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At PepperTree Complete Care, we take great pride in our approach to customer service. The resources contained on this page can assist you with answers to many questions that we receive everyday from our clients and prospective clients.
Case management services are essential components of the CLASS program and CFC Personal Assistance Services/Habilitation (PAS/HAB) within CLASS. Individuals enrolled in these programs select a Case Management Agency (CMA) in their local catchment area, with the option to transfer to another CMA as needed.
CMAs provide ongoing case management services, including:
– Maintaining Medicaid eligibility assistance.
– Handling enrollment tasks.
– Conducting service planning.
– Providing technical support for Consumer Directed Services (CDS) participants completing Form 3596, PAS/Habilitation Plan – CLASS/DBMD/CFC.
– Monitoring service delivery.
– Safeguarding individual rights.
– Intervening during crises.
– Coordinating CLASS and non-CLASS services through person-centered planning techniques.
These services support the CLASS program’s objectives of community integration, preventing institutionalization, and fostering independent living skills.
Video Link: https://youtu.be/hWnKwZAFczc
In the Community Living Assistance and Support Services (CLASS) program, individuals have the option to choose Consumer Directed Services (CDS) for self-directing certain program services. These services include CFC Personal Assistance Services/Habilitation (PAS/HAB), CLASS transportation – habilitation, in and out-of-home respite, nursing, employment assistance, supported employment, cognitive rehabilitation therapy, physical therapy, occupational therapy, and speech/language pathology.
When opting for the CDS option, individuals are required to use Financial Management Services (FMS), provided by a Financial Management Services Agency (FMSA) of their choice. FMS includes payroll processing, ensuring compliance with employment taxes and workers’ compensation, and budget oversight. Individuals can also access support consultation to receive additional training and assistance beyond FMS requirements, aiding them in fulfilling employer responsibilities under the CDS option.
Support consultation is provided by qualified advisors and helps CDS employers with tasks like hiring, training, and dismissing attendants. This service is budgeted within the individual’s CDS budget and is not listed separately on their Individual Plan of Care (IPC).
The choice between CDS and Agency Option (where services are delivered by a CLASS Direct Services Agency) is made by the individual or their legally authorized representative (LAR) during service planning. The CLASS case manager offers the CDS option at enrollment, annually, and upon request. Individuals can switch between service delivery options at any time, though a 90-day waiting period is required if switching back to CDS after opting for the Agency Option.
Overall, these options provide flexibility and autonomy to individuals receiving services through the CLASS program, supporting their preferences and needs in service delivery.
Video Link: https://youtu.be/I3w1iN8X2AY
Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.
Also know that while Medicare and Medicaid are both health insurance programs administered by the government, there are differences in covered services and cost-sharing. Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are a dual-eligible.
Video Link: https://youtu.be/xyB-jD0wC0I
All individuals receiving Community Living Assistance and Support Services (CLASS) program services and Community First Choice (CFC) Personal Assistance Services/Habilitation (PAS/HAB) must choose a Direct Services Agency (DSA) with a valid provider agreement in their local catchment area. They have the option to request a transfer to another DSA at any time.
A DSA delivers CLASS program services, CFC PAS/HAB services, and CFC Emergency Response Services (ERS) as detailed in the Individual Plan of Care (IPC), Individual Program Plan (IPP), and Individual Program Plan Addendum (IPP-A). Individuals may opt to receive some or all services through the DSA, with certain services available for self-direction through Consumer Directed Services (CDS) by the individual or their legally authorized representative (LAR). Refer to what is the Consumer Directed Services (CDS) option.
The selected DSA is responsible for ongoing tasks including:
– Providing necessary documentation to HHSC for assessing and renewing the individual’s level of care.
– Participating in developing the PAS/Habilitation Plan – CLASS/DBMD/CFC to outline the individual’s needs.
– Contributing to the IPC addressing all CLASS or CFC service needs.
– Collaborating on the IPP-A using person-centered planning.
– Delivering all provider-managed services according to the IPP-A and IPP.
– Monitoring service provision to ensure compliance with qualified providers and the IPP-A.
– Coordinating with CMAs and other providers to initiate IPC and IPP-A revisions based on changes in the individual’s needs.
The comprehensive services provided through CLASS and CFC aim to integrate individuals into the community, prevent institutionalization, and enhance independent living capabilities.
Respite care services in the Community Living Assistance and Support Services (CLASS) program provide temporary relief to unpaid caregivers of members who are unable to care for themselves, typically on an emergency or short-term basis. Eligibility requires that the member resides in their own home or with relatives.
The respite care provider cannot be the primary caregiver, whether they are related to the member or not, and must not live with the member needing care. If the primary caregiver also serves as a paid attendant providing unpaid care, in-home respite care can only be provided during the hours the primary caregiver would typically be unpaid. If the primary caregiver (who is also the paid attendant) is absent during paid hours, the employer of record is responsible for arranging a substitute attendant.
Respite care aims to support primary caregivers during short-term, planned, or emergency periods and must be authorized through the individual service plan (ISP) before commencement.
Additionally, in the CLASS program, respite care can be used to enable clients to attend camps, enhancing their experience and support beyond the home environment. Thirty units of respite care equate to approximately 720 hours per IPC year, providing significant flexibility for caregivers and enhancing the overall quality of life for CLASS program participants.
Video Link: https://youtu.be/ezQWSSlhKUA