016-05-17 Ark. Code R. § 6
However, these Certification Standards do not contain a comprehensive listing of all laws, statutes, guidelines, or other rules and regulations with which a Provider must comply. Depending on the services or programs a Provider chooses to offer and participate in, there may be other federal, state and local statutes, acts, and regulations with which a Provider must comply, including, but not limited to, the following:
* Health Insurance Portability and Accountability Act
* Freedom of Information Act
* Individuals with Disabilities Education Act
* American with Disabilities Act
* Federal Privacy Act
* Developmentally Disabled Assistance & Bill of Riglits Act.
DDS Quality Assurance has the right to enforce Provider compliance with all applicable laws, statutes, guidelines, or other regulations not found in the Certification Standards. For enforcement purposes, any federal, State of Arkansas, or local laws, statutes, guidelines or other rules or regulations applicable to a Provider but not contained within these Certification Standards are incorporated herein by reference.
DDS has established an optional Organized Health Care Delivery System election as per 42 C.F.R. 447.10(b) for Providers. A Provider must deliver to DDS, in writing, a guarantee that the Provider will ensure the services of each subcontractor will comply with all Medicaid regulations and the Certification Standards. The Provider assumes all liability for subcontractor non-compliance. The Provider must deliver at least one HCBS Waiver service utilizing its own employees. DDS Quality Assurance will review compliance with the Certification Standards annually during an on-site visit.
The Provider is required to have a duly executed subcontract in place that specifies the services to be rendered and assures that services will be completed by the subcontractor in a timely manner and be satisfactory to the beneficiary. The Provider is also responsible for the financial accountability of any subcontractor by ensuring that subcontractor services were delivered and proper documentation was submitted.
The Provider must shall obtain and verify each of the following from an applicant prior to employment:
If an applicant is hired, the Provider shall maintain all the above documentation in the applicant's personnel file for at least one (1) year following the applicant's ceasing to work for the Provider.
The Provider shall obtain and verify within thirty (30) days of an applicant's employment the following:
The Provider shall maintain the above documentation in the employee's personnel file for at least one (1) year following terminafion of employment.
The criminal background, adult maltreatment and child maltreatment checks required upon hiring in Section 201 must be repeated for each applicant at least once every two (2) years. Failure to pass any of the three (3) required follow-up checks at any time requires that the employee immediately cease providing services to beneficiaries.
If DDS or the Provider receives additional information after hiring that creates a reasonable belief that an employee has had a change in status in connection with one of the requirements in Section 201 (A) or (B) above (i.e. the employee's license has expired, the employee has committed a crime, etc.), then the Provider must verify that the employee still meets all requirements for employment. Any applicant who submits evidence of holding a current professional license is exempt fi-om the requirements under Section 201.
The Provider shall create written job descriptions for each position offered that describe the duties, responsibilities, and qualifications for such staff position. In addition, the job description shall include the physical and educational qualifications and license&'certifications required for each position. All employees that require a professional license must maintain current credentials.
Each Provider must ensure that sub-contractors, students, interns, volunteers, and trainees or any other person who has regular, routine contact with beneficiaries are in compliance with all the requirements applicable to an "employee" that are contained in this Section 200. The classification of a worker as something other than an "employee" will not negate the responsibilities of the Provider under this Section 200.
Providers must submit an incident report to DDS Quality Assurance using the automated form DHS 1910 via secure e-mail upon the occurrence of any one of the following events:
* Requires the attention of an Emergency Medical Technician, a paramedic, or physician
* May cause death
* May result in a substantial permanent impairment
* Requires hospitalization
Providers must report the following incidents to the DDS Quality Assurance emergency number ((501) 765-9018) within one (I) hour of occurrence, regardless of hour:
* Suicide
* Death from adult abuse
* Death from child maltreatment
* Serious injury
Incidents, regardless of category, that a Provider should reasonably know might be of interest to the public andor media must be immediately reported to DDS Quality Assurance in central office if during business hours, and to the DDS Quality Assurance emergency number ((501) 765-9018), if after business hours.
All reportable incidents must be reported to DDS Quality Assurance using the automated form DHS 1910 via secure e-mail within two (2) days following the incident. Any incident that occurs on a Friday is still considered timely if reported by the Monday immediately following.
When applicable, the Provider shall notify the parent or legal guardian of the beneficiary any time an incident report is submitted.
* The initial report should be resubmitted with the "follow-up" or "final" report areas checked and dated in the appropriate space on the incident report form.
* The current date should precede the new information in the text/narrative sections to differentiate follow-up information from the information originally submitted.
* A new form DHS-1910 should be submitted for follow-up and final reports only when there is insufficient space on the original form. Whenever a new form is submitted, the date of the original written report must be included for cross-referencing.
