Medical Residential Services shall mean a type of residential service provided in a residence where all of the residents require direct skilled nursing services and habilitative services and supports that enable a waiver participant to acquire, retain, or improve skills necessary to reside in a community-based setting.
Medical Residential Services must be medically necessary. The waiver participant who receives Medical Residential Services must have a medical diagnosis and treatment needs that would justify the provision of direct skilled nursing services that must be provided directly by a registered nurse or a licensed practical nurse, and such services must be needed on a daily basis and at a level which cannot for practical purposes be provided through two or fewer daily skilled nursing visits and which cannot be more cost-effectively provided through a combination of waiver services and other available services. There must be an order by a physician, physician assistant, or nurse practitioner for one or more specifically identified skilled nursing services, excluding nursing assessment or oversight, that must be provided directly by a registered nurse or by a licensed practical nurse in accordance with the Tennessee Nurse Practice Act. Therapeutic goals and objectives shall be required for waiver participants receiving Medical Residential Services support.
The Medical Residential Services provider shall be responsible for providing an appropriate level of services and supports, including skilled nursing services, 24 hours per day 7 days a week when the waiver participant is not at school; however, a nurse is not required to be present in the home during those time periods when skilled nursing services are not medically necessary. One nurse can provide services to more than one waiver participant in the home during the same time period if it is medically appropriate to do so.
The Medical Residential Services provider shall be responsible for the cost of Day Services needed by the waiver participant and any skilled nursing services needed while receiving Day Services.
The service includes direct assistance as needed with activities of daily living (e.g., bathing, dressing, personal hygiene, eating, and meal preparation excluding cost of food), household chores essential to the health and safety of the waiver participant, budget management, attending appointments, and interpersonal and social skills building to enable the waiver participant to live in a home in the community. It also may include medication administration as permitted under Tennessee’s Nurse Practice Act.
A Medical Residential Services home shall have no more than 4 residents with the exception of those homes which were licensed as a Residential Habilitation Facility prior to July 1, 2000.
Medical Residential Services shall not be provided in schools or in institutional settings (e.g., inpatient hospitals, nursing facilities, and Intermediate Care Facilities for Individuals with Intellectual Disabilities).
Medical Residential Services shall not be provided in a home where a waiver participant lives with family members unless such family members are also waiver participants receiving Medical Residential Services. Family member shall be interpreted to mean the mother, father, grandmother, grandfather, sister, brother, son, daughter, or spouse, whether the relationship is by blood, by marriage, or by adoption.
Since the Medical Residential Services provider is responsible for providing direct support services, Day Services, and other services 24 hours per day 7 days per week when the waiver participant is not at school, a waiver participant who is receiving Medical Residential Services shall not be eligible to receive Personal Assistance, Day Services, or Respite. Medical Residential Services are not intended to replace services available through the Medicaid State Plan/TennCare Program.
With the exception of transportation to and from medical services covered through the Medicaid State Plan/TennCare Program, transportation shall be a component of Medical Residential Services and shall be included in the reimbursement rate for such.
Reimbursement for Medical Residential Services shall not be made for room and board or for the cost of maintenance of the dwelling if the home is rented, leased, or owned by the provider. If the home is rented, leased, or owned by the waiver participant, reimbursement shall not be made for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the waiver participant and who provides services to the waiver participant in the waiver participant’s place of residence. If a waiver participant owns or leases the place of residence, residential expenses (e.g., phone, cable TV, food, rent) shall be apportioned between the waiver participant, other residents in the home, and (as applicable) live-in or other caregivers.
Reimbursement for Medical Residential Services shall not include payment made for services provided by the waiver participant’s conservator. Reimbursement for Medical Residential Services shall not include payment for Medical Residential Services provided by the spouse of a waiver participant. The Medical Residential Services provider and provider staff shall not be the parent or custodial grandparent of a waiver participant under age 18 years, whether the relationship is by blood, by marriage, or by adoption; and reimbursement shall not include payment for Medical Residential Services provided by such individuals.
Applicable limits, if any, on the amount, frequency, or duration of this service: None