OSP Service Definitions. Service Name Service Description Office of Social Programs: Act 150, Attendant Care, COMMCARE, Independence, OBRA

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1 Office of Social Programs:,,,, Adult Day Services Adult Day services are services furnished for 4 or more hours per day on a regularly scheduled basis, for one or more days per week, in an outpatient setting, encompassing both health and social services needed to the optimal functioning of the individual. Meals provided as part of this service shall not constitute a full nutritional regimen (3 meals a day). Physical, occupational and speech therapies indicated in the individual s plan of care will be furnished as a component part of this service. 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. Assistive Technology / Specialized Medical Equipment / Supplies Assistive Technology/Specialized Medical Equipment/Supplies and related services includes: devices, controls or appliances specified in the plan of care which enable individuals to increase their abilities to perform activities of daily living, or to perceive, control or communicate with the environment in which they live. This service also includes items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and nondurable medical equipment not available under the state plan. Items reimbursed with Waiver funds shall be in addition to any medical supplies furnished under the state plan and shall exclude those items not of direct medical or remedial benefit to the individual. Purchase BASIC SERVICES - Assisting a person to get in and out of a bed, wheelchair and/or motor vehicle. Assisting a person to perform routine bodily functions including, but not limited to the following: 1.) Health maintenance activities; 2) Bathing and personal hygiene; 3) Dressing and grooming; and 4) eating, including meal preparation and cleanup. ANCILLARY SERVICES - Can not be provided unless the consumer is receiving basic services, are defined as "homemaker - type services including, but not limited to, shopping, laundry, cleaning and seasonal chores; companion - type services including, but not limited to, assistance with transportation, letter writing, reading mail and escort; assistance with cognitive tasks including, but not limited to, managing finances, planning activities and making decisions. Behavioral Specialist Consultant Services Services of an expert who advises the members of the treatment team and develops an individual behavior management plan for implementation by the family and professionals working with the consumer. 1 hour Behavioral Therapy Assessment plan will not apply. Services will be as defined in the approved state plan. The provider qualifications in the plan will apply and are hereby incorporated by reference Session Chore Services Chore services are those services needed to maintain the home in a clean, sanitary, and safe environment. This service includes heavy household chores such as washing floors, windows and walls, tacking down loose rug and tiles, moving heavy items or furniture in order to provide safe access and exit, and seasonal chores such as cutting grass and shoveling snow. Coaching/Cueing This service is provided to consumers needing minimal or no hands on assistance. Prompting and cueing to carry out the routines and tasks of daily living is provided This device can be provided in or out of the home. It also provides cues and prompts, facilitates environmental changes, and provides training to enable consumers to perform daily living activities themselves. Cognitive Therapy Therapy which focuses on the attainment/reattainment of cognitive skills (through which we make sense of the world) lost or altered as a result of traumatic brain injury. The aim of therapy is the enhancement of the consumer s functional competence in real-world situations. The process includes attainment/reattainment of skills through direct retraining, use of compensator strategies, and use of cognitive orthotics and prostheses. Page 1 of 5

