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May 1, 2012 - April 30, 2013
WHAT IS A WAIVER?
A process by which states may apply to the Centers for Medicare and Medicaid Services (CMS) for approval to implement a program (s) to provide home and community-based services to a targeted group of Medicaid recipients.
WHAT IS THE AIDS WAIVER?
The AIDS Waiver is a home and community-based waiver program that offers additional services to those living with symptomatic HIV or AIDS, in order to provide an alternative to hospitalization or institutional care.
TO BE ELIGIBLE FOR THE AIDS WAIVER, RECIPIENTS MUST MEET THE FOLLOWING REQUIREMENTS:
WHAT SERVICES ARE COVERED BY THE AIDS WAIVER?
WHAT ARE HOME HEALTH NURSING VISITS?
Supplemental home nursing visits beyond the maximum number of visits permitted through the state plan. Nursing visits provided through the waiver can only be authorized by the AIDS Waiver staff, after a denial is obtained from prior authorization, for services beyond the regular state plan. Waiver authorized nursing visits will be reviewed at intervals not to exceed sixty (60) days.
WHAT ARE SUPPLEMENTAL HOME HEALTH AIDE VISITS?
Supplemental home health aide visits beyond the maximum number of visits permitted through the state plan. Home Health aide visits provided through the waiver can only be authorized by the AIDS Waiver staff, after a denial is obtained from prior authorization, for services beyond the regular state plan. Waiver authorized home health aide visits will be reviewed at intervals not to exceed sixty (60) days.
WHAT ARE HOMEMAKER SERVICES?
Homemaker services are non-medical services for the recipient who has lost daily functioning abilities, i.e. bathing, dressing, light housekeeping, meal preparation, washing dishes, grocery shopping, instructional services (nutrition) and care giver relief. This service will be provided through enrolled AIDS Waiver home health agencies, personal care agencies, or homemaker agencies. Homemaker visits will be authorized by the AIDS Waiver Unit staff, with a minimum visit of 1 hour per day, and a maximum or 10 hours per day, or 70 hours per week.
WHAT ARE THE SPECIALIZED EQUIPMENT AND SUPPLIES?
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 the environment in which they live.
This service also includes items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the Medicaid State plan. Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies furnished under the State plan and shall exclude those items which are not of medical or remedial benefit to the individual. All items shall meet applicable standards of manufacture, design and installation.
WHAT ARE NUTRITIONAL CONSULTATIONS?
Initial nutritional assessment, reassessment, or nutritional counseling can be provided to a waiver client. This service is reimbursable to Medical Assistance registered dietitians who are enrolled as 0192-AIDS Waiver Providers. Services are to be provided in 15-minute blocks with each waiver client limited to 90 minutes of nutritional consultations per calendar month.
ARE NUTRITIONAL SUPPLEMENTS COVERED BY THE WAIVER?
The waiver does not provide for coverage of five categories of Medicare approved nutritional supplements. They are part of the State Plan and are covered through Medical Assistance for eligible consumers.
WHAT IS TRANSITIONAL SERVICES?
It is a one time expense, not to exceed $4000 per consumer. These are set up expenses for individuals who make the transition from an institution to their own home or apartment in the community. The funds may be used to pay the necessary expenses for an individual to establish his or her basic living arrangement and to move home. This service may not include ongoing payment for rent.
Such items include:
HOW DOES A CLIENT GAIN ACCESS TO AIDS WAIVER SERVICES?
A client gains access to AIDS Waiver services by requesting and completing an AIDS Waiver application form.
IS PARTICIPATION IN THE AIDS WAIVER PROGRAM REQUIRED FOR ALL CLIENTS WHO ARE CERTIFIED FOR ACUTE HOSPITAL, SKILLED NURSING OR INTERMEDIATE LEVEL OF CARE?
WHAT DO YOU MEAN BY COST EFFECTIVE?
Cost effective means that the annual cost of all Medical Assistance services while on the waiver cannot exceed the average annual cost of services for a comparable group of clients not participating in the waiver.
APPROVAL FOR WAIVER SERVICE:
IS CASE MANAGEMENT A WAIVER SERVICE?
WHO CAN THE CLIENT CONTACT FOR MORE INFORMATION FOR THE WAIVER?
Additional Information may be obtained from the Waiver Implementation Unit at the following address:
AIDS Waiver Program
PO Box 2675
555 Walnut Street, 5th Floor
Harrisburg, PA 17105-2675