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DEVELOPMENTAL DISABILITIES
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long term services and supports

Home & Community-Based Services Waiver Program

The Home and Community Based Services Waiver operated by the Division of Long Term Services and Supports, allows the Department to use Title XIX Medicaid to provide home and community-based services to individuals that are risk for institutionalization.  

LTSS Waiver Amendment 2017

Target Population

Elders and consumers who are over age 18 with a qualifying disability may be eligible for Home and Community-Based Waiver services.

Eligibility

In order to qualify, the following must occur:

Services

Services provided through the Home and Community-Based Services Waiver include:

Service Title

Service Definition

Applicable Limits on the Amount, Frequency or Duration of this Service
Adult Companion Services Non-medical care, assistance, supervision or socialization provided to a consumer living at home or in an Assisted Living Center. Companions perform tasks that are incidental to the care and supervision of the consumer as opposed to completing the tasks for the consumer. Completion of homemaker, personal care and chore services will must be authorized and provided as distinct, unduplicated services as assessed and specified in the Care Plan.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

Adult Day Services Adult day services provide regular care, supervision and structured activities in a non-institutional community-based setting. Adult day services include both health and social services needed to ensure the optimal functioning of the consumer for a period of less than 24 hours per day. Adult day services are provided to a consumer who lives at home. Nutritious meals/snacks are available but are billed as a separate service. Adult day services are integrated in the community. Although not required, nursing services are provided based on assessed need and include health screenings, blood pressure checks, medication management, and a general assessment of the consumer’s condition. Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.
Assisted Living

Assisted living centers offer homemaker, personal care, chore, and meal preparation to consumers who reside in a homelike, non-institutional setting that includes 24-hour on-site response capability to meet scheduled or unpredictable consumer needs and to provide supervision, safety and security. The assisted living location promotes the health, treatment, comfort, safety, and well-being of residents, with easy accessibility for visitors and others.

Services also include social and recreational programming, and medication assistance (to the extent permitted under State law). Services that are provided by third parties must be coordinated with the assisted living provider.

Nursing and skilled therapy services are incidental rather than integral to the provision of assisted living services. Payment is not made for 24-hour skilled care. Federal financial participation is not available for room and board, items of comfort or convenience, or the costs of facility maintenance, upkeep and improvement.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of homemaker, personal care, chore services, emergency response systems, respite care, meals, and environmental accessibility adaptations as distinct additional services is prohibited for a consumer who resides in an assisted living center.
Chore Services

Chore services are defined as Chore services needed to maintain the consumer’s home in a healthy and safe environment. Chore services are lawn mowing, snow and ice removal from sidewalks and driveways, or other services which the home owner is required to complete by city or county ordinance.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of chore services as a distinct additional service is prohibited for a consumer who resides in an assisted living center.
Emergency Response Systems An Emergency Response System is an electronic device that enables a consumer who lives in his or her home to secure help in an emergency. The consumer may also wear a portable "help" button to allow for mobility. The system is connected to a consumer's phone and programmed to signal a response center once a "help" button is activated.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of the emergency response service as a distinct additional service is prohibited for a consumer who resides in an assisted living center.
Environmental Accessibility Adaptations

Those physical adaptations to the private residence of the consumer, or the consumer's family, required by the consumer's care plan, that are necessary to ensure the health, welfare, and safety of the consumer or that enable the consumer to function with greater independence in the home. Such adaptations include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or the installation of specialized electric or plumbing systems that are necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the consumer.

Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the consumer. Adaptations or improvements that add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation (i.e., in order to improve entrance/egress to a residence or to widen a bathroom to accommodate a wheelchair). This service does not include general repair or maintenance to the residence, which are considered to be standard housing obligations of the owner or tenant.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of environmental accessibility adaptations as a distinct additional service is prohibited for a consumer who resides in an assisted living center.
Homemaker In-home services consist of the performance of general household tasks provided by a homemaker, when the consumer is unable to manage the home and care for him or herself or others in the home. Homemaker services are included within personal care services in South Dakota’s Medicaid State Plan. Homemaker services within this waiver are those services that are provided when homemaker services furnished under the approved State Plan limits are exhausted. The scope and nature of these services do not differ from homemaker services furnished under the State Plan. The provider qualifications specified in the State Plan apply. The additional amount of services that may be provided through the waiver is the provision of additional homemaker services over and above the amount allowed in the State Plan.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of homemaker services as a distinct additional service is prohibited for a consumer who resides in an assisted living center. Homemaker services are included in the scope of services provided to a consumer living in an assisted living center.
Meals Nutritious meals, provided to a consumer who lives at home, which follow federal dietary guidelines and can be provided for breakfast, lunch and dinner to enhance a consumer’s diet.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of meals as a distinct additional service is prohibited for a consumer who resides in an assisted living center.
In-Home Nursing Services Individual and continuous care (in contrast to part time or intermittent care) provided by licensed nurses within the scope of State of South Dakota Codified Law. Services are provided to consumers who live at home. Approved State Plan services for the in-home nursing services are provided under the waiver when nursing services furnished under the approved State Plan limits are exhausted. The scope and nature of these services do not differ from nursing services furnished under the State Plan. The provider qualifications specified in the State Plan apply. The additional amount of services that are provided through the waiver is the provision of additional nursing services over and above the amount allowed in the State Plan. Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.
Nutritional Supplements Nutritional supplements provided to a consumer who lives at home and is below his or her medically recommended body weight; nutritionally deficient or malnourished; or to manage a skin condition or promote wound healing. Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

Personal Care Services

Personal care includes assistance provided to a consumer living at home to perform his or her activities of daily living. In-home personal care services are those services provided when personal care furnished under the approved State Plan limits are exhausted. The additional amount of services that may be provided through the waiver is the provision of additional personal care services over and above the amount allowed in the State Plan. The scope and nature of these services do not differ from personal care services furnished under the State Plan. The provider qualifications specified in the State Plan apply.

The concurrent provision of personal care services as a distinct additional service is prohibited for a consumer who resides in an assisted living center. Personal care services are included in the scope of services provided to a consumer living in an assisted living center.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

Respite

Respite care will be provided short-term (less than 30 consecutive days) for an individual who is unable to care for him or herself in the absence of or for the relief of the caregiver. Respite care is available to eligible individuals who reside with unpaid caregivers.

Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

The concurrent provision of respite care as a distinct additional service is prohibited for a consumer who resides in an assisted living center.

Specialized Medical Equipment

Specialized medical equipment are devices, controls, or appliances, specified in the plan of care, that enable consumers to increase their ability to perform activities of daily living and assist the consumer to remain living safely at home. Services consist of assistive technology equipment, installation and monitoring, purchasing, leasing or otherwise providing devices, controls, sensors or appliances to be used to increase, maintain, or improve functional capabilities of consumers. Specialized medical equipment reimbursed with waiver funds is in addition to any specialized medical equipment furnished under the State Plan and excludes those items that are not of direct medical or remedial benefit to the consumer. Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

Specialized Medical Supplies

Specialized medical supplies are disposable supplies which are necessary to maintain a consumer’s health, manage a medical or physical condition, improve functioning, or enhance independence as specified in the Care Plan. Medical supplies reimbursed with waiver funds are in addition to any medical supplies furnished under the State Plan and exclude those items that are not of direct medical or remedial benefit to the consumer. Services are based on assessed need as identified in the person centered care plan with a threshold equal to the average cost of nursing home care. Services over this threshold are subject to an exceptions process.

 

   

 

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