Long Term Care Division

1. Long Term Care Division Alabama Medicaid Agency Long Term Care Division February 2008

2. P R E S E N T S An Overview of the Long Term Care Programs

3. Nursing Homes Intermediate Care Facility for the Mentally Retarded (ICF-MR) Institution for Mental Diseases (IMD) Home Health Durable Medical Equipment Hospice Private Duty Nursing Targeted Case Management Ombudsman Program Elderly and Disabled Waiver Mentally Retardation Waiver Living at Home Waiver State of Alabama Independent Living Waiver HIV/AIDS Waiver Technology Assisted Waiver for Adults Long Term Care Programs

4. Nursing Homes • An institution which primarily engages in providing nursing care and related rehabilitative services on a regular basis to individuals who because of their mental or physical condition require care and services which may be available to them only through institutional facilities.

5. Intermediate Care Facility for the Mentally Retarded (ICF/MR) • An institution that is primarily for the diagnosis, treatment or rehabilitation of the mentally retarded or persons with related conditions, and provides in a protected residential setting, ongoing evaluations, planning, 24 hour supervision, coordination and integration of health or rehabilitative services to help each individual function at their greatest ability.

6. Institution for Mental Diseases (IMD) • A facility that has more than fifty percent (50%)ofmental residents. • An individual is considered to have mental illness if he or she has a current primary or secondary diagnosis of a major mental disorder (as defined in the Diagnostic and Statistics Manual of Mental Disorders), and does not have a primary diagnosis of dementia (including Alzheimer’s disease or a related disorder).

7. Home Health • Skilled nursing and home health aide services prescribed by a physician are provided to eligible recipients on a part-time or intermittent basis.

8. Durable Medical Equipment • Equipment which can stand repeated use, is used to serve a purpose for medical reasons, and is appropriate and suitable for use in the home.

9. Hospice • A comprehensive home care program which primarily provides reasonable and necessary medical and support services for terminally ill individuals. • This care may be provided in the patient’s home or in a nursing facility, if that is the recipient’s place of residence.

10. Private Duty Nursing • Private Duty Nursing services must be prescribed as medically necessary by a licensed physician as the result of an Early Periodic Screening Diagnostic Test (EPSDT) screening and referral, based upon the expectation that the recipients medical needs can be adequately and safely met in the home.

11. Targeted Case Management • Services that assist Medicaid eligible persons in gaining access to needed medical, social, educational, and other services.

12. Ombudsman Program • Advocates for residents of long-term care facilities, or their friends or families, who work to protect the health, safety, welfare and rights of Alabama’s senior citizens.

13. Elderly and Disabled (E&D) Waiver • Provides Home and Community Based Services to elderly and/or disabled individuals to live in the community who would otherwise require nursing facility care

14. Mentally Retarded Waiver • Provides Home and Community Based Services to Medicaid eligible individuals who would otherwise require the level of care available in an Intermediate Care Facility for the Mentally Retarded (ICF/MR)

15. Living at Home Waiver • Provides Home and Community Based Services to Medicaid eligible individuals who would otherwise require the level of care available in an Intermediate Care Facility for the Mentally Retarded

16. State of Alabama Independent Living (SAIL) Waiver • Serves disabled adults with specific medical diagnoses who are at risk of being institutionalized in a nursing home.

17. HIV/AIDS Waiver • The HIV/AIDS Waiver is designed to address the needs of individuals with a diagnosis of HIV, AIDS, and related illness who meet the nursing facility level of care criteria.

18. Technology Assisted (TA) Waiver for Adults • The TA Waiver was designed for Individuals who received private duty nursing services, through the EPSDT Program under the Alabama Medicaid State Plan who will no longer be eligible for this service upon turning age 21.

19. Olmstead Planning Initiative • The 1999 Supreme Court decision that requires states to administer their services, programs and activities, “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”

20. NEW INITIATIVE

21. New Initiative • Personal Choices – Consumer Directed Care

22. Personal Choices-Consumer Directed Care • The state plan option is available to states under the Deficit Reduction Act (DRA) of 2005, Section 6087 or 1915 (J).1915 (i) is specific to self-directed care, such as the Personal Choices Program, to offer consumers more control in managing their daily lives.

23. Program Value • Budget-neutral; • Offers consumers satisfaction and enhances their quality of life; • Reduces unmet care needs, and • Increases access to authorized services.

24. Additional Information If you have further questions regarding Alabama Medicaid Agency Long Term Care Programs, please contact: • Hattie Nettles, Associate Director, Long Term Care Division, 334-242-5644 Email: hattie.nettles@medicaid.alabama.gov