Current through Register Vol. 49, No. 9, September, 2024
200.000
ADULT DEVELOPMENTAL DAY TREATMENT (ADDT) GENERAL INFORMATION
201.000 Arkansas Medicaid Participation
Requirements for Adult
Developmental Day Treatment (ADDT) Providers
Adult Developmental Day Treatment (ADDT) providers must meet
the Provider Participation and enrollment requirements contained within Section
140.000 of this manual as well as the following criteria to be eligible to
participate in the Arkansas Medicaid Program:
A. Each provider of ADDT must be licensed as
an Adult Developmental Day Treatment clinic by the Division of Provider
Services and Quality Assurance (DPSQA), as the regulatory entity governing
licensure.
B. A copy of the current
license must accompany the provider application and the Medicaid
contract.
201.100
Providers of ADDT Services in Arkansas and Bordering States
ADDT providers in Arkansas and within fifty (50) miles of the
state line in the six bordering states (Louisiana, Mississippi, Missouri,
Oklahoma, Tennessee and Texas) may be enrolled as ADDT providers if they meet
all Arkansas Medicaid participation requirements.
ADDT providers may furnish and claim reimbursement for covered
services in the Arkansas Medicaid Program subject to benefit limits and
coverage restrictions set forth in this Manual. Claims must be filed according
to the specifications in this Manual.
201.200 ADDT Providing Occupational,
Physical, or Speech Therapy
Optional services available through ADDT include occupational,
physical and speech therapy and evaluation as a component of the individual
program plan (IPP) for an individual accepted for adult developmental
disabilities services. Therapy services are not included in the core services
and are provided in addition to the core services (see Sections 214.210 and
215.200 of this manual for additional requirements for provision of therapy
services)
An ADDT facility may contract with or employ qualified therapy
practitioners. The individual therapy practitioner who actually performs a
service on behalf of the ADDT facility must be identified on the claim as the
performing provider when the ADDT facility bills for that service. This action
is taken in compliance with the federal Improper Payments Information Act of
2002 (IPIA),
Public
Law 107-300 and the resulting Payment Error Rate
Measurement (PERM) program initiated by the Centers for Medicare and Medicaid
Services (CMS).
If the facility contracts with a qualified therapy
practitioner, the criteria for group providers of therapy services apply (See
Section 201.100 of the Occupational, Physical, Speech Therapy Services manual)
The qualified therapy practitioner who contracts with the facility must be
enrolled with Arkansas Medicaid. The contract practitioner who performs a
service must be listed as the performing provider on the claim when the
facility bills for that service.
If the facility employs a qualified therapy practitioner, that
practitioner has the option of either enrolling with Arkansas Medicaid or
requesting a Practitioner Identification Number (View or print form
DMS-7708). The employed practitioner who performs a service must be
listed as the performing provider on the claim when the facility bills for that
service.
202.000
Documentation Requirements
202.100
Documentation Requirements for All Medicaid Providers
See Section 141.000 for the documentation that is required for
all Medicaid providers.
202.200 Clinical Records ADDT Providers Must
Keep
A. Providers must establish and maintain
medical records for each beneficiary that include documentation of medical
necessity for ADDT services and the beneficiary's individual program plan
(IPP).
B. Sufficient written
documentation for each beneficiary record must support the medical necessity of
each of the services provided. This requirement applies to core services and
optional services. Refer to Sections 214.000 through 216.200 of this manual for
descriptions of services.
C.
Dailyservice documentation for each ADDT beneficiary must, at
a minimum, include the following items.
1.
Thespecific services furnished,
2.
The date and actual beginning and ending time of day the services were
performed,
3. Name(s) and title{s)
of the person(s) providing the service(s), and
4. The relationship of the services to the
goals and objectives described in the beneficiary's IPP.
D. The record must include
weekly progress notes, signed or initialed by the person(s)
providing the service(s), describing each beneficiary's status with respect to
his or her goals and objectives.
202.300 Electronic Signatures
Medicaid will accept electronic signatures provided the
electronic signatures comply with Arkansas Code §
25-31-103
et seq.
210.000
PROGRAM COVERAGE
211.000
Introduction
Medicaid assists eligible individuals to obtain medical care in
accordance with the guidelines specified in Section I of this manual.
Reimbursement may be made for covered adult day treatment services provided to
Medicaid beneficiaries at qualified provider facilities.
211.100 Developmental Disability Diagnosis
In order to receive ADDT services, a beneficiary must have a
developmental disability diagnosis that originated before the age of 22.
A. A developmental disability is:
1. Is attributable to intellectual
disability, cerebral palsy, spina bifida, Down syndrome, epilepsy or autism
spectrum disorder.
a. Intellectual Disability
- As established by scores of intelligence which fall two or more standard
deviations below the mean of a standardized test of intelligence administered
by a legally qualified professional;
b. Cerebral Palsy - As established by the
results of a medical examination provided by a licensed physician;
c. Spina bifida - As established by the
results of a medical examination provided by a licensed physician.
d. Down syndrome - As established by the
diagnosis of a licensed physician.
e. Epilepsy - As established by the results
of a neurological and/or licensed physician;
f. Autism Spectrum Disorder - As established
by the results of a team evaluation including at least a licensed physician and
a licensed psychologist and a licensed Speech Pathologist;
NOTE: Each of these six conditions is sufficient for
determination of eligibility independent of each other. This means that a
person who is intellectually disabled does not have to have a diagnosis of
autism spectrum disorder, epilepsy, spina bifida, down syndrome, or cerebral
palsy. Conversely, a person who has autism spectrum disorder, cerebral palsy,
epilepsy, spina bifida, or Down syndrome does not have to have an intellectual
disability to receive services.
2. Is attributable to any other condition of
a person found to be closely related to intellectual disability because it
results in impairment of general intellectual functioning or adaptive behavior
similar to those of persons with intellectual disability or requires treatment
and services similar to those required for such persons. This determination
must be based on the results of a team evaluation including at least a licensed
Physician and a licensed Psychologist.
a. tn
the case of individuals being evaluated for service, eligibility determination
shall be based upon establishment of intelligence scores which fall two or more
standard deviations below the mean of a standardized test of intelligence OR,
is attributable to any other condition found to be closely related to an
intellectual disability because it results in impairment of general
intellectual functioning or adaptive behavior similar to those of persons with
an intellectual disability, or requires treatment and services similar to those
required for such persons.
b.
Adults will be eligible for services If their I.Q. scores fall two or more
standard deviations below the mean of a standardized test
3. Is attributable to dyslexia resulting from
intellectual disability, cerebral palsy, epilepsy spina bifida, Down syndrome
or autism spectrum disorder as established by the results of a team evaluation
including at least a licensed Physician and a licensed Psychologist.
NOTE: In the case of individuals being evaluated for service,
eligibility shall be based upon their condition closely related to an
intellectual disability by virtue of their adaptive behavior
functioning.
B.
The disability has continued or is expected to continue indefinitely;
and
C. The disability constitutes a
substantial handicap to the beneficiary's ability to function without
appropriate support services.
212.000 Scope
A. ADDT services in qualified facilities may
be covered only when they are:
1. Provided to
outpatients who have been diagnosed with a developmental disability, and are
either 21 and older or between 18-21 years of age with a diploma or certificate
of completion.
2. Determined
medically necessary for the beneficiary.
3. Provided pursuant to a written
prescription by a physician, and
4.
Provided in accordance with a written, individual program plan (IPP).
B. Outpatients are individuals who
travel to and from a treatment site on the same day, who do not reside in an
intermediate care facility for individuals with developmental disabilities
(ICF/IDD) and who are not inpatients of a hospital.
C. Please refer to Sections 215.000 through
216.100 of this manual for details regarding medical necessity and individual
program plans (IPP).
213.000 Non-Covered Services
Non-covered services include, but are not limited to:
A. Assessment services and adult habilitative
services less than 1 hour in length,
B. Supervised living services,
C. Educational services, and
D. Services to inpatients.
An AODT clinic must provide only those services that DPSQA
licenses the ADDT clinic to provide.
214.000 Coverage of ADDT Services
214.100 ADDT Core Services
ADDT services may be furnished only by DPSQA licensed,
comprehensive adult developmental day treatment centers offering as core
services:
A. Assessment; and
B. Adult Habilitative Services.
214.110 Assessment Services
Assessment services are covered separately from ADDT
habilitative services. Assessment services are reimbursed on a per unit basis
with one unit equal to one hour of service. The length of the service may not
exceed one unit per date of service. The billable unit includes time spent
administering the test, time spent scoring the test and/or time spent writing a
test report. Assessment services are covered once each calendar year, if deemed
medically necessary.
214.120
Adult Habilitative Services
A. Adult
habilitative services are instruction in areas of cognition, communication,
social/emotional, motor, and adaptive (including self-care); or to reinforce
skills learned and practiced in occupational, physical or speech therapy. These
services must be based on the goals and objectives of the client's individual
program plan (IPP). (Refer to Section 215.000 of this manual.)
B. Medicaid covers adult habilitative
services only in clinical settings licensed by DPSQA and enrolled in
Medicaid.
C. Adult habilitative
services are provided to adults who have been diagnosed with a developmental
disability. Qualifying individuals must be between ages 18 and 21 with a
diploma or certificate of completion, or age 21 and older.
D. ADDT providers must ensure that a noon
meal is available to each Medicaid beneficiary who receives at least four hours
of adult habilitative services in a day and who is unable to provide his or her
own meal on that date of service.
1. When
being responsible for providing his or her own meal is a component of a
beneficiary's IPP, the provider may request the beneficiary furnish the
meal.
2. A beneficiary may not be
charged for a meal the facility provides, whether or not providing his or her
own meal is included in the client's IPP.
3. If a beneficiary who is responsible for
providing his or her own meal fails to do so, the provider must furnish a meal
for that individual if he or she receives more than four (4) hours of
habilitative services that day.
E. Adult habilitative services may include
prevocational services that prepare a beneficiary for employment. Prevocational
services:
1. May
not be
job-task oriented, but
a. May include such
habituation goals as compliance, attending, task completion,
problem solving and safety, and
b.
May be provided only to persons who are not expected to be able to join the
general work force or to participate in a transitional sheltered workshop
within one year (excluding supported employment programs).
2. May not be primarily directed at teaching
specific job skills.
3. Must be
listed in the IPP as adult habilitative services and may not address explicit
employment objectives.
4. The
person's compensation must be less than 50% of minimum wage in order for the
training to qualify as prevocational services. Commensurate wage must be paid
under a current Wage and Hour Sheltered Workshop Certificate.
5. Documentation must be maintained in each
person's file showing that the services are not available under a program
funded under Section 110 of the Rehabilitation Act of 1973, as amended, or the
Individuals with Disabilities Education Act (IDEA) of 1997.
F. Adult habilitative services are
established on a unit-of-service basis. Each unit of service equals one (1)
hour in the facility with a maximum of five (5) units reimbursable per day.
Time spent in transit from the person's place of residence to the provider
facility and from the facility back to the person s place of residence is not
included in the unit of service calculation
215.000 Individual Program Plan (IPP)
For each beneficiary who enters the ADDT Program, an individual
program plan (IPP) must be developed. This consists of a written,
individualized plan to improve or maintain the beneficiary's condition based
upon evaluation of the beneficiary. The IPP must contain a written description
of the treatment objectives for the beneficiary. It also must describe:
A. The treatment regimen-the specific
services, therapies and activities that will be used to achieve the treatment
objectives.
B. A schedule for
service delivery-this includes the frequency and duration of each type of
service.
C. The job titles or
credentials of personnel that will furnish each service,
D. A tentative schedule for completing
revaluations of the beneficiary's condition and updating the IPP.
The IPP must be authorized by the physician determining that
ADDT services are medically necessary. The physician's original personal
signature and the date signed must be recorded on the IPP. Delegation of this
function or a stamped signature is not allowed.
216.000 ADDT Optional Services
216.100 Occupational, Physical and Speech
Therapy
Optional services available through ADDT include occupational,
physical and speech therapy and assessment as an essential component of the
individual program plan (IPP) for an individual accepted for adult
developmental disabilities services.
A. The ADDT client's primary care physician
(PCP) or attending physician must refer a client for assessment for
occupational, physical or speech therapy services.
B. If the beneficiary qualifies for services
based on the assessment, the ADDT client's primary care physician (PCP) or
attending physician must prescribe occupational, physical and/or speech therapy
services. The prescribed therapy must be included in the individual's ADDT IPP.
A copy of the prescription must be maintained in the beneficiary's records. The
original prescription is to be maintained by the prescribing physician. After
the initial referral and initial prescription, subsequent referrals and
prescriptions forcontinued therapy may be made at the same time. Medicaid will
accept an electronic signature provided it is in compliance with Arkansas Code
25-31-103.
C. Therapies in the ADDT Program may be
provided only to individuals whose IPP includes adult nabilitative services.
Medicaid does not cover optional therapy services furnished by an ADDT provider
as "stand-alone" services. To ensure quality care, group therapy sessions are
limited to no more than four persons in a group.
1. When an ADDT provider renders therapy
services in conjunction with an ADDT core service, therapy services must be
billed by the ADDT provider according to billing instructions in Section II of
thismanual.
2. ADDT providers may
not bill under the Medicaid Occupational, Physical and Speech Therapy Program
for therapy services available in the ADDT Program and provided to ADDT
clients.
3. Therapy services may
not be provided during the same time period ADDT core services are
provided.
D. Arkansas
Medicaid applies the following therapy benefits to all therapy services
provided In the ADDT program:
1. Medicaid
will reimburse up to four (4) occupational, physical and speech therapy
evaluation units (1 unit = 30 minutes) per discipline, per state fiscal year
(July 1 through June 30) without authorization. Additional evaluation units for
beneficiaries under age 21 will require an extended therapy request.
2. Medicaid will reimburse up to six (6)
occupational, physical and speech therapy units (1 unit = 15 minutes) per week,
per discipline, without prior authorization.
E. Therapy services carried out by an
unlicensed therapy student may be covered only when the following criteria are
mef
1. Therapies performed by an unlicensed
student must be under the direction of a licensed therapist and the direction
is such that the licensed therapist is considered to be providing the medical
assistance
2. The licensed
therapist must be present and engaged in student oversight during the entirety
of any encounter.
F. All
therapy services must be provided and billed in accordance with the
Arkansas Medicaid Provider Manual for Occupational, Physical and Speech
Therapy Services.
216.200 Nursing Services
Nursing services are available for beneficiaries who are
medically fragile, have complex health needs, or both, if prescribed by the
beneficiary's PCP and prior authorized, in accordance with this manual.
Nursing services that are needed by a beneficiary and that can
only be performed by a licensed nurse may be billed by an ADDT with prior
authorization. For the purposes of this manual, nursing services are defined as
the following, or similar, activities:
1. Assisting ventilator-dependent
beneficiaries;
2. Tracheostomy:
suctioning and care;
3. Feeding
tube: feeding, care and maintenance;
4. Catheterizations;
5. Breathing treatments; and
6. Monitoring of vital statistics, including
diabetes sugar checks, insulin, blood draws and pulse ox; and
7. Administration of medication.
Reimbursable nursing services do not include the taking of
temperature, or provision of standard first aid.
Administration of medication alone does not qualify a
beneficiary for nursing services.
Nursing services must be performed by a licensed Registered
Nurse or Licensed Practical Nurse, and must be within the nurse's scope of
practice as set forth by the Arkansas State Board of Nursing.
