Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 05 - Developmental Disabilities Services
Rule 016.05.21-002 - DDS Admin. 1089, Expansion of Children's Early Intervention Day Treatment Sevices
Universal Citation: AR Admin Rules 016.05.21-002
Current through Register Vol. 49, No. 9, September, 2024
ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES SERVICES DDS DIRECTOR'S OFFICE POLICY MANUAL
I. Purpose. This policy implements Ark. Code Ann. § 20-48-105, as amended by Act 1017 of 2013.
II. Scope. This policy applies to all Division of Developmental Disabilities Services ("DDS" or "Division") staff charged with implementation of licensure requirements, and to DDS licensed community based providers of nomesidential services to adults that are or could be covered under the Arkansas DDTCS program
This policy does not apply to the provision or regulation of services under the ACS Waiver Program or to Early Intervention services delivered pursuant to the Individuals with Disabilities Education Improvement Act of 2004 ("IDEA"), Public Law 108-446.
III. Definitions.
1.
Existing Provider:
A) A DDS licensed nonprofit community program
that offers nomesidential services to adults covered under the Arkansas DDTCS
program at an approved site within the county in question, or;
B) A DDS licensed nonprofit community program
that does not have an approved site in a county but provides developmental
disabilities services covered under the Arkansas DDTCS program to 20 or more
adults who reside in that county.
C) A nonprofit community program that was
issued a DDS license on or before February 1, 2007, that does not operate an
approved site but provides developmental disabilities services to
adults.
2.
Underserved: A county is underserved if:
A) There is no DDS licensed provider
operating a site offering adult development community-based, nomesidential
services covered by the Arkansas DDTCS program in the county.
B) There is at least one site operated by a
DDS licensed provider in the county, but a service covered under the DDTCS
program for adults is unavailable to an eligible adult recipient at an existing
site in that county.
C) There is at
least one site operated by a DDS licensed provider in the county, but a parent,
guardian, recipient, or prospective eligible adult who has exhausted the
grievance mediation procedure set forth in section V of this policy remains
dissatisfied and desires another choice of providers of DDTCS covered adult
services in that county.
IV. Existing Provider Expansion: Existing providers of adult services having no approved site within the county may purchase, construct, or lease a site in the county subject to DDS site approval. Approval shall be limited to:
1.
Providers that serve at least 20 eligible, enrolled, and participating adults
of that county that are covered under the Arkansas DDTCS program.
2. Providers that were issued a DDS license
on or before February 1, 2007, but that do not currently operate an approved
site for adult services. Such providers may open a site for the provision of
adult services in the county where the nonprofit community program maintains
its headquarters. If a provider subject to this provision has more than one
headquarters, it must designate one county as housing the primary headquarters
for purposes of this section.
V. Dissatisfied Parent, Guardian, Recipient, or Prospective Eligible Individual Grievance Mediation Procedure. If a parent, guardian, recipient, or prospective eligible adult individual provides DDS with a written statement of dissatisfaction with an eligible adult's current service provider, and asserts that other providers in the recipient adult's county of residence cannot meet his or her needs, DDS will schedule mediation between authorized representatives of the parties as soon as practicable but no later than 45 days from the date of receipt of the statement of dissatisfaction.
1. Every
parent, guardian, or adult recipient will be provided notice by their chosen
provider of available service options and grievance procedures, including DDS
contact information regarding grievances in compliance with DDS licensure
standards.
2. If DDS receives an
allegation that the statement of dissatisfaction was solicited in violation of
DDS licensure policy, DDS shall investigate the allegation. The individual or
organization making the allegation shall provide DDS with all documents,
supporting materials, and other relevant information which form the basis of
the allegation within ten (10) business days.
3. If the mediation fails to resolve the
grievance, and parent, guardian, recipient, or prospective eligible adult
desires another choice of provider, DDS shall declare the county underserved as
defined in section III(C) of this policy.
4. The purpose of the mediation process is to
provide a mechanism to resolve a legitimate grievance brought by a parent,
guardian, adult recipient, or prospective eligible adult, and is subject to the
following provisions:
A) The grievance
mediation procedure is intended to resolve disputes related to dissatisfaction
with the quality or quantity of services provided or available.
B) In the exercise of its discretion, if DDS
determines that a statement of dissatisfaction is wholly unrelated to the
quality or quantity of services provided or available, the Division may decline
to schedule the mediation.
