23 Miss. Code. R. 208-3.6

Current through December 10, 2024

Rule 23-208-3.6 - 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.

23 Miss. Code. R. 208-3.6

42 C.F.R. §§ 431.53, 440.170, 440.180; Miss. Code Ann. § 43-13-121.

Revised Miss. Admin. Code Part 208, Rule 3.6.B. and added Miss. Admin. Code Part 208, Rule 3.6.C. to correspond with changes in the AL Waiver renewal (eff. 10/01/2013) eff. 05/01/2014.

Amended 1/1/2017