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Who can receive services?

In addition to being Medicaid eligible, individuals receiving PAC waiver services must meet the following eligibility criteria:
· Be diagnosed with AIDS;
· Be determined disabled according to Social Security standards;
· Need and receive case management and one other service and have an enrolled PAC waiver case manager;
· Have an “at risk of hospitalization” or an “at risk of institutionalization”
nursing facility level of care determination;
· Be able to remain safely in the home and community; and
· Have a completed PAC Waiver Enrollment Application, Level of Care from The Department of Elder Affairs (DOEA), Comprehensive Assessment and Review of Long Term Care Services (CARES)


Case management is the identifying, organizing, coordinating, and monitoring of services needed by a recipient. It assists waiver recipients in gaining access to waiver services as well as other services, regardless of the funding source.(Ryan White, General Revenue, HOPWA, Miami-Dade)

Case Manager Requirement: Every PAC waiver recipient must have a Medicaid-enrolled PAC waiver casemanager who is employed by a Medicaid-enrolled PAC waiver case management agency.

Case Manager Responsibilities: The case manager is responsible for performing and documenting the following activities:
· Comprehensive needs assessment and identification of service needs;
· Development of plans of care and authorization of services;
· Referral to available and appropriate resources;
· Monthly contacts with the recipient;
· Monitoring services received by the recipient; and
· Reassessment of the recipient’s needs.

Case Management Documentation Records: Case managers must develop and maintain case records for every recipient receiving PAC waiver services. The purpose of keeping this record is to assure that information regarding the recipient’s condition and service provision is contained in a single location to promote continuity and quality of care. It is the basis for quality assurance monitoring.

To ensure the confidentiality of recipient information, case records must be maintained by the case management agency at a secured central location.


Chore services are provided for the purpose of maintaining the recipient’s home in a clean, sanitary and safe environment.

Who Can Receive Services? Chore services may be provided only to recipients with limitations in activities of daily living when neither the recipient nor anyone else in the recipient’s household is capable of accomplishing the household chores.

Covered Services:
· Heavy household cleaning, and
· Removing barriers to safety and access in and around the recipient’s home. Heavy Household Chores are household chores to maintain a clean and sanitary living environment and reduce the potential for opportunistic infection for persons with AIDS.

Such chores are not routine housekeeping activities, but include seasonal cleaning, washing floors, walls, windows and draperies, carpet cleaning, and heavy cleaning and sanitation of bathrooms and kitchens.

Household Maintenance: Medicaid does not reimburse for general household maintenance and upkeep such as changing light bulbs and air conditioning filters.

Removing Barriers to Safety and Access:
Medicaid reimburses activities to remedy identified safety and accessibility barriers in the recipient’s living environment.

Services include:

· Moving heavy items or home furnishings to provide safe access and egress,
· Tacking down loose rugs and tiles,                                                                          · External maintenance to steps and sidewalks, and                                            · Yard maintenance to the minimum extent necessary to allow safe access and egress to and from the recipient’s residence.

Service Requirements:
Prior to the provision of service, the chore services provider must furnish a detailed work order to the recipient and case manager outlining scope of work, all supplies with associated costs required to complete the work, notification of any potentially hazardous chemicals to be used in the work, and the total cost of the service including labor.

Case Manager’s Responsibilities Prior to authorizing chore services, case managers must:                                                                                                                      · Ensure that no relative, caregiver, community or volunteer agency or third party is available to provide the services;
· Examine the lease agreement to determine the landlord’s responsibility, if the recipient lives on rental property; and
· Ensure the recipient’s safety if any potentially dangerous chemicals are to be used during service provision by documenting that the recipient’s physician approves the service.

Service Limitations:
Chore services are limited to individuals with a moderate acuity level 2 and a high acuity level 3. Services are available when needed.


Day health care is an organized program of therapeutic, social, and health activities and services provided in an ambulatory setting designed to restore or maintain the recipient’s optimal capacity for self-care and health promotion.