C) In
the exercise of its discretion, if DDS determines that a statement of
dissatisfaction is wholly unrelated to the quality or quantity of services
provided or available, the Division shall not declare the recipient's county of
residence as underserved as defined in section IIl(C) of this policy.
VI. General Provisions. DDS may authorize the expansion of the number of developmental disabilities service provider's sites for adult services in a specific county if it determines the county as underserved.
Following such a determination, DDS will apply the following procedures:
1. DDS will send written
notice that a county is underserved to all qualified nonprofit community
programs for adult services as defined in Ark. Code Ann. §
20-48-101(6)(A)
that are existing providers in the underserved county. The notified providers
shall have 30 days from receipt of notice to state in writing to DDS whether
they wish to alter their operations to eliminate the reason or reasons the
county is underserved.
2. Any
provider stating an intention to alter its operations must accomplish the
alteration within 90 days from the date it receives notification from DDS that
the county is underserved.
3. The
90 day period may be extended by DDS if the provider demonstrates in writing to
the Division that there is good cause for the delay. In no event shall an
aggregate of 180 days be exceeded unless substantial progress has been made
towards meeting site approval requirements. DDS shall consider the following:
Whether a lease has been secured or construction commenced; whether staff has
been recruited or hired for employment.
4. If no existing provider of a qualified
nonprofit community program for adult services states an intention to alter its
services, or if a provider expresses an intention to alter its services but
fails to accomplish the alteration before deadlines stated above DDS shall
proceed to the following step.
5.
DDS shall send written notice that the county is underserved to all qualified
nonprofit community programs providing adult services, as defined in Ark. Code
Ann. §
20-48-101(6)(A),
having one or more approved sites within the State of Arkansas. The notified
providers shall have 30 days from receipt of notice to state in writing to DDS
whether they wish to expand operations to eliminate the reason or reasons that
the county is underserved with regard to adult services.
A) Any provider stating an intention to alter
its operations must accomplish the alteration within 90 days from the date it
receives notification from DDS that the county is underserved.
B) The 90 day period may be extended by DDS
if the provider demonstrates in writing to the Division that there is good
cause for the delay. In no event shall an aggregate of 180 days be exceeded
unless substantial progress has been made towards meeting site approval
requirements. DDS shall consider the following: Whether a lease has been
secured or construction commenced; whether staff has been recruited or hired
for employment.
C) If no existing
provider of a qualified nonprofit community program states an intention to
alter its services, or if a provider expresses an intention to alter its
services but fails to accomplish the alteration before deadlines stated above
DDS shall proceed to the following step.
6. DDS will publish notice to the general
public in statewide print media that the agency is accepting applications from
any accredited nonprofit entity, as defined in Ark. Code Ann. §
20-48-101(1)
(A), that provides adult services in the
underserved county. Any such entity shall have 30 days from the date of
publication to state in writing that it desires to obtain a license and offer
the services in question.
A) Any accredited
nonprofit entity that states in writing an intention to begin providing adult
services under this section shall have 90 days from the date it received
notification from DDS to obtain a license from DDS and begin provision of the
services in question.
B) The 90 day
period may be extended by DDS if the provider demonstrates in writing to the
Division that there is good cause for the delay. In no event shall an aggregate
of 180 days be exceeded unless substantial progress has been made towards
meeting site approval requirements. DDS shall consider the following: Whether a
lease has been secured or construction commenced; whether staff has been
recruited or hired for employment.
C) If no in-state accredited nonprofit entity
that provides adult services indicates a desire to apply for a DDS license, or
if such an organization fails to obtain a license and begin providing services
prior to the deadline, DDS will accept applications from accredited nonprofit
organization from outside the State of Arkansas.
7.
Limitation: Existing
providers who are on a regular with requirements, temporary, or provisional
licensure status with DDS, or are excluded under DHS Policy 1088 may not file
any notice or application to expand under this policy.
I. Purpose. This policy implements Ark. Code Ann. § 20-48-1101 et seq.
II. Scope. This policy applies to:
1. All Division of Developmental Disabilities
Services ("DDS" or "Division") staff charged with implementation of licensure
requirements.
2. DDS licensed
community based providers of nonresidential services that are or could be
covered under the Arkansas developmental day treatment clinic services
("DDTCS") program for children who have a developmental disability.
3. Programs that satisfy all certification
criteria established by the Department of Human Services ("DHS" or
"Department") for child health management services ("CHMS") and child health
management services operated by an academic medical center.
