9 CRR-NY 6654.15NY-CRR
9 CRR-NY 6654.15
9 CRR-NY 6654.15
6654.15 EISEP eligibility and definitions.
(a) To be eligible for EISEP services, an individual must:
(1) be at least 60 years of age or older;
(2) be functionally impaired, as shown by a need for the assistance of another person, in at least one activity of daily living (bathing, dressing, toileting, being continent of urine and/or feces, transferring, walking and eating) or two instrumental activities of daily living (housekeeping, shopping, preparing meals, managing money, laundry, using transportation, telephoning and taking medication);
(3) have unmet needs for such assistance;
(4) not be eligible to receive the same or similar services under title XVIII, XIX or XX of the Federal Social Security Act or any other governmental program or services provided to residents in adult residential care facilities which had previously been provided by the facility or which by law are required to be provided by such facility;
(5) apply for Medicaid if it appears that:
(i) due to income and assets, he or she may be eligible for Medicaid without any spend- down; or
(ii) due to income, assets and qualifying expenses, he or she may be eligible for Medicaid, provided that no such application shall be required if such individual does not have available income to pay such qualifying expenses in the amount by which such individual's income exceeds the Medicaid eligibility level;
(6) be able to be maintained safely in his or her home environment; and
(7) for noninstitutional respite, have one or more informal caregivers who provide continuing care.
(b) To be eligible for consumer directed in-home services, an individual must meet the requirements included in subdivision (a) of this section and:
(1) be capable of making choices regarding their activities of daily living and instrumental activities of daily living and the type, quality and management of his or her in-home services worker; understand the impact of these choices; and assume responsibility for the results of these choices; or
(2) be capable of delegating authority to another who is capable of carrying out the activities listed in paragraph (1) of this subdivision on behalf of the consumer and meets the requirements of paragraph (d)(3) of this section; or
(3) if not capable of delegating authority to another, have someone who meets the qualifications of paragraph (d)(3) of this section.
(c) Determinations of eligibility are made using the standardized screening instrument and assessment process prescribed by the office.
(d) Definitions.
(1) Consumer means an individual who is receiving consumer directed in-home services and who is responsible for specific tasks as noted in section 6654.17 of this Part, as well as recruiting, interviewing, hiring, training, supervising and if necessary, dismissing their in-home services worker.
(2) Consumer directed in-home services means assistance with those tasks that are the same or similar to those listed as Personal Care Level I and Personal Care Level II in section 6654.17(f) and (g) of this Part and for which the consumer is assuming the responsibilities as noted in section 6654.17 of this Part.
(3) Consumer representative means any individual who is at least 18 years or older who on behalf of the consumer, is willing and able to perform the functions related to consumer directed in-home services as noted in paragraphs (b)(1) and (d)(1) of this section and section 6654.17 of this Part and has been delegated to do so by the consumer, provided however that when the consumer is not able to delegate a representative, the consumer representative shall:
(i) be the legally appointed guardian or conservator; or
(ii) have been previously designated as a representative by the consumer to be responsible for coordinating his/her care and the individual is currently performing and is willing to continue to perform the role; or
(iii) be currently involved in the consumer’s life and have a strong personal commitment to the consumer and demonstrates knowledge of the consumer’s preferences.
(4) Fiscal intermediary means an entity that carries out administrative functions as specified in the agreement with the area agency and shall include functions such as processing the consumer directed in-home services worker’s payroll with respect to Federal, State and local income tax and other payroll withholding requirements including FICA, workers’ compensation, unemployment insurance and other employee benefits.
(5) In-home services means services that provide assistance with those tasks listed as Personal Care Level I and Personal Care Level II in section 6654.17(f) and (g) of this Part.
(6) In-home services agency means an agency that provides Personal Care Level I and/or Personal Care Level II as defined in section 6654.17(f) and (g) of this Part.
(7) In-home services worker under consumer directed in-home services means an individual who performs the tasks listed in section 6654.17(f) and (g) of this Part and meets the following requirements:
(i) is at least 18 years of age;
(ii) is a citizen of the United States or has legal authority to work in the United States;
(iii) is not the consumer representative; and
(iv) has not been convicted of Medicaid or other benefits fraud or any form of abuse, neglect or exploitation.
9 CRR-NY 6654.15
Current through July 31, 2021
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IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.