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Adult Day Services - Resources for Section 61 Adult Day Resources

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Section 61 funding Becoming a New Section 61 Provider Consumer Eligibility for Section 61 funding Enrolling Consumers in Section 61 Forms for Section 61 Approval Annual Re-Assessment for Section 61 Monthly Reimbursements Instructions for Invoices MED Tool (MED Form) Goold Health Systems Assessments 2009 Income Guidelines

Section 61 Rules Information for Consumers Consumer Complaints Consumer Records Section 61 Denials Denial/Reduction/Termination Letters Resource Guides for Elders and Adults with Disabilities Adult Day Resources Adult Day Activities Funding Opportunities

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Section 61 funding

The Office of Elder Services offers Adult Day funding to those with financial need. Eligible consumers who are not eligible for MaineCare and who are not currently funded through certain state-funded programs may be able to receive OES funding. This funding, which falls under Section 61 of the OES policy manual, is currently offered in the form of reimbursement to providers at a maximum of 30 hours/week, or 129.9 hours a month. The current maximum reimbursement rate is $9.45/hour.

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Becoming a New Section 61 Provider

Steps to becoming a new Section 61 provider include:

• Provide Adult Day license and a description of your programming.
• Meet with OES staff to discuss your Adult Day programming, Section 61 policies, and other related topics.
• Complete a contract with OES.

Please contact the Office of Elder Services for information on how to become a Section 61 Adult Day provider.

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Consumer Eligibility for Section 61 funding

Section 61 funding was established as a safety net for people lacking the resources to pay for Adult Day on their own. After exhausting other sources of funding, those with financial need are encouraged to apply for Section 61 funding through a local Adult Day provider. As limited funds are available under Section 61, if the individual is financially eligible for MaineCare, s/he must apply for MaineCare Adult Day funding. For more information on MaineCare, please visit the MaineCare provider website.

To receive Section 61 funding, consumers must meet certain income and asset guidelines. The 2009 income guidelines for consumers can be found below. The current Section 61 asset limit is $50,000 for an individual and $75,000 for couples.

While consumers receiving funding through Section 61 are asked to pay a co-pay of 20% of their Section 61 costs, people with assets under $15,000 may be eligible for a co-pay waiver. Please contact the Office of Elder Services for further information on eligibility.

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Enrolling Consumers in Section 61

Please note that you do not need to mail OES any forms (including the invoice forms). You can simply just fax (or email with a scanned signature) the required forms. While we need to see consumer/agency signatures, these do not have to be original signatures.

All consumers must have a medical eligibility assessment (please see below for further details). Please complete the MED form with the consumer and the caregiver, unless the consumer has already had an assessment with Goold Health Systems. Goold provides free comprehensive medical eligibility assessments to determine consumer eligibility for a variety of programs, including Adult Day and home-based care. If the consumer has already had a Goold assessment, that assessment can be used in place of the MED form, and should be added to the consumer’s file.

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Forms for Section 61 Approval

The following forms should be faxed/emailed with scanned signatures to OES for each new consumer:

1. Section 61 Funds Request form. Microsoft Word or Adobe PDF (*free viewer)
   
   This form should be completed based on the results of the MED form or the Goold assessment. You will need to complete several fields, including the following:
   1. Rate per hour: Please indicate the rate that your program charges consumers. While OES will reimburse up to $9.45/hour, many programs charge less than this rate. If your program charges less than $9.45/hour, you should list your rate instead of $9.45.
   2. Hours attending: Please list the number of hours the consumer would like Section 61 funds to cover. For example, if the consumer plans to ask Section 61 to fund 20 hours a week at Adult Day, the number of hours listed would be 20.
   3. Co-pay waiver requested: If the consumer has significant financial need and meets the financial requirements for a co-pay waiver as described below, please circle “yes” here.
   4. Diagnosis: The responses here must be based on the results of the MED form or on the Goold assessment.
   5. Description of Need: Please describe the consumer’s specific need for Adult Day services.
      
