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 Medicaid Provider Long Term Services and Support (LTSS)

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LTSS Overview

 

    LTSS includes both Long-Term Care (LTC) and Home and Community Based Services (HCBS). Long-Term Care programs are when an individual is living in a facility-based care setting (such as a nursing home or intermediate care facility). Home and community-based services programs provide alternatives to living in facility-based care settings. These programs empower consumers to take an active role in their health care and to remain in the community. The programs serve people who are older adults, people with intellectual and/or developmental disabilities, or people with disabilities.

Adult Day Program Adult Day Program

 

    Services are furnished four or more hours per day on a regularly scheduled basis, for one or more days per week, or as specified in the Plan of Care, in a non-institutional, community-based setting, encompassing both health and social services needed to ensure the optimal functioning of the Member. Meals provided as part of these services shall not constitute a “full nutritional regimen,” i.e., three meals per day. Physical, occupational and speech therapies may be furnished as component parts of this service.   

 

Assistive Technology

 

    This includes technology items used to increase, maintain, or improve a Member’s functioning and promote independence. The service may include assisting the Member in the selection, design, purchase, lease, acquisition, application, or use of the technology item. This service also includes vehicle modifications to the vehicle that is the Member's primary method of transportation. This service includes repairs and maintenance of assistive technology devices.

 

Chore Services

 

    Services needed to maintain the home in a clean, sanitary, and safe environment to provide safe access inside the home and yard maintenance and snow plowing to provide access to and egress outside of the home. This service includes tasks such as heavy household chores (washing floors, windows, and walls), tacking loose rugs and tiles, moving heavy items of furniture, mowing, raking, and cleaning hazardous debris such as fallen branches and trees, and pest control. May include materials and disposable supplies used to complete chore tasks.

Community Transition Services

    This service includes non-reoccurring expenses for Members transitioning from a nursing facility to another residence where the Member is responsible for his or her own living arrangement.

 

Environmental Modifications

   

    Physical adaptations to the home, required by the Member’s Plan of Care, that are necessary to ensure the health and welfare of the Member or that enable the Member to function with greater independence in the home.  Such adaptations include the installation of ramps and grab bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies necessary for the welfare of the Member.

Expanded Community Living Supports

 

    To receive Expanded Community Living Supports (ECLS), Members MUST have a need for prompting, cueing, observing, guiding, teaching, and/or reminding to independently complete activities of daily living (ADLs) such as eating, bathing, dressing, toileting, other personal hygiene, etc.

Home Delivered Meals

 

    The provision of one to two nutritionally sound meals per day to Members who are unable to care for their nutritional needs. This service must include and prioritize healthy meal choices that meet any established criteria under state or federal law. Meal options must meet Member preferences in relation to specific food items, portion size, dietary needs, and cultural and/or religious preferences. Each provider shall document meals served.

 

Non-Medical Transportation

 

    Service offered to enable Members to gain access to waiver and other community services, activities, and resources, specified by the Plan of Care.

 

Personal Care Services

 

    Personal care services are available to persons who require hands-on assistance in activities of daily living (ADLs): eating, toileting, bathing, grooming, dressing, mobility, and transferring, as well as direct assistance in instrumental activities of daily living (IADL), including personal laundry, light housekeeping, shopping, meal preparation and cleanup, and medication administration.

Respite Care 

 

    Respite Care services are provided on a short-term, intermittent basis to relieve the Member’s family or other primary caregiver(s) from daily stress and care demands during times when they are providing unpaid care. Relief needs of hourly or shift staff workers should be accommodated by staffing substitutions, plan adjustments, or location changes and not by respite care.

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