§ 40-8.10-4 - Assessment and Coordination Unit (ACU).

SECTION 40-8.10-4

   § 40-8.10-4  Assessment and CoordinationUnit (ACU). – (a) The department of human services, in collaboration with the executiveoffice of health and human services, shall implement a long-term care optionscounseling program to provide individuals or their representative, or both,with long-term care consultations that shall include, at a minimum, informationabout long- term care options, sources and methods of both public and privatepayment for long term care services, and an assessment of an individual'sfunctional capabilities and opportunities for maximizing independence. Eachindividual admitted to or seeking admission to a long-term care facility,regardless of the payment source, shall be informed by the facility of theavailability of the long-term care options counseling program and shall beprovided with a long-term care options consultation, if he or she so requests.Each individual who applies for Medicaid long-term care services shall beprovided with a long-term care consultation.

   (b) Core and preventative home and community based servicesdefined and delineated in § 40-8.10-2 shall be provided only to thoseindividuals who meet one of the levels of care provided for in this chapter.Other long term care services authorized by the federal government, such asmedication management, may also be provided to Medicaid eligible recipients whohave established the requisite need as determined by the Assessment andCoordination Unit (ACU). Access to institutional and community based supportsand services shall be through the Assessment and Coordination Unit (ACU). Theprovision of Medicaid-funded long-term care services and supports shall bebased upon a comprehensive assessment that shall include, but not be limitedto, an evaluation of the medical, social and environmental needs of eachapplicant for these services or programs. The assessment shall serve as thebasis for the development and provision of an appropriate plan of care for theapplicant.

   (c) The ACU shall assess the financial eligibility ofbeneficiaries to receive long-term care services and supports in accordancewith the applicable provisions of § 40-8.9-9.

   (d) The ACU shall be responsible for conducting assessments;determining a level of care for applicants for medical assistance; developingservice plans; pricing a service budget and developing a voucher whenappropriate; making referrals to appropriate settings; maintaining a componentof the unit that will provide training to and will educate consumers, dischargeplanners and providers; tracking utilization; monitoring outcomes; andreviewing service/care plan changes. The ACU shall provide interdisciplinaryhigh cost case reviews and choice counseling for eligible recipients.

   (e) The assessments for individuals conducted in accordancewith this section shall serve as the basis for individual budgets for thosemedical assistance recipients eligible to receive services utilizing aself-directed delivery system.

   (f) Nothing in this section shall prohibit the secretary ofthe executive office of health and human services, or the directors of thatoffice's departments from utilizing community agencies or contractors whenappropriate to perform assessment functions outlined in this chapter.