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Greenville   (252) 355-4703 Elizabeth City   (252) 338-1553

Our Promise to You:

Pinnacle Home Care, Inc. is dedicated to providing quality care and compassion for our clients. Pinnacle Home Care, Inc. strives to provide services in accordance with the highest ethical standards. We assure the basic human rights for each client receiving services are ensured so that the diverse needs whether individual, cultural, or linguistic are recognized and met within the organization. We uphold to the highest degree to which a product, device, service, or environment is available to as many people as possible. We will be creative and open to new ideas and opportunities.

Community Living and Support is an individualized service that enables the waiver beneficiary to live successfully in his/her own home, the home of his/her family or natural supports and be an active member of his/her community. A paraprofessional assists the person to learn new skills and/or supports the person in activities that are individualized and aligned with the person’s preferences. The intended outcome of the service is to increase or maintain the person’s life skills or provide the supervision needed to empower the person to live in the home of his/her family or natural supports, maximize his or her self-sufficiency, increase self- determination and enhance the person’s opportunity to have full membership in his/her community.

Community Living and Support enables the person to learn new skills, practice and/or improve existing skills. Areas of skill acquisition are: interpersonal, independent living, community living, self-care, and self-determination.

Community Living and Support provides supervision and assistance for the person to complete an activity to his/her level of independence. Areas of support consist of assistance in monitoring a health condition, nutrition or physical condition, incidental supervision, daily living skills, community participation, and interpersonal skills.

Community Living and Support provides technical assistance to unpaid supports who live in the home of the individual to assist the individual to maintain the skills they have learned. This assistance can be requested by the unpaid support or suggested by the Individual Support Planning team and must be a collaborative decision. The technical assistance is incidental to the provision of Community Living and Supports.

Exceptional Needs:

Community Living and Supports Exceptional Needs are used to meet exceptional, short term situations that require services beyond 12 hours per day. The Individual Support Plan documents the exceptional supports needed based on the SIS® or other assessments that explain the nature of the issue and the expected intervention. A plan to transition the individual to sustainable supports is required. The plan may document the use of assistive technology or home modifications to reduce the amount of the support for behavioral and/or safety issues. Medical, behavioral, and support issues require documentation of when the situation is expected to resolve, evaluations/assessments needed to assist in resolving issues, and other service options explored. EPSDT and other appropriate State Plan services must always be utilized before waiver services are provided.

All Requests for Community Living and Supports require prior approval by the PIHP.

  1. Requests for up to 12 hours daily may be authorized for the entire plan year.
  2. Requests for up to 16 hours daily may be authorized for a six-month timeframe, within the plan year
  3. Requests for more than 16 hours daily are authorized for up to a 90-day period within the plan year. In situations requiring an authorization beyond the initial 90-day period, the PIHP shall approve such authorization based on review of the transition plan that details the transition of the participant from Community Living and Supports to other appropriate services.

The service may be provided in the home or community. The involvement of unpaid supports in the generalization of the service is an important aspect to ensure that achieved goals are practiced and maintained. Services may be allowed in the private home of the provider or staff of an Employer of Record at the discretion and agreement of the support team and when consistent with the ISP goals.

Community Networking services provide individualized day activities that support the waiver beneficiary’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the beneficiary requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the individual. This service is provided separate and apart from the beneficiary’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the beneficiary the opportunity to develop meaningful community relationships with non-disabled individuals. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the beneficiary to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the beneficiary gain skills and increase community connections, service hours may fade.

Community Networking services consist of:

  1. Participation in adult education (College, Vocational Studies, and other educational opportunities);
  2. Development of community-based time management skills;
  3. Community-based classes for the development of hobbies or leisure/cultural interests;
  4. Volunteer work;
  5. Participation in formal/informal associations and/or community groups;
  6. Training and education in self-determination and self-advocacy;
  7. Using public transportation;
  8. Inclusion in a broad range of community settings that allow the beneficiary to make community connections;
  9. For children, staffing supports are covered to assist children to participate in day care/after school summer programs that serve typically developing children and are not funded by Day Supports;
  10. Payment for attendance at classes and conferences is also included.
  11. Payment for memberships can be covered when the beneficiary participates in an integrated class; and
  12. Transportation, when the activity does not include staffing support and the destination of the transportation is an integrated community setting or a self-advocacy activity. Payments for transportation are an established per trip charge or mileage.

This service includes a combination of training, personal assistance and supports as needed by the beneficiary during activities. Transportation to/from the beneficiary’s residence and the training site(s) is covered.

Payment for attendance at classes and conferences is also covered.

Developmental Therapy is a developmental disability service that includes individually designed instruction, training or functional developmental intervention activities based on the assessment of, and unique strengths and needs of the individual child or adult. It is designed to support the individual in the acquisition of skills that the recipient has not gained during the developmental stages of life, and is not likely to develop without additional training and supports. For children the focus is on strengthening skills in the major developmental domains and may include training and activities in areas such as self-help, language and cognitive development, and psychosocial skills. For adults, Developmental Therapy may include training in activities to strengthen appropriate developmental functioning in areas such as self-care, mobility, socialization, independent living, self-advocacy and rights.

