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Montana. Legislature. Office of the Legislative Au.

Performance audit report, Medicaid home and community-based services program, Department of Social and Rehabilitation Services (Volume 1985) online

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Sincerely yours.






Dave M. Lewis
Director



27



SRSEA-61



MONTANA DEPARTMENT OF SOCIAL & REHABILITATION SERVICES

LETTER OF NOTIFICATION



Nam* of Applicinl or Raclpltnt:



SIraat Addrass:



City and Zip Code:



Organizational Unit:



Straat Addrsat:



City and Zip Code:



Phone;



1. PROGRAM:



SCREENING FOR LONG TERM CARE



2. ACTION:



On.



_, you were screened to determine if you are eligible for Medicaid payment for long



term care. The decision of the screening team is:



You do not require long term care and are not eligible for Medicaid payment for such care.
You may check with your County Office of Human Services to learn if you are eligible for
other Medicaid benefits.

You do require long term care and may be eligible for Medicaid payment. The eligibility tech-
nician in your County Office of Human Services will decide if you are financialy eligible for
Medicaid payment.



Legal Basis for Action:

46.12.1301 ARM



PLACEMENT DECISION:



. Nursing Home
. Home & Community
Services



42



CFR



456.1,456.271,456.350



53-2-201,53-6-101,53-6-111



MCA



If you have any questions regarding this action or if there are additional facts relating to your circumstances which you have not
reported to us, please write or telephone. We will answer your questions or make an appointment to see you in person. Please
remember that this action pertains only to the circumstances you reported to us. (PLEASE READ THE REVERSE SIDE OF THIS
NOTICE FOR YOUR FAIR HEARING RIGHTS).



LONG TERM CARE SPECIALIST



(DATE)



NURSE COORDINATOR



(DATE)



REQUEST FOR FAIR HEARING



This is to request a fair hearing. I am making this request because:.



I understand that the right to a fair hearing includes an administrative review and a pre-hearing conference. If my reasons for a fair
hearing have not been resolved during the administrative review and/or pre-hearing conference, I understand that a fair hearing will be
scheduled.



I have an attorney: D Yes D No.
His/her address is:



My attorney's name is:_



His/her phone number is:.



(CLAIMANT OR AUTHORIZED REPRESENTATIVE)



(PHONE)



(DATE)



*T0 REQUEST A FAIR HEARING COMPLETE, SIGN AND MAIL THE WHITE COPY OF THIS NOTICE TO: HEARINGS
OFFICER, BOX 4210, HELENA, MT 59604. 28

Distribution: White — Patient; Yellow — E.T, Pink — Screening Team



APPENDIX



APPENDIX A

SERVICE ELIGIBLE THROUGH THE HOME AND CO^ylMUNITY-BASED

SERVICES PROGRAM

The following definitions apply to the waiver services offered:

1 . Case Management Services

Services whereby an individual or organization is re-
sponsible for locating, coordinating, and monitoring
community-based services to individuals.

More specifically, case management includes:

1) Setting up written plan of care goals in a system-
atic way and with the client's and attending
physician's involvement;

2) Monitoring, managing, writing, and recording
written plans of care in a way the client and others
understand;

3) Setting up relationships with resources;

4) Maximizing the individual's efficient use of re-
sources;

5) Facilitating interaction between people working in
resource systems; and

6) Mobilizing and using "natural helping networks"
such as family members, church members and
friends.

2. Homemaker Services

Homemaker services consist of general household activ-
ities provided by a homemaker when the individual
regularly responsible for these activities is absent or
unable to manage the home and care for himself/herself
or others in the home. Services in this program include
meal preparation, cleaning, simple household repairs,
laundry, shopping for food and supplies and other
routine household care.

3. Personal Care Attendant Services

Personal Care Attendant services entail:

1) Assistance with personal hygiene, dressing, eating
and ambulatory needs of the individual; and



A-1



2) Performance of household tasks incidental to the
person's health care needs or otherwise necessary
to contribute to maintaining the individual at home.

