Current through Register Vol. 41, No. 3, September 23, 2024
A. Service description. Independent living
support service means a service provided to adults 18 years of age and older
that offers targeted skill building and supports necessary for individuals to
secure and maintain their own home in the community. An individual receiving
this service typically lives alone or with roommates in the individual's own
home or apartment. The supports may be provided in the individual's residence
or in other community settings. Independent living support service shall be
covered in the BI waiver.
B.
Criteria and allowable activities. The need for independent living support
service shall be clearly indicated in the ISP. Independent living support
service shall be authorized for Medicaid reimbursement only when the individual
requires this service and the service is set out in the plan for supports. This
service shall include a skills development component along with the provision
of supports as needed. Allowable activities include the following:
1. Skill building and supports necessary to
promote the individual's stability in the individual's own home and community
in the absence of a primary caregiver living in the residence;
2. Skill-building and supports to promote the
individual's community participation and inclusion in meaningful
activities;
3. Skill-building and
supports to increase the individual's socialization skills and maintain
relationships;
4. Skill-building
and supports to improve and maintain the individual's health, safety, and
fitness, as necessary;
5.
Skill-building and supports to promote the individual's decision-making and
self-determination;
6.
Skill-building and supports to improve and maintain, as needed, the
individual's skills with ADLs and IADLs;
7. Routine supports with transportation to
and from community locations and resources; and
8. General supports, as needed.
C. Service units and limits.
1. The independent living support service
unit of service delivery shall be a month or, when beginning or ceasing the
service, may be a partial month. Sufficient hours of service shall be provided
to meet the requirements set forth in the plan for supports.
2. Independent living support service shall
not be provided in a licensed residential setting.
3. Independent living support service is a
tiered service for reimbursement purposes. Providers shall only be reimbursed
for the individual's assigned level and tier.
D. Provider requirements.
1. Providers shall meet all of the
requirements of 12VAC30-122-110 through 12VAC30-122-140.
2. Independent living support service shall
be provided by agencies licensed by DBHDS as providers of supportive in-home
service. These providers shall have a signed participation agreement with
DMAS.
3. The provider designated on
the agreement shall directly render this service and shall directly bill DMAS
for reimbursement.
4. Providers
shall ensure that staff providing independent living support service meet
provider training and competency requirements as specified in
12VAC30-122-180.
5. 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, 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 plan for supports,
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. All correspondence to the
individual and the individual's family/caregiver, as appropriate, the support
coordinator, DMAS, and DBHDS.
g.
Written documentation of contacts made with the individual's family/caregiver,
physicians, providers, and all professionals concerning the
individual.
2. Provider
documentation shall support all claims submitted for DMAS reimbursement. Claims
for payment that are not supported by supporting documentation shall be subject
to recovery by DMAS or its designee as a result of utilization reviews or
audits.
Statutory Authority: §
32.1-325
of the Code of Virginia;
42 USC §
1396 et
seq.