The Arkansas Child Maltreatment Act and the Arkansas Adult Maltreatment Act deem all staff of Providers to be mandated reporters of any suspected adult or child abuse, neglect, exploitation, and maltreatment. Failure on the part of a Provider to properly report suspected abuse, neglect, exploitation, and maltreatment to the appropriate hotline is a violation of these Certification Standards.
Each Provider must implement policies that enumerate in clear and understandable language each beneficiary's rights and the rights of the legal guardian of each beneficiary. The Provider must take reasonable steps to ensure beneficiaries and their legal guardians are:
Each Provider must, at a minimum, ensure the following beneficiary rights:
* physical or psychological abuse or neglect
* retaliation
* coercion
* humiliation
* financial exploitation
The Provider must ensure that the application of corporal punishment to beneficiaries is prohibited. "Corporal punishment" refers to the application of painflil stimuli to the body in an attempt to terminate behavior or as a penalty for behavior.
* If a beneficiary is age eighteen (18) or older, he she is considered competent unless there is a court appointed legal guardian. Competent adults must always sign their own consents, releases, or other documentation requiring a signature.
* A beneficiary who has a court appointed legal guardian retains all legal and civil rights except those which have been expressly limited by the court in the court order, or which have been specifically granted to the legal guardian pursuant to the court order.
* Adult individuals who are legally competent shall have the right to decide whether their family will be involved in planning and implementing the PCSP.
* There is a limited exception when residing in a Provider owned/controlled setting if the required work is related to the upkeep of the beneficiary's own living space, or the common living area and grounds that the beneficiary shares with others.
* Providers must ensure beneficiaries have access to legal entities for appropriate and adequate representation, advocacy support services, and must adhere to research and ethics guidelines ( 21 U.S.C § 321-392 ).
* Provider rules may not contain provisions that result in the unfair, arbitrary, or unreasonable treatment of a beneficiary.
* The Provider must maintain the documentation relating to all investigations of alleged beneficiary rights violations, and the actions taken to intervene in such situations. The Provider will ensure that the beneficiary has been notified of their right to appeal according to DDS Policy #1076.
* Beneficiaries may not be prohibited from having access to their own service records, unless a specific state law indicates otherwise.
* Service delivery
* Release of information
* Composition of the service delivery team
* Involvement in research projects, if applicable
* Daily activities
* Physical environment
* With whom to interact
The beneficiary and/or legal guardian shall be informed of their rights. The Provider shall maintain documentation in the beneficiary's service record showing that the following information has been provided to the beneficiary or legal guardian in writing:
This Section applies if the Provider serves as a representative payee of a beneficiary, is involved in managing the fijnds of the beneficiary, receives benefits on behalf of the beneficiary, or temporarily safeguards fiands or personal property for the beneficiary.
The Provider must demonstrate, to the reasonable satisfaction of DDS, that there is a system in place to protect the financial interests of all beneficiaries. Provider personnel and the beneficiary or their legal guardian must receive a copy of the Provider's Financial Safeguards Policies and Procedures.
Beneficiaries and their legal guardians must have access to financial records concerning the beneficiary's account/fiands at all times.
The Provider shall obtain consent fi-om the beneficiary or their legal guardian prior to implementing the following:
Providers will be monitored to ensure that the budget is being implemented properly. It is the Provider's responsibility to revise the budget with the help of the beneficiary or legal guardian if the budget does not accurately reflect the actual income and/or expenditures of the beneficiary.
DDS will not authorize or continue waiver services under the following conditions:
* The case manager to conduct required visits,
* Direct care staff to provide scheduled care, and
* DHS or CMS officials acting in their role as oversight authority for compliance or audit purposes.
All ACS waiver services are delivered pursuant to a Person Centered Service Plan ("PCSP"), which is based on the Independent Assessment and other needs assessments. The PCSP must have measurable goals and specific objectives, measure progress through data collection, be overseen and updated by the beneficiary's case manager through consultation with the team that must include the beneficiary.
Providers must include the beneficiary and/or their legal guardian as an active participant in the PCSP planning and revision process. The Provider must ensure that the PCSP development, planning, and revision process is driven to the maximum extent possible by the beneficiary andor their legal guardian. Providers shall deliver services based on the choices of the beneficiary and.'or their legal guardian.
The written PCSP must be finalized and agreed to, with the informed consent of the beneficiary or their legal guardian in writing, and signed by all individuals and Providers responsible for its implementafion (see § 42 CFR 441.725 B).
* A beneficiary must receive an Independent Assessment through the designated DDS third party vendor at least once every three (3) years.
