a.) Home and Community Care for Functionally Disabled Elderly Individuals75
As part of their plans for medical assistance, states must provide coverage for home and community care to functionally disabled elderly individuals. There are a variety of options within this care, such as home health aide services, personal care services, and adult day care.76 A functionally disabled elderly individual is one who is 65 years or over, qualifies for state medical assistance, and is determined to be functionally disabled.77
At the request of an eligible individual, the state must conduct an assessment to determine whether the individual is functionally disabled, which must contain:78
- An identification or review of the individual’s functional disabilities and need for home and community care and;
- Information about the individual’s health status, home and community environment, and informal support system.
A qualified case manager must use the results of each functional assessment to establish, review and revise an Individual Community Care Plan (ICCP) after a face-to-face interview with the individual or his primary caregiver.79 The ICCP must specify what care and services the participant will receive and his preferences for the types and providers of services.80 The functional assessment must be reviewed and revised at least annually.81 All home and community care must be provided in a manner that respects, protects and promotes participant’s rights.82 These rights include:83
- The right to voice grievances regarding services that are furnished with discrimination, and the right to be free from reprisal for voicing such grievances;
- The right to confidentiality of personal and clinical records; and
- The right to privacy and to have one’s property treated with respect.
The state must periodically review providers’ performance in providing care under the ICCP and must conduct regular surveys of community care settings; the Secretary will conduct subsequent validation surveys.84 The state must provide a process for the receipt, review, and investigation of allegations of neglect and abuse and of misappropriation of individual property by home and community care providers and must disclose any adverse findings upon request.85 The state must notify any affected individual and an immediate family member if the care provided by a home or community care provider is substandard.86 All surveys, reviews and certifications must be provided to the state fraud and abuse control unit and be made public.87
Footnotes
- 75. Social Security Act § 1929, 42 U.S.C. 1396t (available at http://www.ssa.gov/OP_Home/ssact/title19/1915.htm).
- 76. Social Security Act §1 1929(a), 42 U.S.C. 1396t(a).
- 77. Social Security Act § 1929(b)(1), 42 U.S.C. 1396t(b)(1).
- 78. Social Security Act § 1929(c)(2), 42 U.S.C. 1396t(c)(2).
- 79. Social Security Act § 1929(d)(1)(A), 42 U.S.C. 1396t(d)(1)(A).
- 80. Social Security Act § 1929(d)(1)(B), 42 U.S.C. 1396t(d)(1)(B).
- 81. Social Security Act § 1929(c)(2)(D), 42 U.S.C. 1396t(c)(2)(D).
- 82. Social Security Act § 1929(f)(1)(B), 42 U.S.C. 1396t(f)(1)(B).
- 83. Social Security Act s 1929(f)(2), 42 U.S.C. 1396t(f)(2).
- 84. Social Security Act § 1929(i)(2), 42 U.S.C. 1396t(i)(2).
- 85. Social Security Act § 1929(i)(5), 42 U.S.C. 1396t(i)(5).
- 86. Social Security Act § 1929(i)(6)(B), 42 U.S.C. 1396t(i)(6)(B).
- 87. Social Security Act § 1929(i)(6), 42 U.S.C. 1396t(i)(6).
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