The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. The program permits a State to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waiver’s target population.
Waiver services complement and/or supplement the services that are available to participants through the Medicaid State plan and other federal, state and local public programs as well as the supports that families and communities provide. The Centers for Medicare & Medicaid Services (CMS) recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the State, service delivery system structure, State goals and objectives, and other factors. A State has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of services.
Waivers offer an array of services and benefits such as choice of qualified providers, due process, and health and safety assurances. The name waiver comes from the fact that the federal government “waives” Medical Assistance/Medicaid rules for institutional care in order for Pennsylvania to use the same funds to provide supports and services for people closer to home in their own communities.
In Pennsylvania, the Department of Human Services administers multiple Medical Assistance/Medicaid waivers. Each waiver has its own unique set of eligibility requirements and services.
Office of Long-Term Living Waiver Programs – (Service descriptions)
Service Name: Adult Daily Living – PROGRAM WAIVER: COMMCARE Independence OBRA:
Adult Daily Living services are comprehensive services provided to meet the personal care, social, nutritional, therapeutic, educational, and recreational needs of individuals in a licensed center. Transportation between the individual’s place of residence and the adult day health center will be provided as a component part of the service. The cost of this service is not included in the rate.
Service Name: Personal Assistant Service – PROGRAM WAIVER: COMMCARE Independence OBRA Attendant Care Act 150
Personal Assistance Services are aimed at assisting the individual to complete tasks of daily living that would be performed independently if they had no disability. These services include: Nonmedical personal care (eating, bathing, dressing, personal hygiene), general household activities/chores (light housekeeping tasks, preparing meals, grocery shopping, laundry), cueing to prompt the participant to perform a task, and assisting a functionally impaired individual who cannot be safely left alone;• Health maintenance activities provided for the participant, such as bowel and bladder routines, ostomy care, catheter, wound care and range of motion as indicated in the individual’s service plan;• Routine wellness services to enable adequate nutrition, exercise, keeping of medical appointments and all other health regimens related to healthy living activities; Overnight Personal Assistance Services provide intermittent or ongoing, awake, overnight assistance to a participant in their home for up to eight hours. Overnight Personal Assistance services require awake-staff; and• Chore services needed to maintain the home in a clean, sanitary and safe environment, such as washing floors, windows and walls, and tacking down loose rugs and tiles
Let the experts at Liberty Licensing & Consulting help enroll your new or existing Home Care or Home Health Agency in the Office of Long Term Living (“OLTL”) or the Office of Developmental Programs (“ODP”) waiver programs along with supplying you and your staff with the appropriate policies.
Call us today (215) 709-7070