Page 177

i. Assistance with activities of daily living ii. Attendant care iii. Supervision iv. Reporting changes in the member’s condition, v. Assistance with medication and medical procedures which are normally self- administered, or vi. The extension of therapy services, ambulation and exercise. vii. Tasks associated with routine household upkeep, including general housekeeping chores, lawn mowing, snow removal, changing storm or screen windows and other household services that are essential to the member’s safety, well-being and care at home. f. Transportation. g. Community Based Residential Facility (CBRF), Adult Family/Foster Home (AFH), Residential Care Apartment Complex (RCAC), and all other community substitute care setting program costs not including room and board expenses. 3. Ambulance service and other medical transportation including attendant services 4. Medical insurance premiums paid by a member of the BadgerCare Plus Group. These insurance premiums include disease specific and per diem hospital and nursing home insurance payments. Do not allow accidental insurance policy premiums as a countable cost. Note Unlike other expenses listed in this section that may not be applied toward a deductible until they are incurred, count medical insurance premiums from the first day of the deductible period if the premium will be coming due anytime during the current deductible period. 5. Medical bills paid by a party who is not legally liable to pay them can be counted against a deductible. Examples of parties that pay medical bills when not legally liable include, but are not limited to: Churches, fraternal organizations, Children's Special Health Needs Unit of the Division of Public Health, Veterans Administration, and the AIDS Drug Assistance Program (ADAP). 6. The cost of medical services received at a Hill-Burton facility. The Hill-Burton Act was enacted by Congress to provide federal assistance for the construction and modernization of health care facilities. Medical facilities which receive Hill-Burton assistance must provide without charge a reasonable volume of services to persons unable to pay for those services. 7. In-kind payments. These are services or goods supplied to the provider in lieu of cash. Self declaration of the bill being satisfied is adequate verification. 8. Medical or remedial expenses that are paid or will be paid by a state, county, city or township administered program that meets the conditions detailed in #1 through #7 above. Examples include: a. General Assistance b. Community Options Program c. AIDS Drug Assistance Program (ADAP) Example 1 Jenna receives a medical service which will be paid by ADAP. When Jenna becomes pregnant and applies for BadgerCare Plus she has a deductible to meet. This medical bill that has not been paid can be used immediately because it will be paid by the state administered ADAP program.