4. Adult Day Care Services

Adult day care services provide for health, social and
habilitation needs for a person in a setting outside the
person's place of residence for periods of four or more
hours daily.

5. Habilitation Services

Habilitation services are designed to assist in the devel-
opment of a person's skills or the reduction of behavior
which interferes with a person's development. The skills
must be identified in the individuals plan of care as
appropriate to the person's current developmental level.

For physically disabled individuals the service provides
independent living evaluation and individual and class-
room instruction in adaptive techniques to achieve maxi-
mum independence in the areas of homemaking tech-
niques, personal hygiene, money management and bud-
geting, use of community resources with an emphasis on
emergency care, transportation systems and housing
assistance.

6. Respite Care Services

Respite care is available to elderly, physically disabled
or developmentally disabled individuals unable to care for
themselves. Such care is provided on a short-term basis
because of the absence of or need for relief of those
persons normally providing the care.

7. Medical Alert and Monitoring System

The medical alert can be a small instrument worn by the
client, or a telephone alert system. By a push of a
button, the instrument alerts other support staff who
have been designated by the case management team to
respond to the needs of individuals.

Without this service, certain individuals who require
prompt medical attention would be institutionalized.

8. Meals on Wheels/Congregate Meals

This service is to provide hot or other appropriate meals
once or more a day, up to seven days a week. A full
nutritional regimen will not be provided, in keeping with
the exclusion of room and board as covered services.



A-2



Without this service, certain individuals would receive
inadequate nourishment, and would require institutional-
ization .

9. Transportation Services

This service is to provide transportation services to
individuals to get to social, religious and nonmedical
services and could include escort services if the plan of
care calls for this.

Without this service, certain individuals would be denied
access to social, religious and other nonmedical services
which would be offered them in an institutional setting;
they may therefore choose to be institutionalized.

10. Environmental Modifications Adaptive Equipment

These services are designed to provide the individual
accessibility in the home environment so as to maintain
or improve the ability to remain in the home. Services
may include installation of wheelchair ramps and grab-
bars.

Without this service, certain individuals would be unable
to remain in their own homes, and would be institution-
alized.

*
1 1 . Physical Therapy Services

These services will be provided through direct contact
between therapists and clients as well as between thera-
pists and individuals involved with the client. Physical
therapists may provide treatment training programs that
are designed to:

1) Preserve and improve abilities for independent
function, such as range of motion, strength, toler-
ance, coordination and activities of daily living; and

2) Prevent, insofar as possible, irreducible or progres-
sive disabilities through means such as the use of
orthotic prosthetic appliances, assistive and adap-
tive devices, positioning, behavior adaptations and
sensory stimulation.

Without this service in the community, certain
individuals would be institutionalized, as physical
therapy for habilitative purposes may not be other-
wise available.



A-3



*

12. Occupational Therapy Services

These services will be provided through direct contact
between therapists and clients as well as between thera-
pists and individuals involved with clients. Occupational
therapists may provide treatment training programs that
are designed to meet objectives as identified for occupa-
tional therapy services.

Without this service, certain individuals would be insti-
tutionalized, as occupational therapy for habilitative
purposes may not be otherwise available.

*

1 3. Speech Pathology and Audiology Services

1) Speech pathology services are those diagnostic,
screening, preventative or corrective services
provided by a licensed speech pathologist, upon
physician referral, to individuals with speech and
language disorders.

2) Audiology services include hearing aid evaluations
and basic audio assessment provided by a licensed
audiologist, upon physician referral, to individuals
with hearing disorders.



Note: These services are to be provided to disabled individuals.

They are defined here in order to provide habilitative

professional services to individuals eligible under the
waiver.



Source: Home and Community-Based Service Request For Waiver ;
December, 1982; State of Montana, Department of Social
and Rehabilitation Services.



A-4



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Online LibraryMontana. Legislature. Office of the Legislative AuPerformance audit report, Medicaid home and community-based services program, Department of Social and Rehabilitation Services (Volume 1985) → online text (page 3 of 3)