Who Can Receive Services? These services are provided to recipients with functional limitations in activities of daily living or serious health conditions resulting from AIDS. In order to be reimbursed for day health care services, the recipient must be present for a minimum of four hours. This need not be a continuous time period,but must be provided in one day.

Service Requirements: A registered nurse (RN) or licensed practical nurse (LPN) must be on site during all hours of program operation. Nutrition services must be provided under supervision of a licensed dietitian or nutritionist.

Dietitian Certification: Day health care providers must maintain documentation that a licensed dietitian or nutritionist has certified that meals provided meet the RDA requirements and the certification must include the dietitian’s registration number and signature.

The following services must be provided:
· Periodic nursing evaluations conducted at least monthly;
· Medication monitoring;
· Medical supervision of progress toward therapeutic goals identified in the recipient’s plan of care;
· Dietary and nutritional education;
· At least one meal that meets one-third of the current daily Recommended Dietary Allowances (RDA) established by the Food and Nutrition Board of the National Academy of Sciences;
· Transportation between the recipient’s residence and the day health center; and
· Therapeutic activities as described below.

Therapeutic Activities Day health care must include the development and implementation of planned group or individual therapeutic activities provided in accordance with the goals identified in a recipient’s plan of care for management of preventable disease and early intervention to promote optimal health. These activities may include physical fitness, nutrition counseling, stress reduction techniques, and other specific measures to avoid declines in health status. They may also include health promotion programs to assist recipients in understanding how lifestyle impacts physical and mental health and to develop personal practices that enhance their total well being.

Activities of Daily Living: Day health care must also provide supportive care and supervision to recipients with functional limitations in activities of daily living resulting from AIDS or AIDS dementia. These recipients must be unable to care for themselves because the individuals who normally provide care to the recipients are absent or need relief.

Service Limitations: Day health care services are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. This service is available to individuals with a moderate acuity level 2 and a high acuity level 3 on an as needed basis.


Education and support services consist of face-to-face counseling and therapy services directed toward the elimination of psychosocial barriers resulting from the diagnosis of AIDS and progression of the disease.

Service Requirements: Education and support services must be based on an individualized support plan, which is a structured, goal-oriented schedule of services developed jointly by the recipient and the provider of education and support services. The support plan must contain measurable objectives, anticipated outcomes, and planned interventions for resolution of barriers and the provision of AIDS-related education.

The provider is required to submit to the case manager a copy of the recipient’s education and support plan prior to its implementation. The provider is also required, on a quarterly basis, to send reports that outline milestones achieved by the recipient in the previous quarter. Reports should be submitted to the case manager within ten working days of the end of the quarter.

Covered Services: Education and support services include:
· Developing the recipient’s personal support networks;
· Assisting the recipient’s caregivers in making positive contributions to the recipient’s ability to remain in the home;
· Identifying barriers to optimal interpersonal functioning; and
· Developing or modifying the recipient’s skills that are necessary to prevent institutional placement.

Non-Duplication of Services: Counseling, therapy and treatment services are provided under the Medicaid community mental health program. Education and support services provided under the PAC waiver may not duplicate services that are provided under another Medicaid program.

Service Limitations: Education and support services are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager.

This service is available to individuals with low acuity Level 1 for three (3) months from the date of enrollment. Individuals with moderate acuity level 2 have the service available for six (6) months from enrollment or in crisis. Individuals with high acuity level 3 have the service available for ongoing needs.


Environmental modifications are structural modifications, accessibility adaptations, and other physical changes to a recipient’s living environment. The modifications are provided to ensure the health and safety of a recipient, to compensate for the recipient’s limitations in activities of daily living, and to promote greater independent functioning of the recipient in the home.

Structural Modifications:
The program reimburses for the following structural modification services,
· Physical adaptations to the home that involve structural changes such as building ramps, widening doors, lowering countertops and cabinets, and modifying bathroom facilities to accommodate wheelchairs and other assistive devices.
· Installation of specialized electrical or plumbing systems necessary to accommodate required medical equipment.

Structural modifications must be provided by a licensed contractor in accordance with a building permit, if required, and conform to applicable building codes.

