Regulation .23 Limitations.
Regulation .23 Limitations.LinkCopy Citation
A.
Reimbursement for Personal Emergency Response System is limited to participants who:
(1)
Live alone; or
(2)
Have no regular caregiver for extended parts of the day and would otherwise require extensive routine supervision to ensure the participant’s health and safety.
B.
The Department shall establish a budget for personal assistance services and home-delivered meals that may be included in the participant’s plan of service, based on each participant’s assessed need.
C.
The Program does not cover the following services:
(1)
Service primarily for the purpose of housekeeping unrelated to the participant’s activities of daily living, such as:
(a)
Cleaning of the floor and furniture in areas not occupied by the participant;
(b)
Laundry other than that incidental to services for the participant; and
(c)
Shopping for groceries or household items unless in the company of the participant;
(2)
Services provided by providers not approved for participation by the Department;
(3)
Expenses incurred while escorting participants:
(a)
To obtain medical diagnosis or treatment;
(b)
To or from the participant’s workplace; or
(c)
For participation in social or community activities;
(4)
Expenses related to room and board for either the participant or the worker;
(5)
Transition services more than 60 days post transition;
(6)
Personal assistance services provided outside the State for more than 30 days per calendar year;
(7)
Environmental adaptations to the home which:
(a)
Are of general maintenance, such as carpeting, roof repair, and central air conditioning;
(b)
Are not of direct medical or remedial benefit to the participant;
(c)
Add to the home’s total square footage; or
(d)
Modify the exterior of the home, other than the provision of ramps, lifts, sidewalks necessary to utilize a ramp or lift, and railings; or
(8)
Experimental technology or equipment.
D.
Payment for supports planning and nurse monitoring services shall be limited to direct services to the participant and may not be made for:
(1)
Administrative overhead;
(2)
Travel;
(3)
Internal quality monitoring activities;
(4)
Staff supervision, training, or consultation; or
(5)
Services rendered by an individual supports planner or nurse monitor in excess of 7 hours per day unless preauthorized by the Department in writing.
E.
Payment for environmental adaptations and technology that substitutes for human assistance is limited to a combined reimbursement of up to $15,000 over a 3-year period per participant.
F.
For technology items or services above $1,000, multiple quotes from providers are required.