Long Term Services & Supports - Benefits & Services Glossary

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Acupuncture

Acupuncture means the stimulation of anatomical points on the body by penetrating the skin with thin, solid, metallic, single-use needles that are manipulated by the hands or by electrical stimulation for the purpose of bringing about beneficial physiologic and /or psychological changes. The utilization of acupuncture may typically begin at a higher frequency and is expected to decrease as the client progresses. Authorization and payment for the acupuncture service is limited as follows:
  • During the first 90 days of the initial alternative therapies Care plan, the schedule of services recommended by the supervising physician shall not exceed 60 (15 minute) units for any one alternative therapy service or 120 (15 minute) units for any combination of alternative therapies. 
     
  • After the first 90 days of the initial alternative therapies care plan and in all subsequent alternative therapies care plans, the schedule of services recommended by the supervising physician shall not exceed 48 (15 minute) units for any one alternative therapy service or 96 (15 minute) units for any combination of alternative therapies per 90 day period.
     
  • Services are limited based on the client's assessed need for services, physician's orders, and prior authorization by case managers up to the cost containment parameters.
Waiver(s) which include this service:
 

Adult Day Services

Services furnished 4 or more hours per day in a community-based setting, encompassing both health and social services needed to ensure the optimal functioning of the participant. 
 
There are two types of Adult Day Services Centers:
  1. Basic Adult Day Services (ADS) Centers provide basic social and health services to participants.
  2. Specialized Adult Day Services (SADS) Centers provide intensive health supportive services for participants with a primary diagnosis of Alzheimer's and related disorders, Multiple Sclerosis, Brain Injury, Chronic Mental Illness, Developmental Disability or poststroke participants who require extensive rehabilitative therapies.
 
The following activities are performed by staff and are designed to assist individuals to reside as interdependently as possible in the community.
  • Daily monitoring to assure that participants are maintaining activities prescribed; and assisting with activities of daily living (e.g., eating, dressing, bathing).
  • Emergency services including written procedures to meet medical crises.
  • Activities to assist in the development of self-care capabilities, personal hygiene, and social support services.
  • Nutrition services including therapeutic diets and snacks appropriate to the participant's care plan and hours in which the participant is served.
  • Health monitoring services provided to monitor the participant's health status, supervise medications, and carry out physicians' orders in participant's care plan as needed.
  • Social and recreational services as prescribed to meet the participant's needs and as documented in the participant's care plan. Participants have the right to choose not to participate in social and recreational activities.
  • Therapies, such as physical therapy, occupational therapy and speech therapy, if prescribed by the participant's physician, documented in the participant's care plan and such services are not being provided in the participant's home.
  • Basic personal care services including bathing in emergency situations shall be provided by ADC who were  certified on or after July 1, 1996.
 
Waiver(s) which include this service:
HCBS WAIVER for PERSONS with a BRAIN INJURY
 

Alternative Care Facility

An Assisted Living Residence to provide alternative care services and Protective Oversight to Medicaid clients.  Alternative care services include, but are not limited to, personal care and homemaker services. Room and board shall not be a benefit of ACF services. Clients shall be responsible for room and board in an amount not to exceed the Department established rate.
 
Waiver(s) which include this service:
 

Assistive Technology Services

  • Assistive technology services may include the evaluation of the child's need for assistive technology related to the disability, helping to select and obtain appropriate devices, designing, fitting and customizing those devices, purchasing, repairing or replacing the devices, and training the child and/or family to use the devices effectively.
  • Assistive technology services includes devices and services that will help a child with a developmental disability and the child's family to overcome barriers related to the disability that they face in their daily lives. This may include the use of devices to help the child move around, such as wheelchairs, wheelchair adaptations, and adaptations for vans (e.g., lifts for vans or roof storage for wheelchairs), devices that help the child communicate such as electronic communication devices (excluding cell phones, pager and internet access unless prior authorized by the State); devices that make learning easier such as adapted games, toys an computers; and devices that control the environment such as switches.
  • Recreational equipment, such as, a flotation collar for swimming, a bowling ramp, various types of balls with internal auditory devices and other types of equipment appropriate for the recreational needs of a child with developmental disability.
 
Waiver(s) which include this service:
 

Assistive Technology Services, Extended

Devices, items, pieces of equipment, or product system used to increase, maintain, or improve functional capabilities of clients and training in the use of the technology when the cost is not otherwise covered through the State Plan durable medical equipment benefit or home modification waiver benefit or available through other means.

  • Examples include: adaptive cooking utensils, communication devices such as PDAs, environmental control units
     
Waiver(s) or programs which include this service:
 

Behavioral Therapies

  • Intensive developmental behavioral therapies developed specific to the client's needs including conditioning, biofeedback or reinforcement techniques.
  • Treatment goals that are consistent with building elementary verbal skills, teaching imitation, establishing appropriate toy play or interactive play with other children, teaching appropriate expression of emotions and behaviors, and where necessary, reducing self stimulation and aggressive behaviors.
  • One on one behavior therapy conducted with the client and Line Staff, following a specific protocol established by the Lead Therapist.
Training or modeling for parents or a guardian so that the behavioral therapies can continue in the home. Training or modeling shall be:
  • Directed towards instruction on therapies and use of equipment specified in the Care Plan.
  • Carried out in the presence of and for the direct benefit of the client.
  • Conducted by the Line Staff.
 
Waiver(s) which include this service:
 

Brain Injury Waiver (BI)

  • Adult Day Services
This service is for at least  2 or more hours of attendance for one or more days per week Services furnished in a community-based setting, encompassing both health and social services needed to ensure the optimal functioning of the participant.
 
The following activities are performed by staff and are designed to assist individuals to reside as interdependently as possible in the community.
  • Daily monitoring to assure that participants are maintaining activities prescribed; and assisting with activities of daily living (e.g., eating, dressing, bathing).
  • Emergency services including written procedures to meet medical crises.
  • Activities to assist in the development of self-care capabilities, personal hygiene, and social support services.
  • Nutrition services including therapeutic diets and snacks appropriate to the participant's care plan and hours in which the participant is served
  • Health monitoring services provided to monitor the participant's health status, supervise medications, and carry out physicians' orders in participant's care plan as needed.
  • Social and recreational services as prescribed to meet the participant's needs and as documented in the participant's care plan. Participants have the right to choose not to participate in social and recreational activities.
  • Therapies, such as physical therapy, occupational therapy and speech therapy, if prescribed by the participant's physician, documented in the participant's care plan and such services are not being provided in the participant's home.
 