All nursing services must be prior authorized. To establish
medical necessity for nursing services, the beneficiary must have a medical
diagnosis and a comprehensive nursing evaluation approved by a PCP that
designates the need for nursing services. The evaluation must specify what the
needed nursing services are, and the number of nursing units needed per
day.
217.000
Establishing Medical Necessity for ADDT
217.100 Establishing Medical Necessity for
Core Services
Reimbursement for ADDT services will be approved only when the
individual's attending physician has determined ADDT core services are
medically necessary.
A. The physician
must identify the individual's medical needs or medical or developmental
diagnosis that habilitative services can address.
B. To initiate ADDT services the individual's
physician must issue a written prescription. The prescription for ADDT is valid
for one year unless the prescribing physician specifies a shorter period of
time. The prescription must be renewed at least once a year for services to
continue.
C. Each prescription must
be dated and signed by the physician with his or her original signature to be
considered a valid prescription.
D.
It is presumed that no more than eight (8) hours of ADDT core services and
optional services combined per day is medically necessary.
217.200 Establishing Medical Necessity for
Occupational, Physical and
Speech Therapy Services
Occupational, physical, and speech therapy services must be
medically necessary to the treatment of the beneficiary's developmental
disability, in accordance with the Medicaid Provider Manual for Occupational,
Physical, and Speech Therapy Services, Section II. A diagnosis alone is not
sufficient documentation to support the medical necessity of therapy.
230.000
REIMBURSEMENT AND
RECOUPMENT
231.000 Method of
Reimbursement
The reimbursement methodology for ADDT services is a "fee
schedule" methodology. Under the fee schedule methodology, reimbursement is
made at the lower of the billed charge for each procedure or the maximum
allowable for each procedure. The maximum allowable fee for a procedure is the
same for alt ADDT providers.
231.100 Fee Schedules
Arkansas Medicaid provides fee schedules on the Arkansas
Medicaid website. The fee schedule link is located at
https://www.medicaid.state.ar.us
under the provider manual section. The fees represent the fee-for-service
reimbursement methodology.
Fee schedules do not address coverage limitations or special
instructions applied by Arkansas Medicaid before final payment is
determined-Procedure codes and/or fee schedules do not guarantee payment,
coverage or amount allowed. Information may be changed or updated at any time
to correct a discrepancy and/or error. Arkansas Medicaid always reimburses the
lesser of the amount billed or the Medicaid maximum.
232.000 Retrospective Reviews
Arkansas Medicaid conducts retrospective reviews of all
non-prior authorized ADDT services. The purpose of the retrospective review is
to promote the effective, efficient, and economical delivery of health care
services.
The Quality Improvement Organization (QIO) under contract to
the Arkansas Medicaid program performs retrospective reviews of medical records
to determine if services delivered and reimbursed by Medicaid meet medical
necessity requirements as outlined in the Medicaid Provider Manual.
233.000 Recoupment
The Division of Medical Services (DMS). Utilization Review
Section (UR) is required to initiate the recoupment process for all services
denied by the Arkansas Medicaid programs' contracted
Quality Improvement Organization (QIO) for retrospective
therapy reviews for not meeting the medical necessity requirement. Based on QIO
findings during retrospective reviews, UR will initiate recoupment as
appropriate.
DMS will send the provider an Explanation of Recoupment Notice
that will include the claim date of service, Medicaid beneficiary name and ID
number, service provided, amount paid by Medicaid, amount to be recouped, and
the reason the claim has been denied.
234.000 Administrative Reconsideration
When a provider or beneficiary wishes to ask for administrative
reconsideration of a DH3 decision, he or she should follow the procedure laid
out in the Medicaid Provider Manual, Section 161.200.
234.100 Appeal Process
When the Division of Medical Services (DMS) denies coverage of
services, the beneficiary or the provider may request a fair hearing to appeal
the denial of services from the Department of Health and Human Services. To do
so, the beneficiary or provider should follow the procedures laid out in the
Medicaid Provider Manual, Sections 160.000 & 190.000.
234.200 Utilization Review
A. The Utilization Review Section of the
Arkansas Medicaid Program has the responsibility for assuring quality medical
care for Medicaid beneficiaries and for protecting the integrity of state and
federal funds supporting the Medical Assistance Program. Those responsibilities
are mandated by federal regulations.
B. The Utilization Review team shall:
1. Conduct on-site medical audits for the
purpose of verifying the nature and extent of services paid for by the Medicaid
Program,
2. Research all inquiries
from beneficiaries in response to the Explanation of Medicaid Benefits
and
3. Retrospectively evaluate
medical practice patterns and providers' patterns by comparing each provider's
pattern to norms and limits set by all the providers of the same
specialty.
240.000
BILLING PROCEDURES
241.000 Introduction To Billing
ADDT service providers use form CMS-1500 to bill the Arkansas
Medicaid Program for services provided to Medicaid beneficiaries. Each claim
may contain charges for only one beneficiary,
Section III of this manual contains information about Provider
Electronic Solutions (PES) and other available options for electronic claim
submission.
242.000
CMS-1500 Billing Procedures
242.100
ADDT Core Services Procedure Cades
ADDT core services are reimbursable on a per unit basis.
Partial units are not reimbursable. Service time less than a full unit of
service may not be rounded up to a full unit of service and may not be carried
over to the next service date.
|
Procedure Code |
Required Modifier |
Description |
|
T1015 |
U6, UA |
Adult Habilitative Services (1 unit equals 1 hour of
sen/ice; maximum of 5 cumulative units per day.) |
|
T1023 |
U6, UA |
Diagnosis and Evaluation Services (not to be billed for
therapy evaluations) (1 unit equals 1 hour; maximum of 1 unit per day, once per
year.) |
|
T1002 |
U6.UB |
Nursing Services (must be prior authorized; 1 unit
equals 15 minutes of service) |
|
99367 |
U6, UC |
Treatment Plan Development. Plan must include short and
long term goals and objectives and the activities to meet those goals and
objectives (1 unit equals 1 event; limit of 1
unit annually) |
242.110 Occupational Physical and Speech
Therapy Procedure Codes
ADDT therapy services may be provided only outside the time
ADDT core services are furnished. The following procedure codes must be used
for therapy services in the ADDT Program for Medicaid beneficiaries of all
ages.
A. Occupational Therapy
Procedure Codes
|
Procedure Code |
Required Modifier(s)
|
Description |
|
97003 |
Evaluation for occupational therapy (30-minute unit;
maximum of 4 units per state fiscal year, July 1 through June
30) | |
|
97150 |
U1.UB |
Group occupational therapy by occupational therapy
assistant (15-minute unit; maximum of 4 units per day, maximum of 4 clients per
group) |
|
97150 |
U2 |
Group occupational therapy by Occupational Therapist
(15-minute unit; maximum of 4 units per day, maximum of 4 clients per
group) |
|
97530 |
- |
Individual occupational therapy by Occupational
Therapist (15-minute unit; maximum of 4 units per day) |
|
97530 |
UB |
Individual occupational therapy by occupational therapy
assistant (15-minute unit; maximum of 4 units per day) |
B.
Physical Therapy Procedure Codes
|
Procedure Code |
Required Modifier(s) |
Description |
|
97001 |
- |
Evaluation for physical therapy (30-minute unit;
maximum of 4 units per state fiscal year, July 1 through June 30) |
|
97110 |
- |
Individual physical therapy by Physical Therapist
(15-minute unit; maximum of 4 units per day) |
|
97110 |
UB |
Individual physical therapy by physical therapy
assistant (15-minute unit; maximum of 4 units per day) |
|
97150 |
- |
Group physical therapy by Physical Therapist (15-minute
unit; maximum of 4 units per day, maximum of 4 clients per group) |
|
97150 |
UB |
Group physical therapy by physical therapy assistant
(15-minute unit; maximum of 4 units per day, maximum of 4 clients per
group) |
C.
Speech Therapy Procedure Codes
|
Procedure Code |
Required Modifier(s) |
Description |
|
92521 |
UA |
*'*Evaluation of speech fluency (e.g. stuttering,
cluttering) (maximum of four 30-minute units per state fiscal year, July 1
through June 30) |
|
92522 |
UA |
*"*Evaluation of speech sound production (e.g.
articulation, phonological process, apraxia, dysarthria) (maximum of four
30-minute units per state fiscal year, July 1 through June 30) |
|
92523 |
UA |
*"*Evaluation of speech sound production (e.g.
articulation, phonological process, apraxia, dysarthria) with evaluation of
language comprehension and expression (e.g. receptive and expressive language)
(maximum of four 30-minute units per state fiscal year, July 1 through June
30) |
|
92524 |
UA |
*"*Behavioral and qualitative analysis of voice and
resonance (maximum of four 30-minute units per state fiscal year, July 1
through June 30) |
|
92507 |
- |
Individual speech session by Speech Therapist
(15-minute unit; maximum of 4 units per day) |
|
92507 |
UB |
Individual speech therapy by speech language pathology
assistant (15-minute unit; maximum of 4 units per day) |
|
92508 |
- |
Group speech session by Speech Therapist (15-minute
unit; maximum of 4 units per day, maximum of 4 clients per group) |
|
92508 |
UB |
Group speech therapy by speech language pathology
assistant (15-minute unit; maximum of 4 units per day, maximum of 4 clients per
group) |
NOTE: A(...) This symbol, along with text In parentheses,
Indicates the Arkansas
Medicaid description of the service. When using a
procedure code with this symbol, the service must meet the indicated Arkansas
Medicaid description.
242.200 National Place of Service (POS) Codes
Listed below is the National Place of Service (POS) Code for
ADDT procedures.
Electronic and paper claims now require the same National Place
of Service code.
|
Place of Service |
POS Codes |
|
Day Care Facility/ADDT Clinic |
99 |
242.300
Billing Instructions-
Paper Only
The Arkansas Medicaid fiscal agent offers providers several
options for electronic billing. Therefore, claims submitted on paper are lower
priority and are paid once a month. The only claims exempt from this rule are
those that require attachments or manual pricing.
Bill Medicaid for professional services with form CMS-1500. The
numbered items in the following instructions correspond to the numbered fields
on the claim form. View a sample form CMS-1500.
Carefully follow these instructions to help the Arkansas
Medicaid fiscal agent efficiently process claims. Accuracy, completeness, and
clarity are essential. Claims cannot be processed if necessary information is
omitted.
Forward completed claim forms to the Claims Department. View or
print the Claims Department contact information,
NOTE: A provider delivering services without verifying
beneficiary eligibility for each date of service does so at the risk of not
being reimbursed for the services.
242.310 Completion of the CMS-1500 Claim Form
|
Field Name and Number |
Instructions for Completion |
|
1. (type of coverage)
1a. INSUREDS I.D. NUMBER (For Program in Item
1) |
Not required.
Beneficiary's or participant's 10-digit Medicaid
identification number. |
|
2. PATIENTS NAME (Last Name, First Name,
Middle Initial) |
Beneficiary's or participant's last name and first
name |
|
3. PATIENT'S BIRTH DATE SEX |
Beneficiary's or participant's date of birth as given
on the individual's Medicaid identification card, Format: MM/DD/YY.
Check M for male or F for female- |
|
4. INSURED'S NAME (Last Name, FirstName,
Middle Initial) |
Required if insurance affects this claim. Insured's
last
name, first name, and middle initial |
|
5. PATIENT'S ADDRESS (No., Street)
CITY
STATE ZIP CODE |
Optional. Beneficiary s or participant s complete
mailing address (street address or post office box)
Name of the city in which the beneficiary or
participant resides.
Two-letter postal code for the state in which the
beneficiary or participant resides.
Five-digit zip code; nine digits for post office
box. |
|
TELEPHONE (Include Area Code) |
The beneficiary's or participant's telephone number or
the number of a reliable message/contact/ emergency telephone. |
|
6. PATIENT RELATIONSHIP TO INSURED |
If insurance affects this claim, check the box
indicating the patient's relationship to the insured. |
|
7. INSURED'S ADDRESS (No., Street)
CITY
STATE
ZIP CODE
TELEPHONE (Include Area Code) |
Required if insured's address is different from the
patient's address. |
|
8. RESERVED |
Reserved for NUCC use. |
|
9. OTHER INSUREDS NAME (Last name, First Name, Middle
Initial)
a. OTHER INSURED'S POLICY OR GROUP NUMBER
b. RESERVED SEX
c. RESERVED
d. INSURANCE PLAN NAME OR PROGRAM
NAME |
If patient has other insurance coverage as indicated in
Field 11d, the other insured's last name, first name, and middle
initial.
Policy and/or group number of the insured
individual.
Reserved for NUCC use.
Not required.
Reserved for NUCC use.
Name of the insurance company. |
|
10. IS PATIENT'S CONDITION RELATED TO:
a. EMPLOYMENT? (Current or Previous)
b. AUTO ACCIDENT? PLACE (State)
c. OTHER ACCIDENT?
d. CLAIMS CODES |
Check YES or NO.
Required when an auto accident is related to the
services. Check YES or NO.
If 10b is YES, the two-letter postal abbreviation for
the state in which the automobile accident took place.
Required when an accident other than automobile is
related to the services. Check YES or NO.
The "Claim Codes" identify additional information about
the beneficiary's condition or the claim. When applicable, use the Claim Code
to report appropriate claim codes as designated by the NUCC. When required to
provide the subset of Condition Codes, enter the condition code in this field.
The subset of approved Condition Codes is found at
www.nucc.org under Code
Sets. |
|
11. INSUREDS POLICY GROUP OR FECA NUMBER |
Not required when Medicaid is the only
payer. |
|
a. INSURED'S DATE OF BIRTH
SEX
b. OTHER CLAIM ID NUMBER
c. INSURANCE PLAN NAME OR PROGRAM NAME
d. IS THERE ANOTHER HEALTH BENEFIT PLAN? |
Not required.
Not required, Not required.
Not required.
When private or other insurance may or will cover any
of the services, check YES and complete items 9, 9a and 9d. Only one box can be
marked. |
|
12. PATIENTS OR AUTHORIZED PERSON'S
SIGNATURE |
Enter "Signature on File," "SOF" or legal
signature, |
|
13. INSURED'S OR
AUTHORIZED PERSON'S SIGNATURE |
Enter "Signature on File," "SOF" or legal
signature. |
|
14. DATE OF CURRENT:
ILLNESS (First symptom) OR INJURY (Accident) OR
PREGNANCY (LMP) |
Required when services furnished are related to an
accident, whether the accident is recent or in the past. Date of the
accident.
Enter the qualifier to the right of the vertical dotted
line. Use Qualifier 431 Onset of Current Symptoms or Illness; 484 Last
Menstrual Period- |
|
15. OTHER DATE |
Enter another date related to the beneficiary's
condition or treatment, Enter the qualifier between the left-hand set of
vertical, dotted lines.
The "Other Date" identifies additional date information
about the beneficiary's condition or treatment. Use qualifiers:
454 Initial Treatment
304 Latest Visit or Consultation
453 Acute Manifestation of a Chronic Condition
439 Accident
455 Last X-Ray 471 Prescription
090 Report Start (Assumed Care Date)
091 Report End (Relinquished Care Date) 444 First Visit
or Consultation |
|
16. DATES PATIENT UNABLE TO WORK IN CURRENT
OCCUPATION |
Not required. |
|
17. NAME OF REFERRING PROVIDER OR OTHER
SOURCE |
Referring physician's name and title. ADDT optional
therapy services require primary care physician (PCP) referral. |
|
17a. (blank) 17b. NPI |
The 9-digit Arkansas Medicaid provider ID number of the
referring physician.