* The results of any evaluations that are specific to the needs of the beneficiary
* The results of any psychological testing during eligibility determination
* The results of any adaptive behavior assessments conducted to establish eligibility
* If the beneficiary objects to the presence of any individual at the PCSP development meeting, then the individual is not permitted to attend the PCSP development meeting.
Generally, the PCSP must reflect the services and supports that are important for the beneficiary to meet the needs identified in the Independent Assessment and other needs assessments, as well as what is important to the beneficiary with regard to preferences for the delivery of such services and supports. Commensurate with the level of need of the beneficiary, the written PCSP must:
* The discussions and activities involved at each quarterly review meeting must be documented and maintained by the case manager in the beneficiary's service file.
The writing should document the beneficiary's input and participation in all aspects of the review.
A Provider must develop, implement, and monitor an appropriate behavior management plan incorporating positive behavior support strategies when:
A Provider must provide training to all persons who implement a behavior management plan. Training requirements include Introduction to Behavior Management, Abuse and Neglect and any other training as necessary.
The Provider shall implement policies regarding behavior management plans. The policies must:
' "Challenging Behaviors" behaviors defined as problematic or maladaptive by others who observe the behaviors or by the person displaying the behaviors. They are actions that:
* Come into conflict with what is generally accepted in the individual's community,
* Often isolate the person from their community, or
* Are barriers to the person living or remaining in the community, and
* Vary in seriousness and intensity.
Behavior management plans must be written and supervised by a qualified professional who is, at a minimum, a Qualified Developmental Disabilities Professional ("QDDP"). The case manager and supportive living provider will corroborate in developing and implementing a beneficiary's behavior management plan. All behavior management plans must:
All behavior management plans must be re-evaluated at least quarterly. Behavior Management plans must be re-evaluated if distinct behaviors occur three (3) or more times in a three (3) month period. Three (3) distinct occurrences could take place in one day.
The Provider must collect data on the behavior management plan so that the effectiveness can be evaluated. The Provider is required to:
The Provider shall develop and implement a medication management plan for all beneficiaries with prescribed medication/s. A medical prescription for medications, services, and level of care must be obtained annually. When medication is used to treat a specifically diagnosed mental illness, the prescribed medication must be managed by a psychiatrist who periodically provides information regarding the effectiveness of, and any side effects experienced from the medication. The prescription and management may be by a physician, if a psychiatrist is not available. Medications may NOT be used to modify behavior in the absence of a specifically diagnosed mental illness, or for the purpose of chemical restraint.
* How medication/s will be administered (i.e. times, doses, delivery, etc.) and charted.
* A list of potential side effects caused by any medication/s.
* A description of the reason each medication has been prescribed and the related symptoms.
* The beneficiary's or their legal guardian's consent to the administration of the medication/s.
* How the medication/s must be administered and by whom, in order to comply with the Nurse Practice Act and the Consumer Directed Care Act. This would include a list which medications may be administered by which staff
* Name and dosage of the medication administered.
* Route the medication was administered.
* Date and time the medication was administered (recorded at the time of medication administration).
* Initials of the person administering or assisting with the administration of the medication.
* Any side effects or adverse reactions to the medication.
* Any errors in administering the medication.
* How often the medication is used.
* Date and time each medication was administered (recorded at the time of medication administration).
* The circumstances in which the medication is used.
* The symptom for which the medication was used.
* The effectiveness of the medication.
* An incident report must be filed with DDS Quality Assurance in accordance with Section 300 for any medication administration error that caused or had the potential to cause serious injury or illness to a beneficiary.
* All medications were administered accurately as prescribed.
* The medication is effectively addressing the reason for which it was prescribed.
* Any side effects are noted, reported, and being managed appropriately.
Daily service activity logs shall provide specific information relating to the individually identified goals and desired outcomes for the beneficiary, so that the case manager and PCSP development team can measure and record the progress on each of the beneficiary's idenfified goals and desired outcomes. There is no required format for a daily service activity log, however, the daily service activity logs must document the following:
A Provider is prohibited from using any restraints or restrictive interventions on a beneficiary unless the Provider has developed and implemented a behavior management plan for the beneficiary, which incorporates alternative strategies to avoid the use of restraints and restrictive interventions, and includes the use of positive behavior support strategies as an integral part of the behavior management plan (See Section 502 "Behavior Management Plans"). There is a limited exception to this requirement when the use of an emergency restraint is necessary (See Section 505 (E) "Emergency Restraint")
* Under no circumstances are mechanical restraints permitted to be used on a beneficiary.
* Under no circumstances are chemical restraints permitted to be used on a beneficiary.
* Under no circumstances is seclusion permitted to be used on a beneficiary.
Permitted restraints and interventions may be used only when a challenging behavior exhibited by the beneficiary threatens the health or safety of the beneficiary or others. The use of restraints or interventions must be supported by a specific assessed need and justified in the beneficiary's PCSP.