  • Assistive Technology (Specialized medical equipment and supplies
Specialized medical equipment and supplies includes device controls, or appliances which enable recipients to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. Assistive technology devices shall enable the client to remain safely in their own home by enabling them to secure help in the event of an emergency or by providing reminders to the individual of medical appointments, treatments, or medication schedules.
 
Specialized Medical Equipment and Supplies (Assistive Technology) services shall be authorized only for individuals who have the physical and mental capacity to utilize the particular system requested for that individual.
 
Specialized Medical Equipment and Supplies (Assistive Technology) do not include:
  • Augmentative communication devices and communication boards
  • Hearing aids and accessories;
  • Phonic ears;
  • Environmental control units, unless required for medical safety of a client living alone unattended;
  • Computers and computer software;
  • Wheelchair lifts for automobiles or vans;
  • Exercise equipment, such as exercise cycles;
  • Hot tubs, Jacuzzis, or similar items.
     
  • Behavioral Programming
Behavioral programming and education is an individually developed intervention designed to decrease/control the client's severe maladaptive behaviors which, if not modified, will interfere with the individual's ability to remain integrated in the community.
 
Programs consist of a comprehensive assessment of behaviors, development of a structured behavioral intervention plan, and ongoing training of family and caregivers for feedback about plan effectiveness and revision. Consultation with other providers may be necessary to ensure comprehensive application of the program in all facets of the person's environment.

 

Behavioral programs may be provided in the community or in the client's residence unless the residence is a transitional living center which provides behavioral intervention as a treatment component.
 
  • Day Treatment

Day Treatment consists of intensive therapeutic services scheduled on a regular basis for two or more hours per day, one or more days per week directed at the ongoing development of community living skills.

Services take place in a non-residential setting separate from the home in which the recipient lives.
 
Therapeutic services include:
  • physical therapy
  • speech therapy
  • vocational counseling
  • nursing
  • social work
  • recreational therapy
  • case management
  • neuropsychology
 
Services include:
  • social skills training
  • sensory motor development
  • reduction/elimination of maladaptive behavior
  • services aimed at preparing the individual for community reintegration
 
Transportation between therapeutic tasks in the community is also included in the day treatment.
 
  • Independent Living Skills Training
Independent Living Skills Training and Development means services designed and directed at the development and maintenance of the participant's ability to independently sustain himself/herself physically, emotionally, and economically in the community. Skills training may be provided in the client's residence, in the community or in a group living situation.
 
Services may include assessment, training, and supervision or assistance to an individual with:
  • self care
  • medication supervision
  • task completion
  • communication skill building
  • interpersonal skill development
  • socialization
  • therapeutic recreation
  • sensory motor skills
  • mobility or community transportation training
  • reduction or elimination of maladaptive behaviors
  • problem solving skill development
  • benefits coordination
  • resource coordination
  • financial management
  • household management
     
  • Mental Health Counseling (Individual, Family, Group)
Mental Health Counseling services are individualized services designed to assist the participants and their support systems to more effectively manage and overcome the difficulties and stresses confronted by people with brain injuries. Services may be provided in the client's residence, a community setting, or in the provider's office.
 
Mental Health Counseling is available to:
  • An individual or group setting
  • The client's family in conjunction with the client if they have a significant role in supporting the client or live with or provide care to the client
 
Prior authorization is required after thirty visits of individual, group, family or a combination of the modalities have been provided. Re-authorization is submitted to the State Brain Injury Program Coordinator.
 
  • Substance Abuse Counseling (Individual, Family, Group)
Substance abuse counseling services are individually designed interventions to reduce or eliminate the use of alcohol and/or drugs by the waiver participant which, if not effectively dealt with, may interfere with the individual's ability to remain integrated in the community.

Substance Counseling is available to:
  • An individual or group setting
  • The client's family in conjunction with the client if they have a significant role in supporting the client or live with or provide care to the client

Prior authorization is required after thirty visits of individual, group, family or a combination of the modalities have been provided. Re-authorization is submitted to the State Brain Injury Program Coordinator.

 

  • Supported Living Program

Supported Living Program (SLP) is a specialized program designed for the client whose independence can be maximized in the community by the provision of 24-hour supervision, structure, and supportive services provided in a certified Supported Living Program facility.

SLP is available only to a client who has a brain injury and is determined through the ULTC 100.2 to be eligible for nursing facility level of care.
 
Services include, but are not limited to, assessment, training and supervision of self-care, protective oversight and supervision, behavioral management, cognitive supports, interpersonal and social skills development, medical management, physical, speech, and occupational therapies to maintain functionality, financial management, household management, individual activity plans, and recreational and social activities on and off the facility.
 
Include transportation between therapeutic tasks in the community, recreational outings, and activities of daily living.
 
  • Transitional Living

Transitional living services are provided in a residential setting, and are designed to improve the client's ability to live in the community by provision of 24 hour services, support and supervision. Clients must need assistance in a residential setting for safety and supervision and require support in meeting their psychosocial needs. Clients must also require high intensity therapy which is defined as needing more than three hours per week of any one therapeutic discipline; i.e., physical therapy, occupational therapy, or speech therapy. All services must be documented in an approved plan of care and must be prior authorized by the State Brain Injury Program Coordinator.

 
Services include but are not limited to assessment, training, and supervision of self-care, medication management, communication skills, interpersonal skills, socialization, sensory/motor skills, money management, and ability to maintain a household. Services are normally limited in duration to six months.
 
Clients shall be responsible for room and board in an amount not to exceed the Department established rate.
 
ALL of the previous services are offered as part of the Brain Injury Waiver
 

Caregiver Education

Educational and coaching services that assist clients and family members to recruit other family members and friends to form an informal caregiver network to share caregiving responsibilities. 

  • Training activities might include helping clients and caregivers identify:
    • What does caregiving look like for your family member or loved one?
    • What does caregiving look like for the caregivers?
    • How do caregivers identify client needs?
    • How do clients ask for help for what they need?
    • How to do clients match people with the assistance or support they need?
    • What do clients expect of their caregivers?
    • What tasks will the caregiver be expected to perform?
    • What does the caregiving schedule look like and how does it fit the needs of both the client and the caregiver? Daily? Weekly? Monthly? Yearly?
       
