Current through March 20, 2024
All certified agency providers and independent providers of
services under Medicaid Home and Community Based Services waivers must meet
requirements established by the Department of Health and Human Services in
this.
001.01 Provider services are
based on goals and needs identified in the participant's individual support
plan (ISP). The provider must:
(A) Participate
in the individual support planning team;
(B) Provide services in accordance with the
participant's individual support plan (ISP);
(C) Prioritize the needs of the participant,
such that:
(i) The participant is challenged
to overcome barriers that result in the need for specialized services;
and
(ii) The highest level of
independence in all areas of community living is achieved;
(D) Develop strategies and supports that are:
(i) Based on prioritized needs;
(ii) Relevant to the individual support plan
(ISP);
(iii) Functional;
(iv) Tailored to individual needs, and
respectful of participant choice; and
(v) Documented in the individual support plan
(ISP);
(E) Implement
training and supports consistently in all settings, as the need arises and as
opportunities occur;
(F) Encourage
and reinforce incidental learning and appropriate behaviors;
(G) Provide activities and environments that
facilitate acquisition of skills, appropriate behavior, greater independence,
and personal choice;
(H) Accurately
measure performance and modify training, supports, or both based on data and
changes in the participant's circumstances; and
(I) Monitor service delivery and address
needs as they occur. Participants with conditions that make further growth or
development unlikely must receive training and supports designed to maintain
skills and functioning and to prevent regression to the fullest extent
possible.
001.02
NON-RESIDENTIAL LOCATION REQUIREMENTS. When a service
is provided in a provider-controlled or operated setting outside of the
participant's home, the provider must provide services in a facility or
location that:
(A) Is architecturally
designed to accommodate the needs of the participant being served;
(B) Is accessible to the participant, clean,
in good repair, free from hazards, and free of rodents and insects;
(C) Is equipped to provide comfortable
temperature and ventilation conditions;
(D) Has an operable telephone and emergency
numbers available;
(E) Has toilet
facilities that are clean and in working order;
(F) Has eating areas and equipment that are
clean and in good repair;
(G) Is
free from fire hazards and contains working smoke detectors;
(H) Has the furnace and water heater located
safely;
(I) Ensures any firearms on
site are in a locked unit and inaccessible to the participant;
(J) Has an area that is inaccessible to
participants in which medications, harmful chemicals, and poisons are stored;
and
(K) If it has household pets,
keeps the necessary vaccinations current.
001.03
RESPITE
PROVIDERS. In addition to general provider standards, providers of
respite services must:
(A) Be 18 years old or
older, if certified provider staff, and 19 or older if an Independent
Provider;
(B) Hold a current
certification in basic first aid and cardiopulmonary resuscitation
(CPR);
(C) Agree to never leave a
minor participant alone; and
(D)
Prepare and serve any appropriate meals and snacks to meet the participant's
dietary needs, as explained by the usual caregiver.
001.04
HOMEMAKER SERVICE
PROVIDERS. In addition to general provider standards, providers of
homemaker service must:
(A) Be 19 years old
or older. If no provider age 19 or older is available and acceptable to the
family, and the participant requests a younger provider, the Department may
authorize a younger provider, considering the following:
(i) The capacity of the provider to meet the
child's needs in the case of an emergency; and
(ii) Which of the homemaker tasks will be
authorized;
(B) Exercise
reasonable caution and care in the family's home and in the use of the family's
equipment, appliances, and supplies;
(C) Have training or home experience in
carrying out homemaker services;
(D) Provide any tools or equipment necessary
to perform authorized tasks or duties, if the family does not provide them;
and
(E) If he or she is less than
19 years old and not emancipated, have the service provider agreement signed by
his or her parent or legal guardian.
001.05
HOME MODIFICATION
PROVIDERS. In addition to general provider standards, providers of
home modification service must:
(A) Comply
with applicable local and state building codes;
(B) Be appropriately licensed or certified
persons, when applicable;
(C)
Ensure all products and materials installed conform to specifications, unless
blemished or reused building materials are stated in the cost estimate and
prior approval;
(D) Accept
responsibility for repair of all surfaces including furniture, walls, floor
covering, doors, woodwork and trim, exterior pavement and yards, and equipment
and fixtures affected during the course of constructions, to original or better
condition;
(E) Warranty all work,
materials, and products for a minimum of one year;
(F) Ensure any and all subcontractors' work
will conform to the terms and conditions of the home modification service
contract;
(G) Accept sole
responsibility for all work performed pursuant to the home modification service
contract; and
(H) Have the service
provider agreement signed by his or her parent or legal guardian, if the
provider is less than 19 years old and not emancipated.
001.06
ASSESSMENTS.
The provider must conduct assessments for each participant to obtain accurate
and complete information related to the participant's history, preferences,
strengths, abilities, and needed services. The assessments must be the basis of
development of the individual support plan (ISP). Assessments, as assigned to
the provider, must be completed for each participant within 30 calendar days of
entry to services. At least annually, the assessments must be reviewed and
updated to reflect the participant's current status.
001.07
INDIVIDUAL SUPPORT
PLAN. The provider must participate in development of the annual
individual support plan (ISP) and review the individual support plan (ISP),
discussions, and decisions for accuracy. The provider must develop and
implement programs and supports based on the individual support plan (ISP).
001.07(A)
INDIVIDUAL SUPPORT PLAN
TEAM PROCESS. The individual support plan (ISP) is developed
through an individual support planning team process. The individual support
planning team assigns responsibility for obtaining and providing services to
meet the identified needs of the participant. The individual support planning
team will get input from the participant and provider.
001.08
POSITIVE BEHAVIORAL
SUPPORTS. In addressing the participant's behaviors, the provider
must:
(A) Develop and implement policies and
procedures that emphasize positive approaches directed towards maximizing the
growth and development of each participant;
(B) Develop an assessment that defines the
communicative function of the behavior for the participant and focuses on what
purpose the identified behavior serves in the participant's life;
(C) Review the participant's day supports,
residential supports, and other relevant data and incorporate it in the
assessment process;
(D) Develop a
plan for the participant that emphasizes positive meaningful activities and
options that are inconsistent with the behavior targeted for change;
(E) Plan a meaningful day that has
individualized supports for the participant;
(F) Document potential stressors and triggers
that may lead to the participant experiencing a crisis. Once identified, there
must be a comprehensive safety plan developed and implemented;
(G) Conduct meaningful and individualized
data collection and data analysis that tracks the progress of the participant.
The data must be presented in a useful manner and collected through a range of
methods that are valid and meaningful for planning and evaluation efforts;
and
(H) Utilize data analysis and
progress to adjust services to meet the participant's needs.
001.09
NOTICE OF COSTS
TO THE PARTICIPANT. The provider must develop and implement a
system for notification to participants of any associated cost to the
participant for services or items not funded by developmental disabilities
services, and terms of payment. Written notice must be given to the participant
before initiation of service and before any change, giving adequate time for
the participant to respond to the notice. The notice must specify that
participants will not be charged for services or items that are covered through
other funding sources, including but not limited to, items necessary to provide
habilitation and transportation related to habilitation.
001.10
HEALTH
SERVICES. Unless otherwise assigned in the individual support plan
(ISP), the provider must assist and support participants in obtaining health
services and arrange for or assist the participant in obtaining evaluations
consistent with his or her needs. Participant health services and evaluations
include, but are not limited to:
(1) Physical
exams;
(2) Dental
services;
(3) Psychological
services;
(4) Physical and
occupational therapy;
(5) Speech
therapy;
(6) Audiological
services;
(7) Vision
services;
(8) Nutrition
therapy;
(9) A medical evaluation
at the frequency determined appropriate by the participant's treating medical
provider;
(10) A dental evaluation
at the frequency determined appropriate by the participant's treating dental
provider.
(11) Medication
administration and monitoring;
(12)
Medical services;
(13) Nutritional
services;
(14) Health monitoring
and supervision;
(15) Assistance
with personal care;
(16) Personal
health care and education;
(17)
Exercise; and
(18) Other
therapies.
001.10(A)
OBSERVING AND REPORTING. Regardless of whether the
provider has been assigned the responsibility of obtaining health services for
the participant, the provider must observe, report, and respond to the
participant's health status and physical conditions, in a timely and
appropriate manner, as needed.
001.11
DISASTER PREPAREDNESS AND
MANAGEMENT. The provider must establish and implement disaster
preparedness plans and procedures to ensure that participants' care, safety,
and well-being are provided and maintained during and following instances of
natural or other disasters, disease outbreaks, or other similar situations.
These plans and procedures must address and delineate:
(A) How the provider will maintain the proper
identification of each participant to ensure that care coincides with the
participant's needs;
(B) How the
provider will move participants to points of safety or provide other means of
protection when all or part of the building is damaged or uninhabitable due to
natural or other disaster;
(C) How
the provider will protect participants during the threat of exposure to the
ingestion, absorption, or inhalation of hazardous substances or
materials;
(D) How the provider
will provide food, water, medicine, medical supplies, and other necessary items
for care in the event of a natural or other disaster; and
(E) How the provider will provide for the
comfort, safety, and well-being of participants served in the event of 24 or
more consecutive hours of:
(i) Electrical or
gas outage;
(ii) Heating, cooling,
or sewer system failure; or
(iii)
Loss or contamination of water supply.
