What are Medicaid Waiver Assisted Living Services?

Medicaid Waiver Assisted Living Services are:

• a broad range of support services
• provided in the residents' own living units
• that allow residents to take charge of their lives and participate in decision in a homelike environment

To understand how the process works, let's invent an imaginary resident, “Jane.” First, she must be financially eligible for Medicaid, the Nebraska Medical Assistance Program. Jane is then assessed by a Services Coordinator who determines that she meets the level of care required for waiver eligibility. This will help identify the adequacy of assisted living and other services available under the Home and Community-Based Services Medicaid Waiver.

If “Jane” is determined eligible for Waiver Services and chooses assisted living, a Services Coordinator will work with her and the Assisted Living Facility to develop a Resident Service Agreement. This Agreement ensures that the facility “Jane” chooses includes the services she needs as identified in her Plan of Services and Supports/DSS-12AD (Appendix B ).

Along with the services required under your Assisted Living license, the following service components are required, based on the resident's individual assessment, when you become a Medicaid Waiver Provider. Please remember that while an Assisted Living Facility must be able to provide all of these services, individuals may not need them all. The Plan of Services and Supports and the Resident Service Agreement are designed to keep the resident as independent as possible.

• Adult day care/socialization activities - Structured social, habilitative and health activities geared to each resident's individual needs.
• Escort - Accompanying or assisting a resident unable to travel or wait alone. This may include assistance to and from a vehicle and/or place of local destination or providing or making arrangements for supervision and support to the resident while s/he's away from the Assisted Living Facility.
• Essential shopping - Helping a resident unable to obtain clothing and personal care items for him/herself. This does not include financing the purchases of clothing or special request personal care items.
• Health maintenance activities - Noncomplex health care interventions that can safely be performed according to exact directions that do not require alterations of standard procedure and for which the results and residents' responses are predictable. For example, these interventions could include recording height and weight, monitoring blood pressure and blood sugar and providing insulin injections as long as the resident's condition is stable and predictable as defined in the "Nurses Practices Act" and the "Medication Aide Act." Each resident's individual needs determine the need for health maintenance activities.
• Housekeeping activities - Cleaning of private residences such as dusting, vacuuming, cleaning floors or bathrooms and making and changing beds. Change bed linens as soiled or at least weekly. Make clean bath linens available daily.
• Laundry - Washing, drying, folding and returning a resident's clothing to his/her room. Dry cleaning is each resident's responsibility but please assist in arranging for it, if needed.
• Meals - Provision of three meals per day, seven days per week, as well as access to between-meal snacks. Each meal must:
  • consist of a variety of properly prepared foods containing at least one-third of the Minimum Daily Nutritional Requirements for adults; and
  • take into account cultural and personal preferences for foods served at specific times of the day.
  Deliver meals to the room of any temporarily ill resident.
• Medication assistance - Giving help to residents taking prescription and/or nonprescription medications, if needed.
• Personal Care - Assistance with activities of daily living (ADL's) such as transferring, dressing, eating, bathing, toileting and incidents of bladder and bowel incontinence. Helping residents with meals and snacks including opening packages, cutting food, adding condiments and performing other activities which the resident cannot. If a resident cannot eat independently for a short period of time, feed him/her or assure that other meal and snack arrangements are made. Provide personal care services to each resident in a way that helps them maintain as much independence and privacy as possible.
• Transportation - Transporting or making arrangements for transporting residents to and from local community resources. These resources are identified during each client's assessment and included in his/her Plan of Services and Supports and his/her Resident Service Agreement as directly contributing to his/her ability to remain in an Assisted Living Facility.

To become a facility providing Medicaid Waiver Assisted Living for the Home and Community-Based Services Medicaid Waiver, you should have:

• Worked with Nebraska Department of Regulation and Licensure staff and received an Assisted Living license;
• Worked with DHHS and/or its contracted Resource Developers to complete Medicaid Waiver certification including completing and singing one each: a Service Provider Agreement; an Assisted-Living Service Provider Addendum/MILTC-22 (Appendix C); and an Assisted Living Service Provider Checklist/MILTC-1AD (Appendix D);
• Provided DHHS Resource Development staff and/or that of its contractor with your agency's hiring and reporting policies for background checks of the Adult Protective Services Central Registry and the Child Abuse/Neglect, Central Register and verification that checks show there are no substantiated or inconclusive reports of abuse or neglect by you and/or your current direct care staff as well as all new hires;
• Provided a statement concerning any felony and/or misdemeanor arrests, convictions and pending criminal charges involving you and your direct care staff and if asked, signed a release of information to allow DHHS to get any additional information that may be needed; and
• Proven that you and your direct care staff have not been convicted of or admitted to evidence of crimes against a child or vulnerable adult. Those crimes include but are not limited to, bodily harm, illegal use of a controlled substance or crimes involving moral turpitude.