Waiver(s) or programs which include this service:
 

Case Management

Case management is assistance provided by a case management agency on behalf of an eligible client, which includes referral of needed Medicaid services and supports that enable the client to remain in his/her community-based setting.

A case manager is responsible for:

  • Assessing a client's long-term care needs;
  • Developing and implementing a care plan for the client;
  • Coordinating and monitoring the delivery of long-term care services;
  • Evaluating the effectiveness of the services; and
  • Periodically re-assessing the client's needs.

 


Children's Extensive Support - Personal Assistance Services

Child care services: The temporary care of a child, which is necessary to keep a child in the home and avoid institutionalization.
  • Personal supports: Personal supports may include assistance with bathing and personal hygiene, eating, dressing and grooming, bowel and bladder care, menstrual care, transferring, basic first aid, giving medications, operating and maintaining medical equipment for a child who cannot perform these functions alone due to the developmental disability or medical condition.
  • Household services: Assistance in performing housekeeping tasks which, due to the needs of the child with a developmental disability, are above and beyond the tasks generally required in a home and/or increase the parent(s) ability to provide care needed by the child with a developmental disability.
 
Waiver(s) which include this service:
 

Children with Life Limiting Illness Waiver (CLLI)

  • Bereavement Counseling
Bereavement counseling means counseling provided to the client and/or family members in order to guide and help them cope with the client's illness and the related stress that accompanies the continuous, daily care required for a child with a life-threatening condition. Enabling the client and family members to manage this stress improves the likelihood that the child with a life-threatening condition will continue to be cared for at home, thereby preventing premature and otherwise unnecessary institutionalization. Bereavement activities offer the family a mechanism for expressing emotion and asking questions about death and grieving in a safe environment thereby potentially decreasing complications for the family after the child dies.
 
  • Massage Therapy

    Massage therapy is the physical manipulation of muscle contractures, spasms, extention, muscle relaxation and muscle tension.

 

  • Therapeutic Life Limiting Illness Support
Therapeutic Life Limiting Illness Support means grief/loss or anticipatory grief counseling that assist the client and family to decrease emotional suffering due to the client's health status, to decrease feelings of isolation or to cope with the client's life-limiting diagnosis. Support is intended to help the child and family in the disease process. Support is provided to the client to decrease emotional suffering due to health status and develop coping skills. Support is provided to the family to alleviate the feelings of devastation and loss related to a diagnosis and prognosis for limited lifespan, surrounding the failing health status of the client, and impending death of a child. Support is provided to the client and/or family members in order to guide and help them cope with the client's illness and the related stress that accompanies the continuous, daily care required by a terminally ill child. Support will include but is not limited to counseling, attending physician visits, providing emotional support to the family/caregiver if the child is admitted to the hospital or having stressful procedures, and connecting the family with community resources such as funding or transportation.
 
  • Respite Care
Respite Care means services provided to an eligible client who is unable to care for himself/herself on a short term basis because of the absence or the need for relief of those persons normally providing care. Respite Care is provided in the client's residence and may be provided by different levels of providers depending upon the needs of the client. Skilled versus unskilled care are dependent upon the needs of the client and the physician's order. Skilled Respite care must be provided by an RN, LPN or CNA.
 
Respite care may be provided for up to a maximum of 30 days per year. 
 
Waiver(s) which include these services:
 

Chiropractic Care

Chiropractic Care means the use of manual adjustments (manipulation or mobilization) of the spine or other parts of the body with the goal of correcting alignment and other musculoskeletal problems. The utilization of chiropractic care may typically begin at a higher frequency and is expected to decrease as the client progresses. Authorization and payment for the chiropractic service is limited as follows:
  • During the first 90 days of the initial alternative therapies Care plan, the schedule of services recommended by the supervising physician shall not exceed 60 (15 minute) units for any one alternative therapy service or 120 (15 minute) units  for any combination of alternative therapies. 
     
  • After the first 90 days of the initial alternative therapies care plan and in all subsequent alternative therapies care plans, the schedule of services recommended by the supervising physician shall not exceed 48 (15 minute) units for any one alternative therapy service or 96 (15 minute) units for any combination of alternative therapies per 90 day period.
     
  • Services are limited based on the client's assessed need for services, physician's orders, and prior authorization by case managers up to the cost containment parameters.
Waiver(s) which include this service:
 

Community Connector Services

The Community Connector will explore community services appropriate to the individual in their community, natural supports available to the individual, match and monitor community connections to enhance socialization and community access capability.
 
Recreation and Leisure Activities (for the child with a developmental disability):
Recreational programs that will allow the child with a developmental disability to experience typical community leisure time activities, increase their ability to participate in these activities and develop appropriate physical and psychological-social skills.  (Limited to $500 per year).
 
Waiver(s) which include this service:
 

Community Transition Services

Community Transition Services (CTS) are activities essential to move a client from a skilled nursing facility and establish a community-based residence.  Services are provided by a Transition Coordination Agency (TCA) and include at least two Independent Living Core Services.
 
Essential items purchased in order to move a client from a skilled nursing facility and establish a community based residence.  Items must be for the benefit of the client only and may be purchased only when they can not be provided by other means. Items that may be purchased with CTS funds include the following:
  • Security deposits that are required to obtain a lease on a residence
  • Set-up fees or deposits for utility or service access, including telephone, electricity, heating and water
  • Household items and furnishings such as a bed, linens, seating, lighting, dishes, utensils and food preparation items
  • Moving expenses required to occupy a community-based residence
  • Health and safety assurances including a one-time pest eradication and a one-time cleaning prior to occupancy
  • A one-time purchase of food not to exceed $100
 
CTS funds can not be used to purchase the following:
  • Monthly rental expenses or other ongoing periodic residential expenses
  • Recreation, entertainment or convenience items
 
Waiver(s) or programs which include this service:
 

Consumer Directed Attendant Support Services (CDASS)

Consumer Directed Attendant Support Services (CDASS) is a service delivery option available under the Home and Community Based Services - Elderly, Blind and Disabled (HCBS-EBD), Community Mental Health Supports (CMHS), Spinal Cord Injury (SCI), and Brain Injury (BI) waivers. CDASS allows clients to manage their personal care, homemaker and health maintenance services.  
 
