Goals • To assist people with disabilities apply for Home and Community Based (HCBS) programs. • To provide choice to all consumers applying for HCBS programs. • To create one process for enrollment into HCBS programs for the entire state. • To provide quality enrollment services for the Commonwealth of Pennsylvania.
HCBS Programs HCBS programs that the PA IEB completes enrollment: Independence Waiver OBRA Waiver Commcare Waiver Attendant Care Waiver HIV/AIDS Waiver Attendant Care ACT 150 PDA Waiver (Lebanon Co only)
Independence Waiver Description The Independence Waiver provides home and community based services to individuals with physical disabilities who are Medicaid eligible and are 18 to 59 years of age. These individuals are physically disabled, and do not have mental retardation or a major mental health disorder as a primary diagnosis. These individuals have substantial functional limitations in three or more major life activities (capacity for independent living, mobility, self-direction, learning, understanding and use of language, and self-care.) Eligibility • U.S. citizen or permanent resident. • PA residents aged 18 – 59 with provisions to transition to over 60 comparable programs seamlessly • Nursing facility level of care required • Income and resources must be within established limits.
Independence Waiver Services – Recipients of this Waiver may be eligible for the following services. • • Assistive Technology Service Coordination • • Medical Equipment Extended State Plan – Home Health, Nursing Services, Occupational • Environmental Modifications Therapy, Speech Therapy, Physical • Community Integration Therapy • Community Transition • Non-Medical Transport • Personal Assistance Services (Agency • Education or Consumer Directed Model) • • Supported Employment Personal Emergency Response • Systems (PERS) Adult Daily Living • • Respite (In Home or Facility) Therapeutic and Counseling Services • Financial Management Services
OBRA Waiver Description The OBRA Waiver provides services to individuals 18 to 59 years of age who are Medicaid eligible. These individuals have physical, sensory, or neurological disabilities which manifested before age 22, are likely to continue indefinitely, and result in substantial functional limitations in three or more of the following areas of major life activity: capacity for independent living, mobility, self-direction, learning, understanding and use of language, and self-care. These individuals cannot have mental retardation or a major mental disorder as a primary diagnosis. Eligibility • U.S. citizen or permanent resident. • PA residents aged 18 – 59 with provisions to transition to over 60 comparable programs seamlessly • Intermediate Care/Other Related Condition level of care required • Income and resources must be within established limits.
OBRA Waiver Services – Recipients of this Waiver may be eligible for the following services. Assistive Technology Medical Equipment Environmental Modifications Community Integration Community Transition Personal Assistance Services (Agency or Consumer Employer Model) PERS Prevocational and Supported Employment Education Respite Supports Coordination Extended State Plan – Visiting Nurse, Physical Therapy, Occupational Therapy, Speech Therapy, Behavior Therapy Non-medical transport
Commcare Waiver Description This Waiver provides community-based services for individuals with a medically determined diagnosis of traumatic brain injury (TBI). CommCare prevents the institutionalization of individuals with TBI and helps them to remain as independent as possible. Eligibility • PA residents age 21+ with a diagnosis of TBI and who require a Nursing Facility (NF) level of care. • Has a disability likely to continue indefinitely and results in 3 or more substantial functional limitations in major life activities. • Income and resources must be within established limits.
Commcare Waiver Services – Recipients of this Waiver may be eligible for the following services. Supports Coordination Extended State Plan – Home Health Aide, Nursing Service, Occupational Personal Assistance Services (Agency Therapy, Speech Therapy, Physical and Consumer Directed Model) Therapy Respite Supported Employment Education Adult Daily Living Assistive Technology Residential Habilitation Medical Equipment Therapeutic and Counseling Services Environmental Modifications Prevocational Services Non-Medical Transportation Community Integration Personal Emergency Response Systems Community Transition (PERS) Structured Day Habilitation
Attendant Care Waiver Description This Waiver provides home and community-based services to individuals 18-59 years old, who are mentally alert, have physical disabilities, and are Medicaid eligible. Eligibility • U.S. citizen or permanent resident. • PA residents aged 18 – 59 with provisions to transition to over 60 comparable programs seamlessly • Physical impairment expected to last for at least a continuous 12 months or may result in death. • Able to manage own care but assistance required to complete functions of daily living, self-care and mobility. • Nursing facility level of care required • Income and resources must be within established limits. Services – Recipients of this Waiver may be eligible for the following services. • Personal Assistance Services (Agency or Consumer Directed Model) • Supports Coordination • Personal Emergency Response Systems (PERS) • Community Transition
HIV/AID (0192) Waiver Description The 0192 (AIDS) Waiver provides home and community based services to eligible persons age 21 or older who have symptomatic HIV Disease or AIDS. Eligibility • U.S. citizen or permanent resident. • PA residents age 21+ with symptomatic HIV or AIDS. • Income limit of 300% of Federal benefit. • Physician Certification for level of care for Acute, Skilled Nursing or Intermediate Care Facility. • Asset limit of $6,000-8,000 Services – Recipients of this Waiver may be eligible for the following services. • Home Nursing Visits • Home Health Care Aide • Homemaker Services • Medical Equipment & Supplies • Nutrition Consultations • Transition Services
Attendant Care ACT 150 Description Program provides for basic and ancillary services that enable an eligible person to remain in his or her home and community rather than an institution and to carry out functions of daily living, self-care and mobility . An eligible person as defined under Act 150 as any individual with physical disabilities who is mentally alert and at least 18 years of age but less than 60 who, in addition to requiring attendant care services, experiences any medically determinable physical impairment which can be expected to last for a continuous period of 12 months or may result in death. That person must also be capable of selecting, supervising and, if needed, firing an attendant and be capable of managing their own financial and legal affairs.
Attendant Care ACT 150 Eligibility • U.S. citizen or permanent resident. • PA residents aged 18 – 59 with provisions to transition to over 60 comparable programs seamlessly • Physical impairment expected to last for at least a continuous 12 months or may result in death, must be Nursing Facility Level of Care. • Able to manage own care but assistance required to complete functions of daily living, self-care and mobility. • May have income OR resources too high for M.A. eligibility. • To take advantage of the Attendant Care Act 150 Program, you may be assessed a minimal co-payment. This co-payment is based on your household income and will not be more than the total costs of services Services – Recipients of this Program may be eligible for the following services. • Personal Assistance Services • Supports Coordination • Personal Emergency Response Systems (PERS)
How to Apply: Begin the process by calling the PA IEB at: 877-550-4227 The person needing assistance should call to allow for an appointment to be scheduled immediately.
What are the Steps in the Process: Applicants will get a reminder call three days before their scheduled visit An Enrollment Broker will visit and complete an assessment of needs with the applicant to begin the process of enrolling for HCBS . Applicants may also be asked to provide information on income, assets and proof of age. Applicant will be asked to choose a Service Coordination Agency. PA IEB will work with the applicants, their physician and the Area Agency on Aging (AAA) -To complete a physician certification-noting diagnosis, expected length of disability and signed by DO or MD - To complete a AAA Level of Care Assessment for nursing facility level of care needs.
Steps in the Process After the PA IEB receives documentation from the applicants physician and the AAA an enrollment is completed for the Office of Long Term Living (OLTL) for programmatic review. PA IEB will help to facilitate an application for Medical Assistance (MA) through the County Assistance Office (CAO) for financial review and waiver approval. Upon CAO approval, files will be transferred to the Service Coordination Agency of choice. Consumers will be notified of eligibility via a mailed letter.
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