Any PCSP permitting the use of restraints or interventions must include the following information:
Personal restraints (use of staff member's body to prevent injury to the beneficiary or another person) are allowed in cases of emergency, even if a behavior management plan incorporating the use of restraints has not been developed and implemented. An "emergency" exists in the following situations:
The Provider must hold an interdisciplinary team meeting to revise the PCSP and implement a behavior management plan when there are more than three (3) emergency restraint incidents within a three (3) month period. It is an emergency restraint "incident if each of the following occurred:
* A behavior was exhibited
* A restraint procedure was used
* The beneficiary was no longer thought to be dangerous
* The restraint procedure was discontinued
An incident report must be completed and submitted to DDS Quality Assurance in accordance with Section 300 herein no later than the end of the second business day following the date any restraint or restrictive intervention is administered. If the use of a restraint or restrictive intervention occurs more than three (3) times in any thirty (30) day period, permitted use of restraints and interventions must be discussed by the interdisciplinary team and addressed in the PCSP.
Any use of restraint and intervention, whether permitted or prohibited, also must be documented in the beneficiary's service record, and must include the following information:
The Provider shall establish a service record for each beneficiary. At a minimum, the service record file must contain:
A summary document ("Face sheet") must be maintained at the front of a beneficiary's service record file, which must document the following:
* The beneficiary
* The legal guardian of the beneficiary, if applicable
* Professional staff providing direct care services to the beneficiary
* Authorized Provider administrative staff
* Any other individual authorized by the beneficiary or their legal guardian
Adult beneficiaries who are legally competent shall have the right to decide whether their family will be involved in planning and implementing their PCSP, and a signed release or document shall be present in their service record either granting permission for family involvement or declining family involvement.
etc.).
DOS shall have access to all beneficiary files/service records maintained by the Provider at any time upon demand.
Providers shall not refiase services to any beneficiary unless the Provider cannot ensure the beneficiary's health, safety, or welfare. Providers invoking this health, safety, and welfare exclusion must have attempted to deliver services and must provide the documented proof described below:
* Recruitment efforts
* Retention efforts
* Identification of any trends in personnel turnover
Turnover of Paperwork/Records: The current Provider must turnover copies of all the beneficiary's files, service records, data, and other paperwork without delay. If all copies of requested paperwork have not been provided to the case manager, DDS Waiver Specialist or the new Provider within thirty (30) days of the request, it is presumed to be unreasonable delay in violation of these Certification Standards.
While the Provider may not staff a person on a 24 7 schedule, the Provider is responsible to ensure that sufficient staff is maintained to guarantee the health, safety, and welfare of each beneficiary, and to meet the established outcomes of the beneficiary as stated in their PCSP. Sufficiently trained staff shall be on duty at all times. Provisions shall be made for relief of supportive living staff during vacations, other relief periods and unplanned absences. Providers must have backup plans in place to address contingencies if scheduled staff are unable, fail, or refiase to provide supportive living services.
The Provider is responsible for the interviewing, hiring, firing, training, and scheduling of direct care staff providing supportive living services. Providers must ensure that each staff member providing supportive living and transportation services has one of the following:
* A high school diploma or GED; and
* One (I) year of relevant, supervised work experience with a public health, human services or other community service agency; or
* Two (2) years' verifiable successful experience working with individuals with developmental disabilities
The Provider has an on-going responsibility for monitoring beneficiary medication regimens. Providers must ensure that supportive living staff are at all times aware of the medications used by the beneficiary, and are knowledgeable of potential side effects.
* Name and dosage of the medication administered.
* Route the medication was administered.
* Date and time the medication was administered (recorded at the time of medication administration).
* Initials of the person administering or assisting with the administration of the medication.
* Any side effects or adverse reactions to the medication.
* Any errors in administering the medication.
* How often the medication is used.
* Date and time each medication was administered (recorded at the time of medication administration).
* The circumstances in which the medication is used.
* The symptom for which the medication was used.
* The effectiveness of the medication.
* An incident report must be filed with DDS Quality Assurance in accordance with Section 300 for any medication administration error that caused or had the potential to cause serious injury or illness to a beneficiary.
* All medications were administered accurately as prescribed.
* The medication is effectively addressing the reason for which it was prescribed.
* Any side effects are noted, reported, and being managed appropriately.
Providers must ensure supportive living staff maintain daily service activity logs (See Section 504) that provide specific information relating to the individually identified goals and desired outcomes for the beneficiary, so the case manager and PCSP development team can measure and record the progress on each identified goal and desired outcome. There is no required format for a daily service activity log, however, the daily service activity logs must, at a minimum, include:
* The course must provide a certificate of completion that can be maintained in the supportive living staffs personnel file.