4. Programs related to the delivery of early
intervention day treatment services provided by a successor program that is
created as a replacement for, combination of, or derived in whole or in part
from the CHMS program and the DDTCS program for children. A successor program
is not required to include CHMS programs operated by an academic medical
center, but CHMS programs operated by an academic medical center shall be
subject to all other provisions of this policy.
5. This policy does not apply to the
provision or regulation of services under the ACS Waiver Program or to Early
Intervention services delivered pursuant to the Individuals with Disabilities
Education Improvement Act of 2004 ("IDEA"),
Public
Law 108-446.
III. Definitions.
1.
"Accredited entity" means a
corporate entity that meets the definition of Ark. Code Ann. §
20-48-1102(1).
2. "Child health management
services means an array of clinic services for children:
(A) Intended to provide full medical
multidiscipline diagnosis, evaluation, and treatment of developmental delays in
Medicaid recipients; and
(B) That
are diagnostic, screening, valuation, preventive, therapeutic, palliative, or
rehabilitative services, including early intervention day treatment
services
3.
"Child
health management services operated by an academic medical center" means
an academic. medical center program specializing in developmental pediatrics
that is administratively staffed and operated by an academic medical center and
under the direction of a board-certified or board-eligible developmental
pediatrician.
(A) An academic medical center
consists of a medical school and its primary teaching hospitals and clinical
programs.
(B) For a child health
management services program operated by an academic medical center, services
may be provided at different sites operated by the academic medical center as
long as the child health management services program falls under one
administrative structure within the academic medical center.
4.
"Developmental day
treatment clinic services for children" means early intervention day
treatment provided to children by a nonprofit community program that:
(A) Is licensed to provide center-based
community services by the Division.
(B) Serves as a quasi-governmental
instrumentality of the state by providing support and services to persons who
have a developmental disability or delay and would otherwise require support
and services through state-operated programs and facilities.
5.
"Early Developmental
Center" means a site from which early intervention day treatment
services are provided.
6.
"Early intervention day treatment" means services provided by a
pediatric day treatment program run by early childhood specialists, overseen by
a physician and serving children with developmental disabilities, developmental
delays, or a medical condition that puts them at risk for developmental delay.
(A) Early intervention day treatment includes
without limitation diagnostic, screening, evaluation, preventive, therapeutic,
palliative, rehabilitative and habilitative services, including speech,
occupational, and physical therapies and any medical or remedial services
recommended by a physician for the maximum reduction of physical or mental
disability and restoration of the child to the best possible functional
level.
(B) CHMS and DDTCS or a
successor program constitute the state's early intervention day treatment
program.
7.
"Existing Operations" means:
(A)
Early intervention day treatment services provided by a child health management
services program that was either operating a site on or before July 1, 2013 or
submitted a completed application to the Division of Medical Services of the
Department of Human Services to serve as a Medicaid provider no later than July
1, 2013.
(B) Early intervention day
treatment services provided by a licensed developmental day treatment clinic
services program.
(C) An early
intervention day treatment program that does not have an approved site in a
county but provides early intervention day treatment services covered under the
Arkansas DDTCS or CHMS program to 30 or more enrolled children who reside in
that county.
8.
"Successor Program" means a program:
(A) That provides early intervention day
treatment to children;
(B) That is
created as a replacement for, combination of, or derived in whole or in part
from the CHMS program and the DDTCS program for children; and
(C) In which the for-profit and nonprofit
providers from CHMS programs and DDTCS programs are eligible to
participate.
(D) Any successor
program is not required to include CHMS services offered by an academic medical
center.
9.
"Underserved" means:
A county is underserved with regard to early intervention day treatment services under the following conditions:
(A) There is no DDS licensed or DHS certified
provider with existing operations operating a site offering nonresidential
services to children covered by the Arkansas DDTCS or CHMS program in the
county.
(B) There is at least one
site operated by a DDS licensed or DHS certified provider in the county, but a
service covered under the DDTCS or CHMS program for children is unavailable to
an eligible recipient at an existing site in that county.
(C) There is at least one site offering early
intervention day treatment clinic services operated by a DDS licensed or DHS
certified provider in the county, but a parent, guardian, recipient, or
prospective eligible child who has exhausted the grievance mediation procedure
set forth in section V of this policy remains dissatisfied and desires another
choice of providers of early intervention day treatment services for children
in that county.