Water Filtration Systems
The program reimburses the purchase and installation of a water filtration system where evidence of cryptosporidium is documented as being present in the recipient's local water supply. Water filtration systems must be able to filter basophilic spherules as small as absolute 1 micron.

Accessibility Adaptations
The program reimburses the purchase and installation of grab bars, specialized hardware and fixtures, and other devices required to compensate for a recipient’s limitations in activities of daily living.

Service Requirements:
Prior to the provision of service, the environmental modification provider must furnish a detailed work order to the recipient and case manager outlining the scope of work, all supplies with associated costs required to complete the work, the estimated time for completing the work, and the total cost of the service including labor.

Case Manager’s Responsibilities:
Prior to authorizing environmental modification services, case managers must,
· Ensure that no relative, caregiver, community or volunteer agency or third party is available to provide the services;
· Examine the lease agreement to determine the landlord’s responsibility, if the recipient lives on rental property; and
· Ensure the recipient’s safety if any potentially dangerous chemicals are to be used during service provision by documenting that the recipient’s physician approves the service.

Service Limitations:
Environmental modification services are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. Medicaid must approve environmental modifications that will exceed $250 before services are considered authorized. The case manager must submit a Request for Plan of Care Expenditure Exception and a copy of the detailed work order to Medicaid for approval. This service is available to individuals with a moderate acuity level 2 and high acuity level 3, when they are homeowners and to promote greater independence.


Home delivered meals provide nutritionally sound meals, fresh or frozen, delivered directly to the recipient’s home.

Who Can Receive Services?
Home delivered meals may be provided only under the following circumstances:
· The recipient is not capable of preparing meals or is homebound and unable to shop for food to prepare meals; and no other person in the recipient’s household is able to prepare meals, or the person who usually prepares meals is temporarily absent or unable to manage meal preparation.
· A physician prescribes a therapeutic diet for the recipient that can only be implemented through home delivered meals.

Service Requirements:
Each meal must be individually packed and meet one-third of the current daily Recommended Dietary Allowances (RDA) established by the Food and Nutrition Board of the National Academy of Sciences. More than one meal per day may be delivered for consumption each day, but may not constitute a full nutritional regimen (three meals per day). Providers must maintain a formal sanitation program that complies with Chapter 10D-13, F.A.C. for sanitation and food safety.

Home delivered meals provided under a therapeutic diet must be prescribed by a physician.

Dietitian’s Certification:
The provider must maintain documentation that a licensed dietitian or nutritionist has certified that meals provided meet the RDA requirements. The certification must include the dietitian’s registration number and signature.

Freshly Prepared Meals:
Freshly prepared meals must be delivered daily to the recipient’s home. All foods must be packaged and transported under conditions that will ensure temperature control during delivery and prevent contamination and spillage. Hot and cold foods must be packaged separately; the temperature of hot foods and cold foods must be maintained at temperatures appropriate to ensure food safety.

Frozen Meals:
Frozen meals may be delivered for daily consumption or in bulk for not more than one week’s consumption. A maximum of 14 frozen meals may be delivered for consumption in a week, which is not meant to constitute a full nutritional regimen (three meals per day). Frozen meals must have a satisfactory storage life, contain a preparation date, and be clearly labeled with instructions for storage and reheating. Frozen meals must be delivered at temperatures appropriate for ensuring food safety. When frozen meals are delivered to a recipient, the case manager must document in the plan of care that the recipient has a means for heating the meal. The home delivered meal provider must also ensure that the recipient has the means to store and cook the meals safely in accordance with the directions provided.

Service Limitations
Home delivered meals are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. This service is available to individuals with moderate acuity level 2 when prescribed by their physician and when no in –home support is present for up to two (2) months of discharge from institution. Individuals with high acuity level 3 the service is available prescribed by their physician and when no in-home support is present for up to three (3) months of discharge from institution.


Homemaker services are provided for the purpose of maintaining the recipient’s home in a clean and sanitary environment, and to compensate for functional limitations in activities of daily living resulting from AIDS.

