Long Term Care Division

1. Long Term Care Division Alabama Medicaid Agency Long Term Care Division Outreach and Education Unit February 2004

2. P R E S E N T S An Overview of the Long Term Care Programs

3. Nursing Homes Intermediate Care Facility for the Mentally Retarded (ICF-MR) Institution for Mental Diseases (IMD) Home Health Durable Medical Equipment Hospice Private Duty Nursing Targeted Case Management Ombudsman Program Elderly and Disabled Waiver Mentally Retardation-Developmentally Disabled Waiver Living at Home Waiver State of Alabama Independent Living Waiver HIV/AIDS Waiver Technology Assisted Waiver for Adults Specialty Care Assisted Living Facility Waiver Long Term Care Programs

4. Nursing Homes • An institution which primarily engages in providing nursing care and related rehabilitative services on a regular basis to individuals who because of their mental or physical condition require care and services which may be available to them only through institutional facilities.

5. Intermediate Care Facility for the Mentally Retarded (ICF/MR) • An institution that is primarily for the diagnosis, treatment or rehabilitation of the mentally retarded or persons with related conditions, and provides in a protected residential setting, ongoing evaluations, planning, 24 hour supervision, coordination and integration of health or rehabilitative services to help each individual function at their greatest ability.

6. Institution for Mental Diseases (IMD) • A facility that has more than fifty percent (50%)ofmental residents. • An individual is considered to have mental illness if he or she has a current primary or secondary diagnosis of a major mental disorder (as defined in the Diagnostic and Statistics Manual of Mental Disorders), and does not have a primary diagnosis of dementia (including Alzheimer’s disease or a related disorder).

7. Home Health • Skilled nursing and home health aide services prescribed by a physician are provided to eligible recipients on a part-time or intermittent basis.

8. Durable Medical Equipment • Equipment which can stand repeated use, is used to serve a purpose for medical reasons, and is appropriate and suitable for use in the home.

9. Hospice • A comprehensive home care program which primarily provides reasonable and necessary medical and support services for terminally ill individuals. • This care may be provided in the patient’s home or in a nursing facility, if that is the recipient’s place of residence.

10. Private Duty Nursing • Private Duty Nursing services must be prescribed as medically necessary by a licensed physician as the result of an Early Periodic Screening Diagnostic Test (EPSDT) screening and referral, based upon the expectation that the recipients medical needs can be adequately and safely met in the home.

11. Targeted Case Management • Services that assist Medicaid eligible persons in gaining access to needed medical, social, educational, and other services.

12. Ombudsman Program • Advocates for residents of long-term care facilities, or their friends or families, who work to protect the health, safety, welfare and rights of Alabama’s senior citizens.

13. Elderly and Disabled (E&D) Waiver • Provides Home and Community Based Services to elderly and/or disabled individuals to live in the community who would otherwise require nursing facility care

14. Mentally Retarded-Developmentally Disabled (MRDD) Waiver • Provides Home and Community Based Services to Medicaid eligible individuals who would otherwise require the level of care available in an Intermediate Care Facility for the Mentally Retarded (ICF/MR)

15. Specialty Care Assisted Living Facility (SCALF) Waiver • The SCALF Waiver is designed to address the needs of individuals with a diagnosis of Alzheimer’s and/or Dementia who meet the nursing facility level of care criteria.

16. Living at Home Waiver • Provides Home and Community Based Services to Medicaid eligible individuals who would otherwise require the level of care available in an Intermediate Care Facility for the Mentally Retarded

17. State of Alabama Independent Living (SAIL) Waiver • Serves disabled adults with specific medical diagnoses who are at risk of being institutionalized in a nursing home.

18. HIV/AIDS Waiver • The HIV/AIDS Waiver is designed to address the needs of individuals with a diagnosis of HIV, AIDS, and related illness who meet the nursing facility level of care criteria.

19. Technology Assisted (TA) Waiver for Adults • The TA Waiver was designed for Individuals who received private duty nursing services, through the EPSDT Program under the Alabama Medicaid State Plan who will no longer be eligible for this service upon turning age 21.

20. SPECIAL PROJECTS

21. Special Projects • Olmstead Planning Initiative • Ticket to Work/Medicaid Infrastructure Grant • Real Choice Systems Change Grant

22. Olmstead Planning Initiative • The 1999 Supreme Court decision that requires states to administer their services, programs and activities, “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”

23. Ticket to Work/Medicaid Infrastructure Grant • The Ticket To Work Incentive Improvement Act provides support to people with disabilities in securing and sustaining competitive employment in an integrated setting.

24. Real Choice Systems Change Grant • The Real Choice Systems Change Grant was received from the Centers for Medicare and Medicaid Services (CMS) in the amount of $2 million for a three year period, September 28, 2001 - September 27, 2004 that serves the following purposes:

25. Real Choice Systems Change Grant • To improve health, long-term care services, and supports for Alabamians with disabilities and long term illnesses, helping them remain in their communities • To exercise meaningful choices about their lives • To obtain quality services in a manner that reflects their own preferences and priorities

26. NEW INITIATIVES

27. New Initiatives • Adult Protective Services (APS) Waiver • Pace Project • Motorized Wheelchairs • Hope VI

28. Adult Protective Service (APS) Waiver • This waiver is designed to protect individuals age 18 and older, living in the community, who are at risk of abuse, neglect, or exploitation or at risk of institutionalization and are in need of protective services.

29. Coverage of Motorized Wheelchairs • Effective June 20, 2003, Medicaid began coverage of motorized wheelchairs for adults 21 years of age and above. • To qualify the patient must meet Alabama Medicaid’s established coverage criteria and all necessary medical documentation must be submitted.

30. Additional Information If you have further questions regarding Alabama Medicaid Agency Long Term Care Programs, please contact: • Wanda Davis, Assistant Director, Long Term Care Division, 334-242-5018 Email: wdavis@medicaid.state.al.us