CurrentMontana Department of Public Health & Human ServicesPolicy N/A

Senior Companion Services (BSW 731) — Coverage Criteria

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Defines Senior Companion services provided via Senior Corps/Area Agencies on Aging programs, covering intended services, requirements, limitations, and provider qualifications for Montana DPHHS members.

Policy Summary

PayerMontana Department of Public Health & Human Services

PolicySenior Companion Services (BSW 731) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDocument member needs to be limited to companionship and minimal assistance (no hands-on personal care) and ensure service is not provided concurrently with respite or homemaking.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4Service types

Senior CorpsProvider type

Hands-on careExclusion

1Concurrent services

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CurrentMontana Department of Public Health & Human ServicesPolicy N/A

Senior Companion Services (BSW 731) — Coverage Criteria

Customize your policy alerts

Sign up for all Montana Department of Public Health & Human Services policy alerts

Know when Montana Department of Public Health & Human Services releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerMontana Department of Public Health & Human Services

PolicySenior Companion Services (BSW 731) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDocument member needs to be limited to companionship and minimal assistance (no hands-on personal care) and ensure service is not provided concurrently with respite or homemaking.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4Service types

Senior CorpsProvider type

Hands-on careExclusion

1Concurrent services

Coverage Criteria for Senior Companion Services

Covered Services

Covered when ALL of the following are met

Eligibility and Service Nature: Member requires companionship and minimal assistance (no hands-on personal care).

From definition and service limitation.

Service Components: Services consist of respite, socialization, supervision, and homemaking as defined by the program.

Provider must deliver these components as applicable.

Provider Qualification: Provider must be a Senior Companion program that is part of Senior Corps/Area Agencies on Aging.

Provider requirement specified in document.

Non-concurrency: Service is not provided simultaneously with respite or homemaking (i.e., cannot be billed/provided concurrently).

Service limitation prohibits concurrent provision.

This service is not appropriate for members who require hands-on assistance with personal care needs. Documentation must show the member’s needs are limited to companionship and minimal assistance rather than hands-on personal care.

Senior Companion services will not be provided simultaneously with respite or homemaking. Providers should not bill or deliver these services concurrently.

Services are not medically necessary for members requiring hands-on personal care, because those needs exceed the scope of Senior Companion services.

Provider Actions, Documentation & Authorization

Prior Authorization

Prior authorization

No prior authorization requirement is specified in the policy.

Step Therapy

Step therapy

No step therapy or trial-of-service requirements are specified for Senior Companion services in this policy.

Documentation Required

Documentation requirements

Document the member's needs to show services are limited to companionship and minimal assistance and do not include hands-on personal care.

Background

Senior Companion services provide social support and limited assistance to older adults who do not require hands-on personal care. The program emphasizes companionship, supervision, respite, and light homemaking delivered by Senior Companion program staff affiliated with Senior Corps/Area Agencies on Aging.

Definitions

Senior Companion services — definition

DefinitionServices directed at providing companionship and minimal assistance.

Intended recipientsOlder adults who do not require hands-on personal care.

Primary service focusSocial support and companionship rather than clinical or hands-on personal care.

Scope of assistanceMinimal assistance only; tasks that do not include direct personal care or hands-on activities.