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COPES Ancillary Services

1. Adult Day Care Services
2. Client Training
3. Community Transportation
4. Environmental Modification
5. Home Delivered Meals
6. Home Health Aide
7. Personal Emergency Response System
8. Skilled Nursing
9. Specialized Medical Equipment

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

Adult Day Care Services

Clients eligible for Adult Day Care services (ADC) are:

• Age 18 or over
• COPES eligible (in other words, assessed as having an unmet need in one or more of the following areas):
  • Personal Care
  • Routine Health Monitoring with RN consultation
  • General Therapeutic Activities
  • Supervision/Protection for those who require it for safety

Clients not eligible are COPES Clients who:

• Can independently perform or obtain the services provided at ADC
• Have unmet needs that can be met more cost-effectively through other COPES services
• Have needs that exceed the scope of ADC; can be met in a less-structured care setting; or are being met by paid or unpaid caregivers
• Live in a nursing home, boarding home, Adult Family Home, or other licensed institutional or residential facility
• Can not participate safely in a group care setting

The providers listed below are authorized COPES Adult Day Care providers. The ADS web site also has a list of Adult Day Health Providers (including Medicaid authorized providers).

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

Client Training

When to Authorize

Service provides client training by licensed and certified providers with expertise in the area of the client’s training need. Use this service when:

• the client’s training need is identified in the comprehensive assessment; and
• the training is provided in accordance with a therapeutic goal in the client's service plan.

Additional Information:

• Only 20 units (hours) can be authorized in a six month period
• This service may be used to meet a client's intense service need by proration and authorization of the hours over a shorter period of time, or the 20 hours may be prorated and authorized to meet a client's ongoing need throughout the entire six month period.
• Examples of training include: nutrition evaluation and counseling; adjustment to a serious impairment; self-management of personal care needs; medication management or, development of a client's skills to deal with care providers.

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

Community Transportation

There are no COPES providers of Community Transportation. Please contact Senior Services at (206) 448-5740 to arrange non-COPES funded transportation.

When to Authorize:

Authorize units of transportation when the client's family, neighbors; or community resources are unable to provide transportation to essential community services and resources included in the client's service plan; and

• access to a community service or resource is essential and provided in accordance with a therapeutic goal in the service plan; and
• the service is not purely diversional in nature.

Additional Information:

• Senior Services, gives priority to medical and other essential appointments and people must be able to transfer into a vehicle with minimal assistance. Notice must be given at least seven days in advance. Drivers are volunteers. Zones are defined as East King County, South King County and Seattle/Shoreline. Inter-zone is travel between zones.
• This service is in addition to the brokered transportation to medical services available to the client through the use of the client’s medical identification card. This service shall not replace nor be a substitute for the medical transportation.

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278

Environmental Modification

When to Authorize:

Authorize minor physical adaptations to the client's own home when the service is in the service plan and:

• is necessary to ensure the client's health, welfare, and safety; or
• enables the client to function with greater independence in the home; and
• is of direct medical or remedial benefit to the client; and
• is in accord with applicable state or local building codes; and
• is necessary to prevent the institutionalization of the client.

Services include installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities. Service excludes home improvements which are not of direct medical or remedial benefit to the waiver client, such as carpeting, roof repair, central air conditioning, etc.

Additional Information:

• Services should be billed in the month they are provided.
• If this modification is to be done in a residence that client does not own, the Environmental Modification Property Release Statement must be completed and signed by clients landlord or building manager before the modification is requested.

Home Delivered Meals

When to Authorize:

• Authorize provision of nutritionally balanced meals, delivered to the client in his/her own home, when:
• home delivered meal provision is more cost effective than having a personal care provider prepare the meal; and
• the client is homebound (Definition of homebound: Client is normally unable to leave home unassisted because doing so requires considerable effort. Client may occasionally leave home for medical treatment, or for short, infrequent, non-medical trips such as a hair appointment or church attendance.); and
• the client is unable to prepare the meal and there is no other person, paid or unpaid, to prepare the meal.

Personal Care Hours must be Reduced:

• If a client receives home-delivered meals, the number of personal care hours available for paid caregivers must be reduced. See HDM Deductions Training Handout

Additional Information:

• Meals are dual oven-able (microwave and oven).
• The Case Manager can order up to 31 in a month for a COPES client (1 meal per day).

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

Home Health Aide

When to Authorize:

Authorize home health aide services to provide assistance with hands-on personal care, ambulation and exercise, and self-administered medications when:

• multiple home health aide services are required in one month up to the maximum of 78 units when the client has an intense service needed; or
• fewer home health aide services are required over a six month period when the client has an ongoing need throughout the period; and
• the client has special needs requiring more specialized care than can be provided by an agency or individual personal care provider, e.g. bathing assistance for very frail persons or complex bowel and bladder care for persons with paralysis.
• One aide may occasionally perform some incidental service, e.g., meal preparation, in conjunction with provision of health related services.

