Conn. Agencies Regs. § 17b-262-588

Current through December 27, 2024

Section 17b-262-588 - Definitions

For the purposes of sections 17b-262-587 through 17b-262-596 b, inclusive, of the Regulations of Connecticut State Agencies, the following definitions shall apply:

(1)"Activities of Daily Living" means hands-on activities or tasks, which are essential for a consumer's healthful and safe existence and include, but are not limited to: bathing, dressing, eating, transfers, and bowel and bladder care.

(2)"Adult" means a person 18 through 64 years of age inclusive.

(3)"Applicant" means a person who directly or through a representative completes a Personal Care Assistance Request Form and submits it to the department.

(4)"Assessment" means a comprehensive written evaluation conducted by non-medical department personnel which uses a standard assessment form and which consists of:

(A) an identification of the consumer's limitations in activities of daily living;

(B) the identification of the personal care assistance services required by the consumer and a determination that such services are appropriate for the consumer and, in the non-medical opinion of the department can reasonably be expected to meet the health and safety needs of the consumer;

(C) identification of the training and support needs of the consumer for personal care assistance services;

(D) a face-to-face interview with the consumer;

(E) documentation of the number of hours needed by the consumer to complete the activities of daily living and instrumental activities of daily living with the help of a personal care assistant;

(F) a determination confirming that the consumer would otherwise require institutional care in a nursing facility;

(G) development of a total cost of care plan for the consumer; and

(H) development of a consumer personal care services plan.

(5)"Average nursing facility cost" means a weighted average calculated by multiplying the nursing facility Medical Assistance Program rates in effect on July 1 of each calendar year for each facility by their respective number of days, adding the products and then dividing that total by the total patient days, and reducing the result by the average applied income for nursing facility patients.

(6)"Consumer" means an applicant or eligible person.

(7)"Commissioner" means the chief executive officer of the department appointed pursuant to subsection (a) of section 17b-1 of the Connecticut General Statutes.

(8)"Cost Effective" means the Department's payments for the consumer's total costs of care do not exceed the average nursing facility cost.

(9)"Cost-of-Care Plan" means a plan, which specifies all costs to the State of Connecticut that are associated with the care of the consumer.

(10)"Department" means the Department of Social Services or its agent.

(11)"Eligible Person" means an applicant who meets the criteria to receive personal care assistance services in accordance with section 17b-262-589 of the Regulations of Connecticut State Agencies and who meets all the eligibility requirements for participation in the Medicaid program as set forth in the Department's regulations that are contained in its Uniform Policy Manual.

(12)"Fiscal Intermediary" means an organization selected by the department to perform the payroll function for the administration of this program including but not limited to the fulfillment of all household employer tax obligations.

(13)"Instrumental Activities of Daily Living" means household maintenance activities and tasks, which are essential for a consumer's healthful and safe existence and include, but are not limited to: cooking, cleaning, and shopping.

(14)"Medical Assistance Program" means the medical assistance provided pursuant to Chapter 319v of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act, as amended from time to time.

(15)"Nursing Facility" means an institution as defined in section 1919 of the Social Security Act, as amended from time to time, that participates in Connecticut's Title XIX medical assistance program pursuant to the terms of a provider agreement with the Department.

(16)"Personal Care Assistance Request Form" means a department form used to screen a consumer for financial and functional eligibility for personal care assistance services.

(17)"Personal Care Assistant" means any person, excluding the consumer's spouse, and excluding the consumer's conservator and any person related to the consumer's conservator who is employed by the consumer or the consumer's conservator and is qualified to assist the consumer in carrying out the tasks required in the personal care services plan.

(18)"Personal Care Assistance Services" or "Services" means physical assistance to enable the consumer to carry out activities of daily living and instrumental activities of daily living.

(19)"Personal Care Services Plan" or "Service Plan" means an individualized written plan documenting all necessary personal care assistance services, hours, costs, and training requirements for the consumer as determined by an assessment.

(20) "Personal Emergency Response System" (PERS)- means an electronic device that enables consumers to secure help in an emergency. The system is connected to the person's phone and programmed to signal a response center once the help button is activated. PERS service providers shall be enrolled as performing providers under Medicaid.

(21)"Representative" means a person designated by the consumer to act for the consumer and under the consumer's direction for purposes such as completing paperwork, making phone calls, advertising for personal care assistants, assisting with interviewing or scheduling, and sending paperwork to the fiscal intermediary. When the consumer has a court appointed conservator that person shall act as the consumer's representative in all matters. The conservator cannot also be employed as the consumer's personal care assistant or be related to any person employed as the consumer's personal care assistant.

(22)"Uniform Policy Manual" means department regulations promulgated pursuant to section 17b-10 of the Connecticut General Statutes governing eligibility for public assistance and special programs, and maintained in policy manual form including the Department's Title XIX medical assistance program.

(23)"Waiting List" means a record maintained by the department, which includes the names of the consumers seeking personal care assistance services, and specifies the date the Personal Care Assistance Request Form was received.

(24)"Waiver Program" means the program described in the federal waiver approved pursuant to section 1915(c) of the Social Security Act, as amended from time to time, by the Secretary of the United States Department of Health and Human Services for the provision of personal care assistance services to adults, as a partially federally reimbursed service that may be provided under Connecticut's Medicaid program.

Conn. Agencies Regs. § 17b-262-588

Adopted effective February 8, 1999; Amended March 9, 2006