§ 49-6-63 — Establishment by lead agency of community care service system; certification for benefits; evaluation by assessment team; volunteers; insurance coverage

(a) Each lead agency shall be responsible for the establishment of a community care service system which shall have as its primary purpose the prevention of unnecessary institutionalization of functionally impaired elderly persons through the provision of community based services. Each community care service system shall provide no fewer than six of the services listed in subsection (c) of this Code section, four of which shall include case management, assessment of functional impairment and needed community services, homemaker, and home health care services. Case management services shall be provided to each community care service recipient to ensure that arrangements are made for appropriate services. If independent living is no longer possible for a functionally impaired elderly person, the case manager shall assist the person in locating the most appropriate, least restrictive, and most cost beneficial alternative living arrangement. (b) All existing community resources available to the functionally impaired elderly person shall be coordinated into the community care service system to provide a continuum of care to such persons. The lead agency shall establish agreements, policies, and procedures for service integration and referral mechanisms with such programs. (c) Services to be coordinated by the lead agency shall include, without being limited to, the following: (1) Case management; (2) Assessment of functional impairment and needed community services; (3) Homemaker services; (4) Home health care services; (5) In-home personal care services; (6) Adult day health services; (7) Adult day care; (8) Habilitation services; (9) Respite care; (10) Older Americans Act services, including transportation, nutritional, social, and other services; (11) Title XX services; (12) Senior center services; (13) Protective services; (14) Financial assistance services, including, but not limited to, food stamps, Medicaid, medicare, and Supplemental Security Income; (15) Health maintenance services; and (16) Other community services. (d) Priority in provision of community care services shall be given to those individuals who have been certified for skilled or intermediate institutional nursing care service benefits conferred by the "Georgia Medical Assistance Act of 1977" and who need home and community based services in order to avoid institutionalization. Services may be provided to other functionally impaired persons as resources allow, as determined by the department. Priority in provision of community care services to such other persons shall be based on economic, social, and medical needs. (e) All individuals seeking certification for benefits conferred by the "Georgia Medical Assistance Act of 1977," as amended, to be used to pay the cost of placement in a long-term care facility or individuals who would be eligible for such benefits within 180 days of nursing home admission, shall, as a precondition to such certification, undergo evaluation by an assessment team designated by the lead agency to determine if institutionalization can be avoided by provision of more cost-effective community based services. If the individual being evaluated requires community based services which, over a 12 month period, would cost more than the cost of care in a long-term care facility, then such community based services shall not be deemed cost effective. Such cost-effective determination shall apply to each case management evaluation. The assessment team shall, at a minimum, consist of a physician, a registered nurse, and a social worker. Whenever possible, the assessment team shall be responsible for the precertification for nursing home placement and determination of the appropriate level of care, as required by the State Plan for Medical Assistance, as defined in the "Georgia Medical Assistance Act of 1977." (f) The decision of the assessment team shall be forwarded to the department designated in the State Plan for Medical Assistance, as defined in the "Georgia Medical Assistance Act of 1977," as responsible for the certification of benefits for individuals. If the assessment team and the case manager have determined that an individual could be better and more cost effectively served in the community, the department shall not certify such individual for skilled or intermediate institutional nursing care service benefits until the lead agency has informed such individual of the availability of community based services within the lead agency's geographic service area and of the right of such individual to choose to receive those services as an alternative to placement in a long-term care facility. Such individual shall advise the lead agency of his or her choice of service alternatives. If such individual is otherwise eligible for those benefits for which certification is sought, the department shall certify the individual either for placement in a long-term care facility or for receiving community based services, as the individual advised the lead agency. The evaluation and certification shall be completed in a timely manner. (g) The lead agency shall seek to utilize volunteers to provide community services for functionally impaired elderly persons. The department may provide appropriate insurance coverage to protect volunteers from personal liability while acting within the scope of their volunteer assignments in the community care service system. Coverage may also include excess automobile liability protection.

Legislative History

Amended by 2016 Ga. Laws 547,§ 1, eff. 7/1/2016. Amended by 2009 Ga. Laws 8,§ 49, eff. 4/14/2009.