3.35 Chore (Aged and Disabled Waiver)
Home and Community Based Services Manual
3.35 Chore (Aged and Disabled Waiver)
Revised - April 2011
Chore services are short-term, intermittent tasks necessary to maintain a clean, sanitary and safe home environment as determined by the Assessor to be critical in maintaining the participant’s health and safety. Chore services must be reasonable and necessary according to the condition of the functional capacity of the participant. Limited ability of the participant to perform necessary tasks shall be thoroughly documented. Chore services are mutually identified as necessary by the participant and the Assessor and based on information obtained during the assessment process.
- Authorization for Chore is funded through the Aged and Disabled Waiver (ADW) only.
- All Chore participants must meet the following eligibility criteria:
- At least 63 years of age;
- In active Medicaid status (Medicaid Eligibility)
- Participants who are eligible for Medicaid on a spenddown basis may be authorized to receive Chore services during periods when they meet their spenddown liability.
- A participant is responsible for the cost of services received during periods of time when they have not met their spenddown liability.
- Authorization of Chore does meet the requirement for an individual to be eligible for Home and Community Based (HCB) Medicaid.
- Have an appropriate Medicaid Eligibility (ME) Codes; and
- Meet nursing facility level of care.
- Chore Services shall be provided only when the participant and other household members are incapable of performing and when no other relative, caregiver, landlord, community or volunteer agency, or third party payor is capable of or responsible for providing such tasks.
- In the case of rental property, the responsibility of the landlord shall be explored prior to any authorization of services.
Chore services shall be authorized in 15-minute units.
- Chore units authorized shall be consistent with the identified Chore tasks to be completed for the short term or intermittent authorization period to ensure the participant’s health and safety.
- Chore services shall be included in the overall cost of care (HCBS Cost Maximums) for the participant.
- Chore services authorized together with other Home and Community Based Services (HCBS) shall not exceed 100% of the average statewide monthly cost for care in a nursing facility, without prior approval of the state agency.
NOTE: The cost of one RN, when RN is authorized on a monthly basis, shall be excluded from the calculation of a care plan's cost.
- When the combination of State Plan and Aged and Disabled Waiver services exceed the 100% cost maximum:
- The Assessor’s nurse shall review all person-centered care plan requests over the 100% cost cap to ensure the participant’s unmet needs require the amount of service requested.
- If documentation supports the request, the case shall be forwarded to the state agency for approval prior to authorization over the 100% of the cost cap.
- Pending the approval from the state agency, to exceed the cost cap, HCBS can be authorized up to the 100% of the cost cap.
- Chores services are provided by HCBS providers that are enrolled as an ADW provider with the Department of Social Services (DSS), Missouri Medicaid Audit and Compliance Unit (MMAC). Payment is made to the HCBS provider on behalf of the participant.
- The individual providing the service is an employee of the HCBS provider and cannot be a member of the immediate family of the participant. An immediate family member is defined as a parent; sibling; child by blood, adoption, or marriage (step-child); spouse; grandparent or grandchild.
- Restrictions:
- Individuals who reside in a nursing facility, Residential Care Facility (RCF) or Assisted Living Facility (ALF) licensed by DHSS, Division of Regulation and Licensure, or any group home or residential type facility, licensed by the Department of Mental Health (DMH), are not eligible for Chore services.
- Participants who receive Medicaid due to eligibility for Blind Pension (BP) are not eligible for Chore services.
- Participants in a ‘Transfer of Property penalty’ are not eligible for Chore services.
- Participants receiving services through any other HCBS waiver are not eligible for Chore services funded through the Aged and Disabled Waiver.
- Chore services may include and of the following activities:
- Wash walls and woodwork;
- Clean closets, basement and attics;
- Shampoo rugs;
- Air mattresses and bedding;
- Spray for insects within the home, using over-the-counter supplies; and
- Provide rodent control within the home (setting traps or using over-the-counter supplies).