Not required. |
|
18. HOSPITALIZATION DATES
RELATED TO CURRENT SERVICES |
When the serving/billing provider's services charged on
this claim are related to a beneficiary's or participant's inpatient
hospitalization, enter the individual's admission and discharge dates. Format;
MM/DD/YY. |
|
19. ADDITIONAL CLAIM
INFORMATION
Code
E
F |
For tracking purposes, ADDT providers are required to
enter one of the following therapy codes:
Category
Individuals aged 18 years and up who are receiving
therapy services through the Division of Developmental Disabilities
Services.
Individuals aged 18 years and up who are receiving
therapy services through individual or group providers not included in any of
the previous categories (A-E). |
|
20. OUTSIDE LAB? $ CHARGES |
Not required. Not required. |
|
21. DIAGNOSIS OR NATURE OF ILLNESS OR
INJURY |
Enter the applicable ICD indicator to identify which
version of ICD codes is being reported.
Use "9" for ICD-9-CM
Use"[LESS THAN]rforlCD-10-CM.
Enter the indicator between the vertical, dotted lines
in the upper right-hand portion of the field.
Diagnosis code for the primary medical condition for
which services are being billed. Use the appropriate International
Classification of Diseases (ICD). List no more than 12 diagnosis codes. Relate
lines A-L to the lines of service in 24E by the letter of the line. Use the
highest level of specificity. |
|
22. RESUBMISSION CODE ORIGINAL REF. NO. |
Reserved for future use.
Any data or other information listed in this field does
not/will not adjust, void or otherwise modify any previous payment or denial of
a claim. Claim payment adjustments, voids and refunds must follow previously
established processes in policy. |
|
23. PRIOR AUTHORIZATION
NUMBER |
The prior authorization or benefit extension control
number if applicable. |
|
24A. DATE(S) OF SERVICE
B. PLACE OF SERVICE
C. EMG
D. PROCEDURES, SERVICES, OR SUPPLIES
CPT/HCPCS
MODIFIER
E. DIAGNOSIS POINTER
F. $ CHARGES
G. DAYS OR UNITS H. EPSDT/Family Plan
1. ID QUAL
J. RENDERING PROVIDER ID#
NPI |
The "from" and "to" dates of service for each billed
service. Format: MM/DD/YY.
1. On a single claim detail (one charge on one line),
bill only for services provided within a single calendar month.
2. Providers may bill on the same claim detail
for
two or more sequential dates of service within the same
calendar month when the provider furnished equal amounts of the service on each
day of the date sequence.
Two-digit national standard place of service code. See
Section 262.200 for codes.
Enter "Y" for "Yes" or leave blank if "No." EMG
identifies if the service was an emergency.
Enter the correct CPT or HCPCS procedure code from
Sections 262.100 through 262.110.
Enter the applicable modifier from Section
262.110.
Enter the diagnosis code reference letter (pointer) as
shown in Item Number 21 to relate to the date of service and the procedures
performed to the primary diagnosis, When multiple services are performed, the
primary reference letter for each service should be listed first, other
applicable services should follow, The reference letter(s) should be A-L or
multiple tetters as applicable, The "Diagnosis Pointer" is the line letter from
Item Number 21 that relates to the reason the service(s) was performed
The full charge for the service(s) totaled in the
detail. This charge must be the usual charge to any client, patient, or other
beneficiary of the provider's services.
The units (in whole numbers) of service(s) provided
during the period indicated in Field 24A of the detail,
Enter E if the services resulted from a Child Health
Services (EPSDT) screening/referral.
Not required
The 9-digit Arkansas Medicaid provider ID number of the
individual who furnished the services billed for in the detail
Not required. |
|
25. FEDERAL TAX I.D. NUMBER |
Not required This information is carried in the
provider's Medicaid file. If it changes, please contact Provider
Enrollment. |
|
26. PATIENT'S ACCOUNT N O. |
Optional entry that may be used for accounting
purposes; use up to 16 numeric or alphabetic characters. This number appears on
the Remittance Advice as "MRN." |
|
27. ACCEPT ASSIGNMENT? |
Not required. Assignment is automatically accepted by
the provider when billing Medicaid. |
|
28. TOTAL CHARGE |
Total of Column 24F-the sum all charges on the
claim. |
|
29. AMOUNT PAID |
Enter the total of payments previously received on this
claim. Do not include amounts previously paid by Medicaid. *Do not include in
this total the automatically deducted Medicaid or co-payments. |
|
30. RESERVED |
Reserved for NUCC use. |
|
31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING
DEGREES OR CREDENTIALS |
The provider or designated authorized individual must
sign and date the claim certifying that the services were personally rendered
by the provider or under the provider's direction. "Provider's signature" is
defined as the provider's actual signature, a rubber stamp of the provider's
signature, an automated signature, a typewritten signature, or the signature of
an individual authorized by the provider rendering the service. The name of a
clinic or group is not acceptable. |
|
32. SERVICE FACILITY
LOCATION INFORMATION
a. (blank)
b, (blank) |
If other than home or office, enter the name and
street, city, state, and zip code of the facility where services were
performed.
Not required.
Not required. |
|
33. BILLING PROVIDER INFO & PH #
a. (blank)
b. (blank) |
Billing provider's name and complete address. Telephone
number is requested but not required.
Not required.
Enter the 9-digit Arkansas Medicaid provider ID number
of the billing provider. |
242.400Special Billing Procedure
Special billing procedure are not applicable to this
program
100
GOVERNING BOARD/ORGANIZATION / LEADERSHIP
Guiding Principles:The Governing
Board/organization/Leadership is that body of people who have been chosen by
the corporation and vested with legal authority to be responsible for directing
the business and affairs of the corporation. The responsibilities assured by
each Board/organization member by their acceptance of membership are to provide
effective and ethical governance leadership on behalf of its
owners'/stakeholders' interest to ensure that the organization focuses on its
purpose and outcomes for persons served, resulting in the organization's
long-term success and stability.
The mission statement of the organization is-based on the
Board/organization's philosophical motivations, the services provided, and
values of the members. The mission statement should identify the population to
be served and the services to be provided. This description shall be
nondiscriminatory by reason of sex, age, disability, creed, marital status,
ethnic, or national membership.
NOTE: See Arkansas Code Ann. §§
20-48-201 -
20-48-211
for examples of Board/organization responsibilities.
NOTE: All information regarding your organization shall be
readily available to staff, consumers,
referral and funding sources, and the interested public
pursuant to the Freedom of Infonnation Act.
101 The organization shall be legally
incorporated under the appropriate federal, state or local statues as defined
by its official Articles of Incorporation and registered to do business in the
State of Arkansas.
A. The governing body
should periodically rev ievv the appropriateness of its governing documents.
(Ark. Code Ann. 4}t}
20-48-201 -
20-48-211). This shall include the organizations mission statement as filed with the
Secretary of State, and the Articles of Incorporation.
B. Any changes in the Articles of
Incorporation must be filed with the Secretary of State. This includes name
changes, amendments, or any reconstitution of the Governing Board'organization.
The organization shall provide copies of any changes to DDS upon
filing.
102 Bylaws shall
be established which govern the internal affairs of the organization and will
address each of the following areas as applicable:
A. Composition of Board
1. This shall include the number of Board
members and the eligibility criteria (i.e. citizenship and
residency).
2. Selection of Board
members a. Twenty percent (20°o) consumer and advocate representation on
the Board is required. (Note; defined as a consumer, immediate family
member or guardian of a consumer receiving services or has received services at
the organization or person in a qualified position that advocates on behalf of
the population sened)
B. Term of membership:
1. Number of years as dictated by the
organization's Articles of Incorporation. Note: It is recommended that
membership on the governing body be rotated periodically.
C. Replacement/removal of
directors:
1. Refers to written criteria for
Board membership Shall include any contingency to include but not be limited to
resignation of Board organization members and removal for non-attendance or
other reasons.
D.
Election of officers and directors:
1.
Describe the election process
E. Duties and responsibilities of Board
officers, are described in writing
1. Must
document each position's purpose, structure, responsibilities, authority, if
any, and the relationship of the advisory committee of Board members to other
entities involved with the organization.
F. Appointment of committees, if applicable;
1. Duties and functions of standing
committees are described in writing, if applicable.
G. Meetings of the Board organization and its
committees. All meetings shall be planned, organized, and conducted in
accordance with the organization's by-laws, policies, procedures, applicable
statutes, or other appropriate regulations. In no event shall the full Board
organization meet less than four times per year.
Note: The Board/organization and its committees should
meet with a frequency sufficient to discharge their responsibilities
effectively.
H.
The Board/organization shall adopt written procedures to guide the conduct of
its meetings i.e. Parliamentary Procedure, Robert's Rules of Order, etc.);
I. The Board, organization shall
maintain minutes of all actions taken by the
Board organization for review by DDS. Minutes shall accurately
document all members present and any action taken at the committee meetings to
include any committee recommendations to the Board organization.
1. Written minutes of previous Board
organization meetings should be made available by posting the adopted minutes
in a location convenient to the staff and individuals served, and made
available to members of the public upon request, as required under the Freedom
of Information Act.
103 The Board organization shall establish a
procedural statement addressing nepotism as it relates to Board organization
and staff positions.
103.1 The
Board shall establish a procedural statement addressing conflict of interest
Note: The intent of the standard does not rule out a
business relationship, hut does call for the governing body to decide in
advance what relationships are in the best interest of the
organization.
A. Paid
employees may not serve as Board members. (Note: This
pots no
I include individuals receiving services.)
Note: Paid employees serving on the Hoard as of 11 01
07 max continue to serve for the remainder of their current term at w Inch lime
they must rotate off the Hoard.
B. Directors of organizations may serve as
non-voting ex officio Board members.
104 Board organization meetings and public
meetings as defined by Ark. Code Ann. §§
25-19-106
shall be conducted at a time and place which make the meetings accessible to
the public. Specifically, except as otherwise specifically provided by law, all
meetings, formal or informal, special or regular, of the governing bodies of
all municipalities, counties, townships, and school districts and all boards,
bureaus, commissions, or organizations of the State of Arkansas, except grand
juries, supported wholly or in part by public funds or expending public funds,
shall be public meetings.
A.
Board/organization meetings and Executive sessions shall be announced to be in
compliance with Ark. Code Ann. §§
25-19-101 -
25-19-107"Freedom of Information Act"
B. All
local media are to be notified one week in advance and a notice posted in a
prominent place by the organization. Called meetings shall be announced to the
local media and others who have requested notification at least two hours in
advance of meeting. Documentation of Notification may include newspaper
clippings, copy of item posted on bulletin Board, organization, radio contact
forms, etc.
D. If the meetings arc
held each month at the same time and location, one notification and posting
shall be sufficient.
105
The Board/organization of Directors shall adopt a mission statement to guide
its activities and to establish goals for the organization. The plan shall show
evidence of participation by stakeholders (evidence of open meeting, letters of
input, survey, questionnaire, etc.).
105.1 The Board organization of Directors
shall review the mission statement annually and shall make changes as necessary
to ensure the overall goals and objectives of the organization are reflected in
its mission.
106 The Board
organization maintains a plan which shall identify annual and long range goals;
the plan should address community needs and target populations and should be
reviewed and updated annually.
A. Each Board
organization will develop and implement a long-range plan of action for that
organization. Examples include, but are not limited to starting a new
component, accessing individualized services in the community, etc.
B. Development and implementation of the plan
shall include stakeholder input. The organization shall maintain evidence of
this input (i.e., letters of input, minutes of open meetings, questionnaires,
surveys, etc.)
C. The plan shall be
reviewed annually and updated as needed. The Board organization shall approve
the initiation, expansion, or modification of the organization's program based
on the needs of the community and the capability of the organization to have an
effect upon those needs within its established goals and objectives.
Note: The Board organization of Directors, at its
discretion, may assign this responsibility to staff.
107 The Board/organization shall
demonstrate corporate social responsibility while maintaining overall
accountability for the administration and direction of the organization, and
shall delegate authority and responsibility to executive leadership as deemed
appropriate by the organization.
A. The
organization shall identify:
1. Its
leadership structure.
2. The roles
and responsibilities of each level of leadership.
B. The identified leadership shall guide the
following:
1. Establishment of the mission
and direction of the organization.
2. Promotion of value achievement of outcomes
in the programs and services offered.
3. Balancing the expectations of both the
persons served and other stakeholders, as defined by the organization's
policies.
4. Financial
solvency.
5. Compliance with
insurance and risk management requirements.
6. Ongoing performance improvement.
7. Development and implementation of
corporate responsibilities.
8.
Compliance with all legal and regulatory requirements.
C. The organization shall respond to the
diversity of its stakeholders with respect to:
1. Culture.
2. Age.
3. Gender.
4. Sexual orientation.
5. Spiritual beliefs,
6. Socioeconomic status.
7. Language.
108 The Board organization shall create a
mechanism for monitoring the decisions and operations of the organization's
programs which includes provisions for the periodic review and evaluation of
its program in relation to the program goals. Documentation of the review must
be maintained on file for review. Documentation may include but not be limited
to Board'organization minutes, reports, etc.
Guiding Principle: An organized training program
for Board/organization Members prepares them for their responsibilities and
assures that they are kept up-to-date on issues concerning services offered to
individuals with a developmental disability
109 The Board shall maintain a general plan
for Board organization training and will ensure that all items listed as
required topics are covered in the required three-hour training.
A. Training shall be provided for all Board,
organization members. Where the Board, because of its size, lacks sufficient
resources to conduct a training program, it will make arrangements with another
Board, organization, agency, appropriate community resource, or training
organization lo provide such training.
109.1New Board Members must participate in a
minimum of three hours of training,
A. The
following topics shall be required during the first year of service
1. Functions and Responsibilities of the
Board
2. Composition and Size of
the Board
3. Legal
Responsibilities
4. Funding Sources
and Responsibilities,
5. Equal
Employment Opportunity Affirmative Action,
6. Due Process
7. Ark. Code Ann. §§
25-19-101 -
25-19-107"Freedom of Information Act of 1967"
8. U. S. C. § 12101 et. seq. "Title 42
THE PUBLIC HEALTH AND WELFARE-CHAPTER 126- EQUAL OPPORTUNITY FOR INDIVIDUALS
WITH DISABILITIES-!} 12101. Findings and purpose"
9. DDS Service Policy 3004-1 Maltreatment
Prevention, Reporting and Investigation;
10. DHS Policy 1090, Incident
Reporting.
11. DDS Administrative
Policy 1077
12. Chemical Right to
Know
13. The Health Insurance
Portability and Accountability Act (HIPAA)
Note: Possible Tra i king resol rces include aspen Pub
actnews, which has ma teria ls
ONBOARD/ORGANIZATtO\ ASD ADMINISTRATOR TRAINING.
(HUH.ASPENPUBLISHERS.COM)
Resources or additional information should be obtained
from DDS Licensure.
B. All new Board members as they begin
service shall participate in training. Board members may disseminate training
information to new Board members if they are unable to attend formal training
sessions. Documentation of the information provided, date provided and the
board membcr(s) involved must be maintained for review by DDS. (Note: Training
may be documented in Board minutes or by Certificates of
Attendance.)
109.2 All
Board members shall complete a minimum of three hours annual training. Topics
may be selected by the Board of Directors and must be germane to the annual
plan and services provided. Training should be documented in Board minutes, by
Certificates of Attendance or sign in sheets from approved training.
