A debilitating medical condition including, but is not limited to, any of the following:
Persistent or reoccurring stage three or four wounds;
Late stage cancer;
Frequent and unpredictable seizures;
Debilitating muscle spasms; or
A spinal cord injury or similar disability with permanent impairment.
The individual would otherwise require nursing facility services without Medicaid in-home services.(e)The individual’s service needs exceed in both extent and duration the usual and customary services rendered by one spouse to another.
The spouse demonstrates the capability and health to provide the services and actually provides the principal services, including the majority of service plan hours, for which payment has been authorized.
The Department has reviewed the request and approved program eligibility at enrollment and annually upon re-assessment.
All payments must be prior authorized by the Department or the Department’s designee.
The hours authorized to the spousal pay provider in an individual’s service plan must consist of one-half of the assessed hours for IADLs and all of the hours for specific ADLs based on the service needs of the individual.
Except as described otherwise in subsection (d) of this section, spousal pay providers are paid at hourly homecare worker rates for ADLs and IADLs as defined in the rate schedule.
Homecare workers who marry their consumer-employer are not paid under the spousal pay program. Service plans are based on the needs of the consumer. Hours assigned must reflect the service needs with no reduction in hours. The consumer does not need to meet the spousal pay eligibility criteria as described in section (3) of this rule. Hours authorized in CA/PS will be completed in the same manner as other in-home service plans, which include hourly or Independent Choices Program.
Spousal pay providers may not claim payment from the Department for hours that the spousal pay provider did not work.
A spousal pay HCW may not act as the consumer-employer.