Individual Supports is a service that enables a limited amount of funding to be used by an individual with maximum personal control and flexibility. It is based on research and experience which indicates that when a person and his/her circle of supports are provided with flexible funding over which they exercise primary control, they use that funding in ways that best meet their needs, not necessarily on the traditional services more normally chosen by an interdisciplinary team. With limited funds they are able to make adjustments in their lives which reduce or eliminate their dependence on traditional facility-based programs.

In order to qualify for utilization of Individual Supports, the following components of the service planning and implementation process must be in place:

  1. A person-centered plan and a personal budget to support that plan are created by the individual and those friends, family and persons who know and care about the individual;
  2. The individual maintains control of the expenditure of the funds;
  3. The individual maintains monthly updates over the expenditures through the personal budget;
  4. The personal budget is not managed by the primary service provider;
  5. The utilization of Individual Supports result in a documentable increase in the degree to which the individual exercises choice and control over his/her life.

Guidelines

  1. Any savings over previous costs associated with the individual’s supports and services are utilized for services and supports for others waiting for services and supports.
  2. Documentation for Individual Supports is expected to be a monthly record of supports received or acquired for the month.
  3. In keeping with the emphasis on the provision of a limited amount of money while maximizing participant control and flexibility, the monthly rate for this support is set at $1,000. This monthly reimbursement creates a flexible pot of money at the area program. The exact amount apportioned to each individual is based upon needs and preferences identified in a personal budget.
  4. This service is generally provided alone or in conjunction with non-residential services and supports, except it may be provided in conjunction with Residential Living.

Personal Assistance is a support service which provides aid to a client so that the client can engage in activities and interactions from which the client would otherwise be limited or excluded because of his disability or disabilities. The assistance includes: (1) assistance in personal or regular living activities in the client’s home, (2) support in skill development, or (3) support and accompaniment of the client in regular community activities or in specialized treatment, habilitation or rehabilitation service programs.

Guidelines:

  1. Include face-to-face time providing assistance to the client and time spent transporting the individual to or from services.
  2. Homemaker and Personal Care which are not directed at training new client skills and other similar services are to be reported in this category.
  3. This service is usually provided by non-professionals–with the single goal of providing assistance to the client so s/he can function in more normal environments. When professionals provide this service in addition to habilitation or treatment during the same time period, the outpatient treatment (or other relevant code) should be given precedence for reporting and those documentation requirements shall be met.
  4. Staff Travel Time to be reported separately.
  5. Preparation/documentation time NOT reported.

Authorizations for Personal Care that are current as of the effective date of the waiver amendment will be honored until their end date. No new authorizations for these services will be issued after the effective date of the waiver. Request for Community Living and Support may be made in lieu of these services at any time by the completion of a revision. Once the individual transitions to Community Living and Support, this service will no longer be available to them.

Personal Care Services under North Carolina State Medicaid Plan differs in service definition and provider type from the services offered under the waiver. Personal Care Services under the waiver include support, supervision and engaging participation with eating, bathing, dressing, personal hygiene and other activities of daily living. Support and engaging the beneficiary describes the flexibility of activities that may encourage the beneficiary to maintain skills gained during habilitation while also providing supervision for independent activities. This service may include preparation of meals, but does not include the cost of the meals themselves.

When specified in the ISP, this service may also include housekeeping chores such as bed making, dusting and vacuuming, which are incidental to the care furnished or which are essential to the health and welfare of the beneficiary, rather than the beneficiary’s family. Personal care also includes assistance with monitoring health status and physical condition, assistance with transferring, ambulation, and use of special mobility devices.

Personal Care Services may be provided outside of the private home as long as the outcomes are consistent with the support described in the ISP. Services may be allowed in the private home of the provider, staff or an Employer of Record, or staff of an Agency With Choice if there is documentation in the ISP that the beneficiary’s needs cannot be met in the beneficiary’s private home or another community location.

Residential Supports provides individualized services and supports to enable a person to live successfully in a Group Home or Alternative Family Living (AFL) setting of their choice and be an active participant in his/her community. The intended outcome of the service is to increase or maintain the person’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination and ensure the person’s opportunity to have full membership in his/her community.

Residential Supports includes learning new skills, practice and/or improvement of existing skills, and retaining skills to assist the person to complete an activity to his/her level of independence. Residential Supports includes supervision and assistance in activities of daily living when the individual is dependent on others to ensure health and safety.

Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source.

Residential Supports are provided to individuals who live in a community residential setting that meets the home and community based characteristics as outlined in the Waiver in Appendix C.

Residential Supports may additionally be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. These sites are licensed or unlicensed in accordance with state rule. All unlicensed AFL sites will be reviewed using the PIHP AFL checklist for health and safety related issues. NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports.

LEVELS

Residential Supports levels are determined by the SIS Level.
Level 1: SIS Level A
Level 2: SIS Level B
Level 3: SIS Level C and D
Level 4: SIS Level E, F, and G

The results of a SIS and the SNM Base Budget are guidelines that do not constitute a binding limit that may not be exceeded on the amount of services that may be requested or authorized in a Plan of Care.

Vehicle Modifications may be accessed when the vehicle belongs to the individual and can transition to other settings with the individual.

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