110 Board members shall visit service
components of the organization during operating hours yearly.
A. All components of the organization must be
observ ed annually. If on-site observations to each physical location are not
feasible, at least I physical site from each program component must be observed
during the calendar year. The sites must be rotated yearly. Committees or
individual Board Members may be appointed to visit specific components and
report back to the other Board members on observations. Documentation of
reports in Board minutes shall be accepted as verification,
111 The Board organization shall
establish and approve policies and procedures which define
Eligibility criteria, Readmission criteria, and transition
discharge exit criteria
112
The Board, organization shall establish policy regarding financial oversight of
the organization that addresses the following:
A. The organization's financial planning and
management activities reflect strategic planning designed to meet:
1. Established outcomes for the persons
served.
2. Organizational
performance objectives.
B.Budgets are prepared that:
1. Include:
a. Reasonable projections of revenues and
expenditures.
b. Input from various
stakeholders, as required.
c.
Comparison to historical performance.
2. Are disseminated to:
a. Appropriate personnel.
b. Other stakeholders, as
appropriate.
3. Arc
written.
C. Actual
financial results are:
1. Compared to
budget,
2. Reported to:
a. Appropriate personnel.
b. Persons served, as appropriate.
c. Other stakeholders, as required.
3. Reviewed at least
quarterly.
D. The
organization identifies and reviews, at a minimum:
1. Revenues and expenses.
2. Internal and external;
a. Financial trends,
b. Financial challenges,
c. Financial opportunities.
d. Business trends.
e. Management information.
3. Financial solvency, with the
development and implementation of remediation plans, if appropriate.
113 For-profit
organizations or organizations uho receiv e less than SI (),()()() in
compensation for services under this program shall submit a compilation report
(hat includes a balance sheet and statement of revenue and expense to DDS at
the close of each financial period,
Note: Sections 102 & 104 do not apply to organizations that
are not governed by a Board of Directors
200 PERSONNEL PROCEDURES & RECORDS
201 The organization shall maintain written
personnel procedures that are approved by the Board and are reviewed annually
and which conform to state and federal laws, rules and regulations.
NOTE: DDS SHALL NOT BECOME DIRECTLY IMOLl ED IN
PERSONNEL ISSUES UNLESS IT DIRECTLY IMPACTS CONSUMER CARE AXD/OR
SAFETY.
201.1 Personnel procedures shall be clearly
stated and available in written form to employees as required by
42
U.S.C. §
2000a - 2000 h-6 "Title VI of
the Civil Rights Act of 1964" and U.S.C. § 1201 et. Seq. Americans with
Disabilities Act. These include but are not limited to:
A. Hiring and promotional procedures which
are nondiscriminatory by reason of sex, age, disability, creed, marital status,
ethnic, or national membership
B. A
procedure for discipline, suspension and or dismissal of staff which includes
opportunities for appeal
C. An
appeals procedure allowing for objective review of concerns and
complaints
201.2 One
copy of the organization's Personnel procedures must be available in the
personnel or administrator's office. This copy must be readily accessible to
each employee.
201.3 The
organization shall develop and implement steps to voice grievances within the
organization. All grievances are subject to review by the Governing Board and
Court of Law (29 U.S.C. §§
706(8),
794
-
794(b),
the "Rehabilitation Act of 1973 Section 504;
20 U.S.C. §
1400. et. Seq. Section 615 "The Individual
Disabilities Education Act".
A. All steps in
the Grievance Procedure should be time4x[GREATER THAN]und and documented,
including initial tiling of grievance.
201.4 The organization shall develop and
implement policies regarding whether pre-employment and random drug testing
will be required. If the organization chooses to do drug testing they must
establish guidelines for actions to be taken when the drug test results are
obtained, whether positive or negative.
Note: The organization may contact Arkansas Transit Association
for further information on drug testing
202 Prior to employment, a completed job
application must be submitted which includes the following documents.
A. The organization shall obtain and verify
PRIOR to employment and maintain documentation of the following:
1. The ereden I ia I s req ui red
2. That required credentials remain
current
3. The applicant has
completed a statement related to criminal convictions
4. A criminal background check has been
initiated. Refer to DDS Policy 1087.
5. Declaration of truth of statement on job
application.
6. A release to
complete reference checks is signed and reference checks have been
completed
7. Results of
pre-employment drug screen, if required by organization.
NOTE:THE ITEMS IN 202.15 A\D 202A.6
WILL XOTBE RA TED FOR EMPLOYEES HIRED PRIOR TO JULY I, I986.
B. The organization
shall obtain and verify within 30 days of employment and maintain documentation
of the following:
1. Adult Maltreatment
Central Registry Ark. Code Ann. §§
5-28-201 has been
completed and the response is filed, or a second request submitted
2. Arkansas Child Maltreatment Central
Registry Ark. Code Ann. §§ 12-12-501 - 12-12-515 has been completed
and the response is filed, or a second request submitted. This check will
provide documentation that prospective employee's name do not appear on the
statewide Central Registry.
a. The
organization should adopt policy requiring subsequent criminal checks and
registry checks. The organizations that provide licensed daycare services must
adhere to Child Care Licensing regulations regarding Criminal background checks
and central registry cheeks.
Note: Staff holding professional licenses may be used
in lieu of criminal
background and adult and child maltreatment
checks.
3. TB skin test a. Renewed yearly for ALL
STAFF.
4. Hepatitis B series or
signed declination
5. The results
of criminal background check of the will be on file.
6. Employment reference verification and
signed release
a. On file within thirty (30)
days of hire date
C. The organization shall obtain and verily
information in 202 A and B in response to information received (i.e., a
complaint is received that a person's license has lapsed or a person has been
convicted of a crime since they were hired).
203 The agency shall ensure sub-contractor's
services meet all applicable standards and will assess performance on a regular
basis.
A. The organization shall ensure thai
sub-contractors providing direct care services are in compliance with DDS
policies and must have verification and documentation of all applicable items
listed in 202A.
Note:Staff holding professional licenses may he used in
lieu of criminal background and adult and child maltreatment
checks.
B. The
organization shall demonstrate:
1. Reviews of
all contract personnel utilized by the organization that:
a. Assess performance of their contracts
b.Ensure all applicable policies
and procedures of the organization are followed
c.Ensure they conform to DDS standards
applicable to the services provided
d.Are performed annually
204 The organization
shall develop, implement and monitor policies and procedures for staff
recruitment and retention so that sufficient staff is maintained to ensure the
health and safety of the individuals served, according to their plans of care.
A. The organization must ensure there are an
adequate number of personnel to:
1. Meet the
established outcomes of the persons served.
2. Ensure the safety of persons
served.
3. Deal with unplanned
absences of personnel.
4. Meet the
performance expectations of the organization.
B. The organization shall demonstrate:
1. Recruitment efforts.
2. Retention efforts.
3. Identification of any trends in personnel
turnover.
205
The organization shall develop and implement procedures governing access to
staff members' personnel file.
A. An access
sheet shall be kept in front of the file to be signed and dated by those who
are examining contents, with stated reasons for examination.
B. The policy shall clearly state who, when,
and what is available concerning access to personnel files and be in compliance
with the Federal Privacy Act and Freedom of Information Act. At no time shall
the policy allow access that violates the provisions of the Health Insurance
Portability and Accountability Act (H1PAA).
206 The organization shall develop written
job descriptions which describe the duties, responsibilities, and
qualifications of each staff position.
A. The
organization shall;
1. Identify the skills
and characteristics needed by personnel to:
a. Assist the persons served in the
accomplishment of their established outcomes.
b. Support the organization in the
accomplishment of its mission and goals.
2. Assess the current knowledge and
competencies of personnel at least annually.
3. Provide for the orientation and training
needs of personnel.
4. Provide the
resources to personnel for learning and growth.
5. Identify the supervisor of the position
and the positions to be supervised.
B. Performance management shall include:
1. Job descriptions that are rev iewed and,
or updated annually.
2. Promotion
guidelines,
3. Job posting
guidelines.
4. Performance
evaluations for all personnel directly employed by the organization shall be:
a. Based on measurable objectives that tie
back to specific duties as listed in the Job Description.
b. Evident in personnel files.
c. Conducted in collaborntion with the direct
supervisor with evidence of input from the personnel being evaluated
d. Used to:
1. Assess performance related to objectives
established in the last evaluation period.
2. Establish measurable performance
objectives for the next year.
e. Performed annually.
207 The organization
shall establish employment policies practices for students, interns, volunteers
and trainees utilized by the organization who have regular, routine contact
with consumers.
A. The organization shall
define who has and what constitutes regular, routine contact with
consumers.
B. If students, interns,
volunteers or trainees are used by the organization, the following shall be in
place:
1. A signed agreement.
a. If professional services are provided,
standards or qualifications applied to comparable positions must be
met.
2. Identification
of:
a. Duties.
b. Scope of responsibility.
c. Supervision,
3. Orientation and training.
4. Assessment of performance.
5. Policies and written procedures for
dismissal.
6. Confidentiality
policies.
7. Background checks,
when required.
300 STAFF TRAINING
Guiding Principle: Staff Training is an organized
program which prepares new employees to perform their assigned duties
competently and maintains and improves the competencies of all employees. Staff
Training for the organization shall provide an on-going mechanism for the
evaluation of the impact of the program on services provided to individuals
with developmental disabilities. This should include service outcomes to
individuals, meeting of the organization objectives and overall mission,
compliance with regulatory and professional standards and positive changes in
staff performance and attitudes. The needs of individuals with developmental
disabilities require the efforts of competent personnel who continually seek to
expand knowledge in their fields.
300.1 The organization shall establish a
policy designating one or more employees to be responsible for coordinating
in-service staff training.
A. The employee
responsible for staff training should have broad knowledge of care and service
needs of persons with developmental disabilities, and possess the necessary
skills to organize and implement an in-service training program as evidenced in
resume.
301 The
organization shall establish a written training plan. This plan must show how
the training will be provided and the areas covered. If training occurs during
regularly scheduled service hours, documentation must be present that
individual staff ratios were maintained.
301.1 ALL Personnel shall receive initial and
annual competency-based training to include, but not limited to:
A. Health and safety practices.
1. First Aid (review yearly, renew as
required by American Heart Association, Red Cross, or Medic First Aid,
applicable for ALL direct service personnel)
a.There is immediate access to:
(1) First aid expertise.
(2) First aid equipment and
supplies.
(3) Emergency information
on the:
(a) Persons served.
(b) Personnel.
b. Infection Control Plan
1. The organization shall implement an
infection control plan that includes:
(a).Training regarding the prevention and
control of infections and communicable diseases for:
(1).Persons served, when applicable.
(2).Personnel,
(b).The appropriate use of standard
or universal precautions by all personnel.
(c).P roced ures that spec ify thai cm pi
oyces with in feci ious diseases shall be prohibited from contact with
individuals until a physician's release has been provided to the organization
director.
B. Identification of unsafe environmental
factors.
1. Issues Regarding Prevention of
Acquired Immunodeficiency Syndrome +(AIDS), Hepatitis B (HIV) and other
Bloodbomc Pathogens
C.
Emergency procedures and Evacuation Procedures
1. Emergency and Disaster
Preparedness
2. Fire and Tornado
Drills, Violence in the Workplace, Bomb Threats, Earthquake
D. General Information
1. Overview of Department of Human Sen
ices
2. Overview of Developmental
Disabilities Services
3.
Philosophy, Goals, Programs, Practices, Policies, and Procedures of Local
Organization
4. HIPP A policies and
procedures
5. Orientation to
history of Developmental Disabilities
6. Current Issues Affecting Individuals with
Developmental Disabilities
7.
Introduction to Principles of Normalization
8. Procedures for Incident
Reporting
9. Appeals Procedure for
Individuals Served by the Program
10. Introduction to Behavior
Management
11. Community
Integration Training.
E.
Legal
1. Overview of Federal and State Laws
related to serving individuals with a developmental disability (NOTE: Laws may
change every 2 years)
2. Legal
Rights of Individuals with Developmental Disabilities
3. Application of Federal Civil Rights Laws
to Persons with AIDS or HIV related condition (or those who may be perceived to
have AIDS or HIV related conditions).
4. Ark. Code Ann. $ 56-41-2016-41-222 -The Children
With Disabilities Act of 1973
5.
Ark. Code Ann. §§
20-48-201 -
20-48-211:
-Arkansas Mental Retardation Act
6.
Ark. Code Ann. §§
25-19-10125-19-107
-Freedom of Information Act
7. Ark.
Code Ann. §§
28-65-101
-
28-65-109;
-Guardians Generally
8. Ark. Code
Ann, §§
5-28-101 -
5-28-109; -Abuse of
Adults
9. Ark. Code Ann.
§§ 12-12-501 - 12-12-515; -Arkansas Child Maltreatment Act
10. Ark. Code Ann. §§
25-2-104,
25-2-105,
25-2-107. Type
I, Type 2 and Type 4 Transfers
11.
Ark. Code Ann. §§
25-10-10225-10-116;
Department of Health and Human Services General Provisions
12. Ark. Code Ann. §§
20-78-215
- Child sexual abuse - Federal funds
13. U.S.C. § 12101 et. scq -Americans
with Disabilities Act of 1990
P.
L. 101-336
14.
20 U.S.C. §
1400 et. scq (Part B and Part C - P. L.
94-142 Individuals with Disability Education (IDEA) P.L. 99-457 Part
C
15.
42U.S.C.
§
2000a2000 h-6- Title VI of the Civil
Rights Act of 1964
16.
29 U.S.C. §§
706(8) Rehabilitation Act of
1973, 794 - 794(b) Section 504
17.
5 U.S.C. §
552a - Federal Privacy Act
18.
42 U.S.C. §
6000 - Developmentally Disabled Assistance
& Bill of Rights Act of 1984
19.
P.L.
109-171, Deficit Reduction Act, and 30 U.S.C.
§ 3729 etseq. False Claims Act Note: Documentation of prior
training of individual staff may be used for the required topics, if this
situation is addressed in the organization 's training plan.
301.2.
Documentation of prior training of individual staff may be used for the
required topics, if this situation is addressed in the organization's training
plan.
301.3. Training Requirements
for professional administrative staff, as defined by the agencies policies
1. Twelve (12) hours minimum completed within
ninety (90) days of employment (does not include First Aid and CPR
training)
301.4.
Training Requirements for direct care staff
1.
Twelve (12) hours minimum completed within (30) days of employment (does not
include First Aid and CPR training)
2. In addition to the training requirements
specitled Section 301.1, all direct care staff must receive the following
training:
a. CPR (I nitial Certification,
renew as required by American Heart Association, Medic First Aid, or Red
Cross).
1. ALL direct care staff members,
including bus and van drivers, shall be trained and certified to provide CPR,
unless they arc deemed incapable of performing this task by a licensed medical
professional, such as a nurse or doctor. Documentation must be maintained in
the personnel file. Staff that are physically incapable of performing CPR must
complete and have documentation of CPR training.
b. The organization shall develop and
implement and monitor policy regarding timeframe for CPR certification after
hire date. (Timeframe not to exceed 90 days.)
3. Medication-Implications, Side Effects,
Legality of Administering medication.
NOTE: In addi i ion to tiiosi ar» as addressed in these
standards,
OTHER IDENTIFIED NEEDS BASED ON STAFF INPUT SHOULD BE
ADDRESSED.