Who Can Receive Services?
Homemaker services may be provided only when the recipient is not capable of accomplishing household activities, and no other person in the recipient’s household is able to accomplish household activities, or when the individual who usually performs these services is temporarily absent or unable to manage these household activities. Covered Services Medicaid reimburses general household activities provided by a trained homemaker, including routine housekeeping such as cleaning, dusting, vacuuming and laundry, and assistance with shopping.

Meal planning and preparation may be provided as part of this service when it is not provided through any other service.

Service Limitations:
Homemaker services are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. This service is available to individuals with high acuity level 3, when no in-home support is present, for up to 2 months of discharge from an institution.


Personal care services provide assistance to a recipient with limitations in functioning related to eating, bathing, dressing, ambulating, using the toilet, and other activities of daily living.

Personal care is not medical care, but may be hands-on assistance in areas of self care to maintain and improve the recipient’s personal hygiene and health.

Covered Services program reimbursement for personal care includes:
· Assisting the recipient with eating, bathing, dressing, ambulating, using the toilet, and other activities of daily living.
· Meal preparation and housekeeping activities when such activities are essential to the health of the recipient and no one else is available to perform the activities, and the activities are not provided through other services.

Service Requirements:
Personal care services must be provided under a written program for the recipient that is developed by health care professionals including the attending physician. Personal care services must be documented on a plan of care that complies with the care plan requirements in the Medicaid Home Health Services Coverage and Limitations Handbook. Personal care services must be supervised by a registered nurse in accordance with the recipient’s home health plan of care.

Non-Duplication of Services:
Personal care services are provided under the Medicaid home health program for recipients under age 21. Personal care services provided under the PAC waiver may not duplicate services provided under another Medicaid program.

Service Limitations:
Personal care services are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. This service is available to individuals with high acuity level 3 when prescribed by their physician and or 60 days after discharge from an institution.


Pest control services are provided to eliminate insects, rodents and other potential carriers of disease that could be hazardous to persons with compromised immune systems if present in a recipient’s living environment.

Service Requirement:
Pest control services must be furnished by a pest control business licensed in accordance with Chapter 482, F.S., and enrolled as a PAC waiver provider.

Case Manager’s responsibilities:
Prior to authorizing pest control services, case managers must,
· Ensure that no relative, caregiver, community or volunteer agency or third party is available to provide the services;
· Examine the lease agreement to determine the landlord’s responsibility, if the recipient lives on rental property; and
· Ensure the recipient’s safety if any potentially dangerous chemicals are to be used during service provision by documenting that the recipient’s physician approves the service.

Service Limitations:
Pest control is limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. This service is available to individuals with low acuity level 1, moderate acuity level 2, and high acuity level 3, when needed.


Skilled nursing services are provided to recipients who require medically necessary skilled nursing care provided in their places of residence to maximize the health of the recipient. Medicaid reimburses skilled nursing services provided by registered nurses (RNs) and licensed practical nurse (LPNs).

Examples of skilled nursing care include: infusion therapy; administration of intravenous medications; administration of intramuscular or subcutaneous injections and hypodermoclysis; replacement and sterile irrigation of catheters; colostomy and ileostomy care; treatment of decubitus ulcers; treatment of widespread infected or draining skin disorders; administration of prescribed heat treatments; restorative nursing procedures; nasopharyngeal or tracheotomy aspiration; ventilator care; and levin tube and gastrostomy feedings.

Skilled Nursing by an RN:
RN services include, skilled nursing care rendered by a RN within the scope of Chapter 464, F.S. RN services may be intermittent or continuous nursing care.

Skilled Nursing by an LPN:
LPN services include, skilled nursing care rendered by a LPN within the scope of Chapter 464, F.S. LPN services may be intermittent or continuous nursing care.

Service Requirements:
A licensed physician prior to the provision of care must order skilled nursing. Skilled nursing services must be consistent with the written physician approved plan of care and comply with the requirements of the Medicaid Home Health Services Coverage and Limitations Handbook. Skilled nursing services must also be consistent with accepted standards of medical and nursing practice.

