23 Miss. Code. R. 208-3.6 - Covered Services
A. The Assisted
Living (AL) Waiver covers Case Management Services provided by a social worker
licensed to practice in the State of Mississippi with at least two (2) years of
full-time experience in direct services to elderly and disabled individuals.
B. AL Services include the
following:
1. Personal care services rendered
by personnel of the licensed facility,
2. Homemaker services,
3. Attendant care services,
4. Medication oversight/administration with
personnel operating within the scope of applicable licenses and/or
certifications,
5. Therapeutic,
social, and recreational programming services,
6. Intermittent skilled nursing services and
interventions ordered by the physician and provided:
a. At least eight (8) hours a day, including
weekends and holidays, to assess and assist the waiver person with services
including, but not limited to, medication administration and oversight, and
b. By a nurse with an active and
unencumbered license acting within their scope of practice. If the facility
employs a Licensed Practical Nurse (LPN), the LPN must have supervision by
either a Registered Nurse (RN), nurse practitioner, or a physician.
7. Transportation services must be
provided by the AL Waiver provider or through the Division of Medicaid's
Non-Emergency Transportation (NET) program if the waiver person has not reached
the maximum NET service limits.
8.
An electronic emergency attendant call system in each Personal Care
Home-Assisted Living (PCH-AL) facility which:
a) Is available to waiver persons who are:
1) At risk of falling,
2) At risk of becoming disoriented, or
3) Experiencing some disorder
placing them in physical, mental or emotional jeopardy.
b) Includes twenty-four (24) hour on-site
response staff to meet scheduled or unpredictable needs in a way that promotes
maximum dignity and independence, and provides for supervision, safety and
security.
9. Provision
of normal, daily personal hygiene items including, at a minimum, deodorant,
soap, shampoo, toilet paper, facial tissue, laundry soap and dental hygiene
products.
C. AL Waiver
providers must provide:
1. A setting
physically accessible to the person but not located in:
a) A nursing facility,
b) An institution for mental diseases,
c) An intermediate care facility
for individuals with intellectual disabilities (ICF/IID),
d) A hospital providing long-term care
services, or
e) Any other location
that has qualities of an institutional setting, as determined by the Division
of Medicaid including, but not limited to, any setting:
1) Located in a building that is also a
publicly or privately operated facility that provides inpatient institutional
treatment,
2) Located in a
building on the grounds of or immediately adjacent to a public institution, or
3) Any other setting that has the
effect of isolating persons receiving Medicaid Home and Community-Based
Services (HCBS).
2. A private, home-like living quarter with a
bathroom consisting of a toilet and sink and must:
a) Be a unit or room in a specific physical
place that can be owned, rented or occupied under a legally enforceable
agreement by the waiver person, and the person has, at a minimum, the same
responsibilities and protections from eviction that tenants have under the
landlord/tenant law of the State, county, city or other designated entity. For
settings in which landlord tenant laws do not apply, the Division of Medicaid
must ensure that:
(1) A lease, residency
agreement or other form of written agreement will be in place for each HCBS
person, and
(2) That the document
provides protections that address eviction processes and appeals comparable to
those provided under the jurisdiction's landlord tenant law.
b) Provide each waiver person
privacy in their sleeping or living unit with:
1) Lockable entrance doors with only
appropriate staff having keys to doors, and
2) The option to share living units only at
the choice of the person.
3. A setting which integrates and facilitates
the person's full access to the greater community, including opportunities to
seek employment and work in competitive integrated settings, engage in
community life, control personal resources, and receive services in the
community in the same manner as individuals without disabilities,
4. A setting selected by the person from
among all available alternatives and is identified in the person-centered Plan
of Services and Supports (PSS),
5.
Protection of a person's essential personal rights of privacy, dignity and
respect, and freedom from coercion and restraint,
6. Individual initiative, autonomy, and
independence in making life choices, including but not limited to, daily
activities, physical environment, and with whom to interact,
7. Individual choice regarding services and
supports, and who provides them,
8. An assessment of safety needs of a person
with cognitive impairment supported by a specific assessed need and addressed
in the PSS,
9. Freedom and support
of persons to control their own schedules and activities and have access to
food at any time,
10. Freedom to
have visitors of their choosing at any time,
11. A living environment supportive of the
person to exercise their rights to:
a. Attend
religious and other activities of their choice,
b. Manage their own personal financial
affairs or receive a quarterly accounting of financial transactions made on
their behalf,
c. Not be required
to perform services for the facility,
d. Receive mail unopened or in compliance
with the facility policy,
e. Be
treated with consideration, kindness, respect and full recognition of their
dignity and individuality,
f.
Retain and use personal clothing and possessions as space permits,
g. Voice grievances and recommend changes in
licensed facility policies and services,
h. Not be confined to the licensed facility
against their will and allowed to move about in the community at liberty,
i. Free from physical and/or
chemical restraints,
j. Allowed to
choose a pharmacy or pharmacist provider in accordance with State law,
k. Decide when to go to bed and
get up in the morning,
l. Furnish
and decorate their sleeping or living space within the lease or other
agreement,
m. Allows the person to
decide when to eat his or her meals,
n. Have nutritious snacks available at all
times, and
o. Use the dining room
for congregate meals and socialization.
Notes
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