NOTE; SEE APPENDIX B for Training Resources
301.5. In addition to the
requirements in Section 301.1 -301.4, all direct care staff shall receive
annual in-service training and or continuing education as follows:
A. Minimum of twelve (12) hours of training
annually, including the required topics,
1.
Topics must be applicable to the job and are to be chosen by the organization
based on identified needs. Topics may be a combination of required and job
specific training.
2. Behavior
management techniques programming
B.Documentation of the training shall be
maintained in the staffs personnel file and shall be evidenced by the
signatures of the trainer and the direct care staff, the date the training was
provided and the specific information covered.
302 Annual in-service training and or
continuing education for Managerial Staff, as defined by the agencies policies.
A. Topics Chosen must be related to the job
performed.
B. Minimum of twelve
(12) hours of training required yearly, from the following list:
1. Issues Regarding Prevention of Acquired
Immunodeficiency Syndrome (AIDS), Hepatitis B (HIV) and other Blood Borne
Pathogens
2. Application of Federal
Civil Rights Laws to persons with AIDS or HIV related Conditions (or those who
may be perceived to have AIDS or HIV Related conditions)
3. Management of Non-Profit
Organizations
4. Procedures for
Preventing and Reporting Alleged Maltreatment of Children and Adults
5. Effective Supervision Management
Techniques
6. Selection and
Interviewing
7. Fair Employment
Principles
8. Performance
Evaluation
9. Techniques for
Working with the Board
10. Overview
of Federal and State Laws Related to Serv ing Individuals with a Developmental
Disability (up-dated every two (2) years)
11.Federal and State Law s:
a. Ark. Code Ann. §§
6-41-201 -
6-41-222 -The Children
With Disabilities Act of 1973
b.
Ark. Code Ann. §§
20-48-201 -
20-48-211
-Arkansas Mental Retardation Act
c. Ark. Code Ann. §§
25-19-101
25-19-107 -Freedom of Information Act
d. Ark. Code Ann. §§
28-65-101
-
28-65-109;
--Guardians Generally
e. Ark. Code
Ann. §§
5-28-101 - 5-28-109;
-Abuse of Adults
f. Ark. Code Ann.
§§ 12-12-50112-12-515; -Arkansas Child Maltreatment Act
g. Ark. Code Ann. §§
25-2-104,
25-2-105.
25-2-107, Type
1, Type 2 and Type 4 Transfers
h.
Ark. Code Ann. §§
25-10-102
- 25-10-116, Department of Health and Human Services General Provisions
i. Ark. Code Ann. §§
20-78-215
- Child sexual abuse - Federal funds
j. U.S.C. § 12101 et. seq. -Americans with Disabilities Act
of 1990 P. L.
k.
20 U.S.C. §
1400 et. seq. (Part B and Part C - P. L.
94-142 Individuals 101-336with Disability Fdueation (IDEA) PL. 99-457 Part C
I. 42US.C. §2000a 2000 h-6- I
itlc VI of the Civil Rights Act of 1964
m.
29 U.S.C. §§
706(S) Rehabilitation Act of
1973, 794 794(b) Section 504
n.
5 U.S.C. §
552a-- Federal Privacy Act
o.
42 U.S.C. §
6000-
6083
- Developmentally Disabled Assistance & Bill of Rights Act of 1984
C. Managerial
Staff, as defined by the agencies policies, who have been with the agency for 2
or more years may select from the above list or choose from continuing
education courses.
Note: SEE APPENDIX B for Training Resources
303 All employees who
provide transportation services shall have the following training scheduled
within thirty (30) days of employment and completed within seventy-five (75)
days of employment. This training shall be in addition to the required new
employee training listed in Section 301
A. A
course of instruction in consumer assistance and transfer techniques, lift
operation and how to properly secure a wheelchair, if applicable, prior to
transporting consumers; and
B. The
provider must assure and document that each driver obtains the following:
1. A certificate of completion of an
introductory defensive driving course;
2. A certification of completion of training
addressing the transport of older persons and people with disabilities, and a
refresher course every three years thereafter, both of which must include:
a. Sensitivity to aging training;
b. An overview of diseases and functional
factors commonly affecting older adults;
c. Environmental considerations affecting
passengers;
d. instruction in
consumer assistance and transfer techniques;
e. Training on the management of wheelchairs,
and how to properly secure a wheelchair;
f. The inspection and operation of wheelchair
lifts and other assistive equipment; and,
g. Emergency procedures.
C.
D.Drivers are required to complete refresher
courses every three years after the date the certificate(s) of completion was
received.
Note: For all transportation workers employed prior to
i I 01 07, documentation of the required training must be on file no later than
11 01 OS,
304 Providers must assure:
A. Maintenance of a safety checklist
completed prior to transporting consumer(s) and or travel attendants. Checklist
items shall include, but not be limited to, fire extinguisher; first aid
kit,
B. Maintenance of service logs
or trip sheets that include the date of service the consumer's name, the
pick-up point and destination point for each trip, total mileage per trip, and
the driver's signature.
C.
Assistance in transfer of the consumer, as necessary, safely from the
consumer's door to the vehicle and from the vehicle to the entrance of the
destination point. The provider must perform the same transfer assist service
when transporting the consumer back to the consumer's residence.
400
Individual/Parent/Guardian Rights
Guiding Principle: The organization shall
implement a system of rights that nurtures and protects the dignity and respect
of the persons served. The organization shall protect and promote the rights of
the persons served. This commitment shall guide the delivery of services and
ongoing interactions with the persons served.
401 The organization shall implement policies
promoting the following rights of the persons served and ensures all
information is transmitted to the person served and or their parent or guardian
in a manner and fashion that is clear and understandable:
A. Being free from physical or psychological
abuse or neglect, retaliation, humiliation, and from Financial
exploitation.
B. Having control
over their own financial resources.
C. Being able to receive, purchase, have and
use their own personal property.
D.
Actively and meaningfully making decisions affecting their life.
E. Access to information pertinent to the
person served in sufficient time to facilitate his or her decision
making.
F. Having
Privacy.
G. Being able to associate
and communicate publicly or privately with any person or group of people of the
individual's choice.
H. Being able
to practice the religion of their choice.
I. Being free from the inappropriate use of a
physical or chemical restraint, medication, or isolation as punishment, for the
convenience of the provider or agent, in conflict with a physician's order or
as a substitute for treatment, except when a physical restraint is in
furtherance of the health and safety of the individual.
J.Not being required to work without
compensation, except when the individual is residing and being provided
services outside of the home of a member of the individual's family, and then
only for the purposes of the upkeep of their own living space and of common
living area and grounds that the individual shares with others.
K. Being treated with dignity and
respect.
L. Receiving due
process.
M. Having access to their
own records, including information about how their funds arc accessed and
utilized and what services were billed for on the individual's
behalf.
N. Informed consent or
refusal or expression of choice regarding:
1.
Service delivery.
2. Release of
information.
3. Concurrent
services.
4. Composition of the
service delivery team.
5.
Involvement in research projects, if applicable.
O. Access or referral to legal entities for
appropriate representation.
P.
Access to self-help and advocacy support services.
Q. Adherence to research guidelines and
ethics when persons served are involved, if applicable.
R. Investigation and resolution of alleged
infringement of rights.
1. The agency
maintains documentation of all investigations of all alleged violations of
individual's rights and actions taken to intervene in such situations. The
organization ensures that the individual has been notified of their right to
appeal according to DDS Policy 1076.
R. Rights and responsibilities of
citizenship
S. Other legal and
constitutional rights
402 Records of persons served
A. The organization shall maintain complete
records and treat all information related to persons served as
confidential.
B. The organization
shall create policy for the sharing of confidential billing, utilization,
clinical and other administrative and service-related information, and the
operation of any Intemet-based services that may exist.
1. Information that is used for reporting or
billing shall be shared according to confidentiality guidelines that recognize
applicable regulatory requirements such as the Health Insurance Portability and
Accountability Act (H1PAA).
C. The organization shall comply with its own
service delivery design for the development of the record. Electronic records
are acceptable. Electronic records must meet the following:
1. Format must meet DHS Office of Systems and
Technology standards and be acceptable by the Department.
2. Files must be uniformly organized and
easily accessible.
D.
The location of the case record, and the information contained therein, shall
be controlled from a central location as defined by the agency, shall be stored
under lock and with protection against fire, water, and other hazards in an
accessible location at each site. The organization shall establish and
implement policies and procedures to ensure direct care staff have adequate
access to the individual's current plan of care and other pertinent information
necessary to ensure the individual's health and safety (i.e., name and
telephone number of physician, emergency contact information, insurance
information, etc.). If services are not provided at the central location, at a
minimum the following information must be maintained at the service delivery
site:
A. Access Sheet
B. Face Sheet to include emergency contact
information and pertinent health information
C. Signed consent for emergency
treatment
D. A copy of the
consumer's current program plan
E.
Copies of current progress reports
F. Documentation of serv ice prov jsion to
include date, time in and time out, summary of activities, and signature of
implementor for the period of the current program plan
E. Records maintained on computer shall be
backed up at a minimum weekly and the duplicate copy shall be stored under lock
and with protection against fire, water, and other hazards.
F. A list of the order of the file
information shall either be present in each individual case file or provided to
DDS Licensure staff upon request. The documents in active individual case
records should be organized in a systematic fashion. An indexing and filing
system shall be maintained for all case records.
G. Each organization shall have written
procedures to cover destruction of records. Procedures must comply with all
state and federal regulations
H.
Access sheets shall be located in the front of the file to maintain
confidentiality according to
5 U.S.C. §
552a. If there is a signed release for a list
of authorized persons to review the file, only those not listed will need to
sign the access sheet with date, title, reason for reviewing, and signature. If
there is not a signed release for authorized persons to review, all persons
must sign the access sheet whenever the file is reviewed or any material is
placed in the file.
402.1 DDS staff shall have access upon demand
to all individual case records as designated in Ark. Code Ann. §§
20-48-201 -
20-48-211,
DDS Policy 1090, Licensing Policy for Center-Based Community
Services.
402.2 The organization
shall ensure confidentiality of all case records is maintained. Access to case
records shall be limited to Individual Parent Guardian, professional staff
providing direct services to the person served, plus such other individuals as
may be authorized administratively or by the consumer. All authorizations
either those listed above or others shall be in writing.
A.. Access to individual files shall be
limited to only those staff members who have a need to know information
contained in the records of persons served.
B. Individual service records shall be
maintained according to provisions of the Privacy Act:
C. Access to computer records shall be
limited to those authorized to view records
D. The organization shall ensure the right of
all persons served to access their own records.
E. The organization shall ensure that all
persons served know how to access their records and the organization ensures
that appropriate equipment is available.
F. An organization shall not prohibit the
persons served from having access to their own records, unless a specific state
law indicates otherwise. It is recognized that the organization must comply
with HIPAA regulations as it relates to specific information that cannot be
disclosed to persons served without authorization (i.e., psychotherapy
notes).
402.2 Adult
individuals who are legally competent shall have the right to decide whether
their family will be involved in planning and implementing the individual
service plan. A signed release or document shall be present in individual case
record giving permission for family to be involved.
402.3 The Individual /Parent /Guardian shall
be informed of their rights. The organization shall maintain documentation in
the individual's file that the following information has been provided in
writing: The information listed in 402.3 A-l mi si hi: provided upon admission
and annually TIIKRI: AFTER.
A. All possible
service options, including those not presently provided by the
program.
B. A copy of the rules of
conduct and mission statement of the organization.
C. Current list of Board members of the
community program.
D. Summary of
funding sources.
E. Copy of the
appeal procedure for decisions made by the organization.
F. Solicitation Guidelines **See Solicitation
under Definitions
G. A11 ex terna I
ad vocacy services.
H. Right to
appeal any service decision to DDS, under DDS Policy 1076
I.Name and phone number of the DDS Service
Specialist for that area
403 Grievances and Appeals
Guiding Principle: The organization identifies
clear protocols related to formal complaints, including grievances
and appeals. An organization may have separate policies and procedures
for grievances and appeals, or may include these in a common policy and
procedure covering complaints, grievances, and appeals. A review of formal
complaints, grievances, and appeals gives the organization valuable information
to facilitate change that results in better customer service and results for
the persons served.
A. The organization
shall identify clear protocols related to formal complaints, including
grievances and appeals.
B. The
organization shall:
1. Implement a policy by
which persons served may formally complain to the organization.
2. Implement a procedure concerning fonna!
complaints that:
a. Is written.
b. Specifies:
1. That the action will not result in
retaliation or barriers to services.
2. How efforts will be made to resolve the
complaint.
3. Levels of review,
which includes availability of external review.
4. Time frames that are adequate for prompt
consideration and that result in timely decisions for the person
served.
5. Procedures for written
notification regarding the actions to be taken to address the
complaint.
6. The rights and
responsibilities of each party.
7.
The availability of advocates or other assistance.
3. Make complaint procedures and,
if applicable, forms:
a. Readily available to
the persons served.
b.
Understandable to the persons served and in compliance with
29 U. S. C. §§
706(8),
794
794(b).
C. These procedures
shall be explained to personnel and persons served in a format that is easily
understandable and meets their needs. This explanation may include, but not
limited to a video or audiotape, a handbook, interpreters, etc.
403.1 The organization
shall annually review all formal complaints filed.
A. A written review of formal complaints:
1. Detenu ine:
a. Trends.
b. Areas needing performance
improvement.
c. Action plan or
changes to be made to improve pcrfomiance and to reduce
complaints
403.2 The organization shall document a rev
iew of any action plan or changes made to determine if the plan'changes were
effective in reducing complaints and shall make adjustments to the plan as
deemed necessary to ensure quality services.
404 Health Related Issues
Guiding Principle: A successful health and safety
program goes beyond compliance with regulatory requirements and strives to
manage risk and to protect the health and safety of persons served, employees,
and visitors. A successful health and safety program addresses both minimizing
potential hazards and compliance activities.
A. The organization shall implement
policies/procedures to ensure the rights of individuals who have or who are
perceived as having Acquired Immunodeficiency Syndrome (AIDS) or Human Immune
Virus (HIV) related condition (or those who may be perceived as having AIDS or
AIDS related conditions including Hepatitis B are not discriminated against in
accordance with
29 U.S.C. §§
706(8),
794
-
794(b);
U.S.C. § 12101 et. seq. A copy of the policies/procedures shall be
provided to each Individual'Parent/Guardian(s).
B. The organization shall implement
policies'procedures concerning any person admitted for services or anyone
proposed for admission to ensure confidentiality shall be maintained for all
information related to HIV testing, positive HIV infection, any HIV associated
condition, AIDS or Hepatitis B.
C.
Each organization will protect the confidentiality of records or computer data
that is maintained which relates to HIV, AIDS or Hepatitis
B.
405 Incident /
Accident Reporting
A. The organization shall
report the following incidents to the DDS Licensing Unit in
accordance with DHS Policy 1090. This report shall contain: date,
accident/injury, time, location, persons involved, action taken, follow-up,
signature of person writing the report. The following are reportable incidents:
1. Use of seclusion or restraint.
2. Maltreatment or abuse as defined in
statutes (See Ark. Code Ann. §§ 12-12-501 - 12-12-515 (503); Ark.
Code Ann. §§
5-28-101 - 5- 28-109
(102))
3. Incidents involving
injury:
a. Accident/injury reports shall be
completed for each accident/injury that requires the attention of an EMT,
Paramedic or Physician.
1. Accident is
defined as an event occurring by chance or arising from unknown
causes.
