1. (a) If the eligibility requirements in He-E 503.03 are met, the primary caregiver and contract agency shall collaborate to complete and develop the following:

   1. (1) An assessment in accordance with (b) below;
   2. (2) A person-centered respite care plan; and
   3. (3) A respite care budget in accordance with (e) and (f) below.

2. (b) The assessment shall include the following information:

   1. (1) The primary caregiver’s name, address, and telephone number;
   2. (2) The name of the eligible person;
   3. (3) The relationship of the primary caregiver to the eligible person;

   4. (4) Confirmation that the eligible person:

      1. a. Has received a differential diagnosis of Alzheimer’s disease or a similar irreversible dementia; or
      2. b. Demonstrates symptoms of Alzheimer’s disease or a similar irreversible dementia; and
   5. (5) The primary caregiver’s statement of the eligible person’s need for respite services.
3. (c) If the assessment indicates that the eligibility requirements for ADRD respite service, as described in He-E 503.03, are not met, the contract agency shall assist the primary caregiver to identify and explore other helpful resources, such as the social service block grant or choices for independence programs.
4. (d) The person-centered respite care plan shall be based on the completed assessment described in (b) above.
5. (e) The primary caregiver and the contract agency shall work to develop the respite care budget based on the needs identified in (b)(5) above.
6. (f) To ensure as many primary caregivers as possible receive respite, the respite care budget shall not exceed $2000 per primary caregiver annually.
7. (g) The contract agency shall review the person-centered respite care plan and respite care budget with the primary caregiver annually to determine the ongoing respite care service needs.

Source. #7799, eff 12-4-02, EXPIRED: 12-4-10 New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19 New. #13437, eff 8-19-22