Federally approved BI, CAC, CADI, DD and EW waiver plans

Extended home care services: Services that follow Medical Assistance (MA) state plan home care policies but are allowed to exceed the limits on amount, duration and frequency.

The scope of extended home care services follow MA state plan home care services. For more information, see the service-specific pages.

BI, CAC and CADI

The following extended home care services are available for people on the Brain Injury (BI), Community Alternative Care (CAC) and Community Access for Disability Inclusion (CADI) waivers:

DD

Extended PCA services are available for people on the Developmental Disabilities (DD) Waiver.

EW

The following extended home care services are available for people on the Elderly Waiver (EW):

Extended home care services are not covered under any waiver when MA state plan home care services have not been authorized to the extent allowed under the MA state plan limits. For information about MA state plan home care authorizations, see the service-specific pages.

DD

The following extended home care services are not available to people on the DD Waiver:

EW

Extended home health therapies are not available to people on EW.

AC

Home health therapies and extended home care services are not available to people on the Alternative Care (AC) program. For information about home care services available to people on AC, see CBSM – AC program.

Case managers should use the following information when they authorize extended home care services with MA state plan home care services based on the person's assessed needs.

HHA, HCN and PCA

The case manager authorizes both MA state plan and extended HHA, HCN or PCA on the same service agreement. The case manager must:

For information about limits and procedure codes, see Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Home health therapies

MA state plan home health therapies are not prior authorized on a service agreement. The case manager only authorizes extended home health therapies on the person's service agreement.

The case manager must authorize extended home health therapies using the extended HCPC codes for service units over MA state plan home health therapy limits, as determined in coordination with the person's therapist(s).

For information about limits and procedure codes, see Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

Services through an MCO

BI, CAC, CADI and DD

To authorize extended home care services for people on BI, CAC, CADI and DD waivers who are enrolled in an MCO, the county/tribal nation case manager must:

1. Enter placeholder HCPC procedure code X5609 in MMIS for the state plan home care services for which the MCO is responsible for authorizing. When using this code, the case manager must indicate all of the following:

2. Follow the authorization instructions for extended home care services outlined above.

For more information, see Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF).

EW

To authorize extended home care services for people on EW who are enrolled in an MCO, the care coordinator follows the MCO’s procedure, unless the person receives case management through a tribal nation. Contact the case manager at the tribal nation for more information. See also CBSM – Tribal administration and management of HCBS programs.

The provider standards and qualifications for extended home care services are the same as for MA state plan home care services. For more information, see the service-specific pages.