IV. Existing Provider Expansion; Existing providers having no approved site for the provision of early intervention day treatment services within a county may purchase, construct, or lease a site in that county subject to DDS site approval. New site approval under this provision shall be limited to sites in a county that is contiguous to the county where the provider operates an approved site and shall be based on the needs, benefit, and convenience of the children and families served, and shall be limited to:
1. Providers serving at least 30 children who
are eligible, enrolled, and participating in an early intervention day
treatment program as defined at Ark. Code Ann. §
20-48-1102(5),
but reside in the county in which the provider has no approved site but wishes
to expand.
2. Providers that were
issued a DDS license on or before February 1, 2007, but that do not currently
operate an approved site. Such providers may open a site in the county where
the nonprofit community program maintains its headquarters. If a provider
subject to this provision has more than one headquarters, it must designate one
county as housing the primary headquarters for purposes of this
section.
V. Dissatisfied Parent, Guardian, Recipient, or Prospective Eligible Individual Grievance Mediation Procedure. If a parent, guardian, recipient, or prospective eligible individual provides DDS with a written statement of dissatisfaction with an eligible individual's current service provider, and asserts that other providers in the recipient's county of residence cannot meet his or her needs, DDS will schedule mediation between authorized representatives of the parties as soon as practicable but no later than 45 days from the date of receipt of the statement of dissatisfaction.
A. Every parent, guardian,
and recipient will be provided notice by their chosen provider of available
service options and grievance procedures, including DDS contact information
regarding grievances in compliance with DDS licensure standards.
B. If DDS receives an allegation that the
statement of dissatisfaction was solicited in violation of DDS licensure
policy, DDS shall investigate the allegation. The individual or organization
making the allegation shall provide DDS with all documents, supporting
materials, and other relevant information which form the basis of the
allegation within ten (10) business days.
C. If the mediation fails to resolve the
grievance, and parent, guardian, recipient, or prospective eligible individual
desires another choice of provider, DDS shall declare the county underserved as
defined in section 111(9)(C) of this policy.
D. The purpose of the mediation process is to
provide a mechanism to resolve a legitimate grievance brought by a parent,
guardian, recipient, or prospective eligible individual, and is subject to the
following provisions;
(i) The grievance
mediation procedure is intended to resolve disputes related to dissatisfaction
with the quality or quantity of services provided or available.
(ii) In the exercise of its discretion, if
DDS determines that a statement of dissatisfaction is wholly unrelated to the
quality or quantity of services provided or available, the Division may decline
to schedule the mediation.
(iii) In
the exercise of its discretion, if DDS determines that a statement of
dissatisfaction is wholly unrelated to the quality or quantity of services
provided or available, the Division shall not declare the recipient's county of
residence as underserved as defined in section in(9)(C).
VI. Prerequisites for Certification and Licensure.
1. Children's
Health Management Services:
(A) Certification
by the Department is required for operation as a child health management
services program.
(B) The
Department shall grant certification on a county-wide basis,
(C) Before obtaining certification, a child
health management services program is required to apply to and obtain the
approval of the Division to implement new child health management services
under the criteria established under Ark. Code Ann. §
20-48-1101
et seq.
(D) A
certified child health management services program with existing operations on
the effective date of this act shall not be required to obtain the approval of
the Division to continue existing operations.
2. Developmental Day Treatment Clinic
Services for Children.
(A) Licensure from the
Division is required for operation of a developmental day treatment clinic for
children.
(B) The Division shall
grant licensure on a county-wide basis.
(C) Before obtaining licensure, a nonprofit
community program seeking to operate a developmental day treatment clinic
services for children is required to apply to and obtain the approval of the
Division to implement new developmental day treatment clinic services for
children under the criteria established under Ark. Code Ann. §
20-48-1101 et seq.
(D) A licensed nonprofit community program
providing developmental day treatment clinic services for children with
existing operations on the effective date of this act shall not be required to
obtain the approval of the Division to continue existing operations.
3. A certified CHMS program or a
licensed DDTCS program with existing operations on July 1, 2013 is not required
to obtain approval from DDS to continue existing operations.
VII. Determination of Underserved Status for Expansion of Services.
1. An expansion
of early intervention day treatment services in a county is necessary when the
Division determines that a county is underserved with regard to:
(A) Early intervention day treatment
services.
(B) A specific category
of early intervention day treatment services currently offered to children with
developmental disabilities or delays.
2. As a condition of the issuance of a new
certification to operate a CHMS program, a new license to operate a DDTCS
program for children, or a new certification or license for a successor
program, the Division must determine that a county of the state is underserved
in accordance with Ark. Code Ann. §
20-48-1104.
3. The Division shall have sixty (60) days
from the date of an application for expansion of early intervention day
treatment services in which to determine whether a county is underserved.