In CDASS, you or your authorized representative can do the following:
  • Select attendants (can include family members or friends), based on qualifications that you set
  • Train, supervise and dismiss your attendants
  • Decide when and where you receive services
  • Set wages for your attendants up to the established limit
  • Manage an annual allocation
 
Clients can manage services including hiring, training, supervising and, if necessary, the firing of their attendants. CDASS allows participants to direct certain services provided only by nurses or certified nurse aides due to the exemption of the Nurse Practice Act.
 
Clients interested in directing their attendant support services should contact their local Single Entry Point (SEP) case management agency for more information.
 
Waiver(s) which include this service:
 

Day Habilitation Services

Specialized Day Habilitation
  • Generally in a non-integrated setting where a majority of the persons have a disability, such as program sites.
  • Such services include self-feeding, toileting, self-care, sensory stimulation and integration, self sufficiency, maintenance skills, and supervision.
  • Specialized habilitation services may serve to reinforce skills or lessons taught in school, therapy, or other settings and, where appropriate, be coordinated with any physical, occupational, or speech therapies listed in the plan of care.
 
Community Accessibility Services
  • Support the abilities and skills necessary to enable the individual to access the community and/or provide the basis for building skills that will assist the individual to access the community.
  • Services include socialization, adaptive skills, personnel to accompany and support the individual in all types of community settings, supplies and providing the necessary resources for participation in activities and functions in the community.
 
Waiver(s) which include this service:

Developmental Disabilities Waiver

ALL of the following services are offered as part of the waiver for persons with Developmental Disabilities

  • Behavioral Services

Behavioral services identified in the plan of care and are needed for the individual to acquire or maintain appropriate interactions with others. Intervention modalities must relate to an identified behavioral need of the person and specific criteria for remediation of the behavior must be established.

Services include:
  • Individual and/or group counseling
  • Behavioral interventions
  • Diagnostic evaluations or consultations
 
Behavioral Line Staff are additional staff, which are working under the direction of the senior or lead therapist that is brought into the residential and day program locations to specifically carry out the behavioral plan only. These activities are time limited and targeted to the behavioral plan. This does not include residential or day program staff that are doing follow-up to the behavioral therapy identified in the plan in the course of their regular day or residential program activities. Does not require credentialing but must be trained regarding behavioral plan implementation and interventions.
 
  • Residential Habilitation Services and Supports
Under Residential Habilitation Services and Supports (RHSS) the responsibility for the living environment rests with the service agency and encompass two types of living environments:
 
  • Individual Residential Services and Supports - in which 3 or fewer persons receiving services may live in a single residential setting.  The living environment does not require state licensure however Division of Developmental and Intellectual Disabilities must approve the service agencies to provide such services.
  • Group Residential Services and Supports  encompass group living environments of 4 to 8 persons receiving services who may live in a single residential setting, which is licensed by the State as Residential Care Facility/Residential Community Home.
 
RHSS are not available to individuals who live with or are provided services by members of their family, as defined in C.R.S. 27-10.5-102(15) (a) and (b), or who do not require residential services. The cost of room and board is not included in the reimbursement for RHSS.
 
The following activities are performed by staff and are designed to assist individuals to reside as interdependently as possible in the community.
  • Self-advocacy training may include training to assist in expressing personal preferences, self representation, individual rights, and to make increasingly responsible choices.
  • Independent living training may include personal care, household services, child and infant care (for parents themselves who are developmentally disabled), and communication skills such as the telephone.
  • Cognitive services may include training involving money management and personal finances, planning and decision making.
  • Implementation of recommended follow-up counseling, behavioral or other therapeutic interventions by residential staff, under the direction of a professional, that are aimed at increasing the overall effective functioning of an individual.
  • Emergency assistance training includes developing responses in case of emergencies; prevention planning and training in the use of equipment or technologies used to access emergency response systems.
  • Community access services that explore community services available to all people, natural supports available to the individual, and develop methods to access additional services/supports/activities desired by the individual
  • Travel services may include providing, arranging, transporting, or accompanying a person with developmental Disabilities to services and supports identified in the Individualized Plan (plan of care).
  • Supervision services may include a person safeguarding an individual with developmental disabilities and/or utilizing technology for the same purpose.
     
  • Skilled Nursing Services
Services listed in the plan of care which are within the scope of the State's Nurse Practice Act and are provided by a registered professional nurse, or licensed practical or vocational nurse under the supervision of a registered nurse, licensed to practice in the State. Services otherwise not available through a third-party liability include:
 
  • Evaluating health status through the collection and assessment of health data;
  • Health teaching and health counseling;
  • Providing therapy and treatment that is supportive and restorative to life and well-being either directly to the patient or indirectly through consultation with, delegation to, supervision of, or teaching of others;
  • Executing delegated medical functions;
  • Referring to medical or community agencies those patients who need further evaluation or treatment;
  • Reviewing and monitoring therapy and treatment plans.
     
  • Specialized Medical Equipment and Supplies - Disposable
Specialized medical equipment and supplies to include devices, controls, or appliances, specified in the plan of care, which enable individuals to increase their abilities to perform activities of daily living, or to perceive, control or communicate with he environment in which they live.
 
This service also includes the following:
  • Items necessary for life support
  • Ancillary supplies
  • Maintenance and equipment necessary to the proper functioning of such items
  • Durable and non-durable medical equipment not available under the Medicaid State plan
     
  • Transportation Services
Transportation in order to enable individuals served on the waiver to gain access to waiver day program services and activities, specified by the plan of care.
 
Transportation services under the waiver, including vehicle modification, shall be offered in accordance with the individual's plan of care. Whenever possible, family, neighbors, friends, or community agencies that can provide this service without charge will be utilized.
 

Dental Services

These services are provided only when the services are not available through the Medicaid State Plan due to not meeting the need for medical necessity as defined in Health Care Policy and Financing rules at 8.011.11 or available through a third-party resource.
 
Dental services include:
  • Periodic examination and diagnosis
  • Radiographs when indicated
  • Detection of all manifestations of systemic disease
  • Elimination of infection or life threatening oral conditions, disease of bone and soft tissue of the oral cavity, oral cancer, or cellulites
  • Treatment of injuries
  • Restoration of decayed or fractured teeth
  • Retention or recovery of space between teeth when indicated

 

Waiver(s) which include this service:

 


Enhanced Nursing

Medical care coordination provided by a nurse for medically complex clients who are at risk for negative health outcomes associated with fragmented medical care and poor communication between primary care physicians, nursing staff, case managers, community- based providers and specialty care providers.

