RetiredCareSourcePolicy Supportive Living while Inpatient-AR PASSE-AD PASSE-AD-1174

Supportive Living while Inpatient (Arkansas PASSE)

Defines supportive living services (SLS) for Arkansas PASSE members, eligibility and coverage conditions, including case-by-case authorization for continued supportive living services while an individual is inpatient; applies to CareSource PASSE members in Arkansas.

Policy Summary

PayerCareSource

PolicySupportive Living while Inpatient (Arkansas PASSE)

Policy CodePolicy Supportive Living while Inpatient-AR PASSE-AD PASSE-AD-1174

Change TypeMinor non-material edits

Effective Date11/01/2023-01/31/2024

Next Review Date

Key ActionPrior authorization is required for all supportive living services; CareSource reviews requests case-by-case to authorize continued services while a member is inpatient.

SourceLink

POLICY UPDATE CHANGES

Added NCSS statement to Conditions of Coverage.

Added NCSS & PCSP policies to Related Policies.

14 daysmaximum consecutive days supportive living may continue when performed in hospital supportive care

case-by-caseauthorization review for continued supportive living while inpatient

Prior authrequirement for all services

09/01/2022original issue date

Supportive Living Coverage Criteria

Supportive living services (SLS) are covered with conditions; coverage includes service definitions, exclusions, prior authorization requirements, and case-by-case continuation while a member is inpatient.

ALL of the following

Member is eligible under Arkansas Medicaid through CareSource PASSE and described as Developmental Disability Services (would otherwise require ICF level of care).
Home and community-based waiver services are available only to individuals who are not inpatients unless payment is through private pay or private insurance.

ALL of the following

Services include care, supervision, and habilitative activities that directly relate to active treatment goals and objectives in the member's Person Centered Service Plan (PCSP).
Specific activities may include decision making support, daily living skills training (housekeeping, meal prep, dressing, personal hygiene, self-administration of medications as permitted under state law), money management training/assistance, socialization, mobility and community integration training, communication skills, reinforcement of therapeutic services, behavior shaping/management, companion activities or animal modalities to meet habilitative goals, and health maintenance activities (excluding injections and IV medication administration).

ALL of the following

CareSource will review requests on a case-by-case basis for authorization of non-medical community supports and continued supportive living services to be provided in the inpatient setting by the member's direct service provider.
Continued services must be authorized per each inpatient admission and be part of the member's PCSP.
Prior authorization is required for all services.
When health maintenance activities are performed in a hospital setting for supportive care of the individual while receiving medical care, supportive living cannot exceed 14 consecutive days and must not exceed the approved prior authorized rate for the service during hospitalization.

ALL of the following

Payments will not be made to a spouse or to a guardian or guardian's spouse in specified circumstances; only hired caregivers may be reimbursed for supportive living services provided.
Payments exclude costs of room and board, including general maintenance, upkeep, or improvement to the member's home or that of the member's family.
Services are not to replace traditional outpatient treatment, serve as respite services, or fulfill basic overseeing services (e.g., babysitting); routine care and supervision not directly related to active treatment goals are not payable.

Authorization and Provider Requirements

Prior Authorization

Inpatient Supportive Living requires case-by-case prior authorization

CareSource will review requests on a case-by-case basis to authorize non-medical community supports and continued supportive living services provided in the inpatient setting by the member’s direct service provider; services must be authorized and be part of the member’s Person Centered Service Plan (PCSP). Prior authorization is required for all services.

Review is performed per inpatient admission.
Services must be part of the member’s PCSP and provided by the member’s Direct Service Provider (DSP).
Prior authorization required before services are provided.

Key Definitions

Developmental Disability (DD)

TermDevelopmental Disability (DD)

DefinitionA substantial, long-term disability that begins from birth through age 21, expected to last a lifetime, with impairment of general intellectual functioning or adaptive behavior that substantially impairs the ability to function without appropriate support services.

Examples of supportsMay include planned recreational activities, medical services (e.g., physical therapy, speech therapy), and sheltered employment or job training.

Person Centered Service Plan (PCSP)

TermPerson Centered Service Plan (PCSP)

DefinitionThe total plan of care created according to the planning process described in the 1915(c) waiver requirements for Home and Community-Based Services (42 CFR §441.301(c)) and 1915(i) State Plan Services (42 CFR §441.725).

PurposeDocuments individualized goals and services to support community-based care and habilitation.

Inpatient Settings / IMD

TermInpatient Settings / IMD

Inpatient SettingsIncludes hospital inpatient: items and services furnished by a facility for care and treatment of patients under the direction of a licensed practitioner for medically necessary, documented treatment and care.

Psychiatric InpatientFacilities treating primary diagnoses of mental illness and providing required medical, psychiatric and social services, including medications, evaluations and therapies.

IMD (Institute for Mental Disease)A facility of more than sixteen (16) beds primarily engaged in diagnosis, treatment, or care of persons with mental illness, including medical attention, nursing care, and related services.

Direct Service Provider (DSP)

TermDirect Service Provider (DSP)

DefinitionLicensed or certified organizations who facilitate access to flexible services and other community and support services.

RoleProvides supportive living services as part of the member's care team and may deliver services in inpatient settings when authorized as part of the PCSP.

OpenPayer

Supportive Living while Inpatient (Arkansas PASSE)

Supportive Living Coverage Criteria

Billing and Coding Information

Authorization and Provider Requirements

Key Definitions