LTC - In-Home Support Services - Provider Bulletin
Effective October 1, 2003
Medicaid clients who receive Home and Community Based Services for the Elderly, Blind and Disabled and children who are enrolled in the Home and Community Based Services Children's Waiver will have access to In-Home Support Services (IHSS). Medicaid clients who are eligible for IHSS will be able to direct their own care and select attendants of their choosing to be hired by an In-Home Support Services Agency. Clients can decide when, where and how their services are provided.
In-Home Support Services include health maintenance activities, support for activities of daily living or instrumental activities of daily living, personal care services and homemaker services. Health maintenance activities are those routine and repetitive activities of daily living which are necessary for health and normal bodily functioning that an individual with a disability would carry out if he or she were physically able, or that would be carried out by family members or friends if they were available. Examples of such activities include catheter irrigation, administration of medication, enemas and suppositories, wound care and ventilator monitoring, and/or any other activity approved by the treating physician.
To be eligible for In-Home Support Services, an individual must be Medicaid eligible and eligible for HCBS-EBD or enrolled in the Children's HCBS Waiver. He or she must be willing to participate and have a health condition that limits his or her ability to perform activities of daily living. The participant must furnish a statement from the primary care or treating physician that states he or she has sound judgment and the ability to direct their own care, the eligible child's parent/guardian has sound judgment and the ability to direct the child's care, or the person has an authorized representative. The authorized representative must have the judgment and ability to assist the participant in acquiring and utilizing services.
In-Home Support Services Agencies
The In-Home Support Services Agency is a new Medicaid provider type. In order to qualify as an IHSS Agency, an entity must offer independent living core services, consisting of peer counseling, including cross-disability peer counseling; information and referral services; independent living skills training; and individual and systems advocacy as defined in Colorado Revised Statutes §26-8.1-102 (3). 24-hour back-up services must be provided to eligible consumers by the IHSS Agency at any time that a scheduled attendant is not available. The IHSS Agency must either contract with or have on staff a health professional, who will be responsible for oversight of training of attendants, verification of adequate skills and competence of attendants, assessment of consumer safety, consultation regarding medical issues and shall investigate complaints and critical incidents. The approved reimbursement rate is $21.29 per hour.
Prior Authorization Required
Single entry point case managers will prior authorize services and refer eligible HCBS-EBD clients to IHSS Agencies. Children who are enrolled in the HCBS Children's Waiver will receive authorizations and referrals through certified case management agencies that are certified by the state to provide case management.
Medicaid regulations concerning In-Home Support Services are available online
Agencies who wish to apply as In-Home Support Services Agencies may access enrollment applications by going to the ACS website noted in this bulletin. The provider participation agreement, enrollment application and enrollment application addendum must be completed and returned to ACS. After the enrollment applications are completed and returned to ACS, ACS will notify the Department of Public Health and Environment (DPHE). DPHE will then begin the agency survey process.
303-534-0146 or 1-800-237-0757 (Toll free Colorado)