Choices for Care is a Medicaid-funded, long-term care program to pay for care and support for older Vermonters and people with physical disabilities. The program assists people with everyday activities at home, in an enhanced residential care setting, or in a nursing facility.

Support includes hands-on assistance with eating, bathing, toilet use, dressing, and transferring from bed to chair; assistance with tasks such as meal preparation, household chores, and medication management and increasing or maintaining independence.

A second program is for Moderate Needs individuals who need minimal assistance to remain at home. This program offers limited case management, adult day services, and/or homemaker service.

• Programs

• Services

• Eligibility

• Applying for Services

• Providers of Services

• Program Contacts

• Policies and Guidelines

• Publications

• Forms

• Legislation, Statutes and Regulations

• Training and Events

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Programs Include

The list below represents the Program options available under the Choices for Care (1115 Long-Term Care Medicaid Waiver). To find out more information on each program and how you can receive needed services click on the Program title.

• Flexible Choices
  Flexible Choices allows people to convert their plans of care for home-based services into a dollar-equivalent allowance.

• Enhanced Residential Care (ERC)
  Services are provided in authorized licensed Level III Residential Care Facilities and Assisted Living Residences to people whose needs are greater than what is regularly available in these homes.

• Home-Based Supports
  Services are available to help eligible individuals remain in their homes.

• Nursing Facility Services
  Licensed facilities provide 24-hour care in a nursing home setting.

• Program for All-Inclusive Care for the Elderly (PACE)
  The Program for All-Inclusive Care for the Elderly (PACE) is a health care system for frail individuals 55 years and older that provides all acute, primary, and long-term care needs of the individual.

Information on Related Programs

• Choices for Care Long-Term Care Medicaid Waiver and Green Mountain Care

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Services Include

Choices for Care offers the following services:

• Case Management
• Personal Care
• Respite
• Companion
• Adult Day
• Assistive Device
• Home Modifications
• Personal Emergency Response System

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Eligibility

To be eligible for Choices for Care the person must:

• Be a Vermont resident.
• Be 65 years of age or older or 18 years of age with a physical disability.
• Meet specific clinical criteria.
• Meet financial criteria for Vermont Long-Term Care Medicaid.

Moderate Need Individuals:

A separate eligibility criteria exists for Moderate Needs individuals. Information regarding program eligibility and service availability can be obtained directly from the Adult Day Centers, or Home Maker Agency (Home Health Agency) in your area.

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Applying for Services

• Choices for Care Program Applications and Information are available at Area Agencies on Aging and your local Home Health Agency.

• Hospitals and Nursing Facilities have information packets at time of admission or discharge.

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Providers of Services

The list below indicates the available Choices for Care Service Providers. There are multiple service providers for each county and you can select a provider based on your needs. Click on the Service Provider listed to obtain contact information for a provider in your area.

• Adult Day Centers
  Adult Day Centers provide an array of services to help older adults and adults with disabilities to remain as independent as possible in their own homes. Adult day services provide programs during the daytime. Programs include activities, social interaction, nutritious meals, health screening and monitoring, personal care, and transportation. Respite for family caregivers is also available.

• Area Agencies on Aging
  Area Agencies on Aging provide support to people 60 and older in their efforts to remain active, healthy, financially secure, and in control of their own lives.

• Assisted Living Residences
  Assisted Living Facilities are state licensed residences that combine housing, health and supportive services to support resident independence and aging in place.

• Home Health Agencies
  Health Agencies provide health services in the home. Services include: nursing; personal care; physical therapy; homemaker services; hospice care, and social work services.

• Nursing Facilities
  Nursing homes provide nursing care and related services for people who need nursing, medical, rehabilitation, or other special services. They are licensed by the state and may be certified to participate in the Medicaid and/or Medicare programs. Certain nursing homes may also meet specific standards for subacute care or dementia care.

• Residential Care Homes - Level III
  Residential care homes are state licensed group living arrangements designed to meet the needs of people who can not live independently and usually do not require the type of care provided in a nursing home. When needed, help is provided with daily activities such as eating, walking, toileting, bathing, and dressing. Residential care homes may provide nursing home level of care to residents under certain conditions. Level III homes provide nursing overview, but not full-time nursing care.

• Personal Emergency Response Organizations
  Personal Emergency Response Organizations provide an array of services to help older adults and adults with disabilities to remain as independent as possible in their own homes.

