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016.06.71-213.700. Respite Care

AR ADC 016.06.71-213.700Arkansas Administrative CodeEffective: October 1, 2022

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 71. Archoices in Homecare (Archoices) Home and Community-Based Services (Hcbs) Waiver
Section 210.000. Program Coverage
Effective: October 1, 2022
Ark. Admin. Code 016.06.71-213.700
016.06.71-213.700. Respite Care
Currentness
Procedure Code
Description
T1005
Long-Term Facility-Based Respite Care
S5135
Short-Term Facility-Based Respite Care
S5150
In-Home Respite Care
Respite Care is provided to waiver participants unable to care for themselves and is furnished on a limited or short-term basis because of the absence of, or need for relief of, those persons normally providing the care.
Specifically, Respite Care consists of temporary care provided for short term relief for the primary caregiver, subject to the following:
A. The participant lives at home and is cared for, without compensation, by their families or other informal support systems;
B. As determined by the independent assessment, the participant has a severe physical, mental, or cognitive impairment(s) that prevents him or her from being left alone safely in the absence or unavailability of the primary caregiver;
C. The primary caregiver to be relieved is identified and with sufficient documentation that he or she furnishes substantial care of the participant comparable to or in excess of services described under the Attendant Care service;
D. No other alternative caregiver (e.g., other member of household, other family member) is available to provide a respite for the primary caregiver(s);
E. Respite Care services are limited to (a) direct human assistance with specific Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and health-related tasks as described under Attendant Care services and (b) supervision necessary to maintain the health and safety of the participant, as supported by the independent assessment and determined medically necessary by the PCSP/CC Nurse; and
F. Respite Care solely serves to supplement (not replace) and otherwise facilitate the continued availability of care provided to waiver participants by families and other informal support systems.
Respite Care is available on a short-term basis (8 hours or less per date of service) or a long-term basis (a full 24 hours per date of service) because of the absence or need for relief of those persons who normally provide care for the participant. Respite Care is available to meet an emergency need or to schedule relief periods in accordance with the regular caregiver's need for temporary relief from continuous care giving.
Respite Care is available in the following locations:
A. The Participant's home or place of residence;
B. Medicaid-certified hospital;
C. Medicaid-certified nursing facility;
D. Medicaid-certified adult day health facility; and
E. Medicaid-certified assisted living facility with a level II state license.
To allow the person who normally provides care for the waiver participant some time away from his or her caregiving of the participant, Respite Care may be provided in or outside the participant's home as follows:
A. In-home respite may be provided for up to 24 hours per date of service.
B. Facility-based respite care may be provided outside the participant's home on:
1. A short-term basis (eight (8) hours or less per date of service), or
2. A long-term (maximum of 24 hours per date of service and used most often when respite needed exceeds the short-term respite amount).
Reimbursement is only permitted for direct care rendered according to the participant's person-centered service plan by trained respite care workers employed and supervised by certified in-home respite providers.
Respite care is subject to the following limitations:
C. The purpose of Respite Care is to provide respite for unpaid caregivers. The amount, frequency, and duration of Respite Care must be entirely consistent with the amounts, frequencies, and durations of assistance from unpaid caregivers identified and calculated for the participant in the completed form of the Arkansas Task and Hour Standards (THS). Any amounts, frequencies, or durations in excess of the unpaid caregiver assistance amounts identified for the participant in the THS are not covered.
D. Respite Care excludes:
1. Skilled health professional services, including physician, nursing, therapist, and pharmacist services.
2. Services within the scopes of practice of licensed cosmetologists, manicurists, electrologists, or aestheticians, except for necessary assistance with personal hygiene and basic grooming;
3. Services provided for any other person other than the participant;
4. Companion, socialization, entertainment, or recreational services or activities of any kind, including, but not limited to, game playing, television watching, arts and crafts, hobbies, and other activities pursued for pleasure, relaxation, or fellowship; and
5. Habilitation services, including but not limited to, assistance in acquiring, retaining, or improving self-help, socialization, and/or adaptive skills; and,
6. Services provided for any tasks not included in a participant's service plans.
E. Participants are limited to no more than 1,200 hours (4,800 quarter-hour units) per year of in-home respite care, facility-based respite care, or a combination thereof. Respite Care is not subject to a monthly or weekly limit but is limited to the annual amount of time identified and calculated for the participant in the completed form of the Arkansas Medicaid Task and Hour Standards.
F. Respite Care services are not covered to provide continuous or substitute care while the primary caregiver(s) is working or attending school.
G. Reimbursement is not permitted for Respite Care services provided by a waiver participant's:
1. Spouse;
2. Legal guardian of the person; or,
3. Attorney-in-fact granted authority to direct the participant's care.
In the event the in-home functional assessments performed by the Independent Assessment Contractor and the PCSP/CC NURSE substantiates a need for respite care services, the service will be authorized as needed, via the participant's PCSP, not to exceed an hourly maximum. The PCSP/CC NURSE will establish the service limitation based on the participant's medical need, other services included on the PCSP and support services available to the participant. Respite care services must be provided according to the participant's written PCSP subject to the participant's Individual Services Budget.
An individual living in the home with the participant is prohibited from serving as a Respite Services provider for the participant.

Credits

Adopted Dec. 27, 2015. Amended Oct. 6, 2016; Jan. 1, 2019; Oct. 1, 2022.
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.71-213.700, AR ADC 016.06.71-213.700
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