210-40-05 R.I. Code R. § 1.8

Current through May 28, 2024

Section 210-RICR-40-05-1.8 - Community Medicaid - LTSS Preventive Services

1.8.1Authority

Under the terms of the State's §1115 demonstration waiver, Community Medicaid beneficiaries who do not yet need Medicaid LTSS but are at risk for the nursing facility institutional level of care have access to LTSS preventive services. Beneficiaries who meet the needs-based criteria for these LTSS preventive services are eligible for a limited range of home and community-based services and supports along with the full range of primary care essential benefits they are entitled to receive. The goal of preventive services is to delay or avert LTSS institutionalization or more extensive and intensive home and community-based care.

1.8.2Scope of Services

A. Depending on a beneficiary's needs, the following LTSS preventive services may be available to Community Medicaid beneficiaries:

1. Limited Certified Nursing Assistant/Homemaker Services - These services include general household tasks (e.g., meal preparation and routine household care) and are available when a beneficiary can no longer perform them on their own and there is no other person available to provide assistance. Limited personal care may also be available.

a. Maximum hours available: Six (6) hours per week for a single beneficiary or ten (10) hours per week for a household with two (2) or more beneficiaries.

2. Minor Environmental Modifications - Minor modifications may be available to a beneficiary to facilitate independence and the ability to live at home or in the community safely. Such modifications may include: grab bars, versa frame (toilet safety frame), handheld shower and/or diverter valve, raised toilet seats, and simple devices, such as: eating utensils, a transfer bath bench, shower chair, aids for personal care (e.g. reachers) and standing poles.

1.8.3Prior Authorization

To qualify, the beneficiary's Health Care provider must provide documentation that that one (1) or more LTSS preventive services will improve or maintain the ability of a beneficiary to perform Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs) and/or delay or mitigate the need for intensive home and community-based or institutionally based care. Detailed information about the clinical standards and review process is provided in the Medicaid Code of Administrative Rules, Global Consumer Choice Waiver.

1.8.4Limits

To qualify for preventive level services, there must be no other form of coverage for the services provided and no other person or agency responsible or capable for doing so.

1.8.5Continuing Need

The need for LTSS preventive services is reassessed annually in conjunction with the renewal process. Preventive services continue until the beneficiary reports that the risk for LTSS has been mitigated or a follow-up functional assessment conducted by the State or State designee finds that such services need to be changed or terminated.

210 R.I. Code R. § 210-RICR-40-05-1.8

Amended effective 11/5/2020
Amended effective 6/3/2021
Amended effective 4/9/2023
Amended effective 7/29/2023(EMERGENCY)
Amended effective 11/27/2023