Current through September 24, 2024
A. Medical
Supervised Living is not a separate service from Supervised Living Services but
allows an increased reimbursement rate for persons enrolled in ID/DD Waiver
with significant medical needs. Additional eligibility requirements for persons
who receive this level of support and requirements for Supervised Living
settings to receive the increased reimbursement rate are outlined in this
section. Rule
30.1 Supervised Living Services for
Intellectual/Developmental Disabilities Service Components and Rule
30.4 Environment and Safety for
Supervised Living Services for People with Intellectual/Developmental
Disabilities, applies to Medical Supervised Living.
B. Medical Supervised Living provides
additional support for people with chronic physical or medical condition(s)
requiring prolonged dependency on medical treatment for which skilled nursing
intervention is necessary. Medical Supervised Living cannot be received unless
the person requires frequent nursing oversight to include a minimum of monthly
nursing assessments by the registered nurse.
C. In order to provide Behavioral Supervised
Living, a provider must first be approved to do so by the Bureau of
Intellectual/Developmental Disabilities (BIDD). The following must be submitted
through the Division of Certification:
1.
Documentation and procedures to ensure a Registered Nurse (RN) will conduct all
Nursing Assessments and develop all Nursing Care Plans.
2. Documentation and procedures describing
how nursing staff will provide coverage twenty-four (24) hours per day, seven
(7) days per week in order to respond to the person's medical needs and
requests for assistance/information from staff in the home. Documentation must
include a copy of the nurse's current license to provide nursing
care.
D. Documentation
supporting that the person requires the level of support offered in Medical
Supervised Living is gathered by the Supervised Living Services provider and
Support Coordinator or Transition Coordinator and submitted to the DMH
Specialized Needs Committee for eligibility determination.
E. Criteria to support Medical Supervised
Living include the following:
1. The person's
physical or medical condition may be characterized by one (1) of the following:
(a) A condition that requires medical
supervision and physician treatment consultation.
(b) The need for administration of
specialized treatments that are medically necessary such as, injections, wound
care for decubitus ulcers, etc.
(c)
Dependency on medical technology requiring nursing oversight such as enteral
(feeding tube) or parenteral (intravenous tube) nutrition support (bolus
feedings only) or continuous oxygen.
(d) The administration of specialized
treatments that are ordered by a physician or nurse practitioner.
(e) Other medical support needs that are
approved by the DMH Specialized Needs Committee.
2. Medical Supervised Living will not be
approved unless the person requesting this service requires frequent nursing
oversight to include a minimum of monthly nursing assessments.
F. People living in the home with
someone considered medically fragile must be compatible and not pose a threat
to the person who has higher medical support needs.
G. Pre-Admission Requirements for Medical
Supervised Living
1. For people moving from
home or already receiving Supervised Living Services, the agency provider must
arrange for a nursing assessment to be conducted by a registered nurse before
or the same day the person is admitted to the home. At a minimum, the following
systems must be addressed:
(a)
Integument;
(b) Head;
(c) Eyes and Vision;
(d) Ears and Hearing;
(e) Nose and Sinus;
(f) Mouth;
(g) Neck;
(h) Thorax, Lungs and Abdomen;
(i) Extremities;
(j) Risk for falls; and,
(k) Special Diet Requirements.
The nursing assessment by the registered nurse must result in
a Nursing Care Plan and must be updated every sixty (60) days or as
needed.
2. For
people moving from an institution, the agency provider's registered nurse must
review the nursing assessment from the institution and develop the Nursing Care
Plan. He/she may choose to conduct an on-site nursing assessment.
H. Employee Training
1. Someone already Receiving Supervised
Living Services
If a person is already receiving Supervised Living Services
and is approved for Medical Supervised Living, employees must be trained by the
provider's registered nurse or licensed practical nurse regarding that person's
individual support needs as there must have been a change that necessitated the
transition to Medical Supervised Living.
2. Someone Moving to Medical Supervised
Living from home/institution
If a person is moving into a Medical Supervised Living
arrangement from home or an institution, employees must be trained about the
person's support needs before admission to the home. This can be accomplished
by a nurse (RN or LPN), nurse practitioner, or a physician. Others who know the
person's support needs well (e.g., family member[s], other caregivers the
person has, etc.) may also provide information.
3. Documentation of Training
Documentation of employee training regardless of if a person
is moving into the home or already lives in the home, must be in his/her
record. The documentation must be signed and dated by the person receiving the
training as well as the person providing the training.
I. Additional Documentation
Requirements for Medical Supervised Living
1.
The registered nurse must provide the level of oversight and monitoring
necessary to determine the implementation and efficacy of the strategies in the
nursing assessment/Nursing Care Plan.
2. There must be at least monthly nursing
notes and monthly assessment from a registered nurse that includes:
(a) A summary of all visits/contacts related
to the person's physical or medical condition(s).
(b) A description of the person's current
physical medical status.
(c) The
status of any physician's orders (new orders, discontinued orders, etc.),
status of laboratory or diagnostic tests, specialist evaluations, medical
appointments, medications, treatment, and/or equipment.
3. The skilled nursing services provided and
the person's response to the interventions. J. Additional Requirements
1. Agency providers of Medical Supervised
Living must have a nurse (RN or LPN) on-call twenty-four hours a day, seven
days a week (24/7) to respond to requests for assistance/information from
employees in the home. If a licensed practical nurse is on call, a registered
nurse must be available for consultation or assistance, as needed.
2. Licensed practical nurses can provide
daily nursing care.
K. Ongoing Review of Need for Medical
Supervised Living
1. The DMH Specialized Needs
Committee will review the need for ongoing Medical Supervised Living at least
annually, before recertification.
2. All required documentation must be sent as
a whole to the Support Coordinator within ninety (90) days of the person's
recertification date; partial submissions will not be accepted. The Support
Coordinator will submit the information to the DMH Specialized Needs Committee.
The following information is required:
(a)
Nurse's notes from the previous two (2) months;
(b) Nursing assessments from the previous two
(2) months;
(c) Current Nursing
Care Plan;
(d) Relevant information
from other agency providers (home health, day service, etc.); and,
(e) Rationale for the need for continued
Medical Supervised Living.
L. Short-Term Medical Supervised Living
1. A person can receive Medical Supervised
Living on a short-term basis (60 days) in order to recover from an illness or
procedure because of the need for more intensive medical care than can be
provided in traditional Supervised Living/Shared Supported Living/Supported
Living Services.
2. The need for
short-term Medical Supervised Living will be evaluated by the DMH Specialized
Needs Committee. The following must be submitted to the Support Coordinator for
submission to the Bureau of Intellectual/Developmental Disabilities before
short-term Medical Supervised Living can be authorized.
(a) Physician/Specialty evaluation notes
(agency provider/family responsibility)
(b) Discharge Plan (agency provider/family
responsibility)
(c) Other
information deemed relevant to support the continued need for the
service
3. Short-Term
Medical Supervised Living beyond the initial sixty (60) days can be requested.
The need will be re-evaluated by the DMH Specialized Needs Committee. The
following must be submitted to the Support Coordinator for submission to the
Bureau of Intellectual/Developmental Disabilities within two (2) weeks before
the end of the first sixty (60) day stay:
(a)
Estimated number of additional days needed;
(b) Justification for the additional
days;
(c) Nurse's notes since the
beginning of the stay;
(d) Nursing
assessments;
(e) Nursing Care Plan;
and,
(f) Any information from home
health, therapists, or other agency providers who may have delivered services
to the person.
Section
41-4-7
of the Mississippi Code, 1972, as Amended