Waiver(s) or programs which include this service:
 

Environmental Engineering - Home Modification and Assistive Technology

Environmental engineering consists of devices and adaptations identified in the plan of care which are necessary to overcome environmental barriers which people with disabilities face in their daily lives, whether in their home or in their community. Such devices or adaptations minimize or eliminate the need for ongoing human assistance.
 
Environmental engineering can be included under this waiver when such devices or adaptations are not available under the regular Medicaid State Plan or third party source.
Environmental engineering is available to improve the individual's level of independent functioning in daily living by adapting or supplementing the person's environment through such means as:
 
  • Adaptations to living quarters including showers, toilets, control switches for the home, kitchen equipment for the preparation of special diets and accessibility such as ramps and railings;
  • Mobility devices to help people move around including wheelchairs (general use and customized) and vans adaptations (see the Medicaid State Plan first);
  • Expressive and receptive communication augmentation including electronic communication boards,
  • Skills acquisition supports which make learning more purposeful and useful including computers, adaptations and software, or instructional aids;
  • Safety enhancing supports including security or emergency response systems, and specialized clothing (e.g. Velcro) if the cost is above and beyond that of normal personal needs expenses;
  • Specialized medical equipment, non-durable medical equipment and supplies; and,
  • Assessing the need for, arranging for, providing and maintaining such devices and/or adaptations.
 
***Environmental engineering is limited to a maximum of $10,000 per individual within the duration of this waiver (6/30/09) except on a case-by-case basis the State may prior authorize additional funds for any individual.
 
Waiver(s) which include this service:
 

Expressive Therapy

Expressive Therapy means creative art, music or play therapy which provides children the ability to creatively and kinesthetically express their medical situation for the purpose of allowing the client to express feelings of isolation, to improve communication skills, to decrease emotional suffering due to health status, and to develop coping skills.
 
Waiver(s) which include this service:

HCBS WAIVER for CHILDREN WITH LIFE LIMITING ILLNESS

 

Health Maintenance

Routine and repetitive health related tasks furnished to an eligible client in the community or in the client's home, which are necessary for health and normal bodily functioning that a person with a disability is unable to physically carry out.

This service is included in:

Consumer Directed Attendant Support Services (CDASS)
In-Home Support Services (IHSS)


Home Accessibility Adaptations

Home Accessibility Adaptations are physical adaptations to the primary residence of the client necessary to ensure the health and safety of the client or that enable the client to function with greater independence in the home. All adaptations shall be the most cost-effective means to meet the identified need.

Home Modification

Home Modifications are specific modifications, adaptations or improvements in a client's existing home setting which, based on the client's medical condition are necessary to ensure the health, welfare and safety of the client, and enable the client to function with greater independence in the home to prevent institutionalization of the client.
 
Home Modifications, adaptations or improvements may include but are not limited to the following:
 
  • Installing or building ramps
  • Installing grab-bars and other durable medical equipment as part of a larger Home Modification project
  • Widening doorways
  • Modifying bathrooms
  • Modifying kitchen facilities
  • Installing specialized electric and plumbing systems that are necessary to accommodate medically necessary equipment and supplies.
 
There is a $10,000.00 lifetime maximum for the home modification benefit.
 
 
Waiver(s) which include this service:

Home Modification Services

Home modification services may include those services which assess the need for, arrange for and provide modifications and/or improvements to the family home of a child with a developmental disability to help ensure the child's safety, security and accessibility in the home and community. Home modification services include devices and services to make daily living easier, such as adapted showers or toilets, adaptations that make places accessible, such as ramps and railings and reinforcing or fencing for the child's protection. Services shall exclude those adaptations or improvements to the home which are not of direct medical or remedial benefit to the waiver client, such as carpeting, roof repair, central air conditioning, etc.
 
Waiver(s) which include this service:
 

Home Modifications, Extended

Physical adaptations to the home, required by the client’s plan of care, necessary to ensure the health, welfare, safety and independence of the client above and beyond the cost of caps that exist in applicable Home and Community-Based (HCBS) waivers.

  • Examples include:

    • Installation of ramps or grab bars

    • Accessible shower or other bathroom facilities

    • Lowered kitchen sink, cabinets

    • Widening of doorways

    • Installation of specialized electric and plumbing systems necessary to accommodate medical equipment and supplies.

Waiver(s) or programs which include this service:

Homemaker Services

Homemaker Services are general household activities provided in the home of an eligible client provided by a Homemaker Provider Agency to maintain a healthy and safe home environment for a client, when the person ordinarily responsible for these activities is absent or unable to manage these tasks. Covered benefits shall be for the benefit of the client and not for the benefit of other persons living in the home. Services shall be applied only to the permanent living space of the client.
 
Homemaking Services may include the following:
  • Routine light housecleaning, such as dusting, vacuuming, mopping, and cleaning bathroom and kitchen areas
  • Meal preparation
  • Dishwashing
  • Bed making
  • Laundry
  • Shopping
  • Teaching the skills listed above to clients who are capable of learning to do such tasks for themselves.  Teaching shall result in a decrease of weekly units required within ninety days. If such a savings in service units is not realized, teaching shall be deleted from the care plan.
 
Homemaking Services does not include:
  • Personal care services
  • Services the person can perform independently
  • Services provided by family members
  • Homemakers Services provided in uncertified congregate facilities are not a benefit
 
Waiver(s) which include this service:
 

Hospital Back-Up

The Hospital Back Up (HBU) is a long term care program that provides hospital level care in skilled nursing facility settings. In accordance with 42 CFR 456.1, the HBU is a statewide program that safeguards against unnecessary or inappropriate use of Medicaid services in acute hospitals.  Medicaid clients who no longer need acute care in the hospital but require 24-hour monitoring for medically complex conditions or life sustaining technology may apply to receive long term care in an HBU certified facility.   Clients who are discharged in the HBU program require skilled nursing supervision to remain stable and usually have chronic illnesses requiring ventilator assistance, tracheotomy care or extensive wounds management.
 
The acute hospital initiates the application for HBU placement. The hospital discharge planner shall submit an HBU application to the SURC for admission in an HBU facility on behalf of the Medicaid client.
 