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Program Contacts

For information about Choices for Care:

• DDAS Choices For Care Program: (802) 241-1228
• Choices for Care – Long-Term Care Clinical Coordinators (LTCCC)

Region	Contact Person	Contact Information
Barre	George Jurasinski	(802) 476-1646
Bennington	Jessica Bird	(802) 447-2850
Brattleboro	Mary Woods	(802) 251-2118
Burlington	Paula Hartshorn Toni Morgan Sara Lane	(802) 879-5904
Hartford	Sally Garmon	(802) 296-5592
Middlebury	Mary Gerdt	(802) 388-5730
Morrisville	Maura Krueger	(802) 888-0510
Newport	Paulette Simard	(802) 334-3910
Rutland	Celine Aprilliano	(802) 786-5971
Springfield	Windsor County (North): Sally Garmon Windsor County (South): Mary Woods Jennifer Genung	(802) 885-8875
St Albans	Brenda Smith	(802) 524-7913
St Johnsbury	Julie Bigelow	(802) 748-8361

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Policies and Guidelines

Listing of Choices for Care Policies and Guidelines:

• Choices for Care Guidelines to Paying Spouses as Caregivers Cover Memo

• Choices for Care Guidelines for Paying Spouses as Caregivers (Effective May 1, 2007)

• Flexible Choices Policies & Guidelines
  Letter from Medicare and Medicaid Services outlining special terms and conditions for the award of the Long Term Care Plan section 1115 demonstration.

• Choices for Care 1115 Highest & High Needs Manual
  The operational protocol manual describing the eligibility criteria, services and program procedures to assist individuals, case managers and service providers in planning and managing services for the highest and high needs individuals.

• Choices for Care 1115-Moderate Needs Manual
  The operational protocol manual describing the eligibility criteria, services and program procedures to assist individuals, case managers and service providers in planning and managing services for moderate needs individuals.

• Quality Management Plan (April 2007)
  The Quality Management Plan guides the activities of the Division of Disability and Aging Services Quality Management Unit staff and establishes the standards for assessing the quality of services throughout Vermont.

• Standards for Adult Day Services in Vermont (January 2004) (Updated March 11, 2004)

• 1115 Long-Term Care Waiver Approval Letter (June 2005)
  Letter from the Centers for Medicare & Medicaid Services approving the State of Vermont's Long-Term Care Plan section 1115 demonstration for a 5 year period.

• 1115 Long-Term Care Waiver Special Terms and Conditions
  Letter from Medicare and Medicaid Services outlining special terms and conditions for the award of the Long Term Care Plan section 1115 demonstration.

• 1115 Long-Term Care Waiver Demonstration Appendices
  This demonstration is aimed at giving adults with physical disabilities and the elderly real choices.

• 1115 Long-Term Care Waiver Demonstration Without Appendices
  This demonstration is aimed at giving adults with physical disabilities and the elderly real choices.

• Vermont’s Responses to Questions from 1115 Federal Review Team (January 2004)

• Vermont’s Responses to Questions from 1115 Federal Review Team with Corrected Budget Figures (January 2004)

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Publications

Choices for Care Publications:

• DAIL-DDAS Service Codes and Rates
  Service Codes and Rates for all DAIL-DDAS services. (Includes Moderate Needs Group payment cap for Adult Day & Homemaker providers)

• How to Choose a Case Manager Brochure
  This brochure will assist you to understand what is case management, what agencies provide case management for medicaid waiver, and what does a case manager do.

• Choices for Care Long-Term Care Options Brochure
  This brochure will help you to determine if the Choices for Care Vermont Long-Term Care Medicaid Program may be able to help you, or someone you know.

• Vermont Long Term Care Ombudsman Project Brochure
  The Vermont Long Term Care Ombudsman Project is a special project of Vermont Legal Aid. This is an informational brochure on the Vermont Long Term Care Ombudsman Project.

• Choices for Care Reports to CMS
  Choices for Care reports that are submitted to CMS as mandated.

• Choices for Care Quarterly Data Reports
  These reports present recent data that documents the status and progress of Choices for Care. Taken together, this data is intended to provide useful insight into the enrollment and service trends within Choices for Care. A brief explanation accompanies each graph, chart or table within the report.

• Nursing Facilities Monthly Reports
  These monthly reports are located on the Department of Aging and Independent Living website, but are relevant to DDAS programs.

• LTC Consumer Survey - 2006 (October 2007)

• Choices for Care 1115 Operational Protocol
  The State of Vermont in an effort to further improve its programs developed this demonstration initiative to provide greater choice and the highest quality services possible to recipients in need of long-term care. Through this demonstration the Vermont Agency of Human Services (AHS) will undertake broad based reform of the long-term care service system by offering a continuum of care that includes a series of options, including both home- and community-based alternatives and traditional nursing facility services. This publication will give a full description of the eligibility criteria and benefit package for each of the three clinical groups included in this Operational Protocol along with additional information.

