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  • October 1, 2013 - September 30, 2014

    Home and Community Based Services

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    General Information

    Long-Term Care (LTC) services include both Home and Community-Based Services (HCBS) and LTC Facility Services. A person who has a medical need for LTC services may choose which program to participate in. If a person applies for medical assistance and payment of LTC services, they must also meet the non-financial and financial medical assistance eligibility requirements.

    Long-Term Care Facility Services

    Long-term care facilities, also known as nursing homes, provide both short- and long-term nursing and rehabilitation services for persons that require 24-hour care. A list of LTC facilities in Pennsylvania may be found via the PA Department of Health web site.

    A person may also compare long-term care facilities at http://www.medicare.gov/NHCompare.

    Home and Community-Based Services

    Home and Community-Based Services are also known as Waiver-Funded Services or Waiver Programs. The term "waiver" comes from the fact that the federal government "waives" medical assistance rules for institutional care in order for Pennsylvania to use the funds for HCBS. HCBS provides for supports and services beyond those covered by the Medical Assistance (also referred to as Medicaid) program that enable a person to remain in a community setting rather than being admitted to a Long-Term Care Facility. Currently the Department of Public Welfare administers 12 HCBS programs. Each HCBS program has its own eligibility requirements and services.

    If a person is determined eligible for more than one HCBS program, the person cannot receive services under two or more such programs at the same time. The person must choose one HCBS program and receive the services provided by it.

    A List of the available Home and Community-Based Programs and their associated eligibility requirements follows: 

    WaiverFunctional Eligibility RequirementsServices Provided
    Aging Waiver

    *Age 60 or older
    *Meet nursing facility level of care criteria
    *Wish to be treated in own home or other community setting
     

    *Accessibility Adaptations, Equipment, Technology and Medical Supplies
    *Adult Daily Living Services
    *Community Transition Services
    *Financial Management Services
    *Home Delivered Meals
    *Home Health Services
    *Non-Medical Transportation Services
    *Participant-Directed Community Supports
    *Participant-Directed Goods and Services
    *Personal Assistance Services
    *Personal Emergency Response System (PERS)
    *Respite
    *TeleCare
    *Therapeutic and Counseling Services 
    Attendant Care Waiver/Act 150 Program 

    *Age 18 through 59 (over age 59 conditional)
    *Meet nursing facility level of care; those who do not MAY qualify for Act 150 program
    *Requires assistance with activities of daily living due to a medically determined physical impairment which can be expected to last for a continuous period of not less than 12 months
    *Mentally alert and capable of selecting, supervising, and if needed, firing an attendant, and managing their own financial and legal affairs
    *Be found in need of a basic service
     

    *Community Transition Services (available only through Medicaid Home and Community Based Waiver Services)
    *Financial Management Services
    *Participant-Directed Community Supports
    *Participant-Directed Goods and Services
    *Personal Assistance Services
    *Personal Emergency Response System (PES)
    *Service Coordination 

    Independence Waiver

    *Age 18 through 60
    *Requires nursing facility level of care
    *Persons with physical disabilities
    *Disability results in at least three substantial functional limitations
    *Disability is expected to continue indefinitely

    *Adult Daily Living Services
    *Accessibility Adaptations, Equipment, Technology and Medical Supplies
    *Community Integration
    *Community Transition Services
    *Financial Management Services
    *Home Health
    *Non-Medical Transportation
    *Personal Assistance Services
    *Personal Emergency Response System (PERS)
    *Respite
    *Service Coordination
    *Supported Employment
    *Therapeutic and Counseling Services
    Adult Community Autism Program (ACAP)*21 years or older
    *Diagnosis of Autism Spectrum Disorder (Autistic Disorder, Childhood Disintegrative Disorder, PDD-NOS, Asperger Syndrome or Rett Disorder)
    *Require Intermediate Care Facility (ICF) level of care
    *Be able to live in a home or community setting without 16 hours or more per day of awake staffing and supervision
    *Not have behaviors that are dangerous to yourself or others or that could cause harm to property
     

     *Physician, ICF, psychiatric, nursing facility, hospice services
    *Dental, vision, speech, podiatry, chiropractic services
    *Medical supplies and equipment
    *Health promotion and disease prevention services
    *Targeted case management
    *Mental health crisis intervention services
    *Adult day habilitation services
    *Homemaker services
    *Residential & behavioral support
    *Respite care
    *Supported employment
    *Community transition services
    *Environmental modifications
    *Assistive technology
    *Family counseling 