      
      
2. Financial assessment form Microsoft Word or Adobe PDF (*free viewer)
   
   With assistance from the consumer and his/her caregiver, please list the consumer’s income and assets. Please indicate the cost of the consumer’s care plan, including the 20% co-pay (if applicable). The consumer must indicate that s/he agrees to the payment conditions established here by signing this document where indicated.
   1. Please note that consumers do not need to include Term Life insurance in their financial asset portion, as Term Life has no cash value (and therefore is not a liquid asset).
   2. Please try to ensure that the financial information provided is as accurate as possible.
      
      
      
3. Optional Waiver Co-Payment Allowable Expense Worksheet Microsoft Excel (*free viewer)
   
   This worksheet is only needed if the consumer is requesting a co-pay waiver, and if there is a chance that his/her request may be denied by OES. Please make a detailed list of his/her monthly expenses and income here. Waivers may be granted if the sum of the consumer’s monthly expenses and co-pay is be greater than his/her monthly income.

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Annual Re-Assessment for Section 61

Providers must complete (1) annual MED tool assessments and (2) annual financial assessments for each consumer every 12 months (from the date the consumer first enrolled in Section 61) to determine ongoing eligibility for Adult Day. The MED form should be kept in the consumer’s file. Please fax an updated financial assessment form to OES at the time of re-assessment. You do not need to complete a Section 61 Funds Request form.

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Monthly Reimbursements

OES will email you an invoice template with your agency’s DHHS/OES contract numbers. Please use this invoice template for your invoices each month.

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Instructions for Invoices

Sample invoice template Microsoft Word or Adobe PDF (*free viewer)

1. Fields to be Completed
   1. Payment Period: List the month and year for the current invoice
   2. Amount of request: List the amount your agency requests for reimbursement
   3. Sign and date where indicated (a financial staff person may sign and date)
   4. List the Section 61 consumers that attended Adult Day for the month. List the number of Section 61 hours used by each consumer and the corresponding amounts due from each consumer, minus any co-pays. Please keep in mind that OES will only reimburse for the specific number of hours that each consumer was approved for at enrollment. OES will reimburse for a maximum of 129.9 hours/month.
2. Fax, email/scan, or mail the invoice documents to OES. We ask that you send all invoices by the 10th of each month following the month in which services were provided.

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MED Tool (MED Form)

• MED Form Adobe PDF (*free viewer)
• Instructions for MED Tool Microsoft Word (*free viewer)
• MED Tool Powerpoint Presentation Power Point (*free viewer)

The MED form is used to assess new consumers for Adult Day and Section 61 funding. If a consumer has not had a Goold assessment, you, the ADS provider, will need to complete the MED form before the consumer can receive Section 61 funding. Please contact the Office of Elder Services for any questions on completing the MED form.

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Goold Health Systems Assessments

We recommend referring all consumers, especially those needing additional services beyond Adult Day, to Goold Health Systems for an assessment. The State of Maine requires this assessment to determine consumer eligibility for a variety of services (state-funded or through MaineCare). Anyone can request an assessment by calling 1-800-609-3210. Please visit this page on care choices to learn more about Goold assessments.

We recommend that a caregiver/family member (or a staff member at your agency) be present at the assessment to assist the consumer in answering questions about his/her needs. If the Goold assessing nurse does not find the consumer eligible for Adult Day, the consumer may still be able to access Section 61 funding for Adult Day.

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2009 Income Guidelines

• 2009 Section 61 Income Guidelines Microsoft Word (*free viewer)
  
  In this chart issued by MaineCare, the 200% federal poverty level applies to Adult Day. For co-pay waiver eligibility, the 2009 income upper limit for a single consumer is $1,805, and $2,429 for a 2-person household.

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Section 61 Rules

• DHHS OES Section 61 Rules Microsoft Word or Adobe PDF (*free viewer)
• DHHS Regulations Governing the Licensing and Functionnig of Adult Day Services Programs Microsoft Word or Adobe PDF (*free viewer)

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Information for Consumers

A release of information should be obtained for new ADS consumers, and the consumers should receive a copy of this release.

Consumers should be provided with a copy of their service plan, which is created based on the MED assessment results, in an understandable format. Each consumer should be informed of how his/her co-payment for Section 61 funding was calculated.