2 Community Integration Community Integration Services are services designed to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills necessary to reside in the community. Community integration services and related training enable the recipient to plan for and engage in meaningful adult activities including domestic and leisure activities. Community integration can include cues, on-site modeling of behavior, and/or supervision to assist the consumer in maintaining maximum independent functioning. Counseling A program provided by and under the supervision of a licensed psychologist which uses a variety of methods and techniques that helps the consumer recognize and manage stress and that facilitates interpersonal relationships between the consumer, family, significant others, and the providers of care. Counseling services shall be provided to consumers in order to resolve intra-psychic or interpersonal conflicts, family issues, and conflicts resulting from the brain injury, previous history of substance abuse, or mental health of the consumer. This counseling will provide the consumer with coping skills to deal with the above issues. Educational Services Educational services consist of special education and related services as defined in Sections (15) and (17) of the Individuals with Disabilities Education Act (IDEA), to the extent that they are not available under a program funded by IDEA. Educational services may consist of general adult educational services, including community college, university or other college-level courses, classes, and/or tutoring to receive a GED. Environmental Modifications Those physical modifications to the home required by the individual s plan of care, which are necessary to ensure the health, welfare, and safety of the individual to function with greater independence in the home and without which the individual would require institutionalization. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities or installation of specialized electric and plumbing systems which are necessary to accommodate the medical equipment and supplies which are necessary for the welfare of the individual. Service Habilitation and Support Habilitation and support services provide up to a full day (24-hour basis) of services and or supports which are designed to ensure health, safety, and welfare of the individual, and to assist in the acquisition, retention, and/or improvement in skills necessary to support individuals to live successfully in their homes and communitybased settings. Support is any task performed for the recipient, where learning is secondary or incidental to the task itself, or an adaptation is provided. Residential support expressly includes the provision of personal care services as well as chore type services and household maintenance that does not include modifications to the physical structure of the home. These services may include a combination of lifelong or extended duration supervision, training, and/or support which are essential to daily living, including assessment and evaluation and the cost of training materials, transportation, fees, and supplies. Night Supervision This supervision includes intermittent or ongoing, awake, overnight supervision to a consumer in his or her residence for a period of eight hours. Supervision can also include prompting and cueing for those consumers who need to be aware of appropriate interactions with their surroundings and other people. Assistance with toileting, turning, and repositioning tasks, and assistance with other personal care tasks may be required. Part-time Nursing plan will not apply. Services will be as defined in the approved state plan. The provider qualifications in the plan will apply and are hereby incorporated by reference Personal Assistance Services (, ) Personal assistance services include assistance with eating, bathing, dressing, personal hygiene, and activities of daily living. This service may include assistance with the preparation of meals, but does not include the cost of the meals themselves. When specified in the plan of care, this service may also include such housekeeping chores as bed making, dusting, and vacuuming, which are incidental to the care furnished or which are essential to the health and welfare of the individual rather than the individual s family. This service may also include routine wellness services to enable adequate nutrition, exercise and making and keeping medical appointments, and taking medications. This service may also include health maintenance activities such as bowel and bladder routines, ostomy, catheter, and wound care that consumers if physically capable would provide for themselves and continue to direct. Page 2 of 5

3 Personal Assistance Services () Personal Care Services require assistance with eating, bathing, dressing, personal hygiene, and activities of daily living. These services provide limited prompting to initiate or complete daily activities and may include assistance with preparation of meals, but does not include the cost of the meals themselves. When specified in the service plan, this service may also include such housekeeping chores as bed making, dusting, and vacuuming, which are incidental to the care furnished, or which are essential to the health and welfare of the consumer, rather than the consumer s family. Personal Emergency Response System (P.E.R.S.) PERS is an electronic device that enables an individual at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person s phone and programmed to signal a response center once the help button is activated. The response center is staffed by trained professionals. PERS services are limited to those individuals who live alone or who are alone for significant parts of the day and have no regular caregiver for extended periods of time and would otherwise need extensive routine supervision. Purchase (Installation) (Maintenance) Physical, Occupational, Behavioral, Speech Therapy plan will not apply. Services will be as defined in the approved state plan. The provider qualifications in the plan will apply and are hereby incorporated by reference, 1 hour (Speech) Prevocational Services Prevocational services are services not available under Section 110 of the Rehabilitation Act of 1973 or Section 602 (16) and (17) of the Individuals with Disabilities Education Act (20 U.S.C (16 and 17). Services are aimed at preparing an individual for paid or unpaid employment but are not job-task oriented. Services include teaching such concepts as compliance, attendance, task completion, problem solving and safety. Prevocational services are provided to persons not expected to be able to join the work force or participate in a transitional sheltered workshop within one year (excluding supported employment programs). Respite Services Respite services are services provided to individuals unable to care for themselves; furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care. Respite services consist of temporary services offered to consumers in their homes to relieve family members and other persons who normally provide care. Respite services may be delivered in an individual s home, or place of residence, Medicaid certified ICF/ORC, licensed respite facility, or other community care residential facility approved by the state that is not a private residence. Respite services may also be delivered in a relative or friend s home if the consumer s home is not available. Respite services specific to may occur in a Group Home setting - personal care homes not larger than eight beds with staff deemed competent to serve individuals with TBI. The planning team must justify the use of this type of setting for respite. Respite services may include overnight care and services which a family member or other would perform if they were present. This may include bathing, dressing, eating, housekeeping, and participating in community activities. Structured Day Program These services are directed toward the development and maintenance of community living skills. Services will normally be furnished two or more hours per day on a regularly scheduled basis, for one or more days per week. Structured day program services include supervision and specific training to allow the consumer to attain his or her maximum potential. Services may include social skills training, sensory/motor development, and reduction/elimination of maladaptive behavior. Services directed at preparing the consumer for community reintegration (teaching concepts such as compliance, attending, task completion, problem solving, safety, money management, etc.) are also included. Physical, occupational, speech and cognitive rehabilitation therapies will also be provided in addition to the structured day program if needed as documented in the approved service plan. 1/2 day Page 3 of 5

