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� Definitions of Covezed Services <br /> Introduction <br /> The following are service definitions and descriptions of <br /> the types and scope of services that may be rendered to <br /> l:edicare Al2heimer's Disease Demonstration participants for <br /> vhich reimbursement may be rade under the demonstration. <br /> 1�11 services must be rendered in accordance vith a vritten <br /> plan of care established by the case �aanaqer and approved <br /> and si ne <br /> d b the care ' <br /> 9 iver <br /> Y g , the participant, vhere <br /> appropriate, and a healtA pzofessional. The services <br /> provided should be reasonable and necessary for the <br /> . diagnosis, care and treatment of individuals vho have a <br /> primary diagnosis of 1�lzheimer's disease or related <br /> disorder. When circumstances taarrant a change in the plan <br /> of care, demonstration requirements vill be catisfied as <br /> long as there is an agreement to the ehanges by all <br /> applicable parties and pzoper documentation is �ecured. <br /> A. �av Care Services <br /> Adu_ lt �ay Care <br /> Day care is a ptogram of 6ervices provided in an <br /> ambulatory care settinq for individuals who, due to <br /> the severity of their functional impairment(6j, are <br /> not capable of living fully independent. The <br /> essential elements of a day care program are directed <br /> to�►ard meeting the supervfsory, social and 2�ealth - <br /> restozation and �aaintenance needs of the <br /> participants. The goal of day care is to foster and <br /> sustain optin�al capacity for self-care. 11s a . <br /> component of a total plan of care, day care provides a � <br /> congregate setting tor service delivery during any <br /> part of a day, Dut less than 24 hours. <br /> . To be considered reimbursable under the Medicare - - <br /> Alzheimer's Disease Demonstration, a day care program <br /> �ust be operated under a single administrative unit <br /> responsible for the overall management and conduct of <br /> program activities. l�lso, t�e day care program �ust <br /> be administered under a cet of vritten policies and <br /> procedures vhich teflect the objectives of the proqram <br /> and govern tt�e provision of cervices to program <br /> participants. In addition, provider6 of day care <br /> cervices must comply with all applicable State <br /> licensing tequirements. The pzoviders of day care <br /> services must provide a protective settinq that <br /> maximizes the safety of the participant, ainimizes the <br /> amount of disorientation expezienced by the <br /> participant and prevents participants from vandering <br /> off the grounds. <br /> B-2 <br />