Companionship Services 525-05-30-23

(Revised 01/01/2024 ML #3789)

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Purpose

Reduces social isolation in older adults and individuals with physical disabilities who are eligible for the home and community-based services waiver SPED, or EX-SPED and live alone or with an individual who is not capable or obligated to provide care. Companionship services reduce social isolation which can have a negative impact to physical and mental health that can lead to institutional placement.

 

Service Description

Non-medical care, supervision and socialization, provided to an eligible recipient who is experiencing negative effects of social isolation (e.g. anxiety or depression). The provision of companion services does not entail hands-on nursing care or medication administration. Providers may only perform light housekeeping tasks that are directly related to the companionship activity (example: if the caregiver completes an art project, the caregiver may assist with the cleanup from this companionship activity). This service must be provided in accordance with a therapeutic goal in the care plan and/or service authorization.

 

Socialization that is therapeutic is directly tied to the individual's goal(s) in the person-centered plan. An example of therapeutic activity could be a game or activity that enhances fine motor skills to help the participant recover from a stroke.

 

Activities that support therapeutic socialization could also be associated with a care plan goal to reduce social isolation, or help the individual maintain the most inclusive community life.

 

Service Eligibility, Criteria for

The individual receiving companionship services will meet the following criteria:

  1. Must be eligible for the HCBS Medicaid waiver program OR must be under the age of 60 and eligible for SPED or EX-SPED.
  2. Lives alone or with an individual who is not capable or obligated to provide the care. An individual considered to be obligated is defined as a legal spouse or parent of a child under the age of 18;
  3. Be at least age 18;


The care needs of the individual must fall within the scope of companionship services as described in this service chapter.

 

If an individual requires companionship services, the case manager must justify in the narrative/case note why the individual needs the support.

 

Service Location

Services will be administered in the most integrated setting consistent with the Person-Centered Plan of Care, including (checked if allowable):

ü The individual's home

□Workplace

ü Other community service settings

 

Service Tasks/Activities

Allowable companionship tasks include but are not limited to supervision which means having the knowledge of, and account for, the activity and whereabouts of the recipient at all times to allow immediate provider intervention as necessary to safeguard the individual from harm. During the time that the provider is providing companionship services to the recipient and is not actively providing Medicaid State Plan (MSP) personal care, SPED personal care, Waiver personal care, or homemaker tasks etc., they may play games, visit, read, go for walks, and participate in activities with the individual. If the individual is physically able, they may also participate in activities within the local community or trade area that supports an identified goal on the person-centered plan.

 

If the activity is outside of the recipient’s local community or trade area and the recipient must travel to the event etc., contact the program administrator for prior approval.

 

The following tasks are not considered allowable tasks under this chapter because they would be provided under MSP personal care, SPED personal care, Waiver personal care, or homemaker etc. unless they are incidental to the companionship activity:

Bathing, dress/undress, eye care, feeding/eating, hair/care/shaving, incontinence, mobility, nail (finger) care, skin care, teeth/mouth care, toileting, transferring/turning/ positioning. The global endorsements of exercise, hoyer lift/mechanized bath chair, indwelling catheter, medical gases, prosthetic, orthotics, suppository, bowel program, TED socks, Temp/BP/pulse/respiration rate. The client specific endorsements of apnea monitor, JOBST stockings, ostomy care, postural /bronchial drainage, RIK bed care. Communication, housework, laundry, meal preparation money management, shopping, and medication assistance are not allowable service tasks under this service unless are incidental to the companionship service.

 

Companionship services provided outside of the individual's home

Payment can be made for time performing authorized companionship tasks outside of the individual's home/grounds. Non-medical transportation is an allowable service combination.

 

Service Activity Limits

  1. Companionship services do not include hands-on nursing care but may include verbal instruction or cueing;
  2. Companionship services do not include activity fees (e.g. movie or event fees);
  3. Services can only be provided to individuals who live alone or with someone who is not able or is not obligated to provide the care;
  4. Companionship cannot be combined with adult foster care, adult residential care, family personal care, family home care, transitional living, residential habilitation, community support services, and recipients of the senior companion program under the Cooperation for National and Community Service;
  5. Companionship services cannot be provided by an individual who is identified as the recipients relative within the definition of family home care under subsection 4 of N.D.C.C. 50-06.2-02.
  6. The task of “visiting” is considered a companionship activity; however, a QSP may only bill for a maximum of 2 hours per week for this task, or 8 hours in one month.
  7. Companionship services cannot be provided to residents of a basic care facility, assisted living facility, memory care facility, skilled nursing facility or traumatic brain injury facility.

For unusual or unique circumstances, approval from the HCBS Program Administrator must be obtained.

 

Authorizing Service

  1. The service tasks/activities within the scope of this service chapter must be identified on the Authorization to Provide Service, otherwise known as the PreAuth.
  2. The amount of units allocated for companionship services cannot exceed 10 hours of service per month (40 units).
  3. The companionship provider may also be the personal care, homemaker provider etc. However, the services cannot be provided at the same time.

 

Providers

Companionship Services may NOT be provided by the following individual QSP's or employees of a QSP agency:

 

Standards for Providers

  1. Individuals enrolled as a QSP who meet the standards to provide adult companion services except for individuals who are identified as a relative of the recipient within the definition of family home care under subsection 4 of N.D.C.C. 50-06.2-02.
  2. Agencies enrolled as a QSP that meet the standards for adult companion services.
  1. Employees of agencies enrolled to provide this service cannot use an employee who is identified as a relative of the recipient within the definition of family home care under subsection 4 of N.D.C.C. 50-06.2-02.
  1. Organizations enrolled as a QSP that provide companion service under the Corporation for National and Community Service Senior Companion Programs.
  1. Employees of organizations enrolled to provide this service cannot use an employee who is identified as a relative of the recipient within the definition of family home care under subsection 4 of N.D.C.C. 50-06.2-02.
  2. Organization providers must meet all the standards established by the Corporation for National and Community Service National and Community Service Senior Companion program grantees.
  1. Verification of organization credentials is done by the national corporation.

All individual companionship providers and the employees of agency providers must also have the global endorsement for cognitive/supervision. Organization employees/ volunteers do not need this endorsement.