Section 17b-262-593 - Services covered(a) Services covered are:(1) personal care assistance services provided in accordance with a personal care services plan which enable the consumer to carry out activities of daily living and instrumental activities of daily living in a community living arrangement; and(2) as a result of being determined eligible for Medicaid, any other covered service to the extent that it is necessary, in accordance with Title XIX contained in the Social Security Amendments of 1965 and state and federal regulations adopted pursuant thereto.(3) personal care assistance services up to 25.75 hours per week provided by a single personal care assistant and up to 40 hours per week provided by a single personal care assistant if the consumer documents, to the department's satisfaction, that the consumer has obtained and maintained worker's compensation insurance for the single personal care assistant and that such insurance shall remain in full force and effect for at least one year from the date the personal care assistant begins providing personal care assistance services to the consumer. Personal care assistance services beyond 25.75 hours per week shall not be covered without the submission of such documentation. The social worker shall verify the continuation of the worker's compensation insurance coverage at the time of the annual review.(4) up to 10 additional hours of personal care assistance services beyond those already included in the approved service plan for the purpose of communicating with medical providers during a crisis or an emergency for those consumers who have difficulty communicating verbally their needs to medical providers, as determined by the social worker during the assessment process.(5) for those consumers who either live alone or who remain at home alone with no available caregiver, a personal emergency response system (PERS) may be provided. The department social worker shall determine the need for the PERS as part of the assessment process.(b) Services not covered are: (1) services that are not in the consumer's approved cost of care plan;(2) personal care assistance services provided either in a health care institution that is licensed by the Department of Public Health or in a living arrangement funded by the department which includes funding for the purpose of assisting clients to meet their daily needs as a component in the rate of reimbursement;(3) personal care assistance services provided by the consumer's spouse, the consumer's conservator or any person related to the conservator;(4) personal care assistance services which are duplicative of home health services which the consumer will receive concurrently while participating in the program;(5) scheduled hours which a personal care assistant does not keep;(6) transportation of the personal care assistant to and from the consumer's home;(7) services in excess of those deemed necessary by the department to serve the consumer;(8) services not related to the condition of the consumer or the consumer's physical limitations in performing activities of daily living and instrumental activities of daily living;(9) any service that is required by state law to be provided by licensed staff;(10) services in excess of 25.75 hours per week provided by a single personal care assistant, except as otherwise provided in subdivision (3) of subsection (a) of this section;(11) services provided by an individual who formerly performed such services at no cost;(12) personal care services provided at school or in the workplace;(13) personal care services when the consumer is eligible to receive comparable services that are available from another resource;(14) services performed by someone other than the provider designated in the service plan; and(15) services performed by a provider who does not meet the qualifications outlined in the federally approved waiver.Conn. Agencies Regs. § 17b-262-593
Adopted effective February 8, 1999; Amended March 9, 2006