Non-Duplication of Services:
Skilled nursing services and home health care are provided under the Medicaid home health services program. Skilled nursing services provided under the PAC waiver may not duplicate services that are provided under another Medicaid program.

Service Limitations:
Skilled nursing services are limited to the amount, duration and scope of services described in the recipient’s PAC waiver plan of care as authorized by the case manager. This service is available to individuals with high acuity level 3, when prescribed by their physician for 60 days after discharge for an institution.


Specialized medical equipment and supplies include durable medical and adaptive equipment and consumable medical supplies, which are needed to promote, maintain and optimize health, to minimize the effect of illness and disability resulting from AIDS, or to compensate for limitations in activities of daily living.

Plan of Care and Prescription Requirements:
To be reimbursed by Medicaid, the medical equipment or medical supplies must be,
· Specifically identified in the recipient’s plan of care; and
· Prescribed by a licensed physician, advanced registered nurse practitioner, or physician assistant designee.

Medical and Adaptive Equipment:
Medical and adaptive equipment is medically-necessary equipment that can withstand repeated use, is appropriate for use in the recipient’s home, and serves a medical purpose or enables the recipient to compensate for limitations in the ability to perform activities of daily living. Medicaid reimbursement for medical and adaptive equipment services include the purchase, delivery, set-up and installation in the home, and training and instruction to the recipient or caregiver. Medical and adaptive equipment service may include maintenance and repair when performed by an authorized technician and no other source is available to provide the maintenance or repair.

Medical & Adaptive Equip.Service Requirements: Providers of medical and adaptive equipment and supplies must provide the recipient’s caregiver with all the manufacturers’ instructions, service manuals and operating guides needed for routine service and operation. Providers or manufacturers of medical and adaptive equipment and supplies must warrantee the products for a minimum of one year. No replacement or repairs will be reimbursed for equipment within the first year of service.

Medical & Adaptive Equip.Report Requirements: Providers of medical and adaptive equipment must furnish a report to the recipient and case manager on the equipment furnished to the recipient that includes the following information,
· Full description of the item;
· Manufacturer’s name and address;
· Model and serial number;
· List of parts, components, attachments and special features;
· Recipient’s functional limitations warranting the equipment;
· Medical justification for all unique features and construction;
· Whether the service was the acquisition or the repair of the equipment; and
· Cost of equipment acquisition or repair.

Medical Supplies/Consumable:
Medical supplies are medically-necessary medical or surgical items that are consumable, expendable, disposable or non-durable, and appropriate for use in the recipient’s home. Medicaid only reimburses consumable medical supplies that if not provided could reasonably cause the recipient to require emergency treatment, become hospitalized, or be placed in a long-term care facility. Consumable medical supplies must not exceed one month’s usage.

Providers of consumable medical supplies must furnish an itemized report to the recipient and case manager of all supplies furnished to the recipient which includes the following information:
· Full description of each item,
· Quantity of each item, and
· Per item cost and total costs of supplies furnished.

Non-Duplication of Services:
Durable medical equipment and supplies are provided under the Medicaid durable medical equipment and medical supply service program. Specialized medical equipment and supplies provided under the PAC waiver may not duplicate services that are provided under another Medicaid program.

Service Limitations:
Specialized medical equipment and supplies are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. Specialized medical equipment and supplies that will exceed $250.00 must be approved by Medicaid before services are considered authorized. The case manager must submit a Request for Plan of Care Expenditure Exception, a copy of the physician’s prescription, and an itemized report to Medicaid for approval. This service is available to individuals with any of the three acuity levels when needed.


Substance abuse treatment consists of a structured, goal-oriented schedule of services designed to deter a recipient from dependency on drugs and alcohol, and change behavior to minimize further damage from both the substance abuse and collateral damage resulting from AIDS.

Covered Services:
Substance abuse treatment includes evaluation and treatment that focus on reducing known risk factors associated with the onset of progressive chemical dependency and other alcohol and drug-related problems.

Treatment may include:
· Early identification and screening,
· Liaison and referral services,
· Short-term counseling and support, and
· Outpatient methadone maintenance when this is not available to the recipient from another program.

