Long Term Services and Support

Welcome to Long Term Services and Supports (LTSS)

As an Aetna Better Health member, you are the center of what we do. We want to make sure you get the services you need when you need them.

 

A Nursing Facility (NF) sometimes goes by different names such as Nursing Home, Long Term Care Facility, or Skilled Nursing Facility.   A Nursing Facility is a licensed facility that provides skilled nursing or intermediate long-term care services. These facilities have a variety of services which help meet both the medical and non-medical needs of enrollees with a chronic illness or disability who cannot care for themselves for long periods of time on their own.  They provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing, and using the bathroom, as well as meals, laundry, and other housekeeping needs.

Below are the different Home and Community Based Services Waiver programs that are available:

Waiver program

Elderly

Persons with disabilities

Persons with brain injury

People with HIV or AIDS

Supportive Living Facilities

Services

  • Adult day service
  • Homemaker
  • Emergency home response
  • Adaptive equipment
  • Adult day service
  • Environmental accessibility adaptations
  • Home delivered meals
  • Home health aide
  • Homemaker
  • Nursing, Intermittent
  • Personal care (personal assistant)
  • Personal emergency response system
  • Physical, Occupational and Speech Therapy
  • Respite
  • Skilled nursing
  •  
  • Adaptive equipment
  • Adult day service
  • Behavioral services
  • Day habilitation
  • Environmental accessibility adaptations
  • Home delivered meals
  • Home health aide
  • Homemaker
  • Nursing, intermittent
  • Nursing
  • Personal care (personal assistant)
  • Personal emergency response system
  • Physical, Occupational and Speech Therapy
  • Prevocational services
  • Respite
  • Skilled nursing
  • Supported employment

 

  • Adaptive equipment
  • Adult day service
  • Environmental accessibility adaptations
  • Home delivered meals
  • Home health aide
  • Homemaker
  • Nursing, intermittent
  • Personal care (personal assistant)
  • Personal emergency response system
  • Physical, Occupational and Speech Therapy
  • Respite
  • Skilled nursing

 

Also known as Assisted Living Service

Home and Community Based Services (HCBS) help to keep you independent and living in your own home or in a community setting. Your case manager will work with you and your family to find the right types of service. This includes the amount and duration of those services, based on your waiver eligibility. Not all services will be right for everyone. Once these services are agreed to, your case manager will help to arrange them.

Here is a list of the available services:

Adaptive equipment
This service includes specialized medical equipment and supplies to include devices, controls, or appliances, specified in the plan of care, which enable the enrollee to increase his or her abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live.

Adult day service – also known as adult day health
A daytime community-based program for adults not living in Supported Living Facilities. Adult Day Service provides a variety of social, recreational, health, nutrition, and related support services in a protective setting. Transportation to and from the center and lunch are included as part of this service.

Behavioral services
These services are behavioral therapies designed to assist enrollees with brain injuries in managing their behavior and thinking functions, and to enhance their capacity for independent living.

Day habilitation – also known as habilitation
This service provides enrollees with brain injuries training with independent living skills, such as help with gaining, maintaining, or improving self-help, socialization, and adaptive skills. This service also helps the enrollee to gain or maintain his or her maximum functional level.

Emergency home response – also known as personal emergency response system
This electronic equipment allows enrollees 24-hour access to help in an emergency. The equipment is connected to your phone line and calls the response center and/ or other forms of help once the help button is pressed.

Environmental accessibility adaptations
These are physical modifications to an enrollee’s home. The modifications must be necessary to support the health, welfare, and safety of the enrollee and to enable the enrollee to function with greater independence in their home. Without the modification an enrollee would require some type of institutionalized living arrangement, such as nursing home or assisted living.

Adaptations that do not help the enrollee’s safety or independence are not included as part of this service, such as new carpeting, roof repair, central air, or home additions.

