4.00 Appendix 1 Person Centered Care Planning Collateral Contacts
Home and Community Based Services Manual
4.00 Appendix 1 Person Centered Care Planning Collateral Contacts
1. The Missouri Department of Health and Senior Services (DHSS), Bureau of Special Health Care Needs makes varied Home and Community Based Services (HCBS) available for individuals with special health care needs who have or are at increased risk for a disease, defect or medical condition that may hinder the achievement of normal physical growth and development and who also require health and related services of a type or amount beyond that required by individuals generally. For more information, contact the Bureau of Special Health Care Needs at 573-751-6246 or (toll-free) 800-451-0669 or review the website.
The Bureau of Special Health Care Needs oversees three HCBS programs.
- Healthy Children and Youth Program (HCY)
The (HCY) program provides service coordination and authorization for medically necessary services for MO HealthNet recipients with special health care needs from birth to age 21. Service coordination includes assessment through home visits and links to services and resources that enable participants to remain safely in their homes with their families. Authorized services may include in-home personal care, in-home nursing care, and skilled-nursing visits. - Medically Fragile Adult Waiver (MFAW)
The MFAW provides service coordination and authorization for medically necessary services to MO HealthNet recipients with serious and complex medical needs who have reached the age of 21 and are no longer eligible to receive these services through the HCY program. The Waiver provides a cost effective alternative to placement in an intermediate care facility (ICF). Authorized services may include in-home personal care, in-home nursing care, skilled nursing visits, supplies and equipment. For more information on the MFAW, review the website. - Adult Brain Injury Program (ABI)
The ABI program assists Missouri residents, ages 21 to 65, living with a traumatic brain injury (TBI). Through service coordination, the program links participants to resources to enable each person to obtain goals of independent living, community participation, and employment. Participants who meet financial eligibility requirements may also receive rehabilitative services to help them achieve identified goals. Rehabilitative services include counseling, vocational training, employment supports and home and community based support training.
2. The Missouri Department of Health and Senior Services (DHSS), Bureau of HIV, STD, and Hepatitis offers case management and HCBS for individuals with the Human Immunodeficiency Virus (HIV) virus that causes Acquired Immune Deficiency Syndrome (AIDS). For more information, contact the Bureau of HIV, STD, and Hepatitis at 573-751-6439 or (toll-free) 866-628-9891 or review the website.
- Personal Care
Services available through the State Plan Personal Care Program include personal care (assistance with activities of daily living such as bathing, grooming, dressing and medically related household tasks), advanced personal care (assistance with activities of daily living when such assistance requires devices and procedures related to altered body functions), and authorized nurse visits (maintenance or preventive services provided for stable chronic conditions). - AIDS Waiver Program
Services include waiver personal care, Private Duty Nursing, (needing nursing RN/LPN care in an amount greater than 3 hours per day), Waiver Attendant Care (hands-on supportive and healthrelated care including nursing care), and supplies (under-pads, diapers and gloves).
3. Home care is health care or supportive care provided in an individual’s home by healthcare professionals. Home care is primarily provided by Home Healthcare and Hospice agencies.
- Home Healthcare
Home healthcare provides skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services in the comfort of home. Home healthcare is prescribed by an individual’s physician and is provided by a variety of healthcare professionals. For more information, call toll-free (800) MEDICARE (800-633-4227) or review the website at https://www.medicare.gov/coverage/home-health-services - Hospice
Hospice is a special way of caring for people who are terminally ill, and for their families. This care includes physical care and counseling. Hospice care is given by a public agency or private company approved by Medicare. It is for all age groups, including children, adults, and the elderly during their final stages of life. The goal of hospice is to care for individuals and their family and to help individuals make the most of the last months of life by giving comfort and relief from pain. For more information, review the following website https://www.missourihospice.org/.
4. Area Agencies on Aging (AAA) serve Missouri seniors with a wide variety of programs designed to assist seniors with legal, financial, and health care needs. The Senior Legal Help line, disease prevention, home delivered and congregate meal programs are just a few examples of the services the AAAs have available.
There are 10 AAAs in Missouri, each serving a different geographic area; for more information on a local AAA in a specific area review the MA4 website at https://www.ma4web.org/find-local-agency/.