Long Term Care Division

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Long Term Care Division
Alabama Medicaid Agency Long Term Care
Division February 2008
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P R E S E N T S
An Overview of the
Long Term Care Programs
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Long Term Care Programs

• 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

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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.

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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.

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Institution for Mental Diseases (IMD)

• A facility that has more than fifty percent (50)
  of mental 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
  Alzheimers disease or a related disorder).

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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.

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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.

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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 patients home
  or in a nursing facility, if that is the
  recipients place of residence.

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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.

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Targeted Case Management

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

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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 Alabamas senior citizens.

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Elderly and Disabled (ED) 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

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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)

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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

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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.

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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.

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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.

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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.

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NEW INITIATIVE
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New Initiative

• Personal Choices Consumer Directed Care

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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.

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Program Value

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

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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_at_medicaid.alabama.gov