intake/Screening (DA-1).
- Secure a Physician's Certification (DA-11).
- Secure an Authorization for Services (DA-4).
- Notify the IM worker of any changes of circumstances affecting the claimant's eligibility, on an on-going basis.
810.040.25 FAMILY SUPPORT DIVISION RESPONSIBILITIES
When FSD receives the request for Respite Care the caseworker will:
- Verify the claimant's current Title XIX status:
- If the claimant is currently Title XIX eligible, the worker will notify the Division of Senior Services worker of current Title XIX eligibility dates and the request for Respite Care, by using the (IM-54) Referral for Services form or by verbal confirmation.
- If the claimant is not currently Title XIX eligible, the worker will:
- Take an MA (spend down/non-spend down) application.
- If the request was from a source other than the Division of Senior Services, the IM worker will notify the Senior Services worker of the request for Respite Care Services, by sending: An IM-54, Referral for Services form indicating Title XIX eligibility determination in process and Respite Care Services requested.
- Complete the IM eligibility determination (a DA124A/B is NOT required); and
- Notify the Division of Senior Services worker of Title XIX eligibility or ineligibility. (On approvals, beginning and ending Title XIX dates must be reported to the Senior Services worker, for Title XIX billing purposes). The IM-54 or a copy of the approval or rejection letter may be used as the vehicle for notifying the Senior Services worker.
- The IM worker will keep the Division of Senior Services worker informed of any changes of circumstances affecting the client's Title XIX eligibility, on an ongoing basis, including the results of reinvestigations and any changes in Title XIX eligibility dates.
810.040.30 RESPITE CARE PROVIDER RESPONSIBILITIES
The Respite Care provider is responsible for:
- Delivering the approved services to the claimant.
- Sending all required reports to the Division of Senior Services.
- Sending the claim for payment to the Division of Medical Services fiscal agent.