The patient must be Medicaid certified or eligible. In order to apply for HBU services a Medicaid client shall:
  • Be hospitalized in an acute hospital and deemed clinically stable and ready for discharge;
  • Have no option for discharge home or in a class I. nursing facility due to level of care needs;
  • Meet long term care eligibility as determined by the Single Entry Point (SEP) pursuant to 10 CCR 2505-10, Section 8.110.30.A;
  • Meet clinical criteria as outlined in 10 CCR 2505-10, Section 8.470 as determined by the State Utilization Review Contractor (SURC);
  • Be accepted by an HBU-certified skilled nursing facility
 
HBU clients qualify for all nursing facility benefits and rights as outlined in 10 CCR 2505-10, Section 8.440 and 10 CCR 2505-10, Section 8.057
 
HBU care in individualized and patient centered. The care plan is negotiated between the  clients/legal representative, the medical provider and the clinical team. The care plan is adjusted as needed to meet the needs of the HBU client.
 

Independent Living Skills Training (ILST)

Services designed to improve or maintain a client’s physical, emotional, and economic independence in the community with or without supports.

  • Services may include:
    • Daily assistance/training/coaching in cooking, housekeeping, laundry, other in-home activities
    • Grocery shopping, meal - planning, nutrition
    • Budgeting, financial management, money handling, and consumer skills
    • Prompting/coaching client to manage medical appointments, medical supplies and prescriptions, clothing, seasonal needs and shopping
    • Coaching with using and navigating public transportation
    • Other help with recreation and community access and orientation
    • Establishing schedule for attendants
    • Advocating for one’s self to ensure needs and wants are expressed in care planning
    • Preventing or making known issues of abuse, neglect, or exploitation
    • Assisting with integrating into the community
       
Waiver(s) or programs which include this service:
 

In-Home Support Services (IHSS) - Health Maintenance Activities

In-Home Support Services - Health Maintenance Activities are a service of the Children's Home Care Community Based Waiver.  Health Maintenance Activities are those routine and repetitive health related tasks, which are necessary for health and normal bodily functioning, that an individual with a disability would carry out if he/she were physically able, or that would be carried out by family members or friends if they were available. These activities include, but are not limited to, catheter irrigation, administration of medication, enemas and suppositories and wound care.
 
Waiver(s) which include this service:
 

In-Home Support Services (IHSS) - Personal care, homemaker, health maintenance act

In-Home Support Services (IHSS) is a participant-directed service option that enables participants to direct who is provides their care, as well as the type of care to be provided. IHSS enables consumers to decide which services to use, which workers to hire, and what time of day they will come.
 
IHSS may include the following:
  • Health Maintenance Activities
  • Personal Care and Relative Personal Care
  • Homemaking
 
Waiver(s) which include this service:

Intensive Case Management

Case management services to assist clients in assessing needed home and community-based services, Medicaid State Plan services and non- Medicaid supports and services to support the clients’ return to the community from placement in a qualified institution and to aid the client in attaining their transition and independent living goals.


Waiver(s) or programs which include this service:

Long-Term Care - Home Health

Home Health Services provided in clients place of residence to prevent institutionalization, hospitalization.  The services must be medically necessary, provided for treatment of illness,  for disability, services must be reasonable in amount, duration and frequency.


Massage Therapy

Massage Therapy means the systematic manipulation of the soft tissues of the body, (including manual techniques of gliding, percussion, compression, vibration, and gentle stretching) for the purpose of bringing about beneficial physiologic, mechanical, and/or psychological changes. The utilization of massage therapy may typically begin at a higher frequency and is expected to decrease as the client progresses. Authorization and payment for the massage service is limited as follows:
  • During the first 90 days of the initial alternative therapies Care plan, the schedule of services recommended by the supervising physician shall not exceed 60 (15 minute) units for any one alternative therapy service or 120 (15 minute) units  for any combination of alternative therapies. 
     
  • After the first 90 days of the initial alternative therapies care plan and in all subsequent alternative therapies care plans, the schedule of services recommended by the supervising physician shall not exceed 48 (15 minute) units for any one alternative therapy service or 96 (15 minute) units for any combination of alternative therapies per 90 day period.
     
  • Services are limited based on the client's assessed need for services, physician's orders, and prior authorization by case managers up to the cost containment parameters.
Waiver(s) which include this service:
 

Medication Reminder

Pill reminder services to help individuals take their medications in the correct dosages at the correct times to prevent adverse drug events.

Waiver(s) which include this service:

Non-Medical Transportation

Non-medical transportation services are transportation which enables clients to gain access to non-medical community services and resources, as required by the care plan to prevent institutionalization.
 
Non-medical transportation services shall include, but not be limited to, transportation between the client's home and nonmedical services or resources such as adult day services, shopping, therapeutic swimming, dentist appointments, counseling sessions, and other services as required by the care plan to prevent institutionalization.
 
Waiver(s) which include this service:
 

Palliative/ Supportive Care

Palliative/Supportive Care is a specific benefit offered by a licensed health care facility or provider that is specifically focused on the provision of organized palliative care services. For the purposes of the Children with Life Limiting Illness (CLLI) waiver this includes a Hospice or Home Care Agency. Palliative care is specialized medical care for people with life limiting illnesses. This type of care is focused on providing clients with relief from the symptoms, pain, and stress of serious illness, whatever the diagnosis. The goal is to improve the quality of life for both the client and the family. Palliative care is appropriate at any age (18 and under for CLLI waiver) and at any stage in a life limiting illness and can be provided together with curative treatment. The services are provided by a Hospice or Home Care Agency who has received additional training in palliative care concepts such as adjustment to illness, advance care planning, symptom management and grief/loss.
 
In the CLLI waiver, palliative care includes care coordination and pain and symptom management.
  • Care coordination includes development and implementation of a care plan, home visits for regular monitoring of the health and safety of the client and central coordination of medical and psychological services. The Care Coordinator will organize the multifaceted array of services. This approach will enable the client to receive all medically necessary care in the community with the goal of avoiding institutionalization in an acute care hospital. Additionally, a key function of the Care Coordinator will be to assume the majority of responsibility, otherwise placed on the parents, for condensing, organizing, and making accessible to providers, critical information that is related to care and necessary for effective medical management. The activities of the Care Coordinator will allow for a seamless system of care. Care Coordination shall not duplicate the administrative activities (specifically utilization management; i.e. review and authorization of service requests, level of care determinations, and waiver enrollment) provided by the case manager at the Single Entry Point.
     
