423. Coverage limitations

317:30-5-423. Coverage limitations

Revised 6-25-12

(a) Coverage limitations for residential supports for members with an intellectual disability are:

(1) Description: agency companion services (ACS); Unit: one day; Limitation: 366 units per year;
(2) Description: specialized foster care (SFC); Unit: one day; Limitation: 366 units per year;
(3) Description: daily living supports (DLS); Unit: one day; Limitation: 366 units per year; and
(4) Description: group home services; Unit: one day; Limitation: 366 units per year.

(b) Members may not receive ACS, SFC, DLS and group home services at the same time.

(c) Community transition services (CTS) are limited to $2,400 per eligible member.

(1) CTS is limited to one transition over the member's lifetime. If the member's situation changes after receipt of CTS and hospitalization or readmission to an intermediate care facility for the mentally retarded (ICF/MR) is necessary, CTS is not authorized upon transition back into the community.
(2) Members moving into a group home, SFC, or ACS arrangement in the companion's home are not eligible to receive CTS.

Library: Policy