4 Supports Coordination Supports Coordination services are services that will assist individuals who receive Waiver services in gaining access to needed Waiver services and other state plan services, as well as medical, social, educational and other services regardless of the funding source to which access is gained. Supports Coordination is working with and at the direction of the consumer whenever possible to identify, coordinate, and facilitate Waiver services. Supports Coordination also includes intake, needs assessment, advocacy, for services from local resources, and expertise in coordination of services to achieve maximum consumer input and support. (Attenant Care, ) 1 hour (, ) 1 week () Supported Employment Services Supported Employment Services are paid employment services for persons for whom competitive employment at or above the minimum wage is unlikely, and who because of their disability need intensive ongoing support to perform in a work setting. Supported employment is conducted in a variety of settings, particularly work sites in which persons without disabilities are employed. Supported employment includes activities needed to sustain paid work by individuals receiving Waiver services, including supervision, and training. When supported, employment services are provided at a work site in which persons without disabilities are employed, payment will be made only for the adaptations, supervision, and training of the individuals receiving waiver services as a result of their disabilities and will not include payment for supervisory activities rendered as a normal part of the business setting. Transportation Services Transportation services are services offered in order to enable individuals served on the waiver to gain access to waiver and other community activities and resources, specified by the plan of care/service plan. This service is offered in addition to medical transportation required under 42 CFR (a) (if applicable), and shall not replace them. Visiting Nurse plan will not apply. Services will be as defined in the approved state plan. The provider qualifications in the plan will apply and are hereby incorporated by reference Page 4 of 5

5 Intake Supports Coordination Intake services are one time service coordination activities that are provided from the time an individual is identified as a potential consumer to the time they are either denied services or enrolled as a consumer in one of the waivers or ACT 150 PROGRAM. Intake services include but are not limited to: Documenting and tracking of all referrals/contacts Prescreening before a home and/or institutional visit Providing written notice (w/appeal rights) and referral to other possible resources if individual is found not to be appropriate after prescreening (community resources or other Medical Assistance (MA) resources e.g. MA State Plan services, Michael Dallas Waiver (MDW), Early Periodic Screening and Diagnostic Testing (EPSDT), Department of Aging (PDA)) Conducting a home and/or institutional visit with the potential applicant/participant Assessing the individual s needs within fifteen days of the initial contact, including: home environment, family supports, formal and informal supports, community supports/resources Explaining the various home and community based services (HCBS) waivers and programs to the individual and determining the most appropriate services/waivers/programs to pursue. Coordinating with medical provider(s) to obtain required documentation Coordinating with authority designated to determine functional eligibility (e.g. Area Agency on Aging (AAA) OPTIONS assessor for individuals requiring a nursing facility (NF) level of care, assessors for Intermediate Care Facility for Other Related Conditions (ICF/ORC) or Specialized Rehabilitation Facility (SRF) levels of care) Assisting the individual to gather information for Medicaid waiver financial eligibility determination by the County Assistance Office (CAO) and to complete and submit forms and verification documentation Ensuring that the individual receives a notification of eligibility or ineligibility and has an opportunity to ask questions and/or appeal this decision. Developing an initial Individual Service Plan (ISP) and entering ISP information into the Home and Community Services Information System (HCSIS) Providing state approved information for choice of providers and assisting with selection Assisting with transfer to the consumer s chosen provider when different from the intake provider Providing information about consumer-employer model or agency model and assisting with selection Assisting with finding a consumer employer attendant if consumer-employer model is chosen Completing all required forms Completing service preference (waiver requirement that consumer chooses to be in community or institution) Linking the individual to community resources for services not provided through BHCBS waivers and programs Performing an fee determination (gathering information, making determination regarding fee if appropriate) Providing the consumer with a state approved packet of information regarding selected program Providing the individual with general information for consumer s use (e.g. hotlines, advocacy groups, DPW address, support groups, grievance and appeal process, etc.) Lifetime Page 5 of 5