Home delivered meals
Prepared food brought to the enrollee’s home that may consist of a heated lunch meal and a dinner meal (or both), which can be refrigerated and eaten later. This service is designed for the enrollee who cannot prepare his or her own meals but is able to feed him/herself.

Home health aide
A person who works under the supervision of a medical professional, nurse, physical therapist, to assist the enrollee with basic health services such as assistance with medication, nursing care, physical, occupational and speech therapy.

Homemaker
In-home caregiver hired through an agency. The caregiver helps with housekeeping items such as meal preparation, shopping, light housekeeping, and laundry. The caregiver can also help with hands-on personal care items such as personal hygiene, bathing, grooming, and feeding.

Intermittent nursing
This service focuses on long term needs rather than short-term acute healing needs, such as weekly insulin syringes or medi-set set up for enrollees unable to do this for themselves. These services are provided instead of a hospitalization or a nursing facility stay. A doctor’s order is required for this service.

Skilled nursing
This service provides skilled nursing services to an enrollee in their home for short-term acute healing needs, with the goal of restoring and maintaining an enrollee’s maximal level of function and health. These services are provided instead of a hospitalization or a nursing facility stay. A doctor’s order is required for this service.

Personal assistant – also known as personal care
In-home caregiver hired and managed by the enrollee. The enrollee must be able to manage different parts of being an employer such as hiring the caregiver, managing their time and timesheets, completing other employee paperwork.

The caregiver helps with housekeeping items such as meal preparation, shopping, light housekeeping, and laundry. The caregiver can also help with hands-on personal care items such as personal hygiene, bathing, grooming, and feeding.

Physical, occupational and speech therapy – also known as rehabilitation services
Services designed to improve and or restore a person's functioning; includes physical therapy, occupational therapy, and or speech therapy.

Prevocational services
This service if for enrollees with brain injuries and provides work experiences and training designed to assist individuals in developing skills needed for employment in the general workforce. Services include teaching concepts such as compliance, attendance, task completion, problem-solving and safety.

Respite
This service provides relief for unpaid family or primary caregivers who are meeting all the needs of the enrollee. The respite caregiver assists the enrollee with all daily needs when the family or primary caregiver is absent. Respite can be provided by a homemaker, personal assistant, nurse or in adult day health center.

Supported employment
Supported employment includes activities needed to maintain paid work by individuals receiving waiver services, including supervision and training.

Supportive living facilities – also known as assisted living service
A supportive living facility is a waiver housing option that provides people with many support services to meet their individual needs to help keep them as independent as possible. Examples of support services to meet those needs include: housekeeping, personal care, medication oversight, shopping, and social programs. Supportive Living Facilities do not offer complex medical services or supports.

Refills
If you live in a nursing home, the staff will take care of managing your medications for you and getting refills. The label on your medication bottle tells you how many refills your doctor has ordered for you. If your doctor has ordered refills, you may only get refills one at a time for each prescription.

If your doctor has not ordered refills for you, be sure to call him/her at least five (5) days before your medicine runs out and talk to them about getting a refill. Your doctor may want to see you before giving you a refill.

Durable Medical Equipment (DME)
Members can get medically necessary Durable Medical Equipment (DME). Medically necessary DME may be provided to Aetna Better Health members living in or being discharged to home and community based settings. Nursing facilities are required to provide non-customized DME to members while residing in the facility. Medically necessary customized equipment and specialty beds may be provided to facility members by Aetna Better Health.

Customized DME is medical equipment that is specially made for one member and cannot be used by other members. DME is ordered by the primary care provider and, case managers may from time to time assist in coordinating this process.

Change of address
Aetna Better Health need your correct address. If you are moving, call your case manager with your new address before you move. If you plan to move to a new county, call your case manager so they can coordinate your care and services at your new location. If you do not let your case manager know, you may not get the services you need.

 

Self-directed care is a service option under the Integrated Care Program.

