N.Y. Comp. Codes R. & Regs. Tit. 9 § 6654.15 - EISEP eligibility and definitions
(a) To be eligible for EISEP services, an
individual must:
(1) be at least 60 years of
age or older;
(2) be functionally
impaired, as shown by a need for the assistance of another person, in at least
one activity of daily living (bathing, dressing, toileting, being continent of
urine and/or feces, transferring, walking and eating) or two instrumental
activities of daily living (housekeeping, shopping, preparing meals, managing
money, laundry, using transportation, telephoning and taking
medication);
(3) have unmet needs
for such assistance;
(4) not be
eligible to receive the same or similar services under title XVIII, XIX or XX
of the Federal Social Security Act or any other governmental program or
services provided to residents in adult residential care facilities which had
previously been provided by the facility or which by law are required to be
provided by such facility;
(5)
apply for Medicaid if it appears that:
(i) due
to income and assets, he or she may be eligible for Medicaid without any spend-
down; or
(ii) due to income, assets
and qualifying expenses, he or she may be eligible for Medicaid, provided that
no such application shall be required if such individual does not have
available income to pay such qualifying expenses in the amount by which such
individual's income exceeds the Medicaid eligibility level;
(6) be able to be maintained
safely in his or her home environment; and
(7) for noninstitutional respite, have one or
more informal caregivers who provide continuing care.
(b) To be eligible for consumer directed
in-home services, an individual must meet the requirements included in
subdivision (a) of this section and:
(1) be
capable of making choices regarding their activities of daily living and
instrumental activities of daily living and the type, quality and management of
his or her in-home services worker; understand the impact of these choices; and
assume responsibility for the results of these choices; or
(2) be capable of delegating authority to
another who is capable of carrying out the activities listed in paragraph (1)
of this subdivision on behalf of the consumer and meets the requirements of
paragraph (d)(3) of this section; or
(3) if not capable of delegating authority to
another, have someone who meets the qualifications of paragraph (d)(3) of this
section.
(c)
Determinations of eligibility are made using the standardized screening
instrument and assessment process prescribed by the office.
(d) Definitions.
(1) Consumer means an individual who is
receiving consumer directed in-home services and who is responsible for
specific tasks as noted in section
6654.17 of
this Part, as well as recruiting, interviewing, hiring, training, supervising
and if necessary, dismissing their in-home services worker.
(2) Consumer directed in-home services means
assistance with those tasks that are the same or similar to those listed as
Personal Care Level I and Personal Care Level II in section
6654.17(f) and
(g) of this Part and for which the consumer
is assuming the responsibilities as noted in section
6654.17 of
this Part.
(3) Consumer
representative means any individual who is at least 18 years or older who on
behalf of the consumer, is willing and able to perform the functions related to
consumer directed in-home services as noted in paragraphs (b)(1) and (d)(1) of
this section and section
6654.17 of
this Part and has been delegated to do so by the consumer, provided however
that when the consumer is not able to delegate a representative, the consumer
representative shall:
(i) be the legally
appointed guardian or conservator; or
(ii) have been previously designated as a
representative by the consumer to be responsible for coordinating his/her care
and the individual is currently performing and is willing to continue to
perform the role; or
(iii) be
currently involved in the consumer's life and have a strong personal commitment
to the consumer and demonstrates knowledge of the consumer's
preferences.
(4) Fiscal
intermediary means an entity that carries out administrative functions as
specified in the agreement with the area agency and shall include functions
such as processing the consumer directed in-home services worker's payroll with
respect to Federal, State and local income tax and other payroll withholding
requirements including FICA, workers' compensation, unemployment insurance and
other employee benefits.
(5)
In-home services means services that provide assistance with those tasks listed
as Personal Care Level I and Personal Care Level II in section
6654.17(f) and
(g) of this Part.
(6) In-home services agency means an agency
that provides Personal Care Level I and/or Personal Care Level II as defined in
section
6654.17(f) and
(g) of this Part.
(7) In-home services worker under consumer
directed in-home services means an individual who performs the tasks listed in
section
6654.17(f) and
(g) of this Part and meets the following
requirements:
(i) is at least 18 years of
age;
(ii) is a citizen of the
United States or has legal authority to work in the United States;
(iii) is not the consumer representative;
and
(iv) has not been convicted of
Medicaid or other benefits fraud or any form of abuse, neglect or
exploitation.
Notes
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