Medicaid Redesign Team Changes Effective
August 1, 2013

Date Issued: 8/1/2013

Directly Observed Therapy for Tuberculosis Disease (TB/DOT)

Beginning August 1, 2013, Medicaid managed care will cover outpatient directly observed therapy for tuberculosis (TB/DOT). This therapy involves observing the dispensing of medication, assessing any adverse reactions and collecting sputum samples, as well as case follow up.

Inpatient long-term treatment may be indicated when the Local Public Health Unit has determined the patient:

  • Has a poor treatment response
  • Has medical complications
  • Remains infectious
  • Other intensive residential placement is not possible

Adult Day Health Care/AIDS Adult Day Health Care Services

Effective August 1, 2013, Medicaid managed care plans will cover adult day health care (ADHC) and AIDS adult day health care (AADHC) services.

ADHC is the care and services provided to a patient registered in a residential health care facility (RHCF) or approved extension site under the medical direction of a physician, in accordance with an individualized health care plan based on a comprehensive needs assessment. An ADHC recipient must:

  • Not reside in the RHCF
  • Be functionally impaired and not homebound
  • Require services provided by a general hospital or RHCF including:
    • preventive care
    • diagnostic care
    • therapeutic care
    • rehabilitative care
    • palliative care
  • Have social and health care needs that can be met in whole or in part in an ADHC program.

AADHC services are designed to assist individuals with HIV to live more independently in the community or eliminate the need for residential health care services. AADHC recipients may require a greater range of comprehensive health care services than can be provided in any single setting, but do not require the level of services provided in a residential health care setting. Admission criteria include, at a minimum, the need for general medical care and nursing services. Services include:

  • General medical care
  • Nursing care
  • Medication management
  • Nutritional services
  • Rehabilitative services
  • Substance abuse and mental health services