Here is how it works. Members, working with their care management team, develop a care plan that helps with their activities of daily living. These include support services, such as personal care or meal deliveries that keep the member independent and living in their own home. The member or their representative recruits, hires, terminates and performs all duties of the employer. This also includes paying required state and federal taxes. To assist the member in this area, Aetna Better Health will retain the services of an employer agent who will be the actual employer of record.

Before self-directed services are provided, an Aetna Better Health case manager evaluates the member's independent living skills and needs. Together, the case manager and member agree upon a total number of personal assistance hours to be provided.

  • Eligibility criteria
  • Services covered
  • Responsibility of members and caregivers
  • State support departments

Consumer-directed services benefit members who have significant disabilities, who are working toward living independently. For more information call Aetna Better Health toll free at 1-866-212-2851.

When you receive Long Term Services and Support (LTSS) services you are assigned a case manager. You will receive case management services for as long as you stay in the LTSS program. Your case manager will work with you, your guardian/representative and your doctor to help decide which services will best meet your needs.

The LTSS case manager will visit you in your home setting and help to assess your needs. Your family and anyone else that you want to be involved are always encouraged to help with the assessment.

These visits are held based on where you live:

  • If you live in a nursing home, the case manager visits every six months.
  • If you live in a supportive living facility, the case manager visits every three months.
  • If you live in your own home or family home in the community, the case manager visits every three months.

If your case manager is not visiting you as often as shown above, please call us immediately and we will help.

At each assessment visit, your case manager will ask questions to learn more about you, your strengths and any areas where you might need help. Once the assessment is done, the case manager will work with you and your family to decide on services that meet your needs. Remember that LTSS services are to help add to the care that is already being provided. It is never meant to completely take away family involvement.

We will always work with you and/or your family to ensure you live in the setting that will meet everyone’s needs. If you want to stay at home or in a community setting with support services, your case manager will gladly work to find services to meet your needs. Or if you are ready to move to a supportive living facility or nursing home, your case manager will be there to help, too. Sometimes, your case manager will work with you and your family to see if you can return to a home or community based setting with services and supports.

Remember, case managers will never force you to move to any setting against you or your families’ wishes. Members with mental health diagnoses who are under court ordered treatment are subject to follow the courts’ requirements. 

Once a service plan is created, the case manager will make sure the services on the plan are authorized. Any other service needs, such as medications, provider services and treatments, should always go through your providers.

Call your case manager for any of these reasons:

  • Your caregiver did not show-up as scheduled
  • Your caregiver leaves before shift is over
  • Your caregiver is not providing all the care they were assigned to do.
  • Your caregiver quit
  • You are having trouble getting an appointment with your PCP every time you call
  • You are having trouble picking up your prescriptions or getting them filled
  • You are having trouble getting your supplies or equipment
  • You are admitted to the hospital
  • You were discharged from the hospital and need help re-starting services.
  • When you have a new address or phone number
  • You want to change your living situation. For example, you want to move home   from a nursing home or you want to move from your home to a supportive living facility
  • You want to cancel or put services on hold
  • You want to look at having different/more services in your home
  • You want to report an issue at a nursing home or supportive living home

Note – Home and community based services will not be provided when you are admitted to the hospital or nursing home. The day of admission or discharge is allowed, but the days in between are not. If you reside in a supportive living facility, your case manager can authorize to hold your space for a maximum of 30 days each fiscal year during the time you are out of the facility for hospital or therapeutic treatment. The fiscal year is July 1 through June 30.

How to contact your case manager
At your first visit, your case manager gave you a welcome letter and a business card with the case manager’s name and phone number. If you cannot find these items, please call 1-866-212-2851 and ask to speak to your case manager or ask for your case manager’s work phone number to call them directly.

Trouble reaching your case manager?
If you have tried more than once to call your case manager and are still not getting a response, please call 1-866-212-2851 and ask to speak to your case manager’s supervisor.