(A) The Division shall provide the applicant
with a written report of its findings and conclusions by certified
mail.
(B) The Division shall
provide a copy of the report to the appropriate licensing or certification
authority of the applicant.
4. If the Division determines that the county
is not underserved under this policy, the Division will notify the applicant
that they shall have thirty (30) days from the date of the applicant's receipt
of the written report in which to appeal the determination to the Office of
Appeals and Hearings of the Department of Human Services under the Arkansas
Administrative Procedure Act, Ark. Code Ann. §
25-15-201
et seq.
V II I. Notice of Underserved Area.
1. The Division
shall provide written notice by certified mail of its designation that an area
is underserved to all CHMS programs, DDTCS programs for children, and successor
programs with existing operations in the county designated by the Division as
underserved.
(A) Any qualified provider
stating an intention to alter its operations must accomplish the alteration
within 90 days from the date it receives notification from DDS that the county
is underserved.
(B) The 90 day
period may be extended by DDS if the provider demonstrates in writing to the
Division that there is good cause for the delay. In no event shall an aggregate
of 180 days be exceeded unless substantial progress has been made towards
meeting site approval requirements. DDS shall consider the following: Whether a
lease has been secured or construction commenced; whether staff has been
recruited or hired for employment.
(C) If no existing provider states an
intention to alter its services, or if a provider expresses an intention to
alter its services but fails to accomplish the alteration before deadlines
stated above DDS shall proceed to the following step.
2. If all CHMS programs, DDTCS programs for
children, and successor programs with existing operations in the county
designated by the Division as underserved determine not to expand early
intervention day treatment services, including CHMS, DDTCS for children, or
successor program services in the underserved county, the Division shall
provide written notice by certified mail of its designation that an area is
underserved to all qualified providers of CHMS, DDTCS for children, and any
successor program services in the remainder of the state.
(A) Any qualified provider stating an
intention to alter its operations must accomplish the alteration within 90 days
from the date it receives notification from DDS that the county is
underserved.
(B) The 90 day period
may be extended by DDS if the provider demonstrates in writing to the Division
that there is good cause for the delay. In no event shall an aggregate of 180
days be exceeded unless substantial progress has been made towards meeting site
approval requirements. DDS shall consider the following: Whether a tease has
been secured or construction commenced; whether staff has been recruited or
hired for employment.
(C) If no
existing qualified provider in the state states an intention to alter its
services, or if a provider expresses an intention to alter its services but
fails to accomplish the alteration before deadlines stated above DDS shall
proceed to the following step.
3. If all CHMS programs, DDTCS programs for
children, and successor programs in the remainder of the state determine not to
expand early intervention day treatment services, including CHMS, DDTCS for
children, or successor program services in the underserved county, the Division
shall provide notice to the general public in a newspaper of statewide general
circulation. In the event a new entity that has never been a provider of CHMS
or DDTCS for children services is approved, the deadlines for implementing a
new program will be the same as those found in V III(1)(A)-(C) and
VIII(2)(A)-(C).
IX. Order of Priority for Granting Approval.
1. When considering an application for
approval under this policy for expansion of early intervention day treatment
services, including CHMS, DDTCS for children, or any successor program
services, the Division shall give approval in the following order of
preference:
(A) A certified CHMS, a licensed
DDTCS for children, or a successor program with existing operations in the
county identified by the Division as underserved.
(B) A CHMS program, a licensed DDTCS for
children, or a successor program from another county in the state.
(C) An accredited entity in the underserved
county.
(D) An accredited entity
from another county in the state, and
(E) An accredited entity from outside the
state
2. The Division
shall not require accreditation of the following entities in order to approve
the entity's application for expansion of early intervention day treatment
services:
(A) A certified CHMS program with
existing operations on July 1, 2013.
(B) A licensed nonprofit community program
providing developmental day treatment services for children with existing
operations on July 1,2013.
(C) A
successor program that was a certified CHMS program with existing operations on
July 1, 2013.
(D) A successor
program that was a licensed nonprofit community program providing DDTCS
services for children with existing operations on July 1, 2013.
3. Limitation:
(A) DDTCS providers with existing operations
who are on a regular with requirements, temporary, or provisional licensure
status with DDS, or are excluded under DHS Policy 1088 may not file any notice
or application to expand under this policy.
(B) CHMS providers with existing operations
who are subject to a certification sanction or administrative remedy by DHS,
the Department of Health, or are excluded under DHS Policy 1088 may not file
any notice or application to expand under this policy.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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