Haw. Code R. § 11-88.1-15

Current through September, 2024

Section 11-88.1-15 - Scope of services

(a) Services and support administered or provided by the division for eligible persons with developmental or intellectual disabilities may include:

(1) Access to division services;

(2) Access to support in the community in coordination with other federal, state, county, or private agencies such as:

(A) Adult programs, residential alternatives and services;

(B) Case management services independent of the direct service provider;

(C) Crisis services to maintain persons with developmental or intellectual disabilities in community settings;

(D) Recruiting, training, certifying, monitoring of foster homes for adults with developmental or intellectual disabilities, and referral of these adults in these homes;

(E) Providing, planning, developing, coordinating and monitoring programs, services, or facilities necessary to provide an array of services for persons with developmental or intellectual disabilities, which are not duplicative of other entitlements;

(F) Informational services to families, the general public and to lay and professional groups;

(G) Consultative services to the judicial branch of government, educational institutions, and health and welfare agencies;

(H) Planning and developing collaboratively and cooperatively with public health providers and private agencies for programs to prevent developmental or intellectual disabilities.

(b) Programs and services shall be limited to the amount of resources allocated or available for purposes of this chapter.

(c) A person shall meet eligibility requirements for services and support established and funded by the division.

(1) A person who is qualified for Medicaid coverage shall apply for and utilize home and community-based waiver services prior to accessing state funded services administered by the division.

(2) When a person cannot be served due to the unavailability of appropriate providers, necessary funding, or both, the division shall assist the person in finding other community or department resources or place the person's name on the division's waiting lists for division-funded services, or both.

(d) Home and community-based services, authorized through the Medicaid waiver program, include any service approved by CMS, such as:

(1) Adult day health (ADH);

(2) Assistive technology;

(3) Case management;

(4) Chore services;

(5) Emergency outreach, emergency respite services, emergency shelter services;

(6) Employment services (pre-vocational, individual employment support, group employment support);

(7) Environmental accessibility adaptations (EAA);

(8) Non-medical transportation;

(9) Personal assistance/habilitation (PAB);

(10) Personal emergency response system (PERS);

(11) Respite;

(12) Skilled nursing;

(13) Specialized medical equipment and supplies;

(14) Training and consultation; and

(15) Vehicular modifications.

(e) Consumer-directed services approved by CMS in the waiver application include chore, PAB, and respite services.

(f) All home and community-based services shall be authorized by the division and included in the participant's written ISP.

(g) Home and community based services for a waiver participant shall be subject to the limits and conditions as contained in the Medicaid waiver.

(h) The utilization review committee reviews services for the authorization of services above or below the service limitations or conditions.

(i) Home and community-based services shall not be provided for a waiver participant under the following conditions:

(1) While temporarily admitted to an acute care facility, rehabilitation facility, nursing facility, or intermediate care facility for individuals with intellectual disabilities unless authorized by the division;

(2) For school-aged children for services identified in the individualized education plan; and

(3) For services provided by other state agencies (e.g. department of education, department of human services, division of vocational rehabilitation), so as not to supplant other funding sources.

(j) Waiver participants shall receive the full Medicaid primary and acute care benefit package through a department of human services managed care health plan. All department of human services health plans are required to coordinate the primary and acute health care benefits for the home and community-based waiver participants.

Haw. Code R. § 11-88.1-15

[Eff 10/26/2014] (Auth: HRS §§ 321-9, 333F-18) (Imp: HRS § 321-11.2, HRS § 333F-6, 333F-21, 42 CFR §440.180 )