New ADS consumers should be informed of additional resources in the community that may be useful to them.

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Consumer Complaints

If a consumer (or a representative for a consumer) has a complaint about Adult Day Services, the consumer should be provided with information on how to contact the Long Term Care Ombudsman. The Long Term Care Ombudsman Program (www.maineombudsman.org) can be reached at 1-800-499-0229.

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Consumer Records

The following information should be in a consumer’s ADS record:

1. Consumer details/contact information
2. Emergency contact information
3. A completed MED form
4. A service plan summary
5. Release of information
6. Documentation that consumers were notified of co-pay waiver (if eligible)
7. Progress notes that summarize any contact you have with the consumer.

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Section 61 Denials

Individuals must be financially and medically eligible for Adult Day services to receive Section 61 funding. Individuals residing in hospitals, nursing facilities, licensed residential care facilities, or assisted living program are not eligible for Section 61 Adult Day funding.

Individuals eligible for the following programs cannot receive funding through Section 61:

1. MaineCare Private Duty Nursing/Personal Care Services
2. MaineCare Home and Community-Based Benefits
3. MaineCare Adult Day Health
4. MaineCare Consumer-Directed Attendant Services

Individuals participating in the following programs cannot receive funding through Section 61:

1. In-Home and Community-Based Support Services (OES Policy Manual, Section 63) Microsoft Word (*free viewer)
2. Respite Care for People with Alzheimer’s Disease or Related Disorders(OES Policy Manual, Section 68) Microsoft Word   (*free viewer)
3. Consumer-Directed Home-Based Care (26 M.R.S.A. Section 1412-G) Microsoft Word

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Denial/Reduction/Termination Letters

DHHS regulations require that Section 61-funded Adult Day providers notify current and potential consumers when OES Section 61 funding for Adult Day is being denied, reduced, or terminated.

Please make sure that you send a letter to all individuals whose Adult Day funding will be denied/terminated/reduced. All consumers also should be provided with notification of their right to a hearing. Templates for letters and hearing rights are provided below.

The Discharge/Reduction Letter should be sent as soon as (1) a consumer is denied Section 61 funding, (2) you learn that a consumer is leaving the program or (3) you learn that the consumer would like his/her hours reduced. In the letter, please check the appropriate box next to the reason the consumer is being terminated/having hours reduced. Please also note that the letter gives the consumer 10 days notice, from the date of the discharge/reduction, before the discharge/termination/reduction goes into effect. If a consumer has not attended Adult Day for some time, and 30 days have passed since s/he has last attended, you can send them this letter on the 31st day (which gives the consumer 10 days notice to respond). All efforts should be made to contact the consumer during those 30 days.

• Section 61 Denial Letter  Microsoft Word (*free viewer)
• Section 61 Discharge/Termination Letter  Microsoft Word (*free viewer)
• 10_60 Day Hearing Rights  Microsoft Word (*free viewer)

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Resource Guides for Elders and Adults with Disabilities

The Office of Elder Services publishes several booklets, “Home Care Where To Find It” and the “Resource Directory for Older People in Maine,” which contain a variety of resources for consumers.

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Adult Day Resources

Met Life publishes a variety of guides for the elderly, for caregivers, and retirees.

• Several of these guides can be found at MetLife Consumer Guides
• A guide to “Choosing Adult Day Services” (Adobe PDF*)(*free viewer)

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Adult Day Activities

The internet contains a wealth of information on suggested activities for Adult Day programs.

• Suggested Activity Books:
  • Field of Themes, 100 Activities for Our Senior Friends
    Co-authored by Barbara Fister, the Director of My Friend’s Place, an Adult Day program funded through Section 61 out of Bangor, Maine. To order please visit http://www.gbgm-umc.org/my_friends_place/field_of_themes.htm
  • The Best Friends Book of Alzheimer’s Activities
    Designed for adults with Alzheimer’s disease.  To order please visit http://www.bestfriendsapproach.com/Books.html)

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Funding Opportunities

National private foundations often offer Adult Day funding to organizations.

• List of foundations:
  • The Brookdale Foundation Group

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