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POLICY #: / WAYNE COUNTY
AREA AGENCY ON AGING
Unit Agency (If applicable):
Subject: AREA AGENCY ON AGING
CARE PLAN COST CAP EXCEPTION POLICY / o Proposed o Final
o Effective Date / Revision Date:
The Area Agency on Aging has developed the following policy to address an exception to the Care Plan Cost Cap of $765/month as specified in the Pennsylvania Department of Aging, APD# 15-01-08
POLICY: Exceptions to the Care Plan Cost Cap of $765/month will be considered on a case by case basis and approved by the AAA Director, as budget permits, if the consumer meets all of the following requirements:
A. The consumer’s monthly income must be below the Cost Sharing sliding scale and not exceed 300% of the Federal Poverty Level guidelines.
B. The consumer must be Nursing Facility Clinically Eligible (NFCE). A Nursing Facility Ineligible (NFI) consumer will only be considered if:
a. The consumer receives Adult Day Services only (or Adult Day Services supplemented with other OPTIONS services) in which the cost of the Adult Day Services exceed 50% of the total care plan cost.
b. The consumer possesses a very high need for OPTIONS services that cannot be met through the use of community resources or the consumer’s personal financial resources.
C. The consumer would be placed at “imminent risk” if services were not provided.
PROCEDURE: The Care Manager will complete the Cost Sharing information for the consumer and determine if the consumer’s needs for service exceed $765/month. The Care Manager will verify that the consumer meets all of the above criteria. The Care Manager will then meet with his or her immediate supervisor to formally request an exception to the Care Plan Cost Cap of $765/month.
The Supervisor will meet with the Director of the Area Agency on Aging and present the evidence that the consumer requires services exceeding $765/month and meets all of the above criteria.
The Director and/or OPTIONS Supervisor of the Area Agency on Aging will meet with the Fiscal Officer to determine if funding is available to grant an exception to the Care Plan Cost Cap.
The Director of the Area Agency on Aging will notify the supervisor of the decision, who will in turn notify the consumer’s Care Manager. The Care Manager will notify the consumer of the decision and complete the appropriate paperwork, as necessary.
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