Non-Duplication of Services:
Evaluation and treatment of substance abuse are provided under the Medicaid community mental health program. Substance abuse treatment provided under the PAC waiver may not duplicate services provided under another Medicaid program.

Service Limitations:
This service is available to individuals with all acuity levels when needed and prescribed by their physician (requires a physician order).


Therapeutic massage services are provided to recipients with peripheral neuropathy or severe neuromuscular pain and lymphedema and with related limitations in activities of daily living.

Covered Services:
Therapeutic massage services include an evaluation to determine the recipient’s level of functioning and competencies through therapeutic observation and testing. Therapeutic massage treatment involves face-to-face encounters with a recipient for the purpose of providing massage therapy services.

Prescription Requirement:
Therapeutic massage must be prescribed by a licensed physician, advanced registered nurse practitioner, or physician assistant designee.

Service Limitations:
Therapeutic massage services are limited to the amount, duration and scope of services described in the recipient’s plan of care as authorized by the case manager. This service is available to individuals with acuity levels 2 and 3, by prescription from your physician and for the symptoms above stated.


We are dedicated to the development of the Project AIDS Care Waiver Program, our network companies and our members. The League operates many programs from a uniquely Hispanic cultural perspective regarding service delivery. Quality in case management services is a priority at our company. We measure our success and quality by our members’ satisfaction.

Service Documentation:
The following specific elements must be documented for all PAC waiver services or service components rendered to waiver recipients:

· Name of provider, provider agency and specific individual rendering each service;
· Type of service provided;
· Amount of service provided;
· Date of service; and
· Place of service.

The documentation must clearly describe the activities associated with maintaining the recipient in a community setting. The documentation must show that services are consistent with the plan of care and are being delivered according to the plan.

Patient Confidentiality:
We follow all state, federal and ethical guidelines pertaining to patient confidentiality. Please be assured that your information is safe with us.

Case Management Agency Transfers:
PAC waiver recipients may elect to terminate case management services provided by one case management agency and transfer to another available case management provider. Before transferring to another case management agency, the case manager must inform the recipient of all PAC waiver case management providers located in the area and provide the recipient with a choice of a new case management agency.

To complete the transfer, the recipient must sign and date a PAC Case Management Agency Transfer Request. The current case management agency must send this request via registered mail, along with a complete copy of the recipient’s case record, to the new case management provider within ten working days of the signed request.

Case management services from the transferring case management provider will be terminated on the date the transfer request and case record are received by the new case management agency.

Termination of Services:
PAC waiver services must be terminated or suspended for the following reasons:

· The recipient chooses not to receive a specific PAC waiver service;                             · A specific waiver service is no longer appropriate or needed;
· The recipient temporarily moves out of the area; or
· The recipient is temporarily institutionalized.

Case managers must provide PAC waiver recipients with at least ten days advance notice of any termination or suspension that is initiated by the case management provider.

Termination of Participation:
A recipient’s participation in the PAC waiver must be terminated when the recipient,

· Chooses to stop participating in the PAC waiver;
· Becomes ineligible for Medicaid;
· No longer meets the PAC waiver eligibility criteria;
· Moves from the area;
· Elects to reside in a nursing facility;
· Is unable from a health stand point to be safely maintained in the home;                     · Elects to receive services from a non-HIV/AIDS specialty Medicaid HMO;
· Elects to enroll in a Medicaid Hospice; or
· Dies.

Case Manager's Responsibilities:
When a recipient's participation in the PAC waiver is terminated, the case manager must immediately,

· Notify all service providers to cancel PAC waiver services that are being provided to the recipient; and
· Notify the local Department of Children and Families public assistance office of the termination.

Advance Notice:
Case managers must provider PAC waiver recipients with at least ten days advance notice of any termination or suspension initiated by the case management provider.

Right To A Fair Hearing:
A recipient has the right to appeal any action taken by AHCA, DOEA, the Department of Children and Families or case management providers that adversely affects the recipient’s receipt of services. Required advance notice of termination in services or program participation must inform the PAC recipient of the right to a fair hearing.