Additional Information:

This service is authorized in addition to any home health agency services available to the client through either Medicare or the use of the client’s medical identification card. This service shall not replace nor be a substitute for the Medicare or regular Medicaid home health aide service. Use this service only when the Medicare or the regular Medicaid home health aide services are not sufficient in amount, duration and scope to meet the client’s home care needs.

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

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Personal Emergency Response System

When to Authorize:

Authorize installation of PERS when the service is necessary to enable a high-risk client to secure help in the event of an emergency and the client:

• lives alone, or is alone for significant parts of the day and has no regular care provider for an extended period of time; and
• would otherwise require extensive department-paid routine supervision.

Notes:

• Only persons eligible for the COPES program are eligible for COPES funded personal emergency response systems (PERS).
• There is no other department funded PERS.

Under COPES PERS, it is also possible to secure two additional devices: medication reminders and medication reminder/dispensers, for clients who need additional assistance in adhering to their medication regimens.

Eligibility for reminders or reminder/dispensers:

• Client must be on COPES or MNIW and eligible for a PERS,
• Client cannot have caregiver available when medications need to be taken
• Client must be able to take his/her medications independently
• For the reminder/dispensing unit, the client, family member/caregiver, pharmacy, etc must be able to fill the machine.

When may these devices be inappropriate:

• Client is away from home regularly (at dialysis, adult day health/adult day care, etc.)
• Client has dementia
• Client has uncorrected hearing loss or severe vision loss
• Client has auditory hallucinations
• Client lacks fine motor skills and cannot press buttons, open dispensing cups, etc.
• Client has other physical or mental conditions.

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

Skilled Nursing

When to Authorize:

Authorize skilled nursing services within the scope of the State's Nurse Practice Act when:

• the client requires services beyond the scope which can be provided by non-licensed staff; and
• the skilled nursing services are medically necessary to ensure the client's health, welfare and safety; and
• without which the client would require admittance into a nursing facility.

There is no limit to the number of visits case managers may authorize. Service Units will be authorized based on client need. Exceptions to policy are no longer allowed. Do not authorize for Assisted Living or Enhanced Adult Residential Care.

Additional Information:

This service is authorized in addition to any home health agency skilled nursing services available to the client through either Medicare or the use of the client's medical identification card. This service shall not replace nor be a substitute for the Medicare of regular Medicaid home health agency skilled visits. Use this service only when the Medicare or the regular Medicaid home health agency skilled visits are not sufficient in amount, duration and scope to meet the client's home care needs.

This service should not be used if client is receiving skilled nursing services through any home health agency funded by Medicare or the client's medical identification card and those services are sufficient to cover client's needs.

Codes and Rates:

Code 5243 - Standard Rate, $51 per client visit
Code 5290 - Special Circumstances Rate, $51.02 - $86.86 per client visit (negotiated by Case Manager on case-by-case basis).

Skilled Nursing Special Circumstances - Code 5290

This new service code and rate were developed to allow access to COPES skilled nursing services when circumstances are extraordinary. Parameters for this new service code include unusual client care need and remote location of the client. The Special Circumstances Skilled Nursing Rate is negotiated by the case manage.

Approval by either the ADSA COPES Program Manager or Nursing Services Program Manager is required prior to authorization of this service code. CA and SP must be faxed to the Program Manager at ADSA using the ADSA special COPES fax cover sheet. A response will be faxed back to authorized the special rate or to request further information.

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.

Specialized Medical Equipment

Contracts for Specialized Medical Equipment (SME):

ADS does not contract with SME providers. ADS only maintains the list of authorized SME providers. In order to add a provider to list, follow the steps:

1. Contact Sandee Mitchell, Supervisor - Provider Enrollment, at the Medical Assistance Administration (MAA) (360) 725-1029 to verify the provider has a signed core provider agreement with MAA and a Medicaid provider number.
2. If provider does not have a contract with DSHS, MAA then the provider needs to contact Sandee Mitchell.
3. Once verified a contract is in place, then the CM should check for an active SSPS provider number.
4. If no SSPS number exists, the CM may complete a PFAR and submit to ADS CM administration.
5. If provider has a SSPS number, then send Lori Mina or Terra McCaffree the provider's name, Medicaid number, SSPS number, and products or goods available for addition to the list.

When to Authorize:

Authorize when the specialized medical equipment and supplies are necessary to enable the client to perform activities of daily living or to perceive, control or communicate with the environment in which they live. Include items necessary for life support, ancillary supplies and the equipment necessary to the proper functioning of such items.

Notes:

• Items authorized must not be available under the Medicaid State Plan and must be required by the clients' service plan.
• This code can only be opened in addition to personal care hours.
• The following list of providers consists of commonly-used providers of Specialized Medical Equipment (SME).
• Occasionally, a client has a unique condition that requires SME that is infrequently ordered. Case managers may use non-listed equipment providers under COPES if the provider has a Medicaid Contract with DSHS and a six-digit SSPS number. The Case Manager should verify the accuracy of the SSPS number provided by the vendor.

For more information on COPES Ancillary Services please contact Lori Mina at (206) 684-0278 or Terra McCaffree at (206) 684-0613.