    Adult Autism Waiver (AAW)*Age 21 or older
    *Diagnosed with Autism Spectrum Disorder (Autistic Disorder, Childhood Disintegrative Disorder, PDD-NOS, Asperger Syndrome or Rett Disorder)
    *Meet Intermediate Care Facility level of care
     

    *Assistive technology
    *Behavioral health services
    *Community inclusion
    *Community Transition Services
    *Counseling
    *Day & residential habilitation
    *Environmental modifications
    *Family counseling & training
    *Job assessment and finding
    *Nutritional consultation
    *Occupational therapy
    *Respite
    *Speech/ language therapy
    *Supported employment
    *Supports coordination
    *Temporary crisis services
    *Transitional work services 

    COMMCARE Waiver*Have a diagnosis of traumatic brain injury
    *Age 21 and older
    *Requires nursing facility level of care 
    *Disability results in at least three substantial functional limitations

     *Accessibility Adaptations, Equipment, Technology and Medical Supplies
    *Adult Daily Living
    *Community Integration
    *Community Transition Services
    *Financial Management Services
    *Home Health
    *Non-Medical Transportation
    *Personal Assistance Services
    *Personal Emergency Response System (PERS)
    *Prevocational Services
    *Residential Habilitation
    *Respite
    *Service Coordination
    *Structured Day Habilitation Services
    *Supported Employment
    *Therapeutic and Counseling Services

    Infants, Toddlers and Families Waiver*Between birth and age 3
    *In need of early intervention services
    *Meet Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) or Intermediate Care Facility for Persons with Other Related Conditions (ICF/ORC) level of care
     
    *Habilitation, which is a service provided in home and community settings to assist a child in acquiring, maintaining and improving self-help, domestic, socialization and adaptive skills
    Person/Family-Directed Support (P/FDS) Waiver*Age 3 or older
    *Require an ICF/MR level of care
    *Sub-average intellectual functioning and impairments in adaptive behavior
    *Does not reside in a mental retardation licensed community residential home or a mental retardation licensed family living home
     

    *Homemaker/ chore
    *Habilitation
    *Respite services
    *Physical adaptations
    *Visual mobility therapy
    *Behavioral therapy
    *Visiting nurse
    *Personal support
    *Adaptive appliances and equipment services
    *Extended State Plan services 

    Consolidated Waiver*Age 3 or older
    *Require an ICF/MR level of care
    *Sub-average intellectual functioning and impairments in adaptive behavior
     

    *Community Habilitation
    *Respite services
    *Minor physical adaptations
    *Permanency planning services
    *Therapy services
    *Transportation

    OBRA Waiver
    *Persons with developmental physical disabilities
    *Disability results in at least three substantial functional limitations
    *Age 18 through 59; disability manifested prior to age 22
    *Disability is expected to continue indefinitely
    *Requires ICF/ORC level of care
     

     

     *Adult Daily Living
    *Accessibility Adaptations, Equipment, Technology and Medical Supplies
    *Community Integration
    *Community Transition Services
    *Financial Management Services
    *Home Health
    *Non-Medical Transportation
    *Personal Assistance Services
    *Personal Emergency Response System (PERS)
    *Prevocational Services
    *Residential Habilitation Services
    *Respite
    *Service Coordination
    *Structured Day Habilitation Services
    *Supported Employment
    *Therapeutic and Counseling Services 

    AIDS Waiver*Diagnosed as having AIDS or Symptomatic HIV
    *Age 21 or older
    *Requires level of care provided in a hospital, nursing facility, or ICF
    *Not residing in an institution or inpatient setting

    *Home Health Services
    *Nutritional Consultations
    *Specialized Medical Equipment and  Supplies
    *Personal Assistance Services

    LIFE (Living Independence for the Elderly Program also known as LTCCAP)*Be age 55 or older
    *Meet the level of care needs for a skilled nursing facility or a special rehabilitation facility
    *Reside in an area served by a LIFE provider
    *Be able to be safely served in the community as determined by a LIFE provider

    *Adult Day Health Services
    *Audiology Services
    *Dental Services
    *Emergency Care
    *End of Life Services
    *Hospital and Nursing Facility Services
    *In-home Supportive Care
    *Lab and X-ray Services
    *Meals
    *Medical and Non-Medical Transportation
    *Medical Specialists
    *Optometry Services and Eyeglasses
    *Nursing and Medical Coverage 24/7
    *Nursing Care
    *Personal Care
    *Pharmaceuticals
     *Physical, Speech and Occupational Therapies
    *Primary Medical Care
    *Recreational and Socialization Activities
    *Social Services
    *Specialized Medical Equipment