 |
Home health care as defined under the
Medicaid Home Health Program, including services of medical personnel if
needed. |
|
Personal care services such as hands-on
assistance with activities of daily living (ADLs). This includes help with
bathing, dressing, shampooing hair, ambulating, transfers, medication
reminders, etc. |
|
Homemaker services, such as light
housecleaning, meal preparation, laundry, grocery shopping, etc. |
|
Adult Day Care, offering protective
oversight in a structured environment including activities, meals, and
medication administration. |
|
Transportation to Adult Day services,
grocery store, dental and vision appointments, support groups, and visits
to a spouse in a nursing home. |
|
Respite care in a Medicaid-certified
protective setting, such as a nursing home or assisted living facility,
when the primary caregiver in unavailable. Maximum 30 days benefit per
calendar year. |
|
Home modification such as a wheel chair
ramp, widening doorways, bathroom grab bars, etc. |
|
Electronic monitoring or Lifeline
emergency response system hookup, to signal a provider agency in an
emergency. |
|
Prescription medications. |
An individual applying
for HCBS must be a citizen of the United States either by birth or
naturalization or a legal alien living in the United States prior to August
22, 1996. Entry after that date requires a 5-year continuous period of
residence in the
United States.
An applicant must be a resident of
Colorado.
There is no length of state residency requirement. The individual can
apply for Medicaid the first day in Colorado, provided there is the intent
to remain in
Colorado. The application
process cannot begin before the individual arrives in Colorado, except for
obtaining medical information for the ULTC-100.
MEDICAL NEED
As for nursing home
Medicaid, a physician and a discharge planner, social worker, or nurse must
evaluate the individual’s need for HCBS by using the ULTC-100 assessment
form that requires approval by the Peer Review Organization (PRO). The PRO
consists of a group of physicians and health care professionals contracted
by the state government to review Medicare and Medicaid systems.
The ULTC-100 XE
"ULTC-100: for HCBS" assessment form is used to determine that the
individual qualifies for nursing home care, which also entitles him/her to
HCBS services. The assessment may be done in the hospital, nursing home, or
in the individual’s own home. This assessment is completed by a social
worker or case manager, with one part completed by the individual’s
physician. A second assessment, the MINS (Most in Need of Service) screen is
completed for HCBS eligibility, which further measures mobility, confusion,
bladder and bowel incontinence. This is usually done at the same time as the
ULTC-100 assessment.
Starting July 1, 2003
Part I and Part II of the application must be completed and sent in to the
county Department of Human Services before the ULTC-100 or a home assessment
can be done by the Single Entry Point agency.
INCOME
The gross income of the
applicant must be below $1,656 a month (2003). If the income is over this
amount, an Income Trust must be set up. The rules for an Income Trust for an
individual on HCBS are different than those for an individual on nursing
home Medicaid. This is discussed in Chapter Six.
RESOURCES
The non-exempt resources
of the applicant must be below $2,000. After July 1, 1999 a couple is
allowed the same Community Spouse Resource Allowance (CSRA) as that for
nursing home applicants. See section on Qualifying for Nursing Home Benefits
for resource information.
WHERE TO APPLY
All applications for Home
and Community Based Services are made through the Single Entry Point If the
individual is at home an application for Home and Community Based
Services is made through the Single Entry Point (SEP) agency in the
county where the home is located.
If the individual is in
the hospital an application for Home and Community Based Services is
made through the Single Entry Point agency in the county where the
individual normally resides, although the hospital may be in a different
county. Hospitalization does not cause an individual to lose his/her county
of residence.
A listing of Single Entry
Point agencies is found in Appendix V.
APPLICATION PROCESS
The application for Home
and Community Based Services begins with the Single Entry Point Agency
(SEP). The referral can be made to the SEP by a family member, social
worker, hospital discharge planner, or anyone involved in the care of the
applicant. Once the referral is made, the SEP will see that Part I and Part
II of the application is sent to the applicant or the family.
Once Part II is completed
with documentation and is sent to the county department, a case manager will
come to the individual’s home or to the hospital. The ULTC-100 and MINS
assessments X are done at this time, using information obtained from the
applicant, family members, or hospital personnel. A family member should be
present at this appointment to supplement any information about the
applicant’s condition. A physician must fill out a page of the ULTC-100.
Once these assessments are completed they are sent to the Peer Review
Organization (PRO) for approval. Once approved by the PRO, Part II of the
Medicaid application will be processed by the county Department of Human
Services. An appointment may be set up with an eligibility technician at the
county department for financial eligibility. The application process can
take two to three months before approval. Services cannot begin until the
application is approved.
“MEDICAID PENDING”
There is no
“Medicaid Pending” for Home and Community Based Services. Medicaid begins
on the date the application is approved. There is no back dating for
HCBS services. This is especially important for those persons who are
applying for Medicaid in assisted living facilities.
They will have to pay the
full private pay amount to the facility prior to Medicaid approval of their
application. There is no reimbursement for costs paid during the waiting
period. When applying for assisted living, the applicant may want to pay the
assisted living facility for at least two months in advance while the
application is in process, spending down funds to the acceptable amount, and
insuring payment coverage until Medicaid is approved.