  • Pain and Symptom Management means nursing care in the home by a registered nurse to manage the client's symptoms and pain. Management includes regular, ongoing pain and symptom assessments to determine efficacy of the current regimen and available options for optimal relief symptoms.  Management also includes visits as needed to provide relief of suffering, during which, nurses assess the efficacy of current pain management and modify the regimen if needed to alleviate distressing symptoms and side effects using pharmacological, non-pharmacological and complementary/supportive therapies.
 
Waiver(s) which include this service:

Peer Mentorship

Services provided by peers to promote self-advocacy and encourage community living among clients by instructing and advising on issues and topics related to community living, describing real-world experiences as example and modeling successful community living and problem-solving.


Waiver(s) or programs which include this service:

Personal Care Services

Personal Assistance services provide necessary personnel and supports to meet the daily living needs of a person with a developmental disability. These services and supports, including evaluation and assessment, are provided to ensure adequate functioning in the person's own home, someone else's home, or in the home of their natural or adoptive family.
 
Personal Assistance services may include support or training with a wide range of activities necessary to meet the daily living needs of the person in the home and community including:
  • Personal care, such as hygiene, bathing, eating, dressing, grooming, bowel and bladder care, menstrual care, transferring, supervision, basic first aid, giving medications, relief to a family who normally provides personal care, emergency response in the form of human assistance and operating medical, assistive or adaptive equipment;
  • Household activities necessary to maintain a home living environment on a day-to-day basis, such as meal preparation, shopping and chores, assistance with money management and personal finances, cleaning, laundry, household repairs and maintenance which are related to the person's disability;
  • Mentorship activities, such as assistance with his/her participation on private and public boards, advisory groups and commissions, and person specific training costs associated with providing unique supported living services to an individual, such as training in child and infant care for parent(s) who themselves have a developmental disability.
  • Supported living consultation: Supported living consultation includes assistance with decisionmaking, planning daily activities, and direct assistance to access community resources and/or service providers.
 
Waiver(s) which include this service:
 

Personal Care

Services which provide assistance to a client in their own home in order to meet the client's physical, maintenance and supportive needs. This assistance may take the form of hands-on assistance (actually performing a task for the person) or cuing to prompt the participant to perform a task. Personal care services do not require the supervision of a nurse or physician's orders.
 
Personal care services may include assistance with the following:
  • Bathing
  • Skin Care
  • Hair Care
  • Nail Care
  • Mouth care
  • Shaving
  • Dressing
  • Feeding
  • Ambulation
  • Exercise
  • Transfers
  • Positioning
  • Bladder Care
  • Bowel Care
  • Respiratory Care
  • Accompanying a client to appointments when the above mentioned personal care services are needed in conjunction with the trip. Accompanying does not include transporting the client.
  • Homemaking, if provided in conjunction with the above mentioned personal care services
  • Protective Oversight to supervise a client at risk for wandering.
  • Respite care for primary care givers, provided that the respite care does not duplicate any care which the primary caregiver may be receiving payment to provide.
 
Personal care services do not include skilled personal care, which may only be provided by a certified home health aide.
 
Waiver(s) which include this service:
 

Personal Care Item, not otherwise specified

This code should be used for any item billed that qualifies under the Personal Assistance definition in the Supported Living Services Waiver. The Community Centered Board shall identify in the notes field of the Community Contract Management System (CCMS) the specific description of the item that is being purchased (i.e. monthly rate for housekeeping).
 
This category is used for a service or item under the Personal Assistance category that cannot be billed per hour of service. The procedure code allows Community Centered Boards (CCB) to bill correctly for those circumstances in which one-time costs or rates negotiated for other than an hour of service must be billed. For example, a monthly rate for housekeeping services or a flat-rate emergency back-up. Item billing for Personal Assistance services must be kept separate from the hourly billing for Personal Assistance or services so that the CCB can be appropriately reimbursed for actual expenses.
 
Waiver(s) which include this service:
 
 

Personal Emergency Response System (Electronic Monitoring)

Personal Emergency Response System (Electronic Monitoring) services are the installation, purchase, or rental of devices which enable the client to remain safely in their own home by enabling them to secure help in the event of an emergency.
 
Personal Emergency Response System (Electronic Monitoring) services shall be authorized only for individuals who live alone, or who are alone for significant parts of the day, or whose only companion for significant parts of the day is too impaired to assist in an emergency, and who would otherwise require extensive supervision.
 
Personal Emergency Response System (Electronic Monitoring) services shall be authorized only for individuals who have the physical and mental capacity to utilize the particular system requested for that individual.
 
Personal Emergency Response System (Electronic Monitoring) services do not include:
  • Augmentative communication devices and communication boards
  • Hearing aids and accessories;
  • Phonic ears;
  • Environmental control units, unless required for me medical safety of a client living alone unattended;
  • Computers and computer software;
  • Wheelchair lifts for automobiles or vans;
  • Exercise equipment, such as exercise cycles;
  • Hot tubs, Jacuzzis, or similar items.
 
Waiver(s) which include this service:
 

Pre-Vocational Services

Prevocational services are designed to assist individuals with developmental disabilities in acquiring and maintaining work habits and work-related skills. Prevocational services are intended to have a more generalized result as opposed to vocational training for a specific job. Individuals must have a demonstrated earning capacity of less than 50 percent of the federal minimum wage, as determined in accordance with certification standards promulgated by the U.S. Department of Labor.
 
Prevocational services encompass the following types of work-related activities:
  • teaching an individual such concepts as following directions, attending to task, task completion, communication, decision-making, and problem-solving;
  • training in the areas of safety, self-advocacy, and mobility;
  • intervention and training needed to benefit from Prevocational services which would allow common barriers to participation to be avoided; and,
  • travel training services may include providing, arranging, transporting, or accompanying a person with developmental disabilities to Prevocational services and supports identified in the plan of care.
 
When compensated, individuals are typically paid at less than 50 percent of the minimum wage.
 
