1. A. Reimbursement for the following services shall be a prospective flat rate for each approved unit of service provided to the waiver beneficiary. One quarter hour (15 minutes) is the standard unit of service and reimbursement shall not be made for less than one quarter hour of service. This covers both the service provision and administrative costs for these services:

   1. 1. respite care;
   2. 2. housing stabilization transition;
   3. 3. housing stabilization;

   4. 4. community living supports (CLS);

      1. a. up to three beneficiaries may share CLS services if they share a common provider of this service;
      2. b. there is a separate reimbursement rate for CLS when these services are shared;

   5. 5. professional services furnished by a/an:

      1. a. psychologist;
      2. b. speech therapist;
      3. c. physical therapist;
      4. d. occupational therapist;
      5. e. social worker; or
      6. f. registered dietician;

   6. 6. supported employment;

      1. a. individual placement;
      2. b. micro-enterprise;
   7. 7. adult day health care;
   8. 8. pre-vocational service; and
   9. 9. day habilitation.

2. B. The following services shall be reimbursed at the authorized rate or approved amount of the assessment, installation/fitting, maintenance, repairs, adaptation, device, equipment, or supply item and when the service has been prior authorized by the POC:

   1. 1. environmental accessibility adaptations:

      1. a. upon completion of the environmental accessibility adaptations and prior to submission of a claim for reimbursement, the provider shall give the beneficiary a certificate of warranty for all labor and installation work and supply the beneficiary with all manufacturers’ warranty certificates;
   2. 2. assistive technology/specialized medical equipment and supplies;
   3. 3. personal emergency response system (PERS) installation; and
   4. 4. monitored in-home caregiving (MIHC) assessment.

3. C. The following services are reimbursed at a per diem rate:

   1. 1. host home;
   2. 2. companion care services;

   3. 3. shared living services;

      1. a. per diem rates are established based on the number of individuals sharing the living service module for both shared living non-conversion and shared living conversion services; and

   4. 4. monitored in-home caregiving services.

      1. a. The per diem rate for monitored in-home caregiving services does not include payment for room and board, and federal financial participation is not claimed for room and board.

4. D. The following services shall be reimbursed at an established monthly rate:

   1. 1. support coordination:

      1. a. the reimbursement for support coordination shall be in accordance with the terms of the established contract;
   2. 2. monthly service fee for PERS; and

   3. 3. financial management services.

      EXCEPTION: The reimbursement for support coordination shall be at a fixed monthly rate and in accordance with the terms of the established contract.

5. E. The reimbursement for transportation services is a flat fee based on a capitated rate.
6. F. Nursing services are reimbursed at either an hourly or per visit rate for the allowable procedure codes.
7. G. Transition expenses from an ICF/IID or nursing facility to a community living setting are reimbursed at the cost of the service(s) up to a lifetime maximum rate of $3,000.
8. H. Dental Services. Dental services are reimbursed according to the LA Dental Benefit Program.
9. I. Reimbursement Exclusion. No payment will be made for room and board under this waiver program.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2456 (November 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 39:1049 (April 2013), LR 41:2168, 2170 (October 2015), LR 42:63 (January 2016), LR 42:900 (June 2016), amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 43:2530 (December 2017), LR 45:1769 (December 2019), LR 47:1527 (October 2021), LR 48:1573 (June 2022), LR 50:1838 (December 2024).