2. Injury is defined as an
act that damages or hurts and results in outside medical attention.
3. A copy of the report, redacted as required
by the Freedom of Information Act must be sent to parent guardian of all
children (0-18). and to guardian of adults regardless of severity of
injury.
4. Other health-related
conditions resulting in Emergency treatment or hospitalization,
4. Communicable
disease
5. Violence or
aggression
6. Sentinel events
(i.e., an unexpected occurrence involving death or serious physical or
psychological injury or the risk thereof)
7. Elopement and. or wandering defined as
anytime the location of a person cannot be determined within 2 hours
8. Vehicular accidents
9. Biohazardous accidents
10. Use or possession of illicit substances
or use or possession of licit substances in an unlawful or inappropriate manner
(i.e., possession of prescription drugs by a person to whom the drugs have not
been prescribed and who has no legitimate interest in possession of
prescription drugs, such as a parent or guardian)
11. Arrests or convictions
12. Suicide or attempted suicide
13. Property destruction
14. Any condition or event that prevents the
delivery of DHS services for more than 2 hours
15. Behavioral incidents (incidents involving
an individual's actions that are aggressive, disruptive and. or present a
danger to the individual or to others)
16. Other areas, as required
NOTE:For isdii ton is 3-21)ii irs or
\ge, OESTRtrno v of iscidest
reports mist re is compua we ii itu
dep trtuestof Educa tio\ .
B. The organization shall notify the parent
guardian of all children (0-18) or adults who have a guardian any time an
incident injury report is submitted.
C. The organization shall develop and
implement policies and procedures regarding follow-up of all incidents to
include a time-line for action, remediation and preventative measures that do
not exceed DDS established timeframes, in accordance with DHS Policy
1090.
407 Behavioral
Management
A. The organization shall develop
policy and procedure that demonstrates a commitment to a system that nurtures
personal growth and dignity, and supports the use of positive approaches and
supports
B. The organization's
policy and procedure shall ensure that when behavior management approaches are
used, positive behavior interventions are implemented prior to the use of
restrictive procedures.
C. Written
behavior management policy developed by the organization shall ensure the
rights of individuals.
1. The policy will be
incorporated by the interdisciplinary team in programming, as
appropriate.
2. The plan must be
rev icwed quarterly or as dictated by the needs of the individual
served-
3. This shall include all
types of behavior management used i.e., time out, token economy, etc... This
cannot include procedures that are punishing, physically painful, emotionally
frightening, or deprivation, or that puts the individual served at medical risk
which are used to modify behaviors
D.
If restrictions are placed on the rights of a person served:
1. The organization shall follow its policies
and procedures.
2. The organization
shall obtain informed consent from the individual parent/guardian prior to
implementation.
3. The organization
shall have methods to reinstate rights as soon as possible.
4. Staff members are trained on proper
implementation of all restrictions utilized by the organization.
E. The organization shall assure
that maltreatment or corporal punishment of individuals will not be allowed.
1. Policies and Procedure must state that
corporal punishment is prohibited.
a.
"Corporal punishment" refers to the application of painful stimuli to the body
in an attempt to terminate behavior or as a penalty for behavior.
b. 20 U.S.C. $ 1400 et. scq.; Maltreatment
laws, Ark. Code Ann. §§ 12-12-501 - 12-12-515; Ark. Code Ann. $$
5-28-101 -
5-28-109.
F. Individuals shall
have the right to obtain and retain private property.
1. Personal possessions are regarded as the
private property of the individuals and shall not be taken away unless danger
to safety of the individual or to others is present.
G. Emergency Basis Procedure
An emergency safety situation is defined as unanticipated
behavior that places the person served or others at serious threat of violence
or risk of injury if no intervention occurs.
1. The organization shall establish policies
procedures for the use of restraint and/or emergency intervention procedures
that must be used undertaken in the event of a emergency circumstances for a
consumer who has no behavior management plan in place. The policies, procedures
must identify the circumstances under which emergency procedures will be used
as a protective measure in a life- or safety-threatening situation only when
de-escalation has failed or is not possible.
2. Emergency basis procedures may not be
repeated more than three (3) times within six months without the
interdisciplinary team meeting to revise the individual program plan. Each
incident consists of: a behavior was exhibited, a procedure was used, the
individual was no longer thought to be dangerous, the procedure was
discontinued.
Note: The number three (3) means three (3) distinct
incidents The three (3) distinct occurrences could take place in one (I)
day.
500 SERVICE PROVISION STANDARDS
501 The organization shall establish written
policies and procedures for intake, evaluation, and diagnosis necessary to
determine the eligibility of a person to receive services shall be
documented.
501.1 The organization
shall designate specific staff positions assigned with the responsibility for
intake, evaluation, assessment, family contact, planning, updating, and
alternate placement.
502 Face
sheets shall be completed at intake and shall be updated as needed and at least
annually as documented by date of signature of the person designated in
organization's policy.
502.1 Every
person receiving services shall have a service record face sheet that contains
the information in 502.1 A-S and will be filed in a prominent location in the
front of the file.
A. Full name of
individual
B. Address, county of
residence, telephone number and email address, if applicable
C. Marital status, if applicable
D. Race and gender
E. Birth date
F. Social Security number
G. Medicaid Number
H.Legal status
I. Parents or guardian's name and address and
relationship, if applicable
J.
Name, address, telephone number and relationship of person to contact in
emergency, someone other than item 11
K. Health insurance benefits and policy
number
L. Primary
language
M. Admission
date
N. Statement of primary
secondary disability
O. Physician's
name, address and telephone number
P. Current medications with dosage and
frequency, if applicable
Q. All
known allergies or indicate none, if applicable
R. The results of all independent, annual
developmental screens conducted by the DHS third-party vendor, or authorized
waiver of the developmental screen requirement.
502 A case manager service coordinator
evaluator shall be designated in writing and shall organize the provision of
services for every individual served. The case manager service coordinator
evaluator shall provide the individual or parent guardian with the name and
contact information in writing.
A.For every
individual served, the case manager service coordinator evaluator shall:
1. Assume responsibility for intake,
assessment, planning and services to the person
2. Coordinate the individual program
plan
3. Cultivate the iiulividual's
participation in the services
4.
Monitor and update services to assure that:
a.
The person is adequately oriented
b.
Services proceed m an orderly, purposeful, and timely
manner
c. The transition and or
discharge decision and arrangements for follow-up are properly made.
503 Intake
A. A written intake procedure shall be
available upon request, shall be understandable to the individual receiving the
services, shall be presented to those requesting services, and shall be
followed by the organization in the evaluation of a person to determine
eligibility for services.
B. The
organization shall implement policies and procedures for acceptance into
services. Policies and procedures must:
1.
Establish the criteria for the order of acceptance of any person awaiting
service.
2. Identify the position
or entity responsible for making acceptance decisions.
3. Provide opportunities for persons to learn
about the organization and its services.
4. When a person is found ineligible:
a. The person is informed of the
reasons.
b. The person is given
information about potential alternative services.
5. Ensure that all involved are aware of
their responsibilities regarding services prior to the planning and delivery of
services
6. Ensure signed informed
consent for services are obtained and retained as required by funding sources
and for legal reasons
7. Ensure
persons served are given information about setting their individual service
goals, when applicable, planning the services to be delivered and how progress
on service goals will be communicated with them.
504 Information gathered prior to
admission shall include the following information and shall be filed in the
individual's record:
A. The results of the
independent, annual developmental screen conducted by the DHS third-party
vendor, or the authorized waiver of the developmental screen
requirement.
B. Signed emergency
medical release and all other necessary release forms (i.e., Publicity, field
trip, fund raising, etc.). The emergency medical release form shall remain
current (yearly) for the protection of the organization and the individual.
1. Competent adults must always sign their
releases
2. Publicity releases
shall be obtained on an as-needed basis (for each occurrence)
3. Field trip releases shall be obtained on a
per occurrence basis unless that field trip is part of the regular program
(i.e. bowling each week, swimming each week, etc.)
4. Emergency medical releases must be taken
on field trips or incorporated in the field trip release.
C. Statement of Legal (competency) status;
See Ark. Code Ann. §§
28-65-101
- 28-65-109 (see index)
1. If the individual
is under the age of 18, he she is a minor. Organizations shall determine the
who is the legal guardian of the child: Natural parent(s), ward of the state
(DCFS foster home, etc.) and shall ensure the legal guardian signs all
appropriate documents.
2. If the
individual is age 1S or older, he she is considered competent unless the court
has appointed a legal guardian. Copies of guardianship orders must be
maintained in the individual's record.
Note: An individual for whom a guardian has been
appointed retains all legal and civil rights except those which have been
expressly limited by court order or which have been specifically granted by
order of the court to the guardian.
505 Application for services
A. The organization shall develop and
implement a written application to be made available upon request or presented
to those requesting services. At a minimum, the application shall contain name,
address and telephone number of individual parent guardian and a statement of
the individual's needs. Applications shall be available in an alternate format
and assistance to complete shall be offered to individual's that may require
it
506 The organization
shall complete a Financial Screen for all applicants for services as
applicable.
A. The screen shall be completed
prior to admission and is used by the program in the evaluation of a person's
financial status
B. The
organization shall include all information about benefits for Medicaid
eligibility and, for individuals who may not be eligible for Medicaid, shall
include information about Tax Equity Family Reform Act eligibility.
507 Medical prescription for
services shall be obtained, if applicable
A.
A current prescription for services (within twelve months), signed by qualified
medical personnel, shall be on file prior to admission
508 The organization shall complete or obtain
a full assessment at the time of the admission process. The assessment shall
include the following items:
A. Social
history
1. A social history shall be written
or procured within thirty (30) days of admission. The social history must be
comprehensive, in narrative form or a completed questionnaire. The social
history must be updated annually as evidenced by dated signature.
B. Medical history and evaluation
1. A physical examination assessment signed
by qualified medical personnel shall be on file and current within 5 days but
not longer than thirty (30) days afier admission. In cases where a physical
cannot be obtained within 5 days, documentation of a phvsical within 1 year
will be accepted until a new physical can be obtained
2. Early Periodic Screening Diagnosis
Treatment process for Medicaid eligible individuals (0-21)
a. All individuals 0-21 vears of age eligible
for Medicaid should have evidence in the file that they are participating in
the EPSDT process
509 A psychological evaluation report shall
be on file prior to admission for adults (age IS and older) and for children
(age 5-18) if applicable
A. Adults (age 18-up)
transferring from a DDS Licensed provider may be admitted with a copy of the
most current ps[GREATER THAN]chological evaluation
B. A new psychological evaluation may be
conducted if an Interdisciplinary Team determines that it is reasonable and
necessary based on significant life changes of the individual.
510 Therapy evaluations must be
completed or procured within thirty (30) days after admission, when applicable
or when prescribed by a physician or a therapist working under a physician's
orders. Recommendations from therapy evaluations shall be incorporated into the
individual's plan of care as appropriate.
511 When applicable, all psychiatric
evaluation shall completed by a qualified person and must be on file within
thirty (30) days after admission. Recommendations from psychiatric evaluations
shall be incorporated into the individual's plan of care as
appropriate.
512 The service needs
assessment must be completed on every individual seeking services
NOTE: See Section 521 for further guidelines
(Children's services Section).
A. The person and. or family served and/or
their legal representatives shall be involved in:
1. Assessments of potential risks to each
person's health in the setting in which they receive services as well as in the
community
2. Assessments of
potential risks to each person's safety in the setting in which they receive
services as well as the community
3. Decisions to accept or reject such
risks
4. Identification of actions
to be taken to minimize risks
5.
Identi fication of individuals responsible for those actions
513 Personal Futures
Planning
Guiding Principle: Individual's with developmental
disabilities and their families have competencies, capabilities and personal
goals that shall be recognized, supported, encouraged, and any assistance to
such individual's shall be provided in an individualized manner, consistent
with the unique strengths, resources, priorities, concerns, abilities, and
capabilities of such individuals. Any plan of service developed should
significantly reflect the person for whom it is intended. Services/ supports
are most effective when they are adapted lo address individual outcomes
1.
The organization shall prepare a
written person-centered support plan for each individual that shall meet their
individual needs. At a minimum, the plan shall:
A. Be developed only after consultation with
the individual parent/guardian, and other individuals from the individual's
support network as determined by the individual parent, guardian;
B. Contain a description of the individual's
preferred lifestyle, including:
1. The type
of setting in which the individual wants to live or work;
2. With whom the individual wants to
socialize;
3. The social, leisure,
religious, or other activities in which the individuals wants to
participate;
4. Reflect the
individual's / family's choice of services which are relevant to the
individual's age, abilities, life goals/outcomes
5. Address areas such as the individual's
family's health, safety and challenging behaviors which may put the individual
at risk
6. Demonstrates the rights
and dignity of individual family
7.
Incorporates the culture and value system of the individual family
8. Ensures the individual's, family's
orientation and integration to the community, its sen ices and
resources.
9. The necessary
activities, training, materials, equipment, assistive technology and services
needed to assist the individual in achieving their preferred
lifestyle;
10. Describes how
opportunities for individual choice will be provided;
11. Be approved, in writing by the individual
parent guardian.
2. The organization shall regularly review
and revise the plan whenever necessary to reflect changes in the individual's
preferred lifestyle; achievement of goals or skills outlined within the plan or
the goal is no longer deemed appropriate for the individual
514 Every individual
shall have a written Individualized Program Plan
NOTE: See individi At. program sections for specific time
frames (Children's services. See Section 521).
A. The organization shall include the person
served as an activ e participant giving direction in all aspects of the
planning and revision processes
B.
Services shall be provided based on the choices of the individual parent
guardian (as appropriate) and on the strengths and needs of the individuals to
be served by the organization
C.
Individual choice shall be determined bv personal futures planning as specified
in Section 513 and a comprehensive assessment which addresses:
1. Relevant medical history
2. Relevant psychological in formal
ion
3. Relevant social
information
4. Information on
previous direct services and supports
5. Strengths
6. Abilities
7. Needs
8. Preferences
9. Desired outcomes
10. Cultural background
11.Other issues, as
identified
514.1 The Individualized Program Plan
A. Shall be developed with the input of the
person served and or their legal guardian.
B. Shall Identify:
1. Least restrictive emironment
a.Documentation of discussion of least
restrictive environment appropriate for individual strengths and needs
b.The program must document the
justification for specialized environments if they are to be used. Plans shall
be made for return to normal environments as soon as possible.
1.Individuals shall be in contact as much as
possible with those who do not have disabilities
2. Individual program plans will be reviewed
for provisions of program services in the least restrictive environment
appropriate to the ability of the individual. Document this item with a summary
of the discussion by the entire team about the least restrictive
alternatives
3. If the person
chooses community integration or a less restrictive environment, documentation
of referral attempts for alternate placement shall be present
2. Barriers
a.Describe the conditions or barriers that
interfere with the achievement of the goal(s) or skills(s). Describe why a
particular individual's needs cannot be met or what needs to be accomplished to
meet the need.
b. Resources and or
environment changes, adaptations or modifications necessary to attain the goal
or skill shall be listed. The person responsible for attempting to get the
service must be identified.
Note: Example of barriers are: lack of contract work,
lack of funds, lack of staff, individual absent due to illness, prosthetic
devices, equipment space, etc. The responsible person may be staff member,
individual, family, etc.
c. Documentation of efforts made to remove
the identified barriers shall be noted in the individual's progress
reports.
