The LTSS program focuses on serving frail, elderly, and disabled individuals. The program combines traditional health care benefits (doctor visits, hospital stays, labs) with long-term services and supports with help in a home or community setting with daily living activities such as:
Adult Day Health Program
Elderly and Persons with Physical Disabilities (EPD) Waiver Program
Home Health Services
Personal Care Aide Services (PCA)
Private Duty Nursing Services (PDN)
Personal Emergency Response System
Adult Day Health Program
Adult Day Health Program is designed to encourage older adults to live in the community by offering non-residential medical supports and supervised, therapeutic activities in an integrated community setting; Foster opportunities for community inclusion; and deter more costly facility-based care.
Adult Day Health Program enrollees will receive the same Medicaid benefits as all other District Dual Choice full dual enrollee and are eligible for Adult.
Elderly and Persons with Physical Disabilities Waiver Program (HCBS)
The Elderly and Persons with Physical Disabilities (EPD) waiver program is authorized under the Home and Community-Based Services (HCBS) waiver program in §1915(c) of the Social Security Act. The EPD waiver program provides services to the enrollees who would otherwise qualify for nursing facility care.
These enrollees are referred to the DHCF to determine eligibility and availability. If deemed eligible, the health plan will continue to cover all medically necessary covered services for the enrollee unless/until the enrollee is disenrolled from the Medicaid program.
EPD enrollees will receive the same Medicaid benefits as all other District Dual Choice full dual enrollees. Additionally, the following waiver benefits are available to enrollees who qualify for EPD Waiver enrollment when the services are determined necessary and approved:
Electronic Visit Verification system (EVV) is a system that electronically captures details of home visits and services provided by caregivers while ensuring enrollees are receiving the support they require, and the rendered services are billed accurately.
Do I have to use EVV?
From Feb. 1, 2022 until electronic visit verification (EVV) is ready for the Dual Choice program, providers will be required to record timesheets on paper. Providers should submit claims to UnitedHealthcare. These claims will be matched to authorization during the continuity of care period. No validation will be done to an EVV record until further notice from UnitedHealthcare.
Prior Authorization for LTSS/HCBS Services
The authorization process begins when a case manager assesses the enrollee’s needs and works with the enrollee, family, and health care providers to create a plan of care that specifies which services will be authorized to support their ongoing need(s). The case manager then arranges for the services by contacting the care provider and entering an authorization into our system.
For enrollee referrals or to speak with the clinical team, call the clinical care program at 855-409-7073.
LTSS Contracting and Credentialing
Becoming a Provider
Please include the name of the facility and the words “Credentialing Application” in the subject line.