Waiver(s) which include this service:
WAIVER for PERSONS with DEVELOPMENTAL DISABILITIES
 

Professional Service - Behavioral Services

Counseling and therapeutic services:
  • Individual and/or group counseling, behavioral or other therapeutic interventions related to the child's disability, needed to sustain the overall functioning of the child with a developmental disability.
  • Consultation and direct costs for training parents and other child care providers in techniques to assist in caring for the child's needs. Includes acquisition of information for family members of children with developmental disabilities from support organizations and special resource materials (e.g., publications designed for parents of children with developmental disabilities.).
  • Diagnostic, evaluation and testing services necessary to determine the child's health and mental status and the related social, psychological and cognitive needs and strengths, including genetic counseling and family planning.
 
Professional care services:
Any personal care functions requiring assistance by an RN, LPN, Certified Nurse Aide or Home Health Aide and not otherwise available under Medicaid EPSDT coverage, third party liability coverage, or other state funded programs, services or supports. These services may also include operating and maintaining medical equipment.
 
Waiver(s) which include this service:
 

Professional Services - Including Behavioral Services

The following types of Professional services can be included under this waiver only when they are not available under the regular Medicaid State Plan or from a third party source:
Professional services are those services, including evaluation and assessment, provided for a person with a developmental disability which addresses the physical and mental needs of the person and require the service provider to be licensed or certified in a particular occupational skill area.
 
  • Behavioral services needed for the individual to acquire or maintain appropriate interactions with others including individual or group counseling, behavioral interventions, diagnostic evaluations or consultations. Intervention modalities must relate to an identified behavioral need of the person and specific criteria for remediation of the behavior must be established;
  • Personal care functions requiring professional care by an RN, LPN, Physician's Assistant or other such licensed or certified medical personnel. This may also include operating medical equipment.
 
Waiver(s) which include this service:
 

Respite Care

Respite care services are provided to an eligible client on a short-term basis because of the absence or need for relief of those persons normally providing the care. Respite Care may be provided in a Class I nursing facility, an alternative care facility or by an employee of a certified personal care agency in the clients home. An individual client shall be authorized for no more than thirty (30) days of respite care in each calendar year.
 
Waiver(s) which include this service:
 

Service Assessment

This code is to be used for assessments such as a behavioral assessment where the cost of the assessment is not tied to the number of hours to actually do the assessment. The Community Centered Board shall identify in the notes field of the Community Contract Management System (CCMS) the specific description of the assessment that is being purchased.
 
This category is used for a service or item under the Professional/Behavioral services category that cannot be billed per hour of service. The procedure allows Community Centered Boards (CCB) to bill correctly for those circumstances in which onetime costs or rates negotiated for other than an hour of service must be billed. For example, diagnostic or assessment services which may be a particularly high cost if billed per hour, or a flat rate treatment fee. Item billing for Professional/Behavioral services must be kept separate from the hourly billing for Professional/Behavioral services in order that the CCB can be appropriately reimbursed for actual expenses.
 
Waiver(s) which include this service:
 

Specialized Medical Equipment and Supplies (Assistive Technology)

Specialized Medical Equipment and Supplies (Assistive Technology) services are the installation, purchase, or rental of devices which enable the client to remain safely in their own home by providing reminders to the individual of medical appointments, treatments, or medication schedules.
 
Specialized Medical Equipment and Supplies (Assistive Technology) services shall be authorized only for individuals who have the physical and mental capacity to utilize the particular system requested for that individual.
 
Specialized Medical Equipment and Supplies (Assistive Technology) services does not include:
  • Augmentative communication devices and communication boards
  • Hearing aids and accessories;
  • Phonic ears;
  • Environmental control units, unless required for me medical safety of a client living alone unattended;
  • Computers and computer software;
  • Wheelchair lifts for automobiles or vans;
  • Exercise equipment, such as exercise cycles;
  • Hot tubs, Jacuzzis, or similar items.
 
Waiver(s) which include this service:
 

 

Specialized Medical Equipment/Supplies - Disposable

Other Equipment and Supplies:
  • Kitchen Equipment required for the preparation of special diets if this results in a cost saving over prepared foods.
  • General care items such as distilled water for saline solutions, supplies such as eating utensils, etc., required by a child with a developmental disability and related to the disability.
  • Specially designed clothing (e.g. Velcro) for children if the cost is over and above the costs generally incurred for a child's clothing.
 
Waiver(s) which include this service:
 

Substance Abuse Counseling, Transitional

Enhanced individual or group substance abuse counseling, behavioral interventions, or consultations to address issues, symptoms, and/or behaviors that are exacerbated during the transition period and negatively affect the client’s sobriety. Services can be provided in the home or office setting.


Waiver(s) or programs which include this service:
COLORADO CHOICE TRANSITIONS (CCT)

Supported Employment Services

Supported employment services, which consist of paid employment for persons for whom competitive employment is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting.
 
Supported employment is conducted in a variety of settings, particularly work sites in which persons without disabilities are employed. Supported employment includes activities needed to sustain paid work by individuals including supervision and training. When supported employment services are provided at a work site in which persons without developmental disabilities are employed, payment will be made only for the adaptations, supervision and training required by individuals receiving waiver services as a result of their disabilities, and will not include payment for the supervisory activities rendered as a normal part of the business setting. This includes job coaching.
 
Waiver(s) which include this service:
SUPPORTED LIVING SERVICES WAIVER
 

Transitional Behavioral Health Supports

Services by a qualified paraprofessional to support a client during the transition period to mitigate issues, symptoms, and/or behaviors that are exacerbated during the transition period and negatively affect the client’s stability in the community.


Waiver(s) or programs which include this service:
 

Transitional Specialized Day Rehabilitation Services

Services offered in a group setting designed and directed at the development and maintenance of the client’s ability to independently, or with support, sustain himself/herself physically, emotionally and economically in the community.
 

Waiver(s) or programs which include this service:
 

Vision Services

These services are provided only when the services are not available through the Medicaid State Plan due to not meeting the need for medical necessity as defined in Health Care Policy and Financing rules at 8.011.11 or available through a third party resource.
 
Vision Services are provided by a licensed Optometrist or Physician and include:
  • Eye exams and diagnosis
  • Glasses, except after surgery
  • Contacts
  • Other medically necessary methods used to improve specific dysfunctions of the vision systems.
  • Lasik and other similar types of procedures are only prior approved and allowable when the procedure is necessary due to documented specific behavioral complexities (i.e. constant destruction of eye glasses) associated with the client that make other more traditional remedies impractical.
 
Waiver(s) and programs which include this service: