Rule 23-208-4.5 - Covered ServicesA. The Division of Medicaid covers the following traumatic brain injury/spinal cord injury (TBI/SCI) Waiver services: 1. Case Management services are defined as services assisting beneficiaries in accessing needed waiver and other services, as well as needed medical, social, educational, and other services, regardless of the funding source for the services. a) Case Management services must be provided by Mississippi Department of Rehabilitation Services (MDRS) TBI/SCI counselors/registered nurses who meet minimum qualifications listed in the waiver. b) Responsibilities include, but are not limited to, the following: 1) Initiate and oversee the process of assessment and reassessment of the person's level of care. 2) Provide ongoing monitoring of the services included in the person's plan of care. 3) Develop, review, and revise the plan of care at intervals specified in the waiver. 4) Conduct monthly contact and quarterly face-to-face visits with the person. 5) Document all contacts, progress, needs, and activities carried out on behalf of the person. 2. Attendant Care services are defined as support services provided to assist the person in meeting daily living needs and to ensure adequate support for optimal functioning at home or in the community, but only in non-institutional settings. a) Attendant Care is non-medical, hands-on care of both a supportive and health related nature and does not entail hands-on nursing care. b) Services must be provided in accordance with the approved plan of care and is not purely diversional in nature. c) Services may include, but are not limited to the following: 1) Assistance with activities of daily living defined as assistance with eating, bathing, dressing, and personal hygiene. 2) Assistance with preparation of meals, but not the cost of the meals. 3) Housekeeping chores essential to the health of the person including changing bed linens, cleaning the person's medical equipment and doing the person's laundry. 4) Assistance with community related activities including escorting the person to appointments, shopping facilities and recreational activities. The cost of activities or transportation is excluded. d) Attendant Care providers must meet minimum requirements as specified in the waiver. MDRS TBI/SCI counselors and registered nurses are responsible for certifying and documenting that the provider meets the training and competency requirements as specified in the current waiver document. e) Attendant Care services may be furnished by family members provided they are not legally responsible for the individual. 1) The Division of Medicaid defines legally responsible for an individual as the parent (or step-parent) of a minor child or an individual's spouse. 2) Family members must meet provider standards and they must be certified competent to perform the required tasks by the person and the TBI/SCI counselor/registered nurse. 3) There must be documented justification for the relative to function as the attendant. 3. Respite services are defined as services to assistance beneficiaries unable to care for themselves because of the absence of, or the need to provide relief to the primary caregiver. Institutional Respite is limited to thirty (30) days or less annually. In-home Companion and Nursing respite is limited to sixty (60) hours per month. a) Services must be provided in the person's home, foster home, group home, or in a Medicaid certified hospital, nursing facility, or licensed respite care facility. b) All respite providers must be certified by the Mississippi Department of Rehabilitation Services (MDRS). 4. Specialized medical equipment and supplies are defined as devices, controls, or appliances that will enhance the person's ability to perform activities of daily living or to perceive, control, or communicate with the environment in which they live. This service also includes equipment and supplies necessary for life support, supplies and equipment necessary for the proper functioning of such items, and durable and non-durable medical equipment not available under the Medicaid State Plan. a) The need for/use of such items must be documented in the assessment/case file and approved on the plan of care. b) Items reimbursed with waiver funds are in addition to medical equipment and supplies furnished under Medicaid. c) Items not of direct medical or remedial benefit to the person are excluded. d) Equipment and supplies must meet the applicable standards of manufacture, design, and installation. MDRS is responsible for certifying and documenting that providers meet the criteria/standards in the waiver. 5. Environmental Accessibility Adaptation is defined as those physical adaptations to the home that are necessary to ensure the health, welfare and safety of the person, or which enable the person to function with greater independence, and without which, the person would require institutionalization. a) The need for these adaptations must be identified in the approved plan of care. b) Environmental accessibility adaptations include the following: 1) Installation of ramps and grab bars the widening of doorways. 2) Modification of bathroom facilities. 3) Installation of specialized electric and plumbing systems necessary to accommodate medical equipment and supplies. c) Environmental accessibility adaptations exclude the following: 1) Adaptations or improvements to the home which are not of direct medical or remedial benefit to the person. 2) Adaptations which add to the square footage of the home. d) Providers rendering environmental accessibility adaptations must: 1) Meet all state or local requirements for licensure of certification. 2) Provide services in accordance with applicable state housing and local building codes. 3) Ensure the quality of work meets standards identified in the waiver. e) MDRS is responsible for certifying and documenting that providers meet the criteria/standards in the waiver. 6. Transition Assistance services are defined as services provided to a person currently residing in a nursing facility who wishes to transition from the nursing facility to the TBI/SCI Waiver program. a) Transition Assistance is a one (1) time initial expense required for setting up a household and is capped at eight hundred dollars ($800.00) for the one (1) time initial expense per lifetime. The expenses must be included in the approved plan of care. b) To be eligible for Transition Services, the person must meet all of the following criteria: 1) Be a nursing facility resident whose nursing facility services are paid for by the Division of Medicaid. 2) Have no other source to fund or attain the necessary items/support. 3) Be moving from a nursing facility where these items/services were provided. 4) Be moving to a residence where these items/services are not normally furnished. c) Transition Assistance Services include the following: 1) Security deposits required to obtain a lease on an apartment or home. 2) Essential furnishings defined as a bed, table, chairs, window blinds, eating utensils, and food preparation items. Televisions and cable TV access are not essential furnishings. 4) Fees/deposits for utilities and service access for a telephone. 5) Health and safety assurances defined as pest eradication, allergen control, or onetime cleaning prior to occupancy. d) Transition Assistance is not available for beneficiaries whose stay in a nursing facility is ninety (90) days or less. 23 Miss. Code. R. 208-4.5
42 C.F.R. § 440.180; Miss. Code Ann. §§ 43-13-117, 43-13-121.