3. Long-range
goals (addressing a period of 3-5 years) and annual goals
a. The plan shall incorporate the goals and
objectives of the individual's person centered plan.
b. The planning process shall support the
individual / family in decision making and choosing options by actively
involving the individual family in the Individual Plan (IP)
development
4. Specific
measurable objectives.
514.2 Short-term objectives (3-6 months* time
frame) shall be developed, as needed, for each of the annual goals.
A. Each objective must have criteria for
success that states what the individual must do to complete the
objective.
B. Short-term objectives
must have methods- materials for implementation and give a simple statement
describing the procedures to be used in individual training.
C. The person responsible for implementation
of each short-term and service-objective shall be specified.
Note: Utilization of title is recommended. This could
be the individual or parent/guardian.
D. Short-term objectives shall have an
initiation date, a target date, and, when completed, a completion
date
E. Target dates -
1. The target date shall be individualized
and noted at the same time of the initiation date and the projected date when
the individual can realistically be expected to achieve an objective.
2. The target date shall be used as a prompt
to see if expectations for the individual are realistic in relation to
attainment and appropriateness of goals and objectives. If the starting or
target dates need to be revised, the organization shall mark through, initial
and put in a new date.
3. The
ending date shall be entered in as the person completes each
objective.
514.3 Service Objectives
A. Shall be reviewed on a regular basis with
respect to expected outcomes.
B.
Shall be revised, as appropriate:
1. Based on
the satisfaction of the person served.
2. To remain meaningful to the person
served.
3. Based on the changing
needs of the person served.
C. Shall include a target date, which is a
projected date when the team thinks the individual will no longer need the
service or the service provision should be reviewed.
514.4 The following areas shall be assessed
to determine needs in the plan and shall be documented:
A. Assistive technology.
B. Reasonable accommodations.
C. Identified health and safety
risks
514.5 The
individual program plan shall be communicated in a manner that is
understandable:
A. To the person served and
or their guardian advocate/ representative.
B. To the persons responsible for
implementing the plan.
514.6 The organization shall ensure that
persons in\ oh ed or their legal guardian/advocate understand the plans and
their own involvement in achieving the outcomes.
A. Active participation of the persons
served, or their guardian or advocate in setting goals and planning services
shall be documented. Documentation may be through interviews, records,
checklists, etc. and shall be maintained in the individual's file
B. If a person served needs services that are
not available through the organization, the organization shall make referrals
to other providers as indicated, Documentation of the referral(s) shall be
maintained in the individual's file.
NOTE: Com ,\c i DDS roK a usrni:
providers that provide mi: RIQUSIIDSIRYK k.
515 Every ninety (90) days of serv ice
delivery, the serv ice provider shall complete a quarterly report on the goals,
objectives of the 1PP. If needed, modifications may be made with meeting of
entire team. Quarterly reports must be specific to rcllcct the individual's
performance concerning implemented goals and short-term objectives as specified
in the individual program plan and shall be based on the case notes for the
reporting period.
A. The quarterly notes
shall establish goals or short-term objectives which are:
1. Accomplished
2. To be continued
3. Modified or deleted (with statement of
reason or barrier) and
4. Will be
worked on for the next three months or ninety (90) days
B. Data Collection/case notes shall be
utilized in writing progress reports.
C. Quarterly reports shall be written, dated,
and signed by persons responsible for case management. All persons responsible
for implementation of services must contribute to the report.
D. Quarterly reports shall document referral
to interdisciplinary team for modification of the annual goals as needed, in
compliance with state and federal regulations
E. Documentation of communication of
quarterly reports to the individual parent/guardian (as appropriate) shall
occur at least every three (3) months or ninety (90) days as in compliance with
state and federal regulations.
F.
Quarterly reports must include space for individual and/or parental/guardian
evaluation of services. The organization shall document that the persons served
and or the parent guardian has opportunity to evaluate the services received as
in accordance with state and federal guidelines.
516 Updating
A. The organization shall have policies and
procedures in place for updating individual program plans. Updates shall be
done at least annually and more often if monitoring reports indicate a need or
if federal regulations require more frequent updates.
B. The organization shall have policies and
procedures in place for revising individual program plans when goals
change.
C. Annually update -
financial, if applicable, social, medical, medical prescription for services,
evaluations as applicable, IPP's, and service needs assessment;
517 Termination of services or
alternate placement
NOTE: SKI: Till: SPECIFIC PROGRAMMING SIC I ION FOR MORE
DETAILED INFORMATION (CHILDREN'S SIRVKT-S 521).
A. An exit summary shall be prepared each
time a person leaves a service, not just when the person is leaving the
organization.
1. The report shall summarize
the results of the services received by the person and makes recommendations
for future services to continue the achievement of the person's life
goals.
2. The plan may suggest
referrals to other services that are not available through the
organization
518 Data Collection Requirements
A. Data collections shall provide specific
information on annua] goals and short-term objectives and should be designed to
measure and record the progress on each short-term objective.
B. Data collection shall consist of
sufficient written documentation to support each.
Daily
service documentation must, at a minimum, include:
* The specific services furnished;
* The date and actual beginning and ending time of day the
services were performed;
* Name(s) and title(s) of the person(s) providing the
service(s);
* The relationship of the services to the goals and objectives
described in the person's individualized plan of care and
C. Data collection shall also consist of
weekly or more frequent progress notes, signed or initialed by the person
providing the service(s), describing each individual's status with respect to
his or her goals and objectives.
D.
Data Collection shall be filed in the individual's file at least monthly and
shall be available for review upon request.
520 The organization shall establish and
maintain each individual's daily schedule based upon the individual's program
plan. The schedule shall indicate general activities throughout the day for
each individual. As appropriate the schedule should reflect time segments for
the individual to exercise choice in the selection of activities.
521
Children's Services Individual
Program Planning
As a key element in establishing goals objectives personal
outcomes, the agency shall assess an individual's family's preferences,
desires, lifestyle choices, strengths, needs, skills, etc. through individual
observations or interviews. Documentation of the assessment shall be maintained
in the individual's file. At a minimum, the assessment must include:
A. Developmental Assessment
1. Initial evaluation shall include 2
developmental assessments; I standardized and 1 criterion based.
2. Documentation must include:
a. A written summary that includes standard
deviation and or percentage of delay as determined by the test
protocols
b. An informed clinical
opinion
3. Must be in a
format that is understandable to the parent.
4. Must be signed by the evaluator.
B. An annual assessment must be
conducted using a criterion based test,
C. A Social History must be completed, signed
and dated on the approved form from DOE.
521.1 Children 3-5-The Individual Program
Plan shall include a statement of the specific services necessary to meet the
identified needs of the child family,
A. At a
minimum the IPP must include:
1. Frequency-
Number of days or sessions that a ser\ ice will be provided
2. Intensity- The length of time the serv ice
is prov ided during each session, and whether the service is provided on an
individual or group basis
3.
Location- Location where the service is provided (e.g., in the child's home,
early intervention center, or other setting) as appropriate to the age and
needs of the child
4. Method- How a
service is provided
5. Dates and
duration- Projected dates of initiation of the services, a target date for
completion and or review and the anticipated duration of those services. If
either of these dates needs to be revised, then simply mark through, initial
and put in new date.
B.
Completion of the IPP must meet all State and Federal requirements
C. In order to revise an individual's
objectives, at least three (3) members of the team must be present. Parent(s)
must be included.
521.2
Quarterly reviews must include a Family Rating which must be documented on the
appropriate form as designated by DDS.
521.3 Children reaching 5 years of age must
hav e a transition plan.
A. This plan must be
developed 180 days prior to age 5 as per State and Federal
guidelines.
B. The plan must be
child specific and must include specific steps to ensure a smooth transition
for the child and family, and must be in accordance with State and Federal
Guidelines.
C. The plan must
include a transition plan at kindergarten age. Children entering public schools
must have a transition plan.
D. The
individual program shall include the steps to be taken to support the
transition of the child upon reaching kindergarten age.
E. The organization must document contact
with the agency which will provide services following the transition, and must
demonstrate an attempt to involve that agency in the transition planning.
Documentation must be maintained in the individual's file.
521.4 If the organization is using the
supervising teacher model, the organization must follow all State and Federal
Guidelines and maintain appropriate documentation of supervision and direct
contact with the child on file for review.
522
Vocational Maintenance &
Monitoring
Vocational Maintenance & Monitoring
A. Case Notes
1. Case notes shall document each contact
with the individual the frequency of each contact will be determined by ihe
team during the development of the IPP it should include date, time and summary
of each contact.
2. Service
Objectives shall be listed in an outcome oriented manner.
A. Each service objective shall specify any
environment modification necessary to facilitate Ihe individual's
accomplishment.
B. Each service
objective, including physical adaptations or modifications of the individual's
environment, shall be stated as a single specific outcome.
C. Service objectives shall provide
opportunities in the social environment to support community integration and
the enhancement of individual relationships.
D. Based on the individual's choice, and die
needs assessment, plans shall include facilitation of the individual's
participation in normal activities in normal settings of same-age
peers.
523
Staff Ratios
523.1 Staff Ratios for Early Intervention Day
Treatment Day Programming:
Ratios for Day Programming for Children 0-18 months 1:4
Ratios for Day Programming for Children 18-36 months 1:5
Ratios for Day Programming for Children 3-4 Years 1:7
Ratios for Day Programming for Children 4-6 1:8
Ratios for Day Program for Children 6 and over 1:10
523.2 Ratios for Adult
Developmental Day Treatment Day Programming The organization shall maintain a
1:10 ratio throughout the building.
523.3 For all Day Programming
The Direct Care Staff must have VISUAL CONTACT WHILE ACTIVELY
ENGAGED IN PROVIDING SUPPORT AND SUPERVISION TO CONSUMERS.
524
Square Footage
A minimum of forty (40) square feet of program training area
per individual served shall be required. This is program-training area only.
This does not include halls, storage areas, or administrative
offices.
600
FOOD SERVICES
A. This standards
section shall be applied to all provider owned leased, rented facilities. If
the facility contracts for food services, the organization shall ensure
compliance with DDS policies.
601
Written procedure shall be established that addresses how food services are
provided to the individuals served by the facility:
A. Procedure shall include how meals are
provided as well as staff responsible.
601.1 All Day services programs shall assure
that organization provided meals are approved, adequate diets, which conform to
the recommended dietary allowance.
601.2 Licensed Group Homes shall assure that
three (3) meals a day are available for individuals served.
A. The organization shall keep on hand
suitable food for preparing sack lunches, if appropriate.
B. All meals shall be part of an approved,
adequate diet, which conforms to the recommended dietary allowance.
C. Facilities with apartment units shall have
a mechanism for monitoring the resident's food related
skills.
602 The
organization shall keep menus on file Menu preparation should occur at least
one week in advance in order to:
A. Allow
adequate time to purchase foods to avoid too frequent menu substitutions. Meal
planning shall occur so that identical meals are not served on the same day of
consecutive weeks.
B. Serve as a
reminder for scheduling advance preparation;
C. Allow menus to be available as a teaching
tool for instruction of individuals, to include development of menus by
individuals.
Menus shall be kept on file for a minimum of three (3)
months.
603
Menus shall be prepared or approved by a registered dietitian/nutritionist.
Organizations may contract with a dietitian, nutritionist.
A. Dietitian/nutritionist shall check for
nutritional adequacy of menus and acceptable food safety and sanitation
practices. This must be documented by a written report at least
annually.
B. DDS shall accept
Arkansas Nutrition Program approval, or site monitoring reports, as adequate
approval for Centers that participate in the free/reduced lunch
program.
604 The
organization shall develop and implement written procedures that address
provisions for special diets.
A. Special
diets pertain to allergies, weight control, diabetes, religion, hypertension,
and other medical conditions as documented in the consumers file.
605 Food items and toxic items
shall not he stored together.
700
TRANSPORTATION
A. The organization shall establish written
procedures that address how transportation services are provided to individuals
served by the program.
B. The
procedures shall address transportation to the persons served, as well as staff
responsible.
C. The organization
shall ensure that all individuals receiving services are provided with a copy
of the transportation policies and shall document receipt of this information
in the individual's file.
701 The
organization shall assure safety for all persons being transported. For all
transportation services provided for the persons served by the organization,
the organization shall ensure:
A. For all
vehicles owned or operated by the organization:
1. Compliance with all applicable federal,
state, county, and city requirements,
a. All
vehicles shall be properly licensed by the State of
Arkansas.
2. Appropriate
licensing of all drivers.
a. All drivers must
be licensed according to state requirements for providers of public
transportation.
3.
Review of driving records of all drivers on an initial and annual
basis.
4. Insurance requirements
for vehicles and personnel.
a. The
organization shall maintain insurance coverage providing a minimum of
SI,000,000 comprehensive, liability, and property damage.
5. Safety equipment / features in vehicle(s).
a. Fire extinguisher in every program vehicle
used to transport consumers.
b.
Each vehicle shall utilize scat belts or suitable restraints when in motion in
accordance with Ark Code
27-37-702"Seat Belt Use Required" and
27-34-101 -107
"The Child Passenger Protection Act"
c. The organization shall establish policy
and procedure to ensure Child Safety Alarms on every vehicle required under Ark
Code
20-78-225
(all vehicles designed or used to transport more than 7 passengers and I bus
driver)
6. Accessibility
based on the individual's needs and reasonable requests.
7. Training of drivers in the organization's
transportation requirements.
8.
Written emergency procedures.
a.
Each vehicle used in transporting clients shall have a
documented emergency drill once every six months.
9. Availability of communication devices
(i.e., cell phones 2-way radios, etc.).
10. Road warning/hazard equipment (i.e.,
safety cones. Hairs, reflector signs, etc.)
11. First aid supplies.
a. Every program vehicle used to transport
consumers shall maintain a First Aid kit.
12. Maintenance of vehicles owned or operated
by the organization according to manufacturers' recommendations.
a. The organization shall establish implement
procedures that ensures a vehicle maintenance log is kept up to date for all
vehicles used to transport consumers.
1. The
procedure shall establish who is responsible for upkeep of vehicle and who is
responsible for documentation and update of log.
b. The maintenance log shall document the
following:
1. Oil changes
2. Tires and brakes repair
inspection
3. Head and tail lights
and turn signals repair-inspection
4. Windshield washer and wiper blades
repair/inspection
5. Air
conditioner (if any), and defroster inspection/repair
6. Hoses and fan belts
inspection/replacement
7. Fluid
levels inspection and replacement
8. Exhaust system inspection,
repair
9. Emergency warning system
inspection, repair
10. Steering
assemblage inspection repair
13. If services are contracted;
a. An annual review of the contract against
elements 1-12 of this standard shall be performed by the
organi/ation.
b. Personnel or
contractors shall provide transportation services for the persons served in a
safe manner, with drivers having knowledge of unique needs of persons served,
and consistent with the regulations of the local authorities,
1. This standard shall apply when any
vehicle, including a personal vehicle, is used to provide transportation for
persons served.
702 The organization shall establish written
policy and procedure to address apparent abandonment of consumer by family and
or guardian.
A. The organization shall
develop a procedure to be followed by transportation staff when unable to leave
individuals at home or alternate sites as specified by family that ensure the
safety of the individual at all times.
703 At least one responsible person, in
addition to the driver, shall be present in the vehicle if any of the following
conditions apply:
A. Any person being
transported has medical conditions as defined by the organization
guidelines.
B. Any person being
transported has a severe disability as defined by the organization's
guidelines.
