The concept of SHARe exceptions can be confusing, especially if you’re new to LA Medicaid and how they do things. You might wonder what these exceptions are, when they can be used, and any procedures you may need to follow. And that’s what we’ll go over in this article. Let’s get right into it!
What is a SHARe Exception?
Now, let’s get into a simple definition of SHARe exceptions. The acronym means Service Hour Allocation of Resources (SHARe), which refers to the number of caregiver or support service hours you are allowed as part of your OAAS (Office of Aging and Adult Services) benefits.
The amount of hours you are allowed may work for a time, but there are situations where things may change, and your hours may need to be adjusted. That’s when the SHARe exceptions come into play. Think of them as a failsafe to ensure you always get the care you need.
When Do SHARe Exceptions Apply?
As of the time of this writing, there are five specific situations where SHARe exceptions apply. Otherwise, the OAAS may not grant you an exception. We’ll get into each of said exceptions below:
1. Institutional Risk (IR) CAP and Disabled or No Caregiver
You may be granted an exception to the SHARe if you need additional services to stay at home or in the community instead of a nursing facility. In this case, you’ll receive more hours than before.
2. Top of OAAS Resource Utilization Groups RUG and ADL Index Scores
Another situation where you might be eligible for a SHARe exception concerns your RUG score and your ADL Index score. Here’s what these terms mean:
- RUG Category – A classification system used to categorize beneficiaries based on the level of care they need.
- ADL Index Score – A measure of how well a person can perform essential daily tasks.
If you are at the top of a RUG (Resource Utilization Group) category and your ADL (Activities of Daily Living) Index Score is 15, you are at risk of needing to be transitioned to an institutional facility (nursing home, hospital, etc.). Your hours will be adjusted to ensure you get the care you need to avoid this scenario.
3. Personal Assistance Services (PAS) Conversion
When the OAAS replaced the old EDA waiver program with PAS, it created some discrepancies with the new PAS hours (the hours often went over the max allowed amount for a given beneficiary). If your situation meets the following criteria, you’ll get a PAS SHARe exception where you’ll get the same number of hours as you had the previous year:
- Your RUG score changes
- Your functional needs either remain unchanged or get worse.
- The budgets for both RUG scores are the same.
4. Nursing Facility Transition
Community Choices Waiver (CCW) participants transitioning from a nursing facility to the community may receive a one-time SHARe exception if they meet the below criteria:
- Your current SHARe allotment doesn’t cover assistive devices, nursing evaluations, Skilled Maintenance Therapy evaluations, or Environmental Accessibility Adaptations (EAAs).
- You currently live in a nursing facility or have transitioned from one in the last 365 calendar days.
- You’re enrolled in My Place Louisiana or My Choice Louisiana.
5. interRAI Home Care (iHC) Assessment Conversion
When the Office of Aging and Adult Services changed its assessment systems, certain participants’ SHARe allotments were unfairly reduced. CCW participants who (1) have had no ADL improvements or (2) have a diagnosis of hemiparesis in the old system that can’t be coded on the current system will qualify for an exception. If granted this exception, your SHARe allotment will go back to what it was on the previous assessment system.
Reach Out to Your Support Coordinator
To inquire about a SHARe exception, the best course of action is to contact your support coordinator. They have the resources to tell you whether you qualify for an exception, and they have the authority to get the exception procedure started on your behalf.