• Omnia User Guide
  Omnia Interviewer User Guide

• SAMS LTCCC Full Manual
  LTCCC Full Manual for SAMS 2000

• SAMS LTCCC Procedure Manual
  LTCCC Procedure Manual for SAMS 2000 - accompanies the SAMS LTCCC Full Manual

• SAMS Provider Manual
  SAMS Provider Manual

• SAMS Quick Reference Guide
  Quick Reference Guide for SAMS 2000

• 1115 Long-Term Care: Revised Regulations Schedule
  1115 regulations-Revised Timeline (6.23.05)

• VT Long-Term Care Plan - Budget Neutrality Projections (May 2004)
  Vermont 1115 Demonstration; The Vermont Long-Term Care Plan with revised budget neutrality tables to incorporate minor adjustments and to include all Medicaid costs for individuals receiving long-term care services.

• 1115 Waiver - Responses to Second Round of Questions from CMS (March 2004)
  Report giving Vermont Long-Term Care Plan's responses to CMS' supplemental questions.

• Choices for Care 1115 Waiver: Comments and Responses
  Listing of comments and responses from stakeholders.

• 1115 Long-Term Care Waiver Public Meetings About Choices for Care
  Listing of Vermont Interactive Television Sessions for the Public Meetings that were held about the Choices for Care Vermont's 1115 Long-Term Care Waiver.

• 1115 Vermont Interactive Television (VIT) Session (December 2004)
  Document containing materials that were utilized for discussion during the December 17, 2004 Interactive Television Session.

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Forms

Choices for Care Form Categories

• Flexible Choices Forms

• Highest and High Need Forms

• Moderate Needs Forms

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Flexible Choices Forms

• Flexible Choices Allowance (October 2007)

• Flexible Choices Budget (July 2006)

• Flexible Choices Consent (July 2006)

• Flexible Choices Referral (July 2006)

• Flexible Choices Self Screen (July 2006)

• Flexible Choices Start of Services (July 2006)

• Flexible Choices Stop of Services (July 2006)

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Highest and High Needs Forms

• Agreement for Live-in Care (October 2005)

• ARIS Employer Handbook (June 2006)

• ARIS Employer Agreement (October 2005)

• Assistive Devices & Home Modifications (October 2005)

• Choices for Care Program Application (February 2007)

• Clinical Assessment (October 2005)

• Clinical Certification and/or Highest Paid Provider Change (October 2005)

• Clinical Certification (January 2006)

• Clinical Eligibility Worksheet (March 2008)

• Clinical Eligibility Worksheet - Reassessment (March 2008)
• Comprehensive Resident Assessment
  

• Emergency Contacts & Backup Plan (October 2005)

• Employer Certification (October 2005)

• ERC Service Plan (July 2007)

• ERC Tier Worksheet for CRA (February 2006)

• High Needs Wait List Score Sheet (October 2005)
• High Needs Waiting List Monthly Follow-up Sheet
  

• Highest Paid Provider Change (October 2005)

• Home-Based & ERC Change Report 804 (January 2006)

• Home-Based Service Plan (July 2008)

• Independent Living Assessment (October 2006)

• Nursing Facility-Hospital-Discharge Notice 804A (January 2006)

• Nursing Facility Changes 804B (January 2006)

• Personal Care Worksheet (March 2008)

• Permission for Release of Information for LTCCCs (October 2005)
• Permission for Release of Information for Providers (May 2005)
• Triggers for High Need Wait List Referal for Clinical Review (February 2006)
  

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Moderate Needs Forms

• Moderate Group Wait List-Form 903

• Moderate Needs Application & Request for Reinstatement-Form 900

• Moderate Needs Clinical Worksheet-Form 901

• Moderate Needs Complete Package Checklist-Form 907

• Moderate Needs Group Financial Worksheet-Form 902

• Moderate Needs Service Authorization-Form 904

• Moderate Needs Termination-Form 905

• Moderate Needs Group Change-Form 906B
  
• Moderate Needs Group Annual Reassessment-Form 906A
• Moderate Needs Adult Day Services Wait List Notice
• Moderate Needs Homemaker Services Waiting List Notice
  

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Legislation, Statutes and Regulations

• Choices for Care 1115 Long-Term Care Medicaid Waiver Regulations
  Vermont statutory regulations governing the process for providing Vermonters with equal access to long-term care through either nursing facility, home-based or enhanced residential care services consistent with their choice.

• ACT 56 - An ACT Relating to Long-Term Care Waiver (H.543)

• ACT 123 - An ACT Relating to Improving Availability of Home and Community Based Care Services (H.735)

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Training and Events

• Choices for Care trainings can be found on the Division of Disability and Aging Services' Training Page.

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