NOTE: 'Responsible person ' shall he defined hy the
organization 's policy,
704 Organizations operating vehicles
transporting children shall comply with the child:staff ratio specified by the
Child Care Licensing Standards for Transportation
705 Organizations operating vehicles
transporting adults shall establish implement policies related to adult: staff
ratios.
NOTE: DDSrecouuesds t1 roll) ft trio tr \u.
nuns.
800
Physical Plant, Accessibility and Safety
A. The organization shall provide a physical
plant compatible with services provided and with the needs of the individuals
and staff; provide an accessible and safe environment and be in compliance with
U.S.C. § 12101 et. seq. "American with Disabilities Act of 1990" at all
owned, leased, and/or rented program site(s).
801 The organization shall promote
accessibility in all settings. The organization shall assess all physical sites
to ensure accessibility for individuals and their families and shall establish
time lines and actions to be taken for removal of identified barriers.
A. Organizations shall ensure that all
physical sites address accessibility issues in order to:
1. Enhance the quality of life for those
served in their programs and services.
2. Meet legal and regulatory
requirements.
3. Meet the
expectations of stakeholders in the area of accessibility.
801.1 Accessibility Requirements
A. The organization shall ensure
architectural accessibility at each facility based on the individual's needs.
1. Ramps, doors, corridors, toileting and
bathing facilities, furnishings, and equipment are designed to meet the
individual's needs.
B.
The organization shall ensure that all their facilities are in compliance with
29 U.S.C. §$ 706 (8), 794 - 794(b) "Disability Rights of 1964" and U.S.C.
§ 12101 et. seq. "American with Disabilities Act of 1990". Compliance with
the aforementioned laws is required to receive federal monies. Admissions
criteria of who can be served shall identify any persons the facility or staff
would be prevented from serving due to accessibility issues.
801.2 Accessibility Assessment and
Planning
A. The organization shall assess all
facilities. The assessment shall identify all barriers and shall develop a plan
for removal of barriers in the following areas:
1. Architecture
a. Architectural or physical barriers which
may include steps that prevent access to a building for an individual who uses
a wheelchair, narrow doorways that need to be widened, bathrooms that need to
be made accessible, the absence of light alarms for individuals who have a
hearing impairment, and the absence of signs in Braille for individuals who
have visual impairments.
2. Environment
a. Any location or characteristic of the
setting that compromises, hinders, or impedes service delivery and the benefits
to be gained.
802 Physical Plant Structure
802.1 Architecture
A. All water, food service, and sewage
disposal syslems must meet all local, state, and federal regulatory agencies,
as applicable. The organi/alion shall maintain documentation of all approved
inspections for review by DDS.
1. Sewer
inspections are not required if the site is on city water and sewage
lines.
2. Sites using a well and.
or septic tank, shall be obtain an inspection by the Division of Health
documenting compliance with the DOH and local regulations.
B. Floor furnaces, gas heaters, electric
heaters, hot radiators, and exposed water heaters must be protected by screens
or guards that are without sharp corners and are attached to floor or wall to
prevent persons from falling against the guard and knocking it over.
C. Enclosed gas heaters must be properly
vented to the outside, and installed with permanent connection that includes a
cut-off valve in the rigid part of the gas supply pipe.
Note: DDS recommends gas heaters with a pilot light and
automatic cut-off valve which automatically cuts off gas to the main burner
when the pilot light goes out.
D. Restroom facilities used by individuals
must provide for individual privacy and be appropriate for the individuals
served regarding si/e and accessibility.
802.2 Environment
A. Temperature of each facility must be
maintained within a normal comfort range for the climate. Recognizing that
there may be variances within a building, the organization shall make
reasonable efforts to maintain a comfortable temperature range throughout the
facility.
Note: The recommended standard for range oj comfort is
from 65 to SO degrees F (U.S. Atmospheric Standards 29.1)
B. All areas of the facility shall
be sufficiently lighted to meet the needs of the individuals being served and
the usage of the area.
C. The
organization shall maintain the interior and exterior of the building in a
sanitary and repaired condition.
D.
The premises shall be free of offensive odors.
E. The grounds and all buildings on the
grounds shall be maintained in a clean and repaired condition.
1. Play and activity areas shall be free of
dense undergrowth and refuse accumulations. All landscape plantings and the
lawn shall be well groomed.
F. The facility shall be maintained free of
infestations of insects and rodents.
1. The
organization shall maintain a contract for pest control that is administered by
appropriately licensed professionals.
G. The organization shall establish written
procedures regarding smoking that is in accordance with The Clean Air Indoor
Act (Act 8 of 2006).
1. For all congregate,
day-hab settings, anil licensed group homes, smoking will not be permitted in
the following areas:
a. Common Work Areas
b. Auditoriums
c. Classrooms
d. Conference and Meeting Rooms
e. Private Offices
f. Elevators
g. Hallways
h. Health Care Facilities
i. Cafeterias
j. Employee Lounges
k. Stairs
I. Restrooms
m. All other enclosed areas.
2.Approved Exemptions:
a. Private residences or health care facility
b. All workplaces of any employer
with fewer than three (3) employees. (Note: This exemption does not apply to
any public place)
c. Outdoor areas
of places of employment or group homes
H. All materials and equipment and supplies
shall be stored and maintained in a safe condition. Cleaning fluids and
detergents must be stored in original containers with labels describing
contents.
1. The organization shall maintain
an MSDS manual in a location that is accessible to all employees. All MSDS
sheets must be on file and current.
803 Safety Inspections
803.1 The organization shall ensure that
annual safety inspections are completed by qualified individuals to enhance and
maintain the organization's health and safety practices.
A. All applicable inspections shall be
maintained on file, and current within one year or as specified by law
regulation {i.e., Annual Fire Department, Local Health Department, Safety
Engineer, OSHA, Safety Specialist, and Insurance Carrier).
B. A comprehensive inspection shall be
conducted annually at all facilities where the organization delivers services
or provides administration on a regular and consistent basis. Inspections shall
be conducted by a qualified external authority(ics).
1. Results of each inspection shall contain
written documentation that:
a. Identifies the
areas inspected.
b. Identifies
recommendations for areas needing improvement.
c. Identifies actions taken to respond to the
recommendation(s).
C. All applicable licenses, inspections,
etc., shall be current. This shall include health inspections for food service
preparation, if applicable. Residential facilities with more than ten (10)
residents must have a Division of Health inspection.
803.2 Regular self-inspections shall be
completed to assist personnel in internalizing current health and safety
requirements into everyday practices.
A. The
organization may designate professional personnel (managers, supervisors,
direct service employees, maintenance personnel) or internal groups (safety
committees, safety circles, operation teams, consumers or advocates) within the
organizational structure to conduct self- inspections. The organization shall
ensure that all staff involved in self-inspections have received training in
conducting inspections prior to participation.
B. The organization shall maintain a schedule
of when self-inspections will be conducted.
1.
At a minimum, self-inspections must be conducted:
a. At least twice a year.
b. At all facilities where the organization
delivers services or provides administration on a regular and consistent
basis.
2. Results of
self-inspections shall contain written documentation that:
a. Identifies the areas inspected.
b. Identifies recommendations for areas
needing improvement.
c. Identifies
actions taken to respond to the recommendation(s).
804 Emergency
Procedures
804.1 The organization
shall establish emergency procedures that detail actions to be taken in the
event of emergency and to promote safety for the individuals served.
A. Emergency procedures shall be in written
form, and shall be available and communicated to all members of the staff and
other supervisory personnel.
1. At a minimum,
emergency procedures shall be implemented for:
a. Fires.
b. Bomb threats
c. Natural disasters.
d. Utility failures
e. Medical emergencies
f. Safety during violent or other threatening
situations (i.e., intruders)
2. Written emergency procedures shall:
a. Meet the requirements of all applicable
authorities.
b. Implement practices
appropriate for the locale (i.e., Arkansas Chemical Stockpile Emergency
Preparedness Program CSEPP)
B. The organization shall maintain an
emergency alarm system for each type of drill (fire and tornado).
C. The organization shall ensure that persons
served, as appropriate, are be educated and trained about emergency and
evacuation procedures.
D. The
organization shall evaluate and consider modification of all emergency
procedures during the following times:
a.
Training.
b. After training
drills.
c. As risks
increase.
d. Alter actual
emergencies.
e. When responsibility
is reassigned,
f. When changes are
made to the physical plant.
g. When
changes occur in the physical plant proximity,
h. When a policy or procedure is
revised,
i. When briefing personnel
on emergency plan changes.
E. The organization shall analyze tests of
the emergency and evacuation procedures annually and shall use the results of
the analysis to improve or to affirm satisfactory current practices.
804.2 For all facilities where the
organization delivers services or provides administration on a regular and
consistent basis, the organizations shall establish'implement written
procedures for evacuations,
A. Evacuation
procedures shall address:
1. When evacuation
is appropriate
2. Complete
evacuation from the physical facility,
3. The sa lety of ev acuccs.
4. Accounting for all persons
involved.
5. Temporary shelter,
when applicable.
6. Identification
of essential services.
7.
Continuation of essential services.
8. Emergency phone numbers.
9. Notification of the appropriate emergency
authorities.
B.
Evacuation routes must be posted in conspicuous places, except in residential
settings and must be easily understandable to the individuals
served.
804.3 As a part
of an organization's performance improvement activities shall include emergency
procedure testing.
A. A tornado drill must be
held monthly.
1. Written reports telling
date, hour of day, evacuation time, and other areas of concern shall be
maintained.
B. A fire
drill must be held monthly.
1. Written
reports telling date, hour of day, evacuation time, and other areas of concern
shall be maintained.
804.4 Detectors
Battery operated or electronic smoke detectors, heat sensors,
carbon monoxide detectors and/or sprinklers shall be provided in all buildings
where services are provided and shall meet life safety codes.
A. Fire Marshall's report shall be followed
as to placement of these devices.
B. Equipment shall be tested at least
quarterly or as recommended by the manufacturer monitoring
contractor.
804.5 Fire
Extinguishers
Fire extinguishers shall be required to the extent specified by
the State Fire Marshall or his designee and shall be checked annually.
A. The Fire Marshall uses Ark. Code Ann.
§$
12-13-101 -
I2-I3-116 "Fire Prevention Act"
that follows the Life Safety Code 101 and additional National
Fire Prevention Agency publications.
804.6 Emergency Lighting
The organization shall maintain emergency lighting, (i.e.,
flashlight or other battery operated lights) as required by the life safety
codes.
804.7 First Aid
The organization shall maintain a first aid kit and current
first aid manual at all sites where services are provided on a regular,
consistent basis.
A. Antidote charts
and the telephone numbers of poison control centers shall be readily accessible
to staff and individuals served.
Note: This can he obtained through Poison Control
Center at University of Arkansas
Medical Science Center in Little Rock if you cannot get
locally.
804.8 Water Temperatures
Provisions shall be made to control water temperature at
facilities where services are provided on a regular, consistent basis.
A. To ensure the safety of individuals
served, each organization shall develop, implement policy and procedure
concerning water temperature adhering to current literature regarding water
safety with a maximum temperature of 120 degrees. If the thermostat of the hot
water heater is set above 120 degrees, a mixer must be to the lavatories and
bathing facilities to maintain safety.
Note: This standard shall apply only to sen ice areas
and where consumers are working.
History, Philosophy, Causes and Types, Functional Levels,
Severity Levels. Prevention and Program Issues in Mental Retardation and Other
Developmental Disabilities.
Overview of Federal and State Laws related to serving people
with Developmental Disabilities (see index):
U.SC S2000a - 2000 h-6; Ark. Code Ann SS
6-41-222: 20 U.S.C S
14000 et. seq (Part B & Part H); 29 USC SS 706(8), 794-794{b);
5 USC S 552a; 42 U.S.C SS 6000-6083. Ark Code Ann SS
20-48-201 -
20-48-211;
Ark Code Ann SS
28-65-101
-
28-65-109;
Ark. Code Ann. SS
5-28-101 -
5-28-109; Ark Code Ann
SS 12-12-501 - 12-12-515, Ark Code Ann. SS
25-2-104,
25-2-105,
25-2-107, Ark
Code Ann SS
25-10-102
-
25-10-116;
Ark. Code Ann SS 20-18-215; USC. S 12101 et. Seq.; DHS Administrative Policy
3002-I (Revised) and DDS Service Policy 3016, Prevention of Transmission of
Disease Borne by Blood or other Body Fluids such as AIDS and Hepatitis B, DDS
Administrative Policy 1077 Chemical Right to Know; DDS Service Policy 30044
Maltreatment Prevention, Reporting and Investigation.
9. Clinic Services
(1)
Adult Developmental Day Treatment
(ADDT) and Early Intervention Day Treatment (EIDT)
Reimbursement is based on the lesser of the amount billed or
the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was
established based on a 1980 survey conducted by Developmental Disabilities
Services (DDS) of 85 Arkansas Developmental Day Treatment
providers of their operational costs excluding their therapy services.
An average operational cost was derived for each service. Then an average
number of units was derived for each service. The average operational cost for
each service was divided by the average units for that particular service to
arrive at a maximum rate.
For dates of service occurring on or after February 1, 2010,
the maximum per unit rate for Adult Habilitativc Services is
increased to SI 0.60. These new rates were calculated based on analysis of the
current 2005 cost to provide quality services in compliance with governing
regulations. The rates have been demonstrated to be consistent with the Clinic
Upper Payment Limit at
42
CFR 447.321.
For EI DT and ADDT, I
unit of service equals I hour of service w ith a maximum of 5 units per
day.
For EIDT, auditory, developmental and neuropsychological
testing services listed in the 1990 Blue Cross/Blue Shield Fee Schedule that
are not subject to the other specifically identified reimbursement criteria arc
reimbursed based on 80% of the October, 1990 Blue Cross/Blue Shield Fee
Schedule amounts. For those services that were not included on the 1990 Blue
Cross/Blue Shield Fee Schedule, rates are established per the most current Blue
Cross/Blue Shield Fee Schedule amount less 2.5% and then multiplied by
66%.
For EIDT, Psychological diagnosis/evaluation services arc
reimbursed from the Rehabilitative Services for Persons with Mental Illness
(RSPM I) Fee Schedule as described in Attachment 4.I9-B, Item
I3.d.l.
For EIDT, Medical professional services reimbursement is
based on the physician's fee schedule. Refer to the physician's reimbursement
methodology as described in Attachment 4.19-B, Item 5.
For EIDT, The maximum rates for nutritional services are
based on the entry-level salary for a Dietician (Grade 19). Department of Human
Services position. The cost categories include Salary ($22,795), overhead and
administration (52,276...using salary as the allocation base) and benefits
($4,559...using salary as the allocation base). These costs were allocated at
10% for overhead/administration and 20% for benefits. A 30 minute visit will
equal one unit of services. As such, the unit of services rate is S7.12 as
calculated by |S22,795 + 52,276 + 54,559 = 529,630/2080 (52 weeks x 40 hours
per week) = 514.24 per hour. |
The maximum rate for nursing services is 514.30.
Reimbursement for registered nurse and licensed practical nurses is based on
the Private Duty Nursing Fee Schedule as described in Attachment 4.I9B, Item
8.
State developed fee schedule rates are the same for both public
and private providers of EIDT and ADDT services.
Occupational, physical and speech therapy services under the
EIDT and ADDT Program are reimbursed as is described in
Item 4.b.( 19).
Extensions of benefits will be provided for all EIDT and
ADDT services, If medically necessary.