* Any services provided by a supportive living staff person prior to receiving the above described First Aid Training can only be performed in a training role, under the supervision of another supportive living staff person that has already had the required First Aid Training.
* Training Certification must be maintained and kept up to date throughout the time any supporting living staff is providing services.
* general training on beneficiary's PCSP
* behavior management techniques/programming;
* medication administration and management;
* setting-specific emergency and evacuation procedures
* appropriate and productive community integration acfivities; and
* training specific to certain medical needs.
Documentation evidencing that the necessary types and amount of beneficiary-specific training were completed must be maintained in the personnel file of the supportive living staff member at all times. This type of individualized, beneficiary-specific training shall be required each time a beneficiary's PCSP is updated, amended, or renewed.
* HIPAA Policies and Procedures
* Procedures for Incident Reporting
* Emergency and Evacuation Procedures
* Introduction to Behavior Management
* Arkansas Guardianship statutes
* Arkansas Abuse of Adult statutes
* Arkansas Child Maltreatment Act
* Nurse Practice Act
* Appeals Procedure for Individuals Served by the Program
* Beneficiary Financial Safeguards
* Community Integration Training
* Procedures for Preventing and Reporting Maltreatment of Children and Adults
* Other topics where circumstances dictate that supportive living staff should receive training to ensure the health, safety, and welfare of the beneficiary.
Documentation evidencing that training on the topics has been completed must be maintained in the personnel file of the supportive living staff member at all times.
Case management includes responsibility for providing the beneficiary with guidance and support in all life activities including locating, coordinating and monitoring the following;
The Provider delivering case management services to a beneficiary is prohibited from providing supportive living services to the beneficiary.
Providers must require each case manager to meet one of the following minimum qualification criteria:
Case Management services include responsibility for guidance and support in all life activities including the following:
* The case manager is responsible for scheduling, coordinating, and managing the PCSP development/update meeting, including inviting other participants, and making sure that the location and the participants are acceptable to the beneficiary.
* If the beneficiary objects to the presence of any individual at a PCSP development/update meeting, then that individual is not permitted to attend the PCSP development meeting.
* Whether or not the beneficiary feels that their needs are being met.
* Whether the beneficiary is satisfied with their Provider/s.
* Inform the beneficiary they are always free to change Providers.
* Whether there are any beneficiary health, safety, or welfare concerns.
The case manager must report any service gap of thirty (30) consecutive days to the DDS Wavier Specialist assigned to the beneficiary. The report must include the reason for the gap and identify remedial action to be taken. A copy of the report must be filed in the beneficiary's file.
At least one contact per quarter must be face-to-face.
A beneficiary or their legal guardian may initiate a request to change Providers by contacting (written or verbally) their case manager. If a request to change Provider is received by the case manager, the case manager shall forward the request to the DDS Waiver Specialist within two (2) working days of its receipt. The current service Provider will remain responsible for delivery of services until such time as the transition to the new Provider is complete. When there is a request to change Providers, the case manager is responsible for overseeing and facilitating the transition process, including, but not limited to the following:
* Facilitating a transitional meeting with any direct service provider/s;
* Collecting the beneficiary's files and other available information for the transitional meeting;
* Determining the effective date for transfer of services responsibilities, and completing and transmitting to the DDS Waiver Specialist a revision to the PCSP that identifies change of Provider and any needed service revisions; and
* Ensuring that the beneficiary does not suffer a lapse in services due to the change in Providers.
A case manager must continue monitoring contact with a beneficiary whose case is in abeyance. The case manager must have a minimum of one (1) visit or contact each month and report the status to the appHcable DDS Waiver Specialist.
* "Abeyance": a beneficiary's status when there is a temporary cessation of implementation of the beneficiary's PCSP while they are temporarily placed in a licensed or certified treatment program for the purposes of behavior, physical, or health treatment or stabilization.
* The course must provide a certificate of completion that can be maintained in each case manager's personnel file.
* Training Certification must be maintained and kept up to date throughout the time any case manager is providing case management services.
* HIPAA Policies and Procedures
* Procedures for Incident Reporting
* Emergency and Evacuation Procedures
* Introduction to Behavior Management
* Arkansas Guardianship statutes
* Arkansas Abuse of Adult statutes
* Arkansas Child Maltreatment Act
* Nurse Practice Act
* Appeals Procedure for Individuals Served by the Program
* Community Integration Training.
* Procedures for Preventing and Reporting Maltreatment of Children and Adults
* Other topics where circumstances dictate that case managers should receive training to ensure the health, safety, and welfare of the beneficiary served.
Documentation evidencing that training on the topics listed above was completed must be maintained in the personnel file of each case manager at all times.
