§ 42-66.4-4. Provision of long-term home health care program. (a) When a long-term home health care program as defined under this chapter is available, the department of elderly affairs shall notify the eligible person, in writing, of the provisions of this chapter.

(b) If a person eligible to receive services under the provisions of this title who requires care, treatment, maintenance, nursing or other services in a nursing home desires to remain and is deemed by his or her physician able to remain in his or her own home or the home of a responsible relative or other responsible adult if the necessary services are provided, that person or that person's representative shall inform the department of elderly affairs. If a long-term home health care program as defined under this chapter is provided, the department of elderly affairs shall authorize an assessment under the provisions of this chapter. If the results of the assessment indicate that the person can receive the appropriate level of care at home, the case manager shall prepare for that person a plan for the provision of services comparable to those that would be rendered in a nursing home. In developing this plan, the department shall consult with those persons performing the assessment. The services shall be provided by certified home health agencies, home health aide/homemaker agencies, and adult day care centers.

(c) At the time of the initial assessment, and at the time of each subsequent assessment, the case manager shall establish a monthly budget in accordance with which he shall authorize payment for the services provided under the plan. Total monthly expenditures made under this title for each person shall not exceed a maximum of one hundred percent (100%) or any lesser percentage as may be determined by the director, of the average of the monthly rates payable under this title for skilled nursing/intermediate care facility services as provided for in the department of human services principles of reimbursement for skilled nursing/intermediate care facility services eligible requests of the medical assistance program. If an assessment of the person's needs demonstrates that he or she requires services, the payment for which would exceed the monthly maximum, but it can be reasonably anticipated that total expenditures for required services for that person will not exceed the maximum calculated over a one year period, the department of elderly affairs may authorize payment for those services.

History of Section. (P.L. 1988, ch. 451, § 3.)