Community Living Arrangement Services

Community Residential Alternative (CRA) services are targeted for Individuals who require intense levels of support. These services are a range of interventions with a particular focus on training and support in one or more of the following areas: eating and drinking, toileting, personal grooming and health care, dressing, communication, interpersonal relationships, mobility, home management, and use of leisure time. CRA Services are individually planned and tailored to meet the specific needs of the Individual and to accommodate fluctuations in his or her needs for various services.

CRA services include:

• Assistance with and/or training in activities of daily living, such as bathing, dressing, grooming, other personal hygiene, feeding, toileting, transferring, and other similar tasks.
• Training and/or assistance in household care, such as meal preparation, clothes laundering, bed-making, housecleaning, simple home repair, yard care, and other similar tasks.
• CRA services consist of medically related services, such as basic first aid, arranging and transporting Individuals to medical appointments, assisting with therapeutic exercises, and assisting with or supervising self-administration of medication.
• Implementing behavioral support plans designed for Individuals to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
• CRA Services include transportation to all other waiver services specified in the Individual Service Plan and as needed to facilitate the individual’s participation in personal shopping, recreation and other community activities.

CLS services include training and assistance with activities of daily living (ADLs), such as bathing, dressing, toileting, and transferring, and with instrumental activities of daily living (IADLs), such as personal hygiene, light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone, and medication and money management.

These services include:

• Transportation to facilitate the individual’s participation in grocery or personal shopping, banking, and other community activities that support continued residence of the individual in his or her own or family home.
• CLS services may include medically related services, such as basic first aid, arranging and transporting individuals to medically appointments, accompanying individuals accompanying individuals on medical appointments.
• CLS service includes documenting an individual’s food and/or liquid intake or output, reminding individuals to take medication, and assisting with or supervising self-administration of medication.

Community Access Services are designed to assist the individual in acquiring, retaining, or improving self-help, socialization, and adaptive skills required for active community participation and independent functioning outside the individual’s home or family home.

These services are interventions in the areas of social, emotional, physical, and intellectual development and may include training in the areas of daily living skills (including leisure/recreation skills); communication training; mobility training; programming to reduce inappropriate and/or maladaptive behaviors; and training in the use of common community resources.

The emphasis of training will be on assisting the individual in increasing self-help, socialization skills, or daily living and adaptive skills required for active community participation and independent functioning outside the individual’s home or family home. These activities include accompanying individuals to the grocery store, or eating establishments; teaching an individual programming to reduce inappropriate social and recreational activities.

The following Community Access Services are offered:

• Community Access Group
• Community Access Individual

Prevocational Services occur in facility-based settings or at community sites outside the facility for small groups of individuals, called mobile crews, who travel from the facility to these community sites. Mobile crews receive Prevocational Services by performing tasks, such as cleaning or landscaping, at community sites other than the individual’s home or family home or any residential setting. The emphasis of Prevocational Services is directed to habilitative rather than explicit employment objectives. These services include teaching individuals concepts necessary to perform effectively in a job in the community.

Activities included in these services are directed at teaching concepts:

• Concepts such as rule compliance, attendance, task completion, problem solving, endurance, work speed, work accuracy, increased attention span, motor skills, safety, and appropriate social skills.
• The intended outcome of these services is to prepare the individual for paid or unpaid employment through increased skills. Prevocational Services are individually planned to meet the Individual’s needs for preparation of paid and unpaid employment.

Respite Services may be provided in the individual’s own or family home, or outside the individual’s home in a private residence of a Respite Services provider (i.e., a home that is owned or rented by the provider or an employee of the provider) or in a Licensed Personal Care Home. Respite Services should include short-time services during a day or overnight services.

Respite Services provide brief periods of support or relief for caregivers of individuals with disabilities. Respite is provided in the following situations:

• When families or the usual caretakers are in need of additional support or relief;
• When the individual needs relief or a break from the caretaker;
• When an individual is experiencing a crisis and needs structured, short-term support;
• When relief from care giving is necessitated by unavoidable circumstances, such as a family emergency.

Specialized Medical Supplies (SMS) Services include various supplies which enable individuals to interact more independently

with their environment thus enhancing their quality of life and reducing their dependence on physical support from others. SMS consist of food supplements, special clothing, diapers, bed wetting protective chucks, and other supplies that are specified in the Individual Service Plan and are not available under the Medicaid State Plan.

Ancillary supplies necessary for the proper functioning of approved devices are also included in this service.

Specialized Medical Equipment (SME) Services include various devices, controls or appliances which are designed to enable individuals to interact more independently with their environment thus enhancing their quality of life and reducing their dependence on physical support from others.

SME services also include assessment or training needed to assist individuals with mobility, seating, bathing transferring, security, or other skills such as operating a wheelchair, locks, door openers, or side lyers. These services additionally consist of customizing a device to meet an individual’s needs.