The Provider must submit the price for equipment and/or supplies to be purchased or rented within five (5) business days of the case manager's request. The Provider must maintain a record for each order. The documentation shall consist of:
The Provider must maintain a record for each beneficiary. The record must document the delivery, installation of the equipment purchased or rented, any education and/or instructions for the use of the equipment and/or supplies provided to the beneficiary, and must include documentation of delivery of item(s) to the beneficiary. The documentation shall consist of:
The date on which the equipment and or suppUes were delivered.
ENVIRONMENTAL MODIFICATION SERVICES
Providers must be appropriately licensed and bonded in the State of Arkansas, as required, or have Other appropriate credentials to perform jobs requiring specialized skills, including but not limited to:
* Electrical
* HVAC
* Plumbing
* General Contracting
All services must be completed as directed by the beneficiary's person centered service plan, and in accordance with all applicable state or local building codes. Environmental modifications must be made within the existing square footage of the residence.
Providers must obtain and maintain the following documentation:
The Provider must furnish a warranty covering workmanship and materials with the final invoice submitted to DDS or the case manager. DDS will not pay any invoice that is not accompanied by a warranty.
Environmental modifications may only be funded by Waiver if not available to the beneficiary from any other source. The Provider must, in collaboration with the case manager, ascertain and recoup any third-party resource(s) available to the consumer prior to billing DDS or its designee. When environmental modifications are included as a Medicaid state plan service, a denial by utilization review will be required prior to approval for Waiver funding by DDS.
MEDICAL SUPPLIES
A physician must order or document tlie need for all specialized medical supplies. Specialized medical supplies include:
* Items necessary for life support or to address physical conditions along with, ancillary supplies and equipment necessary for the proper functioning of such items;
* Such other durable and non-durable medical equipment not available under the Medicaid State Plan that is necessary to address participant functional limitations.
* Necessary medical items not available under the Medicaid State Plan.
Additional items are covered as a waiver service when they are considered essential for home and community care. Items covered include:
* Nutritional supplements
* Non-prescription medications (alternative medicines not FDA approved are excluded from coverage)
* Prescription drugs minus the cost of drugs covered by Medicare Part D when extended benefits available under the State plan are exhausted.
The Provider must submit the price for medical supplies to be purchased or rented within five (5) business days of the case manager's request. The Provider must maintain a record for each order. The documentation shall consist of:
The Provider must maintain a record for each beneficiary. The record must document the delivery, installation of the item(s) purchased or rented, any education and. or instructions for the use of the equipment and/or supplies provided to the beneficiary, and must include documentation of delivery of item(s) to the beneficiary. The documentation must include:
* The beneficiary's signature, the signature of the beneficiary's caregiver or electronic verification of delivery.
* The date on which the equipment and/or supplies were delivered.
Providers will be responsible for maintaining the necessary information to document staff qualifications. Selected staffer contract individuals may not provide training unless they possess the specific qualifications required. Consultant services are indirect in nature.
Providers must ensure that any individual providing consultation has current credentials which correspond to the specific area of consultation they provide. Providers must be able to provide evidence that the following professionals providing consultation services through the Provider hold a current license or certification by the following licensing or certification board or organization:
The Provider must maintain a record of every consultation service provided for each beneficiary. The documentation shall consist of:
Providers must ensure that each staff member providing respite services has one of the following:
* A high school diploma or GED; and
* One (1) year of relevant, supervised work experience with a public health, human services or other community service agency; or
* Two (2) years' verifiable successftil experience working with individuals with developmental disabilities
Respite may be provided in the following locations:
When respite is provided in a Medicaid certified ICF/ID, licensed respite facility, or licensed residential mental health facility, the time of the stay may not exceed thirty (30) consecutive days.
Within thirty (30) days of hiring, all respite staff, and any other employees that may be required to provide respite services to a beneficiary (such as on-call emergency staff or management), shall be required to attend and complete a certified first aid course administered by certified instructors of the course. The course must include instruction on common first aid topics and techniques, including, but not limited to, how to perform CPR, how to apply the Heimlich maneuver, how to stop/slow bleeding, etc.
* The course must provide a certificate of completion that can be maintained in the staffs personnel file.
* Any services provided by respite staff prior to receiving the above described First Aid Training can only be performed in a trainee role, under the supervision of another staff person that has already received the required First Aid Training.
* Training Certification must be maintained and kept up to date throughout the time any Respite Service Provider is providing services.
Prior to beginning service delivery, respite staff must receive the amount of individualized, beneficiary-specific training required to demonstrate the skills and techniques necessary to implement the individual Person-Centered Service Plan for each individual for whom they are responsible. Training must focus on skills and competencies directed toward the beneficiaries developmental, behavioral, and health needs. Staff must be able to demonstrate the skills and techniques necessary to administer interventions to manage the inappropriate behavior of beneficiaries. The Provider must ensure that the necessary amount of beneficiary-specific training was completed and written documentation evidencing training must be maintained in the staff member's personnel file at all times.
Respite Services staff must receive appropriate training on the following topics at least once every two (2) calendar years:
* HIPAA Policies and Procedures
* Procedures for Incident Reporting
* Emergency and Evacuation Procedures
* Introduction to Behavior Management
* Arkansas Guardianship statutes
* Arkansas Abuse of Adult statutes
* Arkansas Child Maltreatment Act
* Nurse Practice Act
* Appeals Procedure for Individuals Served by the Program
* Community Integration Training.
* Procedures for Preventing and Reporting Maltreatment of Children and Adults
* Other topics where circumstances dictate that respite staff should receive training to ensure the health, safety, and welfare of the beneficiary served.
Documentation evidencing that training on the topics listed above was completed must be maintained in the staff member's personnel file at all times.
DOS Quality Assurance has the ability to require a respite services Provider to conduct/administer specified training to an individual, group, or all staff working for the Provider, if DOS Quality Assurance reasonably deems such training necessary for the health, welfare, and/or safety of any one or more beneficiaries. Documentation evidencing that the DDS QA mandated training was completed must be maintained in the personnel file of each Respite Services staff member at all times.
Providers must ensure the physical environments of facilities where respite services are provided are compatible with the services being provided and the needs of beneficiary and staff The Provider shall provide an accessible and safe environment and be in compliance with U.S.C. § 12101 et. seq. "American with Disabilities Act of 1990." The environment must be appropriate and cannot jeopardize the health, safety, or welfare of beneficiaries.
Providers must be able to initiate services on-site within two (2) hours of request. Documentation for crisis intervention services must, at a minimum, include the time of the request, the name of the individual making the request, the time of arrival on-site, a summary of the intervention services provided, any recommendations for changes in the behavior plan or recommendations in change in medications, the time intervention services were discontinued, the signature of the Provider, and the signature of the case manager.'caregiver as appropriate.
Each professional staff member providing crisis intervention services must hold a current license/certification through their respective state Board of licensing/certification as follows:
Providers must adhere to Incident Report Standards found in Section 300 of this manual.
Supported Employment is a tailored array of services that offers ongoing support to beneficiaries to assist in their goal of working in competitive integrated work settings for at least minimum wage. It is intended for beneficiaries for whom competitive employment has not traditionally occurred, and who need ongoing supports to maintain their employment.
* Review of the beneficiary's work history, interest, and skills
* Job exploration
* Job shadowing
* Informational interviewing including mock interviews
* Job and task analysis activities
* Situational assessments to assess the beneficiary's interest in and aptitude for a particular type of job
* Employment preparation (i.e. resume development)
* Benefits counseling
* Business plan development for self-employment
* Volunteerism
* Completed Individual Career Profile
* Record of progress notes/narratives detailing information gathering process and steps taken by Provider in developing the beneficiary's Individual Career Profile
* Beneficiary's PCSP
* Detailed progress notes/narratives
* An Arkansas Rehabilitation Services ("ARS") referral letter for beneficiary
Employment supports services consist of two (2) primary components:
* The short and long term employment goals, target wages, task hours, and special conditions that apply to the worksite for that beneficiary.
* The jobs that will be developed and or description of customized tasks that will be negotiated with potential employers.
* An initial list of employer contacts and plan for how many employers will be contacted each week.
* The conditions for use of on-site job coaching.
* Complete job duty and task analysis.
* Assist the beneficiary in learning to do the job by the least intrusive method.
* Develop compensatory strategies, if needed, to cue beneficiary to complete job.
* Analyze work environment during initial training/learning of the job.
* Make determinations regarding modifications or assistive technology.
This service may also be utilized when the beneficiary chooses self-employment. Activities such as assisting the beneficiary to identify potential business opportunities, assisting in the development of business plan, as well as other activities in developing and launching a business. Medicaid Waiver fiands may not be used to defray expenses associated with starting or operating a self-employment business such as capital expenses, advertising, hiring and training of employees.
* ARS letter of closure.
* Beneficiary's remuneration statement.
* Beneficiary's work schedule, if available.
* Detailed documentation of the topics and issues discussed during all Beneficiary and employer meetings/contacts.
Providers must be currently licensed as a vendor by ARS as a Community Rehabilitation Program. Supported employment services must be provided by certified job coaches under the Provider's ARS license. Continued certification is a qualification requirement for the period the Provider is certified to provide supported employment services. Providers must maintain documentation of certification on file.
* The course must provide a certificate of completion that can be maintained in the supported employment staffs personnel file.
* Any services provided by a supported employment staff person prior to receiving the above described First Aid Training can only be performed in a training role, under the supervision of another supported employment staff person that has already completed the required First Aid Training.
* Training Certification must be maintained and kept up to date throughout the time any supported employment staff person is providing supported employment services.
* general training on beneficiary's PCSP
* behavior management techniques/programming;
* medication administration and management;
* setting-specific emergency and evacuation procedures
* appropriate and productive community integration activities; and
* training specific to certain medical needs.
Documentation evidencing that the necessary types and amount of beneficiary-specific training were completed must be maintained in the personnel file of the supported employment staff member at all times. This type of individualized, beneficiary-specific training shall be required each time a beneficiary's PCSP is updated, amended, or renewed.
* HIPAA Policies and Procedures
* Procedures for Incident Reporting
* Emergency and Evacuation Procedures
* Identifying Unsafe Environmental Factors
* Introduction to Behavior Management
* Arkansas Guardianship statutes
* Arkansas Abuse of Adult statutes
* Arkansas Child Maltreatment Act
* Nurse Practice Act
* Procedures for Preventing and Reporting Maltreatment of Children and Adults
* Other topics where circumstances dictate that supported employment staff should receive training to ensure the health, safety, and welfare of the beneficiary served.
Documentation evidencing that training on the topics listed above was completed must be maintained in the personnel file of the supported employment staff member at all times.
DPS OA Mandated Training: DDS Quality Assurance has the ability to require a supported employment provider to conduct/administer spccifled training to an individual, a group, or all supported employment staff working for Provider, if DDS Quality Assurance reasonably deems sucli training necessary for the health, welfare, and/or safety of any one or more beneficiaries. Documentation evidencing that the DDS QA mandated training was completed must be maintained in the personnel file of each supported employment service staff member at all times.
The Provider must require all staff that coordinate the expenditure of supplemental support funds to have at least one of the following qualifications-experience:
Supplemental Support may not include payment for room and board, monthly rental or mortgage expenses, food, regular utility charges, and/or household appliances or items that are intended for purely diversional/recreational purposes. Supplemental Support may not be used to pay for furnishing living arrangements that are owned or leased by a Waiver provider where the provision of these items and services are inherent to the service they are already providing. Diversional or recreational items such as televisions, cable TV access or VCR's are not allowable.
Supplemental support services can be accessed only as a last resort. A lack of other available resources must be documented and proven prior to a beneficiary receiving supplemental support services.
Provider owned/leased.'rented residential settings must be fully accessible by the beneficiary, compatible with the services being provided to the beneficiary, and compatible with the needs of each beneficiary and their staff, as provided in the beneficiary's PCSP. Each Provider owned.'leased/rented residential facility must be in compliance with U.S.C. § 12101 et. seq. "American with Disabilities Act of 1990," and 29 U.S.C. §§ 706(8), 794 - 794(b) "Disability Rights of 1964."
All water, food service, and sewage disposal systems must have the required approval of local, state, and federal regulatory agencies, as applicable.
The Provider must ensure that each Provider owned/leased/'rented residential settings provide a safe and comfortable environment tailored towards the needs of the beneficiary/ies, as provided for in their PCSP.'s. This shall include, but not be limited to:
The Provider must establish emergency procedures which include detailed actions to be taken in the event of emergency and promote safety. Details of emergency plans and procedures must be in written form, and shall be available and communicated to all members of the staff and other supervisory personnel.
Additionally, the emergency procedures must satisfy the requirements of applicable authorities, and contain practices appropriate for the locale (example: nuclear evacuations for those living near a nuclear plant).
Providers must maintain the following items in each setting in which beneficiaries reside:
Beneficiaries must be safe and secure in their homes and communities, taking into account their informed and expressed choices. Participant risk and safety considerations shall be identified and potential interventions considered that promote independence and safety with the informed involvement of the beneficiary.
* This can be achieved through transportation or through local community resources.
All providers must meet the Home and Community-Based Services (HCBS) Settings regulations as established by CMS. The federal regulation for the rule is 42 CFR 441.301(c) (4H5). All Provider ownedyleased/rented residential settings must have the following characteristics:
Solicitation of a beneficiary by a Provider is strictly prohibited, and a Provider that is found to be engaging in solicitation of a beneficiary will be subject to enforcement remedies and potentially decertification. "Solicitation" means when a Provider (through its employees, owners, independent contractors, family members, or other agents) attempts to influence a beneficiary (or his or her family/guardian). Examples of prohibited solicitation include, but are not limited to, the following:
Marketing by a Provider is distinguishable fi-om solicitation and is considered an allowable practice. Examples of acceptable marketing practices include, but are not limited to:
016.05.17 Ark. Code R. § 006