Recipients have flexibility and freedom in choosing their caregivers.

Transcription

1 Hme Care Services in NY (Medicaid). Medicare and ther third party payers have very limited prvisins fr persnal care, als called custdial care, services. ADAP prvides sme hme care services fr eligible clients; lifetime cap f $30,000. Cmprehensive hme care services are nly funded by Medicaid in NY. The NYC Medicaid Hme Care Services Prgram, part f the NYC Human Resurces Administratin (HRA) Medical Insurance Cmmunity Services Administratin (MICASA) was respnsible, until Sept 2012, fr three types f Persnal Care services (PCA): Hme Attendant, Husekeeping, and Cnsumer Directed Persnal Care Services in NYC. T btain PCA services, a persn must becme eligible fr Cmmunity Medicaid, and must get prir apprval and a determinatin f the number f hurs per week needed frm the lcal Medicaid (CASA) ffice. Medicaid PCS I. Hme Attendant Services- persnal care assistance with "activities f daily living" such as bathing, dressing, ambulatin, transfer assistance, tileting, grming, meal preparatin and light cleaning f patient care area. Emplyees are called Hme Attendants. II. Cnsumer Directed Persnal Assistance Prgram (CDPAP) ADL assistance r skilled nursing services t chrnically ill r physically disabled individuals wh have a medical need fr help. Emplyees may have a variety f titles. Services can include any f the services prvided by a persnal care aide (hme attendant), hme health aide, r nurse. Recipients have flexibility and freedm in chsing their caregivers. Recipients must be able and willing t make infrmed chices regarding the management f the services they receive, r have a legal guardian r designated relative r ther adult able and willing t help make infrmed chices. The cnsumer r designee must als be respnsible fr recruiting, hiring, training, supervising and terminating caregivers and must arrange fr back-up cverage when necessary, arrange and crdinate ther services; must keep payrll recrds. III. Husekeeping Services - services are limited t 8 hurs/week and prvide assistance with shpping, cking, cleaning, laundry and ther husehld chres when needed because f disability. They d nt prvide assistance with "activities f daily living" (ADLs). Emplyees are called Husekeepers

2 Fr Medicaid-eligible persns, CASA may cntract with hme-care agencies that emply aides t prvide Medicaid funded persnal care services, and New Yrk State versees the lcal scial services districts administratin f the prgram. These services can be prvided BEFORE Medicaid is apprved. A. Certified Hme Health Agency (CHHA) - a hme care services agency which pssesses a valid certificate f apprval issued pursuant t the prvisins f article 36 f the Public Health Law, r a residential health care facility r hspital pssessing a valid perating certificate issued under article 28 f the Public Health Law which is authrized under article 36 t prvide a lng-term hme health care prgram. CHHAs are agile and able t prvide services in the interim that it takes the Medicaid Prgram t apprve services r fr a Medicaid applicatin t be prcessed. CHHA persnal care wrkers are called Hme Health Aides; hwever, they may be referred t as Hme Attendants if the services are prvided in the interim befre Medicaid apprval fr services are apprved. prvide part-time, intermittent health care and supprt services t individuals wh need intermediate and skilled health care. prvide lng-term nursing and hme health aide services, can help patients determine the level f services they need, and can either prvide r arrange fr ther services including physical, ccupatinal, and speech therapy, medical supplies and equipment, and scial wrker and nutritin services. HHAs prvide persnal care services including sme skilled care may sub-cntract with licensed hme care service agencies t prvide sme services (belw). Services may be reimbursed by Medicare (skilled need requirement and limited HHA hurs (4hrs/3dys per week fr shrt duratin), Medicaid, private payment and ther health insurers. B. Licensed Hme Care Service Agencies (LHCSAs) prvide hurly nursing care and hmemaker, husekeeper, persnal-care attendants and ther health and scial services. Services are available t clients wh have private insurance and thse wh pay privately. In sme cases licensed agencies cntract with lcal scial services departments (CASA) r certified hme health agencies, t prvide services t persns with Medicaid cverage. LHCSAs cannt retractively bill Medicaid fr services prvided (they are nt Medicaid prviders) and must get payment thrugh the CHHA/CASA. The nly Medicaid recipient wh can still apply t the CASA ffices after Nv. 1, 2012 fr hme attendant, husekeeping, and Cnsumer Directed Persnal Care Services (CDPAP) are thse wh: D NOT have Medicare; r Have Medicare but have hspice services, r Have Medicare but need ONLY Husekeeping services (maximum 8 hurs/week)

3 Have waiver services thrugh the Traumatic Brain Injury (TBI) r Nursing Hme Transitin & DIversin Waiver prgram, r Are under 21 years ld (applicants ages and NO Medicare have the ptin f applying t the CASA ffices Or enrlling in a Managed Lng Term Care plan if their functinal needs are extensive enugh that they wuld therwise qualify fr nursing hme care). As f Nvember 2012, any applicant ver age 21 wh HAS MEDICAID AND MEDICARE, with a few exceptins listed abve, may n lnger apply t the CASA ffices fr Medicaid PCS. They must instead enrll in Managed Lng Term Care plans. There is n lnger an ptin f enrlling with a Lmbardi (lng term hme health care) prgram. Other Persnal Care Services (nt btained thrugh CASA) C. EISEP (State and lcal funding) - assists lder peple (aged 60 and lder) with persnal care (such as dressing, bathing, grming) and shpping and cking. Clients ARE NOT eligible fr Medicaid. Services may include case management, nn-institutinal respite, ancillary services and ther cmmunity services. EISEP supprts and supplements the care prvided by families and friends. Clients are required t cst share n sliding scale reflecting their incme and the cst f the services. D. Managed Lng Term Care prgrams (MLTC)- are insurance plans that are paid a mnthly premium ("capitatin") by the New Yrk Medicaid prgram t apprve and prvide Medicaid hme care and ther lng-term care services (listed belw) t peple wh need lng-term care because f a lng-lasting health cnditin r disability. The MLTC plans tk ver the jb the lcal CASA r Medicaid ffices used t d they decide whether yu need Medicaid hme care and hw many hurs yu may receive and arrange fr the care by a netwrk f prviders with which the plan cntracts. They als apprve, manage and pay fr the ther lng-term care services. Services include nursing, physical therapy, ccupatinal therapy, speech pathlgy, medical equipment and supplies, pdiatry, dentistry, ptmetry, respiratin therapy, transprtatin and scial day care. E. Lng Term Hme Health Care Prgrams examples are Lmbardi/LTHHCP, includes AIDS LTHHCP, Traumatic Brain Injury (TBI), Nursing Hme Transitin & Diversin Waiver (NHTDW) and Care at Hme. services prvided at hme t infirm r disabled persns wh are medically eligible fr placement in a hspital r residential health care facility and wh wuld require such placement fr an extended perid f time if such prgram were unavailable; persnal care emplyees are usually called Persnal Care Wrkers. All regular Medicaid hme care services are prvided and the fllwing may be available: Case management by RNs Hme delivered r cngregate meals Husing imprvements and mving assistance

4 Respiratry therapy Medical scial services, nutritin and dietary services Respite care, scial day care and scial transprtatin (As f April 1, 2013, "dual eligibles" (have Medicare and Medicaid) wh are age 21+ can nly access this prgram if they enrll in a MLTC) F. Hspice care prgram that prvides care t terminally ill individuals that fcuses n easing symptms rather than treating disease. The emphasis f the prgram is t help individuals remain at hme fr as lng as pssible. The hspice prgram prvides physical, psychlgical, scial, and spiritual supprt and care fr the patient and their family. Hspice als ffers hspice residences Services ffered thrugh hspice include nursing and physician services, medical scial services, cunseling (including nutritin and bereavement cunseling), and physical and ccupatinal therapy. In additin, hspice can prvide hme health aide and hmemaker services, medical supplies and appliances, speech therapy, and shrt-term inpatient care. G. Family Hme Care is an ACS prgram that prvides child care and husehld management services t families wh need help prviding a safe, nurturing envirnment fr their children. Thrugh training and supprt, hmecare service prviders help families t manage their husehld independently. Tw main services ffered are: Hmemaking - Hmemaking services include training and supprt t families in child care and husehld management (i.e. light cleaning, meal preparatin, and grcery shpping). These services are directed tward the well child (ren) f the parent wh needs hme care. Hme Attendant Services- persnal care t individuals (culd be the parent and/r disabled child), including grming, dressing, r ther necessary daily activities. Eligibility individual may be eligible fr Family Hme Care if he/she: is t ill t care fr the child(ren), is verwhelmed by caring fr ne ill member f the husehld and unable t prperly care fr yur children, r the child need help with everyday activities, will be temprarily ut f the hme fr an emergency (such as hspitalizatin), with n ne t care fr the family, needs training in basic child and hme management skills t prevent abuse and neglect. What is this Family Hme Care NOT t be used fr? Hme Care is a service that prvides temprary help t families in crisis. It is: NOT a babysitting service. NOT a permanent husekeeping service.

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