Current through Register Vol. 41, No. 3, September 23, 2024
A.
Service description. In-home support service means a residential service that
takes place in the individual's home, family home, or community settings that
typically supplement the primary care provided by the individual, family, or
other unpaid caregiver and is designed to ensure the health, safety, and
welfare of the individual. The individual shall be living in his own home or
his family home. This service shall include a skill building (formerly called
training) component, along with the provision of supports that enable an
individual to acquire, retain, or improve the self-help, socialization, and
adaptive skills required for successfully living in his community. In-home
support service shall be covered in the FIS and CL waivers.
B. Criteria and allowable activities. To be
eligible for in-home support service, individuals shall require help with
adaptive skills necessary to reside successfully in the home and
community-based settings.
Allowable activities include the following as may be
appropriate for the individual as documented in his plan for supports:
1. Skill-building and routine supports
related to ADLs and IADLs;
2.
Skill-building, routine supports, and safety supports related to the use of
community resources, such as transportation, shopping, dining at restaurants,
and participating in social and recreational activities;
3. Supporting the individual in replacing
challenging behaviors with positive, accepted behaviors for home and community
environments;
4. Monitoring the
individual's health and physical condition and providing routine and safety
supports with medication or other medical needs;
5. Providing supports with transportation to
and from community sites and resources; and
6. Providing general supports as
needed.
C. Service units
and limitations.
1. The unit shall be one
hour and shall be reimbursed according to the number of individuals
served.
2. In-home support service
shall not typically be provided 24 hours per day but may be authorized for
brief periods up to 24 hours a day when necessary.
3. In-home support service shall not be
covered for the individual simultaneously with the coverage of the group home
residential service, supported living residential service, or sponsored
residential service.
4. Individuals
may have in-home support service, personal assistance service, and respite
service in their ISP but shall not receive these Medicaid-reimbursed services
simultaneously (i.e., on the same dates and times).
5. All individuals shall have a backup plan
prior to initiating services in cases of emergency or should the provider be
unable to render services as needed. This backup plan shall be shared with the
provider and support coordinator at the onset of services and updated with the
provider and support coordinator as necessary.
D. Provider qualifications and requirements.
1. All providers of the in-home support
service shall have current, signed participation agreements with DMAS. The
provider designated in this agreement shall directly submit claims to DMAS for
reimbursement.
2. Providers of the
in-home support service shall be licensed by DBHDS as providers of supportive
in-home service.
3. Providers shall
ensure that staff providing in-home supports meet provider training and
competency requirements as specified in 12VAC30-122-180.
4. Supervision of DSPs shall be provided
consistent with the requirements in 12VAC30-122-120 by a supervisor meeting the
requirements of
12VAC35-105-590.
Providers shall make available for inspection documentation of supervision, and
this documentation shall be completed and signed by the staff person designated
to perform the supervision and oversight. This documentation shall include, at
a minimum, the following:
(i) date of contact
or observation,
(ii) person
contacted or observed,
(iii) a
summary about the direct support professional's performance and service
delivery, and
(iv) any action
planned or taken to correct problems identified during supervision and
oversight.
E. Service documentation and requirements.
1. Providers shall include signed and dated
documentation of the following in each individual's record:
a. A copy of the completed, standard,
age-appropriate assessment form as described in 12VAC30-122-200.
b. The provider's plan for supports per
requirements detailed in 12VAC30-122-120.
c. Documentation as detailed in
12VAC30-122-120. Data shall be collected as described in the ISP, analyzed to
determine if the strategies are effective, summarized, then clearly documented
in the progress notes or supports checklist.
d. Documentation to support units of service
delivered, and the documentation shall correspond with billing. Providers shall
maintain separate documentation for each type of service rendered for an
individual.
e. A written review
supported by documentation in the individual's record that is submitted to the
support coordinator at least quarterly with the plan for supports, if modified.
For the annual review and every time supporting documentation is updated, the
supporting documentation shall be reviewed with the individual or
family/caregiver, as appropriate, and such review shall be documented.
f. An attendance log or similar
document that is maintained and that indicates the date, type of service
rendered, and the number of hours and units provided, including specific
timeframe.
g. All correspondence to
the individual and the individual's family/caregiver, as appropriate, the
support coordinator, DMAS, and DBHDS.
h. Written documentation of all contacts with
the individual's family/caregiver, physicians, providers, and all professionals
regarding the individual.
2. Provider documentation shall support all
claims submitted for DMAS reimbursement. Claims that are not supported by
appropriate documentation shall be subject to recovery by DMAS as a result of
utilization reviews and audits.
Statutory Authority: §
32.1-325
of the Code of Virginia;
42 USC §
1396 et
seq.
