36-2939

36-2939. Long-term care system
services

A. The following services shall be provided by the program contractors to members
determined to need institutional services pursuant to this article:

1. Nursing facility services other than services in an institution for tuberculosis
or mental disease.

2. Notwithstanding any other law, behavioral health services if these services are
not duplicative of long-term care services provided as of January 30, 1993 under this
subsection and are authorized by the program contractor through the long-term care case
management system. If the administration is the program contractor, the administration
may authorize these services.

3. Hospice services. For the purposes of this paragraph, "hospice" means a program
of palliative and supportive care for terminally ill members and their families or
caregivers.

4. Case management services as provided in section 36-2938.

5. Health and medical services as provided in section 36-2907.

B. In addition to the services prescribed in subsection A of this section, the
department, as a program contractor, shall provide the following services if appropriate
to members who are defined as developmentally disabled pursuant to section 36-551 and are
determined to need institutional services pursuant to this article:

1. Intermediate care facility for mental retardation services for a member who has
a developmental disability as defined in section 36-551. For purposes of this article,
such facility shall meet all federally approved standards and may only include the
Arizona training program facilities, a state owned and operated service center, state
owned or operated community residential settings or existing licensed facilities operated
by this state or under contract with the department on or before July 1, 1988.

2. Home and community based services which may be provided in a member's home or an
alternative residential setting as prescribed in section 36-591 or other behavioral
health alternative residential facilities licensed by the department of health services
and approved by the director of the Arizona health care cost containment system
administration and which may include:

(a) Home health, which means the provision of nursing services or home health aide
services or medical supplies, equipment and appliances, which are provided on a part-time
or intermittent basis by a licensed home health agency within a member's residence based
on a physician's orders and in accordance with federal law. Physical therapy,
occupational therapy, or speech and audiology services provided by a home health agency
may be provided in accordance with federal law. Beginning on July 1, 1998, home health
agencies shall comply with federal bonding requirements in a manner prescribed by the
administration.

(b) Home health aide, which means a service that provides intermittent health
maintenance, continued treatment or monitoring of a health condition and supportive care
for activities of daily living provided within a member's residence.

(c) Homemaker, which means a service that provides assistance in the performance of
activities related to household maintenance within a member's residence.

(d) Personal care, which means a service that provides assistance to meet essential
physical needs within a member's residence.

(e) Developmentally disabled day care, which means a service that provides planned
care supervision and activities, personal care, activities of daily living skills
training and habilitation services in a group setting during a portion of a continuous
twenty-four hour period.

(f) Habilitation, which means the provision of physical therapy, occupational
therapy, speech or audiology services or training in independent living, special
developmental skills, sensory-motor development, behavior intervention, and orientation
and mobility in accordance with federal law.

(g) Respite care, which means a service that provides short-term care and
supervision available on a twenty-four hour basis.

(h) Transportation, which means a service that provides or assists in obtaining
transportation for the member.

(i) Other services or licensed or certified settings approved by the director.

C. In addition to services prescribed in subsection A of this section, home and
community based services may be provided in a member's home, in an adult foster care home
as prescribed in section 36-401, in an assisted living home or assisted living center as
defined in section 36-401 or in a level one or level two behavioral health alternative
residential facility approved by the director by program contractors to all members who
are not defined as developmentally disabled pursuant to section 36-551 and are determined
to need institutional services pursuant to this article. Members residing in an assisted
living center must be provided the choice of single occupancy. The director may also
approve other licensed residential facilities as appropriate on a case by case basis for
traumatic brain injured members. Home and community based services may include the
following:

1. Home health, which means the provision of nursing services or home health aide
services or medical supplies, equipment and appliances, which are provided on a part-time
or intermittent basis by a licensed home health agency within a member's residence based
on a physician's orders and in accordance with federal law. Physical therapy,
occupational therapy, or speech and audiology services provided by a home health agency
may be provided in accordance with federal law. Beginning on July 1, 1998, home health
agencies shall comply with federal bonding requirements in a manner prescribed by the
administration.

2. Home health aide, which means a service that provides intermittent health
maintenance, continued treatment or monitoring of a health condition and supportive care
for activities of daily living provided within a member's residence.

3. Homemaker, which means a service that provides assistance in the performance of
activities related to household maintenance within a member's residence.

4. Personal care, which means a service that provides assistance to meet essential
physical needs within a member's residence.

5. Adult day health, which means a service that provides planned care supervision
and activities, personal care, personal living skills training, meals and health
monitoring in a group setting during a portion of a continuous twenty-four hour
period. Adult day health may also include preventive, therapeutic and restorative health
related services that do not include behavioral health services.

6. Habilitation, which means the provision of physical therapy, occupational
therapy, speech or audiology services or training in independent living, special
developmental skills, sensory-motor development, behavior intervention, and orientation
and mobility in accordance with federal law.

7. Respite care, which means a service that provides short-term care and
supervision available on a twenty-four hour basis.

8. Transportation, which means a service that provides or assists in obtaining
transportation for the member.

9. Home delivered meals, which means a service that provides for a nutritious meal
containing at least one-third of the recommended dietary allowance for an individual and
which is delivered to the member's residence.

10. Other services or licensed or certified settings approved by the director.

D. The amount of money expended by program contractors on home and community based
services pursuant to subsection C of this section shall be limited by the director in
accordance with the federal monies made available to this state for home and community
based services pursuant to subsection C of this section. The director shall establish
methods for the allocation of monies for home and community based services to program
contractors and shall monitor expenditures on home and community based services by
program contractors.

E. Notwithstanding subsections A, B, C and F of this section, no service may be
provided that does not qualify for federal monies available under title XIX of the social
security act or the section 1115 waiver.

F. In addition to services provided pursuant to subsections A, B and C of this
section, the director may implement a demonstration project to provide home and community
based services to special populations, including disabled persons who are eighteen years
of age or younger, medically fragile, reside at home and would be eligible for
supplemental security income for the aged, blind or disabled or the state supplemental
payment program, except for the amount of their parent's income or resources. In
implementing this project, the director may provide for parental contributions for the
care of their child.

G. Subject to section 36-562, the administration by rule shall prescribe a
deductible schedule for programs provided to members who are eligible pursuant to
subsection B of this section, except that the administration shall implement a deductible
based on family income. In determining deductible amounts and whether a family is
required to have deductibles, the department shall use adjusted gross income. Families
whose adjusted gross income is at least four hundred per cent and less than or equal to
five hundred per cent of the federal poverty guidelines shall have a deductible of two
per cent of adjusted gross income. Families whose adjusted gross income is more than
five hundred per cent of adjusted gross income shall have a deductible of four per cent
of adjusted gross income. Only families whose children are under eighteen years of age
and who are members who are eligible pursuant to subsection B of this section may be
required to have a deductible for services. For the purposes of this subsection,
"deductible" means an amount a family, whose children are under eighteen years of age and
who are members who are eligible pursuant to subsection B of this section, pays for
services, other than departmental case management and acute care services